Journal of Racial and Ethnic Health Disparities最新文献

{"title":"The L.I.F.T. Project-the 6 Intervention Mapping Steps to Create a Faith-Based HIV Health Education Intervention in the U.S. South.","authors":"L C Pichon, R E Diehl, C London, B Campbell, D E Thompson, A W Stubbs","doi":"10.1007/s40615-026-03240-3","DOIUrl":"https://doi.org/10.1007/s40615-026-03240-3","url":null,"abstract":"<p><p>Memphis, TN ranks first in the U.S. for HIV incidence and is designated as a high priority geographic area by the U.S. Ending the HIV Epidemic (EHE) Initiative. National EHE goals call for active engagement of all community sectors, including faith-based organizations, to promote HIV testing and prevention. Given Memphis' high density of predominately Black Churches and faith-centric culture, these institutions serve as a strategic platform for culturally tailored behavioral interventions. This study details the 6 behavioral intervention mapping (IM) steps used to plan, implement, and evaluate Leading by Igniting Faith and Education to Tackle Stigma (L.I.F.T.)-a faith-based HIV health education curriculum addressing HIV testing and prevention discrepancies in high HIV-incidence areas. IM is a systematic approach, useful for involving faith communities by providing a theory-informed scaffolding to address HIV disparities via community education programming.</p>","PeriodicalId":16921,"journal":{"name":"Journal of Racial and Ethnic Health Disparities","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149228069","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Race, Gender, and Survival: a Scoping Review of Disparities in ICU Post-Resuscitation Care and Neurological Outcomes Following Out-of-Hospital Cardiac Arrest.","authors":"Tiffany Gorée, Xiaochuan Wang","doi":"10.1007/s40615-026-03238-x","DOIUrl":"https://doi.org/10.1007/s40615-026-03238-x","url":null,"abstract":"<p><p>Racial and ethnic disparities in healthcare are well documented, yet limited attention has been given to the intersection of race/ethnicity and gender in high-acuity critical care. Black women experience compounded inequities affecting access to and quality of intensive care unit (ICU) treatment following out-of-hospital cardiac arrest (OHCA). Because outcomes after OHCA are influenced by each link in the chain of survival, disparities in early intervention and subsequent clinical decision-making may contribute to differences in survival and neurological recovery. This study synthesizes evidence on disparities in ICU treatment and outcomes among Black women in the United States while examining how inequities across the chain of survival may influence post-resuscitation care, neurocritical care, and outcomes following OHCA. We conducted a scoping review, guided by the Arksey and O'Malley framework, to analyze peer-reviewed studies identified through electronic databases (e.g., PubMed, CINAHL, and ScienceDirect). Fifteen studies met inclusion criteria and were analyzed using thematic synthesis. Findings indicate persistent disparities, including lower bystander cardiopulmonary resuscitation (CPR) rates, delayed emergency response, reduced access to ICU interventions, and higher rates of early do-not-resuscitate (DNR) orders and withdrawal of life-sustaining therapies (WLST). These inequities may contribute to poorer outcomes and likely reflect a combination of systemic, institutional, and social factors, although relatively few studies directly examined Black women from an intersectional perspective. Addressing these disparities requires improved data disaggregation, culturally responsive care, and interdisciplinary interventions to promote equitable post-resuscitation care and outcomes.</p>","PeriodicalId":16921,"journal":{"name":"Journal of Racial and Ethnic Health Disparities","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149224279","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Disparities in the Epidemiology of COVID-19 in Irish Travellers in the Republic of Ireland.","authors":"Ronan F O'Toole, Lynsey Kavanagh, Catherine M Comiskey","doi":"10.1007/s40615-026-03178-6","DOIUrl":"https://doi.org/10.1007/s40615-026-03178-6","url":null,"abstract":"<p><strong>Introduction: </strong>Irish Travellers, a distinct minority ethnic group, make up 0.64% of the population in the Republic of Ireland (n = 32,949) according to the national census. Major health disparities exist between Travellers and the general population including shorter life expectancy and higher mortality rates from respiratory and cardiovascular disease.</p><p><strong>Methods: </strong>Here, the epidemiology of COVID-19 in Irish Travellers was investigated. Public health surveillance data on 238,907 notified COVID-19 cases in Ireland from March 2020 to April 2021 were analysed.</p><p><strong>Results: </strong>The crude incidence rate (CIR) of recorded COVID-19 infections in Irish Travellers was the highest of any ethnic group in Ireland during the study period. The one-year CIR/100,000 population was 11,094.34 (95% CI:10755.73-11436.95) for Irish Travellers in contrast to 3,213.00 (95% CI:3196.54-3229.53) for the White population and 4,233.77 (95% CI:4216.40-4251.20) for the general population. The mean age of COVID-19 cases was 27.24 years (95% CI:26.66-27.81) in Irish Travellers versus 39.10 (95% CI:39.00-39.21) and 39.65 years (95% CI:39.56-39.73) in the White and general populations, respectively. Age-specific incidence rates were higher in Irish Travellers across each age group ranging from 2.52-fold higher (95% CI:2.34-4.01) in the 20-29 age group to 4.70-fold higher (95% CI:4.36-7.47) in the 0-9 age group relative to the White population.</p><p><strong>Conclusions: </strong>In this study, a higher incidence rate for notified COVID-19 was observed for Irish Travellers compared to the White and general populations in Ireland across all age groups. This highlights ongoing health disparities experienced by Irish Travellers and the need to further address respiratory illnesses in this marginalised ethnic minority.</p>","PeriodicalId":16921,"journal":{"name":"Journal of Racial and Ethnic Health Disparities","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149224312","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Quantifying the Role of Stage-at-Diagnosis in Racial Disparities in US Cancer Survival: A Population-Based SEER Study for 8 Common Cancers.","authors":"Aisha Vayani, Mark Rutherford, Sarah Booth","doi":"10.1007/s40615-026-03197-3","DOIUrl":"https://doi.org/10.1007/s40615-026-03197-3","url":null,"abstract":"<p><strong>Background: </strong>Black patients with cancer experience worse relative survival, yet it remains unclear how far shifting diagnoses towards earlier stage would reduce mortality.</p><p><strong>Methods: </strong>We analysed Surveillance, Epidemiology, and End Results (SEER) data (2004-2022) for U.S. Black and White patients aged 15-89 years with eight common cancers, using a 2021-2022 period-analysis window. We estimated age-standardised survival under observed and counterfactual stage distributions in which Black patients had the White stage distribution. We quantified the proportion of the racial survival gap mediated by stage and deaths postponed beyond specified follow-up times.</p><p><strong>Results: </strong>Among 1,299,386 eligible patients, Black patients were diagnosed at similar or younger ages and had more distant-stage disease for most sites, except rectal cancer in Black women aged < 75 years. At 5 years, stage accounted for large shares of the Black-White disparity in breast, colon, corpus uteri, lung, and oral cavity and pharynx cancers. The mediated proportion was low for rectal cancer in men, pancreatic cancer, and ovarian cancer, with weak evidence for ovarian cancer at age 75 + years and pancreatic cancer in women. The negative indirect effect for rectal cancer in younger women indicated suppression. Deaths postponed varied by follow-up time and cohort size.</p><p><strong>Conclusions: </strong>Stage equalisation could yield meaningful short-term mortality reductions for several sites, but stage-focused strategies are not universally beneficial. Equity-oriented policies should pair earlier diagnosis with interventions to improve downstream care pathways.</p>","PeriodicalId":16921,"journal":{"name":"Journal of Racial and Ethnic Health Disparities","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149224334","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ethnic Identity and Chronic Disease Among Asian Americans: The Roles of Community Social Cohesion, Social Networks, and Ethnic Subgroup Differences.","authors":"Elvina Le, Ivy K Ho, Yan Wang","doi":"10.1007/s40615-026-03230-5","DOIUrl":"https://doi.org/10.1007/s40615-026-03230-5","url":null,"abstract":"<p><strong>Objective: </strong>This study examined associations between identification with one's ethnic group, community social cohesion (CSC), and social networks with chronic disease prevalence among Asian Americans, and whether these relationships differed across East Asian, South Asian, and Southeast Asian subgroups.</p><p><strong>Design: </strong>Using a cross-sectional observational design, we conducted a secondary analysis of the 2016 Asian American Quality of Life survey (n = 1,948). Logistic regression and path analyses were conducted to examine associations among ethnic identification, CSC, social networks, and chronic disease, adjusting for age, gender, educational attainment, subjective financial strain, U.S.-born status, and duration of U.S. residency. Analyses were conducted separately for South Asian, East Asian, and Southeast Asian participants.</p><p><strong>Results: </strong>Overall, identification with one's ethnic group was not significantly associated with chronic disease (OR = 1.19, 95% CI [0.98, 1.45], p = .079), and we did not observe significant indirect effects through either CSC or social networks. Subgroup analyses revealed distinct patterns. Among South Asian participants, CSC and social networks demonstrated opposing significant indirect effects. Among East Asian participants, CSC was associated with lower odds of chronic disease, whereas social networks were associated with higher odds. Among Southeast Asian participants, identification with one's ethnic group was associated with greater chronic disease odds (OR = 1.78, 95% CI [1.39, 2.29], p < .001), while CSC and social networks were associated with lower odds.</p><p><strong>Conclusion: </strong>Associations between sociocultural factors and chronic disease differed across Asian American subgroups, highlighting the importance of disaggregating Asian American populations and considering sociocultural contexts when examining health disparities.</p>","PeriodicalId":16921,"journal":{"name":"Journal of Racial and Ethnic Health Disparities","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149206956","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Racial and Ethnic Disparities in Cardiovascular and All-Cause Mortality Among U.S. Women with Breast Cancer: a National NHANES Analysis.","authors":"Faizan Ahmed, Haris Bin Tahir, Omar Kamel, Zaima Afzaal, Rubiya Ali, Amanullah, Devika Adusumilli, Ramsha Ali, Ch M Umer Zaman","doi":"10.1007/s40615-026-03239-w","DOIUrl":"https://doi.org/10.1007/s40615-026-03239-w","url":null,"abstract":"<p><strong>Background: </strong>Cardiovascular complications are an important and increasingly recognized concern among women with breast cancer. Racial and ethnic differences in cardiovascular disease burden suggest that certain populations may be at heightened risk of adverse cardiovascular outcomes. This study examined racial differences in cardiovascular outcomes and mortality among women with breast cancer using data from the National Health and Nutrition Examination Survey (NHANES).</p><p><strong>Methods: </strong>We conducted a retrospective observational analysis of 669 women with self-reported breast cancer identified in NHANES and linked to the National Death Index. Participants were categorized by race and ethnicity as Non-Hispanic White, Non-Hispanic Black, Mexican American, Other Hispanic, or Other Race. Heart failure prevalence was evaluated as a clinically relevant cardiovascular outcome. Multivariable Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for all-cause and cardiovascular-specific mortality, adjusting for demographic, socioeconomic, and clinical factors. Kaplan-Meier survival curves and forest plots were generated to visualize differences across groups.</p><p><strong>Results: </strong>Non-Hispanic Black women demonstrated the highest prevalence of cardiovascular disease, including heart failure (8.2%), compared with Non-Hispanic White (7.4%), Other Race (6.1%), Other Hispanic (2.2%), and Mexican American women (1.7%). Non-Hispanic Black women showed a trend toward poorer survival outcomes, with an elevated risk of all-cause mortality (HR 1.80; 95% CI: 0.96-3.36) compared with Mexican American women. After multivariable adjustment, this association persisted (HR 1.81; 95% CI: 0.96-3.41). Cardiovascular-specific mortality was higher among Non-Hispanic Black women, reaching statistical significance in the fully adjusted model (adjusted HR 3.46; 95% CI: 1.66-7.24).</p><p><strong>Conclusion: </strong>Racial differences in cardiovascular outcomes and mortality were observed among women with breast cancer, with Non-Hispanic Black women experiencing a higher burden. These findings highlight the need for targeted, evidence-based strategies to address cardiovascular risk and improve equitable outcomes in this population.</p>","PeriodicalId":16921,"journal":{"name":"Journal of Racial and Ethnic Health Disparities","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149207047","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Racial and Ethnic Disparities in Early Pregnancy Loss (EPL) Among U.S. Emergency Department Visits: The Compounding Role of Advanced Maternal Age.","authors":"Amamah Noor, Sara Imanpour, Elvis J Dun-Dery","doi":"10.1007/s40615-026-03231-4","DOIUrl":"https://doi.org/10.1007/s40615-026-03231-4","url":null,"abstract":"<p><strong>Introduction: </strong>Early pregnancy loss (EPL) is one of the most prevalent pregnancy complications in the United States, with maternal age consistently identified as a key correlate. However, limited evidence exists regarding the influence of racial, ethnic, and socioeconomic disadvantage on the settings in which EPL is managed.</p><p><strong>Methods: </strong>This retrospective observational study utilized the 2019 Nationwide Emergency Department Sample. The analytic sample included pregnancy-related emergency department visits by individuals aged 15 to 49 years. The primary outcome was the presence of an ICD-10-CM diagnosis code for EPL (O03.x) during a visit, rather than the actual occurrence of EPL. Key exposures included maternal age and race and ethnicity. Survey-weighted logistic regression models were adjusted for insurance type, patient location, and hospital and visit characteristics.</p><p><strong>Results: </strong>Among 889,060 pregnancy-related ED visits, 43,275 (4.9%) carried an EPL diagnosis code (mean age, 28.8 vs. 27.2 years; p < 0.001). Visits by individuals aged 35 years and older demonstrated higher odds of EPL coding than those aged 15-24 years (aOR 2.26; 95% CI 2.17-2.34). Elevated odds were likewise observed among Hispanic (aOR 1.27; 1.19-1.35) and Asian/Pacific Islander (aOR 1.15; 1.03-1.28) pregnant individuals relative to White pregnant individuals, and among self-pay visits (aOR 2.28; 2.05-2.53). Regional and rural-urban differences were pronounced, and no age-by-race and ethnicity interaction was statistically significant.</p><p><strong>Conclusion: </strong>Racial, ethnic, insurance-related, and geographic differences in EPL-coded ED visits were evident in 2019 and operated across the age distribution rather than widening at AMA. These estimates establish a pre-Dobbs, pre-pandemic baseline against which subsequent shifts in EPL-related emergency care may be evaluated.</p>","PeriodicalId":16921,"journal":{"name":"Journal of Racial and Ethnic Health Disparities","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149207052","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improving Spanish-Speaking Caregivers' Experience with Standardized Discharge Instructions for Asthma Exacerbation in the Pediatric Emergency Department.","authors":"Victoria Vazquez, Julian Alberty Cruz, Noah Defauwes, Cristian Guerrero, Lorraine Bermudez Rivera, Anthony Martinez, Alejandra Duque, Vanessa Perez, Aledie Navas Nazario","doi":"10.1007/s40615-026-03235-0","DOIUrl":"https://doi.org/10.1007/s40615-026-03235-0","url":null,"abstract":"<p><strong>Background: </strong>Pediatric asthma is a leading cause of emergency department (ED) utilization, with higher rates among minority populations. Families with limited English proficiency, particularly Spanish-speaking caregivers, may face discharge communication barriers that contribute to outcome disparities.</p><p><strong>Objective: </strong>To describe Spanish-speaking caregiver-reported experiences with discharge communication and follow-up support after receipt of a standardized Spanish-language asthma discharge protocol and to explore 72-hour ED revisit rates among participating patients.</p><p><strong>Methods: </strong>We conducted a prospective observational study of Spanish-speaking caregivers of children presenting with asthma exacerbations to a tertiary pediatric ED between April 2023 and March 2025. Caregivers completed a REDCap survey assessing demographics, language preferences, interpreter use, discharge communication, and follow-up support. The primary outcome was return ED visits for asthma exacerbation within 72 h, compared with a pediatric ED population using Fisher's exact test.</p><p><strong>Results: </strong>Fifty-four Spanish-speaking caregivers were included. Most preferred discharge instructions in Spanish (94.4%); 30% reported effective English communication. Although satisfaction with interpreter services (92.0%) and provider explanations of asthma (92.6%) was high, 61.1% needed help scheduling follow-up appointments. Contributors to discharge confusion included provider time (23.1%), terminology (15.4%), and language barriers (15.4%). The surveyed group had a significantly higher 72-hour ED revisit rate than the control population (7.7% vs. 2.1%, p = 0.039).</p><p><strong>Conclusions: </strong>Despite high satisfaction with interpreter services and provider explanations, gaps remained in follow-up support. The participating group also had a higher 72-hour revisit rate; however, the observational design cannot determine whether discharge communication or the standardized protocol contributed to this difference.</p>","PeriodicalId":16921,"journal":{"name":"Journal of Racial and Ethnic Health Disparities","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149207000","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Profiles of Risk: The Role of Ethnic Identity Exploration and Neighborhood Violence on Acute Mental Health Symptomatology Among Ethnic Racial Minoritized Youth.","authors":"Raquel E Rose, Sitara M Weerakoon, Joy Lindsay, Ijeoma Opara-Mezue","doi":"10.1007/s40615-026-03183-9","DOIUrl":"https://doi.org/10.1007/s40615-026-03183-9","url":null,"abstract":"<p><strong>Objective: </strong>The objectives of this study were to (1) characterize profiles of neighborhood exposures and factors of ethnic identity and (2) assess associations with mental health outcomes among ethnic-racial minoritized (ERM) youth living in urban areas.</p><p><strong>Method: </strong>Our final sample consisted of (n = 767) youth with a mean age of 15.5 years (SD = 1.7) and were 53.5% males and 46.6% females. Majority of participants identified as Latine (54.3%) followed by Black/African American, Multiracial, and other respectively (31%, 7.4%, and 7.3%). Latent class analysis (LCA) was conducted to identify subgroups of youth based on seven observed indicators: racial self-efficacy, exposure to neighborhood violence, witnessing drugs sold on school property, witnessing drugs sold in the neighborhood, neighborhood support, and two dimensions of ethnic identity: exploration and affirmation. Subsequent analyses examined differences in psychosocial outcomes and demographic characteristics.</p><p><strong>Results: </strong>Three distinct classes emerged with Class 1 (Low Risk) being defined by low exposure to neighborhood violence and drug sales, moderate neighborhood support, and lower levels of ERI exploration and affirmation. In contrast, Class 3 (High Risk) was marked by the greatest exposure to neighborhood violence and drug sales, the highest self-efficacy and neighborhood support, and moderate ERI development. Class 3 exhibited higher levels of anxiety, depression, and both suicidal thoughts and suicide attempts.</p><p><strong>Conclusion: </strong>While neighborhood violence and witnessing drug sales may increase risk, fostering environments which support ethnic-racial identity affirmation, racial self-efficacy, and neighborhood support may promote resilience and advance mental health equity among ERM youth.</p>","PeriodicalId":16921,"journal":{"name":"Journal of Racial and Ethnic Health Disparities","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149207098","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Access Paradox: A Decade of Expanded Influenza Vaccine Access That Did Not Close a Racial Disparity.","authors":"Delia R Howson-Santana","doi":"10.1007/s40615-026-03232-3","DOIUrl":"https://doi.org/10.1007/s40615-026-03232-3","url":null,"abstract":"<p><strong>Objectives: </strong>Despite more than a decade of expanded influenza vaccine access through Medicare, pharmacy-based programs, and community clinics, older African Americans remain vaccinated at markedly lower rates than older White and Asian adults. This study examines why the disparity has persisted and whether U.S. vaccination policy evidence was ever designed to address it.</p><p><strong>Methods: </strong>A narrative review synthesized surveillance data with peer-reviewed literature (2006-2026) on vaccine confidence and uptake among older African American adults, compared against themes from a 2015 qualitative study, and interpreted through the Theory of Planned Behavior and a multidimensional model of healthcare access.</p><p><strong>Results: </strong>Structural interventions endorsed by the CDC's Community Preventive Services Task Force were never evaluated for their capacity to close race-specific disparities; applied nationally for a decade, they did not. Decomposing access into component dimensions showed policy addressed only affordability and availability, leaving accessibility, accommodation, acceptability, and awareness unmeasured. Self-advocacy, evaluating vaccine information independently rather than deferring to providers, was documented in 2006, 2016, and 2025 alike.</p><p><strong>Conclusions: </strong>This \"Access Paradox\", persistent disparity despite expanded, evidence-based structural access, reflects a gap in the evidence base itself, not only a gap in trust. Closing it requires testing trust-centered, culturally responsive approaches with the rigor historically reserved for structural interventions.</p><p><strong>Public health implications: </strong>Provider relationships, culturally responsive communication, and community engagement should complement, not replace, structural access, and self-advocacy should be treated as an asset rather than an obstacle. Structural expansion alone should not be assumed sufficient until interventions are evaluated for equity impact.</p>","PeriodicalId":16921,"journal":{"name":"Journal of Racial and Ethnic Health Disparities","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149182520","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}