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Bergman AJ, Szanton SL, LaFave SE, Fashaw-Walters SA, Taylor JL, Thorpe RJ, Nkimbeng M. Older Black Americans' Perspectives on Structural Racism-Resilience as a Form of Resistance. J Racial Ethn Health Disparities 2023:10.1007/s40615-023-01870-5. [PMID: 38019372 DOI: 10.1007/s40615-023-01870-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 10/14/2023] [Accepted: 11/12/2023] [Indexed: 11/30/2023]
Abstract
PURPOSE The purpose of this study was to develop a deep understanding of the lived experiences of structural racism and discrimination among older Black Americans' and their perceptions of structural racism across their lives. We also considered individual and community resilience capacity and response in the face of systemic racism. METHODS In-depth interviews were conducted with Black community-dwelling adults aged 55 and older in and around Baltimore City. The interview guide used nine contexts to explore perceptions and experiences with structural racism over the life course. Two researchers used reflexive thematic analysis to code and analyze the data. RESULTS Participants endorsed structural racism to varying degrees across contexts of education, employment, neighborhood, healthcare, and income/wealth. Participants who denied structural racism placed blame for Black underachievement on factors such as personal and community deficiencies, unsafe neighborhoods, and institutional indifference. There was broad agreement about the existence of structural racism within the domains of policing and violence but participants were largely ambivalent about other domains such as environment, media, and civics. Resilience factors that helped individuals to resist and rebound from racism emerged as an unexpected and important theme. CONCLUSIONS We used Public Health Critical Race Praxis and the Cells to Society frameworks to contextualize these findings. Due to the ubiquitous nature of racism, individuals may not fully appreciate the impact of structural racism and its impact on Black well-being. This ordinariness of racism is harmful but may simultaneously contribute to resilience within Baltimore's Black community.
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Affiliation(s)
- Alanna J Bergman
- Johns Hopkins University School of Nursing, Baltimore, MD, USA.
- Center for Infectious Disease and Nursing Innovation - Johns Hopkins University School of Nursing, Baltimore, MD, USA.
| | - Sarah L Szanton
- Johns Hopkins University School of Nursing, Baltimore, MD, USA
| | | | | | | | - Roland J Thorpe
- Johns Hopkins University School of Public Health, Baltimore, MD, USA
| | - Manka Nkimbeng
- University of Minnesota School of Public Health, Minneapolis, MN, USA
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LaFave SE, Bandeen-Roche K, Gee G, Thorpe RJ, Li Q, Crews D, Samuel L, Cooke A, Hladek M, Szanton SL. Quantifying Older Black Americans' Exposure to Structural Racial Discrimination: How Can We Measure the Water In Which We Swim? J Urban Health 2022; 99:794-802. [PMID: 35486285 PMCID: PMC9561453 DOI: 10.1007/s11524-022-00626-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/01/2022] [Indexed: 10/18/2022]
Abstract
The USA was built on legalized racism that started with enslavement and continues in the form of structural racial discrimination. This discrimination is difficult to measure because its many manifestations are hard to observe and dynamic. A useful tool would measure across settings, institutions, time periods in a person's life and the country's history. The purpose of this study was to design a measure of structural racial discrimination that meets those criteria and can be used in large national datasets. To do this, we started with an exploratory mixed-methods instrument design, including qualitative interviews with 15 older Black adults and focus groups with 38 discrimination researchers and other key stakeholders. We then identified 27 indicators of structural racial discrimination across nine theorized discrimination contexts. We matched these with historical administrative data sets to develop an instrument that could quantify older Black Americans' exposure to structural racial discrimination across contexts, the life course, and geographies. These can be mapped to the life course of structural discrimination based on the home addresses of those surveyed. Linking these to available indicators is a promising approach. It is a low burden for participants and enables increasingly multifaceted and focused measurement as more national datasets become available. A flexible, feasible comprehensive measure of structural discrimination could allow not only more thorough documentation of inequities but also allow informed decision making about policies and programs intended to promote racial equity. SIGNIFICANCE STATEMENT: To our knowledge, this is the first study that presents a framework for assessing structural racial discrimination across contexts, life course, and geography that is grounded in theory and in the lived experience of intended participants. Leading researchers and policy makers have called for improved measures of structural racism and discrimination and specifically for a lifecourse approach to measurement. This study is a step in that direction. CLASSIFICATION: Social Sciences.
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Affiliation(s)
- S E LaFave
- Johns Hopkins School of Nursing, Baltimore, MD, USA
| | - K Bandeen-Roche
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - G Gee
- UCLA Fielding School of Public Health, Los Angeles, CA, USA
| | - R J Thorpe
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Q Li
- Johns Hopkins School of Nursing, Baltimore, MD, USA
| | - D Crews
- Johns Hopkins School of Nursing, Baltimore, MD, USA
- Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - L Samuel
- Johns Hopkins School of Nursing, Baltimore, MD, USA
| | - A Cooke
- Johns Hopkins School of Nursing, Baltimore, MD, USA
| | - M Hladek
- Johns Hopkins School of Nursing, Baltimore, MD, USA
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Samuel LJ, Hladek M, Tian J, Roberts Lavigne LC, LaFave SE, Szanton SL. Propensity score weighted associations between financial strain and subsequent inflammatory biomarkers of aging among a representative sample of U.S. older adults. BMC Geriatr 2022; 22:467. [PMID: 35641938 PMCID: PMC9158352 DOI: 10.1186/s12877-022-03112-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 05/04/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Despite known socioeconomic disparities in aging-related outcomes, the underlying physiologic mechanisms are understudied. This study applied propensity score weighting to estimate the effect of financial strain on inflammation-related aging biomarkers among a national sample of older adults. METHODS Financial strain severe enough to lack money for housing, utilities, medical/prescription bills or food was measured among 4,593 community-dwelling National Health and Aging Trends Study participants aged ≥ 65 years in 2016. Inverse probability propensity score weights were generated based on 2015 background characteristics, including age, gender, race/ethnicity, income to poverty ratio, education, occupation, home ownership, retirement, Sect. 8 housing, Medicaid, food/energy assistance, childhood health, marital status, and U.S. region. Sampling weights additionally accounted for study design and non-response. RESULTS In propensity score-weighted analyses adjusting for age, gender, race/ethnicity, 2017 income to poverty ratio and education, those with 2016 financial strain had 15% higher IL-6 (p = 0.026) and 20% higher CRP levels (p = 0.002) in 2017 than those who were not strained, but did not differ with regard to hemoglobin A1c or CMV. In weighted comparisons, those with financial strain did not differ from those without with regard any 2015 background characteristics. CONCLUSIONS These results strengthen the etiologic evidence suggesting that financial strain increases inflammatory biomarkers among older adults. Importantly, inflammation is likely a key physiologic pathway contributing to socioeconomic disparities. Therefore, research is needed to address financial strain.
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Affiliation(s)
- Laura J Samuel
- Johns Hopkins University School of Nursing, 525 North Wolfe St., Baltimore, MD, 21205, USA.
| | - Melissa Hladek
- Johns Hopkins University School of Nursing, 525 North Wolfe St., Baltimore, MD, 21205, USA
| | - Jing Tian
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Sarah E LaFave
- Johns Hopkins University School of Nursing, 525 North Wolfe St., Baltimore, MD, 21205, USA
| | - Sarah L Szanton
- Johns Hopkins University School of Nursing, 525 North Wolfe St., Baltimore, MD, 21205, USA
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Affiliation(s)
- Sarah L Szanton
- Johns Hopkins University School of Nursing, Baltimore, Maryland, USA.,Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Sarah E LaFave
- Johns Hopkins University School of Nursing, Baltimore, Maryland, USA
| | - Roland J Thorpe
- Hopkins Center for Health Disparities Solutions, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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DeGroot LG, Zemlak JL, LaFave SE, Marineau L, Wilson D, Warren N. The other "front line": Public health nursing clinical instruction during COVID-19. Public Health Nurs 2021; 38:529-530. [PMID: 34245181 PMCID: PMC8447442 DOI: 10.1111/phn.12928] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 04/26/2021] [Accepted: 04/28/2021] [Indexed: 11/30/2022]
Affiliation(s)
| | | | - Sarah E LaFave
- Johns Hopkins University School of Nursing, Baltimore, MD, USA
| | - Lea Marineau
- Johns Hopkins University School of Nursing, Baltimore, MD, USA
| | - Deborah Wilson
- Johns Hopkins University School of Nursing, Baltimore, MD, USA
| | - Nicole Warren
- Johns Hopkins University School of Nursing, Baltimore, MD, USA
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Roberts Lavigne LC, Tian J, Hladek M, LaFave SE, Szanton SL, Samuel LJ. Residential Street Block Disorder and Biological Markers of Aging in Older Adults: The National Health and Aging Trends Study. J Gerontol A Biol Sci Med Sci 2021; 76:1969-1976. [PMID: 34115871 DOI: 10.1093/gerona/glab166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Residential environments are associated with older adult health, but underlying physiologic causal mechanisms are not well understood. As adults age, street blocks are likely more relevant to their health than the larger neighborhood environment. This study examined the effects of adverse street block conditions on aging biomarkers among older adults. METHODS We included community-dwelling Medicare beneficiaries aged 67 and older with 2017 biomarker data from the nationally representative National Health and Aging Trends Study (n=4,357). Street block disorder in 2016 was measured using interviewer report of any trash/glass/litter, graffiti, or vacant buildings on participants' blocks. Propensity score models were used to create balanced groups with regard to multiple 2015 participant characteristics, including demographic, socioeconomic, residence, and early life characteristics. Linear regressions modeled street block disorder as a predictor of four aging biomarkers, hemoglobin A1C, high-sensitivity C-reactive protein, interleukin-6, and cytomegalovirus antibodies, before and after applying propensity score weighting. RESULTS Adjusting for participant sociodemographic characteristics and applying propensity score weights, living on a block with any disorder was associated with 2% higher mean hemoglobin A1C levels (95% CI: 0.002-0.03), 13% higher C-reactive protein (95% CI: 0.03-0.23), 10% higher interleukin-6 (95% CI: 0.02-0.19), and 19% more cytomegalovirus antibodies (95% CI: 0.09-0.29) compared to living on a block with no disorder. CONCLUSIONS Street block disorder predicted subsequent aging biomarkers after applying a propensity score approach to account for confounding among a national sample of older adults. Targeting street-level residential contexts for intervention may reduce risk for poor health in older adults.
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Affiliation(s)
| | - Jing Tian
- Johns Hopkins Biostatistics Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Melissa Hladek
- John Hopkins School of Nursing, Baltimore, MD, United States
| | - Sarah E LaFave
- John Hopkins School of Nursing, Baltimore, MD, United States
| | - Sarah L Szanton
- John Hopkins School of Nursing, Baltimore, MD, United States
| | - Laura J Samuel
- John Hopkins School of Nursing, Baltimore, MD, United States
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Szanton SL, Clemson L, Liu M, Gitlin LN, Hladek MD, LaFave SE, Roth DL, Marx KA, Felix C, Okoye SM, Zhang X, Bautista S, Granbom M. Pilot Outcomes of a Multicomponent Fall Risk Program Integrated Into Daily Lives of Community-Dwelling Older Adults. J Appl Gerontol 2020; 40:320-327. [PMID: 32193981 DOI: 10.1177/0733464820912664] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objectives: To evaluate whether a fall prevention intervention reduces fall risk in older adults who have previously fallen. Design: Randomized controlled pilot trial. Setting: Participants' homes. Intervention: LIVE-LiFE, adapted from Lifestyle-Intervention Functional Exercise (LiFE) integrates strength and balance training into daily habits in eight visits over 12 weeks. The adaptations to LiFE were to also provide (a) US$500 in home safety changes, (b) vision contrast screening and referral, and (c) medication recommendations. Control condition consisted of fall prevention materials and individualized fall risk summary. Measurement: Timed Up and Go (TUG) and Tandem stand. Falls efficacy, feasibility, and acceptability of the intervention. Results: Sample (N = 37) was 65% female, 65% White, and average 77 years. Compared with the control group, each outcome improved in the intervention. The LIVE-LiFE intervention had a large effect (1.1) for tandem stand, moderate (0.5) in falls efficacy, and small (0.1) in the TUG. Conclusion: Simultaneously addressing preventable fall risk factors is feasible.
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Affiliation(s)
- Sarah L Szanton
- Johns Hopkins School of Nursing, Baltimore, MD, USA.,Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Lindy Clemson
- The University of Sydney, New South Wales, Australia
| | - Minhui Liu
- Johns Hopkins School of Nursing, Baltimore, MD, USA
| | | | | | | | | | | | - Cynthia Felix
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Safiyyah M Okoye
- Johns Hopkins School of Nursing, Baltimore, MD, USA.,Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Xuan Zhang
- Johns Hopkins School of Nursing, Baltimore, MD, USA
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LaFave SE, Granbom M, Cudjoe TK, Gottsch A, Shorb G, Szanton SL. Attention control group activities and perceived benefit in a trial of a behavioral intervention for older adults. Res Nurs Health 2019; 42:476-482. [PMID: 31647125 PMCID: PMC6858509 DOI: 10.1002/nur.21992] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 09/30/2019] [Indexed: 11/11/2022]
Abstract
Researchers trialing behavioral interventions often use attention control groups, but few publish details on attention control activities or perceived benefit. Attention control groups receive the same dose of interpersonal interaction as intervention participants but no other elements of the intervention, to control for the benefits of attention that may come from behavioral interventions. Because intervention success is analyzed compared to control conditions, it is useful to examine attention control content and outcomes. The purpose of this study is to report on attention control visit activities and their perceived benefit in a randomized control trial. The trial tested an aging-in-place intervention comprised of a series of participant goal-directed visits facilitated by an occupational therapist, nurse, and handyman. The attention control group participants received visits from a lay person. We report on the number and length of visits received, types of visit activities that participants chose, and how much visit time was spent on each activity, based on the attention visitor's records. We report on participant perceptions of benefit based on a 10-item Likert-scale survey. The attention control group participants (n = 148) were cognitively intact, at least 65 years old, with at least one Instrumental Activities of Daily Living. Attention control group participants most often chose conversation (20.1% of visit time), and playing games (18.7%), as visit activities. The majority of attention control group participants (63.4%) reported "a great deal" of perceived benefit. Attention control group visits may be an appropriate comparison in studies of behavioral interventions for community-dwelling older adults.
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Affiliation(s)
- Sarah E. LaFave
- Center for Innovative Care in Aging, School of Nursing, Johns Hopkins University, Baltimore, Maryland
| | - Marianne Granbom
- Center for Innovative Care in Aging, School of Nursing, Johns Hopkins University, Baltimore, Maryland
- Department of Health Sciences, Lund University, Sweden
| | - Thomas K.M. Cudjoe
- Center on Aging and Health, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Alex Gottsch
- Duke University Hospital, Durham, North Carolina
| | - Gerard Shorb
- School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Sarah L. Szanton
- Center for Innovative Care in Aging, School of Nursing, Johns Hopkins University, Baltimore, Maryland
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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