Feeling Some Type of Way: Black Feeling and Emotional Ambiguity

The frequent police killings during the COVID-19 pandemic forced a reckoning among Americans from all backgrounds and propelled the Black Lives Matter movement into a global force. This manuscript addresses major issues to aid practitioners in the effective treatment of African Americans via the lens of Critical Race Theory and the Bioecological Model. We place the impacts of racism on Black families in historical context and outline the sources of Black family resilience. We critique structural racism embedded in all aspects of psychology and allied fields. We provide an overview of racial socialization and related issues affecting the parenting decisions in Black families, as well as a detailed overview of impacts of structural racism on couple dynamics. Recommendations are made for engaging racial issues in therapy, providing emotional support and validation to couples and families experiencing discrimination and racial trauma, and using Black cultural strengths as therapeutic resources.

Mental Health in the Context of Health Disparities

<i>Special Report:</i> Racism and Inequities in Health Care for Black Americans

Racial Disparities in Hospitalization Outcomes Among Adult Patients with Neutropenia Using the National Inpatient Sample (2020)

Racism Is a Modifiable Risk Factor: Relationships Among Race, Ethnicity, and Colorectal Cancer Outcomes

Influence of Race, Ethnicity, and Culture on Childhood Obesity: Implications for Prevention and Treatment

Health Disparities in Pulmonary Arterial Hypertension and the Impact of the COVID-19 Pandemic

Purpose: Racism is an essential factor to understand racial health disparities in infection and mortality due to COVID-19 and must be thoroughly integrated into any successful public health response. But highlighting the effect of racism generally does not go far enough toward understanding racial/ethnic health disparities or advocating for change; we must interrogate the various forms of racism in the United States, including behaviors and practices that are not recognized by many as racism.Methods: In this article, we explore the prevalence and demographic distribution of various forms of racism in the United States and how these diverse racial ideologies are potentially associated with racialized responses to the COVID-19 crisis.Results: We find that among white Americans, more than a quarter express traditional racist attitudes, whereas more than half endorse more contemporary and implicit forms of racist ideology. Each of these types of racism helps us explain profound disparities related to COVID-19.Conclusions: Despite a robust literature documenting persistent patterns of racial disparities in the United States, a focus on the role that various forms of racism play in perpetuating these disparities is absent. These distinctions are essential to realizing health equity and countering disparities in COVID-19 and other health outcomes among people of color in the United States.

2020 Rise to the challenge

APOL1, Black Race, and Kidney Disease: Turning Attention to Structural Racism

Commentary on: Kucirka LM, Grams ME, Lessler J, et al. Association of race and age with survival among patients undergoing dialysis. JAMA. 2011;306(6):620-626. Commentary on: Kucirka LM, Grams ME, Lessler J, et al. Association of race and age with survival among patients undergoing dialysis. JAMA. 2011;306(6):620-626. The inception of the end-stage renal disease (ESRD) program in the United States some 40 years ago heralded the near-universal availability of life-saving kidney replacement therapy for all Americans who required this expensive treatment, irrespective of their race or ethnicity, with the intent ultimately to transplant the majority of these patients. Currently, minorities compose >50% of the approximately half-million US ESRD population, almost 35% of whom are African Americans or self-declared blacks.1Kalantar-Zadeh K. Golan E. Shohat T. Streja E. Norris K.C. Kopple J.D. Survival disparities within American and Israeli dialysis populations: learning from similarities and distinctions across race and ethnicity.Semin Dial. 2010; 23: 586-594Crossref PubMed Scopus (29) Google Scholar In contrast, the African American proportion of the US general population currently is 14%.1Kalantar-Zadeh K. Golan E. Shohat T. Streja E. Norris K.C. Kopple J.D. Survival disparities within American and Israeli dialysis populations: learning from similarities and distinctions across race and ethnicity.Semin Dial. 2010; 23: 586-594Crossref PubMed Scopus (29) Google Scholar, 2Kucirka L.M. Grams M.E. Lessler J. et al.Association of race and age with survival among patients undergoing dialysis.JAMA. 2011; 306: 620-626Crossref PubMed Scopus (197) Google Scholar Dialysis patients continue to have an exceptionally high mortality rate, with ∼20% of dialysis patients dying annually in the United States and a 5-year survival rate <35%. Most patients with terminal cancers live longer than dialysis patients.3Norris K. Nissenson A.R. Race, gender, and socioeconomic disparities in CKD in the United States.J Am Soc Nephrol. 2008; 19: 1261-1270Crossref PubMed Scopus (190) Google Scholar Despite poor overall survival, minority dialysis patients and black patients in particular surprisingly have better outcomes than whites. This phenomenon has been called a survival paradox because the lower mortality rate of African American dialysis patients is in sharp contradistinction to the general US population, in which whites have a longer life expectancy than blacks.1Kalantar-Zadeh K. Golan E. Shohat T. Streja E. Norris K.C. Kopple J.D. Survival disparities within American and Israeli dialysis populations: learning from similarities and distinctions across race and ethnicity.Semin Dial. 2010; 23: 586-594Crossref PubMed Scopus (29) Google Scholar A recent report by Kucirka et al2Kucirka L.M. Grams M.E. Lessler J. et al.Association of race and age with survival among patients undergoing dialysis.JAMA. 2011; 306: 620-626Crossref PubMed Scopus (197) Google Scholar in the Journal of the American Medical Association explored the effect of race on dialysis outcomes in more detail, finding that the commonly described African American survival advantage only holds for dialysis patients older than 50 years. Kucirka et al2Kucirka L.M. Grams M.E. Lessler J. et al.Association of race and age with survival among patients undergoing dialysis.JAMA. 2011; 306: 620-626Crossref PubMed Scopus (197) Google Scholar reported that for 1.3 million incident US dialysis patients over nearly 15 years (1995-2009), black dialysis patients had an overall lower death rate than white patients. However, after using a statistical model that accounts more effectively for receiving kidney transplant as a competing risk4Fine J.P. Gray R.J. A proportional hazards model for the subdistribution of a competing risk.J Am Stat Assoc. 1999; 94: 496-509Crossref Scopus (9899) Google Scholar, 5Molnar M.Z. Streja E. Kovesdy C.P. et al.Associations of body mass index and weight loss with mortality in transplant-waitlisted maintenance hemodialysis patients.Am J Transplant. 2011; 11: 725-736Crossref PubMed Scopus (132) Google Scholar and stratifying the cohort by age groups, younger black patients had higher mortality than whites (93%, 46%, and 12% higher mortality at ages 18-30, 31-40, and 41-50 years, respectively), whereas older black patients paradoxically had lower mortality than whites (7%, 13%, 15%, and 13% better survival at ages 51-60, 61-70, 71-80, and >80 years, respectively). The authors concluded that the commonly cited survival advantage for black dialysis patients applies to only older adults, whereas blacks younger than 50 years have a higher risk of death.2Kucirka L.M. Grams M.E. Lessler J. et al.Association of race and age with survival among patients undergoing dialysis.JAMA. 2011; 306: 620-626Crossref PubMed Scopus (197) Google Scholar It is important to note that in the study by Kucirka et al,2Kucirka L.M. Grams M.E. Lessler J. et al.Association of race and age with survival among patients undergoing dialysis.JAMA. 2011; 306: 620-626Crossref PubMed Scopus (197) Google Scholar despite the relatively long cohort time of up to 15 years (1995-2009), median follow-up per patient in this cohort was only 21.5 months. The major strength of long follow-up (eg, >5 years) in a dialysis patient cohort is mostly to examine or account for secular trends, such as change in practice patterns over time. Moreover, there was no distinction between Hispanic and non-Hispanic whites. The reference group combined both ethnically diverse groups into a single category for the sake of comparison to blacks.6Streja E. Molnar M.Z. Kovesdy C.P. Race, age, and mortality among patients undergoing dialysis [letter].JAMA. 2011; 306 (author reply 2215-2216): 2215Crossref Scopus (4) Google Scholar Notably, Hispanics compose nearly 20% of the US dialysis population, and the ESRD incidence rate in the Hispanic population is 1.5 times greater than for non-Hispanic whites.7US Renal Data SystemUnited States Renal Data System 2006 Annual Data Report: Atlas of Chronic Kidney Disease and End-Stage Renal Disease in the United States.Am J Kidney Dis. 2007; 49: 1-296PubMed Google Scholar, 8US Renal Data SystemExcerpts from the USRDS 2005 Annual Data Report: Atlas of End-Stage Renal Disease in the United States, National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases.Am J Kidney Dis. 2006; 47: 1-286PubMed Google Scholar However, similar to African Americans, Hispanic dialysis patients also appear to have consistently better survival than non-Hispanic whites.7US Renal Data SystemUnited States Renal Data System 2006 Annual Data Report: Atlas of Chronic Kidney Disease and End-Stage Renal Disease in the United States.Am J Kidney Dis. 2007; 49: 1-296PubMed Google Scholar, 8US Renal Data SystemExcerpts from the USRDS 2005 Annual Data Report: Atlas of End-Stage Renal Disease in the United States, National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases.Am J Kidney Dis. 2006; 47: 1-286PubMed Google Scholar A recent study of more than 124,000 US hemodialysis patients by Streja et al9Streja E. Kovesdy C.P. Molnar M.Z. et al.Role of nutritional status and inflammation in higher survival of African American and Hispanic hemodialysis patients.Am J Kidney Dis. 2011; 57: 883-893PubMed Scopus (74) Google Scholar found that non-Hispanic whites had higher unadjusted and case-mix–adjusted mortality over 5 years than did Hispanics and African Americans. However, after controlling for surrogates of inflammation and nutritional status, Hispanics had mortality similar to non-Hispanic whites, whereas African Americans had higher mortality.9Streja E. Kovesdy C.P. Molnar M.Z. et al.Role of nutritional status and inflammation in higher survival of African American and Hispanic hemodialysis patients.Am J Kidney Dis. 2011; 57: 883-893PubMed Scopus (74) Google Scholar Hence, the reported findings of higher mortality in young black patients by Kucirka et al2Kucirka L.M. Grams M.E. Lessler J. et al.Association of race and age with survival among patients undergoing dialysis.JAMA. 2011; 306: 620-626Crossref PubMed Scopus (197) Google Scholar might be somewhat misleading because the reference group in their study is the combination of both non-Hispanic whites and the longer living Hispanics. The effect modification by age for the lower mortality observed in African American dialysis patients that Kucirka et al2Kucirka L.M. Grams M.E. Lessler J. et al.Association of race and age with survival among patients undergoing dialysis.JAMA. 2011; 306: 620-626Crossref PubMed Scopus (197) Google Scholar report also may have been influenced by another problem in that the overall hazard ratio of mortality for African American patients was 0.90 (and 0.84 after adjusting for differences in demographics and comorbid conditions and censoring for transplant). However, the death hazard ratios of the individual age subgroups were all higher than this, from 0.95 for the 71- to 80-year-old group to 1.94 in the 18- to 30-year-old group.10Ricks J. Streja L. Greenland S. Race, age, and mortality among patients undergoing dialysis [letter].JAMA. 2011; 306 (author reply 2215-2216): 2215Crossref PubMed Google Scholar Notwithstanding that an explanation for this finding may be related to Berkson's paradox, in which the conditional probability of an event in a subset is inflated relative to its probability in the overall sample, it is unclear whether results of the age subgroup analyses are appropriate to explain the lower mortality rate seen in black dialysis patients.10Ricks J. Streja L. Greenland S. Race, age, and mortality among patients undergoing dialysis [letter].JAMA. 2011; 306 (author reply 2215-2216): 2215Crossref PubMed Google Scholar Recent studies have sought explanations for the better survival of blacks treated with long-term dialysis than whites. Some studies have suggested that a favorable nutritional/inflammatory profile, including larger muscle mass, may explain the survival advantages of black dialysis patients.9Streja E. Kovesdy C.P. Molnar M.Z. et al.Role of nutritional status and inflammation in higher survival of African American and Hispanic hemodialysis patients.Am J Kidney Dis. 2011; 57: 883-893PubMed Scopus (74) Google Scholar In 2 recent studies,11Noori N. Kovesdy C.P. Dukkipati R. et al.Racial and ethnic differences in mortality of hemodialysis patients: role of dietary and nutritional status and inflammation.Am J Nephrol. 2011; 33: 157-167Crossref PubMed Scopus (55) Google Scholar, 12Crews D.C. Sozio S.M. Liu Y. Coresh J. Powe N.R. Inflammation and the paradox of racial differences in dialysis survival.J Am Soc Nephrol. 2011; 22: 2279-2286Crossref PubMed Scopus (49) Google Scholar the predictive value of the proinflammatory cytokine interleukin 6 for mortality was significantly more prominent in whites than in African Americans, which implies that key inflammatory biomarkers have less impact on mortality in the black population. That African Americans appear to be less vulnerable to mortality related to dialysis-associated inflammation seems in keeping with evidence from other studies of the permissive effect that genotype has on the mortality-inflammation link.13Kalantar-Zadeh K. Norris K.C. Is malnutrition-inflammation complex the secret behind greater survival of African American dialysis patients?.J Am Soc Nephrol. 2011; 22: 2150-2152Crossref PubMed Scopus (10) Google Scholar, 14Kovesdy C.P. Kalantar-Zadeh K. Do genes allow inflammation to kill or not to kill?.J Am Soc Nephrol. 2009; 20: 1429-1431Crossref PubMed Scopus (11) Google Scholar For example, Ricks et al15Ricks J. Molnar M.Z. Kovesdy C.P. et al.Racial and ethnic differences in the association of body mass index and survival in maintenance hemodialysis patients.Am J Kidney Dis. 2011; 58: 574-582Abstract Full Text Full Text PDF PubMed Scopus (60) Google Scholar found that of all racial/ethnic groups, the strongest and most consistent association of greater survival with higher body mass index in dialysis patients occurs in African Americans. There may be other conditions that can lead to greater survival of black dialysis patients. Miller et al16Miller J.E. Kovesdy C.P. Nissenson A.R. et al.Association of hemodialysis treatment time and dose with mortality and the role of race and sex.Am J Kidney Dis. 2010; 55: 100-112Abstract Full Text Full Text PDF PubMed Scopus (92) Google Scholar reported that survival had different associations with dose or time of hemodialysis treatment when examined in different combinations of race or sex. Feroze et al17Feroze U. Noori N. Kovesdy C.P. et al.Quality-of-life and mortality in hemodialysis patients: roles of race and nutritional status.Clin J Am Soc Nephrol. 2011; 6: 1100-1111Crossref PubMed Scopus (97) Google Scholar found that dialysis patients with increased body fat, worse nutritional status (hypoalbuminemia), or smaller muscle mass (estimated by lower serum creatinine concentration) perceived a poorer health-related quality of life, and that worse physical health in African American patients correlated less strongly with mortality than in whites. Finally, in another recent study, the survival advantage of African American dialysis patients, who often have higher parathyroid hormone levels, was most notable in those receiving the highest doses of a vitamin D mimetic (paricalcitol >10 μg/wk), whereas no survival difference was found for those who received no vitamin D analogue.18Kalantar-Zadeh K. Miller J.E. Kovesdy C.P. et al.Impact of race on hyperparathyroidism, mineral disarrays, administered vitamin D mimetic, and survival in hemodialysis patients.J Bone Miner Res. 2010; 25: 2448-2458Crossref Scopus (81) Google Scholar Other potential factors predisposing to better survival for blacks include more favorable coping mechanisms and social-mental support in black communities upon dealing with conditions that would be considered much more devastating by other subcultures.19Feroze U. Martin D. Reina-Patton A. Kalantar-Zadeh K. Kopple J.D. Mental health, depression, and anxiety in patients on maintenance dialysis.Iran J Kidney Dis. 2010; 4: 173-180PubMed Google Scholar Interestingly, a similar survival paradox has been reported for dialysis patients in Israel, as Arab Israelis have greater survival than Jewish Israelis, even though transplant rates are somewhat similar between the 2 groups.1Kalantar-Zadeh K. Golan E. Shohat T. Streja E. Norris K.C. Kopple J.D. Survival disparities within American and Israeli dialysis populations: learning from similarities and distinctions across race and ethnicity.Semin Dial. 2010; 23: 586-594Crossref PubMed Scopus (29) Google Scholar Another similar paradox outside the ESRD population is the greater survival of black premature infants compared with their white counterparts, whereas for full-term infants, the opposite is the case, suggesting a biologic advantage in distressed circumstances, possibly in utero epigenetic changes.20Klebanoff M.A. Schoendorf K.C. Invited commentary: what's so bad about curves crossing anyway?.Am J Epidemiol. 2004; 160 (discussion 215-216): 211-212Crossref PubMed Scopus (22) Google Scholar What do prior data tell us about why younger African Americans may not have the survival advantage of older African Americans? Several factors may have a role (Table 1). First, there may be differences in insurance mix; younger African Americans have lesser insurance, whereas in older patients, there is more parity in insurance coverage, which may provide more inclusive health and medication coverage in addition to dialysis treatment. A large number of young urban African Americans have challenging social situations21Kim M.T. Han H.R. Hill M.N. Rose L. Roary M. Depression, substance use, adherence behaviors, and blood pressure in urban hypertensive black men.Ann Behav Med. 2003; 26: 24-31Crossref PubMed Scopus (102) Google Scholar and may have an even greater distrust of institutions, including medical establishments, leading to delayed/reduced visits and/or lesser adherence even if access to care is available. In the general (nondialysis) population, younger otherwise healthy African Americans have higher mortality than other people, probably driven by factors other than chronic disease. For instance, in 1999, the injury death rate for black male Americans aged 15-24 years was 180% of the value for whites.22Hu G. Baker S.P. Reducing black/white disparity: changes in injury mortality in the 15-24 year age group, United States, 1999-2005.Inj Prev. 2008; 14: 205-208Crossref PubMed Scopus (7) Google Scholar Furthermore, there is a large subset of young black dialysis patients with hypertension-induced kidney failure, many of whom may have associated substance abuse and a lifestyle issue that would predispose to worse quality of life and mental health and early mortality.21Kim M.T. Han H.R. Hill M.N. Rose L. Roary M. Depression, substance use, adherence behaviors, and blood pressure in urban hypertensive black men.Ann Behav Med. 2003; 26: 24-31Crossref PubMed Scopus (102) Google Scholar, 23Los Angeles County Department of Public Health, Office of Health Assessment and EpidemiologyMortality in Los Angeles County 2007: Leading causes of death and premature death with trends for 1998-2007.http://www.publichealth.lacounty.gov/dca/data/documents/2007MortalityReport.pdfDate: June 2010Google Scholar At the same time, older African Americans could be steered away from transplants because of the perception that their mortality risk is lower on dialysis therapy.24Norris K.C. Kalantar-Zadeh K. Kopple J.D. Survival among patients undergoing dialysis: the role of race.Nephrol News Issues. 2011 Dec; 25 (16): 13-14PubMed Google Scholar This could create a bias against mortality rates similar to the greater survival of Japanese dialysis patients, for whom the transplant rate is exceptionally low. Also, there has been a decrease in the death rate in dialysis patients, specifically with a noted decrease in the cardiovascular death rate since 2004.25US Renal Data SystemUSRDS 2011 Annual Data Report: Atlas of Chronic Kidney Disease and End-Stage Renal Disease in the United States.Am J Kidney Dis. 2012; 59(1): e1-e420Google Scholar This is attributed in large part to the increased use of cardioprotective agents, such as β-blockers (60%) and angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (ARBs) (50%) being administered fairly evenly across all age groups and racial/ethnic groups.25US Renal Data SystemUSRDS 2011 Annual Data Report: Atlas of Chronic Kidney Disease and End-Stage Renal Disease in the United States.Am J Kidney Dis. 2012; 59(1): e1-e420Google Scholar If this is a major contributor to improved survival, the reduction in cardiovascular deaths in younger dialysis patients would disproportionately enhance the relative impact of noncardiovascular deaths. This would preferentially favor overall survival improvements in young white dialysis patients because young minorities (aged 22-45 years) are more likely to die of homicide, motor vehicle accident, suicide, and drug overdose than their white counterparts.23Los Angeles County Department of Public Health, Office of Health Assessment and EpidemiologyMortality in Los Angeles County 2007: Leading causes of death and premature death with trends for 1998-2007.http://www.publichealth.lacounty.gov/dca/data/documents/2007MortalityReport.pdfDate: June 2010Google ScholarTable 1Potential Contributory Factors for the African American Survival Differential Between Younger Versus Older Dialysis PatientsPotential MechanismDescriptionSuggested SolutionLower transplant rate in African AmericansAfrican Americans could be steered away from transplants because of the general perception of lower mortality on dialysis therapy. This could inflate artificially the survival advantage (similar to Japanese dialysis patient survival).Use survival models that adjust for competing censorship.Inclusion of Hispanics in the reference groupPooling "white" or "nonblack" patients into a single reference leads to the inclusion of Hispanic whites (and in some cases Asians), who traditionally have better survival, analogous to blacks.Exclude minorities from the reference groups.Higher background mortality of young African AmericansIn persons 15-44 years of age, minorities have higher death rates from homicide, motor vehicle accident, suicide, and drug overdose.Adjust for background mortality disparities of the non-ESRD population.Differences in insurance mixYounger African Americans have less insurance, whereas in older patients, there is more parity in insurance coverage.Adjust for insurance mix in multivariate models.Differences in trust of institutionsYounger African Americans may have an even greater distrust of institutions, including medical establishments, leading to delayed/reduced visits and/or lesser adherence even if access to care is available.Adjust for adherence surrogates in multivariate models.Age permissibility of genetic factorsAge may exert a permissive or effect-modifying role on the genetic factors that impact on survival.Conduct gene expression studies.Abbreviation: ESRD, end-stage renal disease. Open table in a new tab Abbreviation: ESRD, end-stage renal disease. Because the effect-modifying impact of age on race was not previously noted, the initial response by the nephrology community was that this must be an aberration of some sort.24Norris K.C. Kalantar-Zadeh K. Kopple J.D. Survival among patients undergoing dialysis: the role of race.Nephrol News Issues. 2011 Dec; 25 (16): 13-14PubMed Google Scholar The observed racial disparity and the "paradox within paradox" appear interesting and consistent with the racial disparities in most other health care arenas. However, it is important to note that the median age of incident dialysis patients in most countries, including the United States, is older than 60 years.2Kucirka L.M. Grams M.E. Lessler J. et al.Association of race and age with survival among patients undergoing dialysis.JAMA. 2011; 306: 620-626Crossref PubMed Scopus (197) Google Scholar Hence, only a small proportion of US and global dialysis patients, including African Americans, are younger than 50 years, making the applicability of these findings somewhat limited. Given the younger mean age of African American dialysis patients, these findings still have important implications for the care of this at-risk cohort, notwithstanding that according to the authors' own data, black dialysis patients older than 50 years, composing the majority of African Americans, maintained the known survival advantage, and this effect could not be explained by any factors in this study.2Kucirka L.M. Grams M.E. Lessler J. et al.Association of race and age with survival among patients undergoing dialysis.JAMA. 2011; 306: 620-626Crossref PubMed Scopus (197) Google Scholar In conclusion, we believe that the survival advantage of African American dialysis patients compared with non-Hispanic whites is rather robust and resilient, and the reduced survival in younger African American dialysis patients, if true, represents more of a societal effect on survival independent of chronic disease. Effective interventions to improve poor conditions and health of younger African Americans in urban areas should target hypertension and other risk factors for chronic kidney disease in this age group. Although we do not dismiss the possibility of a paradox within paradox and the likelihood of less survival benefit of race for younger African American dialysis patients, we suggest that rather than dismissing these survival paradoxes as wrong, unimportant, or residual confounders, better understanding of the roots of the racial/ethnic survival differences may advance our understanding of the pathobiology of chronic disease and its expression in different settings, helping to improve outcomes. Discovering the factors responsible for the survival advantages of African American and Hispanic dialysis patients may have major clinical and public health implications, not only for dialysis patients, but also for other populations with chronic disease states and poor survival. This work was supported by grants from the National Institute of Diabetes, Digestive, and Kidney Disease of the National Institutes of Health (R01-DK078106, K24-DK091419, U54-RR026138, P20-MD00182, and UL1 RR033176) and a philanthropic grant from Mr Harold Simmons. Financial Disclosure: The authors declare that they have no relevant financial interests.

There are approximately 573 practicing Black orthopaedic surgeons in the United States, which represents 1.9% overall. The purpose of this study was to describe this underrepresented cohort within the field of orthopaedic surgery and to report their perception of occupational opportunity and workplace discrimination. An anonymous survey was administered to 455 practicing orthopaedic surgeons who self-identify as Black. The 38-question electronic survey requested demographic and practice information and solicited perspectives on race and racial discrimination in current orthopaedic practices and general views regarding occupational opportunity and discrimination. The survey was completed by 274 Black orthopaedic surgeons (60%). Over 97% of respondents believe that Black orthopaedic surgeons in the United States face workplace discrimination. Most Black orthopaedic surgeons (94%) agreed that racial discrimination in the workplace is a problem but less than 20% agreed that the leaders of national orthopaedic organizations are trying sincerely to end it. Black female orthopaedic surgeons reported lower occupational opportunity and higher discrimination than Black male orthopaedic surgeons across all survey items. This study is the first to report on the workplace environment and the extent of discrimination experienced by Black surgeons, specifically Black orthopaedic surgeons in the United States. Most respondents, particularly female respondents, agreed that racial discrimination and diminished occupational opportunity are pervasive in the workplace and reported experiencing various racial microaggressions in practice.

HOW THE SUPREME COURT DISTORTED TEXT, IGNORED HISTORY, AND GASLIGHTED THE BOLD PROMISE OF THE CIVIL RIGHTS ACT OF 1866 A <i>Comcast</i> Case Study

Introduction: Cancer represents the second leading cause of death in the United States and disproportionately affects Black Americans. In recent years, cancer-related mortality rates have declined for both Black and White Americans. However, mortality rates and rate ratios alone are insufficient for characterizing the burden of cancer disparities between racial groups. Among the most prevalent cancers in the US, we evaluated trends in excess mortality and years of potential life lost between Black and White Americans. Methods: This was a serial cross-sectional study using US national level data from CDC Wonder between the years 1999-2020. We included White and non-Hispanic Black Americans with a cause of death from breast, prostate, lung, colon, bladder, or uterine cancer. We measured age-adjusted excess death as well as excess years of potential life lost for each cancer site among Black and White Americans, stratified by sex when applicable. Annual mortality rates for each cancer site were sourced from the CDC Cancer Statistic Data Visualization tool. Results: The age adjusted mortality rate for all cancers declined between 1999-2020 for Black (257.2 to 166.8 per 100,000) and White Americans (200.9 to 149.3 per 100,000). Site specific cancer mortality rates declined in Black and White Americans for breast, prostate, lung, colon, and bladder cancer, but increased for uterine cancer. Among the most prevalent cancer sites, there were a total of 115,43 excess deaths with 2,093,327 excess years potential life lost for Black men and 59,134 excess deaths with 1,508,052 excess years potential life lost for Black women over a 22-year period. The trend of annual excess death and years potential life lost has slowly increased for Black men with colon cancer as well as Black women with breast and uterine cancer. Annual excess death and years potential life lost in Black men with prostate cancer decreased until 2013 after which it has slowly increased. Conclusion: Despite declining mortality rates in most cancers in the United States, Black Americans still experience a staggering number of excess deaths and years potential life lost due to cancer. Furthermore, the discordance between declining mortality rates and increasing excess death or years potential life lost in breast, prostate, colon, and uterine cancer highlight that racial disparities in cancer care and outcomes are likely worsening among Black Americans. Action is needed to support interventions and organizations committed to addressing cancer health inequities among Black Americans. Citation Format: Daniel S. Carson, Navya Gunaje, Sarah K. Holt, Nana Frimpong, Jenney R. Lee, Liz Sage, Erika M Wolff, Yaw A. Nyame. Cancer related excess death and potential life years lost among Black Americans [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr C139.

Dans cet article, l'auteur se propose d'analyser les similitudes dans l'education des Afro-americains et sud-africains noirs durant les periodes de segregation et d'Apartheid. La nature de l'oppression en milieu scolaire permet de lier les approches des Etats-Unis et de l'Afrique du Sud en matiere d'education pour les populations visees ainsi que l'usage par les communautes noires, dans ces deux contextes, de l'education comme ascenseur social, permettant de depasser les limites imposees par la segregation. Il est a noter egalement les strategies identiques, dans ces deux environnements, mises en place par les parents, les chefs d'etablissements et les enseignants pour encourager les eleves a depasser le contexte de l'oppression...