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Zhang L, An C, Chen J, Li BU, Nakae S, Pang J. Characterizing Asian American medical students' experiences with microaggression and the impact on their well-being. Med Educ Online 2024; 29:2299534. [PMID: 38159282 PMCID: PMC10763848 DOI: 10.1080/10872981.2023.2299534] [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] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 12/21/2023] [Indexed: 01/03/2024]
Abstract
PURPOSE This mixed-methods study quantified and characterized incidents of microaggressions experienced by Asian American medical students. The authors report on their impact and suggest improvements to create a more equitable and supportive learning environment. METHOD Quantitative and qualitative data were collected from 305 participants who self-identified as Asian American or Pacific Islander. An online, anonymous survey was sent to US medical students through the Asian Pacific American Medical Student Association (APAMSA). Questions explored incidence, characteristics of, and response to microaggressions. We conducted four focus groups to further characterize students' experiences. Data were organized and coded, and thematic analysis was used to identify core themes. RESULTS Racial microaggressions were prevalent among Asian American medical students. Nearly 70% (n = 213) of survey respondents reported experiencing at least one incident during their medical training to date. The most common perpetrators were patients (n = 151, 70.9%) and fellow medical students (n = 126, 59.2%), followed by professors (n = 90, 42.3%). The most prevalent themes included being perceived as a perpetual foreigner, the assumption of timidness, and ascription of the model minority myth. Students rarely reported the incident and usually did not respond immediately due to fear of retaliation, uncertainties about the experience or how to respond appropriately, and perception that they would bear the burden of advocacy alone. Experiences with microaggressions led to feelings of frustration and burnout and had a negative impact on mental health. Recommendations were made to improve the anonymous reporting systems in medical schools, and to increase diversity and inclusion in medical education and leadership. CONCLUSIONS Asian American medical students face high exposure to racial microaggressions during their medical education that adversely impact their mental health. Changes are needed in medical training to create a more equitable and inclusive learning environment.
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Affiliation(s)
- Lindy Zhang
- Sidney Kimmel Comprehensive Cancer Center and Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Crystal An
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Joanna Chen
- University of Toledo College of Medicine and Life Sciences, Toledo, OH, USA
| | - B U.K. Li
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Sunny Nakae
- Department of Medical Education, California University of Science and Medicine School of Medicine, Colton, CA, USA
| | - Joyce Pang
- Department of Surgery, University of New Mexico School of Medicine, Albuquerque, NM, USA
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2
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Canli U, Aquino E. Barriers and Challenges Experienced by Latina Nurse Leaders. Hisp Health Care Int 2024; 22:92-98. [PMID: 37728110 DOI: 10.1177/15404153231199175] [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: 09/21/2023]
Abstract
Introduction: Leadership reflecting and representing the diversity of the workforce and patient population has been an ongoing challenge for healthcare institutions. As hospitals strategically plan to improve diversity, equity, and inclusion within their intuitions, especially in executive and other leadership roles, it must be acknowledged that only about 5.3% of the nursing workforce is Latinx and few serve in leadership positions. This study aims to learn about the barriers and challenges Latina nurse leaders have experienced in their ascension into leadership roles. Methods: Using a qualitative descriptive study approach, Latina nurse leaders were interviewed one-on-one about their nursing journey and the challenges experienced. A conventional thematic content analysis approach was used to identify common themes. Results: Seventeen Latina nurse leaders shared their experiences. The themes that emerged included: imposter syndrome being the only one, the need to work harder to be seen, age discrimination, racism and racial discrimination, lack of mentorship, and motherhood. Conclusion: Findings from this study help to highlight barriers to leadership development and success of Latina nurses. The findings can be used to encourage, mentor, and support Latina nurses throughout their careers, so they are provided with opportunities for advancement and nurtured as they become leaders.
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Affiliation(s)
- Ursula Canli
- School of Nursing, DePaul University, Chicago, IL, USA
| | - Elizabeth Aquino
- College of Nursing, University of Illinois at Chicago, Chicago, IL, USA
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3
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Lee K, Pellowski JA, Brayboy LM, Thompson KD, Dunsiger S. The Association of Racism and Discrimination in Disparities of Hypertensive Disorders of Pregnancy in the United States: An Analysis of PRAMS Data. Matern Child Health J 2024; 28:969-978. [PMID: 38308757 DOI: 10.1007/s10995-023-03885-0] [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] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2023] [Indexed: 02/05/2024]
Abstract
BACKGROUND Hypertensive disorders of pregnancy are a leading cause of maternal mortality. Racial disparities in maternal outcomes such as maternal mortality in the United States (US) are well-documented, but the relationship of racism and/or discrimination with one's risk of developing a hypertension during pregnancy (HDP) is not well-studied. METHODS Data from 17 sites that asked questions regarding experiences with racism and/or discrimination during pregnancy via the Pregnancy Risk Assessment Monitoring System (PRAMS) Phase 8 (2016-2020) was used. Logistic regression models were used compare the potential of stress induced HDP from perceived experiences of racism and/or discrimination versus the effect of systemic racism and/or discrimination (in healthcare settings and generally) on racial disparities in HDP diagnosis. RESULTS Among 9,907 live births, 18% of participants reported they were diagnosed with hypertension during pregnancy, with non-Hispanic Black individuals having the highest rate (21.8%). Regarding experiences of racism and/or discrimination, 76.4% of participants responded "yes", with all races/ethnicities studied here except non-Hispanic White individuals responding "yes" at rates higher than 89%. Perceived experiences of racism and/or discrimination did not statistically significantly affect one's odds of being diagnosed with HDP (OR = 0.94, CI: 0.74, 1.20). The disparity in odds of having hypertension during pregnancy between Non-Hispanic Black individuals and non-Hispanic White individuals was not statistically significant when perceived experiences of racism and/or discrimination were included in the model. CONCLUSIONS Experiences of racism and/or discrimination drive racial disparities in hypertensive disorders in pregnancy. PUBLIC HEALTH IMPLICATIONS It is vital to eliminate racist and discriminatory practices and behaviors to reduce maternal morbidity and mortality.
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Affiliation(s)
- Kiara Lee
- Center for Biomedical Engineering, School of Engineering, Brown University, Providence, RI, USA.
| | - Jennifer A Pellowski
- Department of Behavioral and Social Sciences, International Health Institute, Brown University School of Public Health, Providence, RI, USA
| | - Lynae M Brayboy
- Department of Neuropediatrics Charité-Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- Klinik für Pädiatrie m. S. Neurologie, Charité Campus Virchow Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany
- Department of Reproductive Biology, Bedford Research Foundation, Bedford, MA, USA
| | - Kathryn D Thompson
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, USA
- Department of Health Services, Policy and Practice, Brown University School of Public Health, Providence, RI, USA
| | - Shira Dunsiger
- Center for Health Promotion and Health Equity, Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
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4
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Griffith DM. Anti racism and Health Equity Science: Overcoming Scientific Obstacles to Health Equity. Public Health Rep 2024; 139:288-293. [PMID: 38504480 PMCID: PMC11037222 DOI: 10.1177/00333549241236089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2024] Open
Affiliation(s)
- Derek M. Griffith
- Center for Men’s Health Equity, Georgetown University, Washington, DC, USA
- Racial Justice Institute, Georgetown University, Washington, DC, USA
- Department of Health Management and Policy, School of Health, Georgetown University, Washington, DC, USA
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5
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Cénat JM. Racial discrimination in healthcare services among Black individuals in Canada as a major threat for public health: its association with COVID-19 vaccine mistrust and uptake, conspiracy beliefs, depression, anxiety, stress, and community resilience. Public Health 2024; 230:207-215. [PMID: 38574426 DOI: 10.1016/j.puhe.2024.02.030] [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: 10/13/2023] [Revised: 02/09/2024] [Accepted: 02/29/2024] [Indexed: 04/06/2024]
Abstract
OBJECTIVES To examine the prevalence of major racial discrimination (MRD) in healthcare services and its association with COVID-19 vaccine mistrust and uptake, conspiracy theories, COVID-19-related stressors, community resilience, anxiety, depression, and stress symptoms. STUDY DESIGN The study used a population-based cross-sectional design. METHODS Data from the BlackVax dataset on COVID-19 vaccination in Black individuals in Canada was analyzed (n = 2002, 51.66% women). Logistic regression analyses were performed to examine the association between MRD and independent variables. RESULTS 32.55% of participants declared having experienced MRD in healthcare services. Participants with MRD were less vaccinated against COVID-19, presented higher scores of vaccine mistrust, conspiracy beliefs, COVID-19 related stressors, depression, anxiety, and stress, and had lower scores of community resilience. They were more likely to experience depression (AOR = 2.13, P < 0.001), anxiety (AOR = 2.00, P < 0.001), and stress symptoms (AOR = 2.15, P < 0.001). Participants who experienced MRD were more likely to be unvaccinated (AOR = 1.35, P = 0.009). CONCLUSIONS Racial discrimination experienced by Black individuals in health services is a major public health concern and threat to population health in Canada. Federal, provincial, and municipal public health agencies should adapt their programs, strategies, tools, and campaigns to address the mistrust created by racial discrimination.
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Affiliation(s)
- Jude Mary Cénat
- School of Psychology, University of Ottawa, 136 Jean-Jacques-Lussier, 4085, Vanier Hall, Ottawa, Ontario, K1N 6N5, Canada; Interdisciplinary Centre for Black Health, University of Ottawa, Ottawa, Ontario, Canada; University of Ottawa Research Chair on Black Health, Ottawa, Ontario, Canada.
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Simela C, Akanbi-Akinlolu T, Okundi M, Abdalla H, McAdams TA, Harris A, Augustine A, Le H, Abdinasir K, Ayorech Z, Ahmadzadeh YI. Intergenerational consequences of racism in the United Kingdom: a qualitative investigation into parents' exposure to racism and offspring mental health and well-being. Child Adolesc Ment Health 2024; 29:181-191. [PMID: 38523495 DOI: 10.1111/camh.12695] [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] [Accepted: 02/28/2024] [Indexed: 03/26/2024]
Abstract
BACKGROUND Experiences of racism are linked to negative physical and mental health outcomes among those exposed. According to quantitative research derived mainly from the United States, these negative outcomes can have cascading effects in families, when parents' experiences of racism indirectly impact offspring. New research is warranted for families in the United Kingdom, informed by a qualitative approach to canvassing community knowledge and perspectives, exploring how existing findings relate to lived experiences. METHOD We conducted four online focus groups with 14 parents of school-aged children and 14 adolescents who had experienced racism in the United Kingdom. Participants were asked what children know of parents' experiences of racism, and how these experiences can impact parent-child interactions, mental health and well-being. Focus group recordings were transcribed, data coded and analysed through iterative categorisation. RESULTS Analyses drew four themes from participants' insights. Together, themes illuminated the pervasive nature of racism experienced by some families in the United Kingdom. Parent and child experiences of racism were connected and co-occurring, with indirect effects impacting mental health and well-being in both generations. These experiences were linked to both positive and negative changes in parenting behaviour and parent-child relationships, which could be moderated by intersecting identities such as the parent's generational status for immigration to the United Kingdom. Social cohesion, safe spaces and education programmes were highlighted for future intervention. CONCLUSIONS Findings corroborate existing literature, while further emphasising a broader bidirectional picture, requiring a family system and intersectional approach to understanding the mental health impact of racism in families. Avenues for future research are discussed to support development of equitable intervention and support strategies to prevent racism and support those affected.
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Affiliation(s)
| | | | | | | | | | - Androulla Harris
- Centre for Mental Health, Registered Charity No. 1091156, London, UK
| | - Alex Augustine
- Centre for Mental Health, Registered Charity No. 1091156, London, UK
| | - Huong Le
- Centre for Mental Health, Registered Charity No. 1091156, London, UK
| | - Kadra Abdinasir
- Centre for Mental Health, Registered Charity No. 1091156, London, UK
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7
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Hamilton JB, Abiri A, Nicolas CA, Grant EJ, Best NC. Black Appalachia's Oldest Old: Untold Stories of Experienced Racism and Coping With Religious Practices/Beliefs. Gerontologist 2024; 64:gnad143. [PMID: 37875131 DOI: 10.1093/geront/gnad143] [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: 04/29/2023] [Indexed: 10/26/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Racism and religion are recognized as prevailing Social Determinants of Health (SDoH). To explore ways in which racism and religion looms in the daily lives of African Americans, we analyzed the experiences of African Americans born during the Jim Crow years and living in the Southern Appalachian Region of the United States. RESEARCH DESIGN AND METHODS Twenty-seven African Americans participated in this qualitative descriptive study that utilized criterion sampling, open-ended semistructured interviews, and content analysis to identify a typology of categories related to experienced racism and ways in which religion was used in response to those experiences. RESULTS Participants were an average age of 82.22 years (SD = 5.07); primarily women (n = 19, 70.4%); married (n = 11, 40.7%); junior high school (n = 6, 22.2%), high school or general educational diploma (n = 7, 25.9%), completed college or professional school (n = 6, 22.2%); were retired (n = 27, 100.0%); and affiliated with Baptist churches (n = 18, 66.7%). Experiences with racism included inequities in healthcare and education, and racially motivated physical violence. Religious practices/beliefs included forgiveness, humility, and humanity. DISCUSSION AND IMPLICATIONS Racism experienced by African American participants was likely countered by religious practices/beliefs inspired through intergenerational teachings with affiliations to the Black Church. These experiences of the oldest old ) African Americans living in communities of the Southern Appalachia, United States, illustrate the pervasive nature of racism. The religious beliefs that are frequently transmitted intergenerationally through the Black Church are relevant to understand present-day encounters with racism among African Americans and possibly other communities of color.
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Affiliation(s)
- Jill B Hamilton
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA
| | - Autherine Abiri
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA
| | - Charlyne A Nicolas
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA
| | - Ernest J Grant
- School of Nursing, Duke University, Durham, North Carolina, USA
| | - Nakia C Best
- Sue and Bill Gross School of Nursing, University of California Irvine, Irvine, California, USA
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8
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Katcher JG, Klassen AC, Hann HW, Chang M, Juon HS. Racial discrimination, knowledge, and health outcomes: The mediating role of hepatitis B-related stigma among patients with chronic hepatitis B. J Viral Hepat 2024; 31:248-254. [PMID: 38409935 PMCID: PMC11023788 DOI: 10.1111/jvh.13932] [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: 01/07/2024] [Accepted: 02/16/2024] [Indexed: 02/28/2024]
Abstract
It is well described in current literature that Hepatitis B virus (HBV) affects Asian Americans more than any other racial group in the United States and that there is a stigma attached to this condition. The effects of stigma can be lasting, penetrating physiologically and psychologically, yet few studies have focused on the consequences of this phenomenon. The purpose of this study was to examine the mediating role of stigma in the effect of racial discrimination and knowledge (of HBV sequelae) on health status of Korean Americans with chronic hepatitis B (CHB). Three hundred sixty-five CHB patients were recruited and enrolled from two clinics in Philadelphia and Los Angeles. Depressive symptoms were measured using the Patient Health Question-9 (PHQ-9), physical health via self-rated health survey and stigma via hepatitis B quality of life (HBQOL)-stigma survey. Perceived racial discrimination and knowledge of CHB sequelae were independent variables. The cohort had an average age of 60.1 years (range 19-84, SD 10.7), 56% were male and 94% were born in South Korea. Mediational analysis found that stigma was a significant mediator between both racial discrimination (indirect effect = .037, Bootstrap 95% CI = [.010-.064]) and sequelae knowledge (indirect effect = .097, Bootstrap 95% CI = [.018-.176]) and depressive symptoms. Stigma also had a direct effect on depressive symptoms (β = .136, p < .01) and self-rated health (β = .018, p < .05). In addition, age, gender, education and employment were related to health outcomes. The findings of this study indicate that HBV-related stigma is an important mediator of mental health outcomes in this population. Future studies should identify other psychosocial factors to develop effective intervention programs to reduce stigma and improve quality of life among CHB patients.
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Affiliation(s)
- Julia G. Katcher
- Sidney Kimmel Medical College, Thomas Jefferson University,
Philadelphia, PA 19107
| | - Ann C. Klassen
- Dornsife School of Public Health, Drexel University, Philadelphia,
PA 19104
| | - Hie-Won Hann
- Liver Disease Prevention Center, Thomas Jefferson University
Hospital, Philadelphia, PA 19107
| | - Mimi Chang
- Asian Pacific Liver Center, Coalition of Inclusive Medicine, Los
Angeles, CA 90020
| | - Hee-Soon Juon
- Department of Medical Oncology, Thomas Jefferson University,
Philadelphia, PA 19107
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9
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Baker R. Anchor bias, autonomy, and 20th-century bioethicists' blindness to racism. Bioethics 2024; 38:275-281. [PMID: 38165654 DOI: 10.1111/bioe.13258] [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] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Accepted: 12/14/2023] [Indexed: 01/04/2024]
Abstract
The central thesis of this article is that by anchoring bioethics' core conceptual armamentarium in a four-principled theory emphasizing autonomy and treating justice as a principle of allocation, theorists inadvertently biased 20th-century bioethical scholarship against addressing such subjects as ableism, anti-Black racism, classism, and other forms of discrimination, placing them outside of the scope of bioethics research and scholarship. It is also claimed that these scope limitations can be traced to the displacement of the nascent concept of respect for persons-a concept designed to address classist and racist discrimination-with the morally solipsistic concept of autonomy.
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Affiliation(s)
- Robert Baker
- Department of Philosophy, William D. William Emeritus Professor of Philosophy, Union College, Schenectady, New York, USA
- Bioethics Department, Lewis School of Health Sciences, Clarkson University, Capital Region Campus, Schenectady, New York
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10
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Ren H, Cheah CSL, Cho HS, Aquino AK. Cascading effects of Chinese American parents' COVID-19 racial discrimination and racial socialization on adolescents' adjustment. Child Dev 2024; 95:862-878. [PMID: 37984077 DOI: 10.1111/cdev.14037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Revised: 09/26/2023] [Accepted: 10/23/2023] [Indexed: 11/22/2023]
Abstract
Using a three-wave longitudinal sample of 108 Chinese American parent-adolescent dyads (Mparent-ageW1 = 45.44 years, 17% fathers; Madolescent-ageW1 = 13.34 years, 50% boys), this study examined the effects of parents' COVID-19-related racial discrimination experiences on adolescents' ethnic identity exploration and anxiety as mediated by parents' awareness of discrimination (AOD) socialization and moderated by parents' anxiety and racial socialization competency (RSC). Parents' racial discrimination experiences in 2020 predicted adolescents' greater ethnic identity exploration or greater anxiety in 2022 via parents' greater use of AOD in 2021, depending on the levels of parents' anxiety and RSC. These findings highlighted individual and contextual factors impacting racial socialization processes in Chinese American families.
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Affiliation(s)
- Huiguang Ren
- Department of Psychology, University of Maryland, Baltimore County, Baltimore, Maryland, USA
| | - Charissa S L Cheah
- Department of Psychology, University of Maryland, Baltimore County, Baltimore, Maryland, USA
| | - Hyun Su Cho
- Department of Psychology, University of Maryland, Baltimore County, Baltimore, Maryland, USA
| | - Ana Katrina Aquino
- Department of Psychology, University of Maryland, Baltimore County, Baltimore, Maryland, USA
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11
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Roberts SO. Dealing With Diversity in Psychology: Science and Ideology. Perspect Psychol Sci 2024; 19:590-601. [PMID: 38652780 DOI: 10.1177/17456916241240743] [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: 04/25/2024]
Abstract
In the spirit of America's Shakespeare, August Wilson (1997), I have written this article as a testimony to the conditions under which I, and too many others, engage in scholarly discourse. I hope to make clear from the beginning that although the ideas presented here are not entirely my own-as they have been inherited from the minority of scholars who dared and managed to bring the most necessary, unpalatable, and unsettling truths about our discipline to the broader scientific community-I do not write for anyone but myself and those scholars who have felt similarly marginalized, oppressed, and silenced. And I write as a race scholar, meaning simply that I believe that race-and racism-affects the sociopolitical conditions in which humans, and scholars, develop their thoughts, feelings, and actions. I believe that it is important for all scholars to have a basic understanding of these conditions, as well as the landmines and pitfalls that define them, as they shape how research is conducted, reviewed, and disseminated. I also believe that to evolve one's discipline into one that is truly robust and objective, it must first become diverse and self-aware. Any effort to suggest otherwise, no matter how scholarly it might present itself, is intellectually unsound.
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Affiliation(s)
- Steven Othello Roberts
- Department of Psychology, Center for the Comparative Study of Race and Ethnicity, Stanford University
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12
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McKenna BG, Brennan PA. Association between racial discrimination and CTRA expression following trauma exposure provides further context for health inequities and the weathering hypothesis. Brain Behav Immun 2024; 118:364-365. [PMID: 38492759 DOI: 10.1016/j.bbi.2024.03.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2024] [Accepted: 03/12/2024] [Indexed: 03/18/2024] Open
Affiliation(s)
- Brooke G McKenna
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, United States; Department of Psychiatry, Harvard Medical School, Boston, MA, United States.
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13
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Stroebe W. The Myth of the Need for Diversity Among Subjects in Theory-Testing Research: Comments on "Racial Inequality in Psychological Research" by Roberts et al. (2020). Perspect Psychol Sci 2024; 19:576-579. [PMID: 38652782 DOI: 10.1177/17456916241236165] [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: 04/25/2024]
Abstract
Roberts and colleagues focus on two aspects of racial inequality in psychological research, namely an alleged underrepresentation of racial minorities and the effects attributed to this state of affairs. My comment focuses only on one aspect, namely the assumed consequences of the lack of diversity in subject populations. Representativeness of samples is essential in survey research or applied research that examines whether a particular intervention will work for a particular population. Representativeness or diversity is not necessary in theory-testing research, where we attempt to establish laws of causality. Because theories typically apply to all of humanity, all members of humanity (even American undergraduates) are suitable for assessing the validity of theoretical hypotheses. Admittedly, the assumption that a theory applies to all of humanity is also a hypothesis that can be tested. However, to test it, we need theoretical hypotheses about specific moderating variables. Supporting a theory with a racially diverse sample does not make conclusions more valid than support from a nondiverse sample. In fact, cause-effect conclusions based on a diverse sample might not be valid for any member of that sample.
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14
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Arrington LA, Kramer B, Ogunwole SM, Harris TL, Dankwa L, Knight S, Creanga AA, Bower KM. Interrupting false narratives: applying a racial equity lens to healthcare quality data. BMJ Qual Saf 2024; 33:340-344. [PMID: 38216312 DOI: 10.1136/bmjqs-2023-016612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 12/08/2023] [Indexed: 01/14/2024]
Affiliation(s)
| | - Briana Kramer
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | | | - Lois Dankwa
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | - Andreea A Creanga
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Kelly M Bower
- Johns Hopkins University School of Nursing, Baltimore, Maryland, USA
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15
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Wang ML, Gago CM, Rodriguez K. Digital Redlining-The Invisible Structural Determinant of Health. JAMA 2024; 331:1267-1268. [PMID: 38497952 DOI: 10.1001/jama.2024.1628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
This Viewpoint describes digital redlining as racialized inequities in access to technology infrastructure, including access to health care, education, employment, and social services.
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Affiliation(s)
- Monica L Wang
- Boston University School of Public Health, Department of Community Health Sciences, Boston, Massachusetts
- Harvard T.H. Chan School of Public Health, Department of Health Policy and Management, Boston, Massachusetts
| | - Cristina M Gago
- Boston University School of Public Health, Department of Community Health Sciences, Boston, Massachusetts
| | - Kate Rodriguez
- Boston University School of Public Health, Department of Community Health Sciences, Boston, Massachusetts
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16
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Roach P, Ruzycki SM, Lithgow KC, McFadden CR, Chikwanha A, Holroyd-Leduc J, Barnabe C. A logic framework for addressing medical racism in academic medicine: an analysis of qualitative data. BMC Med Ethics 2024; 25:45. [PMID: 38616267 PMCID: PMC11017534 DOI: 10.1186/s12910-024-01045-9] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 04/02/2024] [Indexed: 04/16/2024] Open
Abstract
BACKGROUND Despite decades of anti-racism and equity, diversity, and inclusion (EDI) interventions in academic medicine, medical racism continues to harm patients and healthcare providers. We sought to deeply explore experiences and beliefs about medical racism among academic clinicians to understand the drivers of persistent medical racism and to inform intervention design. METHODS We interviewed academically-affiliated clinicians with any racial identity from the Departments of Family Medicine, Cardiac Sciences, Emergency Medicine, and Medicine to understand their experiences and perceptions of medical racism. We performed thematic content analysis of semi-structured interview data to understand the barriers and facilitators of ongoing medical racism. Based on participant narratives, we developed a logic framework that demonstrates the necessary steps in the process of addressing racism using if/then logic. This framework was then applied to all narratives and the barriers to addressing medical racism were aligned with each step in the logic framework. Proposed interventions, as suggested by participants or study team members and/or identified in the literature, were matched to these identified barriers to addressing racism. RESULTS Participant narratives of their experiences of medical racism demonstrated multiple barriers to addressing racism, such as a perceived lack of empathy from white colleagues. Few potential facilitators to addressing racism were also identified, including shared language to understand racism. The logic framework suggested that addressing racism requires individuals to understand, recognize, name, and confront medical racism. CONCLUSIONS Organizations can use this logic framework to understand their local context and select targeted anti-racism or EDI interventions. Theory-informed approaches to medical racism may be more effective than interventions that do not address local barriers or facilitators for persistent medical racism.
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Affiliation(s)
- Pamela Roach
- Department of Family Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Shannon M Ruzycki
- Department of Medicine, Cumming School of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, AB, 1422, T2N 2T9, Canada.
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada.
| | - Kirstie C Lithgow
- Department of Medicine, Cumming School of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, AB, 1422, T2N 2T9, Canada
| | - Chanda R McFadden
- Department of Allied Health, Alberta Health Services, Calgary, Canada
| | - Adrian Chikwanha
- Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Jayna Holroyd-Leduc
- Department of Medicine, Cumming School of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, AB, 1422, T2N 2T9, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Cheryl Barnabe
- Department of Medicine, Cumming School of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, AB, 1422, T2N 2T9, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
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17
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San Sebastian M, Gustafsson PE, Stoor JPA. Embodiment of discrimination: a cross-sectional study of threats, humiliating treatment and ethnic discrimination in relation to somatic health complaints among Sámi in Sweden. J Epidemiol Community Health 2024; 78:290-295. [PMID: 38350714 DOI: 10.1136/jech-2023-221365] [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: 08/28/2023] [Accepted: 01/12/2024] [Indexed: 02/15/2024]
Abstract
BACKGROUND Ethnic discrimination is acknowledged as a social determinant of health for Indigenous populations worldwide. This study aimed to investigate embodiment of perceived ethnic discrimination among the Sámi population in Sweden. METHODS A population-based health study was conducted among the Sámi population aged 18-84 years in 2021. Perceived discrimination was assessed by three variables: exposure to threat, humiliation treatment and ethnic discrimination. To capture current physical health, complaints of headache, back pain, stomach pain, sleeping problems, dizziness and tiredness were used. An overall somatic complaints score was created by summing up the six individual symptoms. The magnitude of the association between the independent variables and the outcomes was summarised with the β coefficients and prevalence ratios using 95% credible intervals (95% CrI) for inferential purposes. RESULTS Overall, 4.3% reported to have been exposed to threat, 26.1% to humiliation and 11.2% and 32.3% to ethnic discrimination in the last 12 months and beyond 12 months, respectively. After mutual adjustment, threat (β=1.25; 95% CrI=0.88 to 1.60), humiliation (β=1.29; 95% CrI: 1.14 to 1.44) and the two categories of discrimination (β=0.92; 95% CI: 0.64 to 1.21 in the last 12 months and β=0.68; 95% CI: 0.54 to 0.83 beyond) remained significantly associated to the overall somatic complaints score. Similar results were found for individual complaints. CONCLUSIONS This study has shown a strong relationship between different expressions of perceived ethnic discrimination and a series of somatic complaints among the Sámi in Sweden. Efforts to alleviate interpersonal and institutional discrimination against the Sámi would contribute to improve their health.
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Affiliation(s)
| | - Per Erik Gustafsson
- Deapartment of Epidemiology and Global Health, Umeå University, Umea, Sweden
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18
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Brannon TN. Anti racism and positive intergenerational (infant) outcomes: A county-level examination of low birth weight and infant mortality. Proc Natl Acad Sci U S A 2024; 121:e2320299121. [PMID: 38557172 PMCID: PMC11009635 DOI: 10.1073/pnas.2320299121] [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: 11/27/2023] [Accepted: 02/21/2024] [Indexed: 04/04/2024] Open
Abstract
Racism is associated with negative intergenerational (infant) outcomes. That is, racism, both perceived and structural, is linked to critical, immediate, and long-term health factors such as low birth weight and infant mortality. Antiracism-resistance to racism such as support for the Black Lives Matter (BLM) movement-has been linked to positive emotional, subjective, and mental health outcomes among adults and adolescents. To theoretically build on and integrate such past findings, the present research asked whether such advantageous health correlations might extend intergenerationally to infant outcomes? It examined a theoretical/correlational process model in which mental and physical health indicators might be indirectly related to associations between antiracism and infant health outcomes. Analyses assessed county-level data that measured BLM support (indexed as volume of BLM marches) and infant outcomes from 2014 to 2020. As predicted, in the tested model, BLM support was negatively correlated with 1) low birth weight (Ncounties = 1,445) and 2) mortalities (Ncounties = 409) among African American infants. Given salient, intergroup, policy debates tied to antiracism, the present research also examined associations among White Americans. In the tested model, BLM marches were not meaningfully related to rates of low birth weight among White American infants (Ncounties = 2,930). However, BLM support was negatively related to mortalities among White American infants (Ncounties = 862). Analyses controlled for structural indicators of income inequality, implicit/explicit bias, voting behavior, prior low birth weight/infant mortality rates, and demographic characteristics. Theory/applied implications of antiracism being linked to nonnegative and positive infant health associations tied to both marginalized and dominant social groups are discussed.
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Affiliation(s)
- Tiffany N. Brannon
- Department of Psychology, University of California, Los Angeles, CA90095-1563
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19
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Vigil-Fowler M, Desai S. "A Much Wider Field in Which to Operate": Early Black Women Physicians in Public Health. J Hist Med Allied Sci 2024; 79:129-142. [PMID: 37579294 DOI: 10.1093/jhmas/jrad048] [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] [Indexed: 08/16/2023]
Abstract
In a profession shaped by Whiteness and masculinity, the few Black women physicians who earned medical degrees prior to the Second World War found some of their rare professional opportunities in public health. Though their choices were often constrained by racism and sexism, they embraced public health work as a means of carrying out their "mission" in marginalized communities and as a way of practicing medicine with a more expansive definition than treating individual patients or illnesses. Black women physicians shaped public health by creating unique programming to meet the needs of the communities they served, including mobile health clinics and community health weeks. The first Black women physicians who worked in public health in the nineteenth and early twentieth centuries applied the new tool of public health "vital" statistics to Black lives and questioned the limits of their utility when created by White practitioners with racial biases. In the 1930s, some Black women physicians began earning some of the first master's degrees in public health, just as the field was beginning to professionalize. Throughout the twentieth century, Black women physicians pioneered community health programming and, though born from exclusionary policies that limited where they could practice, experimented with alternative clinical spaces, even as the hospital and laboratory became the primary sites of medicine for White clinicians. By embracing public health, Black women physicians shaped the field and used it as a tool to address racial health disparities in the communities they served, acting on their belief that Black health could be improved, thereby contesting notions of biological inferiority.
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20
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Abstract
OBJECTIVES Vicarious racism-witnessing or hearing about other individuals of one's ethnic/racial group being the target of racism-has been salient among Asian Americans during the coronavirus disease (COVID-19) pandemic. There is emerging evidence that such experiences adversely impact several health-related outcomes, including sleep. The present study examines associations between vicarious racism and subjective sleep duration and quality, and the potential moderating role of ethnic/racial identity (ERI). METHOD Multivariable regression models assessed the association between vicarious racism, private regard, and centrality on self-reported sleep disturbance and duration. The sample consisted of an online sample of 600 Asian American adults (Mage = 38.55, SDage = 17.11; 65.17% female; 60% ≥ Bachelor's degree) recruited from May to June 2020. RESULTS Vicarious racism was associated with compromised sleep quality and duration, including after adjustment for sociodemographic variables that have been linked to sleep. Private regard toward one's own ethnic/racial group and centrality of ethnicity/race to self-identity buffered the association between vicarious racism and sleep quality and duration. Adverse effects of high vicarious racism on sleep quality and duration were lessened among respondents reporting high levels of ERI private regard and centrality. CONCLUSIONS Findings from this study extend research on racism and sleep by examining vicarious racism, an understudied facet of racism, and by focusing specifically on Asian Americans and in the context of the COVID-19 pandemic. Future research and practice should consider expanding research on discrimination to include a broader range of unjust experiences. Vicarious racism contributes to health hazards experienced by Asian Americans during the COVID-19 pandemic. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
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Affiliation(s)
- Tiffany Yip
- Department of Psychology, Fordham University
| | - Kara Chung
- School of Public Health and Tropical Medicine, Tulane University
| | - David H Chae
- School of Public Health and Tropical Medicine, Tulane University
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21
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Fernandez AR, Ramírez-Ortiz D, García-Torres MM, Lor M, Luebke J, Cano MÁ, Cordova D. Ethnic discrimination, acculturative stress, and sexual risk among Latinx emerging adults: Examining moderation effects of familism support and ethnic identity. Cultur Divers Ethnic Minor Psychol 2024; 30:349-362. [PMID: 36757988 PMCID: PMC10409880 DOI: 10.1037/cdp0000570] [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] [Indexed: 06/18/2023]
Abstract
OBJECTIVES Ethnic discrimination and acculturative stress play an important role in sexual risk behaviors for Latinx emerging adults, who are at disproportionate risk for sexually transmitted infections. Factors such as familism support and ethnic identity may be protective, yet research is limited. This study is guided by a culturally adapted stress and coping framework to examine associations of ethnic discrimination and acculturative stress with sexual risk behaviors (i.e., multiple sex partners, alcohol or drug use before sex, and condomless sex with a primary or casual partner), and examine the moderating roles of familism support and ethnic identity among Latinx emerging adults. METHOD Participants were recruited from Arizona and Florida and were primarily female (51.3%) with a mean age of 21.48 years (SD = 2.06). Using cross-sectional data from 158 sexually active Latinx emerging adults, this study employed multiple logistic regression and moderation analyses. RESULTS Higher levels of ethnic discrimination and pressure to acculturate were associated with fewer sex partners, and higher levels of pressure against acculturation were associated with increased condomless sex with a casual partner. The moderation effect of higher levels of familism support on pressure to acculturate was associated with fewer sex partners, and the moderation effect of higher levels of ethnic identity on pressure against acculturation was associated with decreased condomless sex with casual partners. CONCLUSIONS Examining the results within a culturally informed theoretical framework supports that protective factors may help mitigate sexual risk factors among Latinx emerging adults experiencing acculturative stress. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
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Affiliation(s)
| | | | | | - Maichou Lor
- School of Nursing, University of Wisconsin-Madison
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22
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Perry S, Wu DJ, Abaied JL, Skinner-Dorkenoo AL, Sanchez S, Waters SF, Osnaya A. White parents' racial socialization during a guided discussion predicts declines in white children's pro-white biases. Dev Psychol 2024; 60:624-636. [PMID: 38386383 DOI: 10.1037/dev0001703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2024]
Abstract
Although parent-child conversations about race are recommended to curb White U.S. children's racial biases, little work has tested their influence. We designed a guided racism discussion task for U.S. White parents and their 8-12-year-old White children. We explored whether children's and parents' (a) pro-White implicit biases changed pre to postconversation, (b) racial socialization messages (color conscious, external attributions for prejudiced behavior and colorblind racial ideology [CBRI]) predicted changes in each other's implicit biases, and (c) associations varied by the type of racism (subtle vs. blatant) discussed. Children's and parents' biases significantly declined, pre to postdiscussion. Parents' color conscious messages predicted greater declines and messages reflecting CBRI and external attributions predicted smaller declines in children's bias. These patterns were observed during discussions of subtle, but not blatant bias. Effects of children's messages on parents' bias were mixed. Our findings suggest that color conscious parent-child discussions may effectively reduce implicit pro-White bias in White children. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
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Affiliation(s)
- Sylvia Perry
- Department of Psychology, Institute for Policy Research, Northwestern University
| | - Deborah J Wu
- Department of Psychology, Northwestern University
| | - Jamie L Abaied
- Department of Psychological Science, University of Vermont
| | | | | | - Sara F Waters
- Department of Psychology, Washington State University
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23
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Corbie G, Durant RW, Katz MH. Communities Reverberate From the Harm by Law Enforcement to Unarmed Black Persons. JAMA Intern Med 2024; 184:373-374. [PMID: 38315467 DOI: 10.1001/jamainternmed.2023.8002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2024]
Affiliation(s)
- Giselle Corbie
- Department of Social Medicine, Department of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill
- Associate Editor, JAMA Internal Medicine
| | - Raegan W Durant
- Associate Editor, JAMA Internal Medicine
- Diversity, Equity, and Inclusion Associate Editor, JAMA Internal Medicine
- Medicine/Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham
| | - Mitchell H Katz
- NYC Health and Hospitals, New York, New York
- Deputy Editor, JAMA Internal Medicine
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24
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Heard-Garris N, Yu T, Brody G, Chen E, Ehrlich KB, Miller GE. Racial Discrimination and Metabolic Syndrome in Young Black Adults. JAMA Netw Open 2024; 7:e245288. [PMID: 38635273 DOI: 10.1001/jamanetworkopen.2024.5288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/19/2024] Open
Abstract
Importance Metabolic syndrome (MetS) is a common health condition that predisposes individuals to cardiovascular disease (CVD) and disproportionately affects Black and other racially and ethnically minoritized people. Concurrently, Black individuals also report more exposure to racial discrimination compared with White individuals; however, the role of discrimination in the development of MetS over time and associated mediators in these pathways remain underexplored. Objective To evaluate the association between racial discrimination and MetS in rural Black individuals transitioning from late adolescence into early adulthood and to identify potential mediating pathways. Design, Setting, and Participants This longitudinal cohort study included Black adolescents enrolled in the Strong African American Families Healthy Adults (SHAPE) Project between June 2009 and May 2021. Families resided in rural counties of Georgia, where poverty rates are among the highest in the nation. Analyses included 322 of the 500 participants who originally enrolled in SHAPE and who were eligible to participate. Guardians provided information about socioeconomic disadvantage. Analyses were conducted in April 2023. Exposures Youths reported exposure to racial discrimination annually from ages 19 to 21 years. Main Outcomes and Measures MetS was the main health outcome and was measured at ages 25 and 31 years. MetS was diagnosed according to the International Diabetes Federation guidelines, which requires central adiposity (ie, waist circumference ≥94 cm for males and ≥80 cm for females) and at least 2 of the 4 additional components: signs of early hypertension (ie, systolic blood pressure ≥130 mm Hg or diastolic blood pressure ≥85 mm Hg); elevated triglyceride levels (ie, >150 mg/dL); elevated fasting glucose level (ie, ≥100 mg/dL); or lowered high-density lipoprotein levels (ie, <40 mg/dL in men and <50 mg/dL in women). At age 25 years, markers of inflammatory activity (ie, soluble urokinase plasminogen activator receptor [suPAR]) and sleep problems were collected to consider as potential mediators. Results In 322 participants (210 [65.2%] female) ages 19 to 21 years, more frequent exposure to racial discrimination was associated with higher suPAR levels (b = 0.006; 95% CI, 0.001-0.011; P = .01) and more sleep problems at age 25 years (b = 0.062; 95% CI, 0.028-0.097; P < .001) as well as a 9.5% higher risk of MetS diagnosis at age 31 years (odds ratio [OR], 1.10; 95% CI, 1.01-1.20; P = .03). Both suPAR (b = 0.015; 95% CI, 0.002-0.037) and sleep problems (b = 0.020; 95% CI, 0.002-0.047) at age 25 years were significant indirect pathways. No significant interactions between sex and discrimination emerged. Conclusions and Relevance This study suggests that racial discrimination in late adolescence is associated with MetS among Black young adults through biobehavioral pathways. Thus, health interventions for MetS in Black adults will need to contend with sleep behaviors and inflammatory intermediaries as well as address and reduce exposure to racial discrimination to narrow disparities and promote health equity.
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Affiliation(s)
- Nia Heard-Garris
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Division of Advanced General Pediatrics and Primary Care, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
- Mary Ann & J. Milburn Smith Child Health Research, Outreach, and Advocacy Center, Stanley Manne Children's Research Institute, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
- Department of Psychology and Institute for Policy Research, Northwestern University, Evanston, Illinois
| | - Tianyi Yu
- Center for Family Research, University of Georgia, Athens
| | - Gene Brody
- Center for Family Research, University of Georgia, Athens
| | - Edith Chen
- Department of Psychology and Institute for Policy Research, Northwestern University, Evanston, Illinois
| | - Katherine B Ehrlich
- Center for Family Research, University of Georgia, Athens
- Department of Psychology, University of Georgia, Athens
| | - Gregory E Miller
- Department of Psychology and Institute for Policy Research, Northwestern University, Evanston, Illinois
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25
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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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26
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Williams KKA, Baidoobonso S, Haggerty J, Lofters A, Adams AM. Anti-Black discrimination in primary health care: a qualitative study exploring internalized racism in a Canadian context. Ethn Health 2024; 29:343-352. [PMID: 38332736 DOI: 10.1080/13557858.2024.2311429] [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] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 01/23/2024] [Indexed: 02/10/2024]
Abstract
OBJECTIVES A growing body of evidence points to persistent health inequities within racialized minority communities, and the effects of racial discrimination on health outcomes and health care experiences. While much work has considered how anti-Black racism operates at the interpersonal and institutional levels, limited attention has focused on internalized racism and its consequences for health care. This study explores patients' attitudes towards anti-Black racism in a Canadian health care system, with a particular focus on internalized racism in primary health care. DESIGN This qualitative study employed purposive maximal variation and snowball sampling to recruit and interview self-identified Black persons aged 18 years and older who: (1) lived in Montréal during the COVID-19 pandemic, (2) could speak English or French, and (3) were registered with the Québec health insurance program. Adopting a phenomenological approach, in-depth interviews took place from October 2021 to July 2022. Following transcription, data were analyzed thematically. RESULTS Thirty-two participants were interviewed spanning an age range from 22 years to 79 years (mean: 42 years). Fifty-nine percent of the sample identified as women, 38% identified as men, and 3% identified as non-binary. Diversity was also reflected in terms of immigration experience, financial situation, and educational attainment. We identified three major themes that describe mechanisms through which internalized racism may manifest in health care to impact experiences: (1) the internalization of anti-Black racism by Black providers and patients, (2) the expression of anti-Black prejudice and discrimination by non-Black racialized minority providers, and (3) an insensitivity towards racial discrimination. CONCLUSION Our study suggests that multiple levels of racism, including internalized racism, must be addressed in efforts to promote health and health care equity among racialized minority groups, and particularly within Black communities.
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Affiliation(s)
| | - Shamara Baidoobonso
- Department of Community Health & Epidemiology, Dalhousie University, Halifax, Canada
| | - Jeannie Haggerty
- Department of Family Medicine, McGill University, Montréal, Canada
| | - Aisha Lofters
- Department of Family & Community Medicine, University of Toronto, Toronto, Canada
- Peter Gilgan Centre for Women's Cancers, Women's College Hospital, Toronto, Canada
| | - Alayne M Adams
- Department of Family Medicine, McGill University, Montréal, Canada
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27
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Hodson G, Meleady R. Replicating and extending Sengupta et al. (2023): Contact predicts no within-person longitudinal outgroup-bias change. Am Psychol 2024; 79:451-462. [PMID: 37956050 DOI: 10.1037/amp0001210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
Intergroup contact has long been touted as a premier means to reduce prejudice and forge positive bonds with outgroups. Given its origins in psychological research, it is perhaps of little surprise that contact is expected to induce change within people over time. Yet using random-intercepts crossed-lagged modeling that parses within-person from between-person effects, Sengupta et al. (2023) recently found no evidence of within-person change, only unexplained between-person effects, regarding contact's effects on outgroup solidarity in New Zealand. We conceptually replicated their study, focusing on modern racism and an affect thermometer as the outcomes, in a three-wave study of White British participants (NT1 = 946, NT2 = 667, NT3 = 591) and their attitudes toward foreigners. We replicated the general pattern described by Sengupta and colleagues, confirming between-person effects without within-person effects, suggestive of third-variable explanations. As a novel finding, we discover that differences in social dominance orientation (SDO) and right-wing authoritarianism (RWA) can account for the observed between-person effects. Problematically for contact theory, contact effects, at least those relying on self-reported accounts, increasingly appear to reflect differences between people (person factors) rather than being context-driven (situation factors)-such that those lower (vs. higher) in SDO and RWA are more favorable toward outgroups, rather than intergroup contact bringing about positive outcomes itself. Implications for theory development and intervention are discussed. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
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28
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Lewis J. Women's Health Disparities: Spotlight on Nonchemical Stressors, Research Inequities. Environ Health Perspect 2024; 132:44002. [PMID: 38602832 PMCID: PMC11008710 DOI: 10.1289/ehp14692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 02/26/2024] [Indexed: 04/13/2024]
Abstract
Participants in an NIEHS workshop call on researchers, clinicians, publishers, and funders to address racism, environmental disparities, and other factors affecting women's health.
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29
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Nguyen AW, Taylor HO, Keith VM, Qin W, Mitchell UA. Discrimination and social isolation among African Americans: The moderating role of skin tone. Cultur Divers Ethnic Minor Psychol 2024; 30:374-384. [PMID: 36441993 PMCID: PMC10225012 DOI: 10.1037/cdp0000569] [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] [Indexed: 05/29/2023]
Abstract
OBJECTIVES Discrimination is an urgent public health problem. A number of major cities and counties across the United States has declared racism a public health crisis. While there is a growing body of research on the discrimination-health connection, less is known regarding the social relational consequences of discrimination. The present study addresses this knowledge gap by investigating the relationship between discrimination, skin tone, and objective and subjective social isolation using a nationally representative sample of African Americans. METHOD This analysis was based upon the African American subsample (N = 3,570) of the National Survey of American Life. Discrimination was assessed with the Everyday Discrimination Scale. Objective and subjective isolation differentiated between respondents who were (a) socially isolated from both family and friends, (b) socially isolated from friends only, (c) socially isolated from family only, and (d) not socially isolated. Skin tone was self-reported. Multinomial logistic regression analyses were used to test the study hypotheses. RESULTS The analyses indicated that more frequent discriminatory experiences were associated with increased risk for subjective and objective social isolation. Skin tone moderated the association between discrimination and subjective isolation; the discrimination-isolation relationship was stronger among participants with darker skin tones. CONCLUSIONS These findings shed light on African Americans' nuanced experiences with discrimination and colorism. Further, the data demonstrate heterogeneity in the vulnerability to the adverse effects of discrimination within the African American population; the relationship between discrimination and subjective isolation was stratified by skin tone. This underscores the well-documented and persistent racialized social stratification system in the United States (PsycInfo Database Record (c) 2024 APA, all rights reserved).
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Affiliation(s)
- Ann W. Nguyen
- Jack, Joseph and Morton Mandel School of Applied Social Sciences, Case Western Reserve University
| | | | - Verna M. Keith
- Department of Sociology, University of Alabama at Birmingham
| | - Weidi Qin
- Populations Studies Center, University of Michigan
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Borowsky PA, Yoon K, Eroraha A, Bonsu JM, Kington D, Lawani PE, Smith RN, Bliton JN. General surgery textbooks and surgical disparities. J Natl Med Assoc 2024; 116:145-152. [PMID: 38245468 DOI: 10.1016/j.jnma.2023.12.009] [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: 12/07/2023] [Accepted: 12/23/2023] [Indexed: 01/22/2024]
Abstract
INTRODUCTION Some academic textbooks have previously disseminated simplistic or even incorrect conceptions of race. Propagation of such ideas in General Surgery could contribute to gaps in quality of care received by minority patients. This study aims to determine whether General Surgery textbooks provide a thorough understanding of racial disparities. METHODS General Surgery texts were drawn from Doody's list, an industry-standard list of textbooks for medical education. Technical guides, atlases, and books for non-General Surgery professionals were excluded. Passages mentioning medical differences amongst racial and ethnic groups were extracted. Six binary classifications were made, based on whether passages (a) described interventions to alleviate difference; (b) addressed environmental mediators of difference; (c) described the contribution of racism or discrimination; (d) used causal language to connect race to difference; (e) referred to known, heritable genetic mechanisms; and (f) directly provided a reference. Types of intervention were also extracted. A heuristic scale was calculated granting one point each for classifications a-c and losing one point for classification d. Three authors performed classifications, and raw agreement and Cohen's kappa were used to assess inter-rater reliability. RESULTS Thirteen textbooks from Doody's list contained 511 passages discussing medical differences among racial/ethnic groups. Among passages, 25% discussed white people, 22% Black people/African Americans, 19% Asians, 9% Latinos, 4% Jewish/Ashkenazi people, 3% Native Americans, and 18% other. Fifteen passages (2.9%) used language indicating race was the cause of medical difference, and only two explicitly discussed racism or discrimination. Most passages (370, 72.3%) received a scale of 0. 120 (23.5%) received a scale of 1, eight (1.2%) received a scale of 2, and zero received a scale of 3. The mean passage scale was 0.24 and is not changing with time (regression coefficient -0.006/year, p = 0.538). Agreement was 91.2% across all categories and overall Kappa was 0.62. CONCLUSIONS General Surgery textbooks do not provide readers with scientifically thorough understanding of health disparities. Teaching more comprehensive conceptions, including systemic causes and the role of racism, may prevent reflexive association of minority patients with poor outcomes. Future editions should include these details where disparities are discussed in an independent, comprehensive section.
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Affiliation(s)
- Peter A Borowsky
- Wellstar Kennestone Regional Medical Center, Department of Surgery, Marietta, GA, United States
| | | | | | - Janice M Bonsu
- Emory University School of Medicine, Department of ORthopaedic Surgery, Atlanta GA, United States
| | - Daniella Kington
- Wellstar Kennestone Regional Medical Center, Department of Surgery, Marietta, GA, United States
| | - Phyllis E Lawani
- NewYork-Presbyterian Brooklyn Methodist Hospital, Department of Women's Health, Brooklyn, NY, United States
| | - Randi N Smith
- Emory University School of Medicine, Department of Acute Care Surgery, Atlanta GA, United States
| | - John N Bliton
- Jamaica Hospital Medical Center, Department of Surgery, Queens, NY, United States.
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Naterwala T, Chia MC, Khorfan R, Cheung EO, Eng JS, Hu YY, Bilimoria KY. Associations Between Program Doximity Reputation Rank and Well-Being in General Surgery Residents. J Surg Res 2024; 296:597-602. [PMID: 38350298 DOI: 10.1016/j.jss.2024.01.036] [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: 10/29/2023] [Revised: 12/19/2023] [Accepted: 01/18/2024] [Indexed: 02/15/2024]
Abstract
INTRODUCTION Burnout and mistreatment are prevalent among surgical residents with considerable program-level variation. Applicants consider "program reputation," among other factors, when ranking programs. Although highly subjective, the only available measure of program reputation is from a physician survey by Doximity. It is unknown how program reputation is associated with resident well-being and mistreatment. METHODS Resident burnout and personal accomplishment were assessed via the 2019 post-American Board of Surgery In-Training Examination survey. Additional outcomes included mistreatment, thoughts of attrition, and suicidality. Residents were stratified into quartiles based on their program's Doximity reputation rank. Multivariable logistic regression models examined the relationship between each outcome with Doximity rank quartile. RESULTS 6956 residents (85.6% response rate) completed the survey. Higher-ranked programs had significantly higher burnout rates (top-quartile 41.3% versus bottom-quartile 33.2%; odds ratio [OR] 1.35, 95% confidence interval [CI] 1.04-1.76). There was no significant difference in personal accomplishment by program rank (OR 1.26, 95% CI 0.86-1.85). There also was no significant association between program rank and sexual harassment (OR 0.90, 95% CI 0.70-1.17), gender discrimination (OR 1.14, 95% CI 0.86-1.52), racial discrimination (OR 1.18, 95% CI 0.91-1.54), or bullying (OR 1.03, 95% CI 0.76-1.40). Suicidality (P = 0.97) and thoughts of attrition (P = 0.80) were also not associated with program rank. CONCLUSIONS Surgical residents at higher-ranked programs report higher rates of burnout but have similar rates of mistreatment and personal accomplishment. Higher-ranked programs should be particularly vigilant to trainee burnout, and all programs should employ targeted interventions to improve resident well-being. This study highlights the need for greater transparency in reporting objective program-level quality measures pertaining to resident well-being.
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Affiliation(s)
- Tanaz Naterwala
- Department of Surgery, Surgical Outcomes and Quality Improvement Center (SOQIC), Indiana University School of Medicine, Indianapolis, Indiana; Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Matthew C Chia
- Department of Surgery, Surgical Outcomes and Quality Improvement Center (SOQIC), Indiana University School of Medicine, Indianapolis, Indiana
| | - Rhami Khorfan
- Department of Surgery, Surgical Outcomes and Quality Improvement Center (SOQIC), Indiana University School of Medicine, Indianapolis, Indiana; Department of Surgery, Saint Joseph Mercy Ann Arbor, Ann Arbor, Michigan
| | - Elaine O Cheung
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Joshua S Eng
- Department of Surgery, Surgical Outcomes and Quality Improvement Center (SOQIC), Indiana University School of Medicine, Indianapolis, Indiana
| | - Yue-Yung Hu
- Department of Surgery, Surgical Outcomes and Quality Improvement Center (SOQIC), Indiana University School of Medicine, Indianapolis, Indiana; Northwestern University Feinberg School of Medicine, Chicago, Illinois; Division of Pediatric Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Karl Y Bilimoria
- Department of Surgery, Surgical Outcomes and Quality Improvement Center (SOQIC), Indiana University School of Medicine, Indianapolis, Indiana.
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Wang K, Guan A, Seto J, Oh DL, Lau K, Duffy C, Castillo E, McGuire V, Wadhwa M, Tepper CG, Wakelee HA, DeRouen MC, Shariff-Marco S, Cheng I, Gomez SL. Asian American Women's Experiences of Discrimination and Health Behaviors during the COVID-19 Pandemic. J Immigr Minor Health 2024; 26:421-425. [PMID: 37882970 PMCID: PMC10937770 DOI: 10.1007/s10903-023-01558-2] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/13/2023] [Indexed: 10/27/2023]
Abstract
The COVID-19 pandemic exacerbated racism experienced by Asian Americans, especially women and older individuals. Little is known about how discriminatory experiences during the pandemic have influenced health behaviors among Asian Americans. Between 10/2021 and 6/2022, we surveyed 193 Asian American women in the San Francisco area. Participants were asked to report types of discrimination they experienced since March 2020. We explored bivariable associations of discrimination and changes in health behaviors and healthcare utilization. Most women were Chinese American (75%) and over 45-years-old (87%). The top three discriminatory experiences reported were being treated with less respect (60%), being treated unfairly at restaurants/stores (49%), and people acting as if they are better (47%). Chinese American women (vs. non-Chinese Asian American women) reported higher frequencies of being threatened/harassed (40% vs. 22%). Women who reported any discriminatory experience (vs. none) were more likely to report less physical exercise (42.7% vs. 26.3%) and canceling/rescheduling medical appointments (65.0% vs. 45.1%). Our findings begin to elucidate Asian American women's experiences of discrimination since the pandemic and provide evidence of the harmful impacts of anti-Asian racism on health behaviors.
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Affiliation(s)
- Katarina Wang
- Department of Epidemiology and Biostatistics, University of California, San Francisco, USA
- Asian American Research Center on Health, University of California, San Francisco, USA
| | - Alice Guan
- Department of Epidemiology and Biostatistics, University of California, San Francisco, USA
| | - Janice Seto
- Department of Epidemiology and Biostatistics, University of California, San Francisco, USA
| | - Debora L Oh
- Department of Epidemiology and Biostatistics, University of California, San Francisco, USA
| | - Kathie Lau
- Department of Epidemiology and Biostatistics, University of California, San Francisco, USA
| | - Christine Duffy
- Department of Epidemiology and Biostatistics, University of California, San Francisco, USA
| | - Esperanza Castillo
- Department of Epidemiology and Biostatistics, University of California, San Francisco, USA
| | - Valerie McGuire
- Department of Epidemiology and Biostatistics, University of California, San Francisco, USA
| | - Michelle Wadhwa
- Department of Epidemiology and Biostatistics, University of California, San Francisco, USA
| | - Clifford G Tepper
- Department of Urology, University of California, Davis, Sacramento, USA
| | - Heather A Wakelee
- Division of Oncology, Stanford University School of Medicine, Stanford, California, USA
| | - Mindy C DeRouen
- Department of Epidemiology and Biostatistics, University of California, San Francisco, USA
| | - Salma Shariff-Marco
- Department of Epidemiology and Biostatistics, University of California, San Francisco, USA
- Asian American Research Center on Health, University of California, San Francisco, USA
| | - Iona Cheng
- Department of Epidemiology and Biostatistics, University of California, San Francisco, USA
- Asian American Research Center on Health, University of California, San Francisco, USA
| | - Scarlett Lin Gomez
- Department of Epidemiology and Biostatistics, University of California, San Francisco, USA.
- Asian American Research Center on Health, University of California, San Francisco, USA.
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Guglielminotti J, LEE A, LANDAU R, SAMARI G, LI G. Structural Racism and Use of Labor Neuraxial Analgesia Among Non-Hispanic Black Birthing People. Obstet Gynecol 2024; 143:571-581. [PMID: 38301254 PMCID: PMC10957331 DOI: 10.1097/aog.0000000000005519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 12/14/2023] [Indexed: 02/03/2024]
Abstract
OBJECTIVE To assess the association between structural racism and labor neuraxial analgesia use. METHODS This cross-sectional study analyzed 2017 U.S. natality data for non-Hispanic Black and White birthing people. The exposure was a multidimensional structural racism index measured in the county of the delivery hospital. It was calculated as the mean of three Black-White inequity ratios (ratios for lower education, unemployment, and incarceration in jails) and categorized into terciles, with the third tercile corresponding to high structural racism. The outcome was the labor neuraxial analgesia rate. Adjusted odds ratios and 95% CIs of neuraxial analgesia associated with terciles of the index were estimated with multivariate logistic regression models. Black and White people were compared with the use of an interaction term between race and ethnicity and the racism index. RESULTS Of the 1,740,716 birth certificates analyzed, 396,303 (22.8%) were for Black people. The labor neuraxial analgesia rate was 77.2% for Black people in the first tercile of the racism index, 74.7% in the second tercile, and 72.4% in the third tercile. For White people, the rates were 80.4%, 78.2%, and 78.2%, respectively. For Black people, compared with the first tercile of the racism index, the second tercile was associated with 18.4% (95% CI, 16.9-19.9%) decreased adjusted odds of receiving neuraxial analgesia and the third tercile with 28.3% (95% CI, 26.9-29.6%) decreased adjusted odds. For White people, the decreases were 13.4% (95% CI, 12.5-14.4%) in the second tercile and 15.6% (95% CI, 14.7-16.5%) in the third tercile. A significant difference in the odds of neuraxial analgesia was observed between Black and White people for the second and third terciles. CONCLUSION A multidimensional index of structural racism is associated with significantly reduced odds of receiving labor neuraxial analgesia among Black people and, to a lesser extent, White people.
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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
| | - Allison LEE
- Department of Anesthesiology, Columbia University Vagelos College of Physicians and Surgeons, 622 West 168th Street, PH5-505, 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
| | - 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
- Department of Population and Public Health Science, Keck School of Medicine, University of Southern California, 1845 North Soto Street, Los Angeles, CA 90033, 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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Trinh NHT, Talukder F, Nagendra A, Ali AM, Emmerich A, Chow L, Jenkins JH, Okereke OI. From Diversity, Equity, and Inclusion to an Anti racism 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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Ryus CR, Yang D, Brackett A, Barnett L, Boatright D. Examining trends in emergency medicine journals' publications about racism. Acad Emerg Med 2024; 31:339-345. [PMID: 38097532 DOI: 10.1111/acem.14852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 12/07/2023] [Accepted: 12/12/2023] [Indexed: 03/12/2024]
Abstract
OBJECTIVE In recent years, the academic medicine community has produced numerous statements and calls to action condemning racism. Though health equity work examining health disparities has expanded, few studies specifically name racism as an operational construct. As emergency departments serve a high proportion of patients with social and economic disadvantage rooted in structural racism, it is critically important that racism be a focus of our academic discourse. This study examines the frequency at which four prominent emergency medicine journals, Annals of Emergency Medicine, Academic Emergency Medicine, the American Journal of Emergency Medicine, and the Western Journal of Emergency Medicine, publish on health disparities and racism. METHODS This is a descriptive analysis measuring the frequency of publications on health disparities and racism in U.S.-based emergency medicine journals from 2014 to 2021. The search strategies for the concepts of "racism" and "health disparities" used a combination of MeSH and keywords. These search strategies were developed based on prior literature and the MEDLINE/PubMed Health Disparities and Minority Health Search Strategy. Articles identified through the PubMed search were then reviewed by two authors for final inclusion. RESULTS Since 2014, a total of 6248 articles were published by the four emergency medicine journals over the 8-year study period. Of those, 82 research papers that focused on health disparities were identified and only 16 that focused on racism. Most emergency medicine publications on racism and health disparities were in 2021. CONCLUSIONS Our findings suggest that the national discourse on racism and calls to action within emergency medicine were followed by an increase in publications on health disparities and racism. Continued investigation is needed to evaluate these trends moving forward.
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Affiliation(s)
- Caitlin R Ryus
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - David Yang
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Alexandria Brackett
- Harvey Cushing/John Hay Whitney Medical Library, Yale School of Medicine, New Haven, Connecticut, USA
| | - Lindsay Barnett
- Yale University Library, Yale School of Medicine, New Haven, Connecticut, USA
| | - Dowin Boatright
- Ronald O. Perelman Department of Emergency Medicine, New York University, New York, New York, USA
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Al-Kire RL, Miller CA, Pasek MH, Perry SL, Wilkins CL. White by Another Name? Can Anti-Christian Bias Claims Serve as a Racial Dog Whistle? Psychol Sci 2024; 35:415-434. [PMID: 38507261 DOI: 10.1177/09567976241236162] [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: 03/22/2024] Open
Abstract
Four preregistered experiments (N = 4,307) explored whether anti-Christian bias claims can discreetly signal White allyship among Christian American adults. In Experiments 1 and 2, reading about anti-Christian bias led White, but not Black, Christians to perceive more anti-White bias. Experiments 3 and 4 demonstrate the connection between Christian and White can be leveraged by politicians in the form of a racial dog whistle. In Experiment 3, White Christians perceived a politician concerned about anti-Christian bias as caring more about anti-White bias and more willing to fight for White people (relative to a control). This politician was also perceived as less offensive than a politician concerned about anti-White bias. In Experiment 4, Black Christians perceived a politician concerned about anti-Christian bias as less offensive than one concerned about anti-White bias yet still unlikely to fight for Black people. Results suggest "anti-Christian bias" can provide a relatively palatable way to signal allegiance to White people.
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Willis DE, Kaholokula JK, Andersen JA, Selig JP, Bogulski CA, Scott AJ, McElfish PA. Racial Misclassification, Discrimination, Consciousness, and Self-Rated Health Among Native Hawaiian and Pacific Islander Adults in the USA. J Racial Ethn Health Disparities 2024; 11:730-738. [PMID: 36892814 PMCID: PMC9997430 DOI: 10.1007/s40615-023-01556-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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 02/22/2023] [Accepted: 02/23/2023] [Indexed: 03/10/2023]
Abstract
BACKGROUND Medical researchers have historically utilized the variable of race uncritically, rarely defining race, rarely acknowledging it as a social construct, and often omitting information about how it was measured. In this study, we use the following definition of race: "a system of structuring opportunity and assigning value based on the social interpretation of how one looks." We examine the influence of racial misclassification, racial discrimination, and racial consciousness on the self-rated health of Native Hawaiian and Pacific Islanders (NHPI) living in the United States of America (USA). METHODS Our analysis used online survey data from a subgroup of NHPI adults living in the USA (n = 252) who were oversampled as part of a larger study of US adults (N = 2022). Respondents were recruited between September 7, 2021 and October 3, 2021, from an online opt-in panel of individuals across the USA. Statistical analyses include weighted and unweighted descriptive statistics for the sample, as well as a weighted logistic regression for poor/fair self-rated health. RESULTS Odds of poor/fair self-rated health were greater for women (OR = 2.72; 95% CI [1.19, 6.21]) and those who experienced racial misclassification (OR = 2.90; 95% CI [1.20, 7.05]). No other sociodemographic, healthcare, or race-related variables were significantly associated with self-rated health in the fully adjusted results. CONCLUSIONS Findings suggest that racial misclassification may be an important correlate of self-rated health among NHPI adults in the US context.
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Affiliation(s)
- Don E Willis
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 2708 S. 48th St., Springdale, AR, 72762, USA.
| | - Joseph Keawe'aimoku Kaholokula
- Department of Native Hawaiian Health, John A. Burns School of Medicine, University of Hawai'i at Manoa, Honolulu, HI, USA
| | - Jennifer A Andersen
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 2708 S. 48th St., Springdale, AR, 72762, USA
| | - James P Selig
- Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences Northwest, Springdale, AR, USA
| | - Cari A Bogulski
- College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Aaron J Scott
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, Springdale, AR, USA
| | - Pearl A McElfish
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 2708 S. 48th St., Springdale, AR, 72762, USA
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Wijeratne C, Sharma S, Large M. Understanding and addressing racism in clinical encounters. Aust N Z J Psychiatry 2024; 58:297-299. [PMID: 38131317 DOI: 10.1177/00048674231219854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Affiliation(s)
- Chanaka Wijeratne
- Euroa Centre, Prince of Wales Hospital, Randwick, NSW, Australia
- School of Clinical Medicine, University of New South Wales, Kensington, NSW, Australia
| | - Swapnil Sharma
- Euroa Centre, Prince of Wales Hospital, Randwick, NSW, Australia
- School of Clinical Medicine, University of New South Wales, Kensington, NSW, Australia
| | - Matthew Large
- Euroa Centre, Prince of Wales Hospital, Randwick, NSW, Australia
- School of Clinical Medicine, University of New South Wales, Kensington, NSW, Australia
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Hubbard A, Harris S, Dick M, McGee D. Understanding African American help-seeking for romantic relationships: Advocacy, barriers, and considerations. J Marital Fam Ther 2024; 50:348-367. [PMID: 38383948 DOI: 10.1111/jmft.12692] [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] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Revised: 11/19/2023] [Accepted: 01/30/2024] [Indexed: 02/23/2024]
Abstract
African American couples experience greater levels of relationship distress than other racial/ethnic groups, but they are less likely to seek formal couple counseling. Existing literature highlights the importance of community support in the form of church, family, and friends. While the literature suggests that African Americans encounter unique barriers, we do not know how racism and discrimination impact the couple help-seeking process. This study seeks to address this gap and better understand unique barriers in the African American couple help-seeking (AACHS) process via a grounded theory-informed qualitative study. Findings from interviews with 11 African American individuals in committed relationships highlighted mistrust as a significant barrier to AACHS, while community supports are frequently sought out. Our findings add to current understandings about AACHS and highlight important areas for future research. In the clinical implications section, the authors outline tangible steps that clinicians can take based on the findings from this study.
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Affiliation(s)
- Aimee Hubbard
- Kansas City Relationship Institute, Independence, Missouri, USA
- Family Social Science, University of Minnesota, St. Paul, Minnesota, USA
| | - Steven Harris
- Family Social Science, University of Minnesota, St. Paul, Minnesota, USA
| | - Mary Dick
- Human Development and Family Sciences, Texas Tech University, Lubbock, Texas, USA
| | - DasJohn McGee
- Build Wealth, Minnesota, Minneapolis, Minnesota, USA
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James D. Initial Development and Validation of the Brief Internalized Heterosexist Racism Scale for Gay and Bisexual Black Men: A Measure of Internalized Heterosexist Racism. Arch Sex Behav 2024; 53:1307-1325. [PMID: 38388762 PMCID: PMC10955034 DOI: 10.1007/s10508-023-02805-1] [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] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 12/29/2023] [Accepted: 12/30/2023] [Indexed: 02/24/2024]
Abstract
We introduce internalized heterosexist racism (IHR), or the internalization of damaging stereotypes, harmful beliefs, and negative attitudes about being a sexual minority person of color. We also present the initial development and validation of the Brief Internalized Heterosexist Racism Scale for gay and bisexual Black men (IHR-GBBM), a unidimensional, 10-item measure of IHR. Exploratory factor analyses on an internet-obtained sample of gay and bisexual Black men (N = 312; Mean age = 30.36 years) show that the IHR-GBBM had evidence of good internal consistency, and good convergent, discriminant, concurrent, and incremental validity. The IHR-GBBM was positively correlated with internalized racism, internalized heterosexism, and discrimination (racist, heterosexist). IHR was also negatively correlated with race stigma consciousness, weakly positively correlated with sexual identity stigma consciousness, but not correlated with either race identity, sexual identity, or social desirability. Hierarchical regressions showed that the IHR-GBBM explained an additional variance of 2.8% and 3.1% in anxiety symptoms and substance use coping, respectively, after accounting for (1) sociodemographics, (2) internalized racism and internalized heterosexism, and (3) an interaction of internalized racism and internalized heterosexism. Older participants and those who were "out" about their sexual identity reported lower IHR. Those who did not know/want to report their HIV status reported greater IHR. Results revealed no sexual identity, sexual position, relationship status, income, education, or employment status differences in IHR. We hope the development of the IHR-GBBM spurs future research on predictors and consequences of IHR. We discuss limitations and implications for the future study of internalized heterosexist racism.
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Affiliation(s)
- Drexler James
- Department of Psychology, University of Minnesota, Twin Cities, 75 E River Rd, Minneapolis, MN, 55455-0366, USA.
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Fix RL. Racism and violence in policing: Perspectives from a juvenile prison. J Community Psychol 2024; 52:459-474. [PMID: 38356270 DOI: 10.1002/jcop.23104] [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: 09/20/2023] [Revised: 11/21/2023] [Accepted: 12/28/2023] [Indexed: 02/16/2024]
Abstract
Following recent events involving racism and violence in policing, the current study sought to understand factors associated with support for related social movements and worries about personal, family, and peer safety. Data were from 78 currently incarcerated young people (M = 16.5 years; 31% Black) and 20 juvenile prison staff (M = 40.3 years; 72% Black) via online surveys. A comparable proportion of young people (47.3%) and staff (47.4%) reported participating in the Black Lives Matter movement. Among young people, prior experiences with police were significantly associated with support for social movements and worries about safety concerning racism and violence in policing. Among staff, race, ethnicity, sexual orientation, and racial and ethnic identity were significantly associated with social movement support and worries about safety. Civic education and interventions to promote racial and ethnic identity may promote support for systemic change and buffer against worries about racism and violence in policing.
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Affiliation(s)
- Rebecca L Fix
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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McMillan RH, Thomas CC. Racial Discrimination, Inflammation, Sleep, and Metabolic Syndrome From Adolescence to Young Adulthood. JAMA Netw Open 2024; 7:e245258. [PMID: 38635277 DOI: 10.1001/jamanetworkopen.2024.5258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/19/2024] Open
Affiliation(s)
- Ross H McMillan
- Section of Gastroenterology, Hepatology & Nutrition, University of Chicago, Chicago, Illinois
| | - Celeste C Thomas
- Section of Endocrinology, Diabetes & Metabolism, University of Chicago, Chicago, Illinois
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Ng R, Indran N. #ProtectOurElders: Analysis of Tweets About Older Asian Americans and Anti-Asian Sentiments During the COVID-19 Pandemic. J Med Internet Res 2024; 26:e45864. [PMID: 38551624 PMCID: PMC10984343 DOI: 10.2196/45864] [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: 01/19/2023] [Revised: 03/12/2023] [Accepted: 09/14/2023] [Indexed: 04/02/2024] Open
Abstract
BACKGROUND A silver lining to the COVID-19 pandemic is that it cast a spotlight on a long-underserved group. The barrage of attacks against older Asian Americans during the crisis galvanized society into assisting them in various ways. On Twitter, now known as X, support for them coalesced around the hashtag #ProtectOurElders. To date, discourse surrounding older Asian Americans has escaped the attention of gerontologists-a gap we seek to fill. Our study serves as a reflection of the level of support that has been extended to older Asian Americans, even as it provides timely insights that will ultimately advance equity for them. OBJECTIVE This study explores the kinds of discourse surrounding older Asian Americans during the COVID-19 crisis, specifically in relation to the surge in anti-Asian sentiments. The following questions guide this study: What types of discourse have emerged in relation to older adults in the Asian American community and the need to support them? How do age and race interact to shape these discourses? What are the implications of these discourses for older Asian Americans? METHODS We retrieved tweets (N=6099) through 2 search queries. For the first query, we collated tweets with the hashtag #ProtectOurElders. For the second query, we collected tweets with an age-based term, for example, "elderly" or "old(er) adults(s)" and either the hashtag #StopAAPIHate or #StopAsianHate. Tweets were posted from January 1, 2020, to August 1, 2023. After applying the exclusion criteria, the final data set contained 994 tweets. Inductive and deductive approaches informed our qualitative content analysis. RESULTS A total of 4 themes emerged, with 50.1% (498/994) of posts framing older Asian Americans as "vulnerable and in need of protection" (theme 1). Tweets in this theme either singled them out as a group in need of protection because of their vulnerable status or discussed initiatives aimed at safeguarding their well-being. Posts in theme 2 (309/994, 31%) positioned them as "heroic and resilient." Relevant tweets celebrated older Asian Americans for displaying tremendous strength in the face of attack or described them as individuals not to be trifled with. Tweets in theme 3 (102/994, 10.2%) depicted them as "immigrants who have made selfless contributions and sacrifices." Posts in this section referenced the immense sacrifices made by older Asian Americans as they migrated to the United States, as well as the systemic barriers they had to overcome. Posts in theme 4 (85/994, 8.5%) venerated older Asian Americans as "worthy of honor." CONCLUSIONS The COVID-19 crisis had the unintended effect of garnering greater support for older Asian Americans. It is consequential that support be extended to this group not so much by virtue of their perceived vulnerability but more so in view of their boundless contributions and sacrifices.
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Affiliation(s)
- Reuben Ng
- Lee Kuan Yew School of Public Policy, National University of Singapore, Singapore, Singapore
- Lloyd's Register Foundation Institute for the Public Understanding of Risk, National University of Singapore, Singapore, Singapore
| | - Nicole Indran
- Lee Kuan Yew School of Public Policy, National University of Singapore, Singapore, Singapore
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Gamba R, Toosi N, Wood L, Correia A, Medina N, Pritchard M, Venerable J, Lee M, Santillan JKA. Racial discrimination is associated with food insecurity, stress, and worse physical health among college students. BMC Public Health 2024; 24:883. [PMID: 38519967 PMCID: PMC10958967 DOI: 10.1186/s12889-024-18240-3] [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: 05/16/2023] [Accepted: 02/29/2024] [Indexed: 03/25/2024] Open
Abstract
BACKGROUND Students of color disproportionately experience racial discrimination and food insecurity, which both lead to poor academic and health outcomes. This study explores the extent to which the location of racial discrimination experienced is associated with food insecurity, stress, physical health and grade point average among college students METHODS: A cross sectional study design was implemented to survey 143 students from a racially diverse public university. Logistic regression models assessed if discrimination at various locations was associated with food insecurity and linear models assessed how racial discrimination was associated with physical health, stress and grade point average RESULTS: Student's experiencing food security had an average discrimination score of 2.3 (1.23, 3.37), while those experiencing food insecurity had a statistically significant (P < 0.001) higher average discrimination score 7.3 (5.4, 9.21). Experiencing any racial discrimination was associated with increased odds of experiencing food insecurity when experienced from the police (OR 11.76, 95% CI: 1.41, 97.86), in the housing process (OR 7.9, 95% CI: 1.93, 32.34) and in the hiring process (OR 6.81, 95% CI: 1.98, 23.48) compared to those experiencing no racial discrimination after adjusting for race, gender, age and income. CONCLUSION The location in which a student experienced racial discrimination impacted the extent to which the racial discrimination was associated with food security status. Further research is needed to explore potential mechanisms for how racial discrimination may lead to food insecurity.
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Affiliation(s)
- Ryan Gamba
- Department of Public Health, California State University, East Bay. SF 102. 25800 Carlos Bee Boulevard, 94542, Hayward, CA, USA.
| | - Negin Toosi
- Department of Psychology, California State University, East Bay. 25800 Carlos Bee Boulevard, 94542, Hayward, CA, USA
| | - Lana Wood
- University Libraries, California State University, East Bay, 94542, Hayward, CA, USA
| | - Alexandra Correia
- Department of Psychology, California State University, East Bay. 25800 Carlos Bee Boulevard, 94542, Hayward, CA, USA
| | - Nomar Medina
- Department of Psychology, California State University, East Bay. 25800 Carlos Bee Boulevard, 94542, Hayward, CA, USA
| | - Maria Pritchard
- Department of Public Health, California State University, East Bay. SF 102. 25800 Carlos Bee Boulevard, 94542, Hayward, CA, USA
| | - Jhamon Venerable
- Department of Psychology, California State University, East Bay. 25800 Carlos Bee Boulevard, 94542, Hayward, CA, USA
| | - Mikayla Lee
- Department of Public Health, California State University, East Bay. SF 102. 25800 Carlos Bee Boulevard, 94542, Hayward, CA, USA
| | - Joshua Kier Adrian Santillan
- Department of Public Health, California State University, East Bay. SF 102. 25800 Carlos Bee Boulevard, 94542, Hayward, CA, USA
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Brown EA, Jones R. Discussing systemic racism and racial privilege at a large, academic health center using a modified privilege walk. BMC Med Educ 2024; 24:327. [PMID: 38520020 PMCID: PMC10960397 DOI: 10.1186/s12909-024-05302-8] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Accepted: 03/12/2024] [Indexed: 03/25/2024]
Abstract
BACKGROUND There is a motivation for organizations to understand race and racism from the perspective of minoritized individuals. Academic health centers (AHC) are ideal organizations to have these conversations as they educate healthcare providers, support research in health disparities, and care for diverse patients. METHODS We piloted and evaluated a virtual Modified Privilege Walk (MPW) with faculty, staff, and students at an AHC in July 2020 to promote difficult conversations about race/racism, social class, and privilege. Each MPW session was voluntary, held virtually over Zoom, and lasted one hour and thirty minutes. Before attending, participants answered questions based on their race/ethnicity and social class to calculate a "privilege score." After each session, attendees were asked to complete an evaluation survey. RESULTS There were five virtual MPWs with 132 attendees, and 74 participants completed an evaluation survey (56% response rate). Many respondents were students (n = 29, 39.2%). Most respondents either agreed (n = 36, 48.6%) or strongly agreed (n = 32, 43.2%) that the virtual MPW positively impacted how they will interact with those of a different race/ethnicity. Attendees requested having more virtual MPWs with leadership, incorporating virtual MPWs in various program curricula, and requiring new employees to participate. CONCLUSIONS American organizations, particularly AHCs, should provide safe spaces and support these discussions surrounding race and racism as many were founded, built, or operated during a time of free labor and segregation that exerted power and control over minoritized individuals. Authors provide recommendations to dismantle organizational racism and support minoritized employees, patients, and students.
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Affiliation(s)
- Elizabeth A Brown
- School of Community & Environmental Health, College of Health Sciences, Old Dominion University, Norfolk, VA, 23529, USA.
| | - Rosemarie Jones
- Bloomberg School of Public Health, Johns Hopkins University, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
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Gruson-Wood JF, Reid K, Rice C, Haines J, Chapman GE, Gibson MF. The Game of Queer Family Life: Exploring 2SLGBTQI+ Parents' Experiences of Cisheteronormativity, Racism, and Colonialism Through Digital Storytelling in Ontario, Canada. J Homosex 2024; 71:887-915. [PMID: 36480036 DOI: 10.1080/00918369.2022.2132581] [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] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
In this article we describe and analyze five videos created through an arts-informed research project, Precarious Inclusion: Studying Ontarian 2SLGBTQI+ parents' experiences childrearing in a post-legal parity framework. Precarious Inclusion used interviews and digital storytelling to investigate Ontario 2SLGBTQI+ parents' current experiences of inclusion and exclusion when navigating institutional and social interactions in everyday life in a post-legal parity context. The study centrally explored how intersecting identities with regards to sexuality, gender, geography, disability, class, race, Indigeneity, and ethnicity intersect with structural forces to influence 2SLGBTQI+ parents' inclusion and exclusion experiences. We examine research creation activities that supported 2SLGBTQI+ parents in making short videos about their experiences of parenting. Our analysis of the five videos created by Indigenous, racialized, trans, nonbinary, Two-Spirit, and disabled parents show how consistent experiences of exclusion mark 2SLGBTQI+ parents' everyday lives. We deepen theorizations of the material and psychological impacts of exclusion for 2SLGBTQI+ families through foregrounding three themes: 1) the operations of racism, white supremacy, and colonialism in makers' lives; 2) misrecognition and its psychic effects of bifurcation and disjuncture; and 3) love, joy, and multi-species kinship as powerful sites of healing and belonging. We further demonstrate how parents used their videos as self-advocacy for resisting precarious inclusion.
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Affiliation(s)
- Julia F Gruson-Wood
- Family Relations and Applied Nutrition, University of Guelph, Guelph, Ontario, Canada
| | - Kael Reid
- Humanities, York University, Toronto, Ontario, Canada
| | - Carla Rice
- Family Relations and Applied Nutrition, University of Guelph, Guelph, Ontario, Canada
| | - Jess Haines
- Family Relations and Applied Nutrition, University of Guelph, Guelph, Ontario, Canada
| | - Gwen E Chapman
- Family Relations and Applied Nutrition, University of Guelph, Guelph, Ontario, Canada
| | - Margaret F Gibson
- Social Development Studies, University of Waterloo, Waterloo, Ontario, Canada
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Fuentes A. Statements by scientific organizations can, and should, shape society. Science 2024; 383:eado7084. [PMID: 38484061 DOI: 10.1126/science.ado7084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
Statements based on the best current scientific data and analyses that bear directly on societal issues, especially ones that are critical to societal justice, equity, and health, are practical responsibilities of professional scientific organizations. And they often have impact.
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Affiliation(s)
- Agustín Fuentes
- Agustín Fuentes is a professor in the Department of Anthropology at Princeton University, Princeton, NJ, USA.
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Matthew DB, Benfer EA. A Clarion Call for Change: The MLP Imperative to Center Racial Discrimination and Structural Health Inequities. J Law Med Ethics 2024; 51:735-747. [PMID: 38477284 PMCID: PMC10951182 DOI: 10.1017/jme.2023.153] [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] [Subscribe] [Scholar Register] [Indexed: 03/14/2024]
Abstract
Across the country, legal and health care professionals who understand that health outcomes are most influenced by social and environmental conditions have improved patient health by adopting the interdisciplinary MLP health care delivery model. However, the MLP field cannot advance population health, let alone long-term health equity, until it addresses the structural determinants of health inequity that are rooted in discrimination, segregation, and other forms of racial and ethnic subordination.
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Affiliation(s)
| | - Emily A Benfer
- GEORGE WASHINGTON UNIVERSITY LAW SCHOOL, WASHINGTON, DC, USA
- PRINCETON UNIVERSITY EVICTION LAB, PRINCETON, NJ, USA
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Gonzalez CM, Ark TK, Fisher MR, Marantz PR, Burgess DJ, Milan F, Samuel MT, Lypson ML, Rodriguez CJ, Kalet AL. Racial Implicit Bias and Communication Among Physicians in a Simulated Environment. JAMA Netw Open 2024; 7:e242181. [PMID: 38506811 PMCID: PMC10955368 DOI: 10.1001/jamanetworkopen.2024.2181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 12/31/2023] [Indexed: 03/21/2024] Open
Abstract
Importance Racial implicit bias can contribute to health disparities through its negative influence on physician communication with Black patients. Interventions for physicians to address racial implicit bias in their clinical encounters are limited by a lack of high-fidelity (realistic) simulations to provide opportunities for skill development and practice. Objective To describe the development and initial evaluation of a high-fidelity simulation of conditions under which physicians might be influenced by implicit racial bias. Design, Setting, and Participants This cross-sectional study, performed on an online platform from March 1 to September 30, 2022, recruited a convenience sample of physician volunteers to pilot an educational simulation. Exposures In the simulation exercise, physicians saw a 52-year-old male standardized patient (SP) (presenting as Black or White) seeking urgent care for epigastric pain, nausea, and vomiting. The case included cognitive stressors common to clinical environments, including clinical ambiguity, stress, time constraints, and interruptions. Physicians explained their diagnosis and treatment plan to the SP, wrote an assessment and management plan, completed surveys, and took the Race Implicit Association Test (IAT) and Race Medical Cooperativeness IAT. The SPs, blinded to the purpose of the study, assessed each physician's communication using skills checklists and global rating scales. Main Outcomes and Measures Association between physicians' IAT scores and SP race with SP ratings of communication skills. Results In 60 physicians (23 [38.3%] Asian, 4 [6.7%] Black, 23 [38.3%] White, and 10 [16.7%] other, including Latina/o/x, Middle Eastern, and multiracial; 31 [51.7%] female, 27 [45.0%] male, and 2 [3.3%] other), the interaction of physicians' Race IAT score and SP race was significant for overall communication (mean [SD] β = -1.29 [0.41]), all subdomains of communication (mean [SD] β = -1.17 [0.52] to -1.43 [0.59]), and overall global ratings (mean [SD] β = -1.09 [0.39]). Black SPs rated physicians lower on communication skills for a given pro-White Race IAT score than White SPs; White SP ratings increased as physicians' pro-White bias increased. Conclusions and Relevance In this cross-sectional study, a high-fidelity simulation calibrated with cognitive stressors common to clinical environments elicited the expected influence of racial implicit bias on physicians' communication skills. The outlined process and preliminary results can inform the development and evaluation of interventions that seek to address racial implicit bias in clinical encounters and improve physician communication with Black patients.
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Affiliation(s)
- Cristina M. Gonzalez
- Institute for Excellence in Health Equity, New York University Grossman School of Medicine, New York
- Department of Medicine, New York University Grossman School of Medicine, New York
- Department of Population Health, New York University Grossman School of Medicine, New York
| | | | - Marla R. Fisher
- Department of Psychiatry, Mount Sinai Morningside-West, New York, New York
| | - Paul R. Marantz
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York
- Department of Medicine, Albert Einstein College of Medicine, Bronx, New York
| | - Diana J. Burgess
- Department of Medicine, University of Minnesota, Minneapolis
- Center for Care Delivery and Outcomes Research in the Minneapolis Veterans Affairs Healthcare System, Minneapolis, Minnesota
| | - Felise Milan
- Department of Medicine, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York
| | | | - Monica L. Lypson
- Columbia University Vagelos College of Physicians and Surgeons, New York, New York
- Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - Carlos J. Rodriguez
- Department of Medicine and Epidemiology & Population Health, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York
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