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Studies have shown that poverty and income are powerful predictors of homicide and violent crime. We hypothesized that the effect of the growing gap between the rich and poor is mediated through an undermining of social cohesion, or social capital, and that decreased social capital is in turn associated with increased firearm homicide and violent crime. Social capital was measured by the weighted responses to two items from the U.S. General Social Survey: the per capita density of membership in voluntary groups in each state; and the level of social trust, as gauged by the proportion of residents in each state who believed that 'most people would take advantage of you if they got the chance'. Age-standardized firearm homicide rates for the years 1987-1991 and firearm robbery and assault incidence rates for years 1991-1994 were obtained for each of the 50 U.S. states. Income inequality was strongly correlated with firearm violent crime (firearm homicide, r = 0.76) as well as the measures of social capital: per capita group membership (r = -0.40) and lack of social trust (r = 0.73). In turn, both social trust (firearm homicide, r = 0.83) and group membership (firearm homicide, r = -0.49) were associated with firearm violent crime. These relationships held when controlling for poverty and a proxy variable for access to firearms. The profound effects of income inequality and social capital, when controlling for other factors such as poverty and firearm availability, on firearm violent crime indicate that policies that address these broader, macro-social forces warrant serious consideration. [ABSTRACT FROM AUTHOR]

We examined the status of women in the 50 American states in relation to women's and men's levels of health. The status of women in each state was assessed by four composite indices measuring women's political participation, economic autonomy, employment and earnings, and reproductive rights. The study design was cross-sectional and ecologic. Our main outcome measures were total female and male mortality rates, female cause-specific death rates and mean days of activity limitations reported by women during the previous month. Measures of women's status were strikingly correlated with each of these health outcomes at the state level. Higher political participation by women was correlated with lower female mortality rates (r = -0.51), as well as lower activity limitations (-0.47). A smaller wage gap between women and men was associated with lower female mortality rates (-0.30) and lower activity limitations (-0.31) (all correlations, P < 0.05). Indices of women's status were also strongly correlated with male mortality rates, suggesting that women's status may reflect more general underlying structural processes associated with material deprivation and income inequality. However, the indices of women's status persisted in predicting female mortality and morbidity rates after adjusting for income inequality, poverty rates and median household income. Associations were observed for specific causes of death, including stroke, cervical cancer and homicide. We conclude that women experience higher mortality and morbidity in states where they have lower levels of political participation and economic autonomy. Living in such states has detrimental consequences for the health of men as well. Gender inequality and truncated opportunities for women may be one of the pathways by which the maldistribution of income adversely affects the health of women. [ABSTRACT FROM AUTHOR]

Background: Exploring the perceptions of underrepresented in medicine (URiM) students about the medical education curriculum and learning environment could optimize their education outcomes. The current study delineated perceptions of URiM medical students about the unique elements and characteristics of an impactful medical education program that create a positive, supportive learning environment culture., Methods: We conducted in-depth interviews with 15 URiM students between January 2018 and April 2018. Interviewees were recruited from an accredited medical education program in Historically Black Colleges and Universities (HBCUs). The University is also a member of the Hispanic Association of Colleges and Universities in the U.S. The main question that guided the study was, "What do URiM students at a Historically Black Colleges and Universities (HBCU) medical school believe would make a medical education program (MEP) impactful?" We used the grounded theory analytical approach and performed content analysis via qualitative thematic evaluation., Results: Of 112 enrolled medical students (MS), 15 verbally consented to participation. We identified four general themes and several subthemes. The themes include 1) Grounding learning in the community; 2) Progressive system-based practice competency; 3) Social justice competency and 4) Trauma-informed medical education delivery. Theme 1 included the following subthemes (a) community engagement, and (b) student-run clinic, mobile clinic, and homeless clinic rotations. Theme 2 includes (a) interprofessional learning and (b) multidisciplinary medicine for cultivating a 'just' healthcare system. Theme 3 includes (a) longitudinal social justice curriculum, (b) advocacy, and (c) health disparity research. Theme 4 had the following subdomains (a) early and ongoing mentoring and (b) provision of supportive policies, services and practices to maximize learning and mental health., Conclusion: Our learners found that social justice, trauma-informed, community-based curricula are impactful for URiM learners. These findings highlight the need for further research to assess the impact of permeating the championship culture, community cultural wealth, and transformational education in all aspects of the MEP in providing a supporting and positive learning environment for URiM students., (© 2022. The Author(s).)

Local face-to-face provider training has the benefit of enabling participants to network with people in their communities who are working on similar issues, to engage in interactive discussions, and to learn from local experts and local program examples. However, face-to-face training has considerable costs (labor and expense) and provides limited exposure to national experts. In recent years, technology has allowed training methods to expand to include distance learning methods (satellite and web-based). The newer methods can decrease per-person training costs, provide exposure to national experts, and result in wide dissemination of information. Yet these distance learning methods often limit the ability of participants to interact and network with each other and substantially reduce opportunities to apply the learning objectives to local circumstances. To maximize the benefits of both models, the Harvard School of Public Health, the Prevention Institute, and the Education Development Center developed, implemented, and evaluated Partnerships for Preventing Violence (PPV), an innovative six-part satellite training series on the public health approach to preventing youth violence. Using a unique hybrid methodology that combines satellite training with local, face-to-face facilitation by trained experts, PPV trained over 13,000 people, generated youth violence prevention activities across the country, and created a national cadre of youth violence prevention leaders.

This study tests the hypothesis that disparities of hypertension risk in African Americans is related to lead exposure, perceptions of racism, and stress, among urban (Roxbury, MA) and rural (Gadsden, FL) communities. Analysis of preliminary data from Phase I reveal 60% in Gadsden and 39% in Roxbury respondents self-reported having hypertension. In Gadsden 80% people did not know if their residence contained lead paint, compared to 45% in Roxbury. In Gadsden County, 58% of respondents reported experiencing racial discrimination in different settings compared with 72% in Roxbury. In regression analyses high cholesterol emerged as a significant predictors of hypertension in Gadsden County (OR=8.29, CI=1.4-49.3), whereas monthly household income (OR=0.15, CI=0.04-0.7) and diabetes (OR=6.06, CI=1.4-26.17) were significant predictors of hypertension in Roxbury after adjusting for other covariates. These preliminary findings set the stage for initiating Phase II (Phase I continues recruitment), that entail biological marker measurements to rigorously test main hypothesis.

Eliminating racial and ethnic disparities in health status and health care, a major focus of Healthy People 2010, remains on the national agenda and among the priorities for the administration of President George W. Bush. Even though the elimination of racial and ethnic health disparities challenges the whole nation, individual states are on the front line of many initiatives and are often the focus of important policy efforts. In addition, it is important to focus on states because they are already responsible for much of the health and public health infrastructure, and several states have developed initiatives dating back to the release of Margaret Heckler's report on the gaps in health outcomes by race in 1985. This article makes the case for an outcome-oriented approach and provides a summary of lessons learned based upon preliminary investigations into constructing and applying two indices, the disparity reduction profile to measure effort and the disparity index to measure outcomes.

Approximately 16.4 million people in the United States have been affected by homicide. Five million adults have experienced the murder of an immediate family member; 6.6 million people have experienced the murder of a relative other than a family member, and 4.8 million have experienced the murder of a close friend. These homicide survivors experience a variety of difficulties, some similar to post-traumatic stress disorder (PTSD). The large incidence of homicide in the U.S. warrants an examination of the research on the impact of a murder on a victim's friends and family and the implications for healthcare providers. Homicide survivors experience negative psychological and physical effects that often result in an increase in the usage of primary care services. Provider training should include protocols to screen for, discuss, and make referrals for the family and friends of homicide victims. This article recommends the development of a training program to equip providers with the tools to recognize and serve this growing population of patients.

A state minority health policy report card may provide an important tool for evaluating and promoting state policies to reduce health disparities. This study develops criteria that can form the basis of such a state report card and assesses the performance of all fifty states on these measures. The results indicate wide variation among states, with geographic region being a significant predictor of performance on all four measures. Future research should be conducted on other predictors of state variation in minority health policy and connections between state policy and health outcomes for minorities.

Objectives: A growing number of studies have documented the deleterious health consequences of the experience of racial discrimination in African Americans. The present study examined the association of racial prejudice--measured at a collective level--to black and white mortality across the United States., Methods: Cross-sectional ecologic study, based on data from 39 states. Collective disrespect was measured by weighted responses to a question on a national survey, which asked: "On the average blacks have worse jobs, income, and housing than white people. Do you think the differences are: (A) Mainly due to discrimination? (yes/no); (b) Because most blacks have less in-born ability to learn? (yes/no); (c) Because most blacks don't have the chance for education that it takes to rise out of poverty? (yes/no); and (d) Because most blacks just don't have the motivation or will power to pull themselves up out of poverty? (yes/no)." For each state, we calculated the percentage of respondents who answered in the affirmative to the above statements. Age-standardized total and cause-specific mortality rates in 1990 were obtained for each state., Results: Both measures of collective disrespect were strongly correlated with black mortality (r = 0.53 to 0.56), as well as with white mortality (r = 0.48 to 0.54). A 1 percent increase in the prevalence of those who believed that blacks lacked innate ability was associated with an increase in age-adjusted black mortality rate of 359.8 per 100,000 (95% confidence interval: 187.5 to 532.1 deaths per 100,000)., Conclusions: These data suggest that racism, measured as an ecologic characteristic, is associated with higher mortality in both blacks and whites.

Violence is exacting an increasingly heavy toll on individuals across the country, causing a marked rise in fear and frustration. However, historical attempts to address violence have been both episodic and inconsistent. There has not been a comprehensive and coordinated, prevention-oriented approach. Many law enforcement experts now agree that violence must be met with solutions from disciplines other than law enforcement, those of public health included. These experts acknowledge that social conditions such as family stability, education, and other societal institutions directly affect the behavior of juveniles and thereby the safety of communities. No single strategy, institution, or discipline can create the changes needed to reduce violence in America. Preventing violence demands not only a long-term commitment but a comprehensive set of strategies and new partnerships. These combined efforts must focus on prevention and not solely on aggressive responses to violence.

Some of the factors associated with such violence, notably racism and poverty, clearly demand societal solutions. Other factors, however, may respond to public health intervention strategies. Emergency room workers can practice secondary intervention, as they do with victims of child abuse, sexual assault, or attempted suicide. Family physicians can refer adolescents for appropriate help.

The Violence Prevention Project is a community-based outreach and education project directed toward reducing the negative social and medical outcomes of violence among adolescents. Community agency personnel are trained to work with youth on issues of anger and conflict resolution. A mass media campaign advertises the issue to the broader population. Interventions, such as the Violence Prevention Project, can use the public health strategies to increase awareness of the problem and associated risk factors, provide alternative conflict resolution techniques, and generate a new community ethos around violence. This approach holds great promise in an area in which after-the-fact legislative and punitive interventions have not worked.

Violence and its consequences are a major issue to be addressed by the health care community. The magnitude and characteristics of the problem cry out for new, creative approaches and provide for some insight into the direction that needs to be taken. Some of the components related to violence are societal in scope and will require long-term strategies well beyond the immediate realm of the health care system. Others provide direction that more clearly present a role for health providers and public health planners. Although there will be no easy answers or solutions to this problem, it is essential that support be developed for experimental efforts. The health community cannot ignore this problem and can in fact make a real contribution to its resolution through prevention, treatment, and research.