Search Results (222)

The existing literature on the differences in the internalization and perception of racism between Black African immigrants and African Americans in the United States has produced myriad data. However, what is lacking is a systematic conceptualization of the revealed patterns and trends. Moreover, the few attempts in this regard are primarily based on a single geopolitical understanding of space in the United States, relegating the geopolitical space of Africa to the back burner. This paper attempts to bridge these gaps by proposing not just a multidisciplinary framework for conceptualization, but also a multi-space plane that cuts across both the American and African geopolitical spaces. The framework proposed in this paper consists of concepts drawn from sociology, negotiation studies, conflict resolution, and international studies. With this, I argued that the differences in self-conception, the availability of BATNA and externalities owing to the transnational identity of Black African immigrants grant them (Black African immigrants) the leverage of a relatively less internalized base of racism than their Afro-American counterparts. Within this context, this paper aims to provide one of many frameworks for assessing racism in the American context. Concomitantly, it adds to the growing body of literature advocating for intersectionality and a multidisciplinary approach as ideally suited to exploring and understanding the complexities associated with racial discourses. Full article

Background: Little is known about women’s contraceptive use in the United States during the novel coronavirus (“COVID-19”) pandemic and the risk of unintended pregnancy. Methods: We compared the weighted response rates on contraception use for female respondents aged 18–44 from the Behavioral Risk Factor Surveillance System (BRFSS) between 2019 and 2022. Results: Our study reveals a significant increase of 16.1% (CI = 0.145, 0.177) in the proportion of women using contraception in 2022 as compared to 2019. The largest increase in the use of non-reversible contraception was seen in the proportion of female sterilization, at 3.0% (CI = 0.017, 0.043), mostly attributed to non-Hispanic Black individuals with a 12% increase (CI = 0.046, 0.198). The largest decrease was seen in the use of condoms, at 7.4% (CI = −0.094, −0.055). This was driven by both non-Hispanic Black and multiracial groups, each experiencing a 19% decrease (CI = −0.251, −0.127; CI = −0.304, −0.068, respectively). The proportion of women at risk of unintended pregnancy increased by 3.7% (CI = 0.010, 0.063). These increases were observed among those with an income of less than USD 15k, showing a 14.9% increase (CI = 0.037, 0.262). Older females and those with Medicaid insurance were more likely to use female sterilization. Hispanics, college graduates, and those with Medicaid insurance were more likely to use condoms. Non-White females and those without annual checkups were more at risk of unintended pregnancy. Conclusions: Contraceptive methods shifted among females with slightly increased sterilization in the years 2019 to 2022. Full article

Background: Tobacco use remains a leading preventable cause of morbidity and mortality in the United States, with persistent disparities in cessation outcomes across socioeconomic and racial groups. While numerous interventions exist, their effectiveness is shaped by complex interrelated factors at individual, social, and healthcare system levels. Identifying and modeling these causal pathways is essential to inform equitable intervention design. Methods: This study applied the Evidence Synthesis for Constructing Directed Acyclic Graphs (ESC-DAG) protocol to integrate empirical findings from 35 quantitative studies examining barriers and facilitators of tobacco cessation intervention uptake in the United States. Using the Andersen and Aday Health Services Research Model as a guiding framework, we extracted, harmonized, and synthesized significant causal relationships into a unified DAG, distinguishing exposures, outcomes, mediators, and confounders. Results: The integrated DAG revealed that structural factors such as socioeconomic disadvantage, digital inequities, rurality, and cultural barriers exerted substantial influence on cessation outcomes. These upstream determinants operated through mediators including motivation, treatment engagement, and access barriers, while healthcare system factors such as provider engagement and proactive outreach emerged as consistent facilitators. Digital access and culturally tailored interventions were identified as underexplored yet potentially high-impact pathways. Discussion: The ESC-DAG methodology provided a structured approach to visualize and synthesize causal mechanisms beyond traditional review synthesis, highlighting points of intervention at both policy and practice levels. The findings underscore the importance of multi-level strategies, including financial support, digital equity initiatives, provider outreach, and culturally tailored cessation services. Conclusions: By applying ESC-DAG methodology, this study contributes a novel causal framework for understanding disparities in tobacco cessation intervention uptake. The resulting DAG can inform future statistical modeling, simulation studies, and equity-focused program design, supporting more effective public health strategies to reduce smoking prevalence and associated inequities. Full article

The U.S. was constructed on a Black–white racial hierarchical system to maintain the subjugation of communities of color, of which we understand through racial formation that race continues to adapt and evolve to support structures of anti-Black racism. Our project centers racial formation as our theoretical framing for why race categories exist under a white supremacist, anti-Black system that profits from hierarchical inhuman realities. This critical collaborative autoethnography explores the learning journeys of one biracial Korean faculty member and one Lebanese-American undergraduate in their continued inquiry about erasure/affirmation of mixed-race and MENA identities. We explored the in-between gray spaces that our mindbodyspirits move through, and revealed the systematic impact of violent structures on our racialized mind–body–spirits. Findings allude to the limits of our belonging, in relation to dominant structures that cannot hold our in-between experiences. We urge social justice professions to recenter the literal marginal voices of mixed-race and MENA peoples as essential in the relational racial healing and restorative journeys of our multiracial and intersecting communities of color. Full article

Background/Objectives: Sleep disturbances are recognized as a common feature of Long COVID but detailed investigation into the specific nature of these sleep symptoms remain limited. This study analyzes comprehensive sleep questionnaire data from a Long COVID clinic to better characterize the nature and prevalence of sleep complaints in this population. Methods: We conducted a cross-sectional analysis of 200 adults referred to the Stanford Long COVID Clinic. Patients completed an intake questionnaire including three sleep-related items (unrefreshing sleep, insomnia, daytime sleepiness) rated on a 0–5 Likert scale. Additionally, patients completed the Alliance Sleep Questionnaire (ASQ), incorporating the Insomnia Severity Index, Epworth Sleepiness Scale, reduced Morningness–Eveningness Questionnaire, and modules for parasomnia, restless legs, and breathing symptoms. We calculated the prevalence of six sleep symptom domains. Standardized symptom data were analyzed using principal component analysis (PCA) and K-means clustering (k = 2) to explore latent phenotypes and used logistic regression to assess associations between demographic and clinical variables and each sleep complaint. Results: Sleep-related breathing complaints affected 57.5% of participants, insomnia 42.5%, and excessive daytime sleepiness 28.5%. Parallel analysis supported a nine-factor structure explaining ~90% of variance, with varimax rotation yielding interpretable domains such as insomnia/unrefreshing sleep, fatigue/post-exertional malaise, parasomnias, and respiratory symptoms. Gaussian mixture modeling favored a two-cluster solution (n = 94 and n = 106); one cluster represented a higher-burden phenotype characterized by greater BMI, insomnia, daytime sleepiness, gastrointestinal symptoms, and parasomnias. Logistic models using factor scores predicted insomnia with high accuracy (AUC = 0.90), EDS moderately well (AUC = 0.81), but extreme chronotype poorly (AUC = 0.39). In adjusted models, hospitalization during acute COVID-19 was significantly associated with insomnia (OR 4.41; 95% CI 1.27–15.36). Participants identifying as multiracial had higher odds of insomnia (OR 3.22; 95% CI 1.00–10.34), though this narrowly missed statistical significance. No other predictors were significant. Conclusions: Sleep disturbances are frequent and diverse in Long COVID. Factor analysis showed overlapping domains, while clustering identified a higher-burden phenotype marked by more severe sleep and systemic complaints. Symptom-based screening may help target those at greatest risk. Full article

Existing research focuses on how different actors infuse space and place with social meaning. In this paper, I examine how biracial rap artists Drake, Logic, and J. Cole construct their racial identities and depict urban areas in line with the strong-willed trope prevalent in rap discourse, drawing on theories and insights regarding the production of space. Specifically, I hypothesize that these artists will affirm a Black male identity and perceive place as a hazardous environment, embracing a specific motif in rap mythology. I conducted a content analysis of 386 songs from 2010 to 2023 and found that not all identify as Black and that two artists portray their surroundings as threatening. Nonetheless, each rapper incorporates their environment as a facet of their rap persona. Focusing on biracial artists enables an exploration of meaning-making at the intersection of racial identity and socio-spatial cultural production, thereby broadening our understanding of place. Full article

Background: Gestational diabetes mellitus (GDM) is a type of diabetes diagnosed during pregnancy and its prevalence is on the rise around the world. GDM increases the risk of serious adverse health outcomes for the mother and child. Multiple types of non-pharmacological interventions have been developed for the management and prevention of GDM; however, there is a lack of clarity regarding their effectiveness. Objective: To summarize the evidence on the efficacy of non-pharmacological interventions in the management and prevention of GDM. Methods: For this integrative review, a comprehensive literature search was conducted in the databases MEDLINE, CINAHL, Embase, Scopus, and Web of Science. The methodology followed the integrative approach outlined by Whittemore and Knafl’s, and study quality was evaluated using the Mixed Methods Assessment Tool. Results: A total of 44 relevant studies were included. Key themes identified for GDM management were (1) nutrition therapy and physical activity, (2) social and psychological support, (3) digital tools, and (4) barriers and facilitators. For GDM prevention, themes were categorized into individual-level approaches, (5) lifestyle and supplements, and population-level approaches: (6) environmental factors, and (7) health in all policies. Conclusions: The growing prevalence of GDM is a major public health concern that requires the implementation of effective multi-level evidence-based strategies. Environmental, socioeconomic, and racial determinants of health have substantial impacts on GDM, highlighting the need to address the root causes of the illness. Further research is needed to support effective preventive and management measures beyond standard pharmacological treatment, so that evidence-based solutions can be applied to enhance and safeguard the health of current and future generations. Full article

The rate pressure product (RPP) is a non-invasive index of myocardial oxygen consumption, derived from heart rate (HR) and systolic blood pressure (SBP). While aerobic exercise is known to improve cardiovascular efficiency, evidence is limited for racialized populations, particularly African Canadians and South Asians who face elevated cardiovascular risk. Objective: The objective of the study was to examine whether a 10-session dance aerobics program provides a cardiovascular stimulus sufficient to affect RPP and blood pressure responses in these groups. Methods: A total of 160 participants with hypertension or related conditions (80 African Canadians, 80 South Asians) completed 10 sessions of community-based aerobic dance. Pre- and post-intervention measurements of systolic blood pressure (SBP), diastolic blood pressure (DBP), HR, and RPP were obtained and analyzed using non-parametric statistical tests. Results: Both groups showed reductions in blood pressure after the intervention. South Asians demonstrated moderate decreases in SBP and RPP, while African Canadians exhibited stable or slightly increased RPP values despite improvements in SBP and DBP. Between-group comparisons showed significant differences in SBP and HR (p < 0.05), but changes in RPP did not reach statistical significance (p > 0.05). Despite the modest reductions in systolic BP (≥5 mmHg), this may carry clinical significance. Conclusion: This study highlights that blood pressure and RPP responses to exercise may differ across ethnic groups. Short-term dance aerobics effectively reduced blood pressure in both African Canadian and South Asian participants, supporting its role as a culturally adaptable intervention. These findings underline the importance of tailoring exercise recommendations to ethnic and cultural contexts and provide a case for larger studies in a multi-ethnic population. Full article

This study examines the use of alternative financial services in the context of COVID-19-induced economic displacement. We utilize data from the 2020 Collaborative Multiracial Post-Election Survey and the ABC-X model of family stress and coping to examine how economic displacement, prior AFS use, and sociodemographic factors collectively promote AFS utilization. This study examines four types of financial coping strategies: credit cards, payday loans, public benefits, and borrowing from family and friends. Of these, payday loan use represents the primary indicator of AFS reliance. Our findings indicate that borrowing from friends and family is a significant predictor of payday loan usage. Furthermore, prior use of AFS, such as payday loans, check-cashing services, and pawnshops, strongly predict future AFS use. This study also finds a negative relationship between ethno-racial identity and AFS use which contradicts much of the existing literature. We find that lower levels of education and living in large urban areas are predictors of AFS use. This study highlights how the pandemic exacerbated financial vulnerabilities and validates the need for education and advocacy to prepare the most vulnerable to break cycles of AFS use. Full article

With increasing attention on DNA ancestry tests, scholars have explored how these tests inform modern understandings of race. Current research reveals the flaws and misinterpretations that arise when DNA tests, such as those offered by 23andMe and AncestryDNA, are used as a proxy for racial identity. While prominent in popular culture, the legitimacy and implications of these tests remain contested in the scholarly literature. Some researchers have explored how the increased availability of DNA tests affects how multiracial individuals identify and disclose their racial and ethnic identities, though this exploration remains limited. As discourse about mixed race identity and ancestry tests becomes more nuanced, I argue for the utility of using diunital perspectives, an expansive lens that resists either/or thinking, to complicate conversations about ancestry tests and multiraciality. This scholarly essay integrates personal narrative and a genealogical deconstruction of monoracialism to explore the question, “How can DNA tests contribute to the unlearning of monoracialism?” I share two personal vignettes to illustrate how these tests can reveal a preference for discrete racial categories. Drawing from Critical Race Theory, strategic essentialism, and diunital perspectives, I examine how DNA tests intersect with identity, family, and monoracialism, concluding with implications for disrupting monoracial logics. Full article

The present study investigates how US Southerners perceive second language (L2) speech by recruiting 170 undergraduate students who spoke Southern American English to listen to recordings of four speakers (US, Bangladeshi, Chinese, and Saudi Arabian) and evaluate their attributes. The listeners were grouped based on their ethnic affiliation: African American, Anglo-American, and Asian/Hispanic/multi-racial. A random half were primed, being asked questions about whether/how other people had negatively commented on their accents. Results showed no effect of priming on speech ratings. Moreover, whilst African American and Anglo-American listeners rated L2 speakers lower than the L1 speaker in almost all aspects, Asian/Hispanic/multi-racial listeners did not. Full article

Buried in 1858, Cornelis Kok II’s grave lay undisturbed in Campbell, Northern Cape, until 1961 when a multiracial coalition, driven by their own sets of interests, unearthed the Griqua leader’s remains. The bones again took centre stage with the collapse of apartheid when different groups called for their return and reburial, with an assertion, variously, of ascendant Griqua, indigenous, Khoisan, and Khoikhoi identities. The 2007 reinterment again courted controversy and protest, while the contemporary neglect of the new gravesite symbolizes feelings of exclusion and marginalization among some Campbell Griqua today. By tracing the life history of Kok II’s remains, well past his natural life, we demonstrate how they serve as a flashpoint mobilized by actors with different aims and objectives at different moments. These motivations range from scientistic confirmation of genealogy and identity under apartheid rule, to post-apartheid calls for repatriation anchored to a global indigenous rights framework, to factional contestations over ownership. Marshalled towards different political projects, for all these actors, the bones nonetheless serve as a resource and link to a 19th century frontier past. Full article

Black patients with metastatic prostate cancer have higher mortality rates compared to non-Hispanic White patients. There are no data on outcomes with [¹⁷⁷Lu]Lu-PSMA-617 (LuPSMA) across racial groups. We evaluated the association between race and outcomes with LuPSMA in a multi-institutional cohort of consecutive patients with mCRPC treated with LuPSMA. The primary outcomes were PSA-50 rate, PSA-progression-free survival (PSA-PFS), and overall survival (OS). Statistical models were adjusted for age, number of prior therapies, sites of metastases, and baseline PSA. A total of 654 patients were included; 593 (91%) were White, 45 (7%) were Black and 16 (2%) were another non-Black minority (NBM). There were no statistically significant differences in PSA-50 rates, PSA-PFS and OS between the groups. Black and White patients treated with LuPSMA had similar clinical outcomes; efforts are needed to ensure Black and NBM patients have equal access to life prolonging therapies to narrow disparities in outcomes. Full article

Background: Irritable bowel syndrome (IBS) is a prevalent disorder of gut–brain interaction (DGBI) with a negative impact on quality of life and healthcare expenditure. This study aimed to investigate sex-based differences in a large cohort of IBS patients from a multiracial safety-net hospital. Methods: An electronic query was performed using the International Classification of Diseases, 9th Revision (ICD-9) coding to identify 740 outpatients with IBS between 1 January 2005 and 30 September 2007. Demographic data and ICD-9 coded comorbidities were extracted from electronic records. Data analysis used descriptive statistics and multiple logistic regression analyses. Results: Comorbid anxiety and depression were significantly more prevalent in female patients (A:24%, p = 0.03; D:29%, p = 0.008) compared with male patients. White female IBS patients had a higher risk for anxiety but not depression compared with non-White patients (p = 0.02). Female sex (p = 0.02), obesity (p = 0.007), and age above fifty (p = 0.02) but not race/ethnicity were significant risk factors for depression. IBS with constipation was more prevalent in female patients (p = 0.005) and in Hispanic compared with non-Hispanic patients (p = 0.03). Conclusions: Significant sex-based and racial/ethnic differences were identified related to body mass index (BMI), age, and IBS subtypes in this study. Comorbid mood disorders occurred significantly more frequently in female patients, and risk factors for comorbid depression included female sex, older age, and obesity but not race/ethnicity. Full article

Background: Postmenopausal women face increased risk of developing metabolic syndrome (MetS) and cardiovascular disease (CVD) due to hormone changes during menopause. Life’s Essential 8 (LE8), a relatively new cardiovascular health assessment index by the American Heart Association, may impact MetS diagnostics and potential treatment strategies. This study investigated the association between LE8 and MetS among postmenopausal women. Methods: National Health and Nutrition Examination Survey (NHANES) data were extracted (2011–2020). LE8 comprised eight health behaviours and factors (score of 0–100) classified into low (0–49), moderate (50–79), and high (80–100) cardiovascular health status. MetS was defined as metabolic dysfunctions comprising insulin resistance, central obesity, dyslipidaemia, impaired glucose metabolism, and hypertension. Complex survey-adjusted regression models were used. Effect modification by race and female hormone use were investigated. Results: 5402 postmenopausal women were included (mean age: 63.0 y), and 3152 (58.3%) met MetS criteria. LE8 scores for those with and without MetS were 58 ± 13.8 and 70 ± 14.1 (p < 0.001), respectively (mean ± SD). Higher LE8 scores were associated with lower odds of having MetS (Odds ratio (OR) for a 10-score increase: 0.53, 95% CI: [0.48, 0.57], p < 0.001). Nicotine exposure score was inversely associated with the likelihood of having MetS (0.52 [0.34, 0.80], p = 0.022). The association between LE8 status and odds of MetS differed by race (p-interaction = 0.01); ‘moderate’ or ‘high’ cardiovascular health status lowered odds of MetS in all races except other/multi-racial. Conclusions: The inverse relationship between LE8 scores and MetS suggests that integrating LE8 components into management strategies may help prevent CVD in postmenopausal women. Full article