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Despite the early promise of centering structural racism in explanatory models of firearm violence, there are noticeable gaps in what's been produced thus far; in particular, a deeper and more serious engagement with long-standing theories of racism is needed to further enrich our understanding of how structural inequalities produce unequal burdens of firearm-related harms. Thus, building on theories and concepts from a range of academic fields and Black philosophical perspectives, we developed a theoretical framework to help explain the role of place-based structural racism on firearm violence disparities. A central component of our framework is the concept racial capitalism, which contends that racial exploitation and the accumulation of assets depend on and reinforce one another. In this article, we present our framework and highlight how two processes related to racial capitalism-racialized dispossession and racialized spatial stigma-are connected with geographic disparities in firearm violence. We also present the results of an ecological cross-sectional study that reveals a potential key association between racial capitalism and firearm violence disparities on the neighborhood-level. We used a structural intersectionality approach and descriptive epidemiological methods to highlight and quantitatively describe spatial firearm violence disparities that could potentially be linked to the varying exposure of two dimensions of racial capitalism-historical redlining and contemporary racialized subprime mortgage lending. We found that sustained disadvantaged census tracts (tracts that were historically redlined and experienced higher contemporary subprime lending) experienced the highest burden of firearm violence in Baltimore City between 2015 and 2019. Our research suggests that racial capitalism could potentially be a root cause of firearm violence disparities. A theoretical framework based on racial capitalism can inform the development and usage of indicators and analytic methods for racism-related firearm violence research. Moreover, this framework can identify factors to prioritize in equity-based violence prevention policies and programs., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

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.

Background: Distress related to systemic racism in the public service and healthcare systems is linked to adverse mental health sequelae in racial and ethnic minority populations. Emerging research has found that distress related to racism may impact military veterans, an increasingly racially and ethnically diverse segment of the US population who are at increased risk of mental health problems relative to non-veterans. To date, however, no known study has examined longitudinal trends in distress related to systemic racism in this population., Methods: A nationally representative sample of 2361 US military veterans completed a baseline assessment in 2020 and a 2-year follow-up in 2022. A multinomial logistic regression analysis was conducted to examine longitudinal courses and baseline predictors of systemic racism-related distress., Results: Relative to the veterans with no racism-related distress, those who reported racism-related distress across the 2-year study period were older, more likely to be female, Black, or Hispanic, and to have completed college or higher education, and reported more lifetime traumas and stressors. Nearly 4-of-5 of Black veterans endorsed distress related to systemic racism over the 2-year study period., Limitations: Use of self-report and abbreviated measures of distress related to systemic racism., Conclusions: Results suggest that distress related to systemic racism may pose a significant emotional burden on subgroups of US veterans. They further underscore the importance of training clinicians to provide culturally-informed assessments and treatments for Black and other racial and ethnic minority veterans who bear the weight of racial discrimination., Competing Interests: Declaration of competing interest None., (Published by Elsevier B.V.)

Increases in conversations about race and racial discrimination experiences during adolescence make this a critical developmental period to investigate adolescents' awareness of racism. We examined bidirectional associations between race-based experiences and awareness of systemic racism-operationalized as understanding systemic causes of racial disparities in education. Adolescents who self-identified as African American/Black were surveyed in Grade 6 (n = 317; M age  = 11.12; 48% girls) and Grade 8 (n = 247; M age  = 13.15; 56% girls). Cross-lagged panel analyses revealed that racial barrier messages, but not racial discrimination experiences, in Grade 6 positively predicted awareness of systemic racism in Grade 8. Adolescents' awareness of systemic racism in Grade 6 did not predict racial socialization or racial discrimination experiences in Grade 8., (© 2024 Society for Research on Adolescence.)

This study explores the experience of promoting inclusion and anti-racism work as either performance or deep work in the couple and family therapy (CFT) field through narrative qualitative analysis. While performance-based approaches focus on meeting external expectations and diversity quotas, deep work involves critical self-reflection, ongoing learning, and a commitment to addressing systemic inequalities. The paper prioritizes how deep inclusion assists with developing new approaches to creating meaningful and lasting change in teaching, research, and clinical work in the CFT field. Some professionals in the field include educators, researchers, and therapists who are engaged in anti-racism work, a recognition of the impact of systemic racism on family dynamics and therapeutic interventions, and a commitment to centering the voices and experiences of marginalized individuals and communities. Implications present a need for ongoing education, training, and support for professionals in the CFT field and other family science and family mental health-related professions. This study also identifies limitations and future directions for research in promoting inclusion and anti-racism work in family science and family mental health-related fields. It is essential to promote inclusion and anti-racism as deep work to create more inclusive and equitable teaching, research, and therapeutic environments that value the experiences of all individuals and communities. Challenges include resistance from shaking systems and making ourselves and others vulnerable with uncomfortable and continuous conversations. Our primary goal is to contribute to and inspire dialogue about the perspectives CFTs and other mental health-related professionals are taking in the relationship to inclusion and anti-racism work., (© 2024 Family Process Institute.)

Introduction: Connections between race and health are discussed, and racism has been called out as a root cause of health disparities. The impacts of systemic racism are not fully understood and should be considered in order to advance health equity. The aim of the study is to explore the impact of racism on healthcare experiences and well-being for communities of color., Methods: Individuals from a Northeast region of Wisconsin, who self-identified as Somali, Hmong, Black/African American, Hispanic/Latino/a, and First Nations/Native American/Indigenous, were invited to participate in focus group discussions, and informed consent was obtained from all participants (25 adults, 17 females, and 8 males). Focus groups were planned so participants from the same self-identified communities were together, and five virtual focus group discussions were carried out. A qualitative content analysis approach was used to gain a deeper understanding of the content., Results: There was a range of experiences; however, everyone experienced the negative impacts of racism. Three categories, representing areas impacted by racism, and a final theme, describing the overall impact on healthcare experiences and well-being, were created. Dealing with systemic racism means that "backgrounds and values," "resources," and "prejudices" (categories) require constant attention, maneuvering, and "juggling the impacts of racism diminishes access to healthcare and well-being for communities of color" (theme)., Discussion: Systemic racism negatively impacts access to healthcare and well-being for communities of color perpetuating health disparities. Planning and policy should include a focus on health equity and target systemic racism in order to diminish health disparities., (© 2023. W. Montague Cobb-NMA Health Institute.)

Background: Structural racism produces mental health disparities. While studies have examined the impact of individual factors such as poverty and education, the collective contribution of these elements, as manifestations of structural racism, has been less explored. Milwaukee County, Wisconsin, with its racial and socioeconomic diversity, provides a unique context for this multifactorial investigation., Objective: This research aimed to delineate the association between structural racism and mental health disparities in Milwaukee County, using a combination of geospatial and deep learning techniques. We used secondary data sets where all data were aggregated and anonymized before being released by federal agencies., Methods: We compiled 217 georeferenced explanatory variables across domains, initially deliberately excluding race-based factors to focus on nonracial determinants. This approach was designed to reveal the underlying patterns of risk factors contributing to poor mental health, subsequently reintegrating race to assess the effects of racism quantitatively. The variable selection combined tree-based methods (random forest) and conventional techniques, supported by variance inflation factor and Pearson correlation analysis for multicollinearity mitigation. The geographically weighted random forest model was used to investigate spatial heterogeneity and dependence. Self-organizing maps, combined with K-means clustering, were used to analyze data from Milwaukee communities, focusing on quantifying the impact of structural racism on the prevalence of poor mental health., Results: While 12 influential factors collectively accounted for 95.11% of the variability in mental health across communities, the top 6 factors-smoking, poverty, insufficient sleep, lack of health insurance, employment, and age-were particularly impactful. Predominantly, African American neighborhoods were disproportionately affected, which is 2.23 times more likely to encounter high-risk clusters for poor mental health., Conclusions: The findings demonstrate that structural racism shapes mental health disparities, with Black community members disproportionately impacted. The multifaceted methodological approach underscores the value of integrating geospatial analysis and deep learning to understand complex social determinants of mental health. These insights highlight the need for targeted interventions, addressing both individual and systemic factors to mitigate mental health disparities rooted in structural racism., (©Fahimeh Mohebbi, Amir Masoud Forati, Lucas Torres, Terri A deRoon-Cassini, Jennifer Harris, Carissa W Tomas, John R Mantsch, Rina Ghose. Originally published in JMIR Public Health and Surveillance (https://publichealth.jmir.org), 03.05.2024.)

In 2021, the American Psychological Association offered an apology to people of color for harms, actions, and inactions and accepted responsibility for contributing to systemic inequities. The field of psychology has a complicated and long history of contributing to American racism and the belief in human hierarchy. This article illustrates the strategy the American Psychological Association followed to issue an apology at a scale that incorporated the voices and perspectives of the association's senior leaders and racial equity experts. The authors shed light on the organizational changes that were necessary to approve the apology and the changes that followed the apology to create long-term, institutional, and sustainable change and advance racial equity within psychology and society. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Health equity tourism (HET) represents yet another example of how structural racism may manifest in our discipline. While not a new phenomenon, HET was coined recently in the context of medicine and is defined as investigators without the requisite experience or commitment to health equity work "parachuting into the field in response to timely and often temporary increases in public interest and resources" (Lett et al., 2022, p. 2). To determine how HET manifests in psychological science, we interviewed 18 health equity experts. Data were analyzed using reflexive thematic analysis. Results revealed that HET manifests as a passing interest in health equity research, minimal engagement with communities under study or with health equity experts, and a failure to appreciate health equity scholarship as a specialty area of psychological science. Consequences of HET include poor quality research, harm to communities under study, funneling of resources away from health equity experts, frustration with and disengagement from the field and academia (leading to slow career advancements and attrition), and a maintenance of structural racism in psychological science. We provide recommendations for preventing the further manifestation of HET in psychology and for reducing the associated harms. These recommendations include education and training regarding the construct of HET, engagement in reflective practice, and a reconsideration of how research with minoritized populations is approached and evaluated. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

The American Psychological Association's resolutions on dismantling systemic racism represent a watershed moment in our discipline, yet confusion remains as to what it means to "dismantle" racism given psychology's emphasis on changing individual beliefs. This submission will review the tension between "idealist" interpretations of critical race theory emphasizing individual beliefs and "realist" perspectives contextualizing racism within political economic arrangements. Psychology's adoption of an "idealist" framework will be shown to privilege a neoliberal project emphasizing individual change and symbolic performances of racial justice instead of structural changes benefitting people of color's material existence. Drawing on a decolonial critique of racial capitalism, we propose an alternative framework to challenge our discipline to broaden its political imagination by supporting evidence-based policies to dismantle racism as a structural and political force. This includes universal policies to reduce racial and economic inequality and population-specific policies such as reparations for African Americans predicted to stimulate economic growth. Urgently, the decolonial lens challenges psychology to theorize racism not as a primarily individual phenomenon but a political force that divides and conquers while enriching white economic elites. To fulfill the promises of the American Psychological Association's resolutions, we must directly challenge the political economic interests that benefit from racism and contribute to the common good as a form of "loving care." (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Objective: We sought to examine reasons for vaccine hesitancy among online communities of US-based Black and Latinx communities to understand the role of historical racism, present-day structural racism, medical mistrust and individual concerns about vaccine safety and efficacy., Design: A qualitative study using narrative and interpretive phenomenological analysis of online bulletin board focus groups., Setting: Bulletin boards with a focus-group-like setting in an online, private, chat-room-like environment., Participants: Self-described vaccine hesitant participants from US-based Black (30) and Latinx (30) communities designed to reflect various axes of diversity within these respective communities in the US context., Results: Bulletin board discussions covered a range of topics related to COVID-19 vaccination. COVID-19 vaccine hesitant participants expressed fears about vaccine safety and doubts about vaccine efficacy. Elements of structural racism were cited in both groups as affecting populations but not playing a role in individual vaccine decisions. Historical racism was infrequently cited as a reason for vaccine hesitancy. Individualised fears and doubts about COVID-19 (short-term and long-term) safety and efficacy dominated these bulletin board discussions. Community benefits of vaccination were not commonly raised among participants., Conclusions: While this suggests that addressing individually focused fear and doubts are central to overcoming COVID-19 vaccine hesitancy in Black and Latinx groups, addressing the effects of present-day structural racism through a focus on community protection may also be important., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY. Published by BMJ.)

Objectives: Belief in an American Indian/Alaska Native (AIAN) specific biological vulnerability (BV) to alcohol problems is associated with worse alcohol outcomes among AIANs. Despite a notable lack of evidence that biogenetic factors play a greater role in the development of alcohol problems among AIANs than other groups, many people still believe this myth. Consistent with theory and evidence that greater experiences with discrimination leads to the internalization of stereotypes and oppression, we hypothesized that greater perceived racial discrimination (racism) would be associated with greater BV belief, but that having a stronger ethnic identity would weaken this association. We also examined whether previous substance use treatment as well as participation in Alcoholics Anonymous (AA) or Narcotics Anonymous (NA) was associated with BV belief., Method: Participants were 198 reservation-dwelling AI adults with a substance use problem who completed a survey as part of a larger community-based participatory study., Results: A multiple regression analysis revealed that greater systemic racism was associated with greater belief in a BV; this association was not moderated by ethnic identity. Greater interpersonal racism was also associated with greater BV belief-but only among those low in ethnic identity. A regression analysis revealed that previous treatment, AA, and NA participation were not associated with BV belief., Conclusions: Greater systemic and interpersonal racism were associated with belief in a BV, and greater ethnic identity buffered the association between interpersonal racism and BV belief. This suggests that both combatting racism and fostering positive ethnic identity may help to lessen BV belief. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

In the United States, suicide deaths have disproportionately increased among Black and Hispanic youth over the past 2 decades. 1 Despite the critical need for more culturally responsive suicide prevention strategies, there has been only sparse research into unique risk factors commonly experienced among ethnoracially minoritized youth, such as racism-related experiences. Experiences of racial and ethnic discrimination (ie, a behavioral manifestation of racism via unfair treatment predicated on an individual's racial and/or ethnic group affiliation) have been associated with higher rates of suicidal thoughts and behaviors (STBs) in Black and Hispanic adolescents. 2 , 3 This research has largely focused on individual-level racism (ie, interpersonal exchanges) assessed via subjective self-report surveys. Thus, less is known about the impact of structural racism, which is enacted at the system level., (Copyright © 2023 American Academy of Child and Adolescent Psychiatry. Published by Elsevier Inc. All rights reserved.)

Cultural stereotypes that link Black race to crime in the United States originated with and are perpetuated by policies that result in the disproportionate criminalization and punishment of Black people. The scientific record is replete with evidence that these stereotypes impact perceivers' perceptions, information processing, and decision-making in ways that produce more negative criminal legal outcomes for Black people than White people. However, relatively scant attention has been paid to understanding how situations that present a risk of being evaluated through the lens of crime-related stereotypes also directly affect Black people. In this article, I consider one situation in particular: encounters with police. I draw on social psychological research on stereotype threat generally as well as the few existing studies of crime-related stereotype threat specifically to illuminate how the cultural context creates psychologically distinct experiences of police encounters for Black people as compared to White people. I further consider the potential ramifications of stereotype threat effects on police officers' judgments and treatment of Black people as well as for Black people's safety and well-being in other criminal legal contexts and throughout their lives. Finally, I conclude with a call for increased scholarly attention to crime-related stereotype threat and the role it plays in contributing to racial disparities in policing outcomes, particularly with regard to diverse racial, ethnic, and intersectional identities and personal vulnerability factors, and the systemic changes that might mitigate its deleterious effects. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Early in the COVID-19 vaccine rollout, Black adults consistently reported more hesitancy than White adults, but few studies have examined variation in hesitancy among Black adults or its associations with racial discrimination. Data were collected from Black Arkansas residents age 18 and older (n = 350) between July 12 th and July 30 th , 2021, as part of a larger survey of Arkansans (N = 1500). Participants were recruited through random digit dialing of both landline and cell phones, with oversampling of Black and Hispanic residents. Respondents reported COVID-19 vaccine hesitancy, sociodemographic information, influenza vaccination history, pandemic-related experiences, and experiences of racial discrimination. Almost half (48.9%) of Black adults in Arkansas were not hesitant towards COVID-19 vaccines, while the remainder reported some level of hesitancy. Nearly a quarter were very hesitant (22.4%), while fewer reported being somewhat (14.0%) and a little (14.7%) hesitant. Using an ordered logistic regression with partial proportional odds, we find odds of COVID-19 vaccine hesitancy decreased as age and influenza vaccination increased. Odds of COVID-19 vaccine hesitancy were 1.70 times greater for Black adults who experienced the death of a close friend/family member due to COVID-19 and 2.61 times greater for individuals reporting discrimination with police or in the courts. Within-group analysis revealed nearly half of Black adults did not report any COVID-19 vaccine hesitancy and heterogeneity among those who were hesitant. Findings suggest there may be an important link between racial discrimination in the criminal justice system and COVID-19 vaccine hesitancy among Black adults., (© 2022. W. Montague Cobb-NMA Health Institute.)

We sought to understand how women in Michigan communities outside of Flint experienced the Flint water crisis, an avoidable public health disaster widely attributed to structural racism. Using survey data from 950 Michigan women aged 18-45 from communities outside of Flint, we examined racial and ethnic differences in personal connections to Flint, perceived knowledge about the water crisis, and beliefs about the role of anti-Black racism in the water crisis factors that could contribute to poor health via increased psychological stress. We found that White (OR = 0.32; 95% CI: 0.22, 0.46) and Hispanic (OR = 0.21; 95% CI: 0.09, 0.49) women had lower odds than Black women of having family or friends who lived in Flint during the water crisis. Compared to Black women, White women were less likely to be moderately or very knowledgeable about the water crisis (OR = 0.58; 95% CI: 0.41, 0.80). White women (OR = 0.26; 95% CI: 0.18, 0.37), Hispanic women (OR = 0.38; 95% CI: 0.21, 0.68), and women of other races (OR = 0.28; 95% CI: 0.15, 0.54) were less likely than Black women to agree that the water crisis happened because government officials wanted to hurt Flint residents. Among those who agreed, White women (OR = 0.47; 95% CI: 0.30, 0.74) and women of other races (OR = 0.33; 95% CI: 0.12, 0.90) were less likely than Black women to agree that government officials wanted to hurt people in Flint because most residents are Black. We conclude that the Flint water crisis was a racialized stressor, with potential implications for the health of reproductive-age Black women., (© 2022. W. Montague Cobb-NMA Health Institute.)

Importance: Structural racism has been implicated in the disproportionally high asthma morbidity experienced by children living in disadvantaged, urban neighborhoods. Current approaches designed to reduce asthma triggers have modest impact., Objective: To examine whether participation in a housing mobility program that provided housing vouchers and assistance moving to low-poverty neighborhoods was associated with reduced asthma morbidity among children and to explore potential mediating factors., Design, Setting, and Participants: Cohort study of 123 children aged 5 to 17 years with persistent asthma whose families participated in the Baltimore Regional Housing Partnership housing mobility program from 2016 to 2020. Children were matched to 115 children enrolled in the Urban Environment and Childhood Asthma (URECA) birth cohort using propensity scores., Exposure: Moving to a low-poverty neighborhood., Main Outcomes: Caregiver-reported asthma exacerbations and symptoms., Results: Among 123 children enrolled in the program, median age was 8.4 years, 58 (47.2%) were female, and 120 (97.6%) were Black. Prior to moving, 89 of 110 children (81%) lived in a high-poverty census tract (>20% of families below the poverty line); after moving, only 1 of 106 children with after-move data (0.9%) lived in a high-poverty tract. Among this cohort, 15.1% (SD, 35.8) had at least 1 exacerbation per 3-month period prior to moving vs 8.5% (SD, 28.0) after moving, an adjusted difference of -6.8 percentage points (95% CI, -11.9% to -1.7%; P = .009). Maximum symptom days in the past 2 weeks were 5.1 (SD, 5.0) before moving and 2.7 (SD, 3.8) after moving, an adjusted difference of -2.37 days (95% CI, -3.14 to -1.59; P < .001). Results remained significant in propensity score-matched analyses with URECA data. Measures of stress, including social cohesion, neighborhood safety, and urban stress, all improved with moving and were estimated to mediate between 29% and 35% of the association between moving and asthma exacerbations., Conclusions and Relevance: Children with asthma whose families participated in a program that helped them move into low-poverty neighborhoods experienced significant improvements in asthma symptom days and exacerbations. This study adds to the limited evidence suggesting that programs to counter housing discrimination can reduce childhood asthma morbidity.

Over the past few years, there has been increased visibility of, and attention paid to, enduring issues such as racial discrimination toward Black Americans. Black psychologists have been called upon to explain various race-related mental health issues to the public, as well as their colleagues and students. Discussions about how to heal from persistent, intergenerational, oppressive attacks on the African psyche are important, but the theories and treatments in which most practitioners are trained and considered "best practices" are Eurocentric in nature. African-centered (or Africentric) psychology is a well-established school of thought, predating the philosophies often discussed in Western/American psychology's History and Systems curriculum, that provides an authentic understanding of the psychology of people of African descent from an African perspective. In this article, we present the historical contention about the lack of inclusion of an African perspective in conceptualizing and addressing the psychological needs of people of African descent, provide an overview of African-centered psychology including its underlying worldview and philosophy, development, and key contributors, and advocate for the inclusion of Africentric psychology in APA-accredited psychology graduate programs. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Objective: This study used the stress process model to test the mediating effects of personal mastery and moderating effects of church-based social support on the relationship between daily discrimination and psychological distress across three age groups of African American and Afro-Caribbean adults., Methods: Using a national sample of 5008 African Americans and Afro-Caribbean adults from the National Survey of American Life Study, this study employs structural equation modeling to investigate the relationships between daily discrimination, personal mastery, church-based social support, and psychological distress., Results: Daily discrimination was an independent predictor of psychological distress across all groups. Group- and age-specific comparisons revealed significant differences in the experience of daily discrimination and psychological distress. Mastery was a partial mediator of the relationship between discrimination and psychological distress among Afro-Caribbeans while church support was a significant moderator only among the young and older African Americans., Implications: Together, our study findings provide useful first steps towards developing interventions to reduce the adverse psychological impacts of daily discrimination on African Americans and Afro-Caribbeans. Intervention efforts such as individual psychotherapy aimed to improve Afro-Caribbean individuals' sense of mastery would be a partial solution to alleviating the adverse effects of discrimination on their psychological health.

Objectives: Immigration enforcement policies are associated with immigrants' barriers to health care. Current evidence suggests that enforcement creates a "chilling effect" in which immigrants avoid care due to fear of encountering enforcement. Yet, there has been little examination of the impact of immigrants' direct encounters with enforcement on health care access. We examined some of the first population-level data on Asian and Latinx immigrants' encounters with law and immigration enforcement and assessed associations with health care access., Methods: We analyzed the 2018 and 2019 Research on Immigrant Health and State Policy survey in which Asian and Latinx immigrants in California (n=1681) reported on 7 enforcement experiences (eg, racial profiling and deportation). We examined the associations between measures of individual and cumulative enforcement experiences and the usual sources of care and delay in care., Results: Latinx, compared with Asian respondents, reported the highest levels of enforcement experiences. Almost all individual enforcement experiences were associated with delaying care for both groups. Each additional cumulative experience was associated with a delay in care for both groups (OR=1.30, 95% CI 1.10-1.50). There were no associations with the usual source of care., Conclusion: Findings confirm that Latinx immigrants experience high levels of encounters with the enforcement system and highlight new data on Asian immigrants' enforcement encounters. Direct experiences with enforcement have a negative relationship with health care access. Findings have implications for health systems to address the needs of immigrants affected by enforcement and for changes to health and immigration policy to ensure immigrants' access to care., Competing Interests: The authors declare no conflict of interest., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

In this article, the authors explain systemic racism through a racial-spatial framework wherein anti-Blackness, white supremacy, and racial capitalism interlock to create and recreate white space and time. Through the creation of private property, institutional inequities become embedded and structured for the benefit of white people. The framework provides a way to conceptualize how our geographies are racialized and how time is often used against Black and non-Black people of Color. In contrast to white experiences of feeling "in-place" almost everywhere, Black and non-Black people of Color continually experience displacement and dispossession of both their place and their time. This racial-spatial onto-epistemology is derived from the knowledge and experiences of Black, Indigenous, Latinx, Asian, and other non-Black people of Color, and how they have learned through acculturation, racial trauma, and micro-aggressions to thrive in white spaces and contend with racism such as time-theft. The authors posit that through reclaiming space and time, Black and non-Black people of Color can imagine and practice possibilities that center their lived experiences and knowledge as well as elevate their communities. Recognizing the importance of reclaiming space and time, the authors encourage counseling psychology researchers, educators, and practitioners to consider their positionalities with respect to systemic racism and the advantages it confers to white people. Through the process of creating counterspaces and using counterstorytelling, practitioners may help clients develop healing and nurturing ecologies that challenge the perniciousness of systemic racism. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

COVID-19 emerged during an era of heightened attention to systemic racism and the spread of misinformation. This context may have impacted public trust in health information about chronic diseases like cancer. Here, we examine data from the 2018 and 2020 Health Information National Trends Survey (N = 7,369) to describe how trust in cancer information from government health agencies, doctors, family and friends, charitable organizations, and religious organizations changed after COVID-19 became a pandemic, and whether that change varied by race/ethnicity. Statistical methods included chi-square tests and multiple logistic regression modeling. Overall, the proportion of respondents who reported a high degree of trust in cancer information from doctors increased (73.65% vs. 77.34%, p = .04). Trends for trust in information from government health agencies and family and friends varied significantly by race/ethnicity, with substantial declines observed among non-Hispanic Blacks (NHB) only. The odds of reporting a high degree of trust in cancer information from government health agencies and friends and family decreased by 53% (OR = 0.47, 95% CI = 0.24-0.93) and 73% (OR = 0.27, 95% CI = 0.09-0.82), respectively, among NHB, but were stable for other groups. Future studies should monitor whether recent declines in trust among NHB persist and unfavorably impact participation in preventive care.

Attachment theory proposes that a central function of caregivers is to provide protection and co-regulation of children's distress in the context of threat, and that children's secure attachment (confidence in a secure base/safe haven when needed) precipitates positive developmental cascades in part by supporting children's emotion regulation. Yet the field of attachment has rarely considered the unique experiences of African American families, including the context of systemic racism in which caregivers must provide physical and emotional protection for their children, and in which children must learn to regulate emotion across different sociocultural contexts (emotional flexibility and "code-switching"; Dunbar et al., 2022a; Lozada et al., 2022; Stern et al., 2022b). This chapter brings attachment theory into conversation with the field of positive Black youth development to explore pathways to emotion regulation in African American children during early childhood. In doing so, we (a) highlight the strengths of African American caregivers in providing unique and specific forms of protection via racial and emotional socialization; (b) review research on predictors and consequences of secure caregiver-child relationships in Black families, with a focus on the outcome of child emotion regulation; (c) present a theoretical framework for understanding cascades of positive Black youth development via healthy relationships and emotion regulation; and (d) outline promising new directions for more inclusive and just attachment research., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Emotions are a central driving force of activism; they motivate participation in movements and encourage sustained involvement. We use natural language processing techniques to analyze emotions expressed or solicited in tweets about 2020 Black Lives Matter protests. Traditional off-the-shelf emotion analysis tools often fail to generalize to new datasets and are unable to adapt to how social movements can raise new ideas and perspectives in short time spans. Instead, we use a few-shot domain adaptation approach for measuring emotions perceived in this specific domain: tweets about protests in May 2020 following the death of George Floyd. While our analysis identifies high levels of expressed anger and disgust across overall posts, it additionally reveals the prominence of positive emotions (encompassing, e.g., pride, hope, and optimism), which are more prevalent in tweets with explicit pro-BlackLivesMatter hashtags and correlated with on the ground protests. The prevalence of positivity contradicts stereotypical portrayals of protesters as primarily perpetuating anger and outrage. Our work offers data, analyses, and methods to support investigations of online activism and the role of emotions in social movements.

Competing Interests: Disclosure: The authors declare no conflict of interest.

The Half-Century long problem of addiction treatment disparities. We cannot imagine addressing disparities in addiction treatment without first acknowledging and deconstructing the etiology of this inequity. This article examines the history of addiction treatment disparities beginning with early twentieth-century drug policies. We begin by discussing structural racism, its contribution to treatment disparities, using opioid use disorder as a case study to highlight the importance of a structural competency framework in obtaining care. We conclude by discussing diversity in the workforce as an additional tool to minimizing disparities. Addiction treatment should be aimed at addressing care delivery in the context of the social, economic, and political determinants of health, which require appreciation of their historical origins to move toward equitable treatment., Competing Interests: Disclosure The authors have nothing to disclose., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Importance: The American Medical Association has acknowledged the public health threat posed by racism in medicine. While clinicians in psychiatry have echoed the sentiment, the research community has largely been silent. Current understanding of the biological domains that underlie psychiatric disorders was historically established by studying White populations, often leaving widely used treatments ineffective for Asian, Black, Hispanic, Indigenous, and other racial and ethnic minority individuals. This article addresses how undersampling of racial and ethnic minority individuals has led to overgeneralized physiological findings, the implications for development of psychiatric treatments, and steps to improve service to racially diverse communities., Observations: Three primary observations regarding differences associated with race and ethnicity have been addressed in the existing psychiatric research: misdiagnosis, medication nonadherence, and treatment efficacy and expression of adverse effects. While cultural factors have been discussed as potential factors associated with these differences, a lack of understanding of physiologic systems may be foundational to each of these issues. Recent evidence points to race differences in psychophysiological measures, likely attributed to factors including the lived experience of racism as opposed to inherent biological differences. This mounting evidence supports a reassessment of existing work to examine potential divergent patterns within racial and ethnic groups. The following strategies may improve understanding of the influence of racism on physiology, allowing clinicians to better address psychiatric symptoms and improve existing treatment approaches. Thus, psychiatric researchers need to (1) understand the historic and current terminology for race and ethnicity and use appropriate terms and categories as defined by sociologists, population health experts, and databases while respecting individuals' right to self-identify, (2) refine research questions, and (3) reexamine research data to determine whether patterns observed in largely White populations can extend to other groups. To appropriately implement these steps, researchers must accept the discomfort that accompanies growth, invite scientists from diverse backgrounds to participate, and use resources to increase diversity in recruitment of study participants. This will require a commitment from funding agencies to provide adequate support to recruit and investigate large, diverse samples., Conclusions and Relevance: To create more suitable medical treatments and improve the quality of care received by those with psychiatric conditions, further discussion is needed surrounding the physiologic toll that racism has had on multiple generations of racial and ethnic minority groups and how that may alter responsivity to biobehavioral interventions. To better inform psychiatric research, the resources provided must be expanded, basic physiologic studies should be replicated with more diverse samples and adequate analyses, and psychiatry scientists must reconsider approaches to clinical research.

Competing Interests: Sapna Syngal Consulting or Advisory Role: Myriad Genetics, DC Health Patents, Royalties, Other Intellectual Property: Dana-Farber Cancer Institute has a registered service mark for the PREMM5 model and holds copyrights for the PREMM questionnaires; Myriad Genetics (through Dana-Farber Cancer Institute) paid an inventor share of the IP (license issue fee) No other potential conflicts of interest were reported. Sapna Syngal Consulting or Advisory Role: Myriad Genetics, DC Health Patents, Royalties, Other Intellectual Property: Dana-Farber Cancer Institute has a registered service mark for the PREMM5 model and holds copyrights for the PREMM questionnaires; Myriad Genetics (through Dana-Farber Cancer Institute) paid an inventor share of the IP (license issue fee) No other potential conflicts of interest were reported.

Importance: Adolescents frequently encounter racism vicariously through online news and social media and may experience negative emotional responses due to these exposures. To mitigate potential adverse health impacts, including negative emotional health, it is important to understand how adolescents cope with these exposures., Objectives: To examine adolescents' responses to online and media-based vicarious racism exposure and to explore coping strategies, particularly positive coping strategies, that may be used to combat negative emotions., Design, Setting, and Participants: This qualitative study rooted in phenomenological research methods conducted 4 semistructured focus groups, with 3 to 6 English-speaking adolescents (aged 13-19 years) in each group, between November 2018 and April 2019. Focus groups were facilitated by 2 research team members. The study was conducted at community sites and youth organizations in the greater Chicago, Illinois, area. Interview transcripts were analyzed thematically., Exposures: Lived experiences of media-based vicarious racism., Main Outcomes and Measures: Focus group participants shared their experiences with media-based vicarious racism online, including their responses to exposure and the coping strategies used., Results: Four focus group sessions were conducted with a total of 18 adolescents. Participants had a mean (SD) age of 16.4 (1.6) years. Overall, 7 participants (39%) self-identified as Black/African American, 8 (44%) as Hispanic/Latinx, and 3 (17%) as White individuals; 7 (39%) were in grades 7 to 9, 8 (44%) in grades 10 to 12 grade, and 3 (17%) at the college or university level. Central themes emerged related to adolescents' experiences, including their emotional and coping responses to media-based vicarious racism. Many participants reported helplessness as a major negative emotion associated with these exposures. Activism was endorsed as a key positive coping strategy that participants used, including online and in-person modalities., Conclusions and Relevance: The findings from this qualitative study suggest adolescents may experience helplessness as a primary negative emotion after exposure to media-based vicarious racism and activism may serve as a coping mechanism. Activism may represent an important and constructive means by which adolescents cope with and combat structural racism, mitigate negative emotions, and potentially prevent adverse health effects.