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Fields ND, Tristan Urrutia A, Morris AA, Kramer MR, Lewis TT, Patel SA. Historical Redlining and Heart Failure Outcomes Following Hospitalization in the Southeastern United States. J Am Heart Assoc 2024; 13:e032019. [PMID: 38563370 DOI: 10.1161/jaha.123.032019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 03/12/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND Historical redlining, a discriminatory lending practice, is an understudied component of the patient risk environment following hospital discharge. We investigated associations between redlining, patient race, and outcomes following heart failure hospitalization. METHODS AND RESULTS We followed a hospital-based cohort of Black and White patients using electronic medical records for acute heart failure hospitalizations between 2010 and 2018 (n=6800). Patient residential census tracts were geocoded according to the 1930s Home Owners' Loan Corporation map grades (A/B: best/still desirable, C: declining, D: redlined). We used Poisson regression to analyze associations between Home Owners' Loan Corporation grade and 30-day outcomes (readmissions, mortality, and their composite). One-third of patients resided in historically redlined tracts (n=2034). In race-stratified analyses, there was a positive association between historically declining neighborhoods and composite readmissions and mortality for Black patients (risk ratio [RR], 1.24 [95% CI, 1.003-1.54]) and an inverse association between redlined neighborhoods and 30-day readmissions among White patients (RR, 0.58 [95% CI, 0.39-0.86]). Examining racial disparities across Home Owners' Loan Corporation grades, Black patients had higher 30-day readmissions (RR, 1.86 [95% CI, 1.31-2.65]) and composite readmissions and mortality (RR, 1.32 [95% CI, 1.04-1.65]) only in historically redlined neighborhoods. CONCLUSIONS Historical redlining had potentially mixed impacts on outcomes by race, such that residing in less desirable neighborhoods was associated with an elevated risk of an adverse outcome following heart failure hospitalization in Black patients and a reduced risk in White patients. Moreover, racial disparities in patient outcomes were present only in historically redlined neighborhoods. Additional research is needed to explore observed heterogeneity in outcomes.
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Affiliation(s)
- Nicole D Fields
- Department of Epidemiology Rollins School of Public Health Emory University Atlanta GA USA
- Hubert Department of Global Health Rollins School of Public Health Emory University Atlanta GA USA
| | - Andrea Tristan Urrutia
- Department of Epidemiology Rollins School of Public Health Emory University Atlanta GA USA
| | | | - Michael R Kramer
- Department of Epidemiology Rollins School of Public Health Emory University Atlanta GA USA
| | - Tené T Lewis
- Department of Epidemiology Rollins School of Public Health Emory University Atlanta GA USA
| | - Shivani A Patel
- Department of Epidemiology Rollins School of Public Health Emory University Atlanta GA USA
- Hubert Department of Global Health Rollins School of Public Health Emory University Atlanta GA USA
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2
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Adkins-Jackson PB, Kim B, Higgins Tejera C, Ford TN, Gobaud AN, Sherman-Wilkins KJ, Turney IC, Avila-Rieger JF, Sims KD, Okoye SM, Belsky DW, Hill-Jarrett TG, Samuel L, Solomon G, Cleeve JH, Gee G, Thorpe RJ, Crews DC, Hardeman RR, Bailey ZD, Szanton SL, Manly JJ. "Hang Ups, Let Downs, Bad Breaks, Setbacks": Impact of Structural Socioeconomic Racism and Resilience on Cognitive Change Over Time for Persons Racialized as Black. Health Equity 2024; 8:254-268. [PMID: 38665381 PMCID: PMC11043623 DOI: 10.1089/heq.2023.0151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2023] [Indexed: 04/28/2024] Open
Abstract
Introduction Older adults racialized as Black experience higher rates of dementia than those racialized as White. Structural racism produces socioeconomic challenges, described by artist Marvin Gaye as "hang ups, let downs, bad breaks, setbacks" that likely contribute to dementia disparities. Robust dementia literature suggests socioeconomic factors may also be key resiliencies. Methods We linked state-level data reflecting the racialized landscape of economic opportunity across the 20th Century from the U.S. Census (1930-2010) with individual-level data on cognitive outcomes from the U.S. Health and Retirement Study participants racialized as Black. A purposive sample of participants born after the Brown v. Board ruling (born 1954-59) were selected who completed the modified Telephone Interview for Cognitive Status between 2010 and 2020 (N=1381). We tested associations of exposure to structural racism and resilience before birth, and during childhood, young-adulthood, and midlife with cognitive trajectories in mid-late life using mixed-effects regression models. Results Older adults born in places with higher state-level structural socioeconomic racism experienced a more rapid cognitive decline in later life compared to those with lower levels of exposure. In addition, participants born in places with higher levels of state-level structural socioeconomic resilience experienced slower cognitive change over time than their counterparts. Discussion These findings reveal the impact of racist U.S. policies enacted in the past that influence cognitive health over time and dementia risk later in life.
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Affiliation(s)
- Paris B. Adkins-Jackson
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Boeun Kim
- School of Nursing, Johns Hopkins University, Baltimore, Maryland, USA
| | - César Higgins Tejera
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Tiffany N. Ford
- Division of Community Health Sciences, School of Public Health, University of Illinois Chicago, Chicago, Illinois, USA
- The Brookings Institution, Washington, District of Columbia, USA
| | - Ariana N. Gobaud
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA
| | | | - Indira C. Turney
- Department of Neurology, Vagelos College of Physicians & Surgeons, Taub Institute for Research on Alzheimer's Disease & The Aging Brain, Columbia University, New York, New York, USA
| | - Justina F. Avila-Rieger
- Department of Neurology, Vagelos College of Physicians & Surgeons, Taub Institute for Research on Alzheimer's Disease & The Aging Brain, Columbia University, New York, New York, USA
| | - Kendra D. Sims
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, USA
| | - Safiyyah M. Okoye
- Department of Graduate Nursing, College of Nursing and Health Professions and Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania, USA
- Department of Health Management and Policy, College of Nursing and Health Professions and Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania, USA
| | - Daniel W. Belsky
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA
- Butler Columbia Aging Center, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Tanisha G. Hill-Jarrett
- Department of Neurology, Memory and Aging Center, University of California San Francisco, San Francisco, California, USA
| | - Laura Samuel
- School of Nursing, Johns Hopkins University, Baltimore, Maryland, USA
| | - Gabriella Solomon
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Jack H. Cleeve
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Gilbert Gee
- Department of Community Health Sciences, University of California at Los Angeles, Los Angeles, California, USA
| | - Roland J. Thorpe
- Alzheimer's Disease Resource Center for Minority Aging Research, Johns Hopkins University, Baltimore, Maryland, USA
| | - Deidra C. Crews
- School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Rachel R. Hardeman
- Center for Antiracism Research for Health Equity, University of Minnesota School of Public Health, Minneapolis, Minnesota, USA
| | - Zinzi D. Bailey
- Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Sarah L. Szanton
- School of Nursing, Johns Hopkins University, Baltimore, Maryland, USA
| | - Jennifer J. Manly
- Department of Neurology, Vagelos College of Physicians & Surgeons, Taub Institute for Research on Alzheimer's Disease & The Aging Brain, Columbia University, New York, New York, USA
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3
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Williams BR, Brady SS, Levin EC, Brown O, Lipman TH, Klusaritz H, Nodora J, Coyne-Beasley T, Putnam S, Gahagan S, Burgio KL. Black women's perspectives on bladder health: Social-ecological and life course contexts. Neurourol Urodyn 2024; 43:849-861. [PMID: 38451032 DOI: 10.1002/nau.25437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 01/21/2024] [Accepted: 02/19/2024] [Indexed: 03/08/2024]
Abstract
AIMS This paper explores Black women's perspectives on bladder health using a social-ecological conceptual framework and life course perspective. METHODS We conducted a directed content analysis of data from the Study of Habits, Attitudes, Realities, and Experiences (SHARE), a focus group study by the Prevention of Lower Urinary Tract Symptoms (PLUS) Research Consortium. Analysis was conducted on data from five focus groups and a member-checking session where all participants self-identified as Black or African American. RESULTS Forty-two participants aged 11-14 or 45+ years reported life course experiences with their bladder. The intersection of race and gender was the lens through which participants viewed bladder health. Participants' accounts of their perspectives on bladder health explicitly and implicitly revealed structural racism as an explanatory overarching theme. Participants described (a) historically-rooted and still pervasive practices of discrimination and segregation, engendering inequitable access to quality medical care and public facilities, (b) institutional barriers to toileting autonomy in educational and occupational settings, promoting unhealthy voiding habits, (c) internalized expectations of Black women's stereotyped role as family caregiver, compromising caregiver health, (d) lack of reliable information on bladder health, leading to unhealthy bladder behaviors, and (e) potentially stress-related comorbid chronic conditions and associated medication use, causing or exacerbating bladder problems. CONCLUSIONS Bladder health promotion interventions should address social-ecological and life course factors shaping Black women's bladder health, including social and structural barriers to accessing equitable health information and medical care.
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Affiliation(s)
- Beverly R Williams
- Department of Medicine, Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Alabama, USA
- Department of Veterans Affairs, Birmingham/Atlanta Geriatric Research, Education, and Clinical Center, Birmingham, Alabama, USA
| | - Sonya S Brady
- Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Elise C Levin
- Division of Community Health Services, School of Public Health, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Oluwateniola Brown
- Division of Female Pelvic Medicine and Reconstructive Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Terri H Lipman
- Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Heather Klusaritz
- Department of Family Medicine and Community Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jesse Nodora
- Division of Applied Sciences, Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California, USA
| | - Tamera Coyne-Beasley
- Department of Pediatrics, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Alabama, USA
| | - Sara Putnam
- Division of Biostatistics, University of Minnesota, Minneapolis, Minnesota, USA
| | - Sheila Gahagan
- Department of Pediatrics, School of Medicine, University of California San Diego, La Jolla, California, USA
| | - Kathryn L Burgio
- Department of Medicine, Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Alabama, USA
- Department of Veterans Affairs, Birmingham/Atlanta Geriatric Research, Education, and Clinical Center, Birmingham, Alabama, USA
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Dove-Medows E, Knox J, Valentine-Graves M, Sullivan P. I Can't Afford it Right Now, So it Doesn't Matter" Structural Drivers of Viral Suppression Among Men Who Have Sex With Men: A Longitudinal Qualitative Approach. Res Sq 2024:rs.3.rs-4001004. [PMID: 38585772 PMCID: PMC10996790 DOI: 10.21203/rs.3.rs-4001004/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/09/2024]
Abstract
Background Racial disparities in outcomes across the HIV care continuum, including in viral suppression, have been observed among sexual minority men (SMM) living with HIV. Structural factors are drivers of these disparities, yet data is lacking at the individual level on how day-to-day experiences of these structural factors contribute to losing viral suppression, and what happens to SMM after loss of viral suppression, including whether they achieve viral suppression again over time. Method We conducted longitudinal semi-structured interviews with a subsample of men living with HIV drawn from a larger cohort study. Three Black and 2 White SMM participated in a series of three interviews after they lost viral suppression, and then again at 6- and 12-months follow-up. The focus of the interviews was on experiences with structural issues (e.g., housing, transportation, employment, insurance) and their impact on HIV care. Results Content analysis showed that multiple structural issues disrupted HIV care, particularly insurance, housing stability, transportation, and employment. Black SMM described experiencing multiple compounding structural barriers, and they struggled to achieve viral suppression again. Conclusions These data show how SMM living with HIV are impacted by structural barriers to HIV care over time. Black SMM experienced multiple, compounding barriers, and these negatively impacted HIV care outcomes over time. Efforts to address long-standing HIV care-related disparities need to address the mechanisms of structural racism.
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Creary MS, Peoples W, Fleming PJ. Health Equity Requires Working Toward Antiracist Local Public Health Departments. Public Health Rep 2024:333549241237382. [PMID: 38519864 DOI: 10.1177/00333549241237382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/25/2024] Open
Affiliation(s)
- Melissa S Creary
- Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Whitney Peoples
- School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Paul J Fleming
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI, USA
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Conway AE, Lieberman J, Codispoti CD, Mahdavinia M, Anagnostou A, Hsu Blatman KS, Lang DM, Oppenheimer J, Mosnaim GS, Bukstein D, Shaker M. Pharmacoequity & Biologics In The Allergy Clinic: Providing The Right Care, At The Right Time, Every time, To Everyone. J Allergy Clin Immunol Pract 2024:S2213-2198(24)00264-2. [PMID: 38458435 DOI: 10.1016/j.jaip.2024.02.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 02/10/2024] [Accepted: 02/28/2024] [Indexed: 03/10/2024]
Abstract
Pharmacoequity refers to equity in access to pharmacotherapy for all patients and is an especially large barrier to biologic agents in patients with allergic diseases. Value-based care models can prompt clinicians to address social determinants of health, thereby promoting pharmacoequity. Pharmacoequity is influenced by numerous factors including socioeconomic status (SES), which may be mediated through insurance status, educational attainment, and access to specialist care. In addition to lower SES, race and ethnicity, age, locations isolated from care systems, and off-label indications for biologic agents all constitute barriers to pharmacoequity. While pharmaco-inequity is more apparent for expensive biologics, it also affects many other allergy treatments including epinephrine autoinjectors and Single Maintenance and Reliever Therapy (SMART) for asthma. Current programs aimed at alleviating cost barriers are imperfect, with Patient Assistance Programs, manufacturer-sponsored free drug programs, and rebates often increasing complexity of care, with resultant inequity, particularly for patients with lower health literacy. Ultimately, single "silver-bullet" solutions are elusive. Long-term improvement instead requires a combination of research, advocacy, and creative problem-solving to design more intelligent and efficient systems that provide timely access to necessary care for every patient, every time.
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Affiliation(s)
| | - Jay Lieberman
- Department of Pediatrics, The University of Tennessee Health Sciences Center, Memphis Tennessee, USA
| | - Christopher D Codispoti
- Rush University Medical Center, Department of Internal Medicine, Division of Allergy, Chicago, IL, USA
| | - Mahboobeh Mahdavinia
- Rush University Medical Center, Department of Internal Medicine, Division of Allergy, Chicago, IL, USA
| | | | - Karen S Hsu Blatman
- Dartmouth Hitchcock Medical Center, Section of Allergy and Clinical Immunology, Lebanon, NH, USA; Geisel School of Medicine at Dartmouth, Department of Medicine, Hanover, NH, USA
| | - David M Lang
- Cleveland Clinic, Department of Allergy and Clinical Immunology, Cleveland OH, USA
| | - John Oppenheimer
- UMDNJ Rutgers University School of Medicine, Newark, New Jersey, USA
| | - Giselle S Mosnaim
- Division of Allergyand Immunology, Department of Medicine, NorthShore University Health System, Evanston, IL, USA
| | - Don Bukstein
- Allergy, Asthma, and Sinus Center, Milwaukee, WI, USA
| | - Marcus Shaker
- Dartmouth Hitchcock Medical Center, Section of Allergy and Clinical Immunology, Lebanon, NH, USA; Geisel School of Medicine at Dartmouth, Departments of Medicine and Pediatrics, Hanover, NH, USA.
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7
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Colen CG, Drotning KJ, Sayer LC, Link B. A Matter of Time: Racialized Time and the Production of Health Disparities. J Health Soc Behav 2024; 65:126-140. [PMID: 37377057 DOI: 10.1177/00221465231182377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/29/2023]
Abstract
An expansive and methodologically varied literature designed to investigate racial disparities in health now exists. Empirical evidence points to an overlapping, complex web of social conditions that accelerate the pace of aging and erodes long-term health outcomes among people of color, especially Black Americans. However, a social exposure-or lack thereof-that is rarely mentioned is time use. The current paper was specifically designed to address this shortcoming. First, we draw on extant research to illustrate how and why time is a critical source of racial disparities in health. Second, we employ fundamental causes theory to explain the specific mechanisms through which the differential distribution of time across race is likely to give rise to unequal health outcomes. Finally, we introduce a novel conceptual framework that identifies and distinguishes between four distinct forms of time use likely to play an outsized role in contributing to racial disparities in health.
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Affiliation(s)
| | | | | | - Bruce Link
- University of California, Riverside, CA, USA
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8
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Brown TH, Homan P. Structural Racism and Health Stratification: Connecting Theory to Measurement. J Health Soc Behav 2024; 65:141-160. [PMID: 38308499 DOI: 10.1177/00221465231222924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2024]
Abstract
Less than 1% of studies on racialized health inequities have empirically examined their root cause: structural racism. Moreover, there has been a disconnect between the conceptualization and measurement of structural racism. This study advances the field by (1) distilling central tenets of theories of structural racism to inform measurement approaches, (2) conceptualizing U.S. states as racializing institutional actors shaping health, (3) developing a novel latent measure of structural racism in states, (4) using multilevel models to quantify the association between structural racism and five individual-level health outcomes among respondents from the Health and Retirement Study (N = 9,020) and the Behavioral Risk Factor Surveillance System (N = 308,029), and (5) making our measure of structural racism publicly available to catalyze research. Results show that structural racism is consistently associated with worse health for Black people but not White people. We conclude by highlighting this study's contributions (theoretical, methodological, and substantive) and important avenues for future research on the topic.
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Desai MU, Guy K, Brown M, Thompson D, Manning B, Johnson S, Davidson L, Bellamy C. "That Was a State of Depression by Itself Dealing with Society": Atmospheric racism, mental health, and the Black and African American faith community. Am J Community Psychol 2024; 73:104-117. [PMID: 37006193 PMCID: PMC10545810 DOI: 10.1002/ajcp.12654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 07/01/2022] [Accepted: 11/25/2022] [Indexed: 06/19/2023]
Abstract
Despite increased societal focus on structural racism, and its negative impact on health, empirical research within mental health remains limited relative to the magnitude of the problem. The current study-situated within a community-engaged project with members of a predominantly Black and African American church in the northeastern US-collaboratively examined depressive experience, recovery, and the role of racism and racialized structures. This co-designed study featured individual interviews (N = 11), a focus group (N = 14), and stakeholder engagement. A form of qualitative, phenomenological analysis that situates psychological phenomena within their social structural contexts was utilized. Though a main focal point of the study was depressive and significantly distressing experience, participant narratives directed us more towards a world that was structured to deplete and deprive-from basic neighborhood conditions, to police brutality, to workplace discrimination, to pervasive racist stereotypes, to differential treatment by health and social services. Racism was thus considered as atmospheric, in the sense of permeating life itself-with social, affective, embodied, and temporal dimensions, alongside practical (e.g., livelihood, vocation, and care) and spatial (e.g., neighborhood, community, and work) ones. The major thematic subsections-world, body, time, community, and space-reflect this fundamental saturation of racism within lived reality. There are two, interrelated senses of structural racism implicated here: the structures of the world and their impact on the structural dimensions of life. This study on the atmospheric nature of racism provides a community-centered complement to existing literature on structural racism and health that often proceed from higher, more population level scales. This combined literature suggests placing ever-renewed emphasis on addressing the causes and conditions that make this kind of distorted world possible in the first place.
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Affiliation(s)
- Miraj U Desai
- Program for Recovery and Community Health, Yale School of Medicine, New Haven, Connecticut, USA
| | - Kimberly Guy
- Program for Recovery and Community Health, Yale School of Medicine, New Haven, Connecticut, USA
| | - Mychal Brown
- Beulah Heights First Pentecostal Church, New Haven, Connecticut, USA
| | - Denisha Thompson
- Beulah Heights First Pentecostal Church, New Haven, Connecticut, USA
| | - Bobby Manning
- Yale School of Public Health, New Haven, Connecticut, USA
| | - Spencer Johnson
- Equity Research and Innovation Center, Yale School of Medicine, New Haven, Connecticut, USA
| | - Larry Davidson
- Program for Recovery and Community Health, Yale School of Medicine, New Haven, Connecticut, USA
| | - Chyrell Bellamy
- Program for Recovery and Community Health, Yale School of Medicine, New Haven, Connecticut, USA
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10
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Franco K, Patler C, Pirtle WL. COVID-19's Unequal Toll: Differences in Health-Related Quality of Life by Gendered and Racialized Groups. J Health Soc Behav 2024; 65:60-74. [PMID: 37830769 PMCID: PMC10908199 DOI: 10.1177/00221465231199734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/14/2023]
Abstract
We examine whether the COVID-19 pandemic was associated with changes to daily activity limitations due to poor physical or mental health and whether those changes were different within and between gendered and racialized groups. We analyze 497,302 observations across the 2019 and 2020 waves of the Centers for Disease Control and Prevention Behavioral Risk Factor Surveillance System survey. Among White men and women, the COVID-19 pandemic was associated with fewer days of health-related activity limitations and decreased frequent activity limitation (≥14 days in the past month) compared to the prepandemic period. By contrast, Latina and Black women experienced increased days of activity limitation and greater likelihood of frequent activity limitation, and these changes were significantly different than for White women. These findings are robust to the inclusion of structural inequality measures and demonstrate how systemic racism and sexism likely exacerbate a myriad of pandemic-related health problems.
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11
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Hing AK, Chantarat T, Fashaw-Walters S, Hunt SL, Hardeman RR. Instruments for racial health equity: a scoping review of structural racism measurement, 2019-2021. Epidemiol Rev 2024:mxae002. [PMID: 38412307 DOI: 10.1093/epirev/mxae002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 11/27/2023] [Indexed: 02/29/2024] Open
Abstract
Progress toward racial health equity cannot be made if we cannot measure its fundamental driver - structural racism. As in other epidemiological studies, the first step is to measure the exposure. But how to measure structural racism is an ongoing debate. To characterize the approaches epidemiologists and other health researchers use to quantitatively measure structural racism, highlight methodological innovations, and identify gaps in the literature, we conducted a scoping review of the peer-reviewed and grey literature published during 2019-2021 to accompany the work of Groos et al. (J Health Dispar Res Pract. 2018;11(2):Article 13), which surveys the scope of structural racism measurement up to 2017. We identified several themes from the recent literature: the current predominant focus on measuring anti-Black racism, using residential segregation as well as other segregation-driven measures as proxies of structural racism, measuring structural racism as spatial exposures, an increasing call by epidemiologists and other health researchers to measure structural racism as a multidimensional, multi-level determinant of health and related innovations, the development of policy databases, the utility of simulated counterfactual approaches in the understanding of how structural racism drive racial health inequities, and the lack of measures of antiracism and limited work on later life effects. Our findings sketch out several future steps to improve the science around structural racism measurements, which is the key to advancing antiracism policies.
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Affiliation(s)
- Anna K Hing
- Division of Health Policy and Management, School of Public Health, University of Minnesota
- Center for Antiracism Research for Health Equity, School of Public Health, University of Minnesota
- Minnesota Population Center, Institute for Social Research and Data Innovation, University of Minnesota
| | - Tongtan Chantarat
- Division of Health Policy and Management, School of Public Health, University of Minnesota
- Minnesota Population Center, Institute for Social Research and Data Innovation, University of Minnesota
| | - Shekinah Fashaw-Walters
- Division of Health Policy and Management, School of Public Health, University of Minnesota
- Center for Antiracism Research for Health Equity, School of Public Health, University of Minnesota
- Minnesota Population Center, Institute for Social Research and Data Innovation, University of Minnesota
| | | | - Rachel R Hardeman
- Division of Health Policy and Management, School of Public Health, University of Minnesota
- Center for Antiracism Research for Health Equity, School of Public Health, University of Minnesota
- Minnesota Population Center, Institute for Social Research and Data Innovation, University of Minnesota
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12
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Dixon SL, Salerno Valdez E, Chan J, Weil M, Fisher T, Simoun A, Egan J, Beatriz E, Gubrium A. Stacked Up Against Us: Using Photovoice and Participatory Methods to Explore Structural Racism's Impact on Adolescent Sexual and Reproductive Health Inequities. Health Promot Pract 2024:15248399241229641. [PMID: 38374717 DOI: 10.1177/15248399241229641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2024]
Abstract
While structural racism has profound impacts on adolescent health, little is known about how youth synthesize racialized experiences and work to dismantle systems of oppression. This article provides an overview of a Youth Participatory Action Research study that used Photovoice and community mapping to explore how structural violence, like racism, impacts the sexual and reproductive health of historically excluded youth as they navigate unjust socio-political landscapes. Youth participants used photography and community maps to identify how the experience of bias, profiling, and tokenism impacted their ability to navigate complex social systems. With youth voices prioritized, participants explored ways to address structural racism in their lives. The importance of co-creating opportunities with and for youth in critical reflection of their lived experience is emphasized. Through an Arts and Cultural in Public Health framework, we provide an analysis of the ways structural racism functions as a gendered racial project and fundamental cause of adolescent sexual and reproductive health inequities, while identifying pathways toward liberation in pursuit of health and well-being.
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Affiliation(s)
| | | | - Jazmine Chan
- University of Massachusetts Amherst, Amherst, MA, USA
| | - Mira Weil
- University of Massachusetts Amherst, Amherst, MA, USA
| | - Tiarra Fisher
- University of Massachusetts Amherst, Amherst, MA, USA
| | - Alya Simoun
- University of Massachusetts Amherst, Amherst, MA, USA
| | - Justine Egan
- Massachusetts Department of Public Health, Boston, MA, USA
| | | | - Aline Gubrium
- University of Massachusetts Amherst, Amherst, MA, USA
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Fall C, Baer RJ, Jelliffe-Pawlowski L, Matoba N, Lee HC, Chambers CD, Bandoli G. Racial and Ethnic Inequities in Therapeutic Hypothermia and Neonatal Hypoxic-Ischemic Encephalopathy: A Retrospective Cohort Study. J Pediatr 2024; 269:113966. [PMID: 38369239 DOI: 10.1016/j.jpeds.2024.113966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 01/19/2024] [Accepted: 02/13/2024] [Indexed: 02/20/2024]
Abstract
OBJECTIVE To investigate racial inequities in the use of therapeutic hypothermia (TH) and outcomes in infants with hypoxic-ischemic encephalopathy (HIE). STUDY DESIGN We queried an administrative birth cohort of mother-baby pairs in California from 2010 through 2019 using International Classification of Diseases codes to evaluate the association between race and ethnicity and the application of TH in infants with HIE. We identified 4779 infants with HIE. Log-linear regression was used to calculate risk ratios (RR) for TH, adjusting for hospital transfer, rural location, gestational age between 35 and 37 weeks, and HIE severity. Risk of adverse infant outcome was calculated by race and ethnicity and stratified by TH. RESULTS From our identified cohort, 1338 (28.0%) neonates underwent TH. White infants were used as the reference sample, and 410 (28.4%) received TH. Black infants were significantly less likely to receive TH with 74 (20.0%) with an adjusted risk ratio (aRR) of 0.7 (95% CI 0.5-0.9). Black infants with any HIE who did not receive TH were more likely to have a hospital readmission (aRR 1.36, 95% CI 1.10-1.68) and a tracheostomy (aRR 3.07, 95% CI 1.19-7.97). Black infants with moderate/severe HIE who did not receive TH were more likely to have cerebral palsy (aRR 2.72, 95% CI 1.07-6.91). CONCLUSIONS In this study cohort, Black infants with HIE were significantly less likely to receive TH. Black infants also had significantly increased risk of some adverse outcomes of HIE. Possible reasons for this inequity include systemic barriers to care and systemic bias.
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Affiliation(s)
- Carolyn Fall
- Rady Children's Hospital of San Diego, University of California, San Diego, San Diego, CA
| | - Rebecca J Baer
- Division of Pediatrics, University of California San Diego, San Diego, CA; Division of Epidemiology, Biostatistics, University of California San Francisco, San Francisco, CA
| | - Laura Jelliffe-Pawlowski
- Division of Epidemiology, Biostatistics, University of California San Francisco, San Francisco, CA
| | - Nana Matoba
- Rady Children's Hospital of San Diego, University of California, San Diego, San Diego, CA
| | - Henry C Lee
- Rady Children's Hospital of San Diego, University of California, San Diego, San Diego, CA
| | - Christina D Chambers
- Rady Children's Hospital of San Diego, University of California, San Diego, San Diego, CA
| | - Gretchen Bandoli
- Rady Children's Hospital of San Diego, University of California, San Diego, San Diego, CA
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14
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Francis B, Pearl M, Colen C, Shoben A, Sealy-Jefferson S. Racial and Economic Segregation Over the Life Course and Incident Hypertensive Disorders of Pregnancy Among Black Women in California. Am J Epidemiol 2024; 193:277-284. [PMID: 37771041 PMCID: PMC11031219 DOI: 10.1093/aje/kwad192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 07/24/2023] [Accepted: 09/26/2023] [Indexed: 09/30/2023] Open
Abstract
Black women in the United States have the highest incidence of hypertensive disorders of pregnancy (HDP) and are disproportionately burdened by its adverse sequalae, compared with women of all racial and ethnic groups. Segregation, a key driver of structural racism for Black families, can provide information critical to understanding these disparities. We examined the association between racial and economic segregation at 2 points and incident HDP using intergenerationally linked birth records of 45,204 Black California-born primiparous mothers (born 1982-1997) and their infants (born 1997-2011), with HDP ascertained from hospital discharge records. Women's early childhood and adulthood neighborhoods were categorized as deprived, mixed, or privileged based on the Index of Concentration at the Extremes (a measure of concentrated racial and economic segregation), yielding 9 life-course trajectories. Women living in deprived neighborhoods at both time points experienced the highest odds of HDP (from mixed effect logistic regression, unadjusted odds ratio = 1.26, 95% confidence interval: 1.13, 1.40) compared with women living in privileged neighborhoods at both time points. All trajectories involving residence in a deprived neighborhood in early childhood or adulthood were associated with increased odds of HDP, whereas mixed-privileged and privileged-mixed trajectories were not. Future studies should assess the causal nature of these associations.
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Affiliation(s)
- Brittney Francis
- Correspondence to Dr. Brittney Francis, 651 Huntington Avenue, Floor 7, Boston, MA 02115 (e-mail: )
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15
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Chen S, Carter D, Brockenbrough PB, Cox S, Gwathmey K. Racial disparities in ALS diagnostic delay: a single center's experience and review of potential contributing factors. Amyotroph Lateral Scler Frontotemporal Degener 2024; 25:112-118. [PMID: 37909302 DOI: 10.1080/21678421.2023.2273361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 10/10/2023] [Indexed: 11/03/2023]
Abstract
OBJECTIVE Outcomes for amyotrophic lateral sclerosis (ALS) patients are improved with prompt diagnosis, earlier initiation of disease-modifying treatments, and participation in a multidisciplinary clinic. We studied diagnostic delay and disease severity at time of clinic presentation between Black and non-Hispanic Caucasian ALS patients. METHODS We performed a retrospective analysis of non-Hispanic Caucasian and Black ALS patients seen in the Virginia Commonwealth University Health System multidisciplinary ALS clinic between 2017 and 2023. Diagnostic delay, ALS Functional Rating Scale-Revised (ALSFRS-R) and upright forced vital capacity (FVC) scores at baseline appointment were collected. Patient's distance from clinic and affluency of residential neighborhood were evaluated. RESULTS We analyzed 172 non-Hispanic Caucasian and 33 Black ALS patients. Black patients had a 64% increase in diagnostic delay compared to non-Hispanic Caucasian patients. Black patients had a lower performance on ALSFRS-R (5.3 points, p < 0.001) and FVC (17.9 percentage points p < 0.001) at time of first clinic visit. Black patients lived closer to clinic, with higher proportion living in the city of Richmond, but in less affluent areas with lower median house income ($55,300 ± 22,600 vs $69,900 ± 23,700). DISCUSSION Our findings demonstrate a large racial difference in ALS diagnostic delay, and greater disease severity and lower respiratory function at time of diagnosis for Black ALS patients. Delay in diagnosis prolongs access to disease-modifying therapies, multidisciplinary care, durable medical equipment, and respiratory and nutritional support. Potential sources of these racial disparities include providers' implicit bias and structural racism.
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Affiliation(s)
- Shanshan Chen
- Department of Biostatistics, Virginia Commonwealth University, Richmond, VA, USA
| | - Demetrius Carter
- Department of Neurology, Virginia Commonwealth University, Richmond, VA, USA
| | | | - Stephen Cox
- Department of Neurology, University of Colorado, Aurora, CO, USA
| | - Kelly Gwathmey
- Department of Neurology, Virginia Commonwealth University, Richmond, VA, USA
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16
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Peterson RL, Pejak R, George KM, Gilsanz P, Ko M, Meyer OL, Mayeda ER, Kind A, Whitmer RA. Race, community disadvantage, and cognitive decline: Findings from KHANDLE and STAR. Alzheimers Dement 2024; 20:904-913. [PMID: 37817548 PMCID: PMC10917037 DOI: 10.1002/alz.13511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 08/24/2023] [Accepted: 09/19/2023] [Indexed: 10/12/2023]
Abstract
INTRODUCTION Community disadvantage is associated with late-life cognition. Few studies examine its contribution to racial disparities in cognition/cognitive change. METHODS Inverse probability weighted models estimated expected mean differences in cognition/cognitive change attributed to residing in less advantaged communities, defined as cohort top quintile of Area Deprivation Indices (ADI): childhood 66-100; adulthood ADI 5-99). Interactions by race tested. RESULTS More Black participants resided in less advantaged communities. Semantic memory would be lower if all participants had resided in less advantaged childhood (b = -0.16, 95% confidence interval [CI] = -0.30, -0.03) or adulthood (b = -0.14, 95% CI = -0.22, -0.04) communities. Race interactions indicated that, among Black participants, less advantaged childhood communities were associated with higher verbal episodic memory (interaction p-value = 0.007) and less advantaged adulthood communities were associated with lower semantic memory (interaction p-value = 0.002). DISCUSSION Examining racial differences in levels of community advantage and late-life cognitive decline is a critical step toward unpacking community effects on cognitive disparities.
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Affiliation(s)
- Rachel L. Peterson
- School of Public and Community Health SciencesUniversity of MontanaMissoulaMontanaUSA
| | - Rebecca Pejak
- School of Public and Community Health SciencesUniversity of MontanaMissoulaMontanaUSA
| | - Kristen M. George
- Department of Public Health SciencesUniversity of California DavisDavisCaliforniaUSA
| | - Paola Gilsanz
- Division of ResearchKaiser Permanente Northern CaliforniaOaklandCaliforniaUSA
| | - Michelle Ko
- Department of Public Health SciencesUniversity of California DavisDavisCaliforniaUSA
| | - Oanh L. Meyer
- Department of NeurologyUniversity of California DavisDavisCaliforniaUSA
| | - Elizabeth Rose Mayeda
- Fielding School of Public HealthUniversity of California Los AngelesLos AngelesCaliforniaUSA
| | - Amy Kind
- University of Wisconsin Center for Health Disparities ResearchMadisonWisconsinUSA
| | - Rachel A. Whitmer
- Departments of Public Health Sciences and NeurologyUniversity of California DavisDavisCaliforniaUSA
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17
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Lopez KN, Allen KY, Baker-Smith CM, Bravo-Jaimes K, Burns J, Cherestal B, Deen JF, Hills BK, Huang JH, Lizano Santamaria RW, Lodeiro CA, Melo V, Moreno JS, Nuñez Gallegos F, Onugha H, Pastor TA, Wallace MC, Ansah DA. Health Equity and Policy Considerations for Pediatric and Adult Congenital Heart Disease Care among Minoritized Populations in the United States. J Cardiovasc Dev Dis 2024; 11:36. [PMID: 38392250 PMCID: PMC10888593 DOI: 10.3390/jcdd11020036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 01/16/2024] [Accepted: 01/19/2024] [Indexed: 02/24/2024] Open
Abstract
Achieving health equity in populations with congenital heart disease (CHD) requires recognizing existing disparities throughout the lifespan that negatively and disproportionately impact specific groups of individuals. These disparities occur at individual, institutional, or system levels and often result in increased morbidity and mortality for marginalized or racially minoritized populations (population subgroups (e.g., ethnic, racial, social, religious) with differential power compared to those deemed to hold the majority power in the population). Creating actionable strategies and solutions to address these health disparities in patients with CHD requires critically examining multilevel factors and health policies that continue to drive health inequities, including varying social determinants of health (SDOH), systemic inequities, and structural racism. In this comprehensive review article, we focus on health equity solutions and health policy considerations for minoritized and marginalized populations with CHD throughout their lifespan in the United States. We review unique challenges that these populations may face and strategies for mitigating disparities in lifelong CHD care. We assess ways to deliver culturally competent CHD care and to help lower-health-literacy populations navigate CHD care. Finally, we review system-level health policies that impact reimbursement and research funding, as well as institutional policies that impact leadership diversity and representation in the workforce.
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Affiliation(s)
- Keila N Lopez
- Texas Children's Hospital, Department of Pediatrics, Division of Pediatric Cardiology, Baylor College of Medicine, Houston, TX 77030, USA
| | - Kiona Y Allen
- Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Carissa M Baker-Smith
- Center for Cardiovascular Research and Innovation, Nemours Cardiac Center, Nemours Children's Health, Wilmington, DE 19803, USA
| | - Katia Bravo-Jaimes
- Department of Cardiovascular Medicine, Mayo Clinic Florida, Jacksonville, FL 32224, USA
| | - Joseph Burns
- Texas Children's Hospital, Department of Pediatrics, Division of Pediatric Cardiology, Baylor College of Medicine, Houston, TX 77030, USA
| | - Bianca Cherestal
- Ward Family Heart Center, Children's Mercy Kansas City, Kansas City, MO 64108, USA
| | - Jason F Deen
- Department of Pediatrics and Medicine, University of Washington, Seattle, WA 98105, USA
| | - Brittany K Hills
- Division of Pediatric Cardiology, UT Southwestern, Children's Health, Dallas, TX 75390, USA
| | - Jennifer H Huang
- Doernbecher Children's Hospital, Oregon Health and Science University, Portland, OR 97239, USA
| | | | - Carlos A Lodeiro
- Texas Children's Hospital, Department of Pediatrics, Division of Pediatric Cardiology, Baylor College of Medicine, Houston, TX 77030, USA
| | - Valentina Melo
- Texas Children's Hospital, Department of Pediatrics, Baylor College of Medicine, Houston, TX 77030, USA
| | - Jasmine S Moreno
- Texas Children's Hospital, Department of Pediatrics, Division of Pediatric Cardiology, Baylor College of Medicine, Houston, TX 77030, USA
| | - Flora Nuñez Gallegos
- Department of Pediatrics, University of California San Francisco Benioff Children's Hospital, San Francisco, CA 94158, USA
| | - Harris Onugha
- Texas Children's Hospital, Department of Pediatrics, Baylor College of Medicine, Houston, TX 77030, USA
| | - Tony A Pastor
- Division of Pediatric Cardiology, Yale School of Medicine, Yale New Haven Hospital, New Haven, CT 06510, USA
| | - Michelle C Wallace
- Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, GA 30322, USA
| | - Deidra A Ansah
- Texas Children's Hospital, Department of Pediatrics, Division of Pediatric Cardiology, Baylor College of Medicine, Houston, TX 77030, USA
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18
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Wexler L, White LA, O'Keefe VM, Rasmus S, Haroz EE, Cwik MF, Barlow A, Goklish N, Elliott E, Pearson CR, Allen J. Centering Community Strengths and Resisting Structural Racism to Prevent Youth Suicide: Learning from American Indian and Alaska Native Communities. Arch Suicide Res 2024:1-16. [PMID: 38240632 DOI: 10.1080/13811118.2023.2300321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
Abstract
The persistence of extreme suicide disparities in American Indian and Alaska Native (AI/AN) youth signals a severe health inequity with distinct associations to a colonial experience of historical and on-going cultural, social, economic, and political oppression. To address this complex issue, we describe three AI/AN suicide prevention efforts that illustrate how strengths-based community interventions across the prevention spectrum can buffer suicide risk factors associated with structural racism. Developed and implemented in collaboration with tribal partners using participatory methods, the strategies include universal, selective, and indicated prevention elements. Their aim is to enhance systems within communities, institutions, and families by emphasizing supportive relationships, cultural values and practices, and community priorities and preferences. These efforts deploy collaborative, local approaches, that center on the importance of tribal sovereignty and self-determination, disrupting the unequal power distribution inherent in mainstream approaches to suicide prevention. The examples emphasize the centrality of Indigenous intellectual traditions in the co-creation of healthy developmental pathways for AI/AN young people. A central component across all three programs is a deep commitment to an interdependent or collective orientation, in contrast to an individual-based mental health suicide prevention model. This commitment offers novel directions for the entire field of suicide prevention and responds to calls for multilevel, community-driven public health strategies to address the complexity of suicide. Although our focus is on the social determinants of health in AI/AN communities, strategies to address the structural violence of racism as a risk factor in suicide have broad implications for all suicide prevention programming.
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Bradley CD, Irie WC, Geng EH. Situating implementation science (IS) in res(IS)tance: a conceptual frame toward the integration of scholarship from the black radical tradition. Front Public Health 2024; 11:1286156. [PMID: 38274530 PMCID: PMC10808293 DOI: 10.3389/fpubh.2023.1286156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 12/14/2023] [Indexed: 01/27/2024] Open
Abstract
This manuscript undertakes a disciplinary self-critique of the field of implementation science, a field which attempts to bridge the gap between evidence-based interventions and their practical application. Despite the heightened emphasis on health equity and racial disparities, the field's current discourse is limited by key epistemic shortcomings. First, even though prevalence of implementation gaps between racialized groups in the United States necessitates a comprehensive understanding of the systems perpetuating these disparities, the field does not operate with a general explanation for disparities not as a failure of systems, but a system historically and structural designed to produce disparities. Second, the field has attempted to address disparities without adequate dialog with a broad tradition of anti-racist and anti-colonial sociology, history and epistemology, and therefore risks a decontextualized analysis of disparities and under-informed approaches to achieving equity. Fortunately, scholarship from the Black radical tradition (BRT), such as the Public Health Critical Race Praxis (PHCRP), Critical Race Theory (CRT), and more broadly conceptual frameworks from post-modern, anti-colonial, Black feminist studies and social epistemology can offer to implementation science frameworks that center power dynamics and racialized oppression. This epistemic re-alignment of implementation research to "center at the margins" can enable the field of implementation science to more critically examine and dismantle systems that perpetuate racial inequalities in access to and utilization of health interventions. For example, normalization and dynamic fit, which are thought to be key mechanisms of implementation, are revealed in the light of this tradition of scholarship to be potentially problematic acquiescence to oppressive systems. Drawing from the concept of resistance anchored in the scholarship of the Black radical tradition as well as contemporary social epistemology such as the work of José Medina and Maria Fricker about epistemic justice, the authors further advance that implementation science could make more substantial contributions to the dismantling of racialized systems and actively work toward health justice through the transdisciplinary lens of resistance. This is a call to action for integrating implementation science with critical philosophical and theoretical perspectives rooted in Black studies and related insights, which have been acquired through the struggle for social justice, to inform the design of implementation strategies and research projects that improve health services and health outcomes for health disparity populations.
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Affiliation(s)
- Cory D. Bradley
- Center for Dissemination and Implementation in the Institute for Public Health at Washington University School of Medicine in St. Louis, St. Louis, MO, United States
| | - Whitney C. Irie
- School of Social Work, Boston College, Chestnut Hill, MA, United States
| | - Elvin H. Geng
- Center for Dissemination and Implementation in the Institute for Public Health at Washington University School of Medicine in St. Louis, St. Louis, MO, United States
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20
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Dixon LB, Goldman HH, Talbott JA. Continuity and Change: 75 Years of Psychiatric Services. Psychiatr Serv 2024; 75:1-2. [PMID: 38161312 DOI: 10.1176/appi.ps.24075002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Affiliation(s)
- Lisa B Dixon
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, and Center for Practice Innovations, New York State Psychiatric Institute, New York City (Dixon); Department of Psychiatry, University of Maryland School of Medicine, Baltimore (Goldman, Talbott)
| | - Howard H Goldman
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, and Center for Practice Innovations, New York State Psychiatric Institute, New York City (Dixon); Department of Psychiatry, University of Maryland School of Medicine, Baltimore (Goldman, Talbott)
| | - John A Talbott
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, and Center for Practice Innovations, New York State Psychiatric Institute, New York City (Dixon); Department of Psychiatry, University of Maryland School of Medicine, Baltimore (Goldman, Talbott)
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21
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Tolliver DG, Hawks LC, Holaday LW, Wang EA. Exploring Parental Incarceration, US Government Support Programs, and Child Health and Well-Being: A National Cross-Sectional Study. J Pediatr 2024; 264:113764. [PMID: 37777171 DOI: 10.1016/j.jpeds.2023.113764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 09/12/2023] [Accepted: 09/25/2023] [Indexed: 10/02/2023]
Abstract
OBJECTIVES To describe relationships between parental incarceration and child health and flourishing-a measure of curiosity, resilience, and self-regulation-and to identify government programs that moderate this relationship. METHODS Using the National Survey of Children's Health data from 2016 through 2019 for children 6-17 years old, we estimated associations with logistic regression between parental incarceration and overall health and flourishing, adjusting for child, caregiver, and household factors. We secondarily examined physical health (asthma, headaches), mental health (attention deficit disorder/attention deficit hyperactivity disorder, depression), developmental needs (learning disability, special educational plan use), and educational (missing ≥11 school days, repeated grade) outcomes. We performed interaction analyses to determine whether government program participation (eg, free/reduced lunch, cash assistance) moderated relationships between parental incarceration and child outcomes. RESULTS Children with parental incarceration accounted for 9.3% of the sample (weighted n = 4 400 000). Black, American Indian/Alaska Native, and multiracial children disproportionately experienced parental incarceration. Parental incarceration was associated with worse health (aOR, 1.31; 95% CI, 1.11-1.55) and higher odds of not flourishing (aOR, 1.66; 95% CI, 1.46-1.89). Physical health, mental health, developmental issues, and educational needs were also associated with parental incarceration. Participation in free and reduced lunch moderated the relationships between parental incarceration and general health and flourishing, and cash assistance moderated the association between parental incarceration and flourishing. For each, parental incarceration had an attenuated association with health among people who participated in government programs. CONCLUSIONS Parental incarceration is disproportionately experienced by Black and Indigenous children and associated with worse child health and well-being. Government support program participation may mitigate negative associations between parental incarceration and child outcomes.
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Affiliation(s)
- Destiny G Tolliver
- Yale National Clinician Scholars Program, Yale School of Medicine, New Haven, CT.
| | - Laura C Hawks
- Division of General Internal Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - Louisa W Holaday
- Yale National Clinician Scholars Program, Yale School of Medicine, New Haven, CT; Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Emily A Wang
- Yale School of Medicine, New Haven, CT; SEICHE Center for Health and Justice, Yale School of Medicine, New Haven, CT
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22
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Jindal M, Chaiyachati KH, Fung V, Manson SM, Mortensen K. Eliminating health care inequities through strengthening access to care. Health Serv Res 2023; 58 Suppl 3:300-310. [PMID: 38015865 PMCID: PMC10684044 DOI: 10.1111/1475-6773.14202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2023] Open
Abstract
OBJECTIVE To provide a research agenda and recommendations to address inequities in access to health care. DATA SOURCES AND STUDY SETTING The Agency for Healthcare Research and Quality (AHRQ) organized a Health Equity Summit in July 2022 to evaluate what equity in access to health care means in the context of AHRQ's mission and health care delivery implementation portfolio. The findings are a result of this Summit, and subsequent convenings of experts on access and equity from academia, industry, and the government. STUDY DESIGN Multi-stakeholder input from AHRQ's Health Equity Summit, author consensus on a framework and key knowledge gaps, and summary of evidence from the supporting literature in the context of the framework ensure comprehensive recommendations. DATA COLLECTION/EXTRACTION METHODS Through a stakeholder-engaged process, themes were developed to conceptualize access with a lens toward health equity. A working group researched the most appropriate framework for access to care to classify limitations identified during the Summit and develop recommendations supported by research in the context of the framework. This strategy was intentional, as the literature on inequities in access to care may itself be biased. PRINCIPAL FINDINGS The Levesque et al. framework, which incorporates multiple dimensions of access (approachability, acceptability, availability, accommodation, affordability, and appropriateness), is the backdrop for framing research priorities for AHRQ. However, addressing inequities in access cannot be done without considering the roles of racism and intersectionality. Recommendations include funding research that not only measures racism within health care but also tests burgeoning anti-racist practices (e.g., co-production, provider training, holistic review, discrimination reporting, etc.), acting as a convener and thought leader in synthesizing best practices to mitigate racism, and forging the path forward for research on equity and access. CONCLUSIONS AHRQ is well-positioned to develop an action plan, strategically fund it, and convene stakeholders across the health care spectrum to employ these recommendations.
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Affiliation(s)
- Monique Jindal
- Department of Academic Internal MedicineUniversity of Illinois ChicagoChicagoIllinoisUSA
| | - Krisda H. Chaiyachati
- Verily, Inc.South San FranciscoCaliforniaUSA
- Perelman School of Medicine at the University of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Vicki Fung
- Department of Medicine, Harvard Medical School, Mongan InstituteMassachusetts General HospitalBostonMassachusettsUSA
| | - Spero M. Manson
- Centers for American Indian and Alaska Native HealthUniversity of Colorado Anschutz Medical CampusAuroraColoradoUSA
| | - Karoline Mortensen
- Department of Health Management and PolicyMiami Herbert Business SchoolCoral GablesFloridaUSA
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23
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Murry VM, Nyanamba JM, Hanebutt R, Debreaux M, Gastineau KAB, Goodwin AKB, Narisetti L. Critical examination of resilience and resistance in African American families: Adaptive capacities to navigate toxic oppressive upstream waters. Dev Psychopathol 2023; 35:2113-2131. [PMID: 37665095 DOI: 10.1017/s0954579423001037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/05/2023]
Abstract
African American families navigate not only everyday stressors and adversities but also unique sociocultural stressors (e.g., "toxic upstream waters" like oppression). These adverse conditions are consequences of the historical vestiges of slavery and Jim Crow laws, often manifested as inequities in wealth, housing, wages, employment, access to healthcare, and quality education. Despite these challenges, African American families have developed resilience using strength-based adaptive coping strategies, to some extent, to filter these waters. To advance the field of resilience research, we focused on the following questions: (1) what constitutes positive responses to adversity?; (2) how is resilience defined conceptually and measured operationally?; (3) how has the field of resilience evolved?; (4) who defines what, when, and how responses are manifestations of resilience, instead of, for example, resistance? How can resistance, which at times leads to positive adaptations, be incorporated into the study of resilience?; and (5) are there case examples that demonstrate ways to address structural oppression and the pernicious effects of racism through system-level interventions, thereby changing environmental situations that sustain toxic waters requiring acts of resilience to survive and thrive? We end by exploring how a re-conceptualization of resilience requires a paradigm shift and new methodological approaches to understand ways in which preventive interventions move beyond focusing on families' capacity to navigate oppression and target systems and structures that maintain these toxic waters.
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Affiliation(s)
- Velma McBride Murry
- Department of Human and Organizational Development, Vanderbilt University, Nashville, TN, USA
- Department of Health Policy, Vanderbilt University, Nashville, TN, USA
| | - Juliet M Nyanamba
- Department of Human and Organizational Development, Vanderbilt University, Nashville, TN, USA
| | - Rachel Hanebutt
- Department of Human and Organizational Development, Vanderbilt University, Nashville, TN, USA
| | - Marlena Debreaux
- Department of Human and Organizational Development, Vanderbilt University, Nashville, TN, USA
| | - Kelsey A B Gastineau
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Aijah K B Goodwin
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Lipika Narisetti
- Center for Medicine Health & Society, Vanderbilt University, Nashville, TN, USA
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Greene M, Houghtaling B, Sadeghzadeh C, De Marco M, Bryant D, Morgan R, Holston D. African Americans' perceptions of nutrition interventions: a scoping review. Nutr Res Rev 2023; 36:320-339. [PMID: 35514108 DOI: 10.1017/s0954422422000099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Nutrition education and policy, systems and environmental (PSE) change interventions may be able to address food insecurity and obesity, conditions which are disproportionately experienced by African Americans. Work that seeks to address these disparities and advance social justice should uplift and learn from participant voices, particularly from marginalised groups. This scoping review aimed to summarise the available literature describing African Americans' perceptions of and experiences participating in nutrition interventions. We conducted an electronic literature search with the assistance of a research librarian which encompassed six databases (MEDLINE, PyscINFO, Agricola, ERIC, SocINDEX and ProQuest Dissertations & Theses) and identified thirty-five sources meeting our inclusion criteria. The majority of studies assessing African Americans' satisfaction with interventions examined educational interventions alone, and about half of the included studies assessed satisfaction through quantitative methods alone. The only studies which found participants to be dissatisfied with interventions used qualitative methods and examined interventions providing education alone. Future work should evaluate African Americans' experience with nutrition-focused PSE changes, interventions which may be better able to address racial disparities in obesity and food insecurity. Nutrition educators working with African Americans should also consider evaluating future interventions using qualitative inquiry, to obtain an in-depth understanding of participant experiences with interventions.
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Affiliation(s)
- Matthew Greene
- School of Nutrition & Food Sciences, Louisiana State University (LSU) & LSU Agricultural Center, Baton Rouge, LA70803, USA
| | - Bailey Houghtaling
- School of Nutrition & Food Sciences, Louisiana State University (LSU) & LSU Agricultural Center, Baton Rouge, LA70803, USA
| | - Claire Sadeghzadeh
- Nutrition Department, Gillings School of Global Public Health & Center for Health Promotion & Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, NC27599, USA
| | - Molly De Marco
- Nutrition Department, Gillings School of Global Public Health & Center for Health Promotion & Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, NC27599, USA
| | - De'Jerra Bryant
- School of Nutrition & Food Sciences, Louisiana State University (LSU) & LSU Agricultural Center, Baton Rouge, LA70803, USA
| | - Randa Morgan
- Agriculture Librarian, LSU Libraries, Louisiana State University, Baton Rouge, LA70803, USA
| | - Denise Holston
- School of Nutrition & Food Sciences, Louisiana State University (LSU) & LSU Agricultural Center, Baton Rouge, LA70803, USA
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Keegan GE, Alexander R, Ogunnowo S, Brown I, Zakrison TL, Hoefer LE. Trauma as a Public Health Moment: Addressing Vaccine Uptake in Trauma Patients. Ann Surg Open 2023; 4:e356. [PMID: 38144493 PMCID: PMC10735124 DOI: 10.1097/as9.0000000000000356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Accepted: 09/28/2023] [Indexed: 12/26/2023] Open
Abstract
Objective Our objective was to identify factors associated with COVID-19 vaccination in trauma patients and to provide an opportunity for patients to engage in conversations about vaccination. Background The trauma surgery service offers a unique opportunity to promote preventative health interventions in hard-to-reach populations. Methods Trauma inpatients in Chicago, IL were recruited for this mixed-methods study from February 2022 to April 2022. Participants completed a survey on demographics, COVID-19 vaccination status, and Experiences of Discrimination Scale adapted for medical settings. Differences between vaccinated and unvaccinated patients were analyzed using the Wilcoxon-rank sum test. A semistructured, qualitative interview was completed. Qualitative data was transcribed and analyzed using Grounded Theory Methodology. Results Fifty-eight trauma patients were surveyed, representing 88% of patients approached. Only 23 (40%) patients reported full vaccination to COVID-19. Previous vaccination (at least 1 dose) was associated with greater concern for COVID-19 (OR 3.47, 95% CI 1.987-6.964, P < 0.001) and higher income (OR 1.21, 95% CI 1.02-1.44, P = 0.03). Higher Experiences of Discrimination Scale scores were associated with decreased likelihood of prior vaccination (OR 0.97, 95% CI 0.95-0.99, P = 0.04). On qualitative analysis, recurrent themes included vaccination motivated by either community-based or personal health-related values, and disinterest in vaccination based on perceived low need or skepticism of experimentation. Fifteen patients (26%) eligible for a vaccine dose consented to onsite vaccination after the survey. Conclusions Trauma patients who have experienced more discrimination in medical settings have lower rates of COVID-19 vaccination. Vaccination rates in our population were over 2 times lower than citywide rates, but admission to the trauma service can increase comprehensive care.
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Affiliation(s)
- Grace E Keegan
- From the Pritzker School of Medicine, University of Chicago, Chicago, IL
| | - Rachel Alexander
- From the Pritzker School of Medicine, University of Chicago, Chicago, IL
| | - Simi Ogunnowo
- From the Pritzker School of Medicine, University of Chicago, Chicago, IL
| | - Isaiah Brown
- From the Pritzker School of Medicine, University of Chicago, Chicago, IL
| | | | - Lea E Hoefer
- Department of Surgery, University of Chicago, Chicago, IL
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Gollust SE, Gansen C, Fowler EF, Moore S, Nagler RH. Polarized Perspectives on Health Equity: Results from a Nationally Representative Survey on U.S. Public Perceptions of COVID-19 Disparities in 2023. J Health Polit Policy Law 2023:11066304. [PMID: 37987174 DOI: 10.1215/03616878-11066304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2023]
Abstract
Republicans and Democrats responded in starkly different ways to the COVID-19 pandemic, from their attitudes in 2020 about whether the virus posed a threat to whether the pandemic ended in 2023. The consequences of COVID-19 for health equity has been a central concern in public health, and the concept of health equity has also been beset by partisan polarization. In this essay, we present and discuss nationally-representative survey data from 2023 on U.S. public perceptions of disparities in COVID-19 mortality (building on a multi-wave previous survey effort), as well as causal attributions for racial disparities, the contribution of structural racism, and broader attitudes about public health authority. We find anticipated gulfs in perspectives between Democrats on the one hand, and Independents and Republicans on the other. The results offer a somewhat pessimistic view on the likelihood of finding common ground in how the general public understands health inequities or the role of structural racism in perpetuating them. However, we show that those who acknowledge racial disparities in COVID-19 are more likely to support state public health authority to act for other infectious disease threats. We explore the implications of these public opinion data for advocacy, communication, and future needed research.
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Linde S, Walker RJ, Campbell JA, Egede LE. Historic Residential Redlining and Present-Day Social Determinants of Health, Home Evictions, and Food Insecurity within US Neighborhoods. J Gen Intern Med 2023; 38:3321-3328. [PMID: 37296361 PMCID: PMC10255945 DOI: 10.1007/s11606-023-08258-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 05/24/2023] [Indexed: 06/12/2023]
Abstract
OBJECTIVE Examine the association between historic residential redlining and present-day racial/ethnic composition of neighborhoods, racial/ethnic differences in social determinant of health domains, and risk of home evictions and food insecurity. RESEARCH DESIGN AND METHODS We examined data on 12,334 (for eviction sample), and 8996 (for food insecurity sample), census tracts in 213 counties across 37 states in the USA with data on exposure to historic redlining. First, we examined relationships between Home Owners' Loan Corporation (HOLC) redlining grades (A="Best", B="Still Desirable", C="Definitely Declining", D="Hazardous") and present-day racial/ethnic composition and racial/ethnic differences in social determinant of health domains of neighborhoods. Second, we examined whether historic redlining is associated with present-day home eviction rates (measured across eviction filings rates, and eviction judgment rates for 12,334 census tracts in 2018) and food insecurity (measured across low supermarket access, low supermarket access and income, low supermarket access and low car ownership for 8996 census tracts in 2019). Multivariable regression models were adjusted for census tract population, urban/rural designation, and county level fixed effects. RESULTS Relative to areas with a historic HOLC grading of "A (Best)", areas with a "D (Hazardous)" grading had a 2.59 (95%CI=1.99-3.19; p-value<0.01) higher rate of eviction filings, and a 1.03 (95%CI=0.80-1.27; p-value<0.01) higher rate of eviction judgments. Compared to areas with a historic HOLC grading of "A (Best)", areas rated with a "D (Hazardous)" had a 16.20 (95%CI=15.02-17.79; p-value<0.01) higher rate of food insecurity based on supermarket access and income, and a 6.15 (95%CI =5.53-6.76; p-value<0.01) higher rate of food insecurity based on supermarket access and car ownership. CONCLUSIONS Historic residential redlining is significantly associated with present-day home evictions and food insecurity, highlighting persistent associations between structural racism and present-day social determinants of health.
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Affiliation(s)
- Sebastian Linde
- Medical College of Wisconsin, Department of Medicine, Division of General Internal Medicine, Milwaukee, WI, USA
- Center for Advancing Population Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Rebekah J Walker
- Medical College of Wisconsin, Department of Medicine, Division of General Internal Medicine, Milwaukee, WI, USA
- Center for Advancing Population Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Jennifer A Campbell
- Medical College of Wisconsin, Department of Medicine, Division of General Internal Medicine, Milwaukee, WI, USA
- Center for Advancing Population Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Leonard E Egede
- Medical College of Wisconsin, Department of Medicine, Division of General Internal Medicine, Milwaukee, WI, USA.
- Center for Advancing Population Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
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Pichardo MS, Ferrucci LM, Molina Y, Esserman DA, Irwin ML. Structural Racism, Lifestyle Behaviors, and Obesity-related Cancers among Black and Hispanic/Latino Adults in the United States: A Narrative Review. Cancer Epidemiol Biomarkers Prev 2023; 32:1498-1507. [PMID: 37650844 PMCID: PMC10872641 DOI: 10.1158/1055-9965.epi-22-1147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 05/02/2023] [Accepted: 08/29/2023] [Indexed: 09/01/2023] Open
Abstract
One in three adults in the United States has obesity; a chronic disease that is implicated in the etiology of at least 14 cancers. Cancer is the leading cause of death among U.S. Hispanic/Latino adults and the second most common cause of death, after cardiovascular disease, for Black adults. Our country's legacy in overt discrimination (e.g., slavery, segregation) generated inequities across all spheres in which people function as defined by the socioecological model-biological, individual, community, structural-and two of the many areas in which it manifests today are the disproportionate burden of obesity and obesity-related cancers in populations of color. Inequities due to environmental, social, and economic factors may predispose individuals to poor lifestyle behaviors by hindering an individual's opportunity to make healthy lifestyles choices. In this review, we examined the evidence on obesity and the lifestyle guidelines for cancer prevention in relation to cancer risk and outcomes for Black and Hispanic/Latino adults. We also discussed the role of structural and societal inequities on the ability of these two communities to adopt and maintain healthful lifestyle behaviors in accordance with the lifestyle guidelines for cancer prevention and control.
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Affiliation(s)
- Margaret S. Pichardo
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, 06520
- Department of Surgery, Hospital of the University of Pennsylvania, University of Pennsylvania Health System, Philadelphia, PA 19104
| | - Leah M. Ferrucci
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, 06520
- Yale Cancer Center, New Haven, CT 06520
| | - Yamile Molina
- School of Public Health, University of Illinois Chicago and Cancer Center University of Illinois Chicago, 60607
| | - Denise A. Esserman
- Department of Biostatistics, Yale School of Public Health, New Haven, CT 06520
| | - Melinda L. Irwin
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, 06520
- Yale Cancer Center, New Haven, CT 06520
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Gotlieb EG, Blank L, Willis AW, Agarwal P, Jette N. Health equity integrated epilepsy care and research: A narrative review. Epilepsia 2023; 64:2878-2890. [PMID: 37725065 DOI: 10.1111/epi.17728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 07/11/2023] [Accepted: 07/26/2023] [Indexed: 09/21/2023]
Abstract
BACKGROUND With the unanimous approval of the Intersectoral Global Action Plan on epilepsy and other neurological disorders by the World Health Organization in May 2022, there are strong imperatives to work towards equitable neurological care. AIMS Using epilepsy as an entry point to other neurologic conditions, we discuss disparities faced by marginalized groups including racial/ethnic minorities, Americans living in rural communities, and Americans with low socioeconomic status. MATERIALS AND METHODS The National Institute on Minority Health Disparities Research Framework (NIMHD) was used to conduct a narrative review through a health equity lens to create an adapted framework for epilepsy and propose approaches to working towards equitable epilepsy and neurological care. RESULTS In this narrative review, we identified priority populations (racial and ethnic minority, rural-residing, and low socioeconomic status persons with epilepsy) and outcomes (likelihood to see a neurologist, be prescribed antiseizure medications, undergo epilepsy surgery, and be hospitalized) to explore disparities in epilepsy and guide our focused literature search using PubMed. In an adapted NIMHD framework, we examined individual, interpersonal, community, and societal level contributors to health disparities across five domains: (1) behavioral, (2) physical/built environment, (3) sociocultural, (4) environment, and (5) healthcare system. We take a health equity approach to propose initiatives that target modifiable factors that impact disparities and advocate for sustainable change for priority populations. DISCUSSION To improve equity, healthcare providers and relevant societal stakeholders can advocate for improved care coordination, referrals for epilepsy surgery, access to care, health informatics interventions, and education (i.e., to providers, patients, and communities). More broadly, stakeholders can advocate for reforms in medical education, and in the American health insurance landscape. CONCLUSIONS Equitable healthcare should be a priority in neurological care.
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Affiliation(s)
- Evelyn G Gotlieb
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Leah Blank
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Department of Population, Health Science and Policy and Institute for Healthcare Delivery Science, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Allison W Willis
- Departments of Neurology and Biostatistics, Epidemiology and Informatics, University of Pennsylvania
- Leonard Davis Institute, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Parul Agarwal
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Department of Population, Health Science and Policy and Institute for Healthcare Delivery Science, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Nathalie Jette
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Department of Population, Health Science and Policy and Institute for Healthcare Delivery Science, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
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Porter JM, Castrucci BC, Orr JY. What's Missing from Data Modernization? A Focus on Structural Racism. Health Equity 2023; 7:699-702. [PMID: 37908401 PMCID: PMC10615079 DOI: 10.1089/heq.2023.0086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/08/2023] [Indexed: 11/02/2023] Open
Abstract
Public health data modernization efforts frequently overlook the far-reaching effects of structural racism across the data life cycle. Modernizing data requires creating data ecosystems grounded in six principles: dismantling structural racism and building community power explicitly; centering justice in all stages of data collection and analysis; ensuring communities can govern their data; driving positive population-level change; engaging nonprofit organizations; and obtaining commitments from governments to make changes in policy and practice. As government agencies spearhead and finance data modernization initiatives, it is imperative that they address structural racism head-on and integrate these principles into all aspects of their work.
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Affiliation(s)
- Jamila M. Porter
- Office of the CEO, de Beaumont Foundation, Bethesda, Maryland, USA
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31
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Small LA, Godoy SM, Lau C. Perceptions of healthcare accessibility and medical mistrust among Black women living with HIV in the USA. Cult Health Sex 2023; 25:1295-1309. [PMID: 36571392 PMCID: PMC10558086 DOI: 10.1080/13691058.2022.2155706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 12/02/2022] [Indexed: 06/17/2023]
Abstract
Black women living with HIV in the USA frequently endure structural racism, racial biases and discrimination in healthcare that affect their access to care. To explore their experiences in healthcare settings as they relate to HIV-treatment accessibility and medical mistrust we used intersectionality and structural intersectionality as guiding frameworks. Four focus groups were conducted with 20 low-income Black women living with HIV in a large urban region. Using thematic analysis, we identified four themes: (1) multilevel stigma and discrimination; (2) medical mistrust of providers across multiple settings; (3) varying responses to stigma, discrimination, and medical mistrust; and (4) preferences for patient-provider relationships. Participants described how medical providers, nurses and other healthcare staff perpetuated negative treatment, including multiple forms of discrimination and stigmatisation based on their HIV diagnosis, race, class and gender. The stigma, discrimination and resulting mistrust experienced often caused hurt feelings and decisions to disengage from treatment or remain with providers while feeling unwelcome. Participants described the strong desire to feel seen, supported and validated by healthcare providers. Narratives reveal that feelings of being discriminated against can cultivate mistrust not only towards doctors, but other provider types and settings. Findings can inform care models for low-income Black women living with HIV.
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Affiliation(s)
- Latoya A. Small
- Luskin School of Public Affairs, Department of Social Welfare, University of California, Los Angeles, California, USA
| | - Sarah M. Godoy
- School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Caitlin Lau
- Luskin School of Public Affairs, Department of Social Welfare, University of California, Los Angeles, California, USA
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32
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Adkins-Jackson PB, Kraal AZ, Hill-Jarrett TG, George KM, Deters KD, Besser LM, Avila-Rieger JF, Turney I, Manly JJ. Riding the merry-go-round of racial disparities in ADRD research. Alzheimers Dement 2023; 19:4735-4742. [PMID: 37394968 DOI: 10.1002/alz.13359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 05/29/2023] [Accepted: 05/30/2023] [Indexed: 07/04/2023]
Abstract
INTRODUCTION With the rapid expansion of the aging population, the burden of Alzheimer's disease related dementias (ADRD) is anticipated to increase in racialized and minoritized groups who are at disproportionately higher risk. To date, research emphasis has been on further characterizing the existence of racial disparities in ADRD through comparisons to groups racialized as White that are assumed to be normative. Much of the literature on this comparison insinuates that racialized and minoritized groups experience poorer outcomes due to genetics, culture, and/or health behaviors. METHODS This perspective shines a light on a category of ADRD research that employs ahistorical methodological approaches to describe racial disparities in ADRD that puts us on a merry-go-round of research with no benefits to society. METHODS This commentary provides historical context for the use of race in ADRD research and justification for the study of structural racism. The commentary concludes with recommendations to guide future research.
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Affiliation(s)
- Paris B Adkins-Jackson
- Departments of Epidemiology & Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - A Zarina Kraal
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA
| | - Tanisha G Hill-Jarrett
- Department of Neurology, Memory and Aging Center, University of California San Francisco, San Francisco, California, USA
| | - Kristen M George
- Department of Public Health Sciences, University of California Davis School of Medicine, Davis, California, USA
| | - Kacie D Deters
- Department of Integrative Biology and Physiology, University of California Los Angeles, Los Angeles, California, USA
| | - Lilah M Besser
- Comprehensive Center for Brain Health, University of Miami Miller School of Medicine, Boca Raton, Florida, USA
| | - Justina F Avila-Rieger
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA
| | - Indira Turney
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA
| | - Jennifer J Manly
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA
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Higginbotham EJ, Hertz K, Fahl C, Duckett DB, Mahoney K, Jameson JL. Addressing Structural Racism Using a Whole-Scale Planning Process in a Single Academic Center. Health Equity 2023; 7:487-496. [PMID: 37731779 PMCID: PMC10507939 DOI: 10.1089/heq.2023.0093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2023] [Indexed: 09/22/2023] Open
Abstract
Purpose The murder of George Floyd in 2020 prompted a national demand for cultural transformation to confront the systemic racism prevalent in the country. Academic medical centers were not exempt from this urgent call. This article evaluates the efficacy of a strategic process in fostering cultural transformation within an academic medical system. Methods A whole-scale strategic planning process was implemented over 13 months, involving multiple working groups representing key stakeholders from each entity across the system, an anonymous survey, a communication plan, and a balanced scorecard to monitor progress. More than 5500 voices, 160 recommendations, 122 data gathering sessions, and town hall meetings contributed to the creation and implementation of vital action items and a strategic framework. The Diversity Engagement Survey (DES) was administered 18 months following the process launch. Results Of the 45,554 employees, students, faculty, and trainees, 96.5% completed unconscious bias education within the fiscal year and 76% of action items, termed "Just Do Its," were completed. Mission, vision, values, and strategic priorities were crafted to serve as a framework for intermediate and long-term actions. The DES revealed improvement in the "respect" attribute of an inclusive culture, and 64% of respondents confirmed that action for cultural transformation is addressing racism both within and outside of the institution. Conclusion Implementing a shared purpose, engaging multiple working groups representing key stakeholders, and empowerment of stakeholders to implement changes, in conjunction with the development of a strategic framework addressing structural racism, resulted in the completion of vital action items to initiate cultural change.
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Affiliation(s)
- Eve J. Higginbotham
- Perelman School of Medicine, Office of the Dean, Department of Ophthalmology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Kya Hertz
- Perelman School of Medicine, Office of the Dean, Department of Ophthalmology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Corrinne Fahl
- Perelman School of Medicine, Office of the Dean, Department of Ophthalmology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Dwaine B. Duckett
- Perelman School of Medicine, Office of the Dean, Department of Ophthalmology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Kevin Mahoney
- Perelman School of Medicine, Office of the Dean, Department of Ophthalmology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - J. Larry Jameson
- Perelman School of Medicine, Office of the Dean, Department of Ophthalmology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Bryant AS, Healey JA, Wilkie S, Carten C, Sequist TD, Taveras EM. A Health System Framework for Addressing Structural Racism: Mass General Brigham's United Against Racism Initiative. Health Equity 2023; 7:533-542. [PMID: 37736521 PMCID: PMC10510684 DOI: 10.1089/heq.2023.0077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/03/2023] [Indexed: 09/23/2023] Open
Abstract
The legacy of racism and structural inequality has taken a heavy toll on the health care system and the health outcomes of patients and members of community catchment areas. To achieve optimal health outcomes for all, health systems will need to enact structural change that is meaningful, measurable, and rooted in evidence. We describe an antiracism campaign organized into three pillars of focus (Leadership/Employees/Culture, Patient Care Equity, and Community Health and Policy Advocacy) and implemented across Mass General Brigham, a large integrated health system in the northeast of the United States. Our study ranges from the foundational to the aspirational and examples of data-driven areas of focus, programs (e.g., staff education, social risk mitigation, and new models of clinical service), and metrics developed for the health care workforce, patients, and surrounding communities are presented.
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Affiliation(s)
- Allison S. Bryant
- Mass General Brigham Health System, Somerville, Massachusetts, USA
- Massachusetts General Hospital, Boston, Massachusetts, USA
| | | | - Sarah Wilkie
- Mass General Brigham Health System, Somerville, Massachusetts, USA
| | - Carla Carten
- Mass General Brigham Health System, Somerville, Massachusetts, USA
| | - Thomas D. Sequist
- Mass General Brigham Health System, Somerville, Massachusetts, USA
- Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Elsie M. Taveras
- Mass General Brigham Health System, Somerville, Massachusetts, USA
- Massachusetts General Hospital, Boston, Massachusetts, USA
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35
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Cersonsky TEK, Ayala NK, Pinar H, Dudley DJ, Saade GR, Silver RM, Lewkowitz AK. Identifying risk of stillbirth using machine learning. Am J Obstet Gynecol 2023; 229:327.e1-327.e16. [PMID: 37315754 PMCID: PMC10527568 DOI: 10.1016/j.ajog.2023.06.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 06/08/2023] [Accepted: 06/09/2023] [Indexed: 06/16/2023]
Abstract
BACKGROUND Previous predictive models using logistic regression for stillbirth do not leverage the advanced and nuanced techniques involved in sophisticated machine learning methods, such as modeling nonlinear relationships between outcomes. OBJECTIVE This study aimed to create and refine machine learning models for predicting stillbirth using data available before viability (22-24 weeks) and throughout pregnancy, as well as demographic, medical, and prenatal visit data, including ultrasound and fetal genetics. STUDY DESIGN This is a secondary analysis of the Stillbirth Collaborative Research Network, which included data from pregnancies resulting in stillborn and live-born infants delivered at 59 hospitals in 5 diverse regions across the United States from 2006 to 2009. The primary aim was the creation of a model for predicting stillbirth using data available before viability. Secondary aims included refining models with variables available throughout pregnancy and determining variable importance. RESULTS Among 3000 live births and 982 stillbirths, 101 variables of interest were identified. Of the models incorporating data available before viability, the random forests model had 85.1% accuracy (area under the curve) and high sensitivity (88.6%), specificity (85.3%), positive predictive value (85.3%), and negative predictive value (84.8%). A random forests model using data collected throughout pregnancy resulted in accuracy of 85.0%; this model had 92.2% sensitivity, 77.9% specificity, 84.7% positive predictive value, and 88.3% negative predictive value. Important variables in the previability model included previous stillbirth, minority race, gestational age at the earliest prenatal visit and ultrasound, and second-trimester serum screening. CONCLUSION Applying advanced machine learning techniques to a comprehensive database of stillbirths and live births with unique and clinically relevant variables resulted in an algorithm that could accurately identify 85% of pregnancies that would result in stillbirth, before they reached viability. Once validated in representative databases reflective of the US birthing population and then prospectively, these models may provide effective risk stratification and clinical decision-making support to better identify and monitor those at risk of stillbirth.
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Affiliation(s)
- Tess E K Cersonsky
- Department of Obstetrics & Gynecology, Women & Infants Hospital of Rhode Island, Warren Alpert Medical School of Brown University, Providence, RI.
| | - Nina K Ayala
- Department of Obstetrics & Gynecology, Women & Infants Hospital of Rhode Island, Warren Alpert Medical School of Brown University, Providence, RI
| | - Halit Pinar
- Department of Pathology, Women & Infants Hospital of Rhode Island, Warren Alpert Medical School of Brown University, Providence, RI
| | - Donald J Dudley
- Department of Obstetrics & Gynecology, University of Virginia, Charlottesville, VA
| | - George R Saade
- Department of Obstetrics & Gynecology, Eastern Virginia Medical School, Norfolk, VA
| | - Robert M Silver
- Department of Obstetrics & Gynecology, University of Utah Health, Salt Lake City, UT
| | - Adam K Lewkowitz
- Department of Obstetrics & Gynecology, Women & Infants Hospital of Rhode Island, Warren Alpert Medical School of Brown University, Providence, RI
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Macias-Konstantopoulos WL, Collins KA, Diaz R, Duber HC, Edwards CD, Hsu AP, Ranney ML, Riviello RJ, Wettstein ZS, Sachs CJ. Race, Healthcare, and Health Disparities: A Critical Review and Recommendations for Advancing Health Equity. West J Emerg Med 2023; 24:906-918. [PMID: 37788031 PMCID: PMC10527840 DOI: 10.5811/westjem.58408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 04/17/2023] [Accepted: 05/24/2023] [Indexed: 10/04/2023] Open
Abstract
An overwhelming body of evidence points to an inextricable link between race and health disparities in the United States. Although race is best understood as a social construct, its role in health outcomes has historically been attributed to increasingly debunked theories of underlying biological and genetic differences across races. Recently, growing calls for health equity and social justice have raised awareness of the impact of implicit bias and structural racism on social determinants of health, healthcare quality, and ultimately, health outcomes. This more nuanced recognition of the role of race in health disparities has, in turn, facilitated introspective racial disparities research, root cause analyses, and changes in practice within the medical community. Examining the complex interplay between race, social determinants of health, and health outcomes allows systems of health to create mechanisms for checks and balances that mitigate unfair and avoidable health inequalities. As one of the specialties most intertwined with social medicine, emergency medicine (EM) is ideally positioned to address racism in medicine, develop health equity metrics, monitor disparities in clinical performance data, identify research gaps, implement processes and policies to eliminate racial health inequities, and promote anti-racist ideals as advocates for structural change. In this critical review our aim was to (a) provide a synopsis of racial disparities across a broad scope of clinical pathology interests addressed in emergency departments-communicable diseases, non-communicable conditions, and injuries-and (b) through a race-conscious analysis, develop EM practice recommendations for advancing a culture of equity with the potential for measurable impact on healthcare quality and health outcomes.
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Affiliation(s)
- Wendy L Macias-Konstantopoulos
- Center for Social Justice and Health Equity, Department of Emergency Medicine, Boston, Massachusetts
- Harvard Medical School, Department of Emergency Medicine, Boston, Massachusetts
| | | | - Rosemarie Diaz
- University of California-Los Angeles, Department of Emergency Medicine, Los Angeles, California
| | - Herbert C Duber
- University of Washington School of Medicine, Department of Emergency Medicine, Seattle, Washington
- Washington State Department of Health, Tumwater, Washington
| | - Courtney D Edwards
- Samford University, Moffett & Sanders School of Nursing, Birmingham, Alabama
| | - Antony P Hsu
- Trinity Health Ann Arbor Hospital, Department of Emergency Medicine, Ypsilanti, Michigan
| | - Megan L Ranney
- Yale University, Yale School of Public Health, New Haven, Connecticut
| | - Ralph J Riviello
- University of Texas Health San Antonio, Department of Emergency Medicine, San Antonio, Texas
| | - Zachary S Wettstein
- University of Washington School of Medicine, Department of Emergency Medicine, Seattle, Washington
| | - Carolyn J Sachs
- Ronald Reagan-UCLA Medical Center and David Geffen School of Medicine at University of California-Los Angeles, Department of Emergency Medicine, Los Angeles, California
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Singleton CR, Wright LA, McDonald M, Archer IG, Bell CN, McLoughlin GM, Houghtaling B, Cooksey Stowers K, Anderson Steeves E. Structural racism and geographic access to food retailers in the United States: A scoping review. Health Place 2023; 83:103089. [PMID: 37557002 DOI: 10.1016/j.healthplace.2023.103089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 05/16/2023] [Accepted: 07/17/2023] [Indexed: 08/11/2023]
Abstract
This scoping review summarized findings and key measures from U.S.-based studies that 1) examined associations between geographic indicators of structural racism (e.g., redlining, racial segregation) and access to food retailers (e.g., supermarkets, convenience stores) or 2) documented disparities in access by neighborhood racial/ethnic composition. In 2022, relevant scientific literature was reviewed using Covidence software. Independent reviewers examined 13,069 citations; 163 citations advanced to the full-text review stage and 70 were selected for inclusion. Twenty-one studies (30%) linked one or more indicator of structural racism to food retailer access while 49 (70%) solely examined differences in access by neighborhood racial/ethnic composition. All studies featuring indicators of structural racism reported significant findings; however, indicators varied across studies making it difficult to make direct comparisons. Key indicators of structural racism in the food access literature included redlining (n = 3), gentrification (n = 3), and racial segregation (n = 4). Many U.S.-based studies have evaluated food retailer access by neighborhood racial/ethnic composition. Moving forward, studies should model indicators of structural racism and determine their influence on geographic access to large and small food retailers.
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Affiliation(s)
- Chelsea R Singleton
- Department of Social, Behavioral, and Population Sciences, Tulane School of Public Health & Tropical Medicine, New Orleans, LA, USA.
| | - Laura A Wright
- Rudolph Matas Library of the Health Sciences, Tulane University, New Orleans, LA, USA
| | - Meredith McDonald
- Department of Social, Behavioral, and Population Sciences, Tulane School of Public Health & Tropical Medicine, New Orleans, LA, USA
| | - Isabel G Archer
- Department of Social, Behavioral, and Population Sciences, Tulane School of Public Health & Tropical Medicine, New Orleans, LA, USA
| | - Caryn N Bell
- Department of Social, Behavioral, and Population Sciences, Tulane School of Public Health & Tropical Medicine, New Orleans, LA, USA
| | - Gabriella M McLoughlin
- Department of Social and Behavioral Sciences, College of Public Health, Temple University, Philadelphia, PA, USA; Implementation Science Center for Cancer Control, Washington University in St. Louis, St. Louis, MO, USA
| | - Bailey Houghtaling
- Gretchen Swanson Center for Nutrition, Omaha, NE, USA; Department of Human Nutrition, Foods, and Exercise, Virginia Tech, Blacksburg, VA, USA
| | - Kristen Cooksey Stowers
- Department of Allied Health Sciences, College of Agriculture, Health, And Natural Resources, University of Connecticut, Storrs, CT, USA
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SCHLAFF ANTHONYL, AMUTAH‐ONUKAGHA NDIDIAMAKAN, MABIALA DORCAS, KAMRUDDIN JASMIN, ONA FERNANDOF. Can US Medical Schools Teach About Structural Racism? Milbank Q 2023; 101:975-998. [PMID: 37082794 PMCID: PMC10509511 DOI: 10.1111/1468-0009.12650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 02/15/2023] [Accepted: 03/28/2023] [Indexed: 04/22/2023] Open
Abstract
Policy Points There need to be sweeping changes to medical school curricula that addresses structural racism in medicine and how to attend to this in medical practice. The Liaison Committee on Medical Education should develop and promulgate specific learning objectives and curricular offerings that require medical schools to teach about structural racism and antiracist medical practice in ways that are robust and standardized. The federal government, through the Health Resources and Services Administration, should prioritize support for antiracism education in medical schools, residency, and continuing medical education in similar ways and with similar effort in scale and scope to its support for primary care, providing technical assistance and grants for programs across the educational spectrum that provide antiracist training. State governments should mandate, as part of continuing education requirements for physicians, 2 or more hours per recertification cycle of antiracist training. CONTEXT Since the beginning of COVID-19 and the rise of social justice movements sparked by the murders of George Floyd and Breonna Taylor in the summer of 2020, many medical schools have made public statements committing themselves to become antiracist institutions. The notions that US society generally, and medicine, are rife with structural racism no longer seems as controversial in the academic community. Challenges remain, however, in how this basic understanding gets translated into medical education practice. Understanding where the profession must go should start with understanding where we currently are. METHODS Prior to the events of 2020, in the spring of 2018, we conducted nine key informant interviews to learn about the challenges and best practices from schools deemed to be positive deviants in teaching about structural racism. FINDINGS Our interviews showed that even those schools deemed positive deviants in the amount of teaching done about structural racism faced significant barriers in providing a robust education. CONCLUSIONS Significant structural change, perhaps far beyond what most schools consider themselves willing and able to engage in, will be necessary if future US physicians are to fully understand and address structural racism as it affects their profession, their practice, and their patients.
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Elston DM, Grant-Kels JM, Levin NA, Alam M, Brodell RT, Fernandez AP, Flamm A, Hurley MY, Ratner D, Schaffer JV, Peebles K, Alexis AF, James AJ. Letter from the journal: Improving diagnostic acumen and patient outcomes. J Am Acad Dermatol 2023; 89:471-472. [PMID: 37172734 DOI: 10.1016/j.jaad.2023.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 05/05/2023] [Indexed: 05/15/2023]
Affiliation(s)
- Dirk M Elston
- Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina, Charleston, South Carolina.
| | - Jane M Grant-Kels
- University of Connecticut Health Center, Farmington, Connecticut; Department of Dermatology, University of Florida, Gainesville, Florida
| | - Nikki A Levin
- Department of Dermatology, University of Massachusetts Chan Medical School, Worcester, Massachusetts
| | - Murad Alam
- Department of Dermatology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - Robert T Brodell
- Departments of Dermatology and Pathology, University of Mississippi Medical Center, Jackson, Mississippi; Sonny Montgomery Veterans Administration Hospital, Jackson, Mississippi
| | | | - Alexandra Flamm
- Department of Dermatology, New York University, New York, New York
| | - M Yadira Hurley
- Department of Dermatology, Saint Louis University, Saint Louis, Missouri
| | - Desiree Ratner
- Department of Dermatology, NYU Grossman School of Medicine, New York, New York
| | - Julie V Schaffer
- Division of Pediatric Dermatology and Department of Pediatrics, Hackensack University Medical Center, Hackensack, New Jersey
| | - Klint Peebles
- Department of Dermatology, Kaiser Permanente Mid-Atlantic Permanente Medical Group, Rockville, Maryland
| | | | - Alaina J James
- Department of Dermatology, University of Pittsburgh School of Medicine / University of Pittsburgh Medical Center, Pittsburgh, Pittsburgh
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Hassan A, Ojanen-Goldsmith A, Hing AK, Mahoney M, Traxler S, Boraas CM. More than tears: associations between exposure to chemical agents used by law enforcement and adverse reproductive health outcomes. Front Epidemiol 2023; 3:1177874. [PMID: 38516336 PMCID: PMC10956352 DOI: 10.3389/fepid.2023.1177874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 07/17/2023] [Indexed: 03/23/2024]
Abstract
Despite routine law enforcement use of chemical agents for crowd control, the reproductive health safety profiles of these products are unknown. Moreover, limited evidence has documented a link between such exposures and adverse reproductive health outcomes including abnormal uterine bleeding and potential pregnancy disruption. This cross-sectional study examined reproductive outcomes in adults with uteri exposed to chemical agents used by law enforcement, more commonly known as "tear gas". Participants were recruited through social media in the wake of police violence protests. Of the 1,276 participants included in analysis, 83% reported experiencing at least one of the outcomes of interest, included uterine cramping (69%), early menstrual bleeding (55%), breast tenderness (30%), and delayed menstrual bleeding (19%). Chemical agent exposure was significantly associated with higher odds of an adverse reproductive health outcome, those with 5 days or more of exposure have 2.6 times the odds (CI: 1.61, 4.22) of adverse outcomes and having a perception that one's menstruation may fluctuate according to psychosocial stressors was associated (OR = 1.94, CI: 1.36, 2.79) with a higher odds of an adverse reproductive health experience. These findings suggest a potential relationship between exposure to chemical agents and adverse reproductive health outcomes. Given the pervasive use of these chemical agents and their potential for reproductive health harm, further investigation into the safety of these products and their impacts on individual and community health is warranted urgently.
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Affiliation(s)
- Asha Hassan
- Research Division, Planned Parenthood North Central States, Minneapolis, MN, United States
- Center for Antiracism Research for Health Equity, University of Minnesota School of Public Health, Minneapolis, MN, United States
| | | | - Anna K. Hing
- Center for Antiracism Research for Health Equity, University of Minnesota School of Public Health, Minneapolis, MN, United States
| | - Madeline Mahoney
- Research Division, Planned Parenthood North Central States, Minneapolis, MN, United States
| | - Sarah Traxler
- Research Division, Planned Parenthood North Central States, Minneapolis, MN, United States
| | - Christy M. Boraas
- Research Division, Planned Parenthood North Central States, Minneapolis, MN, United States
- Department of Obstetrics, Gynecology, and Women’s Health, University of Minnesota Medical School, Minneapolis, MN, United States
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Miller-Kleinhenz JM, Moubadder L, Beyer KM, Zhou Y, Gaglioti AH, Collin LJ, Gohar J, Do W, Conneely K, Krishnamurti U, Gogineni K, Gabram-Mendola S, D’Angelo O, Henry K, Torres M, McCullough LE. Redlining-associated methylation in breast tumors: the impact of contemporary structural racism on the tumor epigenome. Front Oncol 2023; 13:1154554. [PMID: 37621676 PMCID: PMC10446968 DOI: 10.3389/fonc.2023.1154554] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 07/17/2023] [Indexed: 08/26/2023] Open
Abstract
Purpose Place-based measures of structural racism have been associated with breast cancer mortality, which may be driven, in part, by epigenetic perturbations. We examined the association between contemporary redlining, a measure of structural racism at the neighborhood level, and DNA methylation in breast tumor tissue. Methods We identified 80 Black and White women diagnosed and treated for a first-primary breast cancer at Emory University Hospitals (2008-2017). Contemporary redlining was derived for census tracts using the Home Mortgage Disclosure Act database. Linear regression models were used to calculate the association between contemporary redlining and methylation in breast tumor tissue. We also examined epigenetic age acceleration for two different metrics, regressing β values for each cytosine-phosphate-guanine dinucleotide (CpG) site on redlining while adjusting for covariates. We employed multivariable Cox-proportional hazards models and 95% confidence intervals (CI) to estimate the association between aberrant methylation and mortality. Results Contemporary redlining was associated with 5 CpG sites after adjustment for multiple comparisons (FDR<0.10). All genes were implicated in breast carcinogenesis, including genes related to inflammation, immune function and stress response (ANGPT1, PRG4 and PRG4). Further exploration of the top 25 CpG sites, identified interaction of 2 sites (MRPS28 and cg11092048) by ER status and 1 site (GDP1) was associated with all-cause mortality. Contemporary redlining was associated with epigenetic age acceleration by the Hannum metric (β=5.35; CI 95%=0.30,10.4) and showed positive but non-significant correlation with the other clock. Conclusion We identified novel associations between neighborhood contemporary redlining and the breast tumor DNA methylome, suggesting that racist policies leading to inequitable social and environmental exposures, may impact the breast tumor epigenome. Additional research on the potential implications for prognosis is needed.
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Affiliation(s)
| | - Leah Moubadder
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA, United States
| | - Kirsten M. Beyer
- Division of Epidemiology, Institute for Health & Society, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Yuhong Zhou
- Division of Epidemiology, Institute for Health & Society, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Anne H. Gaglioti
- National Center for Primary Care, Department of Family Medicine, Morehouse School of Medicine, Atlanta, GA, United States
- Center for Health Integration, Population Health Research Institute at The MetroHealth System, Case Western Reserve University, Cleveland, OH, United States
| | - Lindsay J. Collin
- Department of Population Health Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, United States
| | - Jazib Gohar
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA, United States
| | - Whitney Do
- Department of Global Health, Emory University Rollins School of Public Health, Atlanta, GA, United States
- Nutrition and Health Sciences Program, Laney Graduate School, Atlanta, GA, United States
| | - Karen Conneely
- Department of Human Genetics, Emory University School of Medicine, Atlanta, GA, United States
| | - Uma Krishnamurti
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA, United States
| | - Keerthi Gogineni
- Department of Medical Oncology, Emory University School of Medicine, Atlanta, GA, United States
| | | | - Olivia D’Angelo
- Department of Surgery, Jackson Memorial Hospital/University of Miami Miller School of Medicine, Miami, FL, United States
| | - Kashari Henry
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA, United States
| | - Mylin Torres
- Department of Radiation Oncology, Emory University School of Medicine, Atlanta, GA, United States
| | - Lauren E. McCullough
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA, United States
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Sharareh N, Bybee S, Goldstein E, Jones S, Hess R, Wallace A, Seligman H, Wilson FA. Disparities in food insecurity between sexual minority and heterosexual adults - a higher burden on bisexual individuals. Front Public Health 2023; 11:1237091. [PMID: 37608986 PMCID: PMC10441544 DOI: 10.3389/fpubh.2023.1237091] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 07/24/2023] [Indexed: 08/24/2023] Open
Abstract
Background Sexual minorities-individuals who identify as gay/lesbian, bisexual, or other non-heterosexual individuals-experience higher rates of food insecurity (FI) compared to heterosexual individuals. During the COVID-19 pandemic, discrimination and structural racism, which are known risk factors for food insecurity, were perpetuated against sexual and racial/ethnic minorities. However, to our knowledge, a nationally representative analysis of the impact of the pandemic on food insecurity by sexual minority status and based on race/ethnicity is missing. We aimed to determine the degree of association between FI and sexual minority adults overall, before (2019) and during (2020-2021) the pandemic, and stratified by race/ethnicity. Methods We used nationally representative data from the 2019-2021 National Health Interview Survey (NHIS). We specified multivariable logistic regression models to determine the association between FI and identifying as a sexual minority adult (≥18 years old), including gay/lesbian, bisexual, and other non-heterosexual individuals. Results Overall, we only observed FI disparities between bisexuals and heterosexuals (aOR 1.61 [95% CI 1.31-1.99]). Stratified by year, this association was significant only during the pandemic. Stratified by race/ethnicity, non-Hispanic white and non-Hispanic black individuals identifying as bisexual also experienced a significantly higher FI rate than their heterosexual counterparts. Conclusion Our results may be a manifestation of the disproportionate impact of discrimination on bisexual individuals' FI experiences. With the growing number of legislative bills targeting the rights of sexual minorities, we expect to see a higher burden of FI among bisexuals, particularly, bisexual people of color. Future intersectional research regarding FI among bisexual and racial/ethnic minority individuals would further elucidate how membership in multiple minority groups may contribute to a higher risk of FI.
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Affiliation(s)
- Nasser Sharareh
- Department of Population Health Sciences, Spence Fox Eccles School of Medicine, University of Utah, Salt Lake City, UT, United States
| | - Sara Bybee
- College of Nursing, University of Utah, Salt Lake City, UT, United States
| | - Evan Goldstein
- Department of Population Health Sciences, Spence Fox Eccles School of Medicine, University of Utah, Salt Lake City, UT, United States
| | - Shannon Jones
- Department of Nutrition and Integrative Physiology, University of Utah, Salt Lake City, UT, United States
| | - Rachel Hess
- Department of Population Health Sciences, Spence Fox Eccles School of Medicine, University of Utah, Salt Lake City, UT, United States
| | - Andrea Wallace
- Department of Population Health Sciences, Spence Fox Eccles School of Medicine, University of Utah, Salt Lake City, UT, United States
- College of Nursing, University of Utah, Salt Lake City, UT, United States
| | - Hilary Seligman
- Department of Medicine, School of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Fernando A. Wilson
- Department of Population Health Sciences, Spence Fox Eccles School of Medicine, University of Utah, Salt Lake City, UT, United States
- Matheson Center for Health Care Studies, University of Utah, Salt Lake City, UT, United States
- Department of Economics, College of Social and Behavioral Science, University of Utah, Salt Lake City, UT, United States
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Caqueo-Urízar A, Irarrázaval M. Invited Commentary: Improving Instruments to Counter the Bias in Their Construction. Am J Epidemiol 2023; 192:1274-1275. [PMID: 36929419 DOI: 10.1093/aje/kwad063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 12/07/2022] [Accepted: 01/10/2023] [Indexed: 03/18/2023] Open
Abstract
In this issue of the Journal, Villalonga-Olives et al. (Am J Epidemiol. 2023;192(8):1264-1273) examined the psychometric properties of social capital indicators, comparing responses from Black and White people to identify whether there was differential item functioning (DIF) in social capital by race, and also when stratified by educational attainment, as a measure of socioeconomic status. The authors tested whether there is DIF in social capital items between Black and White people and found that DIF across these items was significant although not large, but they were still indicative of measurement error, which they suspected was related to the way these items were developed-that is, based on cultural assumptions tested in mainstream White America. However, some gaps remain to be fleshed out.
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Wispelwey B, Tanous O, Asi Y, Hammoudeh W, Mills D. Because its power remains naturalized: introducing the settler colonial determinants of health. Front Public Health 2023; 11:1137428. [PMID: 37533522 PMCID: PMC10393129 DOI: 10.3389/fpubh.2023.1137428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 05/23/2023] [Indexed: 08/04/2023] Open
Abstract
Indigenous people suffer earlier death and more frequent and severe disease than their settler counterparts, a remarkably persistent reality over time, across settler colonized geographies, and despite their ongoing resistance to elimination. Although these health inequities are well-known, they have been impervious to comprehensive and convincing explication, let alone remediation. Settler colonial studies, a fast-growing multidisciplinary and interdisciplinary field, is a promising candidate to rectify this impasse. Settler colonialism's relationship to health inequity is at once obvious and incompletely described, a paradox arising from epistemic coloniality and perceived analytic challenges that we address here in three parts. First, in considering settler colonialism an enduring structure rather than a past event, and by wedding this fundamental insight to the ascendant structural paradigm for understanding health inequities, a picture emerges in which this system of power serves as a foundational and ongoing configuration determining social and political mechanisms that impose on human health. Second, because modern racialization has served to solidify and maintain the hierarchies of colonial relations, settler colonialism adds explanatory power to racism's health impacts and potential amelioration by historicizing this process for differentially racialized groups. Finally, advances in structural racism methodologies and the work of a few visionary scholars have already begun to elucidate the possibilities for a body of literature linking settler colonialism and health, illuminating future research opportunities and pathways toward the decolonization required for health equity.
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Affiliation(s)
- Bram Wispelwey
- Department of Global Health and Population, School of Public Health, Harvard University, Boston, MA, United States
- Division of Global Health Equity, Department of Medicine, Brigham and Women's Hospital, Boston, MA, United States
- François-Xavier Bagnoud Center for Health and Human Rights, School of Public Health, Harvard University, Boston, MA, United States
| | - Osama Tanous
- François-Xavier Bagnoud Center for Health and Human Rights, School of Public Health, Harvard University, Boston, MA, United States
| | - Yara Asi
- François-Xavier Bagnoud Center for Health and Human Rights, School of Public Health, Harvard University, Boston, MA, United States
- School of Global Health Management and Informatics, College of Community Innovation and Education, University of Central Florida, Orlando, FL, United States
| | - Weeam Hammoudeh
- François-Xavier Bagnoud Center for Health and Human Rights, School of Public Health, Harvard University, Boston, MA, United States
- Institute of Community and Public Health, Birzeit University, Birzeit, Palestine
| | - David Mills
- François-Xavier Bagnoud Center for Health and Human Rights, School of Public Health, Harvard University, Boston, MA, United States
- Division of Emergency Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, United States
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Kaniecki M, Novak NL, Gao S, Harlow S, Stern AM. Operationalizing racialized exposures in historical research on anti-Asian racism and health: a comparison of two methods. Front Public Health 2023; 11:983434. [PMID: 37483944 PMCID: PMC10359498 DOI: 10.3389/fpubh.2023.983434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 06/16/2023] [Indexed: 07/25/2023] Open
Abstract
Background Addressing contemporary anti-Asian racism and its impacts on health requires understanding its historical roots, including discriminatory restrictions on immigration, citizenship, and land ownership. Archival secondary data such as historical census records provide opportunities to quantitatively analyze structural dynamics that affect the health of Asian immigrants and Asian Americans. Census data overcome weaknesses of other data sources, such as small sample size and aggregation of Asian subgroups. This article explores the strengths and limitations of early twentieth-century census data for understanding Asian Americans and structural racism. Methods We used California census data from three decennial census spanning 1920-1940 to compare two criteria for identifying Asian Americans: census racial categories and Asian surname lists (Chinese, Indian, Japanese, Korean, and Filipino) that have been validated in contemporary population data. This paper examines the sensitivity and specificity of surname classification compared to census-designated "color or race" at the population level. Results Surname criteria were found to be highly specific, with each of the five surname lists having a specificity of over 99% for all three census years. The Chinese surname list had the highest sensitivity (ranging from 0.60-0.67 across census years), followed by the Indian (0.54-0.61) and Japanese (0.51-0.62) surname lists. Sensitivity was much lower for Korean (0.40-0.45) and Filipino (0.10-0.21) surnames. With the exception of Indian surnames, the sensitivity values of surname criteria were lower for the 1920-1940 census data than those reported for the 1990 census. The extent of the difference in sensitivity and trends across census years vary by subgroup. Discussion Surname criteria may have lower sensitivity in detecting Asian subgroups in historical data as opposed to contemporary data as enumeration procedures for Asians have changed across time. We examine how the conflation of race, ethnicity, and nationality in the census could contribute to low sensitivity of surname classification compared to census-designated "color or race." These results can guide decisions when operationalizing race in the context of specific research questions, thus promoting historical quantitative study of Asian American experiences. Furthermore, these results stress the need to situate measures of race and racism in their specific historical context.
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Affiliation(s)
- Marie Kaniecki
- University of Michigan, Ann Arbor, MI, United States
- University of California, Los Angeles, Los Angeles, CA, United States
| | - Nicole Louise Novak
- College of Public Health, The University of Iowa, Iowa City, IA, United States
- Public Policy Center, The University of Iowa, Iowa City, IA, United States
| | - Sarah Gao
- University of Michigan, Ann Arbor, MI, United States
- Harvard Center for Population and Development Studies, School of Public Health, Harvard University, Cambridge, MA, United States
| | - Sioban Harlow
- School of Public Health, University of Michigan, Ann Arbor, MI, United States
| | - Alexandra Minna Stern
- University of Michigan, Ann Arbor, MI, United States
- University of California, Los Angeles, Los Angeles, CA, United States
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Rollin F, Van Doren V, Alvarez J, Rousselle R, Bussey-Jones J. Antiracist Structural Intervention at the Emory University Institutional Review Board. Ethics Hum Res 2023; 45:30-34. [PMID: 37368519 DOI: 10.1002/eahr.500174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/29/2023]
Abstract
Although racial and ethnic categories are social constructs without inherent biologic or genetic meaning, race and ethnicity impact health outcomes through racism. The use of racial categories in biomedical research often misattributes the cause of health inequities to genetic and inherent biological differences rather than to racism. Improving research practices around race and ethnicity is an urgent priority and requires education as well as structural change. We describe an evidence-based intervention for an institutional review board (IRB). Our IRB now requires all biomedical study protocols to define racial and ethnic classifications they plan to use, to state whether they are describing or explaining differences between groups, and to provide justification for any use of racial or ethnic group variables as covariates. This antiracist IRB intervention is an example of how research institutions can help ensure the scientific validity of studies and avoid the unscientific reification of race and ethnicity as inherently biological or genetic concepts.
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Affiliation(s)
- Francois Rollin
- Assistant professor in the Department of Medicine at Emory University School of Medicine
| | | | - Jessica Alvarez
- Associate professor in the Division of Endocrinology, Metabolism and Lipids of the Department of Medicine at Emory University School of Medicine
| | - Rebecca Rousselle
- Assistant vice president of the Emory Human Research Protection Program and IRB at Emory University
| | - Jada Bussey-Jones
- Professor of medicine, section chief, and associate division director at Grady General Internal Medicine and the vice chair of diversity, equity, and inclusion in the Department of Medicine at Emory University School of Medicine
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Buxton MA, Fleischer NL, Ro A, O’Neill MS. Structural racism, air pollution and the association with adverse birth outcomes in the United States: the value of examining intergenerational associations. Front Epidemiol 2023; 3:1190407. [PMID: 38455927 PMCID: PMC10910959 DOI: 10.3389/fepid.2023.1190407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 05/26/2023] [Indexed: 03/09/2024]
Abstract
Structurally racist policies and practices of the past are likely to be a driving factor in current day differences in exposure to air pollution and may contribute to observed racial and ethnic disparities in adverse birth outcomes in the United States (U.S.). Non-Hispanic Black women in the U.S. experience poorer health outcomes during pregnancy and throughout the life course compared to non-Hispanic White women. This disparity holds even among non-Hispanic Black women with higher socioeconomic status. Reasons for this finding remain unclear, but long-term environmental exposure, either historical exposure or both historical and ongoing exposure, may contribute. Structural racism likely contributes to differences in social and environmental exposures by race in the U.S. context, and these differences can affect health and wellbeing across multiple generations. In this paper, we briefly review current knowledge and recommendations on the study of race and structural racism in environmental epidemiology, specifically focused on air pollution. We describe a conceptual framework and opportunities to use existing historical data from multiple sources to evaluate multi-generational influences of air pollution and structurally racist policies on birth and other relevant health outcomes. Increased analysis of this kind of data is critical for our understanding of structural racism's impact on multiple factors, including environmental exposures and adverse health outcomes, and identifying how past policies can have enduring legacies in shaping health and well-being in the present day. The intended purpose of this manuscript is to provide an overview of the widespread reach of structural racism, its potential association with health disparities and a comprehensive approach in environmental health research that may be required to study and address these problems in the U.S. The collaborative and methodological approaches we highlight have the potential to identify modifiable factors that can lead to effective interventions for health equity.
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Affiliation(s)
- Miatta A. Buxton
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, United States
| | - Nancy L. Fleischer
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, United States
| | - Annie Ro
- Department of Health, Society, and Behavior, Program in Public Health, University of California, Irvine, Irvine, CA, United States
| | - Marie S. O’Neill
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, United States
- Department of Environmental Health Sciences, School of Public Health, University of Michigan, Ann Arbor, MI, United States
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Masters RK, Tilstra AM, Simon DH, Coleman-Minahan K. Differences in Determinants: Racialized Obstetric Care and Increases in U.S. State Labor Induction Rates. J Health Soc Behav 2023; 64:174-191. [PMID: 37098856 PMCID: PMC10848243 DOI: 10.1177/00221465231165284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Induction of labor (IOL) rates in the United States have nearly tripled since 1990. We examine official U.S. birth records to document increases in states' IOL rates among pregnancies to Black, Latina, and White women. We test if the increases are associated with changes in demographic characteristics and risk factors among states' racial-ethnic childbearing populations. Among pregnancies to White women, increases in state IOL rates are strongly associated with changes in risk factors among White childbearing populations. However, the rising IOL rates among pregnancies to Black and Latina women are not due to changing factors in their own populations but are instead driven by changing factors among states' White childbearing populations. The results suggest systemic racism may be shaping U.S. obstetric care whereby care is not "centered at the margins" but is instead responsive to characteristics in states' White populations.
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Affiliation(s)
- Ryan K. Masters
- University of Colorado Boulder, Boulder, CO, USA
- University of Colorado Population Center, Boulder, CO, USA
| | - Andrea M. Tilstra
- University of Colorado Population Center, Boulder, CO, USA
- Oxford University, Oxford, UK
| | - Daniel H. Simon
- University of Colorado Boulder, Boulder, CO, USA
- University of Colorado Population Center, Boulder, CO, USA
| | - Kate Coleman-Minahan
- University of Colorado Population Center, Boulder, CO, USA
- University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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Lemke MK, Brown KK, Fallah-Fini S, Hall A, Obasanya M. Complex systems and participatory approaches to address maternal health disparities: Findings from a system dynamics group model building project in North Texas. Am J Community Psychol 2023; 71:303-316. [PMID: 36378746 DOI: 10.1002/ajcp.12636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 10/23/2022] [Accepted: 11/03/2022] [Indexed: 06/06/2023]
Abstract
Focusing on non-Hispanic Black women (NHBW) in North Texas, this study employed participatory system dynamics modeling to explore three hypotheses: (1) stakeholders will conceptualize structural racism is a pervasive macrostructural force that exerts downstream impacts to shape and perpetuate maternal health disparities among NHBW; (2) stakeholders will identify key causal forces and leverage points that exist across levels of influence; and (3) stakeholders will identify complex interactions, in the form of circular causality, that are present among the key causal forces and leverage points that shape NHBW maternal health disparities. Nine participants engaged in a virtual system dynamics group model-building session that focused on eliciting key variables, behavior-over-time graphs (BOTGs), causal loop diagram (CLD), and targets for action. Participants identified 83 key variables. BOTGs included an average of 6.56 notations and time horizons that, on average, started in 1956. The CLD featured 11 reinforcing and seven balancing feedback loops. Eleven targets for action were identified. Structural racism was revealed as a pervasive macrostructural force that shaped maternal health outcomes among NHBW. Key causal forces and leverage points were identified across levels of influence. Finally, feedback loops within the CLD exhibited circular causality.
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Affiliation(s)
- Michael K Lemke
- Department of Social Sciences, University of Houston-Downtown, Houston, Texas, USA
| | - Kyrah K Brown
- Department of Kinesiology, University of Texas at Arlington, Arlington, Texas, USA
| | - Saeideh Fallah-Fini
- Industrial and Manufacturing Engineering Department, California State Polytechnic University, Pomona, Pomona, California, USA
| | - Ariel Hall
- Department of Kinesiology, University of Texas at Arlington, Arlington, Texas, USA
| | - Mercy Obasanya
- Department of Kinesiology, University of Texas at Arlington, Arlington, Texas, USA
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Brown-Podgorski BL, Doran-Brubaker S, Vohra-Gupta S. State Minimum Wage Increases As a Potential Policy Lever to Reduce Black-White Disparities in Hypertension. Health Equity 2023; 7:280-289. [PMID: 37284534 PMCID: PMC10240308 DOI: 10.1089/heq.2022.0192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/09/2023] [Indexed: 06/08/2023] Open
Abstract
Introduction Black adults are disproportionately burdened by hypertension. Income inequality is associated with elevated risk of hypertension. Minimum wage increases have been explored as a potential policy lever to address the disparate impact of hypertension on this population. However, these increases may have no significant impact on health among Black adults due to structural racism and "diminished gain" of health effects from socioeconomic resources. This study assesses the relationship between state minimum wage increases and Black-White disparities in hypertension. Methods We merged state-level minimum wage data with survey data from the Behavioral Risk Factor Surveillance System (2001-2019). Odd survey years included questions about hypertension. Separate difference-in-difference models estimated the odds of hypertension among Black and White adults in states with and without minimum wage increases. Difference-in-difference-in-difference models estimated the impact of minimum wage increases on hypertension among Black adults relative to White adults. Results As state wage limits increase, the odds of hypertension significantly decreased among Black adults overall. This relationship is largely driven by the impact of these policies on Black women. However, the Black-White disparity in hypertension worsened as state minimum wage limits increased, and the magnitude of this disparity was larger among women. Conclusion States having a minimum wage above the federal wage limit are not sufficient to combat structural racism and reduce the disparities in hypertension among Black adults. Rather, future research should explore livable wages as a policy lever to reduce disparities in hypertension among Black adults.
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Affiliation(s)
- Brittany L. Brown-Podgorski
- Department of Health Policy and Management, School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Stephanie Doran-Brubaker
- Department of Health Policy and Management, School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Shetal Vohra-Gupta
- Steve Hicks School of Social Work, University of Texas at Austin, Austin, Texas, USA
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