The Health Care Institution, Population Health and Black Lives

The Health Care Institution, Population Health and Black Lives

In this article, Christopher King, PhD (New Connections Network Member) discusses institutionalized racism and discrimination within health care, and how this affects Black lives. The article contains an in-depth literature review, along with a conceptual framework for a more strategic approach to population health improvement within the context of Black lives.

The literature review highlights the disparities within the healthcare system, including the health effects of structural racism, implicit biases in healthcare providers, and the social determinants of health that disproportionately affect the health of African Americans.

The framework outlines internal and external strategies and outcomes to promote equity in health care. The two goals are to “improve the patient experience, decrease medical costs, and reduce or eliminate racial disparities within healthcare settings” and to “improve the social, political, economic, and environmental conditions of historically marginalized communities of color.”

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SUMMARY

Neighborhood Disadvantage, Poor Social Conditions, and Cardiovascular Disease Incidence among African American Adults in the Jackson Heart Study

Neighborhood Disadvantage, Poor Social Conditions, and Cardiovascular Disease Incidence among African American Adults in the Jackson Heart Study

Sharrelle Barber, ScD, (NC 2016) examined the impact of neighborhood conditions resulting from racial residential segregation on cardiovascular disease (CVD) risk.  The researchers used data from the Jackson Heart Study (a study of CVD among African Americans in Jackson, MS to examine neighborhoods and CVD incidence) to develop a measurement of neighborhood disadvantage, using sociodemographic indicators from the Census.

The researchers found that more than 230 CVD events occurred during the eight-year timeframe. A correlation was found between CVD development and neighborhood factors such as less family income, less education, disadvantaged neighborhood settings, higher neighborhood violence, and worse risk factor profiles. Dr. Barber concludes that “poor neighborhood social conditions…do not occur in a vacuum and are a byproduct of the larger context of racial and economic stratification by place”. This work highlights the significance of place and how it interacts with health, encouraging further place-based initiatives.

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SUMMARY

Place Matters: Contextualizing the Roles of Religion and Race for Understanding Americans’ Attitudes about Homosexuality

Place Matters: Contextualizing the Roles of Religion and Race for Understanding Americans’ Attitudes about Homosexuality

Social Science Research (2016)

New Connections alumna Amy Adamczyk (NC 2009) and colleagues highlight the significance of location in social science studies through her recent research, intersecting religion, race, homosexuality, and place. Previously, researchers had given little to no attention to how county characteristics shape attitudes toward homosexuality, focusing more on racial and ethnic differences in public opinions. Many of those studies showed that African Americans appear to be less approving of homosexuality than other ethnicities. This research challenges that premise from a spatial perspective.

 

This research challenges that premise from a spatial perspective–using county-level data from the American National Election Survey, the Census Bureau, and the Association of Religion Data Archives. Employing Hierarchical Linear Modeling techniques, the researchers found that after accounting for the geographical distribution of attitudes across counties, as well as religious involvement, strength of belief, and religious affiliation, African Americans appear to have warmer feelings about homosexuality than whites. They also found that there are no large correlations between race and religion with attitudes toward homosexuality, but that it is more so about county (location) variables.

 

These findings show that previous research was misestimated in regards to African American feelings, as that research did not account for the uneven distribution of attitudes in different counties. This is one of the first studies to examine contextual factors that may explain differences in attitudes about homosexuality.

 

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SUMMARY

Do Age & SES Matter? A Mix-method Exploration of Social Media Use during Good & Bad Times

Monique Clinton Sherrod headshot

Do Age & SES Matter? A Mix-method Exploration of Social Media Use during Good & Bad Times

Alumna Linda Charmaraman, PhD (NC 2013) and researchers studied differences in the utilization of social media and mobile phone technology by age and socioeconomic status (SES) among adolescents. The investigators recruited a diverse sample of more than 2,000 young adults to participate in an online survey.  They subsequently invited the young adults to serve in a follow-up interview. Findings revealed that young adults and upper-level college students were more likely to be unable to live without their cell phones or their short message service (SMS) devices. Freshmen and adolescents have a greater likelihood to share bad experiences on Facebook, in comparison to older counterparts. Middle school students, particularly the most disadvantaged youth, were more likely to use Twitter to communicate about social event and bad days. Similarly, adolescents were more likely to socialize using Twitter. Older participants reported greater usage of SMS and cell phones for fear of missing out. Higher SES was associated with larger online friendship networks. Understanding patterns of social media and mobile phone utilization by age and SES subgroups have implications to tailoring online health interventions, promoting healthier social media communities, and contributing to academic and mental health outcomes.

https://cc.readytalk.com/cc/playback/Playback.do?id=ep15m2

SUMMARY

  • Utilization of social media and mobile phone technology differs by age and socioeconomic status (SES) among adolescents and young adults in sharing good and bad experiences with their online friendship networks.Freshmen and adolescents have a greater likelihood to share bad experiences on Facebook, in comparison to older counterparts. Middle school students, particularly the most disadvantaged youth, are more likely to use Twitter to communicate about social event and bad days. Similarly, adolescents are more likely to socialize using Twitter.
  • Freshmen and adolescents have a greater likelihood to share bad experiences on Facebook, in comparison to older counterparts. Middle school students, particularly the most disadvantaged youth, are more likely to use Twitter to communicate about social event and bad days. Similarly, adolescents are more likely to socialize using Twitter.
  • Higher SES was associated with larger online friendship networks.
  • Understanding patterns of social media and mobile phone utilization by age and SES subgroups have implications for tailoring online health interventions, promoting healthier social media communities, and contributing to academic and mental health outcomes.

Residential Instability & Obesity over Time: The Role of Social & Built Environment

antwan jones headshot

Residential Instability & Obesity over Time: The Role of Social & Built Environment

Alumnus Antwan Jones, PhD (NC 2011) published findings from his research exploring the correlation between residential instability and obesity risk in the United States. In the study, Dr. Jones extracts data from a retrospective longitudinal cohort sample of nearly 14,000 racially diverse adolescents from the National Longitudinal Study of Adult Health and the Obesity and Neighborhood Environment database.  He does this to capture demographic, socioeconomic, and familial characteristics, as well as community level-data. Results demonstrate that environmental changes between past and present residential moves contribute to obesity outcomes. In particular, adolescents who moved to an environment that provided qualitatively better amenities than previous community of residence were less likely to be obese. Health promoting neighborhood factors (e.g., greater access to physical activity resources, more quality supermarkets, lower number of fast-food establishments, and less crime) or upward mobility, are attributed to a reduction in the risk of being obese. Thus, mobility is not a predictor of obesity risk, but rather the spatial environment. The study has implications for health disparities research that implicates the impact of negative neighborhood factors on child obesity risk, and the importance of developing the built environment.

http://www.sciencedirect.com/science/journal/13538292

SUMMARY

  • Environmental changes between past and present residential moves contributes to obesity outcomes.

    Adolescents who moved to an environment that provided qualitatively better amenities than previous community of residence were less likely to be obese.

    Multivariate analyses suggest that mobility has a protective effect against obesity, which may be attributed to upward mobility.

    The study has implications for health disparities research that implicates the impact of negative neighborhood factors on child obesity risk and the importance of developing the built environment.

Exploring Culturally Based Intrafamilial Stressors among Latino Adolescents

Exploring Culturally Based Intrafamilial Stressors among Latino Adolescents

In an exploratory qualitative study New Connections network member David Córdova, PhD, and colleagues, used a grounded theory approach to uncover the effects of acculturative differences on the parent-adolescent dyad that may affect Latino youth development. Specifically, this study expands the knowledge of parent-child cultural discrepancies among Latinos by observing how acculturation influences intrafamilial stressors when Latino youth are more acculturated than their parents in the host culture. Based on findings from 25 focus groups with Latino adolescents, ages 11 to 19, the researchers identified five categories of parent-adolescent acculturation discrepancies: (1) language brokering, (2) parent mistrust of the English language, (3) differences in cultural values, (4) overprotective parenting, and (5) gender-role inequities. Understanding these effects can aid in developing culturally specific preventive interventions, including the development of the youth version of the Hispanic Stress Inventory-Adolescent.

http://onlinelibrary.wiley.com/doi/10.1111/fare.12095/full

 

SUMMARY

  • Parent-child acculturation discordance may contribute to behavioral and mental health issues among Latino adolescents when the host culture acculturation is higher for the child than the parents.
  • Five categories of acculturation discordance were identified that contribute to intrafamilial stressors: (1) language brokering, (2) parent mistrust of the English language, (3) differences in cultural values, (4) overprotective parenting, and (5) gender-role inequities
  • Understanding the culturally rooted behavioral and mental health effects of intrafamilial stress can aid in developing culturally specific preventive interventions.

Urban vs. Rural Differences in Prescription Opioid Misuse among Adults in the United States

Urban vs. Rural Differences in Prescription Opioid Misuse among Adults in the United States

New Connections network member, Khary K. Rigg, PhD, and grantee Shannon M. Monnat, PhD, collaborated on a study addressing the misuse of prescription opioids and its contributing factors by geographic classification. The researchers found that urban adults are at a higher risk of prescription opioid misuse (POM) in comparison to their rural adult counterparts. The higher rate of POM among adults in urban communities may be attributed to the greater likelihood of consuming other alcohol and other illicit drugs during adolescence. Thus, the authors recommend targeting preventive efforts and interventions for illicit drug users, particularly youth under the age of 18.

http://www.ijdp.org/article/S0955-3959(14)00282-5/fulltext.

SUMMARY

  • Urban adults are at a higher risk of prescription opioid misuse (POM) in comparison to their rural adult counterparts.

    Higher rate of POM among adults in urban communities may be attributed to the greater likelihood of consuming other alcohol and other illicit drugs during adolescence.

    Authors recommend targeting preventive efforts and interventions for illicit drug users, particularly youth under the age of 18.

TXT Me I’m Only Sleeping

TXT Me I’m Only Sleeping

New Connections scholar Anna Adachi-Mejia, PhD (NC 2007) and researchers examined the correlations between teen sleeping patterns and cell phone usage at bedtime. Under the premise that nighttime cell phone use is a health risk, interfering with sleep onset, quality, and duration, Dr. Adachi-Mejia and colleagues surveyed participants (ages 12-20) of a New Hampshire pediatric primary care practice.

More than half of the sample reported taking their phones to bed with them (63%), and over a third reported using their phone after going to bed (37%). For those who reported taking their phone to bed, they reported a significant likelihood of disturbed sleep compared to those who did not. The researchers look forward to continuing this pilot study work, and potentially understanding correlations and causations for sleep quality in adolescents.

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SUMMARY

Results from a National Survey of Recruitment and Retention Initiatives in the Nursing Workforce

Results from a National Survey of Recruitment and Retention Initiatives in the Nursing Workforce

New Connections scholars are passionate about diversity initiatives for recruitment and retention in nursing programs. This is evident by the work conducted by New Connections scholars J. Margo Brooks Carthon, PhD (NC 2011) and James Guevara, MD, MPH (NC 2010), network member Thai-Huy Nguyen, PhD, and colleagues. This research, entitled Measuring Success Results from a National Survey of Recruitment and Retention Initiatives in the Nursing Workforce, examined the trends in nursing enrollment and graduation, both with and without diversity pipeline programs. The goals of these pipeline programs include recruitment and enrollment development; certification/degree completion; and/or student support, engagement, and retention efforts.

Drawing from two data sources (the American Association of Colleges and Nursing and the Nursing Workforce Diversity funding list), the researchers surveyed university staff to identify if increasing underrepresented student presence is part of their institution’s mission statement, and if their institution has a pipeline program in place. Twenty percent of the nursing schools reported having a diversity pipeline program. This article outlines particular components of these programs and advocates for their importance.

To access this article, click here.

This research was also featured here.

SUMMARY

Depressive Symptomology & Hostile Affect among Latinos Using Housing Rental Assistance

Depressive Symptomology & Hostile Affect among Latinos Using Housing Rental Assistance

New Connections scholars Earle C. Chambers, PhD, MPH (NC 2006) and Shakira Suglia, ScD (NC 2007), along with colleagues, found correlations between neighborhood characteristics and mental health outcomes. The research team used AHOME (Affordable Housing as an Obesity Mediating Environment Study) data to conduct statistical analyses on the relationship between depressive symptomatology and housing rental assistance in low-income Latino residents in the Bronx, NY.

Findings reveal a higher prevalence of depressive symptomatology in public housing residents (45%) than in voucher users (39%) or in unassisted residents (32%). Variables such as housing type were not significantly associated with depressive symptomatology or hostility, but variables such as physical disorder and perceptions of social cohesion were associated with levels of hostility and depressive symptomatology.

This research shows that the built and physical environment can have mental and physical influences on residents. Questions arise about whether the characteristics of low-income neighborhoods have deleterious effects on residents.

View full research article here.

SUMMARY