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Disparities in Patient Portal Activation and Usage at a Large Pediatric Academic Institution. 一家大型儿科学术机构在患者门户激活和使用方面的差异。
IF 3.2 3区 医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-11-04 DOI: 10.1007/s40615-024-02009-w
Ethan G Chuang, Andrew C Richardson, Zaineb Boulil, Cynthia L Kuelbs, Jeannie S Huang

Background and objective: Access to personal medical information promotes patient understanding of health issues and enables patient self-advocacy of healthcare needs. The advent of electronic medical record systems and the 2016 21st Century CURES Act promoted and encouraged patient access to personal medical information, yet technology-dependent modalities have often disadvantaged certain communities. We sought to evaluate whether disparities existed in access to patient portals at our institution, the main pediatric care provider in an area serving one million children.

Methods: We evaluated the activation of patient portal accounts at our institution over the past decade (2010-2021). Portal activation data were analyzed by ethnic background and language preference and income information available based on primary home access location. Further, we evaluated portal activation rates over time and across institutional interventions. A logistic regression model was used to identify important demographic associations with portal account status.

Results: Over 1 million patients were served at our pediatric institution over the study period with 47.7% having ever activated their patient portals. Univariate analyses and ultimately logistic regression modeling demonstrated significant differences in portal activation by ethnicity (odds ratio (confidence interval):1.36 (1.34, 1.37)), language preference (1.39 (1.37, 1.40)), and median household income (1.00001 (1.00001, 1.00001)). Interim interventions were successful in improving portal activation rates.

Discussion: Overall, electronic medical record portal activation was less prevalent among Hispanic, non-English speakers, and patients living in communities with lower median household income.

Conclusion: Opportunities for interventions exist to reduce healthcare disparities in these underserved communities.

背景和目的:获取个人医疗信息可促进患者对健康问题的了解,并使患者能够自我倡导医疗保健需求。电子病历系统的出现和 2016 年《21 世纪 CURES 法案》促进并鼓励患者获取个人医疗信息,但依赖技术的模式往往使某些社区处于不利地位。我们试图评估本机构在访问患者门户网站方面是否存在差异,本机构是一个服务 100 万儿童地区的主要儿科医疗机构:我们评估了本机构过去十年(2010-2021 年)患者门户网站账户的激活情况。我们根据种族背景、语言偏好和主要家庭访问地点提供的收入信息对门户激活数据进行了分析。此外,我们还评估了不同时期和不同机构干预措施的门户激活率。我们使用逻辑回归模型来确定与门户网站账户状态相关的重要人口统计学因素:在研究期间,我们的儿科机构为超过 100 万名患者提供了服务,其中 47.7% 的患者曾经激活过患者门户网站。单变量分析和最终逻辑回归模型显示,不同种族(几率比(置信区间):1.36 (1.34, 1.37))、语言偏好(1.39 (1.37, 1.40))和家庭收入中位数(1.00001 (1.00001, 1.00001))的患者在门户激活方面存在显著差异。讨论:讨论:总体而言,电子病历门户网站的激活率在西班牙裔、非英语使用者和家庭收入中位数较低社区的患者中较低:结论:在这些医疗服务不足的社区中,存在采取干预措施减少医疗差距的机会。
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引用次数: 0
Socioeconomic Status, Social Support, and Quality of Life Among Black Adults. 黑人成年人的社会经济地位、社会支持和生活质量。
IF 3.2 3区 医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-10-30 DOI: 10.1007/s40615-024-02204-9
Elijah R Murphy, Guillermo M Wippold, Zion R Crichlow

Objectives: Socioeconomic status has a pervasive influence on one's health and quality of life. Social support is known as a factor that can minimize the risk of maladaptive health outcomes while promoting greater quality of life. The purpose of this study was to examine the direct and indirect relationships between perceived socioeconomic status, social support, physical quality of life, and psychological quality of life among Black adults.

Methods: Participants were 304 (118 men, 186 women) adults who identified as African American or Black. Ages ranged from 18 to 75 (Mage = 37.62 years, SD = 12.39 years) and completed a battery of self-report questionnaires on perceived socioeconomic status, social support, physical quality of life, and psychological quality of life.

Results: Structural equation modeling analyses demonstrated that perceived socioeconomic status is associated with greater social support, physical quality of life, and psychological quality of life. Perceived socioeconomic status was also associated with higher physical quality of life and psychological quality of life indirectly through more social support.

Conclusions: These findings provide evidence that perceived socioeconomic status is directly associated with greater quality of life in Black adults. Social support acts as a partial mediator in the relationship between socioeconomic status and quality of life. This research brings to attention the influence that socioeconomic status and social support have on the quality of life of Black adults. These factors are of particular importance when considering social determinants of health in Black communities.

目的:社会经济地位对一个人的健康和生活质量有着普遍的影响。众所周知,社会支持可以最大限度地降低不良健康后果的风险,同时提高生活质量。本研究旨在考察黑人成年人的社会经济地位感知、社会支持、身体生活质量和心理生活质量之间的直接和间接关系:参与者为 304 名(118 名男性,186 名女性)自称为非洲裔美国人或黑人的成年人。年龄从 18 岁到 75 岁(平均年龄 = 37.62 岁,平均年龄 = 12.39 岁)不等,他们完成了一系列自我报告问卷,内容包括感知的社会经济地位、社会支持、身体生活质量和心理生活质量:结构方程模型分析表明,感知的社会经济地位与更大的社会支持、身体生活质量和心理生活质量相关。感知的社会经济地位还通过更多的社会支持间接地与更高的身体生活质量和心理生活质量相关:这些研究结果提供了证据,表明感知到的社会经济地位与黑人成年人更高的生活质量直接相关。社会支持是社会经济地位与生活质量之间关系的部分中介。这项研究使人们注意到社会经济地位和社会支持对黑人成年人生活质量的影响。在考虑黑人社区健康的社会决定因素时,这些因素尤为重要。
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引用次数: 0
Intersecting Epidemics: Examining the Impact of Internalized Homophobia and Depression Symptoms on HIV Testing Through a Suicide Syndemic Among Young Black Men Who Have Sex with Men. 交叉流行病:通过男男性行为者中的自杀综合症,研究内化的同性恋恐惧症和抑郁症状对 HIV 检测的影响。
IF 3.2 3区 医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-10-30 DOI: 10.1007/s40615-024-02225-4
Donte T Boyd, Omar Martinez, Tural Mammadli, Osman Wumpini Shamrock, Gamji Rabiu Abu-Ba'are, Typhanye V Dyer

Young Black men who have sex with men (BMSM) in the USA face disproportionate rates of HIV incidence. Mental health vulnerabilities, including depression, anxiety, substance use, and trauma, further exacerbate the HIV epidemic among this population. Internalized homophobia, discrimination, and depression contribute to elevated rates of suicidal behavior among young BMSM, which in turn may influence engagement in HIV prevention behaviors, such as HIV testing. However, limited research has examined the interplay among suicidal behaviors, internalized homophobia, depression, and HIV testing among young BMSM. This study utilized syndemic theory to explore the relationships among these factors in a sample of 400 young BMSM ages 18-29. Results indicate alarming rates of suicidal behavior among young BMSM, with significant associations among internalized homophobia, depression symptoms, suicidal behavior, and HIV testing. The findings underscore the urgent need for targeted mental health interventions and HIV prevention services tailored to address the unique challenges faced by young BMSM. Comprehensive, multi-level, community-centered interventions are essential to address the syndemics affecting young BMSM, promoting holistic health and well-being while improving outcomes across the HIV prevention continuum.

在美国,年轻的黑人男男性行为者(BMSM)面临着不成比例的艾滋病发病率。心理健康方面的脆弱性,包括抑郁、焦虑、药物使用和心理创伤,进一步加剧了艾滋病毒在这一人群中的流行。内部仇视同性恋、歧视和抑郁导致年轻的 BMSM 自杀行为发生率升高,这反过来又可能影响他们参与 HIV 预防行为,如 HIV 检测。然而,对年轻 BMSM 自杀行为、内化的恐同心理、抑郁和 HIV 检测之间相互作用的研究还很有限。本研究利用综合理论,以 400 名 18-29 岁的年轻 BMSM 为样本,探讨了这些因素之间的关系。结果表明,在年轻的 BMSM 中,自杀行为的发生率令人震惊,内部化的同性恋恐惧症、抑郁症状、自杀行为和 HIV 检测之间存在显著关联。这些研究结果突出表明,针对年轻的 BMSM 所面临的独特挑战,迫切需要有针对性的心理健康干预措施和 HIV 预防服务。全面、多层次、以社区为中心的干预措施对于解决影响年轻 BMSM 的综合症、促进整体健康和福祉,同时改善整个 HIV 预防过程的结果至关重要。
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引用次数: 0
Bridging the Gap: Culturally Responsive Strategies for NIH Trial Recruitment. 缩小差距:美国国立卫生研究院(NIH)试验招募的文化应对策略。
IF 3.2 3区 医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-10-29 DOI: 10.1007/s40615-024-02166-y
Lindsey Ross, Samuel Eberlein, Carine Khalil, So Yung Choi, Karma McKelvey, Brennan M R Spiegel
<p><strong>Objective: </strong>To enhance recruitment and participation rates of non-Hispanic Black (NHB) and Hispanic adult patients in a NIH-funded clinical trial studying an emerging health technology.</p><p><strong>Data sources and study setting: </strong>This study includes primary data collected in Los Angeles, California from November 2020 through November 2023.</p><p><strong>Study design: </strong>To improve the representation of NHB and Hispanic patients in a NIH-funded (NCT04409353) trial on virtual reality for chronic lower back pain (cLBP), we conducted a multi-phase study utilizing a mixed-method approach. First, we conducted focus groups with NHB and Hispanic cohorts aged 18 and older; based on the feedback, we culturally adapted recruitment materials and study correspondences concordantly. Additionally, a cohort builder was used to filter the electronic medical record to isolate non-Hispanic Black (NHB) and Hispanic patients with cLBP for micro-targeted recruitment. These changes were collectively integrated when the parent NIH study had recruited 222 of its 385 final samples (57.7%), creating a pre-post comparison timepoint (May 17, 2022). Quantitative analysis was performed to assess the efficacy of the modified recruitment strategies by comparing the number of recruited and randomized NHB and Hispanic patients pre- and post-intervention.</p><p><strong>Data collection/extraction methods: </strong>Semi-structured focus groups were conducted with NHB and Hispanic patients and community members (age 18 and older). The focus groups were conducted online and recorded with participant consent; transcripts of the recording underwent inductive thematic analysis. Emergent themes directed the modification of study materials, including revised language and imagery, targeted outreach, and incorporation of treating physicians, were implemented in the second half of the study. Quantitative analyses were conducted following parent study completion by comparing records added to the screening database following the implementation of new recruiting methods (5/17/2022) to those added before.</p><p><strong>Principal findings: </strong>Thematic analysis of focus groups identified four key themes: mistrust, lack of interest, culture, and communication. Modifications to recruitment methodology resulted in statistically significant increases in the pre- to post-randomization success rate for the overall study population (p < 0.001), the NHB population (p = 0.011), and the Hispanic population (p < 0.015). When looking at each cohort at different points in the recruitment process before and after the intervention, in the Hispanic population, we saw significant increases in the number approached (p < 0.001) and number randomized (p < 0.001) and statistically insignificant increases in the NHB population approached (p = 0.067) and randomized (p = 0.295). Similarly, we saw that the changes in the recruitment letter led to a statistically significant increase
目标:提高非西班牙裔黑人(NHB)和西班牙裔成年患者在美国国立卫生研究院资助的一项新兴医疗技术临床试验中的招募率和参与率:在一项由美国国立卫生研究院(NIH)资助的研究新兴医疗技术的临床试验中,提高非西班牙裔黑人(NHB)和西班牙裔成年患者的招募率和参与率:本研究包括 2020 年 11 月至 2023 年 11 月在加利福尼亚州洛杉矶市收集的原始数据:为了提高 NHB 和西班牙裔患者在美国国立卫生研究院(NIH)资助(NCT04409353)的慢性下背痛(cLBP)虚拟现实试验中的代表性,我们采用混合方法开展了一项多阶段研究。首先,我们对 18 岁及以上的非华裔和西班牙裔人群进行了焦点小组讨论;根据反馈意见,我们对招募材料和研究报告进行了文化调整。此外,我们还使用了队列构建器来过滤电子病历,以分离出患有 cLBP 的非西班牙裔黑人 (NHB) 和西班牙裔患者,进行微目标招募。当美国国立卫生研究院的母研究招募到 385 个最终样本中的 222 个(57.7%)时,这些变化被整合在一起,形成了一个前后比较时间点(2022 年 5 月 17 日)。通过比较干预前后招募和随机分配的 NHB 和西班牙裔患者人数,进行定量分析以评估修改后招募策略的效果:与新罕布什尔州和西班牙裔患者及社区成员(18 岁及以上)进行了半结构化焦点小组讨论。焦点小组在线进行,并在征得参与者同意后进行了录音;录音誊本进行了归纳式主题分析。新出现的主题指导了研究材料的修改,包括修改语言和图像、有针对性的外联以及纳入主治医生,这些都在研究的后半期实施。在父母研究完成后,通过比较新招募方法实施后(2022 年 5 月 17 日)与之前加入筛选数据库的记录,进行了定量分析:对焦点小组的专题分析确定了四个关键主题:不信任、缺乏兴趣、文化和沟通。对招募方法的修改使整个研究人群的随机化前成功率和随机化后成功率都有了统计学意义上的显著提高(p 结论:本研究引入了几种文化因素,包括:"文化"、"文化 "和 "沟通":本研究介绍了在设计招募材料时应考虑的几个文化敏感因素和可能的方法,解决了不信任、缺乏兴趣、文化和沟通等问题,适用于 NHB 和西班牙裔人群。同样,所述的微目标技术利用了队列构建的技术进步,提高了对代表性不足群体的覆盖率和随机化率,从而增强了临床试验的多样性。
{"title":"Bridging the Gap: Culturally Responsive Strategies for NIH Trial Recruitment.","authors":"Lindsey Ross, Samuel Eberlein, Carine Khalil, So Yung Choi, Karma McKelvey, Brennan M R Spiegel","doi":"10.1007/s40615-024-02166-y","DOIUrl":"https://doi.org/10.1007/s40615-024-02166-y","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To enhance recruitment and participation rates of non-Hispanic Black (NHB) and Hispanic adult patients in a NIH-funded clinical trial studying an emerging health technology.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Data sources and study setting: &lt;/strong&gt;This study includes primary data collected in Los Angeles, California from November 2020 through November 2023.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design: &lt;/strong&gt;To improve the representation of NHB and Hispanic patients in a NIH-funded (NCT04409353) trial on virtual reality for chronic lower back pain (cLBP), we conducted a multi-phase study utilizing a mixed-method approach. First, we conducted focus groups with NHB and Hispanic cohorts aged 18 and older; based on the feedback, we culturally adapted recruitment materials and study correspondences concordantly. Additionally, a cohort builder was used to filter the electronic medical record to isolate non-Hispanic Black (NHB) and Hispanic patients with cLBP for micro-targeted recruitment. These changes were collectively integrated when the parent NIH study had recruited 222 of its 385 final samples (57.7%), creating a pre-post comparison timepoint (May 17, 2022). Quantitative analysis was performed to assess the efficacy of the modified recruitment strategies by comparing the number of recruited and randomized NHB and Hispanic patients pre- and post-intervention.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Data collection/extraction methods: &lt;/strong&gt;Semi-structured focus groups were conducted with NHB and Hispanic patients and community members (age 18 and older). The focus groups were conducted online and recorded with participant consent; transcripts of the recording underwent inductive thematic analysis. Emergent themes directed the modification of study materials, including revised language and imagery, targeted outreach, and incorporation of treating physicians, were implemented in the second half of the study. Quantitative analyses were conducted following parent study completion by comparing records added to the screening database following the implementation of new recruiting methods (5/17/2022) to those added before.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Principal findings: &lt;/strong&gt;Thematic analysis of focus groups identified four key themes: mistrust, lack of interest, culture, and communication. Modifications to recruitment methodology resulted in statistically significant increases in the pre- to post-randomization success rate for the overall study population (p &lt; 0.001), the NHB population (p = 0.011), and the Hispanic population (p &lt; 0.015). When looking at each cohort at different points in the recruitment process before and after the intervention, in the Hispanic population, we saw significant increases in the number approached (p &lt; 0.001) and number randomized (p &lt; 0.001) and statistically insignificant increases in the NHB population approached (p = 0.067) and randomized (p = 0.295). Similarly, we saw that the changes in the recruitment letter led to a statistically significant increase","PeriodicalId":16921,"journal":{"name":"Journal of Racial and Ethnic Health Disparities","volume":null,"pages":null},"PeriodicalIF":3.2,"publicationDate":"2024-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142546100","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
A Review of the Public Health Literature Examining the Roles of Socioeconomic Status and Race/Ethnicity on Health Outcomes in the United States. 审查美国社会经济地位和种族/族裔对健康结果的影响的公共卫生文献综述》(A Review of the Public Health Literature Examining the Roles of Socioeconomic Status and Race/Ethnicity on Health Outcomes in the United States)。
IF 3.2 3区 医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-10-28 DOI: 10.1007/s40615-024-02195-7
Trenton M White, Luisa N Borrell, Ayman El-Mohandes

This review of reviews examines the role of socioeconomic status (SES) indicators on health inequities among different racial and ethnic groups in the United States (US) between 2019 and 2023. Of the 419 articles, 27 reviews met the inclusion criteria and were aggregated into seven categories: COVID-19 and respiratory pandemic disparities; neighborhoods, gentrification, and food environment; surgical treatments; mental, psychological, and behavioral health; insurance, access to care, and policy impact; cancers; and other topics. The findings revealed a documented impact of SES indicators on racial/ethnic health inequities, with racial/ethnic minority communities, especially Black Americans, consistently showing poor health outcomes associated with lower SES, regardless of the outcome or indicator examined. These findings call attention to the importance of policies and practices that address socioeconomic factors and systemic racial/ethnic inequities affecting the social determinants of health affecting racial/ethnic inequities to improve health outcomes in the US population.

本综述研究了2019年至2023年期间社会经济地位(SES)指标对美国不同种族和族裔群体健康不平等的影响。在 419 篇文章中,有 27 篇综述符合纳入标准,并被归纳为七个类别:COVID-19和呼吸道流行病差异;邻里、绅士化和饮食环境;外科治疗;精神、心理和行为健康;保险、获得护理和政策影响;癌症;以及其他主题。研究结果表明,社会经济地位指标对种族/民族健康不平等的影响是有据可查的,少数种族/民族社区,尤其是美国黑人,始终表现出与较低的社会经济地位相关的不良健康结果,无论研究的结果或指标如何。这些研究结果呼吁人们关注解决影响健康的社会决定因素的社会经济因素和系统性种族/族裔不平等的政策和做法对改善美国人口健康结果的重要性。
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引用次数: 0
Rural Alabamians' Unmet Medical Needs: Rethinking the Roles of Online Health Information-Seeking Behaviors. 阿拉巴马州农村居民未得到满足的医疗需求:重新思考在线健康信息搜索行为的作用
IF 3.2 3区 医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-10-28 DOI: 10.1007/s40615-024-02207-6
Dongwook Kim, Young Ji Yoon, Luciana Giorgio Cosenzo, Hee Yun Lee

Introduction: Unmet medical needs in rural areas are of grave concern in the U.S. With the advent of digital technologies, the Internet has become a critical means for accessing essential health information. However, racial/ethnic minority rural communities experiencing scarcity in healthcare services and access to the Internet are underrepresented in digital health studies. This study examined the association between online health information-seeking behaviors and unmet medical needs in a sample of African/Black American adults living in a rural region of the U.S.

Methods: Among a sample of 191 adults, we used descriptive analyses to document the level of unmet medical needs and online health information-seeking behaviors of this population and conducted logistic regressions to test the association between online health information-seeking behaviors and unmet medical needs.

Results: Most participants were older than 50 years old (60.2%), female (68.1%), unemployed (57.6%), and had an annual income of less than $25,000 (60.2%). About 20% of participants experienced unmet medical needs. The mean score of online health information-seeking behaviors was 2.37 (range 0-12). Increasing online health information-seeking behaviors was associated with 5.95 increased odds of experiencing unmet medical needs (OR = 5.95, 95% CI 1.27-27.77).

Discussion: The finding highlights that it is necessary to develop targeted programs aimed at populations with high unmet medical needs, focusing on providing accessible health information and resources. Further research is warranted to investigate the motivations to engage in online health information-seeking behaviors to inform structural and workforce interventions to address unmet medical needs in this under-resourced region.

引言随着数字技术的发展,互联网已成为获取基本健康信息的重要手段。然而,在数字健康研究中,缺少医疗服务和互联网接入的少数民族农村社区的代表性不足。本研究以生活在美国农村地区的非裔/黑人美国成年人为样本,探讨了在线健康信息寻求行为与未满足的医疗需求之间的关联:在 191 名成人样本中,我们使用描述性分析记录了这一人群未满足的医疗需求水平和在线健康信息寻求行为,并进行了逻辑回归以检验在线健康信息寻求行为与未满足的医疗需求之间的关联:大多数参与者年龄在 50 岁以上(60.2%),女性(68.1%),失业(57.6%),年收入低于 25,000 美元(60.2%)。约 20% 的参与者的医疗需求未得到满足。在线健康信息寻求行为的平均得分为 2.37(范围为 0-12)。在线健康信息寻求行为的增加与医疗需求未得到满足的几率增加 5.95 相关(OR = 5.95,95% CI 1.27-27.77):讨论:这一研究结果表明,有必要针对未满足医疗需求较高的人群制定有针对性的计划,重点是提供可获取的健康信息和资源。有必要开展进一步研究,调查参与在线健康信息搜索行为的动机,为结构性干预措施和劳动力干预措施提供信息,以解决这一资源匮乏地区医疗需求得不到满足的问题。
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引用次数: 0
Sociodemographic Factors Associated with the Utilization of Digital Health Technologies Among Informal Caregivers: A Nationwide Study in the USA, 2022. 与非正规护理人员使用数字医疗技术相关的社会人口因素:美国全国性研究,2022 年。
IF 3.2 3区 医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-10-28 DOI: 10.1007/s40615-024-02219-2
Zahra Mojtahedi, Jay J Shen

Background: Informal caregivers can leverage digital health technologies to support their own health while also assisting patients, particularly those with mental or physical challenges. This study investigated the sociodemographic factors associated with the use of digital health technology among informal caregivers.

Methods: Data from the 2022 Health Information National Trends Survey (HINTS) were examined for this cross-sectional study. The survey identified key outcomes related to the use of online medical records, health apps, digital wearable health devices, and the digital sharing of health information with professionals, on social media, or with others facing similar health issues. Sociodemographic factors (gender, race/ethnicity, feelings of one's household income, education, and census division) were also analyzed. Weighted multivariable logistic regression models were employed. A total of 831 individuals were included, representing about 36,960,385 national informal caregivers in 2022.

Results: Caregivers with a high school education or less (vs. those with at least some college education) and non-Hispanic Black caregivers (vs. non-Hispanic White caregivers) were significantly less likely to be offered access to online medical records by their healthcare providers. Additionally, online medical record usage was lower among caregivers with high school education or less, but higher among caregivers aged 50-64 (vs. those aged 35-49). Caregivers with a high school education or less were less likely to use health apps and digital wearable health devices, but more likely to share personal health information on social media. Men caregivers, those aged 50-64 and over 65 (vs. the 35-49 age group), and caregivers who were dissatisfied with their income were less likely to use digital wearable health devices.

Conclusions: The findings underscore disparities in the utilization of caregivers' digital health technology, particularly in digital wearable health devices. Recognizing and addressing these disparities are crucial for tailoring interventions to enhance equitable access to digital health technology among diverse informal caregiver populations.

背景:非正规护理人员可以利用数字健康技术为自己的健康提供支持,同时也能为患者提供帮助,尤其是那些有精神或身体挑战的患者。本研究调查了非正式护理人员使用数字医疗技术的相关社会人口因素:这项横断面研究研究了 2022 年全国健康信息趋势调查(HINTS)的数据。该调查确定了与使用在线医疗记录、健康应用程序、数字可穿戴健康设备以及与专业人士、社交媒体或面临类似健康问题的其他人以数字方式共享健康信息相关的主要结果。此外,还对社会人口因素(性别、种族/民族、家庭收入感受、教育程度和人口普查分区)进行了分析。采用了加权多变量逻辑回归模型。研究共纳入了 831 人,代表了 2022 年全国约 36 960 385 名非正式照顾者:结果:高中或以下教育程度的护理者(与至少受过一些大学教育的护理者相比)和非西班牙裔黑人护理者(与非西班牙裔白人护理者相比)的医疗服务提供者向其提供在线医疗记录的可能性要低得多。此外,高中或以下学历的护理人员使用在线病历的比例较低,但 50-64 岁的护理人员使用率较高(与 35-49 岁的护理人员相比)。高中或以下学历的护理人员不太可能使用健康应用程序和数字可穿戴健康设备,但更有可能在社交媒体上分享个人健康信息。男性护理人员、50-64 岁和 65 岁以上的护理人员(与 35-49 岁年龄组相比)以及对自己收入不满意的护理人员不太可能使用数字可穿戴健康设备:研究结果表明,护理人员在使用数字健康技术,尤其是数字可穿戴健康设备方面存在差异。认识并解决这些差异对于调整干预措施以促进不同非正规护理人群公平使用数字健康技术至关重要。
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引用次数: 0
Connecting Past to Present: Does Historical Redlining Affect Current Life Expectancy? 连接过去与现在:历史上的红线是否影响当前的预期寿命?
IF 3.2 3区 医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-10-28 DOI: 10.1007/s40615-024-02220-9
Charlotte Freifeld, Ava Camarero, Joanne Oh, Alexandra Fairchok, Karen Yang, Michael Siegel

Introduction: Previous research has documented a strong relationship between currently living in the redlined zones of the 1930s and suffering from a higher prevalence of disease. However, little is known about the relationship between historical redlining, modern-day redlining, and current resident health outcomes. This paper aimed to simultaneously model the associations between both historical redlining and modern-day redlining on current health outcomes.

Methods: In this paper, we used structural equation modeling to uncover relationships between current and historical redlining practices and modern-day life expectancy, exploring two levels of potential mediating factors: (1) racial segregation and structural racism; and (2) mediating health outcomes. We analyzed data from 11,661 census tracts throughout the United States using historical redlining data from 1940, modern redlining data from 2010 to 2017, racial segregation and structural racism indices from 2010 to 2019, health outcome data from 2021 to 2022, and life expectancy data from 2010 to 2015. Historical redlining was measured using Home Owners' Loan Corporation (HOLC) ratings, which ranged from 1.0 for favorable neighborhoods ("greenlined") to 4.0 for unfavorable ("redlined") neighborhoods. Modern-day redlining was measured using Home Mortgage Disclosure Act (HMDA) data, which were transformed into four quartiles, ranging from level 1 (low mortgage rejection rates) to level 4 (high mortgage rejection rates).

Results: We found a significant relationship between historic redlining and current life expectancy, with average life expectancy decreasing steadily from 80.7 years in HOLC 1 tracts to 75.7 years in HOLC 4 tracts, a differential of 5.0 years between the greenlined and redlined tracts. We also found a significant relationship between modern-day redlining and current life expectancy, with average life expectancy decreasing steadily from 79.9 years in HMDA 1 tracts to 73.5 years in HMDA 4 tracts, a differential of 6.4 years. In the structural equation model, historical redlining had a total effect of decreasing life expectancy by 1.18 years for each increase of one in the HOLC rating. Modern-day redlining had a total effect of decreasing life expectancy by 1.89 years for each increase of one in the HMDA quartile.

Conclusion: This paper provides new evidence that the legacy of redlining is not relegated to the history books but rather is a present and pressing public health issue today.

导言:以往的研究表明,目前居住在 20 世纪 30 年代的红线区与疾病高发之间存在密切关系。然而,人们对历史上的划定红线、现代的划定红线与当前居民健康结果之间的关系知之甚少。本文旨在同时模拟历史上的划定红线和现代的划定红线对当前健康结果的影响:在本文中,我们使用结构方程模型来揭示当前和历史上的重新划线做法与现代预期寿命之间的关系,并探索了两个层次的潜在中介因素:(1) 种族隔离和结构性种族主义;(2) 调解健康结果。我们分析了全美 11661 个人口普查区的数据,使用的数据包括:1940 年的历史划定红线数据、2010 年至 2017 年的现代划定红线数据、2010 年至 2019 年的种族隔离和结构性种族主义指数、2021 年至 2022 年的健康结果数据以及 2010 年至 2015 年的预期寿命数据。历史上的 "重新划分 "使用房屋所有者贷款公司(Home Owners' Loan Corporation,HOLC)的评级来衡量,评级从 1.0 表示有利社区("绿线")到 4.0 表示不利社区("红线")不等。我们使用《住房抵押贷款披露法》(HMDA)数据对现代 "红线 "进行了衡量,并将其转换为四个四分位数,从第 1 级(低抵押贷款拒绝率)到第 4 级(高抵押贷款拒绝率):我们发现,历史上的红线区划与目前的预期寿命之间存在明显关系,平均预期寿命从 HOLC 1 小区的 80.7 岁稳步下降到 HOLC 4 小区的 75.7 岁,绿线区与红线区之间相差 5.0 岁。我们还发现,现代红线区划与当前预期寿命之间存在重要关系,平均预期寿命从 HMDA 1 小区的 79.9 岁持续下降到 HMDA 4 小区的 73.5 岁,相差 6.4 岁。在结构方程模型中,HOLC 评级每增加 1 级,历史上的 "重新划分 "就会使预期寿命减少 1.18 年。HMDA 四分位数每增加一个,现代的重新划分政策就会使预期寿命减少 1.89 年:本文提供了新的证据,证明红线政策的遗留问题并没有成为历史,而是当今一个紧迫的公共健康问题。
{"title":"Connecting Past to Present: Does Historical Redlining Affect Current Life Expectancy?","authors":"Charlotte Freifeld, Ava Camarero, Joanne Oh, Alexandra Fairchok, Karen Yang, Michael Siegel","doi":"10.1007/s40615-024-02220-9","DOIUrl":"https://doi.org/10.1007/s40615-024-02220-9","url":null,"abstract":"<p><strong>Introduction: </strong>Previous research has documented a strong relationship between currently living in the redlined zones of the 1930s and suffering from a higher prevalence of disease. However, little is known about the relationship between historical redlining, modern-day redlining, and current resident health outcomes. This paper aimed to simultaneously model the associations between both historical redlining and modern-day redlining on current health outcomes.</p><p><strong>Methods: </strong>In this paper, we used structural equation modeling to uncover relationships between current and historical redlining practices and modern-day life expectancy, exploring two levels of potential mediating factors: (1) racial segregation and structural racism; and (2) mediating health outcomes. We analyzed data from 11,661 census tracts throughout the United States using historical redlining data from 1940, modern redlining data from 2010 to 2017, racial segregation and structural racism indices from 2010 to 2019, health outcome data from 2021 to 2022, and life expectancy data from 2010 to 2015. Historical redlining was measured using Home Owners' Loan Corporation (HOLC) ratings, which ranged from 1.0 for favorable neighborhoods (\"greenlined\") to 4.0 for unfavorable (\"redlined\") neighborhoods. Modern-day redlining was measured using Home Mortgage Disclosure Act (HMDA) data, which were transformed into four quartiles, ranging from level 1 (low mortgage rejection rates) to level 4 (high mortgage rejection rates).</p><p><strong>Results: </strong>We found a significant relationship between historic redlining and current life expectancy, with average life expectancy decreasing steadily from 80.7 years in HOLC 1 tracts to 75.7 years in HOLC 4 tracts, a differential of 5.0 years between the greenlined and redlined tracts. We also found a significant relationship between modern-day redlining and current life expectancy, with average life expectancy decreasing steadily from 79.9 years in HMDA 1 tracts to 73.5 years in HMDA 4 tracts, a differential of 6.4 years. In the structural equation model, historical redlining had a total effect of decreasing life expectancy by 1.18 years for each increase of one in the HOLC rating. Modern-day redlining had a total effect of decreasing life expectancy by 1.89 years for each increase of one in the HMDA quartile.</p><p><strong>Conclusion: </strong>This paper provides new evidence that the legacy of redlining is not relegated to the history books but rather is a present and pressing public health issue today.</p>","PeriodicalId":16921,"journal":{"name":"Journal of Racial and Ethnic Health Disparities","volume":null,"pages":null},"PeriodicalIF":3.2,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142522215","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Empowering Early Career Researchers: The Jackson Heart Study Smith Scholars Program. 增强早期职业研究人员的能力:杰克逊心脏研究史密斯学者计划。
IF 3.2 3区 医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-10-25 DOI: 10.1007/s40615-024-02226-3
Cellas A Hayes, Raymond Jones

The University of Mississippi Medical Center Graduate Training and Education Center houses the Robert E. Smith, MD, Scholars Program, a two-year certificate program that equips predoctoral trainees from five Mississippi universities with advanced research skills in cardiovascular epidemiology. Funded by the National Heart, Lung, and Blood Institute (NHLBI), the program focuses on addressing health disparities, minority health, and health inequities in underserved communities. Trainees receive mentorship, career coaching, and a $7,500 annual stipend, building a foundation for postdoctoral opportunities and expanding professional networks. The Smith Scholars Program emphasizes population health and provides interdisciplinary training in areas such as biostatistics, scientific communication, and cardiovascular health. It is uniquely positioned to address systemic challenges, particularly in Mississippi, a state with high cardiovascular disease prevalence and limited research funding. The program's regional advantage and its partnership with the Jackson Heart Study offer scholars exposure to health disparities in Black/African American communities, preparing them to contribute to innovative, community-based research. Additionally, it fosters collaborative science, enabling participants to overcome academic barriers and engage with large-scale health equity research efforts. The Smith Scholars Program has been instrumental in shaping the career trajectories of its participants, facilitating their transition to postdoctoral positions and independent research roles.

密西西比大学医学中心研究生培训与教育中心开设了罗伯特-史密斯学者项目(Robert E. Smith, MD, Scholars Program),这是一个为期两年的证书项目,旨在帮助来自密西西比州五所大学的博士生学员掌握心血管流行病学方面的高级研究技能。该计划由美国国家心肺血液研究所(NHLBI)资助,重点解决服务不足社区的健康差异、少数民族健康和健康不平等问题。学员将获得导师指导、职业辅导和每年 7500 美元的津贴,为获得博士后机会和扩大专业网络奠定基础。史密斯学者项目强调人口健康,并在生物统计学、科学交流和心血管健康等领域提供跨学科培训。该项目在应对系统性挑战方面具有得天独厚的优势,尤其是在密西西比这个心血管疾病高发、研究经费有限的州。该计划的地区优势及其与杰克逊心脏研究的合作关系为学者们提供了接触黑人/非裔美国人社区健康差异的机会,使他们做好准备,为基于社区的创新研究做出贡献。此外,该计划还促进了合作科学的发展,使参与者能够克服学术障碍,参与大规模的健康公平研究工作。史密斯学者项目在塑造参与者的职业轨迹方面发挥了重要作用,促进了他们向博士后职位和独立研究角色的过渡。
{"title":"Empowering Early Career Researchers: The Jackson Heart Study Smith Scholars Program.","authors":"Cellas A Hayes, Raymond Jones","doi":"10.1007/s40615-024-02226-3","DOIUrl":"https://doi.org/10.1007/s40615-024-02226-3","url":null,"abstract":"<p><p>The University of Mississippi Medical Center Graduate Training and Education Center houses the Robert E. Smith, MD, Scholars Program, a two-year certificate program that equips predoctoral trainees from five Mississippi universities with advanced research skills in cardiovascular epidemiology. Funded by the National Heart, Lung, and Blood Institute (NHLBI), the program focuses on addressing health disparities, minority health, and health inequities in underserved communities. Trainees receive mentorship, career coaching, and a $7,500 annual stipend, building a foundation for postdoctoral opportunities and expanding professional networks. The Smith Scholars Program emphasizes population health and provides interdisciplinary training in areas such as biostatistics, scientific communication, and cardiovascular health. It is uniquely positioned to address systemic challenges, particularly in Mississippi, a state with high cardiovascular disease prevalence and limited research funding. The program's regional advantage and its partnership with the Jackson Heart Study offer scholars exposure to health disparities in Black/African American communities, preparing them to contribute to innovative, community-based research. Additionally, it fosters collaborative science, enabling participants to overcome academic barriers and engage with large-scale health equity research efforts. The Smith Scholars Program has been instrumental in shaping the career trajectories of its participants, facilitating their transition to postdoctoral positions and independent research roles.</p>","PeriodicalId":16921,"journal":{"name":"Journal of Racial and Ethnic Health Disparities","volume":null,"pages":null},"PeriodicalIF":3.2,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142502668","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Inequity in Fertility Treatment for Patients that Speak a Language Other than English: A Retrospective Cohort Study. 讲英语以外语言的患者在生育治疗中的不平等:回顾性队列研究
IF 3.2 3区 医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-10-25 DOI: 10.1007/s40615-024-02188-6
Anwyn Pyle, Wan Tinn Teh, Michelle L Giles

Objective: To assess fertility treatment outcomes according to primary language spoken in patients undergoing fertility treatment in an Australian setting.

Methods: This retrospective cohort study examined female patients who received fertility treatment through a public hospital fertility service between September 2020 and May 2023. The primary outcome was clinical pregnancy rate following embryo transfer for patients who spoke English and patients who primarily spoke a language other than English. Poisson regression was used to estimate the association between language spoken and clinical pregnancy rate. Secondary outcomes included rate of other pregnancy outcomes following embryo transfer, number of fertility treatments performed, embryo quality, IVF cancellation rate, discontinuation rate, and time from first fertility appointment to treatment commencement.

Results: Of the 916 patients who accessed fertility treatment during the study period, 112 patients (12.23%) primarily spoke a language other than English. There were no significant differences in clinical pregnancy rate following embryo transfer (IRR 0.92, 95% CI 0.60-1.36), or rates of biochemical pregnancy, miscarriage, or negative pregnancy. However, patients who spoke a language other than English received significantly fewer IVF cycles (1.29 ± 0.61 vs 1.63 ± 1.16 cycles, p = 0.006), greater all-cause IVF cancellation rate (41.33% vs 28.33%, p = 0.048), and longer median time from first appointment to first treatment of any type (341 vs 234.5 days, p < 0.001).

Conclusion: Inequity in all-cause IVF cancellation rate, mean number of IVF cycles, and duration from first fertility appointment to treatment commencement were observed for patients who spoke a language other than English.

目的根据在澳大利亚接受生育治疗的患者所使用的主要语言,评估生育治疗效果:这项回顾性队列研究对 2020 年 9 月至 2023 年 5 月期间通过公立医院不孕不育服务接受不孕不育治疗的女性患者进行了调查。主要结果是会讲英语的患者和主要讲英语以外语言的患者胚胎移植后的临床妊娠率。泊松回归用于估计所讲语言与临床妊娠率之间的关系。次要结果包括胚胎移植后其他妊娠结果的发生率、进行生育治疗的次数、胚胎质量、试管婴儿取消率、中止率以及从首次生育预约到开始治疗的时间:在研究期间接受生育治疗的 916 名患者中,有 112 名患者(12.23%)主要讲英语以外的语言。胚胎移植后的临床妊娠率(IRR 0.92,95% CI 0.60-1.36)、生化妊娠率、流产率或阴性妊娠率均无明显差异。在所有原因的试管婴儿取消率、试管婴儿周期的平均次数以及从首次生育预约到开始治疗的持续时间方面,观察到讲英语以外语言的患者之间存在不平等。
{"title":"Inequity in Fertility Treatment for Patients that Speak a Language Other than English: A Retrospective Cohort Study.","authors":"Anwyn Pyle, Wan Tinn Teh, Michelle L Giles","doi":"10.1007/s40615-024-02188-6","DOIUrl":"https://doi.org/10.1007/s40615-024-02188-6","url":null,"abstract":"<p><strong>Objective: </strong>To assess fertility treatment outcomes according to primary language spoken in patients undergoing fertility treatment in an Australian setting.</p><p><strong>Methods: </strong>This retrospective cohort study examined female patients who received fertility treatment through a public hospital fertility service between September 2020 and May 2023. The primary outcome was clinical pregnancy rate following embryo transfer for patients who spoke English and patients who primarily spoke a language other than English. Poisson regression was used to estimate the association between language spoken and clinical pregnancy rate. Secondary outcomes included rate of other pregnancy outcomes following embryo transfer, number of fertility treatments performed, embryo quality, IVF cancellation rate, discontinuation rate, and time from first fertility appointment to treatment commencement.</p><p><strong>Results: </strong>Of the 916 patients who accessed fertility treatment during the study period, 112 patients (12.23%) primarily spoke a language other than English. There were no significant differences in clinical pregnancy rate following embryo transfer (IRR 0.92, 95% CI 0.60-1.36), or rates of biochemical pregnancy, miscarriage, or negative pregnancy. However, patients who spoke a language other than English received significantly fewer IVF cycles (1.29 ± 0.61 vs 1.63 ± 1.16 cycles, p = 0.006), greater all-cause IVF cancellation rate (41.33% vs 28.33%, p = 0.048), and longer median time from first appointment to first treatment of any type (341 vs 234.5 days, p < 0.001).</p><p><strong>Conclusion: </strong>Inequity in all-cause IVF cancellation rate, mean number of IVF cycles, and duration from first fertility appointment to treatment commencement were observed for patients who spoke a language other than English.</p>","PeriodicalId":16921,"journal":{"name":"Journal of Racial and Ethnic Health Disparities","volume":null,"pages":null},"PeriodicalIF":3.2,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142502585","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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Journal of Racial and Ethnic Health Disparities
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