Search Results (84)

Background/Objective: Child health serves as a foundational part of human development. Inequities in access to key health services remain high in Sub-Saharan Africa (SSA), most notably among children from disadvantaged, racially, or ethnically marginalized groups. The objective of this structured narrative review is to evaluate and aggregate the available evidence on racial/ethnic disparities in childhood healthcare access in SSA. Methods: A comprehensive search on African Index Medicus (AIM), Web of Science and PubMed for studies published between 2010 and 2025 was executed using relevant MeSH terms and Boolean operators. Studies on healthcare access inequalities among racial or ethnic groups in SSA were included. This study was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Results: Ten articles were included. Ethnicity was an independent contributor to inequities in childhood healthcare across four domains: vaccination coverage (lower for Hausa/Fulani in Nigeria and Somali/Luhya in Kenya compared to dominant groups), timeliness of vaccination, child mortality (higher in economically and ethnically marginalized groups), and nutritional status (elevated stunting and underweight odds in certain ethnic minorities). Conclusions: Racial and ethnic inequalities in child healthcare access across SSA are driven by multi-factor structural, geographical, and cultural barriers. Although socioeconomic improvement reduces some disparities, it does not eradicate them, highlighting that ethnic identity continues to shape health outcomes independently. Addressing these disparities requires strengthening culturally inclusive healthcare delivery, improving access in underserved regions, and integrating ethnicity-disaggregated monitoring into national health systems. Full article

Background: Health disparities are differences in healthcare access influenced by factors such as race, socioeconomic status, and geography. Oral health disparities show similar patterns, with underrepresented minorities (URM) facing greater barriers to care. Racial concordance improves patient outcomes, yet minority representation in orthodontics remains low. This study examined how Howard University’s Orthodontic Residency Program influences workforce diversity and expands care for minority populations. Methods: A retrospective analysis of Howard University’s orthodontic graduates (Classes 2009–2024) was performed to collect demographic information, practice location, and board certification status. Practice addresses were evaluated for Health Professional Shortage Area (HPSA) designation, and geographic analysis identified the demographics of the practice areas. Results: Among the 94 graduates studied, thirty-seven (39.4%) worked in the surrounding Washington, D.C., Maryland, and Virginia (DMV) area. Currently, 30% of graduates practiced in HPSAs, and 53% practiced in majority-minority communities. Board certification rates showed an upward trend, culminating in 100% certification among 2024 graduates. Conclusions: Howard University’s Orthodontic Program has significantly advanced access to specialized care in majority-minority communities through the training of URM orthodontists. Alumni demographics, board certification rates, and placement in underserved areas demonstrate the program’s success in developing diverse professionals committed to clinical excellence and service. Full article

Climate change and sea-level change (SLC) are intensifying flooding in U.S. coastal communities, with disproportionate impacts on Black and minority neighborhoods that face displacement, economic hardship, and heightened health risks. In Norfolk, Virginia, sea levels are projected to rise by at least 0.91 m (3 ft) by 2100, placing underserved neighborhoods such as Oakleaf Forest at particular risk. This study investigates the compounded impacts of flooding at both the building and urban scales, situating the work within the framework of the UN Sustainable Development Goals (UN SDGs). A mixed-method, community-based approach was employed, integrating literature review, field observations, and community engagement to identify flooding hotspots, document lived experiences, and determine preferences for adaptation strategies. Community participants contributed actively through mapping sessions and meetings, providing feedback on adaptation strategies to ensure that the process was collaborative, place-based, and context-specific. Preliminary findings highlight recurring flood-related vulnerabilities and the need for interventions that address both environmental and social dimensions of resilience. The study proposes multi-scale, nature-based solutions (NbS) to mitigate flooding, restore ecological functions, and enhance community capacity for adaptation. Ultimately, this work underscores the importance of coupling technical strategies with participatory processes to strengthen resilience and advance climate justice in vulnerable coastal neighborhoods. Full article

Multiple sclerosis (MS) affects approximately 2.9 million people in the world, exerting a significant economic and societal burden. The disease is increasingly identified among populations considered as uncommonly affected. MS is reported in all regions of the World Health Organization (WHO) member states in Africa, the Americas, South-East Asia, Europe, the Eastern Mediterranean and the Western Pacific, affecting all ethnicities while exhibiting substantially variable prevalences. Countries with high MS prevalence and some with moderate frequencies generally have economically better structured healthcare systems. Nevertheless, health disparities in these countries are accentuated by suboptimal accessibility of care for their minorities, immigrants and other underserved populations. Social Determinants of Health (SDOH) might have an impact on morbidity and higher rates of disability. Large segments of the world population (i.e., African, Latin American, people from the Middle East and Southeast Asia) do not have access to adequate MS diagnostic procedures, compounded by reduced availability of neurologists. Healthcare disparities exist practically in every country of the world. Active wars and a large number of refugees resulting from conflict augments the challenges to healthcare systems. These global factors constitute obstacles to the adequate management of MS. A collective international path is required to facilitate access to highly effective, albeit onerous treatments, some already approved and being utilized, i.e., monoclonal antibodies and B-lymphocyte depletory agents, and others foreseen in the future as advanced therapeutic molecules continue to develop. Full article

Self-efficacy beliefs and mindset influence student success, impacting how a learner experiences and responds to learning situations and setbacks. Accordingly, mindset interventions, are successful at increasing student performance with particular efficacy with historically underserved students such as those attending HBCUs. This paper studies a classroom-based mindset intervention that was implemented with the goal of increasing learning and achievement through improving the students’ cognitive disposition. The intervention, implemented at a mid-Atlantic minority serving institution of higher education, involved the creation of a custom-designed three-tool self-assessment developed to engender students’ critical reflection. The scales in question measured self-efficacy, growth mindset, and mastery goal orientation. This paper presents the results of reliability testing via Cronbach’s alpha and inter-item covariance. According to the findings, all three tools showed strong (good to excellent) reliability with acceptable positive covariance indicating that they are capable of serving as appropriate instruments for further adoption, usage, and analysis. It is the goal that this paper contributes to the body of literature on mindset interventions encouraging more individuals working with traditionally underserved learners to consider exploring efforts to increase students’ positive mindsets. Full article

Background/Objectives: Integrating behavioral health and primary care services is a national public health priority in the US, especially in underserved settings like northern Arizona. This healthcare delivery model is crucial to meet the mental and physical health needs of people with SU/SUDs, particularly those belonging to culturally diverse populations. In collaboration with a behavioral health center in northern Arizona, the current study aimed to assess the perspectives of providers and administrative staff on the implementation of integrated primary care (IPC) services for people with SU/SUDs. Methods: In February 2023, twelve healthcare providers and administrative staff from diverse educational backgrounds were recruited using purposive sampling to capture a range of perspectives on IPC implementation at the behavioral health center. Participants completed individual, semi-structured interviews conducted via Zoom, which were audio recorded and lasted approximately 30 min. The interview recordings were transcribed verbatim using Trint Software, and analyzed on Google Docs using applied thematic analysis. Two researchers coded the transcripts, iteratively developing and refining themes through multiple cycles of review and team discussions. Additional team members provided feedback and verified the themes, with consensus reached through collaborative meetings. This rigorous, iterative approach ensured the reliability and validity of the final thematic framework. Results: We found that IPC supports SU/SUDs recovery by providing holistic care that integrates medical, mental health, and addiction services while addressing social and co-occurring needs. It fosters an empathetic environment where clients do not need to repeatedly disclose their SU/SUDs, improves access to preventive care, and offers continuous support and education. Implementation barriers included workforce shortages, limited internal communication, and insufficient interdisciplinary training. Gaps in culturally centered care were identified, including reliance on Western models, limited representation of Native American and sexual and gender minority staff, and inconsistent use of inclusive practices such as pronouns, traditional healing, and trauma-informed approaches. Additionally, community partnerships with multisectoral organizations help clients access supportive resources beyond the facility, including vision care, clothing, and dental services. Conclusions: The implementation of IPC was seen as important to support the behavioral health center in northern Arizona to foster an empathetic environment where clients with SU/SUDs can have their mental, physical, and social needs addressed, either within the facility or through community partnerships, thereby supporting their recovery. However, progress is hindered by barriers such as workforce shortages, limited internal communication, and insufficient interdisciplinary care training. Additionally, despite regular cultural competency training, gaps remain in culturally centered care for underserved populations, particularly Native American and sexual and gender minority clients. Full article

As of the end of 2024, the NIH-funded Research Centers in Minority Institutions (RCMI) Program supported 21 specialized centers at minority-serving institutions. Its goal is to strengthen biomedical research infrastructure and enhance the capacity of investigators focused on health disparities. Since 2017, the centers have operated under a unified framework that includes four core components, one of which is Community Engagement (CEC). In 2021, the RCMI Coordinating Center established the CEC consortium to unify expertise across minority-serving institutions, which include historically Black colleges and Hispanic-serving institutions. This consortium promotes cross-institutional collaboration and innovation in community-engaged research to advance health equity. This paper examines how RCMI CECs strategically enhance research relevance, advance public health outcomes, and address social determinants of health (SDOH) through inclusive, bidirectional partnerships that position communities as co-leaders in the research process. Drawing on data from NIH RePORTER, the 2024 Community Engagement Consortium Signature Programs Monograph, and RCMI Common Data Elements, we analyze the collective contributions of the Community Engagement Core (CECs) across 21 RCMI centers. Findings underscore the role of tailored strategies, cultural competence, and academic-community partnerships in mitigating health disparities and promoting equity in underserved communities. Full article

Hispanic, Asian, and African Americans are disproportionately affected by liver cancer, viral hepatitis B (HBV), and viral hepatitis C (HCV), in part because of barriers to liver cancer awareness and prevention. We implemented a community-based, culturally tailored initiative to raise awareness and promote uptake of behaviors for liver cancer prevention, early diagnosis, monitoring, and treatment. Guided by community-based participatory research (CBPR) principles and built on well-established collaboration with community-based organizations, we actively engaged the community advisory board (CAB), community health workers, and community members in multiple phases of (1) a community-based educational initiative, (2) a city-wide bus campaign, and (3) community health fairs. This multilevel initiative saw notable changes in community members’ knowledge of liver cancer, viral hepatitis, lifestyle behaviors like dietary patterns, and uptake of screening tests for HBV/HCV. Additionally, the comprehensive engagement of CAB, healthcare workers, and community members significantly benefited community capacity building on cancer research and health promotion. These CBPR-guided community initiatives had remarkable positive impacts on promoting liver cancer awareness and prevention among underserved racial/ethnic minorities. The academic–community relationships built on and strengthened through shared power, mutual respect, and trust serve as the foundation for sustainable community growth and empowerment. Full article

Off-system bridges are critical components of the United States’ transportation infrastructure, providing essential access to rural communities and enabling residents to reach vital services such as employment, education, and healthcare. Many of these bridges are structurally deficient, functionally obsolete, and unmaintained. This disproportionately hinders the mobility of underserved populations, worsening socioeconomic disparities. Despite existing research, there is insufficient focus on the unique challenges posed by off-system bridges, including handling the class imbalanced nature of the bridge condition rating dataset. This paper predicts bridge deck conditions by using Generative Adversarial Networks with Focal Loss (GAN-FL) to generate synthetic data which enhances precision–recall balance in imbalanced datasets. Results show that integrating GAN-FL with random forest (RF) classifiers significantly enhances the performance of minority classes, improving their precision, recall, and F1 scores. The study finds that augmenting training data using GAN-FL greatly enhances minority class prediction, thereby assisting in accurate bridge condition modeling. Full article

Background: Multiple Myeloma (MM) is the most common type of blood cancer among black individuals. CAR-T therapy is crucial, but often inaccessible to many black patients and those from underserved communities. The University of Kansas Health System administers over 100 CAR-T treatments annually and aims to evaluate barriers to CAR-T therapy access related to the social determinants of health in the Midwest area. Methods: This study examined patients with MM referred for CAR-T therapy from January 2021 to December 2023, assessing how race, socioeconomic status, and insurance influenced eligibility for leukapheresis. Data on income and travel were gathered from the 2022 US Census and analyzed using R software. Results: The study included 271 referrals for MM CAR-T therapy involving 179 patients, with a median age of 66 years (51% male). Demographics: 80% white, 16% black, 2.2% other races, 1.8% Asian, with a median income of $70,644. Nearly half lived more than 30 min from the center (Mainly from Kansas, Missouri and Nebraska). Apheresis rates were similar across racial groups: 54% for whites, 54% for blacks, and 50% for others, while none of the three Asian patients proceeded. Nine patients (5%) could not proceed because of caregiver or insurance barriers, and cell collection rates were comparable regardless of distance (34% vs. 35%). Conclusion: This study showed that black representation in CAR-T access matches local demographics, indicating less disparity among minorities. Unlike national reports, distance, income, and insurance do not significantly affect access, suggesting the need for a national study on the social determinants impacting CAR-T access for multiple myeloma. Full article

Objectives: The adoption of telemedicine, which is the delivery of healthcare services through digital platforms, exploded during the COVID-19 pandemic as a means to ensure the continuity of care while minimizing infection risks. While this modality improved access and convenience for many, disparities in adoption have emerged, particularly in rural and underserved populations. This study aims to evaluate the impact of telemedicine on patient satisfaction before and during the pandemic, with a focus on chronic disease management—notably hypertension—and to identify factors influencing the equitable adoption of telehealth. Methods and Procedures: This study used a mixed method approach, combining quantitative survey data and causal loop modeling to analyze patient satisfaction levels and the interplay between telehealth adoption, healthcare access, and demographic disparities. Patient-reported satisfaction data were collected in two time periods—before and during the pandemic. Causal modeling was used to explore systemic relationships between provider support, technology access, patient engagement, and health equity. Results: The findings revealed that telemedicine significantly enhanced healthcare access during the pandemic, with a notable increase in patient satisfaction scores. Patients with chronic conditions, especially those diagnosed with hypertension, reported the improved continuity of care and reduced geographic barriers. However, disparities in telehealth access were more pronounced in non-metropolitan areas and among older adults and minority populations. Causal analysis highlighted key enablers of telehealth success, i.e., provider support, digital literacy, and access to reliable internet and devices. Conclusions: Telemedicine presents a transformative solution for equitable healthcare delivery, especially in chronic disease management. Strategic efforts are needed to address adoption disparities and ensure the sustained and inclusive integration of telehealth after the pandemic. Full article

Background/Objective: To assess vulnerable Romanian children’s knowledge, attitudes, and beliefs regarding the HPV vaccination. Methods: Vulnerable children (ethnic minorities, high social vulnerability index, or low socioeconomic status) from three schools in Cluj County, Romania, were enrolled in a short educational presentation regarding HPV and were delivered a physical questionnaire consisting of 26 items. Results: 199 vulnerable school students concluded the questionnaire with a mean age of 14.62. Most participants were unaware of the HPV infection or the HPV vaccine. Following the educational program, most participants exhibited a reasonably elevated level of knowledge, which positively correlated with the intention to vaccinate. Fifty-three per cent of respondents would vaccinate in school if the vaccine were available, fifty-four per cent would vaccinate if the product were free of charge or at minimal cost, and over sixty-four per cent would vaccinate at their doctor’s recommendation. Several knowledge items, beliefs, and attitudes towards vaccination were disclosed to influence children’s preference to participate in vaccination campaigns. Conclusions: This analysis unveiled the pivotal role of knowledge about HPV in the immunization uptake within underserved, vulnerable populations of Romanian children. An intricate interplay between vulnerability, knowledge, accessibility, and the willingness to vaccinate was impacted by several beliefs and attitudes towards HPV vaccination. Most children were willing to participate in HPV immunization campaigns, whether school-based, reimbursed, or at the doctor’s recommendation. These findings act as pillars for assembling future educational campaigns in vulnerable Romanian communities of children, aiming to enhance awareness and coverage of HPV vaccination and ensure inclusive health policies. Full article

Ride-pooling, as a sustainable mode of ride-hailing services, enables different riders to share a vehicle while traveling along similar routes. The COVID-19 pandemic led to the suspension of this service, but Transportation Network Companies (TNCs) such as Uber and Lyft resumed it after a significant delay following the lockdown. This raises the question of what determinants shape ride-pooling in the post-pandemic era and how they spatially influence shared ride-hailing compared to the pre-pandemic period. To address this gap, this study employs geospatial analysis and machine learning to examine the factors affecting ride-pooling trips in pre- and post-pandemic periods. Using over 66 million trip records from 2019 and 43 million from 2023, we observe a significant decline in shared trip adoption, from 16% to 2.91%. The results of an extreme gradient boosting (XGBoost) model indicate a robust capture of non-linear relationships. The SHAP analysis reveals that the percentage of the non-white population is the dominant predictor in both years, although its influence weakened post-pandemic, with a breakpoint shift from 78% to 90%, suggesting reduced sharing in mid-range minority areas. Crime density and lower car ownership consistently correlate with higher sharing rates, while dense, transit-rich areas exhibit diminished reliance on shared trips. Our findings underscore the critical need to enhance transportation integration in underserved communities. Concurrently, they highlight the importance of encouraging shared ride adoption in well-served, high-demand areas where solo ride-hailing is prevalent. We believe these results can directly inform policies that foster more equitable, cost-effective, and sustainable shared mobility systems in the post-pandemic landscape. Full article

This paper presents the development, implementation, and outcomes of the ELEVATE-US-UP (Engaging Learners through Exploration of Visionary Academic Thought and Empowerment in UnderServed and UnderPrivileged communities) teaching methodology, an equity-centered, culturally responsive pedagogical framework designed to enhance student engagement, academic performance, and science identity among underrepresented learners. This framework was piloted at Northern New Mexico College (NNMC), a Hispanic- and minority-serving rural institution. ELEVATE-US-UP reimagines science education as a dynamic, inquiry-driven, and contextually grounded process that embeds visionary scientific themes, community relevance, trauma-informed mentoring, and authentic assessment into everyday instruction. Drawing from culturally sustaining pedagogy, experiential learning, and action teaching, the methodology positions students not as passive recipients of content but as knowledge-holders and civic actors. Implemented across upper-level environmental science courses, the method produced measurable gains: class attendance rose from 67% to 93%, average final grades improved significantly, and over two-thirds of students reported a stronger science identity and a newfound confidence in their academic potential. Qualitative feedback highlighted increased perceptions of classroom inclusivity, community relevance, and instructor support. By centering on cultural context, student voice, and place-based application, the ELEVATE-US-UP framework offers a replicable and scalable model for educational transformation in underserved regions. Full article

Background: Pain is a prevalent issue among breast cancer patients and survivors, with a significant proportion receiving hydrocodone for pain management. However, the rescheduling of hydrocodone from Schedule III to Schedule II by the U.S. Drug Enforcement Administration (DEA) in October 2014 raised concerns about potential barriers to opioid access for cancer patients, particularly among vulnerable populations such as dually eligible Medicare–Medicaid beneficiaries and racial/ethnic minorities. Methods: We conducted a retrospective cohort study using Surveillance, Epidemiology, and End Results (SEER)-Medicare linked data including 52,306 early-stage breast cancer patients from 2011 to 2019. We employed multivariable logistic regression models with model specification tests to stratify the subgroups and evaluate the differential effects of the policy change by Medicaid dual eligibility and race–ethnicity, while adjusting for other patient demographics, clinical characteristics, and cancer treatments. Results: The rescheduling of hydrocodone was associated with significantly different effects on prescription opioid use across subgroups, with the most pronounced reduction in hydrocodone prescription observed among dual-eligible racial/ethnic minority patients (adjusted odds ratio [AOR] = 0.57; 95% confidence interval [CI]: 0.44–0.74; p < 0.001). Non-dual-eligible patients experienced a smaller reduction in hydrocodone use (AOR = 0.84; 95% CI: 0.78–0.90; p < 0.001). Concurrently, non-hydrocodone opioid use significantly increased among non-dual-eligible non-Hispanic White patients (AOR = 1.29; 95% CI: 1.19–1.40; p < 0.001), suggesting a substitution effect, while smaller non-significant increases were observed among other subgroups. Conclusions: Hydrocodone rescheduling led to the greatest reduction in hydrocodone use among dual-eligible racial–ethnic minority patients. The corresponding increase in non-hydrocodone opioid use was limited to non-dual-eligible non-Hispanic White patients. These findings highlight the need for opioid policies that balance misuse prevention with equitable access to pain relief, particularly among underserved populations. Full article