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Brewer G, Singh J, Lyons M. The Lived Experience of Racism in the Sikh Community. JOURNAL OF INTERPERSONAL VIOLENCE 2024; 39:2415-2436. [PMID: 38059486 PMCID: PMC11071603 DOI: 10.1177/08862605231218225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/08/2023]
Abstract
The Sikh community may be more visible and vulnerable to racism than other religious groups, and previous research has documented the racism targeted at Sikh men and women in the United States. Relatively few studies have, however, addressed the racism experienced by Sikh communities in other countries, where racism may be less closely connected to the events of 9/11. The present study investigates the lived experience of racism in Sikh adults living in the United Kingdom. Six participants (5 male, 1 female) aged 19 to 30 years (M = 24.17, SD = 3.98) were recruited via advertisements placed on social media. Both Amritdhari Sikhs (n = 4) who had undertaken the Amrit Sanskar initiation ceremony or commitment and Sahajdhari Sikhs (n = 2) who had not undertaken the initiation participated. Semi-structured interviews were conducted (totaling 372 minutes of interview data), covering a range of subjects including personal experiences of racism and subsequent responses to the racist abuse. Interpretative Phenomenological Analysis of the interview transcripts identified five superordinate themes. These were (1) Appearance and Visibility; (2) Inevitability and Normalization; (3) Coping and Conformity (Religion as Support, Fitting In, Internalization); (4) Education and Understanding; and (5) Bystander Behavior (Experiences of Intervention, Religious Duty to Intervene, Consequences of Intervention). Findings highlight the extent to which racism occurs and the increased vulnerability of the Sikh community (e.g., appearance being the focus of racist abuse). Findings also highlight the importance of religion as a source of support and cultural pride and the significance of education and bystander behavior. Future research should further investigate these themes and introduce interventions to support the safety and well-being of members of the Sikh community experiencing racist abuse.
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Freelon D. The shared psychological roots of prejudice and conspiracy theory belief. Curr Opin Psychol 2024; 56:101773. [PMID: 38118270 DOI: 10.1016/j.copsyc.2023.101773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 11/20/2023] [Accepted: 11/22/2023] [Indexed: 12/22/2023]
Abstract
The psychological literature on prejudice and conspiracy theory belief have generally remained distinct, implicitly treating the two as unrelated phenomena. In this brief review, I demonstrate that the two phenomena share at least three dispositional precursors: ingroup bias, right-wing ideology (specifically right-wing authoritarianism and social dominance orientation), and need for closure. The evidence I present suggests that prejudice and conspiracy beliefs may be more closely related both conceptually and normatively than existing research has indicated. In particular, they may appear in the same individuals, cause similar kinds of harms in adherents as well as target populations, and respond to similar counteractive interventions.
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Affiliation(s)
- Deen Freelon
- Annenberg School for Communication, University of Pennsylvania, Philadelphia, PA, USA.
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3
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Hoverd E, Effiom V, Gravesande D, Hollowood L, Kelly T, Mukuka E, Owatemi T, Sargeant I, Ward S, Spencer R, Edge D, Dale J, Staniszewska S. Understanding the inclusion and participation of adults from Black African Diaspora Communities (BAFDC) in health and care research in the UK: a realist review protocol. BMJ Open 2024; 14:e082564. [PMID: 38553075 PMCID: PMC10982753 DOI: 10.1136/bmjopen-2023-082564] [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: 11/27/2023] [Accepted: 03/13/2024] [Indexed: 04/02/2024] Open
Abstract
INTRODUCTION People from Black African Diaspora Communities (BAFDC) experience poorer health outcomes, have many long-term conditions and are persistently under-represented in health and care research. There is limited focus on programmes, or interventions that support inclusion and participation of people from BAFDC in research. Through coproduction, this realist review seeks to provide a programme theory explaining what context and mechanisms may be required, to produce outcomes that facilitate inclusion and participation for people from BAFDC in health and care research, in the UK. METHODS AND ANALYSIS A group of people from BAFDC with lived and professional experience, representing all levels of the health and care research system, will coproduce a realist review with a team of African-Caribbean, white British and white British of Polish origin health and care researchers. They will follow Pawson's five steps: (1) shaping the scope of the review; (2) searching for evidence; (3) document selection and appraisal; (4) data extraction and (5) data synthesis. The coproduction group will help to map the current landscape, identifying key issues that may inhibit or facilitate inclusion. Data will be extracted, analysed and synthesised following realist logic analysis, identifying and explaining how context and mechanisms are conceptualised in the literature and the types of contextual factors that exist and impact on inclusion and participation. Findings will be reported in accordance with Realist and Meta-narrative Evidence Synthesis Evolving Standards . ETHICS AND DISSEMINATION The coproduction group will agree an ethical approach considering accountability, responsibility and power dynamics, by establishing a terms of reference, taking a reflexive approach and coproducing an ethical framework. Findings will be disseminated to BAFDC and the research community through arts-based methods, peer-reviewed publications and conference presentations, agreeing a coproduced strategy for dissemination. Ethical review is not required. PROSPERO REGISTRATION NUMBER CRD42024517124.
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Affiliation(s)
- Eleanor Hoverd
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Violet Effiom
- NIHR Clinical Research Network West Midlands, Coventry, UK
| | | | | | | | | | | | | | | | - Rachel Spencer
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Dawn Edge
- University of Manchester, Manchester, UK
| | - Jeremy Dale
- Warwick Medical School, University of Warwick, Coventry, UK
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Legha R, Mabeza RM. Ethical guidelines for antiracism work in medicine: lessons from the antiracist healing collaborative. MEDICAL HUMANITIES 2024; 50:103-108. [PMID: 38388183 DOI: 10.1136/medhum-2023-012761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/21/2023] [Indexed: 02/24/2024]
Abstract
An explosion of antiracism in medicine efforts have transpired since 2020. However, no ethical guidelines exist to guide them. This oversight is concerning because the racism and white supremacy rife within medicine can easily thwart them. This article addresses this gap by highlighting ethical guidelines for antiracism work in medicine. We present nine core tenets derived from our experience forming the Antiracist Healing Collaborative (AHC), a medical student-led initiative committed to developing bold and disruptive antiracist medical education content. Our lessons developing and implementing these tenets can guide other antiracism in medicine collaborations striving to promote liberation and healing, rather than recapitulating the racism and white supremacy culture embedded within medicine. We close by reflecting on how these tenets have steadied our recent decision to draw AHC to a close. They have allowed us to honour what we achieved together, strengthen the relationship that formed the foundation for our activism and bolster the shared antiracism mission that will guide our individual journeys moving forwards. The first of their kind, our ethical guidelines for antiracism work in medicine can facilitate greater recognition of the risks embedded in anti-oppression work transpiring in academic settings.
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Affiliation(s)
| | - Russyan Mark Mabeza
- Department of Surgery, University of California, San Francisco, San Francisco, California, USA
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5
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Siegel MR, Simione M, James KE, Perkins ME, Luo M, Swift H, Kim J, Jasset OJ, Shook LL, Taveras EM, Edlow AG. Helping Us Grow Stronger (HUGS)/Abrazos: a community-based initiative improved perinatal mental health in an urban cohort. Am J Obstet Gynecol MFM 2024; 6:101264. [PMID: 38135219 PMCID: PMC10922876 DOI: 10.1016/j.ajogmf.2023.101264] [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: 09/11/2023] [Revised: 12/14/2023] [Accepted: 12/18/2023] [Indexed: 12/24/2023]
Abstract
BACKGROUND Targeted programs aimed at improving maternal mental health, particularly among those exposed to social determinants of health, are increasingly critical since the onset of the COVID-19 pandemic, yet the impact of such programs is poorly understood. OBJECTIVE This study aimed to evaluate the impact of a novel, language-concordant community-based program on perinatal mental health. STUDY DESIGN We conducted a prospective cohort study of peripartum individuals referred to a new community-based intervention known as Helping Us Grow Stronger (HUGS/Abrazos). Participants received up to 4 remote sessions with a cognitive behavioral therapy trained social worker, up to 3 resource navigation sessions with a community health worker, and direct relief with a grocery gift card and care package. Before and after the program, participants completed validated survey instruments to assess mental health and social determinants of health. RESULTS A total of 178 participants were assessed after program completion, including 133 who were assessed before and after the program. The cohort was composed of 62.9% Hispanic or Latinx participants with a mean age of 29.8 year (standard error of mean, 0.46). There were high rates of food insecurity (111/178; 62.4%), experiences of discrimination (119/178; 66.9%), and SARS-CoV-2 infection (105/178; 59.0%). The program was associated with statistically significant improvements in the Edinburgh Postnatal Depression scores (baseline [mean±standard error of mean], 8.44±0.55 vs 6.77±0.51 after program completion; P=.0001) and Perceived Stress Scale scores (baseline, 15.2±0.74 vs 14.0±0.71; P=.035). Participants exposed to stressors including food insecurity and experiences of discrimination had higher baseline depression, stress, and anxiety scores. Those with experiences of discrimination, food insecurity, and SARS-CoV-2 infection during pregnancy were more likely to have improvements in mental health scores postintervention. CONCLUSION In this diverse urban cohort, a novel community-based intervention was associated with improvements in depressive symptoms, perceived stress, and anxiety, particularly among those with social determinants of health.
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Affiliation(s)
- Molly R Siegel
- Department of Obstetrics and Gynecology, Massachusetts General Hospital and Harvard Medical School, Boston, MA (Drs Siegel, James, Shook, and Edlow).
| | - Meg Simione
- Division of General Academic Pediatrics, Department of Pediatrics, Mass General Hospital for Children, Boston, MA (Dr Simione, Mses Perkins and Luo, and Dr Taveras)
| | - Kaitlyn E James
- Department of Obstetrics and Gynecology, Massachusetts General Hospital and Harvard Medical School, Boston, MA (Drs Siegel, James, Shook, and Edlow)
| | - Meghan E Perkins
- Division of General Academic Pediatrics, Department of Pediatrics, Mass General Hospital for Children, Boston, MA (Dr Simione, Mses Perkins and Luo, and Dr Taveras)
| | - Man Luo
- Division of General Academic Pediatrics, Department of Pediatrics, Mass General Hospital for Children, Boston, MA (Dr Simione, Mses Perkins and Luo, and Dr Taveras)
| | - Hannah Swift
- Vincent Center for Reproductive Biology, Massachusetts General Hospital, Boston, MA (Mses Swift, Kim, and Jasset and Drs Shook and Edlow)
| | - Joon Kim
- Vincent Center for Reproductive Biology, Massachusetts General Hospital, Boston, MA (Mses Swift, Kim, and Jasset and Drs Shook and Edlow)
| | - Olyvia J Jasset
- Vincent Center for Reproductive Biology, Massachusetts General Hospital, Boston, MA (Mses Swift, Kim, and Jasset and Drs Shook and Edlow)
| | - Lydia L Shook
- Department of Obstetrics and Gynecology, Massachusetts General Hospital and Harvard Medical School, Boston, MA (Drs Siegel, James, Shook, and Edlow); Vincent Center for Reproductive Biology, Massachusetts General Hospital, Boston, MA (Mses Swift, Kim, and Jasset and Drs Shook and Edlow)
| | - Elsie M Taveras
- Division of General Academic Pediatrics, Department of Pediatrics, Mass General Hospital for Children, Boston, MA (Dr Simione, Mses Perkins and Luo, and Dr Taveras); Kraft Center for Community Health, Massachusetts General Hospital, Boston, MA (Dr Taveras); Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA (Dr Taveras)
| | - Andrea G Edlow
- Department of Obstetrics and Gynecology, Massachusetts General Hospital and Harvard Medical School, Boston, MA (Drs Siegel, James, Shook, and Edlow); Vincent Center for Reproductive Biology, Massachusetts General Hospital, Boston, MA (Mses Swift, Kim, and Jasset and Drs Shook and Edlow).
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Legate N, Weinstein N. Motivation Science Can Improve Diversity, Equity, and Inclusion (DEI) Trainings. PERSPECTIVES ON PSYCHOLOGICAL SCIENCE 2024:17456916231186410. [PMID: 38285642 DOI: 10.1177/17456916231186410] [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: 01/31/2024]
Abstract
Recent reviews of efforts to reduce prejudice and increase diversity, equity, and inclusion (DEI) in the workplace have converged on the conclusion that prejudice is resistant to change and that merely raising awareness of the problem is not enough. There is growing recognition that DEI efforts may fall short because they do not effectively motivate attitudinal and behavioral change, especially the type of change that translates to reducing disparities. Lasting change requires sustained effort and commitment, yet insights from motivation science about how to inspire this are missing from the scientific and practitioner literatures on DEI trainings. Herein, we leverage evidence from two complementary approaches to motivating change and reducing defensiveness: self-determination theory, a metatheory of human motivation, and motivational interviewing, a clinical approach for behavior change, to tackle the question of how to improve DEI efforts. We distill these insights for researchers, teachers, practitioners, and leaders wanting to apply motivational principles to their own DEI work. We highlight challenges of using this approach and recommend training takes place alongside larger structural and organizational changes. We conclude that motivation is a necessary (but insufficient) ingredient for effective DEI efforts that can energize personal commitment to DEI.
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Affiliation(s)
- Nicole Legate
- Department of Psychology, Illinois Institute of Technology
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7
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Freelander L, Rickless DS, Anderson C, Curriero F, Rockhill S, Mirsajedin A, Colón CJ, Lusane J, Vigo-Valentín A, Wong D. The impact of COVID-19 on healthcare coverage and access in racial and ethnic minority populations in the United States. GEOSPATIAL HEALTH 2023; 18:10.4081/gh.2023.1222. [PMID: 38150046 PMCID: PMC10790404 DOI: 10.4081/gh.2023.1222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 11/22/2023] [Indexed: 12/28/2023]
Abstract
This study described spatiotemporal changes in health insurance coverage, healthcare access, and reasons for non-insurance among racial/ethnic minority populations in the United States during the COVID-19 pandemic using four national survey datasets. Getis-Ord Gi* statistic and scan statistics were used to analyze geospatial clusters of health insurance coverage by race/ethnicity. Logistic regression was used to estimate odds of reporting inability to access healthcare across two pandemic time periods by race/ethnicity. Racial/ethnic differences in insurance were observed from 2010 through 2019, with the lowest rates being among Hispanic/Latino, African American, American Indian/Alaska Native, and Native Hawaiian/Pacific Islander populations. Pre-pandemic insurance coverage rates were geographically clustered. The percentage of adults citing change in employment status as the reason for non-insurance increased by about 7% after the start of the pandemic, with a small decrease observed among African American adults. Almost half of adults reported reduced healthcare access in June 2020, with 38.7% attributing reduced access to the pandemic; however, by May 2021, the percent of respondents reporting reduced access for any reason and due to the pandemic fell to 26.9% and 12.7%, respectively. In general, racial/ethnic disparities in health insurance coverage and healthcare access worsened during the pandemic. Although coverage and access improved over time, pre-COVID disparities persisted with African American and Hispanic/Latino populations being the most affected by insurance loss and reduced healthcare access. Cost, unemployment, and eligibility drove non-insurance before and during the pandemic.
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Affiliation(s)
- Lauren Freelander
- Centers for Disease Control and Prevention/Agency for Toxic Substances and Disease Registry, Office of Innovation and Analytics, Geospatial Research, Analysis, and Services, Atlanta, GA.
| | - David S Rickless
- Centers for Disease Control and Prevention/Agency for Toxic Substances and Disease Registry, Office of Innovation and Analytics, Geospatial Research, Analysis, and Services, Atlanta, GA.
| | - Corey Anderson
- Centers for Disease Control and Prevention/Agency for Toxic Substances and Disease Registry, Office of Innovation and Analytics, Geospatial Research, Analysis, and Services, Atlanta, GA.
| | - Frank Curriero
- Centers for Disease Control and Prevention/Agency for Toxic Substances and Disease Registry, Office of Innovation and Analytics, Geospatial Research, Analysis, and Services, Atlanta, GA; Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD.
| | - Sarah Rockhill
- Centers for Disease Control and Prevention/Agency for Toxic Substances and Disease Registry, Office of Innovation and Analytics, Geospatial Research, Analysis, and Services, Atlanta, GA.
| | - Amir Mirsajedin
- Centers for Disease Control and Prevention/Agency for Toxic Substances and Disease Registry, Office of Innovation and Analytics, Geospatial Research, Analysis, and Services, Atlanta, GA.
| | - Caleb J Colón
- US Department of Health and Human Services, Office of Minority Health, Rockville, MD.
| | - Jasmine Lusane
- US Department of Health and Human Services, Office of Minority Health, Rockville, MD.
| | | | - David Wong
- US Department of Health and Human Services, Office of Minority Health, Rockville, MD.
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Gabarrell-Pascuet A, Lloret-Pineda A, Franch-Roca M, Mellor-Marsa B, Alos-Belenguer MDC, He Y, Hafi-Elmokhtari RE, Villalobos F, Bayes-Marin I, Aparicio Pareja L, Álvarez Bobo O, Espinal Cabezas M, Osorio Y, Haro JM, Cristóbal-Narvaez P. Impact of perceived discrimination and coping strategies on well-being and mental health in newly-arrived migrants in Spain. PLoS One 2023; 18:e0294295. [PMID: 38134016 PMCID: PMC10745147 DOI: 10.1371/journal.pone.0294295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 10/29/2023] [Indexed: 12/24/2023] Open
Abstract
OBJECTIVES To explore how perceived discrimination impacts the emotional well-being and mental health of newly-arrived migrants in Spain; and to identify the coping strategies and behavioral changes used to deal with perceived discrimination. DESIGN 102 individual audio-recorded in-depth qualitative interviews were conducted. The interviews were transcribed and analyzed through content analysis. RESULTS Negative emotions related to perceived discrimination included disgust, sadness, fear, loneliness, humiliation, sense of injustice, rage, feeling undervalued or vulnerable, and mixed emotions. Change in behaviors due to perceived discrimination comprised westernization or cultural assimilation, creating a good image, avoiding going out or leaving alone, hypervigilance, stop participating in politics, self-sufficiency, a positive adaptation, and paradoxically, becoming an oppressor. The identified coping strategies to deal with perceived discrimination were ignoring or not responding, isolation, self-medication, engagement in intellectual activities, leisure and sport, talking or insulting the oppressor, denouncement, physical fight or revenge, seeking comfort, increasing solidarity with others, crying, or using humor. Discrimination-related stress and related mental health problems were conveyed, as challenges related to substance abuse and addictive behaviors, mood, and anxiety. CONCLUSIONS Findings establish initial evidence of the great impact of perceived discrimination on the health, emotional well-being, and behavior of newly-arrived migrants in Spain, alerting to the need for targeted policies and services to address the effects of discrimination in this population. Further research is needed to explore more closely the causes and effects of perceived discrimination on mental health, to develop more targeted and effective interventions.
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Affiliation(s)
- Aina Gabarrell-Pascuet
- Teaching, Research & Innovation Unit, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain
- Center for Biomedical Research on Mental Health (CIBERSAM), Madrid, Spain
| | - Amanda Lloret-Pineda
- Teaching, Research & Innovation Unit, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain
| | - Marta Franch-Roca
- Teaching, Research & Innovation Unit, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain
| | - Blanca Mellor-Marsa
- Teaching, Research & Innovation Unit, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain
| | | | - Yuelu He
- Teaching, Research & Innovation Unit, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain
| | - Rachid El Hafi-Elmokhtari
- Teaching, Research & Innovation Unit, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain
| | - Felipe Villalobos
- Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
| | - Ivet Bayes-Marin
- Center for Biomedical Research on Mental Health (CIBERSAM), Madrid, Spain
- Department of Medicine, School of Medicine and Health Sciences, Universitat Internacional de Catalunya, Sant Cugat del Vallés, Spain
| | - Lola Aparicio Pareja
- Servicio de Atención a la Migración en Salud Mental (SATMI), Parc Sanitari Sant Joan de Déu, Barcelona, Spain
| | - Oscar Álvarez Bobo
- Servicio de Atención a la Migración en Salud Mental (SATMI), Parc Sanitari Sant Joan de Déu, Barcelona, Spain
| | - Mercedes Espinal Cabezas
- Servicio de Atención a la Migración en Salud Mental (SATMI), Parc Sanitari Sant Joan de Déu, Barcelona, Spain
| | - Yolanda Osorio
- Servicio de Atención a la Migración en Salud Mental (SATMI), Parc Sanitari Sant Joan de Déu, Barcelona, Spain
- Equip Salut Mental Sense Sostre (ESMES), Parc Sanitari Sant Joan de Déu, Barcelona, Spain
| | - Josep Maria Haro
- Teaching, Research & Innovation Unit, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain
- Center for Biomedical Research on Mental Health (CIBERSAM), Madrid, Spain
| | - Paula Cristóbal-Narvaez
- Teaching, Research & Innovation Unit, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain
- Center for Biomedical Research on Mental Health (CIBERSAM), Madrid, Spain
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Oppelt TF, Polsonetti B, Caron MF, Collins-Carriveau C, Fischer N, Gofman L, Ghazipura M. Patient Perceptions of their COVID-19 Inpatient Hospital Experience: a Survey Exploring Inequities in Healthcare Delivery. J Racial Ethn Health Disparities 2023; 10:2775-2782. [PMID: 36417149 PMCID: PMC9684944 DOI: 10.1007/s40615-022-01454-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 10/14/2022] [Accepted: 11/07/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Compared with White patients, Black and Latinx patients have higher infection, hospitalization, and mortality rates from COVID-19; yet, little is known about their perspective before, during, and after a COVID-19 hospitalization. The objective of this study conducted in White, Black, and Latinx patients was to assess perceptions of their COVID-19-related hospitalization from onset of symptoms through the post-discharge period to identify disparities in their perceived care. METHODS A cross-sectional observational study using an online survey from May 19 to June 23, 2021, was conducted by The Harris Poll in 200 White, 200 Black, and 201 Latinx patients hospitalized for COVID-19 in the US. Main measures obtained included baseline demographic variables, socioeconomic status, and social determinants of health. Survey questions were specific to key aspects of the patient experience before, during, and after a COVID-19-related hospitalization. RESULTS Compared with White patients, Latinx and Black patients faced unique challenges in their healthcare journey including higher likelihood of delaying their hospitalization (10% Black vs. 4% White patients, respectively, P = 0.025), lower perceived satisfaction with care (82% Latinx vs 91% White patients, P = 0.002), and lower trust in providers following their hospitalization (85% White vs. 65% Latinx [P = 0.027] and 73% Black [P = 0.050] patients). CONCLUSIONS Patient perceptions of their COVID-19 hospitalization experience revealed disparities in perceived quality of care among minority groups. These findings offer insights that health inequities still exist, and strategies need to be taken to make health care delivery more equitable.
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Oddiri U, Kas-Osoka OA, White SL. Learning to Action: Finding Your Anti-Racism and Equity Lens. Pediatrics 2023; 152:e2022061099. [PMID: 37909066 DOI: 10.1542/peds.2022-061099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/05/2023] [Indexed: 11/02/2023] Open
Affiliation(s)
- Uchechi Oddiri
- Renaissance School of Medicine at Stony Brook University, Stony Brook, New York
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Banerjee AT, Tan A, Boston-Fisher N, Dubois CA, LaFontaine A, Cloos P, Vissandjee B, Adams J, Hafeez H, Bumba S, Kernisan K, Ferlatte O, Razack S, Edwards MM, Evans T. Embedding anti-racism in Schools of Public Health: a pathway to accountability for progress towards equity. CANADIAN JOURNAL OF PUBLIC HEALTH = REVUE CANADIENNE DE SANTE PUBLIQUE 2023; 114:872-877. [PMID: 37410365 PMCID: PMC10486309 DOI: 10.17269/s41997-023-00796-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 06/01/2023] [Indexed: 07/07/2023]
Abstract
The importance of seeing race as a socially constructed idea continues to produce unfair differences between humans and establishes power relations that lead to injustice and exposure to death. Since the racial justice movement in early 2020, there has been a heightened awareness of, and increased interest in, addressing historic racial disparities across Schools of Public Health (SPH) in Canada. Steps have been taken to recognize systemic racism and increase diversity through structural reforms to advance equity and inclusion; however, addressing racism demands collectively uprooting racist institutional designs still inherent in learning, teaching, research, service, and community engagement. This commentary highlights the need for sustained commitment to establishing longitudinal benchmarks for greater racial equity among students, staff, and faculty; revising curricula to include historic and contemporary narratives of colonialism and slavery; and providing community-engaged learning opportunities as instrumental to dismantle systemic drivers of racial health inequities locally and globally. We also advocate for intersectoral collaboration, mutual learning, and sharing of resources across SPH and partner agencies to accomplish a continual collective agenda for racial health equity and inclusion that is intersectional in Canada, while being held accountable to Indigenous and racialized communities.
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Affiliation(s)
- Ananya Tina Banerjee
- School of Population & Global Health, McGill University, Montreal, Quebec, Canada.
| | - Amy Tan
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Nikita Boston-Fisher
- School of Population & Global Health, McGill University, Montreal, Quebec, Canada
| | - Carl-Ardy Dubois
- École de Santé Publique, Université de Montréal, Montreal, Quebec, Canada
| | - Alika LaFontaine
- Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Patrick Cloos
- École de Santé Publique, Université de Montréal, Montreal, Quebec, Canada
| | - Bilkis Vissandjee
- École de Santé Publique, Université de Montréal, Montreal, Quebec, Canada
| | - Jennifer Adams
- Faculty of Science, University of Calgary, Calgary, Alberta, Canada
| | - Hinna Hafeez
- School of Population & Global Health, McGill University, Montreal, Quebec, Canada
| | - Stephanie Bumba
- École de Santé Publique, Université de Montréal, Montreal, Quebec, Canada
| | | | - Olivier Ferlatte
- École de Santé Publique, Université de Montréal, Montreal, Quebec, Canada
| | - Saleem Razack
- Pediatrics and Institute for Health Sciences Education, McGill University, Montreal, Quebec, Canada
| | - Mairi McKenna Edwards
- Ontario Institute for Studies in Education, University of Toronto, Toronto, Ontario, Canada
| | - Tim Evans
- School of Population & Global Health, McGill University, Montreal, Quebec, Canada
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Pattillo M, Stieglitz S, Angoumis K, Gottlieb N. Racism against racialized migrants in healthcare in Europe: a scoping review. Int J Equity Health 2023; 22:201. [PMID: 37770879 PMCID: PMC10540333 DOI: 10.1186/s12939-023-02014-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 09/14/2023] [Indexed: 09/30/2023] Open
Abstract
BACKGROUND Racism is frequently mentioned as a social determinant of migrants' health and a barrier to health services. However, in the European context, racism and its impact on racialized migrants' access to healthcare is remarkably under-researched. This scoping review makes a first step toward filling this void by mapping the existing literature on racial and ethnic discrimination against racialized migrants in healthcare in Europe, identifying evidence gaps, and offering recommendations for future research on this topic. METHODS Following PRISMA guidelines, four databases were searched for empirical studies published in English between 1992 and 2022. Studies were included if they report findings on manifestations, experiences and/or impacts of racial or ethnic discrimination against racialized migrants in a healthcare setting in a European country. They were summarized by study characteristics (geographical scope, study design, research question and measures) and research findings were synthesized. RESULTS Out of 2365 initial hits, 1724 records were included in the title/abstract-screening, 87 records in the full text-screening, and 38 records in the data extraction. For many country and healthcare contexts, evidence on racism in healthcare is lacking. Most studies apply an explorative qualitative research design; comparability and generalizability of research results are low. Our analysis furthermore shows a near-exclusive research focus on racism on the interpersonal level as compared to institutional and structural levels. Our synthesis of study results identifies three interrelated ways in which racism manifests in and impacts migrants' healthcare: 1) general anti-migration bias, 2) health- and healthcare-related prejudice, and 3) differential medical treatment. CONCLUSIONS Our review underscores how racism reinforces inequities in healthcare access and quality for racialized migrants. It also highlights the need for more research on racism in Europe across a greater scope of country contexts, healthcare settings and migrant/racialized categories in order to understand specific forms of racism and capture race as a context-contingent social construct. It is critical that future research includes the consideration of individual-level racism as embedded in racism on institutional and structural levels. Methods and insights from other disciplines may help to critically examine concepts in light of underlying historical, sociopolitical and socioeconomic processes and structures, and to improve methods for researching racialization and racism in healthcare.
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Affiliation(s)
- Mia Pattillo
- Weill Cornell Medicine, 1300 York Avenue, New York, NY, 10021, USA
| | - Sigsten Stieglitz
- Bielefeld School of Public Health, Universitätsstrasse 25, 33615, Bielefeld, Germany
| | - Konstantinos Angoumis
- Bielefeld School of Public Health, Universitätsstrasse 25, 33615, Bielefeld, Germany
| | - Nora Gottlieb
- Bielefeld School of Public Health, Universitätsstrasse 25, 33615, Bielefeld, Germany.
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13
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Wells JCK. An evolutionary perspective on social inequality and health disparities: Insights from the producer-scrounger game. Evol Med Public Health 2023; 11:294-308. [PMID: 37680454 PMCID: PMC10482145 DOI: 10.1093/emph/eoad026] [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: 04/21/2023] [Revised: 07/13/2023] [Indexed: 09/09/2023] Open
Abstract
There is growing concern with social disparities in health, whether relating to gender, ethnicity, caste, socio-economic position or other axes of inequality. Despite addressing inequality, evolutionary biologists have had surprisingly little to say on why human societies are prone to demonstrating exploitation. This article builds on a recent book, 'The Metabolic Ghetto', describing an overarching evolutionary framework for studying all forms of social inequality involving exploitation. The dynamic 'producer-scrounger' game, developed to model social foraging, assumes that some members of a social group produce food, and that others scrounge from them. An evolutionary stable strategy emerges when neither producers nor scroungers can increase their Darwinian fitness by changing strategy. This approach puts food systems central to all forms of human inequality, and provides a valuable lens through which to consider different forms of gender inequality, socio-economic inequality and racial/caste discrimination. Individuals that routinely adopt producer or scrounger tactics may develop divergent phenotypes. This approach can be linked with life history theory to understand how social dynamics drive health disparities. The framework differs from previous evolutionary perspectives on inequality, by focussing on the exploitation of foraging effort rather than inequality in ecological resources themselves. Health inequalities emerge where scroungers acquire different forms of power over producers, driving increasing exploitation. In racialized societies, symbolic categorization is used to systematically assign some individuals to low-rank producer roles, embedding exploitation in society. Efforts to reduce health inequalities must address the whole of society, altering producer-scrounger dynamics rather than simply targeting resources at exploited groups.
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Affiliation(s)
- Jonathan C K Wells
- Childhood Nutrition Research Centre, Population, Policy and Practice Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London, UK
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14
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Torres CIH, Gold R, Kaufmann J, Marino M, Hoopes MJ, Totman MS, Aceves B, Gottlieb LM. Social Risk Screening and Response Equity: Assessment by Race, Ethnicity, and Language in Community Health Centers. Am J Prev Med 2023; 65:286-295. [PMID: 36990938 PMCID: PMC10652909 DOI: 10.1016/j.amepre.2023.02.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 02/14/2023] [Accepted: 02/14/2023] [Indexed: 03/31/2023]
Abstract
INTRODUCTION Little has previously been reported about the implementation of social risk screening across racial/ethnic/language groups. To address this knowledge gap, the associations between race/ethnicity/language, social risk screening, and patient-reported social risks were examined among adult patients at community health centers. METHODS Patient- and encounter-level data from 2016 to 2020 from 651 community health centers in 21 U.S. states were used; data were extracted from a shared Epic electronic health record and analyzed between December 2020 and February 2022. In adjusted logistic regression analyses stratified by language, robust sandwich variance SE estimators were applied with clustering on patient's primary care facility. RESULTS Social risk screening occurred at 30% of health centers; 11% of eligible adult patients were screened. Screening and reported needs varied significantly by race/ethnicity/language. Black Hispanic and Black non-Hispanic patients were approximately twice as likely to be screened, and Hispanic White patients were 28% less likely to be screened than non-Hispanic White patients. Hispanic Black patients were 87% less likely to report social risks than non-Hispanic White patients. Among patients who preferred a language other than English or Spanish, Black Hispanic patients were 90% less likely to report social needs than non-Hispanic White patients. CONCLUSIONS Social risk screening documentation and patient reports of social risks differed by race/ethnicity/language in community health centers. Although social care initiatives are intended to promote health equity, inequitable screening practices could inadvertently undermine this goal. Future implementation research should explore strategies for equitable screening and related interventions.
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Affiliation(s)
| | - Rachel Gold
- Center for Health Research, Kaiser Permanente and OCHIN, Inc., Portland, Oregon
| | | | - Miguel Marino
- Department of Family Medicine, OHSU, Portland, Oregon
| | | | - Molly S Totman
- Quality, Community Care Cooperative, Boston, Massachusetts
| | - Benjamín Aceves
- Social Interventions Research and Evaluation Network, Department of Family and Community Medicine, University of California, San Francisco, San Francisco, California
| | - Laura M Gottlieb
- Social Interventions Research and Evaluation Network, Department of Family and Community Medicine, University of California, San Francisco, San Francisco, California
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15
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Mukhopadhyay P, Desouza S, Lolayekar AP. What does the demographic profile of convicts tell us about social equity in India? PLoS One 2023; 18:e0288127. [PMID: 37428733 DOI: 10.1371/journal.pone.0288127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 06/16/2023] [Indexed: 07/12/2023] Open
Abstract
Social equity is a critical component of social justice and is measured in multiple ways. Conventionally, researchers use literacy levels, workforce participation, political participation and representation, corporate presence, and demographic parity as indicators of social and economic equity. We add law enforcement outcomes to this literature by examining the demographic profiles of convicts in prisons in India for each state and compare it with that of the population of the respective state. To test whether entrenched social inequities have permeated into the law enforcement system, we use three indicators of social identity-religion, caste, and domicile-to create a social equity index (SEI). This is a composite index combining caste, religion and domicile similar in method to the Human Development Index which combines income, education and health. Our indicators are not considered in other popular development indices and is a conceptual innovation. Our paper innovates by combining prison data and census data at the state level over the two latest census rounds (2001 and 2011). We use a spatial panel analysis as well as a distributional dynamics approach to test for bias and transitions over time at the state level. We find that entrenched social hierarchies are mirrored in conviction outcomes and that social identities influence law enforcement. In contrast to earlier studies, we find that states that are conventionally considered to perform poorly in terms of economic and human development have done better in terms of social equity than economically advanced states.
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Affiliation(s)
| | - Shaila Desouza
- Manohar Parrikar School of Law, Governance and Public Policy, Goa University, Goa, India
| | - Aparna P Lolayekar
- Manohar Parrikar School of Law, Governance and Public Policy, Goa University, Goa, India
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16
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Deivanayagam TA, English S, Hickel J, Bonifacio J, Guinto RR, Hill KX, Huq M, Issa R, Mulindwa H, Nagginda HP, de Morais Sato P, Selvarajah S, Sharma C, Devakumar D. Envisioning environmental equity: climate change, health, and racial justice. Lancet 2023; 402:64-78. [PMID: 37263280 PMCID: PMC10415673 DOI: 10.1016/s0140-6736(23)00919-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 04/28/2023] [Accepted: 05/02/2023] [Indexed: 06/03/2023]
Abstract
Climate change has a broad range of health impacts and tackling climate change could be the greatest opportunity for improving global health this century. Yet conversations on climate change and health are often incomplete, giving little attention to structural discrimination and the need for racial justice. Racism kills, and climate change kills. Together, racism and climate change interact and have disproportionate effects on the lives of minoritised people both within countries and between the Global North and the Global South. This paper has three main aims. First, to survey the literature on the unequal health impacts of climate change due to racism, xenophobia, and discrimination through a scoping review. We found that racially minoritised groups, migrants, and Indigenous communities face a disproportionate burden of illness and mortality due to climate change in different contexts. Second, this paper aims to highlight inequalities in responsibility for climate change and the effects thereof. A geographical visualisation of responsibility for climate change and projected mortality and disease risk attributable to climate change per 100 000 people in 2050 was conducted. These maps visualise the disproportionate burden of illness and mortality due to climate change faced by the Global South. Our third aim is to highlight the pathways through which climate change, discrimination, and health interact in most affected areas. Case studies, testimony, and policy analysis drawn from multidisciplinary perspectives are presented throughout the paper to elucidate these pathways. The health community must urgently examine and repair the structural discrimination that drives the unequal impacts of climate change to achieve rapid and equitable action.
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Affiliation(s)
- Thilagawathi Abi Deivanayagam
- Institute for Global Health, University College London, London, UK; Lancaster Medical School, Faculty of Health and Medicine, Lancaster University, Lancaster, UK.
| | - Sonora English
- Institute for Global Health, University College London, London, UK
| | - Jason Hickel
- Institute for Environmental Science and Technology, Autonomous University of Barcelona, Barcelona, Spain; International Inequalities Institute, London School of Economics and Political Science, London, UK
| | - Jon Bonifacio
- Youth Advocates for Climate Action Philippines, Quezon City, Philippines
| | - Renzo R Guinto
- Planetary and Global Health Program, St Luke's Medical Center College of Medicine-William H Quasha Memorial, Quezon City, Philippines
| | - Kyle X Hill
- Department of Indigenous Health, School of Medicine and Health Sciences, University of North Dakota, Grand Forks, ND, USA
| | - Mita Huq
- Institute for Global Health, University College London, London, UK
| | - Rita Issa
- Institute for Global Health, University College London, London, UK; School of International Development, University of East Anglia, Norwich, UK
| | | | | | | | | | - Chetna Sharma
- Institute for Global Health, University College London, London, UK
| | - Delan Devakumar
- Institute for Global Health, University College London, London, UK
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17
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Moody SN, Phan JM, Shirtcliff EA, Wang W, Drury S, Theall K. Transgenerational effect of Mothers' experiences of discrimination on Black youths' hormone coupling in response to laboratory stress. RESEARCH IN HUMAN DEVELOPMENT 2023; 20:25-47. [PMID: 37484485 PMCID: PMC10358998 DOI: 10.1080/15427609.2023.2215130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/25/2023]
Abstract
Exposure to pervasive racial discrimination of Black Americans is transgenerational in that mothers' experiences of discriminatory violence impacts their children. This study explored whether stress-related biomarkers reflect transgenerational racial stress by implementing a "dual activation" framework to probe how adrenal and gonadal hormones underlying adolescent development are co-regulated during a laboratory stressor. Data were collected from 120 Black families in the United States. Children completed the Trier Social Stress Task (TSST-C) and provided 4 saliva samples across 2 days that were assayed for cortisol (C), dehydroepiandrosterone (DHEA), and testosterone (T). Mothers reported their experiences of total discrimination and racial discrimination related to skin color/race. Thirty four percent reported experiences of discrimination and on average 46.7% reported experiences of discrimination due to their race or skin tone. Mothers' experiences of racial discrimination were associated with their child's hormonal reactivity to and recovery from the TSST-C. Youth showed stronger positive hormone coupling between C-T if their mother experienced greater discrimination. Mothers' experiences of racial discrimination influenced both C-T coupling and youths' cortisol recovery from the TSST-C. For youths with high testosterone, cortisol recovery was blunted. Results suggest that associations between racism and hormonal stress response may be transgenerational. Mothers' experiences of discrimination had a profound impact on their children's hormonal co-regulation.
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Affiliation(s)
- Shannin N. Moody
- Department of Neurology, Louisiana State University Health Sciences Center, New Orleans (LA), USA
- Department of Human Development and Family Studies, Iowa State University, Ames, (IA), USA
| | - Jenny M. Phan
- Center for Autism Spectrum Disorders, Children’s National Hospital, Washington (D.C.) USA
| | - Elizabeth A. Shirtcliff
- Center for Translational Neuroscience, Department of Psychology, University of Oregon, Eugene (OR), USA
| | - Wen Wang
- Center for Translational Neuroscience, Department of Psychology, University of Oregon, Eugene (OR), USA
| | - Stacy Drury
- Department of Pediatrics, Tulane University, New Orleans, (LA), USA
| | - Katherine Theall
- Departments of Social, Behavioral, and Population Sciences and Epidemiology, Tulane University, New Orleans, (LA), USA
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18
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Mashford-Pringle A, Tan S, Stutz S, Tjong G. Designing accountability measures for health professionals: results from a community-based micro-credential: case study on Indigenous cultural safety. BMC Public Health 2023; 23:879. [PMID: 37173719 PMCID: PMC10176280 DOI: 10.1186/s12889-023-15721-9] [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: 11/03/2022] [Accepted: 04/20/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND There is a widespread commitment to implementing anti-Indigenous racism with health organizations in Canada by introducing cultural safety staff training. In partnership with a public health unit in Ontario, Canada, we developed an evaluation tool to assess the performance of staff who completed an online Indigenous cultural safety education course. AIMS To develop an accountability checklist that could be used for annual employee performance reviews to assess the use and level of knowledge received in professional cultural safety training. INTERVENTION We co-created a professional development accountability checklist. Five areas of interest were identified: terminology, knowledge, awareness, skills, and behaviours. The checklist comprises of 37 indicators linked to our community collaborators' intended goals as defined in our partnership agreement. OUTCOMES The Indigenous Cultural Safety Evaluation Checklist (ICSEC) was shared with public health managers to use during regularly scheduled staff performance evaluations. The public health managers provided feedback on the design, checklist items, and useability of the ICSEC. The pilot of the checklist is in the preliminary stage and data is unavailable about effectiveness. IMPLICATIONS Accountability tools are important to sustain the long-term effects of cultural safety education and prioritize the wellbeing of Indigenous communities. Our experience can provide guidance to health professionals in creating and measuring the efficacy of Indigenous cultural safety education to foster an anti-racist work culture as well as improved health outcomes among Indigenous communities.
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Affiliation(s)
- Angela Mashford-Pringle
- Waakebiness-Bryce Institute for Indigenous Health, University of Toronto, 155 College Street, Toronto, ON, M5T 3M7, Canada.
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
| | - Sharon Tan
- Waakebiness-Bryce Institute for Indigenous Health, University of Toronto, 155 College Street, Toronto, ON, M5T 3M7, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Sterling Stutz
- Waakebiness-Bryce Institute for Indigenous Health, University of Toronto, 155 College Street, Toronto, ON, M5T 3M7, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Gabriel Tjong
- Waakebiness-Bryce Institute for Indigenous Health, University of Toronto, 155 College Street, Toronto, ON, M5T 3M7, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
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19
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Muruthi JR, Muruthi BA, Thompson Cañas RE, Romero L, Taiwo A, Ehlinger PP. Daily discrimination, church support, personal mastery, and psychological distress in black people in the United States. ETHNICITY & HEALTH 2023; 28:503-521. [PMID: 35733281 DOI: 10.1080/13557858.2022.2078481] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
OBJECTIVE This study used the stress process model to test the mediating effects of personal mastery and moderating effects of church-based social support on the relationship between daily discrimination and psychological distress across three age groups of African American and Afro-Caribbean adults. METHODS Using a national sample of 5008 African Americans and Afro-Caribbean adults from the National Survey of American Life Study, this study employs structural equation modeling to investigate the relationships between daily discrimination, personal mastery, church-based social support, and psychological distress. RESULTS Daily discrimination was an independent predictor of psychological distress across all groups. Group- and age-specific comparisons revealed significant differences in the experience of daily discrimination and psychological distress. Mastery was a partial mediator of the relationship between discrimination and psychological distress among Afro-Caribbeans while church support was a significant moderator only among the young and older African Americans. IMPLICATIONS Together, our study findings provide useful first steps towards developing interventions to reduce the adverse psychological impacts of daily discrimination on African Americans and Afro-Caribbeans. Intervention efforts such as individual psychotherapy aimed to improve Afro-Caribbean individuals' sense of mastery would be a partial solution to alleviating the adverse effects of discrimination on their psychological health.
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Affiliation(s)
- James R Muruthi
- Department of Counseling Psychology and Human Services, University of Oregon, Eugene, USA
| | - Bertranna A Muruthi
- Department of Counseling Psychology and Human Services, University of Oregon, Eugene, USA
| | - Reid E Thompson Cañas
- Department of Counseling Psychology and Human Services, University of Oregon, Eugene, USA
| | - Lindsey Romero
- Department of Counseling Psychology and Human Services, University of Oregon, Eugene, USA
| | - Abiola Taiwo
- Department of School Psychology, University of Oregon, Eugene, USA
| | - Peter P Ehlinger
- Department of Counseling Psychology and Human Services, University of Oregon, Eugene, USA
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20
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Vincent W, Del Río-González AM, Neilands TB, Bowleg L. Resilience and Its Limits: The Roles of Individual Resilience, Social Capital, Racial Discrimination, and Binge Drinking on Sexual Behavior Among Black Heterosexual Men. ARCHIVES OF SEXUAL BEHAVIOR 2023; 52:1419-1434. [PMID: 36512168 DOI: 10.1007/s10508-022-02488-0] [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: 08/10/2021] [Revised: 10/21/2022] [Accepted: 11/16/2022] [Indexed: 06/17/2023]
Abstract
In response to the increased recognition of racism as a public health crisis, we assessed links between racial discrimination and HIV-related risk behavior for Black men. Specifically, using survey data from 530 Black heterosexual men (18-44 years old, M = 31.0, SD = 7.8), we tested two moderated-mediation models: (1) a protective model, in which resilience and social capital protected against the indirect effect of racial discrimination on alcohol-related sexual behavior via binge drinking, and (2) a bounded model, in which racial discrimination limited the indirect effects of resilience and social capital on alcohol-related sexual behavior via binge drinking. We found support for the bounded model only. Specifically, resilience was indirectly associated with decreased alcohol-related sexual behavior via lower binge drinking when racial discrimination was low to moderately high, but not when racial discrimination was at its highest levels. Resilience was not directly associated with alcohol-related sexual behavior. Social capital was directly related to lower odds of alcohol-related sexual behavior. At high levels of racial discrimination, however, social capital was indirectly related to increased alcohol-related sexual behavior via binge drinking. High levels of racial discrimination limit beneficial effects of resilience on alcohol-related sexual behavior. Social capital maintains a beneficial effect if social bonds are not associated with binge-drinking norms or behaviors. Results highlight the limitations of individual-level resilience and the need to conceptualize and support resilience as a social-structural resource.
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Affiliation(s)
- Wilson Vincent
- Department of Psychology, Temple University, Weiss Hall, 1701 N. 13th Street, Philadelphia, PA, 19122, USA.
| | | | - Torsten B Neilands
- Center for AIDS Prevention Studies, Department of Medicine, University of California, San Francisco, CA, USA
| | - Lisa Bowleg
- Department of Psychological and Brain Sciences, The George Washington University, Washington, DC, USA
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21
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Briggs LG, Riew GJ, Kim NH, Aharon S, Klickstein JA, Cao AQ, Lites C, Sedlacek V, Seward MW, Soled DR, Palamara K. Racial and Gender Differences in Medical Student Burnout: A 2021 National Survey. Mayo Clin Proc 2023; 98:723-735. [PMID: 37137644 DOI: 10.1016/j.mayocp.2022.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 11/01/2022] [Accepted: 11/03/2022] [Indexed: 05/05/2023]
Abstract
OBJECTIVE To measure racial and gender differences in medical student burnout and identify possible contributing factors. PATIENTS AND METHODS Electronic surveys were distributed to medical students at 9 US medical schools from December 27, 2020, through January 17, 2021. Questions covered demographic characteristics, stressors contributing to burnout, and the 2-item Maslach Burnout Inventory. RESULTS Of 5500 invited students, 1178 (21%) responded (mean age, 25.3 years; 61% identified as female). Fifty-seven percent of respondents identified as White, 26% as Asian, and 5% as Black. Overall, 75.6% of students met the criteria for burnout. Women reported more burnout (78% vs 72%; P=.049). There were no differences in burnout prevalence by race. Students commonly reported that lack of sleep (42%), decreased engagement in hobbies or self-care (41%), stress about grades (37%), feeling socially disconnected (36%), and lack of exercise (35%) contributed to burnout. Compared with students of other races, Black students reported that their feelings of burnout were affected significantly more by lack of sleep and poor diet, and Asian students more by stress about grades, residency, and publishing pressure (all P<.05). Female students were more affected than male students by stress about grades, poor diet, and feelings of social disconnectedness and inadequacy (all P<.05). CONCLUSION Burnout (75.6%) was higher than historical norms, and female students reported higher burnout than male students. There was no difference in burnout prevalence by race. There were racial and gender differences in self-identified contributors of burnout. Additional research is needed to confirm whether stressors were contributors to or consequences of burnout, as well as how to address them.
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Affiliation(s)
- Logan G Briggs
- Department of Urologic Surgery, Mayo Clinic, Phoenix, AZ.
| | | | | | - Shani Aharon
- Department of General Surgery, Virginia Mason Franciscan Health, Seattle, WA
| | | | | | | | | | | | - Derek R Soled
- Department of Medicine and Pediatrics, Brigham and Women's Hospital, Boston Children's Hospital, and Boston Medical Center, Boston, MA
| | - Kerri Palamara
- Harvard Medical School, Boston, MA; Department of Medicine, Massachusetts General Hospital, Boston, MA
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22
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Centeno JG, Obler LK, Collins L, Wallace G, Fleming VB, Guendouzi J. Focusing Our Attention on Socially Responsive Professional Education to Serve Ethnogeriatric Populations With Neurogenic Communication Disorders in the United States. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2023:1-11. [PMID: 37099740 DOI: 10.1044/2023_ajslp-22-00325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
PURPOSE This viewpoint discusses a plausible framework to educate future speech-language pathologists (SLPs) as socially responsive practitioners who serve and advocate for the burgeoning vulnerable ethnogeriatric populations with neurogenic communication disorders. METHOD We provide an overview of the demographic, epidemiological, and biopsychosocial context that supports the implementation of equity-based, population-grounded educational approaches for speech-language pathology services in ethnogeriatric neurorehabilitation caseloads and discuss a plausible perspective based on the educational social determinants of health (SDOH) framework by the National Academies of Sciences, Engineering, and Medicine. RESULTS The NASEM's three-domain SDOH educational perspective integrates education, community, and organization to create a self-reinforcing pedagogical coproduction that, grounded in the synergized partnerships of educational institutions, engaged communities, and organizational leadership, aims to address systemic drivers of health perpetuating ethnoracial disparities in health, care, and outcomes. CONCLUSION Exponentially growing vulnerable ethnogeriatric populations with age-related neurogenic communication disorders warrant the implementation of health equity education strategies to train technically prepared, socially conscious SLPs as service providers and advocates.
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Affiliation(s)
- José G Centeno
- Department of Rehabilitation and Movement Sciences, Rutgers School of Health Professions, Newark, NJ
| | - Loraine K Obler
- Department of Speech-Language-Hearing Sciences, City University of New York, New York
| | - Linda Collins
- Department of Health and Human Sciences, Southeastern Louisiana University, Hammond
| | - Gloriajean Wallace
- Department of Communication Sciences and Disorders, Chapman University, Irvine, CA
| | - Valarie B Fleming
- Department of Communication Disorders, Texas State University, San Marcos
| | - Jacqueline Guendouzi
- Department of Health and Human Sciences, Southeastern Louisiana University, Hammond
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23
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Ivey Henry P, Spence Beaulieu MR, Bradford A, Graves JL. Embedded racism: Inequitable niche construction as a neglected evolutionary process affecting health. Evol Med Public Health 2023; 11:112-125. [PMID: 37197590 PMCID: PMC10184440 DOI: 10.1093/emph/eoad007] [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: 10/10/2022] [Revised: 04/11/2023] [Indexed: 05/19/2023] Open
Abstract
Racial health disparities are a pervasive feature of modern experience and structural racism is increasingly recognized as a public health crisis. Yet evolutionary medicine has not adequately addressed the racialization of health and disease, particularly the systematic embedding of social biases in biological processes leading to disparate health outcomes delineated by socially defined race. In contrast to the sheer dominance of medical publications which still assume genetic 'race' and omit mention of its social construction, we present an alternative biological framework of racialized health. We explore the unifying evolutionary-ecological principle of niche construction as it offers critical insights on internal and external biological and behavioral feedback processes environments at every level of the organization. We Integrate insights of niche construction theory in the context of human evolutionary and social history and phenotype-genotype modification, exposing the extent to which racism is an evolutionary mismatch underlying inequitable disparities in disease. We then apply ecological models of niche exclusion and exploitation to institutional and interpersonal racial constructions of population and individual health and demonstrate how discriminatory processes of health and harm apply to evolutionarily relevant disease classes and life-history processes in which socially defined race is poorly understood and evaluated. Ultimately, we call for evolutionary and biomedical scholars to recognize the salience of racism as a pathogenic process biasing health outcomes studied across disciplines and to redress the neglect of focus on research and application related to this crucial issue.
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Affiliation(s)
- Paula Ivey Henry
- Department of Social and Behavioral Sciences, T. H. Chan School of Public Health, Harvard University, Boston, MA, USA
| | | | - Angelle Bradford
- Department of Physiology, Tulane University School of Medicine, New Orleans, LA, USA
| | - Joseph L Graves
- Department of Biology, North Carolina A&T State University, Greensboro, NC, USA
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Brookfield S. What isn't public health? J Public Health Policy 2023:10.1057/s41271-023-00404-x. [PMID: 37012486 PMCID: PMC10068696 DOI: 10.1057/s41271-023-00404-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/16/2023] [Indexed: 04/05/2023]
Abstract
By recognizing the structural causes of health and illness, public health has often been associated with values of compassion and solidarity, and a relational understanding of human agency. Rather than supporting the consistent integration and application of these insights, however, public health is now sometimes invoked more as a rhetorical move, used to construct issues as simple questions of neoliberal scientistic rationalism. Public health practitioners must reckon, therefore, with how the field can be discursively deployed in the public square, for multiple divergent political ends. If public health is always positioned as a value-neutral and detached scientific approach to addressing complex subjects, from drug use to pandemics, it not only fails to connect with the arguments of its critics, but further divorces what was once called the public health 'movement' from the strong and progressive political and theoretical positions it was founded upon and should advocate for today.
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Affiliation(s)
- Samuel Brookfield
- School of Public Health, The University of Queensland, Brisbane, Australia.
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Conneely M, Packer KC, Bicknell S, Janković J, Sihre HK, McCabe R, Copello A, Bains K, Priebe S, Spruce A, Jovanović N. Exploring Black and South Asian women's experiences of help-seeking and engagement in perinatal mental health services in the UK. Front Psychiatry 2023; 14:1119998. [PMID: 37077277 PMCID: PMC10109459 DOI: 10.3389/fpsyt.2023.1119998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 03/06/2023] [Indexed: 04/21/2023] Open
Abstract
Background and aims In the United Kingdom (UK), Black and South Asian women are less likely than White British women to access support from perinatal mental health services, despite experiencing similar, or higher, levels of distress. This inequality needs to be understood and remedied. The aim of this study was to answer two questions: how do Black and South Asian women experience (1) access to perinatal mental health services and (2) care received from perinatal mental health services? Method Semi-structured interviews were conducted with Black and South Asian women (n = 37), including four women who were interviewed with an interpreter. Interviews were recorded and transcribed line-by-line. Data were analyzed using framework analysis, by an ethnically diverse multidisciplinary team of clinicians, researchers and people with lived experience of perinatal mental illness. Results Participants described a complex interplay of factors that impacted on seeking, and receiving help, and benefiting from services. Four themes emerged that captured the highly varied experiences of individuals: (1) Self-identity, social expectations and different attributions of distress deter help-seeking; (2) Hidden and disorganized services impede getting support; (3) The role of curiosity, kindness and flexibility in making women feel heard, accepted and supported by clinicians; (4) A shared cultural background may support or hinder trust and rapport. Conclusion Women described a wide range of experiences and a complex interplay of factors impacting access to, and experience of, services. Women described services as giving them strength and also leaving them disappointed and confused about where to get help. The main barriers to access were attributions related to mental distress, stigma, mistrust and lack of visibility of services, and organizational gaps in the referral process. These findings describe that many women feel heard, and supported by services, reporting that services provide a high quality of care that was inclusive of diverse experiences and understandings of mental health problems. Transparency around what PMHS are, and what support is available would improve the accessibility of PMHS.
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Affiliation(s)
- Maev Conneely
- Unit for Social and Community Psychiatry, WHO Collaborating Centre, Wolfson Institute of Population Health, Queen Mary University of London, London, United Kingdom
- East London NHS Foundation Trust, London, United Kingdom
| | - Katy C. Packer
- Camden and Islington NHS Foundation Trust, London, United Kingdom
- North East London NHS Foundation Trust, London, United Kingdom
| | - Sarah Bicknell
- Birmingham and Solihull Mental Health Foundation Trust, Birmingham, United Kingdom
| | - Jelena Janković
- Birmingham and Solihull Mental Health Foundation Trust, Birmingham, United Kingdom
- School of Psychology, University of Birmingham, Birmingham, United Kingdom
| | - Harpreet Kaur Sihre
- Department of Applied Health Research, University College London, London, United Kingdom
| | - Rosemarie McCabe
- School of Health and Psychological Sciences, City, University of London, London, United Kingdom
| | - Alex Copello
- Birmingham and Solihull Mental Health Foundation Trust, Birmingham, United Kingdom
- School of Psychology, University of Birmingham, Birmingham, United Kingdom
| | - Kiren Bains
- Birmingham and Solihull Mental Health Foundation Trust, Birmingham, United Kingdom
- School of Psychology, University of Birmingham, Birmingham, United Kingdom
| | - Stefan Priebe
- Unit for Social and Community Psychiatry, WHO Collaborating Centre, Wolfson Institute of Population Health, Queen Mary University of London, London, United Kingdom
- East London NHS Foundation Trust, London, United Kingdom
| | - Amy Spruce
- Action on Postpartum Psychosis, London, United Kingdom
| | - Nikolina Jovanović
- Unit for Social and Community Psychiatry, WHO Collaborating Centre, Wolfson Institute of Population Health, Queen Mary University of London, London, United Kingdom
- East London NHS Foundation Trust, London, United Kingdom
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26
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Ballantyne G, Giarrusso V. Asian Australian Experiences of Racism During the COVID-19 Pandemic in Victoria: a Preliminary Analysis. JOURNAL OF INTERNATIONAL MIGRATION AND INTEGRATION 2023; 24:1-17. [PMID: 37360634 PMCID: PMC9976652 DOI: 10.1007/s12134-023-01018-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/11/2023] [Indexed: 03/05/2023]
Abstract
Since the outbreak of COVID-19, reports of racism and racial discrimination towards those of an Asian cultural background have increased in culturally diverse countries around the world. The current study sought to gain clarity about Asian Australian experiences of racism by conducting inferential and descriptive analysis of cross-sectional survey data collected from the Australian state of Victoria (n = 436). Building on previous studies which have identified a range of modalities and consequences of COVID-19-related racism, participants were prompted to consider their experiences of racism in the year prior to the outbreak of COVID-19 as well as their experiences during the pandemic on four measures-Direct Experiences of Racism, Vicarious Experiences of Racism (online and in-person), Everyday Racism and Hypervigilance. For the target group (participants with an East or Southeast Asian cultural background resident in Victoria), analysis showed an increase in experiences across three of the four measures, with small to moderate effect sizes, Everyday Racism (r = 0.22), Vicarious Experiences of Racism (r = 0.19) and Hypervigilance (r = 0.43). Analysis demonstrated that the target group experienced a significant increase in online experiences of racism (r = 0.28). These findings shed light on the contradictory findings of previous research on pandemic-related racism in Australia. We show that the pandemic impacted Victorians likely to be perceived as of Chinese background more than other Asian Australians.
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Affiliation(s)
- Glenda Ballantyne
- School of Social Sciences, Media, Film, and Education, Swinburne University of Technology, John St, Hawthorn, 3122 Australia
| | - Vincent Giarrusso
- School of Social Sciences, Media, Film, and Education, Swinburne University of Technology, John St, Hawthorn, 3122 Australia
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27
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Bozorgmehr K, Kühne S, Biddle L. Local political climate and spill-over effects on refugee and migrant health: a conceptual framework and call to advance the evidence. BMJ Glob Health 2023; 8:bmjgh-2022-011472. [PMID: 36898715 PMCID: PMC10008416 DOI: 10.1136/bmjgh-2022-011472] [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: 12/06/2022] [Accepted: 02/21/2023] [Indexed: 03/12/2023] Open
Abstract
The health of refugees and migrants is determined by a wide range of factors. Among these, the local political climate in the postmigration phase is an important determinant which operates at interpersonal and institutional levels. We present a conceptual framework to advance theory, measurement and empirical evidence related to the small-area factors which shape and determine the local political climate, as these may translate into variations in health outcomes among refugees, migrants and other marginalised population groups. Using the example of Germany, we present evidence of small-area variation in factors defining political climates, and present and discuss potential pathways from local political climates to health outcomes. We show that anti-immigrant and antirefugee violence is a Europe-wide phenomenon and elaborate how resilience of individuals, communities, and the health system may function as moderator of the effects of the local political climate on health outcomes. Building on a pragmatic review of international evidence on spill-over effects identified in other racialised groups, we present a conceptual framework which incorporates direct effects as well as 'spill-over' effects on mental health with the aim to spark further academic discussion and guide empirical analysis on the topic. After presenting and discussing methodological challenges, we call for collective efforts to build coalitions between social sciences, conflict and violence studies, political science, data science, social psychologists and epidemiology to advance theory, measurement, and analysis of health effects of local political climates.
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Affiliation(s)
- Kayvan Bozorgmehr
- Department of Population Medicine & Health Services Research, School of Public Health, Bielefeld University, Bielefeld, Germany .,Section Health Equity Studies & Migration, University Hospital Heidelberg, Heidelberg, Germany.,Institute for Interdisciplinary Research on Conflict and Violence (IKG), Bielefeld University, Bielefeld, Germany
| | - Simon Kühne
- Institute for Interdisciplinary Research on Conflict and Violence (IKG), Bielefeld University, Bielefeld, Germany.,Applied Social Data Science, Faculty of Sociology, Bielefeld University, Bielefeld, Germany
| | - Louise Biddle
- Department of Population Medicine & Health Services Research, School of Public Health, Bielefeld University, Bielefeld, Germany
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28
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Pettersen RJ, Debesay J. Substance use and help-seeking barriers: a qualitative study of East African migrants' experiences of access to Norwegian healthcare services. BMC Health Serv Res 2023; 23:107. [PMID: 36726096 PMCID: PMC9891897 DOI: 10.1186/s12913-023-09110-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 01/25/2023] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Migration to Norway has increased rapidly in recent decades. Migrants have a lower prevalence of substance use, but may have an elevated risk of developing mental health issues and substance use problems due to various migration and post-migration factors. Few studies have sought to understand substance use problems among migrants in Norway. This study aimed to explore how people of East African background experience help-seeking for substance use problems in the Norwegian healthcare system. METHODS Using an explorative approach, in-depth individual interviews were conducted with six adult participants from Somalia, Eritrea and Sudan who had been in contact with the Norwegian healthcare system. The goal of the interviews was to facilitate in-depth and nuanced descriptions of the participants' lived experience of help-seeking for substance use problems. The data were analysed using interpretive phenomenological analysis. RESULTS The analysis resulted in five themes in which participants described their help-seeking experiences for substance use problems as lack of knowledge and access to information, scepticism towards a 'white system', fear of exclusion from family and ethnic community, racism as a barrier to help-seeking, and positive experiences and ideas for future treatment practices. CONCLUSION This study provides an improved understanding of how migrants with substance use problems experience help-seeking in healthcare. The variety of barriers illustrates inequality in substance use care for East African migrants in Norway.
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Affiliation(s)
- Ruben Jervell Pettersen
- grid.412414.60000 0000 9151 4445Faculty of Health, Department of Nursing, Oslo Metropolitan University, St. Olavs Plass, P.O. Box 4, NO-0130 Oslo, Norway
| | - Jonas Debesay
- grid.412414.60000 0000 9151 4445Faculty of Health, Department of Nursing, Oslo Metropolitan University, St. Olavs Plass, P.O. Box 4, NO-0130 Oslo, Norway
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29
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Rivera R, Capers T, Chandler M, Matthews E, Rzewinski J, Rees J, Israel S, Lushin V. Socioeconomic Stability Buffers Racial Discrimination Effect on Depression in a Marginalized Community. J Racial Ethn Health Disparities 2023; 10:130-140. [PMID: 35040107 DOI: 10.1007/s40615-021-01203-4] [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: 07/22/2021] [Revised: 11/30/2021] [Accepted: 12/01/2021] [Indexed: 02/03/2023]
Abstract
Depression disproportionately burdens poverty-affected minority communities. Racism and racial discrimination are well-known determinants of depression among members of marginalized minority communities. Less is known about potential buffers of the discrimination effects on depression, particularly those that could serve as targets for efficient community-based policies and interventions. Our secondary analysis of data from a community needs assessment survey (N = 677) in an urban minority neighborhood of low socio-economic status revealed that high school completion and current employment significantly weakened the association between discrimination and depression. Our findings frame community-level efforts to foster high school completion and employment as potential strategies to reduce the footprint of racism on the mental health of marginalized community members. Implications for future research and policy are discussed.
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Affiliation(s)
- Rebecca Rivera
- Long Island University Brooklyn Campus, Brooklyn, NY, USA
| | - Tracey Capers
- Bedford Stuyvesant Restoration Corporation, Brooklyn, NY, USA
| | | | | | | | - Jo Rees
- School of Health Professions, Long Island University Brooklyn Campus, Brooklyn, NY, USA
| | - Shimonah Israel
- Bedford Stuyvesant Restoration Corporation, Brooklyn, NY, USA
| | - Victor Lushin
- Long Island University Brooklyn Campus, Brooklyn, NY, USA.
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30
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Deivanayagam TA, Selvarajah S, Hickel J, Guinto RR, de Morais Sato P, Bonifacio J, English S, Huq M, Issa R, Mulindwa H, Nagginda HP, Sharma C, Devakumar D. Climate change, health, and discrimination: action towards racial justice. Lancet 2023; 401:5-7. [PMID: 36343651 DOI: 10.1016/s0140-6736(22)02182-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 10/31/2022] [Indexed: 11/06/2022]
Affiliation(s)
- Thilagawathi Abi Deivanayagam
- Institute for Global Health, University College London, London WC1N 1EH, UK; Lancaster Medical School, Faculty of Health and Medicine, Lancaster University, Lancaster, UK.
| | - Sujitha Selvarajah
- Institute for Global Health, University College London, London WC1N 1EH, UK
| | - Jason Hickel
- Institute for Environmental Science and Technology and Department of Anthropology, Autonomous University of Barcelona, Barcelona, Spain; International Inequalities Institute, London School of Economics and Political Science, London, UK
| | - Renzo R Guinto
- Planetary and Global Health Program, St Luke's Medical Center College of Medicine-William H Quasha Memorial, Quezon City, Philippines; Sunway Centre for Planetary Health, Sunway University, Selangor, Malaysia
| | | | - Jon Bonifacio
- Youth Advocates for Climate Action Philippines, Quezon City, Philippines
| | - Sonora English
- Institute for Global Health, University College London, London WC1N 1EH, UK
| | - Mita Huq
- Institute for Global Health, University College London, London WC1N 1EH, UK
| | - Rita Issa
- Institute for Global Health, University College London, London WC1N 1EH, UK
| | | | | | - Chetna Sharma
- Institute for Global Health, University College London, London WC1N 1EH, UK
| | - Delan Devakumar
- Institute for Global Health, University College London, London WC1N 1EH, UK
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31
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Szoko N, Ragunanthan B, Radovic A, Garrison JL, Torres O. Antiracist Curriculum Implementation for Pediatric Residents. JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2023; 10:23821205231162986. [PMID: 37123077 PMCID: PMC10134181 DOI: 10.1177/23821205231162986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Objectives Racism has been recognized as a public health crisis, with calls for greater focus on antiracism in medical training. We sought to evaluate a longitudinal antiracist curriculum among pediatric residents. Methods In 2020-2021, we delivered seven educational sessions to pediatric trainees in a single residency program. We administered pre-/post-surveys to assess changes in awareness of structural racism, knowledge of health inequities, antiracist clinical skills, and individual/institutional advocacy behaviors. Awareness was measured with 27 Likert-type items spanning five conceptual domains (schools, healthcare, justice system, employment, and housing/transportation). We evaluated knowledge with 18 true/false or multiple-choice questions. Participants indicated comfort with clinical skills using 13 Likert-type items drawn from national toolkits and policy statements. Individual/institutional advocacy behaviors were measured with 14 items from the Antiracism Behavioral Inventory. McNemar or paired Wilcoxon signed-rank tests compared measures before and after implementation. Results Out of 121 residents, 79 (65%) completed pre-surveys, 47 (39%) completed post-surveys, and 37 (31%) were eligible for matching across responses. 78% of respondents were female and 68% identified as White. We found significant increases in awareness across several conceptual domains (schools: p = 0.03; healthcare: p = 0.004; employment: p = 0.003; housing/transportation: p = 0.02). Mean knowledge score increased after implementation (p = 0.03). Self-reported clinical skills improved significantly (p < 0.001). Individual advocacy behaviors increased (p < 0.001); there were no changes in institutional advocacy. Conclusion We demonstrate improvements in several educational constructs with a novel antiracist curriculum. Efforts to scale and sustain this work are ongoing, and additional teaching and evaluation methodologies may be incorporated in the future.
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Affiliation(s)
- Nicholas Szoko
- Division of Adolescent and Young Adult Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
- Nicholas Szoko, Division of Adolescent and Young Adult Medicine, UPMC Children’s Hospital of Pittsburgh, 120 Lytton Avenue, Second Floor, Pittsburgh PA, 15213, USA.
| | | | - Ana Radovic
- Division of Adolescent and Young Adult Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Jessica L. Garrison
- Division of Pediatric Hospital Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Orquidia Torres
- Division of Adolescent and Young Adult Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
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32
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Collins SL, Smith TC, Hack G, Moorhouse MD. Exploring public health education's integration of critical race theories: A scoping review. Front Public Health 2023; 11:1148959. [PMID: 37124829 PMCID: PMC10140291 DOI: 10.3389/fpubh.2023.1148959] [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: 01/20/2023] [Accepted: 03/21/2023] [Indexed: 05/02/2023] Open
Abstract
Introduction Public health has declared a commitment toward diversity as a whole, with a commitment toward addressing and dismantling racism being at the forefront. Although public health has admirably taken on this mission, and the foundational principles of public health align with social justice and health equity, public health as a discipline is vastly behind other fields in integrating and utilizing critical race theorizations. Of particular concern is the lack of critical race theorization within public health education materials. Public health education serves as a precursor to public health practice and situates topics and competencies that are essential to one's foundational public health knowledge and skillset, thus the use of strong theoretical groundings is critical in public health education. Objectives Therefore, to explore the current landscape of public health educational research that employs critical race theories, this study sought to conduct a scoping review investigating the current literature of public health pedagogical, instructional, and curricular efforts that utilize race and antiracist theorization principles as a means to administer public health education. More specifically, we sought to investigate how have faculty and instructors published their integration of race theorization in public health curriculum/instruction within the United States since 2011. Results We found 18 examples from peer-reviewed literature of curricular, pedagogical, or instructional practices and strategies that integrate critical theories of race, including contemplative pedagogy (n = 1), antiracism (n = 3), Public Health Critical Race praxis (n = 4), Critical Race (n = 5), critical service-learning/community engagement (n = 2), ethnic studies (n = 1), and intersectionality (n = 2). Conclusion These articles present a wide breadth of innovative approaches to infusing critical race studies within public health higher education, ranging from individual assignments to course design and implementation to institutional culture change, thus demonstrating the multifaceted nature of critical race studies within micro-learning communities and macro-discipline practices. Identifying theoretically grounded, exemplary models and scholarly recommendations of pedagogical, instructional, and curricular practices provides readers the opportunity to borrow from successful practices and implement concepts of race, racism, antiracism, intersectionality, and more into their classrooms.
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Affiliation(s)
- Sarah L. Collins
- College of Public Health and Health Professions, University of Florida, Gainesville, FL, United States
- *Correspondence: Sarah L. Collins,
| | - Travis C. Smith
- Higher Education Administration, Department of Educational Foundations, Leadership, and Technology, College of Education, Auburn University, Auburn, AL, United States
| | - George Hack
- Department of Occupational Therapy, College of Public Health and Health Professions, University of Florida, Gainesville, FL, United States
| | - Michael D. Moorhouse
- Department of Occupational Therapy, College of Public Health and Health Professions, University of Florida, Gainesville, FL, United States
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Devakumar D, Abubakar I, Tendayi Achiume E, Muraya K, Paradies Y, Saini A, Selvarajah S, Shannon G. Executive summary. Lancet 2022; 400:2095-2096. [PMID: 36502847 DOI: 10.1016/s0140-6736(22)02485-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Delan Devakumar
- Institute for Global Health, University College London, London, UK.
| | - Ibrahim Abubakar
- Institute for Global Health, University College London, London, UK
| | - E Tendayi Achiume
- Department of Law, UCLA School of Law, University of California, Los Angeles, CA, USA
| | - Kui Muraya
- KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Yin Paradies
- Alfred Deakin Institute for Citizenship and Globalisation, Deakin University, Melbourne, VIC, Australia
| | | | | | - Geordan Shannon
- Institute for Global Health, University College London, London, UK
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Devakumar D, Selvarajah S, Abubakar I, Kim SS, McKee M, Sabharwal NS, Saini A, Shannon G, White AIR, Achiume ET. Racism, xenophobia, discrimination, and the determination of health. Lancet 2022; 400:2097-2108. [PMID: 36502848 DOI: 10.1016/s0140-6736(22)01972-9] [Citation(s) in RCA: 39] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 09/29/2022] [Accepted: 10/03/2022] [Indexed: 12/13/2022]
Abstract
This Series shows how racism, xenophobia, discrimination, and the structures that support them are detrimental to health. In this first Series paper, we describe the conceptual model used throughout the Series and the underlying principles and definitions. We explore concepts of epistemic injustice, biological experimentation, and misconceptions about race using a historical lens. We focus on the core structural factors of separation and hierarchical power that permeate society and result in the negative health consequences we see. We are at a crucial moment in history, as populist leaders pushing the politics of hate have become more powerful in several countries. These leaders exploit racism, xenophobia, and other forms of discrimination to divide and control populations, with immediate and long-term consequences for both individual and population health. The COVID-19 pandemic and transnational racial justice movements have brought renewed attention to persisting structural racial injustice.
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Affiliation(s)
- Delan Devakumar
- Institute for Global Health, University College London, London, UK.
| | | | - Ibrahim Abubakar
- Institute for Global Health, University College London, London, UK
| | - Seung-Sup Kim
- Department of Environmental Health Sciences, Seoul National University, Seoul, South Korea
| | - Martin McKee
- London School of Hygiene & Tropical Medicine, London, UK
| | - Nidhi S Sabharwal
- Centre for Policy Research in Higher Education, National Institute of Educational Planning and Administration, New Delhi, India
| | | | - Geordan Shannon
- Institute for Global Health, University College London, London, UK
| | - Alexandre I R White
- Johns Hopkins University and Johns Hopkins School of Medicine, Baltimore, MD, USA
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Selvarajah S, Corona Maioli S, Deivanayagam TA, de Morais Sato P, Devakumar D, Kim SS, Wells JC, Yoseph M, Abubakar I, Paradies Y. Racism, xenophobia, and discrimination: mapping pathways to health outcomes. Lancet 2022; 400:2109-2124. [PMID: 36502849 DOI: 10.1016/s0140-6736(22)02484-9] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 10/06/2022] [Accepted: 11/28/2022] [Indexed: 12/13/2022]
Abstract
Despite being globally pervasive, racism, xenophobia, and discrimination are not universally recognised determinants of health. We challenge widespread beliefs related to the inevitability of increased mortality and morbidity associated with particular ethnicities and minoritised groups. In refuting that racial categories have a genetic basis and acknowledging that socioeconomic factors offer incomplete explanations in understanding these health disparities, we examine the pathways by which discrimination based on caste, ethnicity, Indigeneity, migratory status, race, religion, and skin colour affect health. Discrimination based on these categories, although having many unique historical and cultural contexts, operates in the same way, with overlapping pathways and health effects. We synthesise how such discrimination affects health systems, spatial determination, and communities, and how these processes manifest at the individual level, across the life course, and intergenerationally. We explore how individuals respond to and internalise these complex mechanisms psychologically, behaviourally, and physiologically. The evidence shows that racism, xenophobia, and discrimination affect a range of health outcomes across all ages around the world, and remain embedded within the universal challenges we face, from COVID-19 to the climate emergency.
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Affiliation(s)
- Sujitha Selvarajah
- Institute for Global Health, University College London, London, UK; St George's Hospital NHS Foundation Trust, London, UK.
| | | | - Thilagawathi Abi Deivanayagam
- Institute for Global Health, University College London, London, UK; Lancaster Medical School, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | | | - Delan Devakumar
- Institute for Global Health, University College London, London, UK
| | - Seung-Sup Kim
- Department of Environmental Health Sciences, Seoul National University, Seoul, South Korea
| | - Jonathan C Wells
- University College London Great Ormond Street Institute of Child Health, London, UK
| | - Marcella Yoseph
- Global Mental Health, London School of Hygiene & Tropical Medicine, London, UK; Sir Ketumile Masire Teaching Hospital, University of Botswana, Gaborone, Botswana
| | - Ibrahim Abubakar
- Institute for Global Health, University College London, London, UK
| | - Yin Paradies
- Alfred Deakin Institute for Citizenship and Globalisation, Deakin University, Melbourne VIC, Australia
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Diskriminierungssensible Sprache in der Forschung zu Migration und Gesundheit – eine Handreichung. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2022; 65:1316-1323. [DOI: 10.1007/s00103-022-03620-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 10/26/2022] [Indexed: 11/23/2022]
Abstract
Zusammenfassung
Hintergrund
In der Public-Health-Forschung ist Migration als eine Determinante von Gesundheit zunehmend in den Fokus gerückt. Verantwortungsvolle Forschung in diesem Bereich setzt eine antidiskriminierende Vorgehensweise in der Durchführung, Berichterstattung und Ergebnisdissemination voraus. Ein diskriminierungssensibler Sprachgebrauch ist dabei ein zentrales Element. Handreichungen hierzu gibt es im deutschsprachigen Raum für den Bereich Public Health bisher nicht.
Methoden
Im Rahmen des Projektes Improving Health Monitoring in Migrant Populations (IMIRA) am Robert Koch-Institut wurde eine Handreichung zu antidiskriminierender Sprache in der Forschung zu Migration und Gesundheit entwickelt, die aus einem Leitfaden und einer Übersicht über relevante Begriffe und Konzepte besteht. Die Bedarfe, Inhalte und Form dazu wurden in einem Aktionsforschungsprozess mit Projektmitarbeitenden aus dem IMIRA-Projekt erarbeitet.
Ergebnisse
Der Leitfaden zeigt 5 Grundprinzipien für einen antidiskriminierenden Sprachgebrauch auf: 1. Generalisierungen und Verallgemeinerungen vermeiden, 2. diskriminierungssensibel formulieren, 3. Selbst- und Fremdbezeichnungen berücksichtigen, 4. Begriffe unterliegen einem ständigen Wandel und 5. eigene Unsicherheiten offen kommunizieren. Die Übersicht, welche online als „Living Document“ zur Verfügung steht, beinhaltet Begriffe und Konzepte, die im Zusammenhang mit dem Thema Gesundheit und Migration häufig verwendet werden.
Fazit
Die Handreichung soll Forschende dafür sensibilisieren und dabei unterstützen, Sprache antidiskriminierend anzuwenden. Dies geht mit einer Reflexion der eigenen Sprache einher und stärkt verantwortungsvolle Forschung zum Thema Migration und Gesundheit. Die Nutzung und der Nutzen der Handreichung können Gegenstand zukünftiger Evaluationen sein.
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Grieco CA, Currence P, Teraguchi DH, Monroe A, Palermo AGS. Integrated Holistic Student Affairs: A Personalized, Equitable, Student-Centered Approach to Student Affairs. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2022; 97:1441-1446. [PMID: 35612916 DOI: 10.1097/acm.0000000000004757] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Medical education has reached a critical juncture-the structural racism that has permeated the fabric of its systems and institutions for centuries can no longer be ignored. The destructive, disproportionate impact of the COVID-19 pandemic and unabated violence targeting individuals who are Black, Indigenous, and People of Color (BIPOC) exact an incalculable toll on BIPOC students and students from other groups that are historically underrepresented in medicine (UIM). Failing to recognize and act on the well-documented differential experience of BIPOC medical students impedes medical educators' ability to cultivate learning environments where all learners have an equitable opportunity to thrive. Holistic review admission processes, now widely accepted, have challenged admissions committees to consider the "whole applicant" to diversify matriculating classes. While gaining admission is critical, it is merely the first step for BIPOC students, who may face marginalization within what the authors have termed a "sink-or-swim" culture in medical education. For the tremendous potential afforded by holistic review to be realized, the medical education community must extend the holistic approach throughout the medical education continuum, beginning with student affairs practices and support. The authors propose the use of Integrated Holistic Student Affairs (IHSA), a systems-based model that fosters the reexamining and reengineering of existing student affairs structures, policies, and processes to promote a personalized, equitable student-centered approach. The IHSA Model consists of 4 strategic actions-establish vertical and horizontal collaboration, conduct systems thinking analysis, target leverage points for change, and operationalize the change process-and 4 areas of priority for collaboration with student diversity affairs staff and faculty. The IHSA Model provides student affairs staff and faculty with a framework for shifting from reactive, deficit-oriented practices to proactive, empowering, equitable practices, with the goal of allowing BIPOC and all other UIM students to thrive during their journey from matriculation to graduation.
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Affiliation(s)
- C Alexander Grieco
- C.A. Grieco is special assistant to the vice dean for education, The Ohio State University College of Medicine, Columbus, Ohio
| | - Princess Currence
- P. Currence is director of curriculum and education, Rush Medical College, Chicago, Illinois
| | - Daniel H Teraguchi
- D.H. Teraguchi is associate dean for student affairs, University of California Riverside School of Medicine, Riverside, California
| | - Alicia Monroe
- A. Monroe is provost and senior vice president for academic and faculty affairs, Baylor College of Medicine, Houston, Texas
| | - Ann-Gel S Palermo
- A.-G.S. Palermo is senior associate dean for diversity, equity, and inclusion, Icahn School of Medicine at Mount Sinai, New York, New York
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Legha RK, Gordon-Achebe K. The Color of Child Protection in America: Antiracism and Abolition in Child Mental Health. Child Adolesc Psychiatr Clin N Am 2022; 31:693-718. [PMID: 36182219 DOI: 10.1016/j.chc.2022.05.004] [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] [Indexed: 11/24/2022]
Abstract
This article illuminates the color of child protection by exposing the risks of racist and white supremacist harm intrinsic to the child welfare, public education, and juvenile injustice systems, specifically when they intersect with the child mental health system. Relying on bold and radical frameworks, such as abolition, critical race theory, and decolonization, it positions child mental health providers to confront the color of child protection while protecting minoritized children against these systems of harm. These frameworks inspire a daily antiracist practice whereby child mental health providers challenge racist inequities and the historical arcs driving them; protect minoritized children and families against the systems of care designed to harm them; and work toward the longer-term goal of abolishing these systems altogether. In a white supremacist society, child mental health providers have no choice but to engage in such antiracist practices in order to uphold their fundamental oath to first do no harm. The failure to do so amounts to negligence and malpractice.
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Affiliation(s)
| | - Kimberly Gordon-Achebe
- Department of Psychiatry, Division of Child and Adolescent Psychiatry, University of Maryland School of Medicine, 701 West Pratt Street, 4th Floor, Baltimore, MD 21201, USA
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Day S, Hlatshwako TG, Lloyd A, Han L, Tang W, Bayus B, Tucker JD. Evaluating and volunteering for crowdsourced interventions: Cross-sectional data on COVID-19 safety from a University Survey. PLoS One 2022; 17:e0275127. [PMID: 36174013 PMCID: PMC9521840 DOI: 10.1371/journal.pone.0275127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 09/10/2022] [Indexed: 11/19/2022] Open
Abstract
Despite many innovative ideas generated in response to COVID-19, few studies have examined community preferences for these ideas. Our study aimed to determine university community members’ preferences for three novel ideas identified through a crowdsourcing open call at the University of North Carolina (UNC) for making campus safer in the pandemic, as compared to existing (i.e. pre-COVID-19) resources. An online survey was conducted from March 30, 2021 –May 6, 2021. Survey participants included UNC students, staff, faculty, and others. The online survey was distributed using UNC’s mass email listserv and research directory, departmental listservs, and student text groups. Collected data included participant demographics, COVID-19 prevention behaviors, preferences for finalist ideas vs. existing resources in three domains (graduate student supports, campus tours, and online learning), and interest in volunteering with finalist teams. In total 437 survey responses were received from 228 (52%) staff, 119 (27%) students, 78 (18%) faculty, and 12 (3%) others. Most participants were older than age 30 years (309; 71%), women (332, 78%), and white (363, 83.1%). Five participants (1%) were gender minorities, 66 (15%) identified as racial/ethnic minorities, and 46 (10%) had a disability. Most participants preferred the finalist idea for a virtual campus tour of UNC’s lesser-known history compared to the existing campus tour (52.2% vs. 16.0%). For graduate student supports, 41.4% of participants indicated no preference between the finalist idea and existing supports; for online learning resources, the existing resource was preferred compared to the finalist idea (41.6% vs. 30.4%). Most participants agreed that finalists’ ideas would have a positive impact on campus safety during COVID-19 (81.2%, 79.6%, and 79.2% for finalist ideas 1, 2 and 3 respectively). 61 (14.1%) participants indicated interest in volunteering with finalist teams. Together these findings contribute to the development and implementation of community-engaged crowdsourced campus safety interventions during COVID-19.
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Affiliation(s)
- Suzanne Day
- Division of Infectious Diseases, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
- * E-mail:
| | - Takhona Grace Hlatshwako
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Anna Lloyd
- Department of Biology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Larry Han
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Weiming Tang
- Division of Infectious Diseases, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
- Social Entrepreneurship to Spur Health (SESH), Guangzhou, China
- University of North Carolina at Chapel Hill Project–China, Guangzhou, China
| | - Barry Bayus
- Kenan-Flagler Business School, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Joseph D. Tucker
- Division of Infectious Diseases, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
- Social Entrepreneurship to Spur Health (SESH), Guangzhou, China
- University of North Carolina at Chapel Hill Project–China, Guangzhou, China
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, England
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Regional Public Health Training Centers: An Essential Partner in Workforce Development. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2022; 28:S199-S202. [PMID: 35867489 DOI: 10.1097/phh.0000000000001516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Rosen KL, Cobb O, Gavney D, Morris SM, Gutmann DH. Predictors of Patient Return to a Tertiary Neurofibromatosis Subspecialty Clinic. J Pediatr 2022; 248:94-99.e1. [PMID: 35561805 DOI: 10.1016/j.jpeds.2022.05.007] [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: 02/14/2022] [Revised: 04/19/2022] [Accepted: 05/06/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To evaluate sociodemographic and medical predictors of patient return to a neurofibromatosis subspecialty clinic. STUDY DESIGN Data were collected from the Washington University Neurofibromatosis Clinical Program electronic medical records. A total of 713 subjects with initial visits to the Washington University Neurofibromatosis Clinical Program between July 1, 2005 and December 18, 2020 were included. Variables collected included sex, race, ethnicity, age, date of first visit, place of residence, diagnosis, insurance payer, physician recommendation for return, and subject return. Return rates for each demographic group were calculated. Bivariate analyses were performed to inform variable inclusion in the model, and a binary logistic regression model was calculated to predict subject return. RESULTS The overall return rate was 76%. The binary logistic regression model was statistically significant (χ29 = 131.094; P < .001) and showed that subjects who self-identified as Black and/or African American, presented with or received a diagnosis of café-au-lait macules at their initial visit, were from a rural area, were older, or who lived farther from the Washington University Neurofibromatosis Clinical Program were less likely to return to clinic. CONCLUSIONS These findings support the implementation of tailored communication and monitoring interventions to improve the care for children with neurofibromatosis type 1.
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Affiliation(s)
- Kyra L Rosen
- Department of Neurology, Washington University School of Medicine, St Louis, MO
| | - Olivia Cobb
- Department of Neurology, Washington University School of Medicine, St Louis, MO
| | - Deann Gavney
- Department of Neurology, Washington University School of Medicine, St Louis, MO
| | - Stephanie M Morris
- Department of Neurology, Washington University School of Medicine, St Louis, MO
| | - David H Gutmann
- Department of Neurology, Washington University School of Medicine, St Louis, MO.
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Grinspun D, Wallace K, Li SA, McNeill S, Squires JE, Bujalance J, D’Arpino M, De Souza G, Farshait N, Gabbay J, Graham ID, Hutchinson A, Kinder K, Laur C, Mah T, Moore JE, Plant J, Ploquin J, Ruiter PJA, St-Germain D, Sills-Maerov M, Tao M, Titler M, Zhao J. Exploring social movement concepts and actions in a knowledge uptake and sustainability context: A concept analysis. Int J Nurs Sci 2022; 9:411-421. [PMID: 36285080 PMCID: PMC9587399 DOI: 10.1016/j.ijnss.2022.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 07/21/2022] [Accepted: 08/29/2022] [Indexed: 11/17/2022] Open
Abstract
Objectives To share a concept analysis of social movement aimed at advancing its application to evidence uptake and sustainability in health-care. Methods We applied Walker and Avant method to clarify the concept of social movement in the context of knowledge uptake and sustainability. Peer-reviewed and grey literature databases were systematically searched for relevant reports that described how social movement action led to evidence-based practice changes in health and community settings. Titles, abstracts and full texts were reviewed independently and in duplicate, resulting in 38 included articles. Results Social movement action for knowledge uptake and sustainability can be defined as individuals, groups, or organizations that, as voluntary and intrinsically motivated change agents, mobilize around a common cause to improve outcomes through knowledge uptake and sustainability. The 10 defining attributes, three antecedents and three consequences that we identified are dynamic and interrelated, often mutually reinforcing each other to fortify various aspects of the social movement. Examples of defining attributes include an urgent need for action, collective action and collective identity. The concept analysis resulted in the development of the Social Movement Action Framework. Conclusions Social movement action can provide a lens through which we view implementation science. Collective action and collective identity – concepts less frequently canvassed in implementation science literature – can lend insight into grassroots approaches to uptake and sustainability. Findings can also inform providers and change leaders on the practicalities of harnessing social movement action for real-world change initiatives. By mobilizing individuals, groups, or organizations through social movement approaches, they can engage as powered change agents and teams that impact the individual, organizational and health systems levels to facilitate knowledge uptake and sustainability.
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Affiliation(s)
- Doris Grinspun
- Registered Nurses’ Association of Ontario, Toronto, Canada
| | - Katherine Wallace
- Registered Nurses’ Association of Ontario, Toronto, Canada
- Corresponding author.
| | - Shelly-Anne Li
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
| | - Susan McNeill
- Registered Nurses’ Association of Ontario, Toronto, Canada
| | - Janet Elaine Squires
- School of Nursing, University of Ottawa, Ottawa, Canada
- Ottawa Hospital Research Institute, Ottawa, Canada
| | | | | | | | | | - John Gabbay
- University of Southampton, Southampton, England, UK
| | - Ian D. Graham
- Ottawa Hospital Research Institute, Ottawa, Canada
- Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Canada
| | - Alison Hutchinson
- School of Nursing and Midwifery, Deakin University Australia, Victoria, Australia
| | - Kim Kinder
- Healthcare Excellence Canada, Ottawa, Canada
| | - Celia Laur
- Women’s College Hospital Institute for Health System Solutions and Virtual Care (WIHV), Toronto, Canada
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Tina Mah
- Schlegel-UW Research Institute for Aging, Waterloo, Canada
| | | | | | | | | | | | | | - May Tao
- Toronto Public Health, Toronto, Canada
| | - Marita Titler
- School of Nursing, University of Michigan, Ann Arbor, United States
| | - Junqiang Zhao
- School of Nursing, University of Ottawa, Ottawa, Canada
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Using Community-Based System Dynamics to Address Structural Racism in Community Health Improvement. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2022; 28:S130-S137. [PMID: 35616557 DOI: 10.1097/phh.0000000000001492] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
CONTEXT Structural racism is a profound determinant of health resulting in pervasive health inequities for people of color. Despite the recognition of structural racism as a complex, dynamic system, we lack a shared vision of the system that would enable identification of solutions for equitable systems transformation. POLICY Through a public health-led community health improvement planning process, a cross-sector consortium implemented community-based system dynamics to provide a systems science lens to guide efforts to eliminate structural racism. IMPLEMENTATION In group model building sessions involving diverse stakeholders, community-based system dynamics was used to bring together cross-sector stakeholders to create causal loop diagrams of the system of structural racism. Participants identified potential leverage points for actionable focus to eliminate structural racism. EVALUATION Causal loop diagrams of structural racism generated through group model building demonstrate complex dynamics in the areas of criminal justice, education and economic opportunity, health and health care, quality of life, racial trauma and healing, and a promising system transformative solution through perspective transformation. DISCUSSION Community-based system dynamics, employed in the context of local community health improvement planning, engages stakeholders in systems thinking through sharing lived experience to create system maps of structural racism and identify leverage points and transportable solutions that foster health equity. These informal maps serve as the foundation for formal computer simulation models that will guide systemic action on high-yield, community-driven solutions to eliminate structural racism.
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Crouch E, Radcliff E, Merrell MA, Brown MJ, Bennett KJ. A national examination of poverty and interactive caregiving practices among parents of young children. JOURNAL OF CHILD AND FAMILY STUDIES 2022; 31:2266-2274. [PMID: 35765411 PMCID: PMC9226279 DOI: 10.1007/s10826-022-02349-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/13/2022] [Indexed: 06/15/2023]
Abstract
Interactive caregiving practices can be protective for the development of the brain in early childhood, particularly for children experiencing poverty. There has been limited research examining the prevalence of interactive caregiving practices in early childhood at the population level across the U.S. The purpose of this study was to describe the prevalence of three interactive caregiver activities: (1) reading, (2) telling stories/singing songs, and (3) eating a meal together, using the 2017-2018 National Survey of Children's Health, among a sample of children age five and younger, and to examine the relationship between these interactive caregiving practices across income levels and by selected potentially confounding household characteristics. Children living in families with incomes below the federal poverty level had lower odds of being read to every day compared to children living in families with incomes at 400% or more above the federal poverty level (aOR 0.70; 95% CI 0.53-0.92). Children living in families within incomes at 100-199% of the federal poverty level had lower odds of being sung to and told stories to every day than children living in families with incomes at 400% or above the federal poverty level (aOR 0.62; 95% CI 0.50-0.78).These findings have long-term implications for children, as interactive caregiving practices are known to improve cognitive activities such as language development, which is associated with educational attainment into adulthood. Finding ways to increase the adoption of interactive caregiving practices may be one way to mitigate disparities in education, especially among families experiencing poverty.
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Affiliation(s)
- Elizabeth Crouch
- Rural and Minority Health Research Center, Arnold School of Public Health, University of South Carolina, Columbia, SC USA
- Department of Health Services Policy & Management, Arnold School of Public Health, University of South Carolina, Columbia, SC USA
| | - Elizabeth Radcliff
- Rural and Minority Health Research Center, Arnold School of Public Health, University of South Carolina, Columbia, SC USA
| | - Melinda A. Merrell
- Department of Health Services Policy & Management, Arnold School of Public Health, University of South Carolina, Columbia, SC USA
| | - Monique J. Brown
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC USA
- South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, Columbia, SC USA
| | - Kevin J. Bennett
- Department of Family and Preventive Medicine, University of South Carolina School of Medicine, Columbia, SC USA
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Milam AJ, Brown I, Edwards-Johnson J, McDougle L, Sousa A, Furr-Holden D. Experiences of Discrimination, Institutional Responses to Seminal Race Events, and Depressive Symptoms in Black U.S. Medical Students. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2022; 97:876-883. [PMID: 35703911 PMCID: PMC9204755 DOI: 10.1097/acm.0000000000004638] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
PURPOSE To examine the relationship between experiences of discrimination, institutional responses to seminal race events, and depressive symptoms among Black medical students. METHOD This study collected data from a convenience sample of Black U.S. medical students via an anonymous electronic questionnaire in August 2020 that was distributed through the Student National Medical Association and Organization of Student Representatives listservs and an author's social media accounts. It included questions on demographics, institutional responses to seminal race events, experiences of discrimination, and symptoms of depression. Path models were used to examine the relationship between experiences of discrimination, institutional responses to seminal race events, and depressive symptoms among Black medical students. RESULTS Of the 750 students completing the survey, 733 (97.7%) were Black. Experiences of discrimination and a lack of institutional responses to seminal race events were associated with more depressive symptoms (b = 0.19, 95% CI: 0.11, 0.26; P < .001 and b = 0.12, 95% CI: 0.04, 0.20; P = .01). After controlling for gender and clinical diagnosis of depression or anxiety before medical school, there was a relationship between experiences of discrimination and institutional responses to seminal race events such that students who reported more experiences of discrimination were more likely to report that their institution did not respond to seminal race events (b = 0.41, 95% CI: 0.34, 0.48; P < .001). Experiences of discrimination moderated the relationship between institutional responses to seminal race events and depressive symptoms (i.e., the relationship between a lack of institutional responses to seminal race events and depressive symptoms was stronger among students who reported more frequent experiences of discrimination). CONCLUSIONS Institutions dedicated to supporting Black medical student wellness must be diligent in cultivating a culture intolerant of discrimination and deft in their responses to seminal race events in the larger culture.
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Affiliation(s)
- Adam J Milam
- A.J. Milam is associate professor of anesthesiology, Mayo Clinic, Phoenix, Arizona; ORCID: https://orcid.org/0000-0001-9306-1598
| | - Italo Brown
- I. Brown is assistant professor of emergency medicine, Stanford University School of Medicine, Stanford, California
| | - Jennifer Edwards-Johnson
- J. Edwards-Johnson is associate professor and community assistant dean, College of Human Medicine, Michigan State University, East Lansing, Michigan
| | - Leon McDougle
- L. McDougle is professor of family medicine and associate dean for diversity and inclusion, The Ohio State University College of Medicine, Columbus, Ohio; ORCID: https://orcid.org/0000-0003-2400-8763
| | - Aron Sousa
- A. Sousa is interim dean, College of Human Medicine, Michigan State University, East Lansing, Michigan
| | - Debra Furr-Holden
- D. Furr-Holden is the C.S. Mott Endowed Professor of Public Health and associate dean for public health integration, College of Human Medicine, Michigan State University, East Lansing, Michigan; ORCID: https://orcid.org/0000-0002-9337-9886
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Lassiter JM, Dacus JD, Johnson MO. A Systematic Review of Black American Same-Sex Couples Research: Laying the Groundwork for Culturally-Specific Research and Interventions. JOURNAL OF SEX RESEARCH 2022; 59:555-567. [PMID: 34460349 DOI: 10.1080/00224499.2021.1964422] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
ABSTRACTThis article presents the findings of a systematic review of the empirical literature related to Black American same-sex couples (BASCs). We found 16 articles that met inclusion criteria. Most articles were published in journals that focused on interdisciplinary studies, HIV/AIDS, and couples and families' studies. Approximately 63% of the articles reported external funding support. However, only one of these grants was awarded to a Black investigator. Articles predominately focused on BASCs composed of Black sexual minority men residing in major U.S. cities. Only 25% of the articles focused on couples where both partners were Black. Most studies were cross-sectional, used convenience samples, and were reported without mention of a theoretical framework that explicated the philosophical assumptions that guided the research. The articles focused on a range of topics such as resilience, relationship dynamics, couple-level social support, rituals with extended families, and partner-health associations. The implications of these findings for advancing culturally-specific behavioral and social science health research and interventions with BASCs are presented.
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Affiliation(s)
| | - Jagadīśa-Devaśrī Dacus
- The Institute for Sexual and Gender Minority Health and Wellbeing at Northwestern University
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Danielli S, Ashrafian H, Darzi A. Population health: transformation will happen at the speed of trust. J Public Health (Oxf) 2022:6568915. [DOI: 10.1093/pubmed/fdac044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 02/04/2022] [Indexed: 11/14/2022] Open
Abstract
Abstarct
The societal shocks at the beginning of the 2020s have yet again brought into focus fundamental issues of inequality and distrust. These two corrosive and inter-related factors are the root cause of what inhibits our progress on issues such as improving population health and sustainable healthcare. Based on evidence, the authors provide their perspective to suggests three policy proposals; create a new power social movement for better health and equality; delegation of `old power' to City Mayors; handing over power and privilege to communities. This is the only way we will break the cycle of decreasing trust and increasing inequality and build a happier, healthier, and more resilient society.
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Affiliation(s)
- Shaun Danielli
- Kings Health Partners, Guys Hospital, London, SE1 9RT, UK
| | - Hutan Ashrafian
- Imperial College London, South Kensington Campus, London, SW7 2NA, UK
| | - Ara Darzi
- Imperial College London, South Kensington Campus, London, SW7 2NA, UK
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Lu C, Tago A, Olaiya O, Verhovsek M. Race-based data collection among COVID-19 inpatients: A retrospective chart review. Healthc Manage Forum 2022; 35:130-134. [PMID: 35389294 PMCID: PMC9001061 DOI: 10.1177/08404704221077189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Public health data have demonstrated disproportionate COVID-19 morbidity and mortality among racialized populations. However, limited hospital data may prevent research into racial disproportionality among inpatients. We conducted a retrospective cross-sectional study of patients admitted with or without COVID-19 to an Ontario tertiary hospital between March and October 2020 to determine the percentage of inpatients with a formal race or ethnicity assessment in their medical record. The COVID-19 group included inpatients with concurrent COVID-19 positivity; the reference group included a random sample of General Medicine inpatients without COVID-19. We reviewed 80 patients with COVID-19 and 80 patients without COVID-19. Formal ethnicity assessments were recorded among 44% of the COVID-19 group and 49% of the reference group. Race and ethnicity data collection was less than 50% among inpatients with and without COVID-19 in one Ontario hospital. Adequate data collection is necessary to study racial health disparities in the hospital setting.
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Affiliation(s)
- Clara Lu
- 3710McMaster University, Hamilton, Ontario, Canada.,These authors contributed equally to this work
| | - Achieng Tago
- 3710McMaster University, Hamilton, Ontario, Canada.,These authors contributed equally to this work
| | - Oluwatobi Olaiya
- Department of Surgery, 3710McMaster University, Hamilton, Ontario, Canada
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Zhou X, Nguyen-Feng VN, Wamser-Nanney R, Lotzin A. Racism, Posttraumatic Stress Symptoms, and Racial Disparity in the U.S. COVID-19 Syndemic. Behav Med 2022; 48:85-94. [PMID: 35318897 DOI: 10.1080/08964289.2021.2006131] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
The COVID-19 syndemic, with a disproportionately higher adverse impact on communities of color (i.e., COVID-19 infection and death), will likely exacerbate the existing health disparities in trauma-related symptoms between people of color (POC) and White Americans. However, no studies have examined the racial disparity in posttraumatic stress symptoms (PTSS) during COVID-19. Grounded in ecological theory and racial trauma framework, we investigated racial disparity in PTSS and three possible mechanisms, 1) COVID stress, 2) direct racism, and 3) indirect racism, for these disparities using a large U.S. national sample. Results indicated that POC reported higher levels of PTSS than White Americans. The PTSS racial disparity was accounted more by direct and indirect racism than by the COVID-19-specific stressors, after controlling for age, gender, education, income, parent status, adverse childhood experiences (ACEs), and intimate partner violence (IPV). Additional fine-grained analyses for Hispanic/Latinx Americans, Black/African Americans, and Asian American and Pacific Islanders by and large corroborated the above findings. Our findings highlighted the deleterious impact of the ongoing racism pandemic on the POC community as a public health crisis in addition to the COVID-19 pandemic.Supplemental data for this article is available online at at http://doi:10.1080/08964289.2021.2006131.
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Affiliation(s)
- Xiang Zhou
- Educational Studies, Purdue University, West Lafayette, IN, USA
| | | | | | - Annett Lotzin
- Department of Psychiatry and Psychotherapy, MAS, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Fleming E, Raskin SE, Brody E. From describing disparities to understanding why disparities exist: Anti-racist methods to support dental public health research. J Public Health Dent 2022; 82 Suppl 1:73-78. [PMID: 35726470 PMCID: PMC9541958 DOI: 10.1111/jphd.12503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 01/05/2022] [Accepted: 01/10/2022] [Indexed: 11/29/2022]
Abstract
Racism is understudied in the oral health literature at the same time that race is overutilized as an explanatory factor in study design. Social and behavioral methodologies offer conceptual models that can be used to include racism in dental public health questions. In addition, interdisciplinary and mixed methods approaches allow for understanding racism as an underlying cause of social and health disparities and exploring solutions that address historical, institutional, social, political, and economic drivers of oral health inequity, while recognizing the limits of measuring racism quantitatively. In a collective acknowledgement of the limitations of conventional methods, there are new opportunities to explore how qualitative and mixed methods research can serve as drivers for both social justice and health equity, while building and sustaining a diverse research workforce that can better close these disparities and offer antiracist solutions to oral health inequities.
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Affiliation(s)
- Eleanor Fleming
- Department of Dental Public health, University of Maryland School of Dentistry, Baltimore, Maryland, USA
| | - Sarah E Raskin
- iCubed Oral Health Core, L. Douglas Wilder School of Government and Public Affairs and Department of Dental Public Health and Policy, School of Dentistry, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Erica Brody
- Health Sciences Library, Virginia Commonwealth University, Richmond, Virginia, USA
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