Members Of Ethnic Minority Groups Research Articles

Gaps In Quality Of Care Not Consistent Between Traditional Medicare, Medicare Advantage For Racial And Ethnic Groups.

The quality of care experienced by members of racial and ethnic minority groups in Medicare Advantage, which is an increasingly important source of Medicare coverage for these groups, has critical implications for health equity. Comparing gaps in Medicare Advantage and traditional Medicare for three quality-of-care outcomes, measured by adverse health events, between minority and non-Hispanic White populations, we found that the relative magnitude of the gaps varied both by racial and ethnic minority group and by quality measure. Hispanic versus non-Hispanic White gaps were smaller in Medicare Advantage than in traditional Medicare for all outcomes: avoidable emergency department use, preventable hospitalizations, and thirty-day hospital readmissions. The gap between non-Hispanic Black and non-Hispanic White populations was larger in Medicare Advantage than in traditional Medicare for avoidable emergency department use but was no different for hospital readmissions and was smaller for preventable hospitalizations. The Asian versus non-Hispanic White gap was similar in Medicare Advantage and traditional Medicare for avoidable emergency department use and preventable hospitalizations but was larger in Medicare Advantage for hospital readmissions. As Medicare Advantage enrollment expands, monitoring the quality of care for enrollees who are members of racial and ethnic minority groups will remain important.

Ethnic Minority Contact and the Similarities between Adolescent-Reported Parental and Self-Reported Far Right-Wing Attitudes

AbstractRecent developments in society, together with an increase in the number of far-right motivated crimes in Germany, suggest that far right-wing attitudes are becoming increasingly popular within public opinion. Since political attitudes are shaped within the family and peer setting during the adolescent stage, assessing the potential interplay of family and peer relationships with regard to such attitudes appears essential. The present study aims to explore (1) the relationship between perceived parental far right-wing attitudes, as reported by adolescents, and adolescents’ self-reported far right-wing attitudes, as well as (2) the unique and moderating effects of variables related to the contact hypothesis (ethnic minority friends and exposure to ethnic minority group members in the social environment). Using data from a representative school survey of seventh and ninth grade German adolescents, multilevel linear regression models indicated a statistically significant positive association between adolescent-reported parental far right-wing attitudes and adolescents’ far right-wing attitudes. Furthermore, the analyses demonstrated a small but statistically significant moderating effect of friendship with individuals of an ethnic minority: the relationship between parental and adolescent far right-wing attitudes was weaker for adolescents who had more ethnic minority friends. Thus, adolescents who were friends with individuals of an ethnic minority appeared to be less congruent with their parents’ far right-wing attitudes, compared to adolescents without any ethnic minority friends. In contrast, the overall level of exposure to ethnic minority group members in the social environment did not affect the strength of the relationship between perceived parental and adolescent far right-wing attitudes.

Differences by Physician Seniority in Race and Ethnicity and Insurance Coverage of Treated Patients

This cross-sectional study investigates the share of patients who were members of racial and ethnic minority groups or Medicaid enrollees by physician seniority.

Racial Resentment And Administrative Burden Tolerance: The Case Of Expanded SNAP Work Requirements.

Administrative burdens-onerous experiences with policy implementation-can deter access to crucial safety-net programs. New research finds that racial resentment boosts support for one form of administrative burden: work requirements. I discuss these findings and how expanded work requirements under the Fiscal Responsibility Act of 2023 may affect members of racial and ethnic minority groups. I argue that the racial implications may depend on how states and counties apply for hardship exemptions, use time-limit waivers, and implement work requirements as they adjust to the winding down of the COVID-19 public health emergency measures. As demonstrated in other policy domains, racial and ethnic minority populations may be disproportionately harmed by expanded work requirements, especially if they reside in conservative, high-poverty, rural communities.

The socialization of perceived discrimination in ethnic minority groups.

Contact with members of one's own group (ingroup) and other groups (outgroups) shapes individuals' beliefs about the world, including perceptions of discrimination against one's ingroup. Research to date indicates that, among members of disadvantaged groups, contact with an advantaged outgroup is associated with less perceived discrimination, while contact with the disadvantaged ingroup is associated with more perceived discrimination. Past studies, however, considered ingroup and outgroup contact in isolation and overlooked the various processes that could explain these associations. We addressed these issues by examining whether disadvantaged-group members' perceptions of discrimination are shaped by how much contact they have with ingroup and outgroup members (contact effects) or by those ingroup and outgroup members' perceptions of discrimination (socialization effects) while controlling for their tendency to affiliate with similar others (selection effects). Three studies (total N = 5,866 ethnic minority group members) assessed participants' positive contact, friendships, and perceived discrimination and applied longitudinal and social network analyses to separate and simultaneously test contact, socialization, and selection processes. In contrast to previous studies, we found no evidence that contact with members of the advantaged outgroup precedes perceived discrimination. Instead, we found that friendships with members of the disadvantaged ingroup longitudinally predict perceived discrimination through the process of socialization-disadvantaged-group members' perceptions of discrimination became more similar to their ingroup friends' perceptions of discrimination over time. We conclude that perceptions of discrimination should be partly understood as a socialized belief about a shared reality. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Structural and Psychosocial Challenges Among Underserved Patients Receiving Hemodialysis During and Beyond the COVID-19 Pandemic: A Qualitative Study

Racial and ethnic minority groups in the United States are disproportionately affected by chronic kidney disease and progressive kidney failure and face significantly more socioeconomic and psychosocial challenges. However, how such patients' social environment and stigmatization shape their illness experiences and abilities to cope before and during the coronavirus disease 2019 (COVID-19) pandemic has not been well documented, even as social scientific research predicts these groups' exponential vulnerability. Qualitative study using semistructured interviews to elicit individual patient narratives about their personal illness experiences before and during the COVID-19 pandemic, any challenges they faced, and their sources of support. Using purposive sampling, we recruited 20 adult patients receiving maintenance hemodialysis from centers affiliated with a safety-net hospital in Boston, Massachusetts. Interviews were audiotaped, transcribed, and analyzed using thematic content analysis to identify patients' challenges and supports before and during the pandemic. Of the 20 patients in the study, 9 were women, and 18 self-identified as Black or African American. Three main themes emerged, whereby most patients described: (1) stigma and stigmatization as a central element of their life experience; (2) the pandemic as a difficult experience but not a complete rupture from their prepandemic life; and (3) social networks, particularly family, friends, and religious communities, as sources of support crucial to coping with their debilitating illness. Whether the findings apply to other settings is unknown, as participants were recruited from centers in a single safety-net urban hospital setting. Psychosocial and environmental factors, including institutional racism and stigmatization, play significant roles in amplifying the burdens shouldered by racial and ethnic minority individuals with kidney disease who now also face the COVID-19 pandemic that has since turned endemic. The results of this study can inform the development of policy interventions aimed at alleviating tensions and structural conditions that impinge on kidney disease patients' wellbeing and health outcomes. Members of racial and ethnic minority groups in the United States experience the highest rates of progressive kidney failure and face significantly more socioeconomic and psychosocial challenges. We interviewed 20 patients who receive maintenance hemodialysis treatment from centers affiliated with a safety-net hospital. Patients described stigmatization as a central element of their life experience and the pandemic as a difficult challenge (but not a complete rupture) that added to their struggles with illness-related, race-related, and class-related stigmas. Social networks, particularly family, friends, and religious communities, are key sources of support crucial to coping with illness. Findings from this study can inform health care providers and community workers and guide the development of policy interventions to provide better support for these patients.

Analysis of Race and Ethnicity Among United States Medical Board Leadership.

Background: The inequitable representation of women and members of racial and ethnic minority groups in leadership positions within academic medicine is an ongoing challenge with practical and realistic solutions. The purpose of this study was to assess the race and ethnicity of individuals in leadership positions among the 24 Member Boards of Directors (Boards) of the American Board of Medical Specialties (ABMS). Methods: We performed a cross-sectional analysis of the race and ethnicity patterns for individuals holding leadership positions among the 24 Boards of the ABMS as of March 1, 2022. Two independent coders with 100% concordance recorded race and ethnicity using online biographies and photographs. Percentages were compared to the Association of American Medical Colleges (AAMC) 2018 data reports. Results: Among 449 director positions, 415 (92.4%) were physicians. Within the physician subset, 12.3% (51/415) Asian, 8.2% (34/415) Black, and 3.4% (14/415) Hispanic individuals were identified. Women who are members of racial and ethnic minority groups have less representation than men of the same race. Of 24 Boards, 37.5% (9/24) had no Asian women, 50.0% (12/24) had no Black women, and 75.0% (18/24) had no Hispanic women. White physicians were overrepresented on 14 of 21 (66.7%) Boards compared to the proportion of active White physicians or White individuals in the United States general population. Conclusion: Disparities exist for members of racial and ethnic minority groups, particularly women from these groups. As a leader in academic medicine, the ABMS should ensure its Boards are diverse with respect to gender, race, and ethnicity. Diverse groups often contribute unique insights that support medical education, advance science, and improve clinical care.

"Personally, I feel sorry, but professionally, I don't have a choice." Understanding the drivers of anti-Roma discrimination on the rental housing market.

The aim of our study is to assess the drivers of discriminatory behaviors of real-estate agents and private landlords toward prospective Roma tenants, relying on qualitative data from Hungary. Though there is a broad literature on the forms and frequency of discrimination, we know much less about the question of why people discriminate. Previous research suggests that discrimination on the basis of ethnicity is widespread in Hungary. To understand the drivers of discrimination, we analyzed: (a) the sources and justifications of discrimination of Roma people on the rental housing market among real-estate agents and private landlords, the actors making decisions about tenants (b) mapped the social embeddedness of discrimination, and (c) assessed the resilience of discriminatory intentions by analyzing the reactions to a 3-min advocacy video showing discrimination of Roma people on the rental housing market. We conducted and analyzed five online group discussions with 18 real estate agents and landlords advertising properties for rent in different regions of the country. Our qualitative study revealed that discrimination of Roma people is understood to be a widespread and socially acceptable practice driven by the need to avoid risks attributed to Roma tenants based on widely held stereotypes about them. We identified certain specificities in the justification and argumentation strategies of real-estate agents in comparison to private landlords. By providing counter-information presenting the perspective of Roma tenants, negative views could be challenged on the emotional level and also by shifting the group dynamics, strengthening the viewpoint of those without prejudice. We discuss our findings with regards to the possibilities of interventions against discrimination in societies in which neither social norms nor state institutions expect the equal treatment of the members of ethnic minority groups.

Cancer-related cognitive impairment in racial and ethnic minority groups: a scoping review.

Disparities in cognitive function among racial and ethnic groups have been reported in non-cancer conditions, but cancer-related cognitive impairment (CRCI) in racial and ethnic minority groups is poorly understood. We aimed to synthesize and characterize the available literature about CRCI in racial and ethnic minority populations. We conducted a scoping review in the PubMed, PsycInfo, and Cumulative Index to Nursing and Allied Health Literature databases. Articles were included if they were published in English or Spanish, reported cognitive functioning in adults diagnosed with cancer, and characterized the race or ethnicity of the participants. Literature reviews, commentaries, letters to the editor, and gray literature were excluded. Seventy-four articles met the inclusion criteria, but only 33.8% differentiated the CRCI findings by racial or ethnic subgroups. There were associations between cognitive outcomes and the participants' race or ethnicity. Additionally, some studies found that Black and non-white individuals with cancer were more likely to experience CRCI than their white counterparts. Biological, sociocultural, and instrumentation factors were associated with CRCI differences between racial and ethnic groups. Our findings indicate that racial and ethnic minoritized individuals may be disparately affected by CRCI. Future research should use standardized guidelines for measuring and reporting the self-identified racial and ethnic composition of the sample; differentiate CRCI findings by racial and ethnic subgroups; consider the influence of structural racism in health outcomes; and develop strategies to promote the participation of members of racial and ethnic minority groups.

Hispanic/Latinx and Spanish Language Concordance Among Palliative Care Clinicians and Patients in Hospital Settings in California

Background: Members of racial or ethnic minority groups utilize palliative care (PC) services less than non-Hispanic White patients and multiple factors contribute to this disparity. The impact of racial, ethnic, and language (REL) concordance between patients and clinicians has been demonstrated in general medical populations, but not in PC populations. We characterized the racial and ethnic composition and languages spoken of California PC clinicians and patients to examine clinical impacts of REL concordance. Methods: Using Palliative Care Quality Network data, 15 inpatient teams were identified in California that had collected data on patient race/ethnicity and language. Patient and clinician data were analyzed using means and medians for continuous variables, and chi-squared tests to explore similarities and differences between clinician and patient data. Results: 51 clinicians from nine teams completed the survey. The largest non-White and non-English speaking groups among patients and clinicians identified as Hispanic/Latinx (31.5% of patients, 16.3% of clinicians) and as Spanish speakers (22.6% of patients, 7.5% of clinicians). There was a significantly higher proportion of Hispanic/Latinx patients compared to clinicians (p-value 0.01), with Southern California demonstrating the largest difference (30.4% of patients vs. 10.7 % of clinicians, p-value 0.01). Similar proportions of patients and clinicians reported Spanish fluency (22.6% vs 27.5%, p-value 0.31). Discussion: We found significant differences in the racial/ethnic distributions of Hispanic/Latinx patients and clinicians in California, prompting consideration of whether a lack of representation of Hispanic/Latinx clinicians relative to the patient population may contribute to lower palliative care utilization among Hispanic/Latinx patients.

Association Between Patient Race and Ethnicity and Outcomes With COVID-19: A Retrospective Analysis From a Large Mid-Atlantic Health System.

Members of racial and ethnic minority groups have been disproportionately impacted by coronavirus-2019 (COVID-19). The objective of the study is to describe associations between race and ethnicity on clinical outcomes such as need for mechanical ventilation and mortality. Retrospective cohort study of patients with severe COVID-19 infection admitted within a large, not-for-profit healthcare system in the mid-Atlantic region between March and July, 2020. Patient demographic data and clinical outcomes were abstracted from the electronic health record. Logistic regressions were performed to estimate associations between race and ethnicity and the clinical outcomes. The study population (N = 2931) was stratified into 1 of 3 subgroups: non-Hispanic White (n = 466), non-Hispanic Black (n = 1611), and Hispanic (n = 654). The average age of White, Black, and Hispanic patients was 69 ± 17.06, 64 ± 15.9, and 50 ± 15.53 years old, respectively (P < .001). Compared to White patients, Black and Hispanic patients were at increased odds of needing mechanical ventilation due to COVID-19 pneumonia (odds ratio [OR] Black = 1.35, 95% confidence interval [CI] = 1.04 to 1.75, P < .05; OR Hispanic = 1.43, 95% CI = 1.06 to 1.93, P < .05). When compared to White patients, Hispanic patients were at decreased odds of death (OR = 0.45, 95% CI = 0.32 to 0.63, P < .001). However, when adjusting for age, there were no statistically significant differences in the odds of death between these groups (adjusted OR [aOR] Black = 1.05, 95% CI = 0.80 to 1.38, P = .71; aOR Hispanic = 1.10, 95% CI = 0.76 to 1.60, P = .62). Our analysis demonstrated that Hispanic patients were more likely require mechanical ventilation but had lower mortality when compared to White patients, with lower average age likely mediating this association. These findings emphasize the importance of outreach efforts to communities of color to increase prevention measures and vaccination uptake to reduce infection with COVID-19.

Trends in Labor Unionization Among US Health Care Workers, 2009-2021

Labor unionization efforts have resurged in the US, and union membership has been shown to improve worker conditions in some industries. However, little is known about labor unionization membership and its economic effects across the health care workforce. To examine the prevalence of labor unionization among health care workers and its associations with pay, noncash benefits, and work hours. This cross-sectional study was conducted using data from the Current Population Survey and Annual Social and Economic Supplement from 2009 through 2021. The US nationally representative, population-based household survey allowed for a sample of 14 298 self-identified health care workers (physicians and dentists, advanced practitioners, nurses, therapists, and technicians and support staff). Self-reported membership status or coverage in a labor union. Prevalence and trend in labor unionization. Further comparisons included mean weekly pay, noncash benefits (pension or other retirement benefits; employer-sponsored, full premium-covered health insurance; and employer's contribution to the worker's health insurance plan), and work hours. The 14 298 respondents (81.5% women; 7.1% Asian, 12.0% Black, 8.5% Hispanic, 70.4% White individuals; mean [SD] age, 41.6 [13.4] years) included 1072 physicians and dentists, 981 advanced practitioners, 4931 nurses, 964 therapists, and 6350 technicians and support staff. After weighting, 13.2% (95% CI, 12.5% to 13.8%) of respondents reported union membership or coverage, with no significant trend from 2009 through 2021 (P = .75). Among health care workers, those who were members of a racial or ethnic minority group (Asian, Black, or Hispanic individuals compared with White individuals) and those living in metropolitan areas were more likely to report being labor unionized. Reported unionization was associated with significantly higher reported weekly earnings ($1165 vs $1042; mean difference, $123 [95% CI, $88 to $157]; P < .001) and higher likelihood of having a pension or other retirement benefits at work (57.9% vs 43.4%; risk ratio [RR], 1.33 [95% CI, 1.26 to 1.41]; P < .001) and having employer-sponsored, full premium-covered health insurance (22.2% vs 16.5%; RR, 1.35 [95% CI, 1.17 to 1.53]; P < .001). Union members reported more work hours (37.4 vs 36.3; mean differences, 1.11 [95% CI, 0.46 to 1.75]; P < .001) per week. White workers reported mean weekly earnings that were significantly more than members of racial and ethnic minority groups among nonunionized workers ($1066 vs $1001; mean difference, $65 [95% CI, $40 to $91]; P < .001), but there was no significant difference between the 2 groups among unionized workers ($1157 vs $1170; mean difference, -$13 [95% CI, -$78 to $52]; P = .70). From 2009 through 2021, labor unionization among US health care workers remained low. Reported union membership or coverage was significantly associated with higher weekly earnings and better noncash benefits but greater number of weekly work hours.

Introduction: Fertility and Social Inequalities in Migrant Populations: a Look at the Roles of Selection, Context of Reception, and Employment

This paper is the introduction to the Special Issue on “Fertility and social inequalities in migrant populations.” The Special Issue contains twelve empirical papers that deal with both international migrants and internal migrants, both women and men, both older migrant populations spanning several generations as well as recent immigrant groups, such as refugees, and include analyses of both behavior and intentions. The data used comprise macro indicators and individual-level data as well as qualitative material. Regional contexts include classical immigration countries in Europe and Oceania as well as relatively recent destinations. The papers draw on several comparative perspectives—migrants at destination, emigrants and stayers at origin, migrants with different numbers of children upon migration, and different migrant generations—to address three large questions. Six papers explore the role of time and sequencing in migrant fertility, in relation to both period effects and sequencing of births in the life course, as well as the role selection into migration plays in female and male migrants’ fertility behavior. Four papers focus into how regional variation in the receiving contexts shapes fertility behavior, highlighting the role of migrant type, human capital, and social capital. Two papers look at how childbearing is associated with different degrees of economic assimilation, i.e., maternal employment. Overall, this Special Issue demonstrates the large heterogeneity in fertility among migrant and ethnic minority groups. Social inequalities shape fertility differentials, which in turn influence subsequent life courses of migrants and ethnic minority group members. Future research on migrant assimilation should pay more attention to variation in demographic behavior.

Workforce Diversity and disparities in wait time and retention among opioid treatment programs

BackgroundWorkforce diversity is a key strategy to improve treatment engagement among members of racial and ethnic minority groups. In this study, we seek to determine whether workforce diversity plays a role in reducing racial and ethnic differences in wait time to treatment entry and retention in different types of opioid use disorder treatment programs.MethodsWe conducted comparative and predictive analysis in a subsample of outpatient opioid treatment programs (OTPs), who completed access and retention survey questions in four waves of the National Drug Abuse Treatment System Survey (162 OTPs in 2000, 173 OTPs in 2005, 282 OTPs in 2014, and 300 OTPs in 2017). We sought to assess the associations between workforce diversity on wait time and retention, accounting for the role of Medicaid expansion and the moderating role of program ownership type (i.e., public, non-profit, for-profit) among OTPs located across the United States.ResultsWe found significant differences in wait time to treatment entry and retention in treatment across waves. Average number of waiting days decreased in 2014 and 2017; post Medicaid expansion per the Affordable Care Act, while retention rates varied across years. Key findings show that programs with high diversity, measured by higher percent of African American staff and a higher percent of African American clients, were associated with longer wait times to enter treatment, compared to low diversity programs. Programs with higher percent of Latino staff and a higher percent of Latino clients were associated with lower retention in treatment compared with low diversity programs. However, program ownership type (public, non-profit and for-profit) played a moderating role. Public programs with higher percent of African American staff were associated with lower wait time, while non-profit programs with higher percent of Latino staff were related to higher retention.ConclusionsFindings show decreases in wait time over the years with significant variation in retention during the same period. Concordance in high workforce and client diversity was associated with higher wait time and lower retention. But these relations inverted (low wait time and high retention) in public and non-profit programs with high staff diversity. Findings have implications for building resources and service capacity among OTPs that serve a higher proportion of minority clients.

State level income inequality affects cardiovascular stress responses: Evidence from the Midlife in the United States (MIDUS) study

RationaleThe slow and insidious effects of income inequality on health means that their effects can be difficult to reveal, taking many years to become apparent. These effects can also be experienced differently according to subjective status and ethnicity making the relation between income inequality and health difficult to understand. Cardiovascular reactions to acute stress are indicative of future health outcomes. Objective: To examine whether short to medium term income inequality affected cardiovascular responses to acute stress whilst accounting for ethnic groups and subjective status. Method: Participants state of residence was available for 1155 people who participated in the MIDUS biomarker data project. This detail was used to merge the relevant US state level inequality data 1, 5, 10 and 15 years prior to the MIDUS biomarker data project which assessed cardiovascular responses to acute stress. Results: Our analysis demonstrated an association between inequality 5, 10 and 15 year prior and cardiovascular reactions to acute stress. Subjective community status and Black and minority ethnic group membership interacted to affect the association between inequality and cardiovascular reactions. Conclusions: In states where income inequality was high, less healthy cardiovascular responses were evident. However lower subjective community status and Black and Ethnic minority group members interacted with income inequality such that their impact was variable contingent on state level inequality. These findings extend the literature on income inequality and health and particularly highlights a psychophysiology pathway linking income inequality and health.

Racial and Ethnic Disparities in Health Status and Community Functioning Among Persons with Untreated Mental Illness.

Using 6years of data from the National Survey of Drug Use and Health, the present study investigated ethnic minority-White disparities in self-rated health and community functioning for persons with untreated mental illness. Comparing minority and White persons with untreated severe mental illness (SMI) and mild and moderate mental illness (MMMI), the study sought evidence of "double jeopardy": that minority persons with mental illness suffer an added burden from being members of ethnic minority groups. For African Americans with SMI and MMMI, results indicated that the odds were greater of living in poverty, being unemployed, and being arrested in the past year, and for African Americans with SMI, the odds were greater of reporting fair/poor health. For Native Americans/Alaska Native persons with MMMI, the odds were greater of living in poverty and being arrested in the past year. For Latinx persons with SMI and MMMI, the odds were greater of living in poverty and for Latinx persons with SMI the odds were greater of reporting fair/poor health. Results indicate that African Americans with mental illness suffer pervasive adversity relative to Whites and Native Americans/Alaska Natives and Latinx persons do so selectively.

Association of Rurality, Race and Ethnicity, and Socioeconomic Status With the Surgical Management of Colon Cancer and Postoperative Outcomes Among Medicare Beneficiaries

Rural patients with colon cancer experience worse outcomes than urban patients, but the extent to which disparities are explained by social determinants is not known. To evaluate the association of rurality with surgical treatment and outcomes of colon cancer and to investigate the intersection of rurality with race and ethnicity and socioeconomic status. This cohort study included fee-for-service Medicare beneficiaries 65 years or older diagnosed with incident, nonmetastatic colon cancer between April 1, 2016, and September 30, 2018, with follow-up until December 31, 2018. Data were analyzed from August 3, 2020, to April 30, 2021. Rurality of patient's residence, categorized as metropolitan, micropolitan, or small town or rural, using Rural-Urban Commuting Area codes. Receipt of surgery, emergent surgery, or minimally invasive surgery (MIS); 90-day surgical complications; and 90-day mortality. Among 57 710 Medicare beneficiaries with incident, nonmetastatic colon cancer, 46.6% were men, 53.4% were women, and the mean (SD) age was 76.6 (7.2) years. In terms of race and ethnicity, 3.7% were Hispanic, 6.4% were non-Hispanic Black (hereinafter Black), 86.1% were non-Hispanic White (hereinafter White), and 3.8% were American Indian or Alaska Native, Asian or Pacific Islander, or unknown race or ethnicity. Patients residing in nonmetropolitan areas were more likely to undergo surgical resection than those residing in metropolitan areas (69.2% vs 63.9%; P < .001). Black race was independently associated with lower hazard of surgical resection (hazard ratio, 0.92 [95% CI, 0.88-0.95]). Race and ethnicity and measures of socioeconomic status did not modify the association of rurality with surgery. Beneficiaries from small town and rural areas had higher odds of undergoing emergent surgery (adjusted odds ratio [OR], 1.32 [95% CI, 1.20-1.44]) but lower odds of undergoing MIS (adjusted OR, 0.75 [95% CI, 0.70-0.80]), with similar findings for patients residing in micropolitan areas. Members of racial and ethnic minority groups who resided in small town and rural settings experienced higher odds of postoperative surgical complications (P = .001 for interaction) and mortality (P = .001 for interaction). Notably, White patients who resided in small town and rural areas experienced lower odds of postoperative mortality than their White metropolitan counterparts (adjusted OR, 0.81 [95% CI, 0.71-0.92]), but Black patients who resided in small town and rural areas had significantly higher odds of postoperative mortality (adjusted OR, 1.86 [95% CI, 1.16-2.97]) than their Black metropolitan counterparts. These findings suggest that Medicare beneficiaries from small town and rural areas were more likely to undergo surgery for nonmetastatic colon cancer than metropolitan beneficiaries but also more likely to undergo emergent surgery and less likely to have MIS. The experiences of rural patients varied by race; rurality was associated with higher postoperative mortality for Black patients but not for other racial and ethnic groups.

Association between changes in loneliness identified through screening and changes in depression or anxiety in older adults.

Changes in loneliness are associated with corresponding changes in depression, anxiety, and general health in population surveys, but few studies have assessed these associations through repeated screening in clinical settings. Retrospective cohort study among individuals ≥age 65 in an integrated health care system who completed loneliness screening before two annual wellness visits, separated by a mean of 12.9 (SD 2.0) months, between 2013 and 2018. Their responses identified four subgroups: individuals who were persistently lonely; not lonely; experienced an increase (recently lonely); or decrease (previously lonely) in loneliness. Loneliness was assessed with a single item. Depression was assessed with the Patient Health Questionnaire-2. Anxiety was assessed with the Generalized Anxiety Disorder-2. Fair/poor general health was assessed by a single item. Linear mixed effects models assessed changes in outcomes after covariate adjustment. The cohort comprised 24,666 individuals (19.2% of older adults in the system). Mean age was 73.7 years (SD 6.4); 54.6% were female, and 11.6% were members of racial and ethnic minority groups. Of these individuals, 1936 (7.8%) were persistently lonely, 1687 (6.8%) were recently lonely, 1551 (6.3%) were previously lonely, and 19,492 (79.0%) were not lonely at either time point. After adjustment for sociodemographic, clinical and social variables, recent loneliness was associated with increases in depression (adjusted odds ratio [aOR] 1.76, 95% confidence interval [CI] 1.41-2.19) and anxiety (aOR 1.67, 95% CI 1.32-2.10). Previous loneliness was associated with decreases in depression (aOR, 0.46, 95% CI 0.36-0.58) and anxiety (aOR 0.69, 95% CI 0.54-0.90). Changes in loneliness were not associated with changes in general health. Changes in loneliness identified through screening were associated with corresponding changes in depression and anxiety. These findings support the potential value of identifying social risk factors in clinical settings among older adults.

Mindfulness-Based Smoking Cessation Delivered Through Telehealth and Text Messaging for Low-Income Smokers: Protocol for a Randomized Controlled Trial.

BackgroundTobacco use is the leading cause of preventable morbidity and mortality. Adults with low income and members of certain racial and ethnic minority groups are less likely to quit, and therefore, they experience profound tobacco-related health disparities. Mindfulness training can increase the rates of smoking cessation and lapse recovery, and telehealth and SMS text messaging have the potential to provide more accessible treatment.ObjectiveThis study aims to test the efficacy of delivering mindfulness-based smoking cessation treatment through text messaging (iQuit Mindfully) and telehealth (group videoconferencing), both as stand-alone interventions and in combination. In addition, it aims to examine the underlying mechanisms of mindfulness treatment.MethodsIn this 2×2 randomized controlled trial, participants are randomized into 1 of 4 groups based on assignment to iQuit Mindfully text messages (yes or no) and mindfulness videoconference groups (yes or no). The primary outcomes are biochemically verified smoking abstinence at 8, 12, and 24 weeks after the start of treatment. Secondary outcomes include the frequency of home mindfulness practice and self-reported levels of mindfulness, emotions, craving, withdrawal, dependence, self-efficacy, and social support.ResultsRecruitment, treatment, and assessment began in spring and summer 2021, and data collection is expected to continue through spring 2024.ConclusionsThis project aims to improve smoking cessation outcomes for low-income, racially and ethnically diverse smokers through mindfulness-based telehealth group counseling and text messaging support. We also aim to advance the scientific study of the mechanisms of action of mindfulness treatment, which could inform the development of more efficacious and efficient treatments to reduce tobacco disparities.Trial RegistrationClinicaltrials.gov NCT04965181; https://clinicaltrials.gov/ct2/show/NCT04965181International Registered Report Identifier (IRRID)PRR1-10.2196/35688

Microaggressions, Bias, and Equity in the Workplace: Why Does It Matter, and What Can Oncologists Do?

Despite efforts to embrace diversity, women and members of racial, ethnic, and gender minority groups continue to experience bias, inequities, microaggressions, and unwelcoming atmospheres in the workplace. Specifically, women in oncology have lower promotion rates and less financial support and mentorship, and they are less likely to hold leadership positions. These experiences are exceedingly likely at the intersection of identities, leading to decreased satisfaction, increased burnout, and a higher probability of leaving the workforce. Microaggressions have also been associated with depression, suicidal thoughts, and other health and safety issues. Greater workplace diversity and equity are associated with improved financial performance; greater productivity, satisfaction, and retention; improved health care delivery; and higher-quality research. In this article, we provide tools and steps to promote equity in the oncology workplace and achieve cultural change. We propose the use of tailored approaches and tools, such as active listening, for individuals to become microaggression upstanders; we also propose the implementation of education, evaluation, and transparent policies to promote a culture of equity and diversity in the oncology workplace.