Health Equity最新文献

Introduction: Local health departments (LHDs) play an essential role in providing COVID-19 vaccines to underserved populations in Utah. This study aimed to understand barriers to COVID-19 vaccine uptake for these populations and challenges faced by LHDs from LHDs' perspectives. In addition, we explored LHDs' experience with implementing COVID-19 mobile vaccine clinics (MVCs) in Utah.

Materials and methods: We conducted virtual focus group discussions (FGDs) from October 28 to November 1, 2022, with health officers from Utah's Department of Health and Human Services (DHHS) and LHDs. We recruited participants via email, transcribed recordings verbatim, and analyzed data using inductive content analysis.

Results: Eight participants, one from the Utah DHHS and seven from Utah's LHDs (mostly executive directors or managers), participated in two FGDs. Barriers to vaccine uptake among underserved communities included structural, behavioral, and informational barriers. LHDs faced two main challenges to increasing vaccination rate: limited resources and the lack of established partnerships with trusted communities/organizations/leaders. Strategies implemented to increase vaccine uptake included multiple channels for vaccine access and information provision, and building multiple partnerships. Key lessons learned were the importance of partnerships with trusted community/organization leaders and building core staff for vaccine uptake. Regarding MVCs, they were effective in reaching underserved populations, however, their impact was unclear in rural areas.

Conclusion: Building trust through partnerships with trusted community/organization leaders was crucial for increasing vaccine uptake in underserved populations and promoting health equity. The impact of MVCs on underserved populations in different settings remains unclear, further research is needed.

Introduction: Black sexual and gender minoritized (SGM) people assigned female at birth (AFAB) face notable barriers to cervical cancer screening, including racism, heterosexism, and cisgenderism. Although weight-based discrimination is prevalent in the United States and may compound other forms of discrimination, no study has examined the association between weight-based discrimination in health care settings and Pap test use among Black SGM AFAB.

Materials and methods: We conducted a cross-sectional online survey among Black SGM AFAB adults aged 18-45 years (N = 135) and used multivariable logistic modeling to analyze the association between weight-based health care discrimination and Pap test use, adjusting for demographic, socioeconomic, and health care factors.

Results: Approximately one quarter (27.5%; n = 33) of respondents eligible for a Pap test had ever experienced weight-based health care discrimination. Moreover, 63.3% (n = 76) and 45% (n = 54) of respondents had ever received a Pap test in their lifetime and in the last 3 years, respectively. Respondents who had experienced weight-based health care discrimination had significantly lower adjusted odds of having ever received a Pap test in their lifetime (odds ratio [OR] = 0.10; 95% confidence interval [CI]: 0.02-0.40) and in the last 3 years (OR = 0.07; CI: 0.01-0.31) compared with those who had never experienced such discrimination.

Discussion: Additional research is needed to elucidate the unique experiences of specific subgroups of Black SGM people and to inform policies, norms, and practices that mitigate the occurrence and effects of weight-based health care discrimination among Black SGM people in the context of cervical cancer screening and other health services.

Introduction: Hospital-community partnerships have been increasingly emphasized to improve population health in recent decades. This study investigates the effectiveness of hospital-community partnerships in preventive health care interventions, addressing potential racial and ethnic disparities in impact.

Methods: We measured overall hospital-community partnerships with nine community organizations at the county level using the American Hospital Association annual survey. Preventive health care interventions were also measured by preventable hospitalization rates, mammography screening rates, and flu vaccination rates across racial and ethnic groups using County Health Ranking National data. We estimated pooled ordinary least squared models with year-fixed effect and robust cluster standard errors at the state level. We also used generalized least squares models to examine the impact across racial and ethnic groups, including controls for county characteristics.

Results: Among 3785 counties across 50 states in the United States in the pooled data, the findings indicated that hospital-community partnerships were effective in increasing mammography screening and flu vaccination rates in general. However, upon closer examination of the impact across racial and ethnic groups, hospital-community partnerships were not significantly associated with any of the interventions in the Black and Hispanic population, while they were effective in the White population.

Discussion: Hospital-community partnerships can be effective in increasing uptake rates for mammography screening and flu vaccination rates, but their impact is unevenly distributed among racial and ethnic minorities.

Health equity implications: The findings emphasize the need to design targeted hospital-community partnerships for racial and ethnic minorities to mitigate health disparities in preventive health care interventions.

Objective: To understand how declarations of racism as a public health crisis were portrayed in the news from 2019 to 2021.

Methods: We assessed a national sample of articles (n = 127) to see how declarations of racism as a public health crisis were characterized in the news.

Results: Coverage skyrocketed in June 2020 with 800 articles in that month alone, many of which mentioned systemic or structural racism (43% of articles). Government speakers were quoted in 90% of articles while community voices only appeared in 24% of articles.

Discussion: Narratives that center the causes of structural and systemic racism can help inform the public about the health harms of racism and can also report on solutions to achieve health and racial equity that could influence policymakers and the public.

Health equity implications: Those proposing new declarations should make concerted efforts to ensure that these declarations generate news coverage, without relying on acts of violence against Black, Indigenous, and People of Color (BIPOC) communities. Public health practitioners, advocates, and officials should center communities most impacted and help them in creating a system that addresses racial and health inequities.

In the current soft-girl era, a soft lifestyle promotes living with ease, comfort, healing, and joy. As health equity programs evolve, they should provide safe spaces for participants' experiences, desires, and motivations for wellness living. Contributions of the soft-girl era movement challenge the notions for historically marginalized women to thrive in their health rather than merely surviving through it. If public health fields are to expand, including the fields of Black maternal health and Black food justice, Black participation is critical. The movement offers researchers to acknowledge participant voice, thereby gaining their trust, interest, and on-going participation in health programs.

Introduction: Adolescents experience major depression at disproportionately higher rates than their adult counterparts. Perceived neighborhood social environment (PNSE) has been linked with depressive symptoms among adolescents. The primary aim was to investigate the relationships between each PNSE and depressive symptoms. The secondary aim was to examine whether these associations may be varied by gender and race/ethnicity.

Methods: Participants (n = 6083; mean age = 15.4) from the 1994-1995 National Longitudinal Study of Adolescent to Adult Health (Add Health) were asked to respond to items on depressive symptoms using the Center for Epidemiologic Studies Depression Scale (CES-D) and perceived neighborhood measures. The two depressive symptoms outcomes based on CES-D score were a continuous CES-D score and a three-level depressive symptoms variable: (i) minimal symptoms score (referent) <16, (ii) mild: 16 ≤ CES-D < 24, and (iii) moderate/severe: CES-D ≥24. PNSE included safety, social cohesion, and contentedness (i.e., 1-standard deviation unit increase). Weighted regression models were used to examine associations between each PNSE and depressive symptoms, adjusting for covariates.

Results: Perceived neighborhood safety, social cohesion, and contentedness were negatively related to depressive symptoms (β = -1.14, β = -0.59, and β = -1.46, respectively, all p < 0.001). Similar patterns of negative associations were observed by gender, whereas race/ethnicity-specific analyses revealed the complexity of the associations.

Conclusion: As adolescents' favorable perceptions of their neighborhoods (safety, social cohesion, and contentedness) were related to lower depressive symptoms, efforts toward improving neighborhood conditions and resources may be imperative to drive health equity in specific subgroups and address disparities in the adolescent mental health epidemic.

Introduction: Many individuals with coronavirus disease 2019 (COVID-19) faced stigmatization, which may contribute to poor health. However, very few studies have explored the relationship between COVID-19 stigma and health, and even less is known about differences in the relationship by race and ethnicity. This article examines associations between COVID-19 stigma and mental health overall and by race and ethnicity.

Methods: We used a population-based probability sample of Michigan adults with SARS-CoV-2 infection between March 2020 and May 2022. We captured COVID-19 stigma based on perceived COVID-19 stigma, fear of COVID-19 disclosure to friends or family, and fear of COVID-19 disclosure at work. We conducted modified Poisson regression with robust standard errors to estimate associations of COVID-19 stigma with depressive and anxiety symptoms adjusting for confounding factors.

Results: Individuals who experienced perceived COVID-19 stigma had 1.44 times higher prevalence of depressive symptoms (95% confidence intervals [CIs]: 1.23-1.69) and 1.48 times higher prevalence of anxiety symptoms (95% CI: 1.30-1.69) compared with individuals who did not experience perceived stigma. Moreover, individuals who were afraid to disclose their COVID-19 diagnosis to friends or family, or who were afraid to disclose their diagnosis at work, had a higher prevalence of depressive symptoms and anxiety symptoms, compared with those who were not afraid. These associations were more pronounced among racial and ethnic minoritized individuals than non-Hispanic White individuals.

Discussion: COVID-19 stigma was associated with depressive and anxiety symptoms. There is a critical need to examine long-lasting effects of stigma, particularly among racial and ethnic minoritized individuals.

Introduction: The representation of ethnoracial minoritized individuals in health services and policy research (HSPR) has increased in recent years. However, previous literature has exposed a need to acknowledge and attend to inequities within the HSPR workforce.

Methods: To describe educational and workplace experiences that characterize diversity, equity, and inclusion (DEI) within the HSPR profession. In this qualitative study, six focus groups were conducted virtually via Zoom with 27 individuals who reported working or pursuing higher education in HSPR from December 2020 to January 2021. We sought HSPRers perspectives on DEI initiatives, work and educational environments, experiences, and climate, and recommendations for improving DEI in HSPR. We developed a structured codebook and applied a deductive approach to conduct thematic analysis.

Results: Of the 27 participants, nearly half of participants identified as Black/African American (44%); most were women (81%). Three major themes emerged: (1) HSPR work and education spaces subject minoritized HSPRs to a range of exclusionary and harmful practices; (2) DEI initiatives fail to address the need for institutional change; and (3) by working with and for policymakers, HSPRs are uniquely subjected to shifting political contexts that reinforce racism.

Discussion: Despite an increasing commitment to increasing the diversity of the HSPR workforce and improving equity and inclusion in the HSPR workplace, the findings suggest that more intentional and action-oriented work is needed, especially work that emphasizes inclusion and equity across various levels of the workplace.

Health equity implications: The findings offer critical insight on necessary workplace and educational reform to develop the workforce necessary to advance population health equity and equity-oriented policy making.

Introduction: The COVID-19 pandemic placed unprecedented strains on the U.S. health care system, contributing to significant disruptions of care. COVID-19 was also associated with an increase in negative sentiment toward and hate crimes targeting Asian Americans and Pacific Islanders (AAPI) individuals. The rise in anti-AAPI violence seen across the United States may have discouraged AAPI individuals from seeking medical care beyond the barriers to seeking care imposed on all persons by the pandemic. This study examines how COVID-19 and the concurrent increase in hate crimes targeting AAPI individuals impacted care utilization.

Materials and methods: We use fee-for-service claims from Medicare beneficiaries enrolled in Parts A and B for 2017-2021. We present descriptive results and use a difference-in-differences-style regression framework to estimate changes in ambulatory utilization associated with the COVID-19 pandemic and compare results across racial/ethnic groups.

Results: The start of the pandemic is associated with decreases in the percentage of beneficiaries with ≥1 ambulatory visit, ambulatory visit rate, and ambulatory spending, among all racial/ethnic groups. AAPI beneficiaries suffer larger disruptions to all three measures of utilization, compared with other racial/ethnic groups.

Discussion: Trends among AAPI beneficiaries are unlike those seen in Black, Hispanic, or White beneficiaries, suggesting that AAPI beneficiaries experience care disruptions different in cause and/or magnitude from the disruptions affecting other groups.

Conclusions: Racial/ethnic disparities may be overlooked if results are only reported for some sub-groups. The experience of AAPI individuals during the COVID-19 pandemic is markedly different from that of other groups and warrants additional study.

Introduction: Anticipating discrimination can lead to increased vigilance, which acts as a potential stressor similar to actual discrimination experiences. However, there is limited understanding of how discrimination and anticipated discrimination affect Latinos with intersecting identities, particularly those who are immigrants. Using a cross-sectional survey, we examine the association between intersectional anticipated discrimination and mental health among immigrant Latinos.

Methods: We conducted a cross-sectional survey through the Rapid Acceleration of Diagnostics-Underserved Populations initiative (March 2022-May 2023). Participants were foreign-born adults who self-identified as Latino or Hispanic. The exposure measure used the Intersectional Anticipated Discrimination Scale, and outcomes measures included 2-item screens for anxiety (Generalized Anxiety Disorder screener [GAD-2]) and depression (Patient Health Questionnaire [PHQ-2]) and a 3-item screen for hazardous alcohol consumption (Alcohol Use Disorders Identification Test).

Results: A total of 810 participants completed the survey, of whom 66.7% were uninsured. Among them, 25.2% screened positive for anxiety, 18.1% for depression, and 20.2% for hazardous alcohol consumption. Positive screening for anxiety and depression was associated with higher levels of anticipated discrimination (GAD-2 adjusted odds ratio [AOR] = 1.05, 95% confidence interval [CI]: 1.03, 1.07; PHQ-2 AOR = 1.05, 95% CI: 1.03, 1.07). A dose-response relationship was observed with higher levels of anticipated discrimination and higher PHQ-2 and GAD-2 scores.

Conclusions: Anticipated intersectional discrimination was associated with symptoms of anxiety and depression in immigrant Latinos. Prioritizing culturally competent care that recognizes the heterogeneity of the Latino population, enhancing community support, and implementing targeted policy interventions are imperative steps toward promoting mental health equity among this population.