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Wizentier MM, Stephenson BJK, Goodman MS. The measurement of racism in health inequities research. Epidemiol Rev 2023; 45:32-43. [PMID: 37147182 DOI: 10.1093/epirev/mxad004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 04/30/2023] [Accepted: 05/02/2023] [Indexed: 05/07/2023] Open
Abstract
There is limited literature on the measures and metrics used to examine racism in the health inequities literature. Health inequities research is continuously evolving, with the number of publications increasing over time. However, there is limited knowledge on the best measures and methods to examine the impact of different levels of racism (institutionalized, personally mediated, and internalized) on health inequities. Advanced statistical methods have the potential to be used in new ways to examine the relationship between racism and health inequities. In this review, we conduct a descriptive examination of the measurement of racism in the health inequities epidemiologic literature. We examine the study design, methods used for analysis, types of measures used (e.g., composite, absolute, relative), number of measures used, phase of research (detect, understand, solutions), viewpoint (oppressor, oppressed), and components of structural racism measures (historical context, geographical context, multifaceted nature). We discuss methods (e.g., Peters-Belson, latent class analysis, difference in differences) that have demonstrated potential for future work. The articles reviewed were limited to the detect (25%) and understand (75%) phases, with no studies in the solutions phase. Although the majority (56%) of studies had cross-sectional designs, many authors pointed to the need for longitudinal and multilevel data for further exploration. We examined study design features as mutually exclusive elements. However, racism is a multifaceted system and the measurement of racism in many studies does not fit into a single category. As the literature grows, the significance of methodological and measurement triangulation to assess racism should be investigated.
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Affiliation(s)
- Marina Mautner Wizentier
- Department of Biostatistics, School of Global Public Health, New York University, New York, New York 10003, United States
| | - Briana Joy K Stephenson
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States
| | - Melody S Goodman
- Department of Biostatistics, School of Global Public Health, New York University, New York, New York 10003, United States
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Sartor CE, Li EY, Black AC. Profiles of substance use related protective and risk factors and their associations with alcohol and tobacco use initiation among black adolescents. J Ethn Subst Abuse 2022; 23:72-94. [PMID: 35468309 DOI: 10.1080/15332640.2022.2064383] [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: 10/18/2022]
Abstract
Insufficient attention to protective and risk factors of particular salience for Black youth (e.g., racial identity and racial discrimination) in population-based substance use studies has left gaps in our understanding of alcohol and tobacco use development in Black adolescents. The current study aimed to capture the clustering of such understudied factors and their collective influence on alcohol and tobacco use initiation among Black adolescents. Data were drawn from The National Survey of American Life (n = 1,170; age range = 13-17; 6.9% Afro Caribbean, 93.1% African American; 50.0% female). Latent profile analysis applied to 11 indicators representing family, community, and individual level protective and risk factors revealed (1) High Vulnerability (high risk, low protective factors; 17.5%), (2) Moderate Vulnerability (moderate on both; 63.2%), and (3) Low Vulnerability (high protective, low risk factors; 19.3%) classes. Classes differed significantly by religious community support, school bonding, quality of relationship with mother, religious involvement, and interpersonal trauma. Relative to Class 2, Class 1 had higher odds of alcohol (OR = 1.518, CI:1.092-2.109) and tobacco use (OR = 1.998, CI:1.401-2.848); Class 3 had lower odds of alcohol (OR = 0.659, CI:0.449-0.968) but not tobacco use (OR = 0.965, CI:0.611-1.523). Findings suggest that alcohol and tobacco use initiation among Black adolescents is shaped by the collective influence of community and family level support, with commonly experienced risk factors such as non-interpersonal trauma distinguishing liability to a lesser degree. The equally modest prevalence of tobacco use among low and moderate vulnerability classes further indicates that fostering these connections may be especially effective in reducing tobacco use risk.
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Bauer GR, Mahendran M, Walwyn C, Shokoohi M. Latent variable and clustering methods in intersectionality research: systematic review of methods applications. Soc Psychiatry Psychiatr Epidemiol 2022; 57:221-237. [PMID: 34773462 PMCID: PMC8784367 DOI: 10.1007/s00127-021-02195-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 10/31/2021] [Indexed: 12/04/2022]
Abstract
PURPOSE An intersectionality framework has been increasingly incorporated into quantitative study of health inequity, to incorporate social power in meaningful ways. Researchers have identified "person-centered" methods that cluster within-individual characteristics as appropriate to intersectionality. We aimed to review their use and match with theory. METHODS We conducted a multidisciplinary systematic review of English-language quantitative studies wherein authors explicitly stated an intersectional approach, and used clustering methods. We extracted study characteristics and applications of intersectionality. RESULTS 782 studies with quantitative applications of intersectionality were identified, of which 16 were eligible: eight using latent class analysis, two latent profile analysis, and six clustering methods. Papers used cross-sectional data (100.0%) primarily had U.S. lead authors (68.8%) and were published within psychology, social sciences, and health journals. While 87.5% of papers defined intersectionality and 93.8% cited foundational authors, engagement with intersectionality method literature was more limited. Clustering variables were based on social identities/positions (e.g., gender), dimensions of identity (e.g., race centrality), or processes (e.g., stigma). Results most commonly included four classes/clusters (60.0%), which were frequently used in additional analyses. These described sociodemographic differences across classes/clusters, or used classes/clusters as an exposure variable to predict outcomes in regression analysis, structural equation modeling, mediation, or survival analysis. Author rationales for method choice included both theoretical/intersectional and statistical arguments. CONCLUSION Latent variable and clustering methods were used in varied ways in intersectional approaches, and reflected differing matches between theory and methods. We highlight situations in which these methods may be advantageous, and missed opportunities for additional uses.
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Affiliation(s)
- Greta R Bauer
- Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.
| | - Mayuri Mahendran
- Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Chantel Walwyn
- Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Mostafa Shokoohi
- Social and Behavioural Health Sciences, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
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Guan A, Thomas M, Vittinghoff E, Bowleg L, Mangurian C, Wesson P. An investigation of quantitative methods for assessing intersectionality in health research: A systematic review. SSM Popul Health 2021; 16:100977. [PMID: 34869821 PMCID: PMC8626832 DOI: 10.1016/j.ssmph.2021.100977] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 11/16/2021] [Accepted: 11/19/2021] [Indexed: 11/16/2022] Open
Abstract
Intersectionality is a theoretical framework that investigates how interlocking systems of power and oppression at the societal level influence the lived experiences of historically and socially marginalized groups. Currently, there are no consistent or widely adopted quantitative methods to investigate research questions informed by intersectionality theory. The objective of this systematic review is to describe the current landscape of quantitative methods used to assess intersectionality and to provide recommendations on analytic best practices for future research. We searched PubMed, EMBASE, and the Web of Science in December 2019 to identify studies using analytic quantitative intersectionality approaches published up to December 2019 (PROSPERO CRD42020162686). To be included in the study, articles had to: (1) be empirical research, (2) use a quantitative statistical method, (3) be published in English, and (4) incorporate intersectionality. Our initial search yielded 1889 articles. After screening by title/abstract, methods, and full text review, our final analytic sample included 153 papers. Eight unique classes of quantitative methods were identified, with the majority of studies employing regression with an interaction term. We additionally identified several methods which appear to be at odds with the key tenets of intersectionality. As quantitative intersectionality continues to expand, careful attention is needed to avoid the dilution of the core tenets. Specifically, emphasis on social power is needed as methods continue to be adopted and developed. Additionally, clear explanation of the selection of statistical approaches is needed and, when using regression with interaction terms, researchers should opt for use of the additive scale. Finally, use of methods that are potentially at odds with the tenets of intersectionality should be avoided.
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Affiliation(s)
- Alice Guan
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
| | - Marilyn Thomas
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, USA
| | - Eric Vittinghoff
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
| | - Lisa Bowleg
- Department of Psychological and Brain Sciences, The George Washington University, Washington, DC, USA
| | - Christina Mangurian
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, USA
- Center for Vulnerable Populations, University of California, San Francisco, San Francisco, CA, USA
| | - Paul Wesson
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
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Taggart T, Milburn NG, Nyhan K, Ritchwood TD. Utilizing a Life Course Approach to Examine HIV Risk for Black Adolescent Girls and Young Adult Women in the United States: A Systematic Review of Recent Literature. Ethn Dis 2020; 30:277-286. [PMID: 32346273 DOI: 10.18865/ed.30.2.277] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Objective Black female youth have been disproportionately burdened by the HIV epidemic. Emerging literature suggests that individual and social-structural factors may uniquely increase HIV risk within this population during key developmental periods, namely adolescence (ages 10-17 years) and emerging adulthood (ages 18-25 years). Few studies, however, have compared drivers of risk within and between these key developmental periods. Therefore, we conducted a systematic review of recent literature to characterize and identify important gaps in our understanding of the individual, psychosocial, and social-structural determinants of HIV risk among Black adolescent girls and emerging adult women. Design Using a replicable strategy, we searched electronic databases for articles and abstracts published between October 1, 2017 and September 30, 2019 in which the primary focus was on HIV prevention among Black adolescent girls and emerging adults in the United States. Results In total, 21 studies met the inclusion criteria. Most of the studies on Black adolescent girls assessed family functioning, parental monitoring, and parent-adolescent communication as determinants of HIV-related behaviors. However, equivalent studies were lacking for Black emerging adult women. Moreover, few studies assessed neighborhood characteristics, social networks, or other community-level factors as determinants of HIV-related behaviors, which are known drivers of HIV disparities. Conclusions Our findings highlighted several gaps in the literature, including failure to recognize the ethnic and cultural differences among Black women that may contribute to behavioral differences within this population and insufficient acknowledgment of the role of HIV protective factors (eg, resilience and community assets). Implications and future directions are discussed.
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Affiliation(s)
- Tamara Taggart
- Department of Prevention and Community Health, George Washington University, Washington, DC; Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT
| | - Norweeta G Milburn
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA
| | - Kate Nyhan
- Yale School of Public Health; Harvey Cushing/John Hay Whitney Medical Library, Department of Environmental Health Sciences, Yale University, New Haven, CT
| | - Tiarney D Ritchwood
- Department of Family Medicine and Community Health, Duke University School of Medicine, Durham, NC
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Hope MO, Taggart T, Galbraith-Gyan KV, Nyhan K. Black Caribbean Emerging Adults: A Systematic Review of Religion and Health. JOURNAL OF RELIGION AND HEALTH 2020; 59:431-451. [PMID: 31828596 PMCID: PMC7722983 DOI: 10.1007/s10943-019-00932-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Religion, a prominent factor among Black diasporic communities, influences their health outcomes. Given the increase in Black Caribbeans living in the United States, it is important to understand how religion's function among different ethnic groups of Black Americans. We systematically reviewed four databases and included articles of any study design if they (a) focused on the religious experiences of emerging adults (18-29 years) identifying as Black Caribbean in the United States, in light of medical, public health, or mental health outcomes, and (b) were published before November 30, 2018. Study results contribute to future studies' conceptualization and measurement of religion among Black Caribbean emerging adults.
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Affiliation(s)
- Meredith O Hope
- National Center for Institutional Diversity, University of Michigan, 610 East University Avenue, Suite 3338, Ann Arbor, MI, 48109, USA.
| | - Tamara Taggart
- Department of Prevention & Community Health, Milken Institute School of Public Health, George Washington University, 950 New Hampshire Avenue, Washington, DC, USA
| | - Kayoll V Galbraith-Gyan
- School of Nursing, Northeastern University, Robinson Hall, 336 Huntingdon Avenue, Boston, MA, 02215, USA
| | - Kate Nyhan
- Cushing/Whitney Medical Library, Yale University, P.O. Box 208014, New Haven, CT, 06520-8014, USA
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