Ethnicity & Health最新文献

Background: Factors that influence health service utilization among Black immigrant women with experiences of trauma are not well understood. An improved understanding of the impact of cumulative trauma on Black immigrant women's health care utilization is critical to increase access to health services for this population.

Methods: Using baseline data of 147 Black immigrant women from an existing NICHD-funded study, hierarchical multiple linear regression was used to assess the impact of length of stay in the US, education, cumulative trauma frequency, everyday discrimination, and the interaction of discrimination and cumulative trauma on health service utilization. A model-building approach was used to determine covariates to include in the final model.

Results: Cumulative trauma frequency was positively associated with health service usage (b = 0.02; p = 0.026). Compared to Black immigrant women who had lived in the US for longer than 10 years, those who had lived in the US between 1 and 4 years were less likely to use health services (b = -0.89; CI: -1.67, -0.11). Black immigrant women with bachelor's degrees were less likely to use health services compared to Black immigrant women with post-graduate degrees (b = -0.85; CI: -1.61, -0.09). The interaction of cumulative trauma and discrimination was also significantly associated with the behavior of utilizing health services (b = 0.002; CI: 0.0003, 0.004). Those who experienced higher perceived levels of discrimination and high cumulative trauma levels were more likely to use health services compared to those with lower levels of discrimination and high levels of cumulative trauma.

Conclusion: Cumulative trauma experiences were positively correlated with health service utilization, and discrimination strengthened this relationship. Future work must examine long-term data for patterns of seeking health services over time, explore specific types of health services associated with cumulative trauma experiences, and study associations between health service usage and health outcomes.

Objectives: Racism and ethnic discrimination are global health issues, but the extent and effects on Indigenous Peoples in the Arctic region are still poorly understood. By investigating the methods, data sources, and definitions used in articles examining racism and ethnic discrimination among Indigenous peoples in the Arctic between 2008 and 2021 this review aims to create a solid foundation for future research.

Design: We conducted a search across multiple databases, including PubMed, PsycInfo, Web of Science, Scopus, and the Cochrane Review. Our search criteria included: Indigenous groups, racism or ethnic discrimination, and Arctic regions. After removing off-topic articles, two researchers reviewed the remaining articles against predefined eligibility criteria.

Results: The research field is expanding, but a significant portion of Arctic Indigenous peoples remains underrepresented. Predominant research methods include questionnaires, interviews, and case studies, often derived from large cross-sectional studies. Self-reported responses to questions about ethnic discrimination and racism are the primary research method, while some articles involve researchers subjectively evaluating data to determine what qualifies as racism or ethnic discrimination. Reaching a consensus on the definitions of ethnic discrimination and racism is challenging, with definitions ranging from negative, unfair, or differential treatment to broader, structural perspectives. Approximately half of the articles lack clear definitions.

Conclusion: There is a notable difference in terminology, where racism as a term is more used in Canada/US while, ethnic discrimination is more predominant in the Nordic countries. Despite these differences, the scales used to measure racism or ethnic discrimination show significant similarities. A large part of the investigated articles emphasize interpersonal discrimination. An emerging perspective after 2016 views racism/ethnic discrimination as something that produces inequalities between racial or ethnic groups and upholds or creates systems of privilege and oppression. Research consistently highlights the importance of considering local contexts of racism, ethnic discrimination and oppression.

Objective: Lung cancer screening can reduce lung cancer-specific mortality, but it is widely underutilized, especially among minoritized populations that bear a disproportionate burden of lung cancer, such as Black Americans. Racism, discrimination, medical mistrust, and stigma contribute to lower uptake of preventive screenings in general, but the role these factors play in lung cancer screening is unclear. We therefore conducted a scoping review to synthesize the literature regarding how racism, discrimination, medical mistrust, and stigma relate to lung cancer screening.

Design: Informed by PRISMA-ScR guidelines, we searched five databases for relevant literature, and two trained researchers independently reviewed articles for relevance. We conducted a narrative, descriptive analysis of included articles.

Results: A total of 45 studies met our inclusion criteria. Most articles reported on medical mistrust or one of its cognates (e.g. trust and distrust, n = 37) and/or stigma (n = 25), with several articles focusing on multiple constructs. Few articles reported on racism (n = 3), and n = 1 article reported on discrimination. Results from empirical studies suggest that medical mistrust, distrust, and stigma may be barriers to lung cancer screening, whereas trust in health care providers may facilitate screening. The articles reporting on racism were commentaries calling attention to the impact of racism on lung cancer screening in Black populations.

Conclusions: Overall, novel interventions are needed to promote trust and reduce mistrust, distrust, and stigma in lung cancer screening initiatives. Dedicated efforts are especially needed to understand and address the roles that racism and discrimination may play in lung cancer screening.

Objectives: The present study sheds novel light on the so-called 'racial paradox in mental health,' i.e., the phenomenon that Blacks, despite their relative socioeconomic disadvantages are mentally healthier than their more privileged White counterparts in the US. Evidence from prior research has been largely based on non-probability or regional surveys fielded during 'ordinary' times. In contrast, we analyze probability data on American adults collected during the extraordinary period of the COVID-19 pandemic across the country.

Design: Data came from the Census Household Pulse Survey (CHPS). The CHPS sampled community-dwelling U.S. adults across 50 States and the District of Columbia using the Master Address File (MAF). Data collection began on April 23 2020 and was carried out on a biweekly basis. We used three phases of data covering 21 weeks in total (with the week ending on February 1, 2021). Mixed-effects (multilevel) modeling was employed to analyze the data.

Results: Statistical results show that compared to their Black counterparts Whites fared worse mentally during the pandemic. We also found that the magnitude of the focal association is stronger with greater vulnerability operationalized at the individual level, i.e., in the context of lower income, job insecurity, and food shortage. Additionally, significant cross-level interactions emerged: the effect of race was more pronounced in geographic regions with higher coronavirus infection, greater ethnic heterogeneity, and higher structural disadvantage.

Conclusion: Our research supports existing studies that Blacks vis-à-vis Whites are psychologically more resilient. We add to the literature by shedding novel light on the mental health paradox during the extraordinary times brought about by the COVID-19-induced public health crisis. Ironically, there is a mental cost involved with the 'White privilege' in the US.

Objectives: COVID-19 disproportionately affected people of Black ethnicities whilst also negatively affecting the health, wellbeing and livelihoods of people living with HIV. This may have been amplified by pre-existing socioeconomic marginalisation, poorer health, and structural racism. Despite being disproportionately affected by the pandemic, little is known about lived experiences of the COVID-19 pandemic within these communities. Given these disparities, this paper explores the lived experiences of the COVID-19 pandemic among people living with HIV and of Black ethnicities in England.

Design: This qualitative study, comprising five focus group discussions (FGDs) with people of self-reported Black ethnicity, living with HIV in the UK (n = 30). FGDs were conducted between June and August 2022. Topics covered included beliefs and attitudes about COVID-19 (including prevention), COVID-19 information sources and lived experiences. Data were analysed using a reflexive thematic approach.

Results: Analysis of the data generated several main themes: the collective trauma experienced by Black communities; racial bias influenced by inequitable research; conflicting COVID-19 health messages and medical mistrust; socioeconomic marginalisation including financial hardship; intersecting oppressions such as sexism and ageism; and the overall impact of living with a stigmatising condition such as HIV. Participants additionally found navigating the infodemic, being labelled 'clinically vulnerable,' and balancing multiple non-medical needs alongside their cultural, spiritual, and religious beliefs, challenging.

Conclusion: The COVID-19 pandemic has had profound and enduring multidimensional impacts on the lives of people of Black ethnicities living with HIV. This study reveals how socioeconomic, cultural, behavioural, and biological factors intersected to shape experiences of the pandemic within these communities in the UK. Our data illustrate the lived realities of worsening health and social inequalities due to COVID-19, while at the same time highlighting the central importance of trusted community organisations in mitigating some of these negative impacts.

Trial registration: Ethical approval was obtained from the University College London Research Ethics Committee (Project ID/Title: 6698/004).

Objectives: Breast cancer is the most common cancer in the UK, accounting for 15% of all new cases in women. Evidence still points to disparities in outcomes linked to ethnicity and screening uptake is overall lower in South Asians than the White population. We investigated the experiences and perceptions of Gujarati Hindu community members on their 'cancer journeys'.

Design: This study took a participatory approach, involving participants in generating and refining recommendations to improve treatment based on their cohort's experiences and perceptions. Data were collected through two focus groups in 2022, followed by a feedback workshop session, where participants helped refine the research team's initial analysis and agree recommendation. Data were analysed thematically.

Results: 14 women participated in this study from the same support group. They had experienced breast cancer or were undergoing breast cancer treatment at the time of data collection and lived in Greater London. Barriers to engaging in the three key stages of their 'cancer journey' (screening, diagnosis, and treatment) were identified. These centred around language difficulties, not knowing what to expect, and not knowing who to ask for information. Suggestions for improvements included recruiting community champions, having diverse representation on educational materials, and referrals to support groups.

Conclusion: This study adds to the growing literature on the need for culturally tailored and sensitive approaches to cancer treatment. It reinforces the need for health professionals' training around effectively communicating with diverse groups and normalising referral to support groups.

Background: Despite Asians being the fastest-growing ethnic group in the US, most studies have focused on Asian Americans as an aggregate racial/ethnic group. The burden of mental health problems is increasing among caregivers due to population aging, yet little is known about the distress experienced by Asian caregivers when examined by disaggregated ethnic groups.

Methods: Using 2019-2020 California Health Interview Survey data, we examined disparities in psychological well-beings between non-Hispanic White and Asian American adult caregivers, with an emphasis on understudied Asian ethnic groups. Psychological distress was measured using the Kessler 6 scale, with scores ≥6 indicating mental distress and ≥13 indicating serious mental illness. Multivariable logistic regression adjusted for socio-demographics, physical health, caregiving relationship, intensity of care, and care recipients' characteristics.

Results: The study included 8,722 caregivers (mean age, 58.7 years; 61.3% women; 14.1% Asian [379 Chinese, 260 Filipino, 167 Japanese, 138 South Asian, 105 Korean, 101 Vietnamese, 78 other Asian], 85.9% White). Overall, 26.8% had mental distress, and 8.5% had serious mental illness. Compared to White caregivers, Korean American caregivers had higher odds of mental distress (Odds Ratio [OR], 2.37; 95% CI, 1.47-3.82) and serious mental illness (OR, 2.15; 95% CI, 1.17-3.92), while Chinese (OR, 0.72; 95% CI, 0.55-0.95) and Japanese (OR, 0.67; 95% CI, 0.45-0.99) American caregivers had lower odds of mental distress. Korean American caregivers had the highest prevalence of mental distress (43.1%) and serious mental illness (15.3%), compared with White and other Asian American caregivers.

Conclusion: Disaggregating data reveals significant mental health disparities among ethnic subgroups of Asian American caregivers. Tailored resources should address the distinct needs of ethnic subgroups of Asian American caregivers, considering language barriers, acculturation, and cultural norms that may exacerbate psychological distress.

Objectives: There are various factors that influence men's treatment decision-making for prostate cancer. However, the evidence has not been synthesized by ethnicity. The aim of this integrative review is to identify studies exploring men's decision-making treatment choices for prostate cancer by ethnicity.

Design: Literature was sought from the British Nursing Database, CINAHL, PsycINFO and PubMed. The inclusion criteria consisted of studies that concerned men from any ethnic background and had received a diagnosis of prostate cancer and treatment decision-making was discussed. 12 papers were included in this review.

Results: The results showed that a combination of external and internal influences affected men's treatment decision-making based on ethnicity. Men from certain ethnic backgrounds opted for certain types of treatment over others depending on their personal contexts which was further divided amongst age, education, and language spoken. Generally, White men were more likely to opt for surgery, with Black and Hispanic men less likely to undergo surgery.

Conclusion: In this review, White and Black men stated that their doctors' recommendation was a factor in their treatment decision-making for prostate cancer; however, other men reported that their doctors were less helpful with language representing a barrier. Further UK studies are required.

This scoping review examined racial and ethnic bias in artificial intelligence health algorithms (AIHA), the role of stakeholders in oversight, and the consequences of AIHA for health equity. Using the PRISMA-ScR guidelines, databases were searched between 2020 and 2024 using the terms racial and ethnic bias in health algorithms resulting in a final sample of 23 sources. Suggestions for how to mitigate algorithmic bias were compiled and evaluated, roles played by stakeholders were identified, and governance and stewardship plans for AIHA were examined. While AIHA represent a significant breakthrough in predictive analytics and treatment optimization, regularly outperforming humans in diagnostic precision and accuracy, they also present serious challenges to patient privacy, data security, institutional transparency, and health equity. Evidence from extant sources including those in this review showed that AIHA carry the potential to perpetuate health inequities. While the current study considered AIHA in the US, the use of AIHA carries implications for global health equity.

Objectives: Prediabetes is disproportionately prevalent in Hispanic men in the United States. Weight management, such as through lifestyle interventions, effectively reduces diabetes risk. However, Hispanic men remain underrepresented in existing lifestyle interventions, and their preferences for engaging in preventative behaviors remain unexplored. We aimed to explore the experiences of Hispanic men being diagnosed with prediabetes and the perceived influences on engaging in preventative behaviors and lifestyle change.

Design: This qualitative study conveniently sampled Hispanic men with prediabetes (n = 15) from a Federally Qualified Health Center in New York City. Private semi-structured interviews were audio recorded and explored prediabetes beliefs and perceived influences on engaging in preventative lifestyle change. Transcripts were double-coded using a deductive thematic approach, which revealed 5 major themes consistent with the Health Belief Model.

Results: (1) Perceived Susceptibility and Severity: Despite fearing diabetes, Hispanic men are unsure about their personal risk for developing it. (2) Cues to Action: Receiving a clinical diagnosis and recognizing its potential impact on family members heightens concerns about diabetes risk. (3) Benefits of Lifestyle Change: Small, practical changes in dieting and exercising can make preventing diabetes manageable. (4) Barriers to Lifestyle Change: Restrictive environments and schedules, coupled with some cultural habits, can lead to unhealthy lifestyle choices. (5) Self-Efficacy: Lifestyle change is a matter of personal agency, but additional information can support the right changes.

Conclusions: Influences potentially unique to Hispanic men in this setting included references to unhealthy foods environments, overwhelming working conditions, carbohydrate-rich cultural staples, and the threat of diabetes to self-perceptions of being head-of-family. These findings provide insight into Hispanic men's perceived barriers to engaging in preventative behaviors and motivators that can potentially facilitate their engagement in diabetes prevention.