Search

The health and safety of incarcerated persons and correctional personnel have been prominent in the U.S. news media discourse during the COVID-19 pandemic. Examining changing attitudes toward the health of the incarcerated population is imperative to better assess the extent to which the general public favors criminal justice reform. However, existing natural language processing lexicons that underlie current sentiment analysis (SA) algorithms may not perform adequately on news articles related to criminal justice due to contextual complexities. News discourse during the pandemic has highlighted the need for a novel SA lexicon and algorithm (i.e., an SA package) tailored for examining public health policy in the context of the criminal justice system. We analyzed the performance of existing SA packages on a corpus of news articles at the intersection of COVID-19 and criminal justice collected from state-level outlets between January and May 2020. Our results demonstrated that sentence sentiment scores provided by three popular SA packages can differ considerably from manually-curated ratings. This dissimilarity was especially pronounced when the text was more polarized, whether negatively or positively. A randomly selected set of 1,000 manually scored sentences, and the corresponding binary document term matrices, were used to train two new sentiment prediction algorithms (i.e., linear regression and random forest regression) to verify the performance of the manually-curated ratings. By better accounting for the unique context in which incarceration-related terminologies are used in news media, both of our proposed models outperformed all existing SA packages considered for comparison. Our findings suggest that there is a need to develop a novel lexicon, and potentially an accompanying algorithm, for analysis of text related to public health within the criminal justice system, as well as criminal justice more broadly.

As the long-standing and ubiquitous racial inequities of the United States reached national attention, the public health community has witnessed the rise of "health equity tourism". This phenomenon is the process of previously unengaged investigators pivoting into health equity research without developing the necessary scientific expertise for high-quality work. In this essay, we define the phenomenon and provide an explanation of the antecedent conditions that facilitated its development. We also describe the consequences of health equity tourism - namely, recapitulating systems of inequity within the academy and the dilution of a landscape carefully curated by scholars who have demonstrated sustained commitments to equity research as a primary scientific discipline and praxis. Lastly, we provide a set of principles that can guide novice equity researchers to becoming community members rather than mere tourists of health equity.

Differences in health outcomes across racial groups are among the most commonly reported findings in health disparities research. Often, these studies do not explicitly connect observed disparities to mechanisms of systemic racism that drive adverse health outcomes among racialized and other marginalized groups in the United States. Without this connection, investigators inadvertently support harmful narratives of biologic essentialism or cultural inferiority that pathologize racial identities and inhibit health equity. This paper outlines pitfalls in the conceptualization, contextualization, and operationalization of race in quantitative population health research and provides recommendations on how to appropriately engage in scientific inquiry aimed at understanding racial health inequities. Race should not be used as a measure of biologic difference, but rather as a proxy for exposure to systemic racism. Future studies should go beyond this proxy use and directly measure racism and its health impacts.VISUAL ABSTRACTAppeared as Annals "Online First" article.

Gender-affirming hormones have been shown to improve psychological functioning and quality of life among transgender and nonbinary (trans) people, yet, scant research exists regarding whether and why individuals take more or less hormones than prescribed. Drawing on survey data from 379 trans people who were prescribed hormones, we utilized multivariable logistic regression models to identify factors associated with hormone-dosing behaviors and content analysis to examine the reasons for dose modifications. Overall, 24% of trans individuals took more hormones than prescribed and 57% took less. Taking more hormones than prescribed was significantly associated with having the same provider for primary and gender-affirming care and gender-based discrimination. Income and insurance coverage barriers were significantly associated with taking less hormones than prescribed. Differences by gender identity were also observed. Addressing barriers to hormone access and cost could help to ensure safe hormone-dosing behaviors and the achievement trans people's gender-affirmation goals.

PURPOSE We undertook a study to assess whether presence of community support persons (CSPs), with no hospital affiliation or alignment, mitigates acts of obstetric racism during hospitalization for labor, birth, and immediate postpartum care. METHODS We conducted a cross-sectional cohort study, measuring 3 domains of obstetric racism as defined for, by, and with Black birthing people: humanity (violation of safety and accountability, autonomy, communication and information exchange, and empathy); kinship (denial or disruption of community and familial bonds that support Black birthing people); and racism in the form of anti-Black racism and misogynoir (weaponization of societal stereotypes and scripts in service provision that reproduce gendered anti-Black racism in the hospital). We used a novel, validated instrument, the Patient-Reported Experience Measure of Obstetric Racism (the PREM-OB Scale suite), and linear regression analysis to determine the association between CSP presence during hospital births and obstetric racism. RESULTS Analyses were based on 806 Black birthing people, 720 (89.3%) of whom had at least 1 CSP present throughout their labor, birth, and immediate postpartum care. The presence of CSPs was associated with fewer acts of obstetric racism across all 3 domains, with statistically significant reductions in scores in the CSP group of one-third to two-third SD units relative to the no-CSP group. CONCLUSIONS Our findings suggest that CSPs may be an effective way to reduce obstetric racism as part of quality improvement initiatives, emphasizing the need for democratizing the birthing experience and birth space, and incorporating community members as a way to promote the safety of Black birthing people in hospital settings. Key words: childbirth; labor, obstetric; maternal health services; obstetric racism; medical racism; health care disparities; misogynoir; Black maternal health; health inequities; community support person; labor coach; vulnerable populations https://doi.org/10.1370/afm.2958 Annals 'Online First' article, INTRODUCTION The provision of hospital-based obstetrics care in the United States facilitates disparate maternal and perinatal health care experiences and outcomes that disproportionately and unfairly impact Black mothers and birthing [...]

Recent controversies over the characteristics of 'professionalism' and its enforcement by medical educators underscore the racialized and gendered norms implicit in this practice. In this essay, we describe the ways nebulous definitions of 'professionalism' imbue White, cisgender, straight, and able-bodied standards to police the boundaries of belonging in medicine. As such, marginalized trainees remain unfinished sculptures, forced to chisel away dimensions of experience and expression to conform to 'professional' standards. We seek to resculpt professionalism in a way that centers patients and trainees currently at the margins. This will strengthen the increasingly diverse workforce and ensure that they can effectively address the needs of patients often excluded from quality care. https://doi.org/10.1370/afm.2892, 'A patient of mine whom I had not yet met,' the white coat ceremony speaker began, 'once walked up to me and said, 'Hey Doc!' When I asked him how [...]

Resilience, the individual trait of being able to persist and cope with, often recurrent, negative experiences, has experienced an explosion in recent years as a topic of study. In this commentary, we critique this surge and problematize the co-occurring development of the "resilience as treatment" paradigm. We show that resilience is an expectation foisted primarily on historically and contemporarily oppressed and excluded populations often in response to systemic and structural forms of discrimination. We argue that this represents a fundamental mismatch of intervention and problem; offering an individual-level solution to a structural toxin. In doing so, we re-contextualize resilience as an adverse event, more analogous to scar tissue than a reliable treatment paradigm. Our essay concludes with offering alternatives to resilience that originate with the holistic trauma and liberation health frameworks. These paradigms are united in that, in contrast to resilience, they emphasize healing from structural violence, rather than adapting to it. [ABSTRACT FROM AUTHOR]

Purpose: With the expansion of research utilizing electronic healthcare data to identify transgender (TG) population health trends, the validity of computational phenotype (CP) algorithms to identify TG patients is not well understood. We aim to identify the current state of the literature that has utilized CPs to identify TG people within electronic healthcare data and their validity, potential gaps, and a synthesis of future recommendations based on past studies. Methods: Authors searched the National Library of Medicine's PubMed, Scopus, and the American Psychological Association PsycInfo's databases to identify studies published in the United States that applied CPs to identify TG people within electronic healthcare data. Results: Twelve studies were able to validate or enhance the positive predictive value (PPV) of their CP through manual chart reviews (n = 5), hierarchy of code mechanisms (n = 4), key text‐strings (n = 2), or self‐surveys (n = 1). CPs with the highest PPV to identify TG patients within their study population contained diagnosis codes and other components such as key text‐strings. However, if key text‐strings were not available, researchers have been able to find most TG patients within their electronic healthcare databases through diagnosis codes alone. Conclusion: CPs with the highest accuracy to identify TG patients contained diagnosis codes along with components such as procedural codes or key text‐strings. CPs with high validity are essential to identifying TG patients when self‐reported gender identity is not available. Still, self‐reported gender identity information should be collected within electronic healthcare data as it is the gold standard method to better understand TG population health patterns. [ABSTRACT FROM AUTHOR]

Objective: To assess the needs of transgender and nonbinary (TNB) adults for gender‐affirming face, neck, and voice procedures. Study Design: Cross‐sectional survey. Setting: Online, February to May 2022. Methods: Primary outcomes included utilization of otolaryngologists and speech‐language pathologists; gender dysphoria felt from the face, neck, and voice self‐reported on a 0 to 10 numeric rating scale (0 = no dysphoria, 10 = unbearable); and desire for various gender‐affirming face, neck, and voice procedures. We used ordinal logistic and linear regression to assess relationships between site‐specific dysphoria and the desire for relevant procedures. Results: TNB participants (N = 234) infrequently sought gender‐affirming care with speech‐language pathologists (23%), facial plastic surgeons (8%), or laryngologists (3%). Participants experienced the strongest dysphoria from the voice (median 7/10), jawline/chin (4/10), and neck (3.5/10). Transmasculine and nonbinary participants typically seeking masculinization (n = 83) frequently desired voice therapy (want = 35%, had = 8%). Transfeminine and nonbinary participants typically seeking feminization (n = 145) frequently desired voice therapy (want = 52%, had = 23%), chondrolaryngoplasty (want = 45%, had = 5%), and hair removal/electrolysis (want = 43%, had = 44%). Many desired at least 1 facial feminization surgery procedure (65%), especially mandible reduction (want = 42%, had = 3%), rhinoplasty (want = 41%, had = 1%), and forehead reduction (want = 37%, had = 4%). Dysphoria ratings were associated with desiring relevant procedures (p <.05 for all), notably voice therapy (odds ratio [OR] = 1.50), chondrolaryngoplasty (OR = 1.46), mandible reduction (OR = 1.38), rhinoplasty (OR = 1.59), and forehead reduction (OR = 1.82). Conclusion: Gender dysphoria from the face, neck, and voice can be severe for TNB people and is associated with the desire for gender‐affirming procedures. The high demand yet low reported access to these procedures highlights the need for providers of gender‐affirming face, neck, and voice care. [ABSTRACT FROM AUTHOR]

Objective: To assess transgender and nonbinary adults' awareness of Otolaryngologists' (ENT) and speech‐language pathologists' (SLP) ability to perform various face, neck, and voice procedures for gender‐affirming purposes. Study Design: Cross‐sectional survey. Setting: Online, from February to May 2022. Methods: We developed a list of nonsurgical and surgical gender‐affirming face, neck, and voice procedures. We asked transgender and nonbinary (TNB) adults which procedures from this list they knew could be performed by specially‐trained ENTs or SLPs for gender‐affirmation and which listed procedures they knew existed as gender‐affirming treatment before the survey. We assessed awareness of ENTs' and SLPs' ability for each procedure across gender identity using Fisher exact tests. We examined if demographic or socioeconomic factors were associated with the total number of gender‐affirming procedures participants knew ENTs or SLPs could perform using univariable linear regression. Results: TNB adults (N = 234) generally knew these procedures existed as gender‐affirming treatment (64%‐93%). However, TNB adults were largely unaware these gender‐affirming procedures could be performed by specially‐trained ENTs or SLPs (53% or less), especially procedures unrelated to the voice, neck, and nose (26% or less). Knowledge of ENTs' and SLPs' ability was similar across gender identity for most procedures. Total number of procedures known that ENTs or SLPs could perform did not differ by demographic/socioeconomic factors (p >.05). Conclusion: These findings suggest transgender and nonbinary individuals may not know to seek Otolaryngologists or SLP when desiring gender‐affirming face, neck, or voice care. Increased efforts are needed to promote awareness of Otolaryngology's role in providing gender‐affirming care. Level of Evidence: 4. [ABSTRACT FROM AUTHOR]