Ethnicity & Health最新文献

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.

Objectives: Black Americans have experienced a rapid rise in suicidal ideation, plans, and attempts, yet little research has examined whether chronic stress, a well-established driver of mental health disparities, contributes to these suicide outcomes. Chronic stress refers to the persistent, cumulative burdens of daily life shaped by structural racism, making it particularly harmful for Black Americans. Social stress theory emphasizes the importance of psychosocial resources in mitigating the effects of chronic stress. Racial centrality is a culturally grounded measure of racial identity that is related to myriad mental health outcomes. We review data from 627 Black adults in the Nashville Stress and Health Study to ascertain relationships between chronic stress, racial centrality, and suicide outcomes among Black Americans and evaluate whether racial centrality might serve as a buffer against suicide.

Design: An analysis of variance test (ANOVA) explored whether racial centrality was related to chronic stress. Weighted logistic regressions predicted suicide outcomes as a function of chronic stress, racial centrality, and the interaction of the two.

Results: Racial centrality was negatively associated with chronic stress. Suicide outcomes were predicted by chronic stress. Racial centrality served as a buffer, negatively moderating the relationship between chronic stress and suicide.

Conclusion: These findings underscore chronic stress as a critical, understudied risk factor for Black suicide outcomes and highlight racial centrality as a culturally meaningful protective factor with implications for identity-affirming prevention strategies.

Introduction: Globally, there are renewed efforts to improve mental health and wellbeing of migrants. However, lack of policy relevant research including subgroup analysis to understand the determinants of migrants' mental health and funding availability is impeding the roll out of effective interventions. This study examined factors associated with psychological distress and wellbeing among people of African descent living in Western Australia (WA).

Methods: The study involved analysis of cross-sectional survey data sourced from the WA Health and Wellbeing Surveillance System from 2007 to 2021. Bivariable and multivariable logistic regression models, adjusted for survey design, were fitted to examine factors associated with psychological distress and wellbeing among the African population in WA.

Results: The multivariable analysis showed, living with a disability or long-term illness (OR = 4.25 95% CI 2.11-8.54) or living with other family member with a disability (OR = 2.18 95% CI 1.21, 3.91), and experiences of 2 (OR = 3.82 95% CI 1.85, 7.90) or 3 or more stressful events (OR = 6.60 95% CI 3.42, 12.75) were strongly associated with psychological distress. Poor emotional wellbeing was strongly associated with never married status (OR = 1.80 95% CI 1.05, 3.09), living with a disability or long-term illness (OR = 2.60 95% CI 1.44, 4.70) or living with other family member with a disability (OR = 2.10 95% CI 1.31, 3.38), experiences of stressful events [1 stressful event, OR = 1.93 95% CI 1.28, 2.93; 2 stressful events, OR = 2.18 95% CI 1.29, 3.68; 3 or more stressful events, OR = 8.32 95% CI 5.10, 13.59], and being unemployed (OR = 1.60 95% CI 1.01, 2.54).

Conclusion: Among people of African descent living in WA, psychological distress was associated with disability or long-term illness, and stressful major life events. Emotional wellbeing was associated with marital status, disability or long-term illness, stressful major events and employment status. These findings provide support for tailored mental health initiatives for migrant communities in WA.

Objectives: Multimorbidity, otherwise referred to as multiple chronic conditions (MCCs), is defined as the presence of two or more chronic conditions and has been linked to an increased risk of depression in many parts of the world. Disadvantaged social identities potentially play an important role in shaping this association. However, these associations are poorly understood in situations of multiple disadvantaged social identities, especially among Black populations in the United States of America. This study examined the association between multimorbidity and depression severity among Black populations in the United States using the intersectionality approach.

Design: This study utilized IPUMS-NHIS datasets from 2009 to 2019. A weighted sample of 5,745 respondents aged 18 years and above was extracted from the data and analyzed using multinomial logistic regression models.

Results: The study found that although multimorbid individuals had a higher risk of severe depression (RRR = 1.93; p < 0.001; 95% CI:1.58-2.35), there are variations by individual's social identities. The risk was higher among Black Americans (RRR = 2.40; p < 0.001; 95% C.I = 1.89-3.07) with MCCs compared to Black immigrants; and among females (RRR = 2.73; p < 0.001; 95% C.I = 2.11-3.54) and unemployed (RRR = 2.69; p < 0.001; 95% C.I = 2.07-3.51) compared to their male and employed counterparts, respectively. Those with multiple disadvantaged social identities yet had MCCs, especially, unemployed Black American females (RRR = 3.43; p < 0.001; 95% C.I = 2.54-4.63) and males who were unemployed (RRR = 2.02; p < 0.05; 95% C.I = 1.42-2.87) had elevated risk of experiencing severe depression compared to those who had no MCCs and Black immigrants.

Conclusion: The findings suggest the need to focus attention on the complex effects of multiple disadvantaged social identities in shaping mental health outcomes, particularly among individuals experiencing chronic health conditions.

Objective: South Asians have poor sleep health and a high global prevalence of sleep disorders, but little is known about the sleep health of South Asian Americans. Sleep health in immigrants is affected by various factors, including acculturation and acculturative stress, compounding the impact that poor sleep has on health. This study examined associations of acculturation and acculturative stress with sleep health in South Asian Indians and Nepalese in the U.S.

Methods: One hundred fifty South Asian Indian and Nepalese adults aged 18 to 65 years living in the U.S. were enrolled in a descriptive correlational study. Validated self-reported measures were administered. Acculturation, acculturative stress, six sleep characteristics (regularity, satisfaction, alertness, timing, efficiency, duration), and a sleep health composite score were calculated.

Results: Higher acculturation was associated with shorter sleep duration (B = -0.72, p = 0.025), later midpoint sleep (B = 0.47, p = 0.030), and poorer sleep satisfaction (B = 0.24, p = 0.043). Greater acculturative stress was associated with lower sleep efficiency (B = -0.10, p = 0.017) and greater daytime sleepiness (B = 0.07, p = 0.029).

Conclusions: Acculturation and acculturative stress may contribute to poorer sleep health in this population. Attention to the influence of acculturation and associated stress and interventions to improve sleep may help to promote overall health among South Asian Indian and Nepalese Americans.

Objectives: The Hispanic Health Paradox suggests that Hispanics and their culture may possess certain protective factors that mitigate the negative impact of lower socioeconomic status on health. Much of the existing literature has focused on the United States. Such paradoxical advantage on diabetes was explored among Hispanics in Canada.

Design: Secondary data from four cycles of the Canadian Community Health Survey from 2015 to 2018 were examined. Multivariate logistic regression analyses were conducted with the following samples: Hispanics (1,799), Non-Hispanic White (168,225), and other racialized groups (33,730). The statistical and practical significance or strength and precision of the predictor-outcome relationships were estimated with odds ratios (OR) and their 95% confidence intervals (CIs) that were derived from regression statistics.

Results: Despite overall lower socioeconomic status, Hispanics were about 79% less likely than Non-Hispanic Whites to have diabetes. Hispanic ethnicity significantly interacted with age, sex, income, and immigration status in predicting diabetes risk. Hispanic ethnicity was most protective for middle-aged adults (OR = 0.72) but not seniors. Hispanic males experienced greater protection (OR = 0.77) than females (OR = 0.90). Low-income Hispanics showed the strongest protective effects (ORs = 0.62-0.85). Recent immigrants to Canada (<10 years) exhibited moderate protection (ORs = 0.90-0.93), though unexpectedly, Canadian-born Hispanics had the lowest risk (OR = 0.59).

Conclusions: These findings highlight the nuanced and paradoxical protective effects of Hispanic ethnicity on diabetes risk.

Background: Haitian women experience high rates of cervical cancer and are more likely to be diagnosed at advanced stages. Although the HPV vaccine is effective in preventing cervical cancer, limited data exists regarding factors influencing HPV vaccine uptake among Haitian women. Our study explored HPV vaccination knowledge, awareness, and intentions through the domains of cultural worldviews and risk perception among Haitian immigrant and migrant women who recently arrived to the United States.

Methods: These qualitative data are from a larger exploratory sequential mixed-methods study evaluating HPV vaccination intention among Haitian immigrant and migrant women. Semi-structured in-depth interviews were conducted with N = 25 participants. Interviews contained questions exploring health beliefs and knowledge, women's cervical cancer experiences, cultural worldviews, affective evaluations of cervical cancer risk perception, and HPV vaccination intention. Qualitative descriptive methodology using thematic analysis was employed for data analysis on Atlas.ti software.

Results: HPV vaccination knowledge and awareness were exceptionally low in our sample. Women endorsed maintaining cultural practices and beliefs upon migrating to the U.S. which shaped their decision to engage in health promotion behaviors. In response to affective risk perception, women believed that the unpredictability of cervical cancer increased their susceptibility to the disease. Participants endorsed cervical cancer as a fatal illness, with this perception being partly driven by superstitious beliefs toward cervical cancer, along with women's prior experience with the health system in Haiti. These factors demonstrated potential relevance toward women's decision making to engage in HPV vaccination behaviors.

Conclusion: Culture, affective risk perception, and past experiences may be relevant toward Haitian women's decision making to engage in HPV vaccination practices. Our results underscore the importance of using alternative methods in understanding HPV vaccination intention and scaling up HPV vaccination efforts for Haitian women both in the U.S. and in Haiti.

Objective: Pediatric obesity continues to grow in the US Latino population despite public health efforts. Little work has explored the link between acculturation and stress across caregiver-child dyads using systems science.

Methods: Semi-structured interviews were completed with US Latino dyads made up of foreign-born caregivers and US-born children (8-13 years). Participants were recruited from a pediatric weight management clinic in Durham, NC. Interviews were guided by system support mapping to illustrate interconnected components of the child's weight management journey. Maps were thematically coded by responsibilities, needs, resources, wishes. Codes were aggregated across caregivers and children, respectively, and frequency of themes were calculated.

Results: 14 dyads completed interviews. Children reported 17 aspects of health within their responsibility, with a focus on physical activity. Children were unaware of available resources beyond their caregivers. Caregivers reported 26 unique responsibilities, with overlap between basic needs and living in low-resource environments. Immigration and acculturation status were major barriers and sources of stress relevant to aspects of the system support map.

Conclusions: Immigration and acculturation status impede pediatric weight management and increase stress in US Latino caregiver-child dyads. Future studies should consider immigration and acculturation status in caregivers and children as a mediator of treatment outcomes.

Objectives: Refugee mothers are particularly vulnerable to adverse health outcomes due to the compounded challenges of displacement trauma, cultural dislocation, and primary caregiving responsibilities. While existing research documents health challenges among refugees, limited attention has been paid to protective factors that could enhance well-being. This pilot study aimed to develop and evaluate a culturally tailored wellness intervention for refugee mothers, with particular focus on identifying healthcare barriers and promoting sustainable self-care practices.

Design: A mixed-methods study was conducted in Syracuse, New York, from October to November 2022. Initial focus group discussions with nine refugee mothers assessed healthcare barriers and informed the development of a six-week wellness intervention program. The intervention's effectiveness was evaluated using the Mindful Self-Care Scale (MSCS) in a pre - and post-test design, measuring changes across six dimensions of self-care practices.

Results: Focus group discussions revealed that cultural practices, language barriers, and intensive caregiving responsibilities significantly limited refugee mothers' engagement with healthcare services. The intervention significantly enhanced participants' overall self-care practices (mean increase = 0.406, p < 0.05). Most notably, participants showed substantial improvement in mindful relaxation practices (mean increase = 0.881, p < 0.01) and demonstrated promising gains in self-compassion (mean increase = 0.560, p < 0.10) and supportive structure development (mean increase = 0.510, p < 0.10).

Conclusion: Well-designed, culturally tailored wellness programs can effectively promote self-care practices among refugee mothers. This study demonstrates the importance of creating dedicated spaces that respect cultural practices while fostering health engagement. Findings highlight the need for sustained, culturally sensitive support systems that extend beyond short-term interventions to ensure long-term improvement in refugee mothers' well-being and community integration.