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Simpson JN, Wright JL. Pandemic Planning, Response, and Recovery for Pediatricians: A Focus on Health Equity and Social Determinants of Health. Pediatr Clin North Am 2024; 71:515-528. [PMID: 38754939 DOI: 10.1016/j.pcl.2024.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/18/2024]
Abstract
This article summarizes how pediatricians may be uniquely positioned to mitigate the long-term trajectory of COVID-19 on the health and wellness of pediatric patients especially with regard to screening for social determinants of health that are recognized drivers of disparate health outcomes. Health inequities, that is, disproportionately deleterious health outcomes that affect marginalized populations, have been a major source of vulnerability in past public health emergencies and natural disasters. Recommendations are provided for pediatricians to collaborate with disaster planning networks and lead strategies for public health communication and community engagement in pediatric pandemic and disaster planning, response, and recovery efforts.
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Affiliation(s)
- Joelle N Simpson
- Department of Pediatrics and Emergency Medicine, George Washington University School of Medicine, Washington, DC, USA; Emergency Medicine & Trauma Center, Children's National Hospital, 111 Michigan Avenue, Northwest, Washington, DC 20010, USA.
| | - Joseph L Wright
- Department of Pediatrics and Emergency Medicine, George Washington University School of Medicine, Washington, DC, USA; Department of Health Policy and Management, George Washington University School of Public Health, Washington DC 20052
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2
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Jackson DB, Fix RL, Testa A. Sleep Problems Among Black Youth Exposed to Police Violence on Digital Media. J Pediatr 2024; 270:114036. [PMID: 38554747 DOI: 10.1016/j.jpeds.2024.114036] [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: 11/20/2023] [Revised: 03/12/2024] [Accepted: 03/26/2024] [Indexed: 04/02/2024]
Abstract
Findings from a recent survey of a community-based sample of Black youth ages 12 through 21 in Baltimore City, Maryland (n = 345) reveal that viewing fatal police violence videos is associated with significant increases in the odds of youth sleep disturbances, and about 30% of this association is attributable to emotional distress after viewing the videos.
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Affiliation(s)
- Dylan B Jackson
- Department of Population, Family, and Reproductive Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD.
| | - Rebecca L Fix
- Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
| | - Alexander Testa
- Department of Management, Policy and Community Health, The University of Texas Health Science Center at Houston, Houston, TX
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3
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Dickson CA, Ergun-Longmire B, Greydanus DE, Eke R, Giedeman B, Nickson NM, Hoang LN, Adabanya U, Payares DVP, Chahin S, McCrary J, White K, Moon JH, Haitova N, Deleon J, Apple RW. Health equity in pediatrics: Current concepts for the care of children in the 21st century (Dis Mon). Dis Mon 2024; 70:101631. [PMID: 37739834 DOI: 10.1016/j.disamonth.2023.101631] [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: 09/24/2023]
Abstract
This is an analysis of important aspects of health equity in caring for children and adolescents written by a multidisciplinary team from different medical centers. In this discussion for clinicians, we look at definitions of pediatric health equity and the enormous impact of social determinants of health in this area. Factors involved with pediatric healthcare disparities that are considered include race, ethnicity, gender, age, poverty, socioeconomic status, LGBT status, living in rural communities, housing instability, food insecurity, access to transportation, availability of healthcare professionals, the status of education, and employment as well as immigration. Additional issues involved with health equity in pediatrics that are reviewed will include the impact of the COVID-19 pandemic, behavioral health concepts, and the negative health effects of climate change. Recommendations that are presented include reflection of one's own attitudes on as well as an understanding of these topics, consideration of the role of various healthcare providers (i.e., community health workers, peer health navigators, others), the impact of behavioral health integration, and the need for well-conceived curricula as well as multi-faceted training programs in pediatric health equity at the undergraduate and postgraduate medical education levels. Furthermore, ongoing research in pediatric health equity is needed to scrutinize current concepts and stimulate the development of ideas with an ever-greater positive influence on the health of our beloved children. Clinicians caring for children can serve as champions for the optimal health of children and their families; in addition, these healthcare professionals are uniquely positioned in their daily work to understand the drivers of health inequities and to be advocates for optimal health equity in the 21st century for all children and adolescents.
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Affiliation(s)
- Cheryl A Dickson
- Department of Pediatric & Adolescent Medicine, Western Michigan University, Homer Stryker M.D. School of Medicine, Kalamazoo, MI, United States
| | - Berrin Ergun-Longmire
- Department of Pediatric & Adolescent Medicine, Western Michigan University, Homer Stryker M.D. School of Medicine, Kalamazoo, MI, United States
| | - Donald E Greydanus
- Department of Pediatric & Adolescent Medicine, Western Michigan University, Homer Stryker M.D. School of Medicine, Kalamazoo, MI, United States.
| | - Ransome Eke
- Department of Community Medicine, Mercer University School of Medicine, Columbus, GA, United States
| | - Bethany Giedeman
- Western Michigan University, Homer Stryker M.D. School of Medicine, Kalamazoo, MI, United States
| | - Nikoli M Nickson
- Western Michigan University, Homer Stryker M.D. School of Medicine, Kalamazoo, MI, United States
| | - Linh-Nhu Hoang
- Department of Psychology, Western Michigan University, Kalamazoo, MI, United States
| | - Uzochukwu Adabanya
- Department of Community Medicine, Mercer University School of Medicine, Columbus, GA, United States
| | - Daniela V Pinto Payares
- Western Michigan University, Homer Stryker M.D. School of Medicine, Kalamazoo, MI, United States
| | - Summer Chahin
- Department of Psychology, C.S. Mott Children's Hospital/Michigan Medicine, Ann Arbor, MI, United States
| | - Jerica McCrary
- Center for Rural Health and Health Disparities, Mercer University School of Medicine, Columbus, GA, United States
| | - Katie White
- Department of Pediatric & Adolescent Medicine, Western Michigan University, Homer Stryker M.D. School of Medicine, Kalamazoo, MI, United States
| | - Jin Hyung Moon
- Department of Community Medicine, Mercer University School of Medicine, Columbus, GA, United States
| | - Nizoramo Haitova
- Department of Educational Leadership, Research and Technology, Western Michigan University, Kalamazoo, MI, United States
| | - Jocelyn Deleon
- Department of Pediatric & Adolescent Medicine, Western Michigan University, Homer Stryker M.D. School of Medicine, Kalamazoo, MI, United States
| | - Roger W Apple
- Department of Pediatric & Adolescent Medicine, Western Michigan University, Homer Stryker M.D. School of Medicine, Kalamazoo, MI, United States
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Blatt LR, Sadler RC, Jones EJ, Miller P, Hunter-Rue DS, Votruba-Drzal E. Historical Structural Racism in the Built Environment and Contemporary Children's Opportunities. Pediatrics 2024; 153:e2023063230. [PMID: 38192230 DOI: 10.1542/peds.2023-063230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/13/2023] [Indexed: 01/10/2024] Open
Abstract
BACKGROUND AND OBJECTIVES There are well-documented links between structural racism and inequities in children's opportunities. Yet, when it comes to understanding the role of the built environment, a disproportionate focus on redlining obscures other historical policies and practices such as blockbusting, freeway displacement, and urban renewal that may impact contemporary child development. We hypothesized that historical structural racism in Allegheny County, Pennsylvania's, built environment would be associated with fewer contemporary educational, socioeconomic, and health opportunities. We also hypothesized that these measures would explain more collective variance in children's opportunities than redlining alone. METHODS We used geospatial data from the US Census, Mapping Inequality Project, and other archival sources to construct historical measures of redlining, blockbusting, freeway displacement, and urban renewal in ArcGIS at the census tract level. These were linked with data from the Child Opportunity Index 2.0 to measure children's opportunities across domains of education, socioeconomic status, and health. We ran spatial regression analyses in Stata 18.0 to examine individual and collective associations between structural racism and children's opportunities. RESULTS Historical redlining, blockbusting, and urban renewal were largely associated with fewer contemporary educational, socioeconomic, and health opportunities, and explained up to 47.4% of the variance in children's opportunities. The measures collectively explained more variance in children's opportunities than redlining alone. CONCLUSIONS In support of our hypotheses, novel measures of structural racism were related to present-day differences in children's opportunities. Findings lay the groundwork for future research focused on repairing longstanding harm perpetuated by structural racism.
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Guastaferro K, Sheldrick RC, Strayhorn JC, Feinberg E. Operationalizing Primary Outcomes to Achieve Reach, Effectiveness, and Equity in Multilevel Interventions. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2023:10.1007/s11121-023-01613-2. [PMID: 38047992 DOI: 10.1007/s11121-023-01613-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2023] [Indexed: 12/05/2023]
Abstract
When intervention scientists plan a clinical trial of an intervention, they select an outcome metric that operationalizes their definition of intervention success. The outcome metric that is selected has important implications for which interventions are eventually supported for implementation at scale and, therefore, what health benefits (including how much benefit and for whom) are experienced in a population. Particularly when an intervention is to be implemented in a population that experiences a health disparity, the outcome metric that is selected can also have implications for equity. Some outcome metrics risk exacerbating an existing health disparity, while others may decrease disparities for some but have less effect for the larger population. In this study, we use a computer to simulate implementation of a hypothetical multilevel, multicomponent intervention to highlight the tradeoffs that can occur between outcome metrics that reflect different operationalizations of intervention success. In particular, we highlight tradeoffs between overall mean population benefit and the distribution of health benefits in the population, which has direct implications for equity. We suggest that simulations like the one we present can be useful in the planning of a clinical trial for a multilevel and/or multicomponent intervention, since simulated implementation at scale can illustrate potential consequences of candidate operationalization of intervention success, such that unintended consequences for equity can be avoided.
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Affiliation(s)
- Kate Guastaferro
- Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, NY, USA.
| | - R Christopher Sheldrick
- Department of Psychiatry, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Jillian C Strayhorn
- Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, NY, USA
| | - Emily Feinberg
- Hassenfeld Child Health Innovation Institute, Brown University School of Public Health, Providence, RI, USA
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Portillo EN, Rees CA, Hartford EA, Foughty ZC, Pickett ML, Gutman CK, Shihabuddin BS, Fleegler EW, Chumpitazi CE, Johnson TJ, Schnadower D, Shaw KN. Research Priorities for Pediatric Emergency Care to Address Disparities by Race, Ethnicity, and Language. JAMA Netw Open 2023; 6:e2343791. [PMID: 37955894 PMCID: PMC10644218 DOI: 10.1001/jamanetworkopen.2023.43791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 10/06/2023] [Indexed: 11/14/2023] Open
Abstract
Importance Health care disparities are well-documented among children based on race, ethnicity, and language for care. An agenda that outlines research priorities for disparities in pediatric emergency care (PEC) is lacking. Objective To investigate research priorities for disparities in PEC among medical personnel, researchers, and health care-affiliated community organizations. Design, Setting, and Participants In this survey study, a modified Delphi approach was used to investigate research priorities for disparities in PEC. An initial list of research priorities was developed by a group of experienced PEC investigators in 2021. Partners iteratively assessed the list through 2 rounds of electronic surveys using Likert-type responses in late 2021 and early 2022. Priorities were defined as achieving consensus if they received a score of highest priority or priority by at least 60% of respondents. Asynchronous engagement of participants via online web-conferencing platforms and email correspondence with electronic survey administration was used. Partners were individuals and groups involved in PEC. Participants represented interest groups, research and medical personnel organizations, health care partners, and laypersons with roles in community and family hospital advisory councils. Participants were largely from the US, with input from international PEC research networks. Outcome Consensus agenda of research priorities to identify and address health care disparities in PEC. Results PEC investigators generated an initial list of 27 potential priorities. Surveys were completed by 38 of 47 partners (80.6%) and 30 of 38 partners (81.1%) in rounds 1 and 2, respectively. Among 30 respondents who completed both rounds, there were 7 family or community partners and 23 medical or research partners, including 4 international PEC research networks. A total of 12 research priorities achieved the predetermined consensus threshold: (1) systematic efforts to reduce disparities; (2) race, ethnicity, and language data collection and reporting; (3) recognizing and mitigating clinician implicit bias; (4) mental health disparities; (5) social determinants of health; (6) language and literacy; (7) acute pain-management disparities; (8) quality of care equity metrics; (9) shared decision-making; (10) patient experience; (11) triage and acuity score assignment; and (12) inclusive research participation. Conclusions and Relevance These results suggest a research priority agenda that may be used as a guide for investigators, research networks, organizations, and funding agencies to engage in and support high-priority disparities research topics in PEC.
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Affiliation(s)
- Elyse N. Portillo
- Division of Pediatric Emergency Medicine, Baylor College of Medicine, Texas Children's Hospital, Houston
| | - Chris A. Rees
- Division of Pediatric Emergency Medicine, Emory University School of Medicine, Children’s Healthcare of Atlanta, Atlanta, Georgia
| | - Emily A. Hartford
- Division of Emergency Medicine, Department of Pediatrics, University of Washington, Seattle
| | - Zachary C. Foughty
- Division of Pediatric Emergency Medicine, Baylor College of Medicine, Texas Children's Hospital, Houston
| | - Michelle L. Pickett
- Section of Emergency Medicine, Department of Pediatrics, Medical College of Wisconsin, Milwaukee
| | - Colleen K. Gutman
- Department of Emergency Medicine, University of Florida, Gainesville
- Department of Pediatrics, University of Florida, Gainesville
| | - Bashar S. Shihabuddin
- Division of Emergency Medicine, Nationwide Children’s Hospital, The Ohio State University College of Medicine, Columbus
| | - Eric W. Fleegler
- Division of Emergency Medicine, Boston Children’s Hospital, Boston, Massachusetts
| | - Corrie E. Chumpitazi
- Division of Emergency Medicine, Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina
| | - Tiffani J. Johnson
- Department of Emergency Medicine, University of California, Davis, Sacramento
| | - David Schnadower
- Division of Emergency Medicine, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Kathy N. Shaw
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Children’s Hospital of Philadelphia
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Laster M, Kozman D, Norris KC. Addressing Structural Racism in Pediatric Clinical Practice. Pediatr Clin North Am 2023; 70:725-743. [PMID: 37422311 DOI: 10.1016/j.pcl.2023.03.010] [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: 07/10/2023]
Abstract
Structural racism is the inequitable allocation of various social determinants of health to different communities. Exposure to this and other discrimination levied from intersectional identities is the primary driver of disproportionately adverse health outcomes for minoritized children and their families. Pediatric clinicians must vigilantly identify and mitigate racism in health care systems and delivery, assess for any impact of patient and family exposure to racism and direct them to appropriate health resources, foster an environment of inclusion and respect, and ensure that all care is delivered through a race-conscious lens with the utmost cultural humility and shared decision-making.
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Affiliation(s)
- Marciana Laster
- David Geffen School of Medicine, University of California, Los Angeles, CA, USA; Division of Pediatric Nephrology, UCLA Department of Pediatrics, 10833 Le Conte Avenue, MDCC A2-383, Los Angeles, CA 90095-1752, USA
| | - Daniel Kozman
- David Geffen School of Medicine, University of California, Los Angeles, CA, USA; UCLA Department of Medicine, Section of Medicine-Pediatrics & Preventive Medicine
| | - Keith C Norris
- David Geffen School of Medicine, University of California, Los Angeles, CA, USA; Division of General Internal Medicine and Health Services Research, UCLA Department of Medicine, 1100 Glendon Avenue, Suite 710, Los Angeles, CA 90024, USA.
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Gupta M, Madabushi JS, Gupta N. Critical Overview of Patriarchy, Its Interferences With Psychological Development, and Risks for Mental Health. Cureus 2023; 15:e40216. [PMID: 37435274 PMCID: PMC10332384 DOI: 10.7759/cureus.40216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/10/2023] [Indexed: 07/13/2023] Open
Abstract
The systemic oppression of women and gender-based discrimination has deep roots in human civilization. As evident in both written texts and widespread practices, conscious and unconscious biases associated with patriarchy have been and continue to be interlaced with power struggles, control, and conformity enforced by the male-dominant cultures of the time. Brought into bold relief in this pandemic, recent dramatic events (the tragic murder of George Floyd and the overturning of Roe v. Wade, for example) have heightened social outrage against bias, racism, and bigotry and have also brought us to an inflection point demanding our better understanding of the pernicious and long-term mental health effects of patriarchy. There are compelling grounds to further expand their construct, but efforts to do so in psychiatric phenomenology have, until now, failed to gain momentum and substantive attention. The resistance may in part lie in misconceptions that patriarchy is supported by archetypal endowments of the collective unconscious constitutive of shared societal beliefs. While many continue to live with the adverse experiences associated with patriarchy within the current times, critics have argued that our concepts about patriarchy are not empirical enough. Empirically supported deconstruction is necessary to debunk misinformed notions that undermine women's equality.
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Affiliation(s)
- Mayank Gupta
- Psychiatry and Behavioral Sciences, Southwood Psychiatric Hospital, Pittsburgh, USA
| | | | - Nihit Gupta
- Psychiatry, Dayton Children's Hospital, Dayton, USA
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Keum BT, Waters EM, Wong MJ, Salim-Eissa R. Witnessing racism against racial minority individuals online and loneliness among White emerging adults: Anti-racism advocacy as a moderator. JOURNAL OF COMMUNITY PSYCHOLOGY 2023; 51:1634-1652. [PMID: 36170463 DOI: 10.1002/jcop.22944] [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: 03/21/2022] [Revised: 09/03/2022] [Accepted: 09/15/2022] [Indexed: 05/23/2023]
Abstract
Extant literature suggests that racism is associated with difficult emotional reactions and feelings of social disconnect among White individuals. These feelings of social disconnect may be particularly salient in today's digital era in which racism against racial minority individuals is conveniently and frequently witnessed via online platforms. Thus, we examined whether witnessing racism online may be associated with feelings of loneliness among White emerging adults. We also tested whether anti-racism advocacy buffered loneliness given its potential for relationship building and community organizing to promote racial justice and equity. Using data from 227 White emerging adults (Mage = 20.86, SD = 4.82), we conducted a latent moderated structural equation modeling to test individual and institutional anti-racism advocacy as moderators in the link between witnessing racism online (racial victimization of racial minority individuals in online interactions and online content on cultural devaluation/systemic racism against racial minority individuals) and loneliness. Greater exposure to online content on systemic racism and cultural devaluation of racial minority groups significantly predicted greater loneliness. Engagement in individual anti-racism advocacy (mean to high levels) buffered this link. White allies must engage in anti-racism practice to address racism in our society, and our findings advance our understanding of the associated psychosocial costs. Implications for research and practice are discussed.
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Affiliation(s)
- Brian TaeHyuk Keum
- Department of Social Welfare, University of California, Los Angeles, Los Angeles, California, USA
| | - Emily M Waters
- Department of Social Welfare, University of California, Los Angeles, Los Angeles, California, USA
| | - Michele J Wong
- Department of Social Welfare, University of California, Los Angeles, Los Angeles, California, USA
| | - Rangeena Salim-Eissa
- Department of Social Welfare, University of California, Los Angeles, Los Angeles, California, USA
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10
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Keum BT, Choi AY. Profiles of online racism exposure and mental health among Asian, Black, and Latinx emerging adults in the United States. Int Rev Psychiatry 2023; 35:310-322. [PMID: 37267025 DOI: 10.1080/09540261.2023.2180346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 02/10/2023] [Indexed: 06/03/2023]
Abstract
Online racism is a digital social determinant to health inequity and an acute and widespread public health problem. To explore the heterogeneity of online racism exposure within and across race, we latent class modelled this construct among Asian (n = 310), Black (n = 306), and Latinx (n = 163) emerging adults in the United States and analysed key demographic and psychosocial health correlates. We observed Low and Mediated Exposure classes across all racial groups, whereas High Exposure classes appeared among Asian and Black people and the Systemic Exposure classes emerged uniquely in Asian and Latinx people. Generally, the High Exposure classes reported the greatest psychological distress and unjust views of society compared to all other classes. The Mediated and Systemic Exposure classes reported greater mental health costs than the Low Exposure classes. Asian women were more likely to be in the Mediated Exposure class compared to the Low Exposure class, whereas Black women were more likely to be in the Mediated Exposure class compared to both High and Low Exposure classes. About a third of each racial group belonged to the Low Exposure classes. Our findings highlight the multidimensionality of online racism exposure and identify hidden yet divergently risky subgroups. Research implications include examination of class membership chronicity and change over time, online exposure to intersecting oppressions, and additional antecedents and health consequences of diverse forms of online racism exposure.
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Affiliation(s)
- Brian TaeHyuk Keum
- Department of Social Welfare, University of California, Los Angeles, CA, USA
| | - Andrew Young Choi
- Counseling and Student Development Center, University of Hawai'i at Mānoa, Honolulu, HI, USA
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Silvera GA, Erwin CO, Garman AN. A Seat at the Table: An Examination of Hospital Governing Board Diversity, 2011-2021. J Healthc Manag 2023; 68:132-142. [PMID: 36692421 PMCID: PMC9970015 DOI: 10.1097/jhm-d-22-00068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
GOAL Board diversity is increasingly important for hospitals and healthcare systems, with national attention focused on eliminating health disparities and improving health equity. Yet, it remains a challenge despite concerted efforts by leading professional associations (e.g., American College of Healthcare Executives) to galvanize their constituents around the importance of the issue. METHODS This study used survey data from The Governance Institute to explore the ethnoracial and gender diversity of hospital boards spanning 2011 through 2021. PRINCIPAL FINDINGS The results showed modest gains in the mean number of female board members, although a small proportion of hospital boards still have no female representation. There was little change in the number of boards with ethnic minority representation until an uptick in 2021, likely in direct response to high-profile racial incidents and protests. PRACTICAL APPLICATIONS Intentional and sustained efforts are necessary to increase diversity and create a culture of inclusion that fosters meaningful engagement of diverse board members.
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Affiliation(s)
- Geoffrey A. Silvera
- Department of Health Services Administration, University of Alabama at Birmingham, Birmingham, Alabama
| | - Cathleen O. Erwin
- Health Services Administration Program, Auburn University, Auburn, Alabama
| | - Andrew N. Garman
- Department of Health Systems Management, Rush University, Chicago, Illinois
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12
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Criss S, Nguyen TT, Michaels EK, Gee GC, Kiang MV, Nguyen QC, Norton S, Titherington E, Nguyen L, Yardi I, Kim M, Thai N, Shepherd A, Kennedy CJ. Solidarity and strife after the Atlanta spa shootings: A mixed methods study characterizing Twitter discussions by qualitative analysis and machine learning. Front Public Health 2023; 11:952069. [PMID: 36825140 PMCID: PMC9941551 DOI: 10.3389/fpubh.2023.952069] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 01/03/2023] [Indexed: 02/10/2023] Open
Abstract
Background On March 16, 2021, a white man shot and killed eight victims, six of whom were Asian women at Atlanta-area spa and massage parlors. The aims of the study were to: (1) qualitatively summarize themes of tweets related to race, ethnicity, and racism immediately following the Atlanta spa shootings, and (2) examine temporal trends in expressions hate speech and solidarity before and after the Atlanta spa shootings using a new methodology for hate speech analysis. Methods A random 1% sample of publicly available tweets was collected from January to April 2021. The analytic sample included 708,933 tweets using race-related keywords. This sample was analyzed for hate speech using a newly developed method for combining faceted item response theory with deep learning to measure a continuum of hate speech, from solidarity race-related speech to use of violent, racist language. A qualitative content analysis was conducted on random samples of 1,000 tweets referencing Asians before the Atlanta spa shootings from January to March 15, 2021 and 2,000 tweets referencing Asians after the shooting from March 17 to 28 to capture the immediate reactions and discussions following the shootings. Results Qualitative themes that emerged included solidarity (4% before the shootings vs. 17% after), condemnation of the shootings (9% after), racism (10% before vs. 18% after), role of racist language during the pandemic (2 vs. 6%), intersectional vulnerabilities (4 vs. 6%), relationship between Asian and Black struggles against racism (5 vs. 7%), and discussions not related (74 vs. 37%). The quantitative hate speech model showed a decrease in the proportion of tweets referencing Asians that expressed racism (from 1.4% 7 days prior to the event from to 1.0% in the 3 days after). The percent of tweets referencing Asians that expressed solidarity speech increased by 20% (from 22.7 to 27.2% during the same time period) (p < 0.001) and returned to its earlier rate within about 2 weeks. Discussion Our analysis highlights some complexities of discrimination and the importance of nuanced evaluation of online speech. Findings suggest the importance of tracking hate and solidarity speech. By understanding the conversations emerging from social media, we may learn about possible ways to produce solidarity promoting messages and dampen hate messages.
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Affiliation(s)
- Shaniece Criss
- Department of Health Sciences, Furman University, Greenville, SC, United States
| | - Thu T. Nguyen
- Department of Epidemiology and Biostatistics, University of Maryland School of Public Health, College Park, MD, United States
| | - Eli K. Michaels
- Division of Epidemiology, School of Public Health, University of California, Berkeley, Berkeley, CA, United States
| | - Gilbert C. Gee
- Department of Community Health Sciences, University of California, Los Angeles, Los Angeles, CA, United States
| | - Mathew V. Kiang
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA, United States
| | - Quynh C. Nguyen
- Department of Epidemiology and Biostatistics, University of Maryland School of Public Health, College Park, MD, United States
| | - Samantha Norton
- Department of Health Sciences, Furman University, Greenville, SC, United States
| | - Eli Titherington
- Department of Health Sciences, Furman University, Greenville, SC, United States
| | - Leah Nguyen
- Department of Public Health Science, University of Maryland, College Park, MD, United States
| | - Isha Yardi
- Department of Public Health Science, University of Maryland, College Park, MD, United States
| | - Melanie Kim
- Department of Anthropology, Brown University, Providence, RI, United States
| | - Nhung Thai
- Department of Nutritional Sciences and Toxicology, University of California, Berkeley, Berkeley, CA, United States
| | - Ariel Shepherd
- College of Arts and Sciences, University of South Carolina, Columbia, SC, United States
| | - Chris J. Kennedy
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States
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Keum BT, Ángel Cano M. Online racism, depressive and anxiety symptoms, coping-related drinking motives, and alcohol use severity among Black, Latina/o/x, and Asian emerging adults. Addict Behav 2023; 136:107468. [PMID: 36087497 DOI: 10.1016/j.addbeh.2022.107468] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 08/05/2022] [Accepted: 08/18/2022] [Indexed: 02/03/2023]
Abstract
Online racism has been associated with alcohol-related coping, likely to deal with mental health symptoms that arise from experiencing racial discrimination in online settings. Thus, we examined online racism as a risk factor for alcohol-related problems by examining depressive/anxiety symptoms and coping-related drinking motives as mediators among Black, Latina/o/x, and Asian emerging adults in the U.S. We hypothesized that online racism would be associated with greater alcohol use severity through depressive/anxiety symptoms and coping-related drinking motives sequentially. With data from 322 participants (Mage = 23.28; Black, n = 108; Latina/o/x, n = 118; and Asian, n = 96), we conducted a multi-group path analysis of online racism (Perceived Online Racism Scale) linked to alcohol use (Alcohol Use Disorders Identification Test) via depressive (Patient Health Questionnaire-9)/Anxiety (Generalized Anxiety Disorder-7) symptoms and coping-related drinking motives (Drinking Motives Questionnaire-Revised Short Form). The hypothesized indirect pathway was significant in all groups. The direct effect was also significant for Latina/o/x and Asian groups. For the Black group, the direct effect was not significant, highlighting the salience of the mental health symptoms and drinking motives in explaining the link between online racism and alcohol use. Collectively, the results help to contextualize the risks of alcohol-related problems from experiencing contemporary forms of racial trauma such as online racial discrimination and provide implications for intervention development.
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Affiliation(s)
- Brian TaeHyuk Keum
- Department of Social Welfare, University of California, Los Angeles, Los Angeles, CA, United States.
| | - Miguel Ángel Cano
- Department of Epidemiology, Florida International University, Miami, FL, United States
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14
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Gómez JM. Epistemic Oppression, Construct Validity, and Scientific Rigor: Commentary on Woo et al. (2022). PERSPECTIVES ON PSYCHOLOGICAL SCIENCE 2023; 18:32-38. [PMID: 35687744 DOI: 10.1177/17456916211072830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
In this commentary, I highlight flaws in the article by Woo and colleagues (this issue) that undermine its credibility and utility as rigorous science that contributes to the field. I do so by discussing (a) the concept of epistemic oppression regarding the glaring exclusion of multiple germane bodies of research and (b) the importance of including construct validity within a psychometric article regarding the Graduate Record Examination (GRE). I conclude with a plea to the authors that the matter of anti-Black violence and murder, which they reference, is one to be taken respectfully, seriously, and somberly.
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Affiliation(s)
- Jennifer M Gómez
- Center for Advanced Study in the Behavioral Sciences (CASBS), Stanford University, and Center for Institutional Courage, Palo Alto, California
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15
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Fiori KP, Oyeku SO. Addressing Racial, Ethnic, and Socioeconomic Differences in Real-World Practice. Pediatrics 2022; 150:189911. [PMID: 36336641 DOI: 10.1542/peds.2022-058243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/21/2022] [Indexed: 11/09/2022] Open
Affiliation(s)
- Kevin P Fiori
- Department of Family and Social Medicine.,Division of Academic General Pediatrics, Department of Pediatrics, The Children's Hospital at Montefiore and Albert Einstein College of Medicine, Bronx, New York
| | - Suzette O Oyeku
- Division of Academic General Pediatrics, Department of Pediatrics, The Children's Hospital at Montefiore and Albert Einstein College of Medicine, Bronx, New York
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16
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17
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Jackson DB, Jindal M, Testa A, Ganson KT, Fix RL, Nagata JM. Adverse Childhood Experiences and Adolescent Police Contact in the United Kingdom. Pediatrics 2022; 150:189565. [PMID: 36161331 DOI: 10.1542/peds.2021-055889] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/31/2022] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Adverse childhood experiences (ACEs) are prevalent in the population and yield several adverse consequences for child health and development as they accumulate. The objective of the current study is to examine the association between ACEs and adolescent police contact using a national, longitudinal study of adolescents born in the United Kingdom. METHODS Data come from a sample of 11 313 adolescents who participated in the UK Millennium Cohort Study (MCS), which is a national, longitudinal study of adolescents born in the United Kingdom between 2000 and 2002. Accumulating ACEs were measured at ages 5 and 7 years and reports of police contact were measured at age 14 years, including being stopped and questioned, warned/cautioned, and arrested. RESULTS Accumulating ACEs at ages 5 and 7 years are associated with a significant increase in the odds of experiencing police stops by age 14 years, with 3 or more ACEs corresponding to a 100% increase in the odds of police stops. Additional analyses reveal that behavioral health factors at age 11 years explain 58.5% to 78.1% of the association between ACEs and adolescent police stops, with externalizing behavior explaining the largest portion of the association. Finally, accumulating ACEs were most relevant to being warned/cautioned or arrested by police. CONCLUSIONS A history of accumulating ACEs during early childhood elevates the likelihood of police contact by age 14 years, in part by undermining behavioral health. Findings highlight the potential for early interventions in the lives of ACE-exposed adolescents to curtail justice system involvement.
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Affiliation(s)
- Dylan B Jackson
- Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | - Alexander Testa
- The University of Texas Health Science Center at Houston, Houston, Texas
| | | | - Rebecca L Fix
- Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Jason M Nagata
- University of California, San Francisco, San Francisco, California
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18
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Hassoun Ayoub L, Partridge T, Gómez JM. Two sides of the same coin: A mixed methods study of Black mothers' experiences with violence, stressors, parenting, and coping during the COVID-19 pandemic. THE JOURNAL OF SOCIAL ISSUES 2022; 79:JOSI12526. [PMID: 36249547 PMCID: PMC9539242 DOI: 10.1111/josi.12526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 06/16/2022] [Accepted: 06/17/2022] [Indexed: 06/16/2023]
Abstract
Due to systemic and structural inequities, the COVID-19 pandemic disproportionately impacts the Black community, along with ongoing anti-Black racism and violence. Violence against women in the home, particularly Black women, was prevalent during shelter in place, along with the additional family responsibilities of Black mothers. Crenshaw's theory of intersectionality (1991) provides a foundation for examining Black mothers' experiences during shelter-in-place mandates. This mixed-methods study aimed to quantitatively assess violence victimization, acknowledged racial inequities, depression and anxiety, while qualitatively examining Black mothers' experiences in parenting during shelter-in-place orders. Participants (N = 127; Mage = 32.4 years) were mothers who self-identify as Black or African American living in a Midwestern US city. Results showed that Black mothers who perceived greater COVID-19 inequities in the Black community reported increased parental stress, decreased emotional support, greater exposure to physical or sexual violence, and higher symptoms of stress, anxiety, and depression. Qualitative results yielded numerous themes, including the integrative theme of two sides of the same coin, highlighting both positive parenting experiences and significant stressors for Black mothers. The implications point to the need for intersectional and feminist approaches to interventions and initiatives that support Black women as humans, mothers, souls, and spirits.
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Affiliation(s)
| | - Ty Partridge
- Clinical Practice DepartmentSchool of Social Work & Center for Innovation in Social Work & HealthBoston UniversityBostonMassachusettsUSA
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19
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The Association Between Racial Discrimination, Race, and Social Class With Health Among US Children. Acad Pediatr 2022; 22:1228-1236. [PMID: 35644370 DOI: 10.1016/j.acap.2022.05.020] [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: 08/03/2021] [Revised: 05/15/2022] [Accepted: 05/20/2022] [Indexed: 01/19/2023]
Abstract
OBJECTIVES To assess the association between racial discrimination, race and ethnicity, and social class with child health and unmet health care needs among children in the United States (US). METHODS We used a nationally representative sample of children aged 0 to 17 from the 2018-2019 National Survey of Children's Health. Bivariate and multivariable logistic regression were used to test associations between measures of discrimination, social class (income, employment, and education), and race and ethnicity with overall child health and unmet health care needs controlling for covariates identified a priori. RESULTS Overall, 90.3% of children (n = 59,964) had excellent/very good overall health; 3.1% had unmet health care needs. Black, non-Hispanic children had 8.9 times the odds of having experienced racial discrimination compared to White, non-Hispanic children (95% confidence interval [CI], 7.0-11.4). Having special health care needs was significantly associated with greater odds of racial discrimination (OR 2.3; 95% CI, 1.9-2.8). In multivariable models, underrepresented race and ethnicity groups, lower household income level, and lower caregiver education were significantly associated with poorer overall child health. Conversely, experiencing discrimination was not significantly associated with excellent/good overall child health (adjusted odds ratios [aORs], 0.8; 95% CI, 0.6-1.1) Racial discrimination (aOR 2.7; 95% CI, 1.9-4.0) and lower household income (aOR 2.6; 95% CI, 1.8-3.5) were associated with significantly greater odds of unmet health care needs. CONCLUSION Race and ethnicity and low social class were significantly associated with worse overall health while racial discrimination and low-income were associated with more unmet health care needs. These findings underscore the importance of policy and health care system innovations that address the effects of racism and poverty on child health.
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20
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Alvarez K, Cervantes PE, Nelson KL, Seag DEM, Horwitz SM, Hoagwood KE. Review: Structural Racism, Children's Mental Health Service Systems, and Recommendations for Policy and Practice Change. J Am Acad Child Adolesc Psychiatry 2022; 61:1087-1105. [PMID: 34971730 PMCID: PMC9237180 DOI: 10.1016/j.jaac.2021.12.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 11/26/2021] [Accepted: 12/21/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Racism is a public health crisis that impacts on children's mental health, yet mental health service systems are insufficiently focused on addressing racism. Moreover, a focus on interpersonal racism and on individual coping with the impacts of racism has been prioritized over addressing structural racism at the level of the service system and associated institutions. In this paper, we examine strategies to address structural racism via policies affecting children's mental health services. METHOD First, we identify and analyze federal and state policies focused on racism and mental health equity. Second, we evaluate areas of focus in these policies and discuss the evidence base informing their implementation. Finally, we provide recommendations for what states, counties, cities, and mental health systems can do to promote antiracist evidence-based practices in children's mental health. RESULTS Our analysis highlights gaps and opportunities in the evidence base for policy implementation strategies, including the following: mental health services for youth of color, interventions addressing interpersonal racism and bias in the mental health service system, interventions addressing structural racism, changes to provider licensure and license renewal, and development of the community health workforce. CONCLUSION Recommendations are provided both within and across systems to catalyze broader systems transformation.
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Affiliation(s)
- Kiara Alvarez
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.
| | | | - Katherine L Nelson
- Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania; Merck & Co., Inc., Kenilworth, New Jersey
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21
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Wright JL, Golden WC. See It to Be It: Diversity and Inclusion in Academic Pediatrics Starts at the Top. Pediatrics 2022; 150:188906. [PMID: 35996975 DOI: 10.1542/peds.2022-057435] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/22/2022] [Indexed: 11/24/2022] Open
Affiliation(s)
- Joseph L Wright
- Department of Pediatrics; University of Maryland School of Medicine, Baltimore, Maryland.,Department of Health Policy and Management, University of Maryland School of Public Health, College Park, Maryland
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22
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Turner AF, Couch NG, Cowan HR, Otto-Meyer R, Murthy P, Logan RL, Rogers LO, McAdams DP. The Good and the Bad in Black and White: Stories of Life’s High and Low Points Told by Black and White Midlife Adults in America. JOURNAL OF RESEARCH IN PERSONALITY 2022. [DOI: 10.1016/j.jrp.2022.104298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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23
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Countering Educational Disparities Among Black Boys and Black Adolescent Boys from Pre-K to High School: A Life Course-Intersectional Perspective. THE URBAN REVIEW 2022; 54:183-206. [PMID: 34565917 PMCID: PMC8450170 DOI: 10.1007/s11256-021-00616-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 08/23/2021] [Indexed: 11/28/2022]
Abstract
Accounts of educational opportunity gaps for Black boys are overwhelmingly focused on later years of development. Achievement and discipline disparities are evident across their lifespan. Life course and intersectionality theories were used to develop a framework for understanding obstacles Black boys face during their preschool through high school years. Outlining the cumulative impact of threats and protective factors for their academic success provides insight for supporting Black boys at various developmental stages. Implications include tools for families, educators, and practitioners. This perspective will enhance the collective understanding of the resiliency of Black boys and support their educational success throughout the life course.
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24
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Scott K, Salas MDH, Bayles D, Sanchez R, Martin RA, Becker SJ. Substance use workforce training needs during intersecting epidemics: an analysis of events offered by a regional training center from 2017 to 2020. BMC Public Health 2022; 22:1063. [PMID: 35643515 PMCID: PMC9142727 DOI: 10.1186/s12889-022-13500-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 05/24/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Intersecting opioid overdose, COVID-19, and systemic racism epidemics have brought unprecedented challenges to the addiction treatment and recovery workforce. From 2017 to 2020, the New England Addiction Technology Transfer Center (ATTC) collected data in real-time on the training and technical assistance (TA) requested and attended by the front-line workforce. This article synthesizes practice-based evidence on the types of TA requests, topics of TA, attendance numbers, and socio-demographics of TA attendees over a 3-year period spanning an unprecedented public health syndemic.
Methods
We assessed TA events hosted by the New England ATTC using SAMHSA’s Performance Accountability and Reporting System post-event survey data from 2017 to 2020. Events were coded by common themes to identify the most frequently requested training types/topics and most frequently attended training events. We also evaluated change in training topics and attendee demographics over the three-year timeline.
Results
A total of 258 ATTC events reaching 10,143 participants were analyzed. The number of TA events and attendance numbers surged in the 2019–2020 fiscal year as TA events shifted to fully virtual during the COVID-19 pandemic. The absolute number of opioid-related events increased, but the relative proportion remained stable over time. The relative proportions of events and attendance rates focused on evidence-based practice and health equity both increased over the 3-year period, with the largest increase after the onset of the pandemic and the murder of George Floyd. As events shifted to virtual, events were attended by providers with a broader range of educational backgrounds.
Conclusions
Results of the current analysis indicate that the demand for TA increased during the pandemic, with a prioritization of TA focused on evidence-based practice and health equity. The practice-based evidence generated from the New England ATTC may help other training and TA centers to anticipate and nimbly respond to the needs of the workforce in the face of the intersecting epidemics.
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25
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Civilotti C, Acquadro Maran D, Garbarino S, Magnavita N. Hopelessness in Police Officers and Its Association with Depression and Burnout: A Pilot Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19095169. [PMID: 35564562 PMCID: PMC9100122 DOI: 10.3390/ijerph19095169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 04/13/2022] [Accepted: 04/22/2022] [Indexed: 11/23/2022]
Abstract
Hopelessness is a particularly critical condition and a risk factor for suicide. Many studies have reported that this condition is common in some occupations and is associated with high stress that is not properly managed. This study examined the prevalence of hopeless status (HS) in a sample of police officers (POs) and the association of hopelessness with depression, burnout, and suicidality. In total, 127 out of 231 POs participated in the survey; they were assessed with the Beck Hopelessness Scale, the Beck Depression Scale, and the Maslach Burnout Inventory. A total of 26.5% of POs reported hopelessness, and a significant association was found with depression and burnout; in individual cases, these conditions were associated with suicidal thoughts. In a multivariate logistic regression model adjusted for confounding variables, depression, emotional exhaustion, and reduction of personal accomplishment were significantly associated with HP status. Depression (OR = 3.02, 95% CI: 1–9.12) and emotional exhaustion (OR = 1.88, 95% CI: 1.06–3.32) significantly increased the risk of hopelessness, while personal accomplishment (OR = 0.57, 95% CI: 0.32–1) was a protective factor. Hopelessness appears to be a very important factor to consider when assessing POs’ mental health.
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Affiliation(s)
- Cristina Civilotti
- Department of Psychology, Università di Torino, Via Verdi 10, 10124 Torino, Italy;
| | - Daniela Acquadro Maran
- Department of Psychology, Università di Torino, Via Verdi 10, 10124 Torino, Italy;
- WOW-Work and Organizational Wellbeing Research Group, 10124 Torino, Italy
- Correspondence:
| | - Sergio Garbarino
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal/Child Sciences (DI-14 NOGMI), University of Genoa, 16132 Genoa, Italy;
| | - Nicola Magnavita
- Postgraduate School of Occupational Health, Università Cattolica del Sacro Cuore, 00168 Rome, Italy;
- Department of Woman, Child & Public Health Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
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26
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Razack S, de Carvalho Filho MA, Merlo G, Agbor-Baiyee W, de Groot J, Reynolds PP. Privilege, social justice and the goals of medicine: Towards a critically conscious professionalism of solidarity. PERSPECTIVES ON MEDICAL EDUCATION 2022; 11:67-69. [PMID: 35254652 PMCID: PMC8898995 DOI: 10.1007/s40037-022-00699-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 01/22/2022] [Accepted: 02/01/2022] [Indexed: 06/14/2023]
Affiliation(s)
- Saleem Razack
- Pediatrics and Health Sciences Education, McGill University, Montreal, Canada.
| | | | | | | | - Janet de Groot
- Cumming School of Medicine, University of Calgary, Calgary, Canada
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27
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Wilson S, Dumornay NM. Rising Rates of Adolescent Depression in the United States: Challenges and Opportunities in the 2020s. J Adolesc Health 2022; 70:354-355. [PMID: 35183317 PMCID: PMC8868033 DOI: 10.1016/j.jadohealth.2021.12.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 12/05/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Sylia Wilson
- Corresponding author. University of Minnesota, Institute of Child Development, 51 E River Pkwy, Minneapolis, MN 55455;
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Sheats KJ, Wilson RF, Lyons BH, Jack SP, Betz CJ, Fowler KA. Surveillance for Violent Deaths — National Violent Death Reporting System, 39 States, the District of Columbia, and Puerto Rico, 2018. MMWR. SURVEILLANCE SUMMARIES 2022; 71:1-44. [PMID: 35085227 PMCID: PMC8807052 DOI: 10.15585/mmwr.ss7103a1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Problem/Condition In 2018, approximately 68,000 persons died of violence-related injuries in the United States. This report summarizes data from CDC’s National Violent Death Reporting System (NVDRS) on violent deaths that occurred in 39 states the District of Columbia, and Puerto Rico in 2018. Results are reported by sex, age group, race and ethnicity, method of injury, type of location where the injury occurred, circumstances of injury, and other selected characteristics. Period Covered 2018. Description of System NVDRS collects data regarding violent deaths obtained from death certificates, coroner and medical examiner reports, and law enforcement reports. This report includes data collected for violent deaths that occurred in 2018. Data were collected from 36 states with statewide data (Alabama, Alaska, Arizona, Colorado, Connecticut, Delaware, Georgia, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Missouri, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, Ohio, Oklahoma, Oregon, Rhode Island, South Carolina, Utah, Vermont, Virginia, Washington, West Virginia, and Wisconsin), three states with data from counties representing a subset of their population (21 California counties, 28 Illinois counties, and 39 Pennsylvania counties), the District of Columbia, and Puerto Rico. NVDRS collates information for each death and links deaths that are related (e.g., multiple homicides, homicide followed by suicide, or multiple suicides) into a single incident. Results For 2018, NVDRS collected information on 52,773 fatal incidents involving 54,170 deaths that occurred in 39 states and the District of Columbia. In addition, information was collected on 880 fatal incidents involving 975 deaths in Puerto Rico. Data for Puerto Rico were analyzed separately. Of the 54,170 deaths, the majority (64.1%) were suicides, followed by homicides (24.8%), deaths of undetermined intent (9.0%), legal intervention deaths (1.4%) (i.e., deaths caused by law enforcement and other persons with legal authority to use deadly force acting in the line of duty, excluding legal executions), and unintentional firearm deaths (<1.0%). (The term “legal intervention” is a classification incorporated into the International Classification of Diseases, Tenth Revision, and does not denote the lawfulness or legality of the circumstances surrounding a death caused by law enforcement.) Demographic patterns and circumstances varied by manner of death. The suicide rate was higher among males than among females and was highest among adults aged 35–64 years and non-Hispanic American Indian or Alaska Native (AI/AN) and non-Hispanic White persons. The most common method of injury for suicide was a firearm among males and hanging, strangulation, or suffocation among females. Suicide was most often preceded by a mental health, intimate partner, or physical health problem, or a recent or impending crisis during the previous or upcoming 2 weeks. The homicide rate was highest among persons aged 20–24 years and was higher among males than females. Non-Hispanic Black males experienced the highest homicide rate of any racial or ethnic group. The most common method of injury for homicide was a firearm. When the relationship between a homicide victim and a suspect was known, the suspect was most frequently an acquaintance or friend for male victims and a current or former intimate partner for female victims. Homicides most often were precipitated by an argument or conflict, occurred in conjunction with another crime, or, for female victims, were related to intimate partner violence. Homicide suspects were primarily male and the highest proportion were aged 25–44 years. When race and ethnicity information was known, non-Hispanic Black persons comprised the largest group of suspects overall and among those aged ≤44 years, and non-Hispanic White persons comprised the largest group of suspects among those aged ≥45 years. Almost all legal intervention deaths were experienced by males, and the legal intervention death rate was highest among males aged 30–34 years. Non-Hispanic AI/AN males had the highest legal intervention death rate, followed by non-Hispanic Black males. A firearm was used in the majority of legal intervention deaths. When a specific type of crime was known to have precipitated a legal intervention death, the type of crime was most frequently assault or homicide. The most frequent circumstances reported for legal intervention deaths were use of a weapon by the victim in the incident and a mental health or perceived substance use problem (other than alcohol use). Law enforcement officers who inflicted fatal injuries in the context of legal intervention deaths were primarily males aged 25–44 years. Unintentional firearm deaths were most frequently experienced by males, non-Hispanic White persons, and persons aged 15–24 years. These deaths most often occurred while the shooter was playing with a firearm and most frequently were precipitated by a person unintentionally pulling the trigger or mistakenly thinking that the firearm was unloaded. The rate of deaths of undetermined intent was highest among males, particularly among non-Hispanic Black and non-Hispanic AI/AN males, and among persons aged 45–54 years. Poisoning was the most common method of injury in deaths of undetermined intent, and opioids were detected in approximately 80% of decedents tested for those substances. Interpretation This report provides a detailed summary of data from NVDRS on violent deaths that occurred in 2018. The suicide rate was highest among non-Hispanic AI/AN and non-Hispanic White males, and the homicide rate was highest among non-Hispanic Black males. Mental health problems, intimate partner problems, interpersonal conflicts, and acute life stressors were primary circumstances for multiple types of violent death. Circumstances for suspects of homicide varied by age group and included having prior contact with law enforcement and involvement in incidents that were precipitated by another crime, intimate partner violence, and drug dealing or substance use. Public Health Action NVDRS data are used to monitor the occurrence of violence-related fatal injuries and assist public health authorities in developing, implementing, and evaluating programs, policies, and practices to reduce and prevent violent deaths. For example, Arizona and Wisconsin used their state-level VDRS data to support suicide prevention efforts within their respective states. Wisconsin VDRS used multiple years of data (2013–2017) to identify important risk and protective factors and subsequently develop a comprehensive suicide prevention plan. Arizona VDRS partners with the Arizona Be Connected Initiative to provide customized community-level data on veteran suicide deaths in Arizona. Similarly, states participating in NVDRS have used their VDRS data to examine intimate partner violence–related deaths to support prevention efforts. For example, data from the South Carolina VDRS were used to examine intimate partner homicides that occurred in South Carolina during 2017. South Carolina VDRS found that 12% of all homicides that occurred in 2017 were intimate partner violence–related, with females accounting for 52% of intimate partner homicide–related victims. These data were shared with domestic violence prevention collaborators in South Carolina to bolster their efforts in reducing intimate partner violence–related deaths. In 2018, NVDRS data included four additional states compared with 2017, providing more comprehensive and actionable violent death information for public health efforts to reduce violent deaths.
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Affiliation(s)
- Kameron J. Sheats
- Division of Violence Prevention, National Center for Injury Prevention and Control, CDC
| | - Rebecca F. Wilson
- Division of Violence Prevention, National Center for Injury Prevention and Control, CDC
| | - Bridget H. Lyons
- Division of Violence Prevention, National Center for Injury Prevention and Control, CDC
| | - Shane P.D. Jack
- Division of Violence Prevention, National Center for Injury Prevention and Control, CDC
| | - Carter J. Betz
- Division of Violence Prevention, National Center for Injury Prevention and Control, CDC
| | - Katherine A. Fowler
- Division of Violence Prevention, National Center for Injury Prevention and Control, CDC
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29
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Words matter. Pediatr Res 2022; 92:1223-1224. [PMID: 35854093 PMCID: PMC9700512 DOI: 10.1038/s41390-022-02198-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 06/28/2022] [Indexed: 11/08/2022]
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30
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The COVID-19 pandemic and pediatric mental health: advocating for improved access and recognition. Pediatr Res 2022; 91:1018-1020. [PMID: 35102301 PMCID: PMC8801557 DOI: 10.1038/s41390-022-01952-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 12/19/2021] [Indexed: 02/01/2023]
Abstract
Pediatric mental health has been poorly addressed and access to quality psychiatric care is limited in many countries around the world including wealthy nations. The novel coronavirus disease 2019 (COVID-19) pandemic caused a strain on pediatric mental health resources across the globe. This was primarily due to the stress of lockdowns, loss of caregivers, and school interruptions, which further exacerbated the mental health needs of children. Despite their unreadiness, emergency departments have been utilized to address those needs. Kostopoulou et al. reported that, although emergency departments’ pediatric visits have decreased earlier during the pandemic, mental health visits increased during the same period.
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Affiliation(s)
- Elena Fuentes-Afflick
- Department of Pediatrics, Zuckerberg San Francisco General Hospital, University of California, San Francisco, 1001 Potrero Avenue, Room 6D36, San Francisco, CA, 94110, USA.
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An Institutional Approach to Harassment. CJC Open 2021; 3:S118-S129. [PMID: 34993441 PMCID: PMC8712590 DOI: 10.1016/j.cjco.2021.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 08/12/2021] [Indexed: 11/21/2022] Open
Abstract
Harassment is commonly experienced within the hierarchical world of medicine by both learners and faculty. There are different types of harassment; however, all types of harassment have a negative impact on individuals professionally and personally. Harassment also negatively impacts groups, by impacting team dynamics, perceptions of leaders, and upon workplace psychological safety and wellness. To address harassment, the Faculty of Medicine and Dentistry (FoMD) at the University of Alberta (UAlberta) has developed a structured institutional response to harassment through: (1) providing institutional members and leaders with explicit expectations of behaviour, outlining types of harassment, and starting to integrate psychological safety priorities at all levels of the institution; (2) through aiding, training, selecting, and evaluating workplace leaders in psychological safety, workplace wellness, and harassment interventions, guiding leaders through options of: coaching types of interventions, investigations, and when there is a duty to report to formal bodies; (3) educating and providing tools for workplace members to deal with harassment situations either; directly or by reporting; and (4) being aware of, and addressing, unique aspects of: racial, sexual, and online harassment. Through such iterative institutional process improvement and reflection, we are moving towards effectively addressing harassment within all learning and working environments. Our ultimate institutional goal is to eradicate harassment occurrence within our institution, thus creating a psychologically safe, transparent, and accountable culture for individuals, workplaces, and groups.
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Vasan A, Mitchell HK, Fein JA, Buckler DG, Wiebe DJ, South EC. Association of Neighborhood Gun Violence With Mental Health-Related Pediatric Emergency Department Utilization. JAMA Pediatr 2021; 175:1244-1251. [PMID: 34542562 PMCID: PMC8453357 DOI: 10.1001/jamapediatrics.2021.3512] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
IMPORTANCE Many children and adolescents in the United States are exposed to neighborhood gun violence. Associations between violence exposure and children's short-term mental health are not well understood. OBJECTIVE To examine the association between neighborhood gun violence and subsequent mental health-related pediatric emergency department (ED) utilization. DESIGN, SETTING, AND PARTICIPANTS This location-based cross-sectional study included 128 683 ED encounters for children aged 0 to 19 years living in 12 zip codes in Philadelphia, Pennsylvania, who presented to an urban academic pediatric ED from January 1, 2014, to December 31, 2018. Children were included if they (1) had 1 or more ED visits in the 60 days before or after a neighborhood shooting and (2) lived within a quarter-mile radius of the location where this shooting occurred. Analysis began August 2020 and ended May 2021. EXPOSURE Neighborhood violence exposure, as measured by whether a patient resided near 1 or more episodes of police-reported gun violence. MAIN OUTCOMES AND MEASURES ED encounters for a mental health-related chief complaint or primary diagnosis. RESULTS A total of 2629 people were shot in the study area between 2014 and 2018, and 54 341 children living nearby had 1 or more ED visits within 60 days of a shooting. The majority of these children were Black (45 946 [84.5%]) and were insured by Medicaid (42 480 [78.1%]). After adjusting for age, sex, race and ethnicity, median household income by zip code, and insurance, children residing within one-eighth of a mile (2-3 blocks) of a shooting had greater odds of mental health-related ED presentations in the subsequent 14 days (adjusted odds ratio, 1.86 [95% CI, 1.20-2.88]), 30 days (adjusted odds ratio, 1.49 [95% CI, 1.11-2.03]), and 60 days (adjusted odds ratio, 1.35 [95% CI, 1.06-1.72]). CONCLUSIONS AND RELEVANCE Exposure to neighborhood gun violence is associated with an increase in children's acute mental health symptoms. City health departments and pediatric health care systems should work together to provide community-based support for children and families exposed to violence and trauma-informed care for the subset of these children who subsequently present to the ED. Policies aimed at reducing children's exposure to neighborhood gun violence and mitigating the mental symptoms associated with gun violence exposure must be a public health priority.
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Affiliation(s)
- Aditi Vasan
- National Clinician Scholars Program, Perelman School of Medicine, University of Pennsylvania, Philadelphia,Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania,PolicyLab, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Hannah K. Mitchell
- Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Joel A. Fein
- Division of Emergency Medicine, Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania,Center for Violence Prevention, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - David G. Buckler
- The Urban Health Lab, Perelman School of Medicine, University of Pennsylvania, Philadelphia,Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Douglas J. Wiebe
- Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia,Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Eugenia C. South
- The Urban Health Lab, Perelman School of Medicine, University of Pennsylvania, Philadelphia,Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
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Pediatricians Contributing to Poverty Reduction Through Clinical-Community Partnership and Collective Action: A Narrative Review. Acad Pediatr 2021; 21:S200-S206. [PMID: 34740429 DOI: 10.1016/j.acap.2021.04.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Revised: 04/01/2021] [Accepted: 04/10/2021] [Indexed: 12/13/2022]
Abstract
Poverty affects child health and well-being in short- and long-term ways, directly and indirectly influencing a range of health outcomes through linked social and environmental challenges. Given these links, pediatricians have long advocated for poverty reduction in both clinical settings and society. Pediatricians and others who work in pediatric settings are well-suited to address poverty given frequent touchpoints with children and families and the trust that develops over repeated encounters. Many pediatricians also recognize the need for cross-sector engagement, mobilization, and innovation in building larger collaborative efforts to combat the harmful effects of poverty. A range of methods, like co-design, community organizing, and community-engaged quality improvement, are necessary to achieve measurable progress. Moreover, advancing meaningful representation and inclusion of those from underrepresented racial and ethnic minority groups will augment efforts to address poverty within and equity across communities. Such methods promote and strengthen key clinical-community partnerships poised to address poverty's upstream root causes and its harmful consequences downstream. This article focuses on those clinical-community intersections and cross-sector, multi-disciplinary programs like Medical-Legal Partnerships, Medical-Financial Partnerships, clinic-based food pantries, and embedded behavioral health services. Such programs and partnerships increase access to services difficult for children living in poverty to obtain. Partnerships can also broaden to include community-wide learning networks and asset-building coalitions, poised to accelerate meaningful change. Pediatricians and allied professionals can play an active role; they can convene, catalyze, partner, and mobilize to create solutions designed to mitigate the harmful effects of poverty on child health.
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Foreword: Racism and its impact on the learning environment. Curr Probl Pediatr Adolesc Health Care 2021; 51:101086. [PMID: 34915995 DOI: 10.1016/j.cppeds.2021.101086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Bird CM, Webb EK, Schramm AT, Torres L, Larson C, deRoon-Cassini TA. Racial Discrimination is Associated with Acute Posttraumatic Stress Symptoms and Predicts Future Posttraumatic Stress Disorder Symptom Severity in Trauma-Exposed Black Adults in the United States. J Trauma Stress 2021; 34:995-1004. [PMID: 33715212 PMCID: PMC9123835 DOI: 10.1002/jts.22670] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 02/16/2021] [Accepted: 02/19/2021] [Indexed: 12/20/2022]
Abstract
In the United States, Black residents exposed to a traumatic event are at an increased risk of developing posttraumatic stress disorder (PTSD) and experiencing more severe symptoms compared to their non-Hispanic White counterparts. Although previous work has suggested a link between racial discrimination and PTSD symptoms, no studies have assessed this association in a sample of traumatic injury survivors. The current study investigated whether (a) past racial discrimination was associated with acute posttraumatic stress symptoms (PTSS) and (b) discrimination prospectively contributed to the prediction of future PTSD symptoms. African American and/or Black patients (N = 113) were recruited from an emergency department in southeastern Wisconsin. Patients in the acute postinjury phase (i.e., 2 weeks posttrauma) completed self-report measures, with PTSD symptoms assessed using the Clinician-Administered PTSD Scale at 6-month follow-up. Bivariate associations indicated past racial discrimination was significantly related to acute PTSS. A multiple regression analysis revealed that pretrauma exposure to racial discrimination significantly predicted PTSD symptoms at follow-up, even after controlling for age, gender, previous psychiatric diagnosis, social support, and lifetime trauma history. Our results suggest that experiences of racial discrimination add significant additional risk for PTSD symptom development following traumatic injury, R2 = .16, F(6, 106) = 3.25, p = .006. Broadly, these findings add to the body of empirical evidence and personal testimonies of Black individuals in White-centric societies asserting that racial discrimination affects mental health and overall well-being and further highlight the recent call for racism to be classified as a public health crisis.
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Affiliation(s)
- Claire M. Bird
- Department of Psychology, Marquette University, Milwaukee, Wisconsin, USA
| | - E. Kate Webb
- Department of Psychology, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA
| | - Andrew T. Schramm
- Division of Trauma and Acute Care Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Lucas Torres
- Department of Psychology, Marquette University, Milwaukee, Wisconsin, USA
| | - Christine Larson
- Department of Psychology, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA
| | - Terri A. deRoon-Cassini
- Division of Trauma and Acute Care Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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A Scoping Review of Police Involvement in School Crisis Response for Mental Health Emergencies. SCHOOL MENTAL HEALTH 2021. [DOI: 10.1007/s12310-021-09477-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
AbstractThe purpose of this scoping literature review was to examine research on police involvement in school mental health crisis response. The search was conducted in PsychInfo, PubMed, and ERIC and initially identified 315 articles. After applying inclusion/exclusion criteria, 47 articles remained. Detailed review and data extraction by three independent reviewers resulted in a final article count of nine. Three primary themes were identified across articles: (1) perceptions and consequences of law enforcement presence in schools; (2) the role of school-community partnerships in successful crisis response models; and (3) gaps in research and challenges of implementing and scaling existing models. Though in practice law enforcement officers are often involved in school mental health crisis response, there is limited empirical research supporting this approach. Our review did not return any randomized trials. In the absence of empirical evidence supporting the use of current models, there is a need for research on law enforcement involvement in school crisis response and, more broadly, community-partnered models of responding to student mental health needs.
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Nfonoyim B, Martin A, Ellison A, Wright JL, Johnson TJ. Experiences of underrepresented faculty in pediatric emergency medicine. Acad Emerg Med 2021; 28:982-992. [PMID: 33289950 DOI: 10.1111/acem.14191] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 11/22/2020] [Accepted: 11/25/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVE The aim of this study is to elucidate the unique challenges faced by pediatric emergency medicine (PEM) physicians from racial/ethnic groups underrepresented in medicine (URiM). METHODS This study is a subanalysis of data from 18 URiM faculty from a sample of 51 semistructured key informant interviews with PEM faculty in the top NIH-funded pediatric departments and highest-volume pediatric EDs in the country. Faculty are from eight hospitals representing a spectrum of geographic locations including the northeastern, midwestern, western, and southern regions of the country. RESULTS Of 18 study participants, the majority were Black (72.2%) and female (83.3%). Three main thematic categories were identified: challenges related to race, support systems, and suggested strategies to improve diversity and inclusion in PEM. A common race-related experience was microaggressions from colleagues and patients. Additionally, when attempting to lead and assert themselves, URiM women in particular were perceived as "angry" and "intimidating" in a way that non-URiM peers were not. As a result of these negative experiences, participants described the need to go above and beyond to prove themselves. Such pressure produced stress and feelings of isolation. Participants combatted these stressors through resilience strategies such as formal mentorship and peer and family support. Participants indicated the need to increase diversity and create more inclusive work environments, which would benefit both URiM physician wellness and the diverse patients they serve. CONCLUSION Those URiM in PEM face subtle racial discrimination at an institutional, peer, and patient level. The stress caused by this discrimination may further contribute to physician burnout in PEM. While URiMs adopt individual resilience strategies, their unique challenges suggest the need for departmental and institutional efforts to promote greater diversity and inclusion for physician wellness, retention, and quality patient care.
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Affiliation(s)
- Bianca Nfonoyim
- Perelman School of Medicine Philadelphia PA USA
- PolicyLab The Children's Hospital of Philadelphia Philadelphia PA USA
- Department of Pediatrics The Children's Hospital of Philadelphia Philadelphia PA USA
| | - Ashley Martin
- PolicyLab The Children's Hospital of Philadelphia Philadelphia PA USA
- Department of Pediatrics The Children's Hospital of Philadelphia Philadelphia PA USA
- Division of Neonatology The Children's Hospital of Philadelphia Philadelphia PA USA
| | - Angela Ellison
- Department of Pediatrics The Children's Hospital of Philadelphia Philadelphia PA USA
- Division of Emergency Medicine The Children's Hospital of Philadelphia Philadelphia PA USA
| | - Joseph L. Wright
- Department of Pediatrics University of Maryland School of Medicine Baltimore MD USA
- Department of Health Policy and Management University of Maryland School of Public Health College Park MD USA
| | - Tiffani J. Johnson
- Department of Emergency Medicine University of California at Davis Sacramento CA USA
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D'Inverno AS, Bartholow BN. Engaging Communities in Youth Violence Prevention: Introduction and Contents. Am J Public Health 2021; 111:S10-S16. [PMID: 34038153 DOI: 10.2105/ajph.2021.306344] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Ashley S D'Inverno
- Ashley S. D'Inverno and Bradford N. Bartholow are with the Division of Violence Prevention in the National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA
| | - Bradford N Bartholow
- Ashley S. D'Inverno and Bradford N. Bartholow are with the Division of Violence Prevention in the National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA
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Keum BT. Does Witnessing Racism Online Promote Individual and Institutional Anti-Racism Advocacy Among White Individuals? The Role of White Empathy, White Guilt, and White Fear of Other Races. CYBERPSYCHOLOGY BEHAVIOR AND SOCIAL NETWORKING 2021; 24:756-761. [PMID: 33956534 DOI: 10.1089/cyber.2020.0629] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The current study examined the role of White emotional responses (White empathy, guilt, and fear of other races) to (a) witnessing racism online (seeing racial/ethnic minorities discriminated in online interactions) and (b) exposure to online content on the group- and systemic-level racism against racial/ethnic minorities on White individuals' individual and institutional advocacy behaviors. Path analysis using data from 227 White adults revealed that White empathy explained significant indirect relations of witnessing online content on systemic- and group-level racism in society on individual and institutional advocacy behaviors. No significant indirect relations were found regarding witnessing racial/ethnic minorities being discriminated online interactions, but a significant direct link was observed on individual advocacy. In response to witnessing racism online, White empathy appeared to be promotive for advocacy engagement, whereas guilt and fear of other races seemed to be barriers. Limitations and implications for research are discussed.
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Affiliation(s)
- Brian TaeHyuk Keum
- Department of Social Welfare, University of California Los Angeles, Los Angeles, California, USA
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Pretorius J, Lorraine Petersen CA, Pedro A. Caregivers of early adolescent children: Influences of their apartheid experiences on their intergenerational learning practices. JOURNAL OF PSYCHOLOGY IN AFRICA 2021. [DOI: 10.1080/14330237.2021.1927333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Jené Pretorius
- Department of Psychology, Faculty of Community and Health Sciences, University of the Western Cape, Bellville, South Africa
| | | | - Athena Pedro
- Department of Psychology, Faculty of Community and Health Sciences, University of the Western Cape, Bellville, South Africa
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Abstract
Police violence in the United States represents a pressing public health crisis impacting youth, particularly youth of color. This article reviews the recent epidemiology of police executions and conflicts involving children, adolescents, and young adults. The roles of social determinants of health and centuries-long history of white supremacy and racism as root causes of adverse policing are emphasized. The article summarizes the evidence as to how direct and vicarious experiences of police violence impact youth academic, behavioral, and health outcomes. Recommendations are provided for pediatricians to address this public health crisis through clinical practice, education, advocacy, and research.
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Affiliation(s)
- Tiffani J Johnson
- Department of Emergency Medicine, University of California, Davis School of Medicine, 4150 V Street Suite 2100, Sacramento, CA 95817, USA.
| | - Joseph L Wright
- Pediatrics and Health Policy & Management, University of Maryland Schools of Medicine and Public Health, University of Maryland Capital Region Health, 3001 Hospital Drive, Executive Suite, Cheverly, MD 20785, USA
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Fruehwirth JC, Biswas S, Perreira KM. The Covid-19 pandemic and mental health of first-year college students: Examining the effect of Covid-19 stressors using longitudinal data. PLoS One 2021; 16:e0247999. [PMID: 33667243 PMCID: PMC7935268 DOI: 10.1371/journal.pone.0247999] [Citation(s) in RCA: 184] [Impact Index Per Article: 61.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 02/17/2021] [Indexed: 11/19/2022] Open
Abstract
PURPOSE The Covid-19 pandemic has brought unprecedented stress to students and educational institutions across the world. We aimed to estimate the effect of the pandemic on the mental health of college students. METHODS We used data on 419 first-year students (ages 18-20) at a large public university in North Carolina both before (October 2019-February 2020) and after (June/July 2020) the start of the Covid-19 pandemic. After evaluating descriptive data on mental health and stressors by students' demographic characteristics, we estimated the associations between Covid-19 stressors (including work reductions, health, distanced learning difficulties and social isolation) and mental health symptoms and severity controlling for students' pre-pandemic mental health, psychosocial resources, and demographic characteristics. RESULTS We found that the prevalence of moderate-severe anxiety increased from 18.1% before the pandemic to 25.3% within four months after the pandemic began; and the prevalence of moderate-severe depression increased from 21.5% to 31.7%. White, female and sexual/gender minority (SGM) students were at highest risk of increases in anxiety symptoms. Non-Hispanic (NH) Black, female, and SGM students were at highest risk of increases in depression symptoms. General difficulties associated with distanced learning and social isolation contributed to the increases in both depression and anxiety symptoms. However, work reductions as well as Covid-19 diagnosis and hospitalization of oneself, family members or friends were not associated with increases in depression or anxiety symptoms. CONCLUSION Colleges may be able to reduce the mental health consequences of Covid-19 by investing in resources to reduce difficulties with distance learning and reduce social isolation during the pandemic.
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Affiliation(s)
- Jane Cooley Fruehwirth
- Department of Economics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Siddhartha Biswas
- Department of Economics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Krista M. Perreira
- Department of Social Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
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Affiliation(s)
- Jennifer M Gómez
- Department of Psychology, Merrill Palmer Skillman Institute for Child & Family Development (MPSI), Wayne State University
- Center for Institutional Courage
| | - Robyn L Gobin
- Department of Kinesiology and Community Health, University of Illinois at Urbana-ChampaignCenter for Institutional Courage
| | - Melissa L Barnes
- Center for Institutional Courage
- Department of Psychology, University of Oregon
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Roby E, Shaw DS, Morris P, Canfield CF, Miller EB, Dreyer B, Klass P, Ettinger A, Miller E, Mendelsohn AL. Pediatric Primary Care and Partnerships Across Sectors to Promote Early Child Development. Acad Pediatr 2021; 21:228-235. [PMID: 33352322 PMCID: PMC8083845 DOI: 10.1016/j.acap.2020.12.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 11/30/2020] [Accepted: 12/13/2020] [Indexed: 11/25/2022]
Abstract
Poverty remains a critical predictor of children's school readiness, health and longer term outcomes. Early relational health (ERH) (ie, parenting practices and relationship quality) mediates the impact of poverty on child development, and thus has been the focus of many parenting interventions. Despite the documented efficacy of parenting interventions at reducing poverty-related disparities in child health and development, several key barriers prevent achieving population-level reach to families with young children. In the current paper we highlight several of these barriers including gaining population-level access to young children and families, reaching families only through single points of access, addressing the significant heterogeneity of risk that exists among families living in poverty, as well as addressing each of these barriers in combination. We suggest that understanding and confronting these barriers will allow family-centered interventions to more effectively address issues related to ERH at a population level, which in turn will reduce poverty-related disparities in child development.
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Affiliation(s)
- Erin Roby
- Department of Pediatrics, NYU Grossman School of Medicine (E Roby, CF Canfield, EB Miller, B Dreyer, P Klass, and AL Mendelsohn), New York, NY.
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Detchou DK, Onyewuenyi A, Reddy V, Boyke A, Mbabuike N, Ashley WW, Nduom EK. Letter: A Call to Action: Increasing Black Representation in Neurological Surgery. Neurosurgery 2021; 88:E469-E473. [PMID: 33611592 DOI: 10.1093/neuros/nyab057] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Donald K Detchou
- Perelman School of Medicine University of Pennsylvania Philadelphia, Pennsylvania, USA
| | - Alvin Onyewuenyi
- Chicago Medical School Rosalind Franklin University of Medicine and Science Chicago, Illinois, USA
| | - Vamsi Reddy
- Medical College of Georgia Augusta University Augusta, Georgia, USA
| | - Andre Boyke
- Albert Einstein College of Medicine New York, New York, USA
| | - Nnenna Mbabuike
- Department of Neurological Surgery Ascension St. Mary's Hospital Saginaw, Michigan, USA
| | - William W Ashley
- Department of Neurological Surgery Sinai Hospital of Baltimore Baltimore, Maryland, USA
| | - Edjah K Nduom
- Surgical Neurology Branch National Institute of Neurological Disorders and Stroke National Institutes of Health Bethesda, Maryland, USA.,Department of Neurosurgery Emory University School of Medicine Atlanta, Georgia, USA
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Brodie N, Perdomo JE, Silberholz EA. The dual pandemics of COVID-19 and racism: impact on early childhood development and implications for physicians. Curr Opin Pediatr 2021; 33:159-169. [PMID: 33394742 DOI: 10.1097/mop.0000000000000985] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW The novel coronavirus (COVID-19) pandemic has highlighted healthcare and racial inequities. This article discusses recent literature documenting the impact of racism on early childhood development, disparities in access to developmental services and ways healthcare providers and health systems can promote physician well being during these difficult times. RECENT FINDINGS Exposure to racism begins prenatally, and early childhood experiences with racism are intimately tied to adverse physical and mental health outcomes. Early intervention is key to treating children with developmental delay, but disparities exist in accessing eligibility screening and in the provision of services. Paediatric providers are at risk of developing secondary traumatic stress and burnout, which may affect the care that they provide. SUMMARY New research has led to the development of resources that help paediatric providers address racism, access developmental resources in a novel manner and protect the paediatric workforce from trauma and burnout.
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Affiliation(s)
| | - Joanna E Perdomo
- Division of General Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Elizabeth A Silberholz
- Division of General Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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"Organizational solutions: calling the question" APS racism series: at the intersection of equity, science, and social justice. Pediatr Res 2020; 88:702-703. [PMID: 32916683 DOI: 10.1038/s41390-020-01142-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 08/03/2020] [Accepted: 08/16/2020] [Indexed: 11/08/2022]
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Jindal M, Heard-Garris N, Empey A, Perrin EC, Zuckerman KE, Johnson TJ. Getting "Our House" in Order: Re-Building Academic Pediatrics by Dismantling the Anti-Black Racist Foundation. Acad Pediatr 2020; 20:1044-1050. [PMID: 32891802 DOI: 10.1016/j.acap.2020.08.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 08/26/2020] [Accepted: 08/30/2020] [Indexed: 12/31/2022]
Affiliation(s)
- Monique Jindal
- Division of General Pediatrics, Department of Pediatrics, Johns Hopkins School of Medicine (M Jindal), Baltimore, Md.
| | - Nia Heard-Garris
- Division of Academic General Pediatrics, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago and Northwestern University Feinberg School of Medicine (N Heard-Garris), Chicago, Ill; Mary Ann & J. Milburn Smith Child Health Outreach, Research, and Advocacy Center, Stanley Manne Children's Research Institute, Ann and Robert H. Lurie Children's Hospital of Chicago (N Heard-Garris), Chicago, Ill
| | - Allison Empey
- Division of General Pediatrics, Department of Pediatrics, Oregon Health & Science University (A Empey and KE Zuckerman), Portland, Ore
| | - Ellen C Perrin
- Division of Developmental-Behavioral Pediatrics, Floating Hospital for Children, Tufts Medical Center (EC Perrin), Boston, Mass
| | - Katharine E Zuckerman
- Division of General Pediatrics, Department of Pediatrics, Oregon Health & Science University (A Empey and KE Zuckerman), Portland, Ore
| | - Tiffani J Johnson
- Department of Emergency Medicine, University of California, Davis (TJ Johnson), Sacramento, Calif
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Abman SH. "Holistic Promotion of Scholarship and Advancement" APS racism series: at the intersection of equity, science, and social justice. Pediatr Res 2020; 88:694-695. [PMID: 32916687 DOI: 10.1038/s41390-020-01131-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 07/28/2020] [Indexed: 11/09/2022]
Affiliation(s)
- Steven H Abman
- Pediatric Heart Lung Center, University of Colorado Anschutz School of Medicine and Children's Hospital Colorado, Aurora, CO, 80045, USA.
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