Journal of Racial and Ethnic Health Disparities最新文献

Racialized stress disproportionately impacts Black individuals and confers increased risk for psychological distress and executive dysfunction. However, there is little evidence on psychological distress' association with cognitive flexibility (CF), an executive function theorized to be a neurocognitive resilience factor, as it is shown to reflect the ability to adapt thoughts/behaviors to changing environmental stimuli. As such, we aimed to examine the relation between racialized stress and psychological distress and the potential buffering effects of CF. Data were drawn from The Family Life Project and included 372 Black mothers from rural households experiencing poverty. Mothers completed a battery of questionnaires to assess sociodemographics, experiences with racialized stress (RRSE), psychological distress (CES-D), and their cognitive flexibility (WCST-64). Results evidenced a significant association between psychological distress and racialized stress, such that mothers who reported higher racialized stress reported higher psychological distress; this relation remained significant after controlling for a host of sociodemographic risk factors. CF did not emerge as a significant moderator of the relation between psychological distress and racialized stress. Findings highlight the potential deleterious effects of racialized stress on psychological distress. There may be unique facets of racialized stress that differentially impact the risk for psychological distress, and CF potentially buffers this relation. Further investigations are needed to understand the underlying mechanisms that may confer resilience to psychological distress amongst Black mothers.

Aims: To investigate the impact of low socioeconomic status (SES) and/or membership in ethnic minority has on HbA1c before and during the COVID-19 lockdown.

Methods: A retrospective cohort study was conducted between March 2019 and March 2021, based on data from electronic medical records of 17,072 patients with type-2 diabetes, collected by Clalit (Israel's largest health maintenance organization). Low SES was compared to high and ethnic minorities (Arabs and ultra-Orthodox Jews) were compared to the general Israeli population of mostly Jewish, but not ultra-Orthodox, Israeli citizens. Quantile regressions were used to examine the impact of SES and ethnic minority membership on HbA1c levels in the 0.10, 0.25, 0.50, 0.75, 0.90 quantiles before and during the lockdown.

Results: In the pre-lockdown period, patients with type-2 diabetes of low versus high SES, and Arabs versus the general population, had higher HbA1c. During the lockdown HbA1c levels of low versus high SES rose significantly in the 0.10 and 0.90 quantiles, and among Arabs HbA1c levels rose significantly across all quantiles, with a remarkable increment in the 0.90 quantile (from 0.316% in the pre-lockdown period to 0.730% in the lockdown period). Ultra-Orthodox Jewish diabetic patients had a marginally higher mean HbA1C level regardless of the period. Quantile regressions did not reveal a significant difference between the ultra-Orthodox Jewish and the general population.

Conclusion: The lockdown exacerbated disparities in glycemic control between low and high SES individuals and between Arab minority and the general population.

Objectives: Racial and ethnic differences in long-term outcomes associated with medications for opioid use disorder (MOUD) are poorly understood.

Methods: The present analyses were based on 751 participants with opioid use disorder (OUD) who were initially recruited from opioid treatment programs located in California, Connecticut, Oregon, Pennsylvania, and Washington and participated in a randomized controlled trial and at least one follow-up interview. 9.6% (n = 72) of the participants self-identified as Non-Hispanic (NH) Black, 16.0% (n = 120) Hispanic, and 74.4% (n = 559) NH White. We tested racial and ethnic differences in psychiatric or social functioning, substance use and treatment participation.

Results: From the baseline to the end of follow-up interview, compared with NH White, Hispanic participants had a significantly greater proportion of months reporting any opioid use (45.5% vs. 32.5%, p < 0.001) and a smaller proportion of months receiving any MOUD (47.7% vs. 58.1%; p < 0.05), particularly receipt of buprenorphine treatment (8.3% vs. 14.9%; p < 0.01). At the third follow-up interview, data from the Addiction Severity Index (ASI) indicated that Hispanic participants had greater severity in employment problems (0.72 vs. 0.58; p < 0.001), while Black participants had less severity in drug problems (0.11 vs. 0.16; p < 0.05) compared to NH Whites.

Conclusions: The study found that Hispanic participants had higher rates of opioid use (heroin and prescription opioids), but few received MOUD (buprenorphine and methadone) during the follow-up period, which suggests that effective strategies are needed to increase access to MOUD among Hispanics. Additionally, addressing employment challenges might also help improve long-term outcomes for all populations with OUD.

Recent research shows a significant link between race-ethnicity and income concentration and premature death rates in the U.S. However, most studies focus on Black-White residential concentration, overlooking racial-ethnic diversity. Our study examines the impact of racial-ethnic majority composition on mortality and how this relationship varies across different levels of economic concentration in neighborhoods, as defined by census tracts. Premature death rates (under 65 years of age) were retrieved from abridged period life tables from 67,140 U.S. census tracts derived from the U.S. Small-area Life Expectancy Project. Covariate factors were retrieved from the 2011-2015 American Community Survey (ACS) 5-year estimates. We measured racial-ethnic concentration by grouping neighborhoods using each tract's majority racial-ethnic group, and approximated income concentration using the Index of Concentration of the Extremes. We used three-level random intercept models to examine the interaction of racial-ethnic and income concentration and its association with neighborhood mortality risk, accounting for covariates. Our study yielded three salient findings. First, mortality risk varied greatly in poor neighborhoods with different racial-ethnic compositions compared to affluent neighborhoods, with notable higher risk in Black-majority areas. Second, in diverse neighborhoods where no single ethnic group forms a majority-referred to as Minority-majority neighborhoods-the mortality risk is comparable to that in White-majority neighborhoods. Third, Hispanic/Latino- and Asian-majority neighborhoods had lower mortality risk than White-majority neighborhoods in areas with a high concentration of poverty, but similar mortality risk in affluent areas. The study suggests that racial-ethnic and socioeconomic area-based measures are important to consider together to address mortality inequities accurately.

This study analyzes the relationship between anticipatory community and police violence and health outcomes including mental and physical well-being, sleep problems, and functional disability. Using data from a nationally representative survey of 3015 self-identified Black and African American adults in the USA collected in 2023, findings from a series of regression analyses reveal that anticipating community violence is linked to poorer self-rated health and increased sleep problems. Anticipatory police violence is associated with poorer physical health and sleep disturbances. These associations persist even after accounting for previous experiences of violence. The results underscore the potential health consequences of anticipating violence, suggesting that the fear of personal victimization can adversely influence health. Addressing anticipatory violence through trauma-informed public health policies and practices is critical for improving health outcomes and reducing disparities in violence-exposed communities. Future research should explore longitudinal impacts and extend analyses to additional racial groups and health outcomes.

African Americans (AAs) with end-stage kidney disease (ESKD) experience significant barriers to accessing living donor kidney transplantation (LDKT), largely due to individual and systemic factors, including a lack of trust in healthcare systems resulting from a legacy of and continued experiences with medical racism. This cross-sectional study analyzed survey data from 416 AA patients with ESKD undergoing transplant evaluation in 2019-2023 at two kidney transplant centers in the Southeast United States, examining whether trust (specifically trust in kidney doctors, hospitals, and healthcare) modifies the relationship between attitudes towards LDKT and behavioral intentions to discuss LDKT with family and friends. Multivariable analyses revealed significant interactions. The regression model including attitudes and trust in kidney doctors was statistically significant (R² = 0.114, F(7, 368) = 6.779, p ≤ 0.001). It was found that attitudes toward LDKT (β = 0.297, p ≤ 0.001) and trust in kidney doctors (β = 0.132, p = 0.008) were significantly associated with behavioral intentions to discuss LDKT with a family member or friend. Trust in hospitals, trust in the healthcare system, nor the interactions between attitudes and trust variables were significantly associated with behavioral intentions. Our findings support positive relationships between attitudes, trust in one's kidney doctor, and behavioral intentions to pursue LDKT, which have important implications for interventions that seek to improve access to LDKT among AA patients with ESKD.

Dollar stores are the fastest-growing type of food retailer in the United States, prompting policy action across the country related to their perceived negative impact on the communities they serve. However, there is little existing research that explores community member perceptions of dollar stores, which is critical to inform new, equitable policies. To address this gap in Baltimore City, Maryland, where dollar store density is high, we aimed to describe community member perceptions of dollar stores in terms of their role in the broader community. We used thematic analysis to construct themes from community member in-depth interviews (n = 16) and one community member workshop (n = 21) to understand how dollar stores are viewed in the context of the broader Baltimore City community. Six key themes were generated: (1) dollar stores contribute to neighborhood "blight," (2) better retail is needed, (3) dollar stores meet certain community needs, (4) dollar stores do not invest enough in the community, (5) dollar stores vary in location and stock depending on race-based neighborhood qualities, and (6) product quality is low. Overall, participants acknowledged that dollar stores meet certain needs in communities in which there are few alternative retail options, but many did not view them as a benefit and desired to have other retailers instead. Participants also discussed the lack of dollar store investment in the communities they serve, and the low quality of food and non-food products offered. Future policy development should include community member perspectives to understand local context and align policies with community priorities.

Young Black women in the southern US face a high HIV burden. While daily oral HIV pre-exposure prophylaxis (PrEP) can effectively prevent HIV, its use is low among Black women. The acceptability of and perceived intention to use emerging PrEP products among young Black women in the southern US are not well understood. Non-oral PrEP alternatives could address challenges to PrEP uptake and reduce health disparities. We conducted virtual semi-structured interviews with Black women aged 18-34 in Atlanta, GA; Baton Rouge, LA; and Jackson, MS, to explore their perspectives on three emerging PrEP products: a long-acting injection, a subdermal implant, and a dual-purpose contraception and HIV prevention intravaginal ring. Seventy-five interviews were conducted from January to October 2021 and analyzed using inductive thematic analysis with NVivo software. Most participants were open to using medication to prevent HIV. The intravaginal ring was the most preferred, primarily due to its dual-purpose function, although it was also frequently rejected. The long-acting injection was the second most preferred and least rejected, perceived as the least invasive. The skin implant was the least preferred and most rejected, viewed as the most invasive. Our findings highlight the need for multiple PrEP options to meet individual preferences. Detailed descriptions, instructions, and experiential learning methods are crucial for choosing non-oral PrEP modalities. Practitioners should address questions and offer peer-based learning opportunities. Designing and promoting PrEP strategies for young Black women should involve close consultation with these consumers.

Background: This study is a scoping review that maps existing scientific literature on the health needs of racialized men in sex work, framed within the Social Determinants of Health model.

Objectives: The review aims to identify and analyze health vulnerabilities among this population, focusing on how various social determinants impact their health.

Eligibility criteria: Studies published in the last 5 years, in English or Spanish, open-access, focused on male sex workers, without specific geographic limitations.

Sources of evidence: Systematic searches were conducted in Scopus, Redalyc, Google Scholar, and PubMed.

Charting methods: Using search queries "male sex work" AND health; "male sex work" AND race AND health; "male prostitution" AND race AND health, a total of 2,643 records were retrieved and screened. After applying inclusion and exclusion criteria, 32 studies were selected for review.

Results: Analysis based on the Dahlgren-Whitehead Social Determinants of Health model reveals that racialized male sex workers experience health vulnerabilities primarily influenced by individual and proximal determinants, with less emphasis on intermediate and distal factors such as social networks and community support.

Conclusions: These findings highlight significant health disparities affecting racialized MSWs, underscoring the need for a structural and comprehensive approach to address these disparities. This study advocates moving beyond a blame-oriented, moralistic view of individual behaviors in traditional epidemiology, focusing instead on social and structural interventions to improve sexual health outcomes for this marginalized group.

Efforts to understand and respond to the opioid crisis have focused on overdose fatalities. Overdose mortality rates (ratios of overdoses resulting in death) are rarely examined though they are important indicators of harm reduction effectiveness. Factors that vary across urban communities likely determine which community members are receiving the resources needed to reduce fatal overdose risk. Identifying communities with higher risk for overdose mortality and understanding influential factors is critical for guiding responses and saving lives. Using incident reports and mortality data from 2018 to 2021, we defined overdose mortality ratios across Milwaukee at the census tract level. To identify neighborhoods displaying higher mortality than predicted, we used Integrated nested Laplace approximation to define standardized mortality ratios (SMRs) for each tract. Geospatial and spatiotemporal analyses were used to identify emerging hotspots for high mortality risk. Overall, mortality was highest in Hispanic and lowest in White communities. Communities with unfavorable SMRs were predominantly Black or Hispanic, younger, less employed, poorer, less educated, and had higher incarceration rates and worse mental and physical health. Communities identified as hotspots for overdoses were predominantly non-White, poorer, and less employed and educated with worse mental and physical health, higher incarceration rates, and less housing stability. The findings demonstrate that overdose mortality rates vary across urban communities and are influenced by racial disparities. A framework that enables identification of challenged communities and guides community responses is needed.