Journal of Racial and Ethnic Health Disparities最新文献

Background: Immigrants' employment is linked with health care access in the US, but we lack a thorough understanding of how immigrants' experiences of employment exclusions influence their health care access in the context of immigrant racialization. We aimed to assess employment exclusions (i.e., exclusions from jobs and violations at work) across Asian and Latine foreign-born adults, the two largest immigrant racial groups, and their associations with health care access. We also sought to understand variations by race, and current or past legal status.

Methods: We used 2018-2020 Research on Immigrant Health and State Policy survey data from 2,010 Latine and Asian foreign-born adults in California. We measured seven indicators of employment exclusions and used weighted logistic regression to estimate associations between employment exclusions and health care access: usual source of care and delaying care in the past 12 months. We tested race, current legal status and past legal status as moderators.

Results: Nearly one-quarter (23.8%) of respondents reported ≥1 employment exclusion. Latine racial identity, current status as a non-citizen without permanent residency, and being previously undocumented was associated with greater employment exclusions. Employment exclusions were associated with 1.47 times (95% CI: 1.27, 1.69) greater odds of delaying care. Previous undocumented status, but not race or current legal status, moderated associations between violations at work and delay in care.

Conclusions: Latine immigrants face a greater number of barriers to employment opportunities and protections of worker rights compared to Asians, while employment exclusions and past legal status drives poorer health care utilization.

Medical gaslighting, defined as the minimization or dismissal of a patient's symptoms by healthcare providers, has gained increasing visibility, particularly among marginalized populations. This phenomenon disproportionately impacts individuals facing systemic inequities related to race, gender and class, effects that are compounded at the intersection of these identities. Medical gaslighting contributes to misdiagnosis, delayed care, emotional distress, and long-term mistrust in healthcare systems. Through an intersectional framework and illustrative case studies, this paper examines how implicit bias, structural racism, and the historical mistreatment of marginalized groups contribute to the erasure of patient experiences. The emotional and psychological toll of medical gaslighting further exacerbates existing health disparities. To address this issue, we explore strategies including provider education on implicit bias, expanded patient advocacy, and policy reforms aimed at promoting health equity. These interventions are critical for restoring trust and improving health outcomes, particularly for those most vulnerable to systemic healthcare neglect.

Interventions addressing racial and ethnic obesity inequities have lower effectiveness in Black adults. Previous literature linking the neighborhood environment to obesity inequities relies on limited food environment measures. Thus, we conducted semi-structured interviews to assess neighborhood-level barriers and facilitators to health behaviors among ethnically diverse Black adults (n = 24). Interviews were analyzed using thematic analysis (kappa = 0.70- 0.93; IRR = 83%). Participants reported barriers in the food (cost, transportation, high unhealthy food access) and physical activity environment (safety concerns). Facilitators included community food resources and access to safe areas for physical activity. These results may inform future research and weight loss programs for diverse Black adults.

This study examined whether the presence of Asian language-speaking mental health providers increases patient volume among Asian Americans in mental health facilities and whether this relationship is moderated by state-level Medicaid spending per capita. Data were drawn from national facility-level surveys conducted by SAMHSA between 2019 and 2023 (N = 265,395), supplemented with state-level Medicaid spending data from the Kaiser Family Foundation and demographic estimates from the American Community Survey. An instrumental variable approach was used to estimate the effect of Asian language-speaking staff on the number of Asian patients served, addressing potential endogeneity. To assess moderation by Medicaid spending, multilevel modeling with a cross-level interaction was conducted, accounting for clustering of facilities within states. Instrumental variable regression showed facilities with Asian language-speaking staff served significantly more Asian patients (B = 2.92, p < .001). The Hausman test supported IV estimation, and the Anderson-Rubin test confirmed robustness. Multilevel modeling revealed a significant interaction between Medicaid spending per capita and the presence of Asian language-speaking staff (B = 0.028, SE = 0.010, p < .01). Asian language-speaking providers play a significant role in increasing patient volume among Asian American patients. These findings underscore the importance of language-accessible mental health care in improving access for populations with limited English language proficiency. Moreover, results from the moderation analysis suggest this effect is amplified in states with greater Medicaid investment, highlighting the combined importance of workforce diversity and structural funding in reducing racial and linguistic disparities in behavioral health care for Asian American communities.

Chronic Hepatitis B (CHB), a serious disease requiring lifelong management, disproportionately affects Asian Americans, including Korean Americans. Many Korean Americans experience linguistic and sociocultural barriers, potentially worsening health challenges. While social ties and social support are well-recognized determinants of health, their role within unique populations merits exploration. Using longitudinal survey data, we identified patterns of social ties and social support among Korean Americans living with CHB, and how these related to self-assessed physical and mental health over time. Patients in Los Angeles and Philadelphia (n = 309) completed surveys at two timepoints between 2021 and 2024. We measured social ties with the Lubben Social Network Scale (LSNS-6), social support with the eight-item Medical Outcomes Study Social Support Survey (mMOS-SS), and self-assessed health using SF-12 Physical and Mental Component Summary Scores (PCS, MCS). Greater baseline social ties were higher among married, college-educated, and bicultural- or Western-identifying participants. Social support scores were higher among married, English-fluent, and currently working participants. Greater social ties were associated with better baseline physical health (β = 0.134, p = 0.009), and greater social support with better mental well-being (β = 0.206, p < 0.001). Controlling on baseline health, social ties predicted better follow-up PCS (β = 0.108, p = 0.012), and social support predicted better follow-up MCS (β = 0.136, p = 0.007), suggesting that social ties and social support independently and differentially influence physical and mental health over time. Strengthening both structural connections through social ties and perceived social support may delay health decline among immigrant populations managing chronic conditions.

Women and racial/ethnic minorities living with HIV are less likely than White men to be engaged in HIV treatment when entering US jails. Few studies have examined the intersection of gender and race/ethnicity among incarcerated populations. The "Enhancing Linkages to HIV Primary Care and Services in Jail Settings Initiative" (EnhanceLink) was a 10-site prospective cohort study of 1,270 people living with HIV in correctional facilities between 2008 and 2011. Using data from this study (N = 1,096), we assessed the likelihood of having a usual source of HIV care, utilizing ART, and viral suppression (HIV-1 RNA < 200 copies/ml) within 30 days of incarceration among the following groups, stratified by current gender and race/ethnicity, relative to non-Hispanic White men: Non-Hispanic Black women, non-Hispanic Black men, Hispanic/Latina (Hispanic) women, Hispanic men, and non-Hispanic White women. Compared to non-Hispanic White men, non-Hispanic Black women were 20% less likely to report that they had access to HIV care before incarceration after adjusting for age, sexual orientation, incarceration history, and medical comorbidities (prevalence ratio (PR) = 0.8, 95% CI: 0.7-0.9, p = 0.0002). Non-Hispanic Black, Hispanic, and Non-Hispanic White women were 30% less likely to utilize ART (respectively) than White men after adjusting for the same potential confounders (PR = 0.7, 95% CI: 0.6-0.9, p = 0.002; PR = 0.7, 95% CI: 0.5-0.9, p = 0.02; PR = 0.7, 95% CI: 0.5-1.0, p = 0.03). Our findings underscore the importance of culturally informed, community-based HIV interventions that promote equitable access to HIV care.

The COVID-19 pandemic disproportionately impacted minoritized individuals. This study examined the relationships between pandemic-related stressors/distress and bodily pain in 79 Native American (NA) and 101 non-Hispanic White (NHW) participants from the Oklahoma Study of Native American Pain Risk. Online surveys were administered in May/June 2020 (wave 1), March/April 2021 (wave 2), and Sept/Oct 2021 (wave 3). Pandemic-related stressors (e.g., resource loss and added responsibilities) and distress were assessed from a custom-built questionnaire. Bodily pain was assessed from pain items on the Patient Health Questionnaire-15 (PHQ-15). The results indicate NAs and NHWs reported similar pandemic-related stressors and distress at wave 1, which remained at similar levels across all waves in NHWs. By contrast, stressors and distress increased in NAs at waves 2 and 3. Moreover, bodily pain was higher in NAs than NHWs across all waves. Regression-based multilevel analyses predicting bodily pain found that NHWs with more pandemic-related stressors/distress experienced more bodily pain, but stress/distress did not predict bodily pain in NAs. Findings demonstrated that NAs experienced more bodily pain and pandemic-related stressors/distress than NHWs. However, pandemic-related stressors/distress did not further exacerbate NA pain as observed in NHWs. This implies NAs may have demonstrated resiliency that buffered the pronociceptive effects of pandemic-related stress.

Background: Herein, we report the characterization of four cohorts of breast cancer patients including (1) non-Hispanic Whites in Florida, (2) non-Hispanic Blacks in Florida, (3) Hispanics in Florida, and (4) Hispanics in Puerto Rico.

Methods: Data from female breast cancer patients were collected from cancer registry (n = 9361) and self-reported patient questionnaires (n = 4324). Several statistical tests were applied to identify significant group differences.

Results: Breast cancer patients from Puerto Rico were least frequently employed and had the lowest rates of college education among the groups. They also reported more live births and less breastfeeding. Both Hispanic groups reported a higher fraction experiencing menstruation at age 11 or younger (Floridian Hispanics [38%] and Puerto Ricans [36%]) compared to non-Hispanic Whites (20%) and non-Hispanic Blacks (22%). Non-Hispanic Black and Puerto Rican women were significantly older at breast cancer diagnosis than their non-Hispanic White and Floridian Hispanic counterparts. The Puerto Rican and non-Hispanic Black groups more frequently had pathology stage T2 or higher primary breast tumors at diagnosis (non-Hispanic Whites [29%], non-Hispanic Blacks [39%], Floridian Hispanics [33%], Puerto Ricans [46%]). The Puerto Rican (73%, 95% CI [66, 82]) and non-Hispanic Black (79%, 95% CI [75, 84]) groups demonstrate reduced 5-year survival compared to non-Hispanic Whites (89%, 95% CI [86, 92]) and Floridian Hispanics (89%, 95% CI [86, 90]).

Conclusions: These findings demonstrate that Puerto Rican breast cancer patients suffer significant breast cancer health disparities relative to non-Hispanic Whites and Hispanics from Florida similar to the disparities observed for non-Hispanic Blacks. Future work must seek to better understand and address these disparities.

Previous studies have suggested that COVID-19 led to an increase in stigma towards the Asian population with a negative impact on their health. This study aims to explore this phenomenon and its impact on health through the qualitative analysis of semi-structured interviews conducted with 26 people of Asian origin living in Spain from September 2020 to September 2021. Among the results, it was found that, prior to the pandemic, discrimination was mostly verbal. After the outbreak of the pandemic, some participants, who were blamed and referred to as "COVID", experienced fear and physical aggression. Among the health effects, mental and social disturbances such as feeling like "permanent foreigners", worrying about being stigmatized or fear of interacting with others were prominent. The main protective factor was the support network, including education and community cohesion as main determinants. Future research is needed to analyse the evolution of this stigma after the pandemic and to explore in detail its impact on health.