Journal of Racial and Ethnic Health Disparities最新文献

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.

There is an emerging literature exploring the role of discrimination in vaccine hesitancy, particularly among Black individuals. The goal of the present research is to explore how COVID-19 vaccine hesitancy, vaccine status, and vaccine access are associated with race, income, and discrimination. A quota sample of 798 Black/White and low/high income participants from the United States completed an online survey between March 8 and April 19, 2023. The survey assessed self-reported race, income, discrimination, vaccine hesitancy, and vaccine access. Perceived discrimination (B = .15, P = .002) and being Black (B = -.30, P < .001) were associated with higher vaccine hesitancy. Lower income White participants were less likely to be vaccinated than Black or higher income White participants (PR = .66, P = .04). The lowest vaccine access was reported by low-income White participants with high levels of discrimination and the highest access was reported by high-income Black participants with low levels of discrimination (B = -.03, P = .05). Our findings highlight the unique impact of discrimination on vaccine access and vaccine hesitancy. Further, despite previous literature identifying Black populations as having lower vaccine access, our findings suggest that lower income White participants reported the lowest vaccine access and were the least likely to be vaccinated. These findings have implications for understanding the impact of discrimination on vaccine-related beliefs and behaviors, which can inform vaccine-related communication in communities where discrimination is likely.

Objective: The purpose of this review was to identify relationships between social determinants of mental health service utilization and outcomes among Asian American cancer survivors in the United States (U.S.).

Methods: We performed a systematic literature search in PubMed, PsycINFO, CINAHL, and Embase for peer-reviewed studies between January 2000 and May 2024. Based on the Healthy People 2023 framework, social determinants of health (SDOH) were categorized into five SDOH domains. We extracted data using a table of evidence, and we assessed study quality using the Johns Hopkins Evidence-Based Practice.

Results: Ten non-experimental studies, with either "High" or "Good" quality, met eligibility criteria. Two examined mental health service utilization, and nine reported mental health outcomes. Seventy percent of the studies recruited samples from the health systems. The rest were from community settings. Seventy percent included the Asian American subgroup, mainly Chinese Americans. Higher education, English proficiency, more years residing in the U.S., and having social support correlated with better psychological quality of life. Higher-income and education levels were associated with more psychotropic medication use. However, zip code levels were used to estimate actual income and education.

Conclusion: We identified significant SDOH factors that influenced mental health outcomes among Asian American cancer survivors. More research is needed to understand the social determinants of mental health service utilization barriers in this population. Allocating more funding to health research tailored to Asian American cancer survivors, along with data disaggregation, standardizing socioeconomic status measures, and diversifying sampling sources, is essential to enhancing their mental health outcomes.

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.

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.

Background: The Afro-Peruvian population is one of the ethnic minorities most affected by cultural, socioeconomic, and health barriers; however, there is little evidence on health inequalities in this ethnic group. Therefore, We aimed to determine health inequalities among the Peruvian Afro-descendant population in comparison with non-Afro-descendants.

Methods: A cross-sectional study was conducted using data from the Demographic and Family Health Survey 2022. Twenty indicators related to the health, nutrition, and well-being of the Peruvian Afro-descendant population were included. Individuals identifying as native, as well as those who did not know or did not respond to the ethnicity question, were excluded from the analysis. To assess inequalities in these indicators, the difference in percentages between Afro-descendants and non-Afro-descendants was calculated, and the percentages of these indicators across the tertiles of wealth index and the slope index of inequality (SII) were analysed for each ethnic group.

Results: Of a total of 16,875 adults and 23,206 women included in the study, 16.9% and 17.3% were of African descent, respectively. Afro-descendant population had a lower proportion of self-reported diabetes (- 1.5 percetange points (pp); 95% confidence interval (CI), - 2.7 to - 0.3); alcohol consumption in the last 30 days (- 4.5 pp; 95% CI, - 7.2 to - 1.8); higher education (- 20.6 pp, 95% CI, - 23.2 to - 18.0); access to improved water (- 3.4 pp; 95% CI, - 4.6 to - 2.1) and sanitation (- 12.1 pp; 95% CI, - 14.2 to - 10.0); cesarean section (- 9.5 pp; 95% CI, - 12.6 to - 6.4); institutional delivery (- 6.3 pp; 95% CI, - 8.4 to - 4.1); early initiation of prenatal care (- 3.3 pp; 95% CI, - 5.8 to - 0.9); birth registration (- 1.8 pp; 95% CI, - 3.4 to - 0.2) and higher proportion of stunting (+ 4.8 pp; 95% CI, 3.0 to 6.6) and adolescent maternity (+ 5.0 pp; 95% CI, 1.4 to 8.6) compared to their non-Afro-descendant counterparts. In addition, a similar wealth gap between Afro-descendant and non-Afro-descendant populations was observed in various indicators.

Conclusions: In Peru, some indicators reflect the worse living conditions faced by the Afro-descendant population compared to their non-Afro-descendant counterparts in terms of health, nutrition, and well-being.

Background: African-born women in Australia are more likely to experience poorer perinatal outcomes than their Australian-born counterparts. This disparity may be attributed to difficulties in accessing maternity care services. With a rapidly growing African-born population in Australia, understanding African-born women's experiences with maternity care is crucial for ensuring equitable access.

Aim: This study aimed to explore the access to and experiences of maternity care among African-born women living in Melbourne, Australia.

Methods: A qualitative descriptive study was conducted from September to December 2023, involving 15 purposively selected African-born women. An apriori analytic approach was applied to present the findings using the World Health Organization's Availability, Accessibility, Acceptability, and Quality framework. Data management and analysis were undertaken using NVivo 14.

Results: Participants from nine different African countries shared their experiences regarding their most recent encounters with maternity care in Australia. Key challenges identified included difficulties navigating the healthcare system, lack of social support, discomfort with male clinicians, experiences of discrimination, inadequate information, transportation issues, perceived lack of empowerment, financial constraints, and clinician cultural insensitivity. These factors negatively impacted their maternity care experiences.

Conclusions: This study provides empirical evidence to inform policies, practices, and strategies aimed at improving maternity care experiences for African-born women in Australia. There is a need for clinicians to be more aware of and sensitive to these women's cultural needs. Developing and implementing a culturally responsive service model could mitigate negative experiences and enhance access to adequate maternity care, ultimately improving perinatal health outcomes for these women.

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.

Background: The Charlson Comorbidity Index (CCI) is a frequently used mortality predictor based on a scoring system for the number and type of patient comorbidities health researchers have used since the late 1980s. The initial purpose of the CCI was to classify comorbid conditions, which could alter the risk of patient mortality within a 1-year time frame. However, the CCI may not accurately reflect risk among American Indians because they are a small proportion of the US population and possibly lack representation in the original patient cohort. A motivating factor in calibrating a CCI for American Indians is that this population, as a whole, experiences a greater burden of comorbidities, including diabetes mellitus, obesity, cancer, cardiovascular disease, and other chronic health conditions, than the rest of the US population.

Methods: This study attempted to modify the CCI to be specific to the American Indian population utilizing the data from the still ongoing The Strong Heart Study (SHS) - a multi-center population-based longitudinal study of cardiovascular disease among American Indians. A 1-year survival analysis with mortality as the outcome was performed using the SHS morbidity and mortality surveillance data and assessing the impact of comorbidities in terms of hazard ratios with the training cohort. A Kaplan-Meier plot for a subset of the testing cohort was used to compare groups with selected mCCI-AI scores.

Results: A total of 3038 Phase VI participants from the SHS comprised the study population for whom mortality and morbidity surveillance data were available through December 2019. The weights generated by the SHS participants for myocardial infarction, congestive heart failure, and high blood pressure were greater than Charlson's original weights. In addition, the weights for liver illness were equivalent to Charlson's severe form of the disease. Lung cancer had the greatest overall weight derived from a hazard ratio of 8.31.

Conclusions: The mCCI-AI was a statistically significant predictor of 1-year mortality, classifying patients into different risk strata χ² (8, N = 1,245) = 30.56 (p = 0.0002). The mCCI-AI was able to discriminate between participants who died and those who survived 73% of the time.