Showing papers in "Journal of racial and ethnic health disparities in 2020"

The COVID-19 Pandemic: a Call to Action to Identify and Address Racial and Ethnic Disparities.

Abstract: The Coronavirus disease 2019 (COVID-19) pandemic has significantly impacted and devastated the world. As the infection spreads, the projected mortality and economic devastation are unprecedented. In particular, racial and ethnic minorities may be at a particular disadvantage as many already assume the status of a marginalized group. Black Americans have a long-standing history of disadvantage and are in a vulnerable position to experience the impact of this crisis and the myth of Black immunity to COVID-19 is detrimental to promoting and maintaining preventative measures. We are the first to present the earliest available data in the peer-reviewed literature on the racial and ethnic distribution of COVID-19-confirmed cases and fatalities in the state of Connecticut. We also seek to explode the myth of Black immunity to the virus. Finally, we call for a National Commission on COVID-19 Racial and Ethnic Health Disparities to further explore and respond to the unique challenges that the crisis presents for Black and Brown communities.

Police Interactions and the Mental Health of Black Americans: a Systematic Review

Abstract: Black Americans comprise 13% of the US population, yet data suggests that they represent 23% of those fatally shot by police officers. Data on non-lethal encounters with police in the Black community is less available but can understandably result in emotional trauma, stress responses, and depressive symptoms. The aim of this systematic literature review is to assess if interactions with the police are associated with mental health outcomes among Black Americans. Following pre-defined inclusion criteria, 11 articles were reviewed. Using a quality assessment tool, eight studies received a fair quality rating, two studies a poor rating, and one study received a good rating. The types of police interaction reported among study participants included police use of force during arrest, police stops, police searches, exposure to police killings, and interactions with police in the court system and varied mental health outcomes. Most of the studies (6 of 11) reviewed found statistically significant associations between police interactions and mental health (psychotic experiences, psychological distress, depression, PTSD, anxiety, suicidal ideation and attempts), indicating a nearly twofold higher prevalence of poor mental health among those reporting a prior police interaction compared to those with no interaction. Although better quality studies are needed, findings suggest an association between police interactions and negative mental health outcomes. Changes in law enforcement policy, development and implementation of a validated instrument for police experiences, improved community outreach, a federally mandated review of policy and practice in police departments, and expanded police training initiatives could reduce the potential negative mental health impact of police interactions on Black Americans.

Coronavirus (COVID-19) and Racial Disparities: a Perspective Analysis

Abstract: Health disparity refers to systematic differences in health outcomes between groups and communities based on socioeconomic isolation. In the USA, health disparities among minority groups, especially African Americans, limit their access to quality medical care and other beneficial resources and services. Presently, the novel coronavirus (COVID-19) highlights the extreme healthcare challenges that exist in the African American and other minority communities in the USA. African Americans are dying at a rate nearly four times higher than the national average. With inadequate access to quality healthcare, viable resources, and information, COVID-19 will continue to have a disastrous effect on African American communities. This communication provides a brief overview of the health inequalities resulting in African Americans dying disproportionately during the COVID-19 pandemic.

Police Brutality and Mistrust in Medical Institutions

Abstract: People bring the social contexts of their lives into the medical encounter. As a social determinant of health, police brutality influences physical and mental health. However, negative experiences with institutions such as law enforcement might decrease trust in other institutions, including medical institutions. Mistrust might limit engagement with the healthcare system and affect population health. This study investigates the relationship between police brutality and medical mistrust and assesses whether it varies by race. Data were obtained from a 2018 cross-sectional survey of adults living in urban areas in the USA (N = 4389). Medical mistrust was regressed on police brutality (experiences and appraisal of negative encounters with the police), controlling for socio-demographics, health status, and healthcare access. Means of mistrust were predicted by racial group after including interactions between police brutality and race. Respondents who had negative encounters with the police, even if they perceived these encounters to be necessary, had higher levels of medical mistrust compared to those with no negative police encounters. Police brutality increased mistrust for all racial groups. Conditions outside the medical system such as experiencing police brutality impact relationships with the medical system. Given that clinicians are in a unique position of having access to firsthand information about the struggles and injustices that shape their patients’ health, advocating for systemic change on behalf of their patients might build trust.

Racism, COVID-19, and Health Inequity in the USA: a Call to Action.

Abstract: The current national COVID-19 mortality rate for Black Americans is 2.1 times higher than that of Whites. In this commentary, we provide historical context on how structural racism undergirds multi-sector policies which contribute to racial health inequities such as those highlighted by the COVID-19 pandemic. We offer a concrete, actionable path forward to address structural racism and advance health equity for Black Americans through anti-racism, implicit bias, and cultural competency training; capacity building; community-based participatory research (CBPR) initiatives; validated metrics for longitudinal monitoring of efforts to address health disparities and the evaluation of those interventions; and advocacy for and empowerment of vulnerable communities. This necessitates a multi-pronged, coordinated approach led by clinicians; public health professionals; researchers; social scientists; policy-makers at all governmental levels; and local community leaders and stakeholders across the education, legal, social service, and economic sectors to proactively and systematically advance health equity for Black Americans across the USA.

Race/Ethnicity, Gender, and Trajectories of Depressive Symptoms Across Early- and Mid-Life Among the Add Health Cohort

Abstract: While disparities in depressive symptoms by race/ethnicity and gender have been documented, left unclear is how such status characteristics intersect to influence mental health, particularly across early life and among a diverse set of population subgroups. This study investigates how intra- and inter-individual trends in depressive symptoms unfold across a 30-year span (ages 12–42) and are structured by the intersection of race/ethnicity and gender among White, Black, Hispanic, and Asian American young adults (N = 18,566). Analyses use data from the National Longitudinal Study of Adolescent to Adult Health, a nationally representative study of adolescents who have been followed through their fourth decade of life. We draw on Waves I–IV and a representative subsample of the brand new Wave V data. Growth curve models indicated depressive symptoms decreased across adolescence and young adulthood before increasing in the early 30s. Racial/ethnic minorities reported more depressive symptoms than Whites. Women reported more depressive symptoms than men and experienced especially steep increases in their late 30s. Racial/ethnic-gender disparities remained stable with age, except for Hispanic-White disparities among women and Asian American-White disparities among men, which narrowed with age. Overall, findings demonstrate dynamic inequalities across a longer period of the life span than was previously known, as well as heterogeneity in trajectories of poor mental health within and between racial/ethnic-gender groups. Results also suggest that Black and Asian American women experience the highest mental health risks and that interventions for reducing disparities in depressive symptoms should focus on adults in their late 20s/early 30s, particularly women of color.

Health Inequities Among Latinos/Hispanics: Documentation Status as a Determinant of Health.

Abstract: The Hispanic/Latino population is the largest minority group in the USA. Research has documented health disadvantages of undocumented Latinos/Hispanics compared to their documented counterparts. The economic and social conditions that influence immigrant health may operate differently for undocumented immigrants compared to their documented counterparts. Access to healthcare, access to health-protective resources (social, economic, and political contributors), and immigration enforcement actions are three mechanisms that affect immigrants and contribute to the social and health inequities within the Latino/Hispanic population. We argue that social factors within these three mechanisms distinctly affect undocumented immigrants. We discuss these factors by synthesizing the existing literature on documentation status and health. In doing so, we highlight opportunities for future research and provide recommendations for policies and interventions that can ease the taxing effects of documentation status on health among Latinos/Hispanics.

COVID-19 in the Indigenous Population of Brazil

Abstract: Brazil has 896,917 Indigenous individuals distributed among 505 Indigenous lands. There are 274 different Indigenous languages within 305 Indigenous ethnic groups. The Indigenous population is susceptible to pandemics, especially to the current pandemic of COVID-19, which has spread rapidly. In Brazil, after the first COVID-19-confirmed Indigenous case on 05th June 2020, more 420 suspected cases, 1727 confirmed cases being 934 active cases, 715 cases with clinical cure, and 70 cases of death were accounted through the first week of June. The number of cases is underestimated, according to the Special Secretariat for Indigenous Health (SESAI) database, since the deaths are due to respiratory failure, possibly caused by COVID-19, but not confirmed. The first COVID-19-caused death was a 15-year-old Indigenous Yanomami teenage from Roraima State without known previous diseases history and/or comorbidities. In the present study, the importance of social isolation, especially for Indigenous people who are more vulnerable to the COVID-19, was highlighted by the identification of the infection community. An Indigenous of the Kokama ethnicity was infected after coming in contact with a Medical Doctor who was infected with the disease. Later, it was noticed that both, Indigenous and doctor, were responsible for COVID-19’s transmission to 43 other Indigenous individuals (30 in Alto Rio Solimoes and 13 in Parintis), causing possibly other confirmed deaths. The impact of COVID-19 for Indigenous population might be an unprecedented tragedy, and the government in Brazil must take emergency measures as the social isolation.

Awareness and Intent to Use Pre-exposure Prophylaxis (PrEP) Among African American Women in a Family Planning Clinic.

Abstract: Due to the gap between cisgender women eligible for and those accessing pre-exposure prophylaxis (PrEP) for HIV prevention, it is critical to understand knowledge of and attitudes toward PrEP among HIV-vulnerable women. PrEP utilization is particularly low among African American women in the USA. Family planning clinics provide key access points to reach HIV-vulnerable African American women as well as to translate research findings into clinical practice. Our study aimed to (1) describe the awareness of and interest in PrEP among African American cisgender women attending a family planning clinic and (2) document the barriers and facilitators to PrEP uptake among these women. A cross-sectional survey was conducted with sexually active African American women of reproductive age attending a family planning clinic. Descriptive statistics were used to characterize the sample, and bivariate analysis was used to detect difference between categorical and outcome variables. In our survey (N = 109), over 80% of participants listed not knowing PrEP was available as the primary reason for not currently taking PrEP. Seventy percent reported they would probably or definitely like to take PrEP – demonstrating that barriers to uptake might stem from knowledge deficits rather than attitudes toward prevention. Study findings have the potential to inform strategies to increase awareness of PrEP as an HIV prevention option as well as to equip women with greater self-efficacy to access PrEP in family planning settings.

Releasing the Net to Promote Minority Faculty Success in Academic Medicine

Abstract: Underrepresented minority faculty in academic medicine continue to be underrepresented in academic health centers across the country. Their underrepresentation impacts advancements in clinical care, education, and discovery and slows our forward progress in the field. Underrepresented in medicine faculty includes people who are black or African American, Hispanic or Latinx, or Native American. Barriers to underrepresented faculty recruitment, retention, and advancement include minority and gratitude taxes, imposter syndrome, and a lack of an appreciation of power distance and distance traveled. This article reviews five barriers to progress in achieving appropriate diversity among faculty and leadership of academic health centers, focusing on the multiplying effects of these barriers and potential steps forward.

Historical Antecedents of Breastfeeding for African American Women: from the Pre-Colonial Period to the Mid-Twentieth Century

Abstract: African American women have much lower breastfeeding rates than other racial and ethnic groups in the USA. While researchers are beginning to explore contemporary factors contributing to this inequality, much less research has been devoted to the historical conditions that have contributed to these disparities. The aim of this paper was to describe the social, economic, and political factors that have influenced African American breastfeeding behavior in the USA from the colonial era through the mid-twentieth century. A thematic analysis was conducted across multiple databases and sources. A social history framework, which focuses on the experiences of ordinary people and events, was used to identify and integrate themes found within the reviewed literature. Three themes emerged: (1) Labor forces and other socio-cultural factors affected feeding practices and communal caregiving; (2) history of supplementation; and (3) influence of medicalization of birth and mobility on infant feeding in the twentieth century. These themes illustrate how African American women’s ability to breastfeed has been significantly constrained throughout the U.S. history. Supplementation with non-human milk substitutes and communal caregiving helped African American women navigate infant rearing under adverse socioeconomic circumstances. Social, political, and economic factors have contributed significantly to African American women’s ability to breastfeed throughout the U.S. history. Understanding the influences of historical antecedents on breastfeeding decisions over time may be key to finding effective interventions that might increase breastfeeding rates within this population.

Health and Health-Related Correlates of Internalized Racism Among Racial/Ethnic Minorities: a Review of the Literature.

Abstract: Internalized racism (IR) is a form of racism that leads people to internalize beliefs and stereotypes about their racial/ethnic (RE) group and/or about themselves because of their RE group membership. However, relative to other forms of racism research investigating the relationship IR and health is lacking. Thus, in an attempt to promote research on IR, this paper reviews and summarizes 112 empirical quantitative studies—representing nearly three decades of research published between January 1990 to December 2018—that examine the health and health-related correlates of IR among racial/ethnic minorities. Collectively, evidence from this review suggests that (1) IR is negatively associated with health via decrements in positive core self-evaluation; (2) IR exacerbates the relationship between other stressors and ill health; (3) IR mediates the relationship between discrimination and health; and (4) IR is a self-protective strategy that protects against ill health. Using the accumulated evidence, this review presents new conceptualizations of IR, along with specific recommendations on how to improve the scientific study of IR among racial/ethnic minorities.

Social Determinants of Pharmacy Deserts in Los Angeles County

Abstract: As medications are commonly used to prevent and mitigate chronic diseases and their associated complications and outcomes, limited geographic access to medications in communities that are already plagued with health inequity is a growing concern. This is especially important because low-income urban minority communities often have high prevalence and incidence of cardiometabolic and respiratory chronic conditions. Community pharmacy deserts have been established in Chicago, New York, and other locales. In part because the definition was originally adapted from the concept of food deserts, existing studies have either utilized the distance of 1 mile or greater to the nearest community pharmacy solely, or used distance along with the same predefined social indicator thresholds that define food deserts (i.e., income and vehicle ownership), to define and identify areas as pharmacy deserts. No full analysis has been conducted of the social determinants that define and characterize medication shortage areas within a given locale, even though medication and food are usually accessed independently. Therefore, to address this gap in the literature, this study was designed to identify all potential “pharmacy deserts” in Los Angeles County based on distance alone and then characterize them by their social determinants of health (SDOH) indicators. Geographic pharmacy deserts were identified as census tracts where the nearest community pharmacy was 1 mile or more away from a tract centroid. K-means clustering was applied to group pharmacy deserts based on their composition of social determinants of health indicators. Twenty-five percent (571/2323) of LA County census tracts were pharmacy deserts and 75% (1752/2323) were pharmacy non-deserts. Within the desert areas, two statistically distinct groups of pharmacy deserts (type one and type two) emerged from the analysis. In comparison to type two pharmacy deserts, type one pharmacy deserts were characterized by a denser population, had more renters, more residents that speak English as a second language, less vehicle ownership, more residents living under the federal poverty level, more Black and Hispanic residents, more areas with higher crime against property and people, and less health professionals to serve the area. Residing in type one desert areas, potentially compounds the geographic shortage of pharmacies and pharmacy services. As such, residents in Los Angeles County pharmacy deserts might benefit greatly from equitable, innovative, community-based interventions that increase access to medications, pharmacy services, and pharmacists.

Racial Profiling Is a Public Health and Health Disparities Issue.

Abstract: Racial profiling is a public health and health disparities issue through its disparate and adverse health impact on those targeted by this practice, as well as members of their communities. We discuss six ways police profiling and racial discrimination adversely impact Black American health. We identify four direct and two indirect ways. Four direct ways are (1) violent confrontation with police that causes injury or death; (2) police language that escalates a confrontation through micro-aggressions or macro-aggressions; (3) sub-lethal confrontations with police; (4) adverse health consequences of perceived or vicarious threat, i.e., the mere belief in potential harm by police injures health. There are two indirect ways: (5) through knowledge of or personal relationship with someone who directly experienced racial profiling; (6) through public events without a personal knowledge of the unarmed person threatened or killed by police as a result of racial profiling, but where such events cause both individuals and the community at large to perceive a threat. We support recognition of racial profiling as a public health and health disparities issue. We recommend support for community programs that address the clinical health effects of racial profiling. We also recommend widespread engagement of trauma-informed policing (TIP) that acknowledges the clinical effects of racial profiling.

Racial/Ethnic Disparities in Police Reporting for Partner Violence in the National Crime Victimization Survey and Survivor-Led Interpretation.

Abstract: Despite compromising women’s health and safety, intimate partner violence (IPV) is among the most underreported crimes, and our understanding of factors that drive police reporting by race/ethnicity is underdeveloped. The purpose of this study is to examine racial/ethnic differences in self-reporting IPV to police. Race/ethnicity-stratified models identified predictors of reporting IPV to police among recent, female survivors (n = 898) in the National Crime Victimization Survey (NCVS; 2011-15). Focus groups (n = 3) with recent survivors (n = 19) in Baltimore, MD (2018), contextualized results. Black women in the NCVS were twice as likely to report IPV to police relative to White women (AOR = 2.05, 95% CI: 1.01–4.15). In race/ethnicity-stratified models, police reporting significantly increased with increasing age between 18 and < 35 years (AOR = 1.18, 95% CI: 1.05–1.33) for Black women, and with IPV-related injury for Black (AOR = 2.51, 95% CI: 1.10–5.71) and Hispanic women (AOR = 2.87, 95% CI: 1.22–6.71); Hispanics with less than a high school education were least likely to report (AOR = 0.24, 95% CI: 0.07–0.91). Focus groups explained racial/ethnic influences on reporting including a culture of silence and discrimination, socioeconomic status, and social desirability. We identified influences on reporting IPV to police that vary by race/ethnicity using national data in context to an urban environment. Results demonstrate the need to enhance equity in survivors’ health and public safety through training and organizational change.

Disparities in Use of Subspecialty Concussion Care Based on Ethnicity.

Abstract: Concussion is common and subspecialty care can be essential to ensure recovery. However, barriers may exist to accessing care. This study aimed to assess disparities in subspecialty concussion care related to ethnicity, limited English proficiency (LEP), and insurance status. We utilized logistic regression to analyze 2010-2015 administrative data from four Sports Medicine clinics, comparing odds of being seen for concussion to odds of being seen for fracture by ethnicity, insurance type, and interpreter usage, controlling for demographic factors. ICD-9 codes were used to identify concussion and fracture. Our final sample contained 25,294 subjects: 5621 with concussion and 19,673 with fracture. In bivariate analysis, youth seen for concussion had 83% lower odds of being Hispanic compared with youth seen for fracture (95%CI: 75-92%). Due to interactions between ethnicity and interpreter use, we utilized a stratified multivariate model as our final model. Youth with concussion had 1.8× greater odds of having private insurance compared with youth with fracture (Hispanic OR 1.8, 95% CI 1.5-2.3; Non-Hispanic OR 1.8, 95% CI 1.7-2.0). Youth with concussion also had greater odds of not using an interpreter, though the strength of this association was weaker for Hispanic youth compared with non-Hispanic youth (Hispanic OR 1.68, 95% CI 1.30-2.17; Non-Hispanic OR 4.36, 95% CI 3.00-6.35). Age and sex were included as covariates. In conclusion, our analysis suggests disparities in subspecialty concussion care for Hispanic youth, as well as for individuals with LEP and non-private insurance. Further research should explore means for improving access to concussion care for all youth.

Just in TIME: Trauma-Informed Medical Education

Abstract: Numerous organizations implement a trauma-informed approach. This model assists institutions in providing care and education that delivers support to members who have undergone traumatic experiences, and many institutions apply the principles as a universal precaution. Student and trainee experiences in medical education reveal a hidden curriculum that may deliver conflicting messages about the values of an institution, in which equity is promoted, but biased and discriminatory practices are commonplace. Implicit racial bias has been identified in the patient-provider interaction and may also extend its impact on the learner experience. Bias and discrimination inflict trauma on its targets via emotional injury. Applying the principles of the trauma-informed approach, we advocate for trauma-informed medical education (TIME). TIME fosters awareness that students and trainees can experience trauma from a biased system and culture and advocates for the establishment of policies and practices that support learners to prevent further re-traumatization. TIME will serve as a means to deliver just and equitable education.

A Systematic Review of Indian Boarding Schools and Attachment in the Context of Substance Use Studies of Native Americans.

Abstract: This PRISMA style literature review was used to explore substance abuse studies focused on Native American populations in the context of historical trauma (from experiences at Indian boarding schools) and the critical loss of family relationships from colonization. It was found that while Indian boarding schools are recognized as being important research topics related to substance use, they are usually mentioned as a part of the colonization process rather than examined for their specific historical/personal impacts. Furthermore, social science may fail to recognize how detrimental the loss of family relationships was to the traditional bond of a Native American family. Beginning with an extensive list of 402 articles, two criteria were used to arrive at a systematic list of research in the topic areas: the acknowledgment of Indian boarding school attendance and the impact on family relationships. The final list included 27 studies which looked at Indian boarding schools and family relationship's relation to substance use among Native Americans. Overall, this review revealed that family discord should not be singled out as a causal link for Native American families; rather, it should be included in the argument to explain the relationship between Indian boarding school attendance and substance use.

A Multilevel Diabetes and CVD Risk Reduction Intervention in African American Churches: Project Faith Influencing Transformation (FIT) Feasibility and Outcomes.

Abstract: Wide-reaching health promotion interventions are needed in influential, accessible community settings to address African American (AA) diabetes and CVD disparities. Most AAs are overweight/obese, which is a primary clinical risk factor for diabetes/CVD. Using a faith-community-engaged approach, this study examined feasibility and outcomes of Project Faith Influencing Transformation (FIT), a diabetes/CVD screening, prevention, and linkage to care pilot intervention to increase weight loss in AA church-populations at 8 months. Six churches were matched and randomized to multilevel FIT intervention or standard education control arms. Key multilevel religiously tailored FIT intervention components included: (a) individual self-help materials (e.g., risk checklists, pledge cards); (b) YMCA-facilitated weekly group Diabetes Prevention Program (DPP) weight loss classes; (c) church service activities (e.g., sermons, responsive readings); and (d) church-community text/voice messages to promote healthy eating and physical activity. Health screenings (e.g., weight, blood pressure, blood glucose) were held during church services to identify participants with diabetes/CVD risks and refer them to their church’s DPP class and linkage to care services. Participants (N = 352 church members and community members using churches’ outreach ministries) were primarily female (67%) and overweight/obese (87%). Overall, FIT intervention participants were significantly more likely to achieve a > 5 lb weight loss (OR = 1.6; CI = 1.24, 2.01) than controls. Odds of intervention FIT-DPP participants achieving a > 5 lb weight loss were 3.6 times more than controls (p 5 lb. weight loss. AA churches can feasibly assist in increasing reach and impact of diabetes/CVD risk reduction interventions with intensive weight loss components among at risk AA church-populations.

“I Guess I Shouldn’t Come Back Here”: Racism and Discrimination as a Barrier to Accessing Health and Social Services for Urban Métis Women in Toronto, Canada

Abstract: Racism serves as a major barrier in access to health and social services, leading to absent, delayed, and/or avoidance of treatment. Metis Peoples experience barriers to accessing both Indigenous-specific and mainstream services yet are often left out of discourses surrounding racism and service access. Racism and discrimination experienced by Metis people is rooted within a deep history of assimilative and racist colonial policies. The objective of this research was to create space for the all too often unacknowledged voices of Metis Peoples by engaging with the traditional community health experts, Metis women. This research aimed to learn from Metis women's experiences to build an understanding on steps toward filling the health service gap. Nested within a longitudinal cohort study, this research employed a conversational method with urban Metis women in Toronto, Canada. In this paper, we share the experiences of racism and discrimination faced by urban Metis women when accessing and working within health and social services. Metis women (n = 11) experience racial discrimination such as witnessing, absorbing, and facing racism in mainstream service settings, while experiencing lateral violence and discrimination in Indigenous-specific services. This research highlights the need for reframing conversations around race, identity, health services, and the urban Metis community.

Using Motivational Interviewing to Increase PrEP Uptake Among Black Women at Risk for HIV: an Open Pilot Trial of MI-PrEP.

Abstract: Black women in the USA are at the highest risk among women for HIV. Pre-exposure prophylaxis (PrEP) prevents HIV transmission, but uptake among Black women remains low. An open pilot trial was conducted on MI-PrEP, a brief culturally tailored intervention incorporating motivational interviewing (MI) strategies to improve PrEP uptake and motivation. MI-PrEP is the first behavioral intervention developed to promote PrEP uptake among women in the USA. In Miami, FL, ten Black women who met eligibility criteria (e.g., sexual partner with HIV) were enrolled. These women participated in the two sessions of MI-PrEP and a 1-month follow-up. Participants completed measures on PrEP (motivation, uptake [verified via medical records], adherence, and barriers), medical mistrust, and an exit interview. These preliminary findings showed acceptability and feasibility with high satisfaction ratings; increases in PrEP uptake, knowledge, and motivation to use; and decreases in PrEP barriers and medical mistrust. Greater attention is needed on the psychosocial and structural factors among Black women who may benefit from PrEP.

Leveraging Community Engagement: The Role of Community-Based Organizations in Reducing New HIV Infections Among Black Men Who Have Sex with Men.

Abstract: There is growing recognition that a singular focus on biomedical treatments is insufficient to address the HIV prevention and health-care needs of Black men who have sex with men (Black MSM). Ending the HIV epidemic requires a multifactorial approach accounting for the social, cultural, economic, and environmental factors that drive transmission of HIV and other STDs. The two case studies presented were implemented by community-based organizations that have extensive experience with the target population and previous experience implementing HIV prevention-related programs and projects in the Jackson, Mississippi, metropolitan area. Culturally appropriate HIV prevention interventions that explicitly acknowledge the social determinants of health, particularly stigma and discrimination, both racial and sexual, are critical to reducing the number of new infections. These culturally appropriate and locally derived HIV prevention interventions provide a model for HIV health-care providers, public health officials, and community leaders to address the unique needs of Black MSM.

Family First: Asian Americans' Attitudes and Behaviors Toward Deceased Organ Donation.

Abstract: Asian Americans have substantial transplantation needs but have the lowest rates of organ donation in the USA. As the shortage of transplantable organs persists, the rate of deceased donation by Asian Americans has not kept pace with that of the general population. This report is a qualitative study of organ donation-related attitudes and beliefs of three Asian ethnic groups located in the greater Philadelphia metropolitan area: Chinese, Filipino, and Vietnamese Americans. Guided by a Community Advisory Board representing these groups, we conducted 9 focus groups with a total of 64 participants and subsequent thematic analyses. Six major themes emerged: (1) positive views about organ donation, (2) previous exposure to organ donation, (3) primacy of the family in decision making, (4) mistrust of the healthcare and donation systems, (5) religious and cultural beliefs concerning the body, and (6) isolation from mainstream American society. Although participants expressed commonalities and beliefs in line with other American racial and ethnic groups, we also identified unique beliefs, such as familial influence, religious and cultural concerns regarding body wholeness and the dead, and underlying reasons for medical mistrust, such as a belief in a black market. The study's findings challenge the dominant educational and awareness campaigns about organ donation decision making that focus on individual autonomy and overlook the need for incorporating the specific content and message delivery needs of Asian Americans. This study is the first to explore attitudes and knowledge about posthumous organ donation among US Asian American populations in at least a decade.

Characterizing Sugar-Sweetened Beverage Consumption for US Children and Adolescents by Race/Ethnicity.

Abstract: To examine racial/ethnic differences in type of SSB most frequently consumed and in correlates of youth sugar-sweetened beverage (SSB) intake. Data were obtained from the National Health and Nutrition Examination Survey (NHANES), 2011–2016, for children and adolescents aged 5–17 years (n = 6507). The main outcome was SSB consumption (i.e., sodas, sweetened fruit drinks, nectars, sports and energy drinks, sweetened coffees and teas, enhanced waters). Mean and proportions of SSB intake were estimated accounting for complex sampling strategy and weighting. Multivariable regression models were developed for each race/ethnicity and age group. Two-thirds of children and adolescents reported consuming SSB on a given day. Among consumers, mean SSB consumption was greatest for Black children and White adolescents and lowest for Asian American children and adolescents. The most popular type of SSB consumed was sweetened fruit drinks among children and soda among adolescents, except among White and Mexican American children for whom soda and Black adolescents for whom sweetened fruit drinks were most popular. Female sex and water intake were negatively associated with SSB consumption across most races/ethnicities. Screen time, dentist visits, nativity, and guardian education were associated with SSB intake among a subset of races/ethnicities. Associations between covariates and SSB intake as well as types of beverages preferred vary by race/ethnicity, as such chronic disease policies should not be ‘one size fits all’. Targeted interventions for specific groups of vulnerable youths hold promise for further reducing SSB consumption, including directing efforts towards reducing sweetened fruit drinks for Black children.

An Intersectional Approach to HIV Vulnerabilities and Testing Among Heterosexual African Caribbean and Black Men in London, Ontario: Results From the weSpeak Study.

Abstract: Heterosexual African, Caribbean and Black (ACB) men are a vulnerable group to HIV infection in Canada, but little is known about their uptake of HIV testing services. Studies on ACB men HIV vulnerabilities have largely focused on behavioural factors. While these studies have contributed to the current HIV prevention success in Canada, little attention has been paid to structural factors that intersect with prevailing behaviours to reinforce vulnerabilities. Drawing insights from intersectionality theory, we examined healthcare access and HIV testing among heterosexual ACB men in London, Ontario. We fitted the negative log-log link function to 155 individuals' survey. Results show that participants, who had difficulty accessing healthcare, experienced discrimination, and were young, were all less likely to test for HIV. Even though the probability of testing for HIV increased after accounting for the effect of structural factors, the marginal impact was higher for those without any difficulty accessing healthcare than those with difficulty. Findings are discussed within the broader theory of intersectionality and recommendations made for public health policy.

The Inescapable Effects of Parent Support on Black Males and HIV Testing

Abstract: Focusing on parental communication is a promising way to extend the reach of HIV-related interventions and prevention programs to underserved adolescents and their families in the US. One highly relevant population in need of services is Black males who constitute more than one-third of all new HIV infection cases in the US. We sought to determine whether the family context (i.e., parent support, parent relationships) impacted HIV testing over time. For this study, we used the first and third waves of the Add Health restricted dataset from the National Longitudinal Study of Adolescent Health of Black males (average age 16.1 years). Descriptive statistics found that over 75% of the sample had never been tested for HIV/AIDS, while only 58% reported using a condom. Bivariate regression analysis followed by multinomial analysis was conducted to identify the factors that were associated with the likelihood of one-time or continued HIV/AIDS testing. Major study findings indicate that Black males, who reported positive parent support and/or had visited the doctor, were more likely to get tested for HIV/AIDS. Males who had parents or peers that possessed negative attitudes about sex were less likely to get tested for HIV. The findings of this study suggest several implications for prevention and intervention aimed at optimal ways to increase HIV testing among Black males warranting further investigation.

Disparities in Opioid Pain Management for Long Bone Fractures

Abstract: An expanding body of evidence has established that racial disparities exist in the US healthcare system, manifesting in poorer health outcomes for members of the non-white population. This study examines whether disparities exist in the type of analgesia ordered for long bone fractures and the time to medication administration in a community teaching hospital serving a large Hispanic population. We reviewed de-identified data of 115 patients from the emergency department of a community Level II Trauma Center in central Florida with diagnosed long bone fractures and examined the clinical and demographic variables associated with the type of analgesic administered and factors associated with delays in medication administration. We found that women reported higher pain scores than men, but there was no difference in the type of pain medication administered. There was no difference in pain scores between white and non-white patients; however, white patients were more likely to receive opiates for their long bone fractures compared with non-white patients (70 vs 50%, p < 0.0001). Opioid pain medications were prescribed significantly more often to adult and elderly patients compared with pediatric patients who were more likely to receive acetaminophen compared with both other patient groups (p < 0.001). In summary, we found that pain score was not associated with the class of pain medication administered, but that race and age were. This study questions the utility of the pain score for acute injuries and raises concerns about the role of physician bias in analgesia administration.

Climate of Fear: Provider Perceptions of Latinx Immigrant Service Utilization.

Abstract: Latinx immigrants endure stressors throughout the immigration process that detrimentally impact their health and wellbeing. Yet, they also face substantial barriers to accessing and utilizing services. These barriers might be heightened under the Trump administration, which has implemented policies facilitating increased immigration enforcement and punitive immigration practices. This study utilizes data collected from providers who serve Latinx immigrants in the border state of Texas to better understand current immigrant service utilization behaviors. Individual interviews and focus groups were conducted shortly after the last presidential election to inquire about recruitment, retention, program completion, and resources to address key client risk factors. Applying grounded theory analysis strategies, interviews, and focus group recordings were coded for key themes. Data demonstrated central concerns held by providers serving immigrants, and especially those who are undocumented or in mixed-status families. Concerns were related to the following three themes: (1) undocumented immigrant stressors, (2) limited resources for undocumented immigrants, and (3) service utilization barriers. Lack of services for undocumented immigrants and fear related to service utilization were prominent subthemes. These findings extend our knowledge of stressors and barriers of access and utilization for immigrants during this time period of increased immigration enforcement which have valuable implications for practice and future research. Providers can take concrete actions to educate immigrants, regardless of documentation status, on how their clients’ identities will be protected. In addition, intentional trust-building strategies are essential to help overcome fear of utilizing services. Future research should ascertain perspectives of immigrant families, as this study drew perspectives only from providers.

Health Implications of Black Lives Matter Among Black Adults.

Abstract: The current study examined whether knowledge, understanding and support of the Black Lives Matter movement were positively linked to self-reported physical health among a representative sample of Black American adults. The 2016 Collaborative Multiracial Post-election Survey (CMPS) examined attitudes about the 2016 US election, immigration, policing, racial equality, and racial discrimination among Asian American, Black American, Latinx, and White adults. The current study used the Black American sample, which included 3102 individuals (69% female) older than 18 years of age. We used a set of logistic regression models to assess the associations of knowledge, support, and understanding of Black Lives Matter with overall physical health. Although knowledge of Black Lives Matter was not a significant predictor for physical health, understanding and supporting Black Lives Matter significantly predicted positive physical health among Black American adults. Black American adults who understand and support Black Lives Matter reported more positive overall physical health.

Parent and Professional Experiences Supporting African-American Children with Autism.

Abstract: While the identification of autism spectrum disorder (ASD) has stabilized at 1 in 59 children in the USA, and children can now be diagnosed reliably with ASD at 2 years old, African-American children are less likely to be diagnosed with ASD. Once African-American children with ASD are identified, there is a latency between diagnosis and access to services when compared to European American children. In an effort to investigate these disparities, this qualitative study explored the experiences and perceptions of African-American parents of children with ASD. This study also explored the experiences and perceptions of professionals who support African-American children with ASD and their families. Findings indicate that (a) participants identified few facilitators to service access, and (b) both parents and healthcare providers perceived similar barriers and facilitators to early diagnoses and service access. Implications for parents, healthcare providers, and educators are discussed.