Journal of Racial and Ethnic Health Disparities

Physicians' Stigma Towards Ethnicity of Patients with Cancer and Its Effects on the Health Outcomes: The Moderating Effect of Ethnic Dissimilar Medical Encounters
Katalan A, Drach-Zahavy A and Dagan E
This study aimed to examine the moderating effect of ethnic patient-physician similarity versus dissimilarity on the relationship between physicians' stigma towards ethnicity and physicians' communication behaviors during medical encounters and patients' post-meeting anxiety.
Hypertensive Disorders in Pregnancy: Differences by Hispanic Ethnicity and Black Race
Atkinson JA, Carmichael SL and Leonard SA
Black individuals carry the greatest burden of maternal mortality, with hypertensive disorders during pregnancy being a significant driving force to this disparity. However, research on maternal health disparities predominantly groups Hispanic Black individuals with all other individuals of Hispanic ethnicity. We hypothesized that this aggregation might obscure the risk patterns of hypertensive disorders in pregnancy for Hispanic-Black and non-Hispanic Black individuals.
Indian Council of Medical Research (ICMR)-Sickle Cell Disease (SCD) Stigma Scale for India (ISSSI): A Protocol for Scale Development
Bhat D, Sharma Y, Sridevi P, Surti SB, Sarmah J, Ranjit M, Bal M and Babu BV
Sickle cell disease (SCD) is a genetic blood disorder presenting a substantial public health challenge. India, holding the second-highest prevalence globally, exhibits diverse clinical manifestations. The recently launched National SCD Elimination Mission (NSEM) in India has contributed to an increased identification of cases. The national program should extend its services beyond screening and clinical management. The outcome of the disease is influenced by a multitude of factors impacting healthcare utilization, with stigma emerging as a major influencer. Addressing stigma at the right time is crucial to comprehensive disease care. Understanding and quantifying the type and level of stigma in the ecosystem are fundamental steps toward tackling this pressing issue, necessitating the development of a scale. The existing three scales developed and utilized in African and American contexts may not be suitable for the Indian SCD community due to phenotypic, socio-cultural, and contextual variations. Therefore, developing, modifying, and creating a locally applicable scale is imperative. This protocol paper outlines the process of developing, refining, and evaluating the Indian Council of Medical Research (ICMR)-SCD Stigma Scale for India (ISSSI), which will be developed by Indian researchers led by the ICMR.
Dementia Risk and Social Determinants of Health Among Adults Racialized as Black: A Community-Based System Dynamics Perspective
Trani JF, Hart R, Walker AIB, Safi M, Singh RK, Zhu Y and Babulal GM
The aging population in the USA is projected to increase significantly, with a corresponding rise in dementia cases, particularly among racial minorities. This study examines the key drivers of racial disparities in dementia risk among older Black adults in the St. Louis area, a region characterized by entrenched structural racism. Utilizing a Community-Based System Dynamics (CBSD) approach, we engaged cognitively normal Black adults (age ≥ 45) to explore the complex interplay of social and structural determinants of health (S/SDOH) affecting dementia risk.
Racial and Ethnic Disparities in Regional Anesthesia: A Brief Review
Powell A, Khusid E, Lui B, Carlton A, Jotwani R and White RS
Disparities in regional anesthesia may limit patients' access to appropriate care. We reviewed literature from 2013 to 2023 regarding health disparities in regional anesthesia. While there were some exceptions, patients belonging to racial/ethnic minority groups and those with lower socioeconomic status did not receive regional anesthesia as frequently as their White or higher-income peers. As regional anesthesia continues to emerge as a preferred method of managing chronic pain conditions and providing surgical anesthesia, it is essential to ensure that it is provided equitably across the patient population.
Community Member Perceptions of Dollar Stores in Baltimore City, Maryland: "They are Not Progressive for the Communities"
Sundermeir SM, Santos SR, Lewis EC, John S, Wolfson JA, Poirier L, Hua S and Gittelsohn J
Dollar stores are the fastest-growing type of food retailer in the United States, prompting policy action across the country related to their perceived negative impact on the communities they serve. However, there is little existing research that explores community member perceptions of dollar stores, which is critical to inform new, equitable policies. To address this gap in Baltimore City, Maryland, where dollar store density is high, we aimed to describe community member perceptions of dollar stores in terms of their role in the broader community. We used thematic analysis to construct themes from community member in-depth interviews (n = 16) and one community member workshop (n = 21) to understand how dollar stores are viewed in the context of the broader Baltimore City community. Six key themes were generated: (1) dollar stores contribute to neighborhood "blight," (2) better retail is needed, (3) dollar stores meet certain community needs, (4) dollar stores do not invest enough in the community, (5) dollar stores vary in location and stock depending on race-based neighborhood qualities, and (6) product quality is low. Overall, participants acknowledged that dollar stores meet certain needs in communities in which there are few alternative retail options, but many did not view them as a benefit and desired to have other retailers instead. Participants also discussed the lack of dollar store investment in the communities they serve, and the low quality of food and non-food products offered. Future policy development should include community member perspectives to understand local context and align policies with community priorities.
Personal Networks and Cervical Cancer Screening among Black Immigrant Women
Cofie LE, Whitt O and Bhagat N
Prior research has linked personal network characteristics with cancer screening uptake including Papanicolaou (Pap) screening, but less is known about the experiences of Black immigrant women (BIW) in the USA. We examined the relationship between network characteristics and Pap screening among BIW and explored how their network members influence their cancer related knowledge and prevention behaviors.
Worse Clinical and Survival Outcomes in Breast Cancer Patients Living in Puerto Rico Compared to Hispanics, Non-Hispanic Blacks, and Non-Hispanic Whites from Florida
Lantz AE, Gebert R, Li J, Oliveras JA, Gordián ER, Perez-Morales J, Eschrich S, Chen DT, Rosa M, Dutil J, Saavedra HI, Muñoz-Antonia T, Flores I and Cress WD
Herein, we report the characterization of four cohorts of breast cancer patients including (1) non-Hispanic Whites in Florida, (2) non-Hispanic Blacks in Florida, (3) Hispanics in Florida, and (4) Hispanics in Puerto Rico.
Direct and Vicarious Experiences of COVID-19-Related Racism Across Racial and Ethnic Groups in the United States
Cho YJ, Sherchan JS, Fernandez JR, Barlow SA, Strassle PD and Forde AT
Due to stigmatization associated with the COVID-19 pandemic, certain groups were believed to be the cause of COVID-19 and thus experienced COVID-19-related racism through direct interpersonal and vicarious experiences. This study used quantitative and qualitative responses to examine whether the prevalence of experiencing these types of racism varied across racial and ethnic groups.
Gender and Racial/Ethnic Disparities in HIV Care and Viral Suppression at Jail Entry
Vaughn JT, Peterson CE, Hirschtick JL, Ouellet LJ, Hershow RC and Kim SJ
Women and racial/ethnic minorities living with HIV are less likely than White men to be engaged in HIV treatment when entering US jails. Few studies have examined the intersection of gender and race/ethnicity among incarcerated populations. The "Enhancing Linkages to HIV Primary Care and Services in Jail Settings Initiative" (EnhanceLink) was a 10-site prospective cohort study of 1,270 people living with HIV in correctional facilities between 2008 and 2011. Using data from this study (N = 1,096), we assessed the likelihood of having a usual source of HIV care, utilizing ART, and viral suppression (HIV-1 RNA < 200 copies/ml) within 30 days of incarceration among the following groups, stratified by current gender and race/ethnicity, relative to non-Hispanic White men: Non-Hispanic Black women, non-Hispanic Black men, Hispanic/Latina (Hispanic) women, Hispanic men, and non-Hispanic White women. Compared to non-Hispanic White men, non-Hispanic Black women were 20% less likely to report that they had access to HIV care before incarceration after adjusting for age, sexual orientation, incarceration history, and medical comorbidities (prevalence ratio (PR) = 0.8, 95% CI: 0.7-0.9, p = 0.0002). Non-Hispanic Black, Hispanic, and Non-Hispanic White women were 30% less likely to utilize ART (respectively) than White men after adjusting for the same potential confounders (PR = 0.7, 95% CI: 0.6-0.9, p = 0.002; PR = 0.7, 95% CI: 0.5-0.9, p = 0.02; PR = 0.7, 95% CI: 0.5-1.0, p = 0.03). Our findings underscore the importance of culturally informed, community-based HIV interventions that promote equitable access to HIV care.
A Closer Look at the Family Planning Challenges for the Black LGBTQ+ Community via the Black Rainbow Justice Initiative
Nicholson-Robinson V and Oladipo M
Many parts of the USA continue to move towards tremendous societal progression of supporting LGBTQ + marriage and family planning. However, there are other areas, including many states within the southern region of the USA, which tend to be less progressive and more resistant towards this subject matter. As of now, information is limited on understanding the experiences and challenges faced by Black LGBTQ + individuals in regard to how they navigate the healthcare system for family planning purposes. Findings from this study highlight Black LGBTQ + individuals and couples' unique experiences of undergoing fear and discomfort with racial and gender bias in their pursuit of expanding their families. Highlighted findings revealed that many experienced challenges with access due to cost of health care, cost with adoption, lack of Black sperm donors, and negative experiences with their provider. It is our belief that highlighting such experiences will provide a direction for how we may work to improve the well-being of Black LGBTQ + individuals, couples, and their families for the future.
COVID-19 Pandemic-Related Stressors, Distress, and Bodily Pain in Native Americans: Results from the Oklahoma Study of Native American Pain Risk
Ventresca HM, Kell PA, Toledo TA, Street EN, Huber FA, Hellman NM, Brown TV, Vore CN, Trevino K, Shadlow JO and Rhudy JL
The COVID-19 pandemic disproportionately impacted minoritized individuals. This study examined the relationships between pandemic-related stressors/distress and bodily pain in 79 Native American (NA) and 101 non-Hispanic White (NHW) participants from the Oklahoma Study of Native American Pain Risk. Online surveys were administered in May/June 2020 (wave 1), March/April 2021 (wave 2), and Sept/Oct 2021 (wave 3). Pandemic-related stressors (e.g., resource loss and added responsibilities) and distress were assessed from a custom-built questionnaire. Bodily pain was assessed from pain items on the Patient Health Questionnaire-15 (PHQ-15). The results indicate NAs and NHWs reported similar pandemic-related stressors and distress at wave 1, which remained at similar levels across all waves in NHWs. By contrast, stressors and distress increased in NAs at waves 2 and 3. Moreover, bodily pain was higher in NAs than NHWs across all waves. Regression-based multilevel analyses predicting bodily pain found that NHWs with more pandemic-related stressors/distress experienced more bodily pain, but stress/distress did not predict bodily pain in NAs. Findings demonstrated that NAs experienced more bodily pain and pandemic-related stressors/distress than NHWs. However, pandemic-related stressors/distress did not further exacerbate NA pain as observed in NHWs. This implies NAs may have demonstrated resiliency that buffered the pronociceptive effects of pandemic-related stress.
Disparities in Patient Portal Activation and Usage at a Large Pediatric Academic Institution
Chuang EG, Richardson AC, Boulil Z, Kuelbs CL and Huang JS
Access to personal medical information promotes patient understanding of health issues and enables patient self-advocacy of healthcare needs. The advent of electronic medical record systems and the 2016 21st Century CURES Act promoted and encouraged patient access to personal medical information, yet technology-dependent modalities have often disadvantaged certain communities. We sought to evaluate whether disparities existed in access to patient portals at our institution, the main pediatric care provider in an area serving one million children.
Fortifying Physical and Psychological Wellbeing: Leveraging Capital for Resilience Against Racism and Adversity Across Racial Groups
St John VJ and Nemati D
This study examines the impact of various adversities-including racism, indirect adversity, loss of a loved one, and adverse police contact-on psychological and physical health outcomes such as sleep quality, depressive symptoms, serious illness, and self-reported health. Additionally, it investigates how economic, educational, social, and spiritual capital moderate these effects, with attention to racial differences. Leveraging a sample of 1139 participants from the 1995 Detroit Area Study, analyses reveal nuanced effects of adversity, with the impact being neutralized, attenuated, or amplified by coping capacities. Economic and educational supports generally provide protective health benefits, while social and religious supports reveal complex, sometimes divergent effects. Subgroup analyses reveal racial differences: for instance, Black individuals face a higher likelihood of developing a serious illness in connection with adverse police encounters, and White individuals benefit from liquid assets in buffering depressive symptoms. These findings underscore the need for multifaceted, context-sensitive health interventions and policies that enhance economic stability, educational opportunities, and mental health services, while strengthening social and spiritual support systems to build resilience and mitigate the adverse health effects of these adversities.
Connecting Past to Present: Does Historical Redlining Affect Current Life Expectancy?
Freifeld C, Camarero A, Oh J, Fairchok A, Yang K and Siegel M
Previous research has documented a strong relationship between currently living in the redlined zones of the 1930s and suffering from a higher prevalence of disease. However, little is known about the relationship between historical redlining, modern-day redlining, and current resident health outcomes. This paper aimed to simultaneously model the associations between both historical redlining and modern-day redlining on current health outcomes.
Rural Alabamians' Unmet Medical Needs: Rethinking the Roles of Online Health Information-Seeking Behaviors
Kim D, Yoon YJ, Cosenzo LG and Lee HY
Unmet medical needs in rural areas are of grave concern in the U.S. With the advent of digital technologies, the Internet has become a critical means for accessing essential health information. However, racial/ethnic minority rural communities experiencing scarcity in healthcare services and access to the Internet are underrepresented in digital health studies. This study examined the association between online health information-seeking behaviors and unmet medical needs in a sample of African/Black American adults living in a rural region of the U.S.
A Review of the Public Health Literature Examining the Roles of Socioeconomic Status and Race/Ethnicity on Health Outcomes in the United States
White TM, Borrell LN and El-Mohandes A
This review of reviews examines the role of socioeconomic status (SES) indicators on health inequities among different racial and ethnic groups in the United States (US) between 2019 and 2023. Of the 419 articles, 27 reviews met the inclusion criteria and were aggregated into seven categories: COVID-19 and respiratory pandemic disparities; neighborhoods, gentrification, and food environment; surgical treatments; mental, psychological, and behavioral health; insurance, access to care, and policy impact; cancers; and other topics. The findings revealed a documented impact of SES indicators on racial/ethnic health inequities, with racial/ethnic minority communities, especially Black Americans, consistently showing poor health outcomes associated with lower SES, regardless of the outcome or indicator examined. These findings call attention to the importance of policies and practices that address socioeconomic factors and systemic racial/ethnic inequities affecting the social determinants of health affecting racial/ethnic inequities to improve health outcomes in the US population.
Sociodemographic Factors Associated with the Utilization of Digital Health Technologies Among Informal Caregivers: A Nationwide Study in the USA, 2022
Mojtahedi Z and Shen JJ
Informal caregivers can leverage digital health technologies to support their own health while also assisting patients, particularly those with mental or physical challenges. This study investigated the sociodemographic factors associated with the use of digital health technology among informal caregivers.
Bridging the Gap: Culturally Responsive Strategies for NIH Trial Recruitment
Ross L, Eberlein S, Khalil C, Choi SY, McKelvey K and Spiegel BMR
To enhance recruitment and participation rates of non-Hispanic Black (NHB) and Hispanic adult patients in a NIH-funded clinical trial studying an emerging health technology.
Socioeconomic Status, Social Support, and Quality of Life Among Black Adults
Murphy ER, Wippold GM and Crichlow ZR
Socioeconomic status has a pervasive influence on one's health and quality of life. Social support is known as a factor that can minimize the risk of maladaptive health outcomes while promoting greater quality of life. The purpose of this study was to examine the direct and indirect relationships between perceived socioeconomic status, social support, physical quality of life, and psychological quality of life among Black adults.
Intersecting Epidemics: Examining the Impact of Internalized Homophobia and Depression Symptoms on HIV Testing Through a Suicide Syndemic Among Young Black Men Who Have Sex with Men
Boyd DT, Martinez O, Mammadli T, Shamrock OW, Abu-Ba'are GR and Dyer TV
Young Black men who have sex with men (BMSM) in the USA face disproportionate rates of HIV incidence. Mental health vulnerabilities, including depression, anxiety, substance use, and trauma, further exacerbate the HIV epidemic among this population. Internalized homophobia, discrimination, and depression contribute to elevated rates of suicidal behavior among young BMSM, which in turn may influence engagement in HIV prevention behaviors, such as HIV testing. However, limited research has examined the interplay among suicidal behaviors, internalized homophobia, depression, and HIV testing among young BMSM. This study utilized syndemic theory to explore the relationships among these factors in a sample of 400 young BMSM ages 18-29. Results indicate alarming rates of suicidal behavior among young BMSM, with significant associations among internalized homophobia, depression symptoms, suicidal behavior, and HIV testing. The findings underscore the urgent need for targeted mental health interventions and HIV prevention services tailored to address the unique challenges faced by young BMSM. Comprehensive, multi-level, community-centered interventions are essential to address the syndemics affecting young BMSM, promoting holistic health and well-being while improving outcomes across the HIV prevention continuum.