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LeBrón AMW, Rodriguez VE, Sinco BR, Caldwell CH, Kieffer EC. Racialization processes and depressive symptoms among pregnant Mexican-origin immigrant women. AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY 2024. [PMID: 38713848 DOI: 10.1002/ajcp.12755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 01/22/2024] [Accepted: 04/24/2024] [Indexed: 05/09/2024]
Abstract
This study examines how racialization processes (conceptualized as multilevel and dynamic processes) shape prenatal mental health by testing the association of discrimination and the John Henryism hypothesis on depressive symptoms for pregnant Mexican-origin immigrant women. We analyzed baseline data (n = 218) from a healthy lifestyle intervention for pregnant Latinas in Detroit, Michigan. Using separate multiple linear regression models, we examined the independent and joint associations of discrimination and John Henryism with depressive symptoms and effect modification by socioeconomic position. Discrimination was positively associated with depressive symptoms (β = 2.84; p < .001) when adjusting for covariates. This association did not vary by socioeconomic position. Women primarily attributed discrimination to language use, racial background, and nativity. We did not find support for the John Henryism hypothesis, meaning that the hypothesized association between John Henryism and depressive symptoms did not vary by socioeconomic position. Examinations of joint associations of discrimination and John Henryism on depressive symptoms indicate a positive association between discrimination and depressive symptoms (β = 2.81; p < .001) and no association of John Henryism and depressive symptoms (β = -0.83; p > .05). Results suggest complex pathways by which racialization processes affect health and highlight the importance of considering experiences of race, class, and gender within racialization processes.
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Affiliation(s)
- Alana M W LeBrón
- Department of Health, Society, and Behavior, Program in Public Health, University of California, Irvine, Irvine, California, USA
- Department of Chicano/Latino Studies, School of Social Sciences, University of California, Irvine, Irvine, California, USA
| | - Victoria E Rodriguez
- Department of Health, Society, and Behavior, Program in Public Health, University of California, Irvine, Irvine, California, USA
| | - Brandy R Sinco
- School of Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Cleopatra H Caldwell
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Edith C Kieffer
- School of Social Work, University of Michigan, Ann Arbor, Michigan, USA
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Cooper ZW, Mowbray O, Johnson L. Social determinants of health and diabetes: using a nationally representative sample to determine which social determinant of health model best predicts diabetes risk. Clin Diabetes Endocrinol 2024; 10:4. [PMID: 38402223 PMCID: PMC10894485 DOI: 10.1186/s40842-023-00162-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 12/12/2023] [Indexed: 02/26/2024] Open
Abstract
OBJECTIVES Social determinants of health (SDOH) research demonstrates poverty, access to healthcare, discrimination, and environmental factors influence health outcomes. Several models are commonly used to assess SDOH, yet there is limited understanding of how these models differ regarding their ability to predict the influence of social determinants on diabetes risk. This study compares the utility of four SDOH models for predicting diabetes disparities. STUDY DESIGN We utilized The National Longitudinal Study of Adolescent to Adulthood (Add Health) to compare SDOH models and their ability to predict risk of diabetes and obesity. METHODS Previous literature has identified the World Health Organization (WHO), Healthy People, County Health Rankings, and Kaiser Family Foundation as the conventional SDOH models. We used these models to operationalize SDOH using the Add Health dataset. Add Health data were used to perform logistic regressions for HbA1c and linear regressions for body mass index (BMI). RESULTS The Kaiser model accounted for the largest proportion of variance (19%) in BMI. Race/ethnicity was a consistent factor predicting BMI across models. Regarding HbA1c, the Kaiser model also accounted for the largest proportion of variance (17%). Race/ethnicity and wealth was a consistent factor predicting HbA1c across models. CONCLUSION Policy and practice interventions should consider these factors when screening for and addressing the effects of SDOH on diabetes risk. Specific SDOH models can be constructed for diabetes based on which determinants have the largest predictive value.
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Affiliation(s)
- Zach W Cooper
- University of Georgia School of Social Work, 279 Williams Street, Athens, GA, 30602, Georgia.
| | - Orion Mowbray
- University of Georgia School of Social Work, 279 Williams Street, Athens, GA, 30602, Georgia
| | - Leslie Johnson
- Department of Family and Preventative Medicine, School of Medicine, Emory University, Atlanta, Georgia
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3
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Bailey SC, Pack AP, Wismer G, Calderon N, Velazquez E, Batio S, Ekong A, Eggleston A, Wallia A, Wolf MS, Schauer JM, Tenfelde S, Liebovitz DM, Grobman WA. Promoting REproductive Planning And REadiness in Diabetes (PREPARED) Study protocol: a clinic-randomised controlled trial testing a technology-based strategy to promote preconception care for women with type 2 diabetes. BMJ Open 2023; 13:e078282. [PMID: 37940161 PMCID: PMC10632823 DOI: 10.1136/bmjopen-2023-078282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 10/16/2023] [Indexed: 11/10/2023] Open
Abstract
INTRODUCTION Women with type 2 diabetes (T2DM) are more likely to experience adverse reproductive outcomes, yet preconception care can significantly reduce these risks. For women with T2DM, preconception care includes reproductive planning and patient education on: (1) the importance of achieving glycaemic control before pregnancy, (2) using effective contraception until pregnancy is desired, (3) discontinuing teratogenic medications if pregnancy could occur, (4) taking folic acid, and (5) managing cardiovascular and other risks. Despite its importance, few women with T2DM receive recommended preconception care. METHODS AND ANALYSIS We are conducting a two-arm, clinic-randomised trial at 51 primary care practices in Chicago, Illinois to evaluate a technology-based strategy to 'hardwire' preconception care for women of reproductive age with T2DM (the PREPARED (Promoting REproductive Planning And REadiness in Diabetes) strategy) versus usual care. PREPARED leverages electronic health record (EHR) technology before and during primary care visits to: (1) promote medication safety, (2) prompt preconception counselling and reproductive planning, and (3) deliver patient-friendly educational tools to reinforce counselling. Post-visit, text messaging is used to: (4) encourage healthy lifestyle behaviours. English and Spanish-speaking women, aged 18-44 years, with T2DM will be enrolled (N=840; n=420 per arm) and will receive either PREPARED or usual care based on their clinic's assignment. Data will be collected from patient interviews and the EHR. Outcomes include haemoglobin A1c (primary), reproductive knowledge and self-management behaviours. We will use generalised linear mixed-effects models (GLMMs) to evaluate the impact of PREPARED on these outcomes. GLMMs will include a fixed effect for treatment assignment (PREPARED vs usual care) and random clinic effects. ETHICS AND DISSEMINATION This study was approved by the Northwestern University Institutional Review Board (STU00214604). Study results will be published in journals with summaries shared online and with participants upon request. TRIAL REGISTRATION NUMBER ClinicalTrials.gov Registry (NCT04976881).
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Affiliation(s)
- Stacy C Bailey
- Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Allison P Pack
- Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Guisselle Wismer
- Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Norma Calderon
- Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Evelyn Velazquez
- Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Stephanie Batio
- Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | | | | | - Amisha Wallia
- Division of Endocrinology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Michael S Wolf
- Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Jacob M Schauer
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Sandi Tenfelde
- Family and Community Health Department, Marcella Niehoff School of Nursing, Loyola University Chicago, Chicago, Illinois, USA
| | - David M Liebovitz
- Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - William A Grobman
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, The Ohio State University, Columbus, Ohio, USA
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Hassan S, Gujral UP, Quarells RC, Rhodes EC, Shah MK, Obi J, Lee WH, Shamambo L, Weber MB, Narayan KMV. Disparities in diabetes prevalence and management by race and ethnicity in the USA: defining a path forward. Lancet Diabetes Endocrinol 2023; 11:509-524. [PMID: 37356445 PMCID: PMC11070656 DOI: 10.1016/s2213-8587(23)00129-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 05/01/2023] [Accepted: 05/01/2023] [Indexed: 06/27/2023]
Abstract
Type 2 diabetes disparities in the USA persist in both the prevalence of disease and diabetes-related complications. We conducted a literature review related to diabetes prevention, management, and complications across racial and ethnic groups in the USA. The objective of this review is to summarise the current understanding of diabetes disparities by examining differences between and within racial and ethnic groups and among young people (aged <18 years). We also examine the pathophysiology of diabetes as it relates to race and ethnic differences. We use a conceptual framework built on the socioecological model to categorise the causes of diabetes disparities across the lifespan looking at factors in five domains of health behaviours and social norms, public awareness, structural racism, economic development, and access to high-quality care. The range of disparities in diabetes prevalence and management in the USA calls for a community-engaged and multidisciplinary approach that must involve community partners, researchers, practitioners, health system administrators, and policy makers. We offer recommendations for each of these groups to help to promote equity in diabetes prevention and care in the USA.
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Affiliation(s)
- Saria Hassan
- Department of Medicine, Emory University, Atlanta, GA, USA; Emory Global Diabetes Research Center, Emory University, Atlanta, GA, USA; Hubert Department of Global Health, Rollins School of Public Health, Atlanta, GA, USA.
| | - Unjali P Gujral
- Emory Global Diabetes Research Center, Emory University, Atlanta, GA, USA; Hubert Department of Global Health, Rollins School of Public Health, Atlanta, GA, USA
| | - Rakale C Quarells
- Emory Global Diabetes Research Center, Emory University, Atlanta, GA, USA; Department of Community Health and Preventive Medicine, Morehouse School of Medicine, Atlanta, GA, USA
| | - Elizabeth C Rhodes
- Emory Global Diabetes Research Center, Emory University, Atlanta, GA, USA; Hubert Department of Global Health, Rollins School of Public Health, Atlanta, GA, USA
| | - Megha K Shah
- Department of Family and Preventive Medicine, Emory University, Atlanta, GA, USA; Emory Global Diabetes Research Center, Emory University, Atlanta, GA, USA
| | - Jane Obi
- Emory School of Medicine, and the Nutrition and Health Sciences Doctoral Program, Laney Graduate School, Emory University, Atlanta, GA, USA; Emory Global Diabetes Research Center, Emory University, Atlanta, GA, USA
| | - Wei-Hsuan Lee
- Department of Medicine, Emory University, Atlanta, GA, USA
| | - Luwi Shamambo
- Department of Medicine, Emory University, Atlanta, GA, USA
| | - Mary Beth Weber
- Emory School of Medicine, and the Nutrition and Health Sciences Doctoral Program, Laney Graduate School, Emory University, Atlanta, GA, USA; Emory Global Diabetes Research Center, Emory University, Atlanta, GA, USA; Hubert Department of Global Health, Rollins School of Public Health, Atlanta, GA, USA
| | - K M Venkat Narayan
- Department of Medicine, Emory University, Atlanta, GA, USA; Emory School of Medicine, and the Nutrition and Health Sciences Doctoral Program, Laney Graduate School, Emory University, Atlanta, GA, USA; Emory Global Diabetes Research Center, Emory University, Atlanta, GA, USA; Hubert Department of Global Health, Rollins School of Public Health, Atlanta, GA, USA
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Olmos B, Nava A, Jones EJ. Theory Integration for Examining Health Care Discrimination among Minoritized Older Adults with Chronic Illness. West J Nurs Res 2023; 45:262-271. [PMID: 36254404 DOI: 10.1177/01939459221128123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Prevalence of chronic illnesses, including type 2 diabetes (T2DM), is increasing disproportionately among Latinx adults in the United States. Health care inequities such as health care discrimination contribute to the disparities in this population. Academic and clinical nurses must address health care discrimination from a strong theoretical framework. In this article, we integrate the minority stress theory and ecosocial theory of disease distribution to offer a whole-person model that identifies the concepts most relevant to Latinx older adults who function at multiple levels of intersectionality. This paper uses T2DM as an exemplar of chronic illness. The integrated model depicts possible pathways of physiological and psychological embodiment of lived experiences of minoritized older persons managing chronic illness who are living in a society deeply embedded with structural racism and oppression. This model may guide future research aimed at elucidating the social and structural determinants that impact health-related outcomes among Latinx older adults.
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Affiliation(s)
- Brenda Olmos
- Fran and Earl Ziegler College of Nursing, The University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Adrianna Nava
- National Committee for Quality Assurance (NCQA), Washington, DC, USA
| | - Emily J Jones
- Fran and Earl Ziegler College of Nursing, The University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
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Looking at Diabetes-Related Distress through a New Lens: The Socio-Ecological Health Model. ENDOCRINES 2022. [DOI: 10.3390/endocrines3040064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Diabetes-related distress (DRD) is defined as an emotional state experienced by people with diabetes (PWD) who are worried about their disease management, the emotional burden from the condition, and/or potential difficulties accessing care or support. The psychosocial aspect of diabetes management is a factor that directly influences patients’ well-being as well as the chronic management of the condition yet is not a primary clinical problem being addressed within the healthcare setting. This review advocates for a re-evaluation and subsequent adjustment of the current DRD screening methodology by implementing the five primary components (Intrapersonal, Interpersonal, Organizational, Community, and Public Policy) of the Socio-Ecological Model of Health (SEMH), bridging the gaps from a public-health perspective. We searched two electronic databases for studies published in the United States from 1995 to 2020 reporting the effects of social determinants of health (SDOH) on DRD. Articles that contained at least one of the five elements of the SEMH and focused on adults aged 18 years or older were included. SDOH, which include circumstances where individuals grow, work, and age, are highly influenced by external factors, such as the distribution of wealth, power, and resources. Current DRD screening tools lack the capacity to account for all major components of SDOH in a comprehensive manner. By applying the SEMH as a theory-based framework, a novel DRD screening tool addressing sex, ethnicity, and socioeconomic background should be implemented to better improve diabetes management outcomes. By exploring the relationships between each level of the SEMH and DRD, healthcare professionals will be better equipped to recognize potential stress-inducing factors for individuals managing diabetes. Further efforts should be invested with the goal of developing a novel screening tool founded on the all-encompassing SEMH in order to perpetuate a more comprehensive diabetes treatment plan to address barriers within the SDOH framework.
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Discrimination and Health Among First-Generation Hispanic/Latinx Immigrants: the Roles of Sleep and Fatigue. J Racial Ethn Health Disparities 2022; 9:2105-2116. [PMID: 34606072 PMCID: PMC10168626 DOI: 10.1007/s40615-021-01149-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 08/21/2021] [Accepted: 09/06/2021] [Indexed: 12/29/2022]
Abstract
INTRODUCTION A growing literature documents the associations between discrimination and health. Emerging evidence suggests that among Hispanic/Latinx immigrants, discrimination leads to the deterioration of health outcomes over time. While sleep has been proposed as an important mediator of the relationship between discrimination and health, few studies have explicitly investigated this pathway, particularly among Hispanic/Latinx populations. OBJECTIVE To investigate the relationships between racial/ethnic discrimination, sleep, and physical and mental health among Hispanic/Latinx immigrants in the USA. Data and Methods Using data from a parent study of first-generation Hispanic/Latinx immigrants in the southeastern USA, we conducted sequential mediation analyses using the bootstrapping method to investigate whether self-reported sleep duration, sleep quality, and fatigue mediate the relationship(s) between self-reported discrimination, as measured by the discrimination subscale of the Riverside Acculturative Stress Inventory, and self-reported physical and mental health. RESULTS Nocturnal awakenings, fatigue, and sleep quality were statistically significant sequential mediators of the relationship between discrimination and physical health (b = -.001, SE = .001, CI [-.0027, -.0001]); fatigue alone also mediated this relationship (b = -.01, SE = .01, CI [-.0279, -.0003]). Nocturnal awakenings, fatigue, and sleep quality were also significant sequential mediators of the relationship between discrimination and mental health (b = -.001, SE = .001, CI [-.0031, -.0001]). CONCLUSION Sleep and fatigue play an important role in linking discrimination and health among first-generation Hispanic/Latinx immigrants. The development and implementation of interventions that focus on reducing fatigue among this population could mitigate the effects of unfair treatment on health outcomes.
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Adams LB, Zimmer C, Progovac AM, Creedon T, Rodgers CR, Sonik RA, Cook BL. Typologies of mental healthcare discrimination experiences and associations with current provider care ratings: A latent class analysis. SSM - MENTAL HEALTH 2022; 2:100105. [PMID: 36819115 PMCID: PMC9937509 DOI: 10.1016/j.ssmmh.2022.100105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Background Discrimination is experienced across demographic attributes (e.g., race and gender) and vantage points (e.g., personal and vicarious), yet few studies have classified these different experiences of discrimination within healthcare systems. Moreover, which discriminatory experiences have greater influence on patient-reported quality outcomes remains poorly understood. To address these gaps, we used latent class analysis (LCA) to identify typologies of past experiences with healthcare discrimination among adults with depression-who experience more frequent and stigmatizing healthcare interactions than the general population-and assess the relationship between class membership and current ratings of patient-reported quality outcomes. Methods We surveyed a nationally representative sample of adults with depression (n = 803) to assess past experiences of discrimination by medical providers in terms of both the characteristics targeted for discrimination and whether healthcare discrimination was experienced personally or by friends and family members. We conducted an LCA to identify discrimination-exposure classes and a modified Poisson regression to identify associations between class membership and patient-reported quality outcomes (e.g., overall medical provider quality, respect, clear communication, and careful listening), while adjusting for covariates. Results We identified four latent classes of healthcare discrimination: low discrimination (LD; referent class: 72.2% of total sample), vicarious linguistic discrimination (VL; 13.9%), elevated personal and vicarious racial discrimination (EPVR; 10.5%), and high racial/ethnic discrimination (HRE; 3.4%). Compared to those in the LD class, individuals in the EPVR class had higher rates of reporting their current medical provider's respect and careful listening skills as sometimes or never, (Respect aIRR: 1.90, 95% CI: 1.05-3.42; Listening aIRR: 2.18, 95% CI: 1.29-3.66). Those in the HRE class reported higher rates of reporting their medical provider's quality and communication as poor or fair and lower ratings of careful listening (Quality aIRR: 2.06, 95% CI: 1.08-3.93; Communication aIRR: 1.97, 95% CI: 1.00-3.63; Listening aIRR: 2.41, 95% CI: 1.27-4.59), compared to those in the LD class. Those in the VL class had higher rates of reporting that their medical provider never or sometimes respected or carefully listened to them (Respect aIRR: 2.12, 95% CI: 1.20-3.72; Listening aIRR:1.67, 95% CI:1.03-2.71) than those in, the LD class. Conclusions Healthcare organizations committed to providing equitable patient care should establish more robust quality improvement approaches to prevent discrimination at the medical provider level as well as structures of accountability to reconcile previously embedded social inequities within the healthcare system.
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Affiliation(s)
- Leslie B. Adams
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, USA
| | - Catherine Zimmer
- Department of Sociology, University of North Carolina at Chapel Hill, USA
| | - Ana M. Progovac
- Health Equity Research Lab, Cambridge Health Alliance, USA
- Department of Psychiatry, Harvard Medical School, USA
| | | | | | - Rajan A. Sonik
- AltaMed Institute for Health Equity, AltaMed Health Services, USA
| | - Benjamin Lê Cook
- Health Equity Research Lab, Cambridge Health Alliance, USA
- Department of Psychiatry, Harvard Medical School, USA
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Hart S, Campbell C, Divine H, McIntosh T, Dicks M, Schadler A, Kebodeaux C. Participation of Limited English Proficiency Patients in Pharmacist Diabetes Management via Telehealth. J Am Pharm Assoc (2003) 2022; 62:1394-1399. [DOI: 10.1016/j.japh.2022.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 03/08/2022] [Accepted: 03/09/2022] [Indexed: 10/18/2022]
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Olmos B, Jones EJ. Discrimination and Type 2 Diabetes-Related Health Outcomes among Hispanic Adults in the United States: An Integrative Literature Review. HISPANIC HEALTH CARE INTERNATIONAL 2022; 20:256-266. [PMID: 35175144 DOI: 10.1177/15404153221077370] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Brenda Olmos
- Fran and Earl Ziegler College of Nursing, 6186The University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Emily J Jones
- Fran and Earl Ziegler College of Nursing, 6186The University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
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Martínez AD, Mercado E, Barbieri M, Kim SY, Granger DA. The Importance of Biobehavioral Research to Examine the Physiological Effects of Racial and Ethnic Discrimination in the Latinx Population. Front Public Health 2022; 9:762735. [PMID: 35083188 PMCID: PMC8784784 DOI: 10.3389/fpubh.2021.762735] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Accepted: 11/22/2021] [Indexed: 12/23/2022] Open
Abstract
A growing body of research is documenting how racial and ethnic populations embody social inequalities throughout the life course. Some scholars recommend the integration of biospecimens representing the hypothalamic-pituitary-adrenal axis, neurological and endocrinological processes, and inflammation to capture the embodiment of inequality. However, in comparison to other racial and ethnic groups, there has been little research examining how Hispanic/Latinx persons embody racial and ethnic discrimination, much less resulting from institutional and structural racism. We provide a rationale for expanding biobehavioral research examining the physiological consequences of racism among Latinx persons. We identify gaps and make recommendations for a future research agenda in which biobehavioral research can expand knowledge about chronic disease inequities among Latinx populations and inform behavioral and institutional interventions. We end by cautioning readers to approach the recommendations in this article as a call to expand the embodiment of racism research to include the diverse Latinx population as the United States addresses racial inequity.
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Affiliation(s)
- Airín D. Martínez
- Department of Health Promotion and Policy, School of Public Health and Health Sciences, University of Massachusetts-Amherst, Amherst, MA, United States
| | - Evelyn Mercado
- Department of Psychological and Brain Sciences, College of Natural Sciences, University of Massachusetts-Amherst, Amherst, MA, United States
| | - Marielena Barbieri
- Department of Psychological and Brain Sciences, College of Natural Sciences, University of Massachusetts-Amherst, Amherst, MA, United States
| | - Su Yeong Kim
- Department of Human Development and Family Sciences, University of Texas-Austin, Austin, TX, United States
| | - Douglas A. Granger
- Institute for Interdisciplinary Salivary Bioscience Research, University of California, Irvine, Irvine, CA, United States
- The Johns Hopkins University Bloomberg School of Public Health, School of Nursing, School of Medicine, Baltimore, MD, United States
- Saliva Bioscience Laboratory, University of Nebraska-Lincoln, Lincoln, NE, United States
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Butler AM, Brown SD, Carreon SA, Smalls BL, Terry A. Equity in Psychosocial Outcomes and Care for Racial and Ethnic Minorities and Socioeconomically Disadvantaged People With Diabetes. Diabetes Spectr 2022; 35:276-283. [PMID: 36082019 PMCID: PMC9396713 DOI: 10.2337/dsi22-0006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The role of social determinants of health (SDOH) in promoting equity in diabetes prevalence, incidence, and outcomes continues to be documented in the literature. Less attention has focused on disparities in psychosocial aspects of living with diabetes and the role of SDOH in promoting equity in psychosocial outcomes and care. In this review, the authors describe racial/ethnic and socioeconomic disparities in psychosocial aspects of living with diabetes, discuss promising approaches to promote equity in psychosocial care, and provide future research directions.
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Affiliation(s)
- Ashley M. Butler
- Department of Pediatrics, Baylor College of Medicine, Houston, TX
- Corresponding author: Ashley M. Butler,
| | - Susan D. Brown
- Department of Internal Medicine, School of Medicine, University of California, Davis, Sacramento, CA
| | | | - Brittany L. Smalls
- Department of Family and Community Medicine, University of Kentucky College of Medicine, Lexington, KY
| | - Amanda Terry
- Department of Pediatrics, Baylor College of Medicine, Houston, TX
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Rosemberg MS, Li Y, Polick C. Immigration-related stressors and health outcomes among low-wage immigrant hotel workers: A pilot study. Public Health Nurs 2022; 39:1123-1127. [PMID: 35502562 PMCID: PMC9543425 DOI: 10.1111/phn.13086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 04/09/2022] [Accepted: 04/13/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Immigrants comprise over 40% of the low-wage workforce. They are more likely to be employed in service industries, paid less, and experience more illness and injuries than their native counterparts. DESIGN/OBJECTIVE The aim of this cross-sectional pilot study was to explore the relationship between immigrant workers' stressors and health. SAMPLE Twenty-five female Mexican immigrant hotel workers. MEASUREMENTS Surveys and blood samples were analyzed and compared to national data. Descriptive statistics and linear regression were used for analysis. RESULTS Longer length of stay, older age at migration, and higher Demands of Immigration (DI) were significantly associated with more chronic conditions. Higher DI were significantly associated with more depressive symptoms. This is comparable to national data (n = 468) which shows a significant relationship between length of stay, Allostatic Load (AL), and chronic conditions (β = 0.14, p = .043; β = 0.13, p = .025). CONCLUSIONS Immigrant-specific factors affect individuals' health. More studies are needed to further explore the relationship between DI and health among foreign-born workers.
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Affiliation(s)
- Marie‐Anne S. Rosemberg
- Department of SystemsPopulations and LeadershipUniversity of MichiganSchool of NursingAnn ArborMichiganUSA
| | - Yang Li
- Assistant ProfessorUniversity of Texas at AustinSchool of NursingAnn ArborMichiganUSA
| | - Carri Polick
- T32 Predoctoral FellowUniversity of MichiganSchool of NursingAnn ArborMichiganUSA
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Gaston SA, Atere-Roberts J, Ward J, Slopen NB, Forde AT, Sandler DP, Williams DR, Jackson CL. Experiences With Everyday and Major Forms of Racial/Ethnic Discrimination and Type 2 Diabetes Risk Among White, Black, and Hispanic/Latina Women: Findings From the Sister Study. Am J Epidemiol 2021; 190:2552-2562. [PMID: 34215871 DOI: 10.1093/aje/kwab189] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 06/23/2021] [Accepted: 06/24/2021] [Indexed: 01/22/2023] Open
Abstract
Racial/ethnic discrimination may contribute to the risk of type 2 diabetes mellitus (T2DM), but few studies have prospectively examined this relationship among racially/ethnically diverse populations. We analyzed prospective data from 33,833 eligible Sister Study participants enrolled from 2003 to 2009. In a follow-up questionnaire (2008-2012), participants reported their lifetime experiences of everyday and major forms of racial/ethnic discrimination. Self-reported physician diagnoses of T2DM were ascertained through September 2017. Hazard ratios and 95% confidence intervals were estimated using Cox proportional hazards models, overall and by race/ethnicity. Mean age at enrollment was 54.9 (standard deviation, 8.8) years; 90% of participants self-identified as non-Hispanic (NH) White, 7% as NH Black, and 3% as Hispanic/Latina. Over an average of 7 years of follow-up, there were 1,167 incident cases of T2DM. NH Black women most frequently reported everyday (75%) and major (51%) racial/ethnic discrimination (vs. 4% and 2% of NH White women, respectively, and 32% and 16% of Hispanic/Latina women, respectively). While everyday discrimination was not associated with T2DM risk, experiencing major discrimination was marginally associated with higher T2DM risk overall (hazard ratio = 1.26, 95% confidence interval: 0.99, 1.61) after adjustment for sociodemographic characteristics and body mass index. Associations were similar across racial/ethnic groups; however, racial/ethnic discrimination was more frequently reported among racial/ethnic minority women. Antidiscrimination efforts may help mitigate racial/ethnic disparities in T2DM risk.
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Rechenberg K, Szalacha L, Martinez G, Graham M, Stauber L, Menon U. Feasibility and Acceptability of a Language Concordant Health Coaching Intervention Delivered by Nurses for Latinx With Type 2 Diabetes. Worldviews Evid Based Nurs 2021; 18:210-216. [PMID: 33991058 DOI: 10.1111/wvn.12505] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Latinx immigrants have high rates of type 2 diabetes (T2D), exhibit out-of-range glycemic control, and have higher rates of diabetes-related complications than non-Latinx whites, with limited English proficiency (LEP) being a major barrier to care. AIMS We tested the feasibility and acceptability of a language concordant (provider that is proficient in the patient's preferred language) health coaching intervention delivered by nurse and nurse practitioner students in a pilot study of Latinx immigrants with T2D and LEP. METHODS A sample of 17 Latinx immigrants with T2D and LEP were split into intervention and control groups. The control group received basic diabetes care and written educational materials on diabetes self-management in Spanish. Individuals in the intervention group received the standard diabetes care offered by the clinic and six biweekly health coaching sessions (intervention) with a trained language concordant health coach. RESULTS The language concordant health coaching intervention was both feasible (delivery) and acceptable (satisfactory) to Latinx immigrants with T2D and LEP and resulted in clinically meaningful differences in key diabetes-related outcomes. LINKING EVIDENCE TO ACTION Our findings suggest that lack of language concordance between provider and patient has an important and meaningful impact on the ability of an LEP Latinx patient to receive, and perhaps act upon, adequate education for T2D management. Receiving biweekly coaching calls could have offered further emotional support for participants to discuss living with T2D, which may have helped to alleviate symptoms of depression and anxiety that individuals with T2D frequently endure.
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Affiliation(s)
| | - Laura Szalacha
- University of South Florida College of Nursing, Tampa, FL, USA
| | - Glenn Martinez
- The Ohio State University College of Nursing, Columbus, OH, USA
| | - Margaret Graham
- The Ohio State University College of Nursing, Columbus, OH, USA
| | - Leah Stauber
- University of Arizona College of Nursing, Tucson, AZ, USA
| | - Usha Menon
- University of South Florida College of Nursing, Tampa, FL, USA
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The Weight of Racial Discrimination: Examining the Association Between Racial Discrimination and Change in Adiposity Among Emerging Adult Women Enrolled in a Behavioral Weight Loss Program. J Racial Ethn Health Disparities 2021; 9:909-920. [PMID: 33782906 DOI: 10.1007/s40615-021-01030-7] [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: 12/11/2020] [Revised: 03/10/2021] [Accepted: 03/22/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Non-Hispanic Black (NHB) emerging adult (EA) women are at disproportionate risk for obesity but experience limited benefit from behavioral weight loss (BWL) programs. Race-related stress could play a role; the goal of this study was to examine the association between racial discrimination (RD) and early (3 months) changes in adiposity, and to explore potential protective factors, among EA in an adapted BWL program. METHODS This is an ancillary study of non-Hispanic White (NHW) and NHB EA women enrolled in an adapted BWL trial (N = 49; 55.1% NHB; Age 21.2 (2.1); BMI = 33.0 + 4.3 kg/m2). At baseline, group- and personal-level RD (RD-group and RD-personal), racial identity (NHB women only), vigilant coping, and social support were assessed via validated questionnaires. Weight and waist circumference were measured objectively at 0 and 3 months. RESULTS NHW women manifested greater reductions in waist circumference relative to NHB women (p = .004). RD-personal did not predict change in waist circumference at 3 months (p = .402); however, the association between RD-group and change in waist circumference was statistically significant (p = .015), such that reporting greater group-level discrimination predicted a smaller decrease in waist circumference; the model explained 22% of the variance. Social support and vigilant coping were not statistically significant in the model. Among NHB women only, higher racial identity-centrality predicted greater reduction in waist circumference (p = .019). CONCLUSION Findings suggest racial discrimination could contribute to greater cardiometabolic risk during this developmental period. Future research should examine how experiences of racial discrimination unfold in the daily lives of NHB women to inform mechanistic interventions to enhance health and well-being. TRIAL REGISTRATION NCT02736981. Low Intensity Weight Loss for Young Adults.
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Dias J, Echeverria S, Mayer V, Janevic T. Diabetes Risk and Control in Multi-ethnic US Immigrant Populations. Curr Diab Rep 2020; 20:73. [PMID: 33216289 DOI: 10.1007/s11892-020-01358-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/26/2020] [Indexed: 12/19/2022]
Abstract
PURPOSE OF REVIEW The goal of this review is to assess current evidence on diabetes risk and control among adult immigrants in the USA. RECENT FINDINGS Patterns of diabetes risk in US immigrants may reflect global diabetes trends. Asian, Black, and Latinx immigrants all see a diabetes disadvantage relative to US-born Whites. Diabetes risk in Asian immigrants also surpasses US-born Asians. Relative diabetes risk among all groups increases with time in the USA. Research to explain patterns in diabetes risk and control among immigrants has broadened from lifestyle factors to include multi-level, life course influences on trajectories of risk. Some determinants are shared across groups, such as structural racism, healthcare access, and migration stress, whereas others such as diet are embedded in sending country culture. Current literature on diabetes in immigrant populations suggests a need to shift towards a transnational lens and macro-level social determinants of health framework to understand diabetes risk and potential prevention factors.
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Affiliation(s)
- Jennifer Dias
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Sandra Echeverria
- Department of Public Health Education, School of Health and Human Sciences, University of North Carolina at Greensboro, Greensboro, NC, USA
| | - Victoria Mayer
- General Internal Medicine, Population Health Science & Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Teresa Janevic
- Obstetrics, Gynecology, and Reproductive Science, Population Health Science & Policy, Blavatnik Family Women's Health Research Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
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Abstract
PURPOSE OF REVIEW Even with insurance coverage increasing over time among the population with diabetes, a large proportion continues to have poorly controlled disease. The purpose of this narrative literature review is to describe the social determinants of poor management of type 2 diabetes among the insured population and illustrate drivers of poor outcomes beyond insurance coverage. RECENT FINDINGS Despite the provision of health insurance, social determinants play a significant role in shaping diabetes outcomes, especially for economic instability (employment, out-of-pocket expenses associated with diabetes management), food insecurity, education and literacy, access to quality health care (health systems designed to effectively manage chronic disease), neighborhood and the built environment (segregated neighborhoods, socioeconomic conditions of communities, housing), and social and community context (discrimination, social support). Multiple social determinants shape poor diabetes outcomes among the insured. These determinants are now being further exacerbated by the COVID-19 pandemic, which has created the worst economic crisis for US families since the Great Depression. The evidence of this review points to the imperative need for more multilevel intervention approaches to address these determinants in the management of diabetes.
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Affiliation(s)
- Minal R Patel
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, 1415 Washington Heights, SPH 1, Room 3810, Ann Arbor, MI, 48109-2029, USA.
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Cuevas H, Zuñiga J. Latinx with Type 2 Diabetes: Perceptions of Cognitive Health. J Immigr Minor Health 2020; 23:337-343. [DOI: 10.1007/s10903-020-00995-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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Mikell M, Snethen J, Kelber ST. Exploring Factors Associated with Physical Activity in Latino Immigrants. West J Nurs Res 2020; 42:680-689. [DOI: 10.1177/0193945919897547] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Latinos are at increased risk for developing chronic conditions. Regular physical activity (PA) assists in protecting adults from developing type 2 diabetes, excess weight, and heart disease, making PA important for health promotion. This cross-sectional, descriptive investigation was conducted with adults 18 years of age and older in a predominately Latino community. Perceptions of factors which influenced PA were examined. Descriptive statistics and multiple regression analysis were performed. Immigrant Latino males engaged in PA significantly more often than female participants. In Latino participants, those who engaged in walking activities were more likely to engage in both vigorous ( r = .341, p<.005) and moderate PA ( r = .317, p <.001). Self-efficacy and acculturation were significant predictors of PA. Acculturation was associated with physical activity, even after adjusting for perceived stress. Findings highlight the continued importance of self-efficacy to foster health promotion in Latino communities.
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Affiliation(s)
| | - Julia Snethen
- University of Wisconsin-Milwaukee, College of Nursing, Milwaukee, WI, USA
| | - Sheryl T. Kelber
- University of Wisconsin-Milwaukee, College of Nursing, Milwaukee, WI, USA
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Ramos SR, Warren R, Shedlin M, Melkus G, Kershaw T, Vorderstrasse A. A Framework for Using eHealth Interventions to Overcome Medical Mistrust Among Sexual Minority Men of Color Living with Chronic Conditions. Behav Med 2019; 45:166-176. [PMID: 31343963 PMCID: PMC6793989 DOI: 10.1080/08964289.2019.1570074] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 12/20/2018] [Accepted: 12/21/2018] [Indexed: 10/26/2022]
Abstract
The purpose of this paper is to present a stepwise, multi-construct, innovative framework that supports the use of eHealth technology to reach sexual minority populations of color to establish trustworthiness and build trust. The salience of eHealth interventions can be leveraged to minimize the existing paradigm of medical mistrust among sexual minority populations of color living with chronic illnesses. These interventions include virtual environments and avatar-led eHealth videos, which address psychosocial and structural-level challenges related to mistrust. Our proposed framework addresses how eHealth interventions enable technology adoption and usage, anonymity, co-presence, self-disclosure, and social support and establish trustworthiness and build trust.
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Affiliation(s)
| | - Rueben Warren
- b Tuskegee University National Center for Bioethics in Research and Health Care
| | | | - Gail Melkus
- a New York University Rory Meyers College of Nursing
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Mann-Jackson L, Song EY, Tanner AE, Alonzo J, Linton JM, Rhodes SD. The Health Impact of Experiences of Discrimination, Violence, and Immigration Enforcement Among Latino Men in a New Settlement State. Am J Mens Health 2018; 12:1937-1947. [PMID: 29962271 PMCID: PMC6199437 DOI: 10.1177/1557988318785091] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Among Latinos in the United States, particularly in new settlement states, racial/ethnic discrimination, violence, and immigration enforcement contribute to health disparities. These types of experiences were explored among Latino men in North Carolina through quantitative assessment data ( n = 247). Qualitative in-depth interviews were also conducted with a subsample of Latino men who completed the assessment ( n = 20) to contextualize quantitative findings. Participants reported high rates of unfair treatment, discrimination or violence, and questioning about their immigration status. Having been questioned about one's immigration status was significantly associated with increased drug use (adjusted odds ratio [AOR] = 2.16; 95% confidence interval [CI] [1.07, 4.38]) and increased depressive symptoms (AOR = 2.87; 95% CI [1.07, 7.67]). Qualitative themes included: reports of frequent discrimination based on immigration status, race/ethnicity, and language; workplaces and police interactions as settings where reported discrimination is most common and challenging; frequent violent victimization; psychological consequences of experiences of discrimination and violence and concerns related to immigration enforcement for Latino men and their families; inter- and intra-community tensions; health-care services as safe spaces; use of coping strategies; and system-level approaches for reducing discrimination and violent victimization of Latinos. Findings point to the need to address underlying causes of discrimination and violence toward Latinos, particularly those related to immigration enforcement, to support health and well-being.
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Affiliation(s)
- Lilli Mann-Jackson
- 1 Department of Social Sciences and Health Policy, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Eunyoung Y Song
- 1 Department of Social Sciences and Health Policy, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Amanda E Tanner
- 2 Department of Public Health Education, University of North Carolina Greensboro, Greensboro, NC, USA
| | - Jorge Alonzo
- 1 Department of Social Sciences and Health Policy, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Julie M Linton
- 3 Department of Pediatrics and Maya Angelou Center for Health Equity, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Scott D Rhodes
- 1 Department of Social Sciences and Health Policy, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
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