Journal of Racial and Ethnic Health Disparities最新文献

Little data demonstrates the feasibility of place-based, neighborhood-level care delivered by health coaches in medically underserved neighborhoods to expand access to essential primary care and address health disparities. This concurrent mixed-methods pilot study describes experience with the innovative Neighborhood Health Hub Program in Memphis, TN. Patient characteristics, including body mass index (BMI), blood glucose, blood pressure, and service utilization, were assessed. Key informant interviews and community meetings were conducted in an initial community listening period to guide program development. Patient experience with program services was assessed using semi-structured client interviews. In year 1, 355 year-one clients were outreached, 146 (41.1%) through community events, 149 (42%) walk-ins, 38 (10.7%) door-to-door communication, 34 (9.6%) telephone, and 9 (2.5%) referral. Of the 198 (56.1%) fully screened, mean age was 52.0 (± 15.9) years, 94.5% were African American, 55.8% female, and 32.7% without a primary care provider. Baseline blood pressure was uncontrolled (≥ 140/90) in 52.3%, BMI was ≥ 30 in 50%, and random plasma glucose was high (≥ 130 mg/dl) in 23.4%. The majority (68.3%) participated in individual health coaching. Sixty-eight group sessions had an average of 4 participants (range 1-13) and were focused on chronic illness management (39.7%), exercise (26.5%), or nutrition (25.0%). Major qualitative themes highlighted the importance of social barriers and social support for chronic condition management. Place-based, neighborhood-level care delivered by health coaches in medically underserved neighborhoods is a promising approach for extending primary care, expanding access to essential preventive and primary care, reducing health disparities, and improving patient outcomes.

Background: Food insecurity disproportionately affects Black households in the United States (US) and is linked to adverse perinatal health outcomes. Addressing food insecurity is crucial for improving maternal and infant health outcomes, especially among Black mothers. This scoping review explores the impact of food insecurity and low food access (i.e., food deserts) on various maternal health outcomes during the perinatal period among Black women.

Methods: Using the Joanna Briggs Institute guidelines for scoping reviews, literature searches were conducted in PubMed, CINAHL, and Web of Science databases from January 2013 to January 2023. Eligible studies focused on Black women in the US experiencing food insecurity and reporting maternal health outcomes.

Results: Of 154 initially identified studies, nine met the inclusion criteria. Findings reveal diverse associations between food insecurity and perinatal outcomes among Black women, including gestational diabetes, breastfeeding practices, and maternal anemia. While some studies demonstrated direct links, others explored stressors associated with food insecurity during pregnancy.

Conclusion: The current literature suggests that food insecurity exacerbates health disparities among Black birthing individuals, contributing to adverse perinatal health outcomes. Addressing food insecurity is crucial for improving maternal health equity. It is recommended that food insecurity screening and tailored support services be integrated into prenatal care services. To promote health equity, public health policies should prioritize interventions targeting food insecurity among Black birthing individuals and communities. Collaborative efforts between legislators, providers, educators, researchers, and communities are needed to implement comprehensive interventions addressing the systemic inequities from which food insecurity stems, to achieve health and nutritional equity for all birthing individuals.

Asian Americans (AA) have an increased risk of developing type 2 diabetes mellitus (T2DM) and metabolic syndrome (MetS) compared to non-Hispanic White Americans, yet over half of AA patients with T2DM are underdiagnosed or untreated. Surgical stress, known to exacerbate hyperglycemia in T2DM, is also associated with increased morbidity and mortality. Thus, AA patients may be at elevated risk of experiencing poor outcomes following surgery. This review aims to summarize the available literature on the perioperative (defined as before, during, and after surgery) risk and outcomes of T2DM in AA surgical patients and identify specific knowledge gaps. A scoping review protocol was developed in accordance with PRISMA guidelines. Medline, Embase, Web of Science, Scopus, and Cochrane CENTRAL were comprehensively searched for publications without language or date limits on perioperative management of undiagnosed and diagnosed T2DM and/or MetS in AA. Inclusion criteria included full-text studies conducted in the United States (U.S.), specified AA with T2DM and/or MetS as a study population, and focused on perioperative considerations or clinical outcomes. Search results yielded 862 articles imported into Covidence for title, abstracts, full-text screening, and data extraction. Fifteen publications were identified for full review: 13 (86.6%) retrospective cohort study articles, 1 (6.6%) review article, and 1 (6.6%) randomized controlled trial. These articles represented 2,494,987 total patients and 38,440 aggregate Asian American patients (1.5%). Notable findings amongst studies included (1) higher T2DM rates among AA compared to other racial/ethnic groups, (2) diagnosis variations among AA ethnic subgroups, (3) and conflicting findings on postoperative complications in AA. This review highlights knowledge gaps in our current understanding of disparities regarding perioperative risks and outcomes of AA surgical patients with T2DM and/or MetS. There is a need for stronger research methodologies to guide evidence-based recommendations regarding the perioperative risks and optimal management of this patient population.

During the COVID-19 quarantine, the insufficient prioritization of sexual and reproductive health (SRH) resources exacerbated health disparities experienced by young Black women in the post-pandemic period. The historical legacy of medical treatment of Black women persists within current systems of care. In this study, we use the biopsychosocial framework to investigate perceived healthcare treatment and barriers to accessing SRH resources for Black women. We aim to understand how perceived provider treatment impacts SRH experiences and which experiences were perceived as a barrier to accessing SRH resources. Using a cross-sectional design, Qualtrics Panel participants, between ages 18 and 29 years, who identify as Black/African American and female, and living in the USA responded to a sexual health questionnaire. Results from T-test, chi-squared test, and logistic regression models indicate that perceptions of poor provider treatment are associated with poorer SRH experiences, with decreased odds of receiving a prescription for a birth control method (CI 0.913-0.978); receiving a check-up or medical test related to using birth control (CI 0.93-0.997); receiving counseling or information about birth control (CI 0.917-0.983); and asking a question about whether the participant wants to become pregnant in the next year (CI 0.900-0.97). Sexual health advocates should focus on marginalized groups accessing SRH resources. These groups experienced exacerbated sexual health disparities due to treatment delays during COVID-related quarantine orders. Social work and public health researchers should investigate how state and federal policies can prioritize equitable treatment for those most affected by the COVID-19 pandemic in a post-pandemic era.

Purpose: To examine the relationship between residential racial and economic segregation and main causes of death at the county level in the USA.

Methods: Residential racial and economic segregation quintiles were determined using the Index of Concentration at the Extremes (ICE). Linear mixed-effects model was applied to calculate adjusted mortality rate ratios (aRR).

Results: The ICE for race + income outperformed the ICE for race and the ICE for income. Among 3142 counties, the average age-adjusted all-cause mortality rates were 980.25, 919.82, 844.37, 781.82, and 703.01 per 100,000 across ICE for race + income quintiles, from the most deprived to the most privileged, respectively (p for trend: < 0.001). The corresponding aRRs for all-cause mortality were 1.32, 1.23, 1.17, 1.10, and 1 (p for trend: < 0.001). Furthermore, both mortality rates and aRRs for all 11 main causes of death showed a significant decrease from the most deprived to the most privileged counties (p for trend: < 0.001).

Conclusions: There is a strong association between residential racial and economic segregation and age-adjusted all-cause mortality as well as the 11 main causes of death in US counties, with a clear decreasing trend observed across ICE for race + income quintiles. These findings underscore the urgent need for policy interventions to reduce residential segregation, including equitable urban planning, investment in underserved communities, and improved access to healthcare and education in disadvantaged areas. Addressing these structural inequities could be an effective strategy for reducing mortality disparities and advancing health equity.

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.

The life expectancy gap between Black and White Americans has narrowed, but progress remains slow due to the persistent consequences of lifetime exposure to structural and interpersonal experiences of racism and discrimination in various settings, for example, disadvantaged housing, neighborhood, and economic conditions. It is important to understand challenges and facilitators to healthy aging among Black Americans, i.e., maintaining functional ability and well-being in older age. We explore the intersection of housing, neighborhoods, and healthy aging among Black adults who live in two predominantly Black, low-income neighborhoods in Pittsburgh, Pennsylvania. This complementary multi-method study combined survey data (n = 642) and qualitative interviews (n = 60) to delve into the perspectives of individuals aged 35 to 89. Survey and interview respondents were mostly renters (76% and 77% respectively), and about a fifth of those surveyed and interviewed reported any major home environment problems. Half of interviewees described poor quality housing as a source of stress, such as mold, building design, accessibility, and relational difficulties with their landlords and building managers. Buildings' social environment was an important dimension of housing quality among renters-behavioral and value differences between older and younger tenants caused frustration. Survey respondents were mostly (73%) satisfied with their neighborhoods' livability. Good access to transportation and community spaces were seen as positive factors to be sustained and encouraged in future. Policy implications include tracking health outcomes in housing programs for aging Black adults to inform improvements and enhanced oversight and coordination to ensure high-quality housing that meets the needs of older adults.

Background: Insufficient research has been done on NASH-related cirrhosis mortality and potential racial disparities in mortality rates.

Objective: This study aims to analyze racial differences in mortality rates among patients with non-alcoholic fatty liver disease (NAFLD), non-alcoholic fatty liver (NAFL), and non-alcoholic steatohepatitis (NASH), hypothesizing that hazard ratios for mortality among patients with NAFLD, NAFL, and NASH would be significantly different for Mexican American patients compared to other racial groups.

Methods: Data from NHANES III (1988-1994) representing the U.S. population were analyzed. Bivariate analysis and Cox proportional hazards models were employed to determine mortality rates and predictors across different racial/ethnic groups, adjusting for variables age, gender, smoking status (current, former, non-smoker), BMI (normal, overweight, obese), and a series of biomarkers.

Results: The prevalence of liver diseases in the sample was: NAFLD (12.1%), NAFL (20.0%), and NASH (3.1%). Deceased patients with NASH had the highest weighted mortality rate (50.6%), followed by NAFLD (39.1%) and NAFL (35.5%). Compared to White patients, Black and Mexican American patients exhibited lower mortality rates for NAFLD. Mexican American patients also had lower mortality rates for NFAL and NASH. White patients showed higher hazard ratios (HR) for NAFLD and NAFL compared to Black and Mexican-American patients. However, for NASH, there were no significant differences in HR between racial/ethnic groups.

Conclusions: Despite higher prevalence rates among Mexican American and Black patients, their mortality rates for NAFLD, NAFL, and NASH were comparable or lower than those for Whites. This highlights the need for further research to inform better management and treatment strategies.

Representation of professionals from populations affected by health disparities is crucial for equality in healthcare practice and research. Undergraduate research programs focused on health disparities can deeply impact students' self-efficacy, interest, and persistence in health and research-focused careers. In this study, we designed, implemented, and evaluated a novel summer undergraduate research program focused on maternal, child, and family health. Over four summers, 45 students from a range of majors engaged in interdisciplinary faculty-mentored research projects, using methods ranging from molecular biology to community-based participatory research. The impact of the program on these students-the vast majority of whom were from historically marginalized communities-was demonstrated through an evaluation study including pre-program and post-program surveys and tracking post-program student outcomes, including co-authoring publications and conference presentations, and persisting in health and research fields after graduation (an outcome for 76% of our graduates). This program was designed to be accessible and supportive and to offer students the opportunity to engage in research projects focused on the health of the communities in which they are personally invested. Our program makes a novel contribution to the field of health disparities training programs, as we did not encounter in the literature any prior studies describing the establishment and evaluation of an undergraduate research program in maternal, child, and family health. The insights we gained from implementing this program could be utilized by other institutions seeking to design undergraduate research programs focused on maternal, child, and family health specifically, or on health disparities more broadly.

Introduction: Evidence regarding the impact of prenatal depression and other psychosocial factors, such as coping, on perinatal outcomes is limited. We examined whether depressive symptoms during pregnancy were associated with the rate of having a small-for-gestational-age (SGA) infant and whether women's coping styles modified the relationship.

Methods: Data were obtained from a cohort of 1410 Black/African American women in Metropolitan Detroit, MI, using a structured maternal interview and medical record abstraction. Depressive symptomology was measured using the Center for Epidemiologic Studies Depression (CES-D) Scale. Women's coping efforts (confronting, distancing, and internalizing) were assessed using the Ways of Coping (WOC) questionnaire. Modified-Poisson regression models assessed direct and moderated associations.

Results: About 20% of women had severe depressive symptoms (CES-D > 23). Severe depressive symptoms were associated with having an SGA infant (adjusted PR [aPR] = 1.39, 95% CI = 1.02-1.89). Among women who frequently utilized confrontive coping efforts, severe depressive symptoms were marginally associated with SGA (PR = 1.43, 95% CI = 0.98-2.09), but not among women using confrontive coping less frequently. Regarding distance coping, severe depressive symptoms were not associated with SGA among women who frequently used distancing. However, severe depressive symptoms were associated with SGA (PR = 1.52, 95% CI = 1.03-2.24) among women who use distancing coping less frequently.

Conclusions: /Implications. Our findings suggest the use of confrontive and distancing coping moderates the relationship between depressive symptoms and SGA. In addition to screening for depressive symptomology during pregnancy, clinicians may want to assess coping styles as they drive women's response to stress and may be amenable to intervention.