Health Equity最新文献

{"title":"Racial Disparities Among Predicted Bronchopulmonary Dysplasia Risk Outcomes in Premature Infants Born <30 Weeks Gestation.","authors":"Priyanka Patel, Andrew Ellefson, David A Paul","doi":"10.1089/heq.2023.0042","DOIUrl":"https://doi.org/10.1089/heq.2023.0042","url":null,"abstract":"<p><strong>Background and objective: </strong>There is extensive literature to support eliminating race-based risk stratification. The National Institute of Child Health and Human Development (NICHD) calculator, used to predict risk of bronchopulmonary dysplasia (BPD), includes race as a variable. We sought to investigate how utilizing race in determination of risk for BPD may lead to inequitable care.</p><p><strong>Methods: </strong>The study included a retrospective cohort of infants born <30 weeks gestation between January 2016 and February 2022. The primary outcome was the difference in predictive risk of BPD for non-Hispanic Black compared to non-Hispanic White infants. The secondary outcome was the disparity in theoretical administration of post-natal corticosteroids when the calculator was applied to the cohort. Analysis included paired <i>T</i>-tests and Chi-Square.</p><p><strong>Results: </strong>Of the 273 infants studied, 154 were non-Hispanic Black (56%). There was no difference between the groups in gestation or respiratory support on day of life (DOL) 14 or 28. The predicted risk of moderate or severe BPD in non-Hispanic White babies was greater than non-Hispanic Black babies on both DOL 14 and 28 (<i>p</i><0.01). When applied retrospectively to the cohort, the calculator resulted in differences in corticosteroid administration (risk >40%-non-Hispanic White 51.3% vs. non-Hispanic Black 35.7%, <i>p</i>=0.010; risk >50%-non-Hispanic White 42.9% vs. non-Hispanic Black 29.9%, <i>p</i>=0.026).</p><p><strong>Conclusion: </strong>When applied to our study cohort, the calculator resulted in a reduction in the predicted risk of BPD in non-Hispanic Black infants. If utilized to guide treatment, the calculator can potentially lead to disparities in care for non-Hispanic Black infants.</p>","PeriodicalId":36602,"journal":{"name":"Health Equity","volume":"7 1","pages":"825-830"},"PeriodicalIF":2.7,"publicationDate":"2023-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10698790/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138810676","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Challenging Race-Based Medicine Through Historical Education About the Social Construction of Race.","authors":"Allison L Skinner-Dorkenoo, Kasheena G Rogbeer, Apoorva Sarmal, Cynthia Ware, Jennifer Zhu","doi":"10.1089/heq.2023.0036","DOIUrl":"https://doi.org/10.1089/heq.2023.0036","url":null,"abstract":"<p><strong>Background: </strong>Scientifically, there is little genetic variation among humans and race has no biological basis. However, medical school preclinical curricula tend to misrepresent race and reify biologically essentialist explanations for disease. The social construct of race is, therefore, used to inform health care providers' treatment decisions. Use of race-based medicine has been identified as a contributor to racial health disparities, spurring a growing movement to challenge race essentialism and race-based medicine. The current research tested an intervention that educates college students about the historical construction of racial categories in the United States.</p><p><strong>Methods: </strong>Participants who were randomly assigned to the intervention condition read an article highlighting the history of the sociopolitical construction of race. They were then prompted to discuss in dyads how racial categories were created and changed over history, and-in light of all this-the appropriateness of race-based medicine. Those assigned to the control condition advanced directly to the outcome measures.</p><p><strong>Results: </strong>Participants in the intervention condition reported less race essentialism, less support for race-based medicine, and greater belief that race-based medicine contributes to racial health disparities. Findings were not moderated by premed status.</p><p><strong>Discussion: </strong>Our data provide initial evidence that our interactive intervention could effectively reduce biological essentialism and support for race-based medicine in both premed and non-premed students.</p><p><strong>Health equity implications: </strong>This intervention has the potential to shape the way health care providers in-training understand race, their internalization of biologically essentialist explanations for disease, and willingness to adopt race-based treatment plans.</p>","PeriodicalId":36602,"journal":{"name":"Health Equity","volume":"7 1","pages":"764-772"},"PeriodicalIF":2.7,"publicationDate":"2023-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10698761/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138810509","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Associations Between Childhood Sexual Abuse, Intimate Partner Violence Trauma Exposure, Mental Health, and Social Gender Affirmation Among Black Transgender Women.","authors":"JaNelle M Ricks, Jessica Horan","doi":"10.1089/heq.2022.0161","DOIUrl":"https://doi.org/10.1089/heq.2022.0161","url":null,"abstract":"<p><strong>Introduction: </strong>The purpose of this study was to examine associations between social gender affirmation and mental health outcomes. The resulting relationships were explored within the context of childhood sexual abuse (CSA) and intimate partner violence (IPV) trauma history.</p><p><strong>Materials and methods: </strong>A community sample of 138 Black trans women completed structured interviews assessing gender affirmation, mental health, and trauma history. Bivariate associations between gender affirmation scale and mental health measures were assessed using Pearson coefficients. Multiple linear regression models were used to generate adjusted estimates of association.</p><p><strong>Results: </strong>Childhood sexual victimization and IPV were common. Depressive symptoms, anxiety, quality of life, and body image satisfaction were significantly associated with social gender affirmation. Recent IPV dampened this association to not significant. Gender affirmation and anxiety/panic and quality-of-life outcomes did not retain significance in models adjusted for lifetime IPV. CSA did not weaken the association.</p><p><strong>Conclusion: </strong>Incorporating trauma-informed and gender-affirmative frameworks into medical care and evidence-based interventions is a crucial structural step toward protection of the mental health of Black trans women.</p>","PeriodicalId":36602,"journal":{"name":"Health Equity","volume":"7 1","pages":"743-752"},"PeriodicalIF":2.7,"publicationDate":"2023-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10698782/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138810599","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Inclusion of Health Equity Initiatives in Hospitals' Strategic Plans.","authors":"Simone R Singh, Cherie Conley","doi":"10.1089/heq.2023.0183","DOIUrl":"https://doi.org/10.1089/heq.2023.0183","url":null,"abstract":"<p><strong>Objective: </strong>This study examined the health equity initiatives included in US hospitals' strategic plans.</p><p><strong>Methods: </strong>Using data from the American Hospital Association (AHA) 2021 Annual Survey, the study described the types of health equity initiatives that US hospitals included in their strategic plans. The analysis focused on the following seven initiatives: (1) equitable and inclusive organizational policies; (2) systematic and shared accountability for health equity; (3) diverse representation in hospital and health care system leadership; (4) diverse representation in hospital and health care system governance; (5) community engagement; (6) collection and use of segmented data to drive action; and (7) culturally appropriate patient care. Logit and zero-truncated Poisson regression analysis was used to examine organizational and community-level characteristics of hospitals with the most comprehensive health equity strategic plans.</p><p><strong>Results: </strong>Of the 4359 general medical and surgical hospitals that completed the AHA's 2021 survey, 45.1% provided complete information on their health equity strategies. The comprehensiveness of hospitals' health equity efforts varied across organizations. Regression analysis showed that larger hospitals, nonprofit hospitals, and hospitals affiliated with health systems tended to have more comprehensive health equity initiatives as did hospitals located in urban areas, hospitals in communities with higher household incomes, and hospitals in communities with greater proportions of Hispanic residents.</p><p><strong>Conclusions: </strong>While improving health and health equity is a key aspect of many hospitals' missions, the extent to which hospitals include health equity initiatives into their strategic plans varied noticeably. Committing to a comprehensive set of efforts aimed at improving health equity requires human and financial resources as well as dedicated leadership.</p>","PeriodicalId":36602,"journal":{"name":"Health Equity","volume":"7 1","pages":"753-760"},"PeriodicalIF":2.7,"publicationDate":"2023-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10698784/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138810619","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Organizational Facilitation of Latino Substance Use Disorder Treatment: Impact of COVID-19.","authors":"Ruth Campbell, Smita Dewan","doi":"10.1089/heq.2022.0184","DOIUrl":"https://doi.org/10.1089/heq.2022.0184","url":null,"abstract":"<p><strong>Purpose: </strong>Continued high opioid overdose death rates in the United States and increasing New York State (NYS) Latino opioid overdoses make the facilitation of Latino access to NYS substance use disorder (SUD) treatment essential. SUD treatment facilities in NYS sustained an estimated 37% decrease in Latino enrollment during phase one of the pandemic. This study invited NYS SUD service providers to describe ways in which SUD organizations facilitated Latino SUD treatment prior to and during phase one of the pandemic.</p><p><strong>Methods: </strong>Using an individual and community interaction framework of vulnerability and a description of organizational enabling resources in four domains, this study used a cross-sectional descriptive design to investigate the levels of organizational facilitators for Latino SUD treatment access and the impact of the pandemic on these organizational facilitators. A convenience sample of 470 NYS SUD clinicians participated in the study.</p><p><strong>Results: </strong>The outcomes suggest an overall erosion of organizational enabling resources during the pandemic. Erosion was greatest in areas with a higher Latino population density in the domains of insured/immigration/legal information and culture. A pattern of strengthening resources in areas with lower Latino population density in the domains of language and telehealth access has defied the overall pattern of deterioration. The increase in telehealth did not cross the digital divide to stop the decrease in Latino enrollment and did not compensate for the overall erosion of access facilitators.</p><p><strong>Conclusions: </strong>The overall outcomes suggest opportunities to explore local variations in resource health. Recommendations to improve health equity include the use of participatory research to assess community needs and the implementation of community partnerships to address systemic barriers and rebuild equitable addiction services.</p>","PeriodicalId":36602,"journal":{"name":"Health Equity","volume":"7 1","pages":"722-730"},"PeriodicalIF":2.7,"publicationDate":"2023-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10664556/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138463081","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Effect of Social Support on Social Media on Asian College Students' Intention to Participate in Physical Activity in the United States.","authors":"Ni Zhang, Kele Ding, Chulwoo Park, Jane Vo, Katrina Marie Cantos","doi":"10.1089/heq.2022.0208","DOIUrl":"https://doi.org/10.1089/heq.2022.0208","url":null,"abstract":"<p><strong>Background: </strong>College students who identified themselves as Asians in the United States (i.e., Asian college students) are facing health inequalities and engaging in increasingly low levels of physical activity (PA). Although social support was found to be effective in increasing college students' PA and social media is an important channel for social support for Asian students, few studies have explored how to provide social support through social media interventions to promote Asian students' PA level. Thus, this study aimed to explore the effects of social support on social media on Asian college students' intention to participate in PA based on the theory of planned behavior.</p><p><strong>Methods: </strong>We conducted an online Qualtrics survey among all undergraduate students at a university on the West Coast of the United States. Among 936 respondents, 337 (36%) were Asian college students. Descriptive analysis, regression models, and mediating effect tests were performed using SPSS 28.</p><p><strong>Results: </strong>For Asian students, social support on social media has both direct effects and indirect effects through perceived behavioral control (PBC) on their intention to participate in PA.</p><p><strong>Conclusion: </strong>Future interventions could consider encouraging Asian students to provide support to each other and form support groups using social media to increase their PBC.</p>","PeriodicalId":36602,"journal":{"name":"Health Equity","volume":"7 1","pages":"735-742"},"PeriodicalIF":2.7,"publicationDate":"2023-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10664567/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138463082","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Call to Improve Usability, Accuracy, and Equity of Self-Testing for COVID-19 and Other Rapid Diagnostic Tests.","authors":"Paul K Drain, Alexandra K Adams, Larry Kessler, Matthew Thompson","doi":"10.1089/heq.2023.0020","DOIUrl":"https://doi.org/10.1089/heq.2023.0020","url":null,"abstract":"<p><p>The increasing availability of rapid diagnostic self-tests (RDSTs) for COVID-19 has played an important and increasing role during the pandemic. However, for many underserved communities, RDSTs potential benefits are offset by problems with usability, accuracy, and equity. Given the increased need for and interest in home testing for acute and chronic diseases, including COVID-19, this piece offers ways that regulatory agencies, federal public health agencies, and test developers should engage with diverse communities to ensure equity throughout test development, implementation, and evaluation. Such engagement will ensure maximum personal and public health benefits for current and future RDSTs under real-world conditions.</p>","PeriodicalId":36602,"journal":{"name":"Health Equity","volume":"7 1","pages":"731-734"},"PeriodicalIF":2.7,"publicationDate":"2023-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10664557/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138463080","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Systemic Racism Affecting Latinx Population Health During the COVID-19 Pandemic and Beyond: Perspectives of Latinx Community Health Workers and Community-Based Organization Leaders","authors":"Gabriela Plasencia, Rohan Gupta, Kamaria Kaalund, Viviana Martinez-Bianchi, Rosa Gonzalez-Guarda, Andrea Thoumi","doi":"10.1089/heq.2023.0193","DOIUrl":"https://doi.org/10.1089/heq.2023.0193","url":null,"abstract":"Introduction: The purpose of this study is to identify forms of systemic racism experienced by Latinx communities in North Carolina during the COVID-19 pandemic as identified by Latinx community health workers (CHWs) and community-based organization (CBO) leaders. Methods: We conducted three focus groups in July 2022 (N=16). We performed qualitative analysis of data using an iterative inductive approach of the original language in Dedoose. Results: Four central themes emerged: (1) Access to resources for Latinx individuals; (2) Immediate, transitional, and future fears; (3) Benefits of CHWs; and (4) Lessons learned. Discussion: Institutional and state policies often do not involve community members, such as CHWs and CBO leaders, at the start of the development process, leading to ineffective interventions that perpetuate health disparities and systemic racism. Health Equity Implications: Community-informed policy recommendations can improve alignment of community and policy priorities to create more effective interventions to address systemic racism and promote health equity.","PeriodicalId":36602,"journal":{"name":"Health Equity","volume":"22 12","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135514787","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Role of a Local Health Department in Advancing Health Equity: Universal Postpartum Home Visiting in a Large Urban Setting.","authors":"Kristine Zimmermann, Lisa S Haen, Allissa Desloge, Arden Handler","doi":"10.1089/heq.2023.0104","DOIUrl":"10.1089/heq.2023.0104","url":null,"abstract":"<p><strong>Introduction: </strong>Racial and ethnic inequities persist among birthing families in urban U.S. communities, despite public health efforts to improve outcomes. To address these inequities, in 2020, the Chicago Department of Public Health (CDPH) launched Family Connects Chicago (FCC), an evidence-based, universal, postpartum home visiting program. We examine CDPH's transition from \"high risk\" to universal home visiting to determine whether and how this change represent an explicit commitment to advancing maternal and child health equity.</p><p><strong>Methods: </strong>We conducted a secondary analysis of key informant interview data (<i>n</i>=45 interviews) collected from stakeholders involved in FCC's early implementation. Our analysis involved identifying processes used by CDPH in their planning and early implementation of FCC and examining the alignment of these processes with approaches for promoting health equity proposed by Calancie et al.</p><p><strong>Results: </strong>The processes used by CDPH to plan and implement the FCC pilot are reflected in two major themes: (1) CDPH emphasized improving outcomes for all birthing families, and (2) CDPH prioritized engaging multiple stakeholders throughout planning and implementation. Alignment of these themes and their subthemes with the approaches proposed by Calancie et al. demonstrated that CDPH's implementation of FCC represents a commitment to advancing health equity.</p><p><strong>Discussion: </strong>In their planning and implementation of FCC, CDPH appears to have exhibited a concerted effort to address Chicago's persistent health inequities. Institutional commitment, continued stakeholder engagement, ongoing data sharing, and sustainable funding will be crucial to implementing and expanding FCC.</p><p><strong>Health equity implications: </strong>The implementation of FCC, a new service delivery approach for maternal and infant health, marks a new beginning in tackling inequities for Chicago's birthing families.</p>","PeriodicalId":36602,"journal":{"name":"Health Equity","volume":"7 1","pages":"703-712"},"PeriodicalIF":2.6,"publicationDate":"2023-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10615061/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71427620","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"What's Missing from Data Modernization? A Focus on Structural Racism.","authors":"Jamila M Porter,&nbsp;Brian C Castrucci,&nbsp;Jacquelynn Y Orr","doi":"10.1089/heq.2023.0086","DOIUrl":"https://doi.org/10.1089/heq.2023.0086","url":null,"abstract":"<p><p>Public health data modernization efforts frequently overlook the far-reaching effects of structural racism across the data life cycle. Modernizing data requires creating data ecosystems grounded in six principles: dismantling structural racism and building community power explicitly; centering justice in all stages of data collection and analysis; ensuring communities can govern their data; driving positive population-level change; engaging nonprofit organizations; and obtaining commitments from governments to make changes in policy and practice. As government agencies spearhead and finance data modernization initiatives, it is imperative that they address structural racism head-on and integrate these principles into all aspects of their work.</p>","PeriodicalId":36602,"journal":{"name":"Health Equity","volume":"7 1","pages":"699-702"},"PeriodicalIF":2.7,"publicationDate":"2023-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10615079/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71427622","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}