Journal of Racial and Ethnic Health Disparities最新文献

Introduction: Racial and ethnic minorities experience a disproportionate burden of the type 2 diabetes (T2D) and are at a 2 to 5 times higher risk of developing macrovascular disease. The purpose of the study was to describe the perspectives of Haitian American immigrants' challenges to effective T2D self-management.

Methods: Utilizing a descriptive qualitative approach, purposive sampling was employed to recruit a subgroup of adult Haitian American immigrants from a parent cross-sectional study. Content analysis was used to identify themes describing participant perspectives. Lincoln and Guba's four criteria to assess the trustworthiness and ensure the rigor of the study were applied.

Results: A total of 36 participants were enrolled, with 54% being male, and age ranged from 34 to 63 years. The majority were married, and 77% reported using metformin. Three facilitators and two barriers to their T2D self-management were found. Facilitators included (1) family and social support, (2) optimism and hope, and (3) novel devices. Barriers included (1) psychosocial and (2) environmental factors.

Discussion: The facilitators underscore the pivotal role of close familial relationships, communal influence, and the potential utility of innovative devices like continuous glucose monitoring in enhancing T2D management, whereas the barriers delineate the unique challenges posed by discrimination, lack of provider/client decision-making and communication, the compounding effects of COVID-19, concerns about safety, mistrust in healthcare systems, and financial constraints, which collectively exacerbate the complexities of ineffective T2D management. Collaboration between clinicians, clients, and policymakers is imperative to emphasize the urgent necessity for a multifaceted approach in addressing the complex healthcare landscape of Haitian American immigrants managing T2D in the United States.

Hispanic and Non-Hispanic (NH) Black adults, particularly men, disproportionately experience significant smoking-related health disparities, including cancer. Thus, identifying factors that explicate sex, racial, and ethnic differences in cigarette use is critical for developing tailored interventions to prevent smoking-related diseases among these groups. While sociodemographic characteristics and other social determinants of health (SDOH) are identified as key correlates of cigarette use, little is known about how these factors intersect with sex, race, and ethnicity to influence cigarette use. This study examined data from 15,695 Hispanic and Non-Hispanic (NH) Black participants of the National Institutes of Health All of Us Research Program to examine the role of sociodemographic characteristics and SDOH on cigarette use at the intersection of sex, race, and ethnicity. Using Horn's parallel analysis, we created a composite variable corresponding to cigarette use intensity and duration (CSID). Then, linear regressions and relative importance analyses identified the differential and relative associations among sociodemographic factors and SDOH on CSID across Hispanic men, Hispanic women, NH Black men, and NH Black women. Older age and lower educational level were the factors that were most strongly associated with higher CSID across the four groups. While housing insecurity was the third highest negative correlate for Hispanic men and women, religious service attendance, and being married ranked as third most important for NH Black women and men, respectively. These findings highlight specific factors to incorporate in smoking cessation and prevention programs uniquely designed for these populations.

Addressing the grave racial inequities in maternal health requires a new generation of research that better operationalizes root causes of these outcomes. Recent frameworks improving the conceptualization of structural racism have illuminated the need for better conceptual clarity when investigating neighborhoods as a site of structural marginalization for Black birthing populations as well. In particular, better conceptualization of dynamic feedback in how neighborhoods are constructed and experienced, especially as they embed vicious cycles of place-based racialization, is integral to producing conceptually relevant and translatable evidence to address inequities in Black maternal health. This study presents a newly developed framework that integrates dynamic insight on neighborhood contexts from multiple disciplines to better conceptualize how it operates during the childbearing window to drive inequitable maternal morbidity rates among Black birthing people. I also compare and contrast this framework with existing frameworks based on how they represent key domains of social and structural determinants, neighborhood context, and dynamic feedback. Illustrating the strengths and weaknesses of each framework can improve researchers' ability to leverage these frameworks when developing project-specific conceptual models on structural racism, neighborhood context, and Black maternal health. Building a comparative repository of frameworks, in conjunction with developing new frameworks, will improve the field's capacity to follow best practices of rooting research in conceptually explicit models that improve operationalization and translation of evidence to eventually eliminate racial inequities in maternal health.

Background: Age-based stereotypes, prejudices, and discrimination (ageism) are implicated in poor health, yet it is unclear if all groups of older adults experience the same amounts, types, and outcomes of ageism.

Methods: This exploratory study investigated differences in ageism and health among Black and White USA adults ages 50 + who participated in the Experiences of Aging in Society project (2021-2023) (N = 131; 78% female, 46% Black, mean age 70). We compared amounts and types of self-reported ageism by race using three measures: Everyday Ageism Scale, Expectations Regarding Aging Survey, and Everyday Discrimination Scale when attributed to age. We identified racial differences in associations between ageism and the number of chronic health conditions participants had using z-tests of racially-stratified regression parameters.

Results: Black and White older adults generally reported comparable amounts of ageism across measures. Everyday ageism was associated with more chronic conditions at comparable levels by race, though findings suggested race-specific patterns in the most influential types: Black adults-age discrimination and White adults-internalized ageism. Positive expectations of aging and everyday discrimination attributed to age were associated with the health of White but not Black adults; only the former demonstrated significant race differences.

Conclusion: While Black and White older adults may report comparable exposure to ageism, race may contribute to divergent mechanisms of risk and health consequences. Findings endorse the Everyday Ageism Scale for ageism-health research including Black adults and all measures for exclusively White samples. Interventions promoting older adult health may benefit from attending to similarities and differences at the intersection of ageism and race.

The Asian American (AA) population is the fastest-growing major racial group in the U.S. Typically treated as a monolith in research, disaggregated data show disproportionate cardiovascular disease (CVD) burden among certain AA ethnic groups. This analysis aimed to identify which factors explain variance in cardiovascular health among AA ethnic groups. We analyzed pooled 2010-2018 National Health Interview Survey data from Chinese, Asian Indian, Filipino, and Other Asian adults in the U.S. CVD outcomes of interest were coronary heart disease, heart attack, and stroke. Covariates included sociodemographic characteristics, CVD-related health conditions, and behaviors. Variance explained by sociodemographic, health behaviors, and health conditions were calculated based on the adjusted R-squared from a series of five models for each CVD health outcome. Of the 10,353 AA adults in the sample, 53% identified as female. Compared to the aggregate AA sample and the other ethnic groups, Filipinos had a higher burden of any CVD outcome (5.9%), particularly for coronary heart disease (4.0%). The combination of all predictors explained at most 13% of variance, with sociodemographic characteristics accounting for at least half of the variance explained among all participants. Health behaviors explained a greater amount of additional variance for all CVD outcomes among Asian Indians, including an additional 3.1% for stroke. Inversely, existing health conditions were significant predictors of CVD for all AA ethnic groups compared to Asian Indians. There is heterogeneity in CVD outcomes and related risk factors in AA ethnic groups, emphasizing the need for culturally tailored prevention and intervention strategies.

Purpose: Veterans who incur a traumatic brain injury (TBI) during active duty service may be eligible to receive service-connected disability (SCD) compensation. This study examined potential racial/ethnic and geographic disparities in TBI SCD determination and overall monthly SCD compensation. Federal Tribal Land (FTL) was incorporated into existing VA geographic designations of urban, rural, highly rural, and US Territories (UST).

Methods: The association of race/ethnicity and geographic status with TBI SCD was estimated using logit models. Generalized linear models were used to assess the association of Veteran race/ethnicity and geographic status with overall monthly SCD compensation in 2022.

Results: Of the 1,319,590 Veterans with any SCD rating, 7.1% had a TBI SCD determination. Adjusting for demographic and military characteristics, relative to non-Hispanic Whites, Asian American Pacific Islanders (AAPI) (OR 1.19; 95% CI 1.16-1.22) had the highest odds of a TBI SCD, followed by American Indian Alaska Natives (OR 1.12; 95% CI 1.06-1.18). Bivariate analysis showed that relative to urban areas, highly rural (OR 1.44; 95% CI 1.38-1.49) areas had the highest odds of TBI SCD, followed by FTL (OR 1.28; 1.03-1.59). Bivariate analysis indicated that non-Hispanic Blacks ($433; 95% CI 428-439) and UST ($149; 95% CI 92-206) had the highest incremental monthly SCD compensation, while FTL Veterans had decremental compensation (- $80; 95% CI - 157 to - 4).

Conclusions: This study found that AAPI and FTL Veterans ranked lower in SCD compensation relative to their likelihood of a TBI SCD. These findings could be due to several factors that warrant further study.

Background: Due to limited research on Asian Americans and COVID-19, we investigated the perspectives of Vietnamese Americans regarding COVID-19 vaccine acceptance, trusted sources of information, and pandemic-related challenges.

Methods: Vietnamese American adult residents in Texas were recruited between September 2021 through March 2022 to complete the NIH CEAL Common Survey 2 electronically in English or Vietnamese, which contains 23 questions about social determinants of health, information, trust, risk perception, testing and disease control, COVID-19 vaccination, and demographics. We analyzed data using bivariate logistic or linear regression models.

Results: Of the 224 completed responses, 181 participants were vaccinated (80.8%), 20 (8.9%) were partially (one of two-dose courses) vaccinated, and nine (4%) were unvaccinated. Of the unvaccinated individuals, 44.4% reported that getting vaccinated in the next 3 months was "not likely at all," and the top barriers included safety concerns (77.8%), side effects (66.7%), and vaccine efficacy (44.4%). Vietnamese-language responders had significantly higher odds of experiencing non-medical challenges in obtaining food (OR = 2.08, p = 0.020) and transportation (OR = 2.56, p = 0.008) than English-language responders. Older age was significantly associated with reporting non-medical challenges in obtaining food (β = 8.39, p < 0.001), water (β = 9.58, p < 0.05), medications (β = 6.43, p < 0.05), and transportation (β = 5.69, p < 0.05).

Conclusion: Our findings describe barriers to vaccine acceptance and reveal variance in the prevalence of non-medical challenges among Vietnamese-language participants. It also showed within-group variation in COVID-19 vaccine attitudes and trusted sources of information among Vietnamese Americans. Research with disaggregated data can guide strategies to address non-medical health disparities in diverse communities.

Background: African American adults face an elevated risk of cardiovascular disease (CVD) compared to other racial and/or ethnic groups in the USA. Although discrimination has been linked to this disparity, the relationship between skin tone discrimination and CVD incidence remains scarce. This study investigated the associations of in-group discrimination (from African American individuals) and out-group skin tone discrimination (from White individuals) with incident CVD and whether these associations differed by sex and optimism.

Methods: This study analyzed data from 3519 African American participants (aged 21-95 years) in the Jackson Heart Study from 2000 to 2016. Cox Proportional Hazards regression assessed associations between skin tone discrimination and CVD (including stroke and coronary heart disease (CHD)). Each CVD component, along with heart failure (HF), was also analyzed separately. Models adjusting for sociodemographic characteristics, health behaviors, and CVD risk factors estimated hazard ratios (HR) and 95% confidence intervals (CI). Interaction terms were included in the fully adjusted models to assess the moderating roles of sex and optimism.

Results: Over the 16-year follow-up, 8.0% of participants developed CVD, 3.9% developed stroke, 4.9% developed CHD, and 7.3% developed HF. Participants who reported that Black individuals treated them better than other Black individuals because of their skin tone had an increased risk of CVD (HR 1.33, 95% CI 0.95-1.83). Out-group skin tone discrimination, whether better or worse treatment, was associated with a higher incidence of CHD (HRs ranged from 1.23 to 1.43), although CIs were wide. These associations did not vary by sex. Optimism moderated the association between out-group skin tone discrimination and HF, such that those who reported worse treatment and had the highest level of optimism had the greatest risk of HF. Optimism did not moderate the associations between in-group skin tone discrimination and the CVD outcomes.

Conclusions: These findings highlight the differential impact of in-group and out-group skin tone discrimination on cardiovascular health. Better in-group treatment was marginally linked to a higher CVD risk, while out-group skin tone discrimination, whether better or worse treatment, marginally increased CHD risk. Skin tone discrimination may therefore be a unique risk factor for CVD for African American individuals.

The coronavirus disease 2019 (COVID-19) pandemic created a unique set of challenges within the USA. The combination of the pandemic and long-standing systemic racism has generated greater maternal health disparities in minoritized populations, especially Black birthing individuals, creating a syndemic. This systematic review evaluated studies conducted between March 2020 and December 2024 to examine how Black birthing individuals' lives were impacted by the COVID-19 pandemic and systemic racism. Studies were included if (1) Black birthing individuals' experiences were examined; (2) these experiences were a focus of the study; (3) they were peer-reviewed, empirical articles; and (4) data was collected after March 2020. Utilizing PRISMA guidelines, we conducted a systematic review of the published literature up to December 2024 using PubMed, PsycINFO, Web of Science, and EBSCOhost and examined peer-reviewed articles that met inclusion criteria. Four authors independently screened studies and abstracted data. A total of 843 articles were screened, and from the 50 studies that were included in this paper, two overarching areas were identified: (1) societal-level themes and (2) individual- and interpersonal-level themes. Within these two areas, seven total subthemes were identified: (1a) Restrictions; (1b) Medical Mistrust and Healthcare Discrimination; (1c) Delivery, Birth, and Postpartum Experiences; (1d) Police Brutality and Community Violence; (2a) Health and Well-Being; (2b) Financial, Housing, Food, and Work-Related Challenges; and (2c) Caregiving and Family Relationships. Our findings emphasize the need for research to understand Black birthing individuals' experiences and to use these findings to create comprehensive targeted approaches.

Employing a US national sample (N = 1041), this project investigates the relationship between media usage and vaccine hesitancy, as well as the potential variations in this relationship based on vaccine types and individuals' racial backgrounds. Findings revealed that participants held different levels of acceptance of different vaccines. Compared to other racial groups, African Americans held a lower level of positive attitudes toward different types of vaccines; however, racial groups did not differ significantly in terms of intention to receive vaccines. Individuals' exposure to information emphasizing various aspects of vaccination either mitigate or enhance their vaccine hesitancy. In addition, the number of social media platforms individuals regularly use is negatively associated with their vaccine hesitancy. The study offers valuable insights for addressing vaccine hesitancy in diverse populations. Theoretical and practical implications were discussed.