Health Equity最新文献

Purpose: Perceived social status (PSS), a measure of social status, reflects cumulative lifetime effects of an individual's relative social status based on resources and lived experiences. PSS is hypothesized to better capture social status compared to traditional measures of socioeconomic status (SES) (i.e., education, occupation, and income). Although recognized as a predictor of health-related morbidity and mortality, limited research has explored PSS and oral health. This study investigated PSS as a predictor of self-reported oral health among low-income adults.

Methods: In spring 2018, a survey was administered to a random sample of low-income adults in the state of Iowa with public dental insurance (N = 18,000). Respondents were asked about PSS, oral health status, and demographics. Multivariable linear regression models examined PSS as a predictor of self-reported oral health and compared the predictive power of PSS and SES indicators.

Results: The final adjusted sample size was 2,331. The mean PSS (range 1-10) was 5.3 (standard deviation 2.0). A significant positive association was noted between PSS (ß = 0.16, p < 0.0001) and self-reported oral health status when controlling for demographics. Furthermore, PSS accounted for an additional 3% of variance when controlling for demographic and SES indicators.

Conclusions: PSS was associated with self-reported oral health status after adjusting for SES indicators, which reflects the importance of exploring the impact of individuals' perceptions of their social status in addition to objective measures of SES. Results suggest the need for future dental research to explore cumulative effects of lived experiences on current oral health status.

Introduction: The University of California, Los Angeles COVID-19 Health Equity Research and Advisory Committee was created to identify and fund research to address COVID-19 inequities.

Methods: The committee addressed barriers to health equity research and funded $1.5 million of research.

Results: These actions facilitated dialogue, shifted research infrastructure, and piloted strategies to enhance health equity impacts through consultation and feedback. We provide an overview of projects funded and highlight one to demonstrate impact.

Conclusion: We provide a framework to help institutions implement similar approaches to centering health equity in research.

Background: The manuscript examines the nature, manifestations, and potential causes of law enforcement violence as well the need for a model of care for victims. Specifically, it explores development of a preliminary forensic nursing model of care. The questions posed over the course of development of the model follow (1) What are the challenges to developing a rudimentary forensic nursing model of care for victims of law enforcement violence? (2) What are the tenets to be utilized in developing the model? (3) What additional recommendations are to be considered in refining and expanding the model?

Key concept: A review of the literature in forensic nursing found a gap in care for victims of law enforcement violence. To address the gap given the lack of research, a preliminary model of care was developed based on key constructs from the following established models: (1) Theory of Abolition, (2) Critical Race Theory, (3) Levels of Racism, (4) Intersectionality, (5) Social Determinants of Health, (6) Emancipatory Praxis - Theory of Forensic Nursing, (7) Trauma-Informed Model of Care, and (8) Patient-Centered Model of Care.

Implications for practice: The preliminary model developed adheres to the International Council of Nurses guidelines, which emphasize the nurse's duty to care without judgment or bias. Protocols established must be followed precisely to mitigate potential conflicts of interest in care of the victim. A practical application algorithm was developed based on care provided to other victims of violence.

Conclusion: The model developed was focused on forensic nursing care. There is a need for further refinement involving an interdisciplinary approach. There is also a need for additional research as it relates to forensic nursing's role in caring for victims of law enforcement violence.

Purpose: There is a Black maternal health crisis in America, with significant racial disparities in birth outcomes for Black women in Washington, DC. Programs designed to reduce these inequities must intentionally address the role of systemic racism and the ongoing legacy of oppression that is endemic to traditional perinatal care services. This article describes the findings from the quantitative analysis of an innovative perinatal program (Mothers Rising) designed by and for Black women in the Washington, DC, metropolitan area that was part of a larger mixed methods study.

Methods: Using data provided by a Medicaid managed care organization that insured program participants and women who did not receive Mothers Rising, program participants (n = 102) were matched with a group of Black women who did not receive the program (n = 102) using propensity scores matching. Perinatal outcomes were extracted from electronic health records from the managed care dataset, including birth weight and gestational age.

Results: Statistical analyses of the differences in birth outcomes between program participants and their matched peers demonstrated small but statistically significant differences in gestational age, favoring the Mothers Rising group.

Conclusions: This study adds to the evidence base for the effectiveness of culturally tailored interventions to successfully address persistent racial disparities in Black women's perinatal health outcomes that result from persistent racism. Hyperlocal, community-developed home-visiting programs, such as Mothers Rising, should be funded to sustain impact and optimize maternal health outcomes.

Purpose: The prevalence of HIV among Black women is higher than the prevalence among other ethnic groups. Although antiretroviral therapy reduces HIV transmission and mortality, Black women still face health disparities when it comes to receiving health care. The purpose of this scoping review is to synthesize research regarding health disparities and health inequities faced by Black women living with HIV (BWLH).

Methods: We searched three scholarly databases, PsychNet, MEDLINE, and CINAHL, and 18 peer-reviewed complete studies that met the inclusion criteria.

Results: Several themes emerged from the literature, including discrimination, poverty, mental and physical health, health care, and social support. Each theme had a role in the progression of BWLH along the HIV care continuum.

Conclusion: Black women continue to be disproportionately affected by HIV, which involves active engagement in HIV care to sustain viral suppression to prevent the spread of the virus. Factors continue to exist that contribute to health disparities and inequities, such as discrimination, internal and enacted HIV-related stigma, and poverty. Thematic findings in this review indicate that patient-centered care and support systems can positively impact BWLH experiences along the HIV continuum.

Objectives: We aimed to understand factors surrounding COVID-19 testing in vulnerable urban and rural African American communities in Alabama, which are characterized by mistrust in medical research.

Methods: To address widespread mistrust, we trained lay community members as research coordinators (Community Engagement Coordinators-CECs) and employed them for study recruitment and data collection. We then explored their experiences through group discussions and individual interviews.

Results: Ten CECs (8 in Jefferson, 2 in Dallas County; 8 female, 2 male) completed 5 h of instructor-led training followed by virtual Collaborative Institutional Training Initiative (CITI) Human Subjects Training. In 11 weeks, CECs recruited 318 study participants and administered 303 surveys. After survey data collection was completed, CECs recruited survey respondents for participation in focus groups, enrolling 53 individuals. CECs continued their study engagement by reviewing developed study products.

Conclusions: Engaging CECs as research personnel facilitated successful completion of planned enrollment with minimal missing data. Investing in communities by training and employing community members as study personnel can help overcome research mistrust and promote support for research and public health interventions.

Purpose: Young sexual minority adults experience high rates of heterosexist discrimination. The use of substances has been documented as a form of coping with discrimination. While mindfulness has been used to address experiences of discrimination and the use of substances, respectively, few studies have explored whether mindfulness can lower the negative effects of discrimination on substance use. The purpose of this study is to examine the association between heterosexist discrimination and substance use in young adult sexual minority men (YASMM), and if dispositional mindfulness can moderate this relationship.

Methods: Logistic regression analysis was used to examine the association of heterosexist discrimination and cigarette, e-cigarette, and hazardous drinking in a sample of YASMM (18-35 years old; n = 325) from a national survey. A two-way interaction analysis was also implemented to evaluate if dispositional mindfulness moderated this relationship.

Results: Heterosexist discrimination was associated with increased odds of cigarette use (adjusted odds ratio [aOR] = 1.06; 95% confidence interval [CI]: 1.03, 1.08) and e-cigarette use (aOR = 1.03; 95% CI: 1.01, 1.05). Higher scores of dispositional mindfulness moderated the relationship between heterosexist discrimination and hazardous drinking, indicating a weakening effect with higher scores of dispositional mindfulness.

Conclusion: Mindfulness may decrease the negative effects of heterosexist discrimination on hazardous drinking among YASMM.Health Equity Implications: Researchers and practitioners should consider incorporating mindfulness as a component to their intervention to help YASMM deal with stressors engendered by discrimination, which may prevent hazardous drinking as a coping mechanism at a younger age.

Patients and caregivers with a language for care other than English (LOE) are at risk for inequitable care in the pediatric emergency department (ED). Professional interpretation (PI) improves outcomes, but there can be complexity in determining optimal language for care and interpretation need. Our goal was to learn more about the perspectives from caregivers who speak different languages regarding interpretation with a survey near ED discharge. Caregivers of patients with LOE, identified during ED check-in, were approached by research staff using PI near ED discharge. A survey was completed via interpreter or bilingual research staff prior to discharge or by phone within 48 h. Answers were entered into REDCap and analyzed descriptively. A total of 154 participants were approached; 49 completed a survey between April and November 2021. A variety of languages were spoken in the sample (n = 15) and represented the ED population. Twenty percent of caregivers with LOE also reported good comprehension in English. Families indicated a desire for interpretation at various stages of the ED encounter, reported different interpretation needs among family members, and indicated interest in family-initiated interpreter access. Determining optimal language for care and provision of PI during ED encounters can be complex. In this study, we report caregiver perspectives on the use of PI. Most participants wanted PI at all stages of the ED visit and were interested in accessing it themselves. Future directions are to pilot family-initiated access to PI to tailor its use to the needs of patients and families.

Introduction: We examine Black birthing people's experiences with racism, discrimination, and contextualized stress and whether those experiences are associated with preference for racially concordant prenatal care providers.

Methods: This cross-sectional study is the quantitative component of a larger, mixed-methods study. Data were from initial (August-October 2021) and follow-up (December 2022-January 2023) surveys among self-identified Black and/or African American birthing people who delivered a baby at a university system between 2019 and 2021 and were at least 18 years old. Respondents were 3-32 months postdelivery at the initial survey, which collected data on demographics and the Perceived Racism (ranges 0-430), Perceived Discrimination (ranges 0-36), and Jackson, Hogue, Phillips Contextualized Stress Measure (ranges 0-355) scales. The follow-up survey assessed views on racial and gender concordance and continuity with prenatal providers. Pearson correlation coefficients assessed relationships between scale scores and agreement that racial concordance is important and preferable. Poisson regression assessed whether a top quartile score on scales was related to importance of and preference for racial concordance with providers.

Results: Participants (n = 200) scored medians of 99.5 on the racism scale, 33 on the discrimination scale, and 177 on the contextualized stress scale. Of follow-up survey participants (n = 69), 78.3% agreed they would choose a racially concordant prenatal provider if possible (n = 54) and 42.0% agreed that racial concordance with their provider was important (n = 29). Scoring higher on discrimination and contextualized stress scales was positively correlated with agreeing that racial concordance was important. Regression analyses showed no significant associations between scale scores and agreeing that racial concordance with one's prenatal provider is important or preferable.

Conclusion: Black birthing people experience high levels of racism, discrimination, and contextualized stress. The overwhelming majority would choose racial concordance with their prenatal provider if possible.