Search Results (89)

The global Black Lives Matter movement and COVID-19 pandemic drew attention to the urgency of addressing entrenched structural dynamics such as racialization, gender, and colonization shaping health inequities for diverse racialized people. Canadian community-based research with racialized immigrant women recognized the need to enhance service provider capacity using a strengths-based activism approach to support client health and wellbeing. In this study, we aimed to understand the impacts of this mental health promotion practice on service providers and strategies to support them. Through purposeful convenience sampling, three focus groups were completed with 19 service providers working in settlement and mental health services in Toronto, Canada. Participants represented varied ethnicities and work experiences; most self-identified as female and racialized, with experiences living as immigrant women in Canada. Postcolonial feminist and critical mental health promotion analysis illuminated organizational and structural dynamics contributing to burnout and vicarious trauma that necessitate a focus on trauma- and violence-informed care. Transformative narratives reflected service provider resilience and activism, which aligned with and challenged mainstream biomedical approaches to mental health promotion. Implications include employing a postcolonial feminist lens to identify meaningful and comprehensive anti-oppression strategies that take colonialism, racialization, gender, and ableism and their intersections into account to decolonize nursing practices. Promoting health equity for diverse racialized women necessitates focused attention and multilevel anti-oppression strategies aligned with critical mental health promotion practices. Full article

Introduction: Racial and ethnic disparities in end-of-life (EOL) cancer care persist, leading to lower rates of advance care planning (ACP), reduced access to palliative care, and poorer patient outcomes for minority populations. While previous research has documented these inequities, less is known about the specific interventions developed to address them, necessitating a comprehensive review of existing strategies aimed at improving EOL care for racial and ethnic populations. The objective of this scoping review is to examine the extent and characteristics of interventions and their outcomes designed to address racial and ethnic disparities in EOL cancer care in the United States. Methods: A comprehensive search of EOL cancer care interventions for minority populations was conducted in Ovid MEDLINE, CINAHL with Full Text (EBSCOhost), and Scopus (Elsevier) in September 2024. Two independent reviewers screened titles, abstracts, and full texts following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines, with inclusion limited to studies conducted in the US and published in English. Results: Of 3104 screened studies, 10 met the inclusion criteria. Participants enrolled were only from Latino (n = 6 studies) or Black (n = 4 studies) populations. We identified four types of interventions, including communication skills for patients, caregivers, researchers, and clinicians (n = 2), education programs for patients (n = 1), navigation and support programs for patients and caregivers (n = 3), and training programs for health workers and community leaders (n = 4). The most effective interventions were those that addressed linguistic barriers, integrated cultural values, and involved trusted community figures. Faith-based models were particularly successful among African American patients, while bilingual navigation and family-centered ACP interventions had the greatest impact in Latino populations. Conclusions: This review highlights (1) the importance of culturally tailored interventions for specific minority populations and (2) the limited number of such interventions, which primarily target only the largest minority groups. Full article

The COVID-19 pandemic significantly disrupted higher education worldwide, imposing strict isolation measures, transitioning learning online, and exacerbating existing social and economic inequalities. This literature review examines the pandemic’s impact on the mental health of college students, with a focus on those belonging to minority groups, including racial, ethnic, migrant, gender, sexuality-based, and low-income populations. While elevated levels of anxiety, depression, and loneliness were observed across all students, findings indicate that LGBTQ+ and low-income students faced the highest levels of psychological distress, due to compounded stressors such as family rejection, unsafe home environments, and financial insecurity. Racial and ethnic minority students reported increased experiences of discrimination and reduced access to culturally competent mental healthcare. International and migrant students were disproportionately affected by travel restrictions, legal uncertainties, and social disconnection. These disparities underscore the need for higher education institutions to implement targeted, inclusive mental health policies that account for the unique needs of at-risk student populations during health crises. Full article

Healthcare disparities in cancer care remain pervasive, driven by intersecting socioeconomic, racial, and insurance-related inequities. These disparities manifest in various forms such as limited access to medical resources, underrepresentation in clinical trials, and worse cancer outcomes for marginalized groups, including low-income individuals, racial minorities, and those with inadequate insurance coverage, who face significant barriers in accessing comprehensive cancer care. This manuscript explores the multifaceted nature of these disparities, examining the roles of socioeconomic status, race, ethnicity, and insurance status in influencing cancer care access and outcomes. Historical and contemporary data highlight that minority racial status correlates with reduced clinical trial participation and increased cancer-related mortality. Barriers such as insurance coverage, health literacy, and language further hinder access to cancer treatments. Addressing these disparities requires a systemic approach that includes regulatory reforms, policy changes, educational initiatives, and innovative trial and treatment designs. This manuscript emphasizes the need for comprehensive interventions targeting biomedicine, socio-demographics, and social characteristics to mitigate these inequities. By understanding the underlying causes and implementing targeted strategies, we can work towards a more equitable healthcare system. This involves improving access to high-quality care, increasing participation in research, and addressing social determinants of health. This manuscript concludes with policy recommendations and future directions to achieve health equity in cancer care, ensuring optimal outcomes for all patients. Full article

Nonalcoholic fatty liver disease (NAFLD) is a growing global health concern, impacting approximately 32.4% of the worldwide population. As a disease linked to metabolic dysfunction, NAFLD continues to rise alongside global increases in obesity, type 2 diabetes mellitus (T2DM), and metabolic syndrome. There is considerable evidence indicating that NAFLD disproportionately affects racial, ethnic, and minority groups, although the exact reasons for these disparities remain elusive. Contributing factors to this disease may include socioeconomic status, cultural influences, stress, genetic factors, and lifestyle choices. Emerging evidence suggests that these causal factors could influence epigenetic mechanisms, particularly DNA methylation and histone modifications, as well as the composition and diversity of gut microbiota. Nevertheless, there is a scarcity of research that comprehensively examines the interplay between epigenetic changes and gut microbiome variations in relation to NAFLD disparities across different racial and ethnic populations globally. This paper intends to (i) explore the connections between NAFLD, ethnic disparities, gut microbiota composition, and epigenetic alterations, while reviewing pertinent studies that illustrate how these factors contribute to health inequities among various ethnic groups impacted by this disease; (ii) explore potential therapeutic targets and biomarkers to advance the management of NAFLD; and (iii) provide insights to enhance our understanding of the mechanisms associated with this disease, thereby promoting further research in this field. Advancements in this area are anticipated to enhance our understanding of disease susceptibilities in at-risk groups and to provide new therapeutic options for NAFLD and its associated complications. Full article

Despite overall improvements in the accessibility, quality, and outcomes of care in the U.S. health care system over the last 30 years, a large proportion of marginalized racial and ethnic minority (minoritized) groups continue to suffer from worse outcomes across most domains. Many of these health disparities are driven by inequities in access to and the scope of society’s health-affirming structural resources and opportunities commonly referred to as structural drivers or social determinants of health—SDoH. Persistently health-undermining factors in the social environment and the downstream effects of these inequities on neurocognitive and biological pathways exacerbate these disparities. The consequences of these circumstances manifest as behavioral, neurohormonal, immune, and inflammatory and oxidative stress responses, as well as epigenetic changes. We propose a theoretical model of the interdependent characteristics of inequities in the SDoH driven by race-based discriminatory laws, policies, and practices that eventually culminate in poor health outcomes. This model provides a framework for developing and validating multi-level interventions designed to target root causes, thereby lessening health disparities and accelerating improved health outcomes for minoritized groups. Full article

Type 2 diabetes (T2D) is a rapidly growing global health concern, projected to affect 1.3 billion people by 2050, necessitating a multidisciplinary approach. This review examines the epidemiological disparities in T2D, focusing on modifiable and nonmodifiable risk factors, socioeconomic determinants, and healthcare inequities. While genetic predisposition, age, and ethnicity contribute to T2D risk, socioeconomic status (SES) significantly mediates modifiable factors such as diet, physical activity, and access to healthcare. Lower SES is associated with poorer lifestyle choices, limited access to resources, and increased exposure to risk factors, exacerbating T2D prevalence among vulnerable populations. Geographic variations in T2D prevalence are evident, with racial and ethnic minorities and lower-income individuals being disproportionately affected in regions like the United States and Europe. The economic burden of T2D is substantial, with global healthcare expenditures reaching USD 966 billion in 2021 and projected to rise significantly, albeit with variations across different countries and health systems. Despite advancements in treatment, inequities in healthcare access persist, particularly in low- and middle-income countries, hindering optimal glycemic control and consequently contributing to preventable complications and poor health outcomes. This review highlights the critical need for targeted interventions and policy reforms to address the intersection of demographic, economic, and healthcare-related variables influencing T2D disparities. By bridging gaps in prevention, management, and treatment and accounting for the effect of SES on both modifiable and nonmodifiable risk factors, the global disease burden of T2D could be reduced and health equity could be improved. Full article

Introduction: Health disparities affecting minority populations and resulting in poorer outcomes for disadvantaged groups have been documented in the literature. Sodium/glucose-cotransporter 2 (SGLT2i) inhibitors and GLP-1 receptor agonists (GLP-1RA) markedly decrease mortality from kidney and cardiovascular events. However, little is known about the factors and disparities that lead to differences in SGLT2i and GLP-1RA initiation across different ethnic groups. Methods: This scoping review queried databases using key terms related to disparities in the initiation of SGLT2i and GLP-1RA among high-risk populations. Relevant data from eligible studies were extracted, organized, and analyzed thematically to identify key trends and patterns in the literature. Result: Nineteen studies were included in this review. Key risk factors influencing uptake included age, provider type, race, sex, education, comorbidities, insurance, and income, with minority patients consistently showing lower rates of initiation due to systemic barriers and socioeconomic disparities. Patients who were younger, male, had higher education or income levels, and received care from specialists were more likely to use these therapies. Conclusion: The adoption of SGLT2i and GLP-1RA remains suboptimal despite their proven kidney and cardiovascular benefits. Targeted efforts to reduce socioeconomic and racial inequities based on the factors identified should be encouraged. Full article

Background: Marginalized low-income racial and ethnic minority residents of public housing represent an intersectional population with multiple health needs and low healthcare utilization. Telehealth has been proposed as a solution to address healthcare access disparities, yet the role of telehealth attitudes, including perceived benefits and self-efficacy, in influencing telehealth use of this population remains unknown. Objective: This study investigates whether two domains of telehealth attitudes, namely self-efficacy and perceived benefits (expectancy), mediate the relationship between demographic, health, and social determinants of telehealth use among low-income racial and ethnic minority residents of public housing in Los Angeles. Methods: This cross-sectional study analyzed data collected from low-income racial and ethnic minority residents of public housing in Los Angeles. Measures included demographic factors (age and gender), social determinants of health (e.g., education, language, and primacy care provider), health (chronic illnesses and physical mobility), telehealth attitudes (perceived benefits and self-efficacy), and telehealth use frequency. Mediation analysis was conducted to test whether telehealth attitudes explained the association between demographic, social, and health determinants of telehealth use. Results: The findings revealed that neither of the two domains of telehealth attitudes, including perceived benefits and self-efficacy, were significantly associated with telehealth use. As such, these attitude domains did not operate as mediators of the relationship between demographic, health, and social determinants of telehealth use. Conclusion: The study results suggest that structural barriers, rather than individual attitudes, primarily drive telehealth use disparities among this intersectional population. Interventions aimed at increasing telehealth adoption should prioritize addressing systemic inequities rather than focusing solely on changing individual attitudes. These findings underscore the importance of structural solutions to promote equitable telehealth access in marginalized communities. Full article

Background/Objectives: Human papillomavirus (HPV) is linked to multiple cancers that can be prevented through vaccination. While the optimal age for vaccination is in childhood and adolescence, vaccination recommendations include adults through age 26 who missed childhood/adolescent vaccination. There are limited data about disparities among adults eligible for catch-up HPV vaccination. We conducted a comprehensive examination of HPV vaccination among US young adults, disaggregating the group by race/ethnicity and nativity status to identify subgroups that may require additional interventions. Methods: We analyzed 2019 and 2022 data of individuals aged 18–26 years from the National Health Interview Survey. Generalized linear models using Poisson regression with log link were used to examine the receipt of 1+ dose of HPV vaccine, race/ethnicity, and nativity (i.e., US- versus foreign-born) status. Results: The overall receipt of 1+ doses of HPV vaccine was 47.5%. The vaccination rate among the US-born group was 49.7% versus 31.9% among the foreign-born group with an adjusted prevalence ratio (APR) of 0.72; (95% CI, 0.62–0.82). Foreign-born non-Hispanic (NH) Black individuals (APR 0.31; 95% CI, 0.13–0.70) were less likely to be vaccinated against HPV than foreign-born NH White individuals, while US-born NH Asians (APR 1.27; 95% CI, 1.09–1.48) had a higher prevalence of the vaccination than the US-born NH White group. Additionally, foreign-born NH Asian (APR 0.60; 95% CI, 0.46–0.77), NH Black (APR 0.27; 95% CI, 0.12–0.61), and Hispanic (APR 0.76; 95% CI, 0.60–0.97) populations were less likely to be vaccinated than their respective US-born counterparts. Conclusion: Profound HPV vaccination inequalities exist among US young adults with particularly low vaccine coverage among racially and ethnically minoritized immigrant populations. Full article

A growing literature within the field of air pollution exposure assessment addresses the issue of environmental justice. Leveraging the increasing availability of exposure datasets with broad spatial coverage and high spatial resolution, a number of works have assessed inequalities in exposure across racial/ethnic and other socioeconomic groupings. However, environmental justice research presents the additional need to evaluate exposure inequity—inequality that is systematic, unfair, and avoidable—which may be framed in several ways. We discuss these framings and describe inequality and inequity conclusions provided from several contrasting approaches drawn from recent work. We recommend that future work addressing environmental justice interventions include complementary “Exposure-driven” and “Socially weighted” metrics, taking an intersectional view of areas and social groups that are both disproportionately impacted by pollution and are impacted by additional health risks resulting from structural racism and consider implications for environmental justice beyond distributional equity. Full article

Background/Objectives: Particularly in racially and ethnically diverse countries, the necessity of providing individualized care to people seeking diet advice is increasingly recognized and embedded in practice guidelines. Some jurisdictions have a history of colonization with subjugation and marginalization of the Indigenous population, which has led to serious health inequities. One overarching strategy to reduce health inequities is to provide education through a decolonizing lens, so that graduate healthcare professionals, such as dietitians, have a better understanding of how to mitigate colonial attitudes, racism, stereotyping and other behaviours, thereby improving health equity. This review aims to summarize and evaluate educational strategies to decolonize dietetics training programs. Methods: A narrative review was conducted. Results: Professional dietetics organizations in Canada, Australia and New Zealand have incorporated Indigenous-specific outcomes into their standards of practice. Six primary research studies were reviewed, two each from Australia, New Zealand and the United States. The strategies developed include reviewing curriculum content, providing experiential learning opportunities and identifying barriers to the participation of Indigenous students in dietetics programs. Lack of engagement of Indigenous persons in curriculum development, planning and evaluation of efforts is a gap that needs to be addressed. Conclusions: Meeting practice standards and closing the health equity gap for Indigenous peoples require additional research and implementation into practice. Full article

HIV care engagement and antiretroviral therapy (ART) adherence interventions aimed at decreasing viral suppression disparities for women living with HIV (WLWH) in the Southern United States (i.e., the South) are few and seldom consider diverse social locations. These refer broadly and dynamically to contextual factors and the position people occupy in a social hierarchy based on intersecting systems of oppression and social determinants of health like gender, race/ethnic, and class inequities; geographic location; and HIV-related stigma. Using an intersectional approach, we conducted in-depth interviews and used a phased approach to directed content analysis to describe women’s perceptions of their social location and how it impacts their decision-making about HIV care engagement and ART adherence. Participants were recruited to participate from a broad geographic area and represented the diverse social locations occupied by WLWH in the South. Findings from 40 in-depth interviews include descriptions of how geographic context impacts HIV care engagement and medication adherence through access to care, quality of care, and the place-based context of day-to-day experiences of living with HIV. Participants spoke of multilevel power relationships based on their gender and racial identities, and how social determinants and intersecting identities occur simultaneously and vary as a function of one another to impact health and HIV care decision-making. The findings offer a nuanced understanding of how WLWH perceive their contextually specific social locations and make critical decisions about their HIV care engagement and medication adherence. Full article

Structural racism has been identified as a fundamental cause of health disparities. For example, racial, ethnic, and economic neighborhood segregation; concentrated poverty; community disinvestment; and sociocultural context influence obesity and cancer disparities. Effects of structural racism are also evident through neighborhood obesogenic conditions such as limited access to affordable and healthy foods and physical activity opportunities within segregated communities that contribute to obesity and obesity-related cancer disparities. This article describes and expands on cross-cutting themes raised during a webinar held by the National Cancer Institute (NCI): (1) how structural factors, including neighborhood segregation and obesogenic conditions within racial and ethnic disadvantaged communities, influence disparities in the United States; (2) current research challenges and best ways to address them; and (3) selected priorities of the NCI aimed at addressing multilevel and intersecting factors that influence obesity-related cancer disparities. Further research is needed to understand how residential segregation and neighborhood obesogenic conditions influence cancer prevention and control across the continuum. Identifying the best approaches to address obesity and cancer disparities using social determinants of health framework and community-engaged approaches guided by a structural racism lens will allow researchers to move beyond individual-level approaches. Full article

Urban green space (UGS) is a fundamental infrastructure in modern urban settings, crucial for regulating the urban climate and improving public health. Accessibility to UGS represents a significant environmental justice issue, influencing the sustainable development of local communities. In this work, we comprehensively evaluated the temporal dynamics of UGS accessibility and the disparity in exposure for all 31 metropolitan divisions in the United States from 2013 to 2022. Our findings indicate that there have been no significant changes in both population-weighted UGS exposure and within-city inequality of UGS exposure for all racial/ethnic groups across the study period. Furthermore, a consistent racial/ethnic disparity in UGS exposure was noted throughout the study period, with the White group tending to have higher-than-average UGS accessibility, and all other racial/ethnic groups, including Asian, Black, Hispanic, Native American, and Pacific Islander, experiencing lower-than-average UGS accessibility. These findings underscore the urgency for urban planning and policy-making strategies to address these inequities, promoting healthy and sustainable urban development. Full article