Session
Focus on Health Disparities, Empowerment, and Environmental Racism, and Healthcare
APHA 2022 Annual Meeting and Expo
Abstract
Racial Disparities in Colorectal Cancer Screening among Mississippi Adults Aged 50-75 Years Who Met Colorectal Cancer Screening Recommendations
APHA 2022 Annual Meeting and Expo
Background
Colorectal cancer (CRC) is the third leading cause of cancer death for both men and women in the US. In Mississippi, in 2020, age-adjusted CRC death rate was 1.5 times greater for Blacks than Whites. Mississippi has one of the lowest rates of CRC screening in the United States. We assessed racial disparities among Mississippi respondents aged 50-75 who have fully met the US Preventive Services Task Force (USPSTF) recommendations.
Methods
We analyzed the data from the 2020 Mississippi Behavioral Risk Factor Surveillance System, which included a CRC screening module. Respondents were asked if they had at least one of the recommended CRC tests within the recommended time interval. Their responses were classified according to the USPSTF recommendations on CRC screening. We examined racial disparities among those who fully met the US Preventive Services Task Force (USPSTF) recommendations on CRC screening.
Results
In 2020, 71.1% of Mississippi adults aged 50-75 years met the USPSTF recommendations for colorectal cancer screening. Non-Hispanic White adults aged 50-75 years had a 1.3 (adjusted odds ratio (AOR) =1.34, 95% CI, 1.007- 1.801) higher odds of fully meeting the US Preventive Services Task Force (USPSTF) recommendations on CRC screening compared non-Hispanic Black Mississippians.
Conclusion
Racial disparities in CRC screening exist in Mississippi. Targeted interventions that promote CRC screenings are needed for Non-Hispanic Blacks Mississippians.
Abstract
Racial Microaggressions Minorities Experience and the Ability to Seek Health Care
APHA 2022 Annual Meeting and Expo
Racial micro-aggressions significantly affect minorities’ ability in healthcare-seeking. The perception of care that minority patients receive is lowered if they believe that their care is being influenced by factors such as race-based mistreatment, a dissociation of race, or discrimination. The goal of the current study is to identify whether there is a potential relationship between the influences of racial micro-aggressions on healthcare-seeking habits between minorities and non-minorities. It is hypothesized that experiencing racial micro-aggressions in the health care setting, negatively influences minorities' healthcare-seeking habits. Data was gathered through a self-reported questionnaire at a southeastern US college which consisted of 137 students between the ages of 18 to 26. The questionnaire consisted of 40 questions from the Racial Microaggressions in Medicals Practice scale, Medical health-seeking, Raising reproductive health concerns, and Discrimination in medical settings. Age, gender, and race were collected for demographics. Multiple analyses were conducted to compare racial microaggressions and health care seeking between minorities and non-minorities across genders. Preliminary findings of our study show that racial microaggressions and discrimination do affect minorities' health, however, their reproductive health is not impacted. Additionally, we will continue the work by interviewing participants to pinpoint how exactly these participants are affected by racial microaggressions. This research has highlighted the need for implementing microaggression awareness training within the health care setting may assist in establishing patient comfort, which in turn, may reduce the progression of preventable diseases.
Abstract
Empowering Migrant Latina Women using Co-learning for Health & Healing Workshops
APHA 2022 Annual Meeting and Expo
Issues: Latina migrants are at high risk of violence and trauma as a result of existing structural barriers and often put themselves last in familial situations. Latina migrant women often lack social support to seek out preventative care and mental health resources they need.
Description: Workshops were co-developed and piloted with Unidad Latina en Acción, using the framework from “Hablar es Sanar using interactive activities and co-learning to build community, create a healing space and empower Latina migrants. Two workshops were administered to Latina participants, ages 23-53 with n=17 participants in total. Participants (n=6) were given pre- and post-tests for the second workshop to assess changes in knowledge. Focus groups were conducted after each workshop and analyzed utilizing a rapid qualitative analysis to identify key themes and recommendations.
Lessons Learned: The paired t-test of the pre- and post-test surveys resulted in no statistically significant difference in means (p>0.05) as a result of overlooking co-creation of the survey tool with community leaders. Stakeholder collaboration in the survey tool is critical for future workshops. Rapid analysis procedure sheets were completed for focus groups. The participants valued when individuals shared their experiences and felt affirmed when others listened to what they shared.
Recommendations: Results from our focus groups gave insight into which activities helped build community among the women, and inform future workshops. The workshop’s framework of listening and sharing helped participants feel understood and supported. Attending additional workshops may lead to significant increases in participants’ knowledge.
Abstract
The Bronx is Building: medical research, environmental design, and grassroots advocacy to transform the Cross-Bronx Expressway (CBE) as a public health intervention
APHA 2022 Annual Meeting and Expo
Issues: The CBE exemplifies urban planning policy that is disconnected from community priorities, perpetuates environmental racism, and negatively impacts health. Lack of public infrastructure investment compounds disproportionate rates of asthma, obesity, and cardiovascular disease.
Description: Medical students in partnership with a local environmental justice organization, physicians, and policymakers successfully advocated for $2,000,000 in funding for a CBE transformation project in the federal infrastructure bill through:
1. 2021 Annual Report using research from public health experts for grassroots advocacy to change policy and reduce health disparities.
2. Featuring community and public health leaders on our podcast, The Healthy Bronx, to illustrate the connections between the built environment, transportation, and health.
3. Partnering with local journalists/media to increase coverage of advocacy on local television, and in local and international periodicals.
4. Discussing the connections between health and environment with students at Bronx public schools.
5. Curated an exhibit at our hospital in partnership with the Columbia Graduate School of Architecture featuring design renderings that reimagine the CBE.
Lessons Learned: Environmental justice and community priorities are central to public health equity. Bronx residents firmly support this vision and its pertains to transforming the CBE.
Recommendations: Physicians can connect their communities with medical research to strengthen the advocacy of local organizers. Partnership between community organizations, physician advocates, and architects/urban designers create new possibilities for prevention and public health.
Abstract
Scoping review of cervical cancer screening interventions among minority women
APHA 2022 Annual Meeting and Expo
Cervical cancer remains one of the leading causes of mortality among women globally. Barriers to cervical cancer screening include being a minority woman, having limited access to resources, poverty, and lack of insurance. There is a lack of synthesis of the literature on cervical cancer screening interventions among minority women. Therefore, the purpose of this study was to analyze the existing interventions of cervical cancer screening among minority women, identify gaps, and propose future recommendations. Methods: A scoping review was conducted in MEDLINE, CINAHL, and EBSCO databases to search studies published over the past five years using the keywords: intervention, program, screening, cervical cancer, minority women (including all minority race descriptors), AND Pap test. Results: A total of 11 studies were identified describing interventions among minority women. Many studies did not include interventions with a specified theoretical basis. Among theory-based interventions (n=7) social cognitive theory and the health belief model theories were used. Most of the interventions (n=6) were also not adapted specifically for minority women (i.e. Black and Hispanic) and were not culturally adapted using the feedback received from minority women. Most of the interventions (n=10) were aimed to change perceptions of screening and urged regular medical screenings. Conclusions: Cervical cancer disproportionately affects minority women, however, there are not enough interventions with a theoretical framework to help bridge the gap. More theory-based screening interventions need to be developed and disseminated for minority women along with policy measures to address the growing disparities regarding cervical cancer in this subgroup.
Abstract
Racial and Ethnic Disparities Among U.S. Children: National Survey of Children's Health, 2020
APHA 2022 Annual Meeting and Expo
Objective: To examine current patterns of racial/ethnic disparities across multiple domains of children’s health.
Methods: We used the 2020 National Survey of Children’s Health (NSCH), a parent-reported address-based survey of children 0-17 years (n=42,777), to examine the following racial/ethnic categories: American Indian/Alaska Native, Asian, Native Hawaiian/Other Pacific Islander, multiple race, Hispanic, non-Hispanic Black, non-Hispanic White. Using Healthy People and Title V measures as a framework, outcome measures were selected in domains of social determinants of health (n=6), physical and mental health (n=10), health behaviors (n=11), and health care access (n=9). We calculated the Healthy People summary rate ratio measure of disparity using nationally weighted prevalence estimates (average prevalence divided by the lowest prevalence).
Results: There were statistically significant disparities for 28 of 36 indicators. High summary rate ratios (>3.0) were found across all domains: two or more ACEs (3.8[CI:2.6-5.7]),anxiety (3.5[CI:2.3-5.4]), depression (6.4[CI:2.8-14.4]), autism/ASD (6.8[CI:2.2-21.2]), ADD/ADHD(3.8[CI:2.4-6.1]), forgone healthcare(5.4[CI:1.8-16.6]), developmental screening(4.8[CI:2.2-10.1]), physical activity(3.5[CI:2.2-5.5]), and bullying perpetration(3.1[CI:1.8-5.3]). Low summary rate ratios (<1.1) were seen for excellent or very good health status(1.05[CI:0.96-1.15) and family resilience(1.05[CI:0.98-1.1]). Black and Indigenous populations tended to have the least favorable rates while Asian and White populations tended to have the most favorable rates.
Conclusions: Large racial and ethnic disparities were observed for several indicators in every domain.
Policy Implications: More action is needed to advance U.S. children’s health equity, including a focus on issues and populations with the largest disparities.
Abstract
Racial disparity in mental health effects during COVID-19 pandemic
APHA 2022 Annual Meeting and Expo
Background: Existing literature about collective traumatic events provides some insight into the expected mental health effects and disparities of the COVID-19 pandemic. We aimed to identify disparities in the COVID-19 effects on mental health with a focus on social determinants, household composition, and social networks in light of extended periods of economic loss, social isolation, and other disruptions.
Methods: This convenience sample survey (COvid-19 Affecting CHildren and caregivers in New York: COACH-NY), included questions on socio-demographics and household composition; COVID-19 infection; acute and chronic stressors; perceived stress, anxiety, depression, somatic symptoms, and general health using validated scales (i.e., GAD-7 for anxiety, CES-D-10 for depression, and PHQ-15 for somatic symptoms). The survey was administered through the Qualtrics electronic survey platform, after eligibility screening (>17 years resident of New York State, and primary caregiver of child aged 5-17 years).
Results: The sample (N=976) was 59% Female, 51% non-Hispanic White (NHW), 23% Hispanic, 13% non-Hispanic Black (NHB) and 13% Asian. There were significant racial and ethnic differences (p<0.05) for anxiety (54% Asians and 41% NHB vs 31% NHW), depressive symptoms (90% Asians, 79% NHB vs 61% NHW), perceived stress (97% Asians, 90% Hispanics vs 72% NHW) and somatic symptoms (49% Asians, 43% Hispanics vs 31% NHW).
Conclusion: All racial and ethnic groups consistently reported mental health issues in higher proportion compared to non-Hispanic Whites. Further evaluation adjusting for other social determinants (education, household composition, income etc.) and exploration of COVID-19 specific contextual factors to understand mental health problems among Asians is warranted.
Abstract
Barriers, facilitators, and benefits of community-supported agriculture programs among SNAP recipients
APHA 2022 Annual Meeting and Expo
Background: The primary objective of the study was to elicit SNAP participants’ perspectives on barriers and facilitators of Community Supported Agriculture (CSA) participation, as well as program recommendations.
Methods: Twelve SNAP participants were enrolled in a three-week CSA program. Participants completed a post-program survey and took part in a focus group or interview. The research team also collected field notes throughout the research process. The post-program survey was analyzed for descriptive statistics. Field notes, the focus group, and interviews were analyzed using a rapid qualitative analysis technique.
Results: Participants identified barriers to CSA participation including cost, picking up shares and unfamiliar foods. There were several facilitators including the desire to obtain healthy foods and the quality of produce provided in CSA shares. Participants reported increased vegetable consumption and improved overall health as a result of the program. Finally, participants offered recommendations to improve the program including expanded distribution options and additional programming, such as nutrition education.
Conclusions: Study findings may be used to inform the design of CSA programs for SNAP participants.
Abstract
Work accommodations for lower-wage workers: A scoping review
APHA 2022 Annual Meeting and Expo
Background: Lower-wage workers carry a disproportionate burden of chronic disease morbidity due to their overall socioeconomic disadvantage and the risks accrued from lower-wage work environments. Studies show low-wage work is linked to more occupational hazards, higher physical demands, more stress, lack of access to health insurance coverage and paid sick leave, and poverty – all of which result in poorer health. Work accommodations are modifications in the workplace setting that can help minimize health-related work limitations, and employers are required to make “reasonable accommodations , by law, for workers with chronic health conditions. This scoping review identifies what is known about work accommodations for lower-wage workers.
Methods: A systematic search of literature, using the PRISMA-ScR protocol, was conducted in PubMed, CINAHL, and Scopus databases through December 2021. Screening and data abstraction were performed by two independent reviewers. Studies that incorporated work accommodations as a variable were included.
Results: The search produced 610 citations, 8 met inclusion criteria. Only 2 were conducted in the United States. Health conditions studied were variable, and no findings were specific to lower-wage workers. Three studies examined relationships of work accommodations and health; 2 of the 3 were positive associations and 1 found no statistically significant association.
Conclusions: More studies are needed in the United States reflecting lower-wage workers’ requests for and receipt of work accommodations, which may be an important intervention target for reducing morbidity, work limitations, and health inequities among populations with chronic health conditions.
Abstract
Comparative Levels of Antenatal Care Coverage in India: An Analysis of 3,413,674 Pregnant Women During COVID-19 Pandemic
APHA 2022 Annual Meeting and Expo
Background: Provision and access to antenatal care (ANC) for pregnant women in India during COVID-19 pandemic has been challenging. This study estimated ANC coverage during this situation in 2020, 2021, and compared to baseline in 2019 in Gujarat, India.
Methods. ANC coverage by visit and year was estimated for the total of 3,413,674 pregnant women in 2019-2021. Data were obtained from maternal health program’s annual reports of Gujarat State which collected data from all levels of public health institutions in all 41 districts. Four ANC visits were during 12-16, 20-24, 28-32, and 36-40 gestational weeks. ANC coverage was estimated by number of pregnant women attending ANC by visit divided by all registered pregnant women each year. Analysis of variance and Bonferroni multiple comparison test were applied for comparison of mean coverage by visit and year.
Results. Although overall coverage slightly decreased from 96.9% (2019) to 95.7% (2021); mean coverages across districts were significantly declined to 95.4% (2021) compared to 97.0% (2019) and 97.5% (2020) [Bonferroni, p<0.001]. Decreasing trajectory of coverage from the first to the fourth visits was consistently observed for each of the three years. Mean coverage in the subsequent visits significantly decreased in 2021 compared to 2019 and 2020 [Bonferroni, p<0.001]: 2nd visit, 63.1% (2021) versus 79.4% (2019); 3rd visit, 34.4% (2021) versus 56.7% (2019); 4th visit, 13.6% (2021) versus 24.4% (2019).
Conclusion. ANC coverage in Gujarat declined during pandemic. This suggested need for rebuilding resilient ANC system to respond to current and future emerging public health threats.