Racial Minority Women Research Articles

Police violence among women in four U.S. cities

Police violence has been identified as a public health concern in the U.S., yet few studies have assessed the prevalence and nature of police violence among women. Furthermore, increasing evidence suggests that women reporting intimate partner violence (IPV) and sexual violence (SV) to police are often met with harmful or neglectful police responses and thus, women's exposures to police violence may be associated with experiences of IPV and SV; however, this has not yet been empirically tested. This study assesses lifetime prevalence and sociodemographic correlates of police violence among women and investigates potential associations between IPV, SV, and police violence. A cross-sectional survey was administered in four Eastern U.S. cities in March and April 2016 (N=932). Physical, sexual, and psychological police victimization and neglect by police were assessed. Logistic regression was used to examine the relationship between IPV, SV, and police violence, adjusting for sociodemographics. Lifetime prevalence of physical (4%), sexual (3.3%), and psychological (14.4%) police violence and neglect (17.2%), show that a notable proportion of women experience police victimization, with significantly higher rates among racial and ethnic minority women. Women with IPV and SV histories had increased odds of experiencing most forms of police violence compared to women without IPV and SV histories. Findings suggest the need for gender-inclusive community-centered policing initiatives and other preventive efforts aimed at eliminating police violence. Police violence and victimization among women should also be considered in IPV and SV intervention and treatment responses.

Entry and Degree Attainment in STEM: The Intersection of Gender and Race/Ethnicity

This study focused on entry to and attainment of bachelor’s degrees in science, technology, engineering, and mathematics (STEM) fields, by examining gender and race/ethnicity in an intersectional manner and paying particular attention to STEM subfields. The intersectional analysis extends previous research findings that female students are more likely to persist in college once they are in a STEM field and further reveals that racial minority women share the same tendency of persistence with white women. Women and racial minorities are most under-represented in physical-STEM fields. Our analysis reveals that black men would have had the highest probability to graduate in physical-STEM fields, had they had the family socioeconomic background and academic preparations of Asian males. This highlights the critical importance of family socioeconomic background and academic preparations, which improves the odds for STEM degree attainment for all groups. Out of these groups, black students would have experienced the most drastic progress.

Social Cohesion and Food Insecurity: Insights from the Geographic Research on Wellbeing (GROW) Study.

Objectives Food insecurity in the United States is a stubborn public health issue, affecting more than one in five households with children and disproportionately impacting racial and ethnic minority women and their children. Past research and policy has focused on household predictors of food insecurity, but neglected broader factors, such as perceived neighborhood social cohesion, that might protect those most vulnerable to food insecurity. Methods We use a racially and ethnically diverse data set from the Geographic Research on Wellbeing study (N=2847) of women and their young children in California to investigate whether social cohesion influences food insecurity and whether it moderates the relationship between race/ethnicity and food insecurity. Results We find that lower levels of perceived residential neighborhood social cohesion associate with higher odds of food insecurity even after considering important household socioeconomic factors. In addition, our results suggest that social cohesion is most relevant for reducing the risk of food insecurity among racial and ethnic minority mothers. For example, the probability of food insecurity for immigrant Latina mothers is nearly 0.40 in neighborhoods where mothers perceive little to no cohesion and less than 0.10 in neighborhoods where mothers perceive high cohesion. Conclusions for Practice Higher levels of neighborhood perceived social cohesion are protective against food insecurity in households with children and especially so for racial and ethnic minority households who are at a heightened risk of food insecurity. Supporting programs that focus on building closer knit communities may be a key to reducing food insecurity overall and for reducing disparities in food insecurity by race and ethnicity.

Race-based medical mistrust, medication beliefs and HIV treatment adherence: test of a mediation model in people living with HIV/AIDS.

Race-based medical mistrust significantly predicts non-adherence to antiretroviral therapy (ART) in people living with HIV. The current study builds on previous research that shows beliefs about medication necessity (i.e., "My medicines protect me from becoming worse") and concerns (i.e., "Having to take my medicines worries me") mediate the association between race-based medical mistrust and medication adherence. Racial and ethnic minority men and women living with HIV and receiving ART (N=178) in a southern US city completed computerized measures of demographic and health characteristics, telephone interviews of race-based medical mistrust and medication beliefs, and unannounced phone-based pill counts for ART adherence. Multiple mediation modeling showed that medical mistrust is related to medication necessity and concerns beliefs and ART adherence. Furthermore, medication necessity beliefs predicted ART adherence. The indirect effect of medical mistrust on adherence through medication necessity beliefs was also significant. Results confirm that medication necessity beliefs, although not concerns beliefs, mediate the association between medical mistrust and ART adherence. Medication necessity beliefs offer a viable target for interventions to improve ART adherence in the context of mistrust that patients may have for medical providers and health care systems.

Racial and ethnic differences in women's preferences for features of contraceptive methods

ObjectivesTo understand women's preferences for specific features of contraceptive methods, the extent to which features of existing methods match women's preferences and whether this match differs by racial and ethnic subgroups. Study designUsing data from 1783 women in family planning and abortion clinics across the United States, we performed analyses of racial and ethnic differences in contraceptive features reported to be “extremely important” by participants. We explored how preferences vary for more and less effective contraceptive methods. ResultsIn multivariate analysis, non-Hispanic Black, Latinas and Asian Pacific Islander women were more likely to report the following features as extremely important compared to non-Hispanic Whites (p<0.05): being able to stop using the method at any time, using a method only with intercourse and the method not changing her menstrual periods. Non-Hispanic Black and Latina women were statistically more likely to report that protection against sexually transmitted diseases, having control over when and whether to use the method and being able to become pregnant after stopping use were extremely important. The contraceptive feature preferences of racial and ethnic minority women in our study had a relatively lower match with high efficacy methods and higher match for low efficacy methods compared to White women (p<0.05). ConclusionsHigh rates of unintended pregnancy among minority women may be due in part to differences in contraceptive features preferences and discrepancy between their preferences and the features of currently available highly effective methods. ImplicationsIn the context of disparities in rates of unintended pregnancy by racial and ethnic group, this variation in preferences for contraceptive features by race/ethnicity may explain differences in contraceptive use and can inform the development of more acceptable methods of contraception.

Racial Minority Women and Criminal Justice Responses to Domestic Violence

Racialized minority women’s experiences with Canadian specialized criminal justice responses to domestic violence have seldom been documented. Informed by an intersectionality framework, this qualitative study presents the struggles of 14 racial minority women from three Canadian cities and their experiences with the police and criminal court’s response to their partner’s acts of domestic violence. The results focus on how well specialized criminal justice responses address the needs of these women and protect them from further violence. Factors that facilitate or deter these women from approaching the criminal justice system for help are highlighted. The implications of these women’s narratives for criminal justice responses to domestic violence are discussed.

Abstract B68: Explanatory models of risk: The role of social context in breast cancer risk perception and decision making

Abstract Background: The current practice of counseling high-risk breast cancer patients using probabilistic risk estimates has not proven to be effective in engaging women, with less than 1% of eligible women participating in medical interventions to reduce breast cancer risk. Further, studies show that racial and ethnic minority women are under-represented in breast cancer prevention clinical trials (Cyrus-David, 2006), and they are less likely than whites to be aware of, discuss, or take chemoprevention agents (Kaplan et al., 2006). This study seeks to describe how a diverse group of women use explanatory models of risk to describe perceptions of breast cancer risk and make decisions about risk-reducing behaviors. Methods: 30 in-depth, qualitative interviews were collected at two US academic hospitals as part of a National Surgical Adjuvant Breast and Bowel Project mixed-methods study to oversample for racial and ethnic minorities. Women identified to have an elevated risk of developing breast cancer were interviewed following risk counseling with a medical provider. A thematic analysis informed by grounded theory methods was conducted. The explanatory model framework (Kleinman, 1978) guided formation of codes around explanatory model topic areas (etiology, symptoms, pathophysiology, course of illness, and treatment). These explanatory model codes were supplemented with inductive codes developed through open coding related to beliefs about cancer, risk, health, and social context. Results: Two key themes were identified as closely linked to women's explanatory models of risk: ‘risk perception’ and ‘control over risk’. These perceptions of risk and control were used to identify patterns in how women chose to manage their risk for breast cancer. Whether women had high or low perceptions of risk and control affected the ways in which they used explanatory models to describe their decisions. For example, women with perceptions of high risk and high control all discussed their social network as influential in modeling how they could reduce their own risk. These women adopted a variety of behaviors to gain control over risk, ranging from diet and exercise changes to the use of chemoprevention agents. Conversely, women with perceptions of high risk and low control based decisions much more closely on their general explanatory models of health, falling back on established philosophies in their decision-making. Women who opted for chemoprevention agents in this group discussed their philosophy of decision making as dependent on physician recommendations. How women interpreted ‘symptoms’ of risk was also essential to women's descriptions of their participation in risk-reduction behaviors. Those women who perceived their risk to be high interpreted symptoms such as ADH, ALH, or LCIS as a disease that required medical intervention. On the other hand, women with perceptions of low risk interpreted these symptoms as in the normal course of bodily changes, contrasting with information provided by physicians suggesting an increased risk for breast cancer. Discussion: There are important differences in how women use explanatory models of risk that contribute to the adoption of medical interventions. Risk counseling must address patient explanatory models, which influence both perceptions of risk and control over risk. These perceptions subsequently influence the ways in which women describe their decisions about participating in risk-reducing behaviors. New approaches are needed to address patient beliefs and perceptions about risk and prevention for breast cancer. Failing to acknowledge the experiences of patients threatens to marginalize minority groups from preventive care. Citation Format: Christine M. Gunn, Barbara Bokhour, Tracy A. Battaglia, Sarah Blakeslee, Christine Holmberg. Explanatory models of risk: The role of social context in breast cancer risk perception and decision making. [abstract]. In: Proceedings of the Seventh AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 9-12, 2014; San Antonio, TX. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2015;24(10 Suppl):Abstract nr B68.

Alcohol Use and HIV Testing in a National Sample of Women.

The HIV/AIDS epidemic continues to disproportionately affect racial and ethnic minority groups and women in the United States. Prevention research suggests that reduced alcohol use and increased HIV testing are associated with lower incidence of HIV transmission among high-risk populations. Multivariable logistic regression analyses of the 2009 National Health Interview Survey data were performed for a national sample of 15,470 adult women to examine the relationship between alcohol use and likelihood of HIV testing. There is a significant association between level of alcohol use and HIV testing. Women who identified as heavy drinkers and moderate drinkers were significantly less likely to report ever testing for HIV. Findings add to the limited literature on the association between alcohol use and HIV testing behaviors among women. Given the incidence of HIV among women, this study highlights the importance of HIV testing, especially for alcohol-using women.

Global Epidemiology of HIV Among Women and Girls Who Use or Inject Drugs: Current Knowledge and Limitations of Existing Data.

Women and girls who use and inject drugs are a critical population at risk of HIV. In this article, we review data on the epidemiology of drug use and injection among women globally and HIV prevalence among women and girls who use and inject drugs. Women and girls comprise one-third of people who use and inject drugs globally. There is substantial variation in HIV prevalence in this population, between and within countries. There is a pronounced lack of data examining HIV risk among particularly vulnerable subpopulations of women who use and inject drugs, including women who have sex with women, transgender women, racial and ethnic minority women, and young women. Women who use and inject drugs experience stigma and discrimination that affect access to services, and high levels of sexual risk exposures. There are significant gaps in our understanding of the epidemiology of drug use and injecting among women and girls and HIV risk and prevalence in this population. Women are frequently underrepresented in studies of drug use and HIV risk and prevalence among people who inject drugs, limiting our understanding of possible sex differences in this population. Most research originates from developed countries and may not be generalizable to other settings. A great deal of work is needed to improve understanding of HIV among particularly vulnerable subpopulations, such as transgender women who use drugs. Better data are critical to efforts to advocate for the needs of women and girls who use and inject drugs.

Racial and ethnic disparities in breastfeeding.

This article's aim is to review the literature on racial and ethnic disparities in breastfeeding rates and practices, address barriers to breastfeeding among minority women, conduct a systematic review of breastfeeding interventions, and provide obstetrician-gynecologists with recommendations on how they can help increase rates among minority women. In order to do so, the literature of racial and ethnic disparities in breastfeeding rates and barriers among minority women was reviewed, and a systematic review of breastfeeding interventions among minority women on PubMed and MEDLINE was conducted. Racial and ethnic minority women continue to have lower breastfeeding rates than white women and are not close to meeting the Healthy People 2020 goals. Minority women report many barriers to breastfeeding. Major efforts are still needed to improve breastfeeding initiation and duration rates among minority women in the United States. Obstetrician-gynecologists have a unique opportunity to promote and support breastfeeding through their clinical practices and public policy, and their efforts can have a meaningful impact on the future health of the mother and child.

Abstract C49: Treatment delay among African American women in St. Louis, Missouri

Abstract Introduction: Breast cancer mortality rates in the metropolitan St. Louis area are higher than those of Missouri as a whole or the United States. Similar to national trends, African American women in St. Louis have higher mortality rates than their Caucasian counterparts. Differences in the receipt of timely breast cancer treatment have been posited to be a factor that contributes to the disparity in breast cancer mortality between African American and Caucasian women. A cluster of late-stage breast cancer diagnoses has been identified in women living in North St. Louis, a predominantly African American area of St. Louis. Previous studies have shown that significant breast cancer diagnosis delays were occurring in woman referred from the St. Louis Safety Net System. The current study was carried out to examine treatment delay in a cohort of African American women diagnosed with breast cancer in North St. Louis between 2000 and 2008. Methods: Data were obtained from medical record extractions for 85 women who participated in a study funded by Susan G. Komen for the Cure that also included qualitative semi-structured interviews to determine breast cancer treatment histories. Medical records were examined for information about the type, timing, and sequence of breast cancer treatment. All of the women were treated within a local urban academic medical system. Treatment delay was calculated from the date of biopsy to the initiation of treatment and chi square tests were used to examine bivariate associations between demographic or clinical factors and treatment delay. Results: The median treatment delay was 26.5 days; 12.2% of the women had treatment delay over 60 days. This percentage is below the National Breast and Cervical Early Detection Program benchmark which states that no more than 20% of women should have a treatment delay of over 60 days. There were no statistically significant associations between demographic or clinical factors and treatment delay. Discussion: North St. Louis has the most concerning health and community indicators in the St. Louis area. In spite of the fact that this cohort of women resided in North St. Louis at diagnosis, there was no evidence of breast cancer treatment delay. These findings suggest that it is possible to treat racial and ethnic minority women with breast cancer without treatment delay, regardless of demographic factors. Delay in breast cancer treatment affects patient survival and is a vital area of breast cancer treatment research. More multidisciplinary approaches are needed to fully understand the many factors that contribute to breast cancer treatment delay so that interventions can be developed to improve outcomes in all breast cancer patients, particularly for African American women who suffer higher mortality rates despite lower incidence rates. Citation Format: Shahnjayla K. Connors, Melody Goodman, Neeraja Chavakula, Lailea Noel, Sarah Gehlert. Treatment delay among African American women in St. Louis, Missouri. [abstract]. In: Proceedings of the Sixth AACR Conference: The Science of Cancer Health Disparities; Dec 6–9, 2013; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2014;23(11 Suppl):Abstract nr C49. doi:10.1158/1538-7755.DISP13-C49

Political Participation of Women of Color: An Intersectional Analysis

This article develops the hypothesis that participation in American politics of minority women differs from political participation of white women. I propose that individuals with multiple subordinate group identities, namely, racial and ethnic minority women, will experience differences in political mobilization and interest in politics and demonstrate different participatory styles than white women do. On the basis of their identity in racial/ethnic identity groups, minority women operate as both racial/ethnic minorities and women in the American polity. As such, the analysis models intersectionality to account for historical narratives, cultural representations, and legal discrimination to show how both race/ethnicity and gender operate in tandem to influence how minority women participate in American politics.

Factors associated with maternal influenza immunization decision-making

Objective: We examined pregnant women's intention to obtain the seasonal influenza vaccine via a randomized controlled study examining the effects of immunization history, message exposure, and sociodemographic correlates.Methods: Pregnant women ages 18–50 participated in a randomized message framing study from September 2011 through May 2012. Venue-based sampling was used to recruit racial and ethnic minority women throughout Atlanta, Georgia. Key outcomes were evaluated using bivariate and multivariate analyses.Results: History of influenza immunization was positively associated with intent to immunize during pregnancy [OR = 2.31, 90%CI: (1.06, 5.00)]. Significant correlates of intention to immunize included perceived susceptibility to influenza during pregnancy [OR = 3.8, 90% CI: (1.75, 8.36)] and vaccine efficacy [OR = 10.53, 90% CI: (4.34, 25.50)]. Single message exposure did not influence a woman's intent to vaccinate.Conclusions: Prior immunization, perceived flu susceptibility and perceived vaccine effectiveness promoted immunization intent among this population of pregnant minority women. Vaccine efficacy and disease susceptibility are critical to promoting immunization among women with no history of seasonal influenza immunization, while those who received the vaccine are likely to do so again. These findings provide evidence for the promotion of repeated exposure to vaccine messages emphasizing vaccine efficacy, normative support, and susceptibility to influenza.

Public health national approach to reducing breast and cervical cancer disparities.

Breast and cervical cancer have had disparate impact on the lives of women. The burden of breast and cervical cancer is more prominent among some racial and ethnic minority women. Providing comprehensive care to all medically underserved women is a critical element in continuing the battle to reduce cancer burden and eliminate disparities. The National Breast and Cervical Cancer Early Detection Program is the only nationally organized cancer screening program for underserved women in the United States. Its public health goal is to ensure access to high-quality screening, follow-up, and treatment services for diverse and vulnerable populations that, in turn, may reduce disparities.

Mindfulness-based relapse prevention with racial and ethnic minority women

Racial and ethnic disparities in the treatment of addiction have been acknowledged for several years, yet little is known about which empirically supported treatments for substance use disorders are more or less effective in treating racial and ethnic minority clients. The current study was a secondary analysis of a randomized clinical trial of two evidence-based treatments, mindfulness-based relapse prevention (MBRP) and relapse prevention (RP), as part of a residential addiction treatment program for women referred by the criminal justice system (n=70). At 15-week follow-up, regression analyses found that racial and ethnic minority women in MBRP, compared to non-Hispanic and racial and ethnic minority women in RP, reported significantly fewer drug use days (d=.31) and lower addiction severity (d=.65), based on the Addiction Severity Index. Although the small sample size is a limitation, the results suggest that MBRP may be more efficacious than traditional treatments for racial and ethnic minority women.

Rethinking differences and inequality at the age of globalization

PurposeThe purpose of this paper is to use the case of white immigrant women domestics’ experiences in migration to demonstrate that their work experiences are different due to their whiteness. While their racial identity provides them with white privileges, they still face discrimination based on their occupational and immigrant statuses. The case study adds to existing literature on domestic service.Design/methodology/approachThe case study is based on several years of ethnographic work. The author conducted in‐depth interviews with Polish immigrant women and white female employers. The author also held focus groups with Polish women.FindingsWhite immigrant women from Poland do not automatically assume the white racial identity in the USA. Their whiteness is constructed and reinforced through their interactions with their white female employers. Their whiteness renders their experiences different from racial minority women and immigrant women of color. However, Polish domestics construct their positive work identity to counteract the negative images about them and domestic service as an occupation.Research limitations/implicationsThe main limitation the author sees is that the author could have conducted interviews with Mexican immigrant women to compare the differences in terms of their working conditions.Practical implicationsWhile Polish domestics seem to have better experiences than other groups of immigrant women, domestic workers are excluded from the labor law. They are thus without the protection of labor law. It is important for us to work for the right of immigrant workers to eradicate the inequality in society.Social implicationsThis case shows that the transnational labor migration contributes to further inequality in society since it is usually the migrant workers who take up the low skilled or unskilled work that has few possibilities for promotion and has few benefits. The government needs to address the transnational migration process and the exploitation of migrant workers ensuing from the process.Originality/valuePolish immigrant women are a unique group of women mainly because they are among the few white women who perform domestic service. Their experiences are different from racial minority women and immigrant women of color. Merging the whiteness approach and domestic service is an innovative approach.

Geographic and Racial Disparities in Breast Cancer–Related Outcomes in Georgia

To measure the effects of race/ethnicity, area measures of socioeconomic status (SES) and geographic residency status, and health care supply (HCS) characteristics on breast cancer (BC)-related outcomes. Female patients in Georgia diagnosed with BC in the years 2000-2009. Multilevel regression analysis with adjustment for variables at the county, census tract (CT), and individual level. The county represents the spatial unit of analysis for HCS. SES and geographic residency status were grouped at the CT level. Even after controlling for area-level characteristics, racial and ethnic minority women suffered an unequal BC burden. Despite inferior outcomes for disease stage and receipt of treatment, Hispanics had a marginally significant decreased risk of death compared with non-Hispanics. Higher CT poverty was associated with worse BC-related outcomes. Residing in small, isolated rural areas increased the odds of receiving surgery, decreased the odds of receiving radiotherapy, and decreased the risk of death. A higher per-capita availability of BC care physicians was significantly associated with decreased risk of death. Race/ethnicity and area-level measures of SES, geographic residency status, and HCS contribute to disparities in BC-related outcomes.

Ascertainment of Medicaid Payment for Delivery on the Iowa Birth Certificate: Is Accuracy Sufficient for Timely Policy and Program Relevant Analysis?

The Iowa Department of Public Health annually links Medicaid claims data to the birth certificate. Because the latest version of the birth certificate provides more timely and less costly information on delivery payment source, we were interested in assessing the validity and reliability of the birth certificate payment source compared to Medicaid paid claims. We linked Medicaid paid claims to birth certificates for calendar years 2007-2009 (n = 120,626). We measured reliability by Kappa statistic and validity by sensitivity, specificity, predictive value positive and negative. We examined reliability and validity overall and by maternal characteristics (e.g. age, race, ethnicity, education). The Kappa statistic for the birth certificate payment source indicated substantial agreement (0.78; 95 % CL 0.78-0.79). Sensitivity and specificity were also high, 86.3 % (95 % CL 86.0-86 6 %) and 91.9 % (95 % CL 91.7-92.1 %), respectively. The predictive value positive was 87.0 %. The predictive value negative was 91.4 %. Kappa and specificity were lower among women of racial and ethnic minorities, women younger than age 24, and women with less education. The overall Kappa, sensitivity and specificity generally suggest the birth certificate payment source is as valid and reliable as the linked data source. The birth certificate payment source is less valid and reliable for women of racial and ethnic minorities, women younger than age 24, and those with less education. Consequently caution should be exercised when using the birth certificate payment source for monitoring service use by the Medicaid population within specific population subgroups.

Race and gender as moderators of the relationship between the endorsement of traditional masculinity ideology and alexithymia: An intersectional perspective.

Using a large (n 1127) racially diverse (Black Americans, 24.3%; Latino/a Americans, 40.7%; and White Americans, 35.0%) dataset from a prior study (Levant, Richmond, et al., 2003), this study examined the role of race and gender as moderators of the relationship between the endorsement of traditional masculinity ideology and alexithymia. While neither race nor gender moderated the relationship between these two variables, the moderating effect of race on the relationship between endorsement of traditional masculinity ideology and alexithymia was strongly affected by gender: the endorsement of traditional masculinity ideology was more strongly related to alexithymia for White men than for racial minority men, whereas the endorsement of traditional masculinity ideology was more strongly related to alexithymia for racial minority women than for White women.

Women's Access to Credit

Access to credit can have significant effects on standards of living. Credit can allow households to optimally select the timing of their purchases and sustain a certain level of consumption when they are struck by unforeseen setbacks. Some households have been credit constrained and others have not. The difference in credit access may lead to disparities in households’ empowerment and perpetuate imbalances in terms of economic wellbeing. While the literature on credit has long suggested that racial and gender disparities exist in the credit market, to date, few studies have analyzed credit constraints with attention to racial minority women. This study uses household-level data from the Survey of Consumer Finances to examine women’s access to credit. In particular, access to credit of Asian women and that of other groups in the US are compared. This study provides empirical evidence that Asian women are less likely to be constrained in access to credit, while they are more likely to be discouraged by potential lenders than whites even after accounting for proxies for creditworthiness.