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Boamah SA, Antabe R, Baidoobonso S, Etowa J, Djiadeu P, Ongolo-Zogo C, Husbands W, Mbuagbaw L. Factors associated with self-rated health in Black Canadians: A cross-sectional study. CANADIAN JOURNAL OF PUBLIC HEALTH = REVUE CANADIENNE DE SANTE PUBLIQUE 2025; 116:174-183. [PMID: 39592564 PMCID: PMC12075041 DOI: 10.17269/s41997-024-00973-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Accepted: 10/07/2024] [Indexed: 11/28/2024]
Abstract
OBJECTIVES Self-rated health (SRH) has shown to be a strong predictor of morbidity, functional decline, and mortality outcomes. This paper investigates the association between sociodemographic variables (e.g., employment, education, sex) and SRH among Black Canadians. METHODS We used cross-sectional survey data (n = 1380) from the A/C (African Caribbean) Study of first- and second-generation Black Canadians in Toronto and Ottawa. Participants were invited to complete an electronic survey questionnaire in English or French in 2018-2019. Generalized linear model analyses were used to evaluate the associations among sociodemographic factors and self-rated quality of health. RESULTS A total of 1380 self-identified Black individuals completed the survey and were included in the analysis. The majority of participants were under the age of 60 (89.7%), female (63.4%), born outside of Canada (75.1%), and residing in Toronto, Ontario (61.9%). The strongest association with poor SRH was found for difficulties accessing health care, sexual orientation, and substance misuse/disorder, while accessing/meeting basic needs was associated with better SRH, following adjustment for other socioeconomic conditions and lifestyle factors. CONCLUSION Our findings underscore the importance of improving the social determinants of health as a conduit to improving the general health status and the quality of life of Black Canadians. Results revealed that Black Canadians may be demonstrating high levels of resilience in circumventing their current social circumstances and structural disadvantages to live the best quality of life. Understanding sociodemographic and socio-structural barriers that Black people face is essential to reducing vulnerabilities to poor outcomes and improving their health and well-being.
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Affiliation(s)
- Sheila A Boamah
- School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada.
| | - Roger Antabe
- Department of Health and Society, University of Toronto Scarborough, Toronto, ON, Canada
| | - Shamara Baidoobonso
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, NS, Canada
| | - Josephine Etowa
- School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Pascal Djiadeu
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Clemence Ongolo-Zogo
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Winston Husbands
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Lawrence Mbuagbaw
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
- Biostatistics Unit, Father Sean O'Sullivan Research Centre, St. Joseph's Healthcare, Hamilton, ON, Canada
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Zhu J, Rathagirishnan R, Valiquette C, Adibfar A, Snell L. Exploring Skin Tone Diversity in a Plastic Surgery Resident Education Curriculum. Plast Surg (Oakv) 2025; 33:172-178. [PMID: 39876858 PMCID: PMC11770717 DOI: 10.1177/22925503231195023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 06/27/2023] [Accepted: 07/09/2023] [Indexed: 01/31/2025] Open
Abstract
Background: Gaps remain in surgical education regarding the representation of skin tone diversity. To improve equity and prevent misdiagnosis leading to worsened health outcomes, efforts must be made to ensure educational photographs are representative of the diverse patient populations plastic surgery residents will be treated in their future practices. Methods: Four study investigators examined 96 h of recorded lecture seminars from a Canadian plastic surgery resident education curriculum from May 2020 to December 2021. Using Fitzpatrick skin type to codify skin tone, photographic images were individually classified and compared. Program lecturers and residents were invited to participate in an online anonymized survey to explore related perceptions of the curricula. Results: A total of 1990 images were included for analysis. Of these, 83.2% were Fitzpatrick types I to III, 13.1% were Fitzpatrick types IV to V, and 3.7% were Fitzpatrick type VI. There was a statistically greater proportion of Fitzpatrick I to III compared to types IV to V (P < .01), and type VI (P < .01). Fleiss' Kappa was calculated to be 0.896, representing near-perfect agreement. In the survey, 61% (14/22) of faculty respondents believe they include enough diversity in their photographs, however, 46% (4 of 9) of resident respondents would like to see more diversity in lecturers' photographs. Conclusions: There is an underrepresentation of medium (Fitzpatrick types IV-V) and dark (Fitzpatrick VI) images in plastic surgery resident educational images. Providing a curriculum that represents diverse patient populations is crucial to enabling competency and equity of care, particularly in a highly visual field. Incorporating skin tone diversity into educational curricula should be a priority for all plastic surgery programs.
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Affiliation(s)
- Jane Zhu
- Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | | | - Chantal Valiquette
- Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Toronto, Toronto, Canada
| | - Alexander Adibfar
- Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Toronto, Toronto, Canada
| | - Laura Snell
- Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Toronto, Toronto, Canada
- Sunnybrook Health Sciences Centre, Toronto, Canada
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Levacher V, Batal M, Giroux I, Sanou D, Blanchet R. Ultra-processed food consumption: an exploration of social determinants among Black children of African and Caribbean descent in Ottawa. Appl Physiol Nutr Metab 2025; 50:1-12. [PMID: 40294440 DOI: 10.1139/apnm-2024-0525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/30/2025]
Abstract
Consumption of ultra-processed foods (UPF) is a growing concern due to its negative impact on diet quality and health outcomes. To our knowledge, no data on UPF consumption are available for specific racial/ethnic children, including Black children, in Canada. This cross-sectional study aimed to explore the social determinants of UPF consumption among Black children of African and Caribbean descent in Ottawa. It included 174 mothers born in the Caribbean or Sub-Saharan Africa and their children aged 6 to 12. A survey was administered to assess demographic and socio-economic characteristics of mothers, children, and households. Children's dietary intakes were evaluated with a 24 h dietary recall to calculate the proportion of energy from UPF according to the NOVA food classification system. ANOVA and two-step cluster analysis were performed. Identified clusters were compared using chi-square and Student's t tests. Findings indicate that children whose mothers had been living in Canada longer (p < 0.001), whose mothers were family-class immigrants (p = 0.005), and whose households were food secure (p = 0.049), consumed more UPF than their respective counterparts. Cluster analysis revealed two profiles, named settling and established, reinforcing previous associations. Children in the established profile had a mean energy intake from UPF 9% higher than those in the settling profile (p = 0.006). This study provided initial findings on the social determinants of UPF consumption among Black children of African and Caribbean descent. It suggests that immigration-related factors and household food security status shaped UPF consumption of these children.
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Affiliation(s)
- Valérie Levacher
- Département de médecine sociale et préventive, École de santé publique, Université de Montréal, Montréal, QC, Canada
- Centre de recherche en santé publique (CReSP), Montréal, QC, Canada
| | - Malek Batal
- Département de médecine sociale et préventive, École de santé publique, Université de Montréal, Montréal, QC, Canada
- Centre de recherche en santé publique (CReSP), Montréal, QC, Canada
- Département de nutrition, Faculté de médecine, Université de Montréal, Montréal, QC, Canada
| | - Isabelle Giroux
- School of Nutrition Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Dia Sanou
- Food and Agriculture Organization Regional Office for Asia and the Pacific, Dacca, Bangladesh
| | - Rosanne Blanchet
- Département de médecine sociale et préventive, École de santé publique, Université de Montréal, Montréal, QC, Canada
- Centre de recherche en santé publique (CReSP), Montréal, QC, Canada
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Baiden D, Nerenberg K, Hillan EM, Dogba MJ, Parry M. Addressing Known hypertensive disOrders of pregnancy in woMen of African descent in Canada (AKOMA): protocol for a mixed method study. Front Cardiovasc Med 2024; 11:1471199. [PMID: 39736880 PMCID: PMC11683087 DOI: 10.3389/fcvm.2024.1471199] [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: 07/26/2024] [Accepted: 11/30/2024] [Indexed: 01/01/2025] Open
Abstract
Background Hypertensive disorders of pregnancy (HDP) predispose a woman to maternity-related cardiovascular morbidity and mortality. However, there is limited literature on HDP among women of African descent in Canada. Methods and design A convergent mixed-method study will be used to investigate the intersection of self-reported HDP risks in women of African descent in Canada with a history of a HDP (quantitative, cross-sectional survey) and explore the perception and experiences of women of African descent living in Canada with a history of a HDP in relation to the intersection of risk factors (critical qualitative inquiry, interviews). Quantitative analysis will use SPSS V. 27.0 and thematic analysis will be conducted using NVivo V. 12. A joint display will be used to combine the quantitative and qualitative results. Discussion Through the lens of intersectionality, the proposed study aims to provide a comprehensive understanding of the intersection of risks for HDP among women of African descent in Canada with a history of HDP. Furthermore, results could inform future strategies to reduce cardiovascular disease risks. Trial Registration Number This is registered in the Open Sciences Framework as follows: https://doi.org/10.17605/OSF.IO/R6CKY.
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Affiliation(s)
- Deborah Baiden
- Lawrence Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Kara Nerenberg
- Departments of Medicine, Obstetrics & Gynecology, Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Edith M. Hillan
- Lawrence Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Maman Joyce Dogba
- Department of Family and Emergency Medicine, Université Laval, Québec City, QC, Canada
| | - Monica Parry
- Lawrence Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
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Olukotun M, Karanja L, Maduforo A, Renzaho A, Ospina MB, Richter S, Tunde-Byass M, Amodu O, Salami B. Access to Healthcare for Black Women in Alberta: An Interpersonal-Level Analysis of Barriers and Facilitators. QUALITATIVE HEALTH RESEARCH 2024:10497323241301968. [PMID: 39666493 DOI: 10.1177/10497323241301968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2024]
Abstract
Alberta is home to one of Canada's fastest growing populations of Black people, driven by an influx of African immigrants to major metropolitan areas such as Edmonton and Calgary. As the Black population in Alberta continues to grow, it is crucial to the well-being of these communities that we understand their health service needs. Black women are a vulnerable group within the Black population due to inequities in social determinants of health such as access to healthcare. In Canada, little is known about the healthcare access experiences of Black women despite reported disparities in their health outcomes. As such, we undertook a qualitative study to examine access to health services for Black women in Alberta. Semi-structured interviews were completed with 30 Black women from Edmonton and Calgary. We applied intersectionality as an analytical framework to guide our understanding of how interconnected social processes shape Black women's experiences of accessing healthcare. Following our thematic analysis, we identified two major barriers to healthcare access: patient-provider discordance and negative healthcare encounters. We identified two key facilitators: positive patient-provider dynamics and individual and social network strengths. Our findings suggest that Black women have distinct experiences of accessing the healthcare system which are best understood as a confluence of their race, gender, and other aspects of their personhood.
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Affiliation(s)
- Mary Olukotun
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
| | - Lucy Karanja
- Faculty of Education, University of Alberta, Edmonton, AB, Canada
| | - Aloysius Maduforo
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Andre Renzaho
- Translational Health Research Institute, Western Sydney University, Penrith, NSW, Australia
| | | | - Solina Richter
- College of Nursing, University of Saskatchewan, Saskatoon, SK, Canada
| | - Modupe Tunde-Byass
- Department of Obstetrics and Gynaecology, University of Toronto, Toronto, ON, Canada
| | - Oluwakemi Amodu
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
| | - Bukola Salami
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
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Viswanathan M, Sathe NA, Welch V, Francis DK, Heyn PC, Ali R, Duque T, Terhune EA, Lin JS, Pizarro AB, Riddle D. Paper 1: introduction to the series. J Clin Epidemiol 2024; 176:111577. [PMID: 39476937 DOI: 10.1016/j.jclinepi.2024.111577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 10/11/2024] [Accepted: 10/15/2024] [Indexed: 12/15/2024]
Abstract
OBJECTIVES Systematic reviews hold immense promise as tools to highlight evidence-based practices that can reduce or aim to eliminate racial health disparities. Currently, consensus on centering racial health equity in systematic reviews and other evidence synthesis products is lacking. Centering racial health equity implies concentrating or focusing attention on health equity in ways that bring attention to the perspectives or needs of groups that are typically marginalized. STUDY DESIGN AND SETTING This Cochrane US Network team and colleagues, with the guidance of a steering committee, sought to understand the views of varied interest holders through semistructured interviews and conducted evidence syntheses addressing (1) definitions of racial health equity, (2) logic models and frameworks to centering racial health equity, (3) interventions to reduce racial health inequities, and (4) interest holder engagement in evidence syntheses. Our methods and teams include a primarily American and Canadian lens; however, findings and insights derived from this work are applicable to any region in which racial or ethnic discrimination and disparities in care due to structural causes exist. RESULTS In this series, we explain why centering racial health equity matters and what gaps exist and may need to be prioritized. The interviews and systematic reviews identified numerous gaps to address racial health equity that require changes not merely to evidence synthesis practices but also to the underlying evidence ecosystem. These changes include increasing representation, establishing foundational guidance (on definitions and causal mechanisms and models, building a substantive evidence base on racial health equity, strengthening methods guidance, disseminating and implementing results, and sustaining new practices). CONCLUSION Centering racial health equity requires consensus on the part of key interest holders. As part of the next steps in building consensus, the manifold gaps identified by this series of papers need to be prioritized. Given the resource constraints, changes in norms around systematic reviews are most likely to occur when evidence-based standards for success are clearly established and the benefits of centering racial health equity are apparent. PLAIN LANGUAGE SUMMARY Racial categories are not based on biology, but racism has negative biological effects. People from racial or ethnic minority groups have often been left out of research and ignored in systematic reviews. Systematic reviews often help clinicians and policymakers with evidence-based decisions. Centering racial health equity in systematic reviews will help clinicians and policymakers to improve outcomes for people from racial or ethnic minority groups. We conducted interviews and a series of four systematic reviews on definitions, logic models and frameworks, methods, interventions, and interest-holder engagement in syntheses. We found that much work remains to be done in centering racial health equity in systematic reviews. Specifically, systematic reviewers need to change who is represented on their teams, establish foundational guidance (on definitions and causal mechanisms and models, identify what interventions work to address racial health equity, strengthen method guidance, disseminate and implement results, and sustain new practices).
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Affiliation(s)
- Meera Viswanathan
- RTI International, Research Triangle Park, NC, USA; RTI International-University of North Carolina Evidence-Based Practice Center US Cochrane Affiliate, Research Triangle Park, NC, USA.
| | - Nila A Sathe
- RTI International, Research Triangle Park, NC, USA; RTI International-University of North Carolina Evidence-Based Practice Center US Cochrane Affiliate, Research Triangle Park, NC, USA
| | - Vivian Welch
- Bruyère Health Research Institute, University of Ottawa, Ottawa, Canada; School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Damian K Francis
- School of Health and Human Performance, Georgia College and State University, Milledgeville, USA
| | - Patricia C Heyn
- Center for Optimal Aging, Marymount University, Arlington, VA, USA; Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Rania Ali
- RTI International, Research Triangle Park, NC, USA; RTI International-University of North Carolina Evidence-Based Practice Center US Cochrane Affiliate, Research Triangle Park, NC, USA
| | | | | | - Jennifer S Lin
- Kaiser Permanente Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
| | - Ana Beatriz Pizarro
- Cochrane Central Executive Team, London, UK; Clinical Research Center, Fundación Valle del Lili, Cali, Colombia
| | - Dru Riddle
- Center for Translational Research, Texas Christian University, Fort Worth, TX, USA
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Darko NA, Wilson CL, Oliver V. "We are mothers, sisters, and lovers too": Examining young Black women's experiences navigating sex and sexual health. AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY 2024; 74:196-209. [PMID: 38736243 PMCID: PMC11673438 DOI: 10.1002/ajcp.12753] [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: 04/28/2022] [Revised: 01/20/2024] [Accepted: 04/09/2024] [Indexed: 05/14/2024]
Abstract
In Canada, there is a lack of research that addresses the sexual health and well-being of African, Caribbean, and Black young women. This paper aims to gather perspectives of young Black women to address the social contexts of how young Black women navigate issues related to sex and sexual health. Young Black women experience unique dynamics in navigating their sexualities and sexual healthcare. The nuanced experiences stem from social contexts with historical underpinnings, such as the perception of Black women's bodies, Black identity, gender roles, and sexual double standards. This Community-Based Participatory Research study (N = 24) utilized focus groups to examine young Black women's experiences navigating sexual health. Employing a thematic analysis, participants identified four themes representing their narratives of navigating sexual health. The themes included the perceptions and hypersexuality of Black women's bodies, navigating sexual double standards and gender roles as Black women, diverse Blackness, and migration experiences concerning sexual health and surveillance of Black women's bodies. This paper is intended to add to scholarly discourse and will include practical strategies for use by researchers and community practitioners in sexual health within the Black community.
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Affiliation(s)
- Natasha A. Darko
- Department of Psychology, Faculty of ScienceWilfrid Laurier UniversityWaterlooCanada
| | - Ciann L. Wilson
- Department of Psychology, Faculty of ScienceWilfrid Laurier UniversityWaterlooCanada
| | - Vanessa Oliver
- Faculty of Liberal Arts, Child and Youth StudiesWilfrid Laurier UniversityBrantfordCanada
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Williams KKA, Baidoobonso S, Lofters A, Haggerty J, Leblanc I, Adams AM. Anti-Black racism in Canadian health care: a qualitative study of diverse perceptions of racism and racial discrimination among Black adults in Montreal, Quebec. BMC Public Health 2024; 24:3152. [PMID: 39538199 PMCID: PMC11562605 DOI: 10.1186/s12889-024-20636-0] [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: 12/15/2023] [Accepted: 11/05/2024] [Indexed: 11/16/2024] Open
Abstract
BACKGROUND Racism has been shown to impact the health of Black persons through its influence on health care, including its expression through implicit biases in provider training, attitudes, and behaviours. Less is known about the experiences of racism in contexts outside of the USA, and how race and racism interact with other social locations and systems of discrimination to shape Black patients' experiences of racism in health care encounters. To help address this gap, this study examined diverse Black individuals' perceived experiences of, and attitudes towards, anti-Black racism and racial discrimination in Canadian health care, specifically in Montreal, Quebec. METHODS This descriptive qualitative study adopted a social constructionist approach. Employing purposive maximal variation and snowball sampling strategies, eligible study participants were: self-identified Black persons aged 18 years and older who lived in Montreal during the COVID-19 pandemic, who could speak English or French, and who were registered with the Quebec medical insurance program. In-depth interviews were conducted, and a Framework Analysis approach guided the systematic exploration and interpretation of data using an intersectionality lens. RESULTS We interviewed 32 participants, the majority of whom were women (59%), university educated (69%), and modestly comfortable financially (41%), but diverse in terms of age (22 to 79 years), country of origin, and self-defined ethnicity. We identified five major themes demonstrating substantial variations in perceived racism in health care that are influenced by unique social locations such as gender identity, age, and immigration history: (1) no perceptions of racism in health care, (2) ambiguous perceptions of racism in health care, (3) perceptions of overt interpersonal racism in health care, (4) perceptions of covert interpersonal racism in health care (including the downplaying of health concerns, stereotyping, and racial microaggressions), and (5) perceptions of systemic racism in health care. CONCLUSIONS Perceptions of anti-Black racism and racial discrimination in Canadian health care are complex and may include intra-racial group differences. This study begins to address the dearth of empirical research documenting experiences of anti-Black racism in health care in Quebec, highlighting a continued need for serious consideration of the ways in which racism may manifest in the province, as well as a need for anti-racist advocacy. Advancing racial health equity requires greater sensitivity from providers and decision makers to variations in Black patients' health care experiences, towards ensuring that they have access to high quality and equitable health care services.
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Affiliation(s)
- Khandideh K A Williams
- Department of Family Medicine, McGill University, Montreal, Canada.
- St. Mary's Research Center, St. Mary's Hospital Center, Montreal, Canada.
| | - Shamara Baidoobonso
- Department of Community Health & Epidemiology, Dalhousie University, Halifax, Canada
| | - Aisha Lofters
- Department of Family & Community Medicine, University of Toronto, Toronto, Canada
- Peter Gilgan Centre for Women's Cancers, Women's College Hospital, Toronto, Canada
| | - Jeannie Haggerty
- Department of Family Medicine, McGill University, Montreal, Canada
- St. Mary's Research Center, St. Mary's Hospital Center, Montreal, Canada
| | - Isabelle Leblanc
- Department of Family Medicine, McGill University, Montreal, Canada
- University Family Medicine Group St. Mary, St. Mary's Hospital Center, Montreal, Canada
| | - Alayne M Adams
- Department of Family Medicine, McGill University, Montreal, Canada
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Majekodunmi P, Tulli-Shah M, Kemei J, Kayode I, Maduforo AN, Salami B. Interventions employed to address vaccine hesitancy among Black populations outside of African and Caribbean countries: a scoping review. BMC Public Health 2024; 24:3147. [PMID: 39538186 PMCID: PMC11562863 DOI: 10.1186/s12889-024-20641-3] [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: 07/31/2024] [Accepted: 11/06/2024] [Indexed: 11/16/2024] Open
Abstract
BACKGROUND Black people are disproportionately affected by structural and social determinants of health, resulting in greater risks of exposure to and deaths from COVID-19. Structural and social determinants of health feed vaccine hesitancy and worsen health disparities. OBJECTIVE This scoping review explored interventions that have been employed to address vaccine hesitancy among Black population outside of African and Caribbean countries. This review provides several strategies for addressing this deep-rooted public health problem. METHODS The scoping review followed the five-step framework outlined by Arksey and O'Malley. It complies with reporting guidelines from the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). Research studies that examined interventions utilized to promote vaccine confidence within Black populations living outside of African and Caribbean countries were reviewed. FINDINGS A total of 20 articles met the inclusion criteria for this study: 17 were quantitative studies and three were mixed-method studies. This scoping review highlighted six themes: educational advancement, messaging, multi-component approaches, outreach efforts, enhancing healthcare access, and healthcare provider leadership. CONCLUSION The review identified effective interventions for addressing vaccine hesitancy among Black populations outside Africa and the Caribbean, emphasizing education, multidimensional approaches, and healthcare provider recommendations. It calls for more qualitative research and interventions in countries like Canada and the UK to enhance vaccine confidence and reduce mistrust.
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Affiliation(s)
| | - Mia Tulli-Shah
- Black and Racial Health Equity Research Program, Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, T2N 4Z6, Canada
| | - Janet Kemei
- Faculty of Nursing, MacEwan University, Edmonton, AB, Canada
| | - Ibukun Kayode
- Interdisciplinary Studies Graduate Program (ISGP), University of British Columbia, Vancouver, BC, Canada
- Centre for Migration Studies, University of British Columbia, Vancouver, BC, Canada
| | - Aloysius Nwabugo Maduforo
- Black and Racial Health Equity Research Program, Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, T2N 4Z6, Canada.
- Werklund School of Education, University of Calgary, Calgary, AB, Canada.
| | - Bukola Salami
- Black and Racial Health Equity Research Program, Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, T2N 4Z6, Canada
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Salami BO, Kalenga CZ, Olukotun M, Renzaho AMN, Maduforo AN, Serrano‐Lomelin JA, Tunde‐Byass M, King RU, Richter S, Ladha T, Senthilselvan A, Bailey P, Ospina MB. Ethnic and racialized disparities in the use of screening services for pap smears and mammograms in Canada. Cancer Med 2024; 13:e70021. [PMID: 39450619 PMCID: PMC11503031 DOI: 10.1002/cam4.70021] [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: 02/15/2024] [Revised: 07/02/2024] [Accepted: 07/05/2024] [Indexed: 10/26/2024] Open
Abstract
BACKGROUND Breast and cervical cancers pose significant health challenges for women globally, emphasizing the critical importance of effective screening programs for early detection. In Canada, despite the implementation of accessible healthcare systems, ethnic and racialized disparities in cancer screening persist. This study aims to assess ethnic and racialized disparities in breast and cervical cancer screening in Canada. METHODS Using 2015-2019 data from the Canadian Community Health Survey, we analyzed women aged 18-70 in distinct ethnic and racial groups. The primary outcome was mammography or Papanicolaou test (pap smear). The secondary outcome was time since the last screening. We used weighted multivariable logistic regression to estimate the odds of having a pap smear or mammography across the ethnic and racialized groups, adjusted for relevant covariates. Results were reported as odds ratios (ORs) with 95% confidence intervals (CIs). RESULTS We included 14,628,067 women of which 72.5% were White, 8.4% Southeast Asian, 4.7% South Asian, 3.4% Indigenous, 2.7% Black, 2.0% West Asian, and 1.6% Latin American. In comparison with the White reference group, a higher odds ratio of not having a pap smear was estimated for the West Asian (5.63; CI 3.85, 8.23), South Asian (5.19; CI 3.79, 7.12), Southeast Asian (4.35; CI 3.46, 5.46), and Black groups (2.62; CI 1.82, 3.78). Disparities in mammography screening were found only for the Southeast Asian group with higher odds of not having screening (1.85; CI 1.15, 2.98) compared to the White reference group. CONCLUSION This study reveals significant disparities in pap smear and mammography screenings affecting various ethnic groups, particularly in West Asia, South Asian, and Black communities. These findings underscore the urgent need for targeted interventions, policies, and healthcare strategies to address these gaps and ensure equitable access to essential breast and cervical cancer prevention across all ethnicity.
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Affiliation(s)
- Bukola O. Salami
- Department of Community Health SciencesUniversity of CalgaryCalgaryAlbertaCanada
| | - Cindy Z. Kalenga
- Cumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada
| | - Mary Olukotun
- Faculty of NursingUniversity of AlbertaEdmontonAlbertaCanada
| | - Andre M. N. Renzaho
- Translational Health Research InstituteWestern Sydney UniversityCampbelltownNew South WalesAustralia
| | | | | | - Modupe Tunde‐Byass
- Department of Obstetrics and GynecologyUniversity of TorontoTorontoOntarioCanada
| | - Regine U. King
- Faculty of Social WorkUniversity of CalgaryCalgaryAlbertaCanada
| | - Solina Richter
- College of NursingUniversity of SaskatchewanSaskatoonSaskatchewanCanada
| | - Tehseen Ladha
- Department of PediatricsUniversity of AlbertaEdmontonAlbertaCanada
| | | | | | - Maria B. Ospina
- Department of Public Health SciencesQueens UniversityKingstonOntarioCanada
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Ntanda GM, Sia D, Beogo I, Baillot A, Nguemeleu ET, Merry L, Ramdé J, Jean-Charles KP, Philibert L. Factors Influencing the Acceptance or Rejection of Dietary and Body Norm Systems Favorable to the Prevention and Control of Type 2 Diabetes Among Sub-Saharan Africa migrants: A Scoping Review. J Racial Ethn Health Disparities 2024:10.1007/s40615-024-02072-3. [PMID: 38969923 DOI: 10.1007/s40615-024-02072-3] [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: 02/10/2024] [Revised: 06/18/2024] [Accepted: 06/23/2024] [Indexed: 07/07/2024]
Abstract
INTRODUCTION The systems of dietary and body that favor the prevention and control of type 2 diabetes (T2D) go against what is vital for most of the migrant population, exposing them to conflicts of norms that are difficult to reconcile. The purpose of this scoping review is to identify factors that may influence the acceptance or rejection of dietary and body norm systems favorable to the prevention and control of T2D by sub-Saharan Africa migrants living with T2D. METHODS An electronic search of studies from 2011 to 2022, published in English, Italian, French, or Portuguese was conducted in seven databases and in gray literature. The selection of articles was done independently and blindly by six teams of two researchers in accordance with the inclusion and exclusion criteria defined by the PICO. RESULTS Seven studies were included. The results show several factors influencing the acceptance or rejection of dietary and body norms systems favorable to the prevention and control of T2D among the migrants from sub-Saharan Africa, mainly social network, income, availability, and affordability of foods, among others. CONCLUSION Given the paucity of studies available on factors influencing the acceptance or rejection of body norm systems favorable to the prevention and control of T2D by sub-Saharan Africa migrants living with T2D, further studies are needed to better document these factors. A better understanding of these factors and their influence on the well-being of migrant people from sub-Saharan Africa living with T2D could help guide policy, research, and interventions so that they are better adapted to the realities of these populations.
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Affiliation(s)
- Gisèle Mandiangu Ntanda
- Department of Nursing, Université du Québec en Outaouais, Saint-Jérôme, QC, Canada.
- Institut Universitaire Sherpa, Montréal, QC, Canada.
- Institut du Savoir de L'hôpital Montfort-Recherche, Ottawa, ON, Canada.
| | - Drissa Sia
- Department of Nursing, Université du Québec en Outaouais, Saint-Jérôme, QC, Canada
- Institut Universitaire Sherpa, Montréal, QC, Canada
| | - Idrissa Beogo
- Institut du Savoir de L'hôpital Montfort-Recherche, Ottawa, ON, Canada
- School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Aurélie Baillot
- Institut du Savoir de L'hôpital Montfort-Recherche, Ottawa, ON, Canada
- Department of Nursing, Université du Québec en Outaouais, Gatineau, QC, Canada
| | | | - Lisa Merry
- Institut Universitaire Sherpa, Montréal, QC, Canada
- Faculty of Nursing, Université de Montréal, Montréal, Canada
| | - Jean Ramdé
- Département des fondements et pratiques en éducation | Faculté des sciences de l'éducation, Université Laval, Québec, Canada
| | | | - Léonel Philibert
- Institut du Savoir de L'hôpital Montfort-Recherche, Ottawa, ON, Canada
- Pôle Pluralité Humaine, Université de L'Ontario Français, Toronto, Canada
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12
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Cruz AM, Perez H, Rutledge E, Daum C, Liu L. Factors associated with a history of critical wandering among Medic-Alert subscribers. BMC Geriatr 2024; 24:564. [PMID: 38943089 PMCID: PMC11212194 DOI: 10.1186/s12877-024-05162-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Accepted: 06/18/2024] [Indexed: 07/01/2024] Open
Abstract
BACKGROUND Critical wandering occurs when an individual living with dementia leaves a location and is unaware of place or time. Critical wandering incidents are expected to increase with the growing prevalence of persons living with dementia worldwide. We investigated the association between demographic, psychopathological, and environmental factors and a history of critical wandering among Medic-Alert subscribers, both with and without dementia. METHODS Our retrospective study included data of 25,785 Canadian Medic-Alert subscribers who were aged 40 years or older. We used multivariable logistic regression analysis to examine the associations between a history of critical wandering and dementia status as psychopathological independent variable, controlled by demographic (age, ethnic background, sex at birth, Canadian languages spoken) and environmental (living arrangement, population density) factors. RESULTS The overall study sample comprised of mainly older adults (77.4%). Medic-Alert subscribers who were older, male sex at birth, living with dementia, of a minority ethnic group and who did not have proficiency in an official Canadian language had a higher likelihood of a history of critical wandering. Residing in an urban environment, in an institution or with a family member, were environmental factors associated with a higher likelihood of a history of critical wandering. CONCLUSIONS People living with dementia experience a higher likelihood of a history of critical wandering compared to those without dementia. Medic-Alert and similar organizations can develop algorithms based on the associated factors that can be used to flag risks of critical wandering. This can inform preventative strategies at the individual and community levels.
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Affiliation(s)
- Antonio Miguel Cruz
- Department of Occupational Therapy. Faculty of Rehabilitation Medicine, University of Alberta, 2-64 Corbett Hall, Edmonton, AB, T6G 2G4, Canada.
- Innovation & Technology (GRRIT), Glenrose Rehabilitation Research, Glenrose Rehabilitation Hospital, 10230 111 Ave NW, Edmonton, AB, T5G 0B7, Canada.
- School of Public Health Sciences, Faculty of Health, University of Waterloo, 200 University Ave W, Waterloo, ON, N2L 3G5, Canada.
| | - Hector Perez
- School of Public Health Sciences, Faculty of Health, University of Waterloo, 200 University Ave W, Waterloo, ON, N2L 3G5, Canada
| | - Emily Rutledge
- School of Public Health Sciences, Faculty of Health, University of Waterloo, 200 University Ave W, Waterloo, ON, N2L 3G5, Canada
| | - Christine Daum
- School of Public Health Sciences, Faculty of Health, University of Waterloo, 200 University Ave W, Waterloo, ON, N2L 3G5, Canada
| | - Lili Liu
- School of Public Health Sciences, Faculty of Health, University of Waterloo, 200 University Ave W, Waterloo, ON, N2L 3G5, Canada
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13
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Cénat JM. Racial discrimination in healthcare services among Black individuals in Canada as a major threat for public health: its association with COVID-19 vaccine mistrust and uptake, conspiracy beliefs, depression, anxiety, stress, and community resilience. Public Health 2024; 230:207-215. [PMID: 38574426 DOI: 10.1016/j.puhe.2024.02.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 02/09/2024] [Accepted: 02/29/2024] [Indexed: 04/06/2024]
Abstract
OBJECTIVES To examine the prevalence of major racial discrimination (MRD) in healthcare services and its association with COVID-19 vaccine mistrust and uptake, conspiracy theories, COVID-19-related stressors, community resilience, anxiety, depression, and stress symptoms. STUDY DESIGN The study used a population-based cross-sectional design. METHODS Data from the BlackVax dataset on COVID-19 vaccination in Black individuals in Canada was analyzed (n = 2002, 51.66% women). Logistic regression analyses were performed to examine the association between MRD and independent variables. RESULTS 32.55% of participants declared having experienced MRD in healthcare services. Participants with MRD were less vaccinated against COVID-19, presented higher scores of vaccine mistrust, conspiracy beliefs, COVID-19 related stressors, depression, anxiety, and stress, and had lower scores of community resilience. They were more likely to experience depression (AOR = 2.13, P < 0.001), anxiety (AOR = 2.00, P < 0.001), and stress symptoms (AOR = 2.15, P < 0.001). Participants who experienced MRD were more likely to be unvaccinated (AOR = 1.35, P = 0.009). CONCLUSIONS Racial discrimination experienced by Black individuals in health services is a major public health concern and threat to population health in Canada. Federal, provincial, and municipal public health agencies should adapt their programs, strategies, tools, and campaigns to address the mistrust created by racial discrimination.
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Affiliation(s)
- Jude Mary Cénat
- School of Psychology, University of Ottawa, 136 Jean-Jacques-Lussier, 4085, Vanier Hall, Ottawa, Ontario, K1N 6N5, Canada; Interdisciplinary Centre for Black Health, University of Ottawa, Ottawa, Ontario, Canada; University of Ottawa Research Chair on Black Health, Ottawa, Ontario, Canada.
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14
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Bassah N, Beranek J, Kennedy M, Onabadejo J, Santos Salas A. Inequities in access to palliative and end-of-life care in the black population in Canada: a scoping review. Int J Equity Health 2024; 23:81. [PMID: 38664833 PMCID: PMC11044312 DOI: 10.1186/s12939-024-02173-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 04/04/2024] [Indexed: 04/29/2024] Open
Abstract
BACKGROUND Improving equity and early access to palliative care for underserved populations in Canada is a priority. Little is known regarding access to palliative and end-of-life care in the Black population. METHODS We undertook a scoping review using the framework by Arksey and O'Malley to identify knowledge, access gaps, and experiences of palliative and end-of-life care among Blacks living with life-limiting illnesses in Canada. Primary studies, discussion papers, books, and reports were considered eligible. We followed a comprehensive search strategy developed by an information scientist. Searches were performed in the following bibliographic databases: Medline, EMBASE, PsycINFO via OVID, CINAHL via EBSCOhost, Scopus and Cochrane Library via Wiley. The search strategy was derived from three main concepts: (1) Black people; (2) Canada and Canadian provinces; (3) Palliative, hospice, or end-of-life care. No publication date or language limits were applied. Titles and abstracts were screened for eligibility by one reviewer and full text by two independent reviewers. RESULTS The search yielded 233 articles. Nineteen articles were selected for full-text review, and 7 articles met the inclusion criteria. These studies were published between 2010 and 2021, and conducted in the provinces of Ontario and Nova Scotia only. Studies used both quantitative and qualitative methods and included cancer decedents, next of kin, family caregivers and religious leaders. Sample sizes in various studies ranged from 6 - 2,606 participants. Included studies reported a general lack of understanding about palliative and end-of-life care, positive and negative experiences, and limited access to palliative and end-of-life care for Blacks, across all care settings. CONCLUSION Findings suggest limited knowledge of palliative care and inequities in access to palliative and end-of-life care for Blacks living with life-limiting illnesses in 2 Canadian provinces. There is an urgent need for research to inform tailored and culturally acceptable strategies to improve understanding and access to palliative care and end-of-life care among Blacks in Canada.
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Affiliation(s)
- Nahyeni Bassah
- Faculty of Nursing, College of Health Sciences, University of Alberta, Third Floor Edmonton Clinic Health Academy, 11405 87 Avenue NW, Edmonton, AB, T6G 1C9, Canada.
- Department of Nursing, Faculty of Health Sciences, University of Buea, P.O Box 63, Buea, South West Region, Cameroon.
| | - Julia Beranek
- Faculty of Nursing, College of Health Sciences, University of Alberta, Third Floor Edmonton Clinic Health Academy, 11405 87 Avenue NW, Edmonton, AB, T6G 1C9, Canada
| | - Megan Kennedy
- Geoffrey & Robyn Sperber Health Sciences Library, Edmonton Clinic Health Academy, 1-150M, 11405 87 Avenue NW, Edmonton, AB, T6G 1C9, Canada
| | - Juliet Onabadejo
- BScN Program, School of Health and Wellness, Red Deer Polytechnic, 100 College Blvd, Box 5005, Red Deer, AB, Canada
| | - Anna Santos Salas
- Faculty of Nursing, College of Health Sciences, University of Alberta, Third Floor Edmonton Clinic Health Academy, 11405 87 Avenue NW, Edmonton, AB, T6G 1C9, Canada
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15
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Williams KKA, Baidoobonso S, Haggerty J, Lofters A, Adams AM. Anti-Black discrimination in primary health care: a qualitative study exploring internalized racism in a Canadian context. ETHNICITY & HEALTH 2024; 29:343-352. [PMID: 38332736 DOI: 10.1080/13557858.2024.2311429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 01/23/2024] [Indexed: 02/10/2024]
Abstract
OBJECTIVES A growing body of evidence points to persistent health inequities within racialized minority communities, and the effects of racial discrimination on health outcomes and health care experiences. While much work has considered how anti-Black racism operates at the interpersonal and institutional levels, limited attention has focused on internalized racism and its consequences for health care. This study explores patients' attitudes towards anti-Black racism in a Canadian health care system, with a particular focus on internalized racism in primary health care. DESIGN This qualitative study employed purposive maximal variation and snowball sampling to recruit and interview self-identified Black persons aged 18 years and older who: (1) lived in Montréal during the COVID-19 pandemic, (2) could speak English or French, and (3) were registered with the Québec health insurance program. Adopting a phenomenological approach, in-depth interviews took place from October 2021 to July 2022. Following transcription, data were analyzed thematically. RESULTS Thirty-two participants were interviewed spanning an age range from 22 years to 79 years (mean: 42 years). Fifty-nine percent of the sample identified as women, 38% identified as men, and 3% identified as non-binary. Diversity was also reflected in terms of immigration experience, financial situation, and educational attainment. We identified three major themes that describe mechanisms through which internalized racism may manifest in health care to impact experiences: (1) the internalization of anti-Black racism by Black providers and patients, (2) the expression of anti-Black prejudice and discrimination by non-Black racialized minority providers, and (3) an insensitivity towards racial discrimination. CONCLUSION Our study suggests that multiple levels of racism, including internalized racism, must be addressed in efforts to promote health and health care equity among racialized minority groups, and particularly within Black communities.
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Affiliation(s)
| | - Shamara Baidoobonso
- Department of Community Health & Epidemiology, Dalhousie University, Halifax, Canada
| | - Jeannie Haggerty
- Department of Family Medicine, McGill University, Montréal, Canada
| | - Aisha Lofters
- Department of Family & Community Medicine, University of Toronto, Toronto, Canada
- Peter Gilgan Centre for Women's Cancers, Women's College Hospital, Toronto, Canada
| | - Alayne M Adams
- Department of Family Medicine, McGill University, Montréal, Canada
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De Luca GD, Lin X. The role of health and health systems in promoting social capital, political participation and peace: A narrative review. Health Policy 2024; 141:105009. [PMID: 38350755 DOI: 10.1016/j.healthpol.2024.105009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 12/29/2023] [Accepted: 01/09/2024] [Indexed: 02/15/2024]
Abstract
High levels of violence and insecurity are highly detrimental for societies. United Nations Sustainable Development Goal 16 is advocating for peaceful, accountable and inclusive institutions as one powerful channel to foster global development. Investing in health and health policies can potentially contribute achieving these objectives. After providing a conceptual framework, this article reviews the existing literature on the evidence of the role of health and health systems in promoting social capital and trust, political engagement and participation, and peace that closely relate to the objectives of Sustainable Development Goal 16. We provide evidence of a systematically positive impact of better physical and mental health on social capital, and on political participation, both contributing to the sustainability of inclusive democratic institutions. We also document that health and health systems can help supporting peace, both via the reduction of social inequality and grievances, and by reducing the disruptive effects of epidemic shocks. Overall, the study provides evidence that health and health systems can generate co-benefits outside the health domain by promoting social capital, political participation and peace.
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Affiliation(s)
| | - Xi Lin
- University of York, Heslington, YO105DD York, UK
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17
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Clavel MA, Van Spall HG, Mantella LE, Foulds H, Randhawa V, Parry M, Liblik K, Kirkham AA, Cotie L, Jaffer S, Bruneau J, Colella TJ, Ahmed S, Dhukai A, Gomes Z, Adreak N, Keeping-Burke L, Limbachia J, Liu S, Jacques KE, Mullen KA, Mulvagh SL, Norris CM. The Canadian Women's Heart Health Alliance ATLAS on the Epidemiology, Diagnosis, and Management of Cardiovascular Disease in Women - Chapter 8: Knowledge Gaps and Status of Existing Research Programs in Canada. CJC Open 2024; 6:220-257. [PMID: 38487042 PMCID: PMC10935691 DOI: 10.1016/j.cjco.2023.11.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Accepted: 11/14/2023] [Indexed: 03/17/2024] Open
Abstract
Despite significant progress in medical research and public health efforts, gaps in knowledge of women's heart health remain across epidemiology, presentation, management, outcomes, education, research, and publications. Historically, heart disease was viewed primarily as a condition in men and male individuals, leading to limited understanding of the unique risks and symptoms that women experience. These knowledge gaps are particularly problematic because globally heart disease is the leading cause of death for women. Until recently, sex and gender have not been addressed in cardiovascular research, including in preclinical and clinical research. Recruitment was often limited to male participants and individuals identifying as men, and data analysis according to sex or gender was not conducted, leading to a lack of data on how treatments and interventions might affect female patients and individuals who identify as women differently. This lack of data has led to suboptimal treatment and limitations in our understanding of the underlying mechanisms of heart disease in women, and is directly related to limited awareness and knowledge gaps in professional training and public education. Women are often unaware of their risk factors for heart disease or symptoms they might experience, leading to delays in diagnosis and treatments. Additionally, health care providers might not receive adequate training to diagnose and treat heart disease in women, leading to misdiagnosis or undertreatment. Addressing these knowledge gaps requires a multipronged approach, including education and policy change, built on evidence-based research. In this chapter we review the current state of existing cardiovascular research in Canada with a specific focus on women.
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Affiliation(s)
- Marie-Annick Clavel
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Québec, Québec, Canada
| | - Harriette G.C. Van Spall
- Department of Medicine, Department of Health Research Methods, Evidence, and Impact, McMaster University, Toronto, Ontario, Canada
| | - Laura E. Mantella
- Department of Biomedical and Molecular Sciences, Queen’s University, Kingston, Ontario, Canada
| | - Heather Foulds
- College of Kinesiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Varinder Randhawa
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Monica Parry
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Kiera Liblik
- Department of Medicine, Kingston Health Science Center, Kingston, Ontario, Canada
| | - Amy A. Kirkham
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Ontario, Canada
- Toronto Rehabilitation Institute (KITE), University Health Network, Toronto, Ontario, Canada
| | - Lisa Cotie
- Toronto Rehabilitation Institute (KITE), University Health Network, Toronto, Ontario, Canada
| | - Shahin Jaffer
- General Internal Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jill Bruneau
- Faculty of Nursing, Memorial University of Newfoundland and Labrador, St John, Newfoundland and Labrador, Canada
| | - Tracey J.F. Colella
- Toronto Rehabilitation Institute (KITE), University Health Network, Toronto, Ontario, Canada
| | - Sofia Ahmed
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Abida Dhukai
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Zoya Gomes
- Faculty of Medicine, Division of Cardiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Najah Adreak
- Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Lisa Keeping-Burke
- Department of Nursing and Health Sciences, University of New Brunswick, Saint John, New Brunswick, Canada
| | - Jayneel Limbachia
- Schulich School of Medicine, Western University, London, Ontario, Canada
| | - Shuangbo Liu
- Section of Cardiology, Department of Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Karen E. Jacques
- Person with lived experience, Canadian Women’s Heart Health Alliance, Ottawa, Ontario, Canada
| | - Kerri A. Mullen
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Sharon L. Mulvagh
- Faculty of Medicine, Division of Cardiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Colleen M. Norris
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
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Demeke J, Djiadeu P, Yusuf A, Whitfield DL, Lightfoot D, Worku F, Abu-Ba'are GR, Mbuagbaw L, Giwa S, Nelson LE. HIV Prevention and Treatment Interventions for Black Men Who Have Sex With Men in Canada: Scoping Systematic Review. JMIR Public Health Surveill 2024; 10:e40493. [PMID: 38236626 PMCID: PMC10835596 DOI: 10.2196/40493] [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: 06/23/2022] [Revised: 12/28/2022] [Accepted: 08/29/2023] [Indexed: 01/19/2024] Open
Abstract
BACKGROUND Black men who have sex with men (MSM) experience disproportionately high HIV incidence globally. A comprehensive, intersectional approach (race, gender, and sexuality or sexual behavior) in understanding the experiences of Black MSM in Canada along the HIV prevention and care continuums has yet to be explored. OBJECTIVE This scoping review aims to examine the available evidence on the access, quality, gaps, facilitators, and barriers of engagement and identify interventions relevant to the HIV prevention and care continuum for Black MSM in Canada. METHODS We conducted a systematic database search, in accordance with the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) checklist, of the available studies on HIV health experience and epidemiology concerning Black MSM living with or without HIV in Canada and were published after 1983 in either English or French. Searched databases include MEDLINE, Excerpta, Cumulative Index to Nursing and Allied Health Literature, the Cochrane Library, the NHUS Economic Development Database, Global Health, PsycInfo, PubMed, Scopus, and Web of Science. From the 3095 articles identified, 19 met the inclusion criteria and were analyzed. RESULTS Black MSM in Canada consistently report multiple forms of stigma and lack of community support contributing to an increased HIV burden. They experience discrimination based on their intersectional identities while accessing HIV preventative and treatment interventions. Available data demonstrate that Black MSM have higher HIV incidences than Black men who have sex with women (MSW) and White MSM, and low preexposure prophylaxis knowledge and HIV literacy. Black MSM experience significant disparities in HIV prevention and care knowledge, access, and use. Structural barriers, including anti-Black racism, homophobia, and xenophobia, are responsible for gaps in HIV prevention and care continuums, poor quality of care and linkage to HIV services, as well as a higher incidence of HIV. CONCLUSIONS Considering the lack of targeted interventions, there is a clear need for interventions that reduce HIV diagnoses among Black MSM, increase access and reduce structural barriers that significantly affect the ability of Black MSM to engage with HIV prevention and care, and address provider's capacity for care and the structural barriers. These findings can inform future interventions, programming, and tools that may alleviate this HIV inequity. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.1136/bmjopen-2020-043055.
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Affiliation(s)
- Jemal Demeke
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - Pascal Djiadeu
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Abban Yusuf
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
| | | | - David Lightfoot
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - Fiqir Worku
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Gamji Rabiu Abu-Ba'are
- Center for Interdisciplinary Research on AIDS, Yale School of Public Health, New Haven, CT, United States
| | - Lawrence Mbuagbaw
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Sulaimon Giwa
- School of Social Work, St John's College, Memorial University of Newfoundland, St John's, NL, Canada
| | - LaRon E Nelson
- School of Nursing, Yale University, New Haven, CT, United States
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19
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Yuen AWH, Sang JM, Wang L, Barath J, Lachowsky NJ, Lal A, Elefante J, Hart TA, Skakoon-Sparling S, Grey C, Grace D, Cox J, Lambert G, Noor SW, Apelian H, Parlette A, Card KG, Hull MW, Jollimore J, Moore DM. Attitudes of Gay, Bisexual, and Other Men Who Have Sex with Men (GBM) toward Their Use of Amphetamine-Type Stimulants and Relation to Reducing Use in Three Canadian Cities. Subst Use Misuse 2023; 59:278-290. [PMID: 37867395 DOI: 10.1080/10826084.2023.2269577] [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: 10/24/2023]
Abstract
BACKGROUND We explored attitudes of gay, bisexual, and other men who have sex with men (GBM) toward their amphetamine-use and associations with reduced use over time. METHODS We recruited sexually-active GBM aged 16+ years in Montreal, Toronto, and Vancouver, Canada, from 02-2017 to 08-2019, with follow-up visits every 6-12 months until November 2020. Among participants who reported past-six-month (P6M) amphetamine-use at enrollment, we used logistic regression to identify demographic, psychological, social, mental health, other substance-use, and behavioral factors associated with reporting needing help reducing their substance-use. We used mixed-effects logistic regression to model reduced P6M amphetamine-use with perceived problematic-use as our primary explanatory variable. RESULTS We enrolled 2,449 GBM across sites. 15.5-24.7% reported P6M amphetamine-use at enrollment and 82.6 - 85.7% reported needing no help or only a little help in reducing their substance use. Reporting needing a lot/of help or completely needing help in reducing substance-use was associated with group sex participation (AOR = 2.35, 95%CI:1.25-4.44), greater anxiety symptomatology (AOR = 2.11, 95%CI:1.16-3.83), greater financial strain (AOR = 1.35, 95%CI:1.21-1.50), and greater Escape Motive scores (AOR = 1.07, 95%CI:1.03-1.10). Reductions in P6M amphetamine-use were less likely among GBM who perceived their amphetamine-use as problematic (AOR = 0.17 95% CI 0.10 - 0.29). CONCLUSIONS Most amphetamine-using GBM did not feel they needed help reducing their substance use, and many reported reduced amphetamine-use at subsequent visits. Those who perceived their use as problematic were less likely to reduce their use. Further interventions to assist GBM in reducing their use are needed to assist those who perceive their use as problematic.
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Affiliation(s)
| | - Jordan M Sang
- British Columbia Centre on Substance Use, Vancouver, BC, Canada
| | - Lu Wang
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
| | - Justin Barath
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
| | - Nathan J Lachowsky
- University of Victoria, Victoria, BC, Canada
- Community-Based Research Centre, Vancouver, BC, Canada
| | - Allan Lal
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
| | | | - Trevor A Hart
- Toronto Metropolitan University, Toronto, ON, Canada
- University of Toronto, ON, Canada
| | | | | | | | - Joseph Cox
- McGill University, Montreal, QC, Canada
- Research Institute of the McGill University Health Centre, Montréal, QC, Canada
| | - Gilles Lambert
- Research Institute of the McGill University Health Centre, Montréal, QC, Canada
- Institut national de santé publique du Québec, Montréal, QC, Canada
| | - Syed W Noor
- Toronto Metropolitan University, Toronto, ON, Canada
- Louisiana State University Shreveport, Shreveport, Louisiana, USA
| | - Herak Apelian
- McGill University, Montreal, QC, Canada
- Research Institute of the McGill University Health Centre, Montréal, QC, Canada
| | | | - Kiffer G Card
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
- University of Victoria, Victoria, BC, Canada
- Simon Fraser University, Burnaby, BC, Canada
| | - Mark W Hull
- University of British Columbia, Vancouver, BC, Canada
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
| | | | - David M Moore
- University of British Columbia, Vancouver, BC, Canada
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Singh H, Fulton J, Mirzazada S, Saragosa M, Uleryk EM, Nelson MLA. Community-Based Culturally Tailored Education Programs for Black Communities with Cardiovascular Disease, Diabetes, Hypertension, and Stroke: Systematic Review Findings. J Racial Ethn Health Disparities 2023; 10:2986-3006. [PMID: 36508135 PMCID: PMC10645635 DOI: 10.1007/s40615-022-01474-5] [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: 09/28/2022] [Revised: 11/17/2022] [Accepted: 11/21/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Community-based culturally tailored education (CBCTE) programs for chronic diseases may reduce health disparities; however, a synthesis across chronic diseases is lacking. We explored (1) the characteristics and outcomes of CBCTE programs and (2) which strategies for culturally appropriate interventions have been used in CBCTE programs, and how they have been implemented. METHODS A systematic review was conducted by searching three databases to identify empirical full-text literature on CBCTE programs for Black communities with cardiovascular disease, hypertension, diabetes, or stroke. Studies were screened in duplicate, then data regarding study characteristics, participants, intervention, and outcomes were extracted and analyzed. Cultural tailoring strategies within programs were categorized using Kreuter and colleagues' framework. RESULTS Of the 74 studies, most were conducted in the USA (97%) and delivered in one site (53%; e.g., church/home). CBCTE programs targeted diabetes (65%), hypertension (30%), diabetes and hypertension (1%), cardiovascular disease (3%), and stroke (1%). Reported program benefits included physiological, medication-related, physical activity, and literacy. Cultural tailoring strategies included peripheral (targeted Black communities), constituent-involving (e.g., community informed), evidential (e.g., integrated community resources), linguistic (e.g., delivered in community's dialect/accent), and sociocultural (e.g., integrated community members' religious practices). CONCLUSIONS CBCTE programs may have beneficial outcomes, but a small sample size limited several. The strategies identified can be adopted by programs seeking to culturally tailor. Future interventions should clearly describe community members' roles/involvement and deliver programs in multiple locations to broaden reach. TRIAL REGISTRATION PROSPERO CRD42021245772.
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Affiliation(s)
- Hardeep Singh
- Department of Occupational Science & Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, 500 University Avenue Toronto, Toronto, ON, M5G 1V7, Canada.
- KITE, Toronto Rehabilitation Institute, University Health Network, 520 Sutherland Drive, Toronto, ON, Canada.
- Temerty Faculty of Medicine, Rehabilitation Science Institute, University of Toronto, 500 University Avenue Toronto, Toronto, ON, M5G 1V7, Canada.
| | - Joseph Fulton
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- March of Dimes Canada, 10 Overlea Blvd, Toronto, ON, Canada
| | - Sofia Mirzazada
- Department of Occupational Science & Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, 500 University Avenue Toronto, Toronto, ON, M5G 1V7, Canada
| | - Marianne Saragosa
- Bridgepoint Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, 1 Bridgepoint Drive, Toronto, ON, Canada
| | | | - Michelle L A Nelson
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- March of Dimes Canada, 10 Overlea Blvd, Toronto, ON, Canada
- Bridgepoint Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, 1 Bridgepoint Drive, Toronto, ON, Canada
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21
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Nweze N, Davids J, Fang X, Holding A, Koestner R. The Impact of Language on the Mental Health of Black Quebecers. J Racial Ethn Health Disparities 2023; 10:2327-2337. [PMID: 36745264 DOI: 10.1007/s40615-022-01412-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 09/01/2022] [Accepted: 09/04/2022] [Indexed: 02/07/2023]
Abstract
Quebec's English-speaking Black community finds itself at the intersection of racial and linguistic discrimination, which presents challenges to mental wellness. The present study aims to add necessary detail to the conversations surrounding racism and mental health in Canada while including language as a determinant of health and intersecting element affecting the wellbeing of English-speaking Black Quebecers. We recruited 531 Black adults who are currently living in Quebec to complete a survey on various community-relevant items, including their mental and physical health, their experiences of discrimination, and barriers to accessing mental healthcare. Our analyses revealed that English-speaking participants experience more discrimination across all types and report more barriers to mental healthcare and lower mental health than their French-speaking counterparts. Furthermore, we found that language also had a mediated effect on mental health through discrimination and barriers to mental healthcare. Our study adds to the sparse race-based and intersectional literature about Black people in Canada and substantiates a mechanism by which language affects mental health by exposing Black Quebecers to more discrimination and thus higher barriers to care.
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Affiliation(s)
| | - John Davids
- Black Community Resource Center, Montreal, QC, Canada
| | - Xiaoyan Fang
- McGill University, Montreal, QC, Canada
- Black Community Resource Center, Montreal, QC, Canada
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22
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Singh S. Racial biases in healthcare: Examining the contributions of Point of Care tools and unintended practitioner bias to patient treatment and diagnosis. Health (London) 2023; 27:829-846. [PMID: 34875900 PMCID: PMC10423434 DOI: 10.1177/13634593211061215] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Sophisticated algorithms are used daily to search through hundreds of medical journals in order to package updated medical insights into commercial databases. Healthcare practitioners can access these searchable databases-called Point of Care (PoC) tools-as downloadable apps on their smartphones or tablets to comprehensively and efficiently inform patient diagnosis and treatment. Because racist biases are unintentionally incorporated into the search reports that the companies generate and that practitioners regularly access, the aim of this article is to examine how healthcare practitioners' "pre-existing" racial stereotypes interact with pithy conclusions about race and ethnicity in PoC tools. I use qualitative research methods (content analysis, discourse analysis, open-ended semi-structured interviews, and role play) to frame the analysis within the Public Health Critical Race Praxis (PHCRP). This approach facilitates an understanding of how biological racism-the use of scientific evidence to support inherent differences between races-that is embedded in PoC algorithms informs a practitioner's assessment of a patient, and converges with persistent racial bias in medical training, medical research and healthcare. I contextualize the study with one semi-structured interview with an Editor of a leading PoC tool, MedScope (pseudonomized), and 10 semi-structured interviews with healthcare practitioners in S.E. Ontario, Canada. The article concludes that PoC tools and practitioners' personal biases contribute to racial prejudices in healthcare provision. This warrants further research on racial bias in medical literature and curriculum design in medical school.
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23
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Foster N, Kapiriri L, Grignon M, McKenzie K. "But…I survived": A phenomenological study of the health and wellbeing of aging Black women in the Greater Toronto Area, Canada. J Women Aging 2023; 35:22-37. [PMID: 35635795 DOI: 10.1080/08952841.2022.2079925] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Studies that assess the association between race and health have focused intently on the cumulative impact of continuous exposure to racism over an extended period. While these studies have contributed significantly to the general understanding of the life experiences and health status of racialized people, few studies have explicitly bridged the experiences of aging with gender and the wide structural barriers and social factors that have shaped the lives of racialized older women. This study aimed to investigate the origins of health inequities to highlight factors that intersect to affect the health and wellbeing of older Black women across their life course. Descriptive phenomenology was used to describe older Black women's health and wellbeing, and factors that impact their health across their life course. Criteria-based sampling was used to recruit study participants (n = 27). To be eligible women needed to be 55 years or older, speak English, self-identify as a Black female, and live in the Greater Toronto Area. Data analysis was guided by phenomenology. Themes identified demonstrated that participants' health and wellbeing were influenced by gender bias, racism, abuse, and retirement later in life. Participants reported having poor mental health during childhood and adulthood due to anxiety and depression. Other chronic illnesses reported included hypertension, diabetes, and cancer. Qualitative methods provided details regarding events and exposures that illuminate pathways through which health inequities emerge across the life course.
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Affiliation(s)
- Nicoda Foster
- Department of Health, Aging and Society, McMaster University, Hamilton, Canada
| | - Lydia Kapiriri
- Department of Health, Aging and Society, McMaster University, Hamilton, Canada
| | - Michel Grignon
- Department of Health, Aging and Society, McMaster University, Hamilton, Canada
| | - Kwame McKenzie
- Department of Psychiatry, University of Toronto, Toronto, Canada
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24
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Cénat JM, Noorishad PG, Bakombo SM, Onesi O, Mesbahi A, Darius WP, Caulley L, Yaya S, Chomienne MH, Etowa J, Venkatesh V, Dalexis RD, Pongou R, Labelle PR. A Systematic Review on Vaccine Hesitancy in Black Communities in Canada: Critical Issues and Research Failures. Vaccines (Basel) 2022; 10:1937. [PMID: 36423032 PMCID: PMC9695687 DOI: 10.3390/vaccines10111937] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 11/10/2022] [Accepted: 11/11/2022] [Indexed: 07/25/2023] Open
Abstract
Black communities have been disproportionately impacted by Coronavirus Disease 2019 (COVID-19) in Canada, in terms of both number of infections and mortality rates. Yet, according to early studies, vaccine hesitancy appears to be higher in Black communities. The purpose of this systematic review is to examine the prevalence and factors associated with vaccine hesitancy in Black communities in Canada. Peer-reviewed studies published from 11 March 2020 to 26 July 2022, were searched through eleven databases: APA PsycInfo (Ovid), Cairn.info, Canadian Business & Current Affairs (ProQuest), CPI.Q (Gale OneFile), Cochrane CENTRAL (Ovid), Embase (Ovid), Érudit, Global Health (EBSCOhost), MEDLINE (Ovid), and Web of Science (Clarivate). Eligible studies were published in French or English and had empirical data on the prevalence or factors associated with vaccine hesitancy in samples or subsamples of Black people. Only five studies contained empirical data on vaccine hesitancy in Black individuals and were eligible for inclusion in this systematic review. Black individuals represented 1.18% (n = 247) of all included study samples (n = 20,919). Two of the five studies found that Black individuals were more hesitant to be vaccinated against COVID-19 compared to White individuals, whereas the other three found no significant differences. The studies failed to provide any evidence of factors associated with vaccine hesitancy in Black communities. Despite national concerns about vaccine hesitancy in Black communities, a color-blind approach is still predominant in Canadian health research. Of about 40 studies containing empirical data on vaccine hesitancy in Canada, only five contained data on Black communities. None analyzed factors associated with vaccine hesitancy in Black communities. Policies and strategies to strengthen health research in Black communities and eliminate the color-blind approach are discussed.
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Affiliation(s)
- Jude Mary Cénat
- School of Psychology, University of Ottawa, Ottawa, ON K1N 6N5, Canada
- Interdisciplinary Centre for Black Health, University of Ottawa, Ottawa, ON K1N 6N5, Canada
- Faculty of Social Sciences, University of Ottawa, Ottawa, ON K1N 6N5, Canada
| | | | - Schwab Mulopo Bakombo
- Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, ON K1N 6N5, Canada
| | - Olivia Onesi
- School of Psychology, University of Ottawa, Ottawa, ON K1N 6N5, Canada
| | - Aya Mesbahi
- School of Psychology, University of Ottawa, Ottawa, ON K1N 6N5, Canada
| | - Wina Paul Darius
- School of Psychology, University of Ottawa, Ottawa, ON K1N 6N5, Canada
| | - Lisa Caulley
- Interdisciplinary Centre for Black Health, University of Ottawa, Ottawa, ON K1N 6N5, Canada
- Faculty of Medicine, Family Medicine University of Ottawa, Ottawa, ON K1N 6N5, Canada
| | - Sanni Yaya
- School of International Development and Global Studies, Ottawa, ON K1N 6N5, Canada
- The George Institute for Global Health, Imperial College London, London NW9 7PA, UK
| | - Marie-Hélène Chomienne
- Interdisciplinary Centre for Black Health, University of Ottawa, Ottawa, ON K1N 6N5, Canada
- Faculty of Medicine, Family Medicine University of Ottawa, Ottawa, ON K1N 6N5, Canada
- Institut du Savoir Montfort, Ottawa, ON K1K 0T2, Canada
| | - Josephine Etowa
- Interdisciplinary Centre for Black Health, University of Ottawa, Ottawa, ON K1N 6N5, Canada
- School of Nursing, University of Ottawa, Ottawa, ON K1N 6N5, Canada
| | - Vivek Venkatesh
- Department of Art Education, Concordia University, Montreal, QC H3H 1M8, Canada
| | - Rose Darly Dalexis
- Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, ON K1N 6N5, Canada
| | - Roland Pongou
- Department of Economics, University of Ottawa, Ottawa, ON K1N 6N5, Canada
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25
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van Ingen T, Brown KA, Buchan SA, Akingbola S, Daneman N, Warren CM, Smith BT. Neighbourhood-level socio-demographic characteristics and risk of COVID-19 incidence and mortality in Ontario, Canada: A population-based study. PLoS One 2022; 17:e0276507. [PMID: 36264984 PMCID: PMC9584389 DOI: 10.1371/journal.pone.0276507] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 10/07/2022] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES We aimed to estimate associations between COVID-19 incidence and mortality with neighbourhood-level immigration, race, housing, and socio-economic characteristics. METHODS We conducted a population-based study of 28,808 COVID-19 cases in the provincial reportable infectious disease surveillance systems (Public Health Case and Contact Management System) which includes all known COVID-19 infections and deaths from Ontario, Canada reported between January 23, 2020 and July 28, 2020. Residents of congregate settings, Indigenous communities living on reserves or small neighbourhoods with populations <1,000 were excluded. Comparing neighbourhoods in the 90th to the 10th percentiles of socio-demographic characteristics, we estimated the associations between 18 neighbourhood-level measures of immigration, race, housing and socio-economic characteristics and COVID-19 incidence and mortality using Poisson generalized linear mixed models. RESULTS Neighbourhoods with the highest proportion of immigrants (relative risk (RR): 4.0, 95%CI:3.5-4.5) and visible minority residents (RR: 3.3, 95%CI:2.9-3.7) showed the strongest association with COVID-19 incidence in adjusted models. Among individual race groups, COVID-19 incidence was highest among neighbourhoods with the high proportions of Black (RR: 2.4, 95%CI:2.2-2.6), South Asian (RR: 1.9, 95%CI:1.8-2.1), Latin American (RR: 1.8, 95%CI:1.6-2.0) and Middle Eastern (RR: 1.2, 95%CI:1.1-1.3) residents. Neighbourhoods with the highest average household size (RR: 1.9, 95%CI:1.7-2.1), proportion of multigenerational families (RR: 1.8, 95%CI:1.7-2.0) and unsuitably crowded housing (RR: 2.1, 95%CI:2.0-2.3) were associated with COVID-19 incidence. Neighbourhoods with the highest proportion of residents with less than high school education (RR: 1.6, 95%CI:1.4-1.8), low income (RR: 1.4, 95%CI:1.2-1.5) and unaffordable housing (RR: 1.6, 95%CI:1.4-1.8) were associated with COVID-19 incidence. Similar inequities were observed across neighbourhood-level sociodemographic characteristics and COVID-19 mortality. CONCLUSIONS Neighbourhood-level inequities in COVID-19 incidence and mortality were observed in Ontario, with excess burden experienced in neighbourhoods with a higher proportion of immigrants, racialized populations, large households and low socio-economic status.
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Affiliation(s)
| | - Kevin A. Brown
- Public Health Ontario, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Sarah A. Buchan
- Public Health Ontario, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | | | - Nick Daneman
- Public Health Ontario, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Division of Infectious Diseases, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | | | - Brendan T. Smith
- Public Health Ontario, Toronto, Ontario, Canada
- Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- * E-mail:
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26
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Cénat JM, Hajizadeh S, Dalexis RD, Ndengeyingoma A, Guerrier M, Kogan C. Prevalence and Effects of Daily and Major Experiences of Racial Discrimination and Microaggressions among Black Individuals in Canada. JOURNAL OF INTERPERSONAL VIOLENCE 2022; 37:NP16750-NP16778. [PMID: 34120505 DOI: 10.1177/08862605211023493] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
The prevalence and correlates of different forms of racial discrimination among Black Canadians are unknown. This article aims to examine the prevalence of different forms of racial discrimination (daily, major and microaggressions) and their association with self-esteem and satisfaction with life among Black Canadians. A convenience sample of 845 Black Canadians aged 15-40 was recruited. We assessed frequencies of everyday and major racial discrimination, and racial microaggressions against Black Canadians and their association with self-esteem and satisfaction with life, controlling for gender, age, job status, education, and matrimonial status. At least 4 out of 10 participants declared having being victims of everyday racial discrimination at least once per week. Between 46.3% and 64.2% of participants declared having been victims of major racial discrimination in various situations including education, job hiring, job dismissal, health services, housing, bank and loans, and police encounters. Significant gender differences were observed for everyday and major racial discrimination with higher frequencies among female participants. A total of 50.2% to 93.8% of participants declared having been victims of at least one episode of racial microaggressions. Results showed a significant negative association between racial discrimination and satisfaction with life (b = -0.26, p = .003), and self-esteem (b = -0.23, p = .009). This study highlights the need to stop colorblind policies in different sectors in Canada, and for a public commitment to combat racism at the municipal, provincial and federal levels. Implications are discussed for prevention, research and public health.
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Affiliation(s)
| | - Saba Hajizadeh
- School of Psychology, University of Ottawa, Ontario, Canada
| | - Rose Darly Dalexis
- Interdisciplinary School of Health Sciences, University of Ottawa, Ontario, Canada
| | | | | | - Cary Kogan
- School of Psychology, University of Ottawa, Ontario, Canada
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27
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Kogan CS, Noorishad PG, Ndengeyingoma A, Guerrier M, Cénat JM. Prevalence and correlates of anxiety symptoms among Black people in Canada: A significant role for everyday racial discrimination and racial microaggressions. J Affect Disord 2022; 308:545-553. [PMID: 35460740 DOI: 10.1016/j.jad.2022.04.110] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 03/29/2022] [Accepted: 04/14/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Anxiety disorders are highly prevalent worldwide but vary significantly by country and ethnoracial background. Minimal published data exist on the prevalence of clinically significant anxiety among Black people in Canada and none using validated measures. Therefore, this study sought to establish the frequency of clinically significant anxiety symptoms among a sample of Black people living in Canada as well as examine the association with two forms of racism (racial discrimination and racial microaggressions). METHODS Data collected from the Black Community Mental Health project in Canada was analyzed. Participants provided (N= 845) sociodemographic information and completed measures assessing anxiety symptomology (GAD-7), everyday racial discrimination, racial microaggressions, and resilience. Prevalence of anxiety symptomatology was determined across sociodemographic variables as well as categories of everyday racial discrimination and racial microaggressions. Two regression models were conducted to examine the relationship between anxiety symptoms and the two forms of racism controlling for sociodemographic factors. RESULTS Overall, nearly a third of participants endorsed clinically significant levels of anxiety symptoms, with higher rates observed among men, unemployed people, those with higher education, people who are separated, and those with no reported family history of mental health problems. Logistic regression models demonstrated that, except for those reporting the greatest frequency of racial discrimination, there is a general linear trend such that those experiencing higher levels of racial discrimination or racial microaggressions are increasingly more likely to present with anxiety symptoms when compared to those reporting low levels of discrimination or microaggressions. Psychological resilience afforded nominal protection but only against exposure to racial microaggressions. CONCLUSIONS Rates of clinically significant anxiety are higher among Black people in Canada than reported previously. Both racial discrimination and racial microaggressions predicted higher rates of anxiety symptoms. The results are discussed in relation to previous findings from the US that report similar findings.
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Affiliation(s)
- Cary S Kogan
- School of Psychology, University of Ottawa, Ontario, Canada; Interdisciplinary Centre for Black Health, University of Ottawa, Ontario, Canada.
| | | | | | | | - Jude Mary Cénat
- School of Psychology, University of Ottawa, Ontario, Canada; Interdisciplinary Centre for Black Health, University of Ottawa, Ontario, Canada.
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28
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Doan N, Olstad DL, Vanderlee L, Hammond D, Wallace M, Kirkpatrick SI. Investigating the Intersections of Racial Identity and Perceived Income Adequacy in Relation to Dietary Quality Among Adults in Canada. J Nutr 2022; 152:67S-75S. [PMID: 35544238 PMCID: PMC9188862 DOI: 10.1093/jn/nxac076] [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: 10/15/2021] [Revised: 02/16/2022] [Accepted: 03/22/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Structural racism and economic marginalization shape dietary patterns in complex ways. Most research examining race and income inequities discount their interactions in shaping dietary intakes. An intersectional approach is needed to identify interconnected sources of social inequities and to more precisely locate dietary inequities. OBJECTIVES We examined whether racial identity and perceived income adequacy independently and jointly shape dietary quality, defined using the Healthy Eating Index (HEI) 2015, among a large sample of adults in Canada. METHODS Cross-sectional data from 2540 adults (≥18 years of age) in Canada who participated in the 2019 International Food Policy Study were analyzed. Multivariable linear regression models were executed to test the independent associations and interactions between racial identity and perceived income adequacy with HEI-2015 scores. Models were constructed to examine HEI-2015 total and component scores, adjusting for age, gender, and education. RESULTS Perceived income adequacy, but not racial identity, was independently associated with HEI-2015 total scores. The interaction between racial identity and perceived income adequacy was significantly associated with HEI-2015 scores. Compared to the reference group (individuals identifying as White and reporting income adequacy), those identifying as Black and reporting income adequacy were associated with lower HEI-2015 scores (β, -7.30; 95% CI, -13.07 to -1.54) and those identifying as Black and reporting income inadequacy were associated with lower HEI-2015 scores (β, -6.37; 95% CI, -12.13 to -0.60). Individuals who identified as indigenous and reported neither income adequacy nor inadequacy had lower HEI-2015 scores (β, -8.50; 95% CI, -13.82 to -3.18) compared to the reference group. CONCLUSIONS Findings suggest that racial identity and perceived income adequacy jointly shape dietary quality. Inequities in dietary quality may be missed when intersecting racial identities and socioeconomic positions are not explicitly investigated. To support healthier dietary patterns, strategies must reduce socioeconomic barriers that impose dietary constraints on some racialized groups.
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Affiliation(s)
- Natalie Doan
- School of Public Health Sciences, University of Waterloo, Waterloo, Canada
| | - Dana Lee Olstad
- Department of Community Health Sciences, University of Calgary, Calgary, Canada
| | - Lana Vanderlee
- École de Nutrition, Centre Nutrition, santé et société (Centre NUTRISS), and Institut sur la nutrition et les aliments fonctionnels (INAF), Université Laval, Québec, Canada
| | - David Hammond
- School of Public Health Sciences, University of Waterloo, Waterloo, Canada
| | - Michael Wallace
- Department of Statistics and Actuarial Science, University of Waterloo, Waterloo, Canada
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29
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van Ingen T, Brown KA, Buchan SA, Akingbola S, Daneman N, Warren CM, Smith BT. Neighbourhood-level socio-demographic characteristics and risk of COVID-19 incidence and mortality in Ontario, Canada: A population-based study. PLoS One 2022; 17:e0276507. [PMID: 36264984 DOI: 10.1101/2021.01.27.21250618] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 10/07/2022] [Indexed: 05/21/2023] Open
Abstract
OBJECTIVES We aimed to estimate associations between COVID-19 incidence and mortality with neighbourhood-level immigration, race, housing, and socio-economic characteristics. METHODS We conducted a population-based study of 28,808 COVID-19 cases in the provincial reportable infectious disease surveillance systems (Public Health Case and Contact Management System) which includes all known COVID-19 infections and deaths from Ontario, Canada reported between January 23, 2020 and July 28, 2020. Residents of congregate settings, Indigenous communities living on reserves or small neighbourhoods with populations <1,000 were excluded. Comparing neighbourhoods in the 90th to the 10th percentiles of socio-demographic characteristics, we estimated the associations between 18 neighbourhood-level measures of immigration, race, housing and socio-economic characteristics and COVID-19 incidence and mortality using Poisson generalized linear mixed models. RESULTS Neighbourhoods with the highest proportion of immigrants (relative risk (RR): 4.0, 95%CI:3.5-4.5) and visible minority residents (RR: 3.3, 95%CI:2.9-3.7) showed the strongest association with COVID-19 incidence in adjusted models. Among individual race groups, COVID-19 incidence was highest among neighbourhoods with the high proportions of Black (RR: 2.4, 95%CI:2.2-2.6), South Asian (RR: 1.9, 95%CI:1.8-2.1), Latin American (RR: 1.8, 95%CI:1.6-2.0) and Middle Eastern (RR: 1.2, 95%CI:1.1-1.3) residents. Neighbourhoods with the highest average household size (RR: 1.9, 95%CI:1.7-2.1), proportion of multigenerational families (RR: 1.8, 95%CI:1.7-2.0) and unsuitably crowded housing (RR: 2.1, 95%CI:2.0-2.3) were associated with COVID-19 incidence. Neighbourhoods with the highest proportion of residents with less than high school education (RR: 1.6, 95%CI:1.4-1.8), low income (RR: 1.4, 95%CI:1.2-1.5) and unaffordable housing (RR: 1.6, 95%CI:1.4-1.8) were associated with COVID-19 incidence. Similar inequities were observed across neighbourhood-level sociodemographic characteristics and COVID-19 mortality. CONCLUSIONS Neighbourhood-level inequities in COVID-19 incidence and mortality were observed in Ontario, with excess burden experienced in neighbourhoods with a higher proportion of immigrants, racialized populations, large households and low socio-economic status.
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Affiliation(s)
| | - Kevin A Brown
- Public Health Ontario, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Sarah A Buchan
- Public Health Ontario, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | | | - Nick Daneman
- Public Health Ontario, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Division of Infectious Diseases, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | | | - Brendan T Smith
- Public Health Ontario, Toronto, Ontario, Canada
- Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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30
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Cénat JM, Kogan C, Noorishad PG, Hajizadeh S, Dalexis RD, Ndengeyingoma A, Guerrier M. Prevalence and correlates of depression among Black individuals in Canada: The major role of everyday racial discrimination. Depress Anxiety 2021; 38:886-895. [PMID: 33949750 DOI: 10.1002/da.23158] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 02/16/2021] [Accepted: 04/02/2021] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Depression is a common mental health problem causing significant disability globally, including in Canada. Prevalence estimates for depression within Black communities in Canada are unknown. This study determined the prevalence of depression in a sample of Black Canadians and the association between everyday racial discrimination experiences and depression. METHODS We analyzed data collected from the Black Community Mental Health project in Canada. Participants provided sociodemographic information and completed measures assessing depressive symptomology, everyday racial discrimination, and social support. The prevalence of depressive symptomatology was computed across sociodemographic variables and categories of everyday racial discrimination. Different regression models were conducted to examine the relationship between depressive symptoms and everyday racism controlling for sociodemographic factors. RESULTS In total, 65.87% of participants reported severe depressive symptoms, with higher rates among women, those who are employed, and those born in Canada. The linear regression models showed that everyday racial discrimination is the best predictor of depressive symptoms, with a final model explaining 25% of the variance. A logistic regression model demonstrated that those experiencing a high level of racial discrimination are 36.4 more likely to present severe depressive symptoms when compared to those reporting a low level of discrimination. CONCLUSIONS Rates of depressive symptoms among Black individuals are nearly six times the 12-month prevalence reported for the general population in Canada. Racial discrimination, which significantly predicts greater depressive symptomatology, is consistent with earlier studies in the United States and suggests that Canadian colorblind policies may inadvertently reinforce racial discrimination with detrimental effects on mental health.
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Affiliation(s)
- Jude Mary Cénat
- School of Psychology, Faculty of Social Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Cary Kogan
- School of Psychology, Faculty of Social Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Pari-Gole Noorishad
- School of Psychology, Faculty of Social Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Saba Hajizadeh
- School of Psychology, Faculty of Social Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Rose Darly Dalexis
- Interdisciplinary School of Health Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Mireille Guerrier
- School of Psychology, Faculty of Social Sciences, University of Ottawa, Ottawa, Ontario, Canada
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Leitch S, Corbin JH, Boston-Fisher N, Ayele C, Delobelle P, Gwanzura Ottemöller F, Matenga TFL, Mweemba O, Pederson A, Wicker J. Black Lives Matter in health promotion: moving from unspoken to outspoken. Health Promot Int 2021; 36:1160-1169. [PMID: 33305322 PMCID: PMC7953963 DOI: 10.1093/heapro/daaa121] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Racism is a public health crisis. Black communities (including Africans, the African diaspora and people of African descent) experience worse health outcomes as demonstrated by almost any measure of health and wellbeing-e.g. life expectancy; disease prevalence; maternal mortality rates. While health promotion has its foundation in promoting equity and social justice, it is clear that however well-intended, we are not affecting meaningful change for Black communities quickly enough. Through this article, we outline the intersection of social determinants of health and anti-Black racism. We describe how in the first 8 months of 2020 Black communities around the globe have been disproportionately affected by COVID-19, while also having to respond to new instances of police brutality. We assert that the time has come for health promotion to stop neutralizing the specific needs of Black communities into unspoken 'good intentions'. Instead, we offer some concrete ways for the field to become outspoken, intentional and honest in acknowledging what it will take to radically shift how we promote health and wellbeing for Black people.
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Affiliation(s)
- Stephanie Leitch
- TT Black Lives Matter, WOMANTRA, University of the West Indies, Trinidad and Tobago, St. Ann's Port of Spain
| | | | | | - Christa Ayele
- IUHPE’s Student and Early Career Network, Philadelphia, PA, USA
| | - Peter Delobelle
- University of Cape Town and University of Western Cape, and Vrije Universiteit Brussel, Brussels, Belgium
| | | | | | | | - Ann Pederson
- University of British Columbia, British Columbia, Canada
| | - Josette Wicker
- IUHPE’s Student and Early Career Network, Seattle, WA, USA
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Saddler N, Adams S, Robinson LA, Okafor I. Taking Initiative in Addressing Diversity in Medicine. CANADIAN JOURNAL OF SCIENCE, MATHEMATICS AND TECHNOLOGY EDUCATION = REVUE CANADIENNE DE L'ENSEIGNEMENT DES SCIENCES, DES MATHEMATIQUES ET DE LA TECHNOLOGIE 2021; 21:309-320. [PMID: 38624742 PMCID: PMC8294300 DOI: 10.1007/s42330-021-00154-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/20/2021] [Indexed: 04/17/2024]
Abstract
The existence of systemic racism in Canadian healthcare, among other determinants including accessible education, available occupation, and affordable housing, contributes to the racial divide in treatment and poor health outcomes for Black communities. Recent promising work has demonstrated patient-physician racial concordance in populations of colour as a potential area of focus for addressing health inequities for diverse communities. The impact of shared cultural experiences and cultural competency leads to mutual respect, trust, and improved communication between patients and physicians guiding their care. This approach is dependent on the availability of physicians of colour and similarly other healthcare providers. The Temerty Faculty of Medicine at the University of Toronto has attempted to address the deficit in its own community through a two-pronged approach: mentorship through the Community of Support (COS) and the Summer Mentorship Program (SMP), and the implementation of the Black Student Application Program (BSAP). These initiatives have significantly increased Black medical student representation and continue to have considerable impact on Black communities in the surrounding area. Through partnerships with community organizations that support the ethos of these programs, the vision of a more culturally diverse physician workforce in Canada has been reinforced. The adoption of similar programs across Canadian medical schools can lead to better representation within medicine and help contribute to a necessary culture shift within the ranks of medical institutions. These are critical steps in laying the foundation for a medical education grounded in equity, excellence, and strength in diversity, and a healthcare system that truly provides patient-centred care.
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Affiliation(s)
- Nelson Saddler
- Temerty Faculty of Medicine, University of Toronto, Medical Sciences Building, 1 King’s College Cir, Toronto, ON M5S 1A8 Canada
| | - Seana Adams
- Temerty Faculty of Medicine, University of Toronto, Medical Sciences Building, 1 King’s College Cir, Toronto, ON M5S 1A8 Canada
| | - Lisa A. Robinson
- Temerty Faculty of Medicine, University of Toronto, Medical Sciences Building, 1 King’s College Cir, Toronto, ON M5S 1A8 Canada
- Hospital for Sick Children, 555 University Avenue, Toronto, ON M5G 1X8 Canada
| | - Ike Okafor
- Temerty Faculty of Medicine, University of Toronto, Medical Sciences Building, 1 King’s College Cir, Toronto, ON M5S 1A8 Canada
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Abstract
OBJECTIVES Although comorbidity increases the health care and community support needs for patients, and the burden for the health care system, there are few population-based studies on comorbidity in patients with stroke. This study aims to evaluate the occurrence of important comorbidities among stroke patients in the Canadian population. METHODS Data from the population-based 2011-2012 Canadian Community Health Survey containing responses from 124,929 participants covering about 98% of the Canadian population when weighted were examined and analyzed by means of logistic regression models. RESULTS There was a statistically significant association between stroke history and multiple comorbid risk factors. Stroke prevalence increased in individuals with heart disease (odds ratio (OR): 3.80, 95% confidence interval (CI): 3.77-3.84), hypertension (OR: 1.97, 95% CI: 1.95-1.99), diabetes (OR: 1.74, 95% CI: 1.72-1.75), mood disorder (OR: 2.14, 95% CI: 2.12-2.17), and chronic obstructive pulmonary disease (COPD) (OR: 1.46, 95% CI: 1.44-1.48) compared to others without the condition. Of 2067 participants with stroke, 1680 (81.3%) had one or more comorbid conditions (heart disease, hypertension, diabetes, mood disorder, or COPD) that coexist with stroke and 48% had two or more. Comorbidity increased with age, and two-thirds of stroke patients with comorbid medical conditions were 60 years of age or older. CONCLUSION This population-based study provides evidence of comorbidity between stroke and other conditions that include heart disease, hypertension, diabetes, mood disorder, and COPD. Canadian individuals with stroke have a high burden of comorbidity. Health care systems need to recognize and respond to the strong association of comorbidity and stroke occurrence. This key factor should be considered when allocating resources.
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“It’s Not Just about Work and Living Conditions”: The Underestimation of the COVID-19 Pandemic for Black Canadian Women. SOCIAL SCIENCES-BASEL 2021. [DOI: 10.3390/socsci10060210] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The COVID-19 pandemic has increasingly been defined as the shecession for its disproportionate debilitating impact on women. Despite this gendered analysis, a number of health activists have called on governments to account for the experiences of Black communities as they are disproportionately suffering the effects of this pandemic. In the media’s address of the impact of the pandemic, we ask, what experiences are represented in news stories and are Black women present in these representations. Performing a content analysis of 108 news articles, a reading of media discourses through a racial lens reveals a homogenization of women’s experiences and an absence of the Black experience. In the small number of news stories that do focus on Black women, we see that the health disparities are not simply the result of precarious work and living conditions, but also the struggle against anti-Black racism on multiple fronts. In critiquing, however, we also bring forth the small number of news stories on the Black experience that speak to the desire and hope that can thrive outside of white supremacist structures.
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Stinchcombe A, Hammond NG. Correlates of memory and executive function in mid-aged and older adults in the CLSA: A minority stress approach. J Gerontol B Psychol Sci Soc Sci 2021; 77:1105-1117. [PMID: 33964152 DOI: 10.1093/geronb/gbab084] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Maintaining cognitive function is an important component of healthy aging. There is increasing recognition that extraneous factors expedite the typical cognitive aging process. Risk factors for cognitive decline cluster around inequalities and disproportionally affect minority and vulnerable groups. Taking a minority stress approach, we examined the relationship between proxy measures of minority stress and cognitive health in a large sample of Canadians aged 45-85 years. METHODS Data were drawn from the baseline of the Canadian Longitudinal Study on Aging (CLSA), a prospective cohort study. Memory (n = 36,849) and executive function (n = 36,266) were assessed using standardized assessment tools. We ran multiple linear regression models with memory and executive function as the outcomes. Explanatory variables included known correlates of cognitive health (i.e., demographic, health, and cognitive reserve) and proxy measures of minority stress (i.e., sexual orientation, race, and perceived social standing). RESULTS Results were consistent with existing evidence showing that demographic and health variables were associated with cognitive performance. Modifiable health variables, walking and fruit/ vegetable consumption were associated with better cognitive performance, as were cognitive reserve and social support measures. Within the models, racial minority status was consistently associated with lower cognitive performance. As one's perceived social standing within their own community increased, so too did cognitive function. DISCUSSION These findings identify factors that may put people at risk for cognitive decline. There is a need to support the cognitive health of racialized Canadians and members of other disadvantaged groups, while promoting health equity.
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Affiliation(s)
- Arne Stinchcombe
- Department of Recreation and Leisure, Brock University, St. Catharines, Ontario, Canada
| | - Nicole G Hammond
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
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Choi KH, Denice P, Haan M, Zajacova A. Studying the social determinants of COVID-19 in a data vacuum. CANADIAN REVIEW OF SOCIOLOGY = REVUE CANADIENNE DE SOCIOLOGIE 2021; 58:146-164. [PMID: 33942533 PMCID: PMC8206942 DOI: 10.1111/cars.12336] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
Race-based and other demographic information on COVID-19 patients is not being collected consistently across provinces in Canada. Therefore, whether the burden of COVID-19 is falling disproportionately on the shoulders of particular demographic groups is relatively unknown. In this article, we first provide an overview of the available geographic and demographic data related to COVID-19. We then make creative use of these existing data to fill the vacuum and identify key demographic risk factors for COVID-19 across Canada's health regions. Drawing on COVID-19 counts and tabular census data, we examine the association between communities' demographic composition and the number of COVID-19 infections. COVID-19 infections are higher in communities with larger shares of Black and low-income residents. Our approach offers a way for researchers and policymakers to use existing data to identify communities nationwide that are vulnerable to the pandemic in the absence of more detailed demographic and more granular geographic data.
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Affiliation(s)
- Kate H. Choi
- Department of SociologyUniversity of Western OntarioLondonONCanada
| | - Patrick Denice
- Department of SociologyUniversity of Western OntarioLondonONCanada
| | - Michael Haan
- Department of SociologyUniversity of Western OntarioLondonONCanada
| | - Anna Zajacova
- Department of SociologyUniversity of Western OntarioLondonONCanada
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Okoye HU, Saewyc E. Fifteen-year trends in self-reported racism and link with health and well-being of African Canadian adolescents: a secondary data analysis. Int J Equity Health 2021; 20:108. [PMID: 33902594 PMCID: PMC8077748 DOI: 10.1186/s12939-021-01446-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 04/12/2021] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND We assessed the prevalence and trends in racial discrimination among African Canadian adolescents in British Columbia. The association between racial discrimination and self-rated health, access to mental health services, substance use, suicidal thoughts and attempts, experience of extreme stress, among others were examined within the 2018 dataset. METHODS Secondary analysis used the data collected from African Canadian adolescents (n = 2448) as part of the British Columbia Adolescent Health Surveys (2003-2018). We examined whether racial discrimination increased, decreased, or remained stable over time. We evaluated experiences of racial discrimination for all adolescents, and then disaggregated analyses for boys, girls, immigrant, and Canadian-born African adolescents. We used Rao-Scott's adjusted chi-square to test differences in racial discrimination and adjusted logistic regressions to test trends across survey years, widening or narrowing gaps in racial discrimination, as well as the link to health outcomes. RESULTS Racial discrimination was significantly different across the survey years (Adjusted F = 4.60, p < .01), with the highest percentage of adolescents reporting past year racial discrimination in 2018 (29.9%) and the lowest percentage in 2013 (21.3%). Girls and immigrant African Canadian adolescents were more likely to have experienced racial discrimination. However, girls and Canadian-born adolescents had the highest odds of reporting racial discrimination in 2018 compared to 2003, AOR = 1.85, and 1.58, respectively. The findings reveal significant differences in the experiences of racial discrimination for boys and girls, as well as for immigrant and Canadian-born African adolescents. Significant differences were noted in the link between racial discrimination and self-rated health and engaging in behaviours that might expose them to health risks. The worst negative health outcomes were found for boys and immigrant African Canadian adolescents. CONCLUSION The study suggests that more than 1 in 4 African Canadian adolescents in British Columbia report racial discrimination, which is an increasing trend in recent years. Those who reported racial discrimination also had the worst adverse health outcomes. There is a need for more public health action to reduce racism, create awareness about the negative health impacts, and provide better support for African Canadian adolescents.
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Affiliation(s)
- Helen U Okoye
- University of British Columbia, School of Nursing, Vancouver, British Columbia, Canada.
| | - Elizabeth Saewyc
- University of British Columbia, School of Nursing, Vancouver, British Columbia, Canada
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Mahabir DF, O’Campo P, Lofters A, Shankardass K, Salmon C, Muntaner C. Experiences of everyday racism in Toronto's health care system: a concept mapping study. Int J Equity Health 2021; 20:74. [PMID: 33691682 PMCID: PMC7943708 DOI: 10.1186/s12939-021-01410-9] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 02/14/2021] [Indexed: 03/26/2023] Open
Abstract
BACKGROUND In Canada, there is longstanding evidence of health inequities for racialized groups. The purpose of this study is to understand the effect of current health care policies and practices on racial/ethnic groups and in particular racialized groups at the level of the individual in Toronto's health care system. METHODS This study used a semi-qualitative study design: concept mapping. A purposive sampling strategy was used to recruit participants. Health care users and health care providers from Toronto and the Greater Toronto Area participated in all four concept mapping activities. The sample sizes varied according to the activity. For the rating activity, 41 racialized health care users, 23 non-racialized health care users and 11 health care providers completed this activity. The data analysis was completed using the concept systems software. RESULTS Participants generated 35 unique statements of ways in which patients feel disrespect or mistreatment when receiving health care. These statements were grouped into five clusters: 'Racial/ethnic and class discrimination', 'Dehumanizing the patient', 'Negligent communication', 'Professional misconduct', and 'Unequal access to health and health services'. Two distinct conceptual regions were identified: 'Viewed as inferior' and 'Unequal medical access'. From the rating activity, racialized health care users reported 'race'/ethnic based discrimination or everyday racism as largely contributing to the challenges experienced when receiving health care; statements rated high for action/change include 'when the health care provider does not complete a proper assessment', 'when the patient's symptoms are ignored or not taken seriously', 'and 'when the health care provider belittles or talks down to the patient'. CONCLUSIONS Our study identifies how racialized health care users experience everyday racism when receiving health care and this is important to consider in the development of future research and interventions aimed at addressing institutional racism in the health care setting. To support the elimination of institutional racism, anti-racist policies are needed to move beyond cultural competence polices and towards addressing the centrality of unequal power social relations and everyday racism in the health care system.
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Affiliation(s)
- Deb Finn Mahabir
- Faculty of Nursing, University of Toronto, 155 College Street, Suite 130, Toronto, Ontario M5T 1P8 Canada
| | - Patricia O’Campo
- MAP Centre for Urban Health Solutions, 30 Bond Street, Toronto, Ontario M5B 1W8 Canada
| | - Aisha Lofters
- Women’s College Hospital, 76 Grenville St., Toronto, M5S 1B2 Canada
| | - Ketan Shankardass
- Department of Health Sciences, Wilfrid Laurier University, 75 University Avenue West, Waterloo, Ontario N2L 3C5 Canada
| | - Christina Salmon
- Knowledge Translation Li Ka Shing Knowledge Institute, St. Michael’s Hospital, 209 Victoria Street, Toronto, ON M5B 1T8 Canada
| | - Carles Muntaner
- Faculty of Nursing, University of Toronto, 155 College Street, Suite 130, Toronto, Ontario M5T 1P8 Canada
- Dalla Lana School of Public Health, University of Toronto, 155 College St., Toronto, Ontario M5T 3M7 Canada
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Cobb S, Javanbakht A, Khalifeh Soltani E, Bazargan M, Assari S. Racial Difference in the Relationship Between Health and Happiness in the United States. Psychol Res Behav Manag 2020; 13:481-490. [PMID: 32547270 PMCID: PMC7259486 DOI: 10.2147/prbm.s248633] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 03/24/2020] [Indexed: 02/03/2023] Open
Abstract
Background Although health is a prerequisite for happiness, the salience of health for maintaining happiness may be diminished for Blacks when compared to Whites, a phenomenon which can be explained by the Black-White mental health paradox and minorities’ diminished returns. Aim To understand if Black and White adult Americans differ in the effects of self-rated health (SRH) on happiness. Methods This cross-sectional study used data from the General Social Survey (GSS; 1972–2018), a nationally representative survey in the US. Our analytical sample included 42,201 Black and White adults. The independent variable was SRH. Happiness was the dependent variable. Sociodemographic factors were covariates. Race was the moderator. Logistic regression was used to analyze the data without and with interaction terms between race and SRH. Results Overall, good SRH was positively associated with happiness, however, there was a significant interaction between race/ethnicity and good SRH on the outcome (i.e. happiness) . This finding suggested that the boosting effect of good SRH on happiness is weaker for Black than White people. Conclusion In the United States, due to a weaker concordance between good health and happiness, Blacks who have poor SRH are more likely to report happiness. At the same time, Whites who are healthy report happiness, however, Blacks who are healthy do not necessarily report happiness. Disjointed link between health and happiness may be due to different racial, ethnic, and cultural perceptions of physical health and happiness as well as salience of physical health as a component of happiness. This may be an adaptive response of Blacks to sociopolitical as well as health-related adversities over centuries as a result of the combination of oppression, injustice, and poverty.
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Affiliation(s)
- Sharon Cobb
- School of Nursing, Charles R Drew University of Medicine and Science, Los Angeles, CA, USA
| | - Arash Javanbakht
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit, MI, USA
| | | | - Mohsen Bazargan
- Department of Family Medicine, Charles R Drew University of Medicine and Science, Los Angeles, CA, USA.,Department of Family Medicine, UCLA, Los Angeles, CA, USA
| | - Shervin Assari
- Department of Family Medicine, Charles R Drew University of Medicine and Science, Los Angeles, CA, USA
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Husbands W, Oakes W, Mbulaheni T, Ongoïba F, Pierre-Pierre V, Luyombya H. Resourceful masculinities: exploring heterosexual Black men's vulnerability to HIV in Ontario, Canada. ETHNICITY & HEALTH 2020; 25:17-33. [PMID: 29082777 DOI: 10.1080/13557858.2017.1395817] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Accepted: 10/16/2017] [Indexed: 06/07/2023]
Abstract
Objectives: Heterosexually active Black men are alleged to endorse masculine norms that increase their and their female partners' vulnerability to HIV. These norms include Black men's inability or reluctance to productively engage their own health-related personal and interpersonal vulnerabilities. We draw on data from the iSpeak research study in Ontario, Canada, to assess whether and how heterosexual Black men cope with personal and inter-personal vulnerability, namely that heterosexual Black men: avoid emotionally supportive relationships with other men (and women), which diminishes their capacity to productively acknowledge and resolve their health-related challenges; are reticent to productively acknowledge and address HIV and health on a personal level; and are pathologically secretive about their health, which compounds their vulnerability and precipitates poor health outcomes.Design: iSpeak was implemented in 2011 to 2013, and included two focus groups with HIV-positive and HIV-negative self-identified heterosexual men (N = 14) in Toronto and London, a focus group with community-based health promotion practitioners who provide HIV-related services to Black communities in Ontario (N = 6), and one-on-one interviews with four researchers distinguished for their scholarship with/among Black communities in Toronto. Participants in the men's focus group were recruited discretely through word-of-mouth. Focus groups were audiotaped and transcribed verbatim. Team members independently read the transcripts, and then met to identify, discuss and agree on the emerging themes.Results: We demonstrate that iSpeak participants (a) engage their personal and interpersonal vulnerabilities creatively and strategically, (b) complicate and challenge familiar interpretations of Black men's allegedly transgressive masculinity through their emotional and practical investment in their health, and (c) demonstrate a form of resourceful masculinity that ambiguously aligns with patriarchy.Conclusion: We conclude with a range of actionable recommendations to strengthen the discursive framework for understanding heterosexual Black men in relation to HIV and health, and substantively engaging them in community responses to HIV.
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Affiliation(s)
| | - Wesley Oakes
- Africans in Partnership Against AIDS, Toronto, ON, Canada
| | - Tola Mbulaheni
- African and Caribbean Council on HIV/AIDS in Ontario, Toronto, ON, Canada
| | - Fanta Ongoïba
- Africans in Partnership Against AIDS, Toronto, ON, Canada
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Veenstra G. Black, White, Black and White: mixed race and health in Canada. ETHNICITY & HEALTH 2019; 24:113-124. [PMID: 28393550 DOI: 10.1080/13557858.2017.1315374] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Accepted: 03/18/2017] [Indexed: 06/07/2023]
Abstract
Objectives: To document inequalities in hypertension, self-rated health, and self-rated mental health between Canadian adults who identify as Black, White, or Black and White and determine whether differences in educational attainment and household income explain them. Design: The dataset was comprised of ten cycles (2001-2013) of the Canadian Community Health Survey. The health inequalities were examined by way of binary logistic regression modeling of hypertension and multinomial logistic regression modeling of self-rated health and self-rated mental health. Educational attainment and household income were investigated as potentially mediating factors using nested models and the Karlson-Holm-Breen decomposition technique. Results: Black respondents were significantly more likely than White respondents to report hypertension, a disparity that was partly attributable to differences in income. White respondents reported the best and Black respondents reported the worst overall self-rated health, a disparity that was entirely attributable to income differences. Respondents who identified as both Black and White were significantly more likely than White respondents to report fair or poor mental health, a disparity that was partly attributable to income differences. After controlling for income, Black respondents were significantly less likely than White respondents to report fair or poor mental health. Educational attainment did not contribute to explaining any of these associations. Conclusion: Canadians who identify as both Black and White fall between Black Canadians and White Canadians in regards to self-rated overall health, report the worst self-rated mental health of the three populations, and, with White Canadians, are the least likely to report hypertension. These heterogeneous findings are indicative of a range of diverse processes operative in the production of Black-White health inequalities in Canada.
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Affiliation(s)
- Gerry Veenstra
- a Department of Sociology , University of British Columbia , Vancouver , Canada
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Abstract
In the past few decades, most new immigrants to Canada have originated from non-Christian countries. During the same period, the unaffiliation rates have sharply increased in Canada. This paper investigates whether there are any health inequalities associated with religious identity, including also the individuals who do not identify with organized religion in the analysis. The study uses the Canadian General Social Survey of 2012 (N = 23,093), focused on Caregiving and Care-receiving. Employing multivariate regression analysis and controlling for a large set of characteristics inclusive of the degree of religious commitment, individuals who identify as Protestant are found at a physical and mental health advantage, compared with Roman Catholics and most other groups. On the other hand, individuals who identify as Jehovah's Witnesses are found at a considerable physical health disadvantage. Among the unaffiliated individuals, those who have retained some ties with organized religion without formally identifying with it are found at a mental health disadvantage compared with all religious groups, as well as the secular individuals who are strictly committed to their nonreligious views. Possible causes and various implications are discussed.
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Affiliation(s)
- Maryam Dilmaghani
- Department of Economics, Sobey School of Business, Saint Mary's University, 923 Robie Street, Halifax, NS, B3H 3C3, Canada.
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Blanchet R, Nana CP, Sanou D, Batal M, Giroux I. Dietary acculturation among black immigrant families living in Ottawa—a qualitative study. Ecol Food Nutr 2018; 57:223-245. [DOI: 10.1080/03670244.2018.1455674] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Rosanne Blanchet
- School of Nutrition Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Canada
| | - Constance P. Nana
- School of Nutrition Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Canada
| | - Dia Sanou
- FAO Sub Regional Office for Eastern Africa, Addis Abeba, Ethiopia
| | - Malek Batal
- TRANSNUT, Department of Nutrition, Faculty of Medicine, University of Montreal, Montreal, Canada
| | - Isabelle Giroux
- School of Nutrition Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Canada
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Jongen C, McCalman J, Bainbridge R, Clifford A. Cultural Competence Strengths, Weaknesses and Future Directions. SPRINGERBRIEFS IN PUBLIC HEALTH 2018. [DOI: 10.1007/978-981-10-5293-4_8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Gagné T, Veenstra G. Inequalities in Hypertension and Diabetes in Canada: Intersections between Racial Identity, Gender, and Income. Ethn Dis 2017; 27:371-378. [PMID: 29225437 DOI: 10.18865/ed.27.4.371] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
A growing body of research from the United States informed by intersectionality theory indicates that racial identity, gender, and income are often entwined with one another as determinants of health in unexpectedly complex ways. Research of this kind from Canada is scarce, however. Using data pooled from ten cycles (2001-2013) of the Canadian Community Health Survey, we regressed hypertension (HT) and diabetes (DM) on income in subsamples of Black women (n = 3,506), White women (n = 336,341), Black men (n = 2,806) and White men (n = 271,260). An increase of one decile in income was associated with lower odds of hypertension and diabetes among White men (ORHT = .98, 95% CI (.97, .99); ORDM = .93, 95% CI (.92, .94)) and White women (ORHT = .95, 95% CI (.95, .96); ORDM = .90, 95% CI (.89, .91)). In contrast, an increase of one decile in income was not associated with either health outcome among Black men (ORHT = .99, 95% CI (.92, 1.06); ORDM = .99, 95% CI (.91, 1.08)) and strongly associated with both outcomes among Black women (ORHT = .86, 95% CI (.80, .92); ORDM = .83, 95% CI (.75, .92)). Our findings highlight the complexity of the unequal distribution of hypertension and diabetes, which includes inordinately high risks of both outcomes for poor Black women and an absence of associations between income and both outcomes for Black men in Canada. These results suggest that an intersectionality framework can contribute to uncovering health inequalities in Canada.
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Affiliation(s)
- Thierry Gagné
- Département de médecine sociale et préventive, Université de Montréal, Canada.,Institut de Recherche en Santé Publique de l'Université de Montréal (IRSPUM), Canada
| | - Gerry Veenstra
- Department of Sociology, University of British Columbia, Canada
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Trinh E, Na Y, Sood MM, Chan CT, Perl J. Racial Differences in Home Dialysis Utilization and Outcomes in Canada. Clin J Am Soc Nephrol 2017; 12:1841-1851. [PMID: 28835369 PMCID: PMC5672971 DOI: 10.2215/cjn.03820417] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Accepted: 07/17/2017] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND OBJECTIVES Data on racial disparities in home dialysis utilization and outcomes are lacking in Canada, where health care is universally available. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS We studied patients starting maintenance dialysis between 1996 and 2012 in the Canadian Organ Replacement Register, stratified by race: white, Asian, black, Aboriginal, Indian subcontinent, and other. The association between race and treatment with home dialysis was examined using generalized linear models. Secondary outcomes assessed racial differences in all-cause mortality and technique failure using a Fine and Gray competing risk model. RESULTS 66,600 patients initiated chronic dialysis between 1996 and 2012. Compared with whites (n=46,092), treatment with home dialysis was lower among Aboriginals (n=3866; adjusted relative risk, RR, 0.71; 95% confidence interval, CI, 0.66 to 0.76) and higher in Asians (n=4157; adjusted RR, 1.28; 95% CI, 1.22 to 1.35) and others (n=2170; adjusted RR, 1.12; 95% CI, 1.04 to 1.20) but similar in blacks (n=2143) and subcontinent Indians (n=2809). Black (adjusted hazard ratio, HR, 1.31; 95% CI, 1.16 to 1.48) and Aboriginal (adjusted HR, 1.19; 95% CI, 1.06 to 1.33) patients treated with peritoneal dialysis had a significantly higher adjusted risk of technique failure compared with whites, whereas Asians had a lower risk (adjusted HR, 0.89; 95% CI, 0.82 to 0.99). In patients on peritoneal dialysis, the risk of death was significantly lower in Asians (adjusted HR, 0.83; 95% CI, 0.75 to 0.92), blacks (adjusted HR, 0.71; 95% CI, 0.59 to 0.85), and others (adjusted HR, 0.79; 95% CI, 0.68 to 0.92) but higher in Aboriginals (adjusted HR, 1.16; 95% CI, 1.02 to 1.32) compared with whites. Among patients on home hemodialysis, no significant racial differences in patient and technique survival were observed, which may be limited by the low number of events among each subgroups. CONCLUSIONS With the exception of Aboriginals, all racial minority groups in Canada were as likely to be treated with home dialysis compared with whites. However, significant racial differences exist in outcomes.
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Affiliation(s)
- Emilie Trinh
- Division of Nephrology, University Health Network, Toronto, Ontario, Canada
| | - Yingbo Na
- Division of Nephrology, St. Michael’s Hospital and the Keenan Research Center in the Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada; and
| | - Manish M. Sood
- Division of Nephrology, The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | | | - Jeffrey Perl
- Division of Nephrology, St. Michael’s Hospital and the Keenan Research Center in the Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada; and
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King B, Fallon B, Boyd R, Black T, Antwi-Boasiako K, O'Connor C. Factors associated with racial differences in child welfare investigative decision-making in Ontario, Canada. CHILD ABUSE & NEGLECT 2017; 73:89-105. [PMID: 28950215 DOI: 10.1016/j.chiabu.2017.09.027] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Revised: 09/13/2017] [Accepted: 09/18/2017] [Indexed: 06/07/2023]
Abstract
Despite the substantial body of literature on racial disparities in child welfare involvement in the Unites States, there is relatively little research on such differences for Canadian children and families. This study begins to address this gap by examining decision-making among workers investigating Black and White families investigated for child protection concerns in Ontario, Canada. Using provincially representative data, the study assessed whether Black children were more likely than White children to be investigated by child welfare, if there was disparate decision-making by race throughout the investigation, and how the characteristics of Black and White children contribute to the decision to transfer to ongoing services. The results indicate that Black children were more likely to be investigated than White children, but there was little evidence to suggest that workers in Ontario child welfare agencies made the decision to substantiate, transfer to ongoing services, or place the child in out-of-home care based on race alone. Black and White children differed significantly with respect to child characteristics, characteristics of the investigation, caregiver risk factors, and socioeconomic circumstances. When adjusting for these characteristics, Black families had 33% greater odds (OR=1.33; 95% CI: 1.26, 1.40; p=<0.001) of being transferred to ongoing services compared to White families. Among Black families, the assessed quality of the parent-child relationship and severe economic hardship were the most significant and substantial contributors to the decision to provide child welfare services. Implications for practice, policy, and research are discussed.
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Affiliation(s)
- Bryn King
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street West, Toronto, ON M5S 1V4, Canada.
| | - Barbara Fallon
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street West, Toronto, ON M5S 1V4, Canada.
| | - Reiko Boyd
- Graduate College of Social Work, University of Houston, 3511 Cullen Blvd Room 110HA, Houston, TX 77204-4013 USA.
| | - Tara Black
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street West, Toronto, ON M5S 1V4, Canada.
| | - Kofi Antwi-Boasiako
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street West, Toronto, ON M5S 1V4, Canada.
| | - Carolyn O'Connor
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street West, Toronto, ON M5S 1V4, Canada.
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Siddiqi A, Shahidi FV, Ramraj C, Williams DR. Associations between race, discrimination and risk for chronic disease in a population-based sample from Canada. Soc Sci Med 2017; 194:135-141. [PMID: 29100138 DOI: 10.1016/j.socscimed.2017.10.009] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2016] [Revised: 07/11/2017] [Accepted: 10/11/2017] [Indexed: 12/15/2022]
Abstract
A major epidemiological finding emerging from studies using U.S. samples is that racial differences in experiences of discrimination are associated with racial differences in health. A newer area of research is exploring the population-level dynamics between race, discrimination, and health status in various societies. The objective of this study is to assess for the first time in a national sample from Canada: (a) racial differences in experiences of discrimination and, (b) the association between discrimination and chronic conditions and their major risk factors. Data were obtained from the 2013 Canadian Community Health Survey (n = 16,836). Race was categorized as Aboriginal, Asian, Black, or White. Discrimination was measured using the Williams Everyday Discrimination Scale. Outcomes included having any chronic condition or major risk factors (obesity, hypertension, smoking, binge drinking, infrequent physical activity, and poor self-rated health). Crude and adjusted (for age, sex, immigrant status, socioeconomics) logistic regressions modeled the association between (a) race and discrimination and, (b) discrimination and each outcome. Results indicated that Blacks were most likely to experience discrimination, followed by Aboriginals. For example, Blacks were almost twice as likely (OR: 1.92, 95% CI: 1.19-3.11), and Aboriginals 75 percent more likely (OR: 1.75, 95% CI: 1.37-2.22) to report being treated with less courtesy or respect than others. Blacks were more than four times as likely (OR: 4.27, 95% CI: 2.23-8.19), and Aboriginals more than twice as likely (OR: 2.26, 95% CI: 1.66-3.08) to report being feared by others. Asians were not statistically different from Whites. With two exceptions (binge drinking and physical activity), discrimination was associated with chronic conditions and their risk factors (OR for any chronic condition: 1.78, 95% CI: 1.52-2.08). Initial results suggest that in Canada, experience of discrimination is a determinant of chronic disease and chronic disease risk factors, and Blacks and Aboriginals are far more exposed to experiences of discrimination.
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Affiliation(s)
- Arjumand Siddiqi
- Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada; Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina - Chapel Hill, Chapel Hill, United States.
| | - Faraz Vahid Shahidi
- Division of Social and Behavioural Health Sciences, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Chantel Ramraj
- Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - David R Williams
- Department of Social and Behavioral Sciences, Harvard School of Public Health, Harvard University, Boston, United States; Departments of African and African American Studies and Sociology, Harvard University, Cambridge, United States
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Blanchet R, Sanou D, Nana CP, Pauzé E, Batal M, Giroux I. Strategies and Challenges in Recruiting Black Immigrant Mothers for a Community-Based Study on Child Nutritional Health in Ottawa, Canada. J Immigr Minor Health 2016; 19:367-372. [DOI: 10.1007/s10903-016-0536-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Patterson AC, Veenstra G. Black-White health inequalities in Canada at the intersection of gender and immigration. Canadian Journal of Public Health 2016; 107:e278-e284. [PMID: 27763843 DOI: 10.17269/cjph.107.5336] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Revised: 04/27/2016] [Accepted: 02/14/2016] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Intersectionality theory proposes that each combination of social categories derived from gender, race and nationality, such as immigrant White man or native-born Black woman, is associated with unique social experiences. We tested the potential of intersectionality theory for explicating racial inequalities in Canada by investigating whether Black-White health inequalities are conditioned by gender and immigrant status in a synergistic way. METHODS Our dataset comprised 10 cycles (2001-2013) of the Canadian Community Health Survey. We used binary logistic regression to model Black- White inequalities in hypertension, diabetes, self-rated health, self-rated mental health and asthma separately for native-born women, native-born men, immigrant women and immigrant men. RESULTS After controlling for potentially confounding factors we found that immigrant Black women had significantly higher odds of hypertension, diabetes and fair/poor self-rated health than immigrant White women. Native-born Black women and immigrant Black men had higher odds of hypertension and diabetes than native-born White women and immigrant White men respectively, and native-born White women were more likely than native-born Black women to report asthma. There were no statistically significant health differences between native-born Black and White men. Socio-economic status, smoking, physical activity and body mass index were implicated in some but not all of these racial health inequalities. None of the three-way interactions between racial identity, gender and immigration status was statistically significant. CONCLUSION We found relatively high risks of ill health for Black Canadians in three of the four samples. Overall, however, we found little support for the intersectional hypothesis that Black-White health inequalities in Canada are conditioned by gender and immigrant status in a synergistic way.
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Affiliation(s)
- Andrew C Patterson
- Prentice Institute for Global Population and Economy, University of Lethbridge, Lethbridge, AB.
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