Ethnicity & Health最新文献

Objectives: Chronic exposure to psychological stress is a well-established social determinant of health, particularly among racial and ethnic minority groups. Repeated stress can lead to persistent activation of the biological stress response, which may become maladaptive and harm both physical and mental health. Latinx immigrants are especially susceptible due to ongoing acculturative stress-challenges associated with adapting to a new culture and environment. Despite these risks, Latinx immigrants also exhibit strong resilience, which can help buffer the negative health effects of acculturative stress. Minimal research has explored associations among measures of acculturative stressors, psychosocial resilience factors, and immunological biomarkers of the physiological stress response. The current study examines these relationships within a Latinx immigrant population.

Design: We conducted a secondary analysis of baseline data collected between June 2018 and January 2020 from a community-engaged research study of Latinx immigrants in the U.S. Southeast aged 18-44 (N = 391). Participants completed self-report measures of acculturative stressors, resilience factors, and health, as well as urine specimens for biomarker analysis using immunoassays. Hypotheses were tested with Spearman's correlations and multivariate linear regressions.

Results: In bivariate correlations, only IL-18, a pro-inflammatory cytokine, and IL-10, an anti-inflammatory cytokine, were associated with acculturative stressors. In our final regression models accounting for acculturative stressors and resilience factors, no moderation effects were observed, and only BMI remained a significant predictor of IL-18. Exploratory mediation analysis demonstrated that BMI partially mediated the relationship between pre-migration stress and IL-18.

Conclusions: The results highlight significant associations among acculturative stressors, inflammatory cytokines, and BMI. Further exploration of these relationships can identify key social determinants and mechanisms underlying health inequities, such as those related to obesity and cardiometabolic health. These findings may contribute to the design of more effective health promotion and disease prevention interventions for Latinx immigrant populations.

Background: The prevalence of diabetes has rapidly increased for East Asian immigrant populations, exceeding rates in East Asian populations in their home countries and the general population of host countries. The increased risk highlights the complex interplay between genetic predisposition and socio-cultural environmental factors associated with migration. Managing diabetes and navigating unfamiliar healthcare systems are challenging for immigrant populations underscoring the need for research on barriers and effective targeted strategies.

Objectives: Identify barriers to best diabetes management practices and effective interventions among East Asian immigrant populations.

Methods: Studies were identified through PUBMED, OVID MEDLINE, CINAHL COMPLETE and SCOPUS databases utilising Arksey and O'Malley's framework. Peer-reviewed, English reports between January 2010 and August 2024 relating to challenges and barriers of best management practices among adult East Asian immigrants and interventions that facilitated management were identified. Studies of people with type 1 or gestational diabetes and those <18 years old were excluded.

Results: Of 576 articles screened, 18 studies meeting the criteria were included in this review. Twelve studies included Chinese immigrants, 13 studies were from the United States, including six among American-Korean immigrants, three were from Australia and two from Canada. Barriers to best diabetes management practices identified from observational studies were themed as relating to (1) 'Cultural Views' (diabetes, diet, medication, traditional remedies, health professional hierarchy and family roles); (2) 'Immigration Challenges' (communication, communication, transport, financial, time constraints, emotional distress and dissatisfaction with Western healthcare systems). Randomised controlled trials (n = 2) and single-group trials (n = 6) reported on effective interventions that improved self-management and/or cardiometabolic risk factors, focusing on self-management (n = 3), nutritional (n = 4) and social media (n = 1) educational programmes.

Conclusion: Barriers to best diabetes management practices included clashes with cultural views, immigration-related challenges and dissatisfaction with Western healthcare systems. Effective interventions were mostly associated with culturally-tailored, didactic and bilingual diabetes education programmes.

Background: Black women are more likely to experience sleep difficulties compared to their White counterparts. This disparity may be fueled by differences in economic opportunities, race - and gender-based discrimination, and other societal factors. Guided by the socio-ecological model, the purpose of this study was to examine the multi-level barriers and facilitators of sleep among Black women in the United States.

Methods: A qualitative description study design was used. Semi-structured interviews were conducted in English among 28 Black women with sleep difficulties. Interviews were audio-recorded and transcribed. Thematic analysis was used to analyze data.

Results: Participants (mean age = 47.3 years) were primarily single (52%) and employed (84%). Through qualitative interviews, four key themes emerged: (a) Individual-level barriers and facilitators, such as chronic health issues, poor sleep hygiene, stress, trauma, financial strain, and coping strategies like prayer and relaxation routines; (b) Interpersonal influences, including caregiving demands, emotional burdens from family dynamics, and social support; (c) Community-level factors, such as neighborhood noise, violence, and safety concerns contributing to hypervigilance; and (d) Societal-level influences, notably the "strong Black woman" schema and experiences of racism and gendered discrimination, which shaped sleep experiences.

Discussion and conclusion: Black women's sleep is impacted by intersecting factors across individual, interpersonal, community, and societal levels. Culturally grounded, trauma-informed, and equity-focused interventions, targeting all socioecological levels, are essential to improve sleep health of Black women.

Objectives: Aligning with past work positioning racial discrimination as invalidation, or a form of interpersonal rejection and devaluation with myriad psychological effects, we aim to examine the role of Strong Black Woman/Superwoman Schema (SBW/SWS) in the relation between racial discrimination and borderline personality disorder (BPD) symptoms among Black women. We predicted that SWS would explain the relation between experiences of racial discrimination and BPD symptoms. We also hypothesized that while SWS would contribute to emotional control and thereby higher BPD symptoms, SWS would also contribute to racial pride and thereby lower BPD symptoms. Exploratorily, we examined whether emotion regulation challenges moderate the relation between SWS and BPD symptoms.

Methods: A national community sample of 81 Black women (M_age = 37.8, SD_age = 12.8) endorsing racial discrimination were recruited through ResearchMatch and reported on SBW/SWS, BPD symptoms, and other emotion-focused assessments. Simple and serial mediation were used to examine the primary hypotheses.

Results: While racial discrimination was not significantly associated with BPD symptoms, SWS did explain this relation. There was further a significant serial effect such that racial discrimination contributed to SWS, which then fueled emotional overcontrol, and higher BPD symptoms. Racial pride did not emerge as a buffer from BPD symptoms. Lastly, the tendency to use interpersonal pathways to enhance positive affect strengthened the relation between SWS and BPD symptoms.

Conclusions: This paper furthers our understanding of how SWS and associated emotion processes link identity-based discrimination to emotional, identity, and interpersonal challenges among Black women.

Background: Culture is important as it influences how survivors navigate micro (e.g. interpersonal relationships, social networks) and macro systems (e.g. healthcare system, society) in their everyday lives. This study applied a sociocultural lens, using the PEN-3 cultural model, to explore experiences of Black and Latinx cancer survivors and their families with the aim of identifying recommendations to improve cancer survivorship experience.

Methods: We used qualitative descriptive design. A total of 17 (4 men and 13 women) cancer survivors 50 years or older (Mean age = 63.9 years) were interviewed using a semi-structured interview guide. Afterwards, we conducted six focus group discussions (three Latinx and three Black groups) with a total of 33 caregivers of cancer survivors (Mean age = 63 years). All interviews were audio recorded, transcribed verbatim, and analyzed using a hybrid of inductive-deductive thematic analysis.

Results: Three themes were identified from the analysis: Two of the themes were labeled using the PEN-3 cultural model categories; (1) relationships and expectations influencing survivorship experience, (2) cultural empowerment and cancer survivorship. The third theme represents the improvement recommendations provided by the participants; (3) recommendations for improving survivorship.

Discussion: The findings of this study will add to a body of knowledge on using a cultural lens to deepen our understanding cancer survivorship inequities and may inform culturally tailored cancer survivorship interventions in Black and Latinx communities.

Understanding how Superwoman Schema (SWS) dimensions cluster may be key to exploring how this phenomenon varies among Black women. In this study, we identified profiles of Superwoman Schema in a sample of 167 Black women (M_age = 22). We also determined if distinct profiles of Superwoman Schema dimensions predicted perceived stress. Using latent profile analysis, we detected a 4-class solution: Guarded Caregivers (high emotional suppression, resistance to vulnerability, and obligation to help others); Authentically Unburdened (lowest average on all SWS dimensions); Reluctant Superwoman (mid-range adherence to SWS dimensions with a strong sense of the obligation to help others); and Resilient Caregivers (high desire to present strength and a strong sense of the obligation to help others). The Guarded Caregiver profile had the highest perceived stress scores compared to all other profiles. There were no significant differences between profile groups and sociodemographics. Findings suggest that Black women who are high in adherence to emotional suppression, resistance to vulnerability, and obligatory helping may be more likely to experience elevated stress. Thus, interventions to reduce stress should promote emotional expression, foster help-seeking behaviors, and challenge the need for self-sacrifice at the expense of personal well-being.

Objectives: Exposure to adverse childhood experiences (ACE) accounts for up to 1.9 million heart disease cases. This study extends research by examining the association between heart disease and four-forms of ACE heterogeneity (i.e. counts, scores, clusters, and individually) among Black men and women.

Design: Data come from the 2019-2022 Behavioral Risk Factor Surveillance System's ACE supplement (n = 30,746). Latent class analysis of eleven ACEs - verbal, physical, or sexual abuse; experiencing divorced parents, rape, or sexual coercion; or living in a household with domestic violence, imprisonment, drug use, alcohol abuse, or mental illness - identified seven-classes. Multiple gender-stratified binary logistic regressions estimated adjusted odds of heart disease based on ACE counts, scores, individual events, and the seven-classes, which reflected: (1) domestic violence and alcohol abuse, (2) sexual violence, (3) abusive parents, (4) universal ACEs, (5) non-sexual ACEs, (6) few ACEs, and (7) household imprisonment/substance abuse.

Results: Odds of heart disease were higher for women and men with more ACE exposures (i.e. counts and universal-ACEs classification), and when exposed specifically to sexual violence, household drug use, and mental illness. Exceeding the threshold of two-plus ACEs increased odds of heart disease for women but not men. Women's and men's odds of heart disease were higher when experiencing physical/verbal abuse and household imprisonment, respectively.

Conclusion: ACE heterogeneity factors into heart disease patterns for Black men and women with important implications for intersectional screening, intervention, and the advancement of health equity.

Background: Effective vaccines for human papillomavirus (HPV) are readily available but culturally and linguistically diverse (CALD) communities experience vaccination disparities. Whilst community engaged (CE) practices are recommended, we know little about this practice in local settings.

Aim: We aim to compare CE practices within HPV vaccination interventions targeting CALD children aged 9-17 years and identify how CE elements are linked to outcomes.

Method: Included interventions targeted vaccine eligible CALD children, their parents/caregivers, or health professionals servicing CALD populations. We searched six databases for studies published between 2006 and April 2024. We critically appraised included studies, and data was synthesised based on a CE health framework.

Results: We screened 3798 articles to identify 22 studies. Interventions were based in the United States (USA) and targeted nine different CALD communities. CE practice varied across interventions. All CE practices improved vaccine knowledge, but only multi-component, peer-led/delivered CE practice improved series completion. We note several confounders and analysis limitations.

Discussion: Most CE approaches were initiated by health services rather than the local community. All interventions were limited by study bias and reporting details. We experienced difficulties linking CE practice to intervention outcomes, highlighting tensions between health service driven CE and community empowered CE practices.

Background: In the United Kingdom (UK), individuals of minoritized ethnic groups report poorer healthcare experiences and face disparities in health outcomes and access to healthcare services relative to their White counterparts. While it has been demonstrated that sociodemographic characteristics play important roles in the risk of developing rheumatic diseases, disease progression, and treatment journeys, there is limited understanding of the experiences of minoritized ethnic groups in the UK. This study aimed to investigate how the social and structural processes associated with ethnicity affect the medical experiences of people with systemic autoimmune rheumatic diseases in the UK.

Design: Qualitative data were collected between 2023 and 2025 through semi-structured interviews with N = 29 (36% South Asian, 86% female) patients and N = 16 (81% White, 50% female) clinicians. Analysis was thematic and involved immersion in the data, coding using NVivo, and discussion of themes with a multidisciplinary team including patient partners.

Results: Interviews generated three main themes: (1) subtle and systemic racism in care and society, (2) racialized medical and behavioural stereotyping, and (3) socio-cultural factors impacting doctor-patient communication and rapport building. Throughout each theme, participant recommendations for improving care were raised.

Conclusions: Our study demonstrated that the socio-structural processes related to ethnicity, namely racism, social deprivation, stereotyping and institutional bias, impact the medical experiences of SARDs patients in multitudinous ways. Some patients reported systemic and interpersonal racism, racialized stereotyping, and mistrust in care, while others listed factors that they considered were protective against discrimination, such as education and location. Socio-cultural factors, including language barriers and variations in clinician understandings of patient experiences, further impact doctor-patient interactions.

Background and objectives: The global rise in aging populations intersects with increasing rates of forced displacement and chronic illness, prompting an urgent need to integrate older refugees into national healthcare systems. Health service use is a key means of decreasing health disparities and improving health equity, particularly among individuals with chronic illness. Yet little is known about the factors that shape healthcare use among older refugees in the US. This study uses nationally representative data to examine primary care visits among older refugees resettled between 2015 and 2019.

Design and methods: Using data from the 2020 Annual Survey of Refugees, we applied Andersen's Modified Behavioral Model of Health Service Use to examine the association of migration-related predisposing, enabling, and need factors with having a routine physical exam during the past year. Migration-specific variables included post-migration stressors, ethnic density, and arrival cohort. We conducted hierarchical logistic regression to evaluate the relative influence of each factor category, entering predisposing factors first, followed by enabling and need factors.

Results and discussion: Primary care use was significantly associated with race, religion, insurance coverage, education, and English proficiency. Muslim identity was a strong predictor, and Asian and Black refugees were more likely than White refugees to have had a physical exam. Both higher education and lower English proficiency were linked to increased use of primary care.

Implications: Findings highlight key determinants of healthcare utilization and suggest a need for targeted interventions to improve older refugees' use of health services. Notably, need-based health variables were not significantly linked to exam completion. Expanding insurance, education, culturally responsive care, and community-based interventions could enhance access. Future research should incorporate administrative health data and qualitative methods to address survey limitations and explore within-group differences in healthcare utilization.