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In the United Kingdom, people with non-white ethnicities are more likely to report being in worse health conditions and have poorer experiences of healthcare services than white counterparts. The voices of those of Black ethnicities are often merged in literature among other non-white ethnicities. This literature review aims to analyse studies that investigate Black participant experiences of primary care in the UK. We conducted a systematic literature review searching Medline, Web of Science, EMBASE, SCOPUS, Social Policy and Practice, CINAHL plus, Psych INFO and Global Health with specific search terms for appropriate studies. No publish date limit was applied. 40 papers (39 articles and 1 thesis) were deemed eligible for inclusion in the review. A number of major themes emerged. Patient expectations of healthcare and the health seeking behaviour impacted their interactions with health systems in the UK. Both language and finances emerged as barriers through which some Black participants interacted with primary care services. (Mis)trust of clinicians and the health system was a common theme that often negatively impacted views of UK primary care services. The social context of the primary care service and instances of a cultural disconnect also impacted views of primary care services. Some papers detail patients recognising differential treatment based on ethnicity. The review included the voices of primary care professionals where descriptions of Black patients were overwhelmingly negative. Views and experiences of Black groups may be radically different to other ethnic minorities and thus, should be teased out of broader umbrella terms like Black and Asian Minority Ethnic (BAME) and Black Minority Ethnic (BME). To address ethnicity-based health inequalities, culturally sensitive interventions that engage with the impacted community including co-designed interventions should be considered while acknowledging the implications of being racialised as Black in the UK. [ABSTRACT FROM AUTHOR]

In this paper, as Black scholars, we address ways that interventions designed to promote equity in health can create pathways for coupling decolonization with antiracism by drawing on the intersection of the health of Africans and African Americans. To frame this intersection, we offer the Public Health Critical Race Praxis (PHCRP) and the PEN-3 Cultural Model as antiracism and decolonization tools that can jointly advance research on colonization and racism globally. We argue that racism is a global reality; PHCRP, an antiracism framework, and PEN-3, a decolonizing framework, can guide interventions to promote equity for Africans and African Americans. [ABSTRACT FROM AUTHOR]

Diabetes mellitus (DM), a significant public health problem across the nations, is among the top ten leading causes of death. More than 370 million indigenous people (referred to as tribal people in India) are spread across 90 countries. India has the largest tribal people of 104 million. Tribal populations are not exceptional to the threat of type 2 DM (T2DM) and other non-communicable diseases, and hence, public health programmes are addressing this problem. This paper reports the systematic review and meta-analysis of the literature on the prevalence of T2DM. We conducted a systematic review and meta-analysis of the literature to understand the prevalence of T2DM among the tribal populations of India, following the guidelines of the PRISMA Statement for Reporting Systematic Reviews and Meta-Analysis. The gender-wise prevalence was recalculated by extracting the data wherever possible. Forest plots were depicted based on the prevalence, and other analyses were performed. On initial searches from three databases, 5422 citations were identified, and ultimately 27 studies were included in the review. These studies were undertaken amongst different tribes in different parts of India. The pooled prevalence of T2DM among men, women and combined were 6.04% (95% confidence interval (CI): 5.55% to 6.57%), 6.48% (95% CI: 6.01% to 6.99%) and 4.94% (95% CI: 4.72% to 5.17%), respectively. Considerable heterogeneity was found among these studies. This systematic review provides an overview of the prevalence of T2DM among the Indian tribal population. The pooled overall prevalence is slightly lower than the general population. This situation is worrisome as the epidemic of T2DM will affect the poor tribal communities, who can least afford to bear the health care costs. Hence, the public health care services must be strengthened in all tribal areas. This review further warrants establishing surveillance of T2DM in tribal areas. [ABSTRACT FROM AUTHOR]

Although people with a migration background (MB) have more unmet mental health needs than the general population, patients with a MB are still underrepresented in mental health care services. Provider bias towards these patients has been evidenced repeatedly but its driving factors remain elusive. We assessed the moderating effect of the individual (e.g. age and ethnicity), interpersonal (e.g. healthcare provider trust), and organisational (e.g. perceived workload) factors on general practitioners (GPs) differential decision-making regarding diagnosis, treatment, and referral for a depressed patient with or without a MB. An experimental study was carried out in which GPs were shown one of two video vignettes featuring adult male depressed patients, one with a MB and the other without. Belgian GPs (n = 797, response rate was 13%) had to decide on their diagnosis, treatment, and referral. Analysis of variance and logistic regression were used to analyse the effect of a MB, adding interaction terms for the explanatory variables. Overall, we found that there were ethnic differences in GPs' decisions regarding diagnosis and treatment recommendations. GPs perceived the symptoms of the patient with a MB as less severe (F = 7.68, p < 0.01) and demonstrated a reduced likelihood to prescribe a combination of medical and non-medical treatments (F = 11.55, p < 0.001). Those differences increased in accordance with the GP's age and perceived workload; at an interpersonal level, we found that differences increased when the GP thought the patient was exaggerating his distress. This paper showed that lower levels of trust among GPs' towards their migrant patients and high GP workloads contribute to an increased ethnic bias in medical decision-making. This may perpetuate ethnic inequalities in mental health care. Future researchers should develop an intervention to decrease the ethnic inequities in mental health care by addressing GPs' trust in their migrant and ethnic minority patients. [ABSTRACT FROM AUTHOR]

This paper synthesises critique from Māori patients with Bipolar Disorder (BD) and their whānau to identify barriers and propose changes to improve the structure and function of the New Zealand mental health system. A qualitative Kaupapa Māori Research methodology was used. Twenty-four semi-structured interviews were completed with Māori patients with BD and members of their whānau. Structural, descriptive and pattern coding was completed using an adapted cultural competence framework to organise and analyse the data. Three key themes identified the impact of structural features of the New Zealand mental health system on health equity for Māori with BD. Themes involved the accessibility, delivery and scope of the current health system, and described how structural features influenced the quality, utility and availability of BD services for Māori patients and whānau. Structural barriers in the existing design, and potential changes to improve the accessibility, delivery and scope of BD services for Māori, were proposed including a redesign of operational, environmental, staffing, and navigation points (information, transition, fatigue) to better meet the needs of Māori with BD. A commitment to equity when implementing structural change is needed, including ongoing evaluation and refinement. This paper provides specific recommendations that should be considered in health service redesign to ensure the New Zealand mental health system meets the needs of Māori patients with BD and their whānau. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic has exacerbated health inequalities worldwide, having a disproportionately harsh impact on unprivileged populations such as migrants and refugees. These populations are often more exposed to the virus, but less protected, while at the same time being at higher risk of suffering from poor living and working conditions, limited access to healthcare, and discrimination by the host society, all of which is challenging to their mental health. Empirical evidence on how the COVID-19 pandemic is affecting migrants and refugees is required to design effective actions aimed at ensuring health equity. Therefore, this paper aims to analyse how the pandemic has impacted the psychological well-being of migrants and refugees living in Spain. This study was carried out within the framework of the ApartTogether study sponsored by the World Health Organization. Data collection was carried out during March-November 2020, through an online survey completed by 241 participants (age: M = 37 years; 129 women). The results indicate that 78.7% of participants had suffered a decrease in their psychological well-being since the onset of the COVID-19 pandemic, with number of difficulties and worries experienced being the best individual predictors of this outcome. Enjoying social connections and perceiving positive treatment from the host society were positively associated with psychological well-being at a relational and community level, respectively. Based on these findings, we outline priority areas of psychosocial interventions aimed at guaranteeing the mental health of migrants and refugees in the face of the pandemic in Spain. [ABSTRACT FROM AUTHOR]

Objective: The Buffalo, New York region is one of the leading refugee resettlement areas in the country, settling 94% of African refugees in 2014. However, little is known about their health beliefs, particularly regarding sexual health and HIV. This study's purpose was to describe HIV attitudes and beliefs in a sample of African refugee women, a population that is increasingly present in the country, yet seldom represented in the literature. Design: A convenience sample of 101 African refugee women were recruited via snowball technique in Buffalo, New York. Data were collected from July 2017–July 2018, via paper-pen survey, and were analyzed using descriptive statistics. Results: Participants had low levels of education, but high HIV screening rates. Inconsistencies between knowledge of HIV acquisition and behaviors relating to HIV positive individuals may indicate HIV stigma among the population. Conclusion: Novel strategies geared towards educational levels and societal norms to educate African refugee women about HIV are urgently needed. [ABSTRACT FROM AUTHOR]

Objective: To evaluate beliefs, and attitudes about health of refugees with chronic conditions such as diabetes mellitus type 2, hypertension, chronic obstructive pulmonary disease, and posttraumatic stress disorder and the consequent effects on self-care in comparison to resident populations. Design: A systematic review methodology was used. PubMed, Embase, PsycINFO and CINAHL databases were searched for relevant articles. The main terms analysed were health beliefs, chronic conditions and refugee populations. From 844 articles, 45 were retained for further assessment, and finally 5 met the inclusion criteria. Results: Differences in the health beliefs, attitudes and self-care management approaches of refugees compared to resident populations were identified in two studies. The remaining three papers did not make comparisons between the refugees and the resident population, nor did they specifically explore the refugees' health beliefs. Of the five studies, three were carried out in Sweden and two in the US. Refugees who have poorer mental and physical health as well as higher prevalence of chronic diseases than the populations among which they resettle seem to lack the knowledge about their illness, symptoms and self-management and thus are less able to control their chronic conditions. Conclusion: The findings highlighted the deficiency in the literature of studies which examine health beliefs and attitudes of minority groups such as refugees who have chronic conditions. The findings also gave insight to the need for a distinctive understanding of refugee health and the management of chronic conditions in comparison to other non-refugee migrant groups. Further research is needed to fully understand the differences between refugees and local populations in terms health beliefs, chronic disease and self-management. [ABSTRACT FROM AUTHOR]

Introduction: Domestic violence and abuse has been recognised as an international public health problem. However, the pervasiveness of the problem is unknown due in part to underreporting, especially among women from ethnic minority populations. In relation to this group, this review seeks to explore: (1) the barriers to disclosure; (2) the facilitators of help-seeking; and (3) self-perceived impacts of domestic violence. Design: We systematically identified published qualitative studies conducted among women from ethnic minority populations in the UK. Data analysis was completed using thematic analysis approach. Result: 562 papers were identified and eight papers from four studies conducted among women from ethnic minority populations in the UK met the inclusion criteria and were reviewed. Barriers to disclosure include: Immigration status, community influences, problems with language and interpretation, and unsupportive attitudes of staff within mainstream services. Facilitators of help-seeking were: escalation of abuse and safety of children. Self-perceived impact of abuse includes: shame, denial, loss of identity and lack of choice. Conclusion: There is an on-going need for staff from domestic violence services to be aware of the complexities within which women from ethnic minority populations experience domestic violence and abuse. [ABSTRACT FROM AUTHOR]

Stigma of mental illness contributes to silence, denial and delayed help seeking. Existing stigma reduction strategies seldom consider gender and cultural contexts. The Strengths in Unity study was a multi-site Canadian study that engaged Asian men in three stigma reduction interventions (ACT, CEE, psychoeducation) and mobilized them as Community Mental Health Ambassadors. Our participants included both men living with or affected by mental illness (LWA) as well as community leaders (CL). This paper will: (1) describe the baseline characteristics of the Toronto participants including their sociodemographic information, mental illness stigma (CAMI and ISMI), attitudes towards social change (SJS), and intervention-related process variables (AAQ-II, VLQ, FMI, Empowerment); (2) compare the differences among these variables between LWA and CL; and (3) explore factors that may correlate with socio-economic status and mental health stigma. A total of 609 Asian men were recruited in Toronto, Canada. Both CL and LWA had similar scores on measures of external and internalized stigma and social change attitudes, except that LWA had more positive views about the acceptance and integration of those with mental illness into the community on the CAMI, while CL had a higher level of perceived behavioral control on the SJS. Group differences were also observed between LWA and CL in some process-related variables. Exploratory analysis suggests that younger and more educated participants had lower stigma. Our findings underscore the importance of engaging both community leaders and people with lived experience as mental health advocates to address stigma. [ABSTRACT FROM AUTHOR]

Objectives: This paper explores the role of immigrant-serving agencies in facilitating access to dementia services and supports provided by dementia service agencies (particularly the health authority and local chapters of the Alzheimer Society) through their propensity to develop trusting relationships between staff and clients. Design: Our research is a qualitative case study of Punjabi and Korean speakers living in the Lower Mainland of BC, Canada. Data are drawn from interviews with 15 dyads of persons with dementia and their family caregivers (10 Punjabi, 5 Korean), six focus groups (one focus group with each of 8–10 older men, older women, and mixed gender working age adults in each community). We also interviewed 20 managerial and frontline staff of dementia service agencies, i.e. the health authority and the local Alzheimer Society (n = 11) and two immigrant-serving agencies (n = 9), each dedicated to either Punjabi or Korean-speaking clients. We adopted the Candidacy framework for understanding access to dementia services and supports and the concept of trust as guiding precepts in this study. Results: Families of persons with dementia are pivotal to identification of a problem requiring professional help, navigation to appropriate services and acceptance of services offered. However, trust in family members should not be taken for granted, since family dynamics are complex. Alternative sources of trusted support are therefore needed. Immigrant-serving agencies are more often instrumental in establishing trusted relationships between their staff and clients, but they often lack detailed knowledge about heath conditions, their treatment and management, and they lack power to implement statutory care. Conclusions: Partnerships between mainstream mental health/dementia services and the community sector have proven successful in increasing the accessibility of specialized resources, while maximizing their combined trustworthiness, accessibility and effectiveness. Such partnerships should become fundamental components of health service strategy and provision for vulnerable and underserved immigrant older adults. [ABSTRACT FROM AUTHOR]

Objectives: Differences in health among migrant groups are related to the length of stay in host countries. We examined the health of people reporting Caribbean ethnic origins within and outside of Canada; and the possible associations between length of stay and poorer physical and mental health outcomes. Method: Analyses were conducted on population data collected in Canada (2000/2001, 2003, 2005), Jamaica (2005) and Guyana (2005). Physician-diagnosed and self-rated health measures were used to assess physical and mental health statuses. Results: Rates of chronic conditions were generally higher among people reporting Caribbean ethnic origins in Canada compared to those living in the Caribbean region. Self-rated fair or poor general health rates, however, were higher among participants in the Caribbean region. Higher rates of any mood disorders were also found among Caribbean region participants in comparison to those in Canada. Logistic regression analyses revealed that new Caribbean immigrants (less than 10 years since immigration) in Canada had better physical health than those who were more established. Those who immigrated more than 20 years ago showed consistently better health conditions than those who had immigrated between 11 and 20 years ago. This healthy immigration effect, however, was not present for all chronic conditions among all Caribbean origin migrant groups. Moreover, mood disorders were highest among new immigrants compared to older immigrants. Conclusions: When and where ethnic Caribbeans migrate to and emigrate from matters in health statuses. These results have implications for policies related to health and well-being in support of ethnic Caribbean origin individuals who relocate to Canada. The paper concludes with suggestions for future studies regarding the health of ethnic origin Caribbeans living within and outside their regions of birth. [ABSTRACT FROM AUTHOR]

Background and Objectives: Compared with White patients, Black and American Indian/Alaskan Native (AI/AN) patients experience higher rates of kidney cancer incidence, and Black, AI/AN, and Hispanic patients face later stages of disease at diagnosis, poorer survival rates, and greater risk of mortality. Despite the importance that appropriate treatment has in ensuring positive outcomes, little is known about the association between race and ethnicity and receipt of treatment for kidney cancer. Accordingly, the aim of this study was to explore differences in receipt of treatment and patterns of refusal of recommended treatment by race and ethnicity. Design: 96,745 patients ages 45-84 with kidney cancer were identified in the Surveillance, Epidemiology, and End Results (SEER) program between 2007 and 2014. Logistic regression models were used to examine the association of race and ethnicity with treatment and with patient refusal of recommended treatment. Outcomes of interest were (1) receiving any surgical procedure, and (2) refusing recommended surgery. Results: Relative to White patients, Black and AI/AN patients had lower odds of undergoing any surgical procedure (OR = 0.76; 95% CI: 0.72-0.81; p < 0.001, and OR = 0.92; 95% CI: 0.76-1.10; p = 0.36, respectively) after adjusting for gender, age, insurance status, stage at diagnosis, unemployment status, education status, and income as additive effects. Black and AI/AN patients also had higher odds of refusing recommended surgery (OR = 1.93; 95% CI: 1.56-2.39; p <0.001, and OR = 1.99; 95% CI: 1.05-3.76; p = 0.035, respectively). Hispanic patients had slightly higher odds of undergoing any surgical procedure (OR = 1.10; 95% CI: 1.04-1.17; p = 0.001) and lower odds of refusal (OR = 0.67; 95% CI: 0.50-0.90; p = 0.007, respectively). Conclusions: Compared with White patients, Black patients were less likely to receive potentially life-saving surgery, and both Black and AI/AN patients were more likely to refuse recommended surgery. [ABSTRACT FROM AUTHOR]

Background: Australia's overseas-born population continues to grow. This population is disproportionately affected by chronic, non-communicable diseases. Physical activity is the cornerstone of all chronic disease management. Engaging people from culturally and linguistically diverse (CALD) backgrounds in physical activity is an important public health objective. The purpose of this scoping review was to examine the factors that shape physical activity participation among people from CALD backgrounds in Australia. Methods: This scoping review followed Arksey and O'Malley's framework. Medline, Embase and CINAHL were searched with key words relating to 'physical activity', 'CALD' and 'Australia' in July 2021 and again in February 2022 for qualitative studies published in English since 2000. Exclusion criteria were: participants < 18 years old, studies specifically focusing on populations with health issues, pregnant or postpartum states. Methodological quality of included studies was evaluated using the Critical Appraisal Skills Programme with the purpose of informing future research. Data extracted from each study were analysed thematically and results were interpreted using Acculturation theory. Results: Of the 1130 studies, 17 met the inclusion criteria. Findings from each study were captured in three themes: Perceptions of physical activity; Acceptability and Appropriateness; and Access. Following migration, a decrease in physical activity, especially leisure-time activity, was reported. Common factors influencing physical activity engagement included perceptions of physical activity and wellbeing; language, financial and environmental barriers; as well as social, cultural, and religious considerations. Conclusion: This review identified several factors which may interact and contribute to the decline in self-reported physical activity upon migration. Findings from this review may be used to inform future health promotion initiatives targeting people from CALD backgrounds. Future research may benefit from devising a shared definition of physical activity and studying different CALD communities over time. [ABSTRACT FROM AUTHOR]

Objective: Women living with the human immunodeficiency virus (HIV) are less of a focus in the HIV literature, which tends to focus on the HIV experiences of men who have sex with men (MSMs). Hence, we conducted a qualitative study that examined: (a) the type of stigma and discrimination that women living with HIV experience related to their HIV status, (b) the source of this stigma and discrimination, (c) their responses related to this stigma and discrimination, and (d) the ways in which women living with HIV cope with these experiences of stigma and discrimination. Design: Participants consisted of 14 self-identified women living with HIV that were recruited at a community organization in the Southern United States that provides services to individuals living with HIV. The participants ranged in age from 27 to 65 (M = 47.92, SD =13.08). The sample primarily identified as Black (N = 12), followed by White (N =1) and Multiracial (N =1). Most women were cisgender (N =13) with one woman identifying as transgender (N = 1). Results: Fourteen women participated in one of two focus groups (seven in each focus group), which were audio recorded and transcribed. We identified 24 categories across five domains (Stigma and Discrimination, Source of Stigma and Discrimination, Response to Stigma and Discrimination, Coping with Stigma and Discrimination, and Support). Conclusions: This study identified that women living with HIV experience stigma and discrimination in a multitude of ways from different sources. Moreover, women with HIV responded to and coped in negative and positive ways. Multidimensional approaches including personal and community education may help alleviate the stigma and discrimination faced by women living with HIV. [ABSTRACT FROM AUTHOR]

Objectives: Studies on immigration have shown that cultural changes can positively or negatively affect psychological, behavioral, and physical outcomes when different cultures settle into a new host community or country. The majority of research done in the United States and North America has focused on these changes for larger immigrant and minority groups such as Hispanics/Latinos and Asians. However, in the United States, there is a sub-group of immigrants that is largely understudied, resulting in misunderstood data on mental and physical health: Arab Americans. This study assesses mental health disparities between immigrant and non-immigrant populations, before and after COVID-19 restrictions, in Dearborn, MI, a city that has one of the largest concentrations of Arab immigrants in the nation. Design: Using an online survey instrument, this study assessed mental health disparities before and since COVID-19 restrictions, and stressors induced since the pandemic for immigrants and non-immigrants in Dearborn, MI. Results: Through inferential statistics and logistic regressions, results indicate that immigrants are less likely to have healthcare coverage, have lower annual incomes, lower educational attainment, and experience continuously higher mental health issues before the pandemic than non-immigrants faced during the pandemic. Conclusion: This study reinforces that the Arab-American immigrant population is a disadvantaged sub-group and faces considerable stress and mental health concerns as an acculturating population. This stress gets exacerbated when a worldwide event such as the COVID-19 pandemic strikes. Oversight of this population's health issues results in the inability to receive appropriate social services and healthcare that is vital to address this community's concerns. [ABSTRACT FROM AUTHOR]

Rates of HPV infection and HPV-related cancers are elevated in the Black population of the US. Efforts to promote HPV vaccination and cervical cancer screening are important to reducing the cancer burden among Black populations. The purpose of this qualitative descriptive study guided by social ecological model (SEM) was to describe from the perspective of key informants, the challenges and opportunities for HPV vaccination and cervical cancer screening promotion among Black adults. Twenty-three key informants participated in individual interviews over zoom video conferencing. The sessions were audio-recorded, transcribed verbatim, and checked for accuracy prior to data analysis. Two qualitatively trained researchers analyzed the data using content analysis. Participants were aged 50 ± 4.1 years, 12 were females, and 18 identified as Black. Participants included health care providers, teachers, church and community leaders. Themes included HPV and cancer literacy, influence of religion, health care provider recommendations, social and cultural influences, accessibility and availability of services, economic constraints, limited community resources, and HPV vaccine mandates. SEM factors contribute to low HPV vaccine uptake and cervical cancer screening and these factors need to be addressed. Interventions addressing SEM factors peculiar to Black populations may promote HPV vaccination and cancer screening in this population. [ABSTRACT FROM AUTHOR]

Objective: Cases of discrimination and hate crimes against Asian Americans have surged ever since the beginning of the COVID-19 pandemic, with deleterious effects. This scoping review synthesizes the literature on how pandemic-related discrimination is associated with the health of Asian Americans. Design: First, application search terms were entered into selected databases. Next, using a set of inclusion criteria, the articles were screened and assessed for eligibility. Data from the selected articles were extracted and summarized to answer the research questions. Results: Thirty-five studies were included. Almost all the studies examined psychological well-being. The remaining studies examined physical and workplace well-being. All the studies found that discrimination was associated with poorer health outcomes. Conclusion: Further research is needed to address the gaps in knowledge about how pandemic-related discrimination is associated with various domains of health among Asian Americans. [ABSTRACT FROM AUTHOR]

Ethnic minority and immigrant workers comprise a sizable proportion of the low-wage workforce. They are surprisingly understudied despite their workplace prominence. Factors such as workplace policies, structures, worker-related characteristics, and research designs preclude their comprehensive research participation when studies are conducted in work settings. Consequently, ethnic minority and immigrant workers continue to be under-represented in inquiry and simultaneously over-represented with compromising occupational health risks. The purpose of this paper is to provide strategies to promote the inclusion of ethnic minority and immigrant workers in occupational health research. Using three different research-based examples, we illustrate the benefit of conducting occupational health research in non-workplace settings as a way to ensure research representation of ethnic minority and immigrant workers. [ABSTRACT FROM AUTHOR]

Objectives: To understand how various decision-making dynamics interact to shape the risk-management choices of African American women at high-risk of breast cancer, and to explore whether African American and White women have differential access to the information and interactions that promote proactive, confident risk-management behavior. Design: This paper draws on 50 original in-depth, semi-structured interviews with African American and White women at elevated risk of breast cancer. We used inductive grounded-theory methodology to explore the processes by which women make risk-management decisions and to compare those processes between racial groups. Moving backward from women's decisions about whether or not to engage in specific risk-management behaviors, we explored the patterns that underlie behavioral decisions. Results: We find that decisions to engage in risk-management behavior rest on three accumulated layers of information. The layer most proximal to making risk-management decisions involves specific information about risk-management options; the middle layer involves general information about managing breast cancer risk; and the foundational layer involves personal perceptions of breast cancer risk and prevention. African American and White women experience distinct dynamics at each of these levels, and these differences may help explain racial differences in risk-management behavior. Compared to their White counterparts, African American women faced additional burdens at every step along the risk-management journey. Conclusion: These findings suggest that information gathering is more complex than has previously been addressed, that information access and provider access are closely related, and that African American women may be systematically disadvantaged with respect to information-generating experiences. Preventing cancer morbidity and mortality requires that all high-risk women have access to the layers of information necessary to engage in cancer screenings and preventive interventions. These results exemplify the ways that structural, social, and interpersonal inequalities combine to influence risk-management choices. [ABSTRACT FROM AUTHOR]

Studies suggest Black Americans have a lower prevalence of depression than White Americans despite greater exposure to risk factors for depression across the life course. We examined whether this paradox exists among students in higher education, and whether the paradox may be partly explained by racial differences in reports of impairment from depression, which is a required criterion for clinical diagnosis. We analyzed data from the Healthy Minds Study (2020–2021), restricting the sample to young adults (18–29) who identified as either Black or White. Using modified Poisson regression models to estimate risk ratios, we examined associations between race and depression impairment across five levels of depression severity, adjusting for age and gender. Approximately 23% of Black students reported depression impairment, which is significantly lower than the 28% of White students who reported depression impairment. For all students, greater depression severity was associated with greater probability of impairment; however, the relationship was more modest among Black students. At severe, moderately severe, and moderate depression levels, Black students had lower risk of depression impairment compared with White students. White students may be more likely than Black students to report significant impairment at high levels of depression. These findings open the possibility that racial differences in the impairment criterion of clinical diagnoses may explain some the racial depression paradox. [ABSTRACT FROM AUTHOR]

U.S. Latinx/Hispanic families experience higher food insecurity rates than the general population. Few studies have examined factors that contribute to food insecurity among the Latinx/Hispanic population, and none have done so using a national dataset. Drawing from the ecological theory of human development framework, this study explores the following research questions: What micro-, meso-, and exo/macro-system factors are related to adult and child food insecurity? How do these factors compare for Latinx/Hispanic, Black, and White mothers? This study uses data from the Fragile Families and Child Wellbeing Study (FFCWS), a national survey that follows a birth cohort of mostly unwed parents and their children over a 15-year period. The sample was limited to Hispanic (both foreign-born and native-born), non-Hispanic Black mothers, and non-Hispanic White mothers. This yielded a final sample size of 2,636 for all mothers and 665 for Latinx/Hispanic mothers. While micro-level factors were influential for food insecurity, they alone could not explain the variation. Social support, a meso-level factor, remained a consistently significant predictor for both adult and child food insecurity, regardless of race/ethnicity. There were also several key differences in predictors across racial/ethnic groups. Being Spanish speaking and mother's health status were only significant for Latinx/Hispanic mothers, and neighborhood support was not significant for Latinx/Hispanic mothers. Drawing from ecological theory, our study explores the micro-, meso-, and exo-/macro-level variables that influence food insecurity. Findings suggest that access to social support is crucial for disadvantaged families avoiding food insecurity, despite race/ethnicity. Still, factors predicting food insecurity may be racialized and should be recognized as such. [ABSTRACT FROM AUTHOR]

Prostate cancer is among the most prevalent forms of cancer worldwide and is reported to have the highest incidence, mortality, and 5-year prevalence rate of all cancers among men living in Africa. Despite this widespread burden in the African continent, little is known about the perspectives and experience of prostate cancer among African men. To further understand experiences among patients living in urban South Africa, we conducted in-depth, semi-structured qualitative interviews to examine the perceptions and experiences of 28 Black African prostate cancer patients receiving treatment at a major tertiary hospital in Johannesburg, South Africa. Our data explored four major areas of patients' experiences with prostate cancer: detection, diagnosis, treatment, and follow-up care. Our results showed that the experience of living with prostate cancer among low-income, Black South African men is a stressful and emotionally painful experience due in part to men feeling that they had insufficient knowledge about their own condition and feeling disempowered or ill-equipped to manage their cancer. These feelings were strongly associated with distrust or dissatisfaction with physicians and the health care system. Resilience factors include social support from family, friends, and religious communities, acceptance of their diagnosis, religion, and positive appraisals of their medical care. [ABSTRACT FROM AUTHOR]

Significant disparities exist between different ethnic groups when it comes to participation in colorectal cancer (CRC) screening programmes. A variety of interventions have been proposed to improve participation rates of ethnic minorities for CRC screening. This systematic review aims to appraise the evidence available from published randomised controlled trials (RCTs) and to identify effective interventions aimed at promoting CRC screening amongst underserved ethnic minorities. We searched EmBASE, Medline, PsychInfo, Scopus and CINAHL for RCTs that analysed interventions to promote CRC screening in all ethnic minorities. CRC screening was measured as documented or self-reported screening rates. The protocol of this study was registered prospectively on PROSPERO with the registration number CRD42020216384. We identified 42 relevant RCT articles, out of 1805 articles highlighted by the initial search. All except one were conducted in the US. The most frequently studied ethnic groups were African-Americans (33%), East Asians (30%), and Hispanics/Latinos (23%). In total, 7/42 (16%) RCTs had multiple arms. Interventions mainly intended to educate (52%), provide patient navigation services (21%), or provide a combination of these interventions (19%). We demonstrate that combination methods are most effective. Many RCTs, mostly in the US, have trialed interventions aimed to increase CRC screening uptake amongst ethnic minorities to varying success. We conclude that using a combination of methods with patient navigation, education, and cultural tailoring is most effective at increasing CRC screening uptake amongst ethnic minorities. This highlights that multiple factors may hinder CRC screening and finding a one-size-fits-all solution that can be reliably implemented among different cultures and countries may be complex. [ABSTRACT FROM AUTHOR]

Research on dementia literacy in Chinese societies is still emerging, and this is especially the case among racially minoritized groups. The present study explored the knowledge, causal beliefs, and help-seeking behaviors of South Asian migrants in Hong Kong about dementia. It also investigated existing community barriers related to dementia knowledge and help-seeking. We conducted a qualitative study from a purposive sample of 38 older people and family caregivers from India, Pakistan, and Nepal who lived in Hong Kong. Focus groups and individual in-depth interviews were used to gather information, while thematic analysis was employed to analyze the data. Five main themes were identified: normalization with stigmatization of dementia; spiritual and psychosocial attributions of dementia; familial responsibility despite potential caregiving burden; uncertainties versus openness to professional care; and barriers and opportunities in dementia literacy. Ethnic minorities recognized dementia as a disease of normal aging or a mental disorder. They also perceived spiritual and psychosocial factors as their main causes. While participants recognized the potential burden of dementia caregiving, families were their first point of help-seeking, as many of them expressed contrasting feelings of confidence or doubt toward professional services. Utilization of health education strategies, together with collaboration with community leaders, could address the barriers to dementia literacy. This is the first study to explore how ethnic minorities in Asia perceive dementia and its related help-seeking behaviors in their communities. South Asian migrants in Hong Kong have a limited understanding of dementia and may experience delays in obtaining relevant community services. While culture influenced their knowledge, health education may address their misperceptions and help-seeking behaviors toward dementia. Culture- and language-specific programs could also improve dementia knowledge and health service access. [ABSTRACT FROM AUTHOR]

Patient navigation has served as a useful intervention to reduce cancer disparities among diverse ethnic groups. Previous studies have consistently shown the effectiveness of patient navigation in reducing cancer disparities for ethnic minorities; however, few studies have been conducted for cancer screening behaviors focusing on the Asian population. This study aims to identify the overall effectiveness of patient navigation in cancer screening behaviors among Asian Americans through meta-analyses. In addition, this study examines the moderating effects of the type of cancers on cancer screening behaviors. For data analyses, we selected 15 studies through a systematic review and meta-analyses, searching the databases of PubMed, Web of Science, Embase, Scopus, and Cochrane Library. Random-effects models were used for meta-analyses. The results showed that Asian Americans who received patient navigation were more likely to participate in cancer screening behaviors than those who did not receive patient navigation regardless of the type of cancer. Publication bias was tested using a funnel plot, meta-regression, and Failsafe-N. No notable publication bias was found. This study can provide comprehensive evidence regarding the overall effectiveness of patient navigation in cancer screening behaviors of Asian Americans. [ABSTRACT FROM AUTHOR]

Objectives: This paper studies the institutional inequality that exists in the prevalence of diabetes and hypertension, as well as their diagnosis and medication management, between urban and rural residency status (hukou) holders in China. Methods: Exploiting the Chinese Health and Nutrition Survey, we primarily demonstrate that while a lower proportion of rural residency holders suffer from diabetes and hypertension, a larger proportion have never been diagnosed with these conditions and do not take medicine to control them. We explore the determinants of these disparities by the non-linear decomposition method. Results: Decomposition results illustrate that a large part of disparities in the prevalence of diabetes and hypertension can be explained by the differences in demographic structure and occupational socio-economic status. Regarding the ruralurban disparity in the under diagnosis and under-medication rates, the differences in demographic structure, household affluence, occupational socio-economic status and consumption patterns make the greatest contributions. Conclusions: This evidence suggests that improving the institutional economic inequality and enhancing the occupational mobility of rural residency holders are of paramount importance to mitigate any inequality in health and healthcare utilisation. [ABSTRACT FROM AUTHOR]

Objective: The aim of this paper is to provide a systematic review of studies that examine relationships between racial discrimination and trauma in order to further understand the relationship between racial oppression and psychological functioning. Design: In this review, we describe the characteristics of 28 studies, identified by a comprehensive search strategy, including measurements of racial discrimination and trauma, as well as the nature of the reported associations. Results: Half of studies included in this review were published in the last 6 years. The majority of studies used cross-sectional designs and were conducted in the United States with adults ≥18 years old. African American, White, Latinx, and Asian populations were most frequently included in these studies. Of the 44 associations examined in these studies, 70% of the trauma symptomology outcomes were statistically significantly associated with racial discrimination. Significant positive associations ranged in strength, with the strongest relationships between racial discrimination and trauma occurring in studies examining veteran populations and moderate relationships among these variables in non-veteran, student populations. Conclusions: Our findings reveal that current research on race-based trauma seems to be limited by a lack of measures that capture the stress/intensity associated with race-related events, an inability to account for vicarious/collective/intergenerational experiences of trauma, and failure to control for non-race-based trauma. [ABSTRACT FROM AUTHOR]

Human papillomavirus (HPV) is a common virus that currently infects nearly 80 million people in the United States (U.S.) and can lead to cancer. HPV vaccination provides safe, effective, and lasting protection against HPV infections. Nevertheless, vaccination rates remain suboptimal. The purpose of this study was to examine the relationship between sociodemographic characteristics, HPV and HPV vaccine awareness, and knowledge of HPV-associated cancers among U.S. adults. Using responses from 3504 U.S. adults (aged 18 years and older) from the Health Information National Trends Survey 5 Cycle 2 (January–May 2018), we performed descriptive analysis to assess the level of awareness of HPV and HPV vaccines and knowledge of HPV-associated cancer. Multivariable regression analysis (including race, gender, age, level of education, marital status, number of children younger than 18) was conducted with weighted analysis. About 62% of respondents had heard of HPV and HPV vaccine. Asians had a lower level of awareness than non-Hispanic Whites of HPV (36.4% vs. 66.1%) and HPV vaccine (48.7% vs. 67.1%). Multivariable analysis showed that race/ethnicity was associated with outcomes, with Asians being less likely to have heard about HPV (aOR = 0.17, 95% CI: 0.07–0.38) and non-Hispanic Blacks (aOR = 0.57, 95% CI: 0.35–0.91) and Hispanics (aOR = 0.54, 95% CI: 0.36–0.80) being less likely to have heard of the HPV vaccine than non-Hispanic Whites. In addition, gender, age, marital status, and education were associated with awareness of HPV and the HPV vaccine; in particular, individuals who were female, younger (18–45), married, and more highly educated were more likely to have heard of HPV and HPV vaccine. Results highlight disparities in HPV and HPV vaccine awareness among racial/ethnic minority populations. Future interventions and legislation should target racial/ethnic minority populations to foster improvements in HPV vaccine uptake and reduce disparities in HPV-associated cancers. [ABSTRACT FROM AUTHOR]

We explored how Latino cultural values play a role in perceived caregiving experiences. We conducted a qualitative study that used individual, in-depth, semi-structured interviews with middle-aged and older Latinos who were primary caregivers of family members with Alzheimer's disease and related dementias (ADRD). The interview guide consisted of questions about participants' perceptions of family caregiving and interrelationships between the caregiver and care recipient. The interviews were recorded, translated, and transcribed verbatim. We performed direct content analysis. Participants were caregivers, 50–75 years old (n = 16), and the majority were female. We identified four cultural values that were salient to participants' caregiving experiences: (a) familismo, (b) fatalismo (c) marianismo, and (d) machismo. Latino cultural values influenced the role of caregiving and caregiving roles of family members with ADRD. Future research should consider these values as they affect different familial and health dynamics. [ABSTRACT FROM AUTHOR]

Obesity and its sequelae are an increasing problem, disproportionally affecting Māori and Pacific peoples, secondary to multifactorial systemic causes, including the effects of colonisation and the impact of globalisation. There is limited synthesised evidence on interventions to address obesity in these populations. The objective of this review is to identify evaluated interventions for prevention and management of obesity amongst Māori and Pacific adults, assess the effectiveness of these interventions, and identify enablers and barriers to their uptake. Systematic review of databases (Medline, PubMed, EMBASE, CINAHL, Scopus, CENTRAL), key non-indexed journals, and reference lists of included articles were searched from inception to June 2021. Eligibility criteria defined using a Population, Intervention, Control, Outcome format and study/publication characteristics. Quantitative and qualitative data were extracted and analysed using narrative syntheses. Study quality was assessed using modified GRADE approach. From the 8190 articles identified, 21 were included, with 18 eligible for quantitative and five for qualitative analysis. The studies were heterogenous, with most graded as low quality. Some studies reported small but statistically significant improvements in weight and body mass index. Key enablers identified were social connection, making achievable sustainable lifestyle changes, culturally-centred interventions and incentives including money and enjoyment. Barriers to intervention uptake included difficulty in maintaining adherence to a programme due to intrinsic programme factors such as lack of social support and malfunctioning or lost equipment. Normal weight trajectory is progressive increase over time. Modest weight loss or no weight gain after several years may have a positive outcome in lowering progression to diabetes, or improvement of glycaemic control in people with diabetes. We recommend urgent implementation of Māori and Pacific-led, culturally-tailored weight loss programmes that promote holistic, small and sustainable lifestyle changes delivered in socially appropriate contexts. [ABSTRACT FROM AUTHOR]

African Americans suffer disproportionately from cancer compared to their White counterparts. Racism may be an important determinant, but the literature on its association with cancer screening is limited. We examine associations between racism and cancer screening among a sample of African Americans. Guided by the Public Health Critical Race Praxis and the Behavioral Model of Health Services Use, we conducted a multilevel, cross-sectional study using cancer risk assessment data collected from 405 callers to the 2-1-1 Texas helpline. We merged these data with contextual data from the U.S. Census Bureau. We assessed perceived racial discrimination using the Experiences of Discrimination Scale and racial residential segregation using the Location Quotient for Racial Residential Segregation. We used multilevel regression models to test hypothesized associations between each indicator of racism and four cancer screening adherence outcomes (Pap test, mammography, colorectal cancer screening [CRCS], and any cancer screening). Participants were 18–83 years old (mean = 45 years). Most (81%) were non-adherent to at least one recommended screening. Approximately 42% reported experiencing discrimination and 73% lived in a segregated neighborhood. Discrimination was non-significantly related to lower odds of mammography (aOR = 0.68; 95%CI: 0.38-1.22), CRCS (aOR = 0.79; 95%CI: 0.41-1.52), and any cancer screening adherence (aOR = 0.88; 95%CI: 0.59-1.32). Segregation was related to greater odds of mammography (non-significant; aOR = 1.43; 95%CI: 0.76-2.68) and CRCS (significant; aOR = 2.80; 95%CI: 1.21-6.46) but not associated with any cancer screening. Neither indicator of racism was associated with Pap test screening adherence. Racism has a nuanced association with cancer screening among low-income, medically underserved African Americans. Specifically, discrimination appears to be associated with lower odds of screening, while segregation may be associated with higher odds of screening in certain situations. Future research is needed to better explicate relations between indicators of racism and cancer screening among African Americans. [ABSTRACT FROM AUTHOR]

Men and women living in rural communities of the United States (US) are less likely than those in urban or suburban communities to be up to date with cancer screenings. Delayed screening contributes to later stage at diagnosis and higher cancer mortality for individuals living in rural areas. These effects may be compounded in some rural subpopulations (e.g. migrant and seasonal farmworkers). This systematic review examines educational interventions aimed at increasing colorectal, breast, prostate, oral, and/or cervical cancer screening in the rural US, with special consideration for the farmworker subpopulation. Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, our systematic literature review employed the following databases: Ovid MEDLINE, CINAHL Complete, Embase, and Web of Science. Search terms included, but were not limited to 'rural,' 'cancer screening,' 'farmworker,' and 'cancer prevention.' Eligible studies featured an educational intervention implemented in agricultural or rural US settings with a cancer screening behavioral outcome, male and/or female participants, and were published in English between 2002 and 2020. Article screening and data extraction were conducted by two independent reviewers. Twenty-six articles were eligible. Of the six studies focused on the farmworker population (n=2,732), 61.75% of participants reported Hispanic ethnicity. Of the sixteen studies on unspecified rural communities reporting participant race/ethnicity (n=10,442), 39.29% reported Black/African American race. Efficacious interventions included culturally-targeted educational materials, lay health advisors (LHAs), and components that addressed practical barriers (e.g. financial or logistical). Results demonstrate the value of LHAs and targeted education to increase screening for multiple cancer types in rural communities. Prospective research should incorporate and facilitate access to screening and provider-level and/or organizational-level interventions to increase overall impact. HPV: human papillomavirus; LHA: lay health advisors; MeSH: Medical Subject Headings; PRISMA: Preferred Reporting Items for Systematic Reviews and Meta-Analyses; RCT: randomized controlled trial; US: United States [ABSTRACT FROM AUTHOR]

Nearly two-thirds of Black women in the US are obese. Studies have focused more on lifestyle and behavioral factors to explain racial disparities; less research has examined psychosocial factors such as psychological distress and social cohesion. While research suggests that social cohesion may confer benefits for health, no studies have assessed how social cohesion is related to both mental health and obesity, and potential racial differences. Our study examined associations between psychological distress, social cohesion, and obesity among Black and White adult women. Data are from the 2014–2018 National Health Interview Survey (n = 66,743). Participants self-reported psychological distress (Kessler K6 scale), obesity (body mass index≥30 kg/m2), and social cohesion. We fit logistic regression models of obesity with likelihood ratio tests for effect modification by social cohesion and by race. Psychological distress was associated with a 1.19 and 1.31 higher odds of obesity for Black (95% confidence interval: 1.05, 1.36) and White women (1.24, 1.39), respectively. Social cohesion was associated with a 0.75 lower odds of obesity among White (0.69, 0.81) but not Black women (odds ratio 0.94; 0.80, 1.10). Tests of interaction indicated no differences by social cohesion or race in the association between psychological distress and obesity. Findings highlight complex relationships between psychological distress, obesity, and social cohesion in Black and White women. Public health efforts should focus on understanding mechanisms relating social factors to health. [ABSTRACT FROM AUTHOR]

Refugees and immigrants often experience challenges pre- and post-settlement that expose them to risk factors of cardiovascular disease (CVD). Literature on CVD among the growing population of African refugees and immigrants in the United States (US) is scant. This narrative review aimed to evaluate existing studies reporting on CVD and its risk factors among African refugees and immigrants in the US, and to recognize limitations in the current research, policy, and healthcare for adequate CVD-related care for African refugees and immigrants. Articles on African refugee and/or immigrant health were searched on PubMed using multiple key search terms. Studies conducted between 1995 and 2020 and reporting on CVD-related measures in individuals from African countries of origin were included. Six articles were found discussing refugee health only and seven articles discussed refugee and immigrant health together. Overall, the studies showed the varying prevalence of CVD risk factors, mostly depending on the country of origin. Worsening cardiometabolic health with longer residency in the US was generally reported. Refugee-only studies relied mostly on medical records data, while refugee and immigrant studies used both medical records and primary data collection. Limitations in data pertain to the geographical representation of both African countries (predominantly from Somalia despite migrants arriving from diverse African countries) and of regions of settling in the US (predominantly the north/northeast), scarce longitudinal studies, and lack of distinction between refugees and immigrants. Multiple social and structural barriers to cardiovascular health were identified, mostly related to cultural and linguistic challenges and to inadequate or complex health insurance and healthcare systems. The cardiovascular health of African refugees and immigrants remains understudied and underserved. Further research and interventions to alleviate barriers and improve cardiovascular health in African refugees and immigrants in the US should be developed using culturally appropriate, accessible, flexible, and multifaceted strategies. [ABSTRACT FROM AUTHOR]

Objectives: This study aims to review the published literature on the health of the Roma population in Spain, particularly that which describes health interventions and outcomes. Design: A scoping review of published articles/reports on Roma population health was carried out in Spain for publications between 2002 and 2014. Articles in Spanish or English were identified from Pubmed, Scopus, Science Direct, Web of Science, Scielo, IBECS, MEDES, Dialnet, Index Foundation, a database of theses and Google Scholar. After an initial assessment of the article title and summary, genetic studies, editorials, reviews and grey literature with incomplete data were excluded. Two independent researchers followed a protocol to analyze the selected papers in terms of general information, methodology, themes, and results or conclusions. Results: Forty studies were selected for inclusion, primarily located through PubMed and Google Scholar. Most of the papers were scientific articles, published after 2007 in Spanish scientific journals (70.0%) followed by institutional reports (20.0%). The main language was Spanish (84.2%). The studies were carried out mainly by public institutions (35.0%) or universities (22.5%). Most (67.5%) followed a descriptive design and nearly half (47.5%) were concerned only with the Roma population. The main thematic areas were: child health (25%), infectious diseases (25%), health and social education context (20%), perceived health and lifestyle (15%), sexual and reproductive health (7,5%) and health services use (7,5%). We found seven intervention studies related to health, educational environment, or social services. Conclusions: There are few publications related to the health of the Roma community in Spain and even fewer related to health interventions and outcomes. Those that are available have focused on areas such as child health or infectious disease outbreaks. It is important to promote health interventions in Roma communities and longitudinal studies that include a comprehensive vision and account for the social determinants of health. [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]

Objectives: The aim of this scoping review was to uncover and summarize what is known in the literature about the experiences of Indigenous women in Asia regarding access to health services. Design: The study was informed by the scoping review methodology proposed by Arksey and O'Malley [2005. "Scoping Studies: Towards a Methodological Framework." International Journal of Social Research Methodology 8 (1): 19–32. doi:10.1080/1364557032000119616]. A comprehensive search of the databases for peer-reviewed studies and grey literature was conducted between January 2000 and December 2016. The data of selected papers and abstracts were analysed by three independent researchers through a protocol of data charting, descriptive numerical summary, and thematic analysis. Results: Sixteen articles and two abstracts met the inclusion criteria for this scoping review. These 18 peer-reviewed documents consisted of eight qualitative studies, seven quantitative studies, and three mixed-method studies, which included the peer-reviewed poster and oral presentation abstracts from international conferences. The findings were sorted and grouped under the following themes: health care access for Indigenous women in Asia, facilitators to accessing healthcare services, barriers to accessing healthcare services, and cultural contexts impacting health and access. Conclusion: There is limited information about the experiences, facilitators, barriers, and cultural contexts faced by Indigenous women in Asia related to health services accessibility, and even less information related to improving health services accessibility and health outcomes. This scoping review in particular highlights the dearth of literature relating to Indigenous women's postpartum health and access to postnatal supports and services. Generally, it indicates that Indigenous women in Asia are more vulnerable to poor health in comparison to non-Indigenous women, and continue to face challenges and barriers in accessing quality and equitable health services. The barriers identified in this review are useful in explaining why inequities in health and access to health care for Indigenous women living in Asia continue to exist. Recommendations for future research directions are described. [ABSTRACT FROM AUTHOR]

Objectives: This paper is an examination of cancer/health communication factors (i.e. cancer/health information seeking, patient-provider communication (PPC), cancer screening information from providers) and screening for breast and cervical cancer among Asian Americans and five Asian ethnic groups (Chinese, Filipinos, Japanese, Koreans, Vietnamese) in comparison to Whites. Additionally, the relationship between cancer/health communication disparity and cancer screening gaps between Asian Americans and Whites was investigated. Design: Data comes from a nationally representative sample of 2011–2014 Health Information National Trends Surveys (HINTS). Results: Asian Americans and most Asian ethnic-groups reported significantly lower rates of cancer/health information seeking and lower evaluations for PPC as compared to Whites, though differences within Asian ethnic groups were observed (Koreans' greater cancer/health information seeking, Japanese' higher PPC evaluation). When the cancer/health communication factors were controlled, Asian Americans' odds of cancer screening were increased. Especially, Asian Americans' odds of adhering to the breast cancer screening guideline became nearly 1.4 times greater than Whites. Conclusion: This research demonstrates that health organizations, providers, and Asian American patients' collaborative efforts to increase the access to quality cancer information, to make culturally competent but straightforward screening recommendations, and to practice effective communication in medical encounters will contribute to diminishing cancer disparities among Asian Americans. [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]

Objectives: This paper investigates a community-based intervention for young fathers, FatherWorks, compared to care-as-usual, 24/7 Dads. We hypothesized that utilizing the FatherWorks intervention (a 15 session parenting intervention, 13 session employment class, paid internship, case management, and access to behavioral health services) will assist in readiness to use condoms and increase condom usage, which may differ by race/ethnicity. Methods: Eligible males (n = 328) were enrolled into a Randomized Control Trial. Participants were 15–24 years old and had fathered one or more children with a female under the age of 21. A survey was taken at baseline and at 15 weeks following the intervention. Results: Analyses of changes indicated that intervention participants improved from the pre-contemplation stage of condom usage towards contemplation, and from preparation to action. The pattern of improvement in the condom use stage of change was different in African-American versus Hispanic participants. Changes in condom use during last intercourse were not significant. Conclusions: Study findings indicate that FatherWorks is successful in increasing the intent to use condoms, with the effect manifesting differently in African-American and Hispanic young fathers. Future work with minority fathers indicates a need for cultural adaptation of the intervention. [ABSTRACT FROM AUTHOR]

Objective: As part of a large mixed-method study aimed at capturing understandings of dignity, and care expectations of community dwelling older women from Black and minority ethnic (BME) backgrounds living in Wales, the aim of this paper is to compare service providers' perceptions of their care and support provided to older people in general, and to older women from BME backgrounds in particular, with a focus on two dignity indicators: care and support needs, and effective communication. Design: A survey design was used. Results: A total of 124 responses from service providers in Wales were received. Perceived inequalities in care and support were found. Although most respondents reported that care and support provision was generally acceptable, more respondents believed that compared to older people in general, older women from BME backgrounds were seldom or never offered opportunities and support to express their needs, were involved in their own care, were provided appropriate information, had their key needs especially less visible needs (psychological and religious needs) been taken into account, or were communicated with effectively (all p < 0.05). In some cases, respondents tended to report more positively in areas related to their own practice. Conclusion: We suggest that learning from the views and perceptions of service providers, as well as older people and their families, remains key to developing services for the UK's increasingly diverse and ageing population. A better understanding of how inequalities may occur, their impact on older people and their families, and how they may be minimised can inform the development of high quality care for older people regardless of their ethnic and cultural backgrounds in Wales, other parts of the UK and beyond. [ABSTRACT FROM AUTHOR]

Latino men who have sex with men (MSM) are disproportionately affected by HIV in the US and only half of Latinos diagnosed with HIV are virally suppressed. Little is known about the determinants of HIV care and treatment outcomes among Latinos. We used theories of intersectionality to assess the HIV testing, care and treatment experiences of gay Latino men living with HIV in a new immigrant destination. We conducted qualitative in-depth interviews with US and foreign-born gay Latino men living with HIV (n = 14) recruited through referrals from HIV care providers and case managers. We used Maxwell and Miller's theory of qualitative analysis to guide our approach to data analysis, integrating narrative techniques and thematic coding. We used theories of intersectionality – including both intersecting identities and structures – as an interpretive framework to understand participants' outcomes and experiences. All participants were engaged in HIV care at the time of the interviews. The mental health burden of diagnosis and managing life with HIV was a salient theme across all interviews. Most participants had experienced interruptions in their care due to both intersecting stigmatized identities (e.g. being gay, Latino, undocumented) and intersecting structures (healthcare, immigration policy, institutionalized homophobia). Undocumented participants directly connected their immigration status to their ability to get work, which then affected their retention in HIV care and treatment adherence. Examining the interplay between identities and structures provides a contextualized understanding of outcomes along the HIV care continuum among gay Latino men that goes beyond behavioral and cultural explanations. There is a need to assess long-term experiences of navigating HIV care and treatment given the intersecting structures of mobility, housing instability, and immigration policy. [ABSTRACT FROM AUTHOR]

The incoming editors of the journal welcome their readers and they comment on their intentions of maintaining the traditions of the journal in assembling and publishing good-quality research for a wide audience. They indicate that the journal will continue to be international in scope. The editors note the content and aspects of original papers on ethnicity and health that they will encourage. Also noted are disciplines of interest including medicine medicine, nursing, epidemiology, and public health.

The author reflects on ethnic identities and gendered violence in sub-Saharan Africa. According to him, ethnic identities become performative, with the rape of enemy women from different ethnic groups used as strategies of humbling the enemy. He discusses a paper by B.M. Ahlberg and colleagues that examines the growth of forced male circumcision on non-circumcising ethnic groups during the post-election violence in Kenya.

Black women in the U.S. are disproportionately impacted by HIV and adverse life events (ALE). High self-esteem has been noted as a protective factor and low self-esteem has been linked to mental health diagnoses. However, the existing literature is limited in the examination of how self-esteem may buffer relationships between ALE and mental health diagnoses among Black women living with HIV (BWLWH). One hundred and nineteen BWLWH completed self-report measures on self-esteem (Rosenberg Self-Esteem Scale) and ALE (Life Events Checklist for DSM-5) (e.g. sexual assault, physical assault, accidents, natural disaster) as well as a clinical interview (via Mini-International Neuropsychiatric Inventory) to diagnose current depression, PTSD, and suicidality. Multivariable logistic regressions indicated that higher self-esteem was associated with lower likelihood of current depression (OR =.894, p <.01), PTSD (OR =.838, p <.001) and suicidality (OR =.889, p <.05). Interactions between self-esteem and total ALE significantly predicted current depression (OR =.000003, p <.05) and PTSD (OR = 2.7182 × 10−9, p <.001); and higher total ALE related to higher likelihood of current PTSD only among BWLWH reporting lower self-esteem (OR = 1.21, p <.05). Interventions addressing mental health diagnoses among BWLWH should incorporate strategies to enhance self-esteem. [ABSTRACT FROM AUTHOR]

Although links between social relationships and health are well established, few studies have concurrently examined the effects of compositional, structural, and functional dimensions of social networks on glycemic (HbA1c) control in low- and middle-income countries such as Ghana. In these settings where informal social relationships are critical for access to resources, evaluating the links between social network characteristics, social support, and glycemic control may provide clarity about important relationships that facilitate the well-being of individuals with type 2 diabetes mellitus (T2DM). In 2018, we conducted a hospital-based, cross-sectional survey of noninstitutionalized adults with T2DM in Ghana. Using data from 247 study participants, multivariable linear regression models were used to estimate associations between: 1) HbA1c and three social network characteristics (kin composition, household composition, and network density); 2) social support and the three social network characteristics; and 3) HbA1c and social support. We also examined gender differences in these associations and applied mediation techniques to determine if network characteristics operated through social support to affect HbA1c. Findings indicated that higher kin composition and higher household composition were each significantly associated with increased social support. Neither social support nor social network characteristics were significantly related to HbA1c, and there were no gender differences in any of these associations. Although family and household members were identified as important sources of social support for diabetes management, the ways in which they influence HbA1c control among Ghanaians require further investigation. Future studies can examine whether changes in social support over time, social support satisfaction, or other dimensions of social relationships improve T2DM outcomes in countries like Ghana. [ABSTRACT FROM AUTHOR]

Background: Health inequalities for Indigenous people and culturally diverse patients or remote area dwellers are well established. Models of care such as telehealth might have the potential to reduce the disparity of access to health services for Indigenous and culturally diverse ethnic groups. To examine the modalities and clinical and non-clinical effectiveness of telehealth services available to people from Indigenous and culturally and linguistically diverse backgrounds (CALD). A scoping review of peer-reviewed publications (2000–2021) on the effectiveness of telehealth interventions for Indigenous and CALD groups based on searches of Medline, CINAHL, and PsycInfo and manual searches from reference lists of captured literature reviews. Of the initial 601 articles, 10 met the inclusion criteria (seven of clinical effectiveness and three of non-clinical effectiveness), with participants from the USA, Australia, New Zealand, and Canada, with sample sizes ranging from 19 to 1,665 participants (overall 327 Indigenous and 2,030 CALD patients). Telehealth was delivered via telephone or by videoconference—with or without data uploads—and follow-up ranging from 6 months to 5 years. The findings suggest that telehealth shows some promise in: diabetes, depression, neuro/cognitive assessment, and health program adherence/service utilisation/cost. However, our confidence in the accuracy of the results is undermined by the mixed quality of designs and outcome measurements, and the high risk of bias derived from not proper random selections and small sample sizes. The available literature suggests acceptable clinical and non-clinical effectiveness of telehealth against usual care in Indigenous and/or CALD groups but methodological limitations diminish their value in informing practice. Therefore, we consider it is premature to use the findings of these primary studies to draw conclusive recommendations about clinical or other effectiveness of telehealth for the two target groups. Further randomised trials with adequate sampling frames and objective outcome assessments are warranted. [ABSTRACT FROM AUTHOR]

There is a general lack of information about how insufficient physical activity impacts blood pressure and physical fitness in Latin-American ethnic minorities. To describe the interactions between insufficient physical activity, blood pressure, and physical fitness outcomes in Latin-American schoolchildren of different ethnicity. This was a prospective, international, multi-center, and cross-sectional study of three Latin-American countries involving schoolchildren from seven ethnic groups of Colombia (Tikuna, Nasa, Embera), Brazil (African, Mulato), and Chile (Mapuche), and also European schoolchildren from Brazil and Chile. Data were categorized based on whether participants were physically active (PA) or insufficient physical activity (iPA) using the WHO physical activity recommendations. The main outcomes were systolic (SBP), diastolic (DBP), and mean arterial (MAP) blood pressure, and scores for physical and cardiorespiratory fitness (CRF, by estimated V ˙ O2max), handgrip muscle strength (HGS), and standing long jump (SLJ). Secondary outcomes were anthropometric measures (weight, height, body mass index [BMI], waist circumference [WC], waist-to-height ratio), and body fat percentage (BF%, limited data by country). Primary and secondary outcomes were ranked. For both PA and iPA categories, significant interactions between ethnic groups were found concerning SBP/DBP (F(37.7), ES 0.08; F(51.5), ES 0.08), V ˙ O2max (F(37.7), ES 0.08; F(51.5), ES 0.08), HGS (F(33.8), ES 0.07; F(5.03), ES 0.04), and SLJ (F(64.3), ES 0.14; F(64.3), 0.14). In the iPA category, Mapuche schoolchildren were classified 1st (119.5; 81.5) with highest SBP/DBP and highest MAP (94.6 mmHg); Embera schoolchildren were classified 1st with lowest V ˙ O2max (33.7 mL/kg/min); and European schoolchildren were classified 1st (19.9 kg) with lowest HGS and SLJ (121.4 m) physical fitness. Under conditions of insufficient physical activity conditions, Mapuche schoolchildren had the most detrimental blood pressure, whereas Embera, Tikuna, and European schoolchildren had the lowest levels of physical fitness. These results serve to highlight the need for the early and appropriate promotion of physical activity based on ethnic differences in Latin-American schools. [ABSTRACT FROM AUTHOR]

We examined Latinx immigrants' perceptions of US policy related to restrictions on immigrants' use of public resources and their thoughts about the influence of these on immigrants' healthcare utilization. A series of 16 focus group discussions with Latinx immigrant men and women (documented and undocumented) (N = 130) were conducted between May and July 2017 across four US cities. Four central themes emerged: participants attributed the limited resources available for affordable healthcare for many uninsured US immigrants (both documented and undocumented) to the US government's view of immigrants as burdens on public resources and its subsequent unwillingness to dedicate funds for their care; participants expressed concerns, some unfounded, about negative immigration ramifications arising from diagnosis with health conditions perceived to be serious and/or expensive to treat; participants noted that some immigrants avoided using health programs and services to which they were entitled because of immigration concerns; finally, participants described how access to information on immigration laws and healthcare resources, and conversely, misinformation about these, influenced healthcare utilization. Participants were acutely aware of the image of immigrants as public charges or potential burdens on government resources that underlies US immigration policy. In some cases, participants came to inaccurate and potentially harmful conclusions about the substance of laws and regulations based on their beliefs about the government's rejection of immigrants who may burden public resources. This underscores the importance of ensuring that immigrants have access to information on immigration-related laws and regulations and on healthcare resources available to them. Participants noted that access to information also fostered resilience to widespread misinformation. Importantly, however, participants' beliefs had some basis in US immigration policy discourse. Law and policy makers should reconsider legislation and political commentary that frame self-reliance, the guiding principle of US immigration policy, in terms of immigrants' use of publicly funded healthcare resources. [ABSTRACT FROM AUTHOR]