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Ingram BM, DeFreese JD, Kerr ZY, Oyesanya TO, Picha KJ, Register-Mihalik JK. Applying the National Institute on Minority Health and Health Disparities Research Framework to Social Determinants of Health in the Context of Sport-Related Concussion: A Clinical Commentary. J Athl Train 2024; 59:447-457. [PMID: 38446622 PMCID: PMC11127672 DOI: 10.4085/1062-6050-0370.23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2024]
Abstract
Sport-related concussion (SRC) is a prevalent injury. Significant disparities in SRC outcomes exist across racial and ethnic groups. These disparities may be attributed to the unequal distribution of political power (or influence) and resource allocation in various communities, shaping individuals' social determinants of health (SDOH). However, the influence of SDOH on SRC outcomes remains understudied. In this clinical commentary, we use the National Institute on Minority Health and Health Disparities Research Framework and describe how its application can help address gaps in our understanding of SDOH and SRC. This framework provides a comprehensive approach to investigating and addressing health disparities by considering SDOH along multiple levels and domains of influence. Using this framework, athletic trainers can identify areas requiring intervention and better understand how SDOH influence SRC outcomes. This understanding can help athletic trainers develop tailored interventions to promote equitable care for patients with SRC.
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Affiliation(s)
- Brittany M. Ingram
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill
| | - J. D. DeFreese
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill
| | - Zachary Yukio Kerr
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill
| | | | - Kelsey J. Picha
- Department of Interdisciplinary Health Sciences, A.T. Still University, Mesa, AZ
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Curtis MG, Wieling E, Bryant C, Campbell RD, Kogan SM. Systemic effects of the COVID pandemic on rural black American men's interpersonal relationships: A phenomenological examination. PLoS One 2024; 19:e0297876. [PMID: 38630764 PMCID: PMC11023195 DOI: 10.1371/journal.pone.0297876] [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: 10/03/2023] [Accepted: 01/08/2024] [Indexed: 04/19/2024] Open
Abstract
The COVID-19 pandemic was a socionatural disaster that unprecedentedly disrupted the daily lives of individuals, families, and communities. Prior research indicates that Black American men living in rural contexts, particularly in Southern parts of the United States of America, were disproportionately affected by the psychological and economic effects of the pandemic. Despite these disparities, few studies have examined the pandemic's impact on rural Black American men's social networks. This study aimed to explore the effects of the COVID-19 pandemic on rural Black American men's interpersonal relationships. Informed by the principles of critical ethnography and guided by van Manen's hermeneutic phenomenology, seventeen men were interviewed using a semi-structured interview protocol. Interviews were transcribed and then analyzed using an iterative thematic reduction process consistent with van Manen's approach. Four themes were generated: Familial Reorganization, Adaptive Fatherhood, Rona Romance, and Essential Community. Participants recounted how the pandemic motivated them to improve their relationships with family members and children but contributed additional stress to their romantic relationships. Participants further recounted how their friendships were the least impacted as they were willing to make exceptions to their normal protective protocols to socialize with close friends. Participants also noted feeling disconnected from their wider community because they could not attend church even though their religious beliefs remained unchanged. Findings highlight the need for scholars, clinicians, and policymakers to consider men's relational health when developing and implementing pandemic recovery efforts, as it can significantly influence their ability to recuperate mentally and physically. Future research should be dedicated to (1) investigating the effects of the COVID-19 pandemic on fathers, as prior research has nearly exclusively focused on mothers' experiences and (2) delineating protective effects of rural Black American men's involvement in the Black Church from their individual spiritualities to gain a more comprehensive understanding of the influence of contextual crisis on their long-term health and wellbeing.
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Affiliation(s)
- Michael G Curtis
- Department of Global Health Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - Elizabeth Wieling
- Department of Human Development and Family Studies, University of Georgia, Athens, Georgia, United States of America
| | - Chalandra Bryant
- Department of Family Social Science, University of Minnesota, Minneapolis, Minnesota, United States of America
| | | | - Steven M Kogan
- Department of Human Development and Family Studies, University of Georgia, Athens, Georgia, United States of America
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Budhu JA, Chukwueke UN, Jackson S, Lee EQ, McFaline-Figueroa JR, Willmarth N, Dalmage M, Kawachi I, Arons D, Chang SM, Galanis E, Hervey-Jumper SL, Wen PY, Porter AB. Defining interventions and metrics to improve diversity in CNS clinical trial participation: A SNO and RANO effort. Neuro Oncol 2024; 26:596-608. [PMID: 38071654 PMCID: PMC10995510 DOI: 10.1093/neuonc/noad242] [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] [Indexed: 04/06/2024] Open
Abstract
Despite major strides in cancer research and therapy, these advances have not been equitable across race and ethnicity. Historically marginalized groups (HMG) are more likely to have inadequate preventive screening, increased delays in diagnosis, and poor representation in clinical trials. Notably, Black, Hispanic, and Indigenous people represent 30% of the population but only 9% of oncology clinical trial participants. As a result, HMGs lack equitable access to novel therapies, contradicting the principle of distributive justice, as enshrined in the Belmont report, which demands the equitable selection of subjects in research involving human subjects. The lack of clinical trial diversity also leads to low generalizability and potentially harmful medical practices. Specifically, patients with brain cancer face unique barriers to clinical trial enrollment and completion due to disease-specific neurologic and treatment-induced conditions. Collectively, the intersection of these disease-specific conditions with social determinants of health fosters a lack of diversity in clinical trials. To ameliorate this disparity in neuro-oncology clinical trial participation, we present interventions focused on improving engagement of HMGs. Proposals range from inclusive trial design, decreasing barriers to care, expanding trial eligibility, access to tumor profiling for personalized medical trials, setting reasonable metrics and goals for accrual, working with patient community stakeholders, diversifying the neuro-oncology workforce, and development of tools to overcome biases with options to incentivize equity. The diversification of participation amongst neuro-oncology clinical trials is imperative. Equitable access and inclusion of HMG patients with brain tumors will not only enhance research discoveries but will also improve patient care.
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Affiliation(s)
- Joshua A Budhu
- Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Department of Neurology, Weill Cornell Medicine, Joan & Sanford I. Weill Medical College of Cornell University, New York, New York, USA
| | - Ugonma N Chukwueke
- Division of Neuro-Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
- Division of Neuro-Oncology, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Sadhana Jackson
- Surgical Neurology Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland, USA
- Pediatric Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Eudocia Q Lee
- Division of Neuro-Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
- Division of Neuro-Oncology, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - J Ricardo McFaline-Figueroa
- Division of Neuro-Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
- Division of Neuro-Oncology, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Mahalia Dalmage
- Division of Biological Sciences, University of Chicago Pritzker School of Medicine, Chicago, Illinois, USA
| | - Ichiro Kawachi
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - David Arons
- National Brain Tumor Society, Newton, Massachusetts, USA
| | - Susan M Chang
- Division of Neuro-Oncology, University of California San Francisco and Weill Institute for Neurosciences, San Francisco, California, USA
| | | | - Shawn L Hervey-Jumper
- Department of Neurological Surgery, University of California San Francisco and Weill Institute for Neurosciences, San Francisco, California, USA
| | - Patrick Y Wen
- Division of Neuro-Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
- Division of Neuro-Oncology, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Alyx B Porter
- Department of Neurology, Mayo Clinic Cancer Center, Phoenix, Arizona, USA
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Yu H, Bauermeister JA, Oyiborhoro U, Aryal S, Lipman TH, Tan ASL, Glanz K, Villarruel AM, Bonett S. Trust in federal COVID-19 vaccine oversight and parents' willingness to vaccinate their children against COVID-19: a cross-sectional study. BMC Public Health 2024; 24:830. [PMID: 38493101 PMCID: PMC10943829 DOI: 10.1186/s12889-024-18342-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 03/12/2024] [Indexed: 03/18/2024] Open
Abstract
BACKGROUND Over half of the youth population in the United States, aged 6 months to 17 years, have not received the Coronavirus Disease 2019 (COVID-19) vaccine. Given parents' central role in vaccinating their children, we examined associations between parents' trust of the federal oversight of COVID-19 vaccine safety and their willingness to vaccinate their children against COVID-19. METHODS This cross-sectional study included 975 parents of minor children residing in Philadelphia who completed the online survey between September 2021 and February 2022. Trust was measured using a four-point Likert scale ranging from 'do not trust' to 'fully trust' for two variables: (1) trust in federal oversight of COVID-19 vaccine safety for children and (2) trust in federal oversight of COVID-19 vaccine safety for the general public. A multiple logistic regression evaluated associations between trust and parents' willingness to vaccinate their children, which was measured on a five-point Likert scale ranging from 'strongly disagree' to 'strongly agree.' The analysis was adjusted for race/ethnicity, age, sexual orientation, gender, education, insurance, and parents' vaccination status. RESULTS Analyses included 975 parents whose children had not previously been vaccinated against COVID-19 (mean age 36.79, standard deviation 6.4; 42.1% racial/ethnic minorities; 93.2% heterosexual; and 73.7% with a college degree). Greater trust regarding federal oversight of COVID-19 vaccine safety for children [adjusted odds ratio (aOR) = 1.52, 95% confidence interval (CI): 1.13-2.04] and for the public (aOR = 1.58, 95% CI: 1.17-2.14) were each associated with increased willingness to have their child vaccinated against COVID-19. Unvaccinated parents had decreased willingness compared to parents who had received at least one dose of the vaccine (aOR = 0.14, 95% CI: 0.04-0.41). College-graduate parents exhibited increased willingness compared to those without a college degree (aOR = 2.07, 95% CI: 1.52-2.81). Non-heterosexual parents showed increased willingness compared to heterosexual parents (aOR = 2.30, 95% CI: 1.20-4.76). CONCLUSIONS Trust in federal COVID-19 vaccine oversight was associated with parental willingness to vaccinate their children against COVID-19 among parents whose children have not yet been vaccinated. Identifying and addressing causes of mistrust are crucial next steps to promote child vaccination. Intervention efforts to address trust gaps should remain a public health priority.
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Affiliation(s)
- Hyunmin Yu
- School of Nursing, University of Pennsylvania, 418 Curie Blvd, Philadelphia, Pennsylvania, 19104, USA.
| | - José A Bauermeister
- School of Nursing, University of Pennsylvania, 418 Curie Blvd, Philadelphia, Pennsylvania, 19104, USA
| | - Ufuoma Oyiborhoro
- School of Nursing, University of Pennsylvania, 418 Curie Blvd, Philadelphia, Pennsylvania, 19104, USA
| | - Subhash Aryal
- School of Nursing, University of Pennsylvania, 418 Curie Blvd, Philadelphia, Pennsylvania, 19104, USA
| | - Terri H Lipman
- School of Nursing, University of Pennsylvania, 418 Curie Blvd, Philadelphia, Pennsylvania, 19104, USA
| | - Andy S L Tan
- Annenberg School for Communication, University of Pennsylvania, 3620 Walnut Street, Philadelphia, Pennsylvania, 19104, USA
| | - Karen Glanz
- School of Nursing, University of Pennsylvania, 418 Curie Blvd, Philadelphia, Pennsylvania, 19104, USA
- Perelman School of Medicine, University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia, Pennsylvania, 19104, USA
| | - Antonia M Villarruel
- School of Nursing, University of Pennsylvania, 418 Curie Blvd, Philadelphia, Pennsylvania, 19104, USA
| | - Stephen Bonett
- School of Nursing, University of Pennsylvania, 418 Curie Blvd, Philadelphia, Pennsylvania, 19104, USA
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Henderson C, Scott T, Schinder B, Hager E, Friedman FS, Miller E, Ragavan MI. Shifting the Paradigm From Participant Mistrust to Researcher & Institutional Trustworthiness: A Qualitative Study of Researchers' Perspectives on Building Trustworthiness With Black Communities. COMMUNITY HEALTH EQUITY RESEARCH & POLICY 2024; 44:127-136. [PMID: 36125424 DOI: 10.1177/0272684x221117710] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Black communities are deeply underrepresented in research, due, in large part, to research mistrust. It is critical to shift the burden of trust building from communities to researchers and research institutions, which have perpetrated harm against Black communities for centuries. In this study, we examine researchers' perspectives on how to become trustworthy to Black-identifying participants and communities. METHODS We conducted semi-structured interviews with researchers affiliated with our institution's Clinical and Translational Science Institute. Participants were recruited through email and responded to the study team if they wished to participate. Interviews occurred through Zoom, took 60 minutes, and were audio recorded. We used an inductive thematic data analysis approach. RESULTS Sixteen researchers, who were affiliated with medicine, public health, psychology, education, and nursing, participated in this study. Participants agreed that researchers bear the responsibility for building trust and noted how critical it is to address the underrepresentation of Black participants in research through equitable recruitment and that researchers must be transparent and engage in reciprocal research practices. Community-partnered research was highlighted as a way to develop trustworthiness. Finally, participants noted that trustworthiness must also be built at the institutional level, rather than just by individual researchers. DISCUSSION To our knowledge, this is one of the first studies to examine researchers' perspectives on how to build their own trustworthiness, with a specific focus on trust-building with Black communities. Explicit training and resources are needed to build trustworthiness into academic centers.
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Affiliation(s)
| | | | | | - Erricka Hager
- School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Elizabeth Miller
- School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
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Bowen CD, Summersill AR, Google AN, Aadnes MG, Barnes ME. Exploring Black Undergraduate Students' Communication and Biology Education Experiences about COVID-19 and COVID-19 Vaccines During the Pandemic. CBE LIFE SCIENCES EDUCATION 2023; 22:ar42. [PMID: 37751507 PMCID: PMC10756046 DOI: 10.1187/cbe.22-11-0233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 07/31/2023] [Accepted: 08/09/2023] [Indexed: 09/28/2023]
Abstract
Effective communication about science is a core skill undergraduates should learn, but little research has explored how students communicate about culturally controversial science topics. In this study, we explored how Black undergraduate science students took on the role of science communicators in their communities during the COVID-19 pandemic. We interviewed 23 Black students about their experiences learning about COVID-19 vaccines and communicating about COVID-19 vaccines to their communities. We found that students' racial/ethnic and science backgrounds made them feel a responsibility to be effective communicators about COVID-19 vaccines as potential trusted messengers within their communities. However, students were using limited strategies when communicating and were unsure how to communicate about COVID-19 topics effectively to those who were vaccine-hesitant or doubted the severity of the pandemic. Finally, students described ways that their biology instructors could have helped them be more confident when communicating about COVID-19 vaccines with their communities. Findings suggest that biology instructors could teach science communication principles in addition to content knowledge about culturally controversial science topics in their undergraduate classes to build on students' developing science communication skills.
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Affiliation(s)
- Chloe D. Bowen
- Social Perceptions of Science Lab, Department of Biology, Middle Tennessee State University, Murfreesboro, TN 37132
| | - Alexa R. Summersill
- Social Perceptions of Science Lab, Department of Biology, Middle Tennessee State University, Murfreesboro, TN 37132
| | - Angela N. Google
- Department of Biological Sciences, University of Rhode Island, Kingston, RI 02881
| | - Madeline G. Aadnes
- Social Perceptions of Science Lab, Department of Biology, Middle Tennessee State University, Murfreesboro, TN 37132
| | - M. Elizabeth Barnes
- Social Perceptions of Science Lab, Department of Biology, Middle Tennessee State University, Murfreesboro, TN 37132
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Onwumere J, Gentle A, Obanubi R, Davis A, Karuga M, Ali R, Cardi V. Amplifying the voices of Black racial minorities in mental health research through public involvement and engagement: The importance of advisory roles. Health Expect 2023; 27:e13892. [PMID: 37986702 PMCID: PMC10726207 DOI: 10.1111/hex.13892] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 09/13/2023] [Accepted: 10/05/2023] [Indexed: 11/22/2023] Open
Abstract
INTRODUCTION Ensuring adequate representation and the active, meaningful and visible involvement of groups likely to be most impacted by research findings and/or the lack of research inquiry are increasingly acknowledged. This is particularly relevant for Black racially minoritised groups who are less visible as research participants and in patient and public involvement and engagement (PPIE) roles. Our viewpoint article sought to discuss reflections and insights on their involvement experience, with particular attention to perceived barriers and enablers to PPIE involvement. METHODS Qualitative data were collected as part of facilitated group discussions from nine Black racially minoritised experts-by-experience involved in a PPIE advisory group. Data were subjected to thematic analysis to identify key themes. RESULTS Five main themes were identified that reflected factors linked to practicalities: role unfamiliarity, benefits for the larger community, acknowledgement of previous harm and mental health stigma. CONCLUSION Given the existence and importance of the direct links between research and service and treatment innovations in health and social care, ensuring that those from underrepresented Black racial communities are meaningfully and equitably supported to have roles in advising and influencing research programmes should be prioritised and an ongoing consideration for different stakeholders, including research funders, researchers, healthcare providers and community leaders/representatives. PATIENT OR PUBLIC CONTRIBUTION This viewpoint article is a collaboration between lived experience stakeholders and researchers, comprising conceiving the original idea for the paper, its conceptualisation and data generation and the coproduction including editing of the manuscript.
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Affiliation(s)
- Juliana Onwumere
- Department of Psychology, Institute of Psychiatry, Psychology and NeuroscienceKing's College LondonLondonUK
- South London and Maudsley NHS Foundation TrustLondonUK
- NIHR Biomedical Research Centre for Mental Health South London and Maudsley NHSLondonUK
| | | | | | | | | | - Rubbia Ali
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and NeuroscienceKing's College LondonLondonUK
| | | | - Valentina Cardi
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and NeuroscienceKing's College LondonLondonUK
- Department of General PsychologyUniversity of PadovaPaduaItaly
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Bains A, Osathanugrah P, Sanjiv N, Chiu C, Fiorello MG, Siegel NH, Peeler CE, Distefano AG, Lee HJ, Ness S, Desai MA, Titelbaum JR, Pira T, LaMattina KC, Christiansen SP, Cabral HJ, Subramanian ML. Diverse Research Teams and Underrepresented Groups in Clinical Studies. JAMA Ophthalmol 2023; 141:1037-1044. [PMID: 37856135 PMCID: PMC10587823 DOI: 10.1001/jamaophthalmol.2023.4638] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 08/26/2023] [Indexed: 10/20/2023]
Abstract
Importance Several ophthalmic diseases disproportionately affect racial and ethnic minority patients, yet most clinical trials struggle to enroll cohorts that are demographically representative of disease burden; some barriers to recruitment include time and transportation, language and cultural differences, and fear and mistrust of research due to historical abuses. Incorporating diversity within the research team has been proposed as a method to increase trust and improve engagement among potential study participants. Objective To examine how demographic factors of potential research participants and personnel may be associated with patient consent rates to participate in prospective ophthalmic clinical studies. Design, Setting, and Participants This retrospective cohort study included patients from an urban, academic hospital who were approached for consent to participate in prospective ophthalmic clinical studies conducted between January 2015 and December 2021. Main Outcomes and Measures Multivariable logistic regression assessing associations between patient and research personnel demographics and rates of affirmative consent to participate was used. Results In total, 1380 patients (mean [SD] age, 58.6 [14.9] years; 50.3% male) who were approached for consent to participate in 10 prospective ophthalmic clinical studies were included. Of prospective patients, 566 (43.5%) were Black; 327 (25.1%), Hispanic or Latino; 373 (28.6%), White; 36 (2.8%), other race and ethnicity; and 78 (5.8%) declined to answer. Black patients (odds ratio [OR], 0.32; 95% CI, 0.24-0.44; P < .001) and Hispanic or Latino patients (OR, 0.31; 95% CI, 0.20-0.47; P < .001) were less likely to consent compared with White patients. Patients with lower socioeconomic status were less likely to consent than patients with higher socioeconomic status (OR, 0.43; 95% CI, 0.33-0.53; P < .001). Concordance between patient and research staff race and ethnicity was associated with increased odds of affirmative consent (OR, 2.72; 95% CI, 1.99-3.73; P < .001). Conclusions and Relevance In this cohort study, patients from underrepresented racial and ethnic groups and those with lower socioeconomic status were less likely to participate in ophthalmic clinical studies. Concordance of race and ethnicity between patients and research staff was associated with improved participant enrollment. These findings underscore the importance of increasing diversity in clinical research teams to improve racial and ethnic representation in clinical studies.
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Affiliation(s)
- Ashank Bains
- Department of Ophthalmology, University of Washington, Seattle
| | | | - Nayan Sanjiv
- Department of Ophthalmology, Boston Medical Center, Boston, Massachusetts
| | - Cedrick Chiu
- Boston College, Morrissey College of Arts and Sciences, Boston, Massachusetts
| | | | - Nicole H. Siegel
- Department of Ophthalmology, Boston Medical Center, Boston, Massachusetts
- Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
| | - Crandall E. Peeler
- Department of Ophthalmology, Boston Medical Center, Boston, Massachusetts
- Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
| | - Alberto G. Distefano
- Department of Ophthalmology, Boston Medical Center, Boston, Massachusetts
- Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
| | - Hyunjoo J. Lee
- Department of Ophthalmology, Boston Medical Center, Boston, Massachusetts
- Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
| | - Steven Ness
- Department of Ophthalmology, Boston Medical Center, Boston, Massachusetts
- Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
| | - Manishi A. Desai
- Department of Ophthalmology, Boston Medical Center, Boston, Massachusetts
- Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
| | - Jenna R. Titelbaum
- Department of Ophthalmology, Boston Medical Center, Boston, Massachusetts
- Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
| | - Tony Pira
- Department of Ophthalmology, Boston Medical Center, Boston, Massachusetts
- Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
| | - Kara C. LaMattina
- Department of Ophthalmology, Boston Medical Center, Boston, Massachusetts
- Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
| | - Stephen P. Christiansen
- Department of Ophthalmology, Boston Medical Center, Boston, Massachusetts
- Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
- Department of Pediatrics, Boston Medical Center, Boston, Massachusetts
| | - Howard J. Cabral
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts
| | - Manju L. Subramanian
- Department of Ophthalmology, Boston Medical Center, Boston, Massachusetts
- Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
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Mathew L, Stewart M, Damaskos P, Sinha K, Cammarata M, Brown C, Davis M, Abraham Kaba A. Developing Antiracist Social Work Practice at a Comprehensive Cancer Center. HEALTH & SOCIAL WORK 2023; 48:261-269. [PMID: 37652026 DOI: 10.1093/hsw/hlad027] [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: 12/12/2022] [Revised: 02/27/2023] [Accepted: 03/20/2023] [Indexed: 09/02/2023]
Abstract
The combination of the ongoing violence perpetuated against Black, Brown, and Asian people, and the increased incidence of death of Black, Indigenous, people of color (BIPOC) and Asian Americans and Pacific Islanders (AAPI) at the start of the COVID-19 pandemic, elicited an important response from the field of social work across the nation. This article describes the efforts undertaken by a Social Work Department at a comprehensive cancer center in response to a call to develop antiracist practice. This article recounts the process of creating educational opportunities for oncology social workers to help them identify bias and racism in themselves and throughout the healthcare system, to embrace intentional antiracist practice, and to better advocate for BIPOC/AAPI patients and colleagues. The strategies included the development of an antiracism committee, the use of a social location exercise to influence and disrupt white supremacy, the creation of community guidelines for engaging in conversations about race, and the formulation of a new departmental policy ensuring a commitment to antiracist social work practice. In addition, a forum using multimedia was created to explore racial dynamics and to highlight the narratives of BIPOC and AAPI people. Further, a monthly Antiracist Clinical Case Conference was implemented to explore their role in the context of working with the interdisciplinary team in an oncology setting. This article concludes with recommendations for ongoing antiracist social work practice development that may be applied in various healthcare settings.
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Affiliation(s)
- Linda Mathew
- DSW, LCSW-R, is social work manager, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - Melissa Stewart
- LCSW-R, is a social work manager, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Penny Damaskos
- PhD, LCSW, FAOSW, is retired. Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Kasey Sinha
- LCSW, is social worker II, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Meredith Cammarata
- LCSW-R, is social work manager, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Chantelle Brown
- LCSW, is psychotherapist, Ackerman Institute for the Family, New York, NY, USA
| | - Margery Davis
- LCSW-R, are social work managers, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Annamma Abraham Kaba
- LCSW-R, are social work managers, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Ojo-Aromokudu O, Suffel A, Bell S, Mounier-Jack S. Views and experiences of primary care among Black communities in the United Kingdom: a qualitative systematic review. ETHNICITY & HEALTH 2023; 28:1006-1025. [PMID: 37160684 DOI: 10.1080/13557858.2023.2208313] [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: 05/09/2022] [Accepted: 04/24/2023] [Indexed: 05/11/2023]
Abstract
BACKGROUND In the United Kingdom, people with non-white ethnicities are more likely to report being in worse health conditions and have poorer experiences of healthcare services than white counterparts. The voices of those of Black ethnicities are often merged in literature among other non-white ethnicities. This literature review aims to analyse studies that investigate Black participant experiences of primary care in the UK. METHODS We conducted a systematic literature review searching Medline, Web of Science, EMBASE, SCOPUS, Social Policy and Practice, CINAHL plus, Psych INFO and Global Health with specific search terms for appropriate studies. No publish date limit was applied. RESULTS 40 papers (39 articles and 1 thesis) were deemed eligible for inclusion in the review. A number of major themes emerged. Patient expectations of healthcare and the health seeking behaviour impacted their interactions with health systems in the UK. Both language and finances emerged as barriers through which some Black participants interacted with primary care services. (Mis)trust of clinicians and the health system was a common theme that often negatively impacted views of UK primary care services. The social context of the primary care service and instances of a cultural disconnect also impacted views of primary care services. Some papers detail patients recognising differential treatment based on ethnicity. The review included the voices of primary care professionals where descriptions of Black patients were overwhelmingly negative. CONCLUSION Views and experiences of Black groups may be radically different to other ethnic minorities and thus, should be teased out of broader umbrella terms like Black and Asian Minority Ethnic (BAME) and Black Minority Ethnic (BME). To address ethnicity-based health inequalities, culturally sensitive interventions that engage with the impacted community including co-designed interventions should be considered while acknowledging the implications of being racialised as Black in the UK.
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Affiliation(s)
- Oyinkansola Ojo-Aromokudu
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Anne Suffel
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Sadie Bell
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Sandra Mounier-Jack
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
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11
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Cardona ND, Ametaj AA, Cassiello-Robbins C, Tirpak JW, Olesnycky O, Sauer-Zavala S, Farchione TJ, Barlow DH. Outcomes of People of Color in an Efficacy Trial of Cognitive-Behavioral Treatments for Anxiety, Depression, and Related Disorders: Preliminary Evidence. J Nerv Ment Dis 2023; 211:711-720. [PMID: 37432031 PMCID: PMC10524474 DOI: 10.1097/nmd.0000000000001692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/12/2023]
Abstract
ABSTRACT Although evidence-based psychological treatments such as cognitive behavioral therapy (CBT) have strong empirical support for reducing anxiety and depression symptoms, CBT outcome research often does not report race and ethnicity variables, or assess how well CBT works for people from historically excluded racial and ethnic groups. This study presents post hoc analyses comparing treatment retention and symptom outcomes for participants of color ( n = 43) and White participants ( n = 136) from a randomized controlled efficacy trial of CBT. χ 2 tests and one-way ANCOVA showed no observable differences between the two samples on attrition or on clinician-rated measures of anxiety and depression at posttreatment and follow-up. Moderate to large within-group effect sizes on anxiety and depression were found for Black, Latinx, and Asian American participants at almost all time points. These preliminary findings suggest that CBT for anxiety and comorbid depression may be efficacious for Black, Asian American, and Latinx individuals.
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Affiliation(s)
- Nicole D Cardona
- Department of Psychological and Brain Sciences, Boston University, Boston, Massachusetts
| | - Amantia A Ametaj
- Department of Epidemiology, Harvard Chan School of Public Health, Boston, Massachusetts
| | | | | | - Olenka Olesnycky
- Department of Psychology, Hofstra University, Hempstead, New York
| | | | - Todd J Farchione
- Department of Psychological and Brain Sciences, Boston University, Boston, Massachusetts
| | - David H Barlow
- Department of Psychological and Brain Sciences, Boston University, Boston, Massachusetts
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12
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Goodman ML, Seidel SE, Springer A, Elliott A, Markham C, Serag H, Keiser P, Raimer B, Raimer-Goodman L, Gatwiri C, Munene K, Gitari S. Enabling structural resilience of street-involved children and youth in Kenya: reintegration outcomes and the Flourishing Community model. Front Psychol 2023; 14:1175593. [PMID: 37680240 PMCID: PMC10482225 DOI: 10.3389/fpsyg.2023.1175593] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 07/31/2023] [Indexed: 09/09/2023] Open
Abstract
Introduction Millions of children and youth live on city streets across the globe, vulnerable to substance use, abuse, material and structural neglect. Structural resilience, the re-establishment of access to structural goods within a society such as housing, education, and healthcare following some interruption, provides an orientation for research and interventional efforts with street-involved children and youth (SICY). Further, a structural resilience framework supports organizing interactions between levels and sectors of a socio-ecology. Methods Following the expressed interests of Kenyan SICY, and consistent with emerging policy interests at national and global levels, we assess reintegration trajectories of Kenyan SICY (n = 227) participating in a new program intervention and model. The intervention combines two coordinated, parallel programs - one focused on the rescue, rehabilitation, reintegration and resocialization of SICY, and the other focused on empowering families and communities to provide better care for children and youth who are reintegrating from life on the streets to the broader community. Data were collected and analyzed from multiple stages across SICY involvement with the intervention. Results We found 79% of SICY participants reintegrated with the broader community, and 50% reintegrated with families of origin and returned to school. Twenty-five percent of participants reintegrated to a boarding school, polytechnical school, or began a business. Probability of reintegrating successfully was significantly improved among participants whose families participated in the family- and community-oriented program, who were younger, with less street-exposure, expressed more personal interests, and desired to reintegrate with family. Discussion To our knowledge, these are the first quantitative data published of successful reintegration of SICY to the broader, non-institutionalized community in any low- or middle-income country. Future research should (1) identify factors across socio-ecological levels and sectors contributing to health and developmental outcomes of reintegrated children and youth, (2) mechanisms to support SICY for whom the interventional strategy did not work, (3) methods to prevent street-migration by children and youth, and (4) system development to coordinate follow-up and relevant investment by institutions, organizations and community leaders to continue reintegration work.
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Affiliation(s)
- Michael L. Goodman
- Department of Internal Medicine, The University of Texas Medical Branch, Galveston, TX, United States
- Sodzo International, Houston, TX, United States
| | | | - Andrew Springer
- The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Aleisha Elliott
- Texas AHEC East, The University of Texas Medical Branch, Galveston, TX, United States
| | - Christine Markham
- The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Hani Serag
- Department of Internal Medicine, The University of Texas Medical Branch, Galveston, TX, United States
| | - Philip Keiser
- School of Public and Population Health, The University of Texas Medical Branch, Galveston, TX, United States
| | - Ben Raimer
- Office of the President, The University of Texas Medical Branch, Galveston, TX, United States
| | - Lauren Raimer-Goodman
- Community-based Clinics, The University of Texas Medical Branch, Galveston, TX, United States
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13
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Evans KN, Martinez O, King H, van den Berg JJ, Fields EL, Lanier Y, Hussen SA, Malavé-Rivera SM, Duncan DT, Gaul Z, Buchacz K. Utilizing Community Based Participatory Research Methods in Black/African American and Hispanic/Latinx Communities in the US: The CDC Minority HIV Research Initiative (MARI-Round 4). J Community Health 2023; 48:698-710. [PMID: 36943607 PMCID: PMC10028312 DOI: 10.1007/s10900-023-01209-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/02/2023] [Indexed: 03/23/2023]
Abstract
The Centers for Disease Control and Prevention Minority HIV Research Initiative (MARI) funded 8 investigators in 2016 to develop HIV prevention and treatment interventions in highly affected communities. We describe MARI studies who used community-based participatory research methods to inform the development of interventions in Black/African American and Hispanic/Latinx communities focused on sexual minority men (SMM) or heterosexual populations. Each study implemented best practice strategies for engaging with communities, informing recruitment strategies, navigating through the impacts of COVID-19, and disseminating findings. Best practice strategies common to all MARI studies included establishing community advisory boards, engaging community members in all stages of HIV research, and integrating technology to sustain interventions during the COVID-19 pandemic. Implementing community-informed approaches is crucial to intervention uptake and long-term sustainability in communities of color. MARI investigators' research studies provide a framework for developing effective programs tailored to reducing HIV-related racial/ethnic disparities.
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Affiliation(s)
- Kimberly N Evans
- Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Omar Martinez
- Department of Population Health Sciences, College of Medicine, University of Central Florida, Orlando, FL, USA
| | - Hope King
- Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Errol L Fields
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Yzette Lanier
- Rory Meyers College of Nursing, New York University, New York, NY, USA
| | - Sophia A Hussen
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Souhail M Malavé-Rivera
- School of Public Health, University of Puerto Rico-Medical Sciences Campus, San Juan, PR, USA
| | - Dustin T Duncan
- Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Zaneta Gaul
- Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
- Social & Scientific Systems affiliate of DLH, Atlanta, GA, USA
| | - Kate Buchacz
- Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
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14
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Fakhry JS, Pena MJ, Pomputius A, Giap F, Vega RBM. Racial and Ethnic Demographic Reporting in Phase 2 Proton Therapy Clinical Trials: A Review. Int J Part Ther 2023; 10:51-58. [PMID: 37823018 PMCID: PMC10563665 DOI: 10.14338/ijpt-22-00042.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 03/27/2023] [Indexed: 10/13/2023] Open
Abstract
Purpose Equitable inclusion of racial and ethnic participation in clinical trials is crucial to improving disparities in health care, especially for historically marginalized populations. Our study aims to describe the racial and ethnic demographics of patients enrolled in published phase 2 clinical trials involving proton therapy in the United States. Materials and Methods Published manuscripts were identified in PubMed, Embase, World of Science, and Cochrane. Phase 2 trials evaluating proton therapy for US patients were included. For each article in the study, data were collected comprising authors, title, and publication year, and clinical trial numbers were verified. Additional data included tumor site, primary institution, sample size, reported race/ethnicity, and raw number/percentile of race/ethnicity. Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines were used. Results Overall, 970 titles were identified; 636 remained after duplicate screening, and 75 full-text articles were assessed. We identified 38 eligible manuscripts for inclusion comprising 2648 patients. Only 15 (39%) of the publications reported race/ethnicity. Of these, 8 (21%) and 10 (26%) documented Hispanic or Black trial participants, respectively; however, only 6 (16%) documented trial participation for both Hispanic and Black patients. Of the 1409 patients with a documented race/ethnicity, 89.0% (n = 1254) were non-Hispanic white, 5.3% (n = 75) were Black, and 2.2% (n = 31) were Hispanic. Other and unknown race/ethnicity comprised the remaining patients (3.5%; n = 49). Conclusion We identified underreporting of demographic data in published phase 2 proton therapy trials, which unfortunately mirrored underreporting for cancer drug clinical trials. We also noted dramatic Black and Hispanic patient underrepresentation across the trials in which race and ethnicity are reported. Findings highlight the urgent need to identify and address barriers to proton therapy trials for Black and Hispanic patients ensuring clinical trials in radiation oncology are representative of the patients seen in clinical practice.
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Affiliation(s)
- Jonathan S. Fakhry
- Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, FL, USA
| | - M. Juliana Pena
- Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, FL, USA
| | - Ariel Pomputius
- University of Florida Health Science Center Libraries, Gainesville, FL, USA
| | - Fantine Giap
- Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, FL, USA
| | - Raymond B. Mailhot Vega
- Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, FL, USA
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15
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Malik HB, Norman JB. Best Practices and Methodological Strategies for Addressing Generalizability in Neuropsychological Assessment. JOURNAL OF PEDIATRIC NEUROPSYCHOLOGY 2023; 9:47-63. [PMID: 37250805 PMCID: PMC10182845 DOI: 10.1007/s40817-023-00145-5] [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: 12/05/2022] [Revised: 04/11/2023] [Accepted: 04/15/2023] [Indexed: 05/31/2023]
Abstract
Generalizability considerations are widely discussed and a core foundation for understanding when and why treatment effects will replicate across sample demographics. However, guidelines on assessing and reporting generalizability-related factors differ across fields and are inconsistently applied. This paper synthesizes obstacles and best practices to apply recent work on measurement and sample diversity. We present a brief history of how knowledge in psychology has been constructed, with implications for who has been historically prioritized in research. We then review how generalizability remains a contemporary threat to neuropsychological assessment and outline best practices for researchers and clinical neuropsychologists. In doing so, we provide concrete tools to evaluate whether a given assessment is generalizable across populations and assist researchers in effectively testing and reporting treatment differences across sample demographics.
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Affiliation(s)
- Hinza B. Malik
- Department of Psychology, University of North Carolina Wilmington, 601 South College Road, Wilmington, NC 28403-5612 USA
| | - Jasmine B. Norman
- Department of Psychology, University of North Carolina Wilmington, 601 South College Road, Wilmington, NC 28403-5612 USA
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16
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Girolamo T, Ghali S, Eigsti IM. A Community-Based Approach to Longitudinal Language Research With Racially and Ethnically Minoritized Autistic Young Adults: Lessons Learned and New Directions. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2023; 32:977-988. [PMID: 36927069 PMCID: PMC10473368 DOI: 10.1044/2023_ajslp-22-00341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 01/12/2023] [Accepted: 01/14/2023] [Indexed: 05/06/2023]
Abstract
PURPOSE Language and autism research each typically excludes racially and ethnically minoritized (REM) autistic individuals. In addition, in the case of autistic individuals with language impairment, investigators often approach caregivers to discuss research participation, rather than autistic individuals themselves. This gap limits the ecological validity of language research in autism. To address this gap, this clinical focus article describes strategies for engaging REM autistic young adults with language impairment using lessons learned from 5 years of longitudinal research with this population. This approach involved an ongoing community partnership, as well as participatory partnerships with REM autistic individuals and community stakeholders, consistent with a "slow science" approach. CONCLUSIONS The approach yielded excellent retention of participants over 5 years and led to co-development of research projects aimed at priorities described by REM autistic individuals and their families, including understanding self-determination, social determinants of health, and language variability in autistic REM individuals with language impairment. Findings support the utility of community-based methods with autistic REM young adults with language impairment, with key takeaways for diversifying research while replicating, extending, and building theory.
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Affiliation(s)
- Teresa Girolamo
- Department of Psychological Sciences, University of Connecticut, Storrs
- Connecticut Institute of the Brain and Cognitive Sciences, Storrs
| | - Samantha Ghali
- Child Language Doctoral Program, The University of Kansas, Lawrence
| | - Inge-Marie Eigsti
- Department of Psychological Sciences, University of Connecticut, Storrs
- Connecticut Institute of the Brain and Cognitive Sciences, Storrs
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17
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Roy E, Chino F, King B, Madu C, Mattes M, Morrell R, Pollard-Larkin J, Siker M, Takita C, Ludwig M. Increasing Diversity of Patients in Radiation Oncology Clinical Trials. Int J Radiat Oncol Biol Phys 2023; 116:103-114. [PMID: 36526234 PMCID: PMC10414211 DOI: 10.1016/j.ijrobp.2022.11.044] [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: 07/31/2022] [Revised: 10/21/2022] [Accepted: 11/30/2022] [Indexed: 12/14/2022]
Abstract
Radiation oncology clinical trials lack full representation of the ethnic and racial diversity present in the general United States and in the cancer patient population. There are low rates of both recruitment and enrollment of individuals from underrepresented ethnic and racial backgrounds, especially Black and Hispanic patients, people with disabilities, and patients from underrepresented sexual and gender groups. Even if approached for enrollment, barriers such as mistrust in medical research stemming from historical abuse and contemporary biased systems, low socioeconomic status, and lack of awareness prohibit historically marginalized populations from participating in clinical trials. In this review, we reflect on these specific barriers and detail approaches to increase diversity of the patient population in radiation oncology clinical trials to better reflect the communities we serve. We hope that implementation of these approaches will increase the diversity of clinical trials patient populations in not only radiation oncology but also other medical specialties.
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Affiliation(s)
- Emily Roy
- Baylor College of Medicine, Houston, Texas
| | - Fumiko Chino
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Benjamin King
- Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, California
| | - Chika Madu
- Department of Radiation Oncology, Staten Island University Hospital, Staten Island, New York
| | - Malcolm Mattes
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
| | - Rosalyn Morrell
- Advanced Radiation Center of Beverly Hills, Beverly Hills, California
| | | | - Malika Siker
- Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Christiane Takita
- Department of Radiation Oncology, Miami University School of Medicine, Miami, Florida
| | - Michelle Ludwig
- Department of Radiation Oncology, Baylor College of Medicine, Houston, Texas.
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18
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Adebisi YA. Decolonizing Epidemiological Research: A Critical Perspective. Avicenna J Med 2023; 13:68-76. [PMID: 37435557 PMCID: PMC10332938 DOI: 10.1055/s-0043-1769088] [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: 07/13/2023] Open
Abstract
Decolonizing epidemiological research is a crucial endeavor. Historically, colonial and imperialistic ideologies have pervaded epidemiology, leading to an emphasis on Western perspectives and the neglect of indigenous and other marginalized communities' needs and experiences. To effectively address health disparities and promote justice and equality, acknowledging and addressing these power imbalances are imperative. In this article, I highlight the need of decolonizing epidemiological research and make recommendations. These include increasing the representation of researchers from underrepresented communities, ensuring that epidemiological research is contextually relevant and responsive to the experiences of these communities, and collaborating with policymakers and advocacy groups to inform policies and practices that benefit all populations. Moreover, I underscore the importance of recognizing and valuing the knowledge and skills of marginalized populations, and integrating traditional knowledge-the distinct, culturally specific understanding unique to a particular group-into research efforts. I also emphasize the need of capacity building and equitable research collaborations and authorship as well as epidemiological journal editorship. Decolonizing epidemiology research is a continual process that requires continuing discourse, collaboration, and education.
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19
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Diaz Pardo A, Mamon H, Jimenez R. Hypofractionation: Contracting or Expanding Disparities in the Receipt of Radiation Therapy? JCO Oncol Pract 2023; 19:67-69. [PMID: 36623231 DOI: 10.1200/op.22.00798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Affiliation(s)
| | - Harvey Mamon
- Brigham and Women's Hospital/Dana Farber Cancer Institute, Boston, MA
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20
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Smith ED, Savage SK, Andrew EH, Martin GM, Kahn-Kirby AH, LoTempio J, Délot E, Cohen AJ, Pitsava G, Berger S, Fusaro VA, Vilain E. "Development and Implementation of Novel Chatbot-based Genomic Research Consent". BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.01.23.525221. [PMID: 36747692 PMCID: PMC9900780 DOI: 10.1101/2023.01.23.525221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Objective To conduct a retrospective analysis comparing traditional human-based consenting to an automated chat-based consenting process. Materials and Methods We developed a new chat-based consent using our IRB-approved consent forms. We leveraged a previously developed platform (GiaⓇ, or "Genetic Information Assistant") to deliver the chat content to candidate participants. The content included information about the study, educational information, and a quiz to assess understanding. We analyzed 144 families referred to our study during a 6-month time period. A total of 37 families completed consent using the traditional process, while 35 families completed consent using Gia. Results Engagement rates were similar between both consenting methods. The median length of the consent conversation was shorter for Gia users compared to traditional (44 vs. 76 minutes). Additionally, the total time from referral to consent completion was faster with Gia (5 vs. 16 days). Within Gia, understanding was assessed with a 10-question quiz that most participants (96%) passed. Feedback about the chat consent indicated that 86% of participants had a positive experience. Discussion Using Gia resulted in time savings for both the participant and study staff. The chatbot enables studies to reach more potential candidates. We identified five key features related to human-centered design for developing a consent chat. Conclusion This analysis suggests that it is feasible to use an automated chatbot to scale obtaining informed consent for a genomics research study. We further identify a number of advantages when using a chatbot.
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Affiliation(s)
| | | | - E. Hallie Andrew
- Children’s National Rare Disease Institute, Division of Genetics and Metabolism, Washington, DC, USA
- Center for Genetic Medicine Research, Children’s National Research Institute, Washington, DC, USA
| | | | | | - Jonathan LoTempio
- Institute for Clinical and Translational Science, University of California, Irvine, CA, USA
| | - Emmanuèle Délot
- Center for Genetic Medicine Research, Children’s National Research Institute, Washington, DC, USA
- Department of Genomics and Precision Medicine, George Washington University, Washington, DC, USA
| | - Andrea J. Cohen
- Center for Genetic Medicine Research, Children’s National Research Institute, Washington, DC, USA
| | - Georgia Pitsava
- Center for Genetic Medicine Research, Children’s National Research Institute, Washington, DC, USA
| | - Seth Berger
- Children’s National Rare Disease Institute, Division of Genetics and Metabolism, Washington, DC, USA
- Center for Genetic Medicine Research, Children’s National Research Institute, Washington, DC, USA
- Department of Genomics and Precision Medicine, George Washington University, Washington, DC, USA
| | | | - Eric Vilain
- Center for Genetic Medicine Research, Children’s National Research Institute, Washington, DC, USA
- Institute for Clinical and Translational Science, University of California, Irvine, CA, USA
- Department of Genomics and Precision Medicine, George Washington University, Washington, DC, USA
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Antoine-LaVigne D, Hayes T, Fortenberry M, Ohikhuai E, Addison C, Mozee S, McGill D, Shanks ML, Roby C, Jenkins BWC, Tchounwou PB. Trust and Biomedical Research Engagement of Minority and Under-Represented Communities in Mississippi, USA. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1592. [PMID: 36674346 PMCID: PMC9860548 DOI: 10.3390/ijerph20021592] [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: 12/08/2022] [Revised: 12/30/2022] [Accepted: 01/04/2023] [Indexed: 06/17/2023]
Abstract
Trust is critical to the development and maintenance of effective research collaborations and community engagement. The purpose of this study was to assess the current attitudes and level of trust pertaining to health research among residents of Central Mississippi, the priority health region for the Research Centers in Minority Institutions (RCMI) Center for Health Disparities Research (RCHDR) at Jackson State University. The cross-sectional study was conducted from November 2021 to April 2022. The data were analyzed using descriptive statistics carried out by SPSS statistical software. A total of 146 participants responded to the survey. The participants were predominately African American (99%) and female (75%). Historical research studies, the researchers' qualities, and potential benefits from participation were factors affecting the level of trust in the research process. Ninety percent (n = 131) expressed that it was important to be involved in the research process, and 98.5% (n = 144) agreed that discussing the research findings with the participants was important for establishing trust in the research process. While trust in the research process does not guarantee participation, trust is a precursor for those who decide to engage in health disparities research. Key findings will be integrated into the RCHDR research agenda to foster further development and implementation of innovative community-based participatory research toward the control and/or prevention of diseases that disproportionately affect minority and under-represented populations in Mississippi.
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Affiliation(s)
- Donna Antoine-LaVigne
- RCMI Center for Health Disparities Research, Jackson State University, Jackson, MS 39217, USA
| | - Traci Hayes
- School of Health Professions, University of Southern Mississippi, Hattiesburg, MS 39406, USA
| | - Marty Fortenberry
- RCMI Center for Health Disparities Research, Jackson State University, Jackson, MS 39217, USA
| | - Evidence Ohikhuai
- RCMI Center for Health Disparities Research, Jackson State University, Jackson, MS 39217, USA
| | - Clifton Addison
- Jackson Heart Study Graduate Training and Education Center, School of Public Health, Jackson State University, Jackson, MS 39213, USA
| | - Sam Mozee
- Mississippi Urban Research Center, Jackson State University, Jackson, MS 39201, USA
| | - Dorothy McGill
- Innovative Behavioral Services, Ridgeland, MS 39157, USA
| | - Mangle L. Shanks
- Shanks Health Housing, Employment, Education & Training Services, Inc., Jackson, MS 39289, USA
| | | | - Brenda W. Campbell Jenkins
- Jackson Heart Study Graduate Training and Education Center, School of Public Health, Jackson State University, Jackson, MS 39213, USA
| | - Paul B. Tchounwou
- RCMI Center for Health Disparities Research, Jackson State University, Jackson, MS 39217, USA
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Passmore SR, Longhurst C, Gerbitz A, Green-Harris G, Norris N, Edwards DF. "I Want to Know Everything ... ": The Return of Research Results and the Importance of Transparency in the Acceptability of Lumbar Punctures for African American Older Adults. J Alzheimers Dis 2023; 95:663-675. [PMID: 37574732 PMCID: PMC10637283 DOI: 10.3233/jad-230275] [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] [Indexed: 08/15/2023]
Abstract
BACKGROUND Although African Americans experience the highest risk of Alzheimer's disease (AD), they are dramatically underrepresented in preclinical biomarker research. This is especially true for studies involving lumbar puncture as it may involve more perceived risk even for those participants who are otherwise supportive of research. OBJECTIVE To understand the unique concerns of African American participants regarding biomarker studies involving lumbar puncture who demonstrate support for AD research. METHODS Study participants were African American adults contacted through an AD research registry. We employed a novel method used to create hypothetical research studies varying on a set number of factors. The method is designed to collect potential patterns in decision making regarding research participation but differs from experimental vignette design in that the survey is administered with an accompanying qualitive interview to determine the meaning participants ascribe to factors independently and in conjunction with one another. RESULTS Sixty-one participants each reviewed three randomly selected research scenarios and created their "ideal" study involving lumbar puncture. Scenario variables included: disclosure of research results, racial and ethnic identity of the researcher, recruitment method, and amount of incentive. CONCLUSION Findings indicate that transparency in the return of AD research results to be the strongest driver of participation, followed by race of the researcher and amount of incentive. Recruitment method had limited impact on hypothetical decision making.
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Affiliation(s)
- Susan Racine Passmore
- Collaborative Center for Health Equity, Institute for Clinical and Translational Research, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
- School of Nursing, University of Wisconsin, Madison, WI, USA
| | - Colin Longhurst
- Department of Biostatistics and Medical Informatics, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | - Abigail Gerbitz
- Collaborative Center for Health Equity, Institute for Clinical and Translational Research, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | - Gina Green-Harris
- Center for Community Engagement and Health Partnerships, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
- Department of Medicine, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | - Nia Norris
- Department of Medicine, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
- Wisconsin Alzheimer’s Institute, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | - Dorothy Farrar Edwards
- Collaborative Center for Health Equity, Institute for Clinical and Translational Research, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
- Department of Medicine, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
- Department of Kinesiology, School of Education, University of Wisconsin, Madison, WI, USA
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23
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Nduna M, Mayisela S, Balton S, Gobodo-Madikizela P, Kheswa JG, Khumalo IP, Makusha T, Naidu M, Sikweyiya Y, Sithole SL, Tabane C. Research Site Anonymity in Context. J Empir Res Hum Res Ethics 2022; 17:554-564. [PMID: 35257626 DOI: 10.1177/15562646221084838] [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: 01/05/2023]
Abstract
This paper utilizes critical theory to interrogate and problematize the practice of anonymising research sites as an ethical imperative. The contributing authors conduct research in and with various communities in southern Africa, position themselves and work from and within diverse areas and specialities of the social sciences. This article is developed from their rich and wide spectrum of field experience with a great diversity of communities, but mainly the poorer, under-resourced, socially and economically marginalized. The authors strongly identify with these communities whose anonymity in published research is seen as marginalizing. Such research sites are places and communities where these researchers grew up and live in, and thus not just as peripheral or 'out there' entities. Therefore, the naming of research sites in this context is deemed as being ethical, out of respect for participants, for a contextually embedded understanding, and for well-targeted interventions and policy influence.
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Affiliation(s)
- Mzikazi Nduna
- Department of Psychology, 37707University of the Witwatersrand, Johannesburg-Braamfontein, South Africa.,Faculty of Health Sciences, 70679University of Fort Hare, Alice, South Africa
| | - Simangele Mayisela
- Department of Psychology, 37707University of the Witwatersrand, Johannesburg-Braamfontein, South Africa
| | - Sadna Balton
- Chris Hani Academic Hospital, & Centre for Alternate and Augmentative Communication, 56410University of Pretoria, Pretoria, South Africa
| | | | - Jabulani G Kheswa
- Department of Psychology, 70679University of Fort Hare, Alice, South Africa
| | - Itumeleng P Khumalo
- Department of Psychology, University of Free State, Bloemfontein, South Africa
| | - Tawanda Makusha
- Human and Social Capabilities Division, 56867Human Sciences Research Council, Pretoria, South Africa
| | - Maheshvari Naidu
- School of Social Sciences, 56394University of Kwa-Zulu Natal, Durban, South Africa
| | - Yandisa Sikweyiya
- Gender and Health Research Unit, 59097South African Medical Research Council, Tygerberg, South Africa.,School of Public Health, Faculty of Health Sciences, 37707University of the Witwatersrand, Johannesburg, South Africa
| | - Sello L Sithole
- School of Social Sciences, 37714University of Limpopo, Polokwane, South Africa
| | - Cily Tabane
- Curriculum Transformation Unit, 56866UNISA, Pretoria, South Africa
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24
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Nouvini R, Parker PA, Malling CD, Godwin K, Costas-Muñiz R. Interventions to increase racial and ethnic minority accrual into cancer clinical trials: A systematic review. Cancer 2022; 128:3860-3869. [PMID: 36107740 PMCID: PMC10456972 DOI: 10.1002/cncr.34454] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 06/27/2022] [Accepted: 08/02/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND Racial and ethnic minorities (REMs) continue to be underrepresented in clinical trials despite the 1993 National Institutes of Health's Revitalization Act mandating the representation of women and underrepresented minority groups in clinical trials. Although Blacks represent 15% and Hispanics 13% of the cancer population, their clinical trial enrollment rates are disproportionately low at 4% to 6% and 3% to 6%, respectively. A systematic review exploring interventions aimed at improving cancer clinical trial (CCT) enrollment for REMs was conducted. METHODS A systematic search of PubMed, Cochrane CENTRAL, and Ovid PsycINFO was conducted for English-language studies since 1993. Inclusion criteria included peer-reviewed, US-based studies with interventions aimed to recruit underrepresented minority adult patients into cancer clinical trials. REM groups were defined as Black, Hispanic, Asian, American Indian, and Native Hawaiian/other Pacific Islander. RESULTS The systematic search identified 3123 studies, of which nine met inclusion criteria. Interventions included patient navigation/coaching (n = 4), a clinical trial educational video (n = 2), institutional research infrastructure changes (n = 1), a relationship building and social marketing recruitment model (n = 1), and cultural competency training for providers (n = 1). A statistically significant improvement in accrual was shown in three of the patient navigation interventions, one of the clinical trial educational videos and an institutional research infrastructure change. CONCLUSIONS This systematic review illustrates several potential mechanisms by which to increase CCT recruitment for patients of REM backgrounds in various clinical settings. More randomized controlled trials are needed to further explore the benefits of these interventions for REMs.
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Affiliation(s)
- Rosa Nouvini
- Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | | | | | - Kendra Godwin
- Memorial Sloan Kettering Cancer Center, New York, New York, USA
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25
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Ten simple rules in biomedical engineering to improve healthcare equity. PLoS Comput Biol 2022; 18:e1010525. [PMID: 36227840 PMCID: PMC9560067 DOI: 10.1371/journal.pcbi.1010525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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26
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Habr D, Corsaro M. Reimagining diversity in multiple myeloma clinical trials. Hematol Oncol 2022; 40:689-694. [PMID: 35391496 PMCID: PMC9790672 DOI: 10.1002/hon.2997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Dany Habr
- Pfizer OncologyPfizer Inc.New York CityNew YorkUSA
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27
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Sevagamoorthy A, Sockler P, Akoh C, Takeshita J. Racial and Ethnic Diversity of US Participants in Clinical Trials for Acne, Atopic Dermatitis, and Psoriasis: A Comprehensive Review. J DERMATOL TREAT 2022; 33:3086-3097. [PMID: 35980324 DOI: 10.1080/09546634.2022.2114783] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
An increasing body of literature describes underreporting of race and ethnicity, and overrepresentation of White individuals in clinical trials. We aimed to evaluate the racial and ethnic diversity of US participants in clinical trials for acne, atopic dermatitis (AD), and psoriasis. We performed a comprehensive review of clinical trials for these common dermatologic diseases that were published between January 2014 and July 2019. Race and ethnicity reporting among all trials, and the racial and ethnic distribution of US participants were compared by skin disease, intervention type, and trial phase. In total, 103 articles representing 119 unique trials were evaluated. Race and ethnicity were reported in only 22.7% of trials. The proportion of White participants (77.5%) was higher than that of the US population (72.5%, p < 0.01); a finding largely driven by psoriasis trials (84.7% White). The proportions of non-White and Hispanic individuals in non-topical (21.0% and 16.3%, respectively) and phase III (20.5% and 18.7%, respectively) trials were lower than those in topical (23.5% and 23.3%, respectively; p < 0.01) and phase I/II trials (25.6% and 22.3%, respectively; p < 0.01). Race and ethnicity remain underreported in dermatologic clinical trials, and US trial participant diversity differs by skin disease, intervention type, and trial phase.
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Affiliation(s)
- Anjana Sevagamoorthy
- Deparment of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Patrick Sockler
- Deparment of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | | | - Junko Takeshita
- Deparment of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.,Department of Biostatistics, Epidemiology and Informatics; Center for Clinical Epidemiology and Biostatistics; Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
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28
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Cokley K, Krueger N, Cunningham SR, Burlew K, Hall S, Harris K, Castelin S, Coleman C. The COVID-19/racial injustice syndemic and mental health among Black Americans: The roles of general and race-related COVID worry, cultural mistrust, and perceived discrimination. JOURNAL OF COMMUNITY PSYCHOLOGY 2022; 50:2542-2561. [PMID: 34797928 DOI: 10.1002/jcop.22747] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 11/04/2021] [Indexed: 06/13/2023]
Abstract
This study explored intersecting concerns about COVID-19 and racial injustice against Black people in the United States using a syndemic perspective. Findings from a multistate COVID-19 needs assessment project examined the association of general and race-related concerns about COVID-19 and concerns about police violence against Black people with mental health symptoms in a sample of 2480 Black Americans. The role of cultural mistrust in vaccination status was also examined. Concerns about COVID-19 were positively associated with concerns about police violence and associated with worse mental health. Nonvaccinated individuals were higher in cultural mistrust but lower in perceived discrimination than vaccinated individuals. Perceived discrimination partially mediated the relationship between race-related concerns about COVID-19 and mental health symptoms. Findings can inform the development of culturally responsive strategies to address the syndemic effects of COVID-19 and racial injustice.
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Affiliation(s)
- Kevin Cokley
- Department of Educational Psychology, University of Texas at Austin, Austin, Texas, USA
| | - Nolan Krueger
- Department of Educational Psychology, University of Texas at Austin, Austin, Texas, USA
| | | | - Kathleen Burlew
- Department of Psychology, University of Cincinnati, Cincinnati, Ohio, USA
| | - Shaina Hall
- Department of Educational Psychology, University of Texas at Austin, Austin, Texas, USA
| | - Keoshia Harris
- Department of Educational Psychology, University of Texas at Austin, Austin, Texas, USA
| | - Stephanie Castelin
- Department of Psychology, University of Cincinnati, Cincinnati, Ohio, USA
| | - Carly Coleman
- Department of Educational Psychology, University of Texas at Austin, Austin, Texas, USA
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29
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Saiyasit N, Butlig EAR, Chaney SD, Traylor MK, Hawley NA, Randall RB, Bobinger HV, Frizell CA, Trimm F, Crook ED, Lin M, Hill BD, Keller JL, Nelson AR. Neurovascular Dysfunction in Diverse Communities With Health Disparities-Contributions to Dementia and Alzheimer's Disease. Front Neurosci 2022; 16:915405. [PMID: 35844216 PMCID: PMC9279126 DOI: 10.3389/fnins.2022.915405] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 05/31/2022] [Indexed: 12/13/2022] Open
Abstract
Alzheimer's disease and related dementias (ADRD) are an expanding worldwide crisis. In the absence of scientific breakthroughs, the global prevalence of ADRD will continue to increase as more people are living longer. Racial or ethnic minority groups have an increased risk and incidence of ADRD and have often been neglected by the scientific research community. There is mounting evidence that vascular insults in the brain can initiate a series of biological events leading to neurodegeneration, cognitive impairment, and ADRD. We are a group of researchers interested in developing and expanding ADRD research, with an emphasis on vascular contributions to dementia, to serve our local diverse community. Toward this goal, the primary objective of this review was to investigate and better understand health disparities in Alabama and the contributions of the social determinants of health to those disparities, particularly in the context of vascular dysfunction in ADRD. Here, we explain the neurovascular dysfunction associated with Alzheimer's disease (AD) as well as the intrinsic and extrinsic risk factors contributing to dysfunction of the neurovascular unit (NVU). Next, we ascertain ethnoregional health disparities of individuals living in Alabama, as well as relevant vascular risk factors linked to AD. We also discuss current pharmaceutical and non-pharmaceutical treatment options for neurovascular dysfunction, mild cognitive impairment (MCI) and AD, including relevant studies and ongoing clinical trials. Overall, individuals in Alabama are adversely affected by social and structural determinants of health leading to health disparities, driven by rurality, ethnic minority status, and lower socioeconomic status (SES). In general, these communities have limited access to healthcare and healthy food and other amenities resulting in decreased opportunities for early diagnosis of and pharmaceutical treatments for ADRD. Although this review is focused on the current state of health disparities of ADRD patients in Alabama, future studies must include diversity of race, ethnicity, and region to best be able to treat all individuals affected by ADRD.
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Affiliation(s)
- Napatsorn Saiyasit
- Department of Physiology and Cell Biology, College of Medicine, University of South Alabama, Mobile, AL, United States
| | - Evan-Angelo R. Butlig
- Department of Neurology, Eli and Edythe Broad Center of Regenerative Medicine and Stem Cell Research, Intellectual and Developmental Disabilities Research Center, University of California, Los Angeles, Los Angeles, CA, United States
| | - Samantha D. Chaney
- Department of Physiology and Cell Biology, College of Medicine, University of South Alabama, Mobile, AL, United States
| | - Miranda K. Traylor
- Department of Health, Kinesiology, and Sport, University of South Alabama, Mobile, AL, United States
| | - Nanako A. Hawley
- Department of Psychology, University of South Alabama, Mobile, AL, United States
| | - Ryleigh B. Randall
- Department of Physiology and Cell Biology, College of Medicine, University of South Alabama, Mobile, AL, United States
| | - Hanna V. Bobinger
- Department of Physiology and Cell Biology, College of Medicine, University of South Alabama, Mobile, AL, United States
| | - Carl A. Frizell
- Department of Physician Assistant Studies, University of South Alabama, Mobile, AL, United States
| | - Franklin Trimm
- College of Medicine, University of South Alabama, Mobile, AL, United States
| | - Errol D. Crook
- Department of Internal Medicine, College of Medicine, University of South Alabama, Mobile, AL, United States
| | - Mike Lin
- Department of Physiology and Cell Biology, College of Medicine, University of South Alabama, Mobile, AL, United States
| | - Benjamin D. Hill
- Department of Psychology, University of South Alabama, Mobile, AL, United States
| | - Joshua L. Keller
- Department of Health, Kinesiology, and Sport, University of South Alabama, Mobile, AL, United States
| | - Amy R. Nelson
- Department of Physiology and Cell Biology, College of Medicine, University of South Alabama, Mobile, AL, United States
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30
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Medical Mistrust, COVID-19 Stress, and Intent to Vaccinate in Racial-Ethnic Minorities. Behav Sci (Basel) 2022; 12:bs12060186. [PMID: 35735396 PMCID: PMC9219672 DOI: 10.3390/bs12060186] [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: 05/15/2022] [Revised: 06/05/2022] [Accepted: 06/08/2022] [Indexed: 11/17/2022] Open
Abstract
Members of the Black, Asian, and Latinx community have been particularly vulnerable to the COVID-19 pandemic but may be hesitant to vaccinate. In a December 2020 study in Black, Asian, and Latinx adults in the U.S. (n = 779), only 50% of Black respondents endorsed intending to vaccinate against COVID-19, followed by 65% and 75% of Latinx and Asian participants, respectively. Medical mistrust, fears about COVID-19 contamination, and a proclivity for compulsive checking behaviors related to COVID-19 were significant predictors of intent to vaccinate in Black respondents. Similarly, Asian respondents’ intent to vaccinate was predicted by medical mistrust, fears of the dangerous nature of the virus, and xenophobic concerns about viral spread. In Latinx participants, medical mistrust and compulsive checking for COVID-19-related information were significant predictors of intent to vaccinate. Our findings identify specific behaviors, attitudes, and beliefs we can target to inform community-wide outreach and increase the uptake of COVID-19 vaccines.
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31
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Dhanani LY, Franz B. An experimental study of the effects of messaging strategies on vaccine acceptance and hesitancy among Black Americans. Prev Med Rep 2022; 27:101792. [PMID: 35433238 PMCID: PMC9006422 DOI: 10.1016/j.pmedr.2022.101792] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 03/31/2022] [Accepted: 04/11/2022] [Indexed: 12/05/2022] Open
Abstract
Acknowledging past medical harm led to more positive COVID-19 vaccine attitudes. Presenting general information about the vaccine did not improve vaccine attitudes. Tailored messaging strategies showed no backfire effects in other racial groups.
Black Americans have been disproportionately affected by COVID-19 but have comparatively low vaccination rates, creating a need for vaccine messaging strategies that are tailored to this population. We conducted an experimental study to examine the effects of three messaging strategies on Black Americans’ reported willingness to receive the vaccine and vaccine hesitancy. We also recruited White and Hispanic Americans to assess any potential backfire effects of the tailored strategies for non-Black participants. A total of 739 participants completed the study. Results from 4x2 ANCOVAs indicate that, among Black participants, messaging that acknowledged past unethical treatment of Black Americans in medical research and emphasized current safeguards to prevent medical mistreatment was associated with significantly less vaccine hesitancy than the control condition. The same effects were not observed for messaging strategies that provided general safety information about the vaccine or that emphasized the role of the vaccine in reducing racial inequities. There were no significant differences across conditions for participants of other races. Results demonstrate that public health messages tailored to address specific vaccine concerns may aid future vaccination campaigns.
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32
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Schmitz RM, Gomez G, Propst A, Tabler J, Charak R. Queer Politics of a Pandemic: LGBTQ + People's Conceptions of COVID-19's Politicization. SEXUALITY RESEARCH & SOCIAL POLICY : JOURNAL OF NSRC : SR & SP 2022; 20:751-765. [PMID: 35465237 PMCID: PMC9013631 DOI: 10.1007/s13178-022-00719-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/05/2022] [Indexed: 05/28/2023]
Abstract
Introduction Lesbian, gay, bisexual, transgender, and/or queer (LGBTQ+) people have historically been at the center of contentious political debates in the United States. The pandemic's divisive politicization has created societal stress in both hindering mitigation efforts and exacerbating social marginalization. Research has examined relatively privileged groups' COVID beliefs; however, explorations are needed into ideological processes among those marginalized by COVID, such as LGBTQ+ people, to provide a holistic framework of queer politics. Methods Data come from in-depth interviews conducted with 43 LGBTQ+ people collected between October 2020 and January 2021. Purposive sampling was used to recruit participants from a larger survey on pandemic experiences. Results Through the "underdog" framework," LGBTQ+ people held strong convictions to science-informed political beliefs, which informed their critiques of inadequate government leadership. Participants also engaged in ideological resistance to harmful individualistic rhetoric through an emphasis on collectivism. The divisive politicization of the pandemic shaped numerous social stressors that LGBTQ+ people adapted to using various strategies to maintain their mental health. Conclusions Participants viewed American individualism and Christian nationalism as a public health threat that led to resistance to health and safety measures putting other people at risk. Findings support the underdog theory, with LGBTQ+ people elevating evidence-based science and disadvantaged groups' wellbeing by emphasizing social empathy as a collective good that supports community health. Policy Implications Findings can inform policies and community programming that promotes equity across all social identities through the depoliticization of public health and centering LGBTQ+ people's capacity for resistance and resilience.
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Affiliation(s)
- Rachel M. Schmitz
- Department of Sociology, Oklahoma State University, 457 Social Sciences & Humanities, Stillwater, OK 74078 USA
| | - Gabby Gomez
- Department of Sociology, Oklahoma State University, 457 Social Sciences & Humanities, Stillwater, OK 74078 USA
| | - Aidan Propst
- Department of Criminal Justice and Sociology, University of Wyoming, Laramie, WY USA
- Department of English, University of Wyoming, Laramie, WY USA
| | - Jennifer Tabler
- Department of Criminal Justice and Sociology, University of Wyoming, Laramie, WY USA
| | - Ruby Charak
- Department of Psychological Science, The University of Texas Rio Grande Valley, Edinburg, TX USA
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Angelo F, Veenstra D, Knerr S, Devine B. Prevalence and prediction of medical distrust in a diverse medical genomic research sample. Genet Med 2022; 24:1459-1467. [PMID: 35384843 DOI: 10.1016/j.gim.2022.03.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 03/07/2022] [Accepted: 03/08/2022] [Indexed: 10/18/2022] Open
Abstract
PURPOSE Medical distrust has been identified as a persistent barrier to medical care, affecting preventative screening, treatment uptake, and treatment adherence. Despite this, little research to date has examined medical distrust in a genomic medicine context. The goal of this work was to assess the prevalence of medical distrust in a genomic medicine research study and examine patient-level demographic, access-related, and health-status characteristics that predict medical distrust. METHODS We assessed medical distrust in a research sample of adults (N = 967) receiving genomic sequencing to screen for hereditary risk of cancer syndromes in the United States. We used multiple predictive variable selection models to determine predictors of medical distrust followed by marginal mean analyses to characterize the relationships. RESULTS The prevalence of medical distrust was 32%. The final model indicated that Black and African American race/ethnicity; trans, nonbinary, or nonidentifying gender identity; high education; low income; low access to health care; and poor Short Form 12 mental health composite scores predict medical distrust. CONCLUSION Medical distrust may pose similar challenges to genomic sequencing, as it does in other medical contexts. The pattern of variables that predict distrust suggest that increasing access and accommodation for stigmatized and underserved communities may help overcome the negative effects of medical distrust.
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Affiliation(s)
- Frank Angelo
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL.
| | - David Veenstra
- The Comparative Health Outcomes, Policy & Economics (CHOICE) Institute and Department of Pharmacy, School of Pharmacy, University of Washington, Seattle, WA
| | - Sarah Knerr
- Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle, WA
| | - Beth Devine
- The Comparative Health Outcomes, Policy & Economics (CHOICE) Institute and Department of Pharmacy, School of Pharmacy, University of Washington, Seattle, WA
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34
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Wesson P, Hswen Y, Valdes G, Stojanovski K, Handley MA. Risks and Opportunities to Ensure Equity in the Application of Big Data Research in Public Health. Annu Rev Public Health 2022; 43:59-78. [PMID: 34871504 PMCID: PMC8983486 DOI: 10.1146/annurev-publhealth-051920-110928] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The big data revolution presents an exciting frontier to expand public health research, broadening the scope of research and increasing the precision of answers. Despite these advances, scientists must be vigilant against also advancing potential harms toward marginalized communities. In this review, we provide examples in which big data applications have (unintentionally) perpetuated discriminatory practices, while also highlighting opportunities for big data applications to advance equity in public health. Here, big data is framed in the context of the five Vs (volume, velocity, veracity, variety, and value), and we propose a sixth V, virtuosity, which incorporates equity and justice frameworks. Analytic approaches to improving equity are presented using social computational big data, fairness in machine learning algorithms, medical claims data, and data augmentation as illustrations. Throughout, we emphasize the biasing influence of data absenteeism and positionality and conclude with recommendations for incorporating an equity lens into big data research.
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Affiliation(s)
- Paul Wesson
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA;
- Bakar Computational Health Sciences Institute, University of California, San Francisco, California, USA
| | - Yulin Hswen
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA;
- Bakar Computational Health Sciences Institute, University of California, San Francisco, California, USA
| | - Gilmer Valdes
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA;
- Department of Radiation Oncology, University of California, San Francisco, California, USA
| | - Kristefer Stojanovski
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
- Department of Social, Behavioral and Population Sciences, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana, USA
| | - Margaret A Handley
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA;
- Department of Medicine, University of California, San Francisco, California, USA
- Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California, USA
- Partnerships for Research in Implementation Science for Equity (PRISE), University of California, San Francisco, California, USA
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35
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Facilitators and barriers for parental consent to pediatric emergency research. Pediatr Res 2022; 91:1156-1162. [PMID: 34088985 DOI: 10.1038/s41390-021-01600-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 03/15/2021] [Accepted: 05/20/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND Obtaining informed consent for clinical research in the pediatric emergency department (ED) is challenging. Our objective was to understand the factors that influence parental consent for ED studies. METHODS This was a cross-sectional survey assessing parents' willingness to enroll their children into an ED research study. Parents reporting a willingness to enroll in ED studies were presented with two hypothetical scenarios, a low-risk and a high-risk study, and then asked about decision influencers affecting consent. Parents expressing a lack of willingness to enroll were asked which decision influencers impacted their consent decision. RESULTS Among 118 parents, 90 (76%) stated they would be willing to enroll their child into an ED study; of these, 86 (96%) would consent for a low-risk study and 54 (60%) would consent for a high-risk study. Caucasian parents, and those with previous research exposure, were more likely to report willingness to participate. Those who would consent to the high-risk study cited "benefits that research would provide to future children" most strongly influenced their decision to agree. CONCLUSIONS ED investigators should highlight the benefits for future children and inquire about parents' previous exposure to research to enhance ED research enrollment. Barriers to consent in non-Caucasian families should be further investigated. IMPACT Obtaining consent for pediatric emergency research is challenging and this study identified factors influencing parental consent for research in EDs. Benefits for future children and parents' previous research experience were two of the most influential factors in parents' willingness to consent to ED research studies. These findings will help to improve enrollment in ED research studies and better our understanding of how to promote the health and well-being of pediatric patients.
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Vaccine Hesitancy. CURRENT EMERGENCY AND HOSPITAL MEDICINE REPORTS 2022; 10:13-17. [PMID: 35382383 PMCID: PMC8972757 DOI: 10.1007/s40138-022-00243-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/16/2022] [Indexed: 10/30/2022]
Abstract
Purpose of Review Recent Findings Summary
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Chen JH, Shiu CS. Race, ethnicity and COVID-19 vaccine concerns: A latent class analysis of data during early phase of vaccination. SSM Popul Health 2022; 18:101073. [PMID: 35313704 PMCID: PMC8928703 DOI: 10.1016/j.ssmph.2022.101073] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 03/01/2022] [Accepted: 03/14/2022] [Indexed: 02/08/2023] Open
Abstract
Racial gaps in vaccine uptake in the United States have been widely reported. Existing studies, however, have not explored how individuals’ concerns about COVID-19 vaccines are clustered. In this study, racial and ethnic background is linked to constellations of COVID-19 vaccine concerns during the early phase of vaccines in the United States, using the Household Pulse Survey (N = 60,492). Latent class analysis reveals five distinct classes of vaccine concerns: general skepticism, distrust of science and the government, safety, a desire to wait and see, and vague uncertainty. Compared to Whites, people of color more consistently report vaccine hesitancy due to safety and a desire to wait and see, rather than distrust of science and the government. Whites, however, more consistently report general skepticism and distrust of science and the government. Our findings suggest that distrust of science and government is not central to racial minorities' vaccine hesitancy, but it is so for Whites. Studies of COVID-19 vaccine concern are limited by conceptualization and methodology. We examine constellations of vaccine concerns by race/ethnicity using latent class analysis. Results that vaccine concerns cluster in five distinct classes and vary by race/ethnicity. Minorities do not show higher distrust of science and government than other groups. Findings can inform interventions to increase vaccine uptake.
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Affiliation(s)
- Jen-Hao Chen
- Department of Sociology and Department of Psychology, National Chengchi University, Taiwan
- Corresponding author.
| | - Cheng-Shi Shiu
- Department of Social Work, National Taiwan University, Taiwan
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Koritala T, Hussain A, Pleshkova Y, Dondapati L, Tirupathi R, Rabaan AA, Al Mutair A, Alhumaid S, Al-Tawfiq JA, Kashyap R. A narrative review of emergency use authorization versus full FDA approval and its effect on COVID-19 vaccination hesitancy. LE INFEZIONI IN MEDICINA 2022; 29:339-344. [PMID: 35146338 DOI: 10.53854/liim-2903-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 08/04/2021] [Indexed: 01/17/2023]
Abstract
COVID-19 pandemic affected the lives of many with its devastating mortality and morbidity. Acquisition of herd immunity is one way to mitigate the spread of infection. Many factors influence the acceptance of vaccination including the regulatory process of the vaccines. This review article will briefly summarize the Emergency Use Authorization, Full FDA Approval process and highlight how the key factors affecting the vaccination hesitancy, are being influenced by the lack of Full FDA Approval.
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Affiliation(s)
- Thoyaja Koritala
- Department of Internal Medicine, Mayo Clinic Health System, Mankato, MN, USA
| | - Akbar Hussain
- Department of Internal Medicine, Keystone Health, Chambersburg, PA, USA
| | - Yelena Pleshkova
- Department of Clinical Sciences, University of Houston College of Medicine, Houston, TX, USA
| | - Lavanya Dondapati
- Department of Internal Medicine, Baylor St. Luke's Medical Center, Houston, TX, USA
| | - Raghavendra Tirupathi
- Department of Medicine, Keystone Health, Penn state College of Medicine, Chambersburg, PA, USA
| | - Ali A Rabaan
- Molecular Diagnostic Laboratory, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia.,Department of Public Health and Nutrition, University of Haripur, Haripur, Pakistan
| | - Abbas Al Mutair
- Research center, Almoosa Specialist Hospital, Al-Ahsa, Saudi Arabia.,College of Nursing, Princess Norah Bint Abdulrahman University, Riyadh, Saudi Arabia.,School of Nursing, Wollongong University, Wollongong NSW, Australia
| | - Saad Alhumaid
- Administration of Pharmaceutical Care, Al-Ahsa Health Cluster, Ministry of Health, Al-Ahsa, Saudi Arabia
| | - Jaffar A Al-Tawfiq
- Infectious Disease Unit, Specialty Internal Medicine and Infection Control Unit, Quality and Patient Safety, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia.,Infectious Disease Division, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA.,Infectious Disease Division, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Rahul Kashyap
- Department of Anesthesiology and Peri-operative Medicine, Mayo Clinic, Rochester, MN, USA
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Bradley SJ, E.Goldstein S. "People Think It's Easy Because I Smile, But It's Not Easy": The Lived Experiences of Six African American Single Mothers. JOURNAL OF AFRICAN AMERICAN STUDIES (NEW BRUNSWICK, N.J.) 2022; 26:16-36. [PMID: 35125980 PMCID: PMC8807669 DOI: 10.1007/s12111-022-09574-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/17/2022] [Indexed: 06/14/2023]
Abstract
Grounded in Resilience Theory (Masten et al., 1990; Walsh, 1996; Walsh, 2002; Walsh, 2003) with a specific focus on parental resilience (Gavidia-Payne et al., 2015), this qualitative phenomenological study explored the lived experiences of low-income Female adult single parent (FASP) families. Each family had at least one adolescent aged 11 through 21 enrolled in special education classes and engaging in risk behaviors. Two central research questions were addressed. The first focused on the lived experiences of FASP and the second focused on their perspectives on how schools can enhance their support. Data were collected through face-to-face, in-depth, semi-structured interviews. Three major themes emerged: Life adjustment, The child is the priority, and Perseverance revealing their experience to be one of resilience. Participants also shared and provided insight on their perspectives regarding how schools can better support families. Findings revealed limited parent-school collaboration and highlight the need for further research with this population in the context of resilience. Suggestions for schools and communities working with such families are discussed.
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Affiliation(s)
- Shaniqua J. Bradley
- Department of Social Work and Child Advocacy, Montclair State University, Montclair, NJ 07043 USA
| | - Sara E.Goldstein
- Department of Social Work and Child Advocacy, Montclair State University, Montclair, NJ 07043 USA
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Ginossar T, Diaz Fuentes C, Oetzel J. Understanding Willingness to Participate in Cancer Clinical Trials Among Patients and Caregivers Attending a Minority-Serving Academic Cancer Center. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2022; 37:179-187. [PMID: 32666504 PMCID: PMC10685662 DOI: 10.1007/s13187-020-01802-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Advances in cancer treatment are impeded by low accrual rates of patients to cancer clinical trials (CCTs). The national rates of recruitment of underserved groups, including racial/ethnic minorities, are limiting the generalizability of research findings and are likely to enhance inequities in cancer outcomes. The goal of this study was to examine willingness to participate (WTP) in CCTs and factors associated with this willingness among patients and caregivers attending a minority-serving university cancer center in the Southwest. A cross-sectional survey design was utilized (n = 236, 135 patients and 101 caregivers). Fear was the strongest predictor of WTP in CCTs. The only ethnic differences observed related to Spanish-speaking patients exhibiting increased WTP in CCTs, and Spanish-speaking caregivers' decreased WTP, compared to others. These results underscore the importance of future interventions to reduce CCT-related fear among patients and caregivers, with particular need for family-focused tailored interventions designed to meet the needs of Spanish-speaking patients and caregivers.
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Affiliation(s)
- Tamar Ginossar
- Department of Communication and Journalism, University of New Mexico, Albuquerque, NM, 87103, USA.
| | | | - John Oetzel
- Waikato Management School, University of Waikato, Hamilton, 3240, New Zealand
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Harris M, Ekwonye A, Munala L, Buesseler H, Hearst MO. Exploring Knowledge, Prevention Methods, and Prevention Barriers of COVID-19 Among Somali, Karen, and Latinx Community Members in Minneapolis, Minnesota, USA. J Prim Care Community Health 2021; 12:21501327211056595. [PMID: 34854344 PMCID: PMC8646193 DOI: 10.1177/21501327211056595] [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] [Indexed: 11/30/2022] Open
Abstract
Background: As the COVID-19 pandemic has unfolded, understanding the virus and necessary measures to prevent infection have evolved. While effective preventative measures for COVID-19 have been identified, there are also identifiable barriers to implementation. Objective: Explore the access to information, knowledge, and prevention methods and barriers of COVID-19 among Somali, Karen, and Latinx immigrant community members in Minneapolis, Minnesota, USA through analysis of in-depth interviews. Methods: Data were collected through 32 interviews via phone, video conference on a computer, or in-person with Somali, Karen, and Latinx adults to understand the experiences during the COVID-19 pandemic in each group’s native language. All participants were over the age of 18, and identified as Somali, Karen, and Latinx refugee or immigrant. Interview protocol contained 9 main questions including probes. Data were analyzed through use of the qualitative analysis software, Atlas.ti using phenomenology. Results: A total of 32 adults were interviewed (Somali = 12, Karen = 10, and Latinx = 10). One-third were in person and the remainder were remote. The average age recorded was 37 years (range 20-66 years), 43.8% males and 56.3% females. Somali, Karen, and Latinx respondents consistently had accurate knowledge about COVID-19 and were attentive to finding trustworthy information. Information was available in Somali, Karen, and Latinx written language, although Karen elders who are not literate would benefit more from video messaging. Knowledge of preventive measures was consistent; however, barriers included access, working in front-line positions, and living in high density housing. Conclusion: Exploring the impact of COVID-19 on Somali, Karen, and Latinx community members in Minneapolis, MN is advantageous in removing identified barriers and disparities in health. The results of this study highlight the need for increased efforts to address barriers in the prevention of COVID-19, as well as future pandemics for immigrant and refugee populations.
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Passmore SR, Kisicki A, Gilmore-Bykovskyi A, Green-Harris G, Edwards DF. "There's not much we can do…" researcher-level barriers to the inclusion of underrepresented participants in translational research. J Clin Transl Sci 2021; 6:e4. [PMID: 35154814 PMCID: PMC8807123 DOI: 10.1017/cts.2021.876] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 11/03/2021] [Accepted: 11/08/2021] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION The lack of diversity in health research participation has serious consequences for science as well as ethics. While there is growing interest in solving the problem, much of the work to date focuses on attitudes of distrust among members of underrepresented communities. However, there is also a pressing need to understand existing barriers within the cultural and structural context of researchers and research staff. METHODS This study adopted a sequential exploratory mixed-methods design to allow for a focused examination of barriers to inclusive research recruitment among researchers and staff. Barriers first identified from an initial quantitative investigation (web-based survey; n = 279) were further explored through qualitative methods (key informant interviews; n = 26). Participants were investigators and research team members in both phases of the study. RESULTS The survey revealed a paradoxical disconnect between participants' reported belief in the abstract value of diversity in research participation (87.1% important/extremely important) and belief in it as an important goal in their own specific research (38.3% important/extremely important). Interviews reveal that researchers and staff perceive many barriers to the recruitment of members of underrepresented groups and hold a general view of diversity in research as an impractical, even unattainable, goal. CONCLUSIONS It is crucial that principal investigators not only understand the consequences of the continued exclusion of marginalized groups from research but also implement strategies to reverse this trend and communicate with research staff on the issue. While individual bias does play a role (ex: a priori assumptions about the willingness or ability of members of underrepresented groups to participate), these behaviors are part of a larger context of systemic racism.
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Affiliation(s)
- Susan Racine Passmore
- Collaborative Center for Health Equity, Institute for Clinical and Translational Research, University of Wisconsin, Madison, WI, USA
| | - Abby Kisicki
- Collaborative Center for Health Equity, Institute for Clinical and Translational Research, University of Wisconsin, Madison, WI, USA
| | | | - Gina Green-Harris
- Center for Community Engagement and Health Partnerships, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | - Dorothy Farrar Edwards
- Collaborative Center for Health Equity, Institute for Clinical and Translational Research, University of Wisconsin, Madison, WI, USA
- Department of Kinesiology, School of Education, University of Wisconsin, Madison, WI, USA
- Department of Medicine, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
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Golden SH, Galiatsatos P, Wilson C, Page KR, Jones V, Tolson T, Lugo A, McCann N, Wilson A, Hill-Briggs F. Approaching the COVID-19 Pandemic Response With a Health Equity Lens: A Framework for Academic Health Systems. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2021; 96:1546-1552. [PMID: 34705750 PMCID: PMC8541896 DOI: 10.1097/acm.0000000000003999] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
Racially and ethnically diverse and socioeconomically disadvantaged communities have historically been disproportionately affected by disasters and public health emergencies in the United States. The U.S. Department of Health and Human Services' Office of Minority Health established the National Consensus Panel on Emergency Preparedness and Cultural Diversity to provide guidance to agencies and organizations on developing effective strategies to advance emergency preparedness and eliminate disparities among racially and ethnically diverse communities during these crises. Adopting the National Consensus Panel recommendations, the Johns Hopkins Medicine Office of Diversity, Inclusion, and Health Equity; Language Services; and academic-community partnerships used existing health equity resources and expertise to develop an operational framework to support the organization's COVID-19 response and to provide a framework of health equity initiatives for other academic medical centers. This operational framework addressed policies to support health equity patient care and clinical operations, accessible COVID-19 communication, and staff and community support and engagement, which also supported the National Standards for Culturally and Linguistically Appropriate Services in Health and Health Care. Johns Hopkins Medicine identified expanded recommendations for addressing institutional policy making and capacity building, including unconscious bias training for resource allocation teams and staff training in accurate race, ethnicity, and language data collection, that should be considered in future updates to the National Consensus Panel's recommendations.
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Affiliation(s)
- Sherita H. Golden
- S.H. Golden is professor of medicine, Department of Medicine, Division of Endocrinology, Diabetes, and Metabolism, Johns Hopkins University School of Medicine, professor of epidemiology, Johns Hopkins University Bloomberg School of Public Health, and vice president and chief diversity officer, Office of Diversity, Inclusion, and Health Equity, Johns Hopkins Medicine, Baltimore, Maryland
| | - Panagis Galiatsatos
- P. Galiatsatos is assistant professor of medicine, Department of Medicine, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, and health equity colead, Office of Diversity, Inclusion, and Health Equity, Johns Hopkins Medicine, Baltimore, Maryland
| | - Cheri Wilson
- C. Wilson is diversity and inclusion education and training program manager, Office of Diversity, Inclusion, and Health Equity, Johns Hopkins Medicine, Baltimore, Maryland
| | - Kathleen R. Page
- K.R. Page is associate professor of medicine, Division of Infectious Disease Center for Clinical Global Health Education, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Vanya Jones
- V. Jones is associate professor, Department of Health, Behavior, and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Tina Tolson
- T. Tolson is senior director, Office of Language Services, Johns Hopkins Medicine, Baltimore, Maryland
| | - April Lugo
- A. Lugo is diversity, inclusion, and health equity program coordinator, Office of Diversity, Inclusion, and Health Equity, Johns Hopkins Medicine, Baltimore, Maryland
| | - Nicki McCann
- N. McCann is vice president for payer/provider transformation, Presidents Office Administration, Johns Hopkins Health System, Baltimore, Maryland
| | - Alicia Wilson
- A. Wilson is vice president for economic development, Presidents Office Administration for Johns Hopkins University and Johns Hopkins Health System, Baltimore, Maryland
| | - Felicia Hill-Briggs
- F. Hill-Briggs is professor, Department of Medicine, Division of General Internal Medicine, Johns Hopkins University School of Medicine, Department of Health, Behavior and Society, Johns Hopkins University Bloomberg School of Public Health, Department of Acute and Chronic Care, Johns Hopkins University School of Nursing, and health equity senior lead, Office of Diversity, Inclusion, and Health Equity, Johns Hopkins Medicine, Baltimore, Maryland
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McGuire FH, André K, Bradsher ML, Harrison D, Sterling RK, Reddy KR, Serper M, Golin CE, Reau N, Lim JK, Nelson DR, Sarkar S, Evon DM. Willingness to participate in research among black patients with liver disease: A national cross-sectional study. J Viral Hepat 2021; 28:982-993. [PMID: 33665897 DOI: 10.1111/jvh.13493] [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: 12/18/2020] [Revised: 02/16/2021] [Accepted: 02/23/2021] [Indexed: 12/09/2022]
Abstract
In the United States, Black people are disproportionately diagnosed with hepatitis C virus (HCV) compared with White people but are under-represented in HCV studies. In this US-based cross-sectional telephone survey study, we assessed willingness to participate (WTP) in health/medical research and attitudes and beliefs that may influence WTP among Black patients with HCV. Two hundred participants who had current or prior HCV diagnosis and self-identified as Black or African American were recruited from a national HCV cohort study and an outpatient hepatology clinic. WTP responses ranged from 1 (not at all willing) to 5 (very willing). Multivariable models were used to identify factors associated with the overall mean WTP score. In addition, an open-ended question solicited strategies to help increase research participation from the Black community. Overall, participants reported moderate WTP in research (Mean [95% Confidence Interval (CI)] = 3.78 [3.68, 3.88]). Of 13 types of research presented, participants reported lowest WTP for randomized controlled trials of medications (Mean [95% CI] = 2.31 [2.11, 2.50]). The initial multivariable model identified higher subjective knowledge of research as positively associated with WTP (Parameter estimate [95% CI] = 0.15 [0.02, 0.27]). Sensitivity analyses also identified higher perceived benefits of research as an additional factor associated with WTP. Qualitative findings indicate that greater community-based outreach efforts would increase accessibility of research opportunities. When given the opportunity to participate, Black participants with HCV reported moderate WTP in health/medical research. Research sponsors and investigators should employ community-based outreach to expand access and awareness of research opportunities.
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Affiliation(s)
- F Hunter McGuire
- Department of Health Behavior, UNC Gillings School of Global Public Health, Chapel Hill, NC, USA.,Center for Gastrointestinal Biology and Disease, UNC School of Medicine, Chapel Hill, NC, USA
| | - Kat André
- Center for Gastrointestinal Biology and Disease, UNC School of Medicine, Chapel Hill, NC, USA.,College of Psychology, Nova Southeastern University, Fort Lauderdale, FL, USA
| | - Minyone L Bradsher
- Center for Gastrointestinal Biology and Disease, UNC School of Medicine, Chapel Hill, NC, USA
| | - Dawn Harrison
- Division of Gastroenterology and Hepatology, UNC School of Medicine, Chapel Hill, NC, USA
| | - Richard K Sterling
- Division of Gastroenterology, Hepatology & Nutrition, Virginia Commonwealth University, Richmond, VA, USA
| | - K Rajender Reddy
- Division of Gastroenterology and Hepatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Marina Serper
- Division of Gastroenterology and Hepatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Carol E Golin
- Department of Health Behavior, UNC Gillings School of Global Public Health, Chapel Hill, NC, USA.,Division of General Medicine and Epidemiology, UNC School of Medicine, Chapel Hill, NC, USA
| | - Nancy Reau
- Department of Internal Medicine, Section of Hepatology, Rush University Medical Center, Chicago, IL, USA
| | - Joseph K Lim
- Digestive Diseases, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - David R Nelson
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, University of Florida, Jacksonville, FL, USA
| | - Souvik Sarkar
- Division of Gastroenterology and Hepatology, University of California Davis School of Medicine, Sacramento, CA, USA
| | - Donna M Evon
- Center for Gastrointestinal Biology and Disease, UNC School of Medicine, Chapel Hill, NC, USA.,Division of Gastroenterology and Hepatology, UNC School of Medicine, Chapel Hill, NC, USA
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Ali A, Mather JF, McMahon S, Curtis LE, Hoover N, Ayer C, Amer MR, Dibble T, Roper L, Orlando R, McKay RG. Racial and ethnic disparities in the use of transcatheter aortic valve replacement in the State of Connecticut. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2021; 37:7-12. [PMID: 34246611 DOI: 10.1016/j.carrev.2021.06.120] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 06/22/2021] [Accepted: 06/22/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND Although prior national reports have identified trends in the underutilization of transcatheter aortic valve replacement (TAVR) in Afro-American and Latino populations, racial and ethnic healthcare disparities in TAVR use in the State of Connecticut have not been previously reported. METHODS We conducted a retrospective analysis of 1461 patients undergoing TAVR at our institute between from 2012 to 2020. Baseline demographics, procedural characteristics, clinical outcomes, median incomes and insurance coverage were compared between 1417 Caucasian and 44 minority patients, including 23 patients designated as Afro-American and 10 designated as Latino. Demographics of TAVR utilization at our institution were further compared to 6 additional Connecticut TAVR centers using Connecticut Hospital Association (CHA) ChimeData detailing hospital discharges for DRG 266 and 267. RESULTS In comparison to Caucasian patients, minority cohorts were younger (75.7 ± 9.0 vs 81.5 ± 5.1 years, p < 0.001) and had more co-morbidities including diabetes (64% vs 34%, p < 001), coronary artery disease (95% vs 78%, p = 0.039), end stage renal disease requiring dialysis (9% vs 3%, p = 0.009) and atrial fibrillation (77% vs 62%, p = 0.041). The two groups did not differ with respect to other risk factors or co-morbidities, baseline echocardiographic or CTA findings, STS risk score, or procedural technique. Minority patients had a longer length of hospital stay (9.5 ± 9.0 vs 6.4 ± 6.9 days, p = 0.003), but did not differ with respect to procedural complications. Socioeconomic differences between the two groups included lower median incomes and higher rates of Medicaid or no insurance coverage for minority versus Caucasian patients. CHA ChimeData revealed a similar underutilization of TAVR in minority subgroups in the remaining 6 Connecticut TAVR centers. CONCLUSIONS Despite statewide demographics describing 10.7% and 15.7% of the total population as Afro-American and Latino, respectively, only 3.0% of the total TAVR procedures performed at a large Connecticut health care facility were performed in minority subgroups. Despite having a higher burden of co-morbidities, minority patients had similar outcomes compared to Caucasian patients. Similar racial and ethnic disparities in TAVR utilization were confirmed statewide using CHA ChimeData.
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Affiliation(s)
- Abdelrahman Ali
- Divisions of Medicine, Cardiology, Surgery and Research Administration, Hartford Hospital, Hartford, CT, United States of America.
| | - Jeffrey F Mather
- Divisions of Medicine, Cardiology, Surgery and Research Administration, Hartford Hospital, Hartford, CT, United States of America
| | - Sean McMahon
- Divisions of Medicine, Cardiology, Surgery and Research Administration, Hartford Hospital, Hartford, CT, United States of America
| | - Lauren E Curtis
- Divisions of Medicine, Cardiology, Surgery and Research Administration, Hartford Hospital, Hartford, CT, United States of America
| | - Nicole Hoover
- Divisions of Medicine, Cardiology, Surgery and Research Administration, Hartford Hospital, Hartford, CT, United States of America
| | - Courtney Ayer
- Divisions of Medicine, Cardiology, Surgery and Research Administration, Hartford Hospital, Hartford, CT, United States of America
| | - Mostafa R Amer
- Divisions of Medicine, Cardiology, Surgery and Research Administration, Hartford Hospital, Hartford, CT, United States of America
| | - Tina Dibble
- Divisions of Medicine, Cardiology, Surgery and Research Administration, Hartford Hospital, Hartford, CT, United States of America
| | - Lizabeth Roper
- Divisions of Medicine, Cardiology, Surgery and Research Administration, Hartford Hospital, Hartford, CT, United States of America
| | - Rocco Orlando
- Divisions of Medicine, Cardiology, Surgery and Research Administration, Hartford Hospital, Hartford, CT, United States of America
| | - Raymond G McKay
- Divisions of Medicine, Cardiology, Surgery and Research Administration, Hartford Hospital, Hartford, CT, United States of America
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An Investigation of Associations Between Race, Ethnicity, and Past Experiences of Discrimination with Medical Mistrust and COVID-19 Protective Strategies. J Racial Ethn Health Disparities 2021; 9:1430-1442. [PMID: 34117633 PMCID: PMC8195452 DOI: 10.1007/s40615-021-01080-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 05/04/2021] [Accepted: 06/01/2021] [Indexed: 12/31/2022]
Abstract
This study investigates the associations between three forms of discrimination, race and ethnicity, general medical mistrust, health-specific COVID-19 conspiracy beliefs, and adherence to COVID-19 protective behaviors. Participants (n = 963) completed an online survey during May 2020, when stay-at-home orders and other government mandates were implemented in many states. Results indicate that everyday discrimination and healthcare discrimination were associated with significantly higher general medical mistrust, and healthcare discrimination and structural discrimination were associated with higher endorsement of health-specific COVID-19 conspiracy beliefs. Higher endorsement of health-specific COVID-19 conspiracy beliefs, but not general medical mistrust, was associated with significantly lower engagement in health-specific COVID-19 conspiracy beliefs. This study helps to contextualize racial health disparities during the COVID-19 pandemic and the widespread impact of everyday, structural, and healthcare discrimination in society.
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Habr D, Ferdinand R. Addressing racial/ethnic disparities in cancer clinical trials: Everyone has a role to play. Cancer 2021; 127:3282-3289. [PMID: 33904590 DOI: 10.1002/cncr.33600] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 03/25/2021] [Accepted: 03/27/2021] [Indexed: 12/12/2022]
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Upshaw SJ. Using Communication Theory of Identity to Evaluate Decision Aids: Focus Group Research with African American Prostate Cancer Survivors. HEALTH COMMUNICATION 2021; 36:457-467. [PMID: 31814430 DOI: 10.1080/10410236.2019.1700437] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Prostate cancer remains a significant health concern for U.S. adults, especially African American men, who have higher rates of diagnosis than other racial/ethnic groups. The current study evaluated five prostate cancer decision aids (PCDAs) focused on diagnosis and treatment via seven focus groups with 30 African American survivors. Consistent with the communication theory of identity, three layers of identity were salient in discussing PCDAs: personal, relational, and communal. African American men perceived existing PCDAs positively, evaluating them as accessible, efficacy inducing, and helpful in managing identity threats (personal layer of identity). Participants also found PCDAs to be central to decision making (relational layer of identity). Yet, there were concerns about the perceived lack of representation of African Americans in PCDAs (communal layers of identity). The findings suggest that PCDAs connect to personal and relational layers of identity but do not match expectations of communal identity.
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Derreth RT, Wear MP. Critical Online Service-Learning Pedagogy: Justice in Science Education. JOURNAL OF MICROBIOLOGY & BIOLOGY EDUCATION 2021; 22:22.1.61. [PMID: 33884083 PMCID: PMC8046651 DOI: 10.1128/jmbe.v22i1.2537] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 02/05/2021] [Indexed: 05/17/2023]
Abstract
In the year 2020 the world changed dramatically. We went from busy lives spent largely away from home to spending most of our time at home while daily facing deepening national crises. With the violent, needless death of George Floyd, the simmering tensions around race in America boiled over, sending thousands into the streets to protest racial injustices. The world of science education has largely avoided discussing racism in our classes, but we can no longer ignore it. The events of the spring and summer have highlighted our need to integrate conversations and reflections on justice into science education. In this work, we argue that service learning can build this understanding from both theory and experience. Using a critical online service-learning framework, we have developed a service-learning course that incorporates dialogic communication, cross-contextual reflections, and positioning oneself as an ally. This perspective allows science and the community to prioritize relationships and humanity and reflect on our roles as professionals using the online interacting space. This course, taught at the beginning of the pandemic, focuses on critical online service learning for those studying public health. We discuss the challenges we faced moving critical service-learning pedagogy online and the compounding issues brought on by the pandemic itself.
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Affiliation(s)
- R. Tyler Derreth
- SOURCE, Community Engagement and Service-Learning Center at Johns Hopkins University, Schools of Public Health, Nursing, and Medicine, Baltimore, MD, 21205
- Health, Behavior and Society Department, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205
| | - Maggie P. Wear
- Molecular Microbiology and Immunology Department, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205
- R Center for Innovation in Science Education (RISE), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205
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Mittl GS, Cook TS, Hill PA, Cho J, Shea JA, Kahn CE, Zafar HM. Patient Understanding of Abnormal Imaging Findings Under Pennsylvania Act 112: A Call to Revise Mandated Notification Message Language. J Am Coll Radiol 2021; 18:951-961. [PMID: 33726983 DOI: 10.1016/j.jacr.2021.02.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 02/04/2021] [Accepted: 02/08/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE The aim of this study was to evaluate the effect of Pennsylvania Act 112 notification reading level and presentation on patient understanding and anxiety. METHODS Four notifications were developed by alternating 12th grade and 6th grade reading level Act 112 language with letters or infographics. Using Amazon Mechanical Turk, 909 US adult volunteers were randomly assigned to one notification followed by a survey. Participants who answered all 12 survey questions on understanding, anxiety, and sociodemographics were paid $0.10. Chi-square analysis and multivariate regression were used to determine the impact of notification type and sociodemographic data on understanding of communicated information and anxiety. RESULTS Sixty percent of participants (489 of 821) correctly understood all three questions directly answered within notifications regarding Act 112 subject, next steps, and process for obtaining reports. Approximately half of respondents understood that notifications indirectly conveyed "definitely" or "possibly" abnormal test results (344 of 821 [42%] and 99 of 821 [12%], respectively). Compared with the 12th grade letter, correct understanding of all directly communicated information was lower with the 12th grade infographic after adjustment (odds ratio, 0.61; 95% confidence interval, 0.39-0.95; P = .028) and equivalent with the 6th grade infographic and letter (P = .744 and P = .316). Correct indirect understanding of abnormal test results was not associated with notification type after adjustment but was associated with higher anxiety (odds ratio, 2.86; 95% confidence interval, 0.57-1.35; P < .001). CONCLUSIONS Layperson understanding of information directly and indirectly communicated in Pennsylvania Act 112 is suboptimal, regardless of reading level or presentation. New Act 112 language is needed to improve patient understanding, which would ideally be coproduced with Pennsylvania patients, policymakers, and other relevant stakeholders.
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Affiliation(s)
- Gregory S Mittl
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
| | - Tessa S Cook
- Director, Center for Translational Imaging Informatics, Perelmen School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Paul A Hill
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Joshua Cho
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Judy A Shea
- Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Charles E Kahn
- Vice Chairman, Department of Radiology, University of Pennsylvania Health System, Philadelphia, Pennsylvania
| | - Hanna M Zafar
- Associate Professor, Co-director, Automated Radiology Recommendation Tracking Engine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
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