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Elbasheir A, Fulton TM, Choucair KC, Lathan EC, Spivey BN, Guelfo A, Carter SE, Powers A, Fani N. Moral injury, race-related stress and post-traumatic stress disorder in a trauma-exposed Black population. J Psychiatr Res 2024; 173:326-332. [PMID: 38574596 PMCID: PMC11140589 DOI: 10.1016/j.jpsychires.2024.03.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 02/17/2024] [Accepted: 03/15/2024] [Indexed: 04/06/2024]
Abstract
BACKGROUND Race-related stress (RRS) is an unrecognized source of moral injury (MI)-or the emotional and/or spiritual suffering that may emerge after exposure to events that violate deeply held beliefs. Additionally, MI has not been explored as a mechanism of risk for post-traumatic stress disorder (PTSD) in trauma-exposed civilians. We examined relations among exposure to potentially morally injurious events (moral injury exposure, MIE), related distress (moral injury distress, MID), and RRS in Black Americans. Potential indirect associations between RRS and PTSD symptoms via MID were also examined. METHODS Black Americans (n = 228; 90.4% female; Mage = 31.6 years. SDage = 12.8 years) recruited from an ongoing study of trauma completed measures assessing civilian MIE and MID, RRS, and PTSD. Bivariate correlations were conducted with MIE and MID, and mediation analysis with MID, to examine the role of MI in the relationship between RRS and PTSD symptom severity. RESULTS MIE was significantly correlated with cultural (r = 0.27), individual (r = 0.29), and institutional (r = 0.25) RRS; MID also correlated with cultural (r = 0.31), individual (r = 0.31), and institutional (r = 0.26) RRS (ps < 0.001). We found an indirect effect of RRS on PTSD symptoms via MID (β = 0.10, p < 0.005). CONCLUSIONS All types of RRS were associated with facets of MI, which mediated the relationship between RRS and current PTSD symptoms. MI may be a potential mechanism through which RRS increases the risk for PTSD in Black individuals.
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Affiliation(s)
- Aziz Elbasheir
- Emory University School of Medicine, Department of Psychiatry and Behavioral Sciences, USA; Neuroscience PhD Program, Emory University, USA
| | - Travis M Fulton
- Emory University School of Medicine, Department of Psychiatry and Behavioral Sciences, USA; Molecular and Systems Pharmacology PhD Program, Emory University, USA
| | - Khaled C Choucair
- Emory University School of Medicine, Department of Psychiatry and Behavioral Sciences, USA
| | - Emma C Lathan
- Emory University School of Medicine, Department of Psychiatry and Behavioral Sciences, USA
| | | | - Alfonsina Guelfo
- Emory University School of Medicine, Department of Psychiatry and Behavioral Sciences, USA
| | | | - Abigail Powers
- Emory University School of Medicine, Department of Psychiatry and Behavioral Sciences, USA
| | - Negar Fani
- Emory University School of Medicine, Department of Psychiatry and Behavioral Sciences, USA.
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Ward C, Montgomery K. End-of-Life Planning and the Influence of Socioeconomic Status among Black Americans: A Systematic Review. JOURNAL OF HOSPICE AND PALLIATIVE CARE 2024; 27:21-30. [PMID: 38449829 PMCID: PMC10911982 DOI: 10.14475/jhpc.2024.27.1.21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Revised: 01/25/2024] [Accepted: 01/30/2024] [Indexed: 03/08/2024]
Abstract
Purpose The purpose of this systematic review is to explore end-of-life (EOL) care planning and the impact of socioeconomic status (SES) among people who identify as Black or African American. Methods The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) were used to guide and inform this systematic review process. The following academic electronic databases with publications that reflected the interdisciplinary fields related to the research objective were searched APA PsycINFO, CINHAL, PubMed, Scopus, and Social Work Abstracts. Results After the authors conducted the search, 14 articles (from 13 studies) ultimately met the criteria for inclusion. The results substantiated significant concerns highlighted in previous literature regarding SES and its relation to EOL planning, but also revealed an absence of original work and interventions to increase engagement in EOL planning among Black and African American populations. Conclusion Black individuals deserve an equitable EOL experience. Researchers, practitioners, and policymakers need to move towards advocacy and action to meet this important need.
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Affiliation(s)
- Chesney Ward
- College of Social Work, University of Tennessee, Knoxville TN, USA
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3
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Houghton LC, Adkins-Jackson PB. Mixed-Method, Multilevel Clustered-Randomized Control Trial for Menstrual Health Disparities. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2024:10.1007/s11121-024-01646-1. [PMID: 38358576 DOI: 10.1007/s11121-024-01646-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/02/2024] [Indexed: 02/16/2024]
Abstract
Menstrual cycle characteristics are largely considered unmodifiable reproductive factors, a framing that prevents exploration of the ways structural factors interfere with menstrual health. Given the role of structural factors like healthy food and healthcare access on reproductive health and the grave need for structural interventions to known reproductive health disparities that disproportionately target cisgender women racialized as Black, it is imperative that science begin to examine how structural factors influence menstrual health. To explore such research, we employ critical race theory and intersectionality to illustrate what a structural intervention to improve menstrual cycle health could look like. Centering those with the greatest need, persons racialized as Black and/or LatinX living in food and healthcare deserts in Northern Manhattan, our illustrative sample includes four groups of persons who menstruate (e.g., cisgender girls and women) that are pre-menarche, pre-parous, postpartum, or perimenopausal. We describe a hypothetical, multilevel clustered-randomized control trial (cRCT) that provides psychoeducation on racism-related trauma and free delivered groceries to both treatment and control groups, while randomizing 30 clusters of housing associations to receive either sexual health clinics at their housing association or free vouchers for healthcare. We embed mixed methods (diaries, interviews, surveys, mobile apps, observation) into the design to evaluate the effectiveness of the 1-year intervention, in addition to determining the impact on participants through their perspectives. Through this illustration, we provide a novel example of how structural interventions can apply mixed methods to evaluate effectiveness while delivering services to populations impacted by multiple structural factors. We demonstrate how qualitative and quantitative approaches can be paired in clustered RCTs and how a living logic model can empirically incorporate the population perspective into more effective interventions. Lastly, we reveal how sensitive menstrual health is to structural factors and how upstream improvements will trickle down to potentially reduce health disparities in reproductive health.
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Affiliation(s)
- Lauren C Houghton
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, USA.
| | - Paris B Adkins-Jackson
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, USA
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, USA
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Sorensen J, Primdahl NL, Norredam M, Krasnik A. Challenges and Opportunities for Implementing Diversity Competence in a Medical Education Curriculum: A Qualitative Study of Perceptions Among Students and Teachers. JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2024; 11:23821205241236593. [PMID: 38444784 PMCID: PMC10913502 DOI: 10.1177/23821205241236593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 02/15/2024] [Indexed: 03/07/2024]
Abstract
OBJECTIVES Medical education is under continuous pressure to introduce new curriculum content to ensure that physicians possess the competences that the population needs. Diversity competence (DC) is a relatively new area within medicine, challenging the existing curriculum. Frameworks and guidelines have been developed to provide support and assistance to educators in integrating DC into medical programs. However, integrating DC into curriculum has proven difficult and is therefore still not included in many European medical programs. The purpose of the study is therefore to identify the challenges and opportunities for implementing DC including a focus on migrant and ethnic minorities in a medical education program. METHODS From November 2-20, 2020, focus group discussions with medical students, junior physicians and course leaders were conducted. The participants were recruited via Facebook, newsletters, and emails. Two interview guides were developed and used as guidance for topics to be discussed. The focus group discussions were conducted partly physically and partly digitally. The interviews were transcribed and were analyzed using thematic analysis. RESULTS Three main challenges and opportunities were identified across the focus groups. Challenges: (i) a disparaging discourse about humanistic and social disciplines within the curriculum, (ii) limited levels of DC among teachers, and (iii) need for institutional support. Opportunities: (i) a clear interest in strengthening teachers' DC levels, (ii) incentives for improving the image of humanistic and social medicine, and (iii) relevant courses for implementing DC. CONCLUSION Our results showed that action in this area is needed. The themes identified indicated that there are within the curriculum many opportunities to implement DC, but they also illuminated the challenges. The results suggested both a need for focusing on individual competences for medical teachers and students, and also for organizational change and support in favor of DC training.
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Affiliation(s)
- J Sorensen
- Danish Research Centre for Migration, Ethnicity and Health, Department of Public Health,
University of Copenhagen, Copenhagen, Denmark
| | - NL Primdahl
- Danish Research Centre for Migration, Ethnicity and Health, Department of Public Health,
University of Copenhagen, Copenhagen, Denmark
| | - M Norredam
- Danish Research Centre for Migration, Ethnicity and Health, Department of Public Health,
University of Copenhagen, Copenhagen, Denmark
| | - A Krasnik
- Danish Research Centre for Migration, Ethnicity and Health, Department of Public Health,
University of Copenhagen, Copenhagen, Denmark
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Hammett PJ, Eliacin J, Saenger M, Allen KD, Meis LA, Krein SL, Taylor BC, Branson M, Fu SS, Burgess DJ. The Association Between Racialized Discrimination in Health Care and Pain Among Black Patients With Mental Health Diagnoses. THE JOURNAL OF PAIN 2024; 25:217-227. [PMID: 37591480 DOI: 10.1016/j.jpain.2023.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 08/01/2023] [Accepted: 08/10/2023] [Indexed: 08/19/2023]
Abstract
Chronic pain is a costly and debilitating problem in the United States, and its burdens are exacerbated among socially disadvantaged and stigmatized groups. In a cross-sectional study of Black Veterans with chronic pain at the Atlanta VA Health Care System (N = 380), we used path analysis to explore the roles of racialized discrimination in health care settings, pain self-efficacy, and pain-related fear avoidance beliefs as potential mediators of pain outcomes among Black Veterans with and without an electronic health record-documented mental health diagnosis. In unadjusted bivariate analyses, Black Veterans with a mental health diagnosis (n = 175) reported marginally higher levels of pain-related disability and significantly higher levels of pain interference compared to those without a mental health diagnosis (n = 205). Path analyses revealed that pain-related disability, pain intensity, and pain interference were mediated by higher levels of racialized discrimination in health care and lower pain self-efficacy among Black Veterans with a mental health diagnosis. Pain-related fear avoidance beliefs did not mediate pain outcomes. These findings highlight the need to improve the quality and effectiveness of health care for Black patients with chronic pain through the implementation of antiracism interventions within health care systems. Results further suggest that Black patients with chronic pain who have a mental health diagnosis may benefit from targeted pain management strategies that focus on building self-efficacy for managing pain. PERSPECTIVE: Racialized health care discrimination and pain self-efficacy mediated differences in pain-related disability, pain intensity, and pain interference among Black Veterans with and without a mental health diagnosis. Findings highlight the need for antiracism interventions within health care systems in order to improve the quality of care for Black patients with chronic pain. TRIAL REGISTRATION: Clinicaltrials.gov Identifier: NCT01983228.
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Affiliation(s)
- Patrick J Hammett
- Center for Care Delivery and Outcomes Research, Veterans Affairs Medical Center, Minneapolis, Minnesota; Department of Medicine, University of Minnesota, Minneapolis, Minnesota
| | - Johanne Eliacin
- Women's Health Sciences Division, National Center for PTSD, VA Boston Healthcare System, Boston, Massachusetts; Center for Health Information and Communication, Roudebush VA Medical Center, Indianapolis, Indiana; Department of General Internal Medicine and Geriatrics, Indiana University School of Medicine, Indianapolis, Indiana
| | - Michael Saenger
- Anesthesia Service Line, Atlanta Veterans Administration Health Care System, Decatur, Georgia; Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Kelli D Allen
- Center of Innovation to Accelerate Discovery and Practice Transformation, Veterans Affairs (a VA HSR&D Center of Excellence), Veterans Affairs Medical Center, Durham, North Carolina; Department of Medicine & Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Laura A Meis
- Center for Care Delivery and Outcomes Research, Veterans Affairs Medical Center, Minneapolis, Minnesota; Department of Medicine, University of Minnesota, Minneapolis, Minnesota
| | - Sarah L Krein
- Center for Clinical Management Research, Veterans Affairs Healthcare System, Ann Arbor, Michigan; Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - Brent C Taylor
- Center for Care Delivery and Outcomes Research, Veterans Affairs Medical Center, Minneapolis, Minnesota; Department of Medicine, University of Minnesota, Minneapolis, Minnesota
| | - Mariah Branson
- Center for Care Delivery and Outcomes Research, Veterans Affairs Medical Center, Minneapolis, Minnesota
| | - Steven S Fu
- Center for Care Delivery and Outcomes Research, Veterans Affairs Medical Center, Minneapolis, Minnesota; Department of Medicine, University of Minnesota, Minneapolis, Minnesota
| | - Diana J Burgess
- Center for Care Delivery and Outcomes Research, Veterans Affairs Medical Center, Minneapolis, Minnesota; Department of Medicine, University of Minnesota, Minneapolis, Minnesota
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Rutman SP, Borgen N, Spellen S, King DD, Decker MJ, Rand L, Cobbins A, Brindis CD. Addressing anti-black racism in an academic preterm birth initiative: perspectives from a mixed methods case study. BMC Public Health 2023; 23:2039. [PMID: 37853363 PMCID: PMC10585806 DOI: 10.1186/s12889-023-16812-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 09/21/2023] [Indexed: 10/20/2023] Open
Abstract
BACKGROUND Growing recognition of racism perpetuated within academic institutions has given rise to anti-racism efforts in these settings. In June 2020, the university-based California Preterm Birth Initiative (PTBi) committed to an Anti-Racism Action Plan outlining an approach to address anti-Blackness. This case study assessed perspectives on PTBi's anti-racism efforts to support continued growth toward racial equity within the initiative. METHODS This mixed methods case study included an online survey with multiple choice and open-ended survey items (n = 27) and key informant interviews (n = 8) of leadership, faculty, staff, and trainees working within the initiative. Survey and interview questions focused on perspectives about individual and organizational anti-racism competencies, perceived areas of initiative success, and opportunities for improvement. Qualitative interview and survey data were coded and organized into common themes within assessment domains. RESULTS Most survey respondents reported they felt competent in all the assessed anti-racism skills, including foundational knowledge and responding to workplace racism. They also felt confident in PTBi's commitment to address anti-Blackness. Fewer respondents were clear on strategic plans, resources allocated, and how the anti-racism agenda was being implemented. Suggestions from both data sources included further operationalizing and communicating commitments, integrating an anti-racism lens across all activities, ensuring accountability including staffing and funding consistent with anti-racist approaches, persistence in hiring Black faculty, providing professional development and support for Black staff, and addressing unintentional interpersonal harms to Black individuals. CONCLUSIONS This case study contributes key lessons which move beyond individual-level and theoretical approaches towards transparency and accountability in academic institutions aiming to address anti-Black racism. Even with PTBi's strong commitment and efforts towards racial equity, these case study findings illustrate that actions must have sustained support by the broader institution and include leadership commitment, capacity-building via ongoing coaching and training, broad incorporation of anti-racism practices and procedures, continuous learning, and ongoing accountability for both short- and longer-term sustainable impact.
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Affiliation(s)
- Shira P Rutman
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, CA, USA.
| | - Natasha Borgen
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, CA, USA
| | - Solaire Spellen
- Department of Obstetrics, Gynecology and Reproductive Sciences, California Preterm Birth Initiative, University of California, San Francisco, San Francisco, CA, USA
| | - Dante D King
- Department of Obstetrics, Gynecology and Reproductive Sciences, California Preterm Birth Initiative, University of California, San Francisco, San Francisco, CA, USA
| | - Martha J Decker
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, CA, USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - Larry Rand
- Department of Obstetrics, Gynecology and Reproductive Sciences, California Preterm Birth Initiative, University of California, San Francisco, San Francisco, CA, USA
| | - Alexis Cobbins
- Department of Obstetrics, Gynecology and Reproductive Sciences, California Preterm Birth Initiative, University of California, San Francisco, San Francisco, CA, USA
| | - Claire D Brindis
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, CA, USA
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Bazargan-Hejazi S, Shirazi A, Hampton D, Pan D, Askharinam D, Shaheen M, Ebrahim G, Shervington D. Examining racial disparity in psychotic disorders related ambulatory care visits: an observational study using national ambulatory medical care survey 2010-2015. BMC Psychiatry 2023; 23:601. [PMID: 37592201 PMCID: PMC10436449 DOI: 10.1186/s12888-023-05095-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 08/08/2023] [Indexed: 08/19/2023] Open
Abstract
BACKGROUND One of the most consistent research findings related to race and mental health diseases is the disproportionately high rate of psychotic disorder diagnoses among people of color, specifically people of African descent. It is important to examine if a similar pattern exists among specific psychotic disorders. We aimed to examine the racial/ethnic differences in ambulatory care visits diagnosed with schizophrenia-spectrum disorders (SSDs). METHODS We analyzed data from the National Ambulatory Medical Care Survey (NAMCS) 2010-2015. The study sample included physician office-based visits by individuals diagnosed with SSDs, including schizophrenia, schizoaffective, and unspecified psychotic disorder (n = 1155). We used descriptive and bivariate analysis by race/ethnicity and three multinomial logistic regression models to test the association between the SSDs and race/ethnicity, adjusting for age, gender, insurance, disposition, medication Rx, and co-morbidity, considering the design and weight. RESULT Of the 1155 visits for SSDs, 44.8% had schizophrenia, 37.4% had schizoaffective disorder diagnosis, and 19.0% had unspecified psychosis disorder. We found significant racial disparities in the diagnosis of SSDs. Black patients were overrepresented in all three categories: schizophrenia (24%), schizoaffective disorder (17%), and unspecified psychosis disorder (26%). Also, a notable percentage of Black patients (20%) were referred to another physician in cases of schizophrenia compared to other ethnoracial groups (p < 0.0001). Moreover, we found a significant disparity in insurance coverage for schizoaffective disorder, with a higher percentage of Black patients (48%) having Medicaid insurance compared to patients from other ethnoracial groups (p < 0.0001). Black patients had nearly twice the odds of receiving a diagnosis of schizophrenia compared to White patients [AOR = 1.94; 95% CI: 1.28-2.95; P = 0.001]. However, they had significantly lower odds of being diagnosed with schizoaffective disorder [AOR = 0.42, 95% CI: 0.26-0.68; P = 0.003]. Race/ethnicity was not associated with receiving an unspecified psychosis disorder. CONCLUSIONS Our results show that SSDs, more specifically schizophrenia, continue to burden the mental health of Black individuals. Validation of our findings requires rigorous research at the population level that reveals the epidemiological difference of SSDs diagnoses in different race/ethnicity groups. Also, advancing our understanding of the nature of disparity in SSDs diagnoses among the Black population requires disentangling etiologic and systemic factors in play. This could include psychological stress, the pathway to care, services use, provider diagnostic practice, and experiencing discrimination and institutional and structural racism.
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Affiliation(s)
- Shahrzad Bazargan-Hejazi
- Department of Psychiatry, College of Medicine, Charles R. Drew University of Medicine and Science and UCLA David Geffen School of Medicine, Los Angeles, CA, USA
| | - Anaheed Shirazi
- Department of Psychiatry, School of Medicine, University of California San Diego, San Diego, CA, USA
| | - David Hampton
- Department of Family Medicine, College of Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, CA, USA
| | - Deyu Pan
- Charles R Drew University of Medicine and Science, Los Angeles, CA, USA
| | | | - Magda Shaheen
- College of Medicine, Charles R. Drew University of Medicine and Science, UCLA David Geffen School of Medicine, Los Angeles, CA, USA.
| | - Gul Ebrahim
- Kedren Community Care Clinic and Charles R Drew University of Medicine and Science, Los Angeles, CA, USA
| | - Denese Shervington
- Department Psychiatry, College of Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, CA, USA
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Laster M, Kozman D, Norris KC. Addressing Structural Racism in Pediatric Clinical Practice. Pediatr Clin North Am 2023; 70:725-743. [PMID: 37422311 DOI: 10.1016/j.pcl.2023.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/10/2023]
Abstract
Structural racism is the inequitable allocation of various social determinants of health to different communities. Exposure to this and other discrimination levied from intersectional identities is the primary driver of disproportionately adverse health outcomes for minoritized children and their families. Pediatric clinicians must vigilantly identify and mitigate racism in health care systems and delivery, assess for any impact of patient and family exposure to racism and direct them to appropriate health resources, foster an environment of inclusion and respect, and ensure that all care is delivered through a race-conscious lens with the utmost cultural humility and shared decision-making.
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Affiliation(s)
- Marciana Laster
- David Geffen School of Medicine, University of California, Los Angeles, CA, USA; Division of Pediatric Nephrology, UCLA Department of Pediatrics, 10833 Le Conte Avenue, MDCC A2-383, Los Angeles, CA 90095-1752, USA
| | - Daniel Kozman
- David Geffen School of Medicine, University of California, Los Angeles, CA, USA; UCLA Department of Medicine, Section of Medicine-Pediatrics & Preventive Medicine
| | - Keith C Norris
- David Geffen School of Medicine, University of California, Los Angeles, CA, USA; Division of General Internal Medicine and Health Services Research, UCLA Department of Medicine, 1100 Glendon Avenue, Suite 710, Los Angeles, CA 90024, USA.
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Ahmed N, Brown J, Parau C, McCullers A, Sanghavi K, Littlejohn R, Wesley DB. Bridging the Digital Health Divide: Characterizing Patient Portal Users and Nonusers in the U.S. Med Care 2023; 61:448-455. [PMID: 37289563 DOI: 10.1097/mlr.0000000000001869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
OBJECTIVE The objectives of this study were to (1) examine demographic differences between patient portal users and nonusers; and (2) examine health literacy, patient self-efficacy, and technology usage and attitudes between patient portal users and nonusers. METHODS Data were collected from Amazon Mechanical Turk (MTurk) workers from December 2021 to January 2022. MTurk workers completed an online survey, which asked about their health, access to technology, health literacy, patient self-efficacy, media and technology attitudes, and patient portal use for those with an account. A total of 489 MTurk workers completed the survey. Data were analyzed using latent class analysis (LCA) and multivariate logistic regression models. RESULTS Latent class analysis models revealed some qualitative differences between users and nonusers of patient portals in relation to neighborhood type, education, income, disability status, comorbidity of any type, insurance type, and the presence or absence of primary care providers. These results were partially confirmed by logistic regression models, which showed that participants with insurance, a primary care provider, or a disability or comorbid condition were more likely to have a patient portal account. CONCLUSIONS Our study findings suggest that access to health care, along with ongoing patient health needs, influence the usage of patient portal platforms. Patients with health insurance have the opportunity to access health care services, including establishing a relationship with a primary care provider. This relationship can be critical to a patient ever creating a patient portal account and actively engaging in their care, including communicating with their care team.
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Affiliation(s)
| | - Jason Brown
- MedStar Health Research Institute, Hyattsville, MD
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Adkins-Jackson PB, Vázquez E, Henry-Ala FK, Ison JM, Cheney A, Akingbulu J, Starks C, Slay L, Dorsey A, Marmolejo C, Stafford A, Wen J, McCauley MH, Summers L, Bermudez L, Cruz-Roman ZL, Castillo I, Kipke MD, Brown AF. The Role of Anti-Racist Community-Partnered Praxis in Implementing Restorative Circles Within Marginalized Communities in Southern California During the COVID-19 Pandemic. Health Promot Pract 2023; 24:232-243. [PMID: 36419256 PMCID: PMC9703012 DOI: 10.1177/15248399221132581] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The COVID-19 pandemic has exacerbated the adverse influence of structural racism and discrimination experienced by historically marginalized communities (e.g., Black, Latino/a/x, Indigenous, and transgender people). Structural racism contributes to trauma-induced health behaviors, increasing exposure to COVID-19 and restricting access to testing and vaccination. This intersection of multiple disadvantages has a negative impact on the mental health of these communities, and interventions addressing collective healing are needed in general and in the context of the COVID-19 pandemic. The Share, Trust, Organize, and Partner COVID-19 California Alliance (STOP COVID-19 CA), a statewide collaborative of 11 universities and 75 community partners, includes several workgroups to address gaps in COVID-19 information, vaccine trial participation, and access. One of these workgroups, the Vaccine Hesitancy Workgroup, adopted an anti-racist community-partnered praxis to implement restorative circles in historically marginalized communities to facilitate collective healing due to structural racism and the COVID-19 pandemic. The project resulted in the development of a multilevel pre-intervention restorative process to build or strengthen community-institutional partnerships when procurement of funds has been sought prior to community partnership. This article discusses this workgroup's role in advancing health justice by providing a community-based mental health intervention to marginalized communities in Southern California while using an antiracist praxis tool to develop a successful community-institutional partnership and to live up to the vision of community-based participatory research.
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Affiliation(s)
| | | | | | | | - Ann Cheney
- University of California, Riverside, Riverside, CA, USA
| | | | | | - Lindsay Slay
- Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Alexander Dorsey
- Mending Minds Professional Clinical Counseling, Inc, Los Angeles, CA, USA
| | | | | | - James Wen
- St. John's Cathedral, Los Angeles, CA, USA
| | | | - Latrese Summers
- St. John's Well Child and Family Center, Inc., Los Angeles, CA, USA
| | | | | | | | | | - Arleen F Brown
- University of California, Los Angeles, Los Angeles, CA, USA
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Kidd J, Came H, McCreanor T. Using vignettes about racism from health practice in Aotearoa to generate anti-racism interventions. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e4020-e4027. [PMID: 35302269 PMCID: PMC10078765 DOI: 10.1111/hsc.13795] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Revised: 12/02/2021] [Accepted: 03/02/2022] [Indexed: 06/14/2023]
Abstract
Racism is a key modifiable determinant of health that contributes to health inequities in Aotearoa and elsewhere. Experiences of racism occur within the health sector for workers, patients and their whānau (extended family) every day. This paper uses stories of racism from nurses - reworked into vignettes - to examine the dynamics of racism to generate possible micro, meso and macro anti-racism interventions. A critical qualitative design was utilised, informed by kaupapa Māori approaches. The five vignettes in this paper were sourced from a pair of caucused focus groups with nine senior Māori (Indigenous peoples of Aotearoa) and Tauiwi (non-Māori) nurses held in Auckland Aotearoa in 2019. The vignettes were lightly edited and then critically analysed by both authors to identify sites of racism and generate ideas for anti-racism interventions. The vignettes illustrate five key themes in relation to racism. These include (i) mono-cultural practice, (ii) everyday micro-aggressions; (iii) complexity and the costs of racism, (iv) Pākehā (white settler) privilege and (v) employment discrimination. From analysing these themes, a range of evidence-based micro, meso and macro-level anti-racism interventions were derived. These ranged from engaging in reflective practice, education initiatives, monitoring, through to collective advocacy. Vignettes are a novel way to reveal sites of racism to create teachable moments and spark reflective practice and more active engagement in anti-racism interventions. When systematically analysed vignettes can be utilised to inform and refine anti-racist interventions. Being able to identify racism is essential to being able to effectively counter racism.
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Affiliation(s)
- J. Kidd
- Faculty of Health and Environment SciencesAuckland University of TechnologyAucklandNew Zealand
| | - H. Came
- Faculty of Health and Environment SciencesAuckland University of TechnologyAucklandNew Zealand
| | - T. McCreanor
- Te Rōpū WhārikiMassey UniversityAucklandNew Zealand
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Structural Racism, Workforce Diversity, and Mental Health Disparities: A Critical Review. J Racial Ethn Health Disparities 2022:10.1007/s40615-022-01380-w. [PMID: 35930174 PMCID: PMC9361976 DOI: 10.1007/s40615-022-01380-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 07/25/2022] [Accepted: 07/26/2022] [Indexed: 11/23/2022]
Abstract
Objective Racial workforce diversity has been suggested as a critical pathway to address persistent racial mental health disparities. However, structural racism has been noted to diminish such workforce diversity efforts. The purpose of this critical review is to identify the mechanisms through which structural racism operates in organizations, including mental health organizations, to undermine workforce diversity efforts and reinforce inequities. Methods Using the theories of racialized organizations, the current review critically draws on literature underscoring the racial character of organizations as mezzo-level racialized structures that may systematically activate and uphold white privilege in the mental health workplace. Results Findings suggest that in the context of institutionalized white dominance, workers of color within mental health organizations may experience race-based cultural exclusion, identity threat, and racialized workplace emotional expression, and be burdened by racialized tasks. The workers of color may also become the means for organizations to attract communities of color due to their diverse characteristics, yet workers’ effects to address disparities in mental health are minimized due to potential racialized organizational forces, including the whiteness of organizational leadership and color-blindness. Conclusions and Implications for Practice Structural racism may create resistance to the efforts and effects of a racially diverse workforce within mental health organizations. This review calls for a race-conscious framework that drastically shifts the traditional organizational structure to an inverted hierarchy (i.e., client-centered management) to maximize diversity efforts in the mental health organizational workforce to address racial disparities in mental health.
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Mayoum A, Prajapati D, Lamb J, Kruth M, Waddell-Henowitch C, Baxter C, Beeston S, Graham JM, Thomson A. Having Hard Conversations About Racism Within Nursing Education: A Collaborative Process of Developing an Antiracism Action Plan. J Nurs Educ 2022; 61:461-468. [PMID: 35944195 DOI: 10.3928/01484834-20220602-07] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Multiple events that occurred in the United States in early 2020 prompted a widespread response to address racism that exists within systemic and social structures. Third-year psychiatric nursing students at a small Western Canadian university answered the call to action by initiating a process to address racism within clinical and educational settings in their faculty. METHODS The researchers used collaborative autoethnography to examine the experience of students and faculty working collaboratively to create a Faculty of Health Studies antiracism action plan. RESULTS The reflections of the student and faculty researchers highlighted three major themes: what inspired the work of creating an antiracism action plan, doing the work, and lessons learned. CONCLUSION Engaging in this research provided an opportunity to critically reflect on the process of students and faculty working together in establishing an antiracism action plan. [J Nurs Educ. 2022;61(8):461-468.].
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McLane P, Mackey L, Holroyd BR, Fitzpatrick K, Healy C, Rittenbach K, Plume TB, Bill L, Bird A, Healy B, Janvier K, Louis E, Barnabe C. Impacts of racism on First Nations patients' emergency care: results of a thematic analysis of healthcare provider interviews in Alberta, Canada. BMC Health Serv Res 2022; 22:804. [PMID: 35729530 PMCID: PMC9210059 DOI: 10.1186/s12913-022-08129-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 05/23/2022] [Indexed: 11/30/2022] Open
Abstract
Background First Nations people experience racism in society and in the healthcare system. This study aimed to document emergency care providers’ perspectives on care of First Nations patients. First Nations research partner organizations co-led all aspects of the research. Methods Sixteen semi-structured interviews were conducted with Alberta emergency department (ED) physicians and nurses between November 2019 and March 2020. Results ED providers reported that First Nations patients are exposed to disrespect through tone and body language, experience overt racism, and may be neglected or not taken seriously. They described impacts of racist stereotypes on patient care, and strategies they took as individuals to address patient barriers to care. Recognized barriers to care included communication, resources, access to primary care and the ED environment itself. Conclusions Results may inform the content of anti-racist and anti-colonial pedagogy that is contextually tailored to ED providers, and inform wider systems efforts to counter racism against First Nations members and settler colonialism within healthcare. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08129-5.
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Affiliation(s)
- Patrick McLane
- Alberta Health Services, Strategic Clinical Networks, Alberta Health Services Corporate Office, Seventh Street Plaza, 14th Floor, North Tower, 10030 - 107 Street NW, Edmonton, AB, T5J 3E4, Canada. .,Department of Emergency Medicine, University of Alberta, 790 University Terrace Building, 8303 - 112 Street, Edmonton, AB, T6G 2T4, Canada.
| | - Leslee Mackey
- Department of Emergency Medicine, University of Alberta, 790 University Terrace Building, 8303 - 112 Street, Edmonton, AB, T6G 2T4, Canada
| | - Brian R Holroyd
- Alberta Health Services, Strategic Clinical Networks, Alberta Health Services Corporate Office, Seventh Street Plaza, 14th Floor, North Tower, 10030 - 107 Street NW, Edmonton, AB, T5J 3E4, Canada.,Department of Emergency Medicine, University of Alberta, 790 University Terrace Building, 8303 - 112 Street, Edmonton, AB, T6G 2T4, Canada
| | - Kayla Fitzpatrick
- University of Alberta, School of Public Health, Edmonton Clinic Health Academy, 3-341, 11405 87 Ave NW, Edmonton, AB, T6G 1C9, Canada
| | - Chyloe Healy
- Blackfoot Confederacy Tribal Council, P.O. Box 916, Standoff, AB, T0L 1Y0, Canada
| | - Katherine Rittenbach
- Alberta Health Services, Strategic Clinical Networks, Alberta Health Services Corporate Office, Seventh Street Plaza, 14th Floor, North Tower, 10030 - 107 Street NW, Edmonton, AB, T5J 3E4, Canada.,University of Calgary, Department of Psychiatry, Health Sciences Centre, 3330 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada.,University of Alberta, Department of Psychiatry, 1E1 Walter Mackenzie Health Sciences Centre, 8440 112 St NW, Edmonton, AB, T6G 2B7, Canada
| | - Tessy Big Plume
- Stoney Nakoda Tsuut'ina Tribal Council, PO Box 350, 9911 Chiila Boulevard S.W., Tsuut'ina, AB, T2W 6H6, Canada
| | - Lea Bill
- Alberta First Nations Information Governance Centre, Suite 101, 535 8 Ave SE, Calgary, AB, T2G 5S9, Canada
| | - Anne Bird
- Paul First Nation Health Services, Box 89, Duffield, AB, TOE 0N0, Canada
| | - Bonnie Healy
- Blackfoot Confederacy Tribal Council, P.O. Box 916, Standoff, AB, T0L 1Y0, Canada
| | - Kristopher Janvier
- Kee Tas Kee Now Health Services, KTC Sub Office, 17015 - 105 Avenue NW, Edmonton, AB, T5S 1M5, Canada
| | - Eunice Louis
- Maskwacis Health Services, Box 100, 14 Ermineskin Ave, Maskwacis, AB, Canada
| | - Cheryl Barnabe
- University of Calgary, Departments of Medicine and Community Health Sciences, Health Sciences Centre, 3330 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada
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Jones DD. Examining the Unconscious Racial Biases and Attitudes of Physicians, Nurses, and the Public: Implications for Future Health Care Education and Practice. Health Equity 2022; 6:375-381. [PMID: 35651358 PMCID: PMC9148656 DOI: 10.1089/heq.2021.0141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2022] [Indexed: 11/12/2022] Open
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Rohrbaugh RM, DeJong SM. The Role of the Program Director in Supporting Diversity, Equity, and Inclusion. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2022; 46:264-268. [PMID: 34272722 DOI: 10.1007/s40596-021-01474-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 04/27/2021] [Indexed: 06/13/2023]
Affiliation(s)
| | - Sandra M DeJong
- Cambridge Health Alliance and Harvard Medical School, Cambridge, MA, USA
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17
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Scarpa MP, Zopluoglu C, Prilleltensky I. Mattering in the community: Domain and demographic differences in a US sample. JOURNAL OF COMMUNITY PSYCHOLOGY 2022; 50:1481-1502. [PMID: 34614237 DOI: 10.1002/jcop.22728] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 09/21/2021] [Accepted: 09/24/2021] [Indexed: 05/26/2023]
Abstract
Mattering is defined as experiences of feeling valued and adding value in different domains of life: self, relationships, work, and community. Mattering is a construct with great relevance across psychological and social issues. Research has suggested there may be value in understanding group differences in mattering. Following the recent validation of a scale which measures mattering across multiple domains of life (MIDLS), the present study analyzed a representative US sample to identify demographic group differences in domain-specific mattering. Despite the presence of few differences in Overall Mattering, significant differences were found among all domains and between groups for each demographic variable. Overall, high incomes, advanced degrees, and employment were most consistently associated with higher mattering across domains. In addition, individuals across demographic groups and domains were more likely to report adding value than feeling valued. Age, gender, ethnicity, and marital status correlations were found in certain domains. These results demonstrate the value of a multidimensional conception of mattering and provide initial insight into demographic differences in mattering in a United States, English-speaking sample.
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Affiliation(s)
- Michael P Scarpa
- School of Education and Human Development, University of Miami, Coral Gables, Florida, USA
| | | | - Isaac Prilleltensky
- School of Education and Human Development, University of Miami, Coral Gables, Florida, USA
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18
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Smith NA, McDonald A, Wei W, Johnson SA, Adeji D, Witherspoon DP. Embracing Race, Resisting Oppression: African American Parents as Experienced Guides for Navigating Racial Oppression: Dismantling Systems of Racism and Oppression during Adolescence. JOURNAL OF RESEARCH ON ADOLESCENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR RESEARCH ON ADOLESCENCE 2022; 32:115-133. [PMID: 34939723 DOI: 10.1111/jora.12712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 12/01/2021] [Accepted: 12/11/2021] [Indexed: 06/14/2023]
Abstract
This study examined how discrimination experiences, beliefs, and coping in middle adolescence contributed to heterogeneity in African American parent-adolescent relationship (PAR) profiles three years later. Data were from the Maryland Adolescent Development in Context Study in which 589 African American caregivers (92% female; Mage = 39.15, SD = 6.72; range = 27-74 years old) were interviewed when youth were in 8th and 11th grades. We used previously identified profiles of ethnic-racial socialization, general parenting practices, and relationship quality: No-nonsense High Socializers, Indulgent Average Socializers, Unengaged Silent Socializers, and Authoritative Cultural Socializers. Results indicated that parents' discrimination experiences, racial coping self-efficacy, and racial coping socialization when youth were in the 8th grade predicted membership in PAR profiles three years later controlling for youth gender, parent marital status, and family socioeconomic status.
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Affiliation(s)
| | | | - Wei Wei
- The Pennsylvania State University
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19
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Roberts KM, Trejo AN. Provider, Heal Thy System: An Examination of Institutionally Racist Healthcare Regulatory Practices and Structures. CONTEMPORARY FAMILY THERAPY 2022; 44:4-15. [PMID: 35106026 PMCID: PMC8794600 DOI: 10.1007/s10591-021-09630-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/14/2021] [Indexed: 11/25/2022]
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20
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Shelton RC, Adsul P, Oh A, Moise N, Griffith DM. Application of an antiracism lens in the field of implementation science (IS): Recommendations for reframing implementation research with a focus on justice and racial equity. IMPLEMENTATION RESEARCH AND PRACTICE 2021; 2:26334895211049482. [PMID: 37089985 PMCID: PMC9978668 DOI: 10.1177/26334895211049482] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background Despite the promise of implementation science (IS) to reduce health inequities, critical gaps and opportunities remain in the field to promote health equity. Prioritizing racial equity and antiracism approaches is critical in these efforts, so that IS does not inadvertently exacerbate disparities based on the selection of frameworks, methods, interventions, and strategies that do not reflect consideration of structural racism and its impacts. Methods Grounded in extant research on structural racism and antiracism, we discuss the importance of advancing understanding of how structural racism as a system shapes racial health inequities and inequitable implementation of evidence-based interventions among racially and ethnically diverse communities. We outline recommendations for explicitly applying an antiracism lens to address structural racism and its manifests through IS. An anti-racism lens provides a framework to guide efforts to confront, address, and eradicate racism and racial privilege by helping people identify racism as a root cause of health inequities and critically examine how it is embedded in policies, structures, and systems that differentially affect racially and ethnically diverse populations. Results We provide guidance for the application of an antiracism lens in the field of IS, focusing on select core elements in implementation research, including: (1) stakeholder engagement; (2) conceptual frameworks and models; (3) development, selection, adaptation of EBIs; (4) evaluation approaches; and (5) implementation strategies. We highlight the need for foundational grounding in antiracism frameworks among implementation scientists to facilitate ongoing self-reflection, accountability, and attention to racial equity, and provide questions to guide such reflection and consideration. Conclusion We conclude with a reflection on how this is a critical time for IS to prioritize focus on justice, racial equity, and real-world equitable impact. Moving IS towards making consideration of health equity and an antiracism lens foundational is central to strengthening the field and enhancing its impact. Plain language abstract There are important gaps and opportunities that exist in promoting health equity through implementation science. Historically, the commonly used frameworks, measures, interventions, strategies, and approaches in the field have not been explicitly focused on equity, nor do they consider the role of structural racism in shaping health and inequitable delivery of evidence-based practices/programs. This work seeks to build off of the long history of research on structural racism and health, and seeks to provide guidance on how to apply an antiracism lens to select core elements of implementation research. We highlight important opportunities for the field to reflect and consider applying an antiracism approach in: 1) stakeholder/community engagement; 2) use of conceptual frameworks; 3) development, selection and adaptation of evidence-based interventions; 4) evaluation approaches; 5) implementation strategies (e.g., how to deliver evidence-based practices, programs, policies); and 6) how researchers conduct their research, with a focus on racial equity. This is an important time for the field of implementation science to prioritize a foundational focus on justice, equity, and real-world impact through the application of an anti-racism lens in their work.
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Affiliation(s)
- Rachel C. Shelton
- Department of Sociomedical Sciences, Columbia University, Mailman School of Public Health, New York, USA
| | - Prajakta Adsul
- Department of Internal Medicine, School of Medicine, University of New Mexico, Albuquerque, USA
| | - April Oh
- Division of Cancer Control and Population Sciences, Implementation Science Team, National Cancer Institute, Rockville, USA
| | - Nathalie Moise
- Department of Medicine, Columbia University Irving Medical Center, New York, USA
| | - Derek M. Griffith
- Georgetown University, Racial Justice Institute, Washington, USA
- Georgetown University, Center for Men’s Health Equity, Washington, USA
- Department of Health Systems Administration at the School of Nursing & Health Studies, Georgetown University, Washington, USA
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21
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Spheres of Influence and Strategic Advocacy for Equity in Medicine. J Gen Intern Med 2021; 36:3537-3540. [PMID: 34013471 PMCID: PMC8133515 DOI: 10.1007/s11606-021-06893-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 05/03/2021] [Indexed: 11/03/2022]
Abstract
As the extent of health disparities in the USA has been revealed, particularly during the COVID-19 pandemic, physicians have increasingly attended to their roles as advocates for their patients and communities. This article presents "spheres of influence" as a concept that can help physicians think strategically about how to build upon their clinical work and expertise to promote equity in medicine. The physician's primary sphere of influence is in direct patient care. However, physicians today often have many other roles, especially within larger health care institutions in which physicians often occupy positions of authority. Physicians are therefore well-positioned to act within these spheres in ways that draw upon the ethical principles that guide patient care and contribute materially to the cause of equity for colleagues and patients alike. By making changes to the ways they already work within their clinical spaces, institutional leadership roles, and wider communities, physicians can counteract the structural problems that undermine the health of the patients they serve.
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22
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Mitchell O, Bourke L, Shaburdin ZM. A qualitative evaluation of the implementation of a cultural competence project in rural Victoria. Aust N Z J Public Health 2021; 45:227-234. [PMID: 33900657 DOI: 10.1111/1753-6405.13105] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 11/01/2020] [Accepted: 02/01/2021] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To explore the complex factors influencing the implementation of cultural competency frameworks for Aboriginal and Torres Strait Islander peoples within rural, Victorian, mainstream health and community service organisations. METHODS Semi-structured telephone interviews were conducted with key individuals from 20 public health and community services in rural Victoria who had participated in the Koolin Balit Aboriginal Health Cultural Competence Project (KB-AHCC project). Interviews were recorded and transcribed verbatim and a content analysis was undertaken. The findings informed the selection of six case study sites for more in-depth analysis. Following this, an expert reference group provided feedback on the findings. Findings from the different data were triangulated to identify eight factors. RESULTS Key factors acting as barriers and/or enablers to implementing cultural competence frameworks were: comprehensive, structured tools; project workers; communication; organisational responsibility for implementation; prioritising organisational cultural competence resourcing; resistance to focussing on one group of people; and accountability. CONCLUSIONS Embedding cultural competence frameworks within rural, mainstream health and community services requires sustained government resourcing, prioritisation and formal accountability structures. Implications for public health: Findings will inform and guide the future development, implementation and evaluation of organisational cultural competence projects for rural public health and community services.
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Affiliation(s)
- Olivia Mitchell
- Department of Rural Health, The University of Melbourne, Victoria
| | - Lisa Bourke
- Department of Rural Health, The University of Melbourne, Victoria
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Depressive Symptoms in Relation to Adverse Childhood Experiences, Discrimination, Hope, and Social Support in a Diverse Sample of College Students. J Racial Ethn Health Disparities 2021; 9:992-1002. [PMID: 33835419 DOI: 10.1007/s40615-021-01038-z] [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: 09/12/2020] [Revised: 03/31/2021] [Accepted: 04/01/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Young adulthood is a critical transitory period, with various factors impacting mental health and longer-term health outcomes, particularly among racial/ethnic minorities. Drawing from minority stress theory, this study examined correlates of depressive symptoms, specifically adverse childhood experiences (ACEs), racial/ethnic discrimination, hope, social support, and their interactive effects, among a diverse sample of college students. METHODS We analyzed data from 666 racial/ethnic minority college students (57% Black, 22% Latinx, 21% Asian) attending seven colleges and universities in the state of Georgia. Depressive symptoms were assessed using the Patient Health Questionnaire-9 Item (PHQ-9). Multivariable linear regressions included ACEs, racial/ethnic discrimination, hope, and social support, adjusting for sex, race/ethnicity, parent education, nativity, and age. We tested two-way interaction terms in four separate models to examine the potential buffering effect of social support and hope on the association between ACEs and discrimination. RESULTS Participants were on average 20.56 years old (SD = 1.93) and 30% were male. The mean PHQ-9 score was 3.89 (SD = 4.91); 56% reported at least one ACE; 70% experienced racial/ethnic discrimination. ACEs and racial/ethnic discrimination correlated with higher levels of depressive symptoms; higher social support and hope correlated with decreased depressive symptoms. While hope and social support did not moderate the relationships between ACEs or discrimination and depressive symptoms among the full sample, racial/ethnic subgroup analyses indicated that, among Asian students, the positive association between discrimination and depressive symptoms was significantly weaker for those perceiving greater hope. CONCLUSIONS Eliminating racial/ethnic disparities in mental health requires concerted efforts to prevent and/or reduce ACEs and discrimination and identifying protective factors that can mitigate their relationship to depressive symptoms.
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Social determinants of health and coronavirus disease 2019 in pregnancy. Am J Obstet Gynecol MFM 2021; 3:100349. [PMID: 33757936 PMCID: PMC7981575 DOI: 10.1016/j.ajogmf.2021.100349] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 02/09/2021] [Accepted: 03/15/2021] [Indexed: 01/27/2023]
Abstract
Background The social and physical environments in which people live affect the emergence, prevalence, and severity of both infectious and noninfectious diseases. There are limited data on how such social determinants of health, including neighborhood socioeconomic conditions, affect the risk of severe acute respiratory syndrome coronavirus 2 infection and severity of coronavirus disease 2019 during pregnancy. Objective Our objective was to determine how social determinants of health are associated with severe acute respiratory syndrome coronavirus 2 infection and the severity of coronavirus disease 2019 illness in hospitalized pregnant patients in New York during the global coronavirus disease 2019 pandemic. Study Design This cross-sectional study evaluated all pregnant patients who delivered and had polymerase chain reaction testing for severe acute respiratory syndrome coronavirus 2 between March 15, 2020, and June 15, 2020, at 7 hospitals within Northwell Health, the largest academic health system in New York. During the study period, universal severe acute respiratory syndrome coronavirus 2 testing protocols were implemented at all sites. Polymerase chain reaction testing was performed using nasopharyngeal swabs. Patients were excluded if the following variables were not available: polymerase chain reaction results, race, ethnicity, or zone improvement plan (ZIP) code of residence. Clinical data were obtained from the enterprise electronic health record system. For each patient, ZIP code was used as a proxy for neighborhood. Socioeconomic characteristics were determined by linking to ZIP code data from the United States Census Bureau's American Community Survey and the Internal Revenue Service's Statistics of Income Division. Specific variables of interest included mean persons per household, median household income, percent unemployment, and percent with less than high school education. Medical records were manually reviewed for all subjects with positive polymerase chain reaction test results to correctly identify symptomatic patients and then classify those subjects using the National Institutes of Health severity of illness categories. Classification was based on the highest severity of illness throughout gestation and not necessarily at the time of presentation for delivery. Results A total of 4873 patients were included in the study. The polymerase chain reaction test positivity rate was 11% (n=544). Among this group, 359 patients (66%) were asymptomatic or presymptomatic, 115 (21%) had mild or moderate coronavirus disease 2019, and 70 (13%) had severe or critical coronavirus disease 2019. On multiple logistic regression modeling, pregnant patients who had a positive test result for severe acute respiratory syndrome coronavirus 2 were more likely to be younger or of higher parity, belong to minoritized racial and ethnic groups, have public health insurance, have limited English proficiency, and reside in low-income neighborhoods with less educational attainment. On ordinal logit regression modeling, obesity, income and education were associated with coronavirus disease 2019 severity. Conclusion Social and physical determinants of health play a role in determining the risk of infection. The severity of coronavirus disease 2019 illness was not associated with race or ethnicity but was associated with maternal obesity and neighborhood level characteristics such as educational attainment and household income.
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Implementing Anti-Racism Interventions in Healthcare Settings: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18062993. [PMID: 33803942 PMCID: PMC8000324 DOI: 10.3390/ijerph18062993] [Citation(s) in RCA: 90] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 02/22/2021] [Accepted: 02/23/2021] [Indexed: 11/21/2022]
Abstract
Racism towards Black, Indigenous and people of colour continues to exist in the healthcare system. This leads to profound harm for people who use and work within these settings. This is a scoping review to identify anti-racism interventions in outpatient healthcare settings. Searching the peer-reviewed and grey literature, articles were screened for inclusion by at least two independent reviewers. Synthesizing the socio-ecological levels of interventions with inductively identifying themes, a conceptual model for implementing anti-racism interventions in healthcare settings is presented. In total, 37 peer-reviewed articles were included in the review, with 12 empirical studies and 25 theoretical or conceptual papers. Six grey literature documents were also included. Healthcare institutions need to incorporate an explicit, shared language of anti-racism. Anti-racism action should incorporate leadership buy-in and commitment with dedicated resources, support and funding; a multi-level approach beginning with policy and organizational interventions; transparent accountability mechanisms for sustainable change; long-term meaningful partnerships with Black, Indigenous, and people of colour (i.e., racialized communities); and ongoing, mandatory, tailored staff education and training. Decision-makers and staff in healthcare settings have a responsibility to take anti-racism action and may improve the success and sustainability of their efforts by incorporating the foundational principles and strategies identified in this paper.
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Came H, Baker M, McCreanor T. Addressing Structural Racism Through Constitutional Transformation and Decolonization: Insights for the New Zealand Health Sector. JOURNAL OF BIOETHICAL INQUIRY 2021; 18:59-70. [PMID: 33428152 DOI: 10.1007/s11673-020-10077-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 12/16/2020] [Indexed: 06/12/2023]
Abstract
In colonial states and settings, constitutional arrangements are often forged within contexts that serve to maintain structural racism against Indigenous people. In 2013 the New Zealand government initiated national conversations about the constitutional arrangements in Aotearoa. Māori (Indigenous) leadership preceded this, initiating a comprehensive engagement process among Māori in 2010, which resulted in a report by Matike Mai Aotearoa which articulated a collective Māori vision of a written constitution congruent with te Tiriti o Waitangi (the founding document of the colonial state of New Zealand) by 2040.This conceptual article explores the Matike Mai Aotearoa report on constitutional transformation as a novel means to address structural racism within the health system as a key domain within the constitutional sphere. Matike Mai suggests alternative conceptual structural formations through its focus on the kāwanatanga (governance), the relational and the tino rangatiratanga (sovereignty) sphere. This framework is informed by a range of Indigenous ethical values such as tikanga (protocol), belonging, and balance that can usefully inform the redesign of the health sector.We assert that constitutional transformation and decolonization are potentially powerful ethical sources of disruption to whiteness and structural racism. We argue that, to eliminate entrenched health disparities, change processes need to be informed by the Indigenous inspirations expressed in the Matike Mai report.
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Affiliation(s)
- Heather Came
- Faculty of Health and Environment Sciences, Auckland University of Technology, Private Bag, Auckland, 92006, New Zealand.
| | - Maria Baker
- Te Rau Ora, PO Box 5731, Wellington, 6140, New Zealand
| | - Tim McCreanor
- Te Rōpū Whāriki, Massey University, PO Box 6137, Wellesley Street, Auckland, 1141, New Zealand
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Abstract
Men's health equity is an area of men's health research and practice that combines the literature on men's health with that of health equity. More research is needed that describes how to intervene to promote men's health equity. This introduction to the American Journal of Men's Health special collection on promoting men's health equity was created to feature research that describes aspects of promising interventions that (a) are population-specific approaches that consider the unique biopsychosocial factors that affect the health of socially defined populations of men; or (b) use a comparative approach to close or eliminate gaps between socially defined groups of men and women and among socially meaningful groups of men that are unnecessary, avoidable, considered unfair and unjust, and yet are modifiable. The dozen papers from across the globe included in the special collection are grouped in three areas: conceptual approaches and reviews; formative research; and evaluation findings. The papers represent a diverse array of populations under the umbrella of men's health and a range of strategies to improve men's health from tobacco cessation to microfinance. The collection features a range of alternative masculinities that emerge from original research by the contributors that are used in novel ways in the interventions. This editorial argues that more qualitative research is needed to evaluate the intended and unintended findings from interventions. This editorial also highlights the benefits that men's health equity can gain from embracing dissemination and implementation science as a tool to systematically design, implement, refine, and sustain interventions.
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Affiliation(s)
- Derek M Griffith
- Center for Research on Men's Health, Vanderbilt University, Nashville, TN, USA.,Department of Medicine, Health and Society, Vanderbilt University, Nashville, TN, USA
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McLane P, Bill L, Barnabe C. First Nations members' emergency department experiences in Alberta: a qualitative study. CAN J EMERG MED 2020; 23:63-74. [PMID: 33683609 DOI: 10.1007/s43678-020-00009-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Accepted: 07/16/2020] [Indexed: 12/13/2022]
Abstract
OBJECTIVES In Alberta, First Nations members visit Emergency Departments (EDs) at almost double the rate of non-First Nations persons. Previous publications demonstrate differences in ED experience for First Nations members, compared to the general population. The Alberta First Nations Information Governance Centre (AFNIGC), First Nations organizations, Universities, and Alberta Health Services conducted this research to better understand First Nations members' ED experiences and expectations. METHODS This was a participatory research project. Elders selected topics of focus through discussion with the research team, and approved our method of data collection. Sharing circles were held in February 2018 with Elders, First Nations patients, healthcare providers and health administrators from across Alberta. We analyzed data using the Western approach of thematic analysis, with review by two Indigenous team members. AFNIGC is custodian of the research data on behalf of Alberta First Nations, and approves publication of this work. RESULTS Forty-six persons participated in four sharing circles lasting between one and a half and three hours. Findings included First Nations patients' understandings of ED work, limited access to primary care services driving ED use, expectations of different treatment in ED based on race, experiences of racism, concerns about interactions with Children's Services, healthcare avoidance, and avoiding specific hospitals. Equity approaches were identified as key to improving First Nations patients' ED experiences. CONCLUSIONS Bringing First Nations perspectives to Western understandings of ED care is an important step toward identifying required improvements in the health system for better patient experiences and outcomes.
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Affiliation(s)
- Patrick McLane
- Emergency Strategic Clinical Network, Alberta Health Services, 2-033 10030 107 Street, Edmonton, AB, T5J 3E4, Canada. .,Department of Emergency Medicine, University of Alberta, Edmonton, Canada.
| | - Lea Bill
- Alberta First Nations Information Governance Centre, Calgary, Canada
| | - Cheryl Barnabe
- Cumming School of Medicine, University of Calgary, Calgary, Canada
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Glass JE, Williams EC, Oh H. Racial/ethnic discrimination and alcohol use disorder severity among United States adults. Drug Alcohol Depend 2020; 216:108203. [PMID: 32810836 DOI: 10.1016/j.drugalcdep.2020.108203] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 07/21/2020] [Accepted: 07/21/2020] [Indexed: 11/15/2022]
Abstract
BACKGROUND Racism, and resultant racial/ethnic discrimination is a ubiquitous social determinant of health that is linked to adverse alcohol-related outcomes. To our knowledge, no studies have examined whether manifestations of racial/ethnic discrimination increase risk of DSM-5 alcohol use disorder (AUD) severity levels. METHODS Analyses were conducted among 17,115 racial/ethnic minority respondents of the National Epidemiologic Survey on Alcohol-Related Conditions III (NESARC-III), a cross-sectional survey fielded in 2012-2013. We used multinomial logistic regression to examine the associations between measures of racial/ethnic discrimination and past-year AUD severity levels following the DSM-5 definition, while adjusting for poverty thresholds set by the U.S. Census Bureau, and race/ethnicity (American Indian or Alaskan Native; Asian, Native Hawaiian, or Other Pacific Islander; Black or African American; Hispanic or Latino). We also evaluated whether associations between discrimination and AUD severity varied by poverty status and race/ethnicity. RESULTS Covariate-adjusted multinomial logistic regressions suggested that in comparison to those who did not experience discrimination, those who experienced discrimination had a 1.5-fold greater risk of mild AUD, a 1.6-fold greater risk of moderate AUD, and a 2.3-fold greater risk of severe AUD. We found no evidence to suggest that the strength of the association between racial/ethnic discrimination and AUD severity varied across race/ethnic group or poverty status. CONCLUSIONS Experience of racial/ethnic discrimination is associated with greater AUD severity in the U.S. regardless of one's specific racial/ethnic group membership or poverty status. Strategies to reduce risk for severe AUD should include efforts to minimize the occurrence and impact of interpersonal and institutional racism.
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Affiliation(s)
- Joseph E Glass
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Suite 1600, Seattle, WA, 98101, United States.
| | - Emily C Williams
- Department of Health Services, University of Washington School of Public Health, Seattle, WA, United States; Health Services Research & Development (HSR&D) Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs (VA) Puget Sound Health Care System, Seattle, WA, United States
| | - Hans Oh
- University of Southern California, Suzanne Dworak Peck School of Social Work, 1149 Hill St Suite 1422, Los Angeles, CA, 90015, United States
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Wallace J, Bretzin A, Beidler E, Hibbler T, Delfin D, Gray H, Covassin T. The Underreporting of Concussion: Differences Between Black and White High School Athletes Likely Stemming from Inequities. J Racial Ethn Health Disparities 2020; 8:1079-1088. [PMID: 32926391 DOI: 10.1007/s40615-020-00864-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 09/01/2020] [Accepted: 09/02/2020] [Indexed: 10/23/2022]
Abstract
Previous studies have found that Black high school athletes have poorer knowledge about concussions and have fewer sports medicine healthcare resources than White athletes, but research on concussion disclosure by race is still needed. Therefore, the purpose of this study was to examine racial differences in concussion reporting behaviors between Black and White high school athletes. This cross-sectional study administered surveys to 577 high school athletes (64.5% Black; 72.3% males; 16.02 ± 1.2 years) from 14 schools (title I, n = 9; non-title I, n = 5). The survey included self-reported items on concussions and bell-ringers experienced during games and practices and the number of these episodes that were reported to an authoritative figure. Reasons for reporting and not reporting were also assessed. Results found that White athletes were more likely to recall experiencing a bell-ringer in games compared with Black athletes. They were also more likely to report a bell-ringer or concussion that occurred in a game. There was a significantly higher proportion of Black athletes compared with White athletes that did not report their bell-ringer experienced in games and concussions experienced in practices. White athletes were more likely than Black athletes to disclose a concussion because they thought they had a concussion, while there were no racial differences in the reasons for not reporting. The findings of this study highlight the critical role that race, as a social determinant of health, may play in concussion reporting in high school athletes. Future public health efforts should seek to further understand and overcome inequities in healthcare resources for concussion education and management.
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Affiliation(s)
- Jessica Wallace
- Department of Health Science, University of Alabama, 270 Kilgore Lane, 2106 Capital Hall, Tuscaloosa, AL, 35487, USA.
| | - Abigail Bretzin
- Department of Biostatistics, Epidemiology & Informatics, University of Pennsylvania, Blockley Hall Room 937, 423 Guardian Drive, Philadelphia, PA, 19104-6021, USA
| | - Erica Beidler
- Department of Athletic Training, Duquesne University, 600 Forbes Avenue, 118 Health Sciences Building, Pittsburgh, PA, 15282, USA
| | - Tamaria Hibbler
- Department of Kinesiology, Athletic Training, Michigan State University, East Lansing, MI, 48840, USA
| | - Danae Delfin
- Department of Health Science, University of Alabama, 270 Kilgore Lane, 2106 Capital Hall, Tuscaloosa, AL, 35487, USA
| | - Haleigh Gray
- Department of Health Science, University of Alabama, 270 Kilgore Lane, 2106 Capital Hall, Tuscaloosa, AL, 35487, USA
| | - Tracey Covassin
- Department of Kinesiology, Athletic Training, Michigan State University, East Lansing, MI, 48840, USA
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Griffith DM, Semlow AR. Art, Anti-Racism and Health Equity: "Don't Ask Me Why, Ask Me How!". Ethn Dis 2020; 30:373-380. [PMID: 32742139 DOI: 10.18865/ed.30.3.373] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Objective One of the fundamental challenges in research on, and the practice of, anti-racism is helping people open their minds to new possibilities and new ways of thinking. Design This commentary illustrates how art can help people unlearn misinformation and narrow ways of thinking while enhancing flexibility that allows people to think creatively about efforts to eliminate or mitigate the health effects of racism. Results Historically, art has been a critical foundation of the history of protest and struggle to achieve equity in the United States and across the globe. Whether music, poems, paintings or other forms of creative expression, art has been at the core of efforts to express emotion, communicate difficult concepts, spur action and change what seems impossible. Art has been particularly important in illustrating and helping to facilitate how people understand what racism is, how it feels to experience privilege or oppression and exploring the implications of policies and practices that affect health indirectly or directly. Yet, art remains underutilized in anti-racism education, training and organizing efforts within public health. This commentary includes several arts-based examples to illustrate how art can facilitate insights, observations and strategies to address racism and achieve health equity. Conclusion Art can be an important tool to facilitate moving past intellectual arguments that seek to explain, justify and excuse racism. Art may be particularly important in efforts to illuminate how racism operates in organizational or institutional contexts and to communicate hope, resilience, and strength amid what seems impossible.
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Affiliation(s)
- Derek M Griffith
- Center for Research on Men's Health, Vanderbilt University, Nashville, TN
| | - Andrea R Semlow
- Center for Research on Men's Health, Vanderbilt University, Nashville, TN
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Srivastav A, Strompolis M, Moseley A, Daniels K. The Empower Action Model: A Framework for Preventing Adverse Childhood Experiences by Promoting Health, Equity, and Well-Being Across the Life Span. Health Promot Pract 2020; 21:525-534. [PMID: 31760809 PMCID: PMC7298349 DOI: 10.1177/1524839919889355] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
The empower action model addresses childhood adversity as a root cause of disease by building resilience across multiple levels of influence to promote health, equity, and well-being. The model builds on the current evidence around adverse childhood experiences and merges important frameworks within key areas of public health-the socio-ecological model, protective factors, race equity and inclusion, and the life course perspective. The socio-ecological model is used as the foundation for this model to highlight the multilevel approach needed for improvement in public health. Five key principles that build on the protective factors literature are developed to be applied at each of the levels of the socio-ecological model: understanding, support, inclusion, connection, and growth. These principles are developed with actions that can be implemented across the life span. Finally, actions suggested with each principle are grounded in the tenets of race equity and inclusion, framing all actionable steps with an equity lens. This article discusses the process by which the model was developed and provides steps for states and communities to implement this tool. It also introduces efforts in a state to use this model within county coalitions through an innovative use of federal and foundation funding.
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Affiliation(s)
- Aditi Srivastav
- Children’s Trust of South
Carolina, Columbia, SC, USA
- University of South Carolina,
Columbia, SC, USA
| | | | - Amy Moseley
- Children’s Trust of South
Carolina, Columbia, SC, USA
| | - Kelsay Daniels
- Children’s Trust of South
Carolina, Columbia, SC, USA
- University of South Carolina,
Columbia, SC, USA
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Indigenous Oral Health Inequalities at an International Level: A Commentary. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17113958. [PMID: 32503229 PMCID: PMC7312047 DOI: 10.3390/ijerph17113958] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 05/29/2020] [Accepted: 06/01/2020] [Indexed: 11/16/2022]
Abstract
Oral health inequalities reflect social injustice. This is because oral health simultaneously reflects material circumstances, access to health services and inequities across the life course. Oral health inequalities between Indigenous and non-Indigenous populations are among the largest in the world. This paper provides a critical commentary on Indigenous oral health inequalities at an international level based on existing literature and policies. We include the role of systematic and institutionalized racism and how this enables the persistence and flourishing of Indigenous oral health inequalities. We discuss theoretical frameworks—including Shiffman and Smith’s Political Power Framework—that underpin the power constructs that contribute to those. This theory posits that power is exercised in four ways: (i) the power of ideas; (ii) the power of the issue; (iii) the power of the actors; and (iv) the power of the political context. We will demonstrate, using examples of Indigenous oral health inequalities from several countries, how intervening at key leverage points, acting simultaneously on multiple subsystems and counteracting the social determinants of health are crucial strategies for ameliorating Indigenous oral health inequalities at a global level.
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Sullivan AL, Sadeh S, Houri AK. Are school psychologists' special education eligibility decisions reliable and unbiased?: A multi-study experimental investigation. J Sch Psychol 2019; 77:90-109. [PMID: 31837731 DOI: 10.1016/j.jsp.2019.10.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 06/20/2019] [Accepted: 10/31/2019] [Indexed: 11/26/2022]
Abstract
Nearly 50 years of research show persistent racial disproportionality in the identification of special education disabilities, but the underlying mechanisms for these disparities remain largely unexplored. Because ambiguous regulations defining disabilities may allow subjectivity and unlawful differential treatment (i.e., racial bias or discrimination) in the special education eligibility process, an important target of study is disparate treatment of students by race in evaluations required to determine eligibility. School psychologists have long been recognized as highly influential in this process and in schools' resultant decisions. We used a 3 × 2 mixed factorial experimental design in three studies with simulated case report data to measure the influence of race and assessment data on school psychologists' perceptions of students' eligibility for special education in cases centering on emotional disturbance, intellectual disability, or autism, respectively. Participants included 302 practicing school psychologists in three states across the three experiments. There was little evidence of racial disparity, but participants tended to render decisions unsupported by, and even contrary to, evaluation data. Implications for research, practice, and professional development are discussed.
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Affiliation(s)
- Amanda L Sullivan
- Department of Educational Psychology, College of Education & Human Development, University of Minnesota, USA.
| | - Shanna Sadeh
- Department of Educational Psychology, College of Education & Human Development, University of Minnesota, USA
| | - Alaa K Houri
- Department of Educational Psychology, College of Education & Human Development, University of Minnesota, USA
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Miranda DE, Garcia-Ramirez M, Balcazar FE, Suarez-Balcazar Y. A Community-Based Participatory Action Research for Roma Health Justice in a Deprived District in Spain. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E3722. [PMID: 31581695 PMCID: PMC6801624 DOI: 10.3390/ijerph16193722] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 09/28/2019] [Accepted: 09/30/2019] [Indexed: 11/29/2022]
Abstract
Addressing health disparities and promoting health equity for Roma has been a challenge. The Roma are the largest disadvantaged ethnic minority population in Europe and have been the victims of deep social and economic injustices, institutional discrimination, and structural antigypsyism over many centuries. This has resulted in a much worse health status than their non-Roma counterparts. Current strategies based on ameliorative and top-down approaches to service delivery have resulted in paradoxical effects that solidify health disparities, since they do not effectively address the problems of vulnerable Roma groups. Following a health justice approach, we present a community-based participatory action research case study generated by a community and university partnership intended to address power imbalances and build collaboration among local stakeholders. This case study involved a group of health providers, Roma residents, researchers, Roma community organizations, and other stakeholders in the Poligono Sur, a neighborhood of Seville, Spain. The case study comprises four phases: (1) identifying Roma health assets, (2) empowering Roma community through sociopolitical awareness, (3) promoting alliances between Roma and community resources/institutions, and (4) building a common agenda for promoting Roma health justice. We highlighted best practices for developing processes to influence Roma health equity in local health policy agendas.
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Affiliation(s)
- Daniela E Miranda
- CESPYD, Coalition for the Study of Health, Power and Diversity, Department of Social Psychology, Universidad de Sevilla, Seville 41018, Spain.
| | - Manuel Garcia-Ramirez
- CESPYD, Coalition for the Study of Health, Power and Diversity, Department of Social Psychology, Universidad de Sevilla, Seville 41018, Spain.
| | - Fabricio E Balcazar
- Department of Disability and Human Development, University of Illinois at Chicago, Chicago, IL 60608, USA.
| | - Yolanda Suarez-Balcazar
- Department of Occupational Therapy, University of Illinois at Chicago, Chicago, Il 60612, USA.
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Lord B, Khalsa S. Influence of patient race on administration of analgesia by student paramedics. BMC Emerg Med 2019; 19:32. [PMID: 31060513 PMCID: PMC6501458 DOI: 10.1186/s12873-019-0245-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 04/23/2019] [Indexed: 11/10/2022] Open
Abstract
Background Disparities in the management of pain are associated with factors that include social status, age and race. As there is limited data regarding the influence of race on analgesia provided by paramedics this study investigated associations between patient race and student paramedic management of pain. Methods Retrospective study of student paramedic records entered in the FISDAP Skill Tracker database between 1 January 2014 to 31 December 2015. Cases were extracted if aged 16 to 100 years, the patient was alert and the primary or secondary impression was trauma. The primary outcome of interest was the association between patient race and student paramedic administration of any analgesia. The adjusted odds of patients receiving any analgesic was tested with logistic regression using a stepped modelling approach. Results 59,915 cases were available for analysis; median age was 50 years (IQR 39 years), 50.1% were female (n = 30,040). Fall was the most common case type 43% (n = 26,009) of cases. 14.1% of patients received any analgesia (n = 8424). Caucasian patients have significantly higher odds of receiving analgesia than non-Caucasian patients (p < 0.001). When analgesic administration is adjusted for gender, age category and injury cause, African Americans have the lowest logged odds of receiving any analgesia when compared to Caucasian patients (OR 0.60, p < 0.001). Conclusion The results indicate inequality in the provision of analgesia by student paramedics based on patient race. This suggests a need for interventions to reduce disparities in care based on race.
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Affiliation(s)
- Bill Lord
- School of Nursing, Midwifery and Paramedicine, University of the Sunshine Coast, 90 Sippy Downs Drive, Sippy Downs, QLD, 4556, Australia.
| | - Sahaj Khalsa
- Emergency Medical Services Institute & AHAC, Santa Fe Community College, 6401 Richards Ave, Santa Fe, NM, 87508, USA
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Sorensen J, Norredam M, Suurmond J, Carter-Pokras O, Garcia-Ramirez M, Krasnik A. Need for ensuring cultural competence in medical programmes of European universities. BMC MEDICAL EDUCATION 2019; 19:21. [PMID: 30646910 PMCID: PMC6332889 DOI: 10.1186/s12909-018-1449-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Accepted: 12/28/2018] [Indexed: 05/25/2023]
Abstract
BACKGROUND Europe is becoming more social and cultural diverse as a result of the increasing migration, but the medical doctors are largely unprepared. The medical education programmes and teachers have not evolved in line with development of the population. Culturally competent curricula and teachers are needed, to ensure cultural competence among medical doctors and to tackle inequalities in health between different ethnic groups. The objective of this EU financed study is therefore to provide a snapshot of the role of cultural competence in European medical educational programmes. METHODS A questionnaire was developed in order to uncover strengths and weaknesses regarding cultural competence in the European medical education programmes. The questionnaire consisted of 32 questions. All questions had an evidence box to support the informants' understanding of the questions. The questionnaire was sent by email to the 12 European project partners. 12 completed questionnaires were returned. RESULTS Though over half of the participating medical programmes have incorporated how to handle social determinants of health in the curriculum most are lacking focus on how medical professionals' own norms and implicit attitudes may affect health care provision as well as abilities to work effectively with an interpreter. Almost none of the participating medical programmes evaluate the students on cultural competence learning outcomes. Most medical schools participating in the survey do not offer cultural competence training for teachers, and resources spent on initiatives related to cultural competences are few. Most of the participating medical programmes acknowledge that the training given to the medical students is not adequate for future jobs in the health care service in their respective country regarding cultural competence. CONCLUSIONS Our results indicate that there are major deficiencies in the commitment and practice within the participating educational programs and there are clear potentials for major improvements regarding cultural competence in programmes. Key challenges include making lasting changes to the curriculum and motivating and engaging stakeholders (teachers, management etc.) within the organisation to promote and allocate resources to cultural competence training for teachers.
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Affiliation(s)
- Janne Sorensen
- Danish Research Centre for Migration, Ethnicity and Health, Department of Public Health, University of Copenhagen, Oester Farimagsgade 5A, 1014 Copenhagen, Denmark
| | - Marie Norredam
- Danish Research Centre for Migration, Ethnicity and Health, Department of Public Health, University of Copenhagen, Oester Farimagsgade 5A, 1014 Copenhagen, Denmark
| | - Jeanine Suurmond
- Academic Medical Center, University of Amsterdam, Department of Public Health, Amsterdam Public Health research institute, P.O. Box 22660, 1100 DE Amsterdam, The Netherlands
| | - Olivia Carter-Pokras
- School of Public Health, University of Maryland, 4200 Valley Drive, Suite 2242G, College Park, MD 20742-2611 USA
| | - Manuel Garcia-Ramirez
- Faculty of Psychology, University of Seville, C/ Camilo José Cela, S/N, 41018 Sevilla, Spain
| | - Allan Krasnik
- Danish Research Centre for Migration, Ethnicity and Health, Department of Public Health, University of Copenhagen, Oester Farimagsgade 5A, 1014 Copenhagen, Denmark
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Escobar-Ballesta M, García-Ramírez M, Albar-Marín MªJ, Paloma V. [Sexual and reproductive health in Roma women: the family planning programme of Polígono Sur in Seville (Spain)]. GACETA SANITARIA 2018; 33:222-228. [PMID: 29628121 DOI: 10.1016/j.gaceta.2017.12.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Revised: 12/17/2017] [Accepted: 12/18/2017] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To describe the challenges, resources and strategies of the staff of the family planning programme of the Polígono Sur Healthcare Centre in Seville (Spain) in their care of Roma women. METHOD This is a descriptive study in which in-depth interviews and discussion groups were held with all programme professionals, including a documentary review of the programme. The information was analyzed based on the Roma Health Integration Policy Index, a tool that evaluates the entitlement, accessibility, sensitivity and capacity for change of health programmes for the Roma population. RESULTS The professionals encountered multiple challenges to implement the family planning programme with Roma women due to the characteristics of the users and the low sensitivity of the programme towards them. The absence of specific actions for Roma women within the family planning programme, agreed to by the healthcare district, obliges professionals to develop adaptations and strategies to ensure quality sexual and reproductive health services for their users. CONCLUSIONS It is necessary to adapt sexual and reproductive health programmes targeted at Roma women by (a) detecting, evaluating, systematizing and disseminating good practices, (b) developing actions that address the multiple vulnerabilities of Roma women, (c) acknowledging professionals who advocate for the health of these women within their organizations, and (d) promoting reproductive justice as the goal of these programmes.
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Affiliation(s)
- Marta Escobar-Ballesta
- Coalición para el Estudio de la Salud, el Poder y la Diversidad (CESPYD), Universidad de Sevilla, Sevilla, España.
| | - Manuel García-Ramírez
- Coalición para el Estudio de la Salud, el Poder y la Diversidad (CESPYD), Universidad de Sevilla, Sevilla, España
| | - M ª Jesús Albar-Marín
- Coalición para el Estudio de la Salud, el Poder y la Diversidad (CESPYD), Universidad de Sevilla, Sevilla, España
| | - Virginia Paloma
- Coalición para el Estudio de la Salud, el Poder y la Diversidad (CESPYD), Universidad de Sevilla, Sevilla, España
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Terrazas SR, McCormick A. Coping Strategies That Mitigate Against Symptoms of Depression Among Latino Farmworkers. HISPANIC JOURNAL OF BEHAVIORAL SCIENCES 2018. [DOI: 10.1177/0739986317752923] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Latino farmworkers have a higher rate of depression when compared with other Latinos and the general adult population in the United States. Researchers have suggested oppressive labor policies, acculturation stressor, anti-immigrant polices and attitudes, and the dangers associated to farm work as culprits to high rates of depression among farmworkers. We examined the traits farmworkers reported that helped them mitigate symptoms of depression. Our sample consisted of 64 adult male and female farmworkers who lived in western Texas and worked in Eastern New Mexico. We used the Center for Epidemiologic Studies Depression Scale Revised (CESD-R) and self-reports of symptoms of depression to assess for depression. We found that, among this sample, the rates of depression were similar to other studies and that farmworkers used cognitive restructuring strategies to mitigate symptoms of depression.
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Escobar-Ballesta M, García-Ramírez M, Miranda D, Petrova-Benedict R. Shedding light on governance for Roma health inequities. J Prev Interv Community 2017; 46:84-99. [PMID: 29281603 DOI: 10.1080/10852352.2018.1386340] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The health inequities suffered by the Roma population in Europe represent an alarming and unacceptable source of injustice. As the main ethnic minority in Europe, the gap between the health conditions of the Roma and the rest of the population poses a challenge to human rights and public health. Many political efforts have been deployed in Europe to tackle these inequities. However, they have fallen short, even causing paradoxical consequences. In this paper, we argue that previous political efforts have failed because they were developed from a neoliberal perspective, which perceives Roma health inequities as isolated ethnic problems for which there is no political accountability. Hence, there is a need for transformative political change that results in the protection of rights and self-governance to address health inequities experienced by Roma people. We propose a framework of health governance guided by the following principles: (a) effective involvement of multiple stakeholders by building collaborative capacity; (b) infusion of health perspectives in all policies and multisectoral actions;
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Affiliation(s)
| | | | - Daniela Miranda
- a Department of Social Psychology CESPYD , Universidad de Sevilla , Seville , Spain
| | - Roumyana Petrova-Benedict
- b International Organization for Migration , Senior Regional Migration Health Manager for Europe and Central Asia at the Regional Office in Brussels , Brussels , Belgium
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Undergraduate Minor in Health Disparities in Society: a Magnet for Under-represented Pre-professional Students. J Racial Ethn Health Disparities 2017; 5:495-503. [PMID: 28726082 DOI: 10.1007/s40615-017-0391-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Revised: 05/23/2017] [Accepted: 05/25/2017] [Indexed: 10/19/2022]
Abstract
Increasing the diversity of tomorrow's healthcare work force remains a challenge despite many thoughtful published reports and recommendations. As part of an effort to grow a more diverse pre-professional health population, we created an undergraduate minor, Health Disparities in Society, at the University of Florida. Most courses for the minor were identified from existing offerings, and we created only two new courses, an introduction course and a capstone service-learning course. The new minor quickly became the most popular in the College of Liberal Arts and Sciences (which has approximately 12,000 total undergraduate students), and importantly, students selecting the minor were more likely to be under-represented minorities than would be expected given undergraduate demographics. Pre-professional students choosing this minor reflect the desired diversity of the healthcare workforce of tomorrow.
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Enhancing the use of research in health-promoting, anti-racism policy. Health Res Policy Syst 2017; 15:61. [PMID: 28697777 PMCID: PMC5505139 DOI: 10.1186/s12961-017-0223-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Accepted: 06/13/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The Localities Embracing and Accepting Diversity (LEAD) programme was established to improve the health of ethnic minority communities through the reduction of racial discrimination. Local governments in the state of Victoria, Australia, were at the forefront of LEAD implementation in collaboration with leading state and national organisations. Key aims included expanding the available evidence regarding effective anti-racism interventions and facilitating the uptake of this evidence in organisational policies and practices. METHODS One rural and one metropolitan local government areas were selected to participate in LEAD. Key informant interviews and discussions were conducted with individuals who had participated in LEAD implementation and members of LEAD governance structures. Data were also collected on programme processes and implementation, partnership formation and organisational assessments. RESULTS The LEAD model demonstrated both strengths and weaknesses in terms of facilitating the use of evidence in a complex, community-based health promotion initiative. Representation of implementing, funding and advisory bodies at different levels of governance enabled the input of technical advice and guidance alongside design and implementation. The representation structure assisted in ensuring the development of a programme that was acceptable to all partners and informed by the best available evidence. Simultaneous evaluation also enhanced perceived validity of the intervention, allowed for strategy correction when necessary and supported the process of double-loop organisational learning. However, due to the model's demand for simultaneous and intensive effort by various organisations, when particular elements of the intervention were not functional, there was a considerable loss of time and resources across the partner organisations. The complexity of the model also presented a challenge in ensuring clarity regarding roles, functions and the direction of the programme. CONCLUSIONS The example of LEAD provides guidance on mechanisms to strengthen the entry of evidence into complex community-based health promotion programmes. The paper highlights some of the strengths and weaknesses of the LEAD model and implications for practical collaboration between policymakers, implementers and researchers.
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Prabhu A, Parker LS, DeVita MA. Caring for Patients or Organs: New Therapies Raise New Dilemmas in the Emergency Department. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2017; 17:6-16. [PMID: 28430068 DOI: 10.1080/15265161.2017.1299239] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Two potentially lifesaving protocols, emergency preservation and resuscitation (EPR) and uncontrolled donation after circulatory determination of death (uDCDD), currently implemented in some U.S. emergency departments (EDs), have similar eligibility criteria and initial technical procedures, but critically different goals. Both follow unsuccessful cardiopulmonary resuscitation and induce hypothermia to "buy time": one in trauma patients suffering cardiac arrest, to enable surgical repair, and the other in patients who unexpectedly die in the ED, to enable organ donation. This article argues that to fulfill patient-focused fiduciary obligations and maintain community trust, institutions implementing both protocols should adopt and publicize policies to guide ED physicians to utilize either protocol for particular patients, in order to address the appearance of conflict of interest arising from the protocols' similarities. It concludes by analyzing ethical implications of incentives that may influence institutions to develop the expertise required for uDCDD but not EPR.
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Vardeman-Winter J. The Framing of Women and Health Disparities: A Critical Look at Race, Gender, and Class from the Perspectives of Grassroots Health Communicators. HEALTH COMMUNICATION 2017; 32:629-638. [PMID: 27367141 DOI: 10.1080/10410236.2016.1160318] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
As women's health has received significant political and media attention recently, I proposed an expanded structural theory of women's communication about health. Women's health communication and critical race and systemic racism research framed this study. I interviewed 15 communicators and community health workers from grass-roots organizations focused on women's health to learn of their challenges of communicating with women from communities experiencing health disparities. Findings suggest that communicators face difficulties in developing meaningful messaging for publics because of disjunctures between medical and community frames, issues in searching for health among women's many priorities, Whiteness discourses imposed on publics' experiences, and practices of correcting for power differentials. A structural theory of women's health communication, then, consists of tenets around geographic, research/funding, academic/industry, and social hierarchies. Six frames suggesting racial biases about women and health disparities are also defined. This study also includes practical solutions in education, publishing, and policy change for addressing structural challenges.
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Ferdinand KC, Nasser SA. Disparate Cardiovascular Disease Rates in African Americans: The Role of Stress Related to Self-Reported Racial Discrimination. Mayo Clin Proc 2017; 92:689-692. [PMID: 28473033 DOI: 10.1016/j.mayocp.2017.03.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Accepted: 03/27/2017] [Indexed: 11/22/2022]
Affiliation(s)
| | - Samar A Nasser
- Department of Clinical Research & Leadership, School of Medicine and Health Sciences, The George Washington University, Washington, DC
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Came HA, McCreanor T, Doole C, Simpson T. Realising the rhetoric: refreshing public health providers' efforts to honour Te Tiriti o Waitangi in New Zealand. ETHNICITY & HEALTH 2017; 22:105-118. [PMID: 27323889 DOI: 10.1080/13557858.2016.1196651] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
OBJECTIVES New Zealand has a unique tool, Te Tiriti o Waitangi, the Treaty of Waitangi, for addressing health disparities. Indigenous Māori have compromised health status compared to other groups. This paper investigates ways in which public health units (PHUs) and non-governmental organisations (NGOs) use Te Tiriti o Waitangi in service delivery to Māori. DESIGN A nationwide telephone survey of primary health providers (n=162) was conducted in 2014-15. Participants were asked about effectiveness and monitoring of their service delivery to Māori. RESULTS PHUs reported actively working with Māori, and Te Tiriti o Waitangi to reduce health disparities. Direct Māori engagement with development and delivery of programmes was viewed as essential. Strategies included designated PHU staff in positions of responsibility, formal partnerships with Māori, and providing operational and strategic guidance. Some PHUs supported development of cultural competencies. NGO responsiveness to Māori was variable. Some NGOs described prioritising service delivery and programmes for Māori. Others reported the focus of their service was European or other non-Māori ethnicities. Lack of resources or past difficulties engaging with Māori were barriers. CONCLUSION Public health has an ethical commitment to reduce health disparities. Advancing Te Tiriti obligations in everyday practice has the potential to address inequalities.
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Affiliation(s)
- H A Came
- a Faculty of Health and Environmental Sciences , Auckland University of Technology , Auckland , New Zealand
| | - T McCreanor
- b Te Rōpū Whāriki , Massey University , Auckland , New Zealand
| | - C Doole
- a Faculty of Health and Environmental Sciences , Auckland University of Technology , Auckland , New Zealand
| | - T Simpson
- c Health Promotion Forum , Auckland , New Zealand
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Came H, Griffith D. Tackling racism as a "wicked" public health problem: Enabling allies in anti-racism praxis. Soc Sci Med 2017; 199:181-188. [PMID: 28342562 DOI: 10.1016/j.socscimed.2017.03.028] [Citation(s) in RCA: 93] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Revised: 03/10/2017] [Accepted: 03/14/2017] [Indexed: 10/20/2022]
Abstract
Racism is a "wicked" public health problem that fuels systemic health inequities between population groups in New Zealand, the United States and elsewhere. While literature has examined racism and its effects on health, the work describing how to intervene to address racism in public health is less developed. While the notion of raising awareness of racism through socio-political education is not new, given the way racism has morphed into new narratives in health institutional settings, it has become critical to support allies to make informing efforts to address racism as a fundamental cause of health inequities. In this paper, we make the case for anti-racism praxis as a tool to address inequities in public health, and focus on describing an anti-racism praxis framework to inform the training and support of allies. The limited work on anti-racism rarely articulates the unique challenges or needs of allies or targets of racism, but we seek to help fill that gap. Our anti-racism praxis for allies includes five core elements: reflexive relational praxis, structural power analysis, socio-political education, monitoring and evaluation and systems change approaches. We recognize that racism is a modifiable determinant of health and racial inequities can be eliminated with the necessary political will and a planned system change approach. Anti-racism praxis provides the tools to examine the interconnection and interdependence of cultural and institutional factors as a foundation for examining where and how to intervene to address racism.
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Affiliation(s)
- Heather Came
- Faculty of Health and Environment Sciences, Auckland University of Technology, Private Bag 92006, Auckland, New Zealand.
| | - Derek Griffith
- Centre for Medicine, Health and Society, Vanderbilt University, PMB #351665, 2301 Vanderbilt Pace, Nashville, TN 37235-1665, USA.
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Motel L. Increasing diversity through goal-setting in corporate social responsibility reporting. EQUALITY, DIVERSITY AND INCLUSION: AN INTERNATIONAL JOURNAL 2016. [DOI: 10.1108/edi-01-2016-0005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
The purpose of this paper is to evaluate the effect of goal-setting theory in remediating workplace demographic representation inequality.
Design/methodology/approach
This study evaluates the effect of goal-setting theory in Fortune 100 companies’ corporate social reporting (CSR) on year-over-prior change in diversity representation using t-tests and independent, repeated measures ANOVA.
Findings
Reporting companies significantly outperformed the population in minority and female leadership increases. Companies using specific goals and relevant feedback facilitated better outcomes for minority and female leaders, respectively.
Research limitations/implications
Dichotomous coding was employed. Qualitative coding over multiple years is suggested for future research. CSR reporting is voluntary, unaudited, and inconsistent. Comparing outcomes for organizations with mandatory reporting or diversity quotas would provide interesting future comparatives. Despite the limitations, this research demonstrates the benefits of goal-setting theory on social outcomes.
Practical implications
Companies transparently publishing goals, feedback, and metrics lead the way to multicultural environments. Additionally, investors use social responsibility in investment decision making. The Securities and Exchange Commission should incorporate non-financial requirements into existent reporting subject to audit, consistent presentation, and public availability. Organizations should disclose diversity goals and outcomes whether the company aspires to genuinely promote greater representation or avoid greater regulation. Reporting transparency and articulation of specific, measureable goals and feedback are encouraged for non-financial metrics.
Originality/value
Significant research investigates why inequality exists in organizations yet little addresses how to reduce the problem. Pioneer studies in applying goal-setting to diversity show promise. Research exploring the dark side of goal-setting is rapidly emerging. This research pursues the “light side” of goal-setting to evaluate use on social business issues, specifically, increasing diverse representation.
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Hall WJ, Chapman MV, Lee KM, Merino YM, Thomas TW, Payne BK, Eng E, Day SH, Coyne-Beasley T. Implicit Racial/Ethnic Bias Among Health Care Professionals and Its Influence on Health Care Outcomes: A Systematic Review. Am J Public Health 2015; 105:e60-76. [PMID: 26469668 PMCID: PMC4638275 DOI: 10.2105/ajph.2015.302903] [Citation(s) in RCA: 1193] [Impact Index Per Article: 132.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/05/2015] [Indexed: 11/04/2022]
Abstract
BACKGROUND In the United States, people of color face disparities in access to health care, the quality of care received, and health outcomes. The attitudes and behaviors of health care providers have been identified as one of many factors that contribute to health disparities. Implicit attitudes are thoughts and feelings that often exist outside of conscious awareness, and thus are difficult to consciously acknowledge and control. These attitudes are often automatically activated and can influence human behavior without conscious volition. OBJECTIVES We investigated the extent to which implicit racial/ethnic bias exists among health care professionals and examined the relationships between health care professionals' implicit attitudes about racial/ethnic groups and health care outcomes. SEARCH METHODS To identify relevant studies, we searched 10 computerized bibliographic databases and used a reference harvesting technique. SELECTION CRITERIA We assessed eligibility using double independent screening based on a priori inclusion criteria. We included studies if they sampled existing health care providers or those in training to become health care providers, measured and reported results on implicit racial/ethnic bias, and were written in English. DATA COLLECTION AND ANALYSIS We included a total of 15 studies for review and then subjected them to double independent data extraction. Information extracted included the citation, purpose of the study, use of theory, study design, study site and location, sampling strategy, response rate, sample size and characteristics, measurement of relevant variables, analyses performed, and results and findings. We summarized study design characteristics, and categorized and then synthesized substantive findings. MAIN RESULTS Almost all studies used cross-sectional designs, convenience sampling, US participants, and the Implicit Association Test to assess implicit bias. Low to moderate levels of implicit racial/ethnic bias were found among health care professionals in all but 1 study. These implicit bias scores are similar to those in the general population. Levels of implicit bias against Black, Hispanic/Latino/Latina, and dark-skinned people were relatively similar across these groups. Although some associations between implicit bias and health care outcomes were nonsignificant, results also showed that implicit bias was significantly related to patient-provider interactions, treatment decisions, treatment adherence, and patient health outcomes. Implicit attitudes were more often significantly related to patient-provider interactions and health outcomes than treatment processes. CONCLUSIONS Most health care providers appear to have implicit bias in terms of positive attitudes toward Whites and negative attitudes toward people of color. Future studies need to employ more rigorous methods to examine the relationships between implicit bias and health care outcomes. Interventions targeting implicit attitudes among health care professionals are needed because implicit bias may contribute to health disparities for people of color.
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Affiliation(s)
- William J Hall
- At the time of the study, William J. Hall, Mimi V. Chapman, and Steven H. Day were with the School of Social Work; Kent M. Lee and B. Keith Payne were with the Department of Psychology; Yesenia M. Merino, Tainayah W. Thomas, and Eugenia Eng were with the Gillings School of Global Public Health; and Tamera Coyne-Beasley was with the School of Medicine, University of North Carolina, Chapel Hill
| | - Mimi V Chapman
- At the time of the study, William J. Hall, Mimi V. Chapman, and Steven H. Day were with the School of Social Work; Kent M. Lee and B. Keith Payne were with the Department of Psychology; Yesenia M. Merino, Tainayah W. Thomas, and Eugenia Eng were with the Gillings School of Global Public Health; and Tamera Coyne-Beasley was with the School of Medicine, University of North Carolina, Chapel Hill
| | - Kent M Lee
- At the time of the study, William J. Hall, Mimi V. Chapman, and Steven H. Day were with the School of Social Work; Kent M. Lee and B. Keith Payne were with the Department of Psychology; Yesenia M. Merino, Tainayah W. Thomas, and Eugenia Eng were with the Gillings School of Global Public Health; and Tamera Coyne-Beasley was with the School of Medicine, University of North Carolina, Chapel Hill
| | - Yesenia M Merino
- At the time of the study, William J. Hall, Mimi V. Chapman, and Steven H. Day were with the School of Social Work; Kent M. Lee and B. Keith Payne were with the Department of Psychology; Yesenia M. Merino, Tainayah W. Thomas, and Eugenia Eng were with the Gillings School of Global Public Health; and Tamera Coyne-Beasley was with the School of Medicine, University of North Carolina, Chapel Hill
| | - Tainayah W Thomas
- At the time of the study, William J. Hall, Mimi V. Chapman, and Steven H. Day were with the School of Social Work; Kent M. Lee and B. Keith Payne were with the Department of Psychology; Yesenia M. Merino, Tainayah W. Thomas, and Eugenia Eng were with the Gillings School of Global Public Health; and Tamera Coyne-Beasley was with the School of Medicine, University of North Carolina, Chapel Hill
| | - B Keith Payne
- At the time of the study, William J. Hall, Mimi V. Chapman, and Steven H. Day were with the School of Social Work; Kent M. Lee and B. Keith Payne were with the Department of Psychology; Yesenia M. Merino, Tainayah W. Thomas, and Eugenia Eng were with the Gillings School of Global Public Health; and Tamera Coyne-Beasley was with the School of Medicine, University of North Carolina, Chapel Hill
| | - Eugenia Eng
- At the time of the study, William J. Hall, Mimi V. Chapman, and Steven H. Day were with the School of Social Work; Kent M. Lee and B. Keith Payne were with the Department of Psychology; Yesenia M. Merino, Tainayah W. Thomas, and Eugenia Eng were with the Gillings School of Global Public Health; and Tamera Coyne-Beasley was with the School of Medicine, University of North Carolina, Chapel Hill
| | - Steven H Day
- At the time of the study, William J. Hall, Mimi V. Chapman, and Steven H. Day were with the School of Social Work; Kent M. Lee and B. Keith Payne were with the Department of Psychology; Yesenia M. Merino, Tainayah W. Thomas, and Eugenia Eng were with the Gillings School of Global Public Health; and Tamera Coyne-Beasley was with the School of Medicine, University of North Carolina, Chapel Hill
| | - Tamera Coyne-Beasley
- At the time of the study, William J. Hall, Mimi V. Chapman, and Steven H. Day were with the School of Social Work; Kent M. Lee and B. Keith Payne were with the Department of Psychology; Yesenia M. Merino, Tainayah W. Thomas, and Eugenia Eng were with the Gillings School of Global Public Health; and Tamera Coyne-Beasley was with the School of Medicine, University of North Carolina, Chapel Hill
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Blitz LV, Greene MP, Bernabei S, Shah VP. Think creatively and act decisively: creating a antiracist alliance of social workers. SOCIAL WORK 2014; 59:347-350. [PMID: 25365836 DOI: 10.1093/sw/swu031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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