Health Equity最新文献

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.

Background: In the United States, Black women are three times more likely to be affected by maternal mortality than White women. People who live in rural areas also face an increased risk. The objective of this study was to explore the perspectives of Black postpartum women's support persons and health care providers, and the impact of race and rurality on their roles, to inform the development of a mobile health (mHealth) application focused on postpartum transitional care for rural Black women.

Methods: Utilizing a semistructured designed discussion guide, we conducted four focus groups between July 2021 and October 2021. We asked support persons and health care providers to share their opinions about (1) postpartum needs, (2) the current hospital discharge process, (3) gender discrimination and experiences of racism and classism, and (4) suggestions for mobile application development.

Results: Ten health care providers and seven support persons participated in the focus groups. A total of 57.1% of support persons identified themselves as a family member of the mother. In addition, 60% of health care providers indicated they practiced in a rural area at the time. Identified themes included race and rurality, emotional health, participants' roles in relation to mothers' needs, and the importance of technology for accessing information and resources.

Conclusion: When describing their personal experiences, participants emphasized the importance of mHealth technology for helping Black postpartum mothers access health information. Insight from support persons and health care providers highlighted the challenges Black rural mothers face during the postpartum period and how our mobile application can be best utilized to address their needs.

Background: To achieve health equity, interventions should yield similar effectiveness across all patient subgroups. However, the adoption of diabetes prevention strategies and successful weight loss in "real-world" Diabetes Prevention Program (DPP) translational studies have varied by race and ethnicity. We examined racial and ethnic differences in diabetes prevention outcomes among study participants from the Prediabetes Informed Decisions and Education (PRIDE) Study.

Methods: In a retrospective analysis of data from the PRIDE cluster randomized trial across a large health system, we examined (1) percent weight change and (2) uptake of DPP and/or metformin among overweight/obese participants with prediabetes 12 months after participating in a pharmacist-led shared decision-making (SDM) intervention. We stratified the outcomes by race and ethnicity using a generalized linear mixed-effects model.

Results: The study participants (n = 515) had an average age of 56 years (standard deviation [SD] = 11.0), hemoglobin A1c of 6.0% (SD = 0.20), and body mass index of 30.3 (SD = 5.2). Black/African American and Latino study participants lost significantly less weight at the 12-month follow-up compared with White/Caucasian participants (-1.0% and -1.2%, respectively, vs. -3.3%, p < 0.01 for both comparisons). There was no significant difference in the adoption of diabetes prevention strategies between racial and ethnic groups after completing an educational SDM intervention.

Conclusion: To better promote health equity, future studies should investigate the potential causal factors for these differences in weight loss, such as variations in socioeconomic status, physical activity, cultural influences, and neighborhood characteristics.

Background: In unequal economies, the spread of the first waves of the COVID-19 was usually associated with low socioeconomic status of individuals and their families. Chile exemplified this. By mid-2020, Chile had one of the highest SARS-CoV-2 infection rates in the world predominantly in poorer areas. A year later, the country launched a universal vaccination campaign based on the national strategy of immunization established in 1975. By 2022, Chile presented one of the highest COVID-19 vaccination coverages globally, reaching 94.3% of the population with the primary scheme by the end of 2022.

Objective: This study analyzes the spatial distribution of SARS-CoV-2 seroprevalence at the beginning of the pandemic (2020) compared with the seroprevalence after 2 years of ongoing epidemic and COVID-19 vaccination campaigns (2022).

Methods: Two population-based random samples of individuals aged 7 years and older from two Chilean cities were studied. Utilizing an enzyme-linked immunosorbent assay test, IgG antibodies were measured in serum of 1061 participants in 2020, and 853 in 2022.

Results: Using the Global Moran's Index, the seroprevalence distribution pattern for the year 2020 showed clustering in the two cities. Conversely, seroprevalence and vaccinations were homogeneously distributed in 2022. These results show the success of the vaccination campaign in Chile, not only in coverage but also because it widely reached all individuals.

Conclusions: The uptake of this preventive measure is high, regardless of the social and economic factors, achieving broad population immunity. The extensive deployment of the primary health care network contributed to reducing health inequities and promoting to universal health access.

Systematic reviews are used for synthesizing and summarizing published research on any given topic and population of interest. These reviews can expand knowledge within a content area but are limited by place and time values, which can perpetuate bias and systemic racism. This article reports a student's experience with conducting a systematic review on breastfeeding experiences among black birthing parents. We explore the systematic racism perpetuated by the current systematic review search process. We then use McLemore's "Retrofit, Reform, and Reimagine" framework for health equity to propose ways to increase transparency and racial equity through the systematic review process and academic mentoring.

Objectives: The Pediatric Health Equity Collaborative (PHEC) set out to describe the best practices for establishing a health equity-focused office within a clinical setting.

Study design: Survey and in-depth interviews of the members of the PHEC comprised pediatric care delivery systems in the United States and Canada.

Methods: Human-centered design methods were utilized in an iterative fashion to develop and agree on survey and interview domains. The final seven domains were as follows: (1) history of the office, (2) general description of the office, (3) position of the office in the organization, (4) budget and finance, (5) stakeholders, (6) community engagement, and (7) measuring outcomes. Interviews were analyzed using an applied thematic approach to inductively identify themes until saturation was achieved.

Results: PHEC participants articulated several key implementation factors in the development of a health equity office. First, the history of the office is important and has the potential to determine the office's scope of work and sphere of influence. Second, a health equity office can provide crosscutting organizational direction, stability, and execution of equity efforts, reducing the effects of siloing. Third, high-level leadership buy-in provides time and financial resources. Finally, a health equity office should be centrally involved in the collection, analysis, and reporting of equity-focused metrics.

Conclusions: A health equity-focused office can play an integral and sustaining role in representing and focusing equity efforts across an organization, measuring processes and outcomes, and helping to develop the equity mission and vision.

Introduction: Research suggests Hispanic/Latino/a/x/e (hereafter Hispanic) youth/young adult (YYA) tobacco use may vary by acculturation level, but few studies have explored e-cigarette use by acculturation or how bicultural identity may affect tobacco susceptibility. This study examined acculturation's role in U.S. Hispanic YYA e-cigarette use to better understand risk and protective factors.

Methods: We conducted 20 virtual focus groups in English/Spanish with Hispanic 13-24-year-olds (December 2021-January 2022). We coded transcripts in their original language (intercoder reliability kappa 0.89) and conducted thematic analysis segmented by age cohort, e-cigarette use, and acculturation level.

Results: More acculturated participants had greater knowledge/familiarity with tobacco/nicotine compared with less acculturated participants. Bicultural participants more commonly mentioned curiosity and direct peer pressure as e-cigarette use drivers. While bicultural participants noted the negative impacts of e-cigarette use on family relationships, this was not a use deterrent. Less acculturated participants were most concerned with stigma, negative family impacts, and broader Hispanic community disapproval.

Discussion: This study suggests that differences related to Hispanic identity and the acculturative process may increase or decrease e-cigarette use risk. Bicultural YYA, who represent more than half of U.S. Hispanic YYA, toggle between Hispanic roots and mainstream U.S. culture, which can lead to unique stressors that may increase susceptibility to e-cigarettes.

Health equity implications: Public health efforts must recognize the heterogeneity of the Hispanic population and the role acculturation plays in e-cigarette use. A nuanced understanding can inform the design of targeted and effective public health strategies to reduce disparities in e-cigarette risk and use.

Background: Wayne State University School of Medicine (WSUSOM) is the largest single-campus medical school located in a diverse community. WSUSOM's religious holiday policy guarantees time off for observance of one religious holiday. For all other religious holidays, students must request for time off. The current policy lacks specific guidelines to ensure equity across religious identities when granting time off. Religious and spiritual practice can enhance wellness. Therefore, assessing the equity of the current policy is crucial to ensuring equitable access to wellness.

Objective: This project aims to assess students' attitudes and experiences with the current religious holiday policy at WSUSOM and compare experiences across religious identities.

Methods: A 17-question Qualtrics survey was emailed to all WSUSOM students. Survey questions included demographics, experiences with the current policy, and Likert scales to assess attitudes. Data was analyzed holistically and assessed for variation among religious identities using chi-squared analysis.

Results: Analysis included 156 surveys: 27.5% of students reported difficulties getting their religious holiday off, and 9.8% were denied a religious holiday, Muslims being the most impacted (p < 0.01). Muslim identifying students (75%) reported the highest incidence of completing additional work to receive an absence; 35.6% of students agreed that the current policy caused mental distress and majority of those being Muslim students (p < 0.01).

Conclusions: The current policy has caused difficulty for many students and has disproportionately impacted students from minority religions (especially Islam), exposing the need for a new policy.

This guest editorial offers a critical response to Chervenak, McLeod-Sordjan, Pollet et al.'s clinical opinion dismissing obstetric violence as both emotionally charged and damaging to provider-patient relationships. We assert that obstetric violence remains a significant and useful framework to name and challenge racist, misogynist, and harmful medical practices. We note that such harmful practices are embedded in systems and cannot be addressed merely by individual physicians or shifts in the provider-patient relationship. Throughout, we situate the term obstetric violence in historical and legal context and demonstrate its continuing relevance to contemporary reproductive health care.