Health Equity最新文献

Introduction: Female veterans are the fastest growing group of new Veterans Health Administration (VA) users, and 40% identify as belonging to a racialized group. It is unclear if racial/ethnic disparities in reproductive health care and outcomes observed among nonveterans are present among veterans. The purpose of this scoping review was to characterize patterns of racial/ethnic disparities in reproductive health care and outcomes among female veterans.

Methods: A structured PubMed search was performed to extend a prior systematic review (from 2008-2017 to 2018-2023). We included original research on reproductive health care and outcomes in female veterans that also included a measure of association to race or ethnicity. Four hundred thirty-eight articles were identified for potential inclusion. Following PRISMA guidelines, titles and abstracts were screened in duplicate, and full articles were reviewed using a standardized abstraction form. Articles were sorted into six categories by topic (contraception, infertility, pregnancy, reproductive health screenings, gynecology, and menopause) and outcomes characterized as structural (e.g., organization of care), process (e.g., access to services), or clinical/behavioral (e.g., low birthweight) measures per Donabedian's model.

Results: After title and abstract screening, 53 articles were reviewed in full. Four additional articles were excluded for a final sample of 49 articles. All articles described results from observational studies, which were almost exclusively focused on veterans using VA care (94%, n = 46). Topics with the greatest number of articles included pregnancy (43%, n = 21) and contraception (24%, n = 12). Racial/ethnic disparities were detected more frequently for clinical and behavioral outcome measures than for process measures.

Conclusion: Consistent with literature regarding other types of VA care, racial/ethnic disparities were more prevalent for clinical and behavioral outcome measures versus process measures, highlighting that access is necessary but not sufficient for reaching health equity. Understanding the racial/ethnic health disparities and their relationships with different measures of health care quality is essential for achieving health equity for female veterans.

There is a need to shift from deficit-based environmental health approaches toward a more balanced framework that also considers community strengths at a granular level. The Universal Basic Neighborhood Framework integrates both qualitative and quantitative data across 35 health-supportive elements within topics of environmental, housing, social, and transportation domains, promoting an understanding of health as emerging from a range of environmental factors. The framework provides a more balanced approach by presenting both negative and positive health determinants, promotes leveraging community strengths and voice in public health interventions, and enables better understanding of community health needs and assets.

[This corrects the article DOI: 10.1089/heq.2025.0031.].

Objective: To explore disparities in ineligibility for medication abortion using no-test screening criteria compared with assessment with testing including ultrasound.

Methods: From June 2021 to December 2022, we surveyed patients ages ≥15 seeking abortion at nine recruitment facilities in eight U.S. states before ultrasound; clinicians assessed patients' eligibility for medication abortion with ultrasound and other testing. Using clinical guidelines and the no-test protocol criteria, we estimated (1) the proportion ineligible by no-test assessment (pregnancy duration and ectopic pregnancy risk factors as reported in patient surveys and clinician-reported assessment of other contraindications) and (2) the proportion ineligible using no-test criteria yet eligible with testing (false positives). We assessed associations between participant characteristics and ineligibility for medication abortion and reasons for ineligibility.

Results: We approached 2,846 people, of whom 1,591 were eligible for the study. Of the 1,386 who consented and had complete clinician data, 21.1% (306/1,386) were ineligible with testing, 71.5% (n = 991/1,386) were ineligible using no-test criteria, and 51.4% (n = 713/1,386) screened false positive. In adjusted analyses, ineligibility using no-test criteria was significantly greater among people ages 15-19 (86.8% [105/121] vs. 71.5% for full sample, p < 0.001) and experiencing food or housing insecurity (75.8% [525/690] vs. 67.2%[464/693], p < 0.01); people ages 20-24 were more likely to screen false positive (56.1% [263/469] vs. 51.4% for full sample [713/1,386], p = 0.03). Moderate/severe pelvic pain was the most common (614/1,386) patient-reported reason for ineligibility and reported significantly more by people ages 15-19, who were nulliparous, and experienced food or housing insecurity.

Conclusions: Screening criteria for no-test medication abortion may exclude many people who are eligible, disproportionately excluding certain population groups from getting the care they seek. More research is needed to improve screening criteria to ensure equitable access to no-test medication abortion.

As medical research continues to promise the advancement of health equity, it is called to address its incorrect and ongoing use of the term "Caucasian." The term "Caucasian" has persisted in medical research despite its entanglement with beliefs of race as a biological factor. To continue to advance efforts in addressing health disparities and achieving health equity, researchers are called to use accurate racial and ethnic terminology.

Background: Prior research indicates that enrolling underrepresented populations in clinical research is challenging. Although research has identified some barriers to participation and strategies to overcome them, studies have made little progress in being inclusive and representative. There remains a great need for including racial/ethnic minorities, low-income families, and pregnant women in research. The purpose of this article is to describe the implementation of enrollment strategies used in our study to understand the feasibility of building a maternal cohort and better understand the relationship between environmental and social impacts on maternal exposure and child outcomes.

Methods: Working across multiple academic units, our team implemented equity-focused team science strategies to recruit diverse populations into a research study. The phases included development, conceptualization, implementation, and translation.

Results: Our interdisciplinary team study used intentionality and commitment to deploy effective strategies including clearly defining the problem, selecting the correct team members to leverage expertise, clearly defining the study, establishing roles and responsibilities, representation, and clear and constant communication. A total of 100 pregnant women enrolled in our study using a team science interdisciplinary model.

Discussion: Building interdisciplinary teams can help us understand complex problems, increase innovation, and develop effective solutions in policy and practice. More specifically, interdisciplinary teams can advance our ability to recruit diverse populations into research. Future studies should consider how to harness the strengths of the different research team members to achieve more inclusive participation.

Health equity implications: This work has the potential to improve representation in research findings, enhance understanding of health disparities, and promote inclusive research practices.

Health Policy Research Scholars (HPRS) is an innovative, equity-focused leadership program for doctoral students from marginalized backgrounds and identities. HPRS trains scholars from various disciplines to apply their research while engaging in policy to advance health equity. The HPRS logic model illustrates that training will lead to short-term changes including increased knowledge and skills; an interdisciplinary mindset; and increased sense of belonging, confidence, and self-awareness to advance health equity in the longterm. This article provides an overview of HPRS, including the logic model, curriculum, and implications for training doctoral students to become health equity leaders.

The economic burden of medical care is shared (often disproportionately) between patients, health care systems, and payers. Diagnostic scans in particular provide valuable information for providers; however, imaging is often performed in high-cost settings. Independent Diagnostic Testing Facilities have emerged as viable options for patients, but care is often fragmented and may lack sufficient quality standards. To change health care, bold steps are needed to maximize value-based care, enhance access, and ensure affordability for communities. If this fails to occur, for many more years, we will unfortunately hear "should I buy groceries or get a diagnostic scan?".

Background: The National Bleeding Disorders Foundation (NBDF) consistently hears from lived experience experts about daily challenges preventing them from leading their best life and thriving physically, mentally, and emotionally. Dedicated to enabling people and families impacted by inheritable blood and bleeding disorders (BDs) to thrive, NBDF recognized that the impact of social determinants, disparities, and inequities of health must be addressed explicitly to achieve their mission.

Methods: NBDF developed a health equity, diversity, and inclusion strategic direction for the coming decade in the context of collaboration with regional, national, and international partners. Drawing upon limited available data, extensive community consultation, and a thorough landscape scan, NBDF identified specific social determinants of health preventing health equity in the inheritable BDs community.

Results: NBDF developed a model detailing the engaging, empowering, and elevating work individual, community, organizational, and institutional stakeholders must undertake to dismantle health equity barriers. Overarching priorities and strategies were established, providing leadership, and support was offered in the form of tools, resources, and expertise.

Conclusion: Designed to be tailored to needs and capacities, this approach may be applied by other rare disorder communities to develop and operationalize their own health, equity, diversity, and inclusion strategic direction to advance social justice.