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Guilamo-Ramos V, Thimm-Kaiser M, Benzekri A, Johnson C, Williams D, Wilhelm-Hilkey N, Goodman M, Hagan H. Application of a Heuristic Framework for Multilevel Interventions to Eliminate the Impact of Unjust Social Processes and Other Harmful Social Determinants of Health. Prev Sci 2024:10.1007/s11121-024-01658-x. [PMID: 38607535 DOI: 10.1007/s11121-024-01658-x] [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] [Accepted: 02/20/2024] [Indexed: 04/13/2024]
Abstract
There is consensus about the importance of developing a strong cadre of effective multilevel interventions to eliminate the impacts of unjust social processes, such as structural racism and other harmful social determinants of health (SDOH), on health inequities in the USA. However, the available cadre of rigorously evaluated evidence-based interventions for SDOH mitigation remains underdeveloped relative to the magnitude of historic and current health inequities. The proposed manuscript addresses this gap in two ways: first, by introducing a heuristic framework to inform decisions in multilevel intervention development, study design, and selection of analytic methods and, second, by providing a roadmap for future applications of the framework in multilevel intervention research through an exemplar application using the ongoing NIH-funded evaluation study of the Nurse-Community-Family Partnership (NCFP) intervention. NCFP leverages individual, family, institutional, and system factors to shape COVID-19 mitigation outcomes at the individual and household levels. NCFP takes an approach informed by the heuristic framework to addressing and mitigating unjust social processes and other harmful SDOH. We discuss the application of a two-arm parallel explanatory group randomized trial to evaluate the efficacy of NCFP in improving the primary (COVID-19 testing uptake) and secondary (adoption of COVID-19 control measures, COVID-19 vaccine uptake, mutual aid capacity, etc.) outcomes at the individual and household levels. The analysis approach relies on random-intercept models, and we calculate the variance partitioning coefficient to estimate the extent to which household- and individual-level variables contribute to the outcome, allowing examination of NCFP effects at multiple levels.
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Affiliation(s)
- Vincent Guilamo-Ramos
- Center for Latino Adolescent and Family Health, Johns Hopkins University, Washington, DC, 20001, USA.
- Institute for Policy Solutions, Johns Hopkins University School of Nursing, Johns Hopkins University, Washington, DC, 20001, USA.
- School of Nursing, Johns Hopkins University, Baltimore, MD, 21205, USA.
- Presidential Advisory Council On HIV/AIDS, US Department of Health and Human Services, Washington, DC, USA.
| | - Marco Thimm-Kaiser
- Center for Latino Adolescent and Family Health, Johns Hopkins University, Washington, DC, 20001, USA
- Institute for Policy Solutions, Johns Hopkins University School of Nursing, Johns Hopkins University, Washington, DC, 20001, USA
- School of Nursing, Johns Hopkins University, Baltimore, MD, 21205, USA
| | - Adam Benzekri
- Center for Latino Adolescent and Family Health, Johns Hopkins University, Washington, DC, 20001, USA
- Institute for Policy Solutions, Johns Hopkins University School of Nursing, Johns Hopkins University, Washington, DC, 20001, USA
- School of Nursing, Johns Hopkins University, Baltimore, MD, 21205, USA
| | - Celia Johnson
- Center for Latino Adolescent and Family Health, Johns Hopkins University, Washington, DC, 20001, USA
- Institute for Policy Solutions, Johns Hopkins University School of Nursing, Johns Hopkins University, Washington, DC, 20001, USA
- School of Nursing, Johns Hopkins University, Baltimore, MD, 21205, USA
| | - Desiree Williams
- Department of Epidemiology, School of Global Public Health, New York University, New York, NY, 10003, USA
- Department of Social Behavioral Sciences, School of Global Public Health, New York University, New York, NY, 10003, USA
| | - Nash Wilhelm-Hilkey
- Center for Latino Adolescent and Family Health, Johns Hopkins University, Washington, DC, 20001, USA
| | - Melody Goodman
- Department of Biostatistics, School of Global Public Health, New York University, New York, NY, 10003, USA
| | - Holly Hagan
- Department of Epidemiology, School of Global Public Health, New York University, New York, NY, 10003, USA
- Department of Social Behavioral Sciences, School of Global Public Health, New York University, New York, NY, 10003, USA
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Martz CD, Benner AD, Goosby BJ, Mitchell C, Gaydosh L. Structural racism in primary schools and changes in epigenetic age acceleration among Black and White youth. Soc Sci Med 2024; 347:116724. [PMID: 38458127 DOI: 10.1016/j.socscimed.2024.116724] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 11/14/2023] [Accepted: 02/23/2024] [Indexed: 03/10/2024]
Abstract
Structural racism generates racial inequities in U.S. primary education, including segregated schools, inequitable funding and resources, racial disparities in discipline and achievement, and hostile racial climates, which are risk factors for adverse youth health and development. Black youth are disproportionately exposed to adverse school contexts that may become biologically embedded via stress-mediated epigenetic pathways. This study examined whether childhood exposure to adverse school contexts is associated with changes in epigenetic aging during adolescent development. DNA methylation-based epigenetic clocks were calculated from saliva samples at ages 9 and 15 among Black (n = 774) and White (n = 287) youth in the Future of Families and Child Wellbeing Study (2009-2015). We performed latent class analyses to identify race-specific primary school contexts using administrative data on segregation, discipline, achievement, resources, economic disadvantage, and racial harassment. We then estimated change in epigenetic age acceleration from childhood to adolescence across school typologies using GrimAge, PhenoAge, and DunedinPACE epigenetic clocks. Three distinct school contexts were identified for Black youth: segregated and highly-disadvantaged (17.0%), segregated and moderately-disadvantaged (52.1%), and integrated and moderately-disadvantaged (30.8%). Two school contexts emerged for White youth: integrated and unequal (46.5%) and predominantly White & advantaged (53.5%). At age 15, Black youth who attended segregated and highly-disadvantaged primary schools experienced increases in their speed of epigenetic aging with GrimAge and DunedinPACE. Slowed epigenetic aging with GrimAge was observed for Black youth who attended integrated and moderately-disadvantaged schools. School contexts were not associated with changes in epigenetic age acceleration for White youth. Our findings suggest that manifestations of structural racism in primary school contexts are associated with early-life epigenetic age acceleration and may forecast future health inequities.
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Affiliation(s)
- Connor D Martz
- Population Research Center, The University of Texas at Austin, United States.
| | - Aprile D Benner
- Population Research Center, The University of Texas at Austin, United States; Department of Human Development and Family Sciences, The University of Texas at Austin, United States
| | - Bridget J Goosby
- Population Research Center, The University of Texas at Austin, United States; Department of Sociology, The University of Texas at Austin, United States
| | - Colter Mitchell
- Institute for Social Research, University of Michigan, United States
| | - Lauren Gaydosh
- Population Research Center, The University of Texas at Austin, United States; Department of Sociology, The University of Texas at Austin, United States
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El-Khoury B, Yang TC. Reviewing Racial Disparities in Living Donor Kidney Transplantation: a Socioecological Approach. J Racial Ethn Health Disparities 2024; 11:928-937. [PMID: 36991297 PMCID: PMC10057682 DOI: 10.1007/s40615-023-01573-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 08/31/2022] [Accepted: 03/19/2023] [Indexed: 03/31/2023]
Abstract
Despite kidney transplantation having superior outcomes to dialytic therapies, disparities continue to exist among rates of kidney transplantation between Black and non-Hispanic White patients, which cannot be explained by differences in individual characteristics. To better evaluate the persistent Black/White disparities in living kidney transplantation, we review the extant literature and include the critical factors and recent development in living kidney transplantation in the socioecological approach. We also emphasize the potential vertical and hierarchical associations among factors in the socioecological model. Specifically, this review explores the possibility that the relatively low living kidney transplantation among Blacks may be a consequence of individual, interpersonal, and structural inequalities in various social and cultural dimensions. At the individual level, the Black/White differences in socioeconomic conditions and transplant knowledge may account for the low transplantation rates among Blacks. Interpersonally, the relatively weak social support and poor communication between Black patients and their providers may contribute to disparities. At the structural level, the race-based glomerular filtration rate (GFR) calculation that is widely used to screen Black donors is a barrier to receiving living kidney transplantation. This factor is directly related to structural racism in the health care system but its potential impact on living donor transplantation is underexplored. Finally, this literature review emphasizes the current perspective that a race-free GFR should be considered and a multidisciplinary and interprofessional perspective is necessary to devise strategies and interventions to reduce the Black/White disparities in living donor kidney transplantation in the U.S.
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Affiliation(s)
- Bashir El-Khoury
- Department of Preventive Medicine and Population Health, University of Texas Medical Branch, Galveston, USA.
- Civilian Institution Programs, Air Force Institute of Technology, Wright-Patterson Air Force Base, OH, USA.
| | - Tse-Chuan Yang
- Department of Epidemiology, University of Texas Medical Branch, Galveston, USA
- Department of Sociology, University at Albany, State University of New York, Albany, USA
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Trinh NHT, Talukder F, Nagendra A, Ali AM, Emmerich A, Chow L, Jenkins JH, Okereke OI. From Diversity, Equity, and Inclusion to an Antiracism Strategic Plan: An Academic Department of Psychiatry's Journey. Psychiatr Serv 2024; 75:391-394. [PMID: 38347815 DOI: 10.1176/appi.ps.20230024] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
The efforts of an academic psychiatry department to embark on an antiracism strategic planning process are outlined, including the establishment of an antiracism task force charged with the development of an antiracism strategic plan. The initial process of the task force is described, recommendations are summarized, and future directions are outlined.
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Affiliation(s)
- Nhi-Ha T Trinh
- Department of Psychiatry, Massachusetts General Hospital (all authors), and Harvard Medical School (Trinh, Nagendra, Emmerich, Chow, Jenkins, Okereke), Boston
| | - Farhabi Talukder
- Department of Psychiatry, Massachusetts General Hospital (all authors), and Harvard Medical School (Trinh, Nagendra, Emmerich, Chow, Jenkins, Okereke), Boston
| | - Arun Nagendra
- Department of Psychiatry, Massachusetts General Hospital (all authors), and Harvard Medical School (Trinh, Nagendra, Emmerich, Chow, Jenkins, Okereke), Boston
| | - Areeba M Ali
- Department of Psychiatry, Massachusetts General Hospital (all authors), and Harvard Medical School (Trinh, Nagendra, Emmerich, Chow, Jenkins, Okereke), Boston
| | - Anne Emmerich
- Department of Psychiatry, Massachusetts General Hospital (all authors), and Harvard Medical School (Trinh, Nagendra, Emmerich, Chow, Jenkins, Okereke), Boston
| | - Louis Chow
- Department of Psychiatry, Massachusetts General Hospital (all authors), and Harvard Medical School (Trinh, Nagendra, Emmerich, Chow, Jenkins, Okereke), Boston
| | - Jonathan H Jenkins
- Department of Psychiatry, Massachusetts General Hospital (all authors), and Harvard Medical School (Trinh, Nagendra, Emmerich, Chow, Jenkins, Okereke), Boston
| | - Olivia I Okereke
- Department of Psychiatry, Massachusetts General Hospital (all authors), and Harvard Medical School (Trinh, Nagendra, Emmerich, Chow, Jenkins, Okereke), Boston
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Singal S, Howell D, Hanna L, Tang SX, Van Meter A, Saito E, Kane JM, Michaels TI. Race-Based Disparities in the Frequency and Duration of Restraint Use in a Psychiatric Inpatient Setting. Psychiatr Serv 2024; 75:308-315. [PMID: 37855100 DOI: 10.1176/appi.ps.20230057] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2023]
Abstract
OBJECTIVE Patients' race and age have each been identified as risk factors for experiencing restraint events during psychiatric hospitalization. Restraint duration is also an important variable in determining disparities in treatment. To the authors' knowledge, no studies to date have examined the effect of the interaction of race and age on restraint use and duration in inpatient psychiatric settings. This retrospective chart review of electronic medical records of patients admitted between 2012 and 2019 sought to examine whether race and age interacted in predicting differences in the use and duration of restraints in a psychiatric inpatient setting. METHODS Logistic and hierarchical regression analyses were conducted on data from a sample of 29,739 adolescent (ages 12-17 years) and adult (ages ≥18 years) inpatients to determine whether the interaction of race and age group (adolescent or adult) significantly predicted a restraint event or differences in restraint duration. RESULTS Black (adjusted OR [AOR]=1.85) and multiracial (AOR=1.36) patients were more likely to experience a restraint event than were their White peers. Black race was also significantly (p=0.001) associated with longer restraint duration. No significant interaction was detected between race and age in predicting restraint events or duration. CONCLUSIONS Although the interaction between race and age did not predict restraint events or duration, the findings indicate racial disparities in the frequency and duration of restraint events among Black and multiracial individuals and may inform efforts to reduce these events.
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Affiliation(s)
- Sonali Singal
- Institute of Behavioral Science, Feinstein Institutes for Medical Research, Manhasset, New York (Singal, Tang, Kane); Department of Clinical Psychology, Graduate School of Applied and Professional Psychology, Rutgers, State University of New Jersey, New Brunswick (Singal); Donald and Barbara Zucker School of Medicine, Hofstra/Northwell Health, Hempstead, New York (Howell, Hanna, Kane, Michaels); Department of Psychiatry, Zucker Hillside Hospital, Northwell Health, Glen Oaks, New York (Hanna, Tang, Van Meter, Saito, Michaels); Department of Child and Adolescent Psychiatry, Grossman School of Medicine, New York University, New York City (Van Meter)
| | - Danielle Howell
- Institute of Behavioral Science, Feinstein Institutes for Medical Research, Manhasset, New York (Singal, Tang, Kane); Department of Clinical Psychology, Graduate School of Applied and Professional Psychology, Rutgers, State University of New Jersey, New Brunswick (Singal); Donald and Barbara Zucker School of Medicine, Hofstra/Northwell Health, Hempstead, New York (Howell, Hanna, Kane, Michaels); Department of Psychiatry, Zucker Hillside Hospital, Northwell Health, Glen Oaks, New York (Hanna, Tang, Van Meter, Saito, Michaels); Department of Child and Adolescent Psychiatry, Grossman School of Medicine, New York University, New York City (Van Meter)
| | - Lauren Hanna
- Institute of Behavioral Science, Feinstein Institutes for Medical Research, Manhasset, New York (Singal, Tang, Kane); Department of Clinical Psychology, Graduate School of Applied and Professional Psychology, Rutgers, State University of New Jersey, New Brunswick (Singal); Donald and Barbara Zucker School of Medicine, Hofstra/Northwell Health, Hempstead, New York (Howell, Hanna, Kane, Michaels); Department of Psychiatry, Zucker Hillside Hospital, Northwell Health, Glen Oaks, New York (Hanna, Tang, Van Meter, Saito, Michaels); Department of Child and Adolescent Psychiatry, Grossman School of Medicine, New York University, New York City (Van Meter)
| | - Sunny X Tang
- Institute of Behavioral Science, Feinstein Institutes for Medical Research, Manhasset, New York (Singal, Tang, Kane); Department of Clinical Psychology, Graduate School of Applied and Professional Psychology, Rutgers, State University of New Jersey, New Brunswick (Singal); Donald and Barbara Zucker School of Medicine, Hofstra/Northwell Health, Hempstead, New York (Howell, Hanna, Kane, Michaels); Department of Psychiatry, Zucker Hillside Hospital, Northwell Health, Glen Oaks, New York (Hanna, Tang, Van Meter, Saito, Michaels); Department of Child and Adolescent Psychiatry, Grossman School of Medicine, New York University, New York City (Van Meter)
| | - Anna Van Meter
- Institute of Behavioral Science, Feinstein Institutes for Medical Research, Manhasset, New York (Singal, Tang, Kane); Department of Clinical Psychology, Graduate School of Applied and Professional Psychology, Rutgers, State University of New Jersey, New Brunswick (Singal); Donald and Barbara Zucker School of Medicine, Hofstra/Northwell Health, Hempstead, New York (Howell, Hanna, Kane, Michaels); Department of Psychiatry, Zucker Hillside Hospital, Northwell Health, Glen Oaks, New York (Hanna, Tang, Van Meter, Saito, Michaels); Department of Child and Adolescent Psychiatry, Grossman School of Medicine, New York University, New York City (Van Meter)
| | - Ema Saito
- Institute of Behavioral Science, Feinstein Institutes for Medical Research, Manhasset, New York (Singal, Tang, Kane); Department of Clinical Psychology, Graduate School of Applied and Professional Psychology, Rutgers, State University of New Jersey, New Brunswick (Singal); Donald and Barbara Zucker School of Medicine, Hofstra/Northwell Health, Hempstead, New York (Howell, Hanna, Kane, Michaels); Department of Psychiatry, Zucker Hillside Hospital, Northwell Health, Glen Oaks, New York (Hanna, Tang, Van Meter, Saito, Michaels); Department of Child and Adolescent Psychiatry, Grossman School of Medicine, New York University, New York City (Van Meter)
| | - John M Kane
- Institute of Behavioral Science, Feinstein Institutes for Medical Research, Manhasset, New York (Singal, Tang, Kane); Department of Clinical Psychology, Graduate School of Applied and Professional Psychology, Rutgers, State University of New Jersey, New Brunswick (Singal); Donald and Barbara Zucker School of Medicine, Hofstra/Northwell Health, Hempstead, New York (Howell, Hanna, Kane, Michaels); Department of Psychiatry, Zucker Hillside Hospital, Northwell Health, Glen Oaks, New York (Hanna, Tang, Van Meter, Saito, Michaels); Department of Child and Adolescent Psychiatry, Grossman School of Medicine, New York University, New York City (Van Meter)
| | - Timothy I Michaels
- Institute of Behavioral Science, Feinstein Institutes for Medical Research, Manhasset, New York (Singal, Tang, Kane); Department of Clinical Psychology, Graduate School of Applied and Professional Psychology, Rutgers, State University of New Jersey, New Brunswick (Singal); Donald and Barbara Zucker School of Medicine, Hofstra/Northwell Health, Hempstead, New York (Howell, Hanna, Kane, Michaels); Department of Psychiatry, Zucker Hillside Hospital, Northwell Health, Glen Oaks, New York (Hanna, Tang, Van Meter, Saito, Michaels); Department of Child and Adolescent Psychiatry, Grossman School of Medicine, New York University, New York City (Van Meter)
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Pouget ER, Feyissa GT, Wong T. Inequity in US Racial/Ethnic Infant Health and Birth Outcomes: The Role of the Adult Sex Ratio as a Potential Indicator of Structural Anti-Black Racism. J Racial Ethn Health Disparities 2024:10.1007/s40615-024-01984-4. [PMID: 38528178 DOI: 10.1007/s40615-024-01984-4] [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: 12/12/2023] [Revised: 03/07/2024] [Accepted: 03/17/2024] [Indexed: 03/27/2024]
Abstract
BACKGROUND Structural racism accounts for inequity in health outcomes in ways that are difficult to measure. To conduct more actionable research and measure the impact of intervention programs, there is a need to develop indicator measures of structural racism. One potential candidate is the Adult Sex Ratio (ASR), which was identified by Du Bois as an important indicator of social life functioning over 100 years ago and has remained significant up to the present day. This study investigated the utility of this measure. METHODS We compared birth/infant health outcomes using the US 2000 Linked Birth/Infant Death Cohort Data Set matched with 2000 Census data on adult sex ratios in multilevel logistic regression models, stratified by the racial/ethnic category of the mothers. RESULTS In an adjusted model, the odds of infant death was 21% higher among non-Hispanic Black (NHB) women living in counties in the lowest ASR tertile category when compared to their counterparts in counties in the highest ASR tertile. Similarly, the odds of giving birth to a preterm or a low birth weight infant were each 20% higher among NHB women living in counties in the lowest ASR tertile compared to their counterparts in counties in the highest ASR tertile. CONCLUSION ASRs may serve as a useful indicator of anti-Black structural racism at the local level. More research is needed to determine the circumstances under which this factor may serve to improve assessment of structural racism and facilitate health equity research.
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Affiliation(s)
- Enrique R Pouget
- Department of Health and Nutrition Sciences, Brooklyn College, The City University of New York, 2900 Bedford Avenue, Brooklyn, NY, 11210, USA.
| | - Garumma T Feyissa
- Department of Health and Nutrition Sciences, Brooklyn College, The City University of New York, 2900 Bedford Avenue, Brooklyn, NY, 11210, USA
| | - Tracy Wong
- Department of Health and Nutrition Sciences, Brooklyn College, The City University of New York, 2900 Bedford Avenue, Brooklyn, NY, 11210, USA
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Rishworth A, Wilson K, Adams M, Galloway T. Landscapes of inequities, structural racism, and disease during the COVID-19 pandemic: Experiences of immigrant and racialized populations in Canada. Health Place 2024; 87:103214. [PMID: 38520992 DOI: 10.1016/j.healthplace.2024.103214] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 02/12/2024] [Accepted: 02/15/2024] [Indexed: 03/25/2024]
Abstract
The COVID-19 pandemic has disproportionately affected immigrant and racialized communities globally and revealed another public health crisis - structural racism. While structural racism is known to foster discrimination via mutually reinforcing systems, the unevenness of COVID-19 infections, hospitalizations, and deaths across societies has precipitated attention to the impacts of structural racism. Research highlights the inequitable burden of COVID-19 among immigrant and racialized groups; however, little is known about the synergistic impacts of structural racism and COVID-19 on the health and wellbeing of these groups. Fewer studies examine how structural racism and COVID-19 intersect within neighbourhoods to co-produce landscapes of disease exposure and management. This article examines the pathways through which structural racism shapes access, use, and control of environmental resources among immigrant and racialized individuals in the neighbourhoods of the Peel Region and how they converged to shape health and disease dynamics during the height of Canada's COVID-19 pandemic. Findings from in-depth interviews reveal that mutually reinforcing inequitable systems created environments for COVID-19 to reinscribe disparities in access, use, and control of key resources needed to manage health and disease, and created new forms of disparities and landscapes of inequality for immigrants and racialized individuals. We close with a discussion on the impacts for policy and practice.
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Affiliation(s)
- Andrea Rishworth
- Department of Geography, Geomatics and Environment, University of Toronto, Mississauga, ON, Canada.
| | - Kathi Wilson
- Department of Geography, Geomatics and Environment, University of Toronto, Mississauga, ON, Canada.
| | - Matthew Adams
- Department of Geography, Geomatics and Environment, University of Toronto, Mississauga, ON, Canada.
| | - Tracey Galloway
- Department of Anthropology, University of Toronto, Mississauga, ON, Canada.
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Futterman J, Bi C, Crow B, Kureshi S, Okah E. Medical educators' perception of race in clinical practice. BMC Med Educ 2024; 24:230. [PMID: 38439004 PMCID: PMC10913645 DOI: 10.1186/s12909-024-05232-5] [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] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 02/27/2024] [Indexed: 03/06/2024]
Abstract
BACKGROUND While several medical societies endorse race as a social construct, it is still often used as a biological trait in medical education. How medical educators employ race while teaching is likely impacted by their beliefs as to what race represents and its relevance in clinical care. Understanding these beliefs is necessary to guide medical education curriculum reform. METHODS This was a qualitative survey study, conducted in June 2020, of Georgetown University Medical Center faculty. As part of the survey, faculty were asked to rate, on a 5-point Likert scale, the extent to which they perceived race as a biological trait and its importance in clinical care. Self-identified clinical or preclinical faculty (N = 147) who believed that race had any importance were asked to provide an example illustrating its significance. Free-text responses were coded using content analysis with an inductive approach and contextualized by faculty's perspectives on the biological significance of race. RESULTS There were 130 (88%) responses categorized into two major themes: race is important for [1] screening, diagnosing, and treating diseases and [2] contextualizing patients' experiences and health behaviors. Compared to faculty who perceived race as biological, those who viewed race as strictly social were more likely to report using race to understand or acknowledge patients' exposure to racism. However, even among these faculty, explanations that suggested biological differences between racial groups were prevalent. CONCLUSIONS Medical educators use race primarily to understand diseases and frequently described biological differences between racial groups. Efforts to reframe race as sociopolitical may require education that examines race through a global lens, accounting for the genetic and cultural variability that occurs within racial groups; greater awareness of the association between structural racism and health inequities; movement away from identity-based risk stratification; and incorporation of tools that appraise race-based medical literature.
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Affiliation(s)
| | | | - Brendan Crow
- Mountain Area Health Education Center, Asheville, NC, USA
| | - Sarah Kureshi
- Georgetown University School of Medicine, Washington, DC, USA
| | - Ebiere Okah
- Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN, USA.
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Khalil M, Munir MM, Woldesenbet S, Katayama E, Diaz A, Chen JC, Obeng-Gyasi S, Pawlik TM. Association Between Historical Redlining and Access to High-Volume Hospitals Among Patients Undergoing Complex Cancer Surgery in California. Ann Surg Oncol 2024; 31:1477-1487. [PMID: 38082168 DOI: 10.1245/s10434-023-14679-7] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 11/13/2023] [Indexed: 02/08/2024]
Abstract
BACKGROUND We sought to determine the impact of historical redlining on travel patterns and utilization of high-volume hospitals (HVHs) among patients undergoing complex cancer operations. METHODS The California Department of Health Care Access and Information database was utilized to identify patients who underwent esophagectomy (ES), pneumonectomy (PN), pancreatectomy (PA), or proctectomy (PR) for cancer between 2010 and 2020. Patient ZIP codes were assigned Home Owners' Loan Corporation grades (A: 'Best'; B: 'Still Desirable'; C: 'Definitely Declining'; and D: 'Hazardous/Redlined'). A clustered multivariable regression was used to assess the likelihood of patients undergoing surgery at an HVH, bypassing the nearest HVH, and total real driving time and travel distance. RESULTS Among 14,944 patients undergoing high-risk cancer surgery (ES: 4.7%, n = 1216; PN: 57.8%, n = 8643; PD: 14.4%, n = 2154; PR: 23.1%, n = 3452), 782 (5.2%) individuals resided in the 'Best', whereas 3393 (22.7%) individuals resided in redlined areas. Median travel distance was 7.8 miles (interquartile range [IQR] 4.1-14.4) and travel time was 16.1 min (IQR 10.7-25.8). Overall, 10,763 (ES: 17.4%; PN: 76.0%; PA: 63.5%; PR: 78.4%) patients underwent surgery at an HVH. On multivariable regression, patients residing in redlined areas were less likely to undergo surgery at an HVH (odds ratio [OR] 0.67, 95% confidence interval [CI] 0.54-0.82) and were more likely to bypass the nearest hospital (OR 1.80, 95% CI 1.44-2.46). Notably, Medicaid insurance, minority status, limited English-language proficiency, and educational level mediated the disparities in access to HVH. CONCLUSION Surgical disparities in access to HVH among patients from historically redlined areas are largely mediated by social determinants such as insurance and minority status.
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Affiliation(s)
- Mujtaba Khalil
- Department of Surgery, The Urban Meyer III and Shelley Meyer Chair for Cancer Research, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Muhammad Musaab Munir
- Department of Surgery, The Urban Meyer III and Shelley Meyer Chair for Cancer Research, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Selamawit Woldesenbet
- Department of Surgery, The Urban Meyer III and Shelley Meyer Chair for Cancer Research, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Erryk Katayama
- Department of Surgery, The Urban Meyer III and Shelley Meyer Chair for Cancer Research, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Adrian Diaz
- Department of Surgery, The Urban Meyer III and Shelley Meyer Chair for Cancer Research, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - J C Chen
- Department of Surgery, The Urban Meyer III and Shelley Meyer Chair for Cancer Research, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Samilia Obeng-Gyasi
- Department of Surgery, The Urban Meyer III and Shelley Meyer Chair for Cancer Research, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Timothy M Pawlik
- Department of Surgery, The Urban Meyer III and Shelley Meyer Chair for Cancer Research, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA.
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Mays EJ, Diggs S, Vesoulis ZA, Warner B. The Effects of Health Disparities on Neonatal Outcomes. Crit Care Nurs Clin North Am 2024; 36:11-22. [PMID: 38296368 DOI: 10.1016/j.cnc.2023.08.006] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2024]
Abstract
The history of racism in the United States was established with slavery, and the carry-over effect continues to impact health care through structural and institutional racism. Racial segregation and redlining have impacted access to quality health care, thereby impacting prematurity and infant mortality rates. Health disparities also impact neonatal morbidities such as intraventricular hemorrhage and necrotizing enterocolitis and the family care experience including the establishment of breastfeeding and health care provider interactions.
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Affiliation(s)
- Erin J Mays
- St. Louis Children's Hospital NICU, 1 Childrens Place, St Louis, MO 63110, USA.
| | - Stephanie Diggs
- Division of Newborn Medicine, Department of Pediatrics, Washington University School of Medicine, 1 Childrens Place, #8116-NWT 8, St Louis, MO 63110, USA
| | - Zachary A Vesoulis
- Division of Newborn Medicine, Department of Pediatrics, Washington University School of Medicine, 1 Childrens Place, #8116-NWT 8, St Louis, MO 63110, USA
| | - Barbara Warner
- Division of Newborn Medicine, Department of Pediatrics, Washington University School of Medicine, 1 Childrens Place, #8116-NWT 8, St Louis, MO 63110, USA
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11
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da Silva RV, Alves CEA, Montenario MR, Murray LR. Writing to Create, Mend, and Rebel: Three Reflections on Journaling as Escrevivência for Afro-Brazilian Public University Students During COVID-19. Cult Med Psychiatry 2024; 48:123-132. [PMID: 38607461 DOI: 10.1007/s11013-024-09849-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/13/2024] [Indexed: 04/13/2024]
Affiliation(s)
- Renan Vicente da Silva
- Centro de Ciências da Saúde/Universidade Federal do Rio de Janeiro (CSS/UFRJ) - Center for Health Sciences/Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
- Hospital Regional do Medio Paraíba, Volta Redonda, Rio de Janeiro, Brazil
| | - Carlos Eduardo Assunção Alves
- Centro de Ciências da Saúde/Universidade Federal do Rio de Janeiro (CSS/UFRJ) - Center for Health Sciences/Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
- Faculdade de Medicina/Medical School, CSS/UFRJ, Rio de Janeiro, Brazil
| | - Mayana Ribeiro Montenario
- Centro de Ciências da Saúde/Universidade Federal do Rio de Janeiro (CSS/UFRJ) - Center for Health Sciences/Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
- Faculdade de Fisioterapia/School of Physical Therapy, CSS/UFRJ, Rio de Janeiro, Brazil
| | - Laura Rebecca Murray
- Núcleo de Estudos de Políticas Públicas em Direitos Humanos/Universidade Federal do Rio de Janeiro (NEPP-DH/UFRJ) - Center for Studies on Public Policies in Human Rights/Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.
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12
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Askew AJ, Randall A, Alvarez JC, Elbe CI, Caravelli N, Gonzales M, van der Star A, Blashill AJ. Examining the association of structural stigmas with body image-related outcomes among sexual minority individuals. Body Image 2024; 48:101652. [PMID: 38141492 DOI: 10.1016/j.bodyim.2023.101652] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 11/13/2023] [Accepted: 11/20/2023] [Indexed: 12/25/2023]
Abstract
Sexual minority individuals display heightened body image disturbance, which is associated with negative health outcomes. Structural stigmas are associated with negative health outcomes among sexual minority individuals, but the association between structural stigmas and body image is not understood. Using a linear regression approach, we examined how U.S. state-level structural racism and structural sexual minority stigma were associated with body image-related outcomes including eating pathology, appearance and/or performance-enhancing drug (APED) misuse, and dysmorphic concern. Participants were 942 cisgender sexual minority individuals ages 18-30, with approximately equal representation among non-Hispanic/Latinx White, Black, Asian, and Hispanic/Latinx individuals. There was not a significant main effect of state-level structural sexual minority stigma on body image-related outcomes. In states with higher structural racism, Hispanic/Latinx participants endorsed higher APED misuse, and this interaction was not significant among non-Hispanic/Latinx White individuals. This pattern was not found among Black or Asian participants, nor was it replicated for dysmorphic concern or eating pathology. Findings suggest that reducing exposure to structural racism could reduce APED misuse among Hispanic/Latinx individuals.
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Affiliation(s)
- Autumn J Askew
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, 6363 Alvarado Court, Suite 103, San Diego, CA 92120, United States
| | - Alyson Randall
- Department of Psychology, San Diego State University, 5500 Campanile Drive, San Diego, CA 92182, United States
| | - Jordan C Alvarez
- Department of Psychology, Auburn University, Auburn AL, United States
| | - Connor I Elbe
- Department of Psychology, San Diego State University, 5500 Campanile Drive, San Diego, CA 92182, United States
| | - Nicolas Caravelli
- Department of Psychology, San Diego State University, 5500 Campanile Drive, San Diego, CA 92182, United States
| | - Manuel Gonzales
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, 6363 Alvarado Court, Suite 103, San Diego, CA 92120, United States
| | - Arjan van der Star
- Department of Psychology, San Diego State University, 5500 Campanile Drive, San Diego, CA 92182, United States
| | - Aaron J Blashill
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, 6363 Alvarado Court, Suite 103, San Diego, CA 92120, United States; Department of Psychology, San Diego State University, 5500 Campanile Drive, San Diego, CA 92182, United States.
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13
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Siegel M, Nicholson-Robinson V. Association Between Changes in Racial Residential and School Segregation and Trends in Racial Health Disparities, 2000-2020: A Life Course Perspective. J Racial Ethn Health Disparities 2024:10.1007/s40615-024-01960-y. [PMID: 38421509 DOI: 10.1007/s40615-024-01960-y] [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: 12/13/2023] [Revised: 02/15/2024] [Accepted: 02/21/2024] [Indexed: 03/02/2024]
Abstract
INTRODUCTION Most studies of the relationship between racial segregation and racial health disparities have focused on residential segregation. School-based racial segregation is an additional form of segregation that may be associated with racial disparities in health. This study examines the relationship between both residential segregation and school segregation and racial health disparities among non-Hispanic Black compared to non-Hispanic White persons at the county level in the United States. It also examines the relationship between changes in residential and school segregation and subsequent trajectories in a variety of racial health disparities across the life course. METHODS Using the CDC WONDER Multiple Case of Death database, we derived an annual estimate of race-specific death rates and rate ratios for each county during the period 2000-2020. We then examined the relationship between baseline levels of residential and school segregation in 1991 as well as changes between 1991-2000 and the trajectories of the observed racial health disparities between 2000 and 2020. We used latent trajectory analysis to identify counties with similar patterns of residential and school segregation over time and to identify counties with similar trajectories in each racial health disparity. Outcomes included life expectancy, early mortality (prior to age 65), infant mortality, firearm homicide, total homicide, and teenage pregnancy rates. RESULTS During the period 1991-2020, racial residential segregation remained essentially unchanged among the 1051 counties in our sample; however, racial school segregation increased during this period. Increases in school segregation from 1991 to 2000 were associated with higher racial disparities in each of the health outcomes during the period 2000-2020 and with less progress in reducing these disparities. CONCLUSION This paper provides new evidence that school segregation is an independent predictor of racial health disparities and that reducing school segregation-even in the face of high residential segregation-could have a long-term impact on reducing racial health disparities. Furthermore, it suggests that the health consequences of residential segregation have not been eliminated from our society but are now being exacerbated by a new factor: school-based segregation. Throughout this paper, changes in school-based segregation not only show up as a consistent significant predictor of greater racial disparities throughout the life course, but at times, an even stronger predictor of health inequity than residential segregation.
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Affiliation(s)
- Michael Siegel
- Department of Public Health and Community Medicine, Tufts University School of Medicine, 136 Harrison Avenue, Boston, MA, 02111, USA.
| | - Vanessa Nicholson-Robinson
- Department of Public Health and Community Medicine, Tufts University School of Medicine, 136 Harrison Avenue, Boston, MA, 02111, USA
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14
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Houghton LC, Adkins-Jackson PB. Mixed-Method, Multilevel Clustered-Randomized Control Trial for Menstrual Health Disparities. Prev Sci 2024:10.1007/s11121-024-01646-1. [PMID: 38358576 DOI: 10.1007/s11121-024-01646-1] [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] [Accepted: 01/02/2024] [Indexed: 02/16/2024]
Abstract
Menstrual cycle characteristics are largely considered unmodifiable reproductive factors, a framing that prevents exploration of the ways structural factors interfere with menstrual health. Given the role of structural factors like healthy food and healthcare access on reproductive health and the grave need for structural interventions to known reproductive health disparities that disproportionately target cisgender women racialized as Black, it is imperative that science begin to examine how structural factors influence menstrual health. To explore such research, we employ critical race theory and intersectionality to illustrate what a structural intervention to improve menstrual cycle health could look like. Centering those with the greatest need, persons racialized as Black and/or LatinX living in food and healthcare deserts in Northern Manhattan, our illustrative sample includes four groups of persons who menstruate (e.g., cisgender girls and women) that are pre-menarche, pre-parous, postpartum, or perimenopausal. We describe a hypothetical, multilevel clustered-randomized control trial (cRCT) that provides psychoeducation on racism-related trauma and free delivered groceries to both treatment and control groups, while randomizing 30 clusters of housing associations to receive either sexual health clinics at their housing association or free vouchers for healthcare. We embed mixed methods (diaries, interviews, surveys, mobile apps, observation) into the design to evaluate the effectiveness of the 1-year intervention, in addition to determining the impact on participants through their perspectives. Through this illustration, we provide a novel example of how structural interventions can apply mixed methods to evaluate effectiveness while delivering services to populations impacted by multiple structural factors. We demonstrate how qualitative and quantitative approaches can be paired in clustered RCTs and how a living logic model can empirically incorporate the population perspective into more effective interventions. Lastly, we reveal how sensitive menstrual health is to structural factors and how upstream improvements will trickle down to potentially reduce health disparities in reproductive health.
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Affiliation(s)
- Lauren C Houghton
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, USA.
| | - Paris B Adkins-Jackson
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, USA
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, USA
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15
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Attarian H, Dunietz GL, Gavidia-Romero R, Jansen E, Johnson DA, Kelman A, Knutson K. Addressing sleep deserts: A proposed call for action. Sleep Health 2024; 10:S15-S18. [PMID: 37926658 DOI: 10.1016/j.sleh.2023.09.008] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Revised: 09/15/2023] [Accepted: 09/18/2023] [Indexed: 11/07/2023]
Abstract
Sleep deserts are a major cause of health inequity. They occur primarily in disadvantaged neighborhoods because of structural racism, social and environmental factors, and dearth of medical services. We describe several strategies that can serve as a feasible action plan to target structural racism, environmental pollution, and impact of climate change. We also suggest ways healthcare providers in these underserved areas can incorporate sleep medicine into their practice. Lastly, we highlight strategies to increase community awareness of sleep health in a culturally sensitive manner. There are several ways, from a policy level to healthcare that we can begin to eliminate sleep deserts, which is urgently needed.
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Affiliation(s)
- Hrayr Attarian
- Northwestern University, Feinberg School of Medicine, Department of Neurology, Chicago, Illinois, USA.
| | - Galit Levi Dunietz
- University of Michigan Medical School, Department of Neurology, Ann Arbor, Michigan, USA
| | - Ronald Gavidia-Romero
- University of Michigan Medical School, Department of Neurology, Ann Arbor, Michigan, USA
| | - Erica Jansen
- University of Michigan Medical School, Department of Neurology, Ann Arbor, Michigan, USA
| | - Dayna A Johnson
- Emory University, Rollins School of Public Health, Department of Epidemiology, Atlanta, Georgia, USA
| | - Alexa Kelman
- University of Michigan Medical School, Department of Neurology, Ann Arbor, Michigan, USA
| | - Kristen Knutson
- Northwestern University, Feinberg School of Medicine, Department of Neurology, Chicago, Illinois, USA
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16
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Guglielminotti J, Samari G, Friedman AM, Landau R, Li G. State-Level Indicators of Structural Racism and Severe Adverse Maternal Outcomes During Childbirth. Matern Child Health J 2024; 28:165-176. [PMID: 37938439 DOI: 10.1007/s10995-023-03828-9] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2023] [Indexed: 11/09/2023]
Abstract
OBJECTIVES Structural racism (SR) is viewed as a root cause of racial and ethnic disparities in maternal health outcomes. However, evidence linking SR to increased odds of severe adverse maternal outcomes (SAMO) is scant. This study assessed the association between state-level indicators of SR and SAMO during childbirth. METHODS Data for non-Hispanic Black and non-Hispanic white women came from the US Natality file, 2017-2018. The exposures were state-level Black-to-white inequity ratios for lower education level, unemployment, and prison incarceration. The outcome was patient-level SAMO, including eclampsia, blood transfusion, hysterectomy, or intensive care unit admission. Adjusted odds ratios (aORs) of SAMO associated with each ratio were estimated using multilevel models adjusting for patient, hospital, and state characteristics. RESULTS A total of 4,804,488 birth certificates were analyzed, with 22.5% for Black women. SAMO incidence was 106.4 per 10,000 (95% CI 104.5, 108.4) for Black women, and 72.7 per 10,000 (95% CI 71.8, 73.6) for white women. Odds of SAMO increased 35% per 1-unit increase in the unemployment ratio for Black women (aOR 1.35; 95% CI 1.04, 1.73), and 16% for white women (aOR 1.16; 95% CI 1.01, 1.33). Odds of SAMO increased 6% per 1-unit increase in the incarceration ratio for Black women (aOR 1.06; 95% CI 1.03, 1.10), and 4% for white women (aOR 1.04; 95% CI 1.02, 1.06). No significant association was observed between SAMO and the lower education level ratio. CONCLUSIONS FOR PRACTICE State-level Black-to-white inequity ratios for unemployment and incarceration are associated with significantly increased odds of SAMO.
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Affiliation(s)
- Jean Guglielminotti
- Department of Anesthesiology, Columbia University Vagelos College of Physicians and Surgeons, 622 West 168th Street, PH5-505, New York, NY, 10032, USA.
| | - Goleen Samari
- Heilbrunn Department of Population and Family Health, Columbia University Mailman School of Public Health, 722 West 168th Street, New York, NY, 10032, USA
| | - Alexander M Friedman
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Columbia University Vagelos College of Physicians and Surgeons, 622 West 168th Street, New York, NY, 10032, USA
| | - Ruth Landau
- Department of Anesthesiology, Columbia University Vagelos College of Physicians and Surgeons, 622 West 168th Street, PH5-505, New York, NY, 10032, USA
| | - Guohua Li
- Department of Anesthesiology, Columbia University Vagelos College of Physicians and Surgeons, 622 West 168th Street, PH5-505, New York, NY, 10032, USA
- Department of Epidemiology, Columbia University Mailman School of Public Health, 722 West 168th Street, New York, NY, 10032, USA
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17
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Curtis DS, Waitzman N, Kramer MR, Shakib JH. Structural barriers to health care as risk factors for preterm and small-for-gestational-age birth among US-born Black and White mothers. Health Place 2024; 85:103177. [PMID: 38241851 PMCID: PMC10922656 DOI: 10.1016/j.healthplace.2024.103177] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 12/06/2023] [Accepted: 01/08/2024] [Indexed: 01/21/2024]
Abstract
We develop county-level measures of structural and institutional barriers to care, and test associations between these barriers and birth outcomes for US-born Black and White mothers using national birth records for 2014-2017. Results indicate elevated odds of greater preterm birth severity for Black mothers in counties with higher uninsurance rates among Black adults, fewer Black physicians per Black residents, and fewer publicly-funded contraceptive services. Most structural barriers were not associated with small-for-gestational-age birth, and barriers defined for Black residents were not associated with birth outcomes for White mothers, with the exception of Black uninsurance rate. Structural determinants of care may influence preterm birth risk for Black Americans.
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Affiliation(s)
- David S Curtis
- Department of Family and Consumer Studies, University of Utah, Salt Lake City, UT, 84112, USA.
| | - Norman Waitzman
- Department of Economics, University of Utah, Salt Lake City, UT, 84112, USA
| | - Michael R Kramer
- Department of Epidemiology, Emory University, Atlanta, GA, 30322, USA
| | - Julie H Shakib
- Department of Pediatrics, University of Utah, Salt Lake City, UT, 84112, USA
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18
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Woods-Jaeger B, Jahangir T, Lucas D, Freeman M, Renfro TL, Knutzen KE, Cave N, Jackson M, Chandler C, Riggins C, Lightfoot AF. Youth Empowered Advocating for Health (YEAH): Facilitating Partnerships Between Prevention Scientists and Black Youth to Promote Health Equity. Prev Sci 2024; 25:20-30. [PMID: 36287352 PMCID: PMC9607836 DOI: 10.1007/s11121-022-01450-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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] [Accepted: 10/10/2022] [Indexed: 11/25/2022]
Abstract
Structural racism inflicts a disproportionate burden of stress and trauma within Black communities, resulting in physical and mental health inequities that impact Black youth. Yet few multilevel interventions exist to address these deeply rooted inequities from a preventive standpoint, and even fewer are informed by the participatory input of the impacted communities. To bridge these gaps, we developed a community-based prevention strategy that promotes agency and active resistance to structural racism, Youth Empowered Advocating for Health (YEAH), and implemented it across various settings. We outline the development, implementation, and expansion of YEAH as a tool for promoting optimal health among Black communities. Lastly, we discuss lessons learned and offer a framework outlining key principles for prevention scientists to partner with Black youth and engage them in translational science to address structural racism. This framework is aimed at driving policies, practices, and procedures that promote equitable and sustainable change for and with Black communities.
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Affiliation(s)
- Briana Woods-Jaeger
- Rollins School of Public Health, Emory University, Grace Crum Rollins Building1518 Clifton Road NE, Atlanta, GA, #52630322, USA.
| | - Tasfia Jahangir
- Rollins School of Public Health, Emory University, Grace Crum Rollins Building1518 Clifton Road NE, Atlanta, GA, #52630322, USA
| | - Devin Lucas
- Rollins School of Public Health, Emory University, Grace Crum Rollins Building1518 Clifton Road NE, Atlanta, GA, #52630322, USA
| | | | - Tiffaney L Renfro
- Rollins School of Public Health, Emory University, Grace Crum Rollins Building1518 Clifton Road NE, Atlanta, GA, #52630322, USA
| | - Kristin E Knutzen
- Rollins School of Public Health, Emory University, Grace Crum Rollins Building1518 Clifton Road NE, Atlanta, GA, #52630322, USA
| | - Nkosi Cave
- Rollins School of Public Health, Emory University, Grace Crum Rollins Building1518 Clifton Road NE, Atlanta, GA, #52630322, USA
| | | | - Caroline Chandler
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - Alexandra F Lightfoot
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Capers Q, Thomas L. Enhancing the Pipeline for a Diverse Workforce. Child Adolesc Psychiatr Clin N Am 2024; 33:71-76. [PMID: 37981338 DOI: 10.1016/j.chc.2023.06.008] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2023]
Abstract
The lack of diversity in the physician workforce is a multifactorial problem. From elementary school through college, students from minority or socioeconomically disadvantaged backgrounds achieve despite attending underresourced schools, facing low expectations from peers and teachers, and overcoming unconscious biases among decision makers. These and other obstacles lead to significant attrition of talent by the time cohorts prepare to apply to medical school. Pipeline initiatives that inspire and prepare applicants from groups underrepresented in medicine are needed to swell the ranks of diverse individuals entering our profession.
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Affiliation(s)
- Quinn Capers
- Department of Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA.
| | - Lia Thomas
- Department of Psychiatry, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA. https://twitter.com/DrLiaT1
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20
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Newman PA, Dinh DA, Nyoni T, Allan K, Fantus S, Williams CC, Tepjan S, Reid L, Guta A. Covid-19 Vaccine Hesitancy and Under-Vaccination among Marginalized Populations in the United States and Canada: A Scoping Review. J Racial Ethn Health Disparities 2023:10.1007/s40615-023-01882-1. [PMID: 38117443 DOI: 10.1007/s40615-023-01882-1] [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: 09/15/2023] [Revised: 11/20/2023] [Accepted: 11/27/2023] [Indexed: 12/21/2023]
Abstract
BACKGROUND Amid persistent disparities in Covid-19 vaccination and burgeoning research on vaccine hesitancy (VH), we conducted a scoping review to identify multilevel determinants of Covid-19 VH and under-vaccination among marginalized populations in the U.S. and Canada. METHODS Using the scoping review methodology developed by the Joanna Briggs Institute, we designed a search string and explored 7 databases to identify peer-reviewed articles published from January 1, 2020-October 25, 2022. We combine frequency analysis and narrative synthesis to describe factors influencing Covid-19 VH and under-vaccination among marginalized populations. RESULTS The search captured 11,374 non-duplicated records, scoped to 103 peer-reviewed articles. Among 14 marginalized populations identified, African American/Black, Latinx, LGBTQ+, American Indian/Indigenous, people with disabilities, and justice-involved people were the predominant focus. Thirty-two factors emerged as influencing Covid-19 VH, with structural racism/stigma and institutional mistrust (structural)(n = 71) most prevalent, followed by vaccine safety (vaccine-specific)(n = 62), side effects (vaccine-specific)(n = 50), trust in individual healthcare provider (social/community)(n = 38), and perceived risk of infection (individual)(n = 33). Structural factors predominated across populations, including structural racism/stigma and institutional mistrust, barriers to Covid-19 vaccine access due to limited supply/availability, distance/lack of transportation, no/low paid sick days, low internet/digital technology access, and lack of culturally- and linguistically-appropriate information. DISCUSSION We identified multilevel and complex drivers of Covid-19 under-vaccination among marginalized populations. Distinguishing vaccine-specific, individual, and social/community factors that may fuel decisional ambivalence, more appropriately defined as VH, from structural racism/structural stigma and systemic/institutional barriers to vaccination access may better support evidence-informed interventions to promote equity in access to vaccines and informed decision-making among marginalized populations.
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Affiliation(s)
- Peter A Newman
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada.
| | - Duy A Dinh
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
- Faculty of Health Sciences, Queen's University, Kingston, ON, Canada
| | - Thabani Nyoni
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
| | - Kate Allan
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
| | - Sophia Fantus
- School of Social Work, University of Texas at Arlington, Arlington, TX, USA
| | - Charmaine C Williams
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
| | | | - Luke Reid
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
| | - Adrian Guta
- School of Social Work, University of Windsor, Windsor, ON, Canada
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21
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Griffee MJ, Thomson DA, Fanning J, Rosenberger D, Barnett A, White NM, Suen J, Fraser JF, Li Bassi G, Cho SM. Race and ethnicity in the COVID-19 Critical Care Consortium: demographics, treatments, and outcomes, an international observational registry study. Int J Equity Health 2023; 22:260. [PMID: 38087346 PMCID: PMC10717789 DOI: 10.1186/s12939-023-02051-w] [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] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 11/05/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Improving access to healthcare for ethnic minorities is a public health priority in many countries, yet little is known about how to incorporate information on race, ethnicity, and related social determinants of health into large international studies. Most studies of differences in treatments and outcomes of COVID-19 associated with race and ethnicity are from single cities or countries. METHODS We present the breadth of race and ethnicity reported for patients in the COVID-19 Critical Care Consortium, an international observational cohort study from 380 sites across 32 countries. Patients from the United States, Australia, and South Africa were the focus of an analysis of treatments and in-hospital mortality stratified by race and ethnicity. Inclusion criteria were admission to intensive care for acute COVID-19 between January 14th, 2020, and February 15, 2022. Measurements included demographics, comorbidities, disease severity scores, treatments for organ failure, and in-hospital mortality. RESULTS Seven thousand three hundred ninety-four adults met the inclusion criteria. There was a wide variety of race and ethnicity designations. In the US, American Indian or Alaska Natives frequently received dialysis and mechanical ventilation and had the highest mortality. In Australia, organ failure scores were highest for Aboriginal/First Nations persons. The South Africa cohort ethnicities were predominantly Black African (50%) and Coloured* (28%). All patients in the South Africa cohort required mechanical ventilation. Mortality was highest for South Africa (68%), lowest for Australia (15%), and 30% in the US. CONCLUSIONS Disease severity was higher for Indigenous ethnicity groups in the US and Australia than for other ethnicities. Race and ethnicity groups with longstanding healthcare disparities were found to have high acuity from COVID-19 and high mortality. Because there is no global system of race and ethnicity classification, researchers designing case report forms for international studies should consider including related information, such as socioeconomic status or migration background. *Note: "Coloured" is an official, contemporary government census category of South Africa and is a term of self-identification of race and ethnicity of many citizens of South Africa.
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Affiliation(s)
- Matthew J Griffee
- Department of Anesthesiology, University of Utah School of Medicine, 30 N Mario Capecchi Drive, HELIX Tower 5N100, Salt Lake City, UT, 84112, USA.
| | - David A Thomson
- Department of Anaesthesia and Perioperative Medicine, Division of Critical Care, University of Cape Town, Cape Town, South Africa
| | - Jonathon Fanning
- Critical Care Research Group, The Prince Charles Hospital, Chermside, Australia
- Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
| | | | - Adrian Barnett
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, Brisbane, QLD, Australia
| | - Nicole M White
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, Brisbane, QLD, Australia
| | - Jacky Suen
- Critical Care Research Group, The Prince Charles Hospital, Chermside, Australia
- Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - John F Fraser
- Critical Care Research Group, The Prince Charles Hospital, Chermside, Australia
- Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, Brisbane, QLD, Australia
- St Andrew's War Memorial Hospital, UnitingCare, Spring Hill, QLD, Australia
| | - Gianluigi Li Bassi
- Critical Care Research Group, The Prince Charles Hospital, Chermside, Australia
- Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
- St Andrew's War Memorial Hospital, UnitingCare, Spring Hill, QLD, Australia
- Wesley Medical Research Foundation, Auchenflower, QLD, Australia
- Wesley Hospital, Spring Hill, Auchenflower, QLD, Australia
- Queensland University of Technology, Brisbane, Australia
| | - Sung-Min Cho
- Departments of Neurology, Surgery, Anesthesia and Critical Care Medicine, Johns Hopkins Hospital, Baltimore, MD, USA
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Elias A, Ben J. Pandemic Racism: Lessons on the Nature, Structures, and Trajectories of Racism During COVID-19. J Bioeth Inq 2023; 20:617-623. [PMID: 37917295 PMCID: PMC10942924 DOI: 10.1007/s11673-023-10312-0] [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] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 10/10/2023] [Indexed: 11/04/2023]
Abstract
The COVID-19 pandemic has been one of the most acute global crises in recent history, which profoundly impacted the world across many dimensions. During this period, racism manifested in ways specifically related to the pandemic, including xenophobic sentiments, racial attacks, discriminatory policies, and disparate outcomes across racial/ethnic groups. This paper examines some of the pressing questions about pandemic racism and inequity. We review what research has revealed about the nature and manifestations of racism, the entrenchment of structural racism, and trajectories of racism during COVID-19.
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Affiliation(s)
- A Elias
- Alfred Deakin Institute for Citizenship and Globalisation, Deakin University, 221 Burwood HWY, Burwood, Victoria, 3125, Australia.
| | - J Ben
- Alfred Deakin Institute for Citizenship and Globalisation, Deakin University, 221 Burwood HWY, Burwood, Victoria, 3125, Australia
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23
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Siegel M, Rieders M, Rieders H, Moumneh J, Asfour J, Oh J, Oh S. Measuring Structural Racism and Its Association with Racial Disparities in Firearm Homicide. J Racial Ethn Health Disparities 2023; 10:3115-3130. [PMID: 36508134 PMCID: PMC9744051 DOI: 10.1007/s40615-022-01485-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 11/07/2022] [Accepted: 11/29/2022] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Structural racism is strongly related to racial health disparities. However, surprisingly few studies have developed empirical tools to measure structural racism. In addition, the few measures that have been employed have only considered structural racism at the neighborhood level. To expand upon previous studies, this paper uses a novel measure to measure structural racism at the county level for the non-Hispanic Black population. METHODS We used confirmatory factor analysis to create a model to measure the latent construct of structural racism for 1181 US counties. The model included five indicators across five dimensions: racial segregation, incarceration, educational attainment, employment, and economic status/wealth. Structural equation modeling and factor analysis were used to generate factor scores that weighted the indicators in order to produce the best model fit. The resulting factor scores represented the level of structural racism in each county. We demonstrated the utility of this measure by demonstrating its strong correlation with Black-White disparities in firearm homicide rates. RESULTS Our calculations revealed striking geographic differences across counties in the magnitude of structural racism, with the highest values generally being observed in the Midwest and Northeast. Structural racism was significantly associated with higher Black firearm homicide rates, lower White homicide rates, and a higher Black-White racial disparity in firearm homicide. CONCLUSIONS These new measures can be utilized by researchers to relate structural racism to racial health disparities at the county level.
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Affiliation(s)
- Michael Siegel
- Department of Public Health and Community Medicine, Tufts University School of Medicine, 636 Harrison Avenue, Boston, MA, 02111, USA.
| | - Madeline Rieders
- Department of Public Health and Community Medicine, Tufts University School of Medicine, 636 Harrison Avenue, Boston, MA, 02111, USA
| | - Hannah Rieders
- Department of Public Health and Community Medicine, Tufts University School of Medicine, 636 Harrison Avenue, Boston, MA, 02111, USA
| | - Jinan Moumneh
- Department of Public Health and Community Medicine, Tufts University School of Medicine, 636 Harrison Avenue, Boston, MA, 02111, USA
| | - Julia Asfour
- Department of Public Health and Community Medicine, Tufts University School of Medicine, 636 Harrison Avenue, Boston, MA, 02111, USA
| | - Jinseo Oh
- Department of Public Health and Community Medicine, Tufts University School of Medicine, 636 Harrison Avenue, Boston, MA, 02111, USA
| | - Seungjin Oh
- Department of Public Health and Community Medicine, Tufts University School of Medicine, 636 Harrison Avenue, Boston, MA, 02111, USA
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24
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Munir MM, Woldesenbet S, Endo Y, Ejaz A, Cloyd JM, Obeng-Gyasi S, Dillhoff M, Waterman B, Gustin J, Pawlik TM. Association of Race/Ethnicity, Persistent Poverty, and Opioid Access Among Patients with Gastrointestinal Cancer Near the End of Life. Ann Surg Oncol 2023; 30:8548-8558. [PMID: 37667099 DOI: 10.1245/s10434-023-14218-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 08/08/2023] [Indexed: 09/06/2023]
Abstract
BACKGROUND Social determinants of health (SDoH) can impact access to healthcare. We sought to assess the association between persistent poverty (PP), race/ethnicity, and opioid access among patients with gastrointestinal cancer near the end-of-life (EOL). METHODS SEER-Medicare patients with gastric, liver, pancreatic, biliary, colon, and rectal cancer were identified between 2008 and 2016 near EOL, defined as 30 days before death or hospice enrolment. Data were linked with county-level poverty from the American Community Survey and the US Department of Agriculture (2000-2015). Counties were categorized as never high-poverty (NHP), intermittent high-poverty (IHP) and persistent poverty (PP). Trends in opioid prescription fills and daily dosages (morphine milligram equivalents per day) were examined. RESULTS Among 48,631 Medicare beneficiaries (liver: n = 6551, 13.5%; pancreas: n = 13,559, 27.9%; gastric: n = 5486, 1.3%; colorectal: n = 23,035, 47.4%), there was a steady decrease in opioid prescriptions near EOL. Black, Asian, Hispanic, and other racial groups had markedly decreased odds of filling an opioid prescription near EOL (Black: OR 0.84, 95% CI 0.79-0.90; Asian: OR 0.86, 95% CI 0.79-0.94; Hispanic: OR 0.90, 95% CI 0.84-0.95; Other: OR 0.83, 95% CI 0.74-0.93; all p < 0.05). Even after filling an opioid prescription, this subset of patients received lower daily doses versus White patients (Black: -16.5 percentage points, 95% CI -21.2 to -11.6; Asian: -11.9 percentage points, 95% CI -18.5 to -4.9; Hispanic: -19.1 percentage points, 95%CI -23.5 to -14.6; all p < 0.05). The disparity in opioid access and average daily doses among was attenuated in IHP/PP areas for Asian, Hispanic, and other racial groups, yet exacerbated among Black patients. CONCLUSIONS Race/ethnicity-based disparities in EOL pain management persist with SDoH-based variations in EOL opioid use. In particular, PP impacted EOL opioid access and utilization.
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Affiliation(s)
- Muhammad Musaab Munir
- Division of Surgical Oncology, Department of Surgery, The Urban Meyer III and Shelley Meyer Chair for Cancer Research, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Selamawit Woldesenbet
- Division of Surgical Oncology, Department of Surgery, The Urban Meyer III and Shelley Meyer Chair for Cancer Research, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Yutaka Endo
- Division of Surgical Oncology, Department of Surgery, The Urban Meyer III and Shelley Meyer Chair for Cancer Research, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Aslam Ejaz
- Division of Surgical Oncology, Department of Surgery, The Urban Meyer III and Shelley Meyer Chair for Cancer Research, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Jordan M Cloyd
- Division of Surgical Oncology, Department of Surgery, The Urban Meyer III and Shelley Meyer Chair for Cancer Research, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Samilia Obeng-Gyasi
- Division of Surgical Oncology, Department of Surgery, The Urban Meyer III and Shelley Meyer Chair for Cancer Research, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Mary Dillhoff
- Division of Surgical Oncology, Department of Surgery, The Urban Meyer III and Shelley Meyer Chair for Cancer Research, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Brittany Waterman
- Division of Palliative Medicine, Department of Internal Medicine, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Jillian Gustin
- Division of Palliative Medicine, Department of Internal Medicine, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Timothy M Pawlik
- Division of Surgical Oncology, Department of Surgery, The Urban Meyer III and Shelley Meyer Chair for Cancer Research, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA.
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25
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Bennett SJ, Hunt RP, Breathett K, Eaton CB, Garcia L, Jiménez M, Johns TS, Mouton CP, Nassir R, Nuño T, Urrutia RP, Wactawski-Wende J, Cené CW. Racial and Ethnic Differences in Self-Reported COVID-19 Exposure Risks, Concerns, and Behaviors Among Diverse Participants in the Women's Health Initiative Study. J Gerontol A Biol Sci Med Sci 2023; 78:2294-2303. [PMID: 37267463 PMCID: PMC10692417 DOI: 10.1093/gerona/glad133] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Indexed: 06/04/2023] Open
Abstract
BACKGROUND Racial and ethnic disparities in coronavirus disease 2019 (COVID-19) risk are well-documented; however, few studies in older adults have examined multiple factors related to COVID-19 exposure, concerns, and behaviors or conducted race- and ethnicity-stratified analyses. The Women's Health Initiative (WHI) provides a unique opportunity to address those gaps. METHODS We conducted a secondary analysis of WHI data from a supplemental survey of 48 492 older adults (mean age 84 years). In multivariable-adjusted modified Poisson regression analyses, we examined predisposing factors and COVID-19 exposure risk, concerns, and behaviors. We hypothesized that women from minoritized racial or ethnic groups, compared to non-Hispanic White women, would be more likely to report: exposure to COVID-19, a family or friend dying from COVID-19, difficulty getting routine medical care or deciding to forego care to avoid COVID-19 exposure, and having concerns about the COVID-19 pandemic. RESULTS Asian women and non-Hispanic Black/African American women had a higher risk of being somewhat/very concerned about risk of getting COVID-19 compared to non-Hispanic White women and each was significantly more likely than non-Hispanic White women to report forgoing medical care to avoid COVID-19 exposure. However, Asian women were 35% less likely than non-Hispanic White women to report difficulty getting routine medical care since March 2020 (adjusted relative risk 0.65; 95% confidence interval 0.57, 0.75). CONCLUSIONS We documented COVID-related racial and ethnic disparities in COVID-19 exposure risk, concerns, and care-related behaviors that disfavored minoritized racial and ethnic groups, particularly non-Hispanic Black/African American women.
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Affiliation(s)
- Serenity J Bennett
- College of Arts & Sciences, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Rebecca P Hunt
- Fred Hutchinson Cancer Center, Public Health Sciences, Seattle, Washington, USA
| | - Khadijah Breathett
- Division of Cardiovascular Medicine, Krannert Institute of Cardiology, Indiana University, Indianapolis, Indiana, USA
| | - Charles B Eaton
- Department of Family Medicine, Warren Alpert Medical School of Brown University, Pawtucket, Rhode Island, USA
| | - Lorena Garcia
- Department of Public Health Sciences, University of California, Davis, Davis, California, USA
| | - Monik Jiménez
- Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Tanya S Johns
- Department of Medicine, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Charles P Mouton
- Department of Family Medicine, University of Texas Medical Branch, Galveston, Texas, USA
| | - Rami Nassir
- Department of Pathology, University of California, Davis, Davis, California, USA
| | - Tomas Nuño
- Department of Epidemiology & Biostatistics, University of Arizona, Tucson, Arizona, USA
| | - Rachel P Urrutia
- Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Jean Wactawski-Wende
- School of Public Health and Health Professions, University at Buffalo, Buffalo, New York, USA
| | - Crystal W Cené
- Department of Medicine, University of California San Diego, La Jolla, California, USA
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Auletta JJ, Holter-Chakrabarty J, Jain T, Miller B, Ward E, Khera N, Gomez-Arteaga A, Hall A, Nemecek E, Robb D, Yusuf RA, Davies SM. Proceedings of the 2023 Second Annual ASTCT-NMDP ACCESS Initiative Workshop. Transplant Cell Ther 2023; 29:739-746. [PMID: 37805142 DOI: 10.1016/j.jtct.2023.09.026] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 09/29/2023] [Indexed: 10/09/2023]
Abstract
Here the proceedings from the Second Annual American Society for Transplantation and Cellular Therapy (ASTCT) and National Marrow Donor Program (NMDP) ACCESS Initiative are reviewed to inform the hematopoietic cell transplantation (HCT) and cellular therapy (CT) ecosystem about progress and direction of the collaborative. Highlights from the meeting, including updates on the progress of projects from the Awareness, Poverty, and Racial Inequity Committees, are presented. The ACCESS Initiative continues to evolve and will remain dependent on the HCT/CT ecosystem's continued dedication to reduce barriers and improve outcome disparities for all patients in need of HCT/CT.
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Affiliation(s)
- Jeffery J Auletta
- National Marrow Donor Program, Minneapolis, Minnesota; Hematology/Oncology/Blood and Marrow Transplant and Infectious Diseases; Nationwide Children's Hospital, Columbus, Ohio.
| | | | - Tania Jain
- Sidney Kimmel Comprehensive Cancer Center, Baltimore, Maryland
| | - Becca Miller
- National Marrow Donor Program, Minneapolis, Minnesota
| | - Emily Ward
- National Marrow Donor Program, Minneapolis, Minnesota
| | | | | | | | | | - Delilah Robb
- National Marrow Donor Program, Minneapolis, Minnesota
| | | | - Stella M Davies
- Bone Marrow Transplant and Immune Deficiency, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
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27
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Kong AY, Herbert L, Feldman JM, Trangenstein PJ, Fakunle DO, Lee JGL. Tobacco and Alcohol Retailer Availability and Neighborhood Racialized, Economic, and Racialized Economic Segregation in North Carolina. J Racial Ethn Health Disparities 2023; 10:2861-2871. [PMID: 36469288 DOI: 10.1007/s40615-022-01463-8] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Revised: 11/14/2022] [Accepted: 11/15/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Despite evidence of racialized and socioeconomic inequities in tobacco and alcohol outlet availability, few studies have investigated spatial inequities in areas experiencing both concentrated residential racialized segregation and socioeconomic disadvantage. This study examined whether segregation-racialized, economic or both-was associated with alcohol and tobacco retailer counts in North Carolina (NC). METHODS The NC Alcoholic Beverage Control Commission provided lists of 2021 off-premise alcohol retailers. We created a list of 2018 probable tobacco retailers using ReferenceUSA. We calculated three census tract-level measures of the Index of Concentrations at the Extremes (ICE), indicating racialized segregation between non-Hispanic White and Black residents and economic segregation based on household income. We used negative binomial regression to test associations between quintiles of each ICE measure and tobacco and, separately, alcohol retailer counts. RESULTS Tracts with the greatest racialized disadvantage had 38% (IRR, 1.38; 95% CI, 1.15-1.66) and 65% (IRR, 1.65; 95% CI, 1.34-2.04) more tobacco and alcohol outlets, respectively, as tracts with the lowest. Tracts with the highest racialized economic disadvantage had a predicted count of 1.51 tobacco outlets per 1000 people while those in the lowest had nearly one fewer predicted outlet. Similar inequities existed in the predicted count of alcohol outlets. DISCUSSION Tobacco and alcohol outlet availability are higher in NC places experiencing concentrated racialized and economic segregation. A centralized agency overseeing tobacco and alcohol outlet permits and strategies to reduce the retail availability of these harmful products (e.g., capping the number of permits) are needed to intervene upon these inequities.
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Affiliation(s)
- Amanda Y Kong
- Department of Family and Preventive Medicine, The University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.
- TSET Health Promotion Research Center, Stephenson Cancer Center, The University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.
| | - Lily Herbert
- Department of Geography, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | | | - David O Fakunle
- Public Health Program, Morgan State University School of Community Health & Policy, Baltimore, MD, USA
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Larrabee Sonderlund A, Williams NJ, Charifson M, Ortiz R, Sealy-Jefferson S, De Leon E, Schoenthaler A. Structural racism and health: Assessing the mediating role of community mental distress and health care access in the association between mass incarceration and adverse birth outcomes. SSM Popul Health 2023; 24:101529. [PMID: 37841218 PMCID: PMC10570581 DOI: 10.1016/j.ssmph.2023.101529] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 10/01/2023] [Accepted: 10/03/2023] [Indexed: 10/17/2023] Open
Abstract
Research has linked spatial concentrations of incarceration with racial disparities in adverse birth outcomes. However, little is known about the specific mechanisms of this association. This represents an important knowledge gap in terms of intervention. We theorize two pathways that may account for the association between county-level prison rates and adverse birth outcomes: (1) community-level mental distress and (2) reduced health care access. Examining these mechanisms, we conducted a cross-sectional study of county-level prison rates, community-level mental distress, health insurance, availability of primary care physicians (PCP) and mental health providers (MHP), and adverse birth outcomes (preterm birth, low birth weight, infant mortality). Our data set included 475 counties and represented 2,677,840 live U.S. births in 2016. Main analyses involved between 170 and 326 counties. All data came from publicly available sources, including the U.S. Census and the Centers for Disease Control and Prevention. Descriptive and regression results confirmed the link between prison rates and adverse birth outcomes and highlighted Black-White inequities in this association. Further, bootstrap mediation analyses indicated that the impact of spatially concentrated prison rates on preterm birth was mediated by PCP, MHP, community-level mental distress, and health insurance in both crude and adjusted models. Community-level mental distress and health insurance (but not PCP or MHP) similarly mediated low birthweight in both models. Mediators were less stable in the effect on infant mortality with only MHP mediating consistently across models. We conclude that mass incarceration, health care access, and community mental distress represent actionable and urgent targets for structural-, community-, and individual-level interventions targeting population inequities in birth outcomes.
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Affiliation(s)
- Anders Larrabee Sonderlund
- Center for Healthful Behavior Change, Institute for Excellence in Health Equity, NYU Grossman School of Medicine, USA
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Denmark
| | - Natasha J. Williams
- Center for Healthful Behavior Change, Institute for Excellence in Health Equity, NYU Grossman School of Medicine, USA
| | - Mia Charifson
- Department of Population Health, NYU Grossman School of Medicine, USA
- Vilcek Institute of Graduate Biomedical Sciences, NYU Grossman School of Medicine, USA
| | - Robin Ortiz
- Center for Healthful Behavior Change, Institute for Excellence in Health Equity, NYU Grossman School of Medicine, USA
- Department of Pediatrics, NYU Grossman School of Medicine, USA
| | | | - Elaine De Leon
- Department of Population Health, NYU Grossman School of Medicine, USA
| | - Antoinette Schoenthaler
- Center for Healthful Behavior Change, Institute for Excellence in Health Equity, NYU Grossman School of Medicine, USA
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29
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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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30
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Silva A, Saiyed NS, Canty E, Benjamins MR. Pre-pandemic trends and Black:White inequities in life expectancy across the 30 most populous U.S. cities: a population-based study. BMC Public Health 2023; 23:2310. [PMID: 37993811 PMCID: PMC10664538 DOI: 10.1186/s12889-023-17214-1] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 11/12/2023] [Indexed: 11/24/2023] Open
Abstract
BACKGROUND Racial inequities in life expectancy, driven by structural racism, have been documented at the state and county levels; however, less information is available at the city level where local policy change generally happens. Furthermore, an assessment of life expectancy during the decade preceding COVID-19 provides a point of comparison for life expectancy estimates and trends post COVID-19 as cities recover. METHODS Using National Vital Statistics System mortality data and American Community Survey population estimates, we calculated the average annual city-level life expectancies for the non-Hispanic Black (Black), non-Hispanic White (White), and total populations. We then calculated the absolute difference between the Black and White life expectancies for each of the 30 cities and the U.S. We analyzed trends over four time periods (2008-2010, 2011-2013, 2014-2016, and 2017-2019). RESULTS In 2017-2019, life expectancies ranged from 72.75 years in Detroit to 83.15 years in San Francisco (compared to 78.29 years for the U.S.). Black life expectancy ranged from 69.94 years in Houston to 79.04 years in New York, while White life expectancy ranged from 75.18 years in Jacksonville to 86.42 years in Washington, DC. Between 2008-2010 and 2017-2019, 17 of the biggest cities experienced a statistically significant improvement in life expectancy, while 9 cities experienced a significant decrease. Black life expectancy increased significantly in 14 cities and the U.S. but decreased significantly in 4 cities. White life expectancy increased significantly in 17 cities and the U.S. but decreased in 8 cities. In 2017-2019, the U.S. and all but one of the big cities had a significantly longer life expectancy for the White population compared to the Black population. There was more than a 13-year difference between Black and White life expectancies in Washington, DC (compared to 4.18 years at the national level). From 2008-2010 to 2017-2019, the racial gap decreased significantly for the U.S. and eight cities, while it increased in seven cities. CONCLUSION Urban stakeholders and equity advocates need data on mortality inequities that are aligned with city jurisdictions to help guide the allocation of resources and implementation of interventions.
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Affiliation(s)
- Abigail Silva
- Parkinson School of Health Sciences and Public Health, Loyola University Chicago, Chicago, IL, USA.
| | | | - Emma Canty
- Parkinson School of Health Sciences and Public Health, Loyola University Chicago, Chicago, IL, USA
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Larson RP, Santaularia NJ, Uggen C. Temporal and spatial shifts in gun violence, before and after a historic police killing in Minneapolis. Spat Spatiotemporal Epidemiol 2023; 47:100602. [PMID: 38042529 PMCID: PMC10693656 DOI: 10.1016/j.sste.2023.100602] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 04/24/2023] [Accepted: 07/14/2023] [Indexed: 12/04/2023]
Abstract
OBJECTIVE To determine the impact of the police murder of George Floyd in Minneapolis, MN on firearm violence, and examine the spatial and social heterogeneity of the effect. METHODS We analyzed a uniquely constructed panel dataset of Minneapolis Zip Code Tabulation Areas from 2016-2020 (n = 5742), consisting of Minnesota Hospital Association, Minneapolis Police Department, Minneapolis Public Schools, Census Bureau, and Minnesota Department of Natural Resources data. Interrupted time-series and random effects panel models were used to model the spatiotemporal effects of police killing event on the rate of firearm assault injuries. RESULTS Findings reveal a rising and falling temporal pattern post-killing and a spatial pattern in which disadvantaged, historically Black communities near earlier sites of protest against police violence experienced the brunt of the post-killing increase in firearm assault injury. These effects remain after adjusting for changes in police activity and pandemic-related restrictions, indicating that rising violence was not a simple byproduct of changes in police behavior or COVID-19 response. CONCLUSIONS The results suggest that the increases in firearm violence as a result of police violence are disproportionately borne by underserved communities.
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Affiliation(s)
- Ryan P Larson
- Department of Criminal Justice and Forensic Science, Hamline University, St. Paul, MN, USA.
| | | | - Christopher Uggen
- Department of Sociology, University of Minnesota - Twin Cities, Minneapolis, MN, USA
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Stanhope KK, Kapila P, Umerani A, Hossain A, Abu-Salah M, Singisetti V, Carter S, Boulet SL. Political representation and perinatal outcomes to Black, White, and Hispanic people in Georgia: a cross-sectional study. Ann Epidemiol 2023; 87:S1047-2797(23)00167-9. [PMID: 37689094 PMCID: PMC10842944 DOI: 10.1016/j.annepidem.2023.09.001] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 07/24/2023] [Accepted: 09/05/2023] [Indexed: 09/11/2023]
Abstract
PURPOSE Our goal was to estimate differences in perinatal outcomes by racial differences in political representation, a measure of structural racism. METHODS We gathered data on the racial composition of county-level elected officials for all counties in Georgia (n = 159) in 2022. We subtracted the percent of non-White elected officials from the percent of non-White residents to calculate the "representation difference," with greater positive values indicating a larger disparity. We linked this to data from 2020-2021 birth certificates (n = 238,795) on outcomes (preterm birth, <37 weeks, low birthweight birth <2500 g, birthweight, hypertensive disorders of pregnancy, cesarean delivery). We fit log binomial and linear models with generalized estimating equations, stratified by individual race/ethnicity and including individual and county covariates. RESULTS Median representation difference was 17.5% points (interquartile range: 17.2). A 25-percentile point increase in representation difference was associated with a greater risk of hypertensive disorders of pregnancy [White: adjusted risk ratio (RR): 1.12, 95% confidence interval (CI): (1.05, 1.2), Black: 1.06, 95% CI: (0.95, 1.17), other: 1.14, 95% CI: (1.0, 1.3), Hispanic: 1.19, 95% CI: (1.07, 1.32)] and lower mean birthweight for Black birthing people [adjusted beta -15.3, 95% CI: (-25.5, -7.4)]. CONCLUSIONS Parity in political representation may be associated with healthier environments.
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Affiliation(s)
- Kaitlyn K Stanhope
- Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, GA.
| | - Pari Kapila
- Emory College of Arts and Sciences, Atlanta, GA
| | | | | | | | | | - Sierra Carter
- Department of Psychology, Georgia State University, Atlanta
| | - Sheree L Boulet
- Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, GA
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Shen A, Graden L, Harper A. Debt Inequity Among Clients of a Community Mental Health Center. Psychiatr Serv 2023; 74:1208-1211. [PMID: 36916063 DOI: 10.1176/appi.ps.202100565] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Abstract
Debt is an overlooked social determinant of health that reinforces systems of discrimination. This study examined the impact of debt among individuals with serious mental illness. Individuals with serious mental illness who identified as Black, Indigenous, or other people of color carried a disproportionate amount of debt, often from attempting to meet basic needs. Increased levels of debt were associated with symptoms of depression. Addressing debt inequity is essential to both financial justice and mental health recovery.
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Affiliation(s)
- Alice Shen
- Department of Psychiatry (Shen), Yale College (Graden), and Program for Recovery and Community Health (Harper), Yale University, New Haven
| | - Luisa Graden
- Department of Psychiatry (Shen), Yale College (Graden), and Program for Recovery and Community Health (Harper), Yale University, New Haven
| | - Annie Harper
- Department of Psychiatry (Shen), Yale College (Graden), and Program for Recovery and Community Health (Harper), Yale University, New Haven
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Siegel M, Rieders M, Rieders H, Dergham L, Iyer R. Association Between Changes in Racial Residential Segregation and Trends in Racial Disparities in Early Mortality in 220 Metropolitan Areas, 2001-2018. J Racial Ethn Health Disparities 2023:10.1007/s40615-023-01830-z. [PMID: 37855998 DOI: 10.1007/s40615-023-01830-z] [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: 08/17/2023] [Revised: 09/29/2023] [Accepted: 10/03/2023] [Indexed: 10/20/2023]
Abstract
INTRODUCTION Racial residential segregation has been shown to affect the absolute levels of racial disparities in a wide variety of health outcomes in the USA but it is not known whether changes in segregation also influence these racial health disparities. This study examines the relationship between changes in racial residential segregation over four decades (1980-2020) and trends in racial disparities in early mortality (under age 65) rates among non-Hispanic Black and non-Hispanic White persons across a wide range of health outcomes in 220 metropolitan statistical areas (MSAs) during the period 2001-2018. METHODS Using the CDC WONDER Underlying Cause of Death database, we derived annual estimates of race-specific death rates and rate ratios for each MSA. We used latent trajectory analysis to examine the relationship between the level of segregation and changes in segregation over time in an MSA and trends in death rate disparities in that MSA. RESULTS The trajectory analysis resulted in a linear, three group model in which trajectory Groups 1 and 2 had decreasing trends in the ratios of Black to White death rates over time while in Group 3, the disparity remained almost constant over time. Increases in the level of segregation in an MSA from 1980 to 2000 were significantly associated with the likelihood that the MSA was in Group 3 and experienced no improvement in racial health disparities in mortality over time. CONCLUSION This paper provides new evidence that changes in segregation are related to trends in racial health disparities in mortality rates over time.
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Affiliation(s)
- Michael Siegel
- Department of Public Health and Community Medicine, Tufts University School of Medicine, 136 Harrison Avenue, Boston, MA, 02111, USA.
| | - Madeline Rieders
- Department of Public Health and Community Medicine, Tufts University School of Medicine, 136 Harrison Avenue, Boston, MA, 02111, USA
| | - Hannah Rieders
- Department of Public Health and Community Medicine, Tufts University School of Medicine, 136 Harrison Avenue, Boston, MA, 02111, USA
| | - Leighla Dergham
- Department of Public Health and Community Medicine, Tufts University School of Medicine, 136 Harrison Avenue, Boston, MA, 02111, USA
| | - Rohan Iyer
- Department of Public Health and Community Medicine, Tufts University School of Medicine, 136 Harrison Avenue, Boston, MA, 02111, USA
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Raskin SE, Thakkar-Samtani M, Santoro M, Fleming EB, Heaton LJ, Tranby EP. Discrimination and Dignity Experiences in Prior Oral Care Visits Predict Racialized Oral Health Inequities Among Nationally Representative US Adults. J Racial Ethn Health Disparities 2023:10.1007/s40615-023-01821-0. [PMID: 37848669 DOI: 10.1007/s40615-023-01821-0] [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: 07/18/2023] [Revised: 09/23/2023] [Accepted: 09/25/2023] [Indexed: 10/19/2023]
Abstract
Racism, an oppressive and fallacious sociopolitical hierarchy, is a fundamental cause of oral health inequities worldwide. Everyday discrimination is associated with worse self-rated oral health, toothache and adult tooth loss, and lower oral care utilization. Few studies examine discrimination or microaggressions within oral care settings or their effects on oral health outcomes. We adapted the seven-item Everyday Discrimination Scale to the oral care setting (EDSOC); developed a four-item Dignity in Oral Care Scale (DOCS); fielded them to a probability-based nationally representative sample of US households as part of the 2022 State of Oral Health Equity in America survey (SOHEA, n = 5682); and examined associations between EDSOC and DOCS scores and three outcomes: self-rated oral health, duration since last oral care visit, and planning for future preventive/routine oral care. Nearly, all EDSCOC and DOCS measures were significantly associated with oral health outcomes. Discrimination experience in dental settings had an additive effect on reporting fair/poor oral health and a suppressive effect on planning a future dental visit. Indignity experience doubled-to-quadrupled the likelihood of reporting fair/poor oral health, not having visited a dentist in 2 years, and not planning a future oral care visit. Racio-ethnically minoritized patients may experience the unjust double bind of resolving urgent dental or completing preventive services needs amidst being treated in a discriminatory manner or without dignity. Oral health stakeholders should invest more effort to understand relationships between racism and oral health outcomes and introduce evidence-based interventions to ultimately abolish this societal harm.
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Affiliation(s)
- Sarah E Raskin
- L. Douglas Wilder School of Government and Public Affairs, Virginia Commonwealth University, 1001 W. Franklin Street, Richmond, VA, 23284, USA.
| | | | - Morgan Santoro
- Analytics and Data Insights, CareQuest Institute for Oral Health, Boston, MA, USA
| | | | - Lisa J Heaton
- Analytics and Data Insights, CareQuest Institute for Oral Health, Boston, MA, USA
| | - Eric P Tranby
- Analytics and Data Insights, CareQuest Institute for Oral Health, Boston, MA, USA
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Smith CM, Daley LA, Lea C, Daniel K, Tweedy DS, Thielman NM, Staplefoote-Boynton BL, Aimone E, Gagliardi JP. Experiences of Black Adults Evaluated in a Locked Psychiatric Emergency Unit: A Qualitative Study. Psychiatr Serv 2023; 74:1063-1071. [PMID: 37042104 PMCID: PMC10732806 DOI: 10.1176/appi.ps.20220533] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/13/2023]
Abstract
OBJECTIVE Evidence shows that Black individuals have higher rates of coercive emergency psychiatric interventions than other racialized groups, yet no studies have elevated the voices of Black patients undergoing emergency psychiatric evaluation. This qualitative study sought to explore the experiences of Black individuals who had been evaluated in a locked psychiatric emergency unit (PEU). METHODS Electronic health records were used to identify and recruit adult patients (ages ≥18 years) who self-identified as Black and who had undergone evaluation in a locked PEU at a large academic medical center. In total, 11 semistructured, one-on-one interviews were conducted by telephone, exploring experiences during psychiatric evaluation. Transcripts were analyzed with thematic analysis. RESULTS Participants shared experiences of criminalization, stigma, and vulnerability before and during their evaluation. Although participants described insight into their desire and need for treatment and identified helpful aspects of the care they received, they noted a mismatch between their expectations of treatment and the treatment received. CONCLUSIONS This study reveals six major patient-identified themes that supplement a growing body of quantitative evidence demonstrating that racialized minority groups endure disproportionate rates of coercive interventions during emergency psychiatric evaluation. Interdisciplinary systemic changes are urgently needed to address structural barriers to equitable psychiatric care.
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Affiliation(s)
- Colin M Smith
- Hubert-Yeargan Center for Global Health, Duke University, Durham, North Carolina (Smith); Department of Psychiatry and Behavioral Sciences (Daley, Tweedy, Staplefoote-Boynton, Gagliardi) and Department of Medicine (Thielman, Staplefoote-Boynton, Gagliardi), School of Medicine, Duke University, Durham, North Carolina; School of Medicine (Lea), Duke University, Durham, North Carolina; Duke Divinity School, Duke University, Durham, North Carolina (Daniel); Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill (Aimone)
| | - Lori-Ann Daley
- Hubert-Yeargan Center for Global Health, Duke University, Durham, North Carolina (Smith); Department of Psychiatry and Behavioral Sciences (Daley, Tweedy, Staplefoote-Boynton, Gagliardi) and Department of Medicine (Thielman, Staplefoote-Boynton, Gagliardi), School of Medicine, Duke University, Durham, North Carolina; School of Medicine (Lea), Duke University, Durham, North Carolina; Duke Divinity School, Duke University, Durham, North Carolina (Daniel); Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill (Aimone)
| | - Chris Lea
- Hubert-Yeargan Center for Global Health, Duke University, Durham, North Carolina (Smith); Department of Psychiatry and Behavioral Sciences (Daley, Tweedy, Staplefoote-Boynton, Gagliardi) and Department of Medicine (Thielman, Staplefoote-Boynton, Gagliardi), School of Medicine, Duke University, Durham, North Carolina; School of Medicine (Lea), Duke University, Durham, North Carolina; Duke Divinity School, Duke University, Durham, North Carolina (Daniel); Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill (Aimone)
| | - Keith Daniel
- Hubert-Yeargan Center for Global Health, Duke University, Durham, North Carolina (Smith); Department of Psychiatry and Behavioral Sciences (Daley, Tweedy, Staplefoote-Boynton, Gagliardi) and Department of Medicine (Thielman, Staplefoote-Boynton, Gagliardi), School of Medicine, Duke University, Durham, North Carolina; School of Medicine (Lea), Duke University, Durham, North Carolina; Duke Divinity School, Duke University, Durham, North Carolina (Daniel); Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill (Aimone)
| | - Damon S Tweedy
- Hubert-Yeargan Center for Global Health, Duke University, Durham, North Carolina (Smith); Department of Psychiatry and Behavioral Sciences (Daley, Tweedy, Staplefoote-Boynton, Gagliardi) and Department of Medicine (Thielman, Staplefoote-Boynton, Gagliardi), School of Medicine, Duke University, Durham, North Carolina; School of Medicine (Lea), Duke University, Durham, North Carolina; Duke Divinity School, Duke University, Durham, North Carolina (Daniel); Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill (Aimone)
| | - Nathan M Thielman
- Hubert-Yeargan Center for Global Health, Duke University, Durham, North Carolina (Smith); Department of Psychiatry and Behavioral Sciences (Daley, Tweedy, Staplefoote-Boynton, Gagliardi) and Department of Medicine (Thielman, Staplefoote-Boynton, Gagliardi), School of Medicine, Duke University, Durham, North Carolina; School of Medicine (Lea), Duke University, Durham, North Carolina; Duke Divinity School, Duke University, Durham, North Carolina (Daniel); Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill (Aimone)
| | - B Lynette Staplefoote-Boynton
- Hubert-Yeargan Center for Global Health, Duke University, Durham, North Carolina (Smith); Department of Psychiatry and Behavioral Sciences (Daley, Tweedy, Staplefoote-Boynton, Gagliardi) and Department of Medicine (Thielman, Staplefoote-Boynton, Gagliardi), School of Medicine, Duke University, Durham, North Carolina; School of Medicine (Lea), Duke University, Durham, North Carolina; Duke Divinity School, Duke University, Durham, North Carolina (Daniel); Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill (Aimone)
| | - Elizabeth Aimone
- Hubert-Yeargan Center for Global Health, Duke University, Durham, North Carolina (Smith); Department of Psychiatry and Behavioral Sciences (Daley, Tweedy, Staplefoote-Boynton, Gagliardi) and Department of Medicine (Thielman, Staplefoote-Boynton, Gagliardi), School of Medicine, Duke University, Durham, North Carolina; School of Medicine (Lea), Duke University, Durham, North Carolina; Duke Divinity School, Duke University, Durham, North Carolina (Daniel); Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill (Aimone)
| | - Jane P Gagliardi
- Hubert-Yeargan Center for Global Health, Duke University, Durham, North Carolina (Smith); Department of Psychiatry and Behavioral Sciences (Daley, Tweedy, Staplefoote-Boynton, Gagliardi) and Department of Medicine (Thielman, Staplefoote-Boynton, Gagliardi), School of Medicine, Duke University, Durham, North Carolina; School of Medicine (Lea), Duke University, Durham, North Carolina; Duke Divinity School, Duke University, Durham, North Carolina (Daniel); Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill (Aimone)
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Sitarik AR, Wegienka G, Johnson CC, Joseph CLM. Impact of Spirometry Race-Correction on Preadolescent Black and White Children. J Allergy Clin Immunol Pract 2023; 11:3097-3106. [PMID: 37301437 PMCID: PMC10592501 DOI: 10.1016/j.jaip.2023.05.045] [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] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 05/24/2023] [Accepted: 05/30/2023] [Indexed: 06/12/2023]
Abstract
BACKGROUND Race-correction for Black patients is standard practice in spirometry testing. History suggests that these corrections are at least partially a result of racist assumptions regarding lung anatomy among Black individuals, which can potentially lead to less frequent diagnoses of pulmonary diseases in this population. OBJECTIVE To evaluate the impact of race-correction in spirometry testing among Black and White preadolescents, and examine the frequency of current asthma symptoms in Black children who were differentially classified depending on whether race-corrected or race-uncorrected reference equations were deployed. METHODS Data from Black and White children who completed a clinical examination at age 10 years from a Detroit-based unselected birth cohort were analyzed. Global Lung Initiative 2012 reference equations were applied to spirometry data using both race-corrected and race-uncorrected (ie, population-average) equations. Abnormal results were defined as values less than the fifth percentile. Asthma symptoms were assessed concurrently using the International Study of Asthma and Allergies in Childhood questionnaire, while asthma control was assessed using the Asthma Control Test. RESULTS The impact of race-correction on forced expiratory volume in 1 second (FEV1)/forced vital capacity ratio was minimal, but abnormal classification of FEV1 results more than doubled among Black children when race-uncorrected equations were used (7% vs 18.1%) and were almost 8 times greater based on forced vital capacity classification (1.5% vs 11.4%). More than half of Black children differentially classified on FEV1 (whose FEV1 was classified as normal with race-corrected equations but abnormal with race-uncorrected equations) experienced asthma symptoms in the past 12 months (52.6%), which was significantly higher than the percentage of Black children consistently classified as normal (35.5%, P = .049), but similar to that of Black children consistently classified as abnormal using both race-corrected and race-uncorrected equations (62.5%, P = .60). Asthma Control Test scores were not different based on classification. CONCLUSIONS Race-correction had an extensive impact on spirometry classification in Black children, and differentially classified children had a higher rate of asthma symptoms than children consistently classified as normal. Spirometry reference equations should be reevaluated to be aligned with current scientific perspectives on the use of race in medicine.
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Affiliation(s)
| | - Ganesa Wegienka
- Department of Public Health Sciences, Henry Ford Health, Detroit, Mich
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Hswen Y, Yang F, Le-Compte C, Hurley ME, Mattie H, Nguyen TT. Structural racism through Sundown towns and its relationship to COVID-19 local risk and racial and ethnic diversity. Prev Med Rep 2023; 35:102260. [PMID: 37363357 PMCID: PMC10207838 DOI: 10.1016/j.pmedr.2023.102260] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 05/21/2023] [Accepted: 05/22/2023] [Indexed: 06/28/2023] Open
Abstract
"Sundown towns" across the US prevented racial and ethnic minorities from living and working within their borders as they forced minorities to leave these towns after sunset. The objective of this study was to explore the relationship between sundown town status, COVID-19 local risk index and racial and ethnic diversity. A multi-level hierarchical model was used to examine the effect of historical segregation through sundown towns status on present day COVID-19 local risk index and city-level diversity. Over 2,400 Sundown towns were cataloged across the United States, with the greatest density in the Midwest. Sundown towns, which historically excluded racial and ethnic minorities, had significantly less city-level diversity and lower COVID-19 local risk index compared to non-Sundown towns. Findings show that Sundown towns perpetuate residual segregation which continues to impact current inequities in COVID-19 risk among racial and ethnic minorities at the neighborhood level. We recommend that public health officials for pandemic preparedness should devote greater resources to these historically segregated racial and ethnic minority areas because of the historic structural racism that has placed these places at higher risk.
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Affiliation(s)
- Yulin Hswen
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
- Bakar Computational Health Sciences Institute, University of California San Francisco, San Francisco, CA, USA
| | - Franklin Yang
- Department of Biostatistics, Harvard T.H Chan School of Public Health, Boston, MA, USA
| | - Circe Le-Compte
- Department of Psychiatry and New York State Psychiatric Institute, Columbia University, New York, NY, USA
| | | | - Heather Mattie
- Department of Biostatistics, Harvard T.H Chan School of Public Health, Boston, MA, USA
| | - Thu. T. Nguyen
- University of Maryland School of Public Health, College Park, MD, USA
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Vora AS, Grilo SA. The Influence of Identity on Multiracial Emerging Adults' Health and Experiences Seeking Healthcare in the United States: a Qualitative Study. J Racial Ethn Health Disparities 2023:10.1007/s40615-023-01785-1. [PMID: 37698751 DOI: 10.1007/s40615-023-01785-1] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 08/30/2023] [Accepted: 08/31/2023] [Indexed: 09/13/2023]
Abstract
BACKGROUND The Multiracial population, defined as having parents who are of two or more racial groups, increased from 2.9% of the United States population in 2010 to 10.2% in 2020. Existing research focused on monoracial populations shows that racial disparities and discrimination affect health. This study explores how emerging adults ages 18-29, who identify as Multiracial, describe the impact of identity on their health and experiences seeking health care in the United States. METHODS Semi-structured interviews were conducted with 21 participants in May 2021. Interview guide categories were the following: health and wellbeing, racial/ethnic identification, childhood upbringing, family influence, peer engagement, discrimination, forming resilience, language, and demographics. A thematic framework analysis was utilized. RESULTS Overarching themes were as follows: mental health and Multiracial identity-related stress, childhood experiences, healthcare experiences, influences on seeking or not seeking care, and the impact of identity on physical health. Our findings suggest that Multiracial emerging adults perceive their identity to influence mental health more than physical health. CONCLUSION Multiracial emerging adults face challenges with healthcare that are unique (e.g., discrimination based on identity defined or perceived by others) and others that are similar to their monoracial counterparts (e.g., structural racism, access to care). This study illustrates how structural factors trickle down to influence care sought and accessibility via socioeconomic status, insurance, childhood experiences, and racial and cultural beliefs about healthcare. Increased awareness and identification of Multiracial individuals and diversity in the workforce may help the US healthcare system better serve Multiracial emerging adults.
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Affiliation(s)
- Anjali S Vora
- Division of Child and Adolescent Health, Department of Pediatrics, Columbia University Irving Medical Center, New York, NY, USA.
- New York-Presbyterian Hospital, New York, NY, USA.
| | - Stephanie A Grilo
- Heilbrunn Department of Population and Family Health, Columbia University Mailman School of Public Health, New York, NY, USA
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Skeen K, Wall BM. Nursing and eugenics in the early 20th century United States. Nurs Outlook 2023; 71:102018. [PMID: 37524000 DOI: 10.1016/j.outlook.2023.102018] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 06/22/2023] [Accepted: 06/26/2023] [Indexed: 08/02/2023]
Abstract
BACKGROUND Research has documented how ideas about race, class, ethnicity, ableism, and structural hierarchies determine health outcomes and disparities today. The historical role of nursing practice and education needs further exploration. PURPOSE This study aims to better understand how some nurses thought about and interacted with eugenics in the early 20th century. METHODS Historical analysis of primary and secondary sources. DISCUSSION In the early 20th century, reformers of the day, including some nurses, demonstrated much ambiguity of thinking as they pushed for eugenic improvement of the "human race" while also enhancing environmental changes, such as good nutrition and clean, safe housing. CONCLUSION Nursing's past relationship with eugenics sheds light on the history and construction of the system leading to health disparities among marginalized groups. Nurses must acknowledge the historical roots and context of their education and practice as we engage in critical conversations about social inequities.
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Affiliation(s)
- Karin Skeen
- University of Virginia School of Nursing, Charlottesville, VA.
| | - Barbra Mann Wall
- Eleanor Crowder Bjoring Center for Nursing Historical Inquiry, University of Virginia School of Nursing, Charlottesville, VA
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Sanchez AL, Cliggitt LP, Dallard NL, Irby D, Harper M, Schaffer E, Lane-Fall M, Beidas RS. Power Redistribution and Upending White Supremacy in Implementation Research and Practice in Community Mental Health. Psychiatr Serv 2023; 74:987-990. [PMID: 36872893 DOI: 10.1176/appi.ps.20220209] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
Abstract
This Open Forum explores how implementation research and practice may sustain White supremacist ideas, perpetuate unequal power dynamics, and maintain mental health care inequities. The following questions were considered: What information is valued and considered evidence? and How do power differentials within implementation research and practice manifest? The implementation of evidence-based interventions within community mental health clinics is used as an example to explore these questions. Recommendations are provided to envision a future that centers collaboratively developed and community-led approaches to foster equity in mental health care.
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Affiliation(s)
- Amanda L Sanchez
- Department of Psychology, George Mason University, Fairfax, Virginia (Sanchez); Hall Mercer Community Mental Health Center, Philadelphia (Cliggitt); Philadelphia Alliance for Child Trauma Services (Dallard, Irby) and Evidence-Based Practice and Innovation Center (Harper, Schaffer), Department of Behavioral Health and Intellectual disAbility Services, Philadelphia; Department of Anesthesiology and Critical Care, Perelman School of Medicine, and Penn Implementation Science Center at the Leonard Davis Institute of Health Economics (PISCE@LDI), University of Pennsylvania, Philadelphia (Lane-Fall); Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia (Beidas); Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago (Beidas). Send correspondence to Dr. Sanchez
| | - Lauren Pilar Cliggitt
- Department of Psychology, George Mason University, Fairfax, Virginia (Sanchez); Hall Mercer Community Mental Health Center, Philadelphia (Cliggitt); Philadelphia Alliance for Child Trauma Services (Dallard, Irby) and Evidence-Based Practice and Innovation Center (Harper, Schaffer), Department of Behavioral Health and Intellectual disAbility Services, Philadelphia; Department of Anesthesiology and Critical Care, Perelman School of Medicine, and Penn Implementation Science Center at the Leonard Davis Institute of Health Economics (PISCE@LDI), University of Pennsylvania, Philadelphia (Lane-Fall); Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia (Beidas); Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago (Beidas). Send correspondence to Dr. Sanchez
| | - Natalie L Dallard
- Department of Psychology, George Mason University, Fairfax, Virginia (Sanchez); Hall Mercer Community Mental Health Center, Philadelphia (Cliggitt); Philadelphia Alliance for Child Trauma Services (Dallard, Irby) and Evidence-Based Practice and Innovation Center (Harper, Schaffer), Department of Behavioral Health and Intellectual disAbility Services, Philadelphia; Department of Anesthesiology and Critical Care, Perelman School of Medicine, and Penn Implementation Science Center at the Leonard Davis Institute of Health Economics (PISCE@LDI), University of Pennsylvania, Philadelphia (Lane-Fall); Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia (Beidas); Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago (Beidas). Send correspondence to Dr. Sanchez
| | - Deborah Irby
- Department of Psychology, George Mason University, Fairfax, Virginia (Sanchez); Hall Mercer Community Mental Health Center, Philadelphia (Cliggitt); Philadelphia Alliance for Child Trauma Services (Dallard, Irby) and Evidence-Based Practice and Innovation Center (Harper, Schaffer), Department of Behavioral Health and Intellectual disAbility Services, Philadelphia; Department of Anesthesiology and Critical Care, Perelman School of Medicine, and Penn Implementation Science Center at the Leonard Davis Institute of Health Economics (PISCE@LDI), University of Pennsylvania, Philadelphia (Lane-Fall); Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia (Beidas); Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago (Beidas). Send correspondence to Dr. Sanchez
| | - Mikaila Harper
- Department of Psychology, George Mason University, Fairfax, Virginia (Sanchez); Hall Mercer Community Mental Health Center, Philadelphia (Cliggitt); Philadelphia Alliance for Child Trauma Services (Dallard, Irby) and Evidence-Based Practice and Innovation Center (Harper, Schaffer), Department of Behavioral Health and Intellectual disAbility Services, Philadelphia; Department of Anesthesiology and Critical Care, Perelman School of Medicine, and Penn Implementation Science Center at the Leonard Davis Institute of Health Economics (PISCE@LDI), University of Pennsylvania, Philadelphia (Lane-Fall); Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia (Beidas); Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago (Beidas). Send correspondence to Dr. Sanchez
| | - Emily Schaffer
- Department of Psychology, George Mason University, Fairfax, Virginia (Sanchez); Hall Mercer Community Mental Health Center, Philadelphia (Cliggitt); Philadelphia Alliance for Child Trauma Services (Dallard, Irby) and Evidence-Based Practice and Innovation Center (Harper, Schaffer), Department of Behavioral Health and Intellectual disAbility Services, Philadelphia; Department of Anesthesiology and Critical Care, Perelman School of Medicine, and Penn Implementation Science Center at the Leonard Davis Institute of Health Economics (PISCE@LDI), University of Pennsylvania, Philadelphia (Lane-Fall); Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia (Beidas); Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago (Beidas). Send correspondence to Dr. Sanchez
| | - Meghan Lane-Fall
- Department of Psychology, George Mason University, Fairfax, Virginia (Sanchez); Hall Mercer Community Mental Health Center, Philadelphia (Cliggitt); Philadelphia Alliance for Child Trauma Services (Dallard, Irby) and Evidence-Based Practice and Innovation Center (Harper, Schaffer), Department of Behavioral Health and Intellectual disAbility Services, Philadelphia; Department of Anesthesiology and Critical Care, Perelman School of Medicine, and Penn Implementation Science Center at the Leonard Davis Institute of Health Economics (PISCE@LDI), University of Pennsylvania, Philadelphia (Lane-Fall); Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia (Beidas); Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago (Beidas). Send correspondence to Dr. Sanchez
| | - Rinad S Beidas
- Department of Psychology, George Mason University, Fairfax, Virginia (Sanchez); Hall Mercer Community Mental Health Center, Philadelphia (Cliggitt); Philadelphia Alliance for Child Trauma Services (Dallard, Irby) and Evidence-Based Practice and Innovation Center (Harper, Schaffer), Department of Behavioral Health and Intellectual disAbility Services, Philadelphia; Department of Anesthesiology and Critical Care, Perelman School of Medicine, and Penn Implementation Science Center at the Leonard Davis Institute of Health Economics (PISCE@LDI), University of Pennsylvania, Philadelphia (Lane-Fall); Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia (Beidas); Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago (Beidas). Send correspondence to Dr. Sanchez
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Thyden NH, Slaughter-Acey J, Widome R, Warren JR, Osypuk TL. Family deaths in the early life course and their association with later educational attainment in a longitudinal cohort study. Soc Sci Med 2023; 333:116161. [PMID: 37595424 PMCID: PMC10529887 DOI: 10.1016/j.socscimed.2023.116161] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 07/11/2023] [Accepted: 08/06/2023] [Indexed: 08/20/2023]
Abstract
Due to structural racism and pathways between racism and health, Black and Native American people die at younger ages than white people. This means that those groups are likely to experience deaths of family members at younger ages. Evidence is mixed about whether family deaths affect educational attainment. We aim to 1) estimate the prevalence of family deaths by age and race 2) estimate the effect of a family death on later educational attainment and 3) analyze whether the effect of a family death varies by age, socioeconomic status, gender, and race. The National Longitudinal Study of Adolescent to Adult Health (Add Health) is a nationally representative sample of U.S. adolescents in grades 7-12 at baseline in 1994-1995. Add Health has a large and racially diverse sample and records family deaths across the entire life course starting from birth. Participants were included in this analysis if they reported their educational attainment in Wave IV (N = 14,796). The racial group with the lowest proportion experiencing a sibling or parent death in the first 23 years of their lives was white participants (11.7%), followed by Asian (12.5%), Hispanic (15.0%), Black (24.3%) and Native American participants (30.3%). In adjusted models, those who experienced a family death had 0.60 times the odds (95% CI 0.51-0.71) of achieving a bachelor's degree compared to those without a family death. Mother deaths, father deaths, and sibling deaths were each harmful for obtaining a college degree and their effects were similar in magnitude. The age range when the effect of a family death was strongest was 10-13 years old (OR = 0.52 95% CI 0.40-0.67). The effect of a family death on college degree attainment did not vary by baseline parent education, participant sex, or race/ethnicity.
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Affiliation(s)
- Naomi Harada Thyden
- University of Minnesota, School of Public Health, Division of Epidemiology and Community Health, United States; University of Minnesota, Minnesota Population Center, United States; University of Illinois Chicago, School of Public Health, Community Health Sciences, United States.
| | - Jaime Slaughter-Acey
- University of Minnesota, School of Public Health, Division of Epidemiology and Community Health, United States
| | - Rachel Widome
- University of Minnesota, School of Public Health, Division of Epidemiology and Community Health, United States
| | - John Robert Warren
- University of Minnesota, Minnesota Population Center, United States; University of Minnesota, Department of Sociology, United States
| | - Theresa L Osypuk
- University of Minnesota, School of Public Health, Division of Epidemiology and Community Health, United States; University of Minnesota, Minnesota Population Center, United States
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Filippone P, Serrano S, Campos S, Freeman R, Cluesman SR, Israel K, Amos B, Cleland CM, Gwadz M. Understanding why racial/ethnic inequities along the HIV care continuum persist in the United States: a qualitative exploration of systemic barriers from the perspectives of African American/Black and Latino persons living with HIV. Int J Equity Health 2023; 22:168. [PMID: 37649049 PMCID: PMC10466874 DOI: 10.1186/s12939-023-01992-6] [Citation(s) in RCA: 1] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 08/15/2023] [Indexed: 09/01/2023] Open
Abstract
BACKGROUND Racial/ethnic inequities along the HIV care continuum persist in the United States despite substantial federal investment. Numerous studies highlight individual and social-level impediments in HIV, but fewer foreground systemic barriers. The present qualitative study sought to uncover and describe systemic barriers to the HIV care continuum from the perspectives of African American/Black and Latino persons living with HIV (PLWH) with unsuppressed HIV viral load, including how barriers operated and their effects. METHODS Participants were African American/Black and Latino PLWH with unsuppressed HIV viral load (N = 41). They were purposively sampled for maximum variability on key indices from a larger study. They engaged in semi-structured in-depth interviews that were audio-recorded and professionally transcribed. Data were analyzed using directed content analysis. RESULTS Participants were 49 years old, on average (SD = 9), 76% were assigned male sex at birth, 83% were African American/Black and 17% Latino, 34% were sexual minorities (i.e., non-heterosexual), and 22% were transgender/gender-nonbinary. All had indications of chronic poverty. Participants had been diagnosed with HIV 19 years prior to the study, on average (SD = 9). The majority (76%) had taken HIV medication in the six weeks before enrollment, but at levels insufficient to reach HIV viral suppression. Findings underscored a primary theme describing chronic poverty as a fundamental cause of poor engagement. Related subthemes were: negative aspects of congregate versus private housing settings (e.g., triggering substance use and social isolation); generally positive experiences with health care providers, although structural and cultural competency appeared insufficient and managing health care systems was difficult; pharmacies illegally purchased HIV medication from PLWH; and COVID-19 exacerbated barriers. Participants described mitigation strategies and evidenced resilience. CONCLUSIONS To reduce racial/ethnic inequities and end the HIV epidemic, it is necessary to understand African American/Black and Latino PLWH's perspectives on the systemic impediments they experience throughout the HIV care continuum. This study uncovers and describes a number of salient barriers and how they operate, including unexpected findings regarding drug diversion and negative aspects of congregate housing. There is growing awareness that systemic racism is a core determinant of systemic barriers to HIV care continuum engagement. Findings are interpreted in this context.
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Affiliation(s)
- Prema Filippone
- New York University Silver School of Social Work, 1 Washington Place North, New York, NY, 10003, USA
| | - Samantha Serrano
- New York University Silver School of Social Work, 1 Washington Place North, New York, NY, 10003, USA
| | - Stephanie Campos
- New York University Silver School of Social Work, 1 Washington Place North, New York, NY, 10003, USA
| | - Robin Freeman
- New York University Silver School of Social Work, 1 Washington Place North, New York, NY, 10003, USA
| | - Sabrina R Cluesman
- New York University Silver School of Social Work, 1 Washington Place North, New York, NY, 10003, USA
| | - Khadija Israel
- New York University Silver School of Social Work, 1 Washington Place North, New York, NY, 10003, USA
| | - Brianna Amos
- New York University Silver School of Social Work, 1 Washington Place North, New York, NY, 10003, USA
| | - Charles M Cleland
- Division of Biostatistics, Department of Population Health, New York University School of Medicine, New York, NY, 10016, USA
| | - Marya Gwadz
- New York University Silver School of Social Work, 1 Washington Place North, New York, NY, 10003, USA.
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Tong G, Spell VT, Horton N, Thornhill T, Keene D, Montgomery C, Spiegelman D, Wang EA, Roy B. Trusted residents and housing assistance to decrease violence exposure in New Haven (TRUE HAVEN): a strengths-based and community-driven stepped-wedge intervention to reduce gun violence. BMC Public Health 2023; 23:1545. [PMID: 37580653 PMCID: PMC10426138 DOI: 10.1186/s12889-023-15997-x] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 05/26/2023] [Indexed: 08/16/2023] Open
Abstract
BACKGROUND We describe the rationale and study design for "TRUsted rEsidents and Housing Assistance to decrease Violence Exposure in New Haven (TRUE HAVEN)," a prospective type 1 hybrid effectiveness/implementation study of a multi-level intervention using a stepped wedge design. TRUE HAVEN aims to lower rates of community gun violence by fostering the stability, wealth, and well-being of individuals and families directly impacted by incarceration through the provision of stable housing and by breaking the cycle of trauma. DESIGN TRUE HAVEN is an ongoing, multi-level intervention with three primary components: financial education paired with housing support (individual level), trauma-informed counseling (neighborhood level), and policy changes to address structural racism (city/state level). Six neighborhoods with among the highest rates of gun violence in New Haven, Connecticut, will receive the individual and neighborhood level intervention components sequentially beginning at staggered 6-month steps. Residents of these neighborhoods will be eligible to participate in the housing stability and financial education component if they were recently incarcerated or are family members of currently incarcerated people; participants will receive intense financial education and follow-up for six months and be eligible for special down payment and rental assistance programs. In addition, trusted community members and organization leaders within each target neighborhood will participate in trauma-informed care training sessions to then be able to recognize when their peers are suffering from trauma symptoms, to support these affected peers, and to destigmatize accessing professional mental health services and connect them to these services when needed. Finally, a multi-stakeholder coalition will be convened to address policies that act as barriers to housing stability or accessing mental healthcare. Interventions will be delivered through existing partnerships with community-based organizations and networks. The primary outcome is neighborhood rate of incident gun violence. To inform future implementation and optimize the intervention package as the study progresses, we will use the Learn As You Go approach to optimize and assess the effectiveness of the intervention package on the primary study outcome. DISCUSSION Results from this protocol will yield novel evidence for whether and how addressing structural racism citywide leads to a reduction in gun violence. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT05723614. Registration date: February 01, 2023. Please refer to https://clinicaltrials.gov/ct2/show/NCT05723614 for public and scientific inquiries.
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Affiliation(s)
- Guangyu Tong
- Department of Biostatistics, Yale School of Public Health, New Haven, CT, USA.
- Center for Methods of Implementation and Prevention Science, Yale School of Public Health, New Haven, CT, USA.
| | | | - Nadine Horton
- Yale School of Medicine, New Haven, CT, USA
- SEICHE Center for Health and Justice, Yale School of Medicine, New Haven, CT, USA
| | - Thomas Thornhill
- Public Health Modeling, Yale School of Public Health, New Haven, CT, USA
| | - Danya Keene
- Department of Social and Behavioral Health, Yale School of Public Health, New Haven, CT, USA
| | - Christine Montgomery
- Clifford Beers Guidance Clinic, New Haven, CT, USA
- Department of Social Work, Southern Connecticut State University, New Haven, CT, USA
| | - Donna Spiegelman
- Department of Biostatistics, Yale School of Public Health, New Haven, CT, USA
- Center for Methods of Implementation and Prevention Science, Yale School of Public Health, New Haven, CT, USA
| | - Emily A Wang
- Yale School of Medicine, New Haven, CT, USA
- SEICHE Center for Health and Justice, Yale School of Medicine, New Haven, CT, USA
| | - Brita Roy
- Yale School of Medicine, New Haven, CT, USA
- SEICHE Center for Health and Justice, Yale School of Medicine, New Haven, CT, USA
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
- Department of Medicine, New York University Grossman School of Medicine, New York, NY, USA
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Siegel M, Rieders M, Rieders H, Moumneh J, Asfour J, Oh J, Oh S. Structural racism and racial health disparities at the state level: A latent variable approach. J Natl Med Assoc 2023; 115:338-352. [PMID: 37500328 DOI: 10.1016/j.jnma.2023.07.003] [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: 05/30/2023] [Revised: 06/22/2023] [Accepted: 07/17/2023] [Indexed: 07/29/2023]
Abstract
Introduction Structural racism is increasingly being recognized as a fundamental cause of racial health disparities. We used a novel measure of structural racism at the state level to examine the relationship between structural racism and disparities in death rates from firearm homicide, infant mortality, HIV, diabetes, stroke, hypertension, asthma, and kidney disease between non-Hispanic Black and non-Hispanic White people in the United States. Methods We used confirmatory factor analysis to measure the latent construct of structural racism for all 50 states. The model included seven indicators across the structural racism domains of residential segregation, economic status/employment, education, incarceration, political participation and representation, environmental racism, and racial equity inclusion. Weights for each of the indicators were determined by examining alternative models and selecting the model with the best fit statistics. The resulting factor scores, representing the level of structural racism in each state across the seven domains, were then used as predictor variables in a series of linear regressions with the ratio of Black to White death rates for each health outcome as the dependent variables. Results We found significant relationships between higher levels of the latent structural racism measure and greater disparities between non-Hispanic Black and non-Hispanic White people in age-adjusted death rates for firearm homicide, infant mortality, HIV, asthma, and obesity. The magnitude of this relationship was greatest for firearm homicide, with each one standard deviation increase in a state's structural racism factor score being associated with an increase of 4.54 (95% CI, 2.91-6.17) in that state's Black-White firearm homicide rate ratio. Conclusions This research provides further evidence that structural racism is a fundamental cause of racial health disparities and that to repair these inequities, macro-level changes in societal structures, institutions, resource allocation, representation, and power will be necessary.
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Affiliation(s)
- Michael Siegel
- Department of Public Health and Community Medicine, Tufts University School of Medicine, 636 Harrison Avenue, Boston, MA 02111, USA.
| | - Madeline Rieders
- Department of Public Health and Community Medicine, Tufts University School of Medicine, 636 Harrison Avenue, Boston, MA 02111, USA
| | - Hannah Rieders
- Department of Public Health and Community Medicine, Tufts University School of Medicine, 636 Harrison Avenue, Boston, MA 02111, USA
| | - Jinan Moumneh
- Department of Public Health and Community Medicine, Tufts University School of Medicine, 636 Harrison Avenue, Boston, MA 02111, USA
| | - Julia Asfour
- Department of Public Health and Community Medicine, Tufts University School of Medicine, 636 Harrison Avenue, Boston, MA 02111, USA
| | - Jinseo Oh
- Department of Public Health and Community Medicine, Tufts University School of Medicine, 636 Harrison Avenue, Boston, MA 02111, USA
| | - Seungjin Oh
- Department of Public Health and Community Medicine, Tufts University School of Medicine, 636 Harrison Avenue, Boston, MA 02111, USA
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Siegel M, Rieders M, Rieders H, Moumneh J, Asfour J, Oh J, Oh S. Using a Latent Variable Method to Develop a Composite, Multidimensional Measure of Structural Racism at the City Level. J Racial Ethn Health Disparities 2023:10.1007/s40615-023-01695-2. [PMID: 37382871 DOI: 10.1007/s40615-023-01695-2] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 06/15/2023] [Accepted: 06/21/2023] [Indexed: 06/30/2023]
Abstract
INTRODUCTION Although structural racism is strongly related to racial health disparities, we are not aware of any composite, multidimensional measure of structural racism at the city level in the United States. However, many of the policies, programs, and institutions that create and maintain structural racism are located at the city level. To expand upon previous research, this paper uses a novel measure to measure structural racism at the city level for the non-Hispanic Black population. METHODS We used confirmatory factor analysis to model the latent construct of structural racism for 776 U.S. cities. The model included six indicators across five dimensions: racial segregation, incarceration, educational attainment, employment, and economic status. We generated factor scores that weighted the indicators in order to produce the best model fit. The resulting factor scores represented the level of structural racism in each city. We demonstrated the utility of this measure by demonstrating its strong correlation with Black-White disparities in firearm homicide rates. RESULTS There were profound differences in the magnitude of structural racism across cities. There were also striking differences in the magnitude of the racial disparity in firearm homicide across cities. Structural racism was a significant predictor of the magnitude of these racial disparities in firearm homicide. Each one standard deviation increase in the structural racism factor score increased the firearm homicide rate ratio by a factor of approximately 1.2 (95% confidence interval, 1.1-1.3). CONCLUSIONS These new measures can be utilized by researchers to relate structural racism to racial health disparities at the city level.
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Affiliation(s)
- Michael Siegel
- Department of Public Health and Community Medicine, Tufts University School of Medicine, 636 Harrison Avenue, Boston, MA, 02111, USA.
| | - Madeline Rieders
- Department of Public Health and Community Medicine, Tufts University School of Medicine, 636 Harrison Avenue, Boston, MA, 02111, USA
| | - Hannah Rieders
- Department of Public Health and Community Medicine, Tufts University School of Medicine, 636 Harrison Avenue, Boston, MA, 02111, USA
| | - Jinan Moumneh
- Department of Public Health and Community Medicine, Tufts University School of Medicine, 636 Harrison Avenue, Boston, MA, 02111, USA
| | - Julia Asfour
- Department of Public Health and Community Medicine, Tufts University School of Medicine, 636 Harrison Avenue, Boston, MA, 02111, USA
| | - Jinseo Oh
- Department of Public Health and Community Medicine, Tufts University School of Medicine, 636 Harrison Avenue, Boston, MA, 02111, USA
| | - Seungjin Oh
- Department of Public Health and Community Medicine, Tufts University School of Medicine, 636 Harrison Avenue, Boston, MA, 02111, USA
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Weßel M, Gerhards SM. "Discrimination is always intersectional" - understanding structural racism and teaching intersectionality in medical education in Germany. BMC Med Educ 2023; 23:399. [PMID: 37268929 DOI: 10.1186/s12909-023-04386-y] [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] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 05/23/2023] [Indexed: 06/04/2023]
Abstract
BACKGROUND Racism in medicine represents a global problem. It takes place on the individual, institutional and structural level. Especially structural racism can have serious effects on the health of individual people. Furthermore, racist discrimination is not always based on race solemnly but frequently intersects with other social categories such as gender, class or religion. To describe this multidimensional form of discrimination the term intersectionality has been coined. However, the understanding of structural intersectional racism in medicine is still fragmented, especially in the German context. Yet, medical students need to be trained in understanding structural and intersectional racism to see the impact of racist structures on the patient's health. METHOD We conducted a qualitative study to explore the knowledge, awareness and perception of racism in medicine and health care of medical students in Germany. Our research questions are how do medical student understand structural racism and its effects on health in Germany? Do students see interrelations with other forms of discrimination and in this context to what extent are they familiar with the concept of intersectionality? Which categories intersect from their point of views with race in context of medicine and health care? We conducted focus groups with medical students (n = 32) in Germany. RESULTS Our results demonstrate that students have a wide spectrum of knowledge, awareness and perceptions about racism from being rather elaborate to very little knowledge about it. The students have particular problems to understand and situate structural racism in Germany. Some raised doubts about the relevance. Yet, other students are aware of the concept of intersectionality and are convinced that racism must be looked at from an intersectional perspective. CONCLUSIONS The diverse knowledge, awareness and perceptions of medical students about structural racism and intersectionality hints to a lack of systematic education of medical students about these issues in Germany. Yet, in context of diversifying societies an understanding about racism and its impact on health is imminent for future medical doctors to provide good care for their patients. Therefore, this knowledge gap must be systematically filled by the medical education.
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Affiliation(s)
- Merle Weßel
- Ethics in Medicine, Carl von Ossietzky University of Oldenburg, Ammerländer Heerstraße 114-118, 26111, Oldenburg, Germany.
| | - Simon Matteo Gerhards
- Ethics in Medicine, Carl von Ossietzky University of Oldenburg, Ammerländer Heerstraße 114-118, 26111, Oldenburg, Germany
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Follis S, Breathett K, Garcia L, Jimenez M, Cené CW, Whitsel E, Hedlin H, Paskett ED, Zhang S, Thomson CA, Stefanick ML. Quantifying structural racism in cohort studies to advance prospective evidence. SSM Popul Health 2023; 22:101417. [PMID: 37207111 PMCID: PMC10189286 DOI: 10.1016/j.ssmph.2023.101417] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 04/21/2023] [Accepted: 04/27/2023] [Indexed: 05/21/2023] Open
Abstract
Calls-to-action in health research have described a need to improve research on race, ethnicity, and structural racism. Well-established cohort studies typically lack access to novel structural and social determinants of health (SSDOH) or precise race and ethnicity categorization, contributing to a loss of rigor to conduct informative analyses and a gap in prospective evidence on the role of structural racism in health outcomes. We propose and implement methods that prospective cohort studies can use to begin to rectify this, using the Women's Health Initiative (WHI) cohort as a case study. To do so, we evaluated the quality, precision, and representativeness of race, ethnicity, and SSDOH data compared with the target US population and operationalized methods to quantify structural determinants in cohort studies. Harmonizing racial and ethnic categorization to the current standards set by the Office of Management and Budget improved measurement precision, aligned with published recommendations, disaggregated groups, decreased missing data, and decreased participants reporting "some other race". Disaggregation revealed sub-group disparities in SSDOH, including a greater proportion of Black-Latina (35.2%) and AIAN-Latina (33.3%) WHI participants with income below the US median compared with White-Latina (42.5%) participants. We found similarities in the racial and ethnic patterning of SSDOH disparities between WHI and US women but less disparity overall in WHI. Despite higher individual-level advantage in WHI, racial disparities in neighborhood resources were similar to the US, reflecting structural racism. Median neighborhood income was comparable between Black WHI ($39,000) and US ($34,700) women. WHI SSDOH-associated outcomes may be generalizable on the basis of comparing across race and ethnicity but may quantitatively (but not qualitatively) underestimate US effect sizes. This paper takes steps towards data justice by implementing methods to make visible hidden health disparity groups and operationalizing structural-level determinants in prospective cohort studies, a first step to establishing causality in health disparities research.
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Affiliation(s)
- Shawna Follis
- Stanford Prevention Research Center, Department of Medicine, Stanford University, 3180 Porter Drive, Mail Code 5702, Palo Alto, CA, 94304, USA
- Corresponding author.
| | - Khadijah Breathett
- Division of Cardiovascular Medicine, Indiana University, Indianapolis, IN, USA
| | - Lorena Garcia
- UC Davis School of Medicine, Department of Public Health Sciences, Davis, CA, USA
| | - Monik Jimenez
- Division of Women's Health and Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Crystal W. Cené
- University of California, San Diego Department of Medicine, San Diego, CA, USA
| | - Eric Whitsel
- Department of Epidemiology, Gillings School of Global Public Health and Department of Medicine, School of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Haley Hedlin
- Quantitative Sciences Unit, Department of Medicine, Stanford University School of Medicine, CA, USA
| | | | - Shiqi Zhang
- Quantitative Sciences Unit, Department of Medicine, Stanford University School of Medicine, CA, USA
| | - Cynthia A. Thomson
- Health Promotion Sciences, Mel & Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
| | - Marcia L. Stefanick
- Stanford Prevention Research Center, Department of Medicine, Stanford University, 3180 Porter Drive, Mail Code 5702, Palo Alto, CA, 94304, USA
- Department of Obstetrics & Gynecology and Department of Epidemiology and Population Health, Stanford University, Stanford, CA, USA
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49
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Kilpatrick SK, Bauer KW, Heard-Garris N, Malone AM, Abdou CM, Weeks HM, Clayson M, Allgood KL, Dokshina D, Needham BL. Experiences of the Flint Water Crisis Among Reproductive-Age Michigan Women in Communities Outside of Flint: Differences by Race and Ethnicity. J Racial Ethn Health Disparities 2023; 10:993-1005. [PMID: 35320509 PMCID: PMC8941828 DOI: 10.1007/s40615-022-01287-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 10/12/2021] [Revised: 02/17/2022] [Accepted: 02/19/2022] [Indexed: 11/02/2022]
Abstract
We sought to understand how women in Michigan communities outside of Flint experienced the Flint water crisis, an avoidable public health disaster widely attributed to structural racism. Using survey data from 950 Michigan women aged 18-45 from communities outside of Flint, we examined racial and ethnic differences in personal connections to Flint, perceived knowledge about the water crisis, and beliefs about the role of anti-Black racism in the water crisis factors that could contribute to poor health via increased psychological stress. We found that White (OR = 0.32; 95% CI: 0.22, 0.46) and Hispanic (OR = 0.21; 95% CI: 0.09, 0.49) women had lower odds than Black women of having family or friends who lived in Flint during the water crisis. Compared to Black women, White women were less likely to be moderately or very knowledgeable about the water crisis (OR = 0.58; 95% CI: 0.41, 0.80). White women (OR = 0.26; 95% CI: 0.18, 0.37), Hispanic women (OR = 0.38; 95% CI: 0.21, 0.68), and women of other races (OR = 0.28; 95% CI: 0.15, 0.54) were less likely than Black women to agree that the water crisis happened because government officials wanted to hurt Flint residents. Among those who agreed, White women (OR = 0.47; 95% CI: 0.30, 0.74) and women of other races (OR = 0.33; 95% CI: 0.12, 0.90) were less likely than Black women to agree that government officials wanted to hurt people in Flint because most residents are Black. We conclude that the Flint water crisis was a racialized stressor, with potential implications for the health of reproductive-age Black women.
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Affiliation(s)
- Sidonie K. Kilpatrick
- Department of Epidemiology, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48104 USA
| | - Katherine W. Bauer
- Department of Nutritional Sciences, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48104 USA
| | - Nia Heard-Garris
- Division of Advanced General Pediatrics and Primary Care, Department of Pediatrics, Ann & Robert H. Lurie Children’s Hospital of Chicago and Northwestern University Feinberg School of Medicine, and Mary Ann & J. Milburn Smith Child Health Outreach, Research, and Evaluation Center, Stanley Manne Children’s Research Institute, Ann & Robert H. Lurie Children’s Hospital of Chicago, 225 E Chicago Ave, Chicago, IL 60611 USA
| | - Anita M. Malone
- Division of Women’s Health, Department of Obstetrics and Gynecology, University of Michigan Medical School, Michigan Medicine Health, 1500 E. Medical Center Dr., Ann Arbor, MI 48109 USA
| | - Cleopatra M. Abdou
- Suzanne Dworak-Peck School of Social Work, University of Southern California, 669 W 34th St, Los Angeles, CA 90089 USA
| | - Heidi M. Weeks
- Department of Nutritional Sciences, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48104 USA
| | - Michelle Clayson
- Department of Nutritional Sciences, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48104 USA
| | - Kristi L. Allgood
- Department of Epidemiology, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48104 USA
| | - Darya Dokshina
- Department of Epidemiology, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48104 USA
| | - Belinda L. Needham
- Department of Epidemiology, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48104 USA
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50
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Quinn KG, Harris M, Sherrod D, Hunt BR, Jacobs J, Valencia J, Walsh JL. The COVID-19, racism, and violence syndemic: Evidence from a qualitative study with Black residents of Chicago. SSM Qual Res Health 2023; 3:100218. [PMID: 36628065 PMCID: PMC9817424 DOI: 10.1016/j.ssmqr.2023.100218] [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] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 01/04/2023] [Accepted: 01/05/2023] [Indexed: 01/09/2023]
Abstract
The COVID-19 pandemic emerged in the United States in the shadows of a vast history of structural racism and community and police violence that disproportionately affect Black communities. Collectively, they have created a syndemic, wherein COVID-19, racism, and violence are mutually reinforcing to produce adverse health outcomes. The purpose of this study was to understand the COVID-19, racism, and violence syndemic and examine how structural racism and violence contributed to the disproportionate impact of COVID-19 on Black communities. In early 2021, we conducted phenomenological qualitative interviews with 50 Black residents of Chicago. Interview transcripts were coded and analyzed using thematic analysis. We identified four primary themes in our analyses: 1) the intersection of racism and violence in Chicago; 2) longstanding inequities were laid bare by COVID-19; 3) the pervasiveness of racism and violence contributes to poor mental health; 4) and COVID-19, racism and violence emerged as a syndemic. Our findings underscore the importance of addressing social and structural factors in remediating the health and social consequences brought about by COVID-19.
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Affiliation(s)
- Katherine G Quinn
- Medical College of Wisconsin, Department of Psychiatry and Behavioral Medicine, Center for AIDS Intervention Research (CAIR), Milwaukee, WI, USA
| | - Melissa Harris
- Medical College of Wisconsin, Institute of Health and Equity, Milwaukee, WI, USA
| | - Darielle Sherrod
- Sinai Health System, Sinai Urban Health Institute, Chicago, IL, USA
| | - Bijou R Hunt
- Sinai Health System, Sinai Infectious Disease Center, Chicago, IL, USA
| | - Jacquelyn Jacobs
- Sinai Health System, Sinai Urban Health Institute, Chicago, IL, USA
| | - Jesus Valencia
- Sinai Health System, Sinai Urban Health Institute, Chicago, IL, USA
| | - Jennifer L Walsh
- Medical College of Wisconsin, Department of Psychiatry and Behavioral Medicine, Center for AIDS Intervention Research (CAIR), Milwaukee, WI, USA
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