Discrimination In Health Care Settings Research Articles

Characterizing the Perceived Need for CRC Screening among the Elderly Living in Rural Areas in the Pacific Northwest US: Roles of Miscommunication, Experience of Discrimination, and Dependence.

Increasing the perceived need for CRC screening can facilitate undertaking CRC screening. This study aims to identify factors associated with the need for CRC screening in rural populations. A cross-sectional online survey. The survey was conducted in June - September 2022 in the rural areas of Alaska, Idaho, Oregon, and Washington, US. The subjects of this study were 250 adults (completion rate: 65%) aged 45-75 residing in rural Alaska, Idaho, Oregon, and Washington. Perceived need for CRC screening, internet usage for health purposes, demographics, and intrapersonal, interpersonal, community, and environmental characteristics. Perceived need for CRC screening were negatively associated with patient-provider miscommunication (β = -.23, P < .001) and perceived discrimination (β = -.21, P < .001), cancer fatalism (β = -.16, P < .05), individualism (β = -.15, P < .05), and dependence on community (β = -.11, P < .05), but positively with compliance with social norms (β = .16, P < .05), trust in health care providers (β = .16, P < .05), knowledge about colorectal cancer (β = .12, P < .05). Our study showed potential individual and situational characteristics that might help increase colorectal cancer screening. Future efforts might consider addressing discrimination in health care settings, improving patient-provider communication, and tailoring messaging to reflect the rural culture.

Investigating the Potential Double-Edged Score of Immigration-Related Stress, Discrimination, and Mental Health Access.

Prior work has suggested that discrimination and immigration-related stress may impede mental health care seeking and utilization among Latinx populations. These effects may be more nuanced as both discrimination and immigration-related stress may increase symptomology, particularly post-traumatic stress disorder (PTSD) and depression. Both symptoms may, in turn, prompt attempts to seek care. The current study examined the direct effects of discrimination and immigration-related stress on care access, as well as potentially indirect effects with PTSD and depression symptoms as mediators. Interviews and online surveys were completed with 234 Latinx residents of the Midwest, assessing everyday discrimination, discrimination in healthcare, PTSD symptoms, depression symptoms, current mental health utilization, and previous unsuccessful attempts to seek care. Direct effects of discrimination and immigration-related stress were largely unrelated to care access variables. Discrimination in healthcare settings predicted both unsuccessful attempts to seek care and current use, but this effect was positive. The indirect effect was largely supported, but only for PTSD symptoms and not depression. Results indicate that further investigation is necessary to understand the direct effects of discrimination on care access. Further, discrimination and immigration-related stress may indirectly prompt attempts to seek mental health care.

Drug Use-Related Discrimination in Healthcare Settings and Subsequent Emergency Department Utilization in a Prospective Cohort Study of People With a History of Injection Drug Use

Background: People with a history of injection drug use face discrimination in healthcare settings that may impede their use of routine care, leading to greater reliance on the emergency department (ED) for addressing health concerns. The relationship between discrimination in healthcare settings and subsequent ED utilization has not been established in this population. Methods: This analysis used longitudinal data collected between January 2014 and March 2020 from participants of the ALIVE (AIDS Linked to the IntraVenous Experience) study, a community-based observational cohort study of people with a history of injection drug use in Baltimore, Maryland. Logistic regressions with generalized estimating equations were used to estimate associations between drug use-related discrimination in healthcare settings and subsequent ED utilization for the sample overall and six subgroups based on race, sex, and HIV status. Results: 1,342 participants contributed data from 7,289 semiannual study visits. Participants were predominately Black (82%), mostly male (66%), and 33% were living with HIV. Drug use-related discrimination in healthcare settings (reported at 6% of study visits) was positively associated with any subsequent ED use (OR = 1.40, 95% CI: 1.15–1.72). Positive associations persisted after adjusting for covariates, including past sixth-month ED use and drug use, among the overall sample (aOR = 1.28, 95% CI: 1.04–1.59) and among some subgroups. Conclusions: Drug use-related discrimination in healthcare settings was associated with greater subsequent ED utilization in this sample. Further exploration of mechanisms driving this relationship may help improve care and optimize healthcare engagement for people with a history of injection drug use.

Social stigma and discrimination towards people living with HIV infection and AIDS patients

Background: Social stigma and discrimination are major barriers to an effective national response to human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS), and there have been repeated calls to transform the current surveillance-focused policy. Serious instances of discrimination and clinical service failings increase the urgency and importance of addressing issues relevant to AIDS-related stigma. Yet, progress in achieving effective and people-centered responses to AIDS is insufficient.Current Concepts: Based on a comprehensive multi-sectoral review of a wide range of literature, this article examines the key features of AIDS-related stigma in South Korea and evaluates governmental and organizational efforts to redress them. Three major areas, of issues and possibilities for change, are identified: (1) addressing discrimination in health care settings, (2) decriminalization of HIV transmission, according to the Undetectable=Untransmittable (U=U) principle, (3) improving the quality of life and social inclusion of people living with HIV.Discussion and Conclusion: An extensive examination of existing evidence on AIDS-related stigma, guided by the authors’ long-term experience of public participation and civic empowerment, suggests that by placing these three issues at the center of the national response to AIDS, significant improvement in the AIDS care continuum is achievable. People-centered service delivery models that focus on dismantling structural barriers and incorporating leadership from key populations will enable high-impact public health responses to AIDS and HIV infection.

Factors Associated with College Students' Attitudes Toward Telehealth for Primary Care.

Introduction: Establishing routine primary care visits helps to prevent serious health issues. College students are less likely than the general population to have a regular primary care provider and engage in routine health visits. Recent research provides evidence that telehealth is a convenient alternative to in-person primary care and that college students are comfortable using this technology, suggesting that telehealth has the potential to mitigate this disparity. As attitudes toward telehealth are one critical precursor to behavioral intention and actual utilization of telehealth, the goal of this study was to investigate which factors predict positive or negative attitudes toward telehealth. Methods: Data for this study were collected from a sample of 621 college students at a large southeastern university between September 19, 2022 and December 19, 2022. Results: The study found that college students who reported more trust in physicians, less medical mistrust, and less discrimination in health care settings reported more positive attitudes toward telehealth. Conclusions: These findings suggest that health care providers' skills in delivering patient-centered culturally informed care and building trust and rapport with patients might promote more positive attitudes toward telehealth and, potentially, greater overall utilization of health care services (including both telehealth and in-person services) among college students. This study lays the foundation for future research to examine psychological mechanisms underlying individuals' utilization of telehealth.

The Effects of Previous Experiences of Healthcare Discrimination on HIV Intervention Outcomes.

Although several healthcare interventions have been developed to address HIV among young Black/African American men who have sex with men (YBMSM), the HIV epidemic in the United States continues to disproportionately burden this population. The current study examines previous healthcare discrimination and how it affects HIV intervention delivery. One hundred seventy-two YBMSM participated in the Peer Promotion of Wellness and Enhanced Linkage to Resources (PPOWER) project, which used a short, multi-faceted, community-level intervention based on Community Peers Reaching Out and Modeling Intervention Strategies (Community PROMISE). Data were collected at baseline, a 45-day follow up, and a 90-day follow up. Generalized Estimating Equations (GEE) were used to examine the effects of previous healthcare discrimination on outcomes related to HIV testing, alcohol and drug use, and sexual behaviors. Previous healthcare discrimination was found to moderate the relationship between time and intentions to test for HIV, perceptions of sexual risk, problem marijuana use, and problem other drug use, such that those who had experienced more healthcare discrimination showed greater improvements over time compared to those who had experienced less healthcare discrimination. The results of the current study suggest that a community-level peer intervention, in combination with a component to promote cultural competency and address prior experiences of discrimination in healthcare settings, may be highly effective for people who have experienced a barrier in their continuum of care as a result of racial discrimination.

Raising awareness of anti-fat stigma in healthcare through lived experience education: a continuing professional development pilot study

BackgroundAnti-fat attitudes and weight-based discrimination are prevalent in healthcare settings and among healthcare practitioners and clinical trainees, and can result in immense harm to patients. There is increasing recognition that anti-fat bias in healthcare is a critical issue that must be addressed, but there is a dearth of evidence demonstrating sustained attitude and behavioural change among clinicians, illustrating a need for more innovative educational approaches and rigorous evaluation. We describe the co-design and delivery of a narrative-based continuing professional development curriculum aimed at raising awareness of weight-based bias and stigma.MethodsOur research team of lived experience educators, clinicians and researchers collaboratively developed a series of seven podcast episodes comprised of narrative descriptions of lived experiences with and impacts of weight bias, stigma and discrimination in healthcare settings, as well as a post-podcast workshop to facilitate reflection and discussion between participants. The curriculum was piloted among 20 clinicians practicing at a large urban hospital in Mississauga, Canada. We explored feasibility, acceptability and learning impact by analyzing responses to questionnaires completed following each podcast episode and responses shared during the workshops and follow-up feedback sessions.ResultsWe observed high acceptability and feasibility of the curriculum. Participants experienced the podcast as a practical and convenient learning format and the workshop as a valuable opportunity to collectively debrief and reflect. The learning impact of the curriculum was strong; participants described a range of emotions elicited by the podcasts, engaged in self-reflection, and expressed a desire to modify clinical approaches. Barriers to the application of learnings identified by participants include pervasiveness of the use of body mass index (BMI) as an indicator of risk and a criterion for referral; discomfort with difficult conversations; prevalent biomedical understandings about the association between weight and health; and clinicians’ defensiveness.ConclusionThis pilot study yielded promising findings and demonstrated potential impact on weight bias and stigma among healthcare providers. Necessary next steps include conducting larger scale, rigorous evaluations of the curriculum among broader populations, both health professions trainees and current healthcare providers.

Discriminatory Healthcare Experiences and Medical Mistrust in Patients With Serious Illness

ContextThough discrimination in healthcare settings is increasingly recognized, the discriminatory experiences of patients with serious illness has not been well studied. ObjectivesDescribe racial differences in patient-reported experiences with discrimination in the healthcare setting and examine its association with mistrust. MethodsWe used surveys containing patient-reported frequency of discrimination using the Discrimination in Medical Setting (DMS) and Microaggressions in Health Care Settings (MHCS) scales, mistrust using the Group Based Medical Mistrust (GBMM) scale, and patient characteristics including patient-reported race, income, wealth, insurance status, and educational attainment. Univariable and multivariable linear regression models as well as risk ratios were used to examine associations between patient characteristics including self-reported race, and DMS, MHCS, and GBMM scores. ResultsIn 174 participants with serious illness, racially minoritized patients were more likely to report experiencing discrimination and microaggressions. In adjusted analyses, DMS scores were associated with elements of class and not with race. Black, Native American/Alaskan Native (NA/AN), and multiracial participants had higher MHCS scores compared to White participants with similar levels of income and education. Higher income was associated with lower GBMM scores in participants with similar DMS or MHCS scores, but Black and NA/AN participants still reported higher levels of mistrust. ConclusionIn this cross-sectional study of patients with serious illness, discriminatory experiences were associated with worse mistrust in the medical system, particularly for Black and NA/AN participants. These findings suggest that race-conscious approaches are needed to address discrimination and mistrust in marginalized patients with serious illness and their families.

Experiences of and recommendations for LGBTQ+-affirming substance use services: an exploratory qualitative descriptive study with LGBTQ+ people who use opioids and other drugs

BackgroundLesbian, gay, bisexual, transgender, queer, and other LGBTQ populations (LGBTQ+; e.g., asexual individuals) have higher rates of substance use (SU) and disorders (SUD) compared to heterosexual and cisgender populations. Such disparities can be attributed to minority stress, including stigma and discrimination in healthcare settings. LGBTQ+-affirming SU treatment and related services remain limited. The purpose of this exploratory qualitative descriptive study was to characterize LGBTQ+ people’s experiences in SU services and recommendations for LGBTQ+- affirming care.MethodsWe conducted demographic surveys (characterized using descriptive statistics) and individual qualitative interviews with N = 23 LGBTQ+ people. We employed flexible coding and a thematic analysis approach to describe participants’ experiences with stigma, discrimination, and support within SU services at the patient-, staff-, and organizational-level; and participant recommendations for how to make such services LGBTQ+-affirming. We highlighted components of minority stress and mitigators of adverse stress responses throughout our thematic analysis.ResultsPatient-level experiences included bullying, name-calling, sexual harassment, and physical distancing from peers; and support via community-building with LGBTQ+ peers. Staff-level experiences included name-calling, denial of services, misgendering, lack of intervention in peer bullying, and assumptions about participants’ sexuality; and support via staff advocacy for LGBTQ+ patients, holistic treatment models, and openly LGBTQ+ staff. Organizational-level experiences included stigma in binary gendered program structures; and support from programs with gender-affirming groups and housing, and in visual cues (e.g., rainbow flags) of affirming care. Stigma and discrimination led to minority stress processes like identity concealment and stress coping responses like SU relapse; support facilitated SU treatment engagement and retention. Recommendations for LGBTQ+-affirming care included non-discrimination policies, LGBTQ+-specific programming, hiring LGBTQ+ staff, routine staff sensitivity training, and gender-inclusive program structures.ConclusionsLGBTQ+ people experience stigma and discrimination within SU services; supportive and affirming care is vital to reducing treatment barriers and promoting positive health outcomes. The current study offers concrete recommendations for how to deliver LGBTQ+-affirming care, which could reduce SU disparities and drug overdose mortality overall.

Racial discrimination in healthcare settings and mental health among a population-based sample of racial and ethnic minoritized adults with COVID-19 in Michigan

The COVID-19 pandemic has worsened existing racial health disparities and racial discrimination in healthcare; however, little is known about how racial discrimination in healthcare settings is related to mental health during the pandemic. Using a population-based probability sample of racial and ethnic minoritized adults with a polymerase chain reaction (PCR)-confirmed SARS-CoV-2 infection in Michigan, we examined how measures of perceived racial discrimination in (1) seeking healthcare for COVID-19 (n = 1,210) and (2) receiving testing/treatment for COVID-19 (n = 1,364) were associated with binary variables of depressive and anxiety symptoms. We conducted a modified Poisson regression analysis with robust standard errors to estimate associations between each measure of racial discrimination and each mental health outcome separately, adjusting for demographic and socio-economic variables, health insurance, and pre-existing physical and psychiatric conditions. 7.3 % and 8.7 % of adults reported racial discrimination in seeking healthcare for COVID-19 and in getting testing/treatment for COVID–19, respectively. Although the overall prevalence of racial discrimination in healthcare settings was low, experiences of racial discrimination were associated with depressive symptoms. Adults who experienced racial discrimination in seeking healthcare had 1.74 times higher prevalence of reporting depressive symptoms (95 % CI:1.21–2.52) than those who did not. Moreover, adults who experienced racial discrimination in getting testing/treatment had 1.86 times higher prevalence of reporting depressive symptoms (95 % CI:1.36–2.53) than those who did not. Neither measure of racial discrimination was associated with anxiety symptoms in the adjusted models. There is a need for promoting anti-racial discrimination policies, educational programs, and awareness efforts in healthcare settings.

Exploring the Experiences of Pediatric Patients with Sickle Cell Disease and Their Families

Background: Sickle Cell Disease (SCD) is a common lifelong genetic disorder of red blood cells, which causes abnormal hemoglobin shape often resulting in pain crises and other serious health complications (Ware, et al., 2017). SCD disproportionally affects people of African descent, and several recent surveys have shown that patients with SCD experience discrimination in healthcare settings (Nelson and Hackman, 2013; Haywood, et al., 2014; Kanter, 2020; Oyedeji and Strouse, 2020). In pediatrics, parents of patients with SCD report higher levels of race-related discrimination in healthcare settings compared to families with other chronic illnesses, as well as decreased satisfaction in several areas of their care (Brousseau, 2009; Oyedeji, 2020; Kanter, et al., 2020). This qualitative project aimed to explore further specific, actionable areas of dissatisfaction and any areas of increased satisfaction among pediatric patients with SCD and their families. Methods: Semi-structured interviews were conducted with pediatric patients with SCD and/or their guardians at one academic institution. Any patient with SCD over the age of eight was eligible to participate in an interview, and parents of a child with SCD of any age were eligible to participate, as well. Interviews were audio-recorded and took place in person in clinic. Recordings were then transcribed verbatim. The interviews were qualitatively coded using standard multi-level semantic analysis, working directly from the transcriptions and audio-recordings. Seven (41%) interviews were independently double-coded, and discrepancies were resolved by consensus. Final codes were analyzed, and major themes were identified. Results: Eighteen pediatric patients with SCD and/or their families were asked to participate in the study, and seventeen (94%) agreed. There were twenty-six total participants. Ten family interviews were conducted, and another seven were conducted with parents only because the patients were younger than eight years old. Fifteen families identified as African American, one family identified as Hispanic, and one family identified as African. Patients and their families described five main areas leading to dissatisfaction in the healthcare setting: (1) Long wait times; (2) Neglect for SCD protocols within emergency departments; (3) Biases against patients with sickle cell disease; (4) Frustration with procedures, specifically with blood draws; (5) Lack of empathy and compassionate listening among healthcare providers. Positive experiences were almost all due to aspects of strong patient-provider relationships. Outside of the healthcare setting, patients and their families emphasized the need for improved education and awareness of SCD within the community. Conclusion: While this qualitative study explored perspectives from only a limited number of pediatric families, these conversations provided insight into specific areas of dissatisfaction among patients with SCD. This research provides actionable items that healthcare providers can apply to help improve the healthcare experiences and the everyday lives of children with SCD. Additional efforts and resources should be directed toward addressing social determinants of health and systemic racism to future improve healthcare experiences of patients with SCD.

Transgender and non-binary people’s perception of their healthcare in relation to endometriosis

Background Endometriosis is described as a gynecological disease that can severely impact on people’s quality of life. Much of endometriosis research and literature is focused on cis women, although gender diverse people and cis men have been diagnosed with this disease. Cis women have reported problems in their healthcare for endometriosis due to delays in diagnosis and a lack of support in their treatment. Gender diverse people have reported to experience discrimination in healthcare settings. There is a lack of research on gender diverse people’s experience of living with endometriosis and little is known about their experience of healthcare for endometriosis. Aim Our aim in this article is to report on the healthcare experiences of transgender and non-binary people with endometriosis. Methods We used a phenomenological lens to explore the experiences of transgender and non-binary people with endometriosis’ perceptions of healthcare. Eleven participants were recruited through social media internationally. We recruited participants that identified as transgender and/or non-binary, had suspected/diagnosed endometriosis and were 18 years old or older. Participants took part in three online semi-structured interviews and completed a diary for three months. We used Hermeneutic Analysis to analyze the data via themes. Phenomenology of embodiment was used as a theoretical point of departure in understanding the data. Results From the analysis, the following themes were created that captured participants’ healthcare experiences: (1) Medical Gaslighting of Endometriosis and Gender Diverse Experiences, (2) Misgendering and Gendered Language, (3) Medical Discrimination, and (4) Validating Experiences with Health Care Providers (HCPs) and Recommendations by Participants. The findings revealed that medical gaslighting, misgendering and experiences of discrimination in healthcare settings had a psychological effect on participants, with reports of dysphoria, self-doubt, fear and a trauma response. Discussion Experiences of medical gaslighting, misgendering and discrimination in the healthcare of endometriosis may limit communication between HCPs and patients through limited treatment options being communicated, assumptions in healthcare and participants not feeling safe to disclose their gender identity for a disease that already from cis women’s reports has difficulties in diagnosis and treatment. This highlights additional barriers for gender diverse people to overcome in their healthcare for endometriosis. We recommend that HCPs may benefit from further awareness and training with working with gender diverse people with endometriosis.

Recommendations for Improving Systemic Lupus Erythematosus Care From Black Adults

Racial inequities in incidence, morbidity, and mortality are a defining feature of systemic lupus erythematosus (SLE). Health care systems are integral to addressing these inequities. However, qualitative evidence that highlights Black SLE care experiences is limited. To identify opportunities for improving SLE care based on the experiences and perspectives of Black adults with SLE. In this qualitative study, an interpretive description approach was used and data were analyzed using inductive thematic analysis. Semistructured interviews with Black adults in Michigan who were diagnosed with SLE were conducted. Interviews occurred from November 2, 2021, to July 19, 2022, and data analysis occurred from May 6, 2022, to April 12, 2023. Deidentified transcripts from the interviews were analyzed to develop themes that focused on opportunities to improve quality of care and symptom management. The participants included 30 Black adults with SLE (97% women; mean age, 41 years; range, 18-65 years). Four main themes were identified: (1) awareness of SLE signs and symptoms before diagnosis (participants emphasized delays in diagnosis and how knowledge concerning SLE could be limited in their families and communities); (2) patient-clinician interactions (participants faced discrimination in health care settings and talked about the value of coordinated and supportive health care teams); (3) medication adherence and health effects (participants experienced a range of adverse effects from medications that treat SLE and described how monitoring medication use and efficacy could inform tailored care approaches); and (4) comprehensive care plans after diagnosis (participants reported persistent pain and other symptoms despite treatment). In the context of disease management, participants emphasized the importance of behavioral change and the negative impact of social risk factors. The findings of this qualitative study suggest how limited information about SLE, experiences of racism, treatment regimens, and social risk factors may affect Black people with SLE. Future research should further engage and include Black communities within the context of treatment and intervention development to reduce racial inequities.

Knowledge and attitudes towards LGBT people and their healthcare needs among doctors in two selected hospitals in Sri Lanka

Abstract Introduction The sexual and gender minority (SGM) community is subjected to discrimination in healthcare settings due to the lack of knowledge and hostile attitudes among healthcare professionals globally. This study assesses the knowledge and attitudes of doctors in two hospitals in Sri Lanka towards SGM people &amp; identifies various factors associated with their knowledge &amp; attitudes. Methods This cross-sectional study was conducted among 112 Medical Officers in two Sri Lankan hospitals. Data were collected through an online self-administered survey created using the modified SEKHQ (Sex Education and Knowledge about Homosexuality Questionnaire) &amp; AHQ (Attitudes Towards Homosexuality Questionnaire). The response rate was 97.3% (N = 109). Cutoff scores were created to determine whether the knowledge and attitudes were ‘good’, &amp; we used the Pearson correlation to assess their relationship. The association between attitudes and various factors was analyzed using the t test and we report p-values under 0.05. Results The preliminary results indicated that most Medical Officers had ‘good’ knowledge (70.6%; n = 84) &amp; attitudes (94.5%; n = 103) toward SGM people. A moderate &amp; positive linear correlation (r = 0.567) between knowledge &amp; attitudes was noted, such that better knowledge aligned with better attitudes. Sociodemographic factors, such as sex, marital status, &amp; hometown of the participants, &amp; professional factors, such as years of experience &amp; graduation from university, showed no association with attitudes. In contrast, a strong association between self-perceived religiosity (higher religiosity) &amp; negative attitudes was identified (p &amp;lt; 0.05). Conclusions The knowledge and attitudes of doctors in the selected hospitals are satisfactory, &amp; knowledge is a possible tool in shaping the attitudes toward the SGM community in Sri Lanka. Self-perceived religiosity harmed attitudes, which calls attention to specific education efforts needed among more religious providers.

Shared Decision-Making in Patients Seeking Surgery for Facial Trauma: The Role of Decisional Conflict and Perceived Discrimination.

Background: Shared decision-making (SDM) may facilitate challenging discussions between patients with facial trauma and reconstructive surgeons. Objective: To determine among patients seeking surgical evaluation for facial trauma, whether patient demographics, decisional conflict (DC), or experiences of discrimination in health care are associated with patient perceptions of SDM, as measured by scored responses on the CollaboRATE-10 questionnaire. Methods: English-speaking adults who presented to the offices of five facial trauma surgeons were contacted by telephone after their visit to complete a cross-sectional survey. Results: After screening 247 patients, 131 patients were recruited (53.0%). DC and history of discrimination were associated with lower perceived SDM (p < 0.001 and p = 0.048, respectively). After adjusting for age, sex, race, education, initial emergency department presentation, DC, and past discrimination, patients of older age (odds ratio [OR] 1.1, 95% confidence interval [CI] 1.02-1.09) and non-White race (OR 3.5, 95% CI 1.1-11.4) had higher perceptions of SDM; patients with DC (OR 0.52, 95% CI 0.01-0.20) reported less SDM. Conclusions: Patients who present to clinic for surgical evaluation after facial trauma feel that their physicians involve them less when deciding on a treatment plan if they have experienced discrimination in health care settings in the past, or if they have significant difficulty deciding between treatment options.

Young black women's desired pregnancy and birthing support during coronavirus disease 2019 pandemic

ObjectiveTo document pregnancy and birthing experiences of young, Black pregnant women in one geographic area to make recommendations for improving young Black women's pregnancy and birthing experiences. MethodsParticipants were recruited through The YoungMoms Study (R01 DA04640101A1) in Pittsburgh, Pennsylvania, and included Black or biracial participants ages 16–23 (n = 25). Individual interviews were conducted from March 2022–July 2022 to assess pre-, peri-, and post-natal healthcare system encounters; experiences of structural and obstetric racism and discrimination in healthcare settings while obtaining prenatal care; attitudes around healthcare systems and medical professionals; effects of COVID-19 pandemic on participants lives and the impact of enacted healthcare policies in their perinatal experience; substance use changes during pregnancy; and coping mechanisms for stress. NVivo 13 was used to code transcripts, then major themes and subthemes were identified using thematic content analysis and based on grounded theory. ResultsTwenty-five interviews were conducted, and four themes emerged from participant experiences of racial discrimination in healthcare settings; (1) awareness of historical racism that influences perinatal care; (2) clinical providers assume participant substance use and enact reproductive coercion; (3) clinical providers question validity of Black women's birthing complaint; and (4) Young Black pregnant women know and will express what they desire in their perinatal experience if asked. ConclusionsYoung Black pregnant women encounter structural racism and intersectional bias from healthcare providers. By centering the perspectives and experiences of this overlooked population, public health researchers and clinical providers can utilize anti-racist frameworks to create more equitable, just practices in reproductive healthcare.

Healthcare discrimination, anticipated HIV stigma, and income as predictors of HIV testing among a community sample of YBMSM

ABSTRACT Young Black men who have sex with men (YBMSM) are at particular risk for HIV, and knowing one’s HIV status is key to preventing new HIV infections. Data were derived from a community-based study involving 250 YBMSM to examine the relationships between race-based discrimination experienced in healthcare settings, anticipated HIV stigma, household income and lifetime HIV testing. Lifetime HIV testing was regressed on racial discrimination in healthcare settings, anticipated HIV stigma, and income, and a significant 3-way interaction was found. To help interpret the 3-way interaction, lifetime HIV testing was regressed on racial discrimination in healthcare settings and anticipated HIV stigma in two separate models; with low-income and higher-income YBMSM. Anticipated HIV stigma was found to predict HIV testing among low-income YBMSM. A significant interaction was detected such that low-income YBMSM with low levels of anticipated HIV stigma were more likely to get tested for HIV regardless of experiences with healthcare discrimination, while low-income YBMSM who reported greater anticipated HIV stigma and more experiences of healthcare discrimination were less likely to get tested for HIV. Understanding the complexity of potential barriers is crucial for developing interventions to increase HIV testing within this population.

Perceptions of COVID-19 Vaccines: Lessons from Selected Populations Who Experience Discrimination in the Australian Healthcare System

COVID-19 vaccination is particularly challenging among populations who have experienced discrimination in healthcare settings. This paper presents qualitative findings from in-depth interviews about COVID-19 vaccination conducted in Australia between October 2020 and November 2021. Data from four different studies are presented; each population has unique experiences of discrimination within the healthcare system: Aboriginal people; people who inject drugs (PWID); people living with HIV (PLHIV); and gay and bisexual men (GBM). Analyses were guided by the behavioural and social determinants model that forms the basis of the World Health Organization’s “data for action: achieving high uptake of COVID-19 vaccines” interim guidance. All populations viewed vaccination as necessary for community protection, although narratives of community care were most common among Aboriginal people. Concerns about vaccine safety were expressed by all participant groups, although participants living with HIV and GBM were more trusting of vaccines possibly because of their ongoing and usually positive past experiences with biomedical technologies for HIV management and sexual health. Aboriginal participants reported distrust of mainstream government and participants who inject drugs expressed a more generalised suspicion about COVID-19 and its origins. Practical problems related to transport, booking appointments for vaccination and so forth, were more common among participants living with HIV and GBM, possibly because these specific interviews were conducted throughout 2021 when vaccines were more available, whereas data for the other populations were collected before the vaccine rollout. Findings show that vaccine willingness is shaped by past experiences of discrimination in healthcare setting, but different histories of discrimination can differently impact vaccine willingness. Promotional messaging and delivery must take account of these important differences so to not treat these populations homogenously.

The Association Between Racialized Discrimination in Health Care and Pain Among Black Patients With Mental Health Diagnoses

Chronic pain is a costly and debilitating problem in the United States, and its burdens are exacerbated among socially disadvantaged and stigmatized groups. In a cross-sectional study of Black Veterans with chronic pain at the Atlanta VA Health Care System (N = 380), we used path analysis to explore the roles of racialized discrimination in health care settings, pain self-efficacy, and pain-related fear avoidance beliefs as potential mediators of pain outcomes among Black Veterans with and without an electronic health record-documented mental health diagnosis. In unadjusted bivariate analyses, Black Veterans with a mental health diagnosis (n = 175) reported marginally higher levels of pain-related disability and significantly higher levels of pain interference compared to those without a mental health diagnosis (n = 205). Path analyses revealed that pain-related disability, pain intensity, and pain interference were mediated by higher levels of racialized discrimination in health care and lower pain self-efficacy among Black Veterans with a mental health diagnosis. Pain-related fear avoidance beliefs did not mediate pain outcomes. These findings highlight the need to improve the quality and effectiveness of health care for Black patients with chronic pain through the implementation of antiracism interventions within health care systems. Results further suggest that Black patients with chronic pain who have a mental health diagnosis may benefit from targeted pain management strategies that focus on building self-efficacy for managing pain. PerspectiveRacialized health care discrimination and pain self-efficacy mediated differences in pain-related disability, pain intensity, and pain interference among Black Veterans with and without a mental health diagnosis. Findings highlight the need for antiracism interventions within health care systems in order to improve the quality of care for Black patients with chronic pain. Trial registrationClinicaltrials.gov Identifier: NCT01983228.

Understanding disruptions in cancer care to reduce increased cancer burden.

This study seeks to understand how and for whom COVID-19 disrupted cancer care to understand the potential for cancer health disparities across the cancer prevention and control continuum. In this cross-sectional study, participants age 30+residing in an 82-county region in Missouri and Illinois completed an online survey from June-August 2020. Descriptive statistics were calculated for all variables separately and by care disruption status. Logistic regression modeling was conducted to determine the correlates of care disruption. Participants (N=680) reported 21% to 57% of cancer screening or treatment appointments were canceled/postponed from March 2020 through the end of 2020. Approximately 34% of residents stated they would need to know if their doctor's office is taking the appropriate COVID-related safety precautions to return to care. Higher education (OR = 1.26, 95% CI:1.11-1.43), identifying as female (OR = 1.60, 95% CI:1.12-2.30), experiencing more discrimination in healthcare settings (OR = 1.40, 95% CI:1.13-1.72), and having scheduled a telehealth appointment (OR = 1.51, 95% CI:1.07-2.15) were associated with higher odds of care disruption. Factors associated with care disruption were not consistent across races. Higher odds of care disruption for White residents were associated with higher education, female identity, older age, and having scheduled a telehealth appointment, while higher odds of care disruption for Black residents were associated only with higher education. This study provides an understanding of the factors associated with cancer care disruption and what patients need to return to care. Results may inform outreach and engagement strategies to reduce delayed cancer screenings and encourage returning to cancer care. This study was supported by the National Cancer Institute's Administrative Supplements for P30 Cancer Center Support Grants (P30CA091842-18S2 and P30CA091842-19S4). Kia L. Davis, Lisa Klesges, Sarah Humble, and Bettina Drake were supported by the National Cancer Institute's P50CA244431 and Kia L. Davis was also supported by the Breast Cancer Research Foundation. Callie Walsh-Bailey was supported by NIMHD T37 MD014218. The content does not necessarily represent the official view of these funding agencies and is solely the responsibility of the authors.