White Residents Research Articles

Examining discrimination in home improvement financing (Home Mortgage Disclosure Act 2012–2016) and neighborhood health in the United States

ABSTRACT Institutional racism by financial institutions historically denied Black homeowners access to home mortgage loans. An understudied aspect of the homeownership continuum is home repair and maintenance, with few studies assessing discrimination in access to funding for home improvement. Using US Home Mortgage Disclosure Act data between 2012 and 2016, we assess individual and census-tract level predictors of applying to, and being denied home improvement loans. We find non-Hispanic Black applicants are significantly more likely to be denied loans (OR: 2.28 p < 0.01), and that loans for areas with a high proportion of non-Hispanic Black residents (OR: 1.09, p < 0.01) are most likely to be denied, while applications in tracts with the highest proportion of non-Hispanic white residents (OR: 0.90, p < 0.01) are least likely to be denied. We find that white (r = 0.203), but not Black (r = 0.02) home improvement applications are correlated with the proportion of Black residents currently residing in the census tract. Additionally, at the census tract level, home improvement loan denial rates are associated with usually getting less than 7 hours of sleep, which is associated with adverse health outcomes. Future research on institutional racism should consider the social and health impacts of discrimination in home improvement loan financing for Black applicants and within Black communities.

Community gardens and the 15-minute city: Scenario analysis of garden access in New York City

Community gardens are a form of green infrastructure that provides social and environmental benefits for garden users and the surrounding area. However, little is known about who has walking access to community gardens in most cities today and how this may change in the future. To address this gap, we examine 15-minute walking access to community gardens in New York City (NYC), and how land-use and investment decisions will impact the future of NYC as a 15-minute garden city. Our results indicate that more than half of the city’s residents have this access to a community garden, and that neighborhoods with lower income, lower proportions of white residents and homeowners, and higher rates of educational attainment have better access. Optimization modeling indicates that universal 15-minute access is unlikely, though more than 70% of NYC residents could have walking access with as few as 50 additional community gardens. Supporting new community gardens on vacant land and parking lots is the most efficient way to expand access, though siting community gardens on a range of land use types is required to maximize access. By mapping community gardens, analyzing their distribution, and modeling how to scale-up urban agriculture, this paper presents a scenario-based process for exploring how and where to expand urban amenities.

Racial/ethnic differences in receipt of naloxone distributed by opioid overdose prevention programs in New York City

IntroductionWe evaluated racial/ethnic differences in the receipt of naloxone distributed by opioid overdose prevention programs (OOPPs) in New York City (NYC).MethodsWe used naloxone recipient racial/ethnic data collected by OOPPs from April 2018 to March 2019. We aggregated quarterly neighborhood-specific rates of naloxone receipt and other covariates to 42 NYC neighborhoods. We used a multilevel negative binomial regression model to assess the relationship between neighborhood-specific naloxone receipt rates and race/ethnicity. Race/ethnicity was stratified into four mutually exclusive groups: Latino, non-Latino Black, non-Latino White, and non-Latino Other. We also conducted racial/ethnic-specific geospatial analyses to assess whether there was within-group geographic variation in naloxone receipt rates for each racial/ethnic group.ResultsNon-Latino Black residents had the highest median quarterly naloxone receipt rate of 41.8 per 100,000 residents, followed by Latino residents (22.0 per 100,000), non-Latino White (13.6 per 100,000) and non-Latino Other residents (13.3 per 100,000). In our multivariable analysis, compared with non-Latino White residents, non-Latino Black residents had a significantly higher receipt rate, and non-Latino Other residents had a significantly lower receipt rate. In the geospatial analyses, both Latino and non-Latino Black residents had the most within-group geographic variation in naloxone receipt rates compared to non-Latino White and Other residents.ConclusionsThis study found significant racial/ethnic differences in naloxone receipt from NYC OOPPs. We observed substantial variation in naloxone receipt for non-Latino Black and Latino residents across neighborhoods, indicating relatively poorer access in some neighborhoods and opportunities for new approaches to address geographic and structural barriers in these locations.

Trends in Cardiovascular Disease Mortality by County-Level Social Vulnerability Index in the United States.

Background Although cardiovascular mortality(CVM) rates in the United States have been declining overall, our study evaluated whether this holds true for areas with increased social deprivation. Methods and Results We used county-level cross-sectional age-adjusted CVM rates (aa-CVM) (2000-2019) linked to the Centers for Disease Control and Prevention Social Vulnerability Index (SVI-2010). We grouped counties as per SVI (Groups I 0-0.2, II 0.21-0.4, III 0.41-0.6, IV 0.61-0.8, and V 0.81-1) and calculated the relative change in the aa-CVM between 2000 to 2003 and 2016 to 2019. We used adjusted linear regression analyses to explore the association between a higher SVI and temporal aa-CVM improvement; we studied this temporal change in aa-CVM across subgroups of race, sex, and location. The median aa-CVM rate (per 100 000) was 272.6 (interquartile range [IQR]: 237.5-311.7). The aa-CVM was higher in men (315.6 [IQR: 273.4-363.9]) than women (221.3 [IQR: 189.6-256.7]), and in Black residents (347.2 [IQR: 301.1-391.1]; P<0.001) than White residents (258.9 [IQR: 226-299.1]; P<0.001). The aa-CVM for SVI I (233.6 [IQR: 214.8-257.0]) was significantly lower than that of group V (323.6 [IQR: 277.2-359.2]; P<0.001). The relative reduction in CVM was significantly higher for SVI group I (32.2% [IQR: 24.2-38.4]) than group V (27.2% [IQR: 19-34.1]) counties. After multivariable adjustment, a higher SVI index was associated with lower relative improvement in the age-adjusted CVM (model coefficient -3.11 [95% CI, -5.66 to -1.22]; P<0.001). Conclusions Socially deprived counties in the United States had higher aa-CVM rates, and the improvement in aa-CVM over the past 20 years was lower in these counties.

Adolescents with substance use referred to child protective services: Does substance use treatment prevent foster care entry?

AbstractAdolescent substance use has been linked to several negative outcomes, which can be exacerbated by exposure to adversity such as child maltreatment. However, few studies have examined the intersection of adolescent substance use and child protective service (CPS) involvement. This study examined the relationship between substance use treatment and entries into foster care among adolescents referred to CPS for maltreatment. Data for this study came from the National Child Abuse and Neglect Data System (NCANDS), an annually reported database that contains information on all CPS reports screened for investigation. NCANDS was merged with county‐level data from the American Community Survey to explore the relationship between treatment and foster care entry while adjusting for contextual factors. Our sample included 2326 adolescents who were referred to CPS in fiscal year (FY) 2018 and were followed until FY 2019 to examine correlates of foster care entry. A series of multilevel logistic regressions were conducted. Approximately 1 in 20 adolescents entered foster care during the study period and 1 in 10 used treatment services prior to foster care entry. Substance use treatment increased the odds of foster care entry (adjusted odds ratios = 2.30, p &lt; 0.05), while adolescents residing in counties with higher percentages of non‐Hispanic White residents had lower odds of foster care entry (adjusted odds ratios = 0.67, p &lt; 0.05). Among adolescents with substance use referred to CPS, substance use treatment increases the likelihood of foster care entry. This may highlight the need to provide services earlier and to ensure that adolescents can access treatment without entering state custody. Future research should explore these relationships in more depth.

Intersectional Disparities in Emergency Medicine Residents’ Performance Assessments by Race, Ethnicity, and Sex

Previous studies have demonstrated sex-specific disparities in performance assessments among emergency medicine (EM) residents. However, less work has focused on intersectional disparities by ethnoracial identity and sex in resident performance assessments. To estimate intersectional sex-specific ethnoracial disparities in standardized EM resident assessments. This retrospective cohort study used data from the Association of American Medical Colleges and the Accreditation Council for Graduate Medical Education Milestones (Milestones) assessments to evaluate ratings for EM residents at 128 EM training programs in the US. Statistical analyses were conducted in June 2020 to January 2023. Training and assessment environments in EM residency programs across comparison groups defined by ethnoracial identity (Asian, White, or groups underrepresented in medicine [URM], ie, African American/Black, American Indian/Alaska Native, Hispanic/Latine, and Native Hawaiian/Other Pacific Islander) and sex (female/male). Mean Milestone scores (scale, 0-9) across 6 core competency domains: interpersonal and communications skills, medical knowledge, patient care, practice-based learning and improvement, professionalism, and system-based practice. Overall assessment scores were calculated as the mean of the 6 competency scores. The study sample comprised 128 ACGME-accredited programs and 16 634 assessments for 2708 EM residents of which 1913 (70.6%) were in 3-year and 795 (29.4%) in 4-year programs. Most of the residents were White (n = 2012; 74.3%), followed by Asian (n = 477; 17.6%), Hispanic or Latine (n = 213; 7.9%), African American or Black (n = 160; 5.9%), American Indian or Alaska Native (n = 24; 0.9%), and Native Hawaiian or Other Pacific Islander (n = 4; 0.1%). Approximately 14.3% (n = 386) and 34.6% (n = 936) were of URM groups and female, respectively. Compared with White male residents, URM female residents in 3-year programs were rated increasingly lower in the medical knowledge (URM female score, -0.47; 95% CI, -0.77 to -0.17), patient care (-0.18; 95% CI, -0.35 to -0.01), and practice-based learning and improvement (-0.37; 95% CI, -0.65 to -0.09) domains by postgraduate year 3 year-end assessment; URM female residents in 4-year programs were also rated lower in all 6 competencies over the assessment period. This retrospective cohort study found that URM female residents were consistently rated lower than White male residents on Milestone assessments, findings that may reflect intersectional discrimination in physician competency evaluation. Eliminating sex-specific ethnoracial disparities in resident assessments may contribute to equitable health care by removing barriers to retention and promotion of underrepresented and minoritized trainees and facilitating diversity and representation among the emergency physician workforce.

Geospatial Distribution of Racial Disparities in Influenza Vaccination in Nursing Homes

ObjectivesThis study aimed to assess the distribution of racial disparities in influenza vaccination between White and Black short-stay and long-stay nursing home residents among states and hospital referral regions (HRRs). DesignRetrospective cohort study. Setting and ParticipantsWe included short-stay and long-stay older adults residing in US nursing homes during influenza seasons between 2011 and 2018. Included residents were aged ≥65 years and enrolled in Traditional Medicare. Analyses were conducted using resident-seasons, whereby residents could contribute to one or more influenza seasons if they resided in a nursing home across multiple seasons. MethodsOur comparison of interest was marginalized vs privileged racial group membership measured as Black vs White race. We obtained influenza vaccination documentation from resident Minimum Data Set assessments from October 1 through June 30 of a particular influenza season. Nonparametric g-formula was used to estimate age- and sex-standardized disparities in vaccination, measured as the percentage point (pp) difference in the proportions of individuals vaccinated between Black and White nursing home residents within states and HRRs. ResultsThe study included 7,807,187 short-stay resident-seasons (89.7% White and 10.3% Black) in 14,889 nursing homes and 7,308,111 long-stay resident-seasons (86.7% White and 13.3% Black) in 14,885 nursing homes. Among states, the median age- and sex-standardized disparity between Black and White residents was 10.1 percentage points (pps) among short-stay residents and 5.3 pps among long-stay residents across seasons. Among HRRs, the median disparity was 8.6 pps among short-stay residents and 5.0 pps among long-stay residents across seasons. Conclusions and ImplicationsOur analysis revealed that the magnitudes of vaccination disparities varied substantially across states and HRRs, from no disparity in vaccination to disparities in excess of 25 pps. Local interventions and policies should be targeted to high-disparity geographic areas to increase vaccine uptake and promote health equity.

Demographic and Geographic Characterization of Excess Mortality During the COVID-19 Pandemic in Baltimore City, Maryland, March 2020 to March 2021.

Estimates of excess mortality can provide insight into direct and indirect impacts of the coronavirus disease 2019 (COVID-19) pandemic beyond deaths specifically attributed to COVID-19. We analyzed death certificate data from Baltimore City, Maryland, from March 1, 2020, to March 31, 2021, and found that 1,725 individuals (95% confidence interval: 1,495, 1,954) died in excess of what was expected from all-cause mortality trends in 2016-2019; 1,050 (61%) excess deaths were attributed to COVID-19. Observed mortality was 23%-32% higher than expected among individuals aged 50 years and older. Non-White residents of Baltimore City also experienced 2 to 3 times higher rates of excess mortality than White residents (e.g., 37.4 vs. 10.7 excess deaths per 10,000 population among Black residents vs. White residents). There was little to no observed excess mortality among residents of hospice, long-term care, and nursing home facilities, despite accounting for nearly 30% (312/1,050) of recorded COVID-19 deaths. There was significant geographic variation in excess mortality within the city, largely following racial population distributions. These results demonstrate the substantial and unequal impact of the COVID-19 pandemic on Baltimore City residents and the importance of building robust, timely surveillance systems to track disparities and inform targeted strategies to remediate the impact of future epidemics.

Racial/ethnic disparities in timely receipt of buprenorphine among Medicare disability beneficiaries

BackgroundMedicare disability beneficiaries (MDBs) have disproportionately high risk of opioid use disorder (OUD) and related harms given high rates of comorbidities and high-dose opioid prescribing. Despite this increased risk, little is known about timely receipt of medication for opioid use disorder (MOUD), including potential disparities by patient race/ethnicity or moderation by county-level characteristics. MethodsNational Medicare claims for a sample of MDBs with incident OUD diagnosis between March 2016 and June 2019 were linked with county-level data. Multivariable mixed effects Cox proportional hazards models estimated time (in days) to buprenorphine receipt within 180 days of incident OUD diagnosis. Primary exposures included individual-level race/ethnicity and county-level buprenorphine prescriber availability, percent non-Hispanic white (NHW) residents, and Social Deprivation Index (SDI) score. ResultsThe sample (n=233,079) was predominantly White (72.3%), ≥45 years old (76.3%), and male (54.8%). Black (adjusted hazard ratio [aHR]=0.50; 95% CI, 0.47–0.54), Asian/Pacific Islander (aHR=0.54; 95% CI, 0.41–0.72), Hispanic/Latinx (aHR=0.81; 95% CI, 0.76–0.87), and Other racial/ethnic groups (aHR=0.75; 95% CI, 0.58–0.97) had a lower likelihood of timely buprenorphine than non-Hispanic white beneficiaries after adjusting for individual and county-level confounders. Timely buprenorphine receipt was positively associated with county-level buprenorphine prescriber availability (aHR=1.05; 95% CI, 1.04–1.07), percent non-Hispanic white residents (aHR=1.01; 95% CI, 1.00–1.01), and SDI (aHR=1.06; 95% CI, 1.01–1.10). ConclusionsRacial/ethnic disparities highlight the need to improve access to care for underserved groups. Implementing equity-focused quality and performance measures and developing interventions to increase office-based buprenorphine prescribing in predominantly minority race/ethnicity counties may reduce disparities in timely access to medication for OUD.

A Right Restricted: Racial Threat and the Sponsorship of Restrictive Voting Laws

AbstractIn the aftermath of the United States’ 2020 presidential election, state legislatures have introduced and passed an unprecedented number of restrictive voting bills. While past research has looked at the state-level drivers of restrictive voting legislation, this project explores what factors predict which legislators within states push for these laws. Specifically, I ask whether district-level characteristics predict when lawmakers use bill sponsorship to send messages about their positions beyond those sent by simple roll-call votes. I use theories of geographical threat and racial resentment to predict where sponsorship of these bills is most likely. My results tie these theoretical expectations to observed legislative activity: the whitest state legislative districts in the least-white states were the most likely to be represented by lawmakers who sponsored restrictive bills, as were districts with the most racially resentful white residents. I conclude that, despite lawmakers justifying these restrictive laws by claiming that fraud is a major problem, race and racism are inherently tied to the introduction and passage of these bills. This raises important questions about commitments to multiracial democracy.

“We grew up in the church”: A critical discourse analysis of Black and White rural residents’ perceptions of mental health

RationaleKnown as the “Black-White mental health paradox,” Black Americans typically report better mental health than White Americans, despite chronic exposure to the psychologically harmful effects of racism and discrimination. Yet, researchers rarely examine how mental health is experienced across racial groups in economically distressed rural regions where all residents have disproportionately less access to mental healthcare resources. ObjectiveThe purpose of this study was to explore how the racialized social system potentially contributes to the mental health beliefs and attitudes of racially majoritized and minoritized rural residents. MethodsWe conducted a secondary analysis of 29 health-focused oral history interviews from Black American (n = 16) and White American (n = 13) adults in rural North Carolina. Through critical discourse analysis, we found nuanced discourses linked to three mental-health-related topics: mental illness, stressors, and coping. ResultsWhite rural residents’ condemning discourses illustrated how their beliefs about mental illnesses were rooted in meritocratic notions of individual choice and personal responsibility. Conversely, Black rural residents offered compassionate discourses toward those who experience mental illness, and they described how macro-level mechanisms can affect individual well-being. Stressors also differed along racial lines, such that White residents were primarily concerned about perceived social changes, and Black residents referenced experiences of interpersonal and structural racism. Related to coping, Black and White rural residents characterized the mental health benefits of social support from involvement in their respective religious organizations. Only Black residents signified that a personal relationship with a higher power was an essential positive coping mechanism. ConclusionsOur findings suggest that belief (or disbelief) in meritocratic ideology and specific religious components could be important factors to probe with Black-White patterning in mental health outcomes. This research also suggests that sociocultural factors can disparately contribute to mental health beliefs and attitudes among diverse rural populations.

The Intersection of Race and Sex: A New Perspective Into Diversity Trends in Orthopaedic Surgery.

Studies on diversity in orthopaedic surgery have exclusively examined challenges from a race or sex perspective. This study examines trends in the diversity of entering orthopaedic surgery residents from the intersection of race and sex. The American Association of Medical Colleges was queried for individuals entering orthopaedic surgery residencies in the United States from 2001 to 2020. Deidentified data on self-reported sex and race were collected. Proportions by the intersection of sex and race were calculated for 5-year intervals. From 2001 to 2020, most of the new female residents identified as White (mean, 71.0%). The average proportion of White female residents was lower in 2016 to 2020 than in 2001 to 2005 (71.0% vs. 73.2%) but higher than that in 2011 to 2015 (66.8%). The 2016 to 2020 average was lower than that of 2001 to 2005 for those who identified as Asian (11.7% vs. 14.9%), Black (4.1% vs. 4.8%), Hispanic (3.0% vs. 4.4%), and American Indian/Alaska Native (0.0% vs. 1.5%). Most of the new male orthopaedic surgery residents from 2001 to 2020 identified as White (mean, 74.1%), but the average decreased across every 5-year interval from 2001 to 2005 (76.1%) to 2016 to 2020 (71.1%). The 2016 to 2020 average was lower than that of 2001 to 2005 for those who identified as Asian (12.2% vs. 13.6%), Black (3.5% vs. 4.2%), Hispanic (3.0% vs. 3.4%), American Indian/Alaska Native (0.0% vs. 0.6%), and Native Hawaiian/Other Pacific Islander (0.1% vs. 0.3%). In 2020, White male residents made up to 54.2% of new residents. White female residents were the second highest group represented (12.1%). Increases in representation were observed for some subgroups of new orthopaedic surgery residents from 2001 to 2020. Although the proportion of both White female and male residents decreased by 11.5% during the 20-year study period, these individuals still made up most of the trainees in 2020. These results underscore the need for conversations and recruitment practices to take into consideration the intersectionality of identities.

Financial, Social, and Health Impacts from the COVID-19 Pandemic: Findings from the Healthy Chicago Survey.

This study examines self-reported impacts of the COVID-19 pandemic among Chicago residents and disparities of these impacts across demographic characteristics. Six logistic regression models were developed to identify demographic and socioeconomic factors associated with each COVID-19 impact. The study used de-identified and weighted data from the 2020 Healthy Chicago Survey (HCS). HCS is an annual survey using an address-based random sampling method administered by the Chicago Department of Public Health (CDPH) across the city of Chicago on adults aged 18 or older living between July 17 and November 11, 2020, and received 4517 responses. Chicago residents with lower socioeconomic status had a higher likelihood of food and housing insecurity. Non-Hispanic (NH) Black residents were more likely to report being unable to obtain food (OR: 2.996; 95% CI: 2.268-2.324); being unable to pay for rent, mortgage, or bills (OR: 2.352; 95% CI: 2.325-2.380); and grief from a loss of someone to COVID-19 (OR: 2.037; 95% CI: 2.013-2.061) compared to NH White residents. NH White residents were more likely than other racial/ethnic groups to report loss of social connections, worsened mental health, and canceling or postponing medical care. The analysis showed higher odds of social contact loss and worsened mental health from COVID-19 in NH White and higher education populations. By implementing strategies to address specific challenges faced by different racial groups, Chicago may effectively mitigate pandemic's adverse effects. These strategies can promote a more inclusive approach to distributing COVID investments for programs and policies.

Cardiac Arrest Survival at Emergency Medical Service Agencies in Catchment Areas With Primarily Black and Hispanic Populations

Black and Hispanic patients are less likely to survive an out-of-hospital cardiac arrest (OHCA) than White patients. Given the central importance of emergency medical service (EMS) agencies in prehospital care, a better understanding of OHCA survival at EMS agencies that work in Black and Hispanic communities and White communities is needed to address OHCA disparities. To examine whether EMS agencies serving catchment areas with primarily Black and Hispanic populations (Black and Hispanic catchment areas) have different rates of OHCA survival than agencies serving catchment areas with primarily White populations (White catchment areas). A cohort study including adults with nontraumatic OHCA from January 1, 2015, to December 31, 2019, in the Cardiac Arrest Registry to Enhance Survival was conducted. Data analysis was conducted from August 17, 2022, to July 7, 2023. Emergency medical service agencies, categorized as working in catchment areas where the combination of Black and Hispanic residents made up more than 50% of the population or where White residents made up more than 50% of the population. The unit of analysis was the EMS agency. The primary outcome was agency-level risk-standardized survival rates (RSSRs) to hospital admission for OHCA at each EMS agency, which were calculated using hierarchical logistic regression and compared between agencies serving Black and Hispanic and White catchment areas. Whether differences in OHCA survival were explained by EMS and first responder measures was evaluated with additional adjustment for these factors. Among 764 EMS agencies representing 258 342 OHCAs, 82 EMS agencies (10.7%) had a Black and Hispanic catchment area. Overall median age of the patients was 63.0 (IQR, 52.0-75.0) years, 36.1% were women, and 63.9% were men. Overall, the mean (SD) RSSR was 27.5% (3.6%), with lower survival at EMS agencies with Black and Hispanic catchment areas (25.8% [3.6%]) compared with agencies with White catchment areas (27.7% [3.5%]; P < .001). Among the 82 EMS agencies with Black and Hispanic catchment areas, a disproportionately higher number (32 [39.0%]) was in the lowest survival quartile, whereas a lower number (12 [14.6%]) was in the highest survival quartile. Additional adjustment for EMS response times, EMS termination of resuscitation rates, and first responder rates of initiating cardiopulmonary resuscitation or applying an automated external defibrillator before EMS arrival did not meaningfully attenuate differences in RSSRs between agencies with Black and Hispanic compared with White catchment areas (mean [SD] RSSRs after adjustment, 25.9% [3.3%] vs 27.7% [3.1%]; P < .001). Risk-standardized survival rates for OHCA were 1.9% lower at EMS agencies working in Black and Hispanic catchment areas than in White catchment areas. This difference was not explained by EMS response times, rates of EMS termination of resuscitation, or first responder rates of initiating cardiopulmonary resuscitation or applying an automated external defibrillator. These findings suggest there is a need for further assessment of these discrepancies.

Federal Nursing Home Policies on Antipsychotics had Similar Impacts by Race and Ethnicity for Residents With Dementia.

Federal initiatives have been successful in reducing antipsychotic exposure in nursing home residents with dementia. We assessed if these initiatives were implemented equally across racial and ethnic minority groups. Retrospective, cross-sectional trends study. National long-stay nursing home residents with dementia from 2011 to2017. We examined trends in psychotropic drug class exposures from the Minimum Data Set assessments for non-Hispanic Black (NHB), Hispanic, and non-Hispanic White (NHW) residents using interrupted time-series analyses with age-sex standardized quarterly outcomes and time points to denote the National Partnership (2012) and Five Star Rating changes (2015). Initially, antipsychotic (33.0%) and sedative (6.8%) exposure was highest for Hispanic residents; antidepressant (59.8%) and anxiolytic (23.4%) exposure was highest for NHW residents; NHB residents had the lowest use of each. Antipsychotic use dropped at the time of the Partnership (β=-0.8807, P=.0023) and the slope declined further after the Partnership (β=-0.6611, P < .0001) for NHW. In comparison to NHW, the level and slope changes for NHB and Hispanics were not significantly different. The Five Star Rating change did not impact the level of antipsychotic use (β= 0.027, P= .9467), but the slope changed to indicate a slowed rate of decline (β= 0.1317, P= .4075) for NHW. As to the other psychotropic drug classes, there were few significant differences between trends seen in the racial and ethnic subgroups. The following exceptions were noted: antidepressant use decreased at a faster rate for NHB residents post-Partnership (β=-0.1485, P= .0371), and after the Five Star Rating change, NHB residents (β=-0.0428, P= .0312) and Hispanic residents (β=-0.0834, P < .0001) saw antidepressant use decrease faster than NHW. Sedative use in slope post-Partnership period (β=-0.086, P= .0275) and post-Five Star Rating (β=-0.0775, P < .0001) declined faster among Hispanic residents. We found little evidence of clinically meaningful differences in changes to 4 classes of psychotropic medication use among racial and ethnic minority nursing home residents with dementia following 2 major federal initiatives.

Model Testing of the Factors that are Associated with Care Interactions among Nursing Home Residents with Dementia.

The purpose of this study was to test a model of the resident and community factors that are associated with quality of care interactions among nursing home (NH) residents living with dementia and test for invariance between model fit when tested with the Black versus White residents and female versus male residents. It was hypothesized that resident age, gender, race, pain, comorbidities, quality of life, resistiveness to care, function, cognition, community profit status, overall community star rating, community size, and staffing star rating would be directly and/or indirectly associated with quality of care interactions. It was also hypothesized that the model fit would be invariant by resident race and gender. This was a secondary data analysis using baseline, cross-sectional data from the Evidence Integration Triangle for Behavioral and Psychological Symptoms of Dementia (EIT-4-BPSD) intervention study. The study included 528 residents from 55 NH facilities. Descriptive statistics and structural equation modeling was used to test the proposed model. The results showed that the final model with significant paths only had a poor fit to the data (χ2/df= 10.79, comparative fit index= 0.57, Tucker-Lewis index= 0.15, normed fit index= 0.57, root mean square error of approximation= 0.13). However, the findings indicated that comorbidities, pain, profit status, and overall community star rating were significantly associated with quality of care interactions. There was no difference in model fit between Black residents versus White residents, and between male versus female residents. This study suggests factors that may influence quality of care interactions. Managing comorbidities, managing pain, and supporting higher quality of care in NH communities will likely help increase the frequency of positive care interactions. These findings can inform future interventions and training curricula for NH care staff to promote positive care interactions.

What is there to be happy about? The impact of race and resilience in the United States

PurposeThe purpose of this study is to investigate racial differences in the moderating role of factors linked with resilience on the relationship between economic stress and happiness for Black and White residents of the USA.Design/methodology/approachSecondary data were downloaded from the World Values Survey Wave 7 for adult respondents living in the USA. The entire sample of respondents who self-identified as belonging to the Black race (n = 209) was statistically matched (based on sex – 50% male and average age – 39 years) with a similarly sized random sample of respondents who self-identified as belonging to the White race (n = 217).FindingsThe results suggest that economic stress had the potential to trigger a resilience response. However, the protective factors in the resilience process differed by race of the respondent. The relationship between economic stress and perceptions of neighborhood safety was conditional on level of control for the White sample. The relationship between economic stress and happiness for the Black sample was conditional on the importance of faith.Originality/valueThe study was able to demonstrate the importance of race-based contextual differences in the roles of faith and control in the resilience process. The findings also increase the understanding of how life circumstances and individual characteristics, including race, impact happiness and how much or little resilience may play a part in the achievement of happiness.

Fear of a Black Neighborhood: Anti-Black Racism and the Health of White Americans.

Does anti-Black racism harm White Americans? We advance hypotheses that address this question within the neighborhood context. Hypotheses are tested with neighborhood and survey data from a probability sample of White residents of Nashville, Tennessee. We find that regardless of neighborhood crime rates or socioeconomic compositions, Whites report heightened perceptions of crime and danger in their neighborhoods as the proportion of Black residents increases. Perceived neighborhood danger, in turn, predicts increased symptoms of psychophysiological distress. When stratified by socioeconomic status (SES), however, low-SES Whites also report perceptions of higher status when living near more Black neighbors, which entirely offsets their distress. We conclude that although anti-Black racism can ironically harm the health of White Americans, compensatory racist ideologies can also offset these harms, particularly for lower-status Whites. We situate our findings within broader discussions of anti-Black racism, residential segregation, and psychiatric disorders commonly observed among White Americans.

The Elephant in the Room: Racial Microaggressions and Implicit Bias in Surgical Training.

The aim of this study was to examine the association between race, experience of microaggressions, and implicit bias in surgical training. There is persistent underrepresentation of specific racial and ethnic groups in the field of surgery. Prior research has demonstrated significant sex differences among those who experience microaggressions during training. However, little research has been conducted on the association between race and experiences of microaggressions and implicit bias among surgical trainees. A 46-item survey was distributed to general surgery residents and residents of surgical subspecialties through the Association of Program Directors in Surgery listserv and social media platforms. The questions included general information/demographic data and information about experiencing, witnessing, and responding to microaggressions during surgical training. The primary outcome was the prevalence of microaggressions during surgical training by self-disclosed race. Secondary outcomes were predictors of and adverse effects of microaggressions. A total of 1624 resident responses were obtained. General surgery residents comprised 825 (50.8%) responses. The female-to-male ratio was nearly equal (815:809). The majority of respondents identified as non-Hispanic White (63.4%), of which 5.3% of residents identified as non-Hispanic Black, and 9.5% identified as Hispanic. Notably, 91.9% of non-Hispanic Black residents (n=79) experienced microaggressions. After adjustment for other demographics, non-Hispanic Black residents were more likely than non-Hispanic White residents to experience microaggressions [odds ratio (OR): 8.81, P <0.001]. Similar findings were observed among Asian/Pacific Islanders (OR: 5.77, P <0.001) and Hispanic residents (OR: 3.35, P <0.001). Race plays an important role in experiencing microaggressions and implicit bias. As the future of our specialty relies on the well-being of the pipeline, it is crucial that training programs and institutions are proactive in developing formal methods to address the bias experienced by residents.

Understanding disruptions in cancer care to reduce increased cancer burden.

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