Ethnicity & Health最新文献

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.

Background: Racial disparities in treatment and mortality were widely studied among prostate cancer patients; however, few studies considered the prevalence of hypertension and diabetes and their treatment status.

Objectives: To determine whether there are racial discrepancies in the use of anti-cancer, antihypertensive, and antidiabetic drugs in a cohort of long-term survivors of prostate cancer diagnosed in 2007-2015; and to examine racial disparities in mortality after adjustments for their differences in those treatments.

Methods: We used the SEER (Surveillance, Epidemiology, and End Results)-Medicare linked database and included records for patients with prostate cancer at age 65 years or older diagnosed from 2007 to 2015 in 17 SEER areas (n = 244,468).

Results: Among non-Hispanic Blacks with prostate cancer, 86.2% were affected by hypertension, with 62.1% taking antihypertensive medications. Additionally, 45.3% of individuals in this group had diabetes, and 41.1% of them received antidiabetic drugs to manage their respective health conditions. Non-Hispanic Blacks were less likely to receive antihypertensive drugs (adjusted odds ratio [aOR]: 0.94, 95% confidence interval [CI]: 0.89-0.99) and antidiabetic drugs (aOR:0.86, 95% CI:0.80-0.92) compared with non-Hispanic Whites. Hispanic and non-Hispanic Asians were significantly less likely to receive chemotherapy and hormone therapy, compared with non-Hispanic Whites. After adjusting for all factors including treatments, the risk of all-cause and cancer-specific mortality was significantly higher for non-Hispanic Blacks (hazard ratio: 1.22, 95% CI: 1.24-1.51 and 1.22, 95% CI:1.17-1.27) than that of non-Hispanic Whites.

Conclusions: There were substantial racial disparities in the receipt of cancer treatments and antihypertension and antidiabetic drugs. Non-Hispanic Black patients with prostate cancer still had a considerably higher risk of all-cause and cancer-specific mortality than non-Hispanic Whites after accounting for demographic, therapy, and tumor factors.

Objective: Chronic Kidney Disease (CKD) disproportionately impacts African American and Latinx populations in the United States. This study utilized a participatory photo-elicitation approach to explore how African American and Latinx individuals with CKD perceive and navigate their disease journeys.

Method: In this qualitative study, remote semi-structured interviews were conducted with a total of 20 African American and Latinx individuals with CKD, and the data were analyzed using reflexive thematic analysis.

Results: Participants' ages ranged from 30 to 67, with 60% identifying as women and 30% reporting annual incomes <$20,000. Data analysis uncovered four key themes: (1) 'The Burden of CKD,' highlighting the physical, social, and emotional toll on patients; (2) 'Navigating CKD with Positivity and Support,' showcasing strategies to cultivate psychological well-being; (3) 'Systemic Difficulties,' addressing barriers within the healthcare system; and (4) 'Building Bridges in the Kidney Community,' illustrating advocacy efforts to combat CKD.

Discussion: This study highlights the nuanced experiences of African American and Latinx individuals with CKD, highlighting their challenges and resilience. These findings emphasize the need for inclusive healthcare strategies that address these racially/ethnically diverse populations' unique needs to improve health outcomes.