Search

Introduction: Race and ethnicity along with social determinants of health have been identified as risk factors for COVID-19. The purpose of this clinical paper is to provide an overview of the National Coalition of Ethnic Minority Nurse Associations (NCEMNA), present COVID-19 epidemiological data on five racial–ethnic groups, identify culturally congruent health care strategies for each group, and provide directions for practice and research. Method : NCEMNA collaborated to provide a clinical paper that addresses information about COVID-19 and culturally congruent health care in five racial–ethnic groups. Results : Every organization presented common themes across the different groups and unique perspectives that each group is faced with during this challenge. Discussion : This article provides an introduction to the issues that minority groups are facing. It is imperative that data are collected to determine the extent of the impact of COVID-19 in diverse communities in the country. [ABSTRACT FROM AUTHOR]

South-East Asian refugees have lived in the United States of America for nearly four decades, with early refugee immigrants experiencing ageing and later life within the refugee context. As refugees age, health concerns of this older population grow, highlighting the need for ongoing assessment of refugee health and health-seeking behaviours. This study builds on previous literature that assessed the health and health-seeking patterns of South-East Asian refugees in the early years following resettlement, exploring how health and health-seeking is understood among older refugees 40 years after immigration. This paper includes a subset of 37 older refugees from a larger, community-based participatory, mixed-methods intergenerational study of Cambodian and Laotian refugee families conducted over four years (quantitative N = 433; qualitative N = 183). Thematic analysis of 34 semi-structured interviews with these older refugees in coastal Alabama revealed trends in health and health-seeking practices. Older refugees reported high rates of diabetes and hypertension within their generational cohort, and indicated a shift in health-seeking behaviours, whereby Western biomedicine is sought first for such chronic concerns, followed by traditional medicines for mild ailments such as headaches or colds. Older refugees underscored barriers of language, finances and transportation as limiting access to Western health care. Implications for engaging in community health practices and incorporating services to specifically meet the needs of the ageing refugee population are discussed. [ABSTRACT FROM AUTHOR]

The authors discuss the disparity in African American infant mortality and suggest ways to surmount the problem. They believe the causes of the disparity are historical and biopsychosocial; racial and ethnic disparities are found in health outcomes. Eliminating factors that cause high rates of pre-term births (PTB) and low birth weight (LBW) is important as. The authors opine that a multidisciplinary approach would address the various causal factors.

Accessible Summary: What Is Known on the Subject?: Economic and educational opportunities are usually the principal driving forces for migration.There is a large body of quantitative research studies, mainly from the U.K., supporting the high prevalence of psychiatric disorders, mainly psychotic disorders, in Afro‐Caribbean immigrants which increases across generations.The process of migration and acculturation can present significant risk factors for psychiatric disorders in immigrants.Research involving members of the Black community is generally conducted with the perception that Blacks are a homogenous group, ignoring the cultural and ethnic differences among the subgroups. What the Paper Adds to Existing Knowledge?: It provides a broadened understanding of the experiences, thoughts and feelings of Afro‐Caribbean immigrants, and the factors within the processes of migration and acculturation that negatively impacts their mental health.It provides context to the volume of quantitative studies indicating a high prevalence of psychiatric disorders, particularly psychotic disorders, in Afro‐Caribbean immigrants and their offspring. What Are the Implications for Practice?: Nurses conducting mental health evaluations and assessments for members of the Black community should be culturally competent. Cultural competence entails an understanding of cultural beliefs, race, ethnicity and values. Additionally, knowledge of the effects of migration and acculturation as mental health risks is also important to improve mental health outcomes.Cultural competence will help reduce health disparities by increasing trust in the health care system and providers, not only for Afro‐Caribbean immigrants, but all immigrant groups. Introduction: There is evidence to support migration as a significant risk factor for psychiatric disorders in immigrants. Unfortunately, as an immigrant group, little is known about the mental health of Afro‐Caribbean immigrants and the factors that threaten their mental health. Aim: To explore the perceived effects of migration on the mental health of Afro‐Caribbean immigrants. Methods: A qualitative narrative synthesis was employed to interpretively integrate 13 primary qualitative research findings. Eleven of the primary studies were conducted in the U.K., one in the U.S. and one in Canada. Results: The themes gleaned: (1) experiences of racism, (2) generational conflicts, (3) feelings of powerlessness, (4) limited socioeconomic resources, (5) unfulfilled expectations, (6) fragmented family and community and (7) ignoring cultural/ethnic identity. Discussion: The findings broadened the understanding and experiences of Afro‐Caribbean immigrants and their mental health vulnerabilities as they navigate through migration and acculturation. Implications for Practice: Addressing the mental health of Afro‐Caribbeans will require health care providers to: (1) be cognizant of their immigrant status; (2) understand how migration and acculturation influence the mental health of immigrants; (3) be aware of the ethnocultural differences among Black subgroups. [ABSTRACT FROM AUTHOR]

Self-rated health (SRH) is a salient outcome for cancer survivors. Although depression is a well-studied correlate with SRH, few studies have focused on the role of cancer survivors' age on the association between depression and SRH. This study evaluates demographic and psychosocial factors associated with cancer survivors' SRH. We also assess the moderating role of age to the association between depression and SRH. This paper analyzed 2,470 U.S. cancer survivors from the 2019 National Health Interview Survey. Two ordered logistic regression models with complex survey weights were used for analyses. Missing data was addressed using multiple imputations by chained equations. Being female, higher education and higher income were positively associated with better SRH. While the relationship between higher education and higher income was consistent with previous findings, the positive association between being female and SRH was different from previous studies. Age significantly moderated the association between depression and SRH, evidenced by results of the joint tests of all interaction term coefficients being statistically significant, F(2, 544.6) = 5.13, p < 0.01. The findings of the study highlighted the significance of screening for social determinants of health and health disparity when supporting cancer survivors. Additionally, findings of this study emphasized the significance of adopting an age-specific approach when evaluating and addressing depression across different age groups of cancer survivors. [ABSTRACT FROM AUTHOR]

Objectives The United States has seen increasing shifts toward home- and community-based services (HCBS) in place of institutional care for long-term services and supports. However, research has neglected to assess whether these shifts have improved access to HCBS for persons with dementia. This paper identifies HCBS access barriers and facilitators, and discusses how barriers contribute to disparities for persons with dementia living in rural areas and exacerbate disparities for minoritized populations. Methods We analyzed qualitative data from 35 in-depth interviews. Interviews were held with stakeholders in the HCBS ecosystem, including Medicaid administrators, advocates for persons with dementia and caregivers, and HCBS providers. Results Barriers to HCBS access for persons with dementia range from community and infrastructure barriers (e.g. clinicians and cultural differences), to interpersonal and individual-level barriers (e.g. caregivers, awareness, and attitudes). These barriers affect the health and quality of life for persons with dementia and may affect whether individuals can remain in their home or community. Facilitators included a range of more comprehensive and dementia-attuned practices and services in health care, technology, recognition and support for family caregivers, and culturally competent and linguistically accessible education and services. Discussion System refinements, such as incentivizing cognitive screening, can improve detection and increase access to HCBS. Disparities in HCBS access experienced by minoritized persons with dementia may be addressed through culturally competent awareness campaigns and policies that recognize the necessity of familial caregivers in supporting persons with dementia. These findings can inform efforts to ensure more equitable access to HCBS, improve dementia competence, and reduce disparities. [ABSTRACT FROM AUTHOR]

Introduction: Few studies of intimate partner violence and health outcomes include multiple forms of intimate partner victimization, so this paper sought to examine health associations with intimate partner violence (IPV), including sexual, physical, stalking, and psychological forms, as well as polyvictimization. Methods: Data are from the 2010-2012 National Intimate Partner and Sexual Violence Survey, an on-going national random-digit-dial telephone survey of U.S. adults. There were 41,174 respondents. Logistic regression was used to compute prevalence ratios for any IPV, adjusted for demographics and non-IPV victimization. For individual forms of IPV, prevalence ratios were further adjusted for other forms of IPV. Tests for linear trend in poly-victimization were performed. Results: Any IPV was associated with all health conditions for both sexes with a few exceptions for males. Female penetrative sexual victimization and male stalking victimization were associated with the most health conditions. For each health condition, a significant linear trend indicated that as the number of forms of IPV experienced increased, prevalence of each health condition increased, with a few exceptions for males. Conclusions: It is important for service providers to screen for multiple forms of IPV, including psychological aggression, because individual forms or polyvictimization may have unique and cumulative health effects. [ABSTRACT FROM AUTHOR]

Background: The COVID-19 pandemic has reinforced awareness that the health of populations is inextricably linked around the globe. Nurses require increased knowledge and preparation in global health. Nursing educators need examples of how to improve content in the curriculum. Aims: The purpose of this paper is to describe reconceptualization of a master’s level nursing course entitled “Population Health in a Global Society” to include global health competencies. Methods: We identified four global health competencies within the following three domains: globalization of health and healthcare; collaboration, partnering, and communication; and sociocultural and political awareness. Implementation: We utilized guest lectures, a panel discussion, discussion forums and an independent research assignment. The methods used were well received by students, and the content delivered improved their perceived knowledge in global population health. Discussion: The global health domains and competencies provided a roadmap for improving our course to focus on population health from a global perspective. Conclusion: In order to prepare nurses to contribute to global population health, population health courses should integrate global health competencies. The content of the revised course will better prepare nurses who will practice in a wide variety of settings and is designed for interdisciplinary education. [ABSTRACT FROM AUTHOR]

The US South is disproportionately impacted by HIV. Social, cultural, economic, and political characteristics of the South shape access to mental health services leaving adverse impacts on health and wellness outcomes among People Living with HIV. The aim of this paper was to: (a) identify meso factors (at individual, organizational and community-level manifestations) which impact mental health services among People living with HIV in the South of those factors and (b) pose community-articulated recommendation and strategies. Through qualitative interviews with People Living with HIV and service providers, this study found that the meso factors of restricted funding and compounding stigma shaped mental health services in the South. Given the disproportionate rate of HIV, lack of mental health care, and landscape of socio-political factors unique to the region, attention to intervenable meso factors and community-based strategies are needed to enhance mental health services and respond to the HIV epidemic in the US South. [ABSTRACT FROM AUTHOR]

Social determinants of health (SDOH) are the greatest predictors of one's health status. There are clear SDOH disparities present in the United States, many of which have been especially evident during the COVID pandemic. SDOH have become a greater focus of payers, including Centers for Medicare & Medicaid Services (CMS). CMS has updated the reimbursement structure of Medicare and Medicaid to incentivize more SDOH-related interventions. Providers are also growing increasingly attentive to the SDOH needs of their patients, but often are unable to sufficiently address them outside of care settings. The combination of increased SDOH funding with inefficient mechanisms to meet patients' SDOH needs has led to the emergence of the for-profit SDOH industry. The purpose of this paper was to investigate the industry and identify its size, scope, and future implications. The authors conducted an analysis of for-profit SDOH companies using a third-party industry research platform. A collection of 58 companies was identified with $2.4 billion in funding and a total valuation of over $18.5 billion as of July, 2021. Two literature searches were conducted to support strategy recommendations for critically evaluating SDOH outcomes from these companies, and to determine the downstream effects they will have on community-based organizations also working to improve SDOH. [ABSTRACT FROM AUTHOR]

Objectives Previous research in the United States suggests contextual income mobility may play a role in explaining the disparities between life expectancy in the United States and peer countries. This article aims to extend previous research by estimating the consequences of average individual exposure to mobility regimes during childhood and adolescence on adult health. Methods This study draws its data from two longitudinal datasets that track the county of residence of respondents during childhood and adolescence, the Panel Study of Income Dynamics and the National Longitudinal Survey of Youth 1997. We implement marginal structural models to assess the association of the average exposure to county income mobility on five health outcomes and behaviors. Results The results are only partially consistent with a systematic association between exposure to income mobility and health outcomes. Evidence obtained from the National Longitudinal Survey of Youth suggests less income mobility might increase the probability of smoking by age 30. Discussion The paper provides a precise assessment of the hypothesis that childhood exposure to income mobility regimes may influence health status through behavior later in life and contribute to longevity gaps. Only partial evidence on smoking suggests an association between income mobility and health, so we discuss potential reasons for the disparities in results with previous research. [ABSTRACT FROM AUTHOR]

Racism has resulted in significant disproportionality and disparity in the US child welfare system. Being Black is not an inherent risk factor for child abuse and neglect yet Black children are almost twice as likely to be victims of substantiated abuse and neglect claims compared to other racial groups. Addressing the disproportionality within the child welfare system due to systemic racism falls squarely under the purview of bioethics. In this paper, we briefly review the impact of racism on child welfare. We then discuss some ethical considerations that mandatory healthcare reporters should think through when determining whether to report potential abuse and neglect. Specifically, we discuss the need for a broader consideration of what constitutes harm. We then present a hypothetical composite case to illuminate where and how bias can enter the process of referral to child protective services (CPS). We encourage thoughtful reporting with consideration of social and historical context and alternative explanations for worrisome findings. We recommend using evidence, avoiding assumptions by seeking clarification from families and ensuring internal consistency. When contemplating CPS referral, medical providers should feel empowered to ask questions if there is concern for potential bias. The ultimate goal is to protect children from harm. If there are clear safety concerns—they must be addressed. However, in the many cases where the safety concern is less tangible, we need to expand our considerations of the harms that can befall children, especially children of color. [ABSTRACT FROM AUTHOR]

The COVID‐19 pandemic has had a disproportionate impact on the health of Black Americans, Latinx or Hispanic Americans, and American Indians. These disparities are deeply unjust, in part, because they are the causal result of racism at both the interpersonal and structural levels. This paper argues, however, that establishing a causal connection between racism and health disparities is not the only way to explain the injustice of these disparities. The COVID‐19 health disparities are arguably unjust because health equity is a "free‐standing" demand of justice, an obligation of reparative justice, a remedy to structural injustice, and part of dismantling pernicious racial concepts. Identifying multiple accounts of injustice may lower the evidentiary bar for our normative claims and help us to identify alternative policy pathways for ending health inequity. [ABSTRACT FROM AUTHOR]

Transgender and gender non‐conforming people (TGNC), individuals whose gender identity differs from the sex they were assigned at birth, experience unique stressors, discrimination, and barriers to health and wellbeing. TGNC People of Colour (POC) navigate the nexus of racism, cisgenderism (and often homophobia) in their daily lives, resulting in uniquely intersecting forms of discrimination, and pronounced disparities in their health and well‐being. In order to examine the current state of knowledge about the health and wellbeing of TGNC POC, we conducted a systematic search and review of peer‐reviewed journal articles published between 1 January 2010 and 1 May 2020 that focused on this population. A systematic search identified (3,575) papers, with 76 of those meeting full inclusion criteria. In our review, we were able to identify physical health and psychological wellbeing (which included resilience), as core clusters of research focused on TGNC POC. We identified specific factors that hindered physical and psychological health (what we call "push" factors) as well as those that promoted it (what we call "pull" factors). Leveraging these findings, we offer ways forward for best practice in clinical work and carrying out research with this population. Please refer to the Supplementary Material section to find this article's Community and Social Impact Statement. [ABSTRACT FROM AUTHOR]

Scholars have identified race-based stress as a unique form of stress and have examined associated mental and physical health outcomes, yet less is known about the emotional responses and accompanying symptoms associated with negative race-based events and how these experiences differ by racial group membership, stress level, and/or race-based event type. This paper explores and compares the differences in emotional and race-based stress symptom reactions to negative racial encounters among 175 Black and White participants. Multivariate analysis of variance revealed different patterns of emotional and race-based stress symptom reactions to racial encounters among Black and White participants. At high levels of stress, Black and White participants experienced markedly different patterns of race-based stress symptoms: White participants primarily exhibited symptoms of intrusion, while Black participants experienced a variety of symptoms including depression, intrusion, anger, hypervigilance, and physical symptoms. Practice and research implications are addressed. [ABSTRACT FROM AUTHOR]

Background: Self-rated health (SRH) is one of the most commonly used summary measures of overall health and well-being available to population scientists due to its ease of administration in large-scale surveys and to its efficacy in predicting mortality. This paper assesses the extent to which SRH is affected by its placement before or after questions about bodyweight on a survey, and whether differences in placement on the questionnaire affects SRH's predictive validity. Methods: I assessed the validity of SRH in predicting the risk of mortality by comparing outcomes of sample members who were asked to rate their health before reporting on their bodyweight (the control group) and sample members who were asked to rate their health after reporting on their bodyweight (the treatment group). Both the control and treatment group were randomly assigned via an experiment administered as a module in a nationally representative sample of adults in the USA in 2019 (N = 2523). Results: The odds of reporting a more favorable appraisal of health are 30% lower for sample members who were in the treatment group when compared with the control group. Additionally, the SRH of treatment group members is significantly associated with their risk of mortality, while the SRH of control group members is not. Conclusion: The findings from this study suggest that for researchers to maximize the utility of SRH, closer attention needs to be paid to the context of the survey within which it asked. SRH is highly sensitive to the questions that precede it, and this sensitivity may in turn mischaracterize the true health of the population that the survey is intending to measure. [ABSTRACT FROM AUTHOR]

Objectives This paper examines health profiles and work environments of hired U.S. farmworkers to understand the risk to essential workers and their employers, to the food supply, and to rural health systems such as what is possible with the COVID-19 pandemic. Methods Large-sample statistical methods and proprietary data from the National Agricultural Workers Survey from 2000 to 2018 were used to assess factors associated with exposure to COVID-19 and vulnerabilities associated with medical complications. Results An aging workforce and increased access to health care within the crop worker population has been associated with a higher reported incidence of diabetes, asthma, and heart disease among workers over time. These trends confirm a vulnerable, but essential, workforce with higher risks for COVID-19 complications than would have been true of U.S. farmworkers as a group in earlier years. Conclusions Increasing age and disease burden in the U.S. agricultural labor force puts workers at increased risk for developing COVID-19 complications. Limits to field sanitation and housing quality inflate the probability of the development of COVID-19 hotbeds in rural communities that could further compromise the physical health of workers, the economic health of farm establishments, the agricultural supply-chain, and rural health capacities. Additional and more targeted worker protections may minimize public health and economic costs in the long run. [ABSTRACT FROM AUTHOR]

Black women in the United States have experienced substantial improvements in health during the last century, yet health disparities persist. These health disparities are in large part a reflection of the inequalities experienced by Black women on a host of social and economic measures. In this paper, we examine the structural contributors to social and economic conditions that create the landscape for persistent health inequities among Black women. Demographic measures related to the health status and health (in)equity of Black women are reviewed. Current rates of specific physical and mental health outcomes are examined in more depth, including maternal mortality and chronic conditions associated with maternal morbidity. We conclude by highlighting the necessity of social and economic equity among Black women for health equity to be achieved. [ABSTRACT FROM AUTHOR]

Objective: This paper examines how mortality covaries with observed skin tone among blacks and in relation to whites. Additionally, the study analyzes the extent to which social factors such as socioeconomic status affect this relationship. Design: This study uses data from the 1982 General Social Survey (N = 1,689) data linked to the National Death Index until 2008. We use this data to examine the links between race, observed skin tone among blacks, and all-cause mortality. Piecewise exponential hazard modeling was used to estimate disparities in skin tone mortality among blacks, and relative to whites. The multivariate models control for age, education, gender, region, metropolitan statistical area, marital status, labor force status, and household income. Results: Observed skin tone is a significant determinant of mortality among blacks and in relation to whites. Light skinned blacks had the lowest mortality hazards among blacks, while respondents with medium and dark brown skin experienced significantly higher mortality. The observed skin tone mortality disparities covaried with education; there are significant mortality disparities across observed skin tone groups among black respondents with high school or more education, and nonsignificant disparities among those with less education. Conclusion: It is crucial to identify the social processes driving racial disparities in health and mortality. The findings reveal that the nuanced social experiences of blacks with different observed skin tones markedly change the experience of racial inequality. Research on the nuanced social processes and biological mechanisms that connect differences in observed skin tone to mortality outcomes promises to better illuminate the experience of racial inequality and policy mechanisms we can use to undermine it. [ABSTRACT FROM AUTHOR]

Despite improvements in access to transition-related medical care, many transgender people still face numerous barriers to paying for gender-affirming procedures. Crowdfunding websites have gained immense popularity as a strategy for trans people to raise money for transition-related healthcare expenses. Using descriptive statistics and thematic content analysis, this paper illustrates how fundraising campaigns for medical gender transition both reveal and reinforce health and social inequalities. Although trans people crowdfund for a variety of transition-related needs, the majority of online campaigns are used to fund chest surgeries among young, white, binary-identified trans men in the United States. Most campaigns fall dramatically short of their fundraising goals. In addition, campaigns use medicalized, normatively gendered transition narratives that privatize inequality in marginalized communities. The article concludes with a consideration of how to incorporate a 'revolutionary etiquette' in crowdfunding for transition healthcare. [ABSTRACT FROM AUTHOR]

In 1999, a cooperative tripartite cancer research and training agreement was signed between Ireland (IE), Northern Ireland (NI) and the United States (US) National Cancer Institute, giving rise to the All-Ireland Cancer Consortium (AICC). We wished to consider if AICC increased the amount/impact of cancer research on the island of Ireland and what effect this enhanced research activity had on cancer services and cancer outcomes. As comparator, we chose the city regions of Copenhagen and Lund & Malmö, whose physical connection was greatly improved following construction of bridges between Denmark and Sweden around the time AICC was established. We analysed cancer research outputs from all four geographical regions in the Web of Science (1988–2017), with a particular focus on citations and journal impact factors. We evaluated disability-adjusted life years (DALYs) as an indicator of change in health status. Research outputs increased in all four regions, but more in IE/NI than in the Scandinavian cities, while collaboration between IE and NI and both the US and the Rest of Europe increased even more substantially. Citation scores also showed a greater improvement for IE and NI. Journal citation impact factors indicated that IE/NI papers were increasingly being published in more highly cited journals. Research-enabled cancer service provision improved on the island of Ireland, with concomitant increases in cancer survival. The AICC collaborative agreement delivered significant additionality on the island of Ireland, promoting transnational cooperation, enhancing cancer research activity, and underpinning improved cancer services and better cancer outcomes. • The All-Ireland Cancer Consortium led to: ○ Increased research outputs on the island of Ireland. ○ Enhanced collaboration. ○ Improved citations and enhanced impact. ○ Improved cancer services and increased cancer survival. [ABSTRACT FROM AUTHOR]

Objective: To understand health disparities, it is important to use an intersectional framework that examines unique experiences of oppression faced by particular groups due to their intersecting identities and social positions linked to societal structures. We focus on Black and Latina women and their experiences with 'gendered racism' – unique forms of oppression due to the intersection of race/ethnicity and gender – to foster understanding of disparities between Black and Latina versus White women in sexual and reproductive health outcomes in the U.S. Specifically, we focus on stereotype-related gendered racism (ongoing discrimination and stereotype threat based on historically-rooted stereotypes about Black and Latina women's sexuality and motherhood) and birth control-related mistrust (ongoing mistrust of the government and medical system related to birth control due to historical and current abuses). Design: We analyzed data from two survey studies with adult women in New York (Study 1: paper-and-pencil community data collection, N = 135, Mage = 43.35) and across the U.S. (Study 2: online data collection, N = 343, Mage = 29.49) who were currently pregnant or had at least one child and identified as Black, Latina, or White. Results: Black and Latina women reported greater frequency of and concern over stereotype-related gendered racism (F(3,131) = 17.90, p <.001 Study 1; F(3,339) = 22.23, p <.001 Study 2) and greater birth control-related mistrust (F(3,131) = 7.55, p <.001 Study 1; F(3,339) = 17.32, p <.001 Study 2) than White women did. In turn, stereotype-related gendered racism was positively associated with pregnancy-specific stress (ß =.40, p <.001 Study 1; ß =.33, p <.001 Study 2), and birth control-related mistrust was negatively associated with sexual relationship power (ß = −.19, p =.002 Study 2), which are factors known to contribute to birth outcomes and sexual risk, respectively. Conclusion: Findings suggest that gendered racism may play an important role in existing racial/ethnic disparities in women's sexual and reproductive health outcomes, and interventions addressing gendered racism at multiple levels are needed to promote health equity. [ABSTRACT FROM AUTHOR]

A health paradox exists in the United States. Men have worse health outcomes than women, but national offices exist for promoting women's but not men's health. Two factors that might contribute to this paradox are: underappreciation for the number of health issues that affect men more than women and unawareness that men's health receives less attention than women's health. Therefore, the aim of this article was to summarize the data related to these two factors. First, using mostly government data, an inventory of health issues that are more common in males than females was generated, with prevalence rates listed. Second, results from two new scientometric analyses are presented: (a) number of times "men's health" and "women's health" appeared in titles or abstracts of papers in PubMed from 1970 to 2018; and (b) number of journals currently indexed in MEDLINE that specialize in men's or women's health. The epidemiological data illustrate numerous health issues are more prevalent in men than women, and scientometric data reveal men's health has been given less attention as a distinct field of biomedical research than women's health. This information can help to educate legislators, health officials, journalists, and the general public about the current paradox surrounding men's health in the United States. [ABSTRACT FROM AUTHOR]

Aim: To explore the factors that influence provider pain treatment decision‐making and the receipt of pain management by injured Black patients in the United States. Design: We completed a systematic mixed studies review using a results‐based convergent synthesis design. Data Sources: PubMed, SCOPUS and CINAHL were searched for articles published between 2007–2017 using the search terms 'African American', 'Black American', 'race', 'pain treatment', 'pain management' and 'analgesia'. Twenty studies were included in this review. Review Method: A search of databases and hand‐searching identified peer‐reviewed published papers. The Mixed Method Appraisal Tool was used to appraise the studies. Results: The results indicate that healthcare provider characteristics, racial myths about pain sensitization and assumed criminality all impact provider treatment decision‐making and the receipt of pain treatment by injured Black patients. Impact: This review addresses racial disparities in pain management by focusing on the factors that impact the receipt of pain treatment by injured Black patients. The findings will have an impact on providers who prescribe pain treatment and on the patients they treat. These findings suggest that assumed criminality of certain patients can negatively impact care, which is a type of bias not frequently explored or discussed in health disparities research. This review will help inform further research in healthcare disparities and prompt providers to examine their assumptions about the patients for whom they care. Conclusion: These results provide important areas for further study, including how assumed criminality of certain patients can have a negative impact on care. [ABSTRACT FROM AUTHOR]

The US South Asian population has grown tremendously, and is now over 2.5 million. South Asians often face tremendous cultural, socioeconomic, linguistic and structural obstacles to good health, and face staggering cardiovascular disease (CVD) and cancer risk. Coupled with this is a paucity of detailed data on the population's unique CVD and cancer risk profiles, etiologic mechanisms, and effective interventions to address South Asian health disparities. This data gap compelled an initiative to develop more targeted research and evidence-based practice and policy approaches. The South Asian Health Initiative (SAHI), a community based participatory research partnership between the Immigrant Health and Cancer Disparities Center at Memorial Sloan Kettering Cancer and the South Asian Council for Social Services (SACSS), and the Palo Alto Medical Foundation Research Institute thus partnered to effect the first national South Asian translational research endeavor, South Asian Health: From Research to Practice and Policy, summarized in this paper. [ABSTRACT FROM AUTHOR]

Objective: To review and synthesise research related to the ageing farming workforce influence on the health and sustainability of agricultural communities. Design: Using the PRISMA framework as a guide, the CINHAL and Medline databases were searched. Search 1 used the key search terms of ageing OR aging, farm*, workforce. Search 2 used health, sustainability and 'agricultural OR farm communit*. Search 3 combined Searches 1 and 2. Search 4 followed journal citations to identify other relevant articles. A process of narrative synthesis was applied to the results through the prism of rural social capital that described the current state of knowledge and understanding under four themes. Result: Database searches and searching of citations identified 16 contemporary articles. Seven of the papers were from Australia, and the balance from five other high‐income countries. The four that themes emerged are: vulnerabilities of ageing farmers; economic and climatic drivers; social capital and sustainability; and integrative strategies, that might offer a way forward. Conclusion: Integrating these forces of nature, economics and sociology to address the ageing farming workforce and the associated health and sustainability of agricultural communities remains a major challenge for researchers, governments, the agricultural sector and rural communities. [ABSTRACT FROM AUTHOR]

Importance: Recent discussion has focused on questions related to the repeal and replacement of portions of the Affordable Care Act (ACA). However, issues central to the future of health and health care in the United States transcend the ACA provisions receiving the greatest attention. Initiatives directed to certain strategic and infrastructure priorities are vital to achieve better health at lower cost.Objectives: To review the most salient health challenges and opportunities facing the United States, to identify practical and achievable priorities essential to health progress, and to present policy initiatives critical to the nation's health and fiscal integrity.Evidence Review: Qualitative synthesis of 19 National Academy of Medicine-commissioned white papers, with supplemental review and analysis of publicly available data and published research findings.Findings: The US health system faces major challenges. Health care costs remain high at $3.2 trillion spent annually, of which an estimated 30% is related to waste, inefficiencies, and excessive prices; health disparities are persistent and worsening; and the health and financial burdens of chronic illness and disability are straining families and communities. Concurrently, promising opportunities and knowledge to achieve change exist. Across the 19 discussion papers examined, 8 crosscutting policy directions were identified as vital to the nation's health and fiscal future, including 4 action priorities and 4 essential infrastructure needs. The action priorities-pay for value, empower people, activate communities, and connect care-recurred across the articles as direct and strategic opportunities to advance a more efficient, equitable, and patient- and community-focused health system. The essential infrastructure needs-measure what matters most, modernize skills, accelerate real-world evidence, and advance science-were the most commonly cited foundational elements to ensure progress.Conclusions and Relevance: The action priorities and essential infrastructure needs represent major opportunities to improve health outcomes and increase efficiency and value in the health system. As the new US administration and Congress chart the future of health and health care for the United States, and as health leaders across the country contemplate future directions for their programs and initiatives, their leadership and strategic investment in these priorities will be essential for achieving significant progress. [ABSTRACT FROM AUTHOR]

This paper examines the importance and increasing need for health care practitioners to develop cultural competence in an effort to engage patients in their care to minimize the health disparities that are found in predominately ethnic minority populations. Although Meaningful Use requires data collection related to race and ethnicity, there is no evidence to support that the data is being used to engage patients in a culturally competent way. Lessons learned from the field of education regarding strategies used to develop cultural competence in the teaching profession can be applied in the health care field. This paper argues that cultural competence and patient engagement are clearly linked. [ABSTRACT FROM AUTHOR]

Many teaching hospitals in the United States were founded on philanthropic principles and aimed to aid the urban poor and underserved. However, as times have changed, there has been a divide created between the urban poor and teaching hospitals. There is a plethora of reasons why this is the case. This paper will specifically focus on the histories of ten hospitals and medical schools and the effect that white flight, segregation, elitism, and marginalization had on healthcare institutions all over the United States. It will call for a reexamination of the values of Ivy League and Ivy Plus teaching hospitals and medical schools and for them to take an intentional look into their communities. [ABSTRACT FROM AUTHOR]

Research into the role of place in shaping inequalities in health has focused largely on examining individual and/or localised drivers, often using a context-composition framing. Whilst this body of work has advanced considerably our understanding of the effects of local environments on health, and re-established an awareness of the importance of place for health, it has done so at the expense of marginalising and minimising the influences of macro political and economic structures on both place and health. In this paper, we argue that: (i) we need to scale up our analysis, moving beyond merely analysing local horizontal drivers to take wider, vertical structural factors into account; and (ii) if we are serious about reducing place-based health inequalities, such analysis needs be overtly linked to appropriate policy levers. Drawing on three case studies (the US mortality disadvantage, Scotland's excess mortality, and regional health divides in England and Germany) we outline the theoretical and empirical value of taking a more political economy approach to understanding geographical inequalities in health. We conclude by outlining the implications for future research and for efforts to influence policy from 'scaling up' geographical research into health inequalities. • Health-place research commonly examines focuses individual and/or localised drivers. • Health geography should 'scale up' analysis of health-place relationships. • Research needs to account for wider, vertical and structural factors. • Political economic approaches add value to insight on geographic health inequalities. • Considers the policy implications of taking a political economy approach. [ABSTRACT FROM AUTHOR]

Objectives: Black Caribbeans in the United States have been the victims of major discrimination (e.g. unfairly fired, denied a promotion, denied housing). What is not known is the degree to which they also experience more routine forms of everyday discrimination such as receiving poor restaurant service, being perceived as dishonest, and being followed in stores. This paper investigates the distribution and correlates of everyday discrimination among a national sample of black Caribbeans in the U.S. Design: This analysis used the black Caribbean sub-sample (n = 1,621) of the National Survey of American Life. Demographic and immigration status correlates of ten items from the Everyday Discrimination Scale were investigated: being treated with less courtesy, treated with less respect, receiving poor restaurant service, being perceived as not smart, being perceived as dishonest, being perceived as not as good as others, and being feared, insulted, harassed, or followed in stores. Results: Roughly one out of ten black Caribbeans reported that, on a weekly basis, they were treated with less courtesy and other people acted as if they were better than them, were afraid of them, and as if they were not as smart. Everyday discrimination was more frequent for black Caribbeans who were male, never married, divorced/separated, earned higher incomes, and who were second or third generation immigrants. Black Caribbeans attributed the majority of the discrimination they experienced to their race. Conclusion: To our knowledge, this is the first study to provide an in-depth investigation of everyday discrimination among the black Caribbean population. It provides the frequency, types and correlates of everyday discrimination reported by black Caribbeans in the United States. Understanding the frequency and types of discrimination is important because of the documented negative impacts of everyday discrimination on physical and mental health. [ABSTRACT FROM AUTHOR]

The federal system for allocating donated livers in the United States is often criticized for allowing geographic disparities in access to livers. Critics argue that such disparities are unfair on the grounds that where one lives is morally arbitrary and so should not influence one's access to donated livers. They argue instead that livers should be allocated in accordance with the equal opportunity principle, according to which US residents who are equally sick should have the same opportunity to receive a liver, regardless of where they live. In this paper, we examine a central premise of the argument for the equal opportunity principle, namely, that geographic location is a morally arbitrary basis for allocating livers. We raise some serious doubts regarding the truth of this premise, arguing that under certain conditions, factors closely associated with geographic location are relevant to the allocation of livers, and so that candidates' geographic location is sometimes a morally non-arbitrary basis for allocating livers. Geographic location is morally non-arbitrary, we suggest, since by taking it into account, the UNOS may better fulfill its central goals of facilitating the effective and efficient placement of organs for transplantation and increasing organ donation. [ABSTRACT FROM AUTHOR]

Environmental justice (EJ) means socially and economically disadvantaged communities and citizens are entitled to an equally clean environment and resources to enjoy. EJ communities are mostly located close to polluters such as Superfund sites, coal‐fired power plants and landfills and are more likely to be exposed to higher levels of environmental hazards than the U.S. population on average. It is often a difficult task to identify EJ communities and the environmental hazards in the communities without using specific EJ screening tools. Therefore, the goal of this manuscript is to introduce public health nurses to map‐based EJ screening tools. This will help public health nurses to identify EJ communities and take appropriate actions. Public Health Nurses can also use other relevant web sites, such as the U.S. Environmental Protection Agency (EPA), National Institute of Environmental Health Sciences (NIEHS) and Toxicology Data Network (TOXNET) as resources concerning potential health effects of pollutants. Using the provided tools in this paper, nurses should be able to identify EJ communities and be united to recognize barriers of EJ communities and become promoters for EJ advocacy in practice, leadership and education. [ABSTRACT FROM AUTHOR]

Interventions aiming to improve access to and retention in HIV care are optimized when they are tailored to clients' needs. This paper describes an initiative of interventions implemented by ten demonstration sites using a transnational framework to tailor services for Mexicans and Puerto Ricans living with HIV. Transnationalism describes how immigrants (and their children) exist in their "receiving" place (e.g., continental U.S.) while simultaneously maintaining connections to their country or place of origin (e.g., Mexico). We describe interventions in terms of the strategies used, the theory informing design and the tailoring, and the integration of transnationalism. We argue how applying the transnational framework may improve the quality and effectiveness of services in response to the initiative's overall goal, which is to produce innovative, robust, evidence-informed strategies that go beyond traditional tailoring approaches for HIV interventions with Latino/as populations. [ABSTRACT FROM AUTHOR]

Background: Health-related quality of life constructs has been used to understand the multiple dimensions (i.e., physical health, psychological, environment and social relationships) that affect a person's health status. In order to improve health-related quality of life for young adults, it is important to understand the factors that influence each dimension. The purpose of this paper was to examine the influence of the presence of autism spectrum disorder and physical activity on the multiple domains of health-related quality of life for young adults. Methods: Three-hundred and twenty participants, including young adults with ASD, completed a questionnaire about their physical activity and health-related quality of life. Results: Five multiple regressions revealed that the presence of autism spectrum disorder significantly predicted overall health-related quality of life, the physical health domain, psychological domain, and the environment domain. Additionally, physical activity significantly predicted each domain and overall health-related quality of life regardless of the presence of autism spectrum disorder. Conclusion: Practitioners should recognize the limitations that individuals with autism spectrum disorder may experience regarding their health-related quality of life, and utilize physical activity as a tool for improving health-related quality of life. Implications for Rehabilitation: In order to address an individual's overall health, practitioners must consider multiple dimensions of health-related quality of life. Autism spectrum disorders influence how people perceive multiple dimensions of their health. Physical activity is a tool for improving perceptions of the multiple dimensions of health for individuals with and without autism spectrum disorders. [ABSTRACT FROM AUTHOR]

Abstract Previous research findings across a variety of nations show that affiliation with the conservative party is associated with greater longevity; however, it is thus far unclear what characteristics contribute to this relationship. We examine the political party/mortality relationship in the United States context. The goal of this paper is two-fold: first, we seek to replicate the mortality difference between Republicans and Democrats in two samples, controlling for demographic confounders. Second, we attempt to isolate and test two potential contributors to the relationship between political party affiliation and mortality: (1) socioeconomic status and (2) dispositional traits reflecting a personal responsibility ethos, as described by the Republican party. Graduate and sibling cohorts from the Wisconsin Longitudinal Study were used to estimate mortality risk from 2004 to 2014. In separate Cox proportional hazards models controlling for age and sex, we adjusted first for markers of socioeconomic status (such as wealth and education), then for dispositional traits (such as conscientiousness and active coping), and finally for both socioeconomic status and dispositional traits together. Clogg's method was used to test the statistical significance of attenuation in hazard ratios for each model. In both cohorts, Republicans exhibited lower mortality risk compared to Democrats (Hazard Ratios = 0.79 and 0.73 in graduate and sibling cohorts, respectively [p < 0.05]). This relationship was explained, in part, by socioeconomic status and traits reflecting personal responsibility. Together, socioeconomic factors and dispositional traits account for about 52% (graduates) and 44% (siblings) of Republicans' survival advantage. This study suggests that mortality differences between political parties in the US may be linked to structural and individual determinants of health. These findings highlight the need for better understanding of political party divides in mortality rates. Highlights • Republicans have greater longevity compared to Democrats, adjusting for demographics. • This relationship is partly explained by Republican's higher socioeconomic status. • This relationship is partly explained by Republican's personal responsibility ethos. [ABSTRACT FROM AUTHOR]

Mediation analysis allows the examination of effects of a third variable in the pathway between an exposure and an outcome. The general multiple mediation analysis method, proposed by Yu et al, improves traditional methods (eg, estimation of natural and controlled direct effects) to enable consideration of multiple mediators/confounders simultaneously and the use of linear and nonlinear predictive models for estimating mediation/confounding effects. In this paper, we extend the method for time-to-event outcomes and apply the method to explore the racial disparity in breast cancer survivals. Breast cancer is the most common cancer and the second leading cause of cancer death among women of all races. Despite improvement of survival rates of breast cancer in the US, a significant difference between white and black women remains. Previous studies have found that more advanced and aggressive tumors and less than optimal treatment may explain the lower survival rates for black women as compared to white women. Due to limitations of current analytic methods and the lack of comprehensive data sets, researchers have not been able to differentiate the relative effect each factor contributes to the overall racial disparity. We use the CDC-funded Patterns of Care study to examine the determinants of racial disparities in breast cancer survival using a novel multiple mediation analysis. Using the proposed method, we applied the Cox hazard model and multiple additive regression trees as predictive models and found that all racial disparity in survival among Louisiana breast cancer patients were explained by factors included in the study. [ABSTRACT FROM AUTHOR]

Objectives The Advisory Committee on Immunization Practices (ACIP) and the American College of Obstetricians and Gynecologists (ACOG) recommend that pregnant women receive the Tdap vaccine during every pregnancy. The objectives of this paper are to evaluate disparities in Tdap vaccination among pregnant women in the U.S., and to assess whether race/ethnicity and other characteristics are associated with factors that inform pregnant women's decisions about Tdap vaccination. Methods We conducted a nationwide cross-sectional web-based survey of pregnant women in the U.S. during June-July 2014. The primary outcome was self-reported vaccination status with Tdap during pregnancy, categorized as vaccinated, unvaccinated with intent to be vaccinated during the current pregnancy, and unvaccinated with no intent to be vaccinated during the current pregnancy. Secondary outcomes included factors that influenced women's decisions about vaccination and information needs. We used multivariable logistic regression models to estimate odds ratios for associations between race/ethnicity and the outcomes. Results Among pregnant women who completed the survey, 41% (95% CI 36-45%) reported that they had received Tdap during the current pregnancy. Among those women in the third trimester at the time of survey, 52% (95% CI 43-60%) had received Tdap during the current pregnancy. Hispanic women had higher Tdap vaccination than white women and black women (53%, p < 0.05, compared with 38 and 36%, respectively). In logistic regression models adjusting for maternal age, geographic region, education, and income, Hispanic women were more likely to have been vaccinated with Tdap compared with white women (aOR 2.29, 95% CI 1.20-4.37). Higher income and residing in the western U.S. were also independently associated with Tdap vaccination during pregnancy. Twenty-six percent of surveyed women had not been vaccinated with Tdap yet but intended to receive the vaccine during the current pregnancy; this proportion did not differ significantly by race/ethnicity. The most common factor that influenced women to get vaccinated was a health care provider (HCP) recommendation. The most common reason for not getting vaccinated was a concern about safety of the vaccine. Conclusions This study found that some disparities exist in Tdap vaccination among pregnant women in the U.S., and HCPs have an important role in providing information and recommendations about the maternal Tdap recommendation to pregnant women so they can make informed vaccination decisions. [ABSTRACT FROM AUTHOR]

Objectives: Social determinants of health (SDOH) such as environmental conditions and the nature of social settings have become highly influential in public health policy-making circles worldwide, yet they may not address clearly the role of ethnicity in health processes.Method: Drawing from the National Institutes of Health's disparity research frameworks, this papers illustrates a set of variables that are advanced as having a unique role in disparities experienced by ethnic populations and Latina/os, in particular. The proposed ethnic determinants of health tap environmental, community, and social-cognitive levels of analyses and are defined as variables that have discernable differences-relative to other subpopulations-in their levels or in the way that they impact health.Results: Health process models illustrate that ethnic determinants such as racism, family cultural norms and cultural change, and ethnic identity can, for example, mediate ethnic health disparities or condition (moderate) the levels of impact that SDOH have on health outcomes. Qualitative research analyses also strengthen ethnic and SDOH research by diversifying researchers' a priori assumptions and methodological limitations imposed by quantitative approaches.Conclusions: The expected dividends of the proposed Latina/o ethnic determinants of health research agenda amount to the generation of research that clarifies the role of ethnicity in SDOH and population health processes that are highly influential in ongoing regional and national health agendas. (PsycINFO Database Record (c) 2019 APA, all rights reserved). [ABSTRACT FROM AUTHOR]

Abstract Our paper explores how legal status stratification shapes the health and health care of low-income patients with chronic illnesses in the U.S. healthcare safety net. Drawing on data from over two years of ethnographic fieldwork at urban safety-net clinics, we examine efforts by Complex Care Management (CCM) teams to stabilize patients with uncontrolled chronic illnesses through primary care-integrated support. We show that stratified citizenship and geographic variability correspond to different possibilities for health care. We suggest an approach to immigration as a structural determinant of health that accounts for the complex, stratified, and changing nature of citizenship status. We also highlight how geographical differences and interactions among local, state, and federal policies support the notion that citizenship is stratified across multiple tiers with distinctive possibilities and constraints for health. While county-based health plans at each of the study sites include residents with varying legal status, lack of formal legal status remains a substantial obstacle to care. Many immigrants are unable to take full advantage of primary and specialty care, resulting in unnecessary morbidity and mortality. In some cases, patients have returned to their country of origin to die. While CCM teams provide an impressive level of support to assist immigrant patients in navigating healthcare and immigration bureaucracies, legal and geographic stratification limit their ability to address broader aspects of these patients' social context. Highlights • Immigration status shapes the health of chronically ill U.S. safety net patients. • Local, state, and federal policies differentially stratify legal status and health. • Ethnography illustrates health impacts of stratified legal status. • Complex care management patients lacking legal status face obstacles to care. • Legal and geographic stratification impede immigrant CCM patients' health. [ABSTRACT FROM AUTHOR]

Purpose: Cancer survivors undergo lifelong surveillance regimens that involve repeated diagnostic medical imaging. As many of these diagnostic tests use ionizing radiation, which may modestly increase cancer risks, they may present a source of worry for survivors. The aims of this paper are to describe cancer survivors’ level of worry about medical imaging radiation (MIR) and to identify patterns of MIR worry across subgroups defined by cancer type, other medical and demographic factors, and physician trust.Method: This cross-sectional study used the 2012-2013 Health Information National Trends Survey of US adults conducted by the National Cancer Institute. The analysis focused on the 452 respondents identifying as cancer survivors. Weighted logistic regression analysis was used to evaluate factors associated with higher MIR worry (reporting “some” or “a lot” of MIR worry).Results: Nearly half (42%) of the sample reported higher worry about MIR. Unadjusted and adjusted logistic regressions indicated higher rates of MIR worry among those with lower incomes, those who self-reported poorer health, and those who completed cancer treatment within the past 10 years. Receipt of radiation treatment was associated with higher MIR worry in unadjusted analysis.Conclusion: Worries about MIR are relatively common among cancer survivors. An accurate assessment of the rates and patterns of worry could aid efforts to improve these individuals’ survivorship care and education. [ABSTRACT FROM AUTHOR]

The United States (US) federal government allocates hundreds of billions of dollars to provide resources to Americans with disabilities, older adults, and the poor. The American Community Survey (ACS) influences the distribution of those resources. The specific aim of the project is to introduce health researchers to Public Use Microdata Sample file from 2009 to 2011. The overall goal of our paper is to promote the use of ACS data relevant to disability status. This study provides prevalence estimates of three disability related items for the population at or over the age of 15 years who reside in one of the continental states. When population weights are applied to the 7,198,221 individuals in the sample under analysis, they are said to represent 239,641,088 of their counterparts in the US population. Detailed tabulations by state (provided as Microsoft Excel® spreadsheets in ACS output) clearly show disability prevalence varies from state-to-state. Because analyses of the ACS data have the ability to influence resources aiding individuals with physical mobility challenges, its use should be promoted. Particular attention should be given to monetary allocations which will improve accessibility of the existing built environment for the individuals with mobility impairment. [ABSTRACT FROM AUTHOR]

In this paper, we present novel evidence of the extent to which intergenerational mobility is generalized or specific across domains of human and health capital. That is, do children who experience greater mobility in one domain (e.g., income) also experience mobility in other domains (education, health status, health behaviors, crime). Using rich data in Add Health, we find evidence against generalized mobility—families that are more mobile in one domain are not more mobile in others. We then ask a place-based version of this question, motivated by Chetty et al. (2014)'s work showing high levels of geographically-based income mobility in the US. The school-based sampling combined with parent-child links across many outcome domains of the Add Health allows us to use a common dataset between the two analyses. Like our individual-based results, we find limited evidence of generalized mobility by place—indeed, most estimates suggest close-to-zero correlations between many of the ten domains we explore. • Theoretically, intergenerational mobility could be generalized or specific. • Empirically, we find more evidence of specific mobility. • People and places with high income mobility may not have high health mobility. [ABSTRACT FROM AUTHOR]

Objectives: To examine: (1) what elements of patient-centered medical homes (PCMHs) are typically provided to low-income populations, (2) whether PCMHs improve health behaviors, experiences, and outcomes for low-income groups.Data Sources/study Setting: Existing literature on PCMH utilization among health care organizations serving low-income populations.Study Design: Systematic review and meta-analysis.Data Collection/extraction Methods: We obtained papers through existing systematic and literature reviews and via PubMed, Web of Science, and the TRIP databases, which examined PCMHs serving low-income populations. A total of 434 studies were reviewed. Thirty-three articles met eligibility criteria.Principal Findings: Patient-centered medical home interventions usually were composed of five of the six recommended components. Overall positive effect of PCMH interventions was d = 0.247 (range -0.965 to 1.42). PCMH patients had better clinical outcomes (d = 0.395), higher adherence (0.392), and lower utilization of emergency rooms (d = -0.248), but there were apparent limitations in study quality.Conclusions: Evidence shows that the PCMH model can increase health outcomes among low-income populations. However, limitations to quality include no assessment for confounding variables. Implications are discussed. [ABSTRACT FROM AUTHOR]

Given the widening gap in health disparities among communities of color, it is critical that we develop a workforce that is equipped to address the needs of a rapidly growing diverse population. Special emphasis is needed in the development of a multi-disciplinary health care workforce that is trained in engaging communities and providing services that are culturally and linguistically appropriate. The goal of this article is to describe the results of a transdisciplinary participatory action course and project aimed at enhancing students' understanding of health disparities and community engagement. Students were involved in preliminary data collection project aimed at scaling up the Kin KeeperSM Cancer Prevention Model. Sixteen undergraduate students self-selected to participate in the course. Students completed key informant interviews to inform the project. The overall outcome of the project was rich data that informed the next step in the translation process. This paper will describe the students' participation in the project and the outcomes of their data. [ABSTRACT FROM AUTHOR]

Despite an abundant literature on social support and health, relatively less is known about how support and its impact on physical health vary within the Black population. Using the National Survey of American Life (NSAL), this paper examines which sources and types of support are associated with physical health among African Americans, U.S.-born Caribbean Blacks and foreign-born Caribbean Blacks. The results showed that for U.S.-born Caribbean Blacks, being married was especially beneficial to health. Closeness to family was associated with better health while negative interactions with family members was associated with worse health for African Americans and foreign-born Caribbean Blacks. Different sources of instrumental support affected all three groups. Overall, the findings reveal that, among Black Americans, the association between social support and physical health is contingent upon ethnicity, nativity, and the ways in which social support and health are operationalized. [ABSTRACT FROM AUTHOR]

Whites in the USA are the dominant racial group, with greater than average access to most material and social rewards. Yet, while whites have better outcomes than other racial groups on some health indicators, whites paradoxically compare poorly on other measures. Further, whites in the USA also rank poorly in international health comparisons. In this paper, we present a framework that combines the concept of whiteness—a system that socially, economically, and ideologically benefits European descendants and disadvantages people in other groups—with research from a variety of fields in order to comprehensively model the social factors that influence whites' health. The framework we present describes how whiteness and capitalism in the USA shape societal conditions, individual social characteristics and experiences, and psychosocial responses to circumstances to influence health outcomes. We detail specific examples of how social policies supported by whiteness, the narratives of whiteness, and the privileges of whiteness may positively and negatively affect whites' health. In doing so, we suggest several areas for future research that can expand our understanding of how social factors affect health and can contribute to the patterns and paradoxes of whites' health. By expanding research to include theoretically-grounded analyses of the dominant group's health, we can achieve a more complete picture of how systems of racial inequity affect health. [ABSTRACT FROM AUTHOR]

There has been a great deal of state-level legislative activity focused on immigration and immigrants over the past decade in the United States. Some policies aim to improve access to education, transportation, benefits, and additional services while others constrain such access. From a social determinants of health perspective, social and economic policies are intrinsically health policies, but research on the relationship between state-level immigration-related policies and Latino health remains scarce. This paper summarizes the existing evidence about the range of state-level immigration policies that affect Latino health, indicates conceptually plausible but under-explored relationships between policy domains and Latino health, traces the mechanisms through which immigration policies might shape Latino health, and points to key areas for future research. We examined peer-reviewed publications from 1986 to 2016 and assessed 838 based on inclusion criteria; 40 were included for final review. These 40 articles identified four pathways through which state-level immigration policies may influence Latino health: through stress related to structural racism; by affecting access to beneficial social institutions, particularly education; by affecting access to healthcare and related services; and through constraining access to material conditions such as food, wages, working conditions, and housing. Our review demonstrates that the field of immigration policy and health is currently dominated by a “one-policy, one-level, one-outcome” approach. We argue that pursuing multi-sectoral, multi-level, and multi-outcome research will strengthen and advance the existing evidence base on immigration policy and Latino health. [ABSTRACT FROM AUTHOR]

Purpose Although incarceration may have life-long negative health effects, little is known about associations between child incarceration and subsequent adult health outcomes. The paper aims to discuss this issue. Design/methodology/approach The authors analyzed data from 14,689 adult participants in the National Longitudinal Study of Adolescent to Adult Health (Add Health) to compare adult health outcomes among those first incarcerated between 7 and 13 years of age (child incarceration); first incarcerated at>or=14 years of age; and never incarcerated. Findings Compared to the other two groups, those with a history of child incarceration were disproportionately black or Hispanic, male, and from lower socio-economic strata. Additionally, individuals incarcerated as children had worse adult health outcomes, including general health, functional limitations (climbing stairs), depressive symptoms, and suicidality, than those first incarcerated at older ages or never incarcerated. Research limitations/implications Despite the limitations of the secondary database analysis, these findings suggest that incarcerated children are an especially medically vulnerable population. Practical implications Programs and policies that address these medically vulnerable children's health needs through comprehensive health and social services in place of, during, and/or after incarceration are needed. Social implications Meeting these unmet health and social service needs offers an important opportunity to achieve necessary health care and justice reform for children. Originality/value No prior studies have examined the longitudinal relationship between child incarceration and adult health outcomes. [ABSTRACT FROM AUTHOR]

Purpose: The main purpose of this paper is to examine geographic variation in unmet need for mental health care among racially/ethnically diverse adults with psychiatric disorders in the US.Methods: Drawn from the Collaborative Psychiatric Epidemiology Surveys (CPES; 2001-2003), adults with any past year psychiatric disorder diagnosis (n = 3211) from diverse racial/ethnic backgrounds were selected for analyses. Using weighted data, descriptive analyses and logistic regression analyses were conducted.Results: Two-thirds of the total sample had unmet mental health care need, which differed significantly by race/ethnicity (p < .001). Logistic regression analyses show regional variation of the effect of race/ethnicity in unmet need: after adjusting for covariates, Latinos in the South, Blacks and Latinos in the Midwest, and Latinos and Asians in the West had higher unmet need than non-Hispanic Whites, whereas no significant racial/ethnic effects were found in the Northeast.Conclusions: Findings suggest that geographic region plays an important role in the sufficient use of mental health services among racial/ethnic minorities. Further research should elucidate reasons for geographic disparities in mental health care among racial/ethnic minority adults to reduce disparities. [ABSTRACT FROM AUTHOR]