Racial Disparities in the Education System: Opportunities for Justice in Schools

Predicting diabetes self-management education engagement: machine learning algorithms and models

INTRODUCTION

Diabetes self-management education (DSME) is endorsed by the American Diabetes Association (ADA) as an essential component of diabetes management. However, the utilization of DSME remains limited in the USA. This study aimed to investigate current DSME participation among the older population and to identify comprehensive factors of DSME engagement through employing various machine learning (ML) models based on a US nationally representative survey linked to claims data.

RESEARCH DESIGN AND METHODS

Data from the Medicare Current Beneficiary Survey were employed, and this study included data on US Medicare beneficiaries with diabetes from 2017 to 2019. Comprehensive variables following the National Institute on Aging Health Disparities Research Framework were employed to ensure a comprehensive evaluation of factors associated with DSME using five common ML approaches.

RESULTS

In our study, 37.94% of participants received DSME after the application of inclusion and exclusion criteria. A total of 95 variables were used and all ML models achieved accuracy scores exceeding 70%. Random forest had better predictive performance, with an accuracy of 85%. Seventy-four of 95 variables were identified as key variables. Racial/ethnic disparities in predictors for DSME were identified in this study.

CONCLUSIONS

This study identified comprehensive and critical factors associated with DSME engagement from biological, behavioral, sociocultural, and environmental domains using different ML models, as well as related racial/ethnic disparities. Aligning these findings with the DSME National Standards from the ADA would enhance the guidelines' effectiveness, promoting tailored and equal diabetes management approaches that cater to diverse races/ethnicities.

School Ethnic Density and Mental Health Problems in Black, Latine, and White Preadolescent Children

OBJECTIVE

Previous studies suggest that school ethnic density is associated with less internalizing problems in Black and Latine adolescents in high school. Here, we assessed associations between school ethnic density and internalizing, externalizing, and thought problems in Black, Latine, and White preadolescent children (mean age = 9.9 years) in elementary school. We additionally examined whether associations differed by family generational status.

METHOD

We analyzed baseline data from the Adolescent Brain and Cognitive Development Study (n = 10, 076). We operationalized school ethnic density as a measure of racial and/or ethnic concordance. In models stratified by race and ethnicity, we used generalized estimating equation models to assess associations between proportions of school racial and/or ethnic concordance, and the internalizing, externalizing, and thought problem subscales of the Child Behavior Checklist. We subsequently adjusted for family and neighborhood socioeconomic factors and tested for interactions with family generational status.

RESULTS

For Black children, a higher proportion of Black students at schools was associated with less internalizing (β = -1.11, 95% CI = -2.82, -0.13; p = .026) and thought problems (β = -0.47, 95% CI = -0.78, -0.06; p = .026). For Latine children, a higher proportion of Latine students was associated with less thought problems, but only among children from immigrant families (β = -0.65, 95% CI = -1.20, -0.09; p = .023). For White children, an initial association between a higher proportion of White students and less externalizing problems disappeared after controlling for socioeconomic factors.

CONCLUSION

This study showed evidence of protective associations between school ethnic density and mental health problems for Black children and Latine children from immigrant families.

STUDY PREREGISTRATION INFORMATION

Associations between School Ethnic Density and Psychopathology Symptoms among Black, Latine, and White Children in the Adolescent Brain and Cognitive Development Study; https://osf.io/3rh74.

The Perniciousness and Promise of School-Based Mental Health Service Delivery for Youth

Rates of child and adolescent mental disorder have risen sharply while access to community-based mental health care options continues to be elusive for many families. Substantial and persistent barriers to community-based mental health care have prompted multiple stakeholders to pursue an approach that emphasizes health promotion and intervention practices within the context of ecologically valid and more accessible environments. The most prominent of these environments has been schools that can serve as local and centralized access points to various services, including mental health care. The rapid expansion of school-based mental health service delivery systems, however, carries both risk of perniciousness as well as significant promise with respect to effective and equitable care. This article summarizes key concerns surrounding school-based mental health service delivery systems, including non-beneficence and harm, support disparities, unsustainable implementation, oppressive school climate, and linkage to punitive and discriminatory practices. Broad-based recommendations to help realize the promise of effective and equitable care for students with mental health and behavioral challenges are also presented vis-à-vis each of these concerns. At the same time, natural tensions between various mandates assigned to schools as well as between schools and their surrounding communities will need to be addressed to reach the full potential of school-based mental health service delivery systems.

Upholding the Human Rights and Well-Being of Refugee Children Through Effective Clinical Care

Refugee children are often exposed to adversities and traumatic experiences that can harm the mental health and well-being of refugee children. These include human trafficking and exploitation and dangers in detention centers and refugee camps. All these adverse events can be traumatic and contribute to poor mental health, including posttraumatic stress, anxiety, depression, and substance use disorders. Therefore, the assessment of refugee children and adolescents should include screening and identification for these experiences, provision of evidence-based trauma treatment, and social supports to promote their well-being and thriving.

Structural racism in primary schools and changes in epigenetic age acceleration among Black and White youth

Structural racism generates racial inequities in U.S. primary education, including segregated schools, inequitable funding and resources, racial disparities in discipline and achievement, and hostile racial climates, which are risk factors for adverse youth health and development. Black youth are disproportionately exposed to adverse school contexts that may become biologically embedded via stress-mediated epigenetic pathways. This study examined whether childhood exposure to adverse school contexts is associated with changes in epigenetic aging during adolescent development. DNA methylation-based epigenetic clocks were calculated from saliva samples at ages 9 and 15 among Black (n = 774) and White (n = 287) youth in the Future of Families and Child Wellbeing Study (2009-2015). We performed latent class analyses to identify race-specific primary school contexts using administrative data on segregation, discipline, achievement, resources, economic disadvantage, and racial harassment. We then estimated change in epigenetic age acceleration from childhood to adolescence across school typologies using GrimAge, PhenoAge, and DunedinPACE epigenetic clocks. Three distinct school contexts were identified for Black youth: segregated and highly-disadvantaged (17.0%), segregated and moderately-disadvantaged (52.1%), and integrated and moderately-disadvantaged (30.8%). Two school contexts emerged for White youth: integrated and unequal (46.5%) and predominantly White & advantaged (53.5%). At age 15, Black youth who attended segregated and highly-disadvantaged primary schools experienced increases in their speed of epigenetic aging with GrimAge and DunedinPACE. Slowed epigenetic aging with GrimAge was observed for Black youth who attended integrated and moderately-disadvantaged schools. School contexts were not associated with changes in epigenetic age acceleration for White youth. Our findings suggest that manifestations of structural racism in primary school contexts are associated with early-life epigenetic age acceleration and may forecast future health inequities.

Advancing Equity Through Centering Societal Values to Operationalize Racism as a Public Health Crisis: The KKey Values Inequities Model

Background

The past two decades have been marked by increased efforts to advance equity in various disciplines, including social sciences, public health, environmental health, and medicine. In 2020, a national movement of municipalities declared racism a public health crisis. These efforts have coincided and likely shaped a growing sphere of federal and philanthropic funding for health equity, which frequently calls for practical interventions toward reducing and ultimately eliminating disparities. Disparities in health such as maternal mortality, infant mortality, diabetes, cancer, and stroke have been linked to root causes such as racism. Often, root causes are also linked to disparities in other sectors (i.e., finance/wealth attainment, educational attainment, career attainment, and home ownership). In 2021, in a study published in the New England Journal of Medicine, suggested that racist policies were root causes of U.S. racial health inequities. While racism, sexism, and classism, etc., are characterized as root causes, we posit that there is a deeper driver that has yet to be advanced. This presents a disparity-inequity model that maps disparities and inequities to the societal value system, not root causes.

Methods

The KKey Values Inequities Disparities Model described in this article combines a case study of the Flint Water Crisis to explore the historic impact of human devaluation and its role in systemic racism and classism, which ultimately creates and exacerbates inequities that produce disparities in communities. The model integrates the value system and its contribution to societal causes (formerly known as root causes).

Conclusions

A broadly defined values-inequities-disparities model will allow researchers, practitioners, decision makers, lawmakers, and community members to (1) assess the core root of inequities and disparities; (2) identify solutions in the human value domain; (3) design appropriate course corrective programming, interventions, processes, and procedures; and (4) create actions to integrate new systemic procedures and practices in our laws and governance to advance equity.

Investigating Racial and Ethnic Differences in Diabetes Self-Management Education Among Adults With Diabetes

PURPOSE

The purpose of this study was to examine racial and ethnic differences in diabetes self-management education (DSME) participation among adults with diabetes.

METHODS

Population-based, cross-sectional data from the 2020 Behavioral Risk Factor Surveillance System diabetes module were analyzed. Study cohort included 9881 adults age 18 years or older with self-reported diabetes living in 11 US states, Washington, DC, and Puerto Rico. The outcome variable was participation in DSME. Weighted descriptive statistics and multivariable logistic regression were computed to investigate the association between race and ethnicity and participation in DSME, adjusting for self-reported social determinants of health factors (eg, sex, education, employment, health insurance).

RESULTS

Overall, 19.3% self-identified as non-Hispanic Black, 16.5% as Hispanic, and 59.9% as non-Hispanic White. Of participants, 44.3% were between 66 and 80 years old, and 50.4% were women. Half (50.1%) reported participating in DSME, and 78.5% had seen clinicians for diabetes-related care 1 to 5 times in the past year. Hispanic participants were less likely to report participation in DSME (28.5%) compared to non-Hispanic Black (60.3%) and non-Hispanic White (53.4%) participants (P < .001). Adults with diabetes who were less likely to participate in DSME tend to be unmarried, have high school or lower-level education, and not exercise regularly.

CONCLUSIONS

Racial and ethnic differences exist in DSME participation. Because DSME has been shown to improve diabetes outcomes, there is a need to develop strategies promoting equity in DSME participation, particularly among Hispanic populations, to reduce health disparities in diabetes care.

“My Story Started When I was Younger. . .”: A Qualitative Analysis of Youth’s Differential Journeys Away From School

Adverse childhood experiences (ACEs) increase youths’ risk for leaving high school before graduating. However, to our knowledge, no one has examined how youth themselves conceptualize the role of ACEs in their journeys away from school. In this exploratory qualitative study, we used narrative analysis to examine (1) whether youth (n = 27) described ACEs leading them away from school, (2) how early these trajectories began, from youth’s own perspectives, and (3) if this varied by elements of identity and social position. Focus groups were conducted with youth ages 18-25 from 13 communities across the U.S. We found that youth described their journeys away from school as starting with early ACEs. We also found that youths’ narratives reflected intersectional gender differences in the pathways away from school that youth described. Girls articulated how ACEs influenced subsequent non-academic priorities; they eventually left or were kicked out due to a lack of credits. Boys expressed that early ACEs were followed by risk behaviors, punishment, and dropout. Implications for healing-centered engagement across settings and targeted dropout prevention are discussed.