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Kammerer E, Elliott SA, Hartling L, Basi C, Dennett L, Khangura JK, Scott SD, Candelaria P, Ruzycki S, Ali S. Pain experiences of marginalized children in the emergency department: A scoping review protocol. PLoS One 2024; 19:e0296518. [PMID: 38635744 PMCID: PMC11025926 DOI: 10.1371/journal.pone.0296518] [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: 12/06/2023] [Accepted: 12/14/2023] [Indexed: 04/20/2024] Open
Abstract
INTRODUCTION Pain affects all children, and in hospitals across North America, this pain is often undertreated. Children who visit the emergency department (ED) experience similar undertreatment, and they will often experience a painful procedure as part of their diagnostic journey. Further, children and their caregivers who experience social injustices through marginalization are more likely to experience healthcare disparities in their pain management. Still, most of our knowledge about children's pain management comes from research focused on well-educated, white children and caregivers from a middle- or upper-class background. The aim of this scoping review is to identify, map, and describe existing research on (a) how aspects of marginalization are documented in randomized controlled trials related to children's pain and (b) to understand the pain treatment and experiences of marginalized children and their caregivers in the ED setting. METHODS AND ANALYSIS The review will follow Joanna Briggs Institute methodology for scoping reviews using the Participant, Concept, Context (PCC) framework and key terms related to children, youth, pain, ED, and aspects of marginalization. We will search Medline, Embase, PsychInfo, CINAHL, Web of Science, Cochrane Library Trials, iPortal, and Native Health Database for articles published in the last 10 years to identify records that meet our inclusion criteria. We will screen articles in a two-step process using two reviewers during the abstract and full-text screening stages. Data will be extracted using Covidence for data management and we will use a narrative approach to synthesize the data. ETHICS AND DISSEMINATION Ethical approval is not required for this review. Findings will be disseminated in academic manuscripts, at academic conferences, and with partners and knowledge users including funders of pain research and healthcare professionals. Results of this scoping review will inform subsequent quantitative and qualitative studies regarding pain experiences and treatment of marginalized children in the ED.
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Affiliation(s)
- Elise Kammerer
- Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Sarah A. Elliott
- Alberta Research Centre for Health Evidence, Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
- Department of Pediatrics, Cochrane Child Health, University of Alberta, Edmonton, AB, Canada
| | - Lisa Hartling
- Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
- Alberta Research Centre for Health Evidence, Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
- Department of Pediatrics, Cochrane Child Health, University of Alberta, Edmonton, AB, Canada
- Women and Children’s Health Research Institute, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Calveen Basi
- Departments of Chemistry and Psychology, Faculty of Science, University of Alberta, Edmonton, AB, Canada
| | - Liz Dennett
- Geoffrey and Robyn Sperber Health Sciences Library, University of Alberta, Edmonton, AB, Canada
| | - Jaspreet K. Khangura
- Department of Emergency Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | | | - Patricia Candelaria
- Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Shannon Ruzycki
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Samina Ali
- Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
- Women and Children’s Health Research Institute, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
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Mitra S, Kerr T, Cui Z, Gilbert M, Fleury M, Hayashi K, Milloy MJ, Richardson L. Patterns of Socioeconomic Marginalization among People Who Use Drugs: A Gender-Stratified Repeated Measures Latent Class Analysis. J Urban Health 2024; 101:402-425. [PMID: 38472731 PMCID: PMC11052948 DOI: 10.1007/s11524-024-00828-0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/17/2024] [Indexed: 03/14/2024]
Abstract
Socioeconomic factors are important correlates of drug use behaviors and health-related outcomes in people who use drugs (PWUD) residing in urban areas. However, less is known about the complex overlapping nature of socioeconomic conditions and their association with a range of individual, drug use, and health-related factors in men and women who use drugs. Data were obtained from two community-recruited prospective cohorts of PWUD. Using a gender-stratified approach, we conducted repeated measures latent class analyses (RMLCA) to identify discrete latent socioeconomic subgroups. Multivariable generalized estimating equations were then used to identify correlates of class membership. Between June 2014 and December 2018, RMLCA of 9844 observations from 1654 participants revealed five distinct patterns of socioeconomic status for both men and women. These patterns were primarily distinguished by variations in income, material and housing security, income generation activity, exposure to violence, criminal justice involvement, and police contact. Across gender, progressive increases in exposure to multiple dimensions of socioeconomic disadvantage were found to be associated with frequent use of opioids and stimulants, accessing social services, and being hepatitis C virus antibody-positive. Similar but less congruent trends across gender were observed for age, binge drug use, engagement with opioid agonist therapy, and living with HIV. Gendered patterns of multiple and overlapping dimensions of socioeconomic adversity aligned with patterns of frequent drug use and health-related concerns, highlighting priority areas for gender-inclusive, multilevel responses to mitigate health disparities and meet the diverse socioeconomic needs of urban-dwelling men and women who use drugs.
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Affiliation(s)
- Sanjana Mitra
- British Columbia Centre On Substance Use, University of British Columbia, 400-1045 Howe, Vancouver, BC, V6Z 2A9, Canada
| | - Thomas Kerr
- British Columbia Centre On Substance Use, University of British Columbia, 400-1045 Howe, Vancouver, BC, V6Z 2A9, Canada
- Department of Medicine, University of British Columbia, 317-2194 Health Sciences Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Zishan Cui
- British Columbia Centre On Substance Use, University of British Columbia, 400-1045 Howe, Vancouver, BC, V6Z 2A9, Canada
- School of Population and Public Health, University of British Columbia, 2206 E Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Mark Gilbert
- School of Population and Public Health, University of British Columbia, 2206 E Mall, Vancouver, BC, V6T 1Z3, Canada
- British Columbia Centre for Disease Control, 655 West 12th Avenue, Vancouver, BC, V5Z 4R4, Canada
| | - Mathew Fleury
- British Columbia Centre On Substance Use, University of British Columbia, 400-1045 Howe, Vancouver, BC, V6Z 2A9, Canada
- Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada
| | - Kanna Hayashi
- British Columbia Centre On Substance Use, University of British Columbia, 400-1045 Howe, Vancouver, BC, V6Z 2A9, Canada
- Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada
| | - M-J Milloy
- British Columbia Centre On Substance Use, University of British Columbia, 400-1045 Howe, Vancouver, BC, V6Z 2A9, Canada
- Department of Medicine, University of British Columbia, 317-2194 Health Sciences Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Lindsey Richardson
- British Columbia Centre On Substance Use, University of British Columbia, 400-1045 Howe, Vancouver, BC, V6Z 2A9, Canada.
- Department of Sociology, University of British Columbia, 6303 NW Marine Drive, Vancouver, BC, V6T 1Z1, Canada.
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Boeskov Øzhayat E, Elmongy A, Tanderup L, Bordorff SL, Thiesen H. A cross-sectional study on oral health-care habits and oral-health-related quality-of-life in marginalized persons in Copenhagen. Acta Odontol Scand 2024; 83:7-12. [PMID: 37975754 DOI: 10.1080/00016357.2023.2282648] [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: 11/21/2023] [Revised: 06/29/2023] [Accepted: 11/08/2023] [Indexed: 11/19/2023]
Abstract
OBJECTIVE The aim of this cross-sectional study was to investigate the oral-health-related quality-of-life (OHRQoL) and oral health-care habits in a population of marginalized persons in Copenhagen. MATERIALS AND METHODS Patients attending a dental clinic for marginalized persons filled in the 14-item version of the oral-health-impact profile (OHIP-14) regarding their OHRQoLand a questionnaire on their oral health-care habits. Age, gender, smoking habits, need for general and oral health-care, and living conditions were further registered. RESULTS Of the 212 participants, 72% had not visited a dental clinic within the past two years and in 68% of the cases, the last dental visit was related to dental treatment. Tooth brushing at least once a day was reported by 93%. The mean OHIP-14 score in the participants was 24.9 (SD: 13.6). The most frequent problems were pain, chewing difficulties, being self-conscious, tense, and embarrassed as well as affected life. The mean OHIP-14 score was significantly higher in participants in need of general health-care (29.5, SD: 12.2) than in participants not in need of general health-care (22.8, SD: 13.9). The same applied to participants referred for dental treatment (26.1, SD: 12.7) compared to participants not being referred (20.2, SD: 15.9). CONCLUSIONS The OHRQoLis poor in the population with pain, chewing difficulties and aesthetic issues as the most prominent problems. The participants had low and treatment-oriented use of the dental care system. This indicates a high need for dental care in the population with a focus on including them in the dental care system.
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Affiliation(s)
- Esben Boeskov Øzhayat
- Section of Community Dentistry, Department of Odontology, University of Copenhagen, Copenhagen, Denmark.
| | - Ashraf Elmongy
- HealthTeam for the Homeless, Copenhagen, Center for Marginalized Adults and Families, Copenhagen City Social Services, Copenhagen, Denmark
| | - Lene Tanderup
- HealthTeam for the Homeless, Copenhagen, Center for Marginalized Adults and Families, Copenhagen City Social Services, Copenhagen, Denmark
| | - Sine Lykke Bordorff
- HealthTeam for the Homeless, Copenhagen, Center for Marginalized Adults and Families, Copenhagen City Social Services, Copenhagen, Denmark
| | - Henrik Thiesen
- HealthTeam for the Homeless, Copenhagen, Center for Marginalized Adults and Families, Copenhagen City Social Services, Copenhagen, Denmark
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Dillis C, Petersen-Rockney M, Polson M. A theory of geo- social marginalization: A case study of the licensed cannabis industry in California. J Environ Manage 2024; 355:120396. [PMID: 38430877 DOI: 10.1016/j.jenvman.2024.120396] [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: 07/31/2023] [Revised: 12/20/2023] [Accepted: 02/11/2024] [Indexed: 03/05/2024]
Abstract
The licensed cannabis industry represents one of the top five most economically valued agricultural commodities in California, yet farming largely remains on remote, environmentally sensitive, "marginal" lands. Using mixed methods, this paper examines the determinants of this marginalization, their embedded elaboration, and their relation to historical policy regimes. We used Generalized Additive Models (GAMs) to determine the most important predictors of licensed cannabis industry development since the inception of a statewide licensing program in 2018 and to compare the distribution of licensed cannabis to other forms of rural agriculture, including vineyards and pasture, to understand landscape factors and environmental sensitivity of land uses. We found that a county's median income and the extent of traditional (non-cannabis) agriculture, as measured by the proportion of on-farm (non-cannabis) employment, were both negatively associated with its amount of licensed cannabis agriculture. Ethnographic data suggests that cannabis is often excluded from traditional agricultural areas, through formal local-level bans, restrictive zoning, high "prime" farmland values, and cultural exclusions from other powerful resource users. The resulting relegation to "marginal" lands foments conflicts with amenity land users and environmentalists, even as it partly supports "legacy" cultivators whose farms were established under prior policy regimes. Results suggest that cannabis is more likely to be grown under conditions that introduce regulatory hurdles, including farming on steeper slopes, with natural streams onsite, and without access to large groundwater aquifers for irrigation. Our findings suggest that failure to allow licensed cannabis farming in traditional agriculture regions has led to a self-fulfilling prophecy wherein cannabis cultivation is largely relegated to environmentally sensitive areas where cultivation activity has an elevated tendency for environmental impacts.
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Affiliation(s)
- Chris Dillis
- Department of Environmental Science, Policy & Management (ESPM), University of California, Berkeley, United States.
| | - Margiana Petersen-Rockney
- Department of Environmental Science, Policy & Management (ESPM), University of California, Berkeley, United States
| | - Michael Polson
- Department of Geography, University of California, Berkeley, United States
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Thai M, Nylund JL. What are they in it for? Marginalised group members' perceptions of allies differ depending on the costs and rewards associated with their allyship. Br J Soc Psychol 2024; 63:131-152. [PMID: 37534748 DOI: 10.1111/bjso.12670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 05/28/2023] [Indexed: 08/04/2023]
Abstract
Advantaged group allies can incur costs or rewards as a result of their allyship. The present work investigates whether such costs and rewards affect how marginalised group members perceive these allies. Across four experiments that collectively examine marginalised group members' perceptions of individual and corporate allies in the context of allyship for women's rights, Black Lives Matter and the LGBTQI+ community, we find that allies are perceived differently as a function of the costs and rewards associated with their allyship. Allies who face costs are perceived more positively in terms of tenacity and genuine motivations, and are generally evaluated more favourably compared to allies who do not face costs and those who, instead, garner rewards for their allyship. These findings demonstrate that marginalised group members are cognisant of the costs and rewards allies may reap, and that this information can shape their judgements of allies' investment in the cause.
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Affiliation(s)
- Michael Thai
- School of Psychology, The University of Queensland, St Lucia, Queensland, Australia
| | - Jarren L Nylund
- School of Psychology, The University of Queensland, St Lucia, Queensland, Australia
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Karuga R, Kabaria C, Chumo I, Okoth L, Njoroge I, Otiso L, Muturi N, Karki J, Dean L, Tolhurst R, Steege R, Ozano K, Theobald S, Mberu B. Voices and challenges of marginalized and vulnerable groups in urban informal settlements in Nairobi, Kenya: building on a spectrum of community-based participatory research approaches. Front Public Health 2023; 11:1175326. [PMID: 38074741 PMCID: PMC10701261 DOI: 10.3389/fpubh.2023.1175326] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 11/06/2023] [Indexed: 12/18/2023] Open
Abstract
Urbanization is rapidly increasing across Africa, including in Nairobi, Kenya. Many people, recent migrants and long-term residents, live within dense and dynamic urban informal settlements. These contexts are fluid and heterogeneous, and deepening the understanding of how vulnerabilities and marginalization are experienced is important to inform pointed action, service delivery and policy priorities. The aim of this paper is to explore vulnerabilities and marginalization within Korogocho and Viwandani informal settlements in Nairobi and generate lessons on the value of a spectrum of community based participatory research approaches for understanding health and well-being needs and pinpointing appropriate interventions. In the exploratory stages of our ARISE consortium research, we worked with co-researchers to use the following methods: social mapping, governance diaries, and photo voice. Social mapping (including the use of Focus Group Discussions) identified key vulnerable groups: marginalized and precarious child heads of households (CHHs), Persons with disability who face multiple discrimination and health challenges, and often isolated older adults; and their priority needs, including health, education, water and sanitation. The governance diaries generated an understanding of the perceptions of the particularly vulnerable and marginalized informal settlement residents regarding the various people and institutions with the power to influence health and wellbeing; while photo voice highlighted the lived experiences of vulnerability and marginality. Understanding and responding to fluid and intersecting marginalities and vulnerabilities within growing urban informal settlements is particularly critical to achieving inclusive urbanization, where no one is left behind, a theme central to the Sustainable Development Goals and Kenya's Vision 2030.
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Affiliation(s)
- Robinson Karuga
- Department of Research and Strategic Information, LVCT Health, Nairobi, Kenya
| | - Caroline Kabaria
- Urbanization and Wellbeing Unit, African Population and Health Research Center, Nairobi, Kenya
| | - Ivy Chumo
- Urbanization and Wellbeing Unit, African Population and Health Research Center, Nairobi, Kenya
| | - Linet Okoth
- Department of Research and Strategic Information, LVCT Health, Nairobi, Kenya
| | - Inviolata Njoroge
- Department of Research and Strategic Information, LVCT Health, Nairobi, Kenya
| | - Lilian Otiso
- Department of Research and Strategic Information, LVCT Health, Nairobi, Kenya
| | - Nelly Muturi
- Airbel Impact Lab, International Rescue Committee, Nairobi, Kenya
| | - Jiban Karki
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Laura Dean
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Rachel Tolhurst
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Rosie Steege
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Kim Ozano
- The SCL Agency, Wales, United Kingdom
| | - Sally Theobald
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Blessing Mberu
- Urbanization and Wellbeing Unit, African Population and Health Research Center, Nairobi, Kenya
- Department of Demography and Population Studies, University of Witwatersrand, Johannesburg, South Africa
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Abstract
Marginalization encompasses structural, interpersonal, and intergroup dynamics that perpetuate inequality and exclusion. This manuscript advocates that the solution to marginalization lies in fostering a sense of belonging. Belonging is a fundamental human need, critical for mental well-being, academic success, and personal growth. It significantly impacts engagement, retention, and overall development, especially in health professional education settings like nursing schools. When individuals feel they belong, they are more likely to seek support, engage actively in learning, and perform better academically. However, achieving a sense of belonging is not straightforward, and many challenges at both individual and institutional levels hinder its realization. Individual challenges include resistance to change, implicit biases, and lack of awareness of the disparities caused by marginalization. Institutional challenges include insufficient commitment, inadequate resource allocation, and lack of representation from marginalized groups. In the United States, recent legislation obstructing initiatives toward diversity, equity, and inclusion poses additional obstacles. To overcome these challenges and promote belonging, this manuscript offers strategies that highlight the importance of aligning institutional values with policies and practices, recognizing and rewarding inclusive efforts, and actively seeking diverse perspectives.
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Affiliation(s)
- Brigit M Carter
- Chief Diversity, Equity, and Inclusion Officer, American Association of Colleges of Nursing, Washington, DC
| | | | - Wanda Thruston
- Director Diversity, Equity, and Inclusion Officer, American Association of Colleges of Nursing, Washington, DC
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Medina Gómez OS, Villegas Lara B, Escobedo DE LA Peña J. Impact of social marginalization on oral health-related quality of life in older adults. Braz Oral Res 2023; 37:e095. [PMID: 37820253 DOI: 10.1590/1807-3107bor-2023.vol37.0095] [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: 05/12/2022] [Accepted: 06/15/2023] [Indexed: 10/13/2023] Open
Abstract
The aim of this study was to determine the association between oral health-related quality of life (OHRQoL) and social marginalization in people aged 60 years and older enrolled in social security in Mexico. A cross-sectional and analytical study was carried out in older adults. To assess the OHRQoL, the OHIP-14 instrument was applied, and the degree of social marginalization and sociodemographic characteristics were analyzed. Measures of central tendency and dispersion, simple frequencies and proportions were estimated. Student's t-test was used for comparison of means, and prevalence ratio (PR) and logistic regression were used to assess associations, all with a significance value of 0.05 and 95% confidence intervals. Perceived OHRQoL in the population measured through the OHIP-14 reached an average value of 9.84 ± 8.91, with the highest value in the dimension of physical pain (2.06 ± 1.91). Perceived treatment need was higher among people with social marginality (p = 0.011). The multivariate analysis shows that marginalized people have a lower OHRQoL. Socially marginalized older adults showed a low a better perception of OHRQoL, independent of demographic and clinical factors.
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Affiliation(s)
- Oswaldo Sinoe Medina Gómez
- Instituto Mexicano del Seguro Social,HGR 1 Carlos MacGregor Sánchez Navarro, Unidad de Investigación en Epidemiología Clínica, Ciudad de México, México
| | - Beatriz Villegas Lara
- Instituto Mexicano del Seguro Social,HGR 1 Carlos MacGregor Sánchez Navarro, Unidad de Investigación en Epidemiología Clínica, Ciudad de México, México
| | - Jorge Escobedo DE LA Peña
- Instituto Mexicano del Seguro Social,HGR 1 Carlos MacGregor Sánchez Navarro, Unidad de Investigación en Epidemiología Clínica, Ciudad de México, México
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Briere J, Runtz M. Police in the rearview mirror: Social marginalization, trauma, and fear of being killed. Am J Orthopsychiatry 2023; 94:15-22. [PMID: 37796598 DOI: 10.1037/ort0000700] [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] [Subscribe] [Scholar Register] [Indexed: 10/06/2023]
Abstract
An online sample of 528 people was asked to respond to a hypothetical scenario: If a police car came up right behind you with its lights flashing, how much would you worry that you would be killed? Participants also reported on whether they experienced aggressive behavior by police in the past (provoked or otherwise) and, if so, completed a measure of associated posttraumatic stress. At least some fear of being killed by police (FKP) in the rearview mirror scenario was reported by the majority (56%) of Black participants, 39% of those self-describing as "other or mixed" race, and 31% of Hispanic participants, as compared to 26% of those of Asian descent and 19% of those identifying as White. When the highest level of FKP was considered, Black participants were 12 times more likely than White participants to report "extreme" fear of death at the hands of police. Lesbian, gay, bisexual, transgender, queer, and more participants were also more likely than cisgender/heterosexual respondents to report both FKP (35% vs. 20%) and "extreme" FKP (8% vs. 3%). FKP was also more prevalent among those self-reporting unprovoked police aggression in the past and those for whom police aggression had led to posttraumatic stress disorder. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
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Affiliation(s)
- John Briere
- Department of Psychiatry and Behavioral Sciences, Keck School of Medicine, University of Southern California
| | - Marsha Runtz
- Department of Psychiatry and Behavioral Sciences, Keck School of Medicine, University of Southern California
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Abstract
Despite being targets of intervention practice and research for over 60 years, autistic people have been left out of the conversation. Until recently, nearly no research or implementation work has sought the input of autistic people in regard to the design of interventions and, more importantly, how the goals for such interventions are prioritized and determined. This reframe has profound implications for autism-focused interventions and research, most of which have aimed to reduce or eliminate autism symptoms, with variable empirical support (Bottema-Beutel, 2023). These outcomes are practically and ethically incompatible with a neurodiversity perspective. Most prominently, applied behavior analysis (ABA), which was the first intervention approach widely applied to autistic people, has come under increasing scrutiny and criticism for failing to include autistic people in the design of intervention elements and consideration of goals; moreover, autistic people are increasingly identifying iatrogenic effects they have experienced when receiving ABA (Bottema-Beutel, 2023), with these concerns often being met with minimization rather than an endorsement of their validity and willingness to hear them out. Thus, there is a pressing need for a neurodiversity-affirming interventions (NAI) framework for autism. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
| | - Ava N. Gurba
- Department of Psychology, Stony Brook University
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11
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Corpuz JC. The marginalization of LGBTQIA+ in public health discourse. J Public Health (Oxf) 2023; 45:e592-e593. [PMID: 37000530 DOI: 10.1093/pubmed/fdad033] [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] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 01/05/2023] [Accepted: 03/08/2023] [Indexed: 04/01/2023] Open
Affiliation(s)
- Jeff Clyde Corpuz
- Department of Theology and Religious Education, De La Salle University, Manila 1004, The Philippines
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Mazon C, Jimenez-Maldonado J, Walters FP. Intersectionality and adolescent medicine: an overview. Curr Opin Pediatr 2023; 35:401-407. [PMID: 37014804 DOI: 10.1097/mop.0000000000001251] [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: 04/05/2023]
Abstract
PURPOSE OF REVIEW This review defines intersectionality, discusses recent studies that use an intersectional framework in adolescent health research, and outlines ways where clinicians can use intersectionality to address health disparities in youth of color through clinical practice, research, and advocacy. RECENT FINDINGS Research using an intersectional framework can identify populations at risk for certain disorders or behaviors. Recent studies in adolescent health research using an intersectional lens identified lesbian girls of color as an at-risk population for e-cigarette use, demonstrated lower skin color satisfaction among Black girls of all ages predicted greater binge-eating disorder symptoms, and showed that two-thirds of Latine (gender-neutral term that refers to people with Latin American roots) youth who recently immigrated to the United States experienced at least one traumatic event during their migration journey, putting them at risk for PTSD and other mental health disorders. SUMMARY Intersectionality refers to how multiple social identities intersect to produce a specific experience that reflects overlapping systems of oppression. Diverse youth contain multiple identities that intersect to produce unique experiences and health inequities. Using an intersectional framework acknowledges that youth of color are not homogenous. Intersectionality becomes an important tool to care for marginalized youth and advance health equity.
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Affiliation(s)
- Candice Mazon
- Division of Adolescent and Young Adult Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Heerde JA, Merrin GJ, Le VT, Toumbourou JW, Bailey JA. Health of Young Adults Experiencing Social Marginalization and Vulnerability: A Cross-National Longitudinal Study. Int J Environ Res Public Health 2023; 20:1711. [PMID: 36767076 PMCID: PMC9914820 DOI: 10.3390/ijerph20031711] [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: 11/27/2022] [Revised: 12/22/2022] [Accepted: 12/27/2022] [Indexed: 06/18/2023]
Abstract
People who experience social marginalization and vulnerability have uniquely complex health needs and are at risk of poor health outcomes. Regression analyses using longitudinal data from a cross-national, population-based sample of young adults participating in the International Youth Development Study, tested associations between social marginalization and vulnerabilities and physical health, mental health, and substance use outcomes. Participants from Victoria, Australia, and Washington State in the US were surveyed at ages 25 (2014) and 29 years (2018; N = 1944; 46.7% male). A history of adverse childhood experiences (ACEs), LGBT identity, financial insecurity, and justice system involvement at age 25 predicted poor health outcomes at age 28, including lower perceived health status, risk for chronic illness, depression and anxiety symptoms, and diagnosed mental health/substance use disorders. Tests of model equivalence across states showed that a history of ACEs was more strongly related to health status and serious injury at age 28 and justice system involvement at age 25 was more strongly related to age 28 serious injury in Victoria than in Washington State. Findings strengthen the case for future population-based research identifying life-course interventions and state policies for reducing poor health and improving health equity among members of socially marginalized groups.
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Affiliation(s)
- Jessica A. Heerde
- Department of Paediatrics, The University of Melbourne, Parkville 3052, Australia
- Department of Social Work, The University of Melbourne, Parkville 3010, Australia
- Centre for Adolescent Health, Murdoch Children’s Research Institute, Parkville 3052, Australia
| | - Gabriel J. Merrin
- Department of Human Development and Family Science, Syracuse University, Syracuse, NY 13244, USA
| | - Vi T. Le
- Social Development Research Group, School of Social Work, University of Washington, Seattle, WA 98115, USA
| | - John W. Toumbourou
- Centre for Adolescent Health, Murdoch Children’s Research Institute, Parkville 3052, Australia
- Centre for Social and Early Emotional Development, School of Psychology, Deakin University, Burwood 3125, Australia
| | - Jennifer A. Bailey
- Social Development Research Group, School of Social Work, University of Washington, Seattle, WA 98115, USA
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Shashikumar SA, Gulseren B, Berlin NL, Hollingsworth JM, Joynt Maddox KE, Ryan AM. Association of Hospital Participation in Bundled Payments for Care Improvement Advanced With Medicare Spending and Hospital Incentive Payments. JAMA 2022; 328:1616-1623. [PMID: 36282256 PMCID: PMC9597389 DOI: 10.1001/jama.2022.18529] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 09/20/2022] [Indexed: 11/14/2022]
Abstract
Importance Bundled Payments for Care Improvement Advanced (BPCI-A) is a Centers for Medicare & Medicaid Services (CMS) initiative that aims to produce financial savings by incentivizing decreases in clinical spending. Incentives consist of financial bonuses from CMS to hospitals or penalties paid by hospitals to CMS. Objective To investigate the association of hospital participation in BPCI-A with spending, and to characterize hospitals receiving financial bonuses vs penalties. Design, Setting, and Participants Difference-in-differences and cross-sectional analyses of 4 754 139 patient episodes using 2013-2019 US Medicare claims at 694 participating and 2852 nonparticipating hospitals merged with hospital and market characteristics. Exposures BPCI-A model years 1 and 2 (October 1, 2018, through December 31, 2019). Main Outcomes and Measures Hospitals' per-episode spending, CMS gross and net spending, and the incentive allocated to each hospital. Results The study identified 694 participating hospitals. The analysis observed a -$175 change in mean per-episode spending (95% CI, -$378 to $28) and an aggregate spending change of -$75.1 million (95% CI, -$162.1 million to $12.0 million) across the 428 670 episodes in BPCI-A model years 1 and 2. However, CMS disbursed $354.3 million (95% CI, $212.0 million to $496.0 million) more in bonuses than it received in penalties. Hospital participation in BPCI-A was associated with a net loss to CMS of $279.2 million (95% CI, $135.0 million to $423.0 million). Hospitals in the lowest quartile of Medicaid days received a mean penalty of $0.41 million; (95% CI, $0.09 million to $0.72 million), while those in the highest quartile received a mean bonus of $1.57 million; (95% CI, $1.09 million to $2.08 million). Similar patterns were observed for hospitals across increasing quartiles of Disproportionate Share Hospital percentage and of patients from racial and ethnic minority groups. Conclusions and Relevance Among US hospitals measured between 2013 and 2019, participation in BPCI-A was significantly associated with an increase in net CMS spending. Bonuses accrued disproportionately to hospitals providing care for marginalized communities.
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Affiliation(s)
- Sukruth A Shashikumar
- Cardiovascular Division, Department of Medicine, Washington University School of Medicine, St Louis, Missouri
| | - Baris Gulseren
- School of Public Health, University of Michigan, Ann Arbor
- Center for Evaluating Health Reform, University of Michigan, Ann Arbor
| | - Nicholas L Berlin
- Department of Surgery, Section of Plastic Surgery, University of Michigan, Ann Arbor
| | | | - Karen E Joynt Maddox
- Cardiovascular Division, Department of Medicine, Washington University School of Medicine, St Louis, Missouri
- Center for Health Economics and Policy, Institute for Public Health, Washington University in St Louis, St Louis, Missouri
- Associate Editor, JAMA
| | - Andrew M Ryan
- School of Public Health, Brown University, Providence, Rhode Island
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15
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Yalcinoz-Ucan B, Zilney L, Zientarska-Kayko A, Ireland T, Browne DT. Examining the effectiveness of psychological interventions for marginalised and disadvantaged women and individuals who have experienced gender-based violence: protocol for a scoping review. BMJ Open 2022; 12:e060479. [PMID: 35798531 PMCID: PMC9263928 DOI: 10.1136/bmjopen-2021-060479] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Exposure to gender-based violence (GBV) has devastating psychological outcomes for victims/survivors. Particularly in conditions where GBV intersects with multiple forms of oppression, the negative impacts of violence are more challenging to overcome and potential pathways for recovery become less accessible. However, evidence regarding the availability and effectiveness of mental health interventions for GBV survivors from marginalised and disadvantaged communities has yet to be systematically integrated and synthesised. The proposed scoping review will examine the relevant literature regarding the availability and effectiveness of psychological interventions for survivors of GBV from marginalised and disadvantaged backgrounds. This review will (i) document what psychological interventions have been available and empirically established for marginalised and disadvantaged women and individuals with experiences of GBV, (ii) provide a narrative examination of the treatment outcomes of identified interventions regarding their effectiveness and (iii) examine the degree to which GBV interventions in selected sources are designed and applied with a recognition of the social determinants of mental health. METHODS AND ANALYSIS The search for the proposed scoping review will include five electronic databases: PsycINFO, Scopus, Web of Science, Ovid Medline, and CINAHL. The database search will be completed in June 2022. An additional search will be conducted before the completion of the study in December 2022. The search will target research studies published after 2010. The primary eligibility criterion for study selection is having a focus on psychological interventions for GBV survivors from marginalised and disadvantaged groups. Two reviewers will conduct screening and data extraction. The data will be evaluated to map the treatment outcomes of interventions and their effectiveness. Implications for clinical services will be discussed. ETHICS AND DISSEMINATION No ethical consideration is foreseen for this scoping review. The dissemination will be done through a publication in a top-tier open access journal and conference presentations.
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Affiliation(s)
| | | | | | - Timothy Ireland
- Information Services and Resources, University of Waterloo, Waterloo, Ontario, Canada
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16
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Littman DM. Third Places, Social Capital, and Sense of Community as Mechanisms of Adaptive Responding for Young People Who Experience Social Marginalization. Am J Community Psychol 2022; 69:436-450. [PMID: 34080191 DOI: 10.1002/ajcp.12531] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 06/12/2023]
Abstract
Many young people who experience social marginalization (such as young people of color, who identify as LGBTQ, and who have experienced housing instability, among others) have often faced significant trauma exposure and social oppression and may endure subsequent adverse impacts on their well-being. Conversely, many such young people exhibit adaptive responding-the ability to maintain well-being through and despite such contextual constraints. This theoretical paper illustrates a conceptual model for how third places-public settings which offer sociability and community connection-may foster adaptive responding through the mutually constitutive (i.e., mutually reinforcing and interrelated) mechanisms of psychological sense of community and social capital. As prior work on third places has not considered the social marginalization which many young people face, especially in public settings, this theoretical model also considers how social policing in third places potentially moderates the mutually constitutive relationships between participation in third places, social capital, and psychological sense of community. This paper ends with a proposed research agenda, which may empirically test this theoretical model and its assumptions through future model development. Lastly, key considerations for policy and practice are offered, with particular attention to how young people may be affirmed and welcomed in third places rather than socially policed.
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Affiliation(s)
- Katrina Armstrong
- From the Department of Medicine, Massachusetts General Hospital, Boston
| | - Christine Ritchie
- From the Department of Medicine, Massachusetts General Hospital, Boston
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18
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Flores MW, Moyer M, Rodgers CRR, Cook BL. Major Depressive Episode Severity Among Adults from Marginalized Racial and Ethnic Backgrounds in the US. JAMA Psychiatry 2021; 78:1279-1280. [PMID: 34495282 PMCID: PMC8427491 DOI: 10.1001/jamapsychiatry.2021.2485] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 07/01/2021] [Indexed: 11/14/2022]
Affiliation(s)
- Michael William Flores
- Health Equity Research Lab, Cambridge Health Alliance, Cambridge, Massachusetts
- Center for Health Equity, Albert Einstein College of Medicine, Bronx, New York
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Margo Moyer
- Health Equity Research Lab, Cambridge Health Alliance, Cambridge, Massachusetts
| | - Caryn R. R. Rodgers
- Center for Health Equity, Albert Einstein College of Medicine, Bronx, New York
- Department of Psychiatry & Behavioral Sciences, Albert Einstein College of Medicine, Bronx, New York
- Department of Pediatrics, Albert Einstein College of Medicine, Bronx, New York
| | - Benjamin Lê Cook
- Health Equity Research Lab, Cambridge Health Alliance, Cambridge, Massachusetts
- Center for Health Equity, Albert Einstein College of Medicine, Bronx, New York
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
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Farina M, Lavazza A. Advocating for Greater Inclusion of Marginalized and Forgotten Populations in COVID19 Vaccine Rollouts. Int J Public Health 2021; 66:1604036. [PMID: 34707472 PMCID: PMC8542671 DOI: 10.3389/ijph.2021.1604036] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 09/16/2021] [Indexed: 12/18/2022] Open
Abstract
Objectives: Many countries recently approved a number of SARS-CoV-2 vaccines. There is therefore growing optimism around the world about their future availability and effectiveness. However, supplies are likely to be limited and restricted to certain categories of individuals, at least initially. Thus, governments have suggested prioritization schemes to allocate such limited supplies. The majority of such schemes are said to be developed to safeguard the weakest sections of society; that is, healthcare personnel and the elderly. Methods: In this work, we analyse three case studies (incarcerated people; homeless people, asylum seekers and undocumented migrants). We propose a bioethical argument that frames the discussion by describing the salient facts about each of the three populations and then argue that these characteristics entail inclusion and prioritization in the queue for vaccination in their country of residence. Results: Through an analysis informed by ethical considerations revolving around the concepts of fairness and equality, we try to raise awareness of these important issues among decision makers. Conclusion: Our goal is to advocate for the development of more inclusive policies and frameworks in SARS-CoV-2 vaccine allocation and, in general, in all scenarios in which there is a shortage of optimal care and treatments.
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Affiliation(s)
- Mirko Farina
- Faculty of Humanities and Social Sciences, Innopolis University, Innopolis, Russia
| | - Andrea Lavazza
- Department of Neuroethics, Centro Universitario Internazionale, Arezzo, Italy
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20
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Stein J, Fasold M, Daguerre KJ, Richardson J, Cheek S, Charlot M, Basch E. Use of an Analytics and Electronic Health Record-Based Approach for Targeted COVID-19 Vaccine Outreach to Marginalized Populations. JAMA Oncol 2021; 7:1570-1572. [PMID: 34410323 PMCID: PMC8377601 DOI: 10.1001/jamaoncol.2021.3833] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 06/29/2021] [Indexed: 11/14/2022]
Affiliation(s)
- Jacob Stein
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill
- Division of Oncology, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill
| | - Megan Fasold
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill
- North Carolina Cancer Hospital, UNC Health, Chapel Hill
| | - Karyn Jean Daguerre
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill
- North Carolina Cancer Hospital, UNC Health, Chapel Hill
| | - Jaime Richardson
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill
- North Carolina Cancer Hospital, UNC Health, Chapel Hill
| | - Summer Cheek
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill
- North Carolina Cancer Hospital, UNC Health, Chapel Hill
| | - Marjory Charlot
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill
- Division of Oncology, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill
| | - Ethan Basch
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill
- Division of Oncology, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill
- Associate Editor, JAMA
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21
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Tsang K, de Wildt G, Mwingira U, Mtuy TB. Implementing trachoma control programmes in marginalised populations in Tanzania: A qualitative study exploring the experiences and perspectives of key stakeholders. PLoS Negl Trop Dis 2021; 15:e0009727. [PMID: 34506482 PMCID: PMC8432809 DOI: 10.1371/journal.pntd.0009727] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 08/14/2021] [Indexed: 11/19/2022] Open
Abstract
Background Despite aspects of the SAFE strategy for reducing trachoma in Tanzania have been somewhat successful, the disease still persists in marginalised communities even with repeated trachoma control interventions. This study aims to understand the facilitators and barriers associated with implementing trachoma control programmes in these communities, from the perspective of non-governmental organisations (NGOs). Methods Participants were the representatives of NGOs who had knowledge and experience in the implementation of trachoma control programmes. Data was collected using in-depth, semi-structured interviews guided by a topic guide, which was updated after each interview using a constant comparative method. Interviews were audio-recorded and then transcribed verbatim. Thematic analysis was done inductively. Codes were generated from the transcripts and then clustered into themes. Findings The context within marginalised communities often acted as a perceived barrier to successful implementation of control programmes. This included poor environmental cleanliness, lack of trust, poor disease knowledge and traditional lifestyles. Community values could either be a facilitator or a barrier, depending on the scenario. The anatomical location of the disease and the poor understanding of the disease progression also served as barriers. Considerations affecting decision-making among NGO’s include financial feasibility, community needs and whether the quality of the intervention could be improved. NGOs felt that the collaboration and the opportunity to learn from other organisations were beneficial aspects of having different actors. However, this also resulted in variability in the effectiveness of interventions between districts. Conclusion NGOs should focus on behaviour change and health education that is tailored to marginalised communities and seek innovative ways to implement trachoma intervention programmes whilst being minimally intrusive to the traditional way of life. Partners should also implement ways to ensure high quality programmes are being provided, by increasing staff accountability and compensating volunteers fairly. Trachoma is a neglected tropical disease caused by the bacterium Chlamydia trachomatis and can result in blindness if left untreated. The World Health Organisation devised the SAFE strategy (Surgery, Antibiotics, Facial Cleanliness and Environmental Improvements) to combat this disease. In Tanzania, many trachoma control interventions are implemented by non-governmental organisations (NGOs). The disease still persists in areas with marginalised, including Maasai, despite repeated interventions. These communities are often difficult to reach due to their livelihoods and local beliefs. This study investigates the facilitators and barriers to implementing interventions within hard to reach communities from the perspectives of NGOs. Findings will provide insight on how NGOs implement and ensure their programmes are effective, whilst being mindful of the intrinsic factors important to the community, which will inform improvements and alterations in trachoma interventions.
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Affiliation(s)
- Kaki Tsang
- The Department of Population Sciences and Humanities, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
- * E-mail:
| | - Gilles de Wildt
- The Department of Population Sciences and Humanities, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Upendo Mwingira
- RTI International, Washington DC, United States of America
- NTD Control Programme, National Institute for Medical Research, Dar es Salaam, Tanzania
| | - Tara B. Mtuy
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, United Kingdom
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22
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Rowlands Snyder EC, Boucher LM, Bayoumi AM, Martin A, Marshall Z, Boyd R, LeBlanc S, Tyndall M, Kendall CE. A cross-sectional study of factors associated with unstable housing among marginalized people who use drugs in Ottawa, Canada. PLoS One 2021; 16:e0253923. [PMID: 34197552 PMCID: PMC8248707 DOI: 10.1371/journal.pone.0253923] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 06/15/2021] [Indexed: 11/23/2022] Open
Abstract
Introduction Housing affects an individual’s physical and mental health, particularly among people who use substances. Understanding the association between individual characteristics and housing status can inform housing policy and help optimize the care of people who use drugs. The objective of this study was to explore the factors associated with unstable housing among people who use drugs in Ottawa. Methods This is a cross-sectional analysis of data from 782 participants in the Participatory Research in Ottawa: Understanding Drugs (PROUD) Study. PROUD is a prospective cohort study of people who use drugs in Ottawa. Between March and December 2013, participants were recruited through peer-based recruitment on the streets and in social services settings and completed a peer-administered questionnaire that explored socio-demographic information, drug use patterns, community integration, experiences with police and incarceration, and access to health care and harm reduction services. Eligibility criteria included age of 16 years or older, self-reported illicit drug use within the past 12 months and having lived in Ottawa for at least 3 months. Housing status was determined by self-report. “Stable housing” was defined as residence in a house or apartment and “unstable housing” was defined as all other residence types. Exploratory multivariable logistic regression analyses of the association between characteristics of people who use drugs and their housing status were conducted. Results Factors that were associated with unstable housing included: recent incarceration; not having a regular doctor; not having received support from a peer worker; low monthly income; income source other than public disability support payments; and younger age. Gender, language, ethnicity, education level, opioid use and injection drug use were not independently associated with housing status. Conclusions People who use drugs face significant barriers to stable housing. These results highlight key areas to address in order to improve housing stability among this community.
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Affiliation(s)
| | - Lisa M. Boucher
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Ahmed M. Bayoumi
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
- Division of General Internal Medicine, St. Michael’s Hospital, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Alana Martin
- Somerset West Community Health Centre, Ottawa, Ontario, Canada
- PROUD Community Advisory Committee, Ottawa, Ontario, Canada
| | - Zack Marshall
- School of Social Work, McGill University, Montreal, Quebec, Canada
| | - Rob Boyd
- Sandy Hill Community Health Centre, Ottawa, Ontario, Canada
| | - Sean LeBlanc
- PROUD Community Advisory Committee, Ottawa, Ontario, Canada
- Drug Users Advocacy League, Ottawa, Ontario, Canada
| | - Mark Tyndall
- Faculty of Medicine, School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Claire E. Kendall
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, Ontario, Canada
- * E-mail:
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24
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Becker CB, Middlemas K, Gomez F, Kilpela LS. An exploratory examination of internalized weight stigma in a sample living with food insecurity. Body Image 2021; 37:238-245. [PMID: 33770554 PMCID: PMC8991369 DOI: 10.1016/j.bodyim.2021.03.006] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 02/25/2021] [Accepted: 03/06/2021] [Indexed: 11/19/2022]
Abstract
Internalized weight stigma (IWS) is associated with various health concerns, regardless of body size. One weakness of existing IWS research is that it largely lacks diverse study populations. One recent exception, however, found increasing IWS was associated with higher levels of food insecurity (FI) in a low-income, majority Latinx sample. Using the same sample (N = 530), the present study further explored levels of IWS as compared to documented (mostly White/European) samples; we also investigated IWS in relation to three dichotomous eating disorder (ED) outcomes (e.g., any/no vomiting). Finally, based on previous qualitative findings regarding dietary restraint in the most severe level of FI, we explored the independent contribution of dietary restraint and IWS to cross-sectional risk of ED pathology. Results indicated that individuals living with FI experience IWS at concerning levels. Additionally, IWS played a small yet significant role in cross-sectional risk for ED pathology regardless of FI severity, while dietary restraint contributed to independent risk only in those with the most severe FI. Findings suggest that IWS is prevalent in this marginalized population, associated with ED pathology, and that the effect of dietary restraint on risk for ED pathology appears to uniquely impact those living with severe FI.
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Affiliation(s)
| | - Keesha Middlemas
- Department of Political Science, Howard University, United States
| | | | - Lisa Smith Kilpela
- Barshop Institute for Longevity and Aging Studies, Research to Advance Community Health Center, Department of Psychiatry and Behavioral Sciences, UT Health San Antonio, United States
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25
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Tan AX, Hinman JA, Abdel Magid HS, Nelson LM, Odden MC. Association Between Income Inequality and County-Level COVID-19 Cases and Deaths in the US. JAMA Netw Open 2021; 4:e218799. [PMID: 33938935 PMCID: PMC8094008 DOI: 10.1001/jamanetworkopen.2021.8799] [Citation(s) in RCA: 82] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 03/12/2021] [Indexed: 11/17/2022] Open
Abstract
Importance Socioeconomically marginalized communities have been disproportionately affected by the COVID-19 pandemic. Income inequality may be a risk factor for SARS-CoV-2 infection and death from COVID-19. Objective To evaluate the association between county-level income inequality and COVID-19 cases and deaths from March 2020 through February 2021 in bimonthly time epochs. Design, Setting, and Participants This ecological cohort study used longitudinal data on county-level COVID-19 cases and deaths from March 1, 2020, through February 28, 2021, in 3220 counties from all 50 states, Puerto Rico, and the District of Columbia. Main Outcomes and Measures County-level daily COVID-19 case and death data from March 1, 2020, through February 28, 2021, were extracted from the COVID-19 Data Repository by the Center for Systems Science and Engineering at Johns Hopkins University in Baltimore, Maryland. Exposure The Gini coefficient, a measure of unequal income distribution (presented as a value between 0 and 1, where 0 represents a perfectly equal geographical region where all income is equally shared and 1 represents a perfectly unequal society where all income is earned by 1 individual), and other county-level data were obtained primarily from the 2014 to 2018 American Community Survey 5-year estimates. Covariates included median proportions of poverty, age, race/ethnicity, crowding given by occupancy per room, urbanicity and rurality, educational level, number of physicians per 100 000 individuals, state, and mask use at the county level. Results As of February 28, 2021, on average, each county recorded a median of 8891 cases of COVID-19 per 100 000 individuals (interquartile range, 6935-10 666 cases per 100 000 individuals) and 156 deaths per 100 000 individuals (interquartile range, 94-228 deaths per 100 000 individuals). The median county-level Gini coefficient was 0.44 (interquartile range, 0.42-0.47). There was a positive correlation between Gini coefficients and county-level COVID-19 cases (Spearman ρ = 0.052; P < .001) and deaths (Spearman ρ = 0.134; P < .001) during the study period. This association varied over time; each 0.05-unit increase in Gini coefficient was associated with an adjusted relative risk of COVID-19 deaths: 1.25 (95% CI, 1.17-1.33) in March and April 2020, 1.20 (95% CI, 1.13-1.28) in May and June 2020, 1.46 (95% CI, 1.37-1.55) in July and August 2020, 1.04 (95% CI, 0.98-1.10) in September and October 2020, 0.76 (95% CI, 0.72-0.81) in November and December 2020, and 1.02 (95% CI, 0.96-1.07) in January and February 2021 (P < .001 for interaction). The adjusted association of the Gini coefficient with COVID-19 cases also reached a peak in July and August 2020 (relative risk, 1.28 [95% CI, 1.22-1.33]). Conclusions and Relevance This study suggests that income inequality within US counties was associated with more cases and deaths due to COVID-19 in the summer months of 2020. The COVID-19 pandemic has highlighted the vast disparities that exist in health outcomes owing to income inequality in the US. Targeted interventions should be focused on areas of income inequality to both flatten the curve and lessen the burden of inequality.
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Affiliation(s)
- Annabel X. Tan
- Department of Epidemiology and Population Health, Stanford University, Stanford, California
| | - Jessica A. Hinman
- Department of Epidemiology and Population Health, Stanford University, Stanford, California
| | - Hoda S. Abdel Magid
- Department of Epidemiology and Population Health, Stanford University, Stanford, California
| | - Lorene M. Nelson
- Department of Epidemiology and Population Health, Stanford University, Stanford, California
| | - Michelle C. Odden
- Department of Epidemiology and Population Health, Stanford University, Stanford, California
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Affiliation(s)
- Olivia P Matshabane
- Department of Medicine, Faculty of Health Sciences, University of Cape Town, South Africa.
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Ezell JM, Griswold D, Chase EC, Carver E. The blueprint of disaster: COVID-19, the Flint water crisis, and unequal ecological impacts. Lancet Planet Health 2021; 5:e309-e315. [PMID: 33964240 PMCID: PMC9709384 DOI: 10.1016/s2542-5196(21)00076-0] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 03/10/2021] [Accepted: 03/25/2021] [Indexed: 05/09/2023]
Abstract
COVID-19 is unique in the scope of its effects on morbidity and mortality. However, the factors contributing to its disparate racial, ethnic, and socioeconomic effects are part of an expansive and continuous history of oppressive social policy and marginalising geopolitics. This history is characterised by institutionally generated spatial inequalities forged through processes of residential segregation and neglectful urban planning. In the USA, aspects of COVID-19's manifestation closely mirror elements of the build-up and response to the Flint crisis, Michigan's racially and class-contoured water crisis that began in 2014, and to other prominent environmental injustice cases, such as the 1995 Chicago (IL, USA) heatwave that severely affected the city's south and west sides, predominantly inhabited by Black people. Each case shares common macrosocial and spatial characteristics and is instructive in showing how civic trust suffers in the aftermath of public health disasters, becoming especially degenerative among historically and spatially marginalised populations. Offering a commentary on the sociogeographical dynamics that gave rise to these crises and this institutional distrust, we discuss how COVID-19 has both inherited and augmented patterns of spatial inequality. We conclude by outlining particular steps that can be taken to prevent and reduce spatial inequalities generated by COVID-19, and by discussing the preliminary steps to restore trust between historically disenfranchised communities and the public officials and institutions tasked with responding to COVID-19.
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Affiliation(s)
- Jerel M Ezell
- Africana Studies and Research Center, Cornell University, Ithaca, NY, USA; Cornell Center for Health Equity, Cornell University, Ithaca, NY, USA.
| | | | - Elizabeth C Chase
- Department of Biostatistics, University of Michigan, Ann Arbor, MI, USA
| | - Evan Carver
- Program on the Global Environment, University of Chicago, Chicago, IL, USA
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Abstract
The Covid-19 pandemic has revealed myriad social, economic, and health inequities that disproportionately burden populations that have been made medically or socially vulnerable. Inspired by state and local governments that declared racism a public health crisis or emergency, the Anti-Racism in Public Health Act of 2020 reflects a shifting paradigm in which racism is considered a social determinant of health. Indeed, health inequities fundamentally rooted in structural racism have been exacerbated by the Covid-19 pandemic, which calls for the integration of antiracist praxis to promote ethical public health research processes. This commentary describes ways in which antiracist praxis-which emphasizes empowerment of traditionally marginalized populations-offers strategies to explicitly address power imbalance, stigmatization, and other consequences of structural racism in public health research.
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Hui A, Rennick-Egglestone S, Franklin D, Walcott R, Llewellyn-Beardsley J, Ng F, Roe J, Yeo C, Deakin E, Brydges S, Penas Moran P, McGranahan R, Pollock K, Thornicroft G, Slade M. Institutional injustice: Implications for system transformation emerging from the mental health recovery narratives of people experiencing marginalisation. PLoS One 2021; 16:e0250367. [PMID: 33861807 PMCID: PMC8051813 DOI: 10.1371/journal.pone.0250367] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 04/06/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Institutional injustice refers to structures that create disparities in resources, opportunities and representation. Marginalised people experience institutional injustice, inequalities and discrimination through intersecting personal characteristics and social circumstances. This study aimed to investigate sources of institutional injustice and their effects on marginalised people with experience of mental health problems. METHODS Semi-structured interviews were conducted with 77 individuals from marginalised groups with experience of mental health problems, including psychosis, Black, Asian and minority ethnic (BAME) populations, complex needs and lived experience as a work requirement. These were analysed inductively enabling sensitising concepts to emerge. FINDINGS Three processes of institutional injustice were identified: not being believed because of social status and personal backgrounds; not being heard where narratives did not align with dominant discourses, and not being acknowledged where aspects of identity were disregarded. Harmful outcomes included disengagement from formal institutions through fear and mistrust, tensions and reduced affiliation with informal institutions when trying to consolidate new ways of being, and damaging impacts on mental health and wellbeing through multiple oppression. CONCLUSIONS Institutional injustice perpetuates health inequalities and marginalised status. Master status, arising from dominant discourses and heuristic bias, overshadow the narratives and experiences of marginalised people. Cultural competency has the potential to improve heuristic availability through social understandings of narrative and experience, whilst coproduction and narrative development through approaches such as communities of practice might offer meaningful avenues for authentic expression.
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Affiliation(s)
- Ada Hui
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
| | - Stefan Rennick-Egglestone
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
| | - Donna Franklin
- NEON Lived Experience Advisory Panel, Nottingham, United Kingdom
| | - Rianna Walcott
- Department of Digital Humanities, King’s College London, London, United Kingdom
| | - Joy Llewellyn-Beardsley
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
| | - Fiona Ng
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
| | - James Roe
- National Institute for Health Research, ARC East Midlands, University of Nottingham, Nottingham, United Kingdom
| | - Caroline Yeo
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
| | - Emilia Deakin
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
| | - Sarah Brydges
- School of Pharmacy, University of Nottingham, Nottingham, United Kingdom
| | - Patricia Penas Moran
- Department of Personality, Assessment and Psychological Treatment, University of Deusto, Bilbo, Spain
| | - Rose McGranahan
- Unit of Social and Community Psychiatry, Queen Mary University of London, London, United Kingdom
| | - Kristian Pollock
- School of Health Sciences, University of Nottingham, Nottingham, United Kingdom
| | - Graham Thornicroft
- Centre for Global Mental Health and Centre for Implementation Science, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Mike Slade
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
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Affiliation(s)
- Jennifer M Gómez
- Department of Psychology, Merrill Palmer Skillman Institute for Child & Family Development (MPSI), Wayne State University
- Center for Institutional Courage
| | - Robyn L Gobin
- Department of Kinesiology and Community Health, University of Illinois at Urbana-ChampaignCenter for Institutional Courage
| | - Melissa L Barnes
- Center for Institutional Courage
- Department of Psychology, University of Oregon
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Affiliation(s)
- Michael Knipper
- Institute for the History of Medicine, University Justus Liebig Giessen, 35392 Giessen, Germany.
| | - Kayvan Bozorgmehr
- Department of Population Medicine and Health Services Research, School of Public Health, Bielefeld University, Bielefeld, Germany
| | | | - Miriam Orcutt
- Institute for Global Health, University College London, London, UK
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Yap A. Hidden Costs of Inquiry: Exploitation, World-Travelling and Marginalized Lives. Kennedy Inst Ethics J 2021; 31:153-173. [PMID: 34120952 DOI: 10.1353/ken.2021.0010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
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Abstract
OBJECTIVES The COVID-19 outbreak in Singapore has largely centred around migrant worker dormitories, comprising over 90% of all cases in the country. Dormitories are home to a culturally and linguistically distinct, low-income population, without on-site healthcare after-hours. The primary objective of this study was to assess the engagement and utilisation of a simple, low-cost, accessible, mobile health solution for remote self-reporting of vital parameters in dormitory residents with COVID-19. DESIGN Retrospective review of medical care. SETTING Two large migrant worker dormitories with a combined population of 31 546. PARTICIPANTS All COVID-19-affected residents housed in dormitories during the study period. INTERVENTION All residents were taught to use a chat assistant to self-report their temperature, heart rate and oxygen saturations. Results flowed into a dashboard, which alerted clinicians of abnormal results. OUTCOMES The primary outcome measure was engagement rate. This was derived from the total number of residents who registered on the platform over the total number of COVID-19-affected residents in the dormitories during the study period. Secondary outcome measures included outcomes of the alerts and subsequent escalations of care. RESULTS 800 of the 931 COVID-19-affected residents (85.9%) engaged with the platform to log a total of 12 511 discrete episodes of vital signs. Among 372 abnormal readings, 96 teleconsultations were initiated, of which 7 (1.8%) were escalated to emergency services and 18 (4.9%) were triaged to earlier physical medical review on-site. CONCLUSIONS A chat-assistant-based self-reporting platform is an effective and safe community-based intervention to monitor marginalised populations with distinct cultural and linguistic backgrounds, living communally and affected by COVID-19. Lessons learnt from this approach may be applied to develop safe and cost-effective telemedicine solutions across similar settings.
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Affiliation(s)
- Stephanie Q Ko
- Division of Advanced Internal Medicine, University Medicine Cluster, National University Hospital, Singapore
| | - Benjamin M Y Hooi
- Division of Advanced Internal Medicine, University Medicine Cluster, National University Hospital, Singapore
| | - Chieh-Yang Koo
- Department of Cardiology, National University Heart Centre, Singapore
| | - Daniel W P Chor
- Department of Emergency Medicine, National University Hospital, Singapore
| | - Zheng Jye Ling
- Department of Medical Informatics, National University Health System, Singapore
| | - Yen-Lin Chee
- Department of Haematology-Oncology, National University Cancer Institute, Singapore
| | - Wei-Ying Jen
- Department of Haematology-Oncology, National University Cancer Institute, Singapore
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Wilson WJ, Richards KAR, Haegele JA, Holland SK. Perceived Workplace Experiences of Adapted Physical Educators and Physical Educators. Res Q Exerc Sport 2020; 91:618-629. [PMID: 32053466 DOI: 10.1080/02701367.2019.1694632] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 08/12/2019] [Accepted: 11/13/2019] [Indexed: 06/10/2023]
Abstract
Purpose: The purpose of this study was to compare the workplace experiences of physical education and adapted physical education teachers while also considering biological sex. Role socialization theory was used as a guiding lens. Method: Participants included 653 teachers (women = 382) who taught physical education (n = 420) or adapted physical education (n = 233). Five instruments were used to examine workplace experiences regarding: (a) marginalization and isolation, (b) two elements of perceived mattering, (c) three role stressors, (d) resilience, and (e) emotional exhaustion. Group comparisons were analyzed using a 2 × 2 (discipline x biological sex) factorial MANCOVA while including years of teaching experience as a covariate. Results: No significant interaction effect between teacher group and biological sex was detected; however, there were significant main effects of teacher group, F(9,640) = 19.49, p < .001; Wilk's Λ = .79, partial-η2 = .22, and of biological sex, F(9,640) = 2.81, p < .01; Wilk's Λ = .96, partial-η2 = .04, on the dependent variables. Significant follow-up univariate tests showed that the adapted physical education teachers perceived less marginalization, less isolation, more perceived mattering, and less emotional exhaustion than the physical education teachers. Women from both groups felt significantly more role overload when compared to the men. Conclusion: Collectively, these findings both relate to and extend role socialization theory in explaining how adapted physical education teachers are socialized through the workplace in comparison to their physical education counterparts. Practical implications for preservice and inservice teacher preparation and future research directions are discussed.
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Hendl T, Chung R, Wild V. Pandemic Surveillance and Racialized Subpopulations: Mitigating Vulnerabilities in COVID-19 Apps. J Bioeth Inq 2020; 17:829-834. [PMID: 32840858 PMCID: PMC7445800 DOI: 10.1007/s11673-020-10034-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [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] [Received: 05/19/2020] [Accepted: 08/03/2020] [Indexed: 05/15/2023]
Abstract
Debates about effective responses to the COVID-19 pandemic have emphasized the paramount importance of digital tracing technology in suppressing the disease. So far, discussions about the ethics of this technology have focused on privacy concerns, efficacy, and uptake. However, important issues regarding power imbalances and vulnerability also warrant attention. As demonstrated in other forms of digital surveillance, vulnerable subpopulations pay a higher price for surveillance measures. There is reason to worry that some types of COVID-19 technology might lead to the employment of disproportionate profiling, policing, and criminalization of marginalized groups. It is, thus, of crucial importance to interrogate vulnerability in COVID-19 apps and ensure that the development, implementation, and data use of this surveillance technology avoids exacerbating vulnerability and the risk of harm to surveilled subpopulations, while maintaining the benefits of data collection across the whole population. This paper outlines the major challenges and a set of values that should be taken into account when implementing disease surveillance technology in the pandemic response.
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Affiliation(s)
- Tereza Hendl
- Institute of Ethics, History and Theory of Medicine, Ludwig-Maximilians-University in Munich, Lessingstr. 2, 80336, Munich, Germany.
| | - Ryoa Chung
- Department of Philosophy, Université de Montréal, C.P. 6128, succ. Centre-Ville, Montréal, Québec, H3C 3J7, Canada
| | - Verina Wild
- Institute of Ethics, History and Theory of Medicine, Ludwig-Maximilians-University in Munich, Lessingstr. 2, 80336, Munich, Germany
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Abstract
This research investigates gender and sexuality identity management among gay men. Thirty self-identified gay men participated in semi-structured, in-depth interviews and provided their accounts of how they manage performances of gender and sexuality in the workplace. This research contributes to the scholarship of gender and sexuality by highlighting how sexuality, as an organizing principle, contributes to the further marginalization of an already marginalized population of gay men, via a concept I call hegemonic sexuality. The men's narratives help us understand how certain performances of sexuality permit some men to be recognized as "acceptable," while others are labeled "too gay" in different work environments. I investigate the motivations and consequences of men's concerted workplace identity management strategies. I conclude by suggesting that hegemonic sexuality be used as a tool to understand how some gay men are deemed more acceptable than others in additional social spaces.
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Affiliation(s)
- Travis Speice
- Department of Sociology, Xavier University , Cincinnati, Ohio, USA
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Jones J. What Do We Mean When We Call Someone a Drug Addict? Health Care Anal 2020; 28:391-403. [PMID: 33104912 DOI: 10.1007/s10728-020-00410-0] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/12/2020] [Indexed: 10/23/2022]
Abstract
When thinking about the harms of drug addiction, there is a tendency to focus on the harms of drug consumption. But not all harms associated with drug addiction are caused by drug consumption. There is at least another dimension of harm worth considering: what I call the linguistic harm of drug addiction. Starting with an analysis of 'drug addict' as it appears in the media, I argue that 'drug addict' is inconsistently applied to people with drug addiction and that this inconsistency reveals two important features of the term. First, being called a 'drug addict' is worse than being described as 'having a drug problem'. Second, being called a drug addict exacerbates the challenges experienced by people with drug addiction. Referencing the 'addict' narrative, I detail how calling someone a drug addict can add to the marginalization of people with drug addiction and argue that to eliminate the linguistic harm of drug addiction, we ought to reduce it first. Using the analysis of 'drug addict' from the first half of the paper, I propose a novel harm reduction strategy that benefits people with drug addiction but calls on people who do not use drugs.
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Affiliation(s)
- Janet Jones
- University of Waterloo, 200 University Ave., W, Waterloo, ON, N2L 3G1, Canada.
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Olaniyan A, Creasy SL, Batey DS, Brooks MM, Maulsby C, Musgrove K, Hagan E, Martin D, Sashin C, Farmartino C, Hawk M. Protocol of a randomized controlled trial to test the effects of client-centered Representative Payee Services on antiretroviral therapy adherence among marginalized people living with HIV. BMC Public Health 2020; 20:1443. [PMID: 32967646 PMCID: PMC7509495 DOI: 10.1186/s12889-020-09500-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 09/03/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Client-Centered Representative Payee (CCRP) is an intervention modifying implementation of a current policy of the US Social Security Administration, which appoints organizations to serve as financial payees on behalf of vulnerable individuals receiving Social Security benefits. By ensuring beneficiaries' bills are paid while supporting their self-determination, this structural intervention may mitigate the effects of economic disadvantage to improve housing and financial stability, enabling self-efficacy for health outcomes and improved antiretroviral therapy adherence. This randomized controlled trial will test the impact of CCRP on marginalized people living with HIV (PLWH). We hypothesize that helping participants to pay their rent and other bills on time will improve housing stability and decrease financial stress. METHODS PLWH (n = 160) receiving services at community-based organizations will be randomly assigned to the CCRP intervention or the standard of care for 12 months. Fifty additional participants will be enrolled into a non-randomized ("choice") study allowing participant selection of the CCRP intervention or control. The primary outcome is HIV medication adherence, assessed via the CASE adherence index, viral load, and CD4 counts. Self-assessment data for ART adherence, housing instability, self-efficacy for health behaviors, financial stress, and retention in care will be collected at baseline, 3, 6, and 12 months. Viral load, CD4, and appointment adherence data will be collected at baseline, 6, 12, 18, and 24 months from medical records. Outcomes will be compared by treatment group in the randomized trial, in the non-randomized cohort, and in the combined cohort. Qualitative data will be collected from study participants, eligible non-participants, and providers to explore underlying mechanisms of adherence, subjective responses to the intervention, and implementation barriers and facilitators. DISCUSSION The aim of this study is to determine if CCRP improves health outcomes for vulnerable PLWH. Study outcomes may provide information about supports needed to help economically fragile PLWH improve health outcomes and ultimately improve HIV health disparities. In addition, findings may help to refine service delivery including the provision of representative payee to this often-marginalized population. This protocol was prospectively registered on May 22, 2018 with ClinicalTrials.gov (NCT03561103) .
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Affiliation(s)
- Abisola Olaniyan
- Department of Behavioral and Community Health Sciences, University of Pittsburgh Graduate School of Public Health, 130 De Soto Street, 6120 Public Health, Pittsburgh, PA, 15261, USA
| | - Stephanie L Creasy
- Department of Behavioral and Community Health Sciences, University of Pittsburgh Graduate School of Public Health, 130 De Soto Street, 6120 Public Health, Pittsburgh, PA, 15261, USA
| | - D Scott Batey
- Department of Social Work, College of Arts and Sciences, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Maria Mori Brooks
- Epidemiology Data Center, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA
| | - Catherine Maulsby
- Department of Health, Behavior and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | | | | | - Deborah Martin
- Epidemiology Data Center, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA
| | - Courtenay Sashin
- Epidemiology Data Center, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA
| | | | - Mary Hawk
- Department of Behavioral and Community Health Sciences, University of Pittsburgh Graduate School of Public Health, 130 De Soto Street, 6120 Public Health, Pittsburgh, PA, 15261, USA.
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Watson MF, Bacigalupe G, Daneshpour M, Han W, Parra‐Cardona R. COVID-19 Interconnectedness: Health Inequity, the Climate Crisis, and Collective Trauma. Fam Process 2020; 59:832-846. [PMID: 32589267 PMCID: PMC7361773 DOI: 10.1111/famp.12572] [Citation(s) in RCA: 65] [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] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
The COVID-19 pandemic brings to the forefront the complex interconnected dilemmas of globalization, health equity, economic security, environmental justice, and collective trauma, severely impacting the marginalized and people of color in the United States. This lack of access to and the quality of healthcare, affordable housing, and lack of financial resources also continue to have a more significant impact on documented and undocumented immigrants. This paper aims at examining these critical issues and developing a framework for family therapists to address these challenges by focusing on four interrelated dimensions: cultural values, social determinants of health, collective trauma, and the ethical and moral responsibility of family therapists. Given the fact that family therapists may unwittingly function as the best ally of an economic and political system that perpetuates institutionalized racism and class discrimination, we need to utilize a set of principles, values, and practices that are not just palliative or after the fact but bring forth into the psychotherapeutic and policy work a politics of care. Therefore, a strong call to promote and advocate for the broader continuum of health and critical thinking preparing professionals to meet the challenges of health equity, as well as economic and environmental justice, is needed. The issues discussed in this paper are specific to the United States despite their relevance to family therapy as a field. We are mindful not to generalize the United States' reality to the rest of the world, recognizing that issues discussed in this paper could potentially contribute to international discourse.
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Affiliation(s)
- Marlene F. Watson
- Department of Counseling and Family TherapyDrexel UniversityPhiladelphiaPA
| | - Gonzalo Bacigalupe
- School of Education and Human DevelopmentUniversity of Massachusetts BostonBostonMA
| | | | - Wen‐Jui Han
- Silver School of Social WorkNew York UniversityNew YorkNY
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Swannell C. COVID
‐19, Black Lives Matter and making a difference. Med J Aust 2020; 213:C1. [PMID: 32880932 PMCID: PMC7461165 DOI: 10.5694/mja2.50723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Restar AJ, Jin H, Ogunbajo A, Adia A, Surace A, Hernandez L, Cu‐Uvin S, Operario D. Differences in HIV risk and healthcare engagement factors in Filipinx transgender women and cisgender men who have sex with men who reported being HIV negative, HIV positive or HIV unknown. J Int AIDS Soc 2020; 23:e25582. [PMID: 32844564 PMCID: PMC7448155 DOI: 10.1002/jia2.25582] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Revised: 06/12/2020] [Accepted: 06/23/2020] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION Understanding HIV risk and healthcare engagement of at-risk individuals by HIV status is vital to informing HIV programmes in settings where the HIV epidemic is rapidly expanding like the Philippines. This study examined differences in HIV risk and healthcare engagement factors among Filipinx transgender women and cisgender men who have sex with men (trans-WSM and cis-MSM respectively) who self-reported being HIV negative, HIV positive or HIV unknown. METHODS Between 2018 and 2019, we conducted Project #ParaSaAtin, an online cross-sectional survey that examined the structural, social and behavioural factors impacting HIV services among Filipinx trans-WSM and cis-MSM (n = 318). We performed multinomial regression procedures to determine factors associated with HIV status (with HIV-negative referent). Co-variates included participant demographics, experiences of social marginalization, HIV risk, healthcare engagement and alcohol and substance problems. RESULTS Self-reported HIV status of the sample was as follows: 38% HIV negative, 34% HIV positive and 28% HIV unknown. Relative to HIV-negative respondents, HIV-positive respondents were more likely to be older (25- to 29-year-old adjusted risk ratio [aRRR]=5.08, 95% Confidence Interval [95% CI] = 1.88 to 13.72; 30- to 34-year-old aRRR = 4.11, 95% CI = 1.34 to 12.58; and 35 + years old aRRR = 8.13, 95% CI = 2.40 to 27.54, vs. 18 to 25 years old respectively), to live in Manila (aRRR = 5.89, 95% CI = 2.20 to 15.72), exhibit hazardous drinking (aRRR = 2.87, 95% CI = 1.37 to 6.00) and problematic drug use (aRRR = 2.90, 95% CI = 1.21 to 7.13). HIV-positive respondents were less likely to identify as straight (aRRR = 0.13, 95% CI = 0.02 to 0.72), and were more likely to avoid HIV services due to lack of anti-lesbian, gay, bisexual and transgender (LGBT) discrimination policies (aRRR = 0.37, 95% CI = 0.14 to 0.90). Relative to HIV-negative respondents, HIV-unknown respondents were less educated (some college aRRR = 0.10, 95% CI = 0.02 to 0.37, beyond college aRRR = 0.31, 95% CI = 0.09 to 0.99, vs. high school or below respectively), had lower HIV knowledge (aRRR = 0.30, 95% CI = 0.20 to 0.71), and were less communicative about safer sex (ARR = 0.29, 95% CI = 0.09 to 0.92). Moreover, HIV-unknown respondents were also more likely to have avoided HIV services due to cost (aRRR = 4.46, 95% CI = 1.73 to 11.52). CONCLUSIONS This study highlights differences in HIV risks and healthcare engagement by HIV status. These findings show different barriers exist per HIV status group, and underscore the need to address Filipinx trans-WSM and cis-MSM's poor engagement in HIV services in the Philippines.
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Affiliation(s)
- Arjee J Restar
- Department of Behavioral and Social SciencesBrown University School of Public HealthProvidenceRIUSA
- The Philippine Health Initiative for Research, Service, and TrainingBrown University Global Health InitiativeProvidenceRIUSA
- amfARFoundation of AIDS ResearchWashingtonDCUSA
| | - Harry Jin
- Department of EpidemiologyBrown University School of Public HealthProvidenceRIUSA
| | - Adedotun Ogunbajo
- Department of Behavioral and Social SciencesBrown University School of Public HealthProvidenceRIUSA
| | - Alexander Adia
- Department of Behavioral and Social SciencesBrown University School of Public HealthProvidenceRIUSA
- The Philippine Health Initiative for Research, Service, and TrainingBrown University Global Health InitiativeProvidenceRIUSA
| | - Anthony Surace
- Department of Behavioral and Social SciencesBrown University School of Public HealthProvidenceRIUSA
| | - Laufred Hernandez
- Department of Behavioral SciencesUniversity of Philippines ManilaManilaPhilippines
| | - Susan Cu‐Uvin
- Department of Behavioral and Social SciencesBrown University School of Public HealthProvidenceRIUSA
- The Philippine Health Initiative for Research, Service, and TrainingBrown University Global Health InitiativeProvidenceRIUSA
- Providence‐Boston Center for AIDS ResearchProvidenceRIUSA
- Department of MedicineMiriam HospitalProvidenceRIUSA
| | - Don Operario
- Department of Behavioral and Social SciencesBrown University School of Public HealthProvidenceRIUSA
- The Philippine Health Initiative for Research, Service, and TrainingBrown University Global Health InitiativeProvidenceRIUSA
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Reddy-Best KL, Choi E. "Male Hair Cannot Extend Below Plane of the Shoulder" and "No Cross Dressing": Critical Queer Analysis of High School Dress Codes in the United States. J Homosex 2020; 67:1290-1340. [PMID: 30901294 DOI: 10.1080/00918369.2019.1585730] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
In this study, we questioned how high school dress codes outlined in official handbooks were written or presented in regard to the gender binary, either/or perspective. We critically analyzed how or if they allowed for flexibility in expression of gender and sexual identity and if they supported, encouraged, or affirmed a variety of expressions, in particular transgender and gender non-conforming expressions, throughout the text or images. The content analysis method was used to analyze 735 handbooks from the 2016 to 2017 school year. Three themes emerged from the data: (1) support of fluid gender expression, yet not overt support; (2) passive marginalization of gender non-conforming or transgender identities or expressions; and (3) active marginalization of gender non-conforming or transgender identities or expressions. The "LGBTQ+ Dress Code Analysis Tool" was developed for policy makers to use to analyze their dress codes.
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Affiliation(s)
- Kelly L Reddy-Best
- Department of Apparel, Events, and Hospitality Management, Iowa State University , Ames, Iowa, USA
| | - Eunji Choi
- Department of Apparel, Events, and Hospitality Management, Iowa State University , Ames, Iowa, USA
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Joseph A, Jenkins SR, Wright B, Sebastian B. Acculturation processes and mental health of Asian Indian women in the United States: A mixed-methods study. Am J Orthopsychiatry 2020; 90:510-522. [PMID: 32614212 DOI: 10.1037/ort0000465] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Acculturation theories and research find that both new culture acquisition and heritage culture attachment are associated with positive outcomes. However, gender-related analyses are rare. In this mixed-method study of 73 Asian Indian American women who were first- or second-generation immigrants from Kerala, India, those classified as behaviorally bicultural, assimilated, separated, or marginalized did not differ significantly in well-being. Being older and married was related to higher self-esteem; unmarried women reported more Kerala attitudinal marginalization. With age, marital status, immigrant generation, and both cultural behavioral orientations controlled, Kerala attitudinal marginalization (but not Anglo attitudinal marginalization) correlated moderately with both lower self-esteem and more severe depressive symptoms. Content analysis of open-ended question data suggested associations among more intricate and multifaceted acculturation processes and psychological well-being via the rewards and challenges the women described. Attaining the "best of both worlds" that some mentioned meant selective adoption and rejection of facets of each culture: family connectedness and control, freedom and moral decline, opportunity, and discrimination. For these women, status-related characteristics (being younger and single representing lower status), discrimination experiences, and attitudinal rejection of their heritage culture (although it accords women lower status than men) had negative psychological outcomes. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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Moensted ML, Day CA. Health and social interventions in the context of support and control: The experiences of marginalised people who use drugs in Australia. Health Soc Care Community 2020; 28:1152-1159. [PMID: 31908092 DOI: 10.1111/hsc.12946] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 06/18/2019] [Revised: 11/29/2019] [Accepted: 12/20/2019] [Indexed: 06/10/2023]
Abstract
People who use illicit drugs frequently become targets for welfare intervention, often positioned both as complicit in the reproduction of intergenerational poverty and marginalisation, and as sources of hope for interrupting such patterns. This article draws on empirical research exploring the experiences of highly marginalised people with histories of illicit drug-use to investigate how they negotiate service encounters in the context of the participants' previous experiences with welfare interventions. In doing so, the article seeks to texture the conception of the support and control nexus, drawing out the systemic and service level factors of welfare services which inhibit people who use drugs from benefitting from available support. We conducted 12 in-depth interviews with participants subject to interventions by health, social or legal services between July and September 2018. All interviews were audio-recorded, transcribed verbatim and coded in NVivo. Transcripts were analysed using a grounded theory approach where data were subject to an iterative process of constant comparisons to identify emergent themes and theoretical concepts. The findings suggest that the blending of welfare services and systems of control has unintended and often negative consequences for highly marginalised people. In effect, the drug treatment programme's aims of assisting people to reduce harm and increase stability are significantly undermined by control mechanisms such as mandatory reporting policies. A better understanding of the ways in which welfare service processes alienate marginalised people from seeking support, as well as from benefitting from the support available, might provide a way to address these concerns.
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Affiliation(s)
- Maja L Moensted
- Discipline of Addiction Medicine, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia
| | - Carolyn A Day
- Discipline of Addiction Medicine, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia
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Buller AM, Pichon M, McAlpine A, Cislaghi B, Heise L, Meiksin R. Systematic review of social norms, attitudes, and factual beliefs linked to the sexual exploitation of children and adolescents. Child Abuse Negl 2020; 104:104471. [PMID: 32371213 DOI: 10.1016/j.chiabu.2020.104471] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [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: 03/22/2019] [Revised: 02/28/2020] [Accepted: 03/18/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Despite growing interest in the role of social norms in perpetuating the harmful practice of sexual exploitation of children and adolescents (SECA), little is known about the state of the literature on this issue. OBJECTIVE This systematic review aims to summarize what associated norms, attitudes and factual beliefs have been identified by the SECA literature worldwide. METHODS Multiple database searches were conducted using controlled vocabulary and keywords referring to SECA. RESULTS Our searches identified 3690 unique references. After applying our exclusion criteria, 49 studies, including over 14,000 participants from 37 countries and most world regions, were included. Across studies we identified six injunctive norms perpetuating SECA: owning goods as a social status marker ; being sexually active; exchanging sex for favors; contributing financially to the household; stigma and discrimination against young people who experienced SECA; and lack of social sanctions for SECA perpetrators. These norms were supported by enhanced tolerance of SECA when it involved older or more physically developed adolescents and when it occurred in poverty-affected contexts. Beliefs around markers that denote adolescents' readiness for sex; men's entitlement to sex; and the perceived benefits of intergenerational relationships, also contributed to the maintenance and reproduction of SECA. Findings from all regions suggested that marginalized young people are particularly vulnerable to SECA. CONCLUSIONS Interventions to reduce SECA must consider individual, social, and structural factors and how they interrelate. Context-specific social norms interventions are needed to address harmful norms, promote protective norms, and improve services for those who have experienced SECA.
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Affiliation(s)
- Ana Maria Buller
- London School of Hygiene and Tropical Medicine, 15-17 Tavistock Pl, Kings Cross, London, WC1H 9SH, United Kingdom.
| | - Marjorie Pichon
- London School of Hygiene and Tropical Medicine, 15-17 Tavistock Pl, Kings Cross, London, WC1H 9SH, United Kingdom.
| | - Alys McAlpine
- London School of Hygiene and Tropical Medicine, 15-17 Tavistock Pl, Kings Cross, London, WC1H 9SH, United Kingdom.
| | - Beniamino Cislaghi
- London School of Hygiene and Tropical Medicine, 15-17 Tavistock Pl, Kings Cross, London, WC1H 9SH, United Kingdom.
| | - Lori Heise
- Johns Hopkins Bloomberg School of Public Health, 615N. Wolfe Street, Room E4644, Baltimore, MA, 21205, USA.
| | - Rebecca Meiksin
- London School of Hygiene and Tropical Medicine, 15-17 Tavistock Pl, Kings Cross, London, WC1H 9SH, United Kingdom.
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Diniz D. Developing World Bioethics is turning 20: Why are we needed? Dev World Bioeth 2020; 20:2-3. [PMID: 32198846 DOI: 10.1111/dewb.12257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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McKinney M, Smith KE, Dong KA, Babenko O, Ross S, Kelly MA, Salvalaggio G. Development of the Inner City attitudinal assessment tool (ICAAT) for learners across Health care professions. BMC Health Serv Res 2020; 20:174. [PMID: 32143705 PMCID: PMC7059309 DOI: 10.1186/s12913-020-5000-6] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 02/14/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Many health professions learners report feeling uncomfortable and underprepared for professional interactions with inner city populations. These learners may hold preconceptions which affect therapeutic relationships and provision of care. Few tools exist to measure learner attitudes towards these populations. This article describes the development and validity evidence behind a new tool measuring health professions learner attitudes toward inner city populations. METHODS Tool development consisted of four phases: 1) Item identification and generation informed by a scoping review of the literature; 2) Item refinement involving a two stage modified Delphi process with a national multidisciplinary team (n = 8), followed by evaluation of readability and response process validity with a focus group of medical and nursing students (n = 13); 3) Pilot testing with a cohort of medical and nursing students; and 4) Analysis of psychometric properties through factor analysis and reliability. RESULTS A 36-item online version of the Inner City Attitudinal Assessment Tool (ICAAT) was completed by 214 of 1452 undergraduate students (67.7% from medicine; 32.3% from nursing; response rate 15%). The resulting tool consists of 24 items within a three-factor model - affective, behavioural, and cognitive. Reliability (internal consistency) values using Cronbach alpha were 0.87, 0.82, and 0.82 respectively. The reliability of the whole 24-item ICAAT was 0.90. CONCLUSIONS The Inner City Attitudinal Assessment Tool (ICAAT) is a novel tool with evidence to support its use in assessing health care learners' attitudes towards caring for inner city populations. This tool has potential to help guide curricula in inner city health.
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Affiliation(s)
- Mark McKinney
- Inner City Health and Wellness Program, Edmonton, AB Canada
- Department of Emergency Medicine, University of Ottawa, Ottawa, ON Canada
| | - Katherine E. Smith
- Alberta Health Services, Edmonton, AB Canada
- Department of Emergency Medicine, University of Alberta, Edmonton, AB Canada
| | - Kathryn A. Dong
- Inner City Health and Wellness Program, Edmonton, AB Canada
- Alberta Health Services, Edmonton, AB Canada
- Department of Emergency Medicine, University of Alberta, Edmonton, AB Canada
| | - Oksana Babenko
- Department of Family Medicine, University of Alberta, Edmonton, AB Canada
| | - Shelley Ross
- Department of Family Medicine, University of Alberta, Edmonton, AB Canada
| | - Martina A. Kelly
- Department of Family Medicine, University of Calgary Cumming School of Medicine, Calgary, AB Canada
| | - Ginetta Salvalaggio
- Inner City Health and Wellness Program, Edmonton, AB Canada
- Department of Family Medicine, University of Alberta, Edmonton, AB Canada
- Department of Family Medicine, University of Alberta Faculty of Medicine & Dentistry, 610 University Terrace, Edmonton, AB T6G 2T4 Canada
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Affiliation(s)
- Katrina Armstrong
- From the Department of Medicine, Massachusetts General Hospital, and Harvard Medical School - both in Boston (K.A.); and the University of Pennsylvania and the Corporal Michael J. Crescenz VA Medical Center - both in Philadelphia (D.A.A.)
| | - David A Asch
- From the Department of Medicine, Massachusetts General Hospital, and Harvard Medical School - both in Boston (K.A.); and the University of Pennsylvania and the Corporal Michael J. Crescenz VA Medical Center - both in Philadelphia (D.A.A.)
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Muiruri C, Longenecker CT, Meissner EG, Okeke NL, Pettit AC, Thomas K, Velazquez E, Bloomfield GS. Prevention of cardiovascular disease for historically marginalized racial and ethnic groups living with HIV: A narrative review of the literature. Prog Cardiovasc Dis 2020; 63:142-148. [PMID: 32057785 PMCID: PMC7237291 DOI: 10.1016/j.pcad.2020.02.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 02/09/2020] [Accepted: 02/09/2020] [Indexed: 12/16/2022]
Abstract
Despite developments to improve health in the United States, racial and ethnic disparities persist. These disparities have profound impact on the wellbeing of historically marginalized racial and ethnic groups. This narrative review explores disparities by race in people living with cardiovascular disease (CVD) and the Human Immunodeficiency Virus (HIV). We discuss selected common social determinants of health for both of these conditions which include; regional historical policies, incarceration, and neighborhood effects. Data on racial disparities for persons living with comorbid HIV and CVD are lacking. We found few published articles (n = 7) describing racial disparities for persons living with both comorbid HIV and CVD. Efforts to reduce CVD morbidity in historically marginalized racial and ethnic groups with HIV must address participation in clinical research, social determinants of health and translation of research into clinical practice.
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Affiliation(s)
- Charles Muiruri
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA; Duke Global Health Institute, Duke University, Durham, NC, USA.
| | - Chris T Longenecker
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Eric G Meissner
- Division of Infectious Diseases, Medical University of South Carolina, Charleston, SC, USA
| | | | - April C Pettit
- School of Medicine, Vanderbilt University, Nashville, TN, USA
| | - Kevin Thomas
- Department of Medicine, Duke University Medical Center NC, USA; Duke Clinical Research Institute, USA
| | | | - Gerald S Bloomfield
- Duke Global Health Institute, Duke University, Durham, NC, USA; Department of Medicine, Duke University Medical Center NC, USA; Duke Clinical Research Institute, USA
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Mahady JA, Octaviano C, Araiza Bolaños OS, López ER, Kammen DM, Castellanos S. Mapping Opportunities for Transportation Electrification to Address Social Marginalization and Air Pollution Challenges in Greater Mexico City. Environ Sci Technol 2020; 54:2103-2111. [PMID: 31909600 DOI: 10.1021/acs.est.9b06148] [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] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Amid climate change and public health concerns, world economies are seeking to reduce the greenhouse gas emissions and local air pollution from transportation. Population growth in cities worldwide will further increase demand for clean and affordable transportation. We propose a city-specific environmental justice mapping index, inspired by a similar index used in California, that highlights promising areas for clean transportation interventions in Greater Mexico City to reduce greenhouse gas emissions and local pollution. This novel approach leverages highly spatially resolved population, pollution, and transportation data. The proposed index score is designed as an open source, updateable point of orientation for decisionmakers as they consider investment in transportation electrification from the standpoint of overlapping atmospheric pollution and social vulnerability.
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Affiliation(s)
- James Adam Mahady
- California Institute for Energy and Environment University of California at Berkeley Address: Sutardja Dai Hall, fourth floor Berkeley , California 94720 , United States
| | - Claudia Octaviano
- Instituto Nacional de Ecologı́a y Cambio Climático Coordinación General de Mitigación del Cambio Climático Address: Boulevard A. Ruiz Cortines No. 4209 Col. Jardines de la Montan ̃a, Del. Tlalpan, 2b , Ciudad de México , Mexico 14210 , United States
| | - Oscar Sebastian Araiza Bolaños
- Instituto Nacional de Ecologı́a y Cambio Climático Coordinación General de Mitigación del Cambio Climático Address: Boulevard A. Ruiz Cortines No. 4209 Col. Jardines de la Montan ̃a, Del. Tlalpan, 2b , Ciudad de México , Mexico 14210 , United States
| | - Erick Rosas López
- Instituto Nacional de Ecologı́a y Cambio Climático Coordinación General de Mitigación del Cambio Climático Address: Boulevard A. Ruiz Cortines No. 4209 Col. Jardines de la Montan ̃a, Del. Tlalpan, 2b , Ciudad de México , Mexico 14210 , United States
| | - Daniel M Kammen
- Energy and Resources Group University of California at Berkeley 310 Barrows Hall Berkeley , California 94720 , United States
| | - Sergio Castellanos
- California Institute for Energy and Environment University of California at Berkeley Address: Sutardja Dai Hall, fourth floor Berkeley , California 94720 , United States
- Energy and Resources Group University of California at Berkeley 310 Barrows Hall Berkeley , California 94720 , United States
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