Health Disparities Research Research Articles

A Systematic Review of Health Disparities Research in Deep Brain Stimulation Surgery for Parkinson’s Disease (P5-4.001)

A Systematic Review of Health Disparities Research in Deep Brain Stimulation Surgery for Parkinson’s Disease (P5-4.001)

Relationships Among Determinants of Health, Cancer Screening Participation, and Sexual Minority Identity: A Systematic Review.

Purpose: To address cancer screening disparities and reduce cancer risk among sexual minority (SM) groups, this review identifies individual, interpersonal, and community/societal determinants of cancer screening (non)participation among differing SM identities. Methods: Seven scientific databases were searched. Inclusion criteria were as follows: (1) used quantitative methods; (2) English language; (3) cancer screening focus; and (4) at least one SM group identified. Articles were excluded if: (1) analysis was not disaggregated by SM identity (n = 29) and (2) quantitative analysis excluded determinants of cancer screening (n = 19). The Sexual and Gender Minority Health Disparities Research Framework guided literature synthesis. Results: Twelve studies addressed cervical (n = 4), breast (n = 3), breast/cervical (n = 3), or multiple cancers (n = 2). Other cancers were excluded due to inclusion/exclusion criteria. The total sample was 20,622 (mean 1525), including lesbian (n = 13,409), bisexual (n = 4442), gay (n = 1386), mostly heterosexual (n = 1302), and queer (n = 83) identities. Studies analyzing individual-level determinants (n = 8) found that socioeconomic status affected cervical, but not breast, cancer screening among lesbian and bisexual participants (n = 2). At the interpersonal level (n = 7), provider-patient relationship was a determinant of cervical cancer screening among lesbian participants (n = 4); a relationship not studied for other groups. Studies analyzing community/societal determinants (n = 5) found that rurality potentially affected cervical cancer screening among lesbian, but not bisexual people (n = 3). Conclusions: This review identified socioeconomic status, provider-patient relationship, and rurality as determinants affecting cancer screening among SM people. While literature addresses diverse SM groups, inclusion/exclusion criteria identified studies addressing cisgender women. Addressing disparities in the identified determinants of cervical cancer screening may improve participation among SM women. Further research is needed to understand determinants of cancer screening unique to other SM groups.

Discussing systemic racism and racial privilege at a large, academic health center using a modified privilege walk

BackgroundThere is a motivation for organizations to understand race and racism from the perspective of minoritized individuals. Academic health centers (AHC) are ideal organizations to have these conversations as they educate healthcare providers, support research in health disparities, and care for diverse patients.MethodsWe piloted and evaluated a virtual Modified Privilege Walk (MPW) with faculty, staff, and students at an AHC in July 2020 to promote difficult conversations about race/racism, social class, and privilege. Each MPW session was voluntary, held virtually over Zoom, and lasted one hour and thirty minutes. Before attending, participants answered questions based on their race/ethnicity and social class to calculate a “privilege score.” After each session, attendees were asked to complete an evaluation survey.ResultsThere were five virtual MPWs with 132 attendees, and 74 participants completed an evaluation survey (56% response rate). Many respondents were students (n = 29, 39.2%). Most respondents either agreed (n = 36, 48.6%) or strongly agreed (n = 32, 43.2%) that the virtual MPW positively impacted how they will interact with those of a different race/ethnicity. Attendees requested having more virtual MPWs with leadership, incorporating virtual MPWs in various program curricula, and requiring new employees to participate.ConclusionsAmerican organizations, particularly AHCs, should provide safe spaces and support these discussions surrounding race and racism as many were founded, built, or operated during a time of free labor and segregation that exerted power and control over minoritized individuals. Authors provide recommendations to dismantle organizational racism and support minoritized employees, patients, and students.

Assessing the Impact of AI Education on Hispanic Healthcare Professionals' Perceptions and Knowledge.

This study investigates the awareness and perceptions of artificial intelligence (AI) among Hispanic healthcare-related professionals, focusing on integrating AI in healthcare. The study participants were recruited from an asynchronous course offered twice within a year at the University of Puerto Rico Medical Science Campus, titled "Artificial Intelligence and Machine Learning Applied to Health Disparities Research", which aimed to bridge the gaps in AI knowledge among participants. The participants were divided into Experimental (n = 32; data-illiterate) and Control (n = 18; data-literate) groups, and pre-test and post-test surveys were administered to assess knowledge and attitudes toward AI. Descriptive statistics, power analysis, and the Mann-Whitney U test were employed to determine the influence of the course on participants' comprehension and perspectives regarding AI. Results indicate significant improvements in knowledge and attitudes among participants, emphasizing the effectiveness of the course in enhancing understanding and fostering positive attitudes toward AI. Findings also reveal limited practical exposure to AI applications, highlighting the need for improved integration into education. This research highlights the significance of educating healthcare professionals about AI to enable its advantageous incorporation into healthcare procedures. The study provides valuable perspectives from a broad spectrum of healthcare workers, serving as a basis for future investigations and educational endeavors aimed at AI implementation in healthcare.

Leveraging large language models to foster equity in healthcare.

Large language models (LLMs) are poised to change care delivery, but their impact on health equity is unclear. While marginalized populations have been historically excluded from early technology developments, LLMs present an opportunity to change our approach to developing, evaluating, and implementing new technologies. In this perspective, we describe the role of LLMs in supporting health equity. We apply the National Institute on Minority Health and Health Disparities (NIMHD) research framework to explore the use of LLMs for health equity. We present opportunities for how LLMs can improve health equity across individual, family and organizational, community, and population health. We describe emerging concerns including biased data, limited technology diffusion, and privacy. Finally, we highlight recommendations focused on prompt engineering, retrieval augmentation, digital inclusion, transparency, and bias mitigation. The potential of LLMs to support health equity depends on making health equity a focus from the start.

Arab, Middle Eastern, and North African Health Disparities Research: A Scoping Review.

Research in health disparities and how they affect underserved populations continues to grow and expand. However, the experiences of Arab/Middle Eastern and North African (MENA) Americans often go unnoticed, and yet, preliminary data suggests there are significant disparities between this population and other groups. The purpose of this scoping review is to examine and synthesize the extent of available literature on health disparities and outcomes for this group. A scoping review was conducted to investigate the current state of research on health disparities and outcomes among Arab/MENA individuals within the USA. The PRISMA protocol for scoping reviews was utilized. Through the use of PubMed and PsychInfo databases, the search identified 43 articles that were eligible for inclusion in the final review. Five themes emerged: prevalence and health outcomes, factors impacting health, comparison studies, barriers, and health literacy and beliefs. Extant data was equivocal, suggesting the need for further research. Research on Arab/MENA health disparities and outcomes is in the detection phase, indicating that more research is needed to elucidate the state of Arab/MENA health in the USA. These findings can help healthcare professionals and researchers understand the emerging literature on health disparities within the Arab/MENA community and inform further research and clinical practice within this population.

Aging, Race, and Health Disparities: Recommendations From the Research Centers Collaborative Network.

Racial disparities in adverse health outcomes with aging have been well described. Yet, much of the research focuses on racial comparisons, with relatively less attention to the identification of underlying mechanisms. To address these gaps, the Research Centers Collaborative Network held a workshop on aging, race, and health disparities to identify research priorities and inform the investigation, implementation, and dissemination of strategies to mitigate disparities in healthy aging. This article provides a summary of the key recommendations and highlights the need for research that builds a strong evidence base with both clinical and policy implications. Successful execution of these recommendations will require a concerted effort to increase participation of underrepresented groups in research through community engagement and partnerships. In addition, resources to support and promote the training and development of health disparities researchers will be critical in making health equity a shared responsibility for all major stakeholders.

Multilevel approaches to address disparities in lung cancer screening: a study protocol

BackgroundLow-dose computed tomography (lung cancer screening) can reduce lung cancer-specific mortality by 20–24%. Based on this evidence, the United States Preventive Services Task Force recommends annual lung cancer screening for asymptomatic high-risk individuals. Despite this recommendation, utilization is low (3–20%). Lung cancer screening may be particularly beneficial for African American patients because they are more likely to have advanced disease, lower survival, and lower screening rates compared to White individuals. Evidence points to multilevel approaches that simultaneously address multiple determinants to increase screening rates and decrease lung cancer burden in minoritized populations. This study will test the effects of provider- and patient-level strategies for promoting equitable lung cancer screening utilization.MethodsGuided by the Health Disparities Research Framework and the Practical, Robust Implementation and Sustainability Model, we will conduct a quasi-experimental study with four primary care clinics within a large health system (MedStar Health). Individuals eligible for lung cancer screening, defined as 50–80 years old, ≥ 20 pack-years, currently smoking, or quit < 15 years, no history of lung cancer, who have an appointment scheduled with their provider, and who are non-adherent to screening will be identified via the EHR, contacted, and enrolled (N = 184 for implementation clinics, N = 184 for comparison clinics; total N = 368). Provider participants will include those practicing at the partner clinics (N = 26). To increase provider-prompted discussions about lung screening, an electronic health record (EHR) clinician reminder will be sent to providers prior to scheduled visits with the screening-eligible participants. To increase patient-level knowledge and patient activation about screening, an inreach specialist will conduct a pre-visit phone-based educational session with participants. Patient participants will be assessed at baseline and 1-week post-visit to measure provider-patient discussion, screening intentions, and knowledge. Screening referrals and screening completion rates will be assessed via the EHR at 6 months. We will use mixed methods and multilevel assessments of patients and providers to evaluate the implementation outcomes (adoption, feasibility, acceptability, and fidelity).DiscussionThe study will inform future work designed to measure the independent and overlapping contributions of the multilevel implementation strategies to advance equity in lung screening rates.Trial registrationClinicalTrials.gov, NCT04675476. Registered December 19, 2020.

Individual, interpersonal, and community factors associated with health outcomes in patients with type 2 diabetes mellitus treated at federally qualified health centers.

To examine factors of influence in diabetes management and their association with self-reported health outcomes in patients with type 2 diabetes treated at Federally Qualified Health Centers (FQHCs). This cross-sectional study examined data from the 2014 Health Center Patient Survey (HCPS). Predictor variables were categorized across three levels of the National Institute on Minority Health and Health Disparities research framework. Outcome variables retrieved from HCPS included self-reports of blood glucose levels, and diabetes-related emergency department (ED)/hospital visits during past year. A total of 936 patients with diabetes were included. Most (65%) participants received a diabetes self-management plan. During the previous year, 72% received > = 2 A1C checks, 52% reported high blood glucose levels, and 12% visited an ED/hospital. Multivariable results showed that insulin use and receiving a self-management plan were associated with high blood glucose levels and ED/hospital visits. Community factors of being unable to get medications and receiving a specialist foot exam were respectively associated with high blood glucose levels and ED/hospital visits. Different factors were associated with health outcomes in patients with diabetes treated at FQHCs. Identifying these factors can help with targeted screening and follow-up and assessing potential interventions to improve health outcomes. The online version contains supplementary material available at 10.1007/s40200-024-01388-5.

Focus areas and methodological characteristics of North American-based health disparity research in sports medicine: a scoping review

ObjectiveHealth disparities are widely prevalent; however, little has been done to examine and address their causes and effects in sports and exercise medicine (SEM). We aimed to summarise the focus...

Transplant hepatology and diversity: A decade-long analysis (2013-2022).

Diversity among physicians has been shown to positively impact patient care. Physicians from minority backgrounds are more likely to serve underserved communities and be involved in health disparities research. Efforts to increase the proportion of underrepresented minorities and women in medicine will help prepare a physician workforce that best cares for a diversifying nation. The purpose of this paper was to highlight trends in sex and ethnic representation among incoming U.S. transplant hepatology trainees over a 10-year period.

Accelerating health disparities research with artificial intelligence.

Accelerating health disparities research with artificial intelligence.

A Report on the Keynote Address and Symposium on Research in Health Disparities in the USA

Ensuring a diverse cancer research workforce remains challenging despite national recommendations and pathway programs dedicated to this mission. A panel composed of researchers, educators, and implementation scientists convened at the Binaytara Foundation’s 2023 Summit on Cancer Health Disparities to discuss funded pathway opportunities, share case examples, and outline best practices to achieve a diverse workforce and support research in cancer health equity. The panelists highlighted existing pathway opportunities through the National Cancer Institute’s Center to Reduce Health Disparities and illustrated specific funded examples, such as the University of Utah’s Huntsman Cancer Institute’s PathMaker program, the University of Utah’s postbaccalaureate program, and NIH diversity supplement mechanisms. Programmatic examples were illustrated with success stories from the panel. The panelists concluded with the following insights for successful pathway implementation: 1) Since a diverse research workforce benefits society, investing in training and funding mechanisms is critical to promote individual and societal success in making progress towards cancer health equity; 2) A holistic, inclusive, and pathway-focused approach can successfully support, retain, and promote students, trainees, and faculty underrepresented in medicine and science; and 3) An inclusive workforce is best prepared to meet the needs of the diverse communities we serve.

Dehumanization, attitudes toward seeking professional psychological care, and mental health among African American women.

Self-infrahumanization or perceiving oneself as lacking the experience of uniquely human emotions, and endorsement of Strong Black Woman (SBW) schema, or self-superhumanization, are two forms of dehumanization. Among African American women, SBW schema endorsement is associated with greater negative attitudes toward seeking professional psychological help (ATSPPH) and poorer mental health. Self-infrahumanization is associated with fewer adaptive stress responses and poorer well-being. This research examines the relationship between self-infrahumanization and self-superhumanization on ATSPPH and mental health among African American women. We hypothesized that self-infrahumanization and self-superhumanization will be associated with greater negative ATSPPH and greater mental health symptomatology. We also hypothesized that ATSPPH will mediate the interactive effect of self-infrahumanization and SBW schema endorsement on mental health symptomatology. Four hundred and forty-nine self-identified African American women (Mage = 37.96; SDage = 15.55; age range: 18-87) completed an online, self-administered Qualtrics survey investigating the social and psychological determinants of health. Self-infrahumanization was not associated with mental health symptomatology. Greater SBW schema endorsement was associated with greater mental health symptomatology. Self-infrahumanization and SBW schema endorsement were not associated with ATSPPH. ATSPPH mediated the interaction between SBW and self-infrahumanization on mental health symptomatology. At high and average-but not low-levels of SBW schema endorsement, greater self-infrahumanization was associated with lower positive ATSPPH, which was then associated with greater mental health symptomatology. Among African American women, believing that one lacks the experience of uniquely human emotions exacerbates the negative effects of endorsing SBW schema. We discuss the role of dehumanization processes in health disparities research. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

PRESIDENTIAL SYMPOSIUM: BUILDING BRIDGES ACROSS THE SCIENCES TO CATALYZE SLEEP DISPARITIES RESEARCH

Abstract This BSS Presidential Symposium brings together scholars from Sociology, Social and Family Dynamics, Human Development and Family Studies, Occupational Science and Medicine to highlight a multidisciplinary approach to sleep disparities research. Sleep is essential for restoration of healthy brain function, the immune system, and overall physical and emotional well-being. Conversely, sleep deficiencies are associated with a wide range of poor physical and emotional health outcomes, health behaviors and premature mortality. Strong empirical evidence indicates that sleep health is socially patterned, such that minoritized populations are generally more likely to experience sleep disruptions, disorders, and difficulties. These sleep deficiencies are also observed across indicators of socioeconomic status, such as income and educational attainment. Despite documentation of sleep disparities, studies that examine underlying health disparity causal pathways contributing to sleep health disparities are limited. This symposium is aligned with recommended strategies to address sleep health disparities from the National Institutes of Health, including: a) develop and promote integrative research on sleep health disparities, b) investigate the health and social causes and consequences of sleep health disparities, and c) develop multilevel, culturally tailored interventions to address sleep health disparities. By placing people and place at the center of their research, these scholars demonstrate their approach to addressing current research gaps, challenges and opportunities in sleep and health disparities research among middle-aged and older adults that are important to advance this emerging field.

ADVANCING DIVERSITY IN AGING: THE AGE-ADAR SCHOLARS PROGRAM AT WVU

Abstract As the number and racial/ethnic diversity of older Americans, ages 65+ years increases, recruiting, training, and retaining a diverse workforce to support aging-related fields is essential. Supported by an R25 grant from the NIA, the goals of the Appalachian Gerontology Experiences: Advancing Diversity in Aging Research (AGE-ADAR) Scholars Program include training undergraduate MSTEM majors in aging and health disparities research, especially as these topics interact in Appalachia. In this brief presentation, we will review the goals and mechanisms through which these aims are accomplished. We will review both hard outcomes (i.e., conference presentations, publications) and soft outcomes (attitude change, career specialization) among our first two cohorts of Scholars. For example, each Scholar prepares two empirical abstracts, presents a poster on campus, presents one or more posters off-campus, produces a public-facing infographic about health disparities and aging, conducts a literature review, and composes an integrated essay related to how their MSTEM major can help to solve issues of health disparities among older adults in Appalachia. About half of our Scholars have co-authored published manuscripts, as well. Finally, other funding mechanisms to support training the next generation of researchers, scholars, and applied workers in aging will be discussed.

EFFECTIVE SOLUTIONS FOR CAREGIVERS OF OLDER ADULTS: A RAPID UMBRELLA REVIEW

Abstract The negative health impacts confronting over 35 million informal caregivers of older adults in the U.S. are well documented. Although targeted interventions aimed at informal caregivers have demonstrated efficacy in mitigating poor caregiver outcomes, gaps in the literature regarding cost, scalability, and the impact of policy remain. Such knowledge is essential, given the projected growth in the need for caregiving associated with a rapidly aging population coupled with the shrinking of the caregiving workforce. This rapid umbrella review aims to synthesize findings from systematic reviews of randomized clinical trials of interventions that targeted caregivers and specified caregiver outcomes. The National Institute on Minority Health and Health Disparities research framework guided this review to identify gaps in existing intervention research. Databases from diverse disciplinary perspectives, including PubMed, Scopus, APA PsycINFO, ABIM, ATLA, Sociological Abstracts, PAIS, and EconLit, were searched from 2018 to 2023. A total of 52 systematic reviews that met inclusion criteria and were published in English were included in the final review. Reviews described interventions targeting caregivers of older adults with the following conditions: dementia (30), stroke (4), cancer (4), heart disease (1), renal disease (1), mental illness (1), and mixed-diagnoses (11). Major findings reveal varied effects on caregiver burden, quality of life, and mental health, and the growing integration of telehealth interventions. Studies were commonly limited by heterogeneity of interventions and outcomes and small effect sizes. Future intervention development should consider targeting the specific needs of diverse caregivers and scaling effective interventions to broader caregiver populations.

Response to “The health disparities research industrial complex”

Response to “The health disparities research industrial complex”

Factors Influencing Eye Screening Adherence Among Latinx Patients With Diabetes: A Qualitative Study.

Latinx populations have the highest rates of visual impairment and blindness of any ethnic group in the United States, with most cases of diabetic retinopathy remaining undiagnosed. We aimed to identify factors influencing adherence with diabetic eye screening in Latinx communities. We conducted semistructured individual interviews with adult Latinx patients in Dane County, WI. Interviews were transcribed verbatim, translated from Spanish to English, and analyzed using QSR NVivo software. We performed both inductive open coding and deductive coding using the National Institute on Minority Health and Health Disparities Research Framework, as well as the Campbell and Egede Model. All participants (n = 20) self-identified as Latinx and were diagnosed with type 2 diabetes. The mean age was 61.5 years (range 33-79 years). Most participants were uninsured (60%), self-reported low or moderate health literacy (60%), and preferred to speak Spanish during their clinic appointments (75%). Individual-level barriers to diabetic eye screening included limited eye health literacy, lack of insurance coverage, and low self-efficacy with diabetes management. Health system-level facilitators included a recommendation to obtain eye screening from a primary care provider and the use of nonwritten forms of patient education. Community-level barriers included social isolation, concerns about inconveniencing others, machismo, and immigration status. We identified several health system- and community-level factors, in addition to individual-level factors, influencing adherence with diabetic eye screening in Latinx communities. Strategies addressing these factors may enhance the effectiveness of interventions to prevent blindness from diabetes and contribute to advancing health equity in Latinx communities.

Abstract IA016: Best practice strategies for SOGI data collection: Lessons learned from conducting and implementing the Ask SOGI study

Abstract Background: Collection of reliable data on Sexual Orientation and Gender Identity (SOGI) is essential for improving cancer care for Sexual and Gender Minority (SGM) populations that experience health disparities. To address gaps in reliable SOGI data collection, the National Cancer Institute (NCI) funded a series of awards to enhance sexual orientation and gender identity (SOGI) data collection at cancer centers. In August 2022, we launched the “We Ask Because We Care: Enhancing Sexual Orientation and Gender Identity Data Collection in New Mexico Cancer Center” (Ask SOGI) research intervention at the University of New Mexico Comprehensive Cancer Center (UNMCCC). Methods: Our research team used a mixed methods framework that included a cancer center-wide readiness assessment survey and focus groups to: 1) identify potential barriers to the systematic collection of patient SOGI data, incorporate National Academy of Science Engineering Medicine (NASEM) recommended SOGI measures into the UNMCCC Electronic Health Records; 2) tailor future staff/provider-cultural competency/cultural humility educational interventions, and 3) design a patient-facing “We Ask Because We Care” campaign to encourage welcoming and comfortable care for SGM patients and their informal cancer caregivers. Results: Although the study is on-going, initial survey findings suggest that staff and provider concerns regarding the appropriate method and time for asking patients about their SOGI may inhibit data collection at the cancer center. Respondents desired cancer center led education and training for staff and faculty that would include appropriate points and methods for SOGI data collection, demonstrations of SOGI integration and utilization into the electronic health record, and strategies to encourage conversational confidence so staff and providers can engage patients and their caregivers in sensitive topics. Moreover, SGM patients and caregiver focus group participant reviewers of the emerging “We Ask Because We Care” campaign were positive about the visual images, and acknowledged the importance of such efforts for creating affirmative spaces for SGM persons experiencing cancer. Conclusion: Interventions that address multilevel staff and provider, as well as patient and caregiver concerns regarding discussions of sexual orientation and gender identity data collection may increase more consistent collection of SOGI data that can be used to enhance cancer care and health disparities research. Citation Format: Miria Kano, Dolores Guest, Amy Farnbach Pearson, Mikaela Kosich, Kendal A. Jacobson, Shiraz Mishra, Andrew Sussman, Bernard Tawfik, Zoneddy Dayao, NFN Scout, Cathleen Willging. Best practice strategies for SOGI data collection: Lessons learned from conducting and implementing the Ask SOGI study [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr IA016.