RESUMEN
The COVID-19 crisis can be defined as a collective trauma, which contributes to an upheaval of community connection and functioning. The current pandemic has also illuminated disparities in mental health supports. In this commentary, we highlight one community organization, located in metro Detroit, that has responded to the trauma by bolstering resources and supports for residents, many of whom are ethnoracial minorities. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
Asunto(s)
Servicios Comunitarios de Salud Mental/organización & administración , Infecciones por Coronavirus , Disparidades en Atención de Salud/etnología , Pandemias , Aceptación de la Atención de Salud/etnología , Neumonía Viral , Pobreza/etnología , Trauma Psicológico/etnología , Trauma Psicológico/terapia , COVID-19 , Humanos , Michigan/etnología , Trauma Psicológico/etiologíaRESUMEN
The mental health consequences of the COVID-19 pandemic are particularly relevant in African-American communities because African-Americans have been disproportionately impacted by the disease, yet they are traditionally less engaged in mental health treatment compared with other racial groups. Using the state of Michigan as an example, we describe the social and psychological consequences of the pandemic on African-American communities in the United States, highlighting community members' concerns about contracting the disease, fears of racial bias in testing and treatment, experiences of sustained grief and loss, and retraumatization of already-traumatized communities. Furthermore, we describe the multilevel, community-wide approaches that have been used thus far to mitigate adverse mental health outcomes within our local African-American communities. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
Asunto(s)
Negro o Afroamericano/etnología , Servicios Comunitarios de Salud Mental , Infecciones por Coronavirus/etnología , Pesar , Disparidades en Atención de Salud/etnología , Servicios de Salud Mental , Neumonía Viral/etnología , Trauma Psicológico/etnología , Religión y Psicología , Adulto , COVID-19 , Humanos , Michigan/etnología , Pandemias , Trauma Psicológico/terapiaRESUMEN
There is growing evidence for the adverse health effects of structural and individual forms of discrimination in multiple religious, ethnic, and racial groups. Since the September 11, 2001 terrorist attacks, Arab Americans have experienced increasingly more frequent and visible forms of discrimination. However, the impact of these experiences on their mental well-being requires further investigation. This study examines the association between perceived discrimination and several markers of mental health and well-being, using cross-sectional data from a convenience sample of 279 Arab American adults from southeast Michigan. After adjustment for a series of relevant confounders, perceived discrimination was significantly associated with depressive symptoms (estimate 0.93, 95% CI 0.53, 1.34, p < 0.01), anxiety symptoms (estimate 0.48, 95% CI 0.19, 0.77, p < 0.01), and poor self-rated health (OR 1.31, 95% CI 1.08, 1.58, p < 0.01). The study highlights the need to address and mitigate health disparities among individuals of Arab descent and improves awareness of the potential health effects of ongoing structural and interpersonal discrimination toward this population.
Asunto(s)
Árabes/psicología , Emigrantes e Inmigrantes/psicología , Etnicidad/psicología , Trastornos Mentales/etiología , Racismo/psicología , Refugiados/psicología , Adulto , Anciano , Anciano de 80 o más Años , Árabes/estadística & datos numéricos , Estudios Transversales , Emigrantes e Inmigrantes/estadística & datos numéricos , Etnicidad/estadística & datos numéricos , Femenino , Humanos , Masculino , Trastornos Mentales/etnología , Michigan/etnología , Persona de Mediana Edad , Racismo/estadística & datos numéricos , Refugiados/estadística & datos numéricos , Estados UnidosRESUMEN
OBJECTIVES: To characterize the burden of unintentional injury mortality among American Indians/Alaska Natives (AI/ANs) in Michigan, Minnesota, and Wisconsin and identify segments of the population that may especially benefit from policy and practice actions to reduce unintentional injury mortality risk factors. DESIGN: Surveillance of mortality data from CDC WONDER and WISQARS online databases. SETTING: The 3 states in the Indian Health Service (IHS) Bemidji Area: Michigan, Minnesota, and Wisconsin. PARTICIPANTS: AI/ANs and whites who died from unintentional injuries in 2011-2015 in Michigan, Minnesota, and Wisconsin. MAIN OUTCOME MEASURE: Unintentional injury mortality rates and AI/AN versus white unintentional injury mortality disparity ratios. RESULTS: For all types of unintentional injury mortality, from 2011 to 2015, AI/ANs in the Bemidji Area died at an age-adjusted rate that was 77% higher than that for whites, a statistically significant difference. For AI/ANs in the 3-state area, the top cause of unintentional death was poisoning. The poisoning rate was a statistically significant 2.64 times as high for AI/ANs as that for whites, the highest disparity seen by type. When analyzed by age, gender, and rural/urban residence, unintentional injury mortality rates were almost always higher for AI/ANs. AI/ANs also had a much higher burden of years of potential life lost. CONCLUSIONS: Unintentional injury mortality significantly affects AI/ANs in the 3-state area and to a larger degree than for whites. However, some of the risk factors for unintentional injury are modifiable and, if addressed effectively, can reduce injury deaths. Governments, local leaders, organizations, and individuals can reduce AI/ANs' risk of unintentional injury by providing effective programming; encouraging or modeling behavior change; advocating for, creating, and enforcing laws and policies; and making infrastructure improvements. Increased attention to this topic and equitable efforts to reduce risk factors have great potential to reduce the burden of unintentional injury deaths for AI/ANs and all peoples.
Asunto(s)
Accidentes/mortalidad , Indígenas Norteamericanos/etnología , Accidentes/estadística & datos numéricos , Adolescente , Adulto , Anciano , Causas de Muerte/tendencias , Femenino , Humanos , Indígenas Norteamericanos/estadística & datos numéricos , Masculino , Michigan/etnología , Persona de Mediana Edad , Minnesota/etnología , Vigilancia de la Población/métodos , Factores de Riesgo , Wisconsin/etnologíaRESUMEN
OBJECTIVE: To investigate the relationship between depressive symptoms and preterm birth (PTB) while adjusting for social support, both general and from the father of the baby. DESIGN: Retrospective study design. SETTING: Participants of the Life-course Influences of Fetal Environments (LIFE) study were recruited from a suburban hospital in Metropolitan Detroit, Michigan. PARTICIPANTS: The LIFE data consisted of 1,410 self-identified Black women age 18 to 45 years; 1,207 women were included in this analysis. METHODS: Women were interviewed using a structured questionnaire administered 24 to 48 hours after birth during their postpartum hospitalization. Data on the newborns and their mothers' health were collected through medical record abstraction. The Center for Epidemiologic Studies Depression Scale (CES-D) was used to measure symptoms of depression. The CES-D scores ≥23 were considered severe symptoms of depression. Modified Poisson regression models were built using a stepwise approach to assess association between symptoms of depression and PTB. RESULTS: Approximately, 17% of women had a PTB and 20% of women in the sample had a CES-D scores ≥23. Women who had CES-D score ≥23 were about 70% more likely to have a PTB compared with women with CES-D scores <23 (PR = 1.68, 95% CI: 1.24-2.16) after adjustment for both general social support and father of the baby support. CONCLUSION: Women with CES-D scores ≥23 were almost twice more likely to have PTB compared with women with CES-D scores <23. Referrals for mental healthcare providers might benefit women with symptoms of depression and improve birth outcomes. Nurses should encourage women to seek support beyond the father of the baby.
Asunto(s)
Depresión/psicología , Nacimiento Prematuro/psicología , Apoyo Social , Adolescente , Adulto , Depresión/epidemiología , Depresión/etnología , Femenino , Humanos , Michigan/epidemiología , Michigan/etnología , Persona de Mediana Edad , Embarazo , Nacimiento Prematuro/epidemiología , Nacimiento Prematuro/etnología , Psicometría/instrumentación , Psicometría/métodos , Estudios Retrospectivos , Factores de Riesgo , Encuestas y CuestionariosRESUMEN
OBJECTIVE: Black patients and their physicians tend to form relatively negative impressions of each other, and these may contribute to racial disparities in health outcomes. The current research tested the hypothesis that the interaction between positive and negative affective behavior predicts the most positive impressions in clinic visits between Black patients and their oncologists. METHOD: Naïve coders rated patients' and oncologists' positive and negative affective behavior in thin slices from 74 video recorded clinic visits. We examined whether (a) physician positive affect, negative affect, or their interaction predicted patients' perceptions of patient-centeredness, trustworthiness, and confidence in recommended treatments and (b) patient positive affect, negative affect, or their interaction predicted physicians' perceptions of patient cognitive ability, likelihood of treatment adherence, and likelihood of treatment tolerance. We also tested whether affective behavior mediated relationships between race-related attitudes and post-visit impressions or influenced post-visit impressions independently of attitudes. RESULTS: When oncologists displayed relatively high levels of both positive and negative affect, patients were more confident in recommended treatments but did not rate physicians higher in patient centeredness or trustworthiness. When patients expressed relatively high levels of positive and negative affect, oncologists perceived patients to be higher in cognitive ability and more likely to adhere to treatment recommendations, but no more likely to tolerate treatments. Affective behavior influenced impressions independently of race-related attitudes. CONCLUSIONS: Positive and negative affective behaviors jointly contribute to impression formation in clinic visits between Black patients and oncologists, and may have implications for patient treatment and outcomes in this underserved patient population.
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Síntomas Afectivos/complicaciones , Negro o Afroamericano/psicología , Neoplasias/complicaciones , Oncólogos/psicología , Relaciones Médico-Paciente , Síntomas Afectivos/psicología , Negro o Afroamericano/etnología , Anciano , Femenino , Humanos , Masculino , Michigan/etnología , Persona de Mediana Edad , Neoplasias/psicología , Grupos Raciales/etnología , Grupos Raciales/psicologíaRESUMEN
OBJECTIVE: The purpose of this study was to examine whether the relationship with the father of the baby was related to psychological stress among Black women. METHODS: This is a secondary analysis of data derived from a retrospective cohort study of 1,410 Black new mothers participating in the Life-course Influences on Fetal Environments (LIFE) study conducted in the Detroit Metropolitan area. Data were obtained from maternal interview and medical records abstraction. Perceived stress was measured by the Cohen's Perceived Stress Scale. The mother's relationship with the father of the baby before and after pregnancy was measured using two questions. RESULTS: Women who reported sometimes close/sometimes distant relationship with the father of the baby prior to pregnancy had higher levels of perceived stress compared with women who reported close relationship with the father of the baby prior to pregnancy (38.73 and 35.10, respectively, p < .001). Women who reported current distant relationship (38.82 and 34.45, respectively, p < .001) and sometimes close/sometimes distant relationship (38.83 and 34.45, respectively, p < .001) reported higher levels of perceived stress compared with women who had current close relationship with the father of the baby. CLINICAL IMPLICATIONS: Women who reported to have a close relationship with the father of the baby before and during the pregnancy reported lower levels of stress compared with women with a distant relationship with the father of the baby. Nurses should assess women's relationship with the father of the baby and their levels of stress.
Asunto(s)
Población Negra/psicología , Padre/psicología , Percepción , Estrés Psicológico/etiología , Adolescente , Adulto , Análisis de Varianza , Población Negra/etnología , Femenino , Humanos , Michigan/etnología , Persona de Mediana Edad , Embarazo , Psicometría/instrumentación , Psicometría/métodos , Estudios Retrospectivos , Apoyo Social , Estrés Psicológico/etnología , Estrés Psicológico/psicologíaRESUMEN
Although Muslims in the United States are a growing population, there is limited research on their relational patterns and how they prepare for marriage. We conducted in-depth interviews with 32 members of the Muslim community in Southeast Michigan including married individuals, divorced individuals, therapists, and imams (Muslim religious leaders) to explore their perceptions and experiences of marriage preparation. Our analysis revealed that marriage preparation varies but is less likely to involve a requirement of premarital counseling, with imams being the primary providers, not therapists. Barriers to participation include stigma, lack of awareness, logistical and financial challenges, and parental influence. Partnerships between imams and therapists, and family and community efforts are necessary to address barriers and increase participation in premarital education programs.
Asunto(s)
Islamismo/psicología , Matrimonio/etnología , Matrimonio/psicología , Religión y Psicología , Adulto , Anciano , Clero , Femenino , Humanos , Masculino , Terapia Conyugal , Michigan/etnología , Persona de Mediana EdadRESUMEN
AIM: This study aimed to investigate gender differences in the association between baseline depressive symptoms and subsequent changes in obesity in a sample of urban Black youth in the USA. METHODS: The current study followed 681 Black youth (335 male and 346 female) for up to 18 years from 1994 to 2012. All youth were selected from an economically disadvantaged urban area in MI, USA. The main independent variable was baseline depressive symptoms measured in 1994. The main outcome was change in body mass index (BMI) from 1999 to 2012, calculated based on self-reported height and weight. Scio-demographics (age, number of parents in the household, and parental employment) were covariates. Gender was the focal moderator. We used linear regressions to test the predictive role of baseline depressive symptoms on change in BMI (from 1999 to 2012) in the pooled sample, and also based on gender. RESULTS: Among Black females, but not Black males, baseline depressive symptoms predicted the BMI change from 1999 to 2012. The association remained significant for Black females after controlling for covariates. CONCLUSION: High depressive symptoms at baseline better predict BMI change over the next decade for female than male Black youth. As a result, detection and reduction of depressive symptoms may be a vital element of obesity prevention programs for Black females. Policies and programs that address determinants of psychological distress as a strategy to prevent obesity among female Black youth in disadvantaged neighborhoods may be especially useful.
Asunto(s)
Conducta del Adolescente/psicología , Negro o Afroamericano/psicología , Trastorno Depresivo/etnología , Trastorno Depresivo/psicología , Obesidad/psicología , Adolescente , Conducta del Adolescente/etnología , Adulto , Negro o Afroamericano/etnología , Anciano , Anciano de 80 o más Años , Índice de Masa Corporal , Peso Corporal , Femenino , Humanos , Masculino , Michigan/etnología , Persona de Mediana Edad , PronósticoRESUMEN
INTRODUCTION: The objective of this study was to investigate the various factors that influence colorectal cancer screening in Michigan using 6091 participants in the Michigan Behavioral Risk Factor Surveillance System representing adults ≥ 50 years old. METHODS: Screening for colorectal cancer was assessed as fecal occult blood testing or colonoscopy/sigmoidoscopy. Full models simultaneously adjusted for alcohol use, angina/coronary heart disease, stroke, heart attack, gender, income, marital status, race, age, diabetes, disability, exercise, health care coverage, health care access, smoking, and mental health. Data analysis included cross-tabulation and logistic regression modeling. RESULTS: Minorities were 1.3 (unadjusted odds ratio; 95% confidence interval = 1.03-1.57) times more likely to never have a colonoscopy/sigmoidoscopy than non-Hispanic whites. Race/ethnicity was not significant in the full model, but adults with the following characteristics were significantly (p < 0.05) more likely to never have a colonoscopy/sigmoidoscopy: no personal doctor/health care provider, no health care coverage, light alcohol consumption ≤ 25% of days, no alcohol consumption, low income < $15,000, 50-64 years old, no diabetes, no activity limitation, no exercise, smoked daily, and smoked some days. CONCLUSION: The racial disparity in colorectal cancer screening in Michigan was explained by other characteristics. The healthcare community can work to eliminate racial disparities in colorectal cancer screening by increasing screening efforts for individuals with these characteristics.
Asunto(s)
Neoplasias Colorrectales/diagnóstico , Neoplasias Colorrectales/etnología , Detección Precoz del Cáncer/estadística & datos numéricos , Etnicidad/estadística & datos numéricos , Disparidades en Atención de Salud/etnología , Tamizaje Masivo/estadística & datos numéricos , Racismo/etnología , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Disparidades en Atención de Salud/estadística & datos numéricos , Hispánicos o Latinos/estadística & datos numéricos , Humanos , Modelos Logísticos , Masculino , Michigan/etnología , Persona de Mediana Edad , Oportunidad Relativa , Racismo/estadística & datos numéricos , Factores Socioeconómicos , Población Blanca/estadística & datos numéricosRESUMEN
Telomeres are the protective caps at the ends of eukaryotic chromosomes. Short telomere length is associated with morbidity and mortality among adults and may mark the biological impact of social experiences. Using archived dried blood spots from the Michigan Neonatal Biobank, this study examined markers of maternal social disadvantage (educational attainment, receipt of public assistance, marital status, and race/ethnicity) from linked birth certificates as predictors of telomere length at birth in a sample of 192 singleton neonates born to non-Hispanic black, non-Hispanic white, and Latina mothers aged 20-35 years. Consistent with two recent studies in newborns, but counter to the idea that maternal social disadvantage is associated with shorter offspring telomere length, we found that infants born to black mothers had longer telomeres than those born to white mothers (b = 0.12, SE = 0.06, p = .05). However, black/white differences in newborn telomere length varied by receipt of public assistance. Among newborns whose mothers received WIC and/or Medicaid, there were no significant black/white differences in telomere length (b = 0.09, SE = 0.08, p = .25). In contrast, among those whose mothers did not receive public assistance-just 6 out of 69 infants born to black mothers versus 41 out of 69 infants born to white mothers-we found that babies born to black mothers had longer telomere length than babies born to white mothers (b = 0.37, SE = 0.16, p = .03). The interaction between black race/ethnicity and receipt of public assistance did not reach the conventional threshold for statistical significance (b = -0.22, SE = 0.15, p = .13), suggesting that this finding may be due to chance. No other markers of maternal social disadvantage were related to infant telomere length. Although replication of these results in a larger sample with more infants born to black mothers with relatively high socioeconomic status is needed, this study offers preliminary support for the hypothesis that race/ethnic differences in newborn telomere length depend on social context.
Asunto(s)
Factores Socioeconómicos , Telómero/clasificación , Adulto , Bancos de Muestras Biológicas , Certificado de Nacimiento , Población Negra/etnología , Población Negra/estadística & datos numéricos , Femenino , Pruebas Hematológicas/métodos , Pruebas Hematológicas/estadística & datos numéricos , Hispánicos o Latinos/estadística & datos numéricos , Humanos , Lactante , Mortalidad Infantil , Recién Nacido , Masculino , Estado Civil , Michigan/etnología , Madres/estadística & datos numéricos , Factores de Riesgo , Población Blanca/etnología , Población Blanca/estadística & datos numéricosRESUMEN
BACKGROUND: Community health worker (CHW) interventions are known to be an effective strategy to improve health behaviors and outcomes in relation to diabetes, particularly for racial/ethnic communities. Although understanding the function of identity with same race/ethnicity among clients of CHW interventions could contribute to more effective program design, few studies have explored whether levels of racial/ethnic identity among participants can influence the effectiveness of CHW interventions. AIMS: We tested the relationship between level of racial/ethnic identity and changes in hemoglobin A1c and diabetes self-efficacy among low-income African American and Latino adults with type 2 diabetes who participated in a CHW intervention. METHODS: Data came from a randomized controlled trial of the CHW intervention with a 6-month delayed control group design for 164 African American and Latino adults in Detroit, Michigan. Racial/ethnic identity was created from two items and classified into high, moderate, and low. We combined the two arms (immediate and delayed) into one because there was no significant difference in baseline characteristics, other than age and postintervention self-efficacy, and multivariable linear regression models were applied in the analysis. RESULTS: Possession of high racial/ethnic identity was associated with greater improvement both in hemoglobin A1c and diabetes self-efficacy at 6 months. Moreover, among those with high hemoglobin A1c at preintervention, higher racial/ethnic identity had a greater impact on hemoglobin A1c improvement, compared with those with lower identity. CONCLUSIONS: This study suggests the importance of considering racial/ethnic identity of the participants in designing and operating the CHW intervention for racial/ethnic minority population.
Asunto(s)
Negro o Afroamericano/estadística & datos numéricos , Agentes Comunitarios de Salud/organización & administración , Diabetes Mellitus Tipo 2/terapia , Hispánicos o Latinos/estadística & datos numéricos , Grupos Raciales , Diabetes Mellitus Tipo 2/etnología , Femenino , Conductas Relacionadas con la Salud , Conocimientos, Actitudes y Práctica en Salud , Humanos , Masculino , Michigan/etnología , Persona de Mediana Edad , Pobreza , AutoeficaciaRESUMEN
RATIONALE: Many states have adopted laws mandating breast density (BD) notification for applicable women; however, very little is known about what women knew or felt about BD and related breast cancer (BC) risk before implementation of BD notification laws. OBJECTIVE: We examined between-race differences in the extent to which having dense breasts was associated with women's related BD cognition and emotion, and with health care providers' communication about BD. METHODS: We received surveys between May and October of 2015 assessing health care provider (HCP) communication about BD, BD-related knowledge, BD-related anxiety and BC worry from 182 African American (AA) and 113 European American (EA) women in the state of Michigan for whom we had radiologists' assessments of BD. RESULTS: Whereas having dense breasts was not associated with any BD-related cognition or emotion, there were robust effects of race as follows: EA women were more likely to have been told about BD by a HCP, more likely to know their BD status, had greater knowledge of BD and of BC risk, and had greater perceptions of BC risk and worry; AA women had greater BD-related anxieties. EA women's greater knowledge of their own BD status was directly related to the increased likelihood of HCP communication about BD. However, HCP communication about BD attenuated anxiety for AA women only. CONCLUSION: We present the only data of which we are aware that examines between-race differences in the associations between actual BD, HCP communication and BD related cognition and emotion before the implementation of BD notification laws. Our findings suggest that the BD notification laws could yield positive benefits for disparities in BD-related knowledge and anxiety when the notifications are followed by discussions with health care providers.
Asunto(s)
Densidad de la Mama/etnología , Neoplasias de la Mama/psicología , Detección Precoz del Cáncer/psicología , Conocimientos, Actitudes y Práctica en Salud , Grupos Raciales/psicología , Adulto , Ansiedad/etnología , Ansiedad/etiología , Población Negra/etnología , Población Negra/psicología , Población Negra/estadística & datos numéricos , Neoplasias de la Mama/etnología , Detección Precoz del Cáncer/métodos , Femenino , Alfabetización en Salud/normas , Humanos , Modelos Logísticos , Tamizaje Masivo/métodos , Michigan/etnología , Percepción , Psicometría/instrumentación , Psicometría/métodos , Grupos Raciales/etnología , Encuestas y Cuestionarios , Población Blanca/etnología , Población Blanca/psicología , Población Blanca/estadística & datos numéricosRESUMEN
With recommended screening for hepatitis C among the 1945-1965 birth cohort and advent of novel highly effective therapies, little is known about health disparities in the Hepatitis C care cascade. Our objective was to evaluate hepatitis C screening rates and linkage to care, among patients who test positive, at our large integrated health system. We used electronic medical records to retrospectively identify patients, in the birth cohort, who were seen in 21 Internal Medicine clinics from July 2014 to June 2015. Patients previously screened for hepatitis C and those with established disease were excluded. We studied patients' sociodemographic and medical conditions along with provider-specific factors associated with likelihood of screening. Patients who tested positive for HCV antibody were reviewed to assess appropriate linkage to care and treatment. Of 40,561 patients who met inclusion criteria, 21.3% (8657) were screened, 1.3% (109) tested positive, and 30% (30/100) completed treatment. Multivariate logistic regression showed that African American race, male gender, electronic health engagement, residency teaching clinic visit, and having more than one clinic visit were associated with higher odds of screening. Patients had a significant decrease in the likelihood of screening with sequential interval increase in their Charlson comorbidity index. When evaluating hepatitis C treatment in patients who screened positive, electronic health engagement was associated with higher odds of treatment whereas Medicaid insurance was associated with significantly lower odds. This study shows that hepatitis C screening rates and linkage to care continue to be suboptimal with a significant impact of multiple sociodemographic and insurance factors. Electronic health engagement emerges as a tool in linking patients to the hepatitis C care cascade.
Asunto(s)
Atención a la Salud/estadística & datos numéricos , Hepatitis C/diagnóstico , Tamizaje Masivo , Factores Socioeconómicos , Registros Electrónicos de Salud , Femenino , Hepatitis C/epidemiología , Hepatitis C/etnología , Humanos , Masculino , Michigan/epidemiología , Michigan/etnología , Persona de Mediana Edad , Estudios RetrospectivosRESUMEN
Although there exists a healthy body of literature related to discrimination in schools, this research has primarily focused on racial or ethnic discrimination as perceived and experienced by students of color. Few studies examine students' perceptions of discrimination from a variety of sources, such as adults and peers, their descriptions of the discrimination, or the frequency of discrimination in the learning environment. Middle and high school students in a Midwestern school district (N=1468) completed surveys identifying whether they experienced discrimination from seven sources (e.g., peers, teachers, administrators), for seven reasons (e.g., gender, race/ethnicity, religion), and in eight forms (e.g., punished more frequently, called names, excluded from social groups). The sample was 52% White, 15% Black/African American, 14% Multiracial, and 17% Other. Latent class analysis was used to cluster individuals based on reported sources of, reasons for, and forms of discrimination. Four clusters were found, and ANOVAs were used to test for differences between clusters on perceptions of school climate, relationships with teachers, perceptions that the school was a "good school," and engagement. The Low Discrimination cluster experienced the best outcomes, whereas an intersectional cluster experienced the most discrimination and the worst outcomes. The results confirm existing research on the negative effects of discrimination. Additionally, the paper adds to the literature by highlighting the importance of an intersectional approach to examining students' perceptions of in-school discrimination.
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Prejuicio/psicología , Instituciones Académicas , Percepción Social , Estudiantes/psicología , Adolescente , Femenino , Humanos , Masculino , Michigan/etnología , Prejuicio/etnologíaRESUMEN
This study examines the relationship between age, comorbidity, and breast and cervical cancer literacy in a sample of African American, Latina, and Arab women (N = 371) from Detroit, Michigan. The Age-adjusted Charlson Comorbidity Index (ACC) was used characterize the impact of age and comorbidity on breast and cervical cancer literacy. The relationship between ACC and breast and cervical cancer screening, and group differences, were assessed. There was a statistically significant difference between breast cancer literacy scores. ACC had a greater impact on breast cancer literacy for African Americans.
Asunto(s)
Neoplasias de la Mama/etnología , Conocimientos, Actitudes y Práctica en Salud/etnología , Alfabetización en Salud/estadística & datos numéricos , Neoplasias del Cuello Uterino/etnología , Adulto , Negro o Afroamericano/estadística & datos numéricos , Factores de Edad , Anciano , Anciano de 80 o más Años , Árabes/estadística & datos numéricos , Comorbilidad , Femenino , Hispánicos o Latinos/estadística & datos numéricos , Humanos , Michigan/etnología , Persona de Mediana Edad , Factores SocioeconómicosRESUMEN
BACKGROUND: African American (AA) women are known to have poorer breast cancer survival than whites, and the differences may be related to underlying disparities in their clinical presentation or access to care. This study evaluated the relationship between demographic, treatment, and socioeconomic factors and breast cancer survival among women in southeast Michigan. METHODS: The population included 2387 women (34% AA) with American Joint Committee on Cancer stage I to III breast cancer who were treated at the Henry Ford Health System (HFHS) from 1996 through 2005. Linked data sets from the HFHS, the Metropolitan Detroit Cancer Surveillance System, and the US Census Bureau were used to obtain demographic and clinical information. Comorbidities were classified with the modified Charlson comorbidity index (CCI). Economic deprivation was categorized with a census tract-based deprivation index (DI), which was stratified into 5 quintiles of increasing socioeconomic disadvantage. RESULTS: Compared with whites, AA women were significantly more likely to have larger, hormone receptor-negative tumors and more comorbidities and to reside in an economically deprived area. In an unadjusted analysis, AAs had a significantly higher risk of death (hazard ratio [HR], 1.36; 95% confidence interval [CI], 1.16-1.59); however, after adjustments for clinical (age, stage, hormone receptor, and CCI) and societal factors (DI), the effect of race was not significant (HR, 1.13 [95% CI, 0.96-1.34] , and HR, 0.97 [0.80-1.19] respectively). CONCLUSIONS: Racial differences in breast cancer survival can be explained by clinical and socioeconomic factors. Nonetheless, AA women with breast cancer remain disproportionately affected by unfavorable tumor characteristics and economic deprivation, which likely contribute to their increased overall mortality.
Asunto(s)
Neoplasias de la Mama/etnología , Neoplasias de la Mama/mortalidad , Accesibilidad a los Servicios de Salud/economía , Negro o Afroamericano/estadística & datos numéricos , Neoplasias de la Mama/economía , Neoplasias de la Mama/patología , Prestación Integrada de Atención de Salud , Femenino , Humanos , Michigan/epidemiología , Michigan/etnología , Medición de Riesgo , Factores Socioeconómicos , Tasa de Supervivencia/tendencias , Servicios Urbanos de Salud , Población Blanca/estadística & datos numéricosRESUMEN
The study explored the psychometric properties of the Arabic version of the ISMI measure on an Arab sub-sample (N = 330) in a health clinic that served mostly refugees in Michigan, USA. Study measures included the ISMI, PTSD, depression, anxiety, CTD (Cumulative Trauma Disorders), and traumatic stress measures. Data analysis included factor analysis, correlation, and multiple regression analysis. The Arabic form of the measure was found to have robust psychometric qualities, with high reliability construct and predictive validity. Factor analysis identified a general stigma factor and different levels of stigma resistance factors. General stigma was significantly associated with and predicted post-trauma symptoms of depression, anxiety, PTSD and CTD (complex PTSD), while tough stigma resistance was associated negatively with PTSD and depression and positively with positive appraisal of traumatic events.
Asunto(s)
Trastornos Mentales/diagnóstico , Refugiados/psicología , Autoimagen , Estigma Social , Adolescente , Adulto , Anciano , Árabes , Análisis Factorial , Femenino , Humanos , Lenguaje , Masculino , Trastornos Mentales/etnología , Michigan/etnología , Persona de Mediana Edad , Escalas de Valoración Psiquiátrica , Psicometría , Análisis de Regresión , Reproducibilidad de los Resultados , Encuestas y Cuestionarios , Adulto JovenRESUMEN
BACKGROUND: The prevalence of obesity and overweight persists in the preschool population, despite some prevention and treatment advances, particularly in minorities. Investigating the prevalence of dyslipidemia and the effect of family health may also guide the focus of intervention efforts. METHODS: Anthropometric data were collected from urban minority preschool children (n=161; 42% female) enrolled in USDA Head Start. Blood was collected by finger prick and analyzed with the Cholestech LDX Analyzer (Cholestech Corporation, Hayward, CA). Caregivers provided a self-reported family health history for cardiovascular diseases (CVDs). RESULTS: By BMI percentile, 8% of the children were underweight (UW), 54% healthy weight (HW), 10% overweight (OW), and 28% obese (OB). One of every 5 children had borderline or high-risk levels for total cholesterol (TC), high-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL) cholesterol, and triglycerides based on the National Cholesterol Education Program categories. In OW/OB children only, BMI was positively correlated with TC (r(61)=0.428; p=0.001) and LDL (r(58)=0.395; p=0.005). Child BMI was also associated with family comorbid diseases (r(159)=0.177; p=0.025). UW/HW children with a family history of CVD had significantly higher LDL than UW/HW children without a family history of CVD (p=0.001). Step-wise regression analysis revealed that BMI (p=0.005) plus family history of heart attack (p=0.018) were significant predictors of blood TC levels. CONCLUSION: Continued efforts to treat and prevent elevated weight are urgently needed for minority preschoolers. Attention to CVD screening may be an important target in school, community, and healthcare arenas for minority populations regardless of weight status.
Asunto(s)
Enfermedades Cardiovasculares/etnología , Dislipidemias/etnología , Salud de la Familia , Educación en Salud/organización & administración , Grupos Minoritarios , Obesidad Infantil/etnología , Glucemia/metabolismo , Índice de Masa Corporal , Enfermedades Cardiovasculares/sangre , Enfermedades Cardiovasculares/epidemiología , Enfermedades Cardiovasculares/prevención & control , Preescolar , HDL-Colesterol/sangre , Dislipidemias/sangre , Dislipidemias/epidemiología , Dislipidemias/prevención & control , Femenino , Humanos , Masculino , Michigan/etnología , Obesidad Infantil/sangre , Obesidad Infantil/epidemiología , Obesidad Infantil/prevención & control , Vigilancia de la Población , Prevalencia , Factores de Riesgo , Triglicéridos/sangre , Población UrbanaRESUMEN
OBJECTIVE: The goal of this research was to identify communication behaviors used by weight loss counselors that mostly strongly predicted black adolescents' motivational statements. Three types of motivational statements were of interest: change talk (CT; statements describing their own desires, abilities, reasons, and need for adhering to weight loss recommendations), commitment language (CML; statements about their intentions or plans for adhering), and counterchange talk (CCT; amotivational statements against change and commitment). METHODS: Thirty-seven black adolescents with obesity received a single motivational interviewing session targeting weight-related behaviors. The video-recorded transcribed sessions were coded using the Minority Youth Sequential Coding for Observing Process Exchanges generating a sequential chain of communication. Data were then subjected to sequential analysis to determine causal relationships between counselor and adolescent communication. RESULTS: Asking open-ended questions to elicit adolescent CT and emphasizing adolescents' autonomy most often led to CT. Open-ended questions to elicit CML, reflecting adolescent CML, and emphasizing autonomy most often led to CML. In contrast, open-ended questions to elicit CCT, reflecting CCT, reflecting ambivalence, and neutral open-ended questions about the target behavior led to CCT. CONCLUSIONS: This study provides clinicians with insight into the most effective way to communicate with black adolescents with obesity about weight loss. Specifically, reflective statements and open questions focusing on their own desires, abilities, reasons, need, and commitment to weight loss recommendations are more likely to increase motivational statements, whereas other types of reflections and questions may be counterproductive. Finally, because adolescents have a strong need for autonomous decision making, emphasizing their autonomy may be particularly effective in evoking motivational statements.