Health Equity最新文献

Objectives: We established a community-academic-policy partnership to examine mobility challenges and opportunities by centering members of a diverse South Seattle neighborhood.

Methods: Three participatory research methods were used: (a) 30- to 60-min qualitative interviews with community leaders (n = 12) and members (n = 16); (b) a photovoice with youth (n = 10); and (c) mobility audits. We also engaged extensively in community dissemination and advocacy.

Results: Four major themes emerged: experiences with the built environment; conflicting views on promoting active transportation; experiences of danger, violence, and racism while moving in the community; and pride and connections within the community. Mobility audit findings reinforced many community member messages about needed infrastructure changes. Participants consistently expressed the need for neighborhood and city-wide structural improvements to support transportation and mobility, including enhanced public transportation; better lighting, crosswalks, sidewalks, pavement, and curb cuts; and maintenance of a neighborhood mixed-use trail. Participants shared the importance of community connection while walking, rolling, or using public transit and wanted to maintain this experience.

Conclusions: Collectively, findings identified ways to increase nonmotorized transportation and public transit access, safety, and resilience, centering solutions on communities of color. We disseminated and amplified community recommendations to advance mobility justice in South Seattle via a community forum, developing a website, holding meetings with local leaders, and writing through print and electronic media. A key, novel strength of our project was the addition of community organizations, community-academic partners, and government leaders from the project's inception. Local leaders should engage in mobility justice-focused community engagement to advance equity.

Background: The Joint Commission (TJC) released new health care equity (HCE) standards for hospitals with the goal of helping organizations monitor and improve equity of care. This study assessed the state of the field immediately following the release of the new standards to gain a baseline understanding of the field's progress toward HCE.

Methods: This was a cross-sectional observational study. An online questionnaire assessed four domains related to organization's progress toward HCE, as it aligns with TJC's accreditation and certification requirements: 1) leadership, 2) collaboration, 3) collecting and using data, and 4) provision of care. The questionnaire was distributed between April and June 2023. Included hospitals received an accreditation visit in 2022 or were scheduled for a visit after October 2024, leaving 2,098 eligible hospitals. A representative sample of 1,625 hospitals received the questionnaire.

Results: In total, 340 hospitals (20.9%) responded to the questionnaire. Hospitals were mostly meeting the mark in the leadership domain, but many have addressed the other domains to a limited degree. Not-for profit hospitals and those that are part of a system were more likely to have made strides toward achieving compliance with HCE requirements, whereas behavioral health/psychiatric hospitals have made less progress in this area.

Health equity implications: Many of the hospitals surveyed have made advances in the HCE-related topics covered in this study, but achieving HCE is only part of the journey toward overall health equity. Societal institutions must work together to address the social determinants of health for entire communities in addition to individual patient needs.

Introduction: During the COVID-19 pandemic, a decrease in physical activity (PA) has been reported in the United States and worldwide. Post-COVID-19, there is thus an urgent need for public health initiatives to revive individuals' interest and support for regular PA. The academic-community partnership between the EMU REACH team and community stakeholders co-designed and implemented an actionable alley activation. The objectives were to (1) Apply a community-based participatory approach for conducting walk audits, and (2) Evaluate the implementation and effectiveness of the alley activation.

Materials and methods: The intervention took place in Hamtramck, Michigan and the project team engaged the stakeholders, performed environmental scans, assessed the setting, developed and implemented alley activation, and evaluated the process and outcomes of the intervention. The pilot was assessed using evaluation surveys in multiple languages and speed studies with traffic data.

Results: Seventy-two residents and business owners helped implement the alley activation; 54 completed surveys offering feedback about the design and their experiences; and 1,669 residents saw immediate improvements in non-motorized connectivity. The evaluation surveys showed that respondents were positive about the project. For the traffic studies, vehicle speeds were reduced from an average of 28.3 MPH during conflicts with pedestrians to 23 MPH, and total conflicts were also reduced.

Conclusion: This quick-build project served as an initial effort for the future implementation of other place-making strategies. The bottom-up community-engaged process has the potential to create a safe, appropriately scaled space that will promote increased walkability in an inner city.

Objectives: Mass incarceration of women systematically targets minoritized groups. Approximately 1,000 births occur from prison annually; and most children must be cared for by someone other than their mother. Little is known about caregiving for infants in the context of maternal incarceration. The purpose of this study was to describe the experiences of caregivers assuming care of newborns of incarcerated mothers to identify challenges and provide policy recommendations.

Materials and methods: Data from this study were drawn from qualitative intake interviews with caregivers of children born to incarcerated mothers in Georgia participating in the Birth Beyond Bars Study, an ongoing birth cohort of children exposed prenatally to incarceration in three states. One of the primary research questions for these interviews was how caregivers were coping with assuming care for the infant. All caregivers of children born to incarcerated women from August 2020 to January 2023 (n = 48) were approached for enrollment into the study by staff at a nonprofit providing support to incarcerated pregnant and postpartum women and their families. We used thematic analysis to analyze data from 36 caregivers.

Results: Caregivers were primarily older (45% were between 46 and 71), female kin (89%), who were frequently impoverished (30%). Caregivers faced challenges in legally assuming care of the infant, maintaining work, securing childcare, enrolling in social services, and managing their health. They primarily relied on their families for support.

Discussion: Caregivers of infants of incarcerated mothers are a vulnerable population requiring enhanced support. Targeted support may ameliorate negative consequences of assuming this role.

Health equity implications: To promote health equity, state social service agencies should target and assist caregivers in enrolling in social services. Most importantly, states should pass legislation prioritizing community-based alternatives to incarceration for pregnant and parenting mothers.

Purpose: Cardiovascular disease disproportionately affects historically marginalized populations in the United States. This study explored disparities in cardiovascular health outcomes, social determinants of health, and health-promoting behaviors across racial and ethnic groups.

Methods: Using data from the 2019 Behavioral Risk Factor Surveillance System, we conducted a descriptive analysis of cardiovascular conditions and diabetes, social determinants of health, and health-promoting behaviors across eight racial/ethnic categories.

Results: Historically marginalized groups had higher rates of cardiovascular conditions and greater barriers to health care access. However, these groups often demonstrated equal or higher rates of engagement in health-promoting behaviors compared with White adults. For example, Black adults had the highest hypertension prevalence (41%) despite having the highest rates of blood pressure management behaviors.

Discussion: The persistence of health disparities despite equivalent health-promoting behaviors suggests a significant influence of structural factors like racism. Critical examination using Quantitative Critical Theory revealed potential biases in measurement tools and data categorization that may perpetuate inequities.

Health equity implications: Findings underscore the need for equity-focused research approaches that explicitly address structural racism. Future studies should prioritize culturally relevant measures, clinically meaningful outcomes, and active involvement of researchers from marginalized communities to advance cardiovascular health equity.

Introduction: Women Veterans are diverse in terms of racial, ethnic, and gender identities and sexual orientation and may experience a variety of forms of discrimination and stigma in health care settings. Our objective was to understand discrimination experienced by women Veterans in the context of Veterans Health Administration (VA) care.

Methods: We analyzed data from a series of semistructured telephone interviews with Veterans identified as females in the VA medical record who received VA health care in the past 12 months, purposively sampled by race/ethnicity and age (N = 28). The interview guide elicited experiences with VA health care, including discrimination. Interviews were audio-recorded, transcribed, and analyzed using inductive and deductive content analysis.

Results: We identified themes regarding structural discrimination, interpersonal discrimination, and strategies employed in response to discrimination. Veterans described structural discrimination, including challenges with spaces not designed to accommodate disabilities or safety needs and care not sensitive to their gender, trauma histories, or sexual orientation. Interpersonal discrimination included harassment from other Veterans and biased treatment from VA providers and staff based on gender, appearance, and sexual orientation. Gender-based discrimination compounded across additional axes of marginalization including body size and stigma regarding mental illness. Experiences of discrimination undermined Veterans' sense of belonging and trust in VA and created barriers to accessing care. Veterans engaged in various strategies to protect themselves from discrimination and get needed care.

Discussion: Quality improvement efforts that address the experience of women Veterans using VA health care must consider multiple forms and sources of discrimination and the intersection of gender-based discrimination with other forms of marginalization.

Background: Transgender youth in Thailand often encounter limitations when accessing gender services, leading many to use nonprescribed hormones.

Objectives: This study aimed to explore 1) the pattern of Gender-Affirming Hormone Treatment (GAHT) use among Thai transfeminine youth, 2) the baseline characteristics of transfeminine youth, and 3) the self-reported happiness score and depression screening.

Methods: We conducted a cross-sectional online survey among Thai transfeminine youth aged 12 to 25 years. Data were collected using a self-administered questionnaire distributed via social media platforms from September 2021 to October 2022.

Results: Of the 256 participants, 226 (88%) reported having used hormones. The average age at which participants first used hormones was 15.5 years (SD 2.5). A majority (94.6%) of those who had used hormones disclosed their gender identity, compared with a lower percentage (60%) in the nonhormone use group. Among those with hormone use experience, only 36.1% reported use that strictly aligned with the recommended regimen, according to the 2017 Endocrine Society Clinical Practice Guideline, which includes an antiandrogen agent (oral cyproterone acetate) and estrogen (either oral estradiol valerate, oral 17 beta-estradiol, or estrogen gel). Furthermore, the average happiness scores and PHQ-A scores showed no significant differences between individuals who have or have not used GAHT.

Conclusion: Thai transfeminine youth have started using GAHT during adolescence. However, many of them use it in ways that deviate from the recommended standard of gender care. The findings underscore the urgent need to enhance medical access, education, and supervision for gender health care among transfeminine youth.

Objectives: To examine if the likelihood of infants and toddlers requiring medical care for diaper dermatitis, a condition linked to infrequent diaper changes and possible diaper need, is different across racial/ethnic groups.

Materials/methods: This is a population-based retrospective study. We collected data via public records requests from the California Department of Health Care Access and Information to determine the number of patients aged 0 to 3 years diagnosed with diaper dermatitis from 2010 to 2021 in emergency departments (EDs) and hospitals. We used two sample t-tests to compare the incidences of ED visits and in-patient hospitalization during the 11-year time period to identify differences across racial/ethnic groups.

Results: From 2010 to 2021, there were 184,097 total diagnoses of diaper dermatitis, 53,678 of which received in-patient treatment. The annual mean was 15,341 and ranged between 9,407 and 17,425. The prevalence (per 1,000 children aged 0-5 of the respective race) was highest for the Black population averaging 9.56 (range: 5.79 to 11.37). The prevalence was 5.93 (3.75 to 7) for the White population, 2.49 (1.78 to 3.14) for Asian/Pacific Islanders, and 6.67 (4.25 to 7.52) for the Hispanic population. We find that Black children were disproportionately diagnosed with diaper dermatitis in California hospitals and EDs (p < 0.001).

Conclusions: Racial disparities in medical conditions that can result from lack of sufficient diapers point to diaper need as a social determinant of health deserving of greater public attention and policy redress.

The socioecological model (SEM) conceptualizes health broadly and focuses on multiple factors that might affect health. This article takes a novel approach to leverage an SEM framework to identify challenges and sustainable opportunities to advance diversity for clinical study participation in apolipoprotein L1 (APOL-1)-mediated kidney disease. We describe four levels of an APOL-1 SEM-intrapersonal, interpersonal, community, and structures/systems-for improved diverse APOL-1 clinical study enrollment and engagement. This SEM can serve as a model for improving clinical study diversity and equity to help improve the generalizability of clinical study results in other disease conditions that disproportionally impact racial and ethnic minority populations.