101
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Subica AM, Link BG. Cultural trauma as a fundamental cause of health disparities. Soc Sci Med 2022; 292:114574. [PMID: 34808396 PMCID: PMC9006767 DOI: 10.1016/j.socscimed.2021.114574] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 11/09/2021] [Accepted: 11/15/2021] [Indexed: 01/03/2023]
Abstract
Health disparities disproportionately affect minority cultural groups (e.g., Indigenous, immigrant, refugee) worldwide; enduring across time, disease states, and risk factors despite co-occurring advancements in health and medicine. Fundamental cause theory holds that important social factors (e.g., socioeconomic status, stigma, racism) produce health disparities by restricting equitable access to health-protective resources. Yet, extant literature has not utilized fundamental cause theory to describe the health disparities impact of cultural trauma: an overwhelming, often ongoing physical or psychological assault by an oppressive dominant group on another group's cultural resources through force, threats of force, or oppressive policies. This paper presents a novel conceptual model detailing cultural trauma and the mechanisms through which it may disrupt health and create disparities by damaging three health-protective cultural resources: cultural modes, institutions, and lands. Following cultural trauma, we propose affected groups are socially disadvantaged and exposed to pervasive stress, stigma, and diminished resources, perpetuating health disparities across generations. Consequently, cultural trauma may represent an unrecognized fundamental cause of health disparities, offering potential avenues for promoting health equity through targeted research, interventions, and policies.
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Affiliation(s)
- Andrew M. Subica
- University of California, Riverside School of Medicine, Department of Social Medicine, Population, and Public Health, 900 University Ave, Riverside, CA, 92521, USA,Corresponding author. (A.M. Subica)
| | - Bruce G. Link
- University of California, Riverside School of Public Policy, 900 University Ave, Riverside, CA, 92521, USA
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102
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Islam SJ, Kim JH, Baltrus P, Topel ML, Liu C, Ko YA, Mujahid MS, Vaccarino V, Sims M, Mubasher M, Khan A, Ejaz K, Searles C, Dunbar S, Pemu P, Taylor HA, Quyyumi AA, Lewis TT. Neighborhood characteristics and ideal cardiovascular health among Black adults: results from the Morehouse-Emory Cardiovascular (MECA) Center for Health Equity. Ann Epidemiol 2022; 65:120.e1-120.e10. [PMID: 33285258 PMCID: PMC8178422 DOI: 10.1016/j.annepidem.2020.11.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 11/25/2020] [Accepted: 11/30/2020] [Indexed: 01/03/2023]
Abstract
PURPOSE Neighborhood environment is increasingly recognized as an important determinant of cardiovascular health (CVH) among Black adults. Most research to date has focused on negative aspects of the neighborhood environment, with little attention being paid to the specific positive features, in particular the social environment, that promote cardiovascular resilience among Black adults.We examined whether better neighborhood physical and social characteristics are associated with ideal CVH among Black adults, as measured by Life's Simple 7 (LS7) scores. METHODS We recruited 392 Black adults (age 53 ± 10 years, 39% men) without known CV disease living in Atlanta, GA. Seven neighborhood domains were assessed via questionnaire: asthetic quality, walking environment, safety, food access, social cohesion, activity with neighbors, and violence. CVH was determined by LS7 scores calculated from measured blood pressure; glucose; cholesterol; body mass index (BMI); and self-reported exercise, diet, and smoking, and categorized into poor (0-8), intermediate (9-10), and ideal (11-14). Multinomial logistic regression was used to examine the association between neighborhood characteristics and the odds of intermediate/ideal CVH categories compared with poor CVH after adjustment for age, gender, household income, education, marital status, and employment status. RESULTS Better scores in the neighborhood domains of social cohesion and activity with neighbors were significantly associated with higher adjusted odds of ideal LS7 scores (OR 2.02, 95% CI [1.36-3.01] and 1.71 [1.20-2.45] per 1 standard deviation [SD] increase in respective scores). These associations were stronger for both social cohesion (OR 2.61, 95% CI [1.48-4.61] vs. 1.40 [0.82-2.40]) and activity with neighbors (OR 1.82, 95% CI [1.15-2.86] vs. 1.53 [0.84-2.78]) in Black women than men. Specifically, better scores in social cohesion were associated with higher odds of ideal CVH in exercise (OR 1.73 [1.16-2.59]), diet (OR 1.90 [1.11-3.26]), and BMI (OR 1.52 [1.09-2.09]); better scores in activity with neighbors were also similarly associated with higher odds of ideal CVH in exercise (OR 1.48 [1.00-2.19]), diet (OR 2.15 [1.23-3.77]), and BMI (OR 1.45 [1.07-1.98]; per 1 SD in respective scores). CONCLUSIONS More desirable neighborhood characteristics, particularly social cohesion and activity with neighbors, were associated with better CVH among Black adults.
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Affiliation(s)
- Shabatun J. Islam
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA
| | - Jeong Hwan Kim
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA
| | - Peter Baltrus
- Department of Community Health and Preventive Medicine, Morehouse School of Medicine, Atlanta, GA,National Center for Primary Care, Morehouse School of Medicine, Atlanta, GA
| | - Matthew L. Topel
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA
| | - Chang Liu
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA,Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Yi-An Ko
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Mahasin S. Mujahid
- Division of Epidemiology, School of Public Health, University of California, Berkeley, Berkeley, CA
| | - Viola Vaccarino
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA,Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Mario Sims
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS
| | - Mohamed Mubasher
- Department of Community Health and Preventive Medicine, Morehouse School of Medicine, Atlanta, GA
| | - Ahsan Khan
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA
| | - Kiran Ejaz
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA
| | - Charles Searles
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA
| | - Sandra Dunbar
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA
| | - Priscilla Pemu
- Department of Medicine, Morehouse School of Medicine, Atlanta, GA
| | - Herman A. Taylor
- Department of Medicine, Morehouse School of Medicine, Atlanta, GA
| | - Arshed A. Quyyumi
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA
| | - Tené T. Lewis
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
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Garey L, Hébert ET, Mayorga NA, Chavez JF, Shepherd JM, Businelle MS, Zvolensky MJ. Evaluating the feasibility and acceptability of a mobile-based health technology for smoking cessation: Mobile Anxiety Sensitivity Program. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2022; 61 Suppl 1:111-129. [PMID: 33939190 PMCID: PMC8563508 DOI: 10.1111/bjc.12294] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 11/21/2020] [Indexed: 01/03/2023]
Abstract
OBJECTIVES Cigarette smoking is the leading preventable cause of death and disability. Although most US smokers want to quit, more than 95% of cessation attempts end in relapse within 6 months. To improve cessation outcomes, research has turned to targetable mechanisms, such as anxiety sensitivity (AS), which maintain smoking behaviour, impede cessation success, and can be effectively targeted in the context of psychosocial interventions. Although integrated treatment programmes that address AS reduction in the context of smoking cessation have demonstrated promising results, presently, no mobile, technology-based integrated treatment exists to expressly address smoking and AS. The current study evaluated the initial feasibility and acceptability of a mobile smoking cessation intervention, Mobile Anxiety Sensitivity Program for smoking (MASP). METHODS Participants were 15 daily adult combustible cigarette smokers (females n = 6, Mage = 46.5 years, SD = 13.3) who completed a 6-week total intervention period (baseline visit, 2 weeks pre-quit, 4 weeks post-quit, follow-up visit). RESULTS Most participants (N = 12) completed the full 6-week intervention, and participant engagement with MASP was high. Participants reported that MASP was acceptable. Biochemical verification of smoking abstinence indicated 25% of smokers were abstinent for at least 24 hr prior to the in-person 4 weeks post-quit follow-up visit. CONCLUSIONS Findings indicated that MASP has the potential to provide effective assistance to those wanting to quit cigarettes. PRACTITIONER POINTS Mobile-based smoking cessation interventions may be a promising treatment option, particularly for those of lower socio-economic status. Targeting AS in the context of a mobile-based smoking cessation app may be a viable way to improve smoking cessation success and treatment outcome. Due to the pilot nature of this study, there was no control group. Thus, comparative conclusions and generalizability based on the current study must be made with caution.
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Affiliation(s)
- Lorra Garey
- Department of Psychology, University of Houston, Texas, USA
| | - Emily T. Hébert
- University of Texas Health Science Center (UTHealth) School of Public Health,Austin, Texas, USA
| | | | | | | | - Michael S. Businelle
- Oklahoma Tobacco Research Center, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Michael J. Zvolensky
- Department of Psychology, University of Houston, Texas, USA,Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA,HEALTH Institute, University of Houston, Texas, USA,Corresponding author: Michael J. Zvolensky, Ph.D., Dept of Psychology, 3695 Cullen Blvd., Room 126. University of Houston, Houston, TX, 77204. (713) 743-8056,
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Dobbs PD, Herrmann E, Vidal C, Mena DA, Jones C. Factors that influence Puerto Rican's intention to get the COVID-19 vaccine. EXPLORATORY RESEARCH IN CLINICAL AND SOCIAL PHARMACY 2022; 5:100106. [PMID: 35098204 PMCID: PMC8783648 DOI: 10.1016/j.rcsop.2022.100106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 11/05/2021] [Accepted: 01/20/2022] [Indexed: 11/21/2022] Open
Abstract
Despite Latino Americans having been found to be disproportionally affected by COVID-19, they report higher hesitancy to receive the COVID-19 vaccine than non-Hispanic whites. The purpose of this study was to examine factors that influence Puerto Rican's intentions to get the COVID-19 Vaccine. A sample (n = 173) of people who currently lived in Puerto Rico were recruited to complete an online, cross-sectional survey about their intention to receive the COVID-19 vaccine. Demographics and vaccine hesitancy were assessed, and logistic regressions explored relationships between variables and intention to get the COVID-19 vaccine when it became available. When controlling for covariates, 30–49-year-olds (aOR = 0.12) and those who had refused a vaccine in the past (aOR = 0.07) had lower odds of vaccine uptake than those between 18 and 29 years and who had not previously refused a vaccine, respectively. Those who had completed at least a 4-year college degree (aOR = 6.78) had greater odds of intending to get vaccinated than their counterparts. Health education campaigns about COVID-19 in Puerto Rico should be tailored to working-age adults who may mistrust information they have heard about the vaccine. Messages could be tailored to preferred communication channels to decrease vaccination hesitancy. Puerto Ricans between 18 and 29 years were more likely to get vaccinated than 30–49-year-olds. Puerto Ricans who had previously refused a vaccine had lower odds of getting the Covid-19 vaccine. Puerto Ricans with a 4-year college degree+ were more likely to get vaccinated.
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Affiliation(s)
- Page D. Dobbs
- Department of Health, Human Performance and Recreation, University of Arkansas, Fayetteville, AR, USA
- Corresponding author at: 308 HPER Building, University of Arkansas, Fayetteville, AR 72701, USA.
| | - Emily Herrmann
- Department of Health, Human Performance and Recreation, University of Arkansas, Fayetteville, AR, USA
| | - Charlie Vidal
- Puerto Rico Public Health Association, Utuado, Puerto Rico
| | - Daniela Ameijeiras Mena
- Department of Health, Human Performance and Recreation, University of Arkansas, Fayetteville, AR, USA
| | - Ches Jones
- Department of Health, Human Performance and Recreation, University of Arkansas, Fayetteville, AR, USA
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105
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Racial and Ethnic Differences in Falls Among Older Adults: a Systematic Review and Meta-analysis. J Racial Ethn Health Disparities 2022; 9:2427-2440. [PMID: 34786654 PMCID: PMC9633486 DOI: 10.1007/s40615-021-01179-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 10/21/2021] [Accepted: 10/22/2021] [Indexed: 12/29/2022]
Abstract
The aim of this systematic review and meta-analysis was to determine whether differences in reported fall rates exist between different ethnic groups. Searches were carried out on four databases: Medline, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Scopus, and Web of Science. Only English language studies with community-dwelling participants aged 60 + years were included. Studies also needed to compare fall prevalence for at least two or more ethnic groups. Two reviewers independently screened all articles and evaluated study quality. Twenty-three articles were included for systematic review, and meta-analyses were carried out on the 16 retrospective studies that reported falls in the previous 12 months. The Asian group demonstrated significantly lower fall prevalence than all other ethnic groups at 13.89% (10.87, 16.91). The Hispanic group had a fall prevalence of 18.54% (12.95, 24.13), closely followed by the Black group at 18.60% (13.27, 23.93). The White group had the highest prevalence at 23.77% (18.66, 28.88). Some studies provided adjusted estimates of effect statistics for the odds/risk of falls, which showed that differences still existed between some ethnic groups even after adjusting for other risk factors. Overall, differences in fall prevalence do appear to exist between different ethnic groups, although the reasons for these differences currently remain undetermined and require further investigation. These findings highlight the need to provide more ethnically tailored responses to public health challenges, which could potentially increase the adherence to prevention interventions, and allow for a more targeted use of resources.
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106
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Schneider EC, Chin MH, Graham GN, Lopez L, Obuobi S, Sequist TD, McGlynn EA. Increasing Equity While Improving the Quality of Care: JACC Focus Seminar 9/9. J Am Coll Cardiol 2021; 78:2599-2611. [PMID: 34887146 PMCID: PMC9172264 DOI: 10.1016/j.jacc.2021.06.057] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 06/02/2021] [Indexed: 01/14/2023]
Abstract
This review summarizes racial and ethnic disparities in the quality of cardiovascular care-a challenge given the fragmented nature of the health care delivery system and measurement. Health equity for all racial and ethnic groups will not be achieved without a substantially different approach to quality measurement and improvement. The authors adapt a tool frequently used in quality improvement work-the driver diagram-to chart likely areas for diagnosing root causes of disparities and developing and testing interventions. This approach prioritizes equity in quality improvement. The authors demonstrate how this approach can be used to create interventions that reduce systemic racism within the institutions and professions that deliver health care; attends more aggressively to social factors related to race and ethnicity that affect health outcomes; and examines how hospitals, health systems, and insurers can generate effective partnerships with the communities they serve to achieve equitable cardiovascular outcomes.
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Affiliation(s)
| | - Marshall H Chin
- University of Chicago, Section of General Internal Medicine, Chicago, Illinois, USA
| | - Garth N Graham
- Healthcare and Public Health, Google, Palo Alto, California, USA
| | - Lenny Lopez
- Division of Hospital Medicine, San Francisco VA Medical Center, University of California-San Francisco, Department of Medicine, San Francisco, California, USA
| | - Shirlene Obuobi
- Internal Medicine, University of Chicago, Section of Cardiology, Chicago, Illinois, USA
| | - Thomas D Sequist
- Division of General Medicine, Brigham and Women's Hospital, Department of Health Care Policy, Harvard Medical School, Department of Quality and Patient Experience, Mass General Brigham, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Elizabeth A McGlynn
- Kaiser Permanente, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California, USA.
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107
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Historical redlining and cardiovascular health: The Multi-Ethnic Study of Atherosclerosis. Proc Natl Acad Sci U S A 2021; 118:2110986118. [PMID: 34903653 PMCID: PMC8713797 DOI: 10.1073/pnas.2110986118] [Citation(s) in RCA: 59] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/14/2021] [Indexed: 12/14/2022] Open
Abstract
We investigated historical redlining, a government-sanctioned discriminatory policy, in relation to cardiovascular health (CVH) and whether associations were modified by present-day neighborhood physical and social environments. Data included 4,779 participants (mean age 62 y; SD = 10) from the baseline sample of the Multi-Ethnic Study of Atherosclerosis (MESA; 2000 to 2002). Ideal CVH was a summary measure of ideal levels of seven CVH risk factors based on established criteria (blood pressure, fasting glucose, cholesterol, body mass index, diet, physical activity, and smoking). We assigned MESA participants' neighborhoods to one of four grades (A: best, B: still desirable, C: declining, and D: hazardous) using the 1930s federal Home Owners' Loan Corporation (HOLC) maps, which guided decisions regarding mortgage financing. Two-level hierarchical linear and logistic models, with a random intercept to account for participants nested within neighborhoods (i.e., census tracts) were used to assess associations within racial/ethnic subgroups (non-Hispanic White, non-Hispanic Black, Hispanic, and non-Hispanic Chinese). We found that Black adults who lived in historically redlined areas had a 0.82 (95% CI -1.54, -0.10) lower CVH score compared to those residing in grade A (best) neighborhoods, in a given neighborhood and adjusting for confounders. We also found that as the current neighborhood social environment improved the association between HOLC score and ideal CVH weakened (P < 0.10). There were no associations between HOLC grade and CVH measures or effect modification by current neighborhood conditions for any other racial/ethnic group. Results suggest that historical redlining has an enduring impact on cardiovascular risk among Black adults in the United States.
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108
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Finch T, Jonas MC, Rubenstein K, Watson E, Basra S, Martinez J, Horberg M. Life Expectancy Trends Among Integrated Health Care System Enrollees, 2014-2017. Perm J 2021; 25:20.286. [PMID: 35348069 PMCID: PMC8784056 DOI: 10.7812/tpp/20.286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 04/15/2021] [Accepted: 04/20/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The Centers for Disease Control and Prevention (CDC) has reported downward trends in life expectancy and racial/ethnic differences between 2014 and 2017. OBJECTIVE To determine the life expectancy of the Kaiser Permanente Mid-Atlantic States (KPMAS) insured population as compared to the CDC National Vital Statistics data from 2014 to 2017. We also aimed to highlight the utilization of membership data to inform population statistical estimates such as life expectancy. We examine whether national trends in life expectancy are reflected in an insured population with relatively uniform access to care. METHODS This retrospective, data only study examined life expectancy between 2014 and 2017. Data from electronic medical records and the National Death Index were combined to construct complete life tables by race and sex for the KPMAS population, which was compared to the CDC National Vital Statistics data. RESULTS From 2014 to 2017, the overall KPMAS population life expectancy at birth varied between 84.6 and 85.2 years compared to the CDC reported national average of 78.6-78.9 years (p < 0.001). While the CDC dataset reported a 3.5- to 3.7-year life expectancy gap between non-Hispanic White and non-Hispanic Black populations, in the KPMAS population, this gap was significantly smaller (0.0-0.9 years). The gap in life expectancy between males and females was consistent across KPMAS and the CDC data; however, overall KPMAS male and female patient life expectancy was extended in comparison. CONCLUSION Among members who disclosed their race/ethnicity, KPMAS Hispanic, non-Hispanic Black, and non-Hispanic White members had significantly higher life expectancies than the CDC dataset in all years reported.
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Affiliation(s)
- Tori Finch
- Mid-Atlantic Permanente Medical Group, Rockville, MD
| | - M Cabell Jonas
- Mid-Atlantic Permanente Medical Group, Rockville, MD
- Mid-Atlantic Permanente Research Institute, Rockville, MD
| | - Kevin Rubenstein
- Mid-Atlantic Permanente Medical Group, Rockville, MD
- Mid-Atlantic Permanente Research Institute, Rockville, MD
| | - Eric Watson
- Mid-Atlantic Permanente Medical Group, Rockville, MD
- Mid-Atlantic Permanente Research Institute, Rockville, MD
| | - Sundeep Basra
- Mid-Atlantic Permanente Medical Group, Rockville, MD
- Mid-Atlantic Permanente Research Institute, Rockville, MD
| | - Jose Martinez
- Mid-Atlantic Permanente Medical Group, Rockville, MD
| | - Michael Horberg
- Mid-Atlantic Permanente Medical Group, Rockville, MD
- Mid-Atlantic Permanente Research Institute, Rockville, MD
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109
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Aaron SP, Gazaway SB, Harrell ER, Elk R. Disparities and Racism Experienced Among Older African Americans Nearing End of Life. CURRENT GERIATRICS REPORTS 2021; 10:157-166. [PMID: 34956825 PMCID: PMC8685164 DOI: 10.1007/s13670-021-00366-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/02/2021] [Indexed: 11/23/2022]
Abstract
Purpose of Review The purpose of this review is to examine racism in healthcare as it relates to older African American adults. We focus on health disparities in old age and medical mismanagement throughout their lifespan. Recent Findings In the United States there have been extensive medical advances over the past several decades. Individuals are living longer, and illnesses that were deemed terminal in the past are now considered chronic illnesses. While most individuals living with chronic illness have experienced better quality of life, this is not the case for many African American older adults. Summary Older African American adults are less likely to have their chronic illness sufficiently managed and are more likely to die from chronic illnesses that are well controlled in Whites. African American older adults also continue to suffer from poorer healthcare outcomes throughout the lifespan to end-of-life.
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Affiliation(s)
- Siobhan P Aaron
- College of Nursing, University of Utah, 10 2000 E, Salt Lake City, UT 84112 U.S.A
| | - Shena B Gazaway
- School of Nursing, University of Alabama Birmingham, Birmingham, AL U.S.A
| | - Erin R Harrell
- Department of Psychology, University of Alabama, Tuscaloosa, AL U.S.A
| | - Ronit Elk
- Department of Medicine, University of Alabama Birmingham, Birmingham, AL U.S.A
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SCHNEIDER RH, GRIM C, KOTCHEN T, MARWAHA K, KOTCHEN J, SALERNO JW, KING CG, NIDICH S, ALEXANDER CN. Randomized controlled trial of stress reduction with meditation and health education in black men and women with high normal and normal blood pressure. Am J Prev Cardiol 2021; 8:100279. [PMID: 34729544 PMCID: PMC8546372 DOI: 10.1016/j.ajpc.2021.100279] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 08/20/2021] [Accepted: 10/01/2021] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Black men and women suffer from disparities in morbidity and mortality from hypertension, cardiovascular disease, and currently, COVID-19. These conditions are associated with social determinants of health and psychosocial stress. While previous trials demonstrated that stress reduction with meditation lowered BP in the grade I range in Black adults, there is a paucity of evidence for high normal and normal BP. OBJECTIVE This randomized controlled trial was conducted to evaluate the effect of stress reduction with the Transcendental Meditation (TM) technique in Black adults with high normal BP and normal BP using international classifications. METHODS A total of 304 Black men and women with high normal (130-139/85-89 mm Hg) and normal BP (120-129/80-84 mm Hg) were randomized to either TM or health education (HE) groups. BP was recorded at 3, 6, 9, 12, 24, 30 and 36 months after baseline. Linear mixed model analysis was conducted to compare the BP change between TM and HE participants in the high-normal BP and normal-BP groups. Survival analysis for hypertensive events was conducted. RESULTS After an average of 19.9 ± 11.1 months follow-up, TM participants in the high-normal BP group showed significantly lower posttest SBP (-3.33 mm Hg, p = 0.045). There was no difference in DBP (-0.785 mm Hg, p = 0.367) compared to HE participants. In the normal BP group, the SBP and DBP were not different between the TM and HE participants. The hazard ratio for hypertensive events was 0.52 (p = 0.15) in the high normal BP group (7 TM vs 13 HE) with no difference in the normal BP group. CONCLUSION This RCT found that meditation lowered systolic BP in Black men and women with high normal BP but not in normal BP participants. These results may be relevant to reducing health disparities in CVD and related co-morbidities.
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Affiliation(s)
- Robert H. SCHNEIDER
- Institute for Prevention Research, 2100 Mansion Drive, Vedic City, Iowa 52556, USA
- College of Integrative Medicine, Institute for Natural Medicine and Prevention, Department of Physiology and Health, Maharishi International University, Fairfield, Iowa USA
| | - Clarence GRIM
- Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Theodore KOTCHEN
- Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Komal MARWAHA
- College of Integrative Medicine, Institute for Natural Medicine and Prevention, Department of Physiology and Health, Maharishi International University, Fairfield, Iowa USA
| | - Jane KOTCHEN
- Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - John W. SALERNO
- Institute for Prevention Research, 2100 Mansion Drive, Vedic City, Iowa 52556, USA
| | - Carolyn Gaylord KING
- Institute for Prevention Research, 2100 Mansion Drive, Vedic City, Iowa 52556, USA
| | - Sanford NIDICH
- Institute for Prevention Research, 2100 Mansion Drive, Vedic City, Iowa 52556, USA
| | - Charles N. ALEXANDER
- Institute for Prevention Research, 2100 Mansion Drive, Vedic City, Iowa 52556, USA
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Williams LD, Tempalski B, Hall HI, Johnson AS, Wang G, Friedman SR. Trajectories of and disparities in HIV prevalence among Black, White, and Hispanic/Latino High Risk Heterosexuals in 89 U.S. Metropolitan statistical areas, 1992-2013. Ann Epidemiol 2021; 64:140-148. [PMID: 34433105 PMCID: PMC8747890 DOI: 10.1016/j.annepidem.2021.08.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 07/21/2021] [Accepted: 08/11/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE Estimates of HIV prevalence, and how it changes over time, are needed to inform action (e.g., resource allocation) to improve HIV-related public health. However, creating adequate estimates of (diagnosed and undiagnosed) HIV prevalence is challenging due to biases in samples receiving HIV testing and due to difficulties enumerating key risk populations. To our knowledge, estimates of HIV prevalence among high risk heterosexuals in the United States produced for geographic areas smaller than the entire nation have to date been only for single years and/or for single cities (or other single geographic locations). METHODS The present study addresses these gaps by using multilevel modeling on multiple data series, in combination with previous estimates of HIV prevalence among heterosexuals from the extant literature, to produce annual estimates of HIV prevalence among high risk heterosexuals for each of 89 metropolitan statistical areas, from 1992 to 2013. It also produces estimates for these MSAs and years by racial/ethnic subgroup to allow for an examination of change over time in racial/ethnic disparities in HIV prevalence among high risk heterosexuals. RESULTS The resulting estimates suggest that HIV prevalence among high risk heterosexuals has decreased steadily, on average, from 1992 to 2013. Examination of these estimates by racial/ ethnic subgroup suggests that this trend is primarily due to decreases among Black and Hispanic/Latino high risk heterosexuals. HIV prevalence among white high risk heterosexuals remained steady over time at around 1% during the study period. Although HIV prevalence among Black and Hispanic/Latino high risk heterosexuals was much higher (approximately 3.5% and 3.3%, respectively) than that among whites in 1992, over time these differences decreased as HIV prevalence decreased over time among these subgroups. By 2013, HIV prevalence among Hispanic/Latino high risk heterosexuals was estimated to be very similar to that among white high risk heterosexuals (approximately 1%), with prevalence among Black high risk heterosexuals still estimated to be almost twice as high. CONCLUSIONS It is likely that as HIV incidence has decreased among heterosexuals from 1992 to 2013, mortality due to all causes has remained disparately high among racial/ethnic minorities, thereby outpacing new HIV cases. Future research should aim to empirically examine this by comparing changes over time in estimated HIV incidence among heterosexuals to changes over time in mortality and causes of death among HIV-positive heterosexuals, by racial/ethnic subgroup.
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Affiliation(s)
- Leslie D Williams
- Division of Community Health Sciences, University of Illinois at Chicago School of Public Health, Chicago, IL, United States.
| | - Barbara Tempalski
- North Jersey Community Research Initiative (NJCRI), North Jersey AIDS Alliance, Newark, NJ, United States; Institute for Infectious Disease Research, National Development and Research Institutes, New York, NY, United States
| | - H Irene Hall
- Centers for Disease Control and Prevention, Atlanta, GA, United States
| | | | - Guoshen Wang
- Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Samuel R Friedman
- Institute for Infectious Disease Research, National Development and Research Institutes, New York, NY, United States; Department of Population Health, New York University School of Medicine, New York, NY, United States
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112
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Gamboa CJ, Julion WA. Caring in the recruitment of older African American adults with chronic health disease: An integrative review. Chronic Illn 2021; 17:323-346. [PMID: 32098480 DOI: 10.1177/1742395320905666] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES The aim of this integrative review is to accrue a comprehensive understanding of caring behavioral characteristics in the recruitment of older African-American adults into health-related research studies centered on chronic diseases. METHODS Combined methodologies, Whittemore & Knafl and Kable, Pich & Maslin-Prothero in accordance with preferred items for systematic reviews and meta-analysis, were used to guide the data collection and to report the findings. The data were analyzed based upon recruitment categorization and Kristen Swanson's middle-range theory of caring. RESULTS Ten out of 260 publications comprised the final sample. They were analyzed and then aggregated by chronic illnesses, recruitment activities, contact level, and Swanson's five caring behavioral concepts. Select cancers, diabetes, hypertension, and Alzheimer's disease were the chronic illness foci of eight publications. Cardiovascular disease and stroke were the focus of two publications. Only three studies utilized all five Swanson's caring concepts, and the frequently used concept throughout all 10 studies was enabling. DISCUSSION Recruitment approaches employed to accrue older African-American adults into chronic illness-related research studies necessitate proactive recruitment strategies that incorporate caring behaviors. Future researchers ought to develop multi-modality recruitment strategies to improve older African-American adults' representation.
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Affiliation(s)
- Charlene J Gamboa
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA
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113
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Lee BP, Dodge JL, Terrault NA. Changes and mediators of survival disparity among Black liver transplant recipients in the United States. Am J Transplant 2021; 21:3883-3893. [PMID: 34374495 DOI: 10.1111/ajt.16767] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 07/02/2021] [Accepted: 07/13/2021] [Indexed: 01/25/2023]
Abstract
A landmark 2002 study identified Black liver transplant (LT) recipients as having lower post-LT survival compared to other races. While persistent disparities exist, changes over time and mediating factors are understudied. Capturing LT recipients between 2002 and 2018 in UNOS, we used logistic regression and Cox proportional-hazard models to calculate differences in post-LT mortality among races. We examined interactions between transplant year and race. A mediation analysis assessed biologic and environmental factors potentially associated with race differences in post-LT survival. The cohort included 46,997 LT recipients (3898 Black;36,560 White;6539 Hispanic). In most years, Black (vs. White) LT recipients had a higher probability of age-adjusted mortality, not observed among Hispanics. In multivariable analysis, Blacks (vs. Whites) had higher (aHR = 1.15, 95% CI 1.07-1.24), whereas Hispanics had lower (aHR = 0.78, 95% CI 0.72-0.83) risk of mortality. Differences in post-LT mortality among Blacks (vs. Whites) narrowed between 2002 and 2009, were similar between 2010 and 2013, and may have worsened between 2014 and 2018. Race differences were larger for mortality beyond 1-year post-LT (vs. within 1-year), and among non-HCV (vs. HCV). Alcohol-associated liver disease (ALD) was the strongest mediator (13.9%, 95% CI 8.7-32.7%) of the Black-White disparity in 2010-2018. Our analyses suggest disparities may worsen with longer follow-up, as HCV recedes with elimination efforts, and with further increases in ALD.
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Affiliation(s)
- Brian P Lee
- Division of Gastroenterology and Liver Diseases, University of Southern California, Los Angeles, CA
| | - Jennifer L Dodge
- Division of Gastroenterology and Liver Diseases, University of Southern California, Los Angeles, CA.,Department of Population and Public Health Sciences, University of Southern California, Los Angeles, CA
| | - Norah A Terrault
- Division of Gastroenterology and Liver Diseases, University of Southern California, Los Angeles, CA
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114
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Wu YY, Thompson MD, Youkhana F, Pirkle CM. Interaction Between Physical Activity and Polygenic Score on Type 2 Diabetes Mellitus in Older Black and White Participants From the Health and Retirement Study. J Gerontol A Biol Sci Med Sci 2021; 76:1214-1221. [PMID: 33515027 DOI: 10.1093/gerona/glab025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Indexed: 02/07/2023] Open
Abstract
This study investigated the association of lifestyle factors and polygenic risk scores (PGS), and their interaction, on type 2 diabetes mellitus (T2D). We examined data from the U.S. Health and Retirement Study, a prospective longitudinal cohort of adults aged 50 years and older, containing nationally representative samples of Black and White Americans with precalculated PGS for T2D (N = 14 001). Predicted prevalence and incidence of T2D were calculated with logistic regression models. We calculated differences in T2D prevalence and incidence by PGS percentiles and for interaction variables using nonparametric bootstrap method. Black participants had approximately twice the prevalence of Whites (26.2% vs 14.2%), with a larger difference between the 90th and 10th PGS percentile from age 50 to 80 years. Significant interaction (pinteraction = .0096) was detected between PGS and physical activity among Whites. Among Whites in the 90th PGS percentile, T2D prevalence for moderate physical activity was 17.0% (95% CI: 14.8, 19.6), 6.8% lower compared to no/some physical activity (23.8%; 95% CI: 20.4, 27.5). T2D prevalence was similar (~10%) for both groups in the 10th PGS percentile. Incident T2D in Whites followed a similar pattern (pinteraction = .0325). No significant interactions with PGS were detected among Black participants. Interaction of different genetic risk profiles with lifestyle factors may inform understanding of varying inventions' efficacy for different groups of people, potentially improving clinical and prevention interventions.
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Affiliation(s)
- Yan Yan Wu
- Thompson School of Social Work & Public Health, University of Hawai'i at Mānoa, Honolulu, USA
| | - Mika D Thompson
- Thompson School of Social Work & Public Health, University of Hawai'i at Mānoa, Honolulu, USA
| | - Fadi Youkhana
- Thompson School of Social Work & Public Health, University of Hawai'i at Mānoa, Honolulu, USA
| | - Catherine M Pirkle
- Thompson School of Social Work & Public Health, University of Hawai'i at Mānoa, Honolulu, USA
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Wortham JM, Meador SA, Hadler JL, Yousey-Hindes K, See I, Whitaker M, O’Halloran A, Milucky J, Chai SJ, Reingold A, Alden NB, Kawasaki B, Anderson EJ, Openo KP, Weigel A, Monroe ML, Ryan PA, Kim S, Reeg L, Lynfield R, McMahon M, Sosin DM, Eisenberg N, Rowe A, Barney G, Bennett NM, Bushey S, Billing LM, Shiltz J, Sutton M, West N, Talbot HK, Schaffner W, McCaffrey K, Spencer M, Kambhampati AK, Anglin O, Piasecki AM, Holstein R, Hall AJ, Fry AM, Garg S, Kim L. Census tract socioeconomic indicators and COVID-19-associated hospitalization rates-COVID-NET surveillance areas in 14 states, March 1-April 30, 2020. PLoS One 2021; 16:e0257622. [PMID: 34559838 PMCID: PMC8462704 DOI: 10.1371/journal.pone.0257622] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 09/06/2021] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVES Some studies suggested more COVID-19-associated hospitalizations among racial and ethnic minorities. To inform public health practice, the COVID-19-associated Hospitalization Surveillance Network (COVID-NET) quantified associations between race/ethnicity, census tract socioeconomic indicators, and COVID-19-associated hospitalization rates. METHODS Using data from COVID-NET population-based surveillance reported during March 1-April 30, 2020 along with socioeconomic and denominator data from the US Census Bureau, we calculated COVID-19-associated hospitalization rates by racial/ethnic and census tract-level socioeconomic strata. RESULTS Among 16,000 COVID-19-associated hospitalizations, 34.8% occurred among non-Hispanic White (White) persons, 36.3% among non-Hispanic Black (Black) persons, and 18.2% among Hispanic or Latino (Hispanic) persons. Age-adjusted COVID-19-associated hospitalization rate were 151.6 (95% Confidence Interval (CI): 147.1-156.1) in census tracts with >15.2%-83.2% of persons living below the federal poverty level (high-poverty census tracts) and 75.5 (95% CI: 72.9-78.1) in census tracts with 0%-4.9% of persons living below the federal poverty level (low-poverty census tracts). Among White, Black, and Hispanic persons living in high-poverty census tracts, age-adjusted hospitalization rates were 120.3 (95% CI: 112.3-128.2), 252.2 (95% CI: 241.4-263.0), and 341.1 (95% CI: 317.3-365.0), respectively, compared with 58.2 (95% CI: 55.4-61.1), 304.0 (95%: 282.4-325.6), and 540.3 (95% CI: 477.0-603.6), respectively, in low-poverty census tracts. CONCLUSIONS Overall, COVID-19-associated hospitalization rates were highest in high-poverty census tracts, but rates among Black and Hispanic persons were high regardless of poverty level. Public health practitioners must ensure mitigation measures and vaccination campaigns address needs of racial/ethnic minority groups and people living in high-poverty census tracts.
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Affiliation(s)
- Jonathan M. Wortham
- CDC COVID-NET Team, Atlanta, GA, United States of America
- US Public Health Service, United States of America
| | - Seth A. Meador
- CDC COVID-NET Team, Atlanta, GA, United States of America
| | - James L. Hadler
- Connecticut Emerging Infections Program, Yale School of Public Health, New Haven, CT, United States of America
| | - Kimberly Yousey-Hindes
- Connecticut Emerging Infections Program, Yale School of Public Health, New Haven, CT, United States of America
| | - Isaac See
- CDC COVID-NET Team, Atlanta, GA, United States of America
- US Public Health Service, United States of America
| | | | | | | | - Shua J. Chai
- California Emerging Infections Program, Oakland, CA, United States of America
- CDC Career Epidemiology Field Officer, Oakland, CA, United States of America
| | - Arthur Reingold
- California Emerging Infections Program, Oakland, CA, United States of America
| | - Nisha B. Alden
- Colorado Department of Public Health and Environment, Denver, CO, United States of America
| | - Breanna Kawasaki
- Colorado Department of Public Health and Environment, Denver, CO, United States of America
| | - Evan J. Anderson
- Emerging Infections Program, Georgia Department of Public Health, Atlanta, GA, United States of America
- Veterans Affairs Medical Center, Atlanta, GA, United States of America
- Division of Infectious Diseases, School of Medicine, Emory University, Atlanta, GA, United States of America
| | - Kyle P. Openo
- Emerging Infections Program, Georgia Department of Public Health, Atlanta, GA, United States of America
- Veterans Affairs Medical Center, Atlanta, GA, United States of America
- Division of Infectious Diseases, School of Medicine, Emory University, Atlanta, GA, United States of America
| | - Andrew Weigel
- Iowa Department of Public Health, Des Moines, IA, United States of America
| | - Maya L. Monroe
- Maryland Department of Health, Baltimore, MD, United States of America
| | - Patricia A. Ryan
- Maryland Department of Health, Baltimore, MD, United States of America
| | - Sue Kim
- Michigan Department of Health and Human Services, Lansing, MI, United States of America
| | - Libby Reeg
- Michigan Department of Health and Human Services, Lansing, MI, United States of America
| | - Ruth Lynfield
- Minnesota Department of Health, St. Paul, MN, United States of America
| | - Melissa McMahon
- Minnesota Department of Health, St. Paul, MN, United States of America
| | - Daniel M. Sosin
- New Mexico Department of Health, Santa Fe, NM, United States of America
| | - Nancy Eisenberg
- University of New Mexico Emerging Infections Program, Albuquerque, NM, United States of America
| | - Adam Rowe
- New York State Department of Health, Albany, NY, United States of America
| | - Grant Barney
- New York State Department of Health, Albany, NY, United States of America
| | - Nancy M. Bennett
- University of Rochester School of Medicine and Dentistry, Rochester, NY, United States of America
| | - Sophrena Bushey
- University of Rochester School of Medicine and Dentistry, Rochester, NY, United States of America
| | | | - Jess Shiltz
- Ohio Department of Health, Columbus, OH, United States of America
| | - Melissa Sutton
- Public Health Division, Oregon Health Authority, Portland, OR, United States of America
| | - Nicole West
- Public Health Division, Oregon Health Authority, Portland, OR, United States of America
| | - H. Keipp Talbot
- Vanderbilt University Medical Center, Nashville, TN, United States of America
| | - William Schaffner
- Vanderbilt University Medical Center, Nashville, TN, United States of America
| | - Keegan McCaffrey
- Utah Department of Health, Salt Lake City, UT, United States of America
| | - Melanie Spencer
- Salt Lake County Health Department, Salt Lake City, UT, United States of America
| | | | - Onika Anglin
- CDC COVID-NET Team, Atlanta, GA, United States of America
| | | | | | - Aron J. Hall
- CDC COVID-NET Team, Atlanta, GA, United States of America
| | - Alicia M. Fry
- CDC COVID-NET Team, Atlanta, GA, United States of America
- US Public Health Service, United States of America
| | - Shikha Garg
- CDC COVID-NET Team, Atlanta, GA, United States of America
- US Public Health Service, United States of America
| | - Lindsay Kim
- CDC COVID-NET Team, Atlanta, GA, United States of America
- US Public Health Service, United States of America
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Tanner JJ, Hanchate S, Price CC, Garvan C, Lai S, Staud R, Deshpande H, Deutsch G, Goodin BR, Fillingim RB, Sibille KT. Relationships Between Chronic Pain Stage, Cognition, Temporal Lobe Cortex, and Sociodemographic Variables. J Alzheimers Dis 2021; 80:1539-1551. [PMID: 33720889 DOI: 10.3233/jad-201345] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Non-Hispanic black (NHB) individuals have increased risk of Alzheimer's disease (AD) relative to non-Hispanic whites (NHW). Ethnicity/race can serve as a proxy sociodemographic variable for a complex representation of sociocultural and environmental factors. Chronic pain is a form of stress with high prevalence and sociodemographic disparities. Chronic pain is linked to lower cognition and accelerated biological aging. OBJECTIVE The purpose of this study is to seek understanding of potential cognitive and temporal lobe structural brain AD vulnerabilities based on chronic pain stage and ethnicity/race. METHODS Participants included 147 community dwelling NHB and NHW adults without dementia between 45-85 years old who had or were at risk of knee osteoarthritis. All participants received an MRI (3T Philips), the Montreal Cognitive Assessment (MoCA), and assessment of clinical knee pain stage. RESULTS There were ethnic/race group differences in MoCA scores but no relationships with chronic knee pain stage. Ethnicity/race moderated the relationship between AD-related temporal lobe thickness and chronic pain stage with quadratic patterns suggesting thinner cortex in high chronic pain stage NHB adults. CONCLUSION There appear to be complex relationships between chronic knee pain stage, temporal lobe cortex, and sociodemographic variables. Specifically, NHB participants without dementia but with high chronic knee pain stage appeared to have thinner temporal cortex in areas associated with AD. Understanding the effects of sociocultural and socioeconomic factors on health outcomes is the first step to challenging the disparities in healthcare that now appear to link disease conditions to neurodegenerative processes.
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Affiliation(s)
- Jared J Tanner
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| | - Shivani Hanchate
- Department of Medicine, University of Florida, Gainesville, FL, USA
| | - Catherine C Price
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA.,Department of Anesthesiology, University of Florida, Gainesville, FL, USA
| | - Cynthia Garvan
- Department of Anesthesiology, University of Florida, Gainesville, FL, USA
| | - Song Lai
- Department of Radiation Oncology, University of Florida, Gainesville, FL, USA
| | - Roland Staud
- Department of Medicine, University of Florida, Gainesville, FL, USA
| | - Hrishikesh Deshpande
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Georg Deutsch
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Burel R Goodin
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Roger B Fillingim
- Department of Community Dentistry and Behavioral Science, University of Florida, Gainesville, FL, USA.,Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, FL, USA
| | - Kimberly T Sibille
- Department of Anesthesiology, University of Florida, Gainesville, FL, USA.,Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, FL, USA.,Department of Aging & Geriatric Research, University of Florida, Gainesville, FL, USA
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117
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Pulvers K, Rice M, Ahluwalia JS, Arnold MJ, Marez C, Nollen NL. "It is the One Thing that has Worked": facilitators and barriers to switching to nicotine salt pod system e-cigarettes among African American and Latinx people who smoke: a content analysis. Harm Reduct J 2021; 18:98. [PMID: 34530834 PMCID: PMC8447685 DOI: 10.1186/s12954-021-00543-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 09/02/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Electronic cigarettes are a harm reduction strategy for individuals who smoke cigarettes who cannot or do not want to quit using FDA-approved cessation methods. Identifying perceived facilitators and barriers to switching among people who smoke cigarettes is critical to optimizing health impact. This is particularly important for the most dominant e-cigarette device, nicotine salt pod electronic cigarettes. We investigate the experience using pod electronic cigarettes among African American and Latinx individuals who smoke, the two largest racial/ethnic minority groups who experience significant health disparities. METHODS From July 2018 to May 2019, adults who smoked cigarettes, age 21 + (N = 114; M age = 44.6, 59.6% male, 52.6% African American from Kansas City, 47.4% Latinx from San Diego) received JUUL-brand electronic cigarettes (referred to hereafter as JUUL) for 6 weeks and answered interview questions at week six. We inquired what they liked and disliked about using JUUL, what helped with switching and made switching difficult, future intentions for continued JUUL use, and how JUUL compared to past smoking reduction methods. Responses were coded into themes by independent raters. Theme frequencies were analyzed separately by race/ethnicity and week 6 use trajectory (exclusive JUUL use, dual JUUL and cigarette use, exclusive cigarette use). RESULTS Clean/smell was the aspect of using JUUL most commonly liked (23%), followed by convenience (19%). Coughing/harshness was a more common barrier to switching for African American (44%) than Latinx (9%), and for continuing cigarette use (56%) than for those who exclusively switched or dually used JUUL and combustible cigarettes (15-21%). Most (78% African American; 90% Latinx) reported that the benefits of using JUUL outweighed barriers, and this varied by JUUL use trajectory: 94% exclusive switch, 86% dual use, and 42% continued cigarette use. The majority said they would continue using JUUL to replace cigarettes (83% African American; 94% Latinx) and that JUUL worked better than other methods to reduce cigarettes (72%). CONCLUSION African American and Latinx individuals who smoked experience using pod electronic cigarettes was generally positive. Understanding facilitators and impediments to switching to electronic cigarettes among racial/ethnic minority people who smoke can inform harm reduction interventions and reduce tobacco-related health disparities. Trial Registration ClinicalTrials.gov Identifier: NCT03511001 posted April 27, 2018.
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Affiliation(s)
- Kim Pulvers
- Department of Psychology, California State University San Marcos, 333 S. Twin Oaks Valley Rd., San Marcos, CA, 92096, USA.
| | - Myra Rice
- Neuroscience Interdepartmental Program, University of California, Los Angeles, CA, 90095, USA
| | - Jasjit S Ahluwalia
- Department of Behavioral and Social Sciences and the Center for Alcohol and Addiction Studies, School of Public Health, Department of Medicine and Brown Cancer Center, Alpert Medical School, Brown University, Providence, RI, USA
| | - Michael J Arnold
- Department of Population Health, University of Kansas School of Medicine, Kansas City, KS, USA
| | - Crystal Marez
- Department of Psychology, California State University San Marcos, 333 S. Twin Oaks Valley Rd., San Marcos, CA, 92096, USA
| | - Nicole L Nollen
- Department of Population Health, University of Kansas School of Medicine, Kansas City, KS, USA
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O'Kane M, Agrawal S, Binder L, Dzau V, Gandhi TK, Harrington R, Mate K, McGann P, Meyers D, Rosen P, Schreiber M, Schummers D. An Equity Agenda for the Field of Health Care Quality Improvement. NAM Perspect 2021; 2021:202109b. [PMID: 34901779 PMCID: PMC8654470 DOI: 10.31478/202109b] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
| | | | | | | | | | | | | | | | | | - Paul Rosen
- Centers for Medicare & Medicaid Services
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119
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Acosta JN, Leasure AC, Both CP, Szejko N, Brown S, Torres-Lopez V, Abdelhakim S, Schindler J, Petersen N, Sansing L, Gill TM, Sheth KN, Falcone GJ. Cardiovascular Health Disparities in Racial and Other Underrepresented Groups: Initial Results From the All of Us Research Program. J Am Heart Assoc 2021; 10:e021724. [PMID: 34431358 PMCID: PMC8649271 DOI: 10.1161/jaha.121.021724] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background All of Us is a novel research program that aims to accelerate research in populations traditionally underrepresented in biomedical research. Our objective was to evaluate the burden of cardiovascular disease (CVD) in broadly defined underrepresented groups. Methods and Results We evaluated the latest data release of All of Us. We conducted a cross‐sectional analysis combining survey and electronic health record data to estimate the prevalence of CVD upon enrollment in underrepresented groups defined by race, ethnicity, age (>75 years), disability (not able to carry out everyday physical activities), sexual orientation and gender identity lesbian, gay, bisexual, transgender, queer, intersex, and asexual (LGBTQIA+), income (annual household income <$35 000 US dollars) and education (less than a high school degree). We used multivariate logistic regression to estimate the adjusted odds ratio (OR) and product terms to test for interaction. The latest All of Us data release includes 315 297 participants. Of these, 230 577 (73%) had information on CVD and 17 958 had CVD (overall prevalence, 7.8%; 95% CI, 7.7–7.9). Multivariate analyses adjusted by hypertension, hyperlipidemia, type 2 diabetes mellitus, body mass index, and smoking indicated that, compared with White participants, Black participants had a higher adjusted odds of CVD (OR, 1.21; 95% CI, 1.16–1.27). Higher adjusted odds of CVD were also observed in underrepresented groups defined by other factors, including age >75 years (OR, 1.90; 95% CI, 1.81–1.99), disability (OR, 1.60; 95% CI, 1.53–1.68), and income <$35 000 US dollars (OR, 1.22; 95% CI, 1.17–1.27). Sex significantly modified the odds of CVD in several of the evaluated groups. Conclusions Among participants enrolled in All of Us, underrepresented groups defined based on race, ethnicity and other factors have a disproportionately high burden of CVD. The All of Us research program constitutes a powerful platform to accelerate research focused on individuals in underrepresented groups.
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Affiliation(s)
- Julián N Acosta
- Department of Neurology Yale School of Medicine New Haven CT
| | | | - Cameron P Both
- Department of Neurology Yale School of Medicine New Haven CT
| | - Natalia Szejko
- Department of Neurology Yale School of Medicine New Haven CT
| | - Stacy Brown
- John A. Burns School of Medicine University of Hawaii Honolulu HI
| | | | - Safa Abdelhakim
- Department of Neurology Yale School of Medicine New Haven CT
| | | | - Nils Petersen
- Department of Neurology Yale School of Medicine New Haven CT
| | - Lauren Sansing
- Department of Neurology Yale School of Medicine New Haven CT
| | - Thomas M Gill
- Department of Internal Medicine Yale School of Medicine New Haven CT
| | - Kevin N Sheth
- Department of Neurology Yale School of Medicine New Haven CT
| | - Guido J Falcone
- Department of Neurology Yale School of Medicine New Haven CT
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Mahajan S, Caraballo C, Lu Y, Valero-Elizondo J, Massey D, Annapureddy AR, Roy B, Riley C, Murugiah K, Onuma O, Nunez-Smith M, Forman HP, Nasir K, Herrin J, Krumholz HM. Trends in Differences in Health Status and Health Care Access and Affordability by Race and Ethnicity in the United States, 1999-2018. JAMA 2021; 326:637-648. [PMID: 34402830 PMCID: PMC8371573 DOI: 10.1001/jama.2021.9907] [Citation(s) in RCA: 90] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 06/01/2021] [Indexed: 12/17/2022]
Abstract
IMPORTANCE The elimination of racial and ethnic differences in health status and health care access is a US goal, but it is unclear whether the country has made progress over the last 2 decades. OBJECTIVE To determine 20-year trends in the racial and ethnic differences in self-reported measures of health status and health care access and affordability among adults in the US. DESIGN, SETTING, AND PARTICIPANTS Serial cross-sectional study of National Health Interview Survey data, 1999-2018, that included 596 355 adults. EXPOSURES Self-reported race, ethnicity, and income level. MAIN OUTCOMES AND MEASURES Rates and racial and ethnic differences in self-reported health status and health care access and affordability. RESULTS The study included 596 355 adults (mean [SE] age, 46.2 [0.07] years, 51.8% [SE, 0.10] women), of whom 4.7% were Asian, 11.8% were Black, 13.8% were Latino/Hispanic, and 69.7% were White. The estimated percentages of people with low income were 28.2%, 46.1%, 51.5%, and 23.9% among Asian, Black, Latino/Hispanic, and White individuals, respectively. Black individuals with low income had the highest estimated prevalence of poor or fair health status (29.1% [95% CI, 26.5%-31.7%] in 1999 and 24.9% [95% CI, 21.8%-28.3%] in 2018), while White individuals with middle and high income had the lowest (6.4% [95% CI, 5.9%-6.8%] in 1999 and 6.3% [95% CI, 5.8%-6.7%] in 2018). Black individuals had a significantly higher estimated prevalence of poor or fair health status than White individuals in 1999, regardless of income strata (P < .001 for the overall and low-income groups; P = .03 for middle and high-income group). From 1999 to 2018, racial and ethnic gaps in poor or fair health status did not change significantly, with or without income stratification, except for a significant decrease in the difference between White and Black individuals with low income (-6.7 percentage points [95% CI, -11.3 to -2.0]; P = .005); the difference in 2018 was no longer statistically significant (P = .13). Black and White individuals had the highest levels of self-reported functional limitations, which increased significantly among all groups over time. There were significant reductions in the racial and ethnic differences in some self-reported measures of health care access, but not affordability, with and without income stratification. CONCLUSIONS AND RELEVANCE In a serial cross-sectional survey study of US adults from 1999 to 2018, racial and ethnic differences in self-reported health status, access, and affordability improved in some subgroups, but largely persisted.
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Affiliation(s)
- Shiwani Mahajan
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - César Caraballo
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Yuan Lu
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Javier Valero-Elizondo
- Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas
- Center for Outcomes Research, Houston Methodist Research Institute, Houston, Texas
| | - Daisy Massey
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut
| | - Amarnath R. Annapureddy
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Brita Roy
- Section of General Internal Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut
| | - Carley Riley
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
- Division of Critical Care Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Karthik Murugiah
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Oyere Onuma
- Section of General Internal Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Marcella Nunez-Smith
- Equity Research and Innovation Center, Section of General Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Howard P. Forman
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut
- Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut
| | - Khurram Nasir
- Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas
- Center for Outcomes Research, Houston Methodist Research Institute, Houston, Texas
| | - Jeph Herrin
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Harlan M. Krumholz
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
- Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut
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Palmer KNB, Rivers PS, Melton FL, McClelland DJ, Hatcher J, Marrero DG, Thomson CA, Garcia DO. Health promotion interventions for African Americans delivered in U.S. barbershops and hair salons- a systematic review. BMC Public Health 2021; 21:1553. [PMID: 34399723 PMCID: PMC8365990 DOI: 10.1186/s12889-021-11584-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 08/02/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND African American adults suffer disproportionately from obesity-related chronic diseases, particularly at younger ages. In order to close the gap in these health disparities, efforts to develop and test culturally appropriate interventions are critical. METHODS A PRISMA-guided systematic review was conducted to identify and critically evaluate health promotion interventions for African Americans delivered in barbershops and hair salons. Subject headings and keywords used to search for synonyms of 'barbershops,' 'hair salons,' and 'African Americans' identified all relevant articles (from inception onwards) from six databases: Academic Search Ultimate, Cumulative Index of Nursing and Allied Health Literature (CINAHL), Embase, PsycINFO, PubMed, Web of Science (Science Citation Index and Social Sciences Citation Index). Experimental and quasi-experimental studies for adult (> 18 years) African Americans delivered in barbershops and hair salons that evaluated interventions focused on risk reduction/management of obesity-related chronic disease: cardiovascular disease, cancer, and type 2 diabetes were included. Analyses were conducted in 2020. RESULTS Fourteen studies met criteria for inclusion. Ten studies hosted interventions in a barbershop setting while four took place in hair salons. There was substantial variability among interventions and outcomes with cancer the most commonly studied disease state (n = 7; 50%), followed by hypertension (n = 5; 35.7%). Most reported outcomes were focused on behavior change (n = 10) with only four studies reporting clinical outcomes. CONCLUSIONS Health promotion interventions delivered in barbershops/hair salons show promise for meeting cancer screening recommendations and managing hypertension in African Americans. More studies are needed that focus on diabetes and obesity and utilize the hair salon as a site for intervention delivery. TRIAL REGISTRATION PROSPERO CRD42020159050 .
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Affiliation(s)
- Kelly N. B. Palmer
- Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, 1295 N Martin Avenue, Tucson, AZ 85721-0202 USA
| | - Patrick S. Rivers
- Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, 1295 N Martin Avenue, Tucson, AZ 85721-0202 USA
| | - Forest L. Melton
- Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, 1295 N Martin Avenue, Tucson, AZ 85721-0202 USA
| | - D. Jean McClelland
- Health Sciences Library, University of Arizona, 1295 N Martin Avenue, Tucson, AZ 85721 USA
| | - Jennifer Hatcher
- Division of Public Health Practice, Mel and Enid Zuckerman College of Public Health, 550 E. Van Buren Street, UA Phoenix Plaza Building 1, Phoenix, AZ 85006 USA
| | - David G. Marrero
- Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, 1295 N Martin Avenue, Tucson, AZ 85721-0202 USA
| | - Cynthia A. Thomson
- Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, 1295 N Martin Avenue, Tucson, AZ 85721-0202 USA
| | - David O. Garcia
- Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, 1295 N Martin Avenue, Tucson, AZ 85721-0202 USA
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Kramer J, Yinusa-Nyahkoon L, Olafsson S, Penti B, Woodhams E, Bickmore T, Jack BW. Black Men's Experiences With Health care: Individuals' Accounts of Challenges, Suggestions for Change, and the Potential Utility of Virtual Agent Technology to Assist Black Men With Health Management. QUALITATIVE HEALTH RESEARCH 2021; 31:1772-1785. [PMID: 34092141 DOI: 10.1177/10497323211013323] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Black men have the highest age-adjusted death rate of any major race-gender group in America. Understanding their perceived barriers to accessing health care may benefit future interventions working to increase Black men's health care engagement. Data collected from focus groups of Black men(N = 67), key informant interviews(N = 12), and interviews(N = 5) with participants who pilot tested an online health education system (called "Gabe") were analyzed to explore their health care experiences and how computer-based health programs might better assist Black men. Concerns pertaining to health care systems' failure to recognize the diversity among Black men, and physicians' lack of sociocultural awareness about the challenges they regularly face, were most salient. Building trust with providers was cited as being central to engagement, with Gabe users perceiving the system to be both trustworthy and accessible. Participants reported an openness to technology assisting with health management and provided suggestions of how online systems can meet the needs of Black men.
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Affiliation(s)
- Justin Kramer
- The University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Leanne Yinusa-Nyahkoon
- Boston University School of Medicine, Boston, Massachusetts, USA
- Boston University, Boston, Massachusetts, USA
| | | | - Brian Penti
- Tufts University School of Medicine, Boston, Massachusetts, USA
| | | | | | - Brian W Jack
- Boston University School of Medicine, Boston, Massachusetts, USA
- Boston University, Boston, Massachusetts, USA
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Metra B, Summer R, Brooks SE, George G, Sundaram B. Racial disparities in COVID-19 associated pulmonary embolism: A multicenter cohort study. Thromb Res 2021; 205:84-91. [PMID: 34274560 PMCID: PMC8254383 DOI: 10.1016/j.thromres.2021.06.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 03/25/2021] [Accepted: 06/29/2021] [Indexed: 11/30/2022]
Abstract
Background Thromboembolism is a recognized component of severe coronavirus disease 2019 (COVID-19) disease. However, research into racial disparities in COVID-19-related pulmonary embolism is limited. Materials and methods In this retrospective cohort study, we examined adults diagnosed with COVID-19 between January 20 and September 30, 2020, using a multicenter electronic health record dataset of over 73 million patients (TriNetX), mostly in the USA. The main study outcomes were development of pulmonary embolism or mortality within 30 days of COVID-19 diagnosis. Secondary outcome analysis included hospitalization, mechanical ventilation, and ICU admission within 30 days of diagnosis, as well as lab values within 0–1 days of diagnosis. Sociodemographic and clinical variables were used to create balanced cohorts via propensity matching. Results 346,953 patients were identified, with 56.0% non-Hispanic white and 14.7% non-Hispanic black; the mean age was 47.6 years. 3879 patients developed PE, with 2036 (1.30% of 157,049) white and 1088 (2.16% of 50,376) black patients. After propensity matching, black race was associated with higher mortality (risk ratio 1.890 [95% CI 1.727–2.067]) and PE (RR 1.537 [1.380–1.711]; p < 0.0001). Both races had higher mortality with COVID-associated PE than COVID or PE alone (RR 1.575–1.627 and 3.000–5.389 respectively; p < 0.0001). Black patients with COVID-19 and PE had a higher rate of mortality compared to white patients (RR 1.397 [1.059–1.844]; p = 0.0174). Interpretation Black race was associated with higher risk of pulmonary embolism and mortality after COVID-19. Additionally, black patients with COVID-19 and PE had a higher mortality compared to white patients.
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Affiliation(s)
- Brandon Metra
- Department of Radiology, Thomas Jefferson University Hospitals, Philadelphia, United States of America
| | - Ross Summer
- Department of Internal Medicine, Thomas Jefferson University Hospitals, Philadelphia, United States of America; The Jane and Leonard Korman Respiratory Institute, Thomas Jefferson University Hospitals, Philadelphia, United States of America
| | - Sandra Elaine Brooks
- Obstetrics and Gynecology, Thomas Jefferson University Hospitals, Philadelphia, United States of America
| | - Gautam George
- Department of Internal Medicine, Thomas Jefferson University Hospitals, Philadelphia, United States of America; The Jane and Leonard Korman Respiratory Institute, Thomas Jefferson University Hospitals, Philadelphia, United States of America
| | - Baskaran Sundaram
- Department of Radiology, Thomas Jefferson University Hospitals, Philadelphia, United States of America.
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Bhuiyan N, McNeill LH, Bopp M, Downs DS, Mama SK. Fostering spirituality and psychosocial health through mind-body practices in underserved populations. Integr Med Res 2021; 11:100755. [PMID: 34354922 PMCID: PMC8322296 DOI: 10.1016/j.imr.2021.100755] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 05/23/2021] [Accepted: 05/30/2021] [Indexed: 01/07/2023] Open
Abstract
Background This study examined changes in spirituality and psychosocial outcomes among African American and rural adults participating in a culturally-adapted mind-body intervention. Methods African American (n = 22) and rural (n = 38) adults in Harmony & Health attended mind-body sessions twice a week for eight weeks and completed questionnaires on spirituality and psychosocial distress at baseline and post-intervention. Linear regression and repeated measures analyses were used to examine associations between intervention attendance and spirituality. Results Attendance was significantly associated with increased spirituality (β=0.168, p = 013). Repeated measures analyses revealed a significant three-way interaction between attendance, spirituality, and study site (F(9,31)=2.891, p = 013). Urban African American participants who attended ≥75% of sessions reported greater increases in spirituality. Conclusion Findings suggest that mind-body practices may foster spirituality in urban African American adults. Additional adaptations are needed to strengthen spirituality in rural residents and to improve psychosocial health and wellbeing in this underserved population.
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Affiliation(s)
- Nishat Bhuiyan
- College of Health Solutions, Arizona State University, Phoenix, AZ, United States
| | - Lorna H. McNeill
- Department of Health Disparities Research, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Melissa Bopp
- Department of Kinesiology, College of Health and Human Development, The Pennsylvania State University, University Park, PA, United States
| | - Danielle Symons Downs
- Department of Kinesiology, College of Health and Human Development, The Pennsylvania State University, University Park, PA, United States
- Department of Obstetrics and Gynecology, The Pennsylvania State University College of Medicine, Hershey, PA, United States
| | - Scherezade K. Mama
- Department of Health Disparities Research, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
- Corresponding author at: Department of Health Disparities Research, The University of Texas MD Anderson Cancer Center, 1400 Pressler St., Unit 1440, Houston, TX 77030, United States.
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Hunter CM, Salandy SW, Smith JC, Edens C, Hubbard B. Racial Disparities in Incidence of Legionnaires' Disease and Social Determinants of Health: A Narrative Review. Public Health Rep 2021; 137:660-671. [PMID: 34185609 DOI: 10.1177/00333549211026781] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES Racial and socioeconomic disparities in the incidence of Legionnaires' disease have been documented for the past 2 decades; however, the social determinants of health (SDH) that contribute to these disparities are not well studied. The objective of this narrative review was to characterize SDH to inform efforts to reduce disparities in the incidence of Legionnaires' disease. METHODS We conducted a narrative review of articles published from January 1979 through October 2019 that focused on disparities in the incidence of Legionnaires' disease and pneumonia (inclusive of bacterial pneumonia and/or community-acquired pneumonia) among adults and children (excluding articles that were limited to people aged <18 years). We identified 220 articles, of which 19 met our criteria: original research, published in English, and examined Legionnaires' disease or pneumonia, health disparities, and SDH. We organized findings using the Healthy People 2030 SDH domains: economic stability, education access and quality, social and community context, health care access and quality, and neighborhood and built environment. RESULTS Of the 19 articles reviewed, multiple articles examined disparities in incidence of Legionnaires' disease and pneumonia related to economic stability/income (n = 13) and comorbidities (n = 10), and fewer articles incorporated SDH variables related to education (n = 3), social support (none), health care access (n = 1), and neighborhood and built environment (n = 6) in their analyses. CONCLUSIONS Neighborhood and built-environment factors such as housing, drinking water infrastructure, and pollutant exposures represent critical partnership and research opportunities. More research that incorporates SDH and multilevel, cross-sector interventions is needed to address disparities in Legionnaires' disease incidence.
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Affiliation(s)
- Candis M Hunter
- 1242 Division of Environmental Health Science and Practice, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Simone W Salandy
- 1242 Division of Environmental Health Science and Practice, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jessica C Smith
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Chris Edens
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Brian Hubbard
- 1242 Division of Environmental Health Science and Practice, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Hall OT, Jordan A, Teater J, Dixon-Shambley K, McKiever ME, Baek M, Garcia S, Rood KM, Fielin DA. Experiences of racial discrimination in the medical setting and associations with medical mistrust and expectations of care among black patients seeking addiction treatment. J Subst Abuse Treat 2021; 133:108551. [PMID: 34244014 DOI: 10.1016/j.jsat.2021.108551] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Revised: 06/16/2021] [Accepted: 06/20/2021] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Experiences of racial discrimination in the medical setting are common among Black patients and may be linked to mistrust in medical recommendations and poorer clinical outcomes. However, little is known about the prevalence of experiences of racial mistreatment by healthcare workers among Black patients seeking addiction treatment, or how these experiences might influence Black patients' medical mistrust or expectations of care. METHODS Participants were 143 Black adults recruited consecutively from two university addiction treatment facilities in Columbus, Ohio. All participants completed validated surveys assessing perceptions of prior racial discrimination in the medical setting and group-based medical mistrust. Participants were also asked a series of questions about their expectations of care with regard to racial discrimination and addiction treatment. Descriptive analyses were used to characterize the sample with regard to demographics, perceived racial discrimination and medical mistrust. Kendall tau-b correlations assessed relationships between racial discrimination, mistrust and expectations of care. RESULTS Seventy-nine percent (n = 113) of participants reported prior experiences of racial discrimination during healthcare. Racial discrimination in the medical setting was associated with greater mistrust in the medical system and worse expectations regarding racial discrimination in addiction treatment including delays in care-seeking due to concern for discrimination, projected non-adherence and fears of discrimination-precipitated relapse. CONCLUSIONS Black patients seeking addiction treatment commonly report experiencing racial discrimination by healthcare workers which may be associated with mistrust in the medical system and expectations of care. Strategies to eliminate and mitigate experiences of racial discrimination may improve addiction treatment receptivity and engagement.
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Affiliation(s)
- O Trent Hall
- Department of Psychiatry and Behavioral Health, Ohio State University Wexner Medical Center, Columbus, OH, United States of America.
| | - Ayana Jordan
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States of America
| | - Julie Teater
- Department of Psychiatry and Behavioral Health, Ohio State University Wexner Medical Center, Columbus, OH, United States of America
| | - Kamilah Dixon-Shambley
- Department of Obstetrics and Gynecology, Ohio State University Wexner Medical Center, Columbus, OH, United States of America
| | - Monique E McKiever
- Department of Obstetrics and Gynecology, Ohio State University Wexner Medical Center, Columbus, OH, United States of America
| | - Mikyung Baek
- Kirwan Institute for the Study of Race and Ethnicity, the Ohio State University, Columbus, OH, United States of America
| | - Stephanie Garcia
- College of Medicine, the Ohio State University, Columbus, OH, United States of America
| | - Kara M Rood
- Department of Obstetrics and Gynecology, Ohio State University Wexner Medical Center, Columbus, OH, United States of America
| | - David A Fielin
- Program in Addiction Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, United States of America; Yale School of Public Health, New Haven, CT, United States of America
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Affiliation(s)
- Yvonne Commodore-Mensah
- Johns Hopkins School of Nursing, Baltimore, MD (Y.C.-M.).,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (Y.C.-M.).,Johns Hopkins Center for Health Equity (Y.C.-M., D.C.C.), Johns Hopkins Medical Institutions, Baltimore, MD.,Welch Center for Prevention, Epidemiology, and Clinical Research (Y.C.-M., D.C.C.), Johns Hopkins Medical Institutions, Baltimore, MD
| | - Deidra C Crews
- Johns Hopkins Center for Health Equity (Y.C.-M., D.C.C.), Johns Hopkins Medical Institutions, Baltimore, MD.,Welch Center for Prevention, Epidemiology, and Clinical Research (Y.C.-M., D.C.C.), Johns Hopkins Medical Institutions, Baltimore, MD.,Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD (D.C.C.)
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Weyand AC, McGann PT. Eliminating race-based reference ranges in haematology: a call to action. LANCET HAEMATOLOGY 2021; 8:e462-e466. [PMID: 34048684 DOI: 10.1016/s2352-3026(21)00106-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 03/26/2021] [Accepted: 03/26/2021] [Indexed: 12/14/2022]
Abstract
In haematology, as in all of medicine, the use of reference intervals for laboratory variables is essential to define disease states and inform treatment decisions. There are many haematological variables, including haemoglobin, mean corpuscular volume, absolute neutrophil count, and iron indices, that are often reported to be different on the basis of a person's race or ethnicity. Although there are many haematological conditions with a genetic basis, such that it is appropriate to consider ancestry in the diagnostic algorithm, defining pathology on the basis of a social construct such as race is unacceptable. The inclusion of separate thresholds or simple statements that so-called normal values vary by race further validates the common misperception that there are physiological differences between Black and white patients. These statements might have downstream effects on diagnostic and treatment decisions that exacerbate existing racial health disparities. In this Viewpoint, we argued for the removal of race-based reference intervals across haematology.
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Affiliation(s)
- Angela C Weyand
- Division of Pediatric Hematology Oncology, Department of Pediatrics, University of Michigan Medical School, Ann Arbor, MI, USA.
| | - Patrick T McGann
- Division of Hematology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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Chang PS, Lu Y, Nguyen CM, Suh Y, Luciani M, Ofner S, Powell S. Effects of Qigong Exercise on Physical and Psychological Health among African Americans. West J Nurs Res 2021; 43:551-562. [PMID: 32942949 PMCID: PMC8159432 DOI: 10.1177/0193945920959067] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Interventions are needed to address physical and psychological health in middle-aged and older African Americans (AAs). The purpose of this pilot study was to evaluate the feasibility and potential benefits of an eight-week Qigong exercise on physical ability and function, balance, frailty, depression and anxiety, and spiritual well-being in AAs using a single-group design. Fifteen AAs with a mean age of 64 years received Qigong exercise over 16 semi-weekly, one-hour sessions. The majority were female (93.3%) and college-level educated (53.3%). Repeat chair stands, physical function, and spiritual well-being improved significantly (p < .05) with effect sizes ranging from .45 to .87. Over 52% of participants showed improved depression scores, fast gait speed, and standing balance. Nearly 42% demonstrated some frailty improvement over baseline. No adverse events were reported. Qigong exercise potentially improves the physical ability and function, and spiritual well-being of AAs and needs further testing in a randomized clinical trial.
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Affiliation(s)
- Pei-Shiun Chang
- Indiana University School of Nursing; 1033 E. Third Street, Bloomington, Indiana 47405
| | - Yvonne Lu
- Indiana University School of Nursing; 600 Barnhill Dr, NU W407, Indianapolis, Indiana 46202
| | - Chi Mai Nguyen
- Indiana University School of Nursing; 1033 E. Third Street, Bloomington, Indiana 47405
| | - Youngnok Suh
- Indiana University School of Nursing; 1033 E. Third Street, Bloomington, Indiana 47405
| | - Mary Luciani
- Indiana University School of Nursing; 600 Barnhill Dr, NU W407, Indianapolis, Indiana 46202
| | - Susan Ofner
- Indiana University School of Medicine, Department of Biostatistics; 410 W. 10th Street, HITS 3000, Indianapolis, IN 46202
| | - Savannah Powell
- Indiana University School of Nursing; 1033 E. Third Street, Bloomington, Indiana 47405
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130
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Affiliation(s)
- Surafel Tsega
- Icahn School of Medicine at Mount Sinai, New York City, NY, USA.
| | - Claiborne Childs
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
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Hill LH, Holland R. Health disparities, race, and the global pandemic of COVID‐19: The demise of Black Americans. NEW DIRECTIONS FOR ADULT AND CONTINUING EDUCATION 2021. [PMCID: PMC8652746 DOI: 10.1002/ace.20425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
This article examines the chronic health conditions of African Americans who experience disparities because of poverty, low literacy, and cultural practices that affect decisions about food, nutrition, and health care. It will examine governmental policies, for example, the Affordable Care Act (ACA) (Artiga et al., 2020), and how these policies contribute to health and wellbeing of people from low‐income communities. Furthermore, it explores the overrepresented deaths among African Americans and other communities of color resulting from the pandemic—deaths that result from co‐existing health conditions and the inability to afford immediate care.
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Affiliation(s)
- Lilian H. Hill
- University of Southern Mississippi Hattiesburg Mississippi USA
| | - Rebecca Holland
- University of Southern Mississippi Hattiesburg Mississippi USA
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Beutler BD, Ulanja MB, Krishan R, Aluru V, Ndukwu ML, Hagen MM, Dupin ZD, Willyard CE, Moody AE, Boampong-Konam K, Zell SC. Sociodemographic Characteristics as Predictors of Outcomes in Hepatocellular Carcinoma: A Retrospective Cohort Study. Cancer Control 2021; 27:1073274820956615. [PMID: 32951450 PMCID: PMC7791478 DOI: 10.1177/1073274820956615] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Race, gender, insurance status, and income play important roles in predicting health care outcomes. However, the impact of these factors has yet to be fully elucidated in the setting of hepatocellular carcinoma (HCC). METHODS We designed a retrospective cohort study utilizing data from the Surveillance, Epidemiology, and End Results (SEER) program to identify patients diagnosed with resectable HCC (N = 28,518). Demographic factors of interest included race (Asian/Pacific Islander [API], African American [AA], Native American/Alaska Native [NA], or White [WH]) and gender (male [M] or female [F]). Insurance classifications included those having Medicare/Private Insurance [ME/PI], Medicaid [MAID], or No Insurance [NI]. Median household income was estimated for all diagnosed with HCC. Endpoints included: (1) overall survival; (2) likelihood of receiving a recommendation for surgery; and (3) specific surgical intervention performed. Multivariate multinomial logistic regression for relative risk ratio (RRR) and Cox regression models were used to identify pertinent associations. RESULTS Race, gender, insurance status, and income had statistically significant effects on the likelihood of surgical recommendation and overall survival. API were more likely to receive a recommendation for hepatic resection (RRR = 1.45; 95% CI: 1.31-1.61; Reference Race: AA) and exhibited prolonged overall survival (HR = 0.77; 95% CI: 0.73-0.82; Reference Race: AA) as compared to members of any other ethnic group; there was no difference in these endpoints between AA, NA, or WH individuals. Gender also had a significant effect on survival: Females exhibited superior overall survival (HR = 0.89; 95% CI: 0.85-0.93; Reference Gender: M) as compared to males. Patients who had ME/PI were more likely than those with MAID or NI to receive a surgical recommendation. ME/PI was also associated with superior overall survival. Conclusions: Race, gender, insurance status, and income have measurable effects on HCC management and outcomes. The underlying causes of these disparities warrant further investigation.
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Affiliation(s)
- Bryce D Beutler
- Department of Internal Medicine, Reno School of Medicine, University of Nevada, Reno, NV, USA
| | - Mark B Ulanja
- Department of Internal Medicine, Reno School of Medicine, University of Nevada, Reno, NV, USA
| | - Rohee Krishan
- Department of Internal Medicine, Reno School of Medicine, University of Nevada, Reno, NV, USA
| | - Vijay Aluru
- Department of Internal Medicine, Reno School of Medicine, University of Nevada, Reno, NV, USA
| | - Munachismo L Ndukwu
- Department of Internal Medicine, Reno School of Medicine, University of Nevada, Reno, NV, USA
| | - Molly M Hagen
- Office of Medical Research, Reno School of Medicine, University of Nevada, Reno, NV, USA
| | - Zachary D Dupin
- Miller Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Charles E Willyard
- Department of Internal Medicine, Reno School of Medicine, University of Nevada, Reno, NV, USA
| | | | | | - Steven C Zell
- Department of Internal Medicine, Reno School of Medicine, University of Nevada, Reno, NV, USA
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Pregnancy and Binge Drinking: An Intersectionality Theory Perspective Using Veteran Status and Racial/Ethnic Identity. Matern Child Health J 2021; 25:1345-1351. [PMID: 33945080 DOI: 10.1007/s10995-021-03171-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/26/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES Alcohol use during pregnancy is a critical public health issue that results in several adverse outcomes for both mother and child. While the prevalence of and consequences of binge drinking among pregnant women is well-documented in the literature, little is known about the intersectional effect of racial/ethnic identity and veteran status. The purpose of this study was to examine the prevalence of binge drinking among pregnant women using the intersectionality of racial/ethnic identity and veteran status. METHODS This study utilized combined data from the 2016, 2017 and 2018 Behavioral Risk Factor Surveillance System (BRFSS). The BRFSS is a telephone survey that collects health-related risk behaviors, chronic health conditions and use of preventative services among U.S residents. Generalized linear mixed models were used to examine the prevalence of binge drinking using the interaction between race/ethnicity and veteran status. RESULTS Overall binge drinking prevalence was 3.60% among the sample of 6101 pregnant women. Binge drinking prevalence was the highest among racial/ethnic minority veterans at 17.42%, compared to 5.34% among white veterans, 4.05% among non-veteran racial/ethnic minorities and 3% among non-veteran whites, supporting the theory of intersectionality. CONCLUSIONS Intersectionality Theory suggests that the stressors from membership in two vulnerable groups may lead to increased disparities. The results of this study highlight the unique experience of being a veteran and identifying as a member of a racial/ethnic minority group. This calls for a need to customize preventative measures that address the combined impact of both racial/ethnic minority group status and veteran status.
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Substance use among women who are pregnant: Examining treatment completion by race and ethnicity. J Subst Abuse Treat 2021; 131:108437. [PMID: 34098297 DOI: 10.1016/j.jsat.2021.108437] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 01/22/2021] [Accepted: 04/22/2021] [Indexed: 11/23/2022]
Abstract
Substance use during pregnancy is a critical public health issue that affects both the mother and the fetus. While research has assessed racial differences in treatment completion among women who are pregnant for specific types of substances, few studies have evaluated treatment completion for a variety of substances. As such, the purpose of this study was to examine racial differences in substance use treatment completion among women who are pregnant. The study derived data from the 2017 Treatment Episode Data-Discharges (TEDS-D) of the Substance Abuse and Mental Health Services Administration (SAMHSA). TEDS-D documents annual discharges from publicly funded substance use treatment programs in the United States, collected by each state and aggregated by SAMHSA. The study used Chi square tests for bivariate analyses and used logistic regression models to predict treatment completion by race and ethnicity. After accounting for other explanatory factors, Black and Hispanic women who were pregnant were significantly less likely to complete treatment compared to Whites. These differences were evident even after examining the interaction between race and substance of use. The study found no differences between Indigenous and Other race women who were pregnant and Whites. Results indicate the need to examine cultural, historical, and systemic factors that could affect lower treatment completion among Black and Hispanic women who are pregnant. Interventions should, therefore, move beyond the impact of socioeconomic factors and focus on the role of social support, external responsibilities, and the criminalizing of substance use during pregnancy.
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135
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Molleston JP, Bennett WE. Mortality, Risk Factors and Disparities Associated with Esophageal Variceal Bleeding in Children's Hospitals in the US. J Pediatr 2021; 232:176-182. [PMID: 33450222 DOI: 10.1016/j.jpeds.2020.12.082] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 12/30/2020] [Accepted: 12/31/2020] [Indexed: 12/13/2022]
Abstract
OBJECTIVES To use a large administrative database to determine the mortality, risk factors, and comorbidities of esophageal variceal bleeding in children. STUDY DESIGN Retrospective cohort study using Pediatric Health Information System data from 50 tertiary children's hospitals in the US. International Classification of Diseases (ICD) codes (FY 2020 ICD-10 update and revision 10 of ICD-9) from 2004 through 2019 identified children 18 years and younger with variceal bleeding and complications. Univariate analyses used the Student t -test for continuous variables (age) and the χ2 test for categorical variables (all others). A mixed-effects linear regression was performed for multiple variables. RESULTS There were 1902 patients who had 3399 encounters for esophageal variceal bleeding. The mortality rate for variceal bleeding was 7.3%, increasing to 8.8% by 6 weeks; any mortality during the study was 20.1%. Transfusion was required in 54.7% of encounters, and 42.6% were admitted to the intensive care unit. Variceal bleeding encounters were complicated by peptic ulcer disease (6.9%), bacteremia (11.4%), acute renal failure (5.1%), mechanical ventilation (18%), ascites (21.3%), and peritonitis (3.3%). Multivariable mixed-effects logistic regression showed that Black race (OR, 2.59; P < .001) or Hispanic ethnicity (OR, 2.31; P = .001), but not sex, household income, or insurance type, were associated with increased mortality. Bacteremia, peritonitis, mechanical ventilation, acute renal failure, and transfusion were associated with higher mortality (ORs of 2.29, 2.18, 1.93, 6.33, and 1.81, respectively; P < .001, .005, .011, <.001, and .005, respectively). CONCLUSIONS The 6-week mortality rate for variceal bleeding in children is 8.8%. Black or Hispanic children are at higher risk of dying. Serious morbidities associated with variceal hemorrhage impact mortality. These data can inform consideration of prophylactic or therapeutic interventions for children at risk.
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Affiliation(s)
- Jean P Molleston
- Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology and Nutrition, Indiana University School of Medicine, Indianapolis, IN.
| | - William E Bennett
- Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology and Nutrition, Indiana University School of Medicine, Indianapolis, IN; Department of Pediatrics, Division of Pediatric and Adolescent Comparative Effectiveness Research, Indiana University School of Medicine, Indianapolis, IN
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Arnold MJ, Nollen NL, Mayo MS, Ahluwalia JS, Leavens EL, Zhang G, Rice M, Pulvers K. Harm reduction associated with dual use of cigarettes and e-cigarettes in Black and Latino smokers: Secondary analyses from a randomized controlled e-cigarette switching trial. Nicotine Tob Res 2021; 23:1972-1976. [PMID: 33837422 DOI: 10.1093/ntr/ntab069] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 04/05/2021] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Most adult cigarette smokers who use e-cigarettes are dual cigarette and e-cigarette (CC-EC) users, yet little is known about relative consumption of cigarettes to e-cigarettes and any associated harm reduction. METHODS Rate of substitution from cigarettes to e-cigarettes at week 6 and change in biomarkers of exposure and potential harm were examined among dual CC-EC users [64/114 (56%); 35 Black, 29 Latino] in an e-cigarette switching randomized trial. RESULTS Dual users averaged 79% substitution of cigarettes for e-cigarettes at week 6, resulting in a reduction from baseline of 70.0 ± 54.1 cigarettes per week (p < .001). Total nicotine consumption remained stable (baseline: 1160.5 ± 1042.1 pg/mL of cotinine, week 6: 1312.5 ± 1725.9 pg/mL of cotinine, p = .47), while significant reductions were seen in the potent lung carcinogen 4-(methylnitrosamino)-1-(3-pyridul)-1-butanol (NNAL) (-55.9 ± 88.6 ng/ml, p < .001), carbon monoxide (-6.3 ± 8.6 ppm, p < .001), and self-reported respiratory symptoms (-3.3 ± 8.0, p = .002). No significant changes were found in blood pressure or spirometry. Greater substitution from cigarettes to e-cigarettes was associated with larger reductions in NNAL (r = -.29, p = .02). CONCLUSIONS The predominant dual use pattern was characterized by regular e-cigarette and intermittent cigarette use. Findings demonstrate the short-term harm reduction potential of this dual use pattern in Black and Latino smokers and suggest that the greatest benefit, aside from cessation of both products, is achieved by higher substitution of e-cigarettes for cigarettes. Findings need confirmation in a larger sample with longer follow-up in dual users with greater variability in rate of substitution.
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Affiliation(s)
- Michael J Arnold
- Department of Population Health, University of Kansas School of Medicine, Kansas City, KS, USA
| | - Nicole L Nollen
- Department of Population Health, University of Kansas School of Medicine, Kansas City, KS, USA
| | - Matthew S Mayo
- Department of Biostatistics & Data Science, University of Kansas School of Medicine, Kansas City, KS, USA
| | - Jasjit S Ahluwalia
- Department of Behavioral and Social Sciences and the Center for Alcohol and Addiction Studies, School of Public Health and Alpert Medical School, Brown University, Providence, RI, USA
| | - Eleanor L Leavens
- Department of Population Health, University of Kansas School of Medicine, Kansas City, KS, USA
| | - Guanlin Zhang
- Department of Biostatistics & Data Science, University of Kansas School of Medicine, Kansas City, KS, USA
| | - Myra Rice
- Department of Psychology, California State University San Marcos, San Marcos, CA, USA
| | - Kim Pulvers
- Department of Psychology, California State University San Marcos, San Marcos, CA, USA
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137
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Lewis TT, Van Dyke ME, Matthews KA, Barinas-Mitchell E. Race/Ethnicity, Cumulative Midlife Loss, and Carotid Atherosclerosis in Middle-Aged Women. Am J Epidemiol 2021; 190:576-587. [PMID: 33034337 DOI: 10.1093/aje/kwaa213] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Revised: 09/25/2020] [Accepted: 10/05/2020] [Indexed: 12/30/2022] Open
Abstract
African-American women have elevated rates of cardiovascular disease compared with women of other races or ethnicities, and race/ethnicity-related stressors may play a role. We examined the association between a race/ethnicity-related stressor, midlife loss, and a marker of cardiovascular risk, carotid intima media thickness (IMT), in 1,410 African-American, White, Chinese, and Hispanic women from the Study of Women's Health Across the Nation. Participants were queried about losses annually over 12 years (1996-2013), with IMT assessed in year 12-13 via ultrasound. Linear regression models were used to examine associations between cumulative upsetting losses and IMT, adjusting for covariates. In minimally adjusted models in the full cohort, 3 or more upsetting losses (vs. none) were associated with IMT (β = 0.03, 95% confidence interval (CI): 0.01, 0.05; P = 0.0003). Results were more robust among African-American women (β = 0.042, 95% CI: 0.01, 0.07; P < 0.01) than White (β = 0.014, 95% CI: -0.01, 0.03; P = 0.21), Chinese (β = 0.036, 95% CI: -0.03, 0.10; P = 0.25), or Hispanic (β = 0.036, 95% CI: -0.07, 0.14; P = 0.51) women, although associations among women from racial/ethnic minorities overall were of similar magnitude. Results persisted in fully adjusted models (P for interaction with race/ethnicity = 0.04). Midlife loss may be a pathway through which race/ethnicity influences cardiovascular risk for African-American women and, potentially, Chinese and Hispanic women.
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138
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Dasa O, Smith SM, Howard G, Cooper-DeHoff RM, Gong Y, Handberg E, Pepine CJ. Association of 1-Year Blood Pressure Variability With Long-term Mortality Among Adults With Coronary Artery Disease: A Post Hoc Analysis of a Randomized Clinical Trial. JAMA Netw Open 2021; 4:e218418. [PMID: 33914047 PMCID: PMC8085725 DOI: 10.1001/jamanetworkopen.2021.8418] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 03/11/2021] [Indexed: 12/11/2022] Open
Abstract
Importance Accumulating evidence indicates that higher blood pressure (BP) variability from one physician office visit to the next (hereafter referred to as visit-to-visit BP variability) is associated with poor outcomes. Short-term measurement (throughout 1 year) of visit-to-visit BP variability in high-risk older patients may help identify patients at increased risk of death. Objective To evaluate whether short-term visit-to-visit BP variability is associated with increased long-term mortality risk. Design, Setting, and Participants The US cohort of the International Verapamil SR-Trandolapril Study (INVEST), a randomized clinical trial of 16 688 patients aged 50 years or older with hypertension and coronary artery disease, was conducted between September 2, 1997, and December 15, 2000, with in-trial follow-up through February 14, 2003. The study evaluated a calcium antagonist (sustained-release verapamil plus trandolapril) vs β-blocker (atenolol plus hydrochlorothiazide) treatment strategy. Blood pressure measurement visits were scheduled every 6 weeks for the first 6 months and biannually thereafter. Statistical analysis was performed from September 2, 1997, to May 1, 2014. Exposures Visit-to-visit systolic BP (SBP) and diastolic BP variability during the first year of enrollment using 4 different BP variability measures: standard deviation, coefficient of variation, average real variability, and variability independent of the mean. Main Outcomes and Measures All-cause death, assessed via the US National Death Index, beginning after the exposure assessment period through May 1, 2014. Results For the present post hoc analysis, long-term mortality data were available on 16 688 patients (9001 women [54%]; mean [SD] age, 66.5 [9.9] years; 45% White patients, 16% Black patients, and 37% Hispanic patients). During a mean (SD) follow-up of 10.9 (4.2) years, 5058 patients (30%) died. All 4 variability measures for SBP were significantly associated with long-term mortality after adjustment for baseline demographic characteristics and comorbidities. After comparison of lowest vs highest variability measure quintiles, the magnitude of the association with death remained statistically significant even after adjustment for baseline demographic characteristics and comorbidities (average real variability: adjusted hazard ratio [aHR], 1.18; 95% CI, 1.08-1.30; standard deviation: aHR, 1.14; 95% CI, 1.04-1.24; coefficient of variation: aHR, 1.15; 95% CI, 1.06-1.26; variability independent of the mean: aHR, 1.15; 95% CI, 1.05-1.25). The signal was stronger in women compared with men. Associations of diastolic BP variability measures with death were weaker than for SBP and were not significant after adjustment. Conclusions and Relevance This study suggests that, in a large population of older patients with hypertension and coronary artery disease, short-term visit-to-visit SBP variability was associated with excess long-term mortality, especially for women. Efforts to identify and minimize visit-to-visit SBP variability may be important in reducing excess mortality later in life. Trial Registration ClinicalTrials.gov Identifier: NCT00133692.
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Affiliation(s)
- Osama Dasa
- Department of Internal Medicine and Epidemiology, College of Public Health and Health Professions, College of Medicine, University of Florida, Gainesville
- Center for Integrative Cardiovascular and Metabolic Diseases, University of Florida, Gainesville
| | - Steven M. Smith
- Center for Integrative Cardiovascular and Metabolic Diseases, University of Florida, Gainesville
- Department of Pharmacotherapy and Translational Research, University of Florida College of Pharmacy, Gainesville
| | - George Howard
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham
| | - Rhonda M. Cooper-DeHoff
- Center for Integrative Cardiovascular and Metabolic Diseases, University of Florida, Gainesville
- Department of Pharmacotherapy and Translational Research, University of Florida College of Pharmacy, Gainesville
- Division of Cardiovascular Medicine, Department of Medicine, College of Medicine, University of Florida, Gainesville
| | - Yan Gong
- Department of Pharmacotherapy and Translational Research, University of Florida College of Pharmacy, Gainesville
| | - Eileen Handberg
- Division of Cardiovascular Medicine, Department of Medicine, College of Medicine, University of Florida, Gainesville
| | - Carl J. Pepine
- Center for Integrative Cardiovascular and Metabolic Diseases, University of Florida, Gainesville
- Division of Cardiovascular Medicine, Department of Medicine, College of Medicine, University of Florida, Gainesville
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Sternfeld B, Colvin A, Stewart A, Appelhans BM, Cauley JA, Dugan SA, El Khoudary SR, Greendale GA, Strotmeyer E, Karvonen-Gutierrez C. Understanding Racial/Ethnic Disparities in Physical Performance in Midlife Women: Findings From SWAN (Study of Women's Health Across the Nation). J Gerontol B Psychol Sci Soc Sci 2021; 75:1961-1971. [PMID: 31412129 DOI: 10.1093/geronb/gbz103] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Evaluate degree to which racial/ethnic differences in physical performance are mediated by sociodemographic, health, behavioral, and psychosocial factors. METHODS Physical performance was evaluated using a decile score derived from grip strength, timed 4 m walk, and timed repeat chair stand in 1,855 African American, Caucasian, Chinese, Hispanic, and Japanese women, mean age = 61.8 (SD = 2.7) in the Study of Women's Health Across the Nation. Mediators included education, financial strain, comorbidities, pain, body mass index (BMI), physical activity, and perceived stress. Structural equation models provided estimates of the total difference in physical performance between Caucasians and each race/ethnic groups and differences due to direct effects of race/ethnicity and indirect effects through mediators. RESULTS The mean decile score for Caucasian women was 16.9 (SD = 5.6), 1.8, 2.6, and 2.1 points higher than the model-estimated scores in African Americans, Hispanics and Chinese, respectively, and 1.3 points lower than the Japanese. Differences between Caucasians and the Chinese and Japanese were direct effects of race/ethnicity whereas in African Americans and Hispanics 75% or more of that disparity was through mediators, particularly education, financial strain, BMI, physical activity, and pain. DISCUSSION Addressing issues of poverty, racial inequality, pain, and obesity could reduce some racial/ethnic disparity in functional limitations as women age.
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Affiliation(s)
| | - Alicia Colvin
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pennsylvania
| | - Andrea Stewart
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pennsylvania
| | - Bradley M Appelhans
- Department of Physical Medicine and Rehabilitation for affiliation, Rush University Medical Center, Chicago, Illinois
| | - Jane A Cauley
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pennsylvania
| | - Sheila A Dugan
- Department of Physical Medicine and Rehabilitation for affiliation, Rush University Medical Center, Chicago, Illinois
| | - Samar R El Khoudary
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pennsylvania
| | - Gail A Greendale
- Department of Gerontology, David Geffen School of Medicine at UCLA, University of California, Los Angeles
| | - Elsa Strotmeyer
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pennsylvania
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Scarinci IC, Pandya VN, Kim YI, Bae S, Peral S, Tipre M, Hardy C, Hansen B, Baskin ML. Factors Associated with Perceived Susceptibility to COVID-19 Among Urban and Rural Adults in Alabama. J Community Health 2021; 46:932-941. [PMID: 33751308 PMCID: PMC7983968 DOI: 10.1007/s10900-021-00976-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/08/2021] [Indexed: 11/30/2022]
Abstract
We examined factors associated with and reasons for perceived susceptibility to COVID-19 among urban and rural adults in Alabama. We surveyed 575 eligible participants’ engagement in preventive behaviors, concern about COVID-19 in their communities, perceived susceptibility to the virus, and reasons for susceptibility across three response options (Yes, No, and Don’t Know/Not Sure). Bivariate analyses compared characteristics by level of perceived susceptibility to COVID-19. A multinomial logistic regression model evaluated the association of demographics, health insurance coverage, and chronic illness status with perceived susceptibility. Participants’ race, gender, and educational attainment were significantly associated with perceived susceptibility to COVID-19. African Americans and males had higher odds of responding ‘No’, compared to ‘Yes’ and ‘Don’t Know/Not Sure’ than Whites and females. Participants with a high school education and lower had higher odds of responding ‘Don’t Know/Not Sure’ versus ‘Yes’ compared to those with college or higher education. Those unconcerned about COVID-19 in their community had higher odds of responding ‘No’ (OR = 2.51, CI 1.35–4.68) and ‘Don’t Know/Not Sure’ (OR = 2.51, CI 1.26–4.99) versus ‘Yes’, as compared to those who were concerned. Possibility of exposure at work was the most frequent reasons for perceiving themselves susceptible to COVID-19, engagement in recommended preventive measures was the most frequent reason among respondents who indicated ‘No’, and uncertainty/perception that everyone is at risk was the most frequent reason among the ones who indicated ‘Don’t Know/Not Sure’. Results indicate that tailored efforts to heighten perceived susceptibility to COVID-19 among specific demographics are needed.
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Affiliation(s)
- Isabel C Scarinci
- Division of Preventive Medicine, University of Alabama at Birmingham, 1717 11th Ave South, Birmingham, AL, 35205, USA. .,O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, 1824 6th Ave South, Birmingham, AL, 35233, USA.
| | - Vishruti N Pandya
- Division of Preventive Medicine, University of Alabama at Birmingham, 1717 11th Ave South, Birmingham, AL, 35205, USA
| | - Young-Il Kim
- Division of Preventive Medicine, University of Alabama at Birmingham, 1717 11th Ave South, Birmingham, AL, 35205, USA.,O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, 1824 6th Ave South, Birmingham, AL, 35233, USA
| | - Sejong Bae
- Division of Preventive Medicine, University of Alabama at Birmingham, 1717 11th Ave South, Birmingham, AL, 35205, USA.,O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, 1824 6th Ave South, Birmingham, AL, 35233, USA
| | - Sylvia Peral
- Division of Preventive Medicine, University of Alabama at Birmingham, 1717 11th Ave South, Birmingham, AL, 35205, USA
| | - Meghan Tipre
- Division of Preventive Medicine, University of Alabama at Birmingham, 1717 11th Ave South, Birmingham, AL, 35205, USA.,O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, 1824 6th Ave South, Birmingham, AL, 35233, USA
| | - Claudia Hardy
- O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, 1824 6th Ave South, Birmingham, AL, 35233, USA
| | - Barbara Hansen
- Division of Preventive Medicine, University of Alabama at Birmingham, 1717 11th Ave South, Birmingham, AL, 35205, USA
| | - Monica L Baskin
- Division of Preventive Medicine, University of Alabama at Birmingham, 1717 11th Ave South, Birmingham, AL, 35205, USA.,O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, 1824 6th Ave South, Birmingham, AL, 35233, USA
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Hughes GD, Mbamalu ON, Okonji CO, Puoane TR. The Impact of Health Disparities on COVID-19 Outcomes: Early Findings from a High-Income Country and Two Middle-Income Countries. J Racial Ethn Health Disparities 2021; 9:376-383. [PMID: 33686624 PMCID: PMC7938881 DOI: 10.1007/s40615-021-00999-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 02/14/2021] [Indexed: 12/20/2022]
Abstract
The SARS-CoV-2 infection, which causes the coronavirus disease (COVID-19), has affected lives, with very adverse outcomes in specific populations in the United States of America (USA), a high-income country, and two middle-income countries, Brazil and South Africa. This paper aims to discuss the relationship of race/ethnicity with COVID-19-associated factors in the three countries. The information is based on data collected from infectious disease/epidemiological centers in the USA, Brazil, and South Africa. Adverse COVID-19 outcomes have been associated with the burden of exposure and disease, linked to socioeconomic determinants, among specific ethnicities in all three countries. The prevalence of comorbidities before and the likelihood of work-related exposure in the context of COVID-19 infection puts ethnic minorities in the USA and some ethnic majorities and minorities in Brazil and South Africa at greater risk. We envisage that this work will contribute to ongoing discussions related to addressing socioeconomic determinants of health, and the need for stakeholders in various sectors to work on addressing observed health disparities for overall improvement in health and healthcare given the current pandemic.
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Affiliation(s)
- Gail Denise Hughes
- Department of Medical Bioscience, Faculty of Natural Sciences, University of the Western Cape, Private Bag X17, Bellville, 7535, South Africa
| | - Oluchi Nneka Mbamalu
- Division of Infectious Diseases and HIV Medicine, Department of Medicine, University of Cape Town, Cape Town, South Africa.
| | - Christabel Osaretin Okonji
- School of Pharmacy, Faculty of Natural Sciences, University of the Western Cape, Private Bag X17, Bellville, 7535, South Africa
| | - Thandi Rose Puoane
- School of Public Health, Faculty of Community and Health Sciences, University of the Western Cape, Private Bag X17, Bellville, 7535, South Africa
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142
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Suntai Z, Noh H, Won CR. Examining Racial Differences in the Informal Discussion of Advance Care Planning Among Older Adults: Application of the Andersen Model of Health Care Utilization. J Appl Gerontol 2021; 41:371-379. [PMID: 33605185 DOI: 10.1177/0733464821993610] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES The purpose of this study was to examine racial differences in the discussion of advance care planning among older adults using Andersen's behavioral model of health care utilization. METHOD This cross-sectional study utilized data from the 2018 National Health and Aging Trends Study. Weighted multivariable logistic regressions were used to predict advance care planning discussion (n = 1,326). RESULTS After accounting for predisposing, enabling, and need factors, Black older adults were less likely to discuss end-of-life care (odds ratio [OR] = .527) and medical power of attorney (OR = .531) compared with Whites. Hispanic older adults were also less likely to discuss end-of-life care (OR = .389) and power of attorney (OR = .384) compared with Whites. DISCUSSION These results point to significant racial disparities in advance care planning discussions among older adults and call for future examinations of cultural, historical, and systemic factors that could influence the discussion of advance care planning among this population.
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143
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Tai DBG, Shah A, Doubeni CA, Sia IG, Wieland ML. The Disproportionate Impact of COVID-19 on Racial and Ethnic Minorities in the United States. Clin Infect Dis 2021; 72:703-706. [PMID: 32562416 PMCID: PMC7337626 DOI: 10.1093/cid/ciaa815] [Citation(s) in RCA: 729] [Impact Index Per Article: 243.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 06/15/2020] [Indexed: 12/19/2022] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has disproportionately affected racial and ethnic minority groups, with high rates of death in African American, Native American, and LatinX communities. Although the mechanisms of these disparities are being investigated, they can be conceived as arising from biomedical factors as well as social determinants of health. Minority groups are disproportionately affected by chronic medical conditions and lower access to healthcare that may portend worse COVID-19 outcomes. Furthermore, minority communities are more likely to experience living and working conditions that predispose them to worse outcomes. Underpinning these disparities are long-standing structural and societal factors that the COVID-19 pandemic has exposed. Clinicians can partner with patients and communities to reduce the short-term impact of COVID-19 disparities while advocating for structural change.
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Affiliation(s)
| | - Aditya Shah
- Division of Infectious Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | - Chyke A Doubeni
- Department of Family Medicine, Mayo Clinic, Rochester, Minnesota, USA.,Center for Health Equity and Community Engagement Research, Mayo Clinic, Rochester, Minnesota, USA
| | - Irene G Sia
- Division of Infectious Diseases, Mayo Clinic, Rochester, Minnesota, USA.,Center for Health Equity and Community Engagement Research, Mayo Clinic, Rochester, Minnesota, USA
| | - Mark L Wieland
- Center for Health Equity and Community Engagement Research, Mayo Clinic, Rochester, Minnesota, USA.,Division of Community Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
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144
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Ames BN, Grant WB, Willett WC. Does the High Prevalence of Vitamin D Deficiency in African Americans Contribute to Health Disparities? Nutrients 2021; 13:499. [PMID: 33546262 PMCID: PMC7913332 DOI: 10.3390/nu13020499] [Citation(s) in RCA: 60] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 01/24/2021] [Accepted: 01/28/2021] [Indexed: 02/06/2023] Open
Abstract
African Americans have higher incidence of, and mortality from, many health-related problems than European Americans. They also have a 15 to 20-fold higher prevalence of severe vitamin D deficiency. Here we summarize evidence that: (i) this health disparity is partly due to insufficient vitamin D production, caused by melanin in the skin blocking the UVB solar radiation necessary for its synthesis; (ii) the vitamin D insufficiency is exacerbated at high latitudes because of the combination of dark skin color with lower UVB radiation levels; and (iii) the health of individuals with dark skin can be markedly improved by correcting deficiency and achieving an optimal vitamin D status, as could be obtained by supplementation and/or fortification. Moderate-to-strong evidence exists that high 25-hydroxyvitamin D levels and/or vitamin D supplementation reduces risk for many adverse health outcomes including all-cause mortality rate, adverse pregnancy and birth outcomes, cancer, diabetes mellitus, Alzheimer's disease and dementia, multiple sclerosis, acute respiratory tract infections, COVID-19, asthma exacerbations, rickets, and osteomalacia. We suggest that people with low vitamin D status, which would include most people with dark skin living at high latitudes, along with their health care provider, consider taking vitamin D3 supplements to raise serum 25-hydroxyvitamin D levels to 30 ng/mL (75 nmol/L) or possibly higher.
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Affiliation(s)
- Bruce N. Ames
- Molecular and Cell Biology, Emeritus, University of California, Berkeley, CA 94720, USA;
| | - William B. Grant
- Sunlight, Nutrition and Health Research Center, San Francisco, CA 94164-1603, USA
| | - Walter C. Willett
- Departments of Nutrition and Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA;
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
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145
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Nollen NL, Ahluwalia JS, Sanderson Cox L, Okuyemi K, Lawrence D, Samuels L, Benowitz NL. Assessment of Racial Differences in Pharmacotherapy Efficacy for Smoking Cessation: Secondary Analysis of the EAGLES Randomized Clinical Trial. JAMA Netw Open 2021; 4:e2032053. [PMID: 33464316 PMCID: PMC7816102 DOI: 10.1001/jamanetworkopen.2020.32053] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
IMPORTANCE Understanding Black vs White differences in pharmacotherapy efficacy and the underlying reasons is critically important to reducing tobacco-related health disparities. OBJECTIVE To compare pharmacotherapy efficacy and examine variables to explain Black vs White differences in smoking abstinence. DESIGN, SETTING, AND PARTICIPANTS This study is a secondary analysis of the Evaluating Adverse Events in a Global Smoking Cessation Study (EAGLES) double-blind, placebo-controlled, randomized clinical trial, which took place at clinical trial centers, academic centers, and outpatient clinics in 29 states in the US. US Black and White smokers who smoked 10 or more cigarettes per day with and without psychiatric comorbidity were enrolled between November 2011 and January 2015. Data analysis was performed from July 2019 to January 2020. INTERVENTIONS Participants were randomized (1:1:1:1) in a double-blind, triple-dummy, placebo- and active-controlled (nicotine patch) trial of varenicline and bupropion for 12 weeks with follow-up through week 24. MAIN OUTCOMES AND MEASURES Biochemically verified continuous cigarette abstinence rate (CAR) from weeks 9 to 24. Baseline, postbaseline treatment, and safety characteristics were examined as variables to explain race differences in abstinence. RESULTS Of the 1065 Black smokers enrolled, 255 were randomized to receive varenicline, 259 received bupropion, 286 received nicotine replacement therapy (NRT [ie, nicotine patch]), and 265 received placebo. Among the 3044 White smokers enrolled, 778 were randomized to receive varenicline, 769 received bupropion, 738 received NRT, and 759 received placebo. Participants were predominantly female (614 Black [57.7%] and 1786 White [58.7%] women) and heavy smokers (mean [SD] cigarettes per day, 18.2 [7.9] for Black and 20.0 [7.5] for White smokers), with a mean (SD) age of 47.2 (11.2) years for Black and 46.5 (12.7) years for White participants. Treatment and race were associated with CAR for weeks 9 to 24. The CAR was 4.9% lower for Black vs White participants (odds ratio [OR], 0.53; 95% CI, 0.41-0.69; P < .001); differences were found across all treatments. Pooling psychiatric and nonpsychiatric cohorts, varenicline (OR, 2.63; 95% CI, 1.90-3.63; P < .001), bupropion (OR, 1.75; 95% CI, 1.25-2.46; P = .001), and NRT (OR, 1.52; 95% CI, 1.07-2.16; P = .02) had greater efficacy than placebo for White participants. Only varenicline (OR, 2.63; 95% CI, 1.26-5.48; P = .01) had greater efficacy than placebo for Black participants. Baseline, postbaseline, and safety characteristics differed by race, but these variables did not eliminate the association of race with CAR. Black participants had 49% reduced odds of CAR for weeks 9 to 24 compared with White participants in the adjusted model (OR, 0.51; 95% CI, 0.39-0.66; P < .001). CONCLUSIONS AND RELEVANCE Black and White smokers achieved the highest rate of abstinence while taking varenicline, suggesting that it is the best first-line therapy for these groups. However, Black smokers were less responsive to all therapies, including placebo. Understanding variables (eg, socioeconomic or biological) beyond those may lead to improved treatment outcomes for Black smokers. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01456936.
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Affiliation(s)
- Nicole L. Nollen
- Department of Population Health, University of Kansas School of Medicine, Kansas City
| | - Jasjit S. Ahluwalia
- Alpert Medical School, Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, Rhode Island
- Alpert Medical School, Department of Medicine, Brown University School of Public Health, Providence, Rhode Island
| | - Lisa Sanderson Cox
- Department of Population Health, University of Kansas School of Medicine, Kansas City
| | - Kolawole Okuyemi
- Department of Family and Preventive Medicine, The University of Utah School of Medicine, Salt Lake City
| | | | | | - Neal L. Benowitz
- Department of Medicine, Bioengineering, and Therapeutic Sciences, University of California, San Francisco
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146
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Benjamins MR, Silva A, Saiyed NS, De Maio FG. Comparison of All-Cause Mortality Rates and Inequities Between Black and White Populations Across the 30 Most Populous US Cities. JAMA Netw Open 2021; 4:e2032086. [PMID: 33471116 PMCID: PMC9386890 DOI: 10.1001/jamanetworkopen.2020.32086] [Citation(s) in RCA: 60] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
IMPORTANCE To address elevated mortality rates and historically entrenched racial inequities in mortality rates, the United States needs targeted efforts at all levels of government. However, few or no all-cause mortality data are available at the local level to motivate and guide city-level actions for health equity within the country's biggest cities. OBJECTIVES To provide city-level data on all-cause mortality rates and racial inequities within cities and to determine whether these measures changed during the past decade. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study used mortality data from the National Vital Statistics System and American Community Survey population estimates to calculate city-level mortality rates for the non-Hispanic Black (Black) population, non-Hispanic White (White) population, and total population from January 2016 to December 2018. Changes from January 2009 to December 2018 were examined with joinpoint regression. Data were analyzed for the United States and the 30 most populous US cities. Data analysis was conducted from February to November 2020. EXPOSURE City of residence. MAIN OUTCOMES AND MEASURES Total population and race-specific age-standardized mortality rates using 3-year averages, mortality rate ratios between Black and White populations, excess Black deaths, and annual average percentage change in mortality rates and rate ratios. RESULTS The study included 26 295 827 death records. In 2016 to 2018, all-cause mortality rates ranged from 537 per 100 000 population in San Francisco to 1342 per 100 000 in Las Vegas compared with the overall US rate of 759 per 100 000. The all-cause mortality rate among Black populations was 24% higher than among White populations nationally (rate ratio, 1.236; 95% CI, 1.233 to 1.238), resulting in 74 402 excess Black deaths annually. At the city level, this ranged from 6 excess Black deaths in El Paso to 3804 excess Black deaths every year in Chicago. The US rate remained constant during the study period (average annual percentage change, -0.10%; 95% CI, -0.34% to 0.14%; P = .42). The racial inequities in rates for the US decreased between 2008 and 2019 (annual average percentage change, -0.51%; 95% CI, -0.92% to -0.09%; P =0.02). Only 14 of 30 cities (46.7%) experienced improvements in overall mortality rates during the past decade. Racial inequities increased in more cities (6 [20.0%]) than in which it decreased (2 [6.7%]). CONCLUSIONS AND RELEVANCE In this study, mortality rates and inequities between Black and White populations varied substantially among the largest US cities. City leaders and other health advocates can use these types of local data on the burden of death and health inequities in their jurisdictions to increase awareness and advocacy related to racial health inequities, to guide the allocation of local resources, to monitor trends over time, and to highlight effective population health strategies.
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Affiliation(s)
| | | | | | - Fernando G. De Maio
- DePaul University, Chicago, Illinois
- American Medical Association, Chicago,
Illinois
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147
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Garey L, Smit T, Neighbors C, Gallagher MW, Zvolensky MJ. Personalized Feedback for Smoking and Anxiety Sensitivity: A Randomized Controlled Trial. Subst Use Misuse 2021; 56:929-940. [PMID: 33761839 PMCID: PMC10032029 DOI: 10.1080/10826084.2021.1900255] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Cigarette smoking is the leading preventable cause of death and disability globally. Most smokers want to quit, and most make a serious quit attempt each year. Nevertheless, more than 95% of cessation attempters relapse within six months. Thus, alternative interventions are needed to combat this major public health concern. Objective: The current study was conducted to develop and test a smoking treatment among 95 (63.2% male; Mage = 46.20 years, SD = 10.90) adult daily cigarette smokers that targets a known risk factor for smoking maintenance and relapse: anxiety sensitivity (AS). Methods: The current study employed a randomized controlled trial design to test an integrated, brief, computer-delivered smoking and AS intervention among current, daily smokers. Participants completed four appointments: (a) phone-screener; (b) baseline (pre-intervention assessment, intervention [personalized feedback intervention (PFI) versus smoking information control], and post-intervention assessment); (c) 2-week follow-up; and (d) 4-week follow-up. Results: Participants indicated highly positive evaluations of both the PFI and control intervention. Between the baseline and 2-week follow-up, 44.2% [PFI: 46.9% (n = 23); control: 41.3% (n = 19)] of participants reported a quit attempt. At the 4-week follow-up, 49.5% [PFI: 57.1% (n = 28); control: 41.3% (n = 19)] of participants reported a quit attempt since their previous laboratory session. Conclusion: Within the context of an intervention development approach, the present investigation provides descriptive data on the feasibility, acceptability, and initial efficacy of a single-session, computer-delivered, AS/smoking PFI.
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Affiliation(s)
- Lorra Garey
- Department of Psychology, University of Houston, Houston, Texas, USA
| | - Tanya Smit
- Department of Psychology, University of Houston, Houston, Texas, USA
| | - Clayton Neighbors
- Department of Psychology, University of Houston, Houston, Texas, USA
| | | | - Michael J. Zvolensky
- Department of Psychology, University of Houston, Houston, Texas, USA
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
- HEALTH Institute, University of Houston, Houston, Texas, USA
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148
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Noel-London KC, Grimsley C, Porter J, Breitbach AP. "The Tip of the Iceberg": Commentary on Sports, Health Inequity, and Trauma Exacerbated by COVID-19. J Athl Train 2021; 56:5-10. [PMID: 33290542 DOI: 10.4085/1062-6050-0350.20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To discuss the relevance of system-level health inequities and their interplay with race in sports and athletic training, particularly during and after the coronavirus disease 2019 (COVID-19) pandemic. BACKGROUND Health inequity is a systemic and longstanding concern with dire consequences that can have marked effects on the lives of minority patients. As a result of the unequal consequences of the COVID-19 pandemic, the magnitude of the outcomes from health inequity in all spheres of American health care is being brought to the fore. The discourse within athletic training practice and policy must shift to intentionally creating strategies that acknowledge and account for systemic health inequities in order to facilitate an informed, evidence-based, and safe return to sport within the new normal. CONCLUSIONS To continue to evolve the profession and solidify athletic trainers' role in public health spaces post-COVID-19, professionals at all levels of athletic training practice and policy must intentionally create strategies that acknowledge and account for not only the social determinants of health but also the effects of racism and childhood trauma on overall health and well-being.
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Affiliation(s)
| | | | | | - Anthony P Breitbach
- Department of Physical Therapy and Athletic Training, Saint Louis University, MO
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149
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Keller AO. A Healthy Life for African American Women Caregivers: A Concept Mapping Study. Womens Health Issues 2021; 31:130-139. [PMID: 33380373 DOI: 10.1016/j.whi.2020.11.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 11/06/2020] [Accepted: 11/25/2020] [Indexed: 01/18/2023]
Abstract
OBJECTIVE African American women experience a higher burden of caregiving, but they are often underrepresented in studies on caregiver health. This study used a participatory process to elucidate how African American women caring for older adults view health and factors that influence health. METHODS We invited African American women ages 24-64 years old who reported caring for an older adult for group concept mapping, a process consisting of five steps: 1) preparation, 2) idea generation, 3) sorting and rating, 4) creating maps, and 5) interpreting maps. Participants (n = 29) first completed idea generation by responding to the focus prompt "A healthy life for a caregiver includes _____." Participants then sorted ideas into clusters based on conceptual similarity and rated each idea on desirability and importance. Data were managed via The Concept System Global MAX Software. RESULTS Idea generation identified 512 ideas that reduced to 99 unique ideas. Using the 99 ideas, a cluster map with 12 outcome domains best fit the data. Identified clusters included spirituality, maintaining relationships, good character, taking action to cope, preserving oneself, support, personal empowerment, resources, striving for peace, handling emotions, wellness, and taking care of self and place. Forty-three ideas representing 10 of the 12 domains were rated high for desirability and importance. CONCLUSION A participatory research method was used to integrate the voices of African American women caregivers and provide a rich set of elements necessary for their health and well-being. We also identified potential focus areas for interventions aimed at promoting the health of these caregivers.
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Affiliation(s)
- Abiola O Keller
- Marquette University College of Nursing, Milwaukee, Wisconsin.
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150
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Bateman LB, Schoenberger YMM, Hansen B, Osborne TN, Okoro GC, Speights KM, Fouad MN. Confronting COVID-19 in under-resourced, African American neighborhoods: a qualitative study examining community member and stakeholders' perceptions. ETHNICITY & HEALTH 2021; 26:49-67. [PMID: 33472411 PMCID: PMC7875151 DOI: 10.1080/13557858.2021.1873250] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 01/04/2021] [Indexed: 05/07/2023]
Abstract
OBJECTIVE The purpose of this study was to examine perceptions of COVID-19 related to prevention, coping, and testing of African American residents in under-resourced communities in Alabama. DESIGN Guided by the PRECEDE-PROCEED model, virtual focus groups were conducted in five urban and rural Alabama communities using secure Zoom meetings. Community residents and stakeholders (N = 36 total) participated; meetings were audio- and video-recorded, transcribed, and analyzed according to Thematic Analysis. Themes were organized by the PRECEDE portion of the model in Predisposing, Reinforcing, and Enabling barriers and facilitators in three focus areas: prevention, coping, and testing. RESULTS Prevention barriers included apathy, difficulty with social distancing, lack of information, mixed messages from authority figures, and lack of personal protective equipment (PPE). Prevention facilitators included concerns about contracting COVID-19, clear and consistent messages from trusted sources, contact tracing, and the provision of PPE. Coping barriers included food insecurity, mental health issues, isolation, economic hardships, lack of health care access, and issues with virtual schooling and church services, which were exacerbated by the inability to connect to the internet. Facilitators to coping included religious faith, increased physical activity, and a sense of hope. Testing barriers included misunderstanding, fear, mistrust, testing restrictions, and location of testing sites. Facilitators to testing included incentives, clear information from trusted sources, convenient testing locations, and free tests. CONCLUSION Gaining community members' perspectives can identify barriers and facilitators to prevention, coping, and testing and potentially improve outcomes. While addressing the social determinants of health (e.g. income, education, medical trust) would be an effective path by which to diminish health disparities related to COVID-19, there is an urgent need to mitigate the spread and severity of COVID-19 in vulnerable populations. Interventions should focus on downstream determinants, such as those emerging from our study.
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Affiliation(s)
- Lori Brand Bateman
- Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, Alabama, U.S
| | - Yu-Mei M. Schoenberger
- Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, Alabama, U.S
| | - Barbara Hansen
- Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, Alabama, U.S
| | - Tiffany N. Osborne
- Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, Alabama, U.S
| | - Grace C. Okoro
- Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, Alabama, U.S
| | - Kimberly M. Speights
- Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, Alabama, U.S
| | - Mona N. Fouad
- Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, Alabama, U.S
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