Journal of Racial and Ethnic Health Disparities最新文献

Introduction: Mental health problems in emerging adulthood are linked to tobacco and cannabis use, but whether race and ethnicity modifies these associations is unclear.

Methods: We used data from wave 4 of the Population Assessment of Tobacco and Health Study (youth n = 6898, young adult n = 10,304) to conduct latent class analysis (LCA) of six past 30-day tobacco and cannabis use indicators (i.e., cigarettes, electronic nicotine delivery systems (ENDS), cigars, blunts, cannabis vaping, other cannabis). We estimated associations between past 30-day internalizing and externalizing (i.e., low (referent), moderate, high) problems and latent classes of tobacco/cannabis use (vs. never/former use) using adjusted multinomial logistic regression. We explored whether associations varied by race and ethnicity through stratification.

Results: We identified four exclusive use latent classes and two dual/poly use latent classes for both youth and young adult samples. Race/ethnicity-stratified models identified associations between internalizing/externalizing problems and most use classes for Hispanic and non-Hispanic White youth/young adults, with mixed results for non-Hispanic Black youth/young adults. For example, Hispanic (OR: 2.50, 95% CI: 1.09-5.74) and non-Hispanic White (OR: 1.90, 95% CI: 1.18-3.06) youth with high internalizing problems had higher odds of ENDS + cannabis vaping. Externalizing problems were not associated with use among non-Hispanic Black youth while internalizing problems were not associated with use among non-Hispanic Black young adults.

Conclusion: We observed racial/ethnic variation in mental health problems and tobacco and cannabis use. Understanding mental health problem and tobacco product and cannabis use comorbidity may better inform culturally relevant interventions aimed to prevent and reduce use.

With the development of the COVID-19 vaccine in late 2020, the importance of understanding the drivers of vaccine acceptance and vaccine hesitancy is important for the health of American Indian and Alaska Native communities. We conducted a cross-sectional, anonymous survey in October 2021 using established quantitative methods of virtual surveys to reach tribal members living on three reservations in the Great Plains (N = 679). We conducted multivariate analyses using logistic regression to assess the association between independent variables and COVID-19 vaccination status after adjusting for confounding. Respondents were more likely to have received a COVID-19 vaccine if they were older, had a full-time job, had previously received a flu vaccination, reported a higher level of trust in the health care system, had increased access to vaccinations, were able to isolate, or if they held a desire to keep their family safe. This study is one of the first to offer insights into the associations and possible determinants of COVID-19 vaccine uptake among American Indians in the Great Plains and was completed as part of the National Institutes of Health Rapid Acceleration of Diagnostics of Underserved Populations consortium. We identified a set of demographic, socioeconomic, and motivational factors that are associated with COVID-19 vaccination uptake among Great Plains American Indians and Alaska Natives. It is possible that future vaccine uptake may be enhanced through economic development, strengthening health care operations and care quality, and focusing vaccination messaging on family and community impact.

Background: The maternal mortality rate (MMR) in the United States (USA) continues to increase despite medical advances and is exacerbated by stark racial disparities. Black women are disproportionately affected and are three times more likely to experience a pregnancy-related death (PRD) compared to Non-Hispanic White (NHW) women.

Methods: A literature review was conducted to examine the racial disparities in the United States' MMR, specifically among pregnant Black women. PubMed and key organizations (World Health Organization, Center for Disease Control and Prevention, American College of Obstetricians and Gynecologists, Alliance for Innovation on Maternal Health, Association of American Medical Colleges, U.S. Census Bureau, and U.S. Congress) were searched for publications after 2014.

Result: Forty-two articles were reviewed to identify the role of structural racism, implicit biases, lack of cultural competence, and disparity education on pregnant Black women. This review highlights that maternal health disparities for Black women are further impacted by both structural racism and racial implicit biases. Cultural competence and educational courses targeting racial disparities among maternal healthcare providers (MHCP) are essential for the reduction of PRDs and pregnancy-related complications (PRC) among this target population. Additionally, quality and proper continuity of care require an increased awareness surrounding the risk of cardiovascular diseases for pregnant Black women.

Conclusions: The surging MMR for Black women is a public health crisis that requires a multi-tiered approach. Interventions should be implemented at the provider and healthcare institution level to dismantle implicit biases and structural racism. Improving patient-provider relationships through increased cultural competency and disparity education will increase patient engagement with the maternal healthcare (MHC) system.

Chronic hepatitis B infection is a leading cause of liver cancer worldwide. In the USA, African immigrants (AI) have high hepatitis B virus (HBV) infection rates but low HBV knowledge and screening rates. Research about HBV among AI living in Philadelphia is particularly limited. This study aims to assess barriers to and factors influencing HBV screening in the Philadelphia AI population. African and Caribbean-born adults in Greater Philadelphia were recruited for phone interviews at community health fairs hosted by the African Cultural Alliance of North America (ACANA) and the African Family Health Organization (AFAHO) in partnership with the Hepatitis B Foundation. Seventeen interviews were recorded, transcribed, and coded independently by two members of the research team using NVivo software. Themes and subthemes were created by analysis of the codes and arranged under Health Belief Model (HBM) concepts. Major perceived barriers included lack of HBV knowledge and awareness and cultural challenges related to health care access, preventive care, fear, and stigma. Participants recommended using community organizations and programs to spread awareness about HBV and serve as cues to action. In-person education was emphasized due to lack of access to and knowledge of technology such as Zoom. While HBV educational sessions have been implemented in this population, they have not been consistent or far-reaching. The results of this study can contribute to the implementation of a comprehensive AI-specific HBV education and screening program through partnerships with community organizations to ensure that all high-risk individuals in the Philadelphia area are screened.

Introduction: This study examines the experience of non-Hispanic Black Americans (hereinafter referred to as Black persons) and non-Hispanic White Americans (hereinafter referred to as White persons) with regard to the incidence (i.e., number of persons diagnosed with HIV), prevalence (i.e., number of persons living with HIV), and mortality rates of persons with HIV in the United States in 2019. With regard to mortality rates, this study examines the mortality rate of all Black persons and White persons with HIV in 2019 as well as the mortality rate of hospitalized Black persons and White persons with HIV in 2019.

Methods: Data on the racial characteristics of all persons in the United States in 2019 were obtained from the United States Census Bureau, and data on the racial characteristics of all persons with HIV in the United States were obtained from HIV Surveillance Reports produced by the Centers for Disease Control and Prevention (CDC). In addition, data on all hospital patients in seven states (California, Florida, Michigan, New Jersey, New York, South Carolina and Wisconsin) in 2019 were obtained from the Agency for Healthcare Research and Quality (AHRQ) Hospital Cost and Utilization Project (HCUP) State Inpatient Database (SID). These seven states included 44 percent of all persons living with HIV in the United States in 2019.

Results: This study found that Black persons were more likely to be diagnosed with HIV, live with HIV, and die with HIV than White persons in the United States. This is illustrated by the fact that in 2019 Black persons comprised 13.4 percent of the population, yet they comprised 42.1 percent of persons diagnosed with HIV, 40.4 percent of persons living with HIV, and 42.9 percent of persons who died with HIV. By comparison, in 2019 White persons comprised 76.3 percent of the population, yet they comprised 24.8 percent of persons diagnosed with HIV, 29.1 percent of persons living with HIV, and 31.8 percent of persons who died with HIV. Nevertheless, this study did not find a statistically significant difference between the in-hospital mortality rates of Black and White persons in seven states in 2019.

Conclusions: The burden of HIV was considerably greater on Black persons than White persons in the United States in 2019.

Racial disparities in the quality of health care services, including end of life (EOL) care, are well-documented. While several explanations for these inequities have been proposed, few studies have examined the underlying mechanisms. This paper presents the results of the qualitative phase of a concurrent mixed-methods study (QUANT + QUAL) that sought to identify explanations for observed racial differences in quality of EOL care ratings using the Department of Veterans Affairs Bereaved Family Survey (BFS). The objective of the qualitative phase of the study was to understand the specific experiences that contributed to an unfavorable overall EOL quality rating on the BFS among family members of Black Veterans. We used inductive thematic analysis to code BFS open-ended items associated with 165 Black Veterans whose family member rated the overall quality of care received by the Veteran in the last month of life as "poor" or "fair." Four major themes emerged from the BFS narratives, including (1) Positive Aspects of Care, (2) Unmet Care Needs, (3) Lack of Empathy, Dignity, and Respect, and (4) Poor Communication. Additionally, some family members offered recommendations for care improvements. Our discussion includes integrated results from both our qualitative and previously reported quantitative findings that may serve as a foundation for future evidence-based interventions to improve the equitable delivery of high-quality EOL care.

This study examined racial disparities in Head Start's impact on health outcomes for families with young children in poverty. Research questions were as follows: (a) are there racial disparities in health outcomes among low-income families? (b) Does Head Start participation promote better health outcomes? And (c) does Head Start's impact on health outcomes differ by race and ethnicity? Logistic regression analysis found that African American and Hispanic children experience lower health outcomes than their white peers, including lower rates of dental screening, more frequent injury-related care, lower overall health status, and lower rates of health insurance coverage. In comparison to White parents, African American and Hispanic parents reported lower levels of cigarette smoking. Children enrolled in Head Start received significantly more dental screening than their non-Head Start peers, regardless of race and ethnicity. The positive impacts of Head Start were particularly pronounced for African American and Hispanic children when compared to White children. Families that do not speak English as their primary language and those with lower household incomes experienced worse health outcomes. The positive impact of Head Start on the health outcomes of marginalized populations highlights the need for continued expansion of Head Start programs, as they strive to provide equal opportunities for improvements in academic, socio-emotional, and health outcomes for children and their parents in low-income households. The recruitment and enrollment process for Head Start should provide eligibility and application information in multiple languages for families in deep poverty.

Aim: As the COVID-19 pandemic response continues to evolve, the need to protect more vulnerable populations in society becomes more apparent. Studies are still emerging on how different population groups have been impacted by the COVID-19 pandemic. Our study explored the impact of COVID-19 for African migrants in New South Wales, Australia, and their coping strategies.

Methods: We employed inductive, exploratory qualitative interpretive research design using individual semi-structured in-depth interviews with 21 African migrants.

Results: COVID-19 lockdowns disrupted the African sense of community. Social isolation, financial insecurity due to joblessness, or reduced working hours led to stress, frustration, anxiety, sadness, loneliness, and depression. On the other hand, COVID-19 lockdowns allowed for more family time, reflecting, and appreciating the gift of life and personal intellectual growth. Despite such challenges, there was much community support, especially from religious organisations. Support from government agencies was available, but access was hampered by misinformation, digital literacy, and immigration status. Holding on to religion and faith was a key coping mechanism, followed by indulging in self-care practices such as healthy eating, exercise, Yoga, meditation, sleep, and limited interaction with social media.

Conclusion: The COVID-19 lockdown disrupted the collectivist culture of African migrants and had untoward socioeconomic impacts that affected their wellbeing, many of which reflect an exacerbation of pre-existing inequities. To ensure that African migrant COVID-19-related health and wellbeing needs are met, the African migrant community must be actively involved in every facet of the NSW COVID-19 and other future outbreak response efforts.

Most Indian tribes have limited access to healthcare facilities and rely heavily on traditional healing practices. This narrative review aimed to identify the disparities in the implementation of healthcare services and in accessing and availing these services by the indigenous population in India. We also have tried to throw light on the plausibility in strengthening the efficiency and efficacy of the public health system, by utilizing the available resources to its maximum potential, so that there will be a measurable outcome in the health status of these populations in India, coherently with the relevant sustainable development goals (SDG). The evidence from published literatures supports the fact that the disparity exists in the health status of indigenous populations in India as compared to the general populations. It emphasizes the need to address the key determinants such as the lack of knowledge, traditional healing practices and poor utilization of healthcare services provided to them. Various factors such as accessibility to healthcare resources, traditional healing practices, lack of awareness regarding healthcare services and schemes provided by the government, insufficient data regarding their issues and challenges and cultural and language barriers worsen the health status of indigenous people. However, our review reiterates that a well-structured and sustainable policy with reframed infrastructure and administration of healthcare system might bring a positive change in the health status of indigenous population in India.

Background: Adults with sickle cell disease (SCD) constitute a unique and vulnerable patient population with complex healthcare needs including routine follow-up visits and acute care evaluations. The COVID-19 pandemic accelerated healthcare systems' transition to providing telemedicine care. The purpose of this qualitative study was to elicit the perspectives of adults with SCD about their experience with telemedicine during the COVID-19 pandemic and to understand their preferences with respect to future telemedicine care.

Methods: Adults with SCD who had a telemedicine visit between March August 2020 and were cared for at our SCD center were eligible to participate in a one-time interview. Interviews were audio taped, transcribed, and analyzed using NVIVO software.

Results: Among 30 interviewed subjects, 28 transcripts were available for analysis. Analysis identified that participants compared telemedicine to in-person care across several domains including (a) how time is used, (b) personal safety, (c) pain management, and (d) maintaining caring relationships. Participants agreed that telemedicine care was most appropriate for follow-up care and less useful for painful crises or urgent needs. They expressed concerns about the need to expand telemedicine to other specialities and to ensure that privacy and technical support are provided.

Conclusions: Telemedicine appeals to adults with SCD for maintenance SCD care. Decisions about in-person or telemedicine care need to be made in discussion with the patient with particular attention to pain management preferences. Ultimately, telemedicine is an option that adults with SCD would like to see continue and that has the potential to expand access to care to more geographically distant regions.