Journal of Racial and Ethnic Health Disparities最新文献

Objectives: We sought to examine the burden and correlates of depression and anxiety among Ethiopian and Eritrean American emerging adults. African immigrants and their children constitute a large and growing proportion of the Black population but are largely overlooked in research focusing on either Black or immigrant youth. As they transition to adulthood, youth of Ethiopian and Eritrean origin must navigate a multitude of challenges including the impacts of traumatic immigration experiences, acculturation, racism, and discrimination.

Methods: We conducted a cross-sectional survey study with N = 200 youth (ages 18-25 years) in Atlanta, GA, in 2022-2023. The 287-item self-administered online survey included measures of depressive symptoms, anxiety symptoms, sociodemographic indicators, and stressor- and resilience-related constructs. We conducted descriptive statistical analysis and estimated multivariate logistic regression models to determine factors associated with symptoms of depression and anxiety.

Results: Forty-nine percent (49.2%) of the sample endorsed depressive symptoms above the threshold for clinical significance, and 57.4% of the sample met symptom criteria for either mild, moderate, or severe anxiety. In adjusted logistic regression analyses, adverse immigration experience (OR 5.45; 95%CI 1.55-19.14), fear of failure (OR 9.15; 95% CI 1.32-63.59), and discrimination (OR 1.48; 95%CI1.07-2.06) were significantly associated with higher odds of depressive symptoms. Higher food security (OR 0.20; 95%CI 0.05-0.85) and normal (OR 0.18; 95%CI 0.06-0.58) or high (OR 0.09; 95% CI 0.01-0.66) levels of resilience were associated with a lower likelihood of depression. Fear of failure (OR 7.34; 95%CI 1.67-32.2) and discrimination (OR 1.68; 95%CI 1.14-2.46) were associated with higher odds of anxiety symptoms, and normal (OR 0.21; 95% CI 0.06-0.68) or high (OR 0.12; 95%CI 0.02-0.77) levels of resilience were associated with lower odds of anxiety.

Conclusions: Stressors related to immigration and discrimination were associated with depression and anxiety among Ethiopian and Eritrean American emerging adults. Our findings point to a role for resilience-supporting interventions with cultural tailoring to address the unique needs of this growing demographic.

Background: Misperceptions of hospice persist in communities of color. This study explored what Black Americans understand about and how they describe hospice care. The goal was to determine if older Black Americans can accurately describe hospice and to explore potential barriers and facilitators to hospice enrollment.

Methods: A content analysis of qualitative data collected in a larger mixed-methods study. Participants responded to the written prompt, "In your own words describe hospice care" with no further instructions. Recruitment occurred from community settings between May 2019 to March 2020. We recruited 144 participants who were at least 65 years old and self-identified as Black or African American. The written narratives were analyzed to determine how accurately participants described: (1) hospice care and eligibility, (2) location of services, (3) services provided, and (4) goals of care.

Results: Participant ages ranged from 65 to 97 years (M = 74.62, SD = 6.94). Participants were predominately female (81%) and widowed (33%). Participants accurately described hospice care and eligibility (80%), goals of hospice (89%), and services hospice provides (83%). Only 39% of participants correctly identified locations of hospice services. Additionally, some participants (8%) reported certain myths and conspiracies pertaining to hospice.

Conclusions: This study found that older Black Americans accurately describe hospice care and eligibility, goals of care, and the services provided by hospice. However, most were unable to accurately describe the location of hospice services and a few reported myths and conspiracies. The study highlights areas to improve communication about hospice which may reduce some of the barriers to hospice enrollment in Black Americans.

Trial registration: ClinicalTrials.gov Identifier: NCT04458090.

Purpose: Healthcare organizations are increasingly piloting weapons screening programs (WSPs) like metal detectors (MDs) to combat rising hospital workplace violence (WPV). This study identifies, analyzes, and concisely reports how the extant body of literature supports the ability of WSPs' to reduce absolute rates of hospital WPV according to public health principles.

Methods: We searched six online databases from July 2023 to December 2024 for full-length papers and abstracts of original research regarding WSPs at public entrances to US hospitals. Study quality and robustness were assessed using the Mixed Methods Appraisal Tool and the 2010 Melnyk and Fineout-Overholt hierarchy of evidence, respectively.

Results: A total of 29 studies were included, and all were nonexperimental designs from academic institutions. Twenty-eight (96.6%) were quantitative descriptive studies, and one was qualitative. All studies ranked within the second lowest tier of experimental robustness with an average quality score of 85.5%. Only two studies directly measured absolute rates of hospital WPV before and after WSP implementation; neither demonstrated objectively lowered rates of WPV. Studies concluding efficacy of WSPs to lower rates of armed hospital WPV are steeped in circular feedback loops anchored in type 1 pseudodisease estimates of prevalence and efficacy where weapons presence is taken for prevalence of armed assault, and weapons removal is taken for reduction of armed assault. Proxy measurements like favorable public opinions and popularity of WSP practice secondarily reinforce extant literatures' conclusions of WSP efficacy.

Conclusions: We found no direct evidence that WSPs reduce absolute rates of hospital WPV based on public health principles. The results of our scoping review by no means suggest that armed WPV is an acceptable or negligible risk to hospital patients and providers. Rather, the low baseline prevalence of armed WPV suggests that even if WSPs were supremely reliable at stopping armed perpetrators with criminal intent, overall rates of hospital WPV would still climb because WSPs do not intervene upon the unarmed preponderance of hospital WPV and may inadvertently divert financial resources needed to improve the clinical factors driving those risks.

Background: Asian Americans (AA) in the United States represent a heterogenous population from various ethnic backgrounds. We compared cancer and cardiovascular disease (CVD) mortality between various AA groups and Non-Hispanic White (NHW) patients diagnosed with urologic cancer.

Methods: We assembled a population-based cohort that included 389,114 prostate cancer, 98,721 renal cell cancer, and 126,485 bladder cancer patients. Cumulative cancer and CVD mortality were compared between AA and NHW groups, accounting for competing risk of death. Multivariable Cox models were used to quantify the cause-specific hazard ratio (HR) with a 95% confidence interval (CI), comparing AA subgroups (Chinese, Japanese, Korean, Filipino, Vietnamese, Other Southeast Asian, and Indian/Pakistani) to NHW patients.

Results: AA ethnic subgroups had a lower or comparable mortality from prostate cancer compared with NHW patients (HR ranged 0.51-1.03). No overall difference was observed for renal cell cancer death, but an increased mortality was observed for Filipino (HR = 1.10; 95% CI, 1.00-1.22) and Other Southeast Asian (HR = 1.50; 95% CI, 1.06-2.12) patients that included Laotian, Hmong, Kampuchean, and Thai ethnicity. Although reduced mortality from bladder cancer (HR = 0.88; 95% CI, 0.83-0.93) was observed compared to NHW patients, an increased mortality was seen among Other Southeast Asians (HR = 1.63; 95% CI, 1.15-2.30). CVD mortality varied across AA ethnicities, with higher mortality observed in Filipino and Other Southeast Asian (HR ranged 1.23-2.40) compared with Chinese patients.

Conclusions: Large heterogeneity exists in mortality among AA patients diagnosed with urologic cancer, with higher mortality from cancer and CVD observed in Filipino and Other Southeast Asian patients.

Access to prescription drugs is a critical issue for adults 65 and older, almost 90% of whom take at least one medication to manage their health. About one in four Medicare beneficiaries has difficulty affording prescription drugs, resulting in delayed and unfilled prescriptions, and the cost burden is higher among non-Hispanic Black and Latino/a adults. We used nationally representative data to evaluate how differences in socioeconomic resources, access to care, health care need, and the use of cost-saving strategies contributed to long-standing racial and ethnic inequalities in prescription cost burden among older Medicare beneficiaries. We used logistic regressions and the Karlson-Holm-Breen decomposition method to quantify the degrees to which each factor accounted for the heightened cost burden among non-Hispanic Black and Latino/a beneficiaries compared to non-Hispanic White beneficiaries. Non-Hispanic White beneficiaries had lower odds of cost burden and higher odds of engaging in cost-saving strategies compared to marginalized groups. Even after controlling for socioeconomic, insurance, and health characteristics, non-Hispanic Black beneficiaries were more likely to experience prescription drug cost burden, and Hispanic or Latino/a beneficiaries were less likely to use cost-saving strategies compared to non-Hispanic White beneficiaries. Socioeconomic inequalities accounted for a large share of the greater cost burden experienced by older non-Hispanic Black and Hispanic/Latino adults. Notably, Hispanic/Latino beneficiaries' lower use of cost-saving strategies was a significant driver of their greater cost burden. Our study highlights how Medicare, a near-universal insurance system for older Americans, still reproduces systemic inequities and threatens the health and financial well-being of many.

Background: Although racially, sexually, and gender minoritized (RSGM) persons experience chronic and sometimes severe financial life stressors that increase their risk of mental health problems across the life course, no studies in this population have examined psychological resilience factors, such as optimism, that may mitigate these negative effects.

Purpose: To investigate how exposure to financial stressors is associated with symptoms of anxiety, depression, and somatization, and whether optimism moderates these associations.

Method: Two hundred and eighty-five RSGM emerging adults (M_age = 25.18, SD = 1.94) completed the Stress and Adversity Inventory and Brief Symptom Inventory online. Participants were Black (22.1%), Latinx (57.9%), and biracial Black-Latinx (20%), and they primarily identified as male (94.7%) and gay (74.2%).

Results: As hypothesized, multiple regression analyses with interaction terms indicated that more frequent and severe acute and chronic lifetime financial stressors were related to greater anxious, depressive, and somatic symptoms. Moreover, greater optimism was associated with fewer mental health symptoms. Additionally, greater optimism was associated with fewer somatic symptoms than lower optimism when exposed to more financial stressors. Similarly, greater optimism attenuated the negative effects of greater financial stressors' severity on depressive symptoms.

Conclusions: Financial stressors are related to worse mental health among RSGM emerging adults, and optimism may mitigate these effects. Screening for lifetime financial stressors and bolstering optimism may help reduce mental health disparities related to financial stressors in this population.

Objectives: People from ethnic minority backgrounds are exposed to greater risk of patient safety events (such as healthcare-acquired infections and medication errors) occurring in their healthcare. However, evidence of the type and frequency of patient safety events occurring in cancer care among patients from ethnic minority background is lacking. This study sought to address this evidence gap.

Design: A two-stage retrospective medical record review was conducted at four cancer services in two Australian states. Eligible medical records at each service that were identified as belonging to ethnic minority patients were reviewed by two clinician researchers in stage one, followed by authentication of extracted data by a site-specific cancer clinician in stage two. Descriptive statistics were used to report the frequency and type of safety events. Chi-square and independent sample T-tests were used to examine the association between safety events and patient socio-cultural indicators.

Results: A total of 628 patient records were included. Of the 628 patient records, 212 (33.75%) documented at least one safety event. A total of 410 safety events were documented in the 212 patient records. Medication-related safety events were most commonly documented (121/410, 29.5%), followed by clinical process/procedure-related safety events (76/410, 18.5%) and patient accidents (60/410, 14.6%). The occurrence of a safety event was associated with patient records that documented 'no interpreter was required'.

Conclusion: Patient safety events in cancer care occur frequently among patients from ethnic minority backgrounds. Unsafe cancer care for this population is associated with inadequate use of interpreters, lack of shared understanding and expectations of care processes linked to cultural and linguistic barriers. Approaches to enhance engagement are required.

Context: To evaluate algorithmic fairness in low birthweight predictive models.

Study design: This study analyzed insurance claims (n = 9,990,990; 2013-2021) linked with birth certificates (n = 173,035; 2014-2021) from the Arkansas All Payers Claims Database (APCD).

Methods: Low birthweight (< 2500 g) predictive models included four approaches (logistic, elastic net, linear discriminate analysis, and gradient boosting machines [GMB]) with and without racial/ethnic information. Model performance was assessed overall, among Hispanic individuals, and among non-Hispanic White, Black, Native Hawaiian/Other Pacific Islander, and Asian individuals using multiple measures of predictive performance (i.e., AUC [area under the receiver operating characteristic curve] scores, calibration, sensitivity, and specificity).

Results: AUC scores were lower (underperformed) for Black and Asian individuals relative to White individuals. In the strongest performing model (i.e., GMB), the AUC scores for Black (0.718 [95% CI: 0.705-0.732]) and Asian (0.655 [95% CI: 0.582-0.728]) populations were lower than the AUC for White individuals (0.764 [95% CI: 0.754-0.775 ]). Model performance measured using AUC was comparable in models that included and excluded race/ethnicity; however, sensitivity (i.e., the percent of records correctly predicted as "low birthweight" among those who actually had low birthweight) was lower and calibration was weaker, suggesting underprediction for Black individuals when race/ethnicity were excluded.

Conclusions: This study found that racially blind models resulted in underprediction and reduced algorithmic performance, measured using sensitivity and calibration, for Black populations. Such under prediction could unfairly decrease resource allocation needed to reduce perinatal health inequities. Population health management programs should carefully consider algorithmic fairness in predictive models and associated resource allocation decisions.

We conducted a demonstration project of telemedicine HIV care services at the University of Florida (UF) College of Medicine, Jacksonville. Our sample focused on members of racial and ethnic minority groups living in an urban setting. As part of the project's evaluation, we conducted 13 focus groups. Focus groups assessed patient, staff, and provider experiences with facilitating or hindering factors to engaging in telemedicine. We also explored the decision-making processes among people with HIV (PWH) to engage or not in telemedicine. The 46 focus group participants included 21 PWH: 12 PWH who accepted and nine who declined participation in telemedicine. The remaining 25 focus group participants were comprised of medical, clinical support, and community-based organization staff who supported the demonstration project. An unexpected finding that emerged in the focus group narratives detailed that some PWH who accepted telemedicine visits appreciated that telemedicine minimized the stigma they have experienced during in-person healthcare encounters. Among PWH who declined a telemedicine visit, they felt the extension of service into their personal world invaded their privacy, created routes for stigma should their HIV status be disclosed outside the healthcare setting, and raised concerns about confidentiality in virtual settings. Like the PWH, the professionals were mixed in their opinions in that some felt telemedicine facilitated care while others raised concerns. Findings point to the importance of allowing PWH to select the format (in-person or via telemedicine) in which their HIV care is rendered and highlight the importance of intervening to decrease healthcare facility-based stigma.

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.