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Nielson SA, Dautovich ND, Dzierzewski JM. Race as a Potential Moderator of the Association between Dysfunctional Beliefs about Sleep and Global Sleep Health. Behav Sleep Med 2024; 22:319-328. [PMID: 37671826 PMCID: PMC10915100 DOI: 10.1080/15402002.2023.2255328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/07/2023]
Abstract
OBJECTIVES Dysfunctional beliefs about sleep are associated with components of sleep health, but their association with global sleep health is understudied. Beliefs about sleep may systematically vary by race, which may influence the association between dysfunctional beliefs about sleep and global sleep health. This study aimed to investigate whether race influences the association between dysfunctional beliefs about sleep and global sleep health. METHODS Data were collected as part of an online survey. Participants were Black (n = 181) and White (n = 179) adults who were matched on age, self-reported sex, and level of education. Global sleep health was measured using the RU-SATED and dysfunctional beliefs about sleep were measured using the DBAS-16. Moderation analyses were conducted to investigate whether race moderated the association between DBAS-16 total and subscale scores and RU-SATED total scores. RESULTS Race moderated the associations between DBAS-16 total score and subscale scores and RU-SATED total score (b = 0.54, p < .001). Higher DBAS-16 scores were significantly associated with lower RU-SATED scores in the white sample, while this association was not significant in the Black sample, except for the Sleep Expectations subscale, where the association was not significant in the White sample, and it was significant in the Black sample. CONCLUSIONS These findings highlight that the association between dysfunctional beliefs about sleep and global sleep health may systematically vary by race which may have implications for promoting sleep health equity in racial minority populations through clinical and advocacy work. Future studies are needed to investigate what specific factors may be impacting these unique associations.
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Abstract
KNOWLEDGE TRANSFER STATEMENT By following best practices related to equity, diversity, and inclusion, oral health researchers may be able to advance the study of health equity, grow a diverse research workforce, and better respond to pressing public health problems.
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Affiliation(s)
- E Fleming
- University of Maryland School of Dentistry, Baltimore, MA
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Bell J, Cook S, Edwards TL, Rice TW, Self WH, Wheeler A, Rhoads J, Stewart TG, Pulley JM, Benhoff K, Harris PA, Wilkins C. Using a multicultural and multilingual awareness-raising strategy to enhance enrollment of racially underrepresented minoritized communities - the PassITON trial. J Clin Transl Sci 2023; 7:e9. [PMID: 36755543 DOI: 10.1017/cts.2022.506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 11/10/2022] [Accepted: 11/11/2022] [Indexed: 12/13/2022] Open
Abstract
Racially and ethnically minoritized populations have been historically excluded and underrepresented in research. This paper will describe best practices in multicultural and multilingual awareness-raising strategies used by the Recruitment Innovation Center to increase minoritized enrollment into clinical trials. The Passive Immunity Trial for Our Nation will be used as a primary example to highlight real-world application of these methods to raise awareness, engage community partners, and recruit diverse study participants.
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AlAzzeh O, M Roman Y. The frequency of rs2231142 in ABCG2 among Native Hawaiian and Pacific Islander subgroups: implications for personalized rosuvastatin dosing. Pharmacogenomics 2023; 24:173-182. [PMID: 36661065 PMCID: PMC10072122 DOI: 10.2217/pgs-2022-0160] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 12/12/2022] [Indexed: 01/21/2023] Open
Abstract
Statins are among the most commonly prescribed medications worldwide. Rosuvastatin is a moderate- to high-intensity statin depending on the prescribed dose. Statin-associated muscle symptoms are the main side effects, contributing to low adherence to statins. The missense variant rs2231142 in ABCG2 affects the functionality of the ABCG2 transporter, altering the pharmacokinetics and pharmacodynamics of rosuvastatin. This special report aims to accentuate the importance of considering the ABCG2 genotype upon prescribing rosuvastatin in high cardiovascular disease risk subgroups, specifically Native Hawaiian and Pacific Islander populations. Based on the reported frequencies of rs2231142 in ABCG2, it may be justifiable to initiate low-dose rosuvastatin in Samoans relative to Marshallese or Native Hawaiians. Interpopulation differences in pharmacogenetic allele frequencies underscore the need to disaggregate broad population categories to achieve health equity in treatment outcomes.
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Affiliation(s)
- Ola AlAzzeh
- Department of Pharmacotherapy & Outcome Science, Virginia Commonwealth University School of Pharmacy, 410 N 12th Street, Richmond, VA 23298, USA
| | - Youssef M Roman
- Department of Pharmacotherapy & Outcome Science, Virginia Commonwealth University School of Pharmacy, 410 N 12th Street, Richmond, VA 23298, USA
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Fritz K, Hong J, Basdeo D, Byrnes K, Cordoba A, Dunn K, Haider U, Kashif M, Lee N, Mohamed Nuhuman AS, Santos R, Jacobs RJ. United Network for Organ Sharing (UNOS) Database Analysis of Factors Associated With Kidney Transplant Time on Waiting List. Cureus 2023; 15:e34679. [PMID: 36909033 PMCID: PMC9997046 DOI: 10.7759/cureus.34679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Accepted: 02/06/2023] [Indexed: 02/09/2023] Open
Abstract
INTRODUCTION In the United States (U.S.), African Americans and other minority groups have longer wait times for kidney transplantation than Caucasians. To date, many studies analyzing time spent on the waitlist for each race/ethnicity have been done. However, there are few to no studies examining waitlist time after the 2019 policy changes to the geographic distribution of donated kidneys. METHODS Data collected from the National Organ Procurement and Transplantation Network database were used to analyze associations between race and time spent on the waitlist for a kidney transplant in the U.S. Additional sub-categorical data were analyzed to determine further associations and potential covariates, such as gender, age, citizenship, primary source of payment, region of transplant center, BMI, Kidney Donor Profile Index (KDPI), renal diagnosis, and presence/type of diabetes. Data were analyzed using odds ratios and validated by Bonferroni-Holm's corrected chi-square tests at confidence intervals of 95% to determine if there are statistically significant differences between transplant time spent on the waitlist and ethnicity, as well as age, diagnosis category, region of transplant center, and KDPI. RESULTS Statistically significant increased odds of remaining on the transplant list at two years existed for all non-white races/ethnicities, except those identifying as multiracial. Asian American candidates had the greatest odds of remaining on the waitlist greater than two years in comparison to white candidates: 1.51 times that of a patient categorized as white (odds ratio [OR] 1.51, confidence interval [CI] 1.44-1.57). African American/Black, (OR 1.38, CI 1.34-1.43) Pacific Islander (OR 1.38, CI 1.17-1.63), Hispanic candidates (OR 1.37, CI 1.32-1.41), and American Indian or Native Alaskan candidates (OR 1.23, CI 1.12-1.46) also had increased odds of remaining on the transplant waitlist greater than two years compared to white candidates. DISCUSSION In this study, ethnic disparities persisted as a barrier for non-white individuals receiving treatment for end-stage kidney disease, specifically in the context of time spent on the waitlist for a kidney transplant. Further research is needed regarding the causes of these disparities in time spent on the waitlist, such as cultural restrictions in organ donation, racial differences in parameters for organ match, and institutionalized racism in health care practitioners.
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Affiliation(s)
- Kristina Fritz
- Medicine, Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, USA
| | - Jennifer Hong
- Medicine, Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, USA
| | - Devina Basdeo
- Medicine, Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, USA
| | - Kimberly Byrnes
- Medicine, Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, USA
| | - Andres Cordoba
- Medicine, Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, USA
| | - Kylie Dunn
- Medicine, Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, USA
| | - Umbul Haider
- Medicine, Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, USA
| | - Mareena Kashif
- Medicine, Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, USA
| | - Nick Lee
- Medicine, Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, USA
| | | | | | - Robin J Jacobs
- Epidemiology and Public Health, Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, USA
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Powers RA, Bleeker K. Self-Defense and Police Reporting of Intimate Partner Violent Victimization: A Comparison of White, Black, and Hispanic Women Victims. J Interpers Violence 2023; 38:4189-4214. [PMID: 35876161 DOI: 10.1177/08862605221114304] [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: 06/15/2023]
Abstract
Although the use of self-defense is common in incidents of intimate partner violence (IPV), correlates of self-protective behaviors in IPV are less known. Furthermore, while research has examined the unintended consequence of dual arrest as a result of using self-defense in IPV incidents, research has not examined whether self-defense is associated with the likelihood of reporting the victimization to the police. The purpose of this study is to first examine the racial differences in the use of self-defense in incidents of IPV. Second, this study examines the relationship between the use of physical self-defense and formal help-seeking (i.e., calling the police) and whether those relationships vary across race/ethnicity for White, Black, and Hispanic women. Using a large nationally representative sample of IPV incidents in the United States, this study found that incidents with Black female victims were more likely to feature physical self-defense compared to incidents with White female victims. Furthermore, incidents with Black female victims were more likely to be reported to the police. There was a positive relationship between physical self-defense and reporting to the police for Black women and an inverse relationship between physical self-defense and reporting to the police for Hispanic women.
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Killough CM, Madaras A, Phillips C, Hettema J, Ceballos V, Fuentes JE, Rishel Brakey H, Wagner K, Page K. Community health worker insights on promoting research engagement with diverse populations. Front Public Health 2023; 10:959504. [PMID: 36711331 PMCID: PMC9874150 DOI: 10.3389/fpubh.2022.959504] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 12/21/2022] [Indexed: 01/13/2023] Open
Abstract
Representation of diverse populations in health research enhances our ability to understand the factors that impact health, generalize results, implement findings, and promote social justice. The primary objective of the study was to understand the unique perspectives of frontline community health workers (CHWs) to identify actionable barriers and facilitators that may impact representation of diverse groups in health research. Focus groups with CHWs were conducted followed by thematic analysis. Results revealed five main themes: barriers/risks to research participation, facilitation of research, CHW roles, recommendations, and transparency. A novel finding was that some CHWs see themselves as both facilitators and gatekeepers. As facilitators, CHWs ensure their patient populations receive resources and benefit from being involved in research; as gatekeepers CHWs feel that they protect patient populations from experiencing further trauma, especially when engaging in research. Recognizing that in many communities there is a high reliance and trust with CHWs, can promote genuine and informed participation at all stages of research.
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Affiliation(s)
- Cynthia M. Killough
- Clinical and Translational Science Center, UNM Health Sciences Center, University of New Mexico, Albuquerque, NM, United States,*Correspondence: Cynthia M. Killough ✉
| | - Annemarie Madaras
- Department of Family and Community Medicine, UNM Health Sciences Center, University of New Mexico, Albuquerque, NM, United States
| | - Christina Phillips
- Department of Family and Community Medicine, UNM Health Sciences Center, University of New Mexico, Albuquerque, NM, United States
| | | | - Venice Ceballos
- Community Health Worker Initiatives, UNM Health Sciences Center, University of New Mexico, Albuquerque, NM, United States
| | - Jesus E. Fuentes
- Clinical and Translational Science Center, UNM Health Sciences Center, University of New Mexico, Albuquerque, NM, United States
| | - Heidi Rishel Brakey
- Clinical and Translational Science Center, UNM Health Sciences Center, University of New Mexico, Albuquerque, NM, United States
| | - Katherine Wagner
- Department of General Internal Medicine, UNM Health Sciences Center, University of New Mexico, Albuquerque, NM, United States
| | - Kimberly Page
- Department of General Internal Medicine, UNM Health Sciences Center, University of New Mexico, Albuquerque, NM, United States
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Hussein HM, Chrenka E, Yang MK, Margolis KL, Kottke TE. Describing Racial Disparity in Hypertension Control in a Large Minnesota Outpatient Practice. Health Serv Res Manag Epidemiol 2023; 10:23333928231192830. [PMID: 37641649 PMCID: PMC10460648 DOI: 10.1177/23333928231192830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 06/28/2023] [Accepted: 07/20/2023] [Indexed: 08/31/2023] Open
Abstract
Introduction This analysis is a part of ongoing quality improvement efforts aiming at improving hypertension control among various racial minority groups seen in a large outpatient practice with a special focus on two war refugee populations, the Hmong and the Somali populations. Method Deidentified medical records were reviewed for adult hypertensive patients who had an outpatient encounter with a hypertension diagnosis during the years 2015 through 2019. The study outcome was the rate of uncontrolled hypertension, defined as systolic blood pressure ≥140 mm Hg or diastolic blood pressure ≥90 mm Hg, and stratified by race, age, and gender. Results There were 752,504 patient records representing 259,824 unique patients (mean age 61 ± 13 years) with 49.1% women, 82.1% white 8.3% African American, 4% Asian, 1.6% Hispanic, Somali 0.6%, and 0.2% Hmong. Hmong men had the highest rate of uncontrolled HTN (33.6%) followed by African American (31.3%) then Somali (29.2%). Among women, African Americans had the highest rate (28.6%) followed by Hmong (28.5%) then Somali (25.7%). In all races except Somali, the rate of uncontrolled hypertension was highest in the 18-29 age group, decreased progressively over the next several decades, then increased again in the ≥70 age group. Conclusion Hmong, African American, and Somali groups have the highest rates of uncontrolled hypertension. Efforts to address hypertension management need to be tailored to the specific characteristics of each racial group and to target young adults.
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Affiliation(s)
| | | | - Mai Kau Yang
- University of Minnesota Neurology Department, Minneapolis, MN, USA
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Keruakous AR, Soror N, Jiménez S, Ashley R, Keruakous M, Sadek BT. Barriers driving health care disparities in utilization of age-appropriate screening. Front Public Health 2023; 11:1100466. [PMID: 36935668 PMCID: PMC10020215 DOI: 10.3389/fpubh.2023.1100466] [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: 11/16/2022] [Accepted: 02/15/2023] [Indexed: 03/06/2023] Open
Affiliation(s)
- Amany R Keruakous
- Department of Internal Medicine, Georgia Cancer Center, Augusta University at Medical College of Georgia, Augusta, GA, United States
| | - Noha Soror
- Section of Hematology-Oncology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Sarah Jiménez
- Department of Internal Medicine, Georgia Cancer Center, Augusta University at Medical College of Georgia, Augusta, GA, United States
| | - Rachel Ashley
- Department of Internal Medicine, Georgia Cancer Center, Augusta University at Medical College of Georgia, Augusta, GA, United States
| | - Mai Keruakous
- Mercer County Community College, West Windsor, NJ, United States
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Abstract
Tobacco advertising exposure increases tobacco use among youth. Data were from a largely racial and ethnic minority sample (60% non-Hispanic (NH) Black/African American) of youth (13-18 years) who were nonsmokers susceptible to future tobacco use (n = 686) or current cigarette smokers (n = 674). Regression models tested associations between tobacco advertisement exposure and smoking status, and determined demographic correlates. Nearly all youth recalled seeing a tobacco advertisement (98%), which was associated with smoking (OR = 1.12; 95% CI = 1.08-1.15). Racial minority youth had higher exposure to tobacco advertising. Policies restricting advertisements for all tobacco products are essential for prevention efforts and may help decrease tobacco-related health disparities.
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Affiliation(s)
- Nicole E Nicksic
- Department of Health Behavior and Policy, Virginia Commonwealth University, One Capitol Square, 830 East Main St, Richmond, VA 23219, USA
| | - Rose S Bono
- Department of Health Behavior and Policy, Virginia Commonwealth University, One Capitol Square, 830 East Main St, Richmond, VA 23219, USA
| | - Alyssa K Rudy
- Department of Psychology, Virginia Commonwealth University, 806 W Franklin St, Richmond, VA 23284, USA
| | - Caroline O Cobb
- Department of Psychology, Virginia Commonwealth University, 806 W Franklin St, Richmond, VA 23284, USA
| | - Andrew J Barnes
- Department of Health Behavior and Policy, Virginia Commonwealth University, One Capitol Square, 830 East Main St, Richmond, VA 23219, USA
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Cancelli G, Audisio K, Perezgrovas-Olaria R, Soletti GJ, Chadow D, Rahouma M, Robinson NB, Gaudino M. Representation of racial minorities in cardiac surgery randomized clinical trials. J Card Surg 2022; 37:1311-1316. [PMID: 35238064 DOI: 10.1111/jocs.16371] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 12/26/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND Racial minorities account for 39.9% of the population in the United States, but are often underrepresented in clinical research. Results from studies predominantly enrolling White patients may not apply to racial minorities. The aim of this analysis is to assess the representation of racial minorities in cardiac surgery randomized clinical trials (RCTs). METHODS A systematic search of the literature was performed. All RCTs published from 2000 to 2020 including at least 100 patients and comparing two or more adult cardiac surgery procedures were included. Meta-analytic estimates were calculated. RESULTS Among 51 cardiac surgery RCTs published between 2000 and 2020, only 9 (17.6%) reported the race of patients and were included in the final analysis. All of them were multicentric, with a mean of 33 centers included. Six RCTs enrolled patients undergoing coronary artery bypass grafting (66.7%), while the remaining three were on valve surgery (33.3%). Overall, 9193 patients were included; of them, 8034 (87.4%) were White and 1026 (11.2%) nonWhite (386 [4.2%] Black, 191 [2.1%] Hispanic, 274 [3.0%] from other races, and 175 [1.9%] nonWhite patients of unspecified race). The proportion of nonWhite patients did not change over time. CONCLUSIONS Only 9 (17.6%) of the 51 cardiac surgery RCTs published between 2000 and 2020 reported the race of the patients enrolled and only 11.2% of them were nonWhite patients. Given the association between race and clinical outcomes, future RCTs should either guarantee a balanced inclusion of racial minorities or be designed to specifically enroll them.
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Affiliation(s)
- Gianmarco Cancelli
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York, USA
| | - Katia Audisio
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York, USA
| | | | - Giovanni J Soletti
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York, USA
| | - David Chadow
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York, USA
| | - Mohamed Rahouma
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York, USA
| | - N B Robinson
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York, USA
| | - Mario Gaudino
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York, USA
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Gerretsen P, Kim J, Quilty L, Wells S, Brown EE, Agic B, Pollock BG, Graff-Guerrero A. Vaccine Hesitancy Is a Barrier to Achieving Equitable Herd Immunity Among Racial Minorities. Front Med (Lausanne) 2021; 8:668299. [PMID: 34901042 PMCID: PMC8652048 DOI: 10.3389/fmed.2021.668299] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 09/30/2021] [Indexed: 11/21/2022] Open
Abstract
Introduction: Racial minority groups have been disproportionately affected by the 2019 novel coronavirus disease (COVID-19). Vaccine hesitancy may be a major barrier to achieving equitable herd immunity and must be addressed to reduce the excess morbidity and mortality of COVID-19 in disproportionately affected communities. This study aimed to determine if COVID-19 vaccine hesitancy, and its factors vaccine complacency and confidence, are more prominent among disproportionately affected racial minority groups. Methods:We collected data from participants aged 18 years or older from the four most populous U.S. states, including New York, California, Florida, and Texas, and Canada. Data were collected using a web-based survey platform. Data are available at http://www.covid19-database.com. Results:Data from 4,434 participants were included [mean (SD) age = 48.7 (17.2) and 50.4% women]. Vaccine hesitancy was higher in Black, Indigenous (Native American and Indigenous People of Canada, including First Nations, Inuit and Métis), and Latinx compared to White participants, while no difference was found between East Asian and White participants. The group differences in vaccine hesitancy for Indigenous and Black compared to White participants remained after controlling for sociodemographic factors. Determinants of vaccine complacency were equivalent between disproportionately affected racial groups and white participants. Vaccine confidence (i.e., trust in vaccine benefit) was generally lower in all racial groups compared to White participants. Differences in vaccine mistrust comparing Black and East Asian to White participants remained after controlling for sociodemographic factors. Discussion:Disproportionately affected racial minorities may have higher vaccine hesitancy and lower confidence in COVID-19 vaccines. Public health and other relevant government services should address vaccine hesitancy among racial minorities using a culturally sensitive, community-centered approach to attain equitable herd immunity.
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Affiliation(s)
- Philip Gerretsen
- Centre for Addiction and Mental Health (CAMH) and Department of Psychiatry, Campbell Family Mental Health Research Institute, University of Toronto, Toronto, ON, Canada
| | - Julia Kim
- Institute of Medical Science, School of Graduate Studies, University of Toronto, Toronto, ON, Canada
| | - Lena Quilty
- Centre for Addiction and Mental Health (CAMH) and Department of Psychiatry, Campbell Family Mental Health Research Institute, University of Toronto, Toronto, ON, Canada
| | - Samantha Wells
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Eric E Brown
- Centre for Addiction and Mental Health (CAMH) and Department of Psychiatry, Campbell Family Mental Health Research Institute, University of Toronto, Toronto, ON, Canada
| | - Branka Agic
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Bruce G Pollock
- Centre for Addiction and Mental Health (CAMH) and Department of Psychiatry, Campbell Family Mental Health Research Institute, University of Toronto, Toronto, ON, Canada
| | - Ariel Graff-Guerrero
- Centre for Addiction and Mental Health (CAMH) and Department of Psychiatry, Campbell Family Mental Health Research Institute, University of Toronto, Toronto, ON, Canada
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Mohanty N, Padilla R, Leo MC, Tilmon S, Akhabue E, Rittner SS, Crawford P, Okihiro M, Persell SD. Disparities in Elevated Body Mass Index in Youth Receiving Care at Community Health Centers. Fam Community Health 2021; 44:238-244. [PMID: 34292227 PMCID: PMC9172270 DOI: 10.1097/fch.0000000000000307] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 06/13/2023]
Abstract
Childhood obesity has increased significantly in the United States. Racial subgroups are often grouped into categories in research, limiting our understanding of disparities. This study describes the prevalence of obesity among youth of diverse racial and ethnic backgrounds receiving care at community health centers (CHCs). This cross-sectional study describes the prevalence of elevated body mass index (BMI) (≥85th percentile) and obesity (≥95th percentile) in youth aged 9 to 19 years receiving care in CHCs in 2014. Multilevel logistic regression estimated the prevalence of elevated BMI and obesity by age, race/ethnicity, and sex. Among 64 925 youth, 40% had elevated BMI and 22% were obese. By race, obesity was lowest in the combined Asian/Pacific Islander category (13%); however, when subgroups were separated, the highest prevalence was among Native Hawaiians (33%) and Other Pacific Islanders (42%) and the lowest in Asians. By sex, Black females and Hispanic and Asian males were more likely to be obese. By age, the highest prevalence of obesity was among those aged 9 to 10 years (25%). Youth served by CHCs have a high prevalence of obesity, with significant differences observed by race, sex, and age. Combining race categories obscures disparities. The heterogeneity of communities warrants research that describes different populations to address obesity.
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Affiliation(s)
- Nivedita Mohanty
- AllianceChicago, Chicago, Illinois (Dr Mohanty and Ms Padilla); SASU Project Management (Ms Rittner) and General Internal Medicine and Geriatrics, Department of Medicine (Dr Persell), Northwestern University Feinberg School of Medicine (Dr Mohanty), Chicago, Illinois; Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Dr Leo and Mr Crawford); University of Chicago, Chicago, Illinois (Ms Tilmon); Division of Cardiology, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey (Dr Akhabue); and University of Hawaii at Manoa, Honolulu (Dr Okihiro)
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Vang ZM, Chau S, Kobayashi K, Owen MJ, McKenzie-Sampson S, Mayrand-Thibert J, Brass G. Pain and Functional Limitations Among Midlife and Older Canadians: The Role of Discrimination, Race and Sense of Belonging. J Gerontol B Psychol Sci Soc Sci 2021:gbab137. [PMID: 34282848 DOI: 10.1093/geronb/gbab137] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES We drew on fundamental cause theory and the weathering hypothesis to examine how discrimination influences aging for midlife and older adults in Canada. METHODS Using nationally representative data, we assessed the associations between discrimination and pain and functional limitations among adults 45 years of age and older. Discrimination was measured using a modified version of the Everyday Discrimination Scale. Chi-square tests were performed to check for baseline differences in the dependent and key predictor variables by race. Logistic regression was used to estimate the associations of discrimination, race, and sense of belonging with pain and functional limitations, net of sociodemographic characteristics and SES. RESULTS Indigenous respondents showed a clear health disadvantage, with higher rates of pain and functional limitations compared to Whites and Asians. Self-reported discrimination was also higher for Indigenous midlife and older adults than for their White and Asian age counterparts. Discrimination had a direct and robust association with pain (OR 1.56, 95% CI 1.31, 1.87) and functional limitations (OR 1.55, 95% CI 1.29, 1.87). However, race moderated the impact of discrimination on functional limitations for Blacks. Finally, a strong sense of belonging to one's local community was protective against pain and functional limitations for all racial groups. DISCUSSION Future research needs to further examine the impact of discrimination on Indigenous peoples' aging process. High rates of discrimination coupled with a greater burden of pain means that Indigenous midlife and older adults may require additional and targeted health and social service resources to age successfully.
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Sosa E, D’Souza G, Akhtar A, Sur M, Love K, Duffels J, Raz DJ, Kim JY, Sun V, Erhunmwunsee L. Racial and socioeconomic disparities in lung cancer screening in the United States: A systematic review. CA Cancer J Clin 2021; 71:299-314. [PMID: 34015860 PMCID: PMC8266751 DOI: 10.3322/caac.21671] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [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: 01/13/2021] [Revised: 03/17/2021] [Accepted: 03/18/2021] [Indexed: 12/14/2022] Open
Abstract
Nonsmall cell lung cancer (NSCLC) is the leading cause of cancer deaths. Lung cancer screening (LCS) reduces NSCLC mortality; however, a lack of diversity in LCS studies may limit the generalizability of the results to marginalized groups who face higher risk for and worse outcomes from NSCLC. Identifying sources of inequity in the LCS pipeline is essential to reduce disparities in NSCLC outcomes. The authors searched 3 major databases for studies published from January 1, 2010 to February 27, 2020 that met the following criteria: 1) included screenees between ages 45 and 80 years who were current or former smokers, 2) written in English, 3) conducted in the United States, and 4) discussed socioeconomic and race-based LCS outcomes. Eligible studies were assessed for risk of bias. Of 3721 studies screened, 21 were eligible. Eligible studies were evaluated, and their findings were categorized into 3 themes related to LCS disparities faced by Black and socioeconomically disadvantaged individuals: 1) eligibility; 2) utilization, perception, and utility; and 3) postscreening behavior and care. Disparities in LCS exist along racial and socioeconomic lines. There are several steps along the LCS pipeline in which Black and socioeconomically disadvantaged individuals miss the potential benefits of LCS, resulting in increased mortality. This study identified potential sources of inequity that require further investigation. The authors recommend the implementation of prospective trials that evaluate eligibility criteria for underserved groups and the creation of interventions focused on improving utilization and follow-up care to decrease LCS disparities.
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Affiliation(s)
- Ernesto Sosa
- Department of Populations Sciences, City of Hope National Medical Center
| | - Gail D’Souza
- Department of Surgery, City of Hope Comprehensive Cancer Center
| | - Aamna Akhtar
- Department of Surgery, City of Hope Comprehensive Cancer Center
| | - Melissa Sur
- Department of Populations Sciences, City of Hope National Medical Center
| | - Kyra Love
- Division of Library Services, City of Hope National Medical Center
| | - Jeanette Duffels
- Division of Library Services, City of Hope National Medical Center
| | - Dan J Raz
- Department of Surgery, City of Hope Comprehensive Cancer Center
| | - Jae Y Kim
- Department of Surgery, City of Hope Comprehensive Cancer Center
| | - Virginia Sun
- Department of Populations Sciences, City of Hope National Medical Center
- Department of Surgery, City of Hope Comprehensive Cancer Center
| | - Loretta Erhunmwunsee
- Department of Populations Sciences, City of Hope National Medical Center
- Department of Surgery, City of Hope Comprehensive Cancer Center
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16
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Yusufov M, Recklitis C, Zhou ES, Bethea TN, Rosenberg L. A population-based psychometric analysis of the insomnia severity index in black women with and without a history of cancer. J Sleep Res 2021; 31:e13421. [PMID: 34128264 DOI: 10.1111/jsr.13421] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 05/19/2021] [Accepted: 05/19/2021] [Indexed: 01/25/2023]
Abstract
Black women are under-represented in insomnia research. Further, cancer treatments increase the risk of late effects, thus affecting the sleep of psychologically and medically vulnerable cancer survivors. The Insomnia Severity Index (ISI) is widely used, but has not been researched in black women, and research in cancer survivors is limited. Prior studies demonstrate that psychometric properties of the ISI are not consistent across samples. This study examined the internal consistency and factor structure of the ISI in 29,500 participants from the Black Women's Health Study, an epidemiological study of black women in the United States. This cohort included 28,214 women without a cancer history and 1,286 cancer survivors. Exploratory, confirmatory and multigroup analyses were conducted to determine the psychometric properties of the ISI in these groups. The mean ISI score was 7.18 (standard deviation [SD] = 6.82). Findings supported the internal consistency reliability of the ISI in black women with (Ω = 0.896) and without (Ω = 0.892) a cancer history. Exploratory factor analyses supported a one-factor structure. Confirmatory factor analyses indicated that fit of this one-factor model was not robust in survivors (Satorra-Bentler chi-square [χSB2 (14)] = 197.78, comparative fit index [CFI] = 0.928, root mean-square error of approximation [RMSEA] = 0.143) or in women with no cancer history (χSB2 (14) = 2,887.93, CFI = 0.945, RMSEA = 0.121), but the alternative models we examined were not superior. Although factor structures in previous studies have varied considerably, we found a one-factor structure. Although internal consistency reliability was strong, factor analytic results did not further support the ISI. Inconsistencies in ISI measurement properties across studies may reflect differences in sample sizes and populations.
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Affiliation(s)
- Miryam Yusufov
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA, USA.,Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Christopher Recklitis
- Perini Family Survivors' Center, Dana-Farber Cancer Institute, Boston, MA, USA.,Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Eric S Zhou
- Perini Family Survivors' Center, Dana-Farber Cancer Institute, Boston, MA, USA.,Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Traci N Bethea
- Georgetown Lombardi Comprehensive Cancer Center, Office of Minority Health and Health Disparities Research, Washington, DC, USA
| | - Lynn Rosenberg
- Slone Epidemiology Center at Boston University, Boston, MA, USA
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17
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Dhawan N, LeBlanc TW. Lean Into the Uncomfortable: Using Trauma-Informed Care to Engage in Shared Decision-Making With Racial Minorities With Hematologic Malignancies. Am J Hosp Palliat Care 2021; 39:4-8. [PMID: 33910380 DOI: 10.1177/10499091211008431] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Discussions involving racial health disparities must include pathways for engaging in shared decision-making with racial/ethnic minorities. Research demonstrates glaring racial and ethnic disparities when it comes to hematologic malignancies from the time of diagnosis to treatment and even at the end of life. Unfortunately, decision-making in these circumstances may be streamlined, given the urgency of the disease, prognostic uncertainty, and varying treatment options. Being diagnosed with cancer is undoubtedly a traumatic experience and a patient's race and/or ethnicity add an important dimension to their experience. The tenets of trauma-informed care (TIC) are anchored in recognizing that trauma can manifest in several ways and acknowledging the impact of past trauma on a patient's present and future behaviors. We argue that using a TIC approach may help hematologists create a space for decision-making while minimizing the risk of re-traumatization and perpetuating racial disparities. Using the foundation of TIC, an interprofessional team can begin addressing manifestations of trauma and hopefully mitigate racial and ethnic disparities.
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Affiliation(s)
- Natasha Dhawan
- 22916Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
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18
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Roman YM, Lor K, Xiong T, Culhane-Pera K, Straka RJ. Gout prevalence in the Hmong: a prime example of health disparity and the role of community-based genetic research. Per Med 2021; 18:311-327. [PMID: 33787318 DOI: 10.2217/pme-2020-0107] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Individuals of distinct Asian backgrounds are commonly aggregated as Asian, which could mask the differences in the etiology and prevalence of health conditions in the different Asian subgroups. The Hmong are a growing Asian subgroup in the United States with a higher prevalence of gout and gout-related comorbidities than non-Hmong. Genetic explorations in the Hmong suggest a higher prevalence of genetic polymorphisms associated with an increased risk of hyperuricemia and gout. History of immigration, acculturation, lifestyle factors, including dietary and social behavioral patterns, and the use of traditional medicines in the Hmong community may also increase the risk of developing gout and lead to poor gout management outcomes. Engaging minorities such as the Hmong population in biomedical research is a needed step to reduce the burden of health disparities within their respective communities, increase diversity in genomic studies, and accelerate the adoption of precision medicine to clinical practice.
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Affiliation(s)
- Youssef M Roman
- Assistant Professor, Virginia Commonwealth University, School of Pharmacy, Richmond, Virginia 23298, USA
| | - Kajua Lor
- Associate Professor & Chair, Medical College of Wisconsin, School of Pharmacy, 8701 W Watertown Plank Rd, Milwaukee, WI 53226, USA
| | - Txia Xiong
- Clinical Pharmacist, West Side Community Health Services, St. Paul, MN 55106, USA
| | | | - Robert J Straka
- Professor & Department Head, University of Minnesota College of Pharmacy, Minneapolis, Minnesota 55455, USA
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19
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Khan MZ, Munir MB, Khan SU, Subramanian CR, Khan MU, Asad ZUA, Talluri S, Madhanakumar A, Lone AN, Khan MS, Michos ED, Alkhouli M. Representation of women, older patients, ethnic, and racial minorities in trials of atrial fibrillation. Pacing Clin Electrophysiol 2021; 44:423-431. [PMID: 33512027 DOI: 10.1111/pace.14178] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 12/28/2020] [Accepted: 01/18/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND Representation trends of women, older adults, and ethnic/racial minorities in randomized controlled trials (RCTs) of atrial fibrillation (AF) are uncertain. METHODS We systematically reviewed 134 AF related RCTs (phase II and III) encompassing 149,162 participants using Medline and ClinicalTrials.gov through April 2019 to determine representation trends of women, older patients (≥75 years), and ethnic/racial minorities. Weighted data on the prevalence of AF from epidemiological studies were used to compare the representation of the studied groups of interest in AF RCTs to their expected burden of the disease. RESULTS Only 18.7% of the RCTs reported proportion of older patients, and 12.7% RCTs reported ethnic/racial minorities. The proportions of women in RCTs versus general population were 35.2% and 35.1%, of Hispanics were 11.9% and 5.2%, of Blacks were 1.2% and 5.7%, of American Indian/Alaskans were 0.2% and 0.2%, of Asians were 14.2% and 2.4%, of native Hawaiian/Pacific Islanders were 0.05% and 0.1% and of non-Whites were 19.5% and 22.5%, respectively. The weighted mean age (SD) across the trials was 65.3 (3.2) years which was less than the corresponding weighted mean age of 71.1 (4.5) years in the comparative epidemiological data. CONCLUSION The reporting of older patients and ethnic/racial minorities was poor in RCTs of AF. The representation of women and American Indian/Alaskan natives matched their expected population share of disease burden. Hispanics and Asians were over-represented and Blacks, native Hawaiian/Pacific Islanders and non-Whites were under-represented in RCTs of AF.
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Affiliation(s)
- Muhammad Zia Khan
- Department of Medicine, West Virginia University, Morgantown, West Virginia, USA
| | - Muhammad Bilal Munir
- Section of Electrophysiology, Division of Cardiovascular Medicine, University of California San Diego, La Jolla, California, USA
| | - Safi U Khan
- Department of Medicine, West Virginia University, Morgantown, West Virginia, USA
| | | | - Muhammad Usman Khan
- Department of Medicine, West Virginia University, Morgantown, West Virginia, USA
| | - Zain Ul Abideen Asad
- Cardiovascular Disease Section, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Swapna Talluri
- Department of Medicine, Guthrie Health System/Robert Packer Hospital, Sayre, Pennsylvania, USA
| | - Aarthi Madhanakumar
- Department of Cardiovascular Medicine, Allegheny General hospital, Pittsburgh, Pennsylvania, USA
| | - Ahmad Naeem Lone
- Department of Medicine, West Virginia University, Morgantown, West Virginia, USA
| | - Muhammad Shahzeb Khan
- Department of Medicine, John H. Stroger Cook County Hospital, Chicago, Illinois, USA
| | - Erin D Michos
- Division of Cardiology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Mohamad Alkhouli
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
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20
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Hayba N, Elkheir S, Hu J, Allman-Farinelli M. Effectiveness of Lifestyle Interventions for Prevention of Harmful Weight Gain among Adolescents from Ethnic Minorities: A Systematic Review. Int J Environ Res Public Health 2020; 17:E6059. [PMID: 32825394 PMCID: PMC7503574 DOI: 10.3390/ijerph17176059] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 08/06/2020] [Accepted: 08/10/2020] [Indexed: 01/08/2023]
Abstract
The escalating obesity among adolescents is of major concern, especially among those from an ethnic minority background. The adolescent period offers a key opportunity for the implementation of positive lifestyle behaviours as children transition to adulthood. The objective of this review was to examine the effectiveness of lifestyle interventions for adolescents and their impact in ethnic and racial minorities for the prevention of overweight and obesity. Seven electronic databases were searched from 2005 until March 2019 for randomized controlled trials of lifestyle programs conducted in this population. The main outcome was change in Body Mass Index (BMI) z-score (kg/m2) or change in BMI and secondary outcomes were changes in physical activity and diet. Thirty studies met the inclusion criteria. Seven studies reported and/or conducted subgroup analysis to determine if ethnic/racial group affected weight change. None demonstrated an overall decrease in BMI z-score. However, six of the seven demonstrated changes in secondary measures such as fruit and vegetable intake and screen time. Results did not differ by ethnic/racial group for primary and secondary outcomes. Overweight and obesity prevention among adolescents from ethnic minorities is an area that needs further research. There is a lack of interventions that include analyses of effectiveness in ethnic minorities.
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Affiliation(s)
- Nematullah Hayba
- Discipline of Nutrition and Dietetics, School of Life and Environmental Science, Charles Perkins Centre, University of Sydney, Sydney 2006, Australia; (S.E.); (J.H.); (M.A.-F.)
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21
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Shervington DO, Richardson L. Mental health framework: coronavirus pandemic in post-Katrina New Orleans. J Inj Violence Res 2020. [PMCID: PMC7487127 DOI: 10.5249/jivr.vo112i2.1538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2022] Open
Abstract
The United Nations Office of Disaster Risk Reduction defines disaster risk as the “likelihood of loss of life, injury or destruction and damage from a disaster in a given period, and a product of the complex interactions that generate conditions of exposure, vulnerability and hazard”. Racial and ethnic minorities in the United States have been shown to have increased vulnerability and risk to disasters due to links between racism, vulnerability, and economic power, based on disadvantage related to different disaster stages: 1) reduced perception of personal disaster risk; 2) lack of preparedness; 3) reduced access and response to warning systems; 4) increased physical impacts due to substandard housing; 5) likelihood of poorer psychological outcomes; 6) cultural insensitivity on the part of emergency workers; 7) marginalization, lower socio-economic status, and less familiarity with support resources leading to protracted recovery; and 8) diminished standard of living, job loss, and exacerbated poverty during reconstruction and community rebuilding. Moreover, given that psychiatric morbidity is predictable in populations exposed to disasters, mental health and psychosocial support programs should increasingly become a standard part of a humanitarian response. In the crisis and immediate recovery phase of disasters, the focus should be on making survivors feel safe and giving them assistance in decreasing their anxiety by addressing their basic needs and welfare. So, it is critical that governmental institutions, business, and non-profit organizations proactively find mechanisms to work collaboratively and share resources. Special attention and extra resources must be directed towards vulnerable and marginalized populations. In this editorial we share lessons learned from experiencing disproportionate impact of health crisis and advocate for the notion that recovery efforts must address trauma at individual, interpersonal and community levels, and be based in a healing justice framework.
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Affiliation(s)
- Denese O. Shervington
- a Charles Drew R. University of Medicine and Science, Los Angles, California, U.S.A.
,
Corresponding Author at:
Denese O. Shervington: MD., M.P.H. Chair, Department of Psychiatry, Charles Drew R. University of Medicine and Science, Los Angles, California, U.S.A. (Shervington DO.).
| | - Lisa Richardson
- b Institute of Women and Ethnic Studies, Los Angles, California, U.S.A.
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22
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Sadarangani T, Missaelides L, Eilertsen E, Jaganathan H, Wu B. A Mixed-Methods Evaluation of a Nurse-Led Community-Based Health Home for Ethnically Diverse Older Adults With Multimorbidity in the Adult Day Health Setting. Policy Polit Nurs Pract 2019; 20:131-144. [PMID: 31373878 PMCID: PMC6827350 DOI: 10.1177/1527154419864301] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Multimorbidity affects 75% of older adults (aged 65 years and older) in the United States and increases risk of poor medical outcomes, especially among the poor and underserved. The creation of a Medicaid option allowing states to establish health homes under the Affordable Care Act was intended to enhance coordinated care for Medicaid beneficiaries with multimorbidity. The Community-Based Health Home (CBHH) model uses the infrastructure of the Adult Day Health Center (ADHC) to serve as a health home to improve outcomes for medically complex vulnerable adults. Between 2017 and 2018, we used a sequential explanatory mixed-methods approach to (a) quantitatively examine changes in depression, fall risk, loneliness, cognitive function, nutritional risk, pain classification, and health care utilization over the course of 12 months in the program and (b) qualitatively explore the perspectives of key stakeholders (registered nurse navigators, participants, ADHC administrators, and caregivers) to identify the most effective components of CBHH. Using data integration techniques, we identified components of CBHH that were most likely driving outcomes. After 12 months in CBHH, our racially diverse sample (N = 126), experienced statistically significant (p < .05) reductions in loneliness, depression, nutritional risk, poorly controlled pain, and emergency department utilization. Stakeholders who were interviewed (n = 40) attributed positive changes to early clinical intervention by the registered nurse navigators, communication with providers across settings, and a focus on social determinants of health, in conjunction with social stimulation and engagement provided by the ADHC. CBHH positions the ADHC as the locus of an effective health home site and is associated with favorable results. CBHH also demonstrates the unique capacity and skill of registered nurses in integrating health and social services across community settings. Continued exploration of CBHH among diverse populations with multimorbidity is warranted.
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Affiliation(s)
| | | | | | | | - Bei Wu
- New York University Rory Meyers College of Nursing, NY, USA
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23
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Banks DE, Zapolski TCB. The crossover effect: A review of racial/ethnic variations in risk for substance use and substance use disorder across development. Curr Addict Rep 2018; 5:386-95. [PMID: 30666284 DOI: 10.1007/s40429-018-0220-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Purpose of Review The "crossover" effect, a phenomenon by which some minority groups switch from low to high risk for substance use as a function of age, was first documented 25 years ago. However, rigorous methodological research examining the crossover effect has only recently emerged. The current paper reviews the past 25 years of research on the crossover effect, which has primarily examined the shift from low to high substance use risk among Blacks relative to Whites. Recent Findings Although findings regarding the crossover effect vary based on gender, socioeconomic status, and substance, Blacks and Hispanics appear to be at lower risk for some substance use- particularly binge drinking and cigarette smoking-than Whites during adolescence and early adulthood, but at higher risk for use in later life. Research regarding the crossover effect of substance use disorder and related problems is limited but more consistent with a similar pattern of effects observed. Summary Due to significant limitations of the extant literature examining the crossover effect, it requires additional research clarifying sociodemographic differences in the, identifying its mechanisms, and determining its clinical implications. Such research may have important implications for preventing racial/ethnic disparities in the consequences associated with disordered substance use.
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Abstract
Sexual minorities and racial minorities experience greater negative impact following sexual assault. We examined recovery from sexual assault among women who identified as heterosexual and bisexual across racial groups. A community sample of women (N = 905) completed three yearly surveys about sexual victimization, recovery outcomes, race group, and sexual minority status. Bisexual women and Black women reported greater recovery problems. However, Black women improved more quickly on depression symptoms than non-Black women. Finally, repeated adult victimization uniquely undermined survivors' recovery, even when controlling for child sexual abuse. Sexual minority and race status variables and their intersections with revictimization play roles in recovery and should be considered in treatment protocols for sexual assault survivors.
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25
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Dillon FR, Whiteman K, Duan R. Measurement Invariance of the Short Inventory of Problems-Revised Across African American and Non-Latino White Substance Users. J Ethn Cult Divers Soc Work 2015; 24:109-129. [PMID: 26207102 PMCID: PMC4509599 DOI: 10.1080/15313204.2014.977985] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/13/2024]
Abstract
This study investigated measurement invariance properties of the Short Inventory of Problems - Revised (SIP-R) across racial groups. The sample included 195 African American and 194 non-Latino White adult participants in a clinical trial investigating the effectiveness of motivational enhancement therapy in the National Institute on Drug Abuse Clinical Trials Network. The SIP-R demonstrated configural invariance and weak metric invariance, suggesting conceptualizations of adverse consequences of substance use are equivalent across racial groups. The SIP-R also indicated partial strong/scalar and strict metric invariance, suggesting a need for continued research of SIP-R items to ensure valid measurement and outcomes across racial groups.
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Affiliation(s)
- Frank R Dillon
- Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA
| | - Karen Whiteman
- Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA
| | - Rui Duan
- Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA
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26
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Lyerly MJ, Wu TC, Mullen MT, Albright KC, Wolff C, Boehme AK, Branas CC, Grotta JC, Savitz SI, Carr BG. The effects of telemedicine on racial and ethnic disparities in access to acute stroke care. J Telemed Telecare 2015; 22:114-20. [PMID: 26116854 DOI: 10.1177/1357633x15589534] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [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: 11/20/2014] [Accepted: 01/05/2015] [Indexed: 11/15/2022]
Abstract
Racial and ethnic disparities have been previously reported in acute stroke care. We sought to determine the effect of telemedicine (TM) on access to acute stroke care for racial and ethnic minorities in the state of Texas. Data were collected from the US Census Bureau, The Joint Commission and the American Hospital Association. Access for racial and ethnic minorities was determined by summing the population that could reach a primary stroke centre (PSC) or telemedicine spoke within specified time intervals using validated models. TM extended access to stroke expertise by 1.5 million residents. The odds of providing 60-minute access via TM were similar in Blacks and Whites (prevalence odds ratios (POR) 1.000, 95% CI 1.000-1.000), even after adjustment for urbanization (POR 1.000, 95% CI 1.000-1.001). The odds of providing access via TM were also similar for Hispanics and non-Hispanics (POR 1.000, 95% CI 1.000-1.000), even after adjustment for urbanization (POR 1.000, 95% CI 1.000-1.000). We found that telemedicine increased access to acute stroke care for 1.5 million Texans. While racial and ethnic disparities exist in other components of stroke care, we did not find evidence of disparities in access to the acute stroke expertise afforded by telemedicine.
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Affiliation(s)
- Michael J Lyerly
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL Stroke Program, Birmingham Veterans Affairs Medical Center, Birmingham, AL
| | - Tzu-Ching Wu
- Department of Neurology, University of Texas - Houston Memorial Hermann Medical Center, Houston, TX
| | - Michael T Mullen
- Department of Neurology, University of Pennsylvania, Philadelphia, PA
| | - Karen C Albright
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL Health Services and Outcomes Research Center for Outcome and Effectiveness Research and Education (COERE), University of Alabama at Birmingham, Birmingham, AL Center for Excellence in Comparative Effectiveness Research for Eliminating Disparities (CERED) Minority Health & Health Disparities Research Center (MHRC), University of Alabama at Birmingham, Birmingham, AL Geriatric Research Education and Clinical Center (GRECC), Birmingham Veterans Affairs Medical Center, Birmingham, AL
| | | | - Amelia K Boehme
- Gertrude Sergievsky Center, Department of Neurology, Columbia University, New York, NY
| | - Charles C Branas
- Department of Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA
| | - James C Grotta
- Department of Neurology, University of Texas - Houston Memorial Hermann Medical Center, Houston, TX
| | - Sean I Savitz
- Department of Neurology, University of Texas - Houston Memorial Hermann Medical Center, Houston, TX
| | - Brendan G Carr
- Department of Emergency Medicine, University of Pennsylvania, Philadelphia, PA
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27
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Myers HF, Wyatt GE, Ullman JB, Loeb TB, Chin D, Prause N, Zhang M, Williams JK, Slavich GM, Liu H. Cumulative burden of lifetime adversities: Trauma and mental health in low-SES African Americans and Latino/as. Psychol Trauma 2015; 7:243-51. [PMID: 25961869 PMCID: PMC4445692 DOI: 10.1037/a0039077] [Citation(s) in RCA: 98] [Impact Index Per Article: 10.9] [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: 01/27/2023]
Abstract
This study examined the utility of a lifetime cumulative adversities and trauma model in predicting the severity of mental health symptoms of depression, anxiety, and posttraumatic stress disorder. We also tested whether ethnicity and gender moderate the effects of this stress exposure construct on mental health using multigroup structural equation modeling. A sample of 500 low-socioeconomic status African American and Latino men and women with histories of adversities and trauma were recruited and assessed with a standard battery of self-report measures of stress and mental health. Multiple-group structural equation models indicated good overall model fit. As hypothesized, experiences of discrimination, childhood family adversities, childhood sexual abuse, other childhood trauma, and chronic stresses all loaded on the latent cumulative burden of adversities and trauma construct (CBAT). The CBAT stress exposure index in turn predicted the mental health status latent variable. Although there were several significant univariate ethnic and gender differences, and ethnic and gender differences were observed on several paths, there were no significant ethnic differences in the final model fit of the data. These findings highlight the deleterious consequences of cumulative stress and trauma for mental health and underscore a need to assess these constructs in selecting appropriate clinical interventions for reducing mental health disparities and improving human health.
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Affiliation(s)
- Hector F Myers
- Center for Medicine, Health, & Society and Psychology, Vanderbilt University
| | - Gail E Wyatt
- Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles
| | | | - Tamra B Loeb
- Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles
| | - Dorothy Chin
- Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles
| | - Nicole Prause
- Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles
| | - Muyu Zhang
- Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles
| | - John K Williams
- Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles
| | - George M Slavich
- Cousins Center for Psychoneuroimmunology, University of California
| | - Honghu Liu
- School of Dentistry, University of California, Los Angeles
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28
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Abstract
This study explored strategies employed by activists engaged in efforts to change policies and laws related to selling and promoting alcoholic beverages based on in-depth interviews with 184 social activists in seven U.S. major cities. Nine strategies aimed at improving local conditions and influencing policy were described by activists across regional contexts. Grassroots mobilization was central to all other strategies, which included the creation or enforcement of laws, meeting with elected officials, media advocacy, working with police/law enforcement, education and training, direct action, changing community norms, and negotiating with store owners.
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Affiliation(s)
- Laurie Drabble
- a San José State University School of Social Work , San José , California
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Kimbrough-Melton RJ. Health for all: the promise of the Affordable Health Care Act for racially and ethnically diverse populations. Am J Orthopsychiatry 2013; 83:352-8. [PMID: 23889026 DOI: 10.1111/ajop.12042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
Cities are now the major sites of human habitation worldwide, a trend that will continue for the foreseeable future, not only in the developed world but in developing countries. Urban residence impacts health and health prospects both positively and negatively through a complex mix of exposures and mechanisms. In addition, cities concentrate population subsets of various demographic, economic, and social characteristics, some with particular health risks and vulnerabilities. Looking at health through the urban lens allows increased understanding of disparate risks and emphasizes the essentiality of collaborative efforts in protecting and enhancing the health of populations, especially those living in cities.
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Abstract
Persistent racial inequality in employment, housing, and a wide range of other social domains has renewed interest in the possible role of discrimination. And yet, unlike in the pre-civil rights era, when racial prejudice and discrimination were overt and widespread, today discrimination is less readily identifiable, posing problems for social scientific conceptualization and measurement. This article reviews the relevant literature on discrimination, with an emphasis on racial discrimination in employment, housing, credit markets, and consumer interactions. We begin by defining discrimination and discussing relevant methods of measurement. We then provide an overview of major findings from studies of discrimination in each of the four domains; and, finally, we turn to a discussion of the individual, organizational, and structural mechanisms that may underlie contemporary forms of discrimination. This discussion seeks to orient readers to some of the key debates in the study of discrimination and to provide a roadmap for those interested in building upon this long and important line of research.
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Affiliation(s)
- Devah Pager
- Department of Sociology, Princeton University, Princeton, New Jersey 08544
| | - Hana Shepherd
- Department of Sociology, Princeton University, Princeton, New Jersey 08544
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