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Health equity is fundamental to improving the health of populations, but in recent decades progress towards this goal has been mixed. To better support this mission, a deeper understanding of the local heterogeneity within population-level health equity is vital. This analysis presents trends in average health and health equity in the United States at the local level from 1990 to 2019 using three different health outcomes: mortality, self-reported health status, and healthy days. Furthermore, it examines the association between these measures of average health and health equity with several structural factors. Results indicate growing levels of geographic inequality disproportionately impacting less urbanized parts of the country, with rural counties experiencing the largest declines in health equity, followed by Medium and Small Metropolitan counties. Additionally, lower levels of health equity are associated with poorer local socioeconomic context, including several measures that are proxies for structural racism. Altogether, these findings strongly suggest social and economic factors play a pivotal role in explaining growing levels of geographic health inequality in the United States. Policymakers invested in improving health equity must adopt holistic and upstream approaches to improve and equalize economic opportunity as a means of fostering health equity.

IntroductionOlder adults racialized as Black experience higher rates of dementia than those racialized as White. Structural racism produces socioeconomic challenges, described by artist Marvin Gaye as "hang ups, let downs, bad breaks, setbacks" that likely contribute to dementia disparities. Robust dementia literature suggests socioeconomic factors may also be key resiliencies.MethodsWe linked state-level data reflecting the racialized landscape of economic opportunity across the 20th Century from the U.S. Census (1930-2010) with individual-level data on cognitive outcomes from the U.S. Health and Retirement Study participants racialized as Black. A purposive sample of participants born after the Brown v. Board ruling (born 1954-59) were selected who completed the modified Telephone Interview for Cognitive Status between 2010 and 2020 (N=1381). We tested associations of exposure to structural racism and resilience before birth, and during childhood, young-adulthood, and midlife with cognitive trajectories in mid-late life using mixed-effects regression models.ResultsOlder adults born in places with higher state-level structural socioeconomic racism experienced a more rapid cognitive decline in later life compared to those with lower levels of exposure. In addition, participants born in places with higher levels of state-level structural socioeconomic resilience experienced slower cognitive change over time than their counterparts.DiscussionThese findings reveal the impact of racist U.S. policies enacted in the past that influence cognitive health over time and dementia risk later in life.

We examine whether the COVID-19 pandemic was associated with changes to daily activity limitations due to poor physical or mental health and whether those changes were different within and between gendered and racialized groups. We analyze 497,302 observations across the 2019 and 2020 waves of the Centers for Disease Control and Prevention Behavioral Risk Factor Surveillance System survey. Among White men and women, the COVID-19 pandemic was associated with fewer days of health-related activity limitations and decreased frequent activity limitation (≥14 days in the past month) compared to the prepandemic period. By contrast, Latina and Black women experienced increased days of activity limitation and greater likelihood of frequent activity limitation, and these changes were significantly different than for White women. These findings are robust to the inclusion of structural inequality measures and demonstrate how systemic racism and sexism likely exacerbate a myriad of pandemic-related health problems.

This article stemmed from an acceptance speech for the Global Alliances' 2022 Presidential Award made by Dr. Gail Christopher and her daughter, Heather McGhee. Heather McGhee is a New York Times best-selling author of the book The Sum of Us: What Racism Costs Everyone and How We Can Prosper Together. The history, transformative impact, and importance of the truth, racial healing, and transformation movement in exposing and eradicating the fallacy of a hierarchy of human value are outlined. Dr. Christopher shares insights into the past and provides hope for the future through her Rx Racial Healing model for authentic storytelling and changes in perspective. The article also discusses the momentum of public health jurisdictions declaring racism as a public health crisis and presents a resource, Healing Through Policy: Creating Pathways to Racial Justice, that has been developed to assist jurisdictions in related work. Public Policy Relevance Statement: A persistent individual and collective belief in racial hierarchy fuels discrimination and inequities in immigration, criminal justice, legal, and health systems. Systems transformation requires eliminating this core belief while redressing the harms it has caused. Transformation also requires implementing sustainable policies to assure equitable opportunities. [ABSTRACT FROM AUTHOR]

The objective of this study was to determine whether exposure to structural racism–related state laws is associated with cardiovascular health among a racially and ethnically diverse sample of US adults. Data were from the Database of Structural Racism–Related State Laws and the Behavioral Risk Factor Surveillance System (BRFSS). The sample included 958 019 BRFSS 2011 and 2013 respondents aged 18 years or older from all 50 US states. The exposure was a summary index of 22 state laws related to the criminal legal system, economics and labor, education, health care, housing, immigration, and political participation. The outcome was the American Heart Association's Life's Simple 7 (LS7), a summary index of 7 cardiovascular health indicators. Linear regression models included fixed effects for year and state to control for time trends and unmeasured, time-invariant, state-level contextual factors. In the full sample, a 1 SD increase in the structural racism state legal index was associated with a 0.06-unit decrease in the LS7 (b = −0.06; 95% CI, −0.09 to 0.02; P  = .001), controlling for individual- and state-level covariates. Contrary to expectations, stratified models revealed no statistically significant differences by race and ethnicity in the association between the structural racism state legal index and the LS7. [ABSTRACT FROM AUTHOR]

While structural racism has profound impacts on adolescent health, little is known about how youth synthesize racialized experiences and work to dismantle systems of oppression. This article provides an overview of a Youth Participatory Action Research study that used Photovoice and community mapping to explore how structural violence, like racism, impacts the sexual and reproductive health of historically excluded youth as they navigate unjust socio-political landscapes. Youth participants used photography and community maps to identify how the experience of bias, profiling, and tokenism impacted their ability to navigate complex social systems. With youth voices prioritized, participants explored ways to address structural racism in their lives. The importance of co-creating opportunities with and for youth in critical reflection of their lived experience is emphasized. Through an Arts and Cultural in Public Health framework, we provide an analysis of the ways structural racism functions as a gendered racial project and fundamental cause of adolescent sexual and reproductive health inequities, while identifying pathways toward liberation in pursuit of health and well-being. [ABSTRACT FROM AUTHOR]

This article examines the possibilities and limitations of ethnoeducation for an anti-racist pedagogical practice. It is based on the study of an elementary school in the Colombian city of Cali. Though severe racial discrimination is naturalised in Colombian educational institutions, the school chosen for this study implements a different educational project based on the valorization of Afrocolombian and Indigenous cultures. The study reveals that the implementation of such an educational project enables the students to acquire basic racial literacy and question overt forms of racial discrimination. However, implicit forms of racial bias and internalized racism persist. In that context, we argue that a comprehensive anti-racist educational praxis needs to emphasise the denaturalisation of internalised forms of racism and the visibilization of the structural aspects of racism. As racism has multiple dimensions, it is necessary to design specific pedagogic strategies to address each one of them. [ABSTRACT FROM AUTHOR]

This commentary highlights a need for comprehensive measures of structural racism tailored to cancer health disparities, in particular Black–White disparities in multiple myeloma (MM). Recent political and social calls and advances in the ability to quantitate structural racism have led to rapidly growing research on the health consequences of structural racism. However, to date, most studies have used unidimensional measures of structural racism that do not capture cumulative influences or enable the identification of factors most responsible for driving disparities. Furthermore, measures may not reflect aspects of structural racism most relevant to underlying disease processes and risks. This study proposes a multifaceted approach to measuring structural racism relevant to MM that includes comprehensive, disease‐ and at‐risk population‐tailored social and environmental data and biomarkers of susceptibility and progression related to underlying biological changes associated with structural racism. Such novel measures of structural racism may improve the ability to assess the influence of structural racism on cancer health disparities, which may advance understanding of disease etiology and differences observed by racialized groups. This commentary highlights a need for comprehensive measures of structural racism tailored to cancer health disparities, in particular Black–White disparities in multiple myeloma. Novel, tailored measures of structural racism may advance understanding of disease etiology and differences observed by racialized groups. [ABSTRACT FROM AUTHOR]

This article explores the experiences of First Nations participants as the #BlackLivesMatter protests burst onto Australian mainstream and social media platforms and onto Australian streets in 2020. We explore First Nations participants' perceptions about the significance and relevance of #BlackLivesMatter in Australia to support First Nations existing political campaigns to address structural racism and settler colonialism in the Australian context. We consider the twin structures of racism and settler colonialism to comparatively analyse the historical experiences of First Nations, in Australia and the US, and Black people in the US in an effort to understand convergences and divergences in the contemporary activist imperatives and aspirations of each group. We conclude by acknowledging that while #BlackLivesMatter activism does have the potential to productively complement First Nations anti-racism activist imperatives and aspirations, it falls short of addressing First Nations anti-colonial imperatives and aspirations. [ABSTRACT FROM AUTHOR]

It is well-recognised in human rights law and discourse that the Roma community is one of the most 'vulnerable' groups in Europe today, but what remains less developed is why and how the Roma are recognised as vulnerable, and what 'Roma vulnerability' means. This article posits that a structural account of Roma vulnerability may help in answering these questions. Such a structural account captures the vulnerability of Roma in the past and the present, as taking economic and cultural forms, spread across laws, policies, and actions, and fundamentally linked to the role of the State. The European Court of Human Rights (ECtHR) is, however, yet to acknowledge the structural nature of Roma vulnerability. Without such a structural engagement, there is a risk that human rights violations committed by the State will go unaddressed. The article thus seeks to introduce this structural account in the Court's jurisprudence to better capture the nature, causes, and extent of the vulnerability experienced by the Roma community. [ABSTRACT FROM AUTHOR]

The lasting health and social effects of the US federal housing policies that created racial residential segregation have been substantial. We aim to evaluate the association between three dimensions of residential segregation (i.e., evenness, exposure, and concentration) and the Framingham 30-year cardiovascular (CVD) risk score. Using the Longitudinal Study of Adolescent to Adult Health, we examined the extent to which three features of Wave I residential segregation were associated with Wave IV Framingham 30-year CVD risk score using separate General Estimating Equation models that accounted for the complex clustered study design. We also examined differences in the associations by race (i.e., non-Hispanic Black and non-Hispanic White). For each exposure, we ran unadjusted covariate adjusted, and a covariate adjusted model containing an interaction between race and the segregation measure. We observed that none of the residential segregation measures were associated with 30-year CVD risk. However, we observed a statistically significant interaction between race and the Black vs. White Index of Concentration of Extremes, whereby segregation was associated with an 8% higher CVD risk among Black participants and a 3% lower CVD risk among White participants. This research suggests that Black young adults residing in communities that have a higher concentration of White residents is harmful to their cardiovascular health, while it is beneficial for White residents. These findings are consistent with the existing literature on harmful effects of structural racism on CVD outcomes and specific CVD risk factors. [ABSTRACT FROM AUTHOR]

Background: The circumstances surrounding chronic kidney disease and its impact on families can be complex and difficult to navigate, leading to these cases being labeled "challenging." Case presentation: We present the case of an adolescent with kidney failure due to unremitting systemic illness and multiple complications ultimately resulting in the family's request to forgo dialysis. Medical team members wrestled with meeting the family's needs among internal and external constraints. Conclusion: Past experiences, systemic inequities, differing perspectives, and consequential decision-making within individual belief systems can lead to friction between and among medical team members and families. As pediatric nephrologists, we must shift our focus from the "challenging" patient or family to addressing what is challenging their ability to flourishing. [ABSTRACT FROM AUTHOR]

In this manuscript, we take up the invitation by the editors of this special issue to contribute to answering the question: "What does it mean to write qualitatively?" Drawing on speculative realism, we describe writing qualitatively as a relational process of becoming through writing and reading creative nonfiction. We reflect on our experiences as researchers, subjects, collaborators, writers, and readers through lens of relational power. By collaborating to craft an immersive true story that revealed larger truths to readers, we were affected by each other, created ourselves out of what we had taken in, and influenced each other and others after being affected by them in our processes of relational becoming. [ABSTRACT FROM AUTHOR]

The widely acknowledged rating system of the Federal Homeowners' Loan Corporation (HOLC) was a relative measure of pre-1940 racist practices in residential real estate activities in large United States central cities. It was not an assessment that guided HOLC or later Federal Housing Administration (FHA) mortgage lending practices. The research question examined here is whether a similar home in different HOLC-rated neighborhoods in the City of Sacramento (California) sold for a different price eight decades after receiving its HOLC grade. A hedonic regression result shows that homes in the two forms of lower-rated neighborhoods sold for about 13% less than those in the two forms of higher-rated neighborhoods. A Blinder-Oaxaca decomposition breaks down the average selling price difference of $195,000 between a home sold in HOLC green/blue compared to yellow/red rated neighborhoods. A third of this difference in home prices, which is not due to home characteristics, represents a starting measure of the legacy of discriminatory housing practices. The remaining two-thirds of the difference could be due to variations in current home characteristics also influenced by Pre-1940s discriminatory housing practices. These findings are relevant to understanding the contribution of past structural racism in the housing market to present inequalities. [ABSTRACT FROM AUTHOR]

Background: Traffic‐related air pollutants have been associated with a variety of adverse human health impacts, including cancers. In the United States, numerous studies have documented racial inequities in neighborhood exposures to traffic‐related air pollution. Emerging evidence suggests that structural racism may influence neighborhood exposures to air pollutants. However, existing research has largely focused on residential racial segregation, one indicator of structural racism. This study developed a multidimensional measure of structural racism to examine the relationship between structural racism and estimated cancer risk from air pollutants in Georgia. Methods: Carcinogenic air toxics data were obtained from the US Environmental Protection Agency's 2019 Air Toxics Screening Assessment and sociodemographic data from the American Community Survey. Guided by stakeholder input, county‐level data on residential segregation, education, employment, incarceration, economic status, political participation, and homeownership were used to create a multidimensional county‐level structural racism index. Relative risks (RRs) were estimated for associations between structural racism and elevated (top 10% in Georgia) estimated cancer risk from air toxics. Results: Multilevel analyses revealed a significant association between multidimensional structural racism and exposure to carcinogenic traffic‐related air pollutants. Neighborhoods in the highest quartile of structural racism exhibited an elevated cancer risk from traffic‐related air pollutants (RR, 7.84; 95% CI, 5.11–12.05) compared to neighborhoods with lower levels of structural racism. Conclusions: Multidimensional structural racism was associated with estimated cancer risk from traffic‐related air pollution in Georgia. Findings can inform future studies and policy interventions that address racial inequalities in exposure to traffic‐related air pollution. Significant associations were observed between high levels of structural racism and estimated cancer risk from traffic‐related air pollution. These findings can inform policy interventions that address racial inequalities in exposure to traffic‐related air pollution. [ABSTRACT FROM AUTHOR]

School racial segregation significantly affects racial disparities in US children's health. Recently, school segregation has been increasing, partially due to Supreme Court decisions since 1991 that have made it easier for school districts to be released from court-ordered desegregation. We investigated the association of the end of court-ordered desegregation with child health, using the 1997-2018 waves of the National Health Interview Survey (n = 8182 Black children; n = 16 930 White children). We exploited quasi-random variation in the timing of school districts' releases from court orders to estimate effects on general health, body weight, mental health, and asthma, using difference-in-differences and event-study methods (including traditional and heterogeneity-robust estimators). Heterogeneity-robust difference-in-differences analyses show that release was associated with increased school segregation, improved mental health among Black children, and better self-reported health among White children. For heterogeneity-robust event-study analyses, school segregation increased steadily over time after release, with worse self-reported health and higher risk of asthma episodes among Black children aged 18 years or older after release. Black children's mental health temporarily improved in the short term. In contrast, White children had improved self-reported health, mental health, and risk of asthma episodes in some years. Interventions to address the harms of school segregation are important for reducing racial health inequities. [ABSTRACT FROM AUTHOR]

Youth interpersonal firearm violence disproportionately affects Black youth, with residential racial segregation as a key determinant. Racially segregated neighborhoods, which are economically isolated (e.g., neighborhood disadvantage), are linked to increased exposure to violence. This exposure, in turn, is a determinant of youth firearm aggression (i.e., using a gun on someone else). Mechanisms from residential racial segregation to firearm aggression, however, have not been evaluated. Therefore, we tested neighborhood disadvantage and exposure to violence as mediators in the association between residential racial segregation and youth firearm aggression. Participants were 338 Black youth who had used drugs in the past 6 months and sought care in an urban emergency department. Using serial mediation analysis, residential racial segregation was indirectly associated with youth firearm aggression via neighborhood disadvantage and then exposure to violence. While researchers have documented the association between structural racism and firearm violence injury and incidents, our study assessed multiple socioecological mechanisms simultaneously. Identifying the downstream socioecological consequences of residential segregation can guide the development of firearm aggression prevention programs addressing the consequences of racism. [ABSTRACT FROM AUTHOR]

Background: Despite higher breast cancer screening rates, black women still are more likely to have late-stage disease diagnosed. This disparity is influenced in part by structural and interpersonal racism. This prospective study sought to determine how interpersonal factors, including perceived discrimination, influence screening and stage of disease at diagnosis. Methods: A prospective cohort study analyzed adult women with stages I to IV breast cancer from the Miami Breast Cancer Disparities Study. Perceived discrimination and mistrust of providers were assessed using previously validated questionnaires. Multivariable logistic regression was used to evaluate the odds of screening mammography utilization and late-stage breast cancer at diagnosis. Results: The study enrolled 342 patients (54.4 % Hispanic, 15.8 % white, and 17.3 % black). Multivariate regression, after control for both individual- and neighborhood-level factors, showed that a higher level of perceived discrimination was associated with greater odds of late-stage disease (adjusted odds ratio [aOR], 1.06; range, 1.01–1.12); p = 0.022) and lower odds of screening mammography (aOR, 0.96; range, 0.92–0.99; p = 0.046). A higher level of perceived discrimination also was negatively correlated with multiple measures of provider trust. Discussion: This study identified that high perceived level of discrimination is associated with decreased odds of ever having a screening mammogram and increased odds of late-stage disease. Efforts are needed to reach women who experience perceived discrimination and to improve the patient–provider trust relationship because these may be modifiable risk factors for barriers to screening and late-stage disease presentation, which ultimately have an impact on breast cancer survival. [ABSTRACT FROM AUTHOR]

There are wide racial disparities in lung cancer incidence, treatment, and outcomes. Previous studies have shown the impact of structural racism and the built environment on lung cancer outcomes in Black communities. The current study sought to understand the mediation of airborne pollutants between racial segregation and lung cancer incidence in the United States. Lung cancer incidence data for Black/white populations from 2014 to 2018 were obtained from the CDC. We assessed the impact of segregation on lung cancer incidence and the mediating effects of pollutants SO2, NO2, PM2.5, O3, and CO in the pathway. We estimated the indirect effect of each pollutant on the interaction between segregation and cancer outcomes. We found that segregation was associated with an 11% increase in lung cancer incidence among Black individuals (IRR 1.11, 95%CI 1.08,1.14) and a 7% increase in white lung cancer incidence (IRR 1.07, 95%CI 1.05,1.09). For Black lung cancer rates, this effect was mediated by SO2/ NO2 (23%), PM2.5 (9.2%), and smoking (36%). For white lung cancer rate, the effect was mediated through SO2/ NO2 (25%), PM2.5 (15%), O3/CO (4%), and smoking (37.4%). Air pollution is an important mediating factor on lung cancer incidence in more segregated areas, suggesting that the increased pollution in more segregated areas likely also affects white residents, leading to higher levels of lung cancer compared to their counterparts in less segregated areas. Policies targeting polluting sources in segregated areas will be important in reducing lung cancer incidence and disparities therein. [ABSTRACT FROM AUTHOR]

Historical mistreatment of Black persons in research settings has had lasting impacts on their recruitment into present-day studies. A medical student recruited Black individuals for a qualitative study aiming to improve the experiences of Black patients treated in a psychiatric emergency department of a large tertiary care setting. The lessons learned, including the nuanced power dynamics present when a Black student is recruiting Black patients, highlight opportunities for addressing racial inequities through empowerment of the Black community and for requiring investigators to create racially conscious recruitment plans. [ABSTRACT FROM AUTHOR]

Achieving health equity in populations with congenital heart disease (CHD) requires recognizing existing disparities throughout the lifespan that negatively and disproportionately impact specific groups of individuals. These disparities occur at individual, institutional, or system levels and often result in increased morbidity and mortality for marginalized or racially minoritized populations (population subgroups (e.g., ethnic, racial, social, religious) with differential power compared to those deemed to hold the majority power in the population). Creating actionable strategies and solutions to address these health disparities in patients with CHD requires critically examining multilevel factors and health policies that continue to drive health inequities, including varying social determinants of health (SDOH), systemic inequities, and structural racism. In this comprehensive review article, we focus on health equity solutions and health policy considerations for minoritized and marginalized populations with CHD throughout their lifespan in the United States. We review unique challenges that these populations may face and strategies for mitigating disparities in lifelong CHD care. We assess ways to deliver culturally competent CHD care and to help lower-health-literacy populations navigate CHD care. Finally, we review system-level health policies that impact reimbursement and research funding, as well as institutional policies that impact leadership diversity and representation in the workforce.

Abstract Aims Racial disparities exist in clinical outcomes for valvular heart disease (VHD). It is unknown whether clinician segregation contributes to these disparities. Among an adequately insured population, we evaluated the relationship between clinician segregation in a hospital and receipt of care by a cardiologist according to patient race. We also evaluated the association between clinician segregation, race and care by a cardiologist on 30‐day readmission and 1‐year survival. Methods and results Using Optum's Clinformatics® Data Mart Database (CDM, US commercial and Medicare beneficiaries) from 2010 to 2018, we identified patients with a primary diagnosis of VHD. Hospitals were categorized into low, medium and high segregation groups (SG), according to clinician segregation index (SI). SI can range from 0–1 (0: the ratio of Black to White patients is the same for all clinicians; 1: each clinician treats only Black or only White patients). Outcomes were analysed using generalized linear mixed effect models. Among 8649 patients [median age 75 (67–82), 45.4% female, 16.1% Black, 83.9% White], odds of care from a cardiologist did not vary across race for all SGs [Low SG adjusted odds ratio (aOR): 0.79 (95% CI: 0.58–1.08), P = 0.14; Medium SG aOR: 0.86 (95% CI: 0.60–1.25), P = 0.43; High SG aOR: 1.07 (95% CI: 0.68–1.69), P = 0.76]. Among those that received care from a cardiologist, there was no difference in the 30‐day readmission between Black and White patients across SGs [Low SG aOR: 1.05 (95% CI: 0.83–1.31), P = 0.70; Medium SG aOR: 1.22 (95% CI: 0.92–1.61), P = 0.17; High SG aOR: 0.81 (95% CI: 0.57–1.17), P = 0.27]. Among patients that did not receive care from a cardiologist, Black patients in low SG had higher odds of 30‐day readmission compared to White patients [aOR: 2.74 (95%CI:1.38–5.43), P

Abstract Across the United Kingdom, medical schools are acknowledging the need to respond to inequalities experienced by minority groups, racism within healthcare, and the need to decolonise medical curricula. Understanding the impact of structural racism is increasingly recognised as part of health professionals’ training. In this paper we report the delivery of a new lecture and workshop on racism to first year medical students at Hull York Medical School, aimed to teach students about structural racism and the impact it has on health and healthcare services. Whereas comparable training programmes focus on personal values of inclusivity and diversity, these sessions encourage students to consider the reality of racism as part of health and healthcare experiences. The session includes conceptual content alongside applied examples of microaggression experienced by a healthcare professional. We report the results of student feedback attained through surveys using Likert scales and free text. We conclude by discussing the benefits of teaching medical students about racism, and its impact on patients and staff, rather than just inclusive practice.

Structural racism and the ongoing modern-colonizing project in Latin America would not be the same without the contributions of Modern Western Science. Contradictorily, it is also through the sciences — especially social sciences — that colonialities have been challenged. Inspired by decolonial criticism, we tell the life story of Waxihô Karajá, an indigenous Karajá Xambioá man who entered and abandoned a Biology course. The results illustrate how Iny indigenous education contributed to the development of Waxihô Karajá's interest in Biology. Our analysis also reveals that the low quality of basic education offered in indigenous communities; the unpreparedness of higher education institutions to receive diversity; the difficulties experienced by young people with low-education backgrounds and the energy expended by cultural minorities to combat a myriad of colonial violences through student activism can compromise academic success. Results indicate that the approach and the departure from natural science courses by young indigenous people seem to have reasons that are sometimes similar and sometimes different from those listed in the research with young people from the national society. There is an urgent need to reorient university retention policies to promote the academic success of indigenous students in natural sciences courses.

Across the United Kingdom, medical schools are acknowledging the need to respond to inequalities experienced by minority groups, racism within healthcare, and the need to decolonise medical curricula. Understanding the impact of structural racism is increasingly recognised as part of health professionals' training. In this paper we report the delivery of a new lecture and workshop on racism to first year medical students at Hull York Medical School, aimed to teach students about structural racism and the impact it has on health and healthcare services. Whereas comparable training programmes focus on personal values of inclusivity and diversity, these sessions encourage students to consider the reality of racism as part of health and healthcare experiences. The session includes conceptual content alongside applied examples of microaggression experienced by a healthcare professional. We report the results of student feedback attained through surveys using Likert scales and free text. We conclude by discussing the benefits of teaching medical students about racism, and its impact on patients and staff, rather than just inclusive practice. [ABSTRACT FROM AUTHOR]

Background: Despite the potential for community health worker (CHW)-led programs to improve the health of people with justice involvement (PWJI), little is known about the practical implementation of such models. We explored barriers and facilitators to implementation of a municipal CHW program, the Health Justice Network (NYC HJN), led by the New York City Department of Health and Mental Hygiene (DOHMH) in partnership with three reentry-focused community-based organizations (CBOs) and three federally qualified health centers (FQHCs) that was designed to serve the health and social service needs of PWJI. Methods: Eighteen in-depth qualitative interviews were conducted with a purposive sample of CHWs, partner site supervisors, and DOHMH staff. Interviews were conducted virtually and transcribed verbatim. Codes and themes were developed using the Consolidated Framework for Implementation Research (CFIR) to understand facilitators and barriers to NYC HJN implementation. Results: Important facilitators to implementation included: lived experience of CHWs, as well as NYC HJN's voluntary nature, lack of onerous eligibility criteria, and prioritization of participant needs. One barrier was the lack of a formal implementation protocol. Themes identified as facilitators in some instances and barriers in others were CHW integration into site partners, the expansive scope of work for CHWs, the integration of a trauma-informed approach, values alignment and existing infrastructure, leadership engagement, CHW training and support, and input, feedback, and communication. Conclusions: Findings will help inform how to successfully implement future CHW-led interventions for PWJI with municipal, health, and social service partners. [ABSTRACT FROM AUTHOR]

• There is a persistent need to address structural racism in developmental science. • Developmental researchers need more tools to operationalize structural racism. • Child exposures to neurotoxicants occur through structurally racist mechanisms. • System dynamics (SD) can illuminate complex social structures and their mechanisms. • This is an opportunity to integrate environmental health and developmental sciences. Current approaches to identifying the impacts of structural racism on human development focus on downstream consequences or developmental outcomes rather than the upstream processes that create and perpetuate those negative consequences. Yet, the hallmarks of complex problems like structural racism include feedback relationships linking factors, path dependence, dynamics, non-linear effects, time delays, counterintuitive, and policy resistance. Pollutant exposures and their resulting deleterious effects on child health and development are among the downstream effects of structural racism. System dynamics modeling, a branch of systems science, provides developmental and environmental researchers with approaches to analyze complexity and integrate evidence from multiple disciplines through a common language and visualization of systems of structural racism. In this commentary, we introduce core tenets of system dynamics modeling as means of delineating the institutional and structural processes of environmental racism from the measurable consequences to child development; highlight specific implications of system dynamics modeling for developmental sciences; use the ongoing environmental health crisis in Flint, MI as a case example of how system dynamics modeling can be used to examine the impacts of structural racism on child development. [ABSTRACT FROM AUTHOR]

In the U.S., inequities by race/ethnicity in health outcomes, such as in the HIV epidemic, are long standing but have come to the forefront during the COVID-19 pandemic. There is growing recognition of the role of structural racism in racialized health inequities, yet the conceptualization and operationalization of structural racism in HIV research lags. We conducted a scoping review of existing published literature, between 1999–April 2024, conceptualizing and measuring structural racism's impact among people living with or at risk for HIV in the U.S. Our initial search yielded 236 unique articles, which after title and abstract screening yielded ten articles meeting full text review criteria. We then extracted key parameters, such as conceptualization, method of measurement of structural racism, study aims, design, and findings. Three of the articles were qualitative studies that conceptualized structural racism using (1) the social network model, (2) individual and structural intersectionality and (3) critical race theory. Operationalization of structural racism within the seven quantitative studies fell into three categories: (1) structural level, (2) a scale of experiences of racism, including structural racism, and (3) using explanatory demographic factors as downstream measures of the effects of structural racism. The variance in the conceptualization and operationalization of structural racism highlights the different interpretations of structural racism in its applications to the field of HIV research. Given the vast racial/ethnic inequities in HIV, we propose three overarching suggestions for next steps in improving the conduct of research on structural racism in HIV: (1) we must prioritize measuring racism past the individual and interpersonal levels to consider systemic factors at a societal level that manifest as structural racism to improve HIV outcomes in the U.S., (2) consider intergenerational effects of structural racism through the use of longitudinal data, and (3) broaden the agenda of structural racism to incorporate other systems of oppression. Additionally, broadening the scope of funding and inclusion of more researchers and individuals with lived experiences to support structural racism research to drive the scientific agenda and design of structural-level interventions will not only bolster achieving the U.S. Ending the HIV Epidemic goals but will do so by addressing inequities. [ABSTRACT FROM AUTHOR]

The persistence of extreme suicide disparities in American Indian and Alaska Native (AI/AN) youth signals a severe health inequity with distinct associations to a colonial experience of historical and on-going cultural, social, economic, and political oppression. To address this complex issue, we describe three AI/AN suicide prevention efforts that illustrate how strengths-based community interventions across the prevention spectrum can buffer suicide risk factors associated with structural racism. Developed and implemented in collaboration with tribal partners using participatory methods, the strategies include universal, selective, and indicated prevention elements. Their aim is to enhance systems within communities, institutions, and families by emphasizing supportive relationships, cultural values and practices, and community priorities and preferences. These efforts deploy collaborative, local approaches, that center on the importance of tribal sovereignty and self-determination, disrupting the unequal power distribution inherent in mainstream approaches to suicide prevention. The examples emphasize the centrality of Indigenous intellectual traditions in the co-creation of healthy developmental pathways for AI/AN young people. A central component across all three programs is a deep commitment to an interdependent or collective orientation, in contrast to an individual-based mental health suicide prevention model. This commitment offers novel directions for the entire field of suicide prevention and responds to calls for multilevel, community-driven public health strategies to address the complexity of suicide. Although our focus is on the social determinants of health in AI/AN communities, strategies to address the structural violence of racism as a risk factor in suicide have broad implications for all suicide prevention programming. HIGHLIGHTS SECTION: Structural violence of racism and colonization are social determinants of suicide. Collaborative and power-sharing implementation strategies can disrupt oppression. Strengths-based collectivist strategies can buffer structural suicide risk. [ABSTRACT FROM AUTHOR]

This article reviews the changing Black family and households. The core theme is to understand the uniqueness of those single and living alone in the Black middle class—the "Love Jones Cohort"—and how their intersecting identities of race, class, gender, and singleness inform their lifestyle, shape how they manage life decisions, and their relationship to policy as well as family law and family court. This essay moves beyond the popularized and omnipresent inquiry: "Why are Black women not getting married?" or "Why are there so many single professional Black women?" This line of questioning throws the spotlight squarely on Black women's individual dating practices, while often ignoring structural factors that undergird those decision‐making processes. It implies that because of the individual actions of the Love Jones Cohort, specifically Black women, they are somehow at a deficiency if they are not married and child‐free, rendering them invisible as a family. This article discusses the legal implications of the presence of the Love Jones Cohort. Key points for the family court community: The concept of the family needs to be reframed, culturally and structurally, to include the growing number of persons who remain single and live alone.Living alone and single comes with personal freedoms and risks.Understand how structural factors constrain personal choices so that those single and living alone are not discriminated against in, family law, family court, and other legal matters.Adopt an intersectional lens to understand that singlehood looks differently for some people and is shaped by intersecting and marginalizing identities. [ABSTRACT FROM AUTHOR]

This study critically examines how police officers attribute racial disparities within the US criminal justice system. For this inquiry, the study used in-depth interviews with 65 police officers from 4 police departments in a midwestern county. The findings revealed that 17 of these police officers invoked structural explanations to account for racial disparities prevalent in the US. However, this apparent racial awareness prompted them to underscore the pervasiveness of racism beyond the realms of criminal justice. Consequently, they attributed racial inequities within the criminal justice system to structural racism entrenched in non-criminal justice institutions, thereby rationalizing the current policing institution. This finding highlights the efficacy of a non-binary notion of color-blind ideology to elucidate the flexible and adaptable cultural frameworks that sustain racial hierarchies. Moreover, it enriches the scholarship on racialized organizations, occupations, and work by discussing the ideological limits of change in fostering racial equity within an occupation. [ABSTRACT FROM AUTHOR]

Introduction. Undocumented migrants live in a state of social, legal, and political invisibility, which affects their mental health while hindering their access to health services. It is therefore essential to understand which situations are linked to their emotional discomfort and how they cope with it. Objective. To explore the sources of emotional discomfort and the strategies used to deal with it in undocumented Mexican migrants residing in an area with a recent migratory tradition. Method. Study conducted using qualitative methodology and ethnographic strategies involving four open interviews with key informants and seven semi-structured interviews with undocumented Mexican immigrants. A thematic analysis was conducted of each of them, and the main categories constructed. Results. Immigration status was the main source of emotional discomfort, creating sadness, anger, and frustration associated with direct acts of racism and discrimination. Religiosity or spirituality, relaxation, avoidance, self-control ("gritting your teeth and bearing it"), and seeking supportive social networks were the most commonly used strategies for coping with this discomfort. Discussion and conclusions. It would be advisable to implement strategies that increased the possibilities of access to professional care, when necessary, without immigrants perceiving a threat due to their immigration status and to promote more robust social networks in the community, as well as virtual networks that could provide an alternative source of care and accompaniment from their place of origin. [ABSTRACT FROM AUTHOR]

In the 1960s, Black student protests of racism through sit-ins, building occupations, and demands for the resignation of university top administrators spurred the creation of ethnic studies and diversity programs on white university campuses in the United States. These efforts did not, unfortunately, dismantle entrenched structural racism. Black student activism continues to confront racial inequities using digitized campaigns on social media platforms to reach a global audience. This study uses critical race theory to explore how Black students at a white-dominant university give meaning to their racialized experiences as communicated using the twitter hashtag campaign #Blackatpwi. The results illuminate the magnitude of anti-Black racism and conditions under which Black students are expected to learn, the myriad ways white institutions reproduce and reinforce white supremacy and the students' mobilization efforts to resist anti-Black racism. We provide recommendations to promote racial equity in higher education. [ABSTRACT FROM AUTHOR]

Objectives: To examine the associations among mass incarceration, maternal vulnerability, and disparities in birth outcomes across U.S. counties, utilizing an ecological model and reproductive justice perspective was used. This study tests whether mass incarceration is associated with infant mortality and low birthweight across U.S. counties, and whether maternal vulnerability explains the relationship between mass incarceration and birth disparities. Methods: Data were derived from a variety of public sources and were merged using federal FIPS codes. Outcomes from the CDC Vitality Statistics include percent low birth weight births (births below 2499 g divided by singleton births to women aged 20 to 39) and infant mortality (infant deaths per 1000 live births). Black–White rate ratios were calculated for the birth outcomes to specifically examine the large Black–White disparity in birth outcomes. The analysis controlled for urbanicity, income inequality, median household income, residential segregation, and southern region, as well as a fixed effect for state level differences. Results: Findings show that counties with higher rates of incarceration have higher prevalence of infant mortality and low birthweight, as well as greater Black–White disparity in infant mortality. Mass incarceration is associated with increases in adverse birth outcomes and maternal vulnerability partially mediates this relationship. Conclusions: Findings provide evidence that heightened levels of incarceration affect birth outcomes for all residents at the county-level. It is imperative to address the overuse of mass incarceration in order to support adequate reproductive healthcare of vulnerable populations in the United States. Significance: Previous research has found a negative realtionship exists between incarceration and population health, but the extent to which birth outcomes vary by incarceration rate at the county level are unknown. This study estimates associations between county-level rates of total incarceration, jail admission, and prison admission, on rates of infant mortality and low-birthweight. Results show that prevalence of low-birthweight and infant mortality are increased in U.S. counties with heightened incarceration rates and that this realtionship is partially mediated by maternal vulnerability, an estimation of risk for adverse pregnancy outcomes for women in the area. This stidy also found that mass incarceration contributes to the widening of Black-White disparities in infant mortality. [ABSTRACT FROM AUTHOR]

Scant attention has been paid to the racial impacts of bankruptcy and foreclosure in the United States. This article examines the links between bankruptcy, housing loss, and "risk responsibilization," a neoliberal process in which consumers rather than lending institutions are held responsible for debt management. We used data sequencing, and Geographic Information Systems Mapping (GIS) to analyse 1,057 cases of home foreclosure and related bankruptcies from 2016 to 2019 in a Deep South US County. We found housing vulnerability to be a racialized process, with Black homeowners more likely to face foreclosure and less likely to receive a fresh start through bankruptcy. In foreclosure, Black-owned homes were more likely to convert to rental property. The study provides sequential and spatial evidence of connections between risk responsibilization, systemic racism, and housing loss in the geography of dispossession. [ABSTRACT FROM AUTHOR]

This paper expands our understanding of the lived experience of policing by exploring how people describe and analyze one of its salient aspects: its economic consequences. Despite growing scholarship on predatory policing strategies in the aftermath of the Justice Department's investigation of Ferguson, Missouri, we lack an understanding of how these practices are experienced, theorized, and resisted by policed, race-class subjugated (RCS) communities. How do people narrate, make meaning from, or theorize their material relationship to policing? Do policed publics understand such practices as part of broader processes of racialized governance, political power, and community inequality? Utilizing the Portals Policing Project, we collected the largest contemporary database of narratives about policing, including over 850 dialogues that were qualitatively coded. Using a grounded theory approach we analyzed a subset of dialogues that focus on financial aspects of police, court, and carceral encounters to examine how people discussed their experiences with monetary sanctions and their broader meanings and relationships to racialized political economy and geography. When people analyzed the material dimensions of policing and incarceration, four prominent discursive theorizations emerged: (1) Police and courts deploy a variety of techniques (criminalizing public space, strategic application of child support fees, unfair taxation, among others) to structurally control the flow of RCS resources, often toward the state and non-policed White communities. (2) Such resource flows occur in the broader context of municipal prioritization of police and carceral institutions over schools and social services, which permit and sustain RCS community criminalization, extraction, and reproduction of marginalization. (3) Police construct racialized urban spaces and markets, marking informal RCS economic activity as transgressive and delimiting their expansion. (4) Police surveillance is racially embodied and permeates daily life to restrict individual activity and, indirectly, economic potential. Overall, these narratives center the police and carceral state in processes of materialized race-making—the active reproduction of racial economic inequality and dispossession that goes beyond basic racial disparities in state punishment and revenue generation. [ABSTRACT FROM AUTHOR]

The article argues that health equity requires working toward antiracist local public health departments (LHD). It explains the role of LHDs in antiracist capacity building to earn public trust where there is race discrimination in the health infrastructure. It proposes the disruption of structural racism and racial health inequities by engaging LHDs in advocacy efforts, cross-sector collaborations and community-based partnerships, and providing services in racially marginalized communities.

The primary aim is to assess the implementation of an eight-session, group therapy pilot for Black and Latina transgender women in Chicago in terms of implementation outcomes regarding intervention effectiveness, acceptability, appropriateness, and feasibility. The Exploration Preparation Implementation Sustainment (EPIS) framework guided implementation processes, including community engagement as an implementation strategy, and an implementation taxonomy was used to evaluate outcomes of acceptability, appropriateness, and feasibility, in addition to intervention effectiveness regarding anxiety and community connectedness. Two rounds of the pilot were completed in 2020, during the COVID-19 pandemic, at a community-based organization serving LGBTQ+ (lesbian, gay, bisexual, transgender, queer/questioning) youth on Chicago's West Side. Participants (N = 14) completed a baseline and postintervention assessment and evaluations after each of eight intervention modules. Descriptive statistics show improvement across measures of anxiety and community connectedness, and high mean scores across domains of acceptability, appropriateness, and feasibility. Pilot findings indicate intervention effectiveness, acceptability, appropriateness, and feasibility to address mental health and social support of Black and Latina transgender women. Additional resources are needed for transgender community-engaged mental health programs and research to establish core and adaptable intervention elements, scaled-up evidence for clinical effectiveness, and, most importantly, to improve mental health outcomes and the sustainability of such interventions. [ABSTRACT FROM AUTHOR]

Research has documented that adolescent sleep is impacted by various stressors, including interpersonal experiences and structural disadvantage. This study extends existing knowledge by empirically examining interconnected individual experiences of structural inequity and assessing its association with subjective and objective sleep outcomes. We utilized data from the Adolescent Brain and Cognitive Development Study to identify seven conceptual domains of structural inequity: perceived discrimination, low school inclusivity, neighborhood safety, unmet medical needs, legal problems, material hardship, and housing insecurity. We operationalized experiences of structural inequity as latent classes, a cumulative exposure, and each domain separately. Sleep disturbances were measured using the Sleep Disturbance Scale, and sleep duration was assessed using Fitbits. Mixed effects linear regression estimated the association between our measures of structural inequity, longitudinal sleep disturbances, and cross-sectional sleep duration. Latent class analysis revealed common exposure profiles (low risk, interpersonal, and systemic) of experiences of structural inequity across our sample. In longitudinal models, structural inequity was associated with higher Sleep Disturbance Scale scores, whether measured as latent classes, a cumulative exposure, or individual domains. Individuals with interpersonal exposures, those with at least one exposure, and those with legal problems, material hardship, and housing insecurity had lower mean sleep duration. Results are consistent with literature that frames structural inequity as a lifelong determinant of sleep disturbance and duration. Adolescence represents a crucial time for interventions aimed at improving sleep and redressing inequities throughout the life course; our work can inform the development of policies and interventions toward this end. [ABSTRACT FROM AUTHOR]