Anti-Black Structural Racism Goes Online: A Conceptual Model for Racial Health Disparities Research

Addressing anti-black racism in an academic preterm birth initiative: perspectives from a mixed methods case study

BACKGROUND

Growing recognition of racism perpetuated within academic institutions has given rise to anti-racism efforts in these settings. In June 2020, the university-based California Preterm Birth Initiative (PTBi) committed to an Anti-Racism Action Plan outlining an approach to address anti-Blackness. This case study assessed perspectives on PTBi's anti-racism efforts to support continued growth toward racial equity within the initiative.

METHODS

This mixed methods case study included an online survey with multiple choice and open-ended survey items (n = 27) and key informant interviews (n = 8) of leadership, faculty, staff, and trainees working within the initiative. Survey and interview questions focused on perspectives about individual and organizational anti-racism competencies, perceived areas of initiative success, and opportunities for improvement. Qualitative interview and survey data were coded and organized into common themes within assessment domains.

RESULTS

Most survey respondents reported they felt competent in all the assessed anti-racism skills, including foundational knowledge and responding to workplace racism. They also felt confident in PTBi's commitment to address anti-Blackness. Fewer respondents were clear on strategic plans, resources allocated, and how the anti-racism agenda was being implemented. Suggestions from both data sources included further operationalizing and communicating commitments, integrating an anti-racism lens across all activities, ensuring accountability including staffing and funding consistent with anti-racist approaches, persistence in hiring Black faculty, providing professional development and support for Black staff, and addressing unintentional interpersonal harms to Black individuals.

CONCLUSIONS

This case study contributes key lessons which move beyond individual-level and theoretical approaches towards transparency and accountability in academic institutions aiming to address anti-Black racism. Even with PTBi's strong commitment and efforts towards racial equity, these case study findings illustrate that actions must have sustained support by the broader institution and include leadership commitment, capacity-building via ongoing coaching and training, broad incorporation of anti-racism practices and procedures, continuous learning, and ongoing accountability for both short- and longer-term sustainable impact.

Unrepresented, unheard and discriminated against: A qualitative exploration of relatives' and professionals' views of palliative care experiences of people of African and Caribbean descent during the COVID-19 pandemic

BACKGROUND

People of African and Caribbean descent experienced disproportionately high mortality from COVID-19 and have poor access to palliative care.

AIM

To explore palliative care experiences of people of African and Caribbean descent during and immediately prior to the pandemic.

DESIGN

Qualitative interview study with thematic analysis. Refinement of themes/recommendations in consultation with an expert patient and public advisory group.

SETTING/PARTICIPANTS

Twenty-six bereaved relatives and 13 health/social care professionals (cared for people of African and Caribbean descent) from throughout England, recruited using social media, community networks and direct advertising to over 150 organisations.

RESULTS

Three themes were identified: Representation: Participants did not see themselves reflected in the palliative care services and did not expect their needs to be understood. Mistrust of the healthcare system and perceptions of racism were common and led to anticipation of inequitable care. Personalisation: Relatives and professionals reported a lack of cultural and religious sensitivity in healthcare. Assumptions were made based on ethnicity, and services not offered to all. Awareness and education: Professionals felt they lacked the knowledge to provide care to diverse communities, but were reluctant to ask, due to fear of making mistakes. Inequitable access to services was exacerbated by, but not unique to, the pandemic. Participants recommended raising awareness of palliative services, building professional competence in culturally-sensitive care, and greater ethnic diversity within services.

CONCLUSIONS

Person-centred, culturally-competent palliative care is not the norm for people of African and Caribbean descent. Expectations of inequitable care are widespread. Sustained action on multiple fronts is needed.

Not Just Time on Social Media: Experiences of Online Racial/Ethnic Discrimination and Worse Sleep Quality for Black, Latinx, Asian, and Multi-racial Young Adults

Sleep quality in young adulthood sets the stage for long-term health. Racial/ethnic sleep disparities between White college-attending young adults and college-attending young adults of color exist. The stress of experiencing racial/ethnic discrimination makes it difficult for college-attending young adults of color to get good quality sleep. Yet it remains unclear if experiencing online racial/ethnic discrimination also has consequences for sleep quality, and if this association may vary by frequency of social media use. To investigate the role of racial/ethnic discrimination on sleep quality, we conducted an online survey of 154 college-attending young adults (Mage = 19.51) who identified as Black (42.2%), Latinx (16.9%), Asian (20.8%), or Bi-/multi-racial (20.1%) from a predominantly White university. Results indicated that more exposure to racial/ethnic discrimination was associated with worse sleep quality for young adults of color. Results suggest that online racial/ethnic discrimination has a similar negative impact on sleep quality regardless of the frequency of social media use. Increased attention to negative race-related experiences online as one potential risk factor for poor long-term health for young adults of color is needed, regardless of how many hours they spend on social media. Structural interventions, screening for stress due to exposure to online racial/ethnic discrimination, and facilitating opportunities to prepare for this exposure may be an important priority for sleep health and reduction of racial/ethnic health disparities.

Geographic differences in the magnitude of black-white disparities in having obesity

Background

Obesity disparities in the United States are well documented, but the limited body of research suggests that geographic factors may alter the magnitude of these disparities. A growing body of evidence has identified a "rural mortality penalty" where morbidity and mortality rates are higher in rural than urban areas, even after controlling for other factors. Black-White differences in health and mortality are more pronounced in rural areas than in urban areas.

Objective

Therefore, the purpose of this study was to explore how rural-urban status and region moderate Black-White health disparities in obesity.

Methods

Data were abstracted from the 2012 Behavioral Risk Factor Surveillance System, with the sample being restricted to Black and White respondents (n = 403,231). Respondents' county of residence was linked to US Census information to obtain the county-level Index of Relative Rurality (IRR) and Census division. Crude and adjusted logistic regression models were utilized to assess the magnitude of Black-White disparities in having obesity (yes/no) by IRR quartile and by Census division.

Results

Overall, Black-White differences in obesity were wider in rural than in urban counties, with a significant linear trend (p < 0.001). Furthermore, when stratified by US Census division, results revealed that disparities were significantly wider in rural than urban areas for respondents living in the Middle Atlantic and South Atlantic divisions. In contrast, the association was reversed for the remaining divisions (New England, East North Central, West North Central, Mountain, and Pacific), where the magnitude of the Black-White difference was the largest in urban areas.

Conclusion

Findings highlight the need to understand and account for critical place-based factors that exacerbate racial obesity disparities to develop and maximize the effectiveness of policies and programs designed to reduce racial inequalities and improve population health.

Profiles of online racism exposure and mental health among Asian, Black, and Latinx emerging adults in the United States

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.

Impact of Online Racism on Suicide Ideation Through Interpersonal Factors Among Racial Minority Emerging Adults: The Role of Perceived Burdensomeness and Thwarted Belongingness

While a growing number of studies have documented significant links between online racism (e.g., racist interactions, contents on racial violence) and comorbid factors (e.g., depression) associated with suicide risk, no studies have examined whether online racism predicts suicide ideation and if interpersonal factors can help explain this link. Thus, the current study examined the direct relationship between online racism and suicide ideation among racial minority emerging adults, and the indirect relationships via the interpersonal factors (perceived burdensomeness and thwarted belongingness). Using data from a convenience sample of 338 racial minority emerging adults, we conducted a path analysis with online racism predicting suicide ideation through thwarted belongingness and perceived burdensomeness. Online racism significantly predicted suicide ideation via perceived burdensomeness but not thwarted belongingness. Post hoc multi-group analysis found that this pathway was consistent across Black, Asian, and Latinx groups but was completely mediated for the Asian group. The findings suggest that online racism can increase feelings of being a burden to society, which can trigger thoughts of suicide. This process may be particularly salient among Asian individuals. Implications for future research are discussed.

Structural racism and homophobia evaluated through social media sentiment combined with activity spaces and associations with mental health among young sexual minority men

BACKGROUND

Research suggests that structural racism and homophobia are associated with mental well-being. However, structural discrimination measures which are relevant to lived experiences and that evade self-report biases are needed. Social media and global-positioning systems (GPS) offer opportunity to measure place-based negative racial sentiment linked to relevant locations via precise geo-coding of activity spaces. This is vital for young sexual minority men (YSMM) of color who may experience both racial and sexual minority discrimination and subsequently poorer mental well-being.

METHODS

P18 Neighborhood Study (n = 147) data were used. Measures of place-based negative racial and sexual-orientation sentiment were created using geo-located social media as a proxy for racial climate via socially-meaningfully-defined places. Exposure to place-based negative sentiment was computed as an average of discrimination by places frequented using activity space measures per person. Outcomes were number of days of reported poor mental health in last 30 days. Zero-inflated Poisson regression analyses were used to assess influence of and type of relationship between place-based negative racial or sexual-orientation sentiment exposure and mental well-being, including the moderating effect of race/ethnicity.

RESULTS

We found evidence for a non-linear relationship between place-based negative racial sentiment and mental well-being among our racially and ethnically diverse sample of YSMM (p < .05), and significant differences in the relationship for different race/ethnicity groups (p < .05). The most pronounced differences were detected between Black and White non-Hispanic vs. Hispanic sexual minority men. At two standard deviations above the overall mean of negative racial sentiment exposure based on activity spaces, Black and White YSMM reported significantly more poor mental health days in comparison to Hispanic YSMM.

CONCLUSIONS

Effects of discrimination can vary by race/ethnicity and discrimination type. Experiencing place-based negative racial sentiment may have implications for mental well-being among YSMM regardless of race/ethnicity, which should be explored in future research including with larger samples sizes.

Online racism, depressive and anxiety symptoms, coping-related drinking motives, and alcohol use severity among Black, Latina/o/x, and Asian emerging adults

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.

Culturally Responsive Telepsychology & mHealth Interventions for Racial-Ethnic Minoritized Youth: Research Gaps and Future Directions

Telepsychology and mHealth (TPmH) services for youth and their families have become increasingly prevalent in recent years. However, significant limitations in theory, research, and policy introduce questions about the effectiveness of such interventions, particularly for racial-ethnic minoritized youth and their families, who already contend with inequities in mental health treatment access and outcomes. Although TPmH have the potential to reduce barriers to mental health services in ways that may benefit racial-ethnic minoritized youth and their families, the mental health field must first grapple with limitations in culturally responsive TPmH work to avoid perpetuating existing mental health inequities. As such, this article begins by briefly reviewing extant literature on (1) TPmH for youth, (2) culturally adapted or culturally responsive evidence-based interventions for racial-ethnic minoritized youth and families, and (3) the intersection of TPmH and culturally responsive interventions. Informed by the gaps identified by this review, we provide recommendations for future directions in culturally responsive TPmH for racial-ethnic minoritized youth and families. These recommendations have been organized into four overarching categories: (1) conceptual and theoretical recommendations, (2) research priorities, (3) practice and policy recommendations, and (4) engagement and access recommendations. These recommendations offer novel ideas for researchers, clinicians, funding agencies, policy-makers, and other key stakeholders and are intended to facilitate equity in TPmH for racial-ethnic minoritized youth and their families.

Race-induced trauma, antiracism, and radical self-care

Being racialized as Black in the United States has contributed to this population having to operate with a level of race-induced trauma, especially those who are darkly melanated. Historically, Black persons have been terrorized into colonization, and the cultural psychology of anti-Blackness has been entrenched in our society. Through the practice of racialization, the historical, social, and political processes of constructing racial identities and meanings have impacted the formation of understanding of the body and the rationalization of hierarchy. In addition, the internalization of these ideas of hierarchy and difference within power/knowledge relations that they (re)produce is pervasive among people in the United States. This article aims to explicitly highlight racism as trauma, address the relevance of radical self-care when disrupting anti-Black racism, and consider steps to promote trauma responsiveness when incorporating these practices.

Asian Australians’ Experiences of Online Racism during the COVID-19 Pandemic

Between 13 November 2020 and 11 February 2021, an online national survey of 2003 Asian Australians was conducted to measure the type and frequency of self-identified Asian Australians’ experiences of racism during the COVID-19 pandemic. The survey also aimed to gauge the relationships between racist experiences and targets’ mental health, wellbeing and sense of belonging. In this paper, we report findings on the type and frequency of online racist experiences and their associations with mental health, wellbeing and belonging. The survey found that 40 per cent of participants experienced racism during the COVID-19 pandemic. Within that group, 66 per cent experienced racism online. The demographic pattern of those most likely to experience online racism were younger age groups, males, those born in Australia, English speakers at home, non-Christians, and migrants who have been in Australia less than 20 years. Analysis also found a strong correlation between Asian Australians’ experiences of online racism and poor mental health, wellbeing and belonging. The relationship between experiencing racism, non-belonging and morbidity were more pronounced for those who experienced online racism compared to those who experienced racism in other offline contexts. This points to the corrosive nature of online racism on social cohesion, health and belonging.

Ending the HIV epidemic for all, not just some: structural racism as a fundamental but overlooked social-structural determinant of the US HIV epidemic

PURPOSE OF REVIEW

We review the recent theoretical and empirical literature on structural racism, social determinants of health frameworks within the context of HIV prevention and treatment, and criticism of the national responses to the US epidemic.

RECENT FINDINGS

In line with growing mainstream attention to the role of structural racism and health inequities, recent editorials and studies cite ending structural racism as an essential step to ending the US HIV epidemic. Recent studies demonstrate that barriers rooted in structural racism such as incarceration, housing instability, police discrimination, neighborhood disadvantage, health service utilization and community violence, and poor or no access to social services, transportation, and childcare, are barriers to HIV prevention. Recent articles also criticize national responses to HIV such as the ending the HIV epidemic (EHE) and National HIV/AIDS Strategy plans for failing to address structural racism and prioritize community engagement in EHE efforts.

SUMMARY

Collectively, the articles in this review highlight a growing consensus that the US has no real chance of EHE for all, absent a meaningful and measurable commitment to addressing structural racism and intersectional discrimination as core determinants of HIV, and without more equitable engagement with community-based organizations and communities disproportionately affected by HIV.

Measuring the biological embedding of racial trauma among Black Americans utilizing the RDoC approach

The National Institute of Mental Health (NIMH) Research Domain Criteria (RDoC) initiative aims to understand the mechanisms influencing psychopathology through a dimensional approach. Limited research thus far has considered potential racial/ethnic differences in RDoC constructs that are influenced by developmental and contextual processes. A growing body of research has demonstrated that racial trauma is a pervasive chronic stressor that impacts the health of Black Americans across the life course. In this review article, we examine the ways that an RDOC framework could allow us to better understand the biological embedding of racial trauma among Black Americans. We also specifically examine the Negative Valence System domain of RDoC to explore how racial trauma is informed by and can help expand our understanding of this domain. We end the review by providing some additional research considerations and future research directives in the area of racial trauma that build on the RDoC initiative.

Impact of Racial Discrimination on the Mental Health of Minoritized Youth

PURPOSE OF REVIEW

The impacts of racism and discrimination on developing minoritized youth are increasingly shown as having the potential to create long-lasting adverse outcomes on children's developmental trajectories.

RECENT FINDINGS

From the quality of the schools they attend, to the level and amount of toxicants in the air they breathe, to equitable access to health care, and within interpersonal relationships and experiences with their peers, multiple forms of racism, systemic/structural, interpersonal/personally mediated, and internalized shape the health status of Black, Indigenous, and people of color (BIPoC) youth. Accordingly, it is exceedingly important to use a developmental lens to distinguish the various outcomes these multiple forms of racism have on the health of minoritized youth. Critically, the time is now for rapid identification of these harms in all of the mediums and spaces in which they present followed by prevention and intervention strategies that are effective in equitably ensuring the healthy development for all of America's children.