Socioeconomic-Status-Based Disrespect, Discrimination, Exclusion, and Shaming: A Potential Source of Health Inequalities?

Observing an association between socioeconomic status (SES) and health reliably leads to the question, "What are the pathways involved?" Despite enormous investment in research on the characteristics, behaviors, and traits of people disadvantaged with respect to health inequalities, the issue remains unresolved. We turn our attention to actions of more advantaged groups by asking people to self-report their exposure to disrespect, discrimination, exclusion, and shaming (DDES) from people above them in the SES hierarchy. We developed measures of these phenomena and administered them to a cross-sectional U.S. national probability sample (N = 1,209). Consistent with the possibility that DDES represents a pathway linking SES and health, the SES→health coefficient dropped substantially when DDES variables were controlled: 112.9% for anxiety, 43.8% for self-reported health, and 49.4% for cardiovascular-related conditions. These results illustrate a need for a relational approach emphasizing the actions of more advantaged groups in shaping health inequities.

Symbolic disempowerment and Donald Trump's 2016 presidential election: Mental health responses among Latinx and white populations.

The 2016 election of United States (U.S.) President Donald Trump was a political event that may have affected population-level mental health. A prominent theme in the Trump election was anti-immigrant policy that contributed to a racist and xenophobic sociopolitical climate. Applying a symbolic dis/empowerment framework, this study examines whether there was an effect of the Trump election on the mental health of the U.S. population that differed by race/ethnicity, language of interview, and state-level support for Trump or Clinton. We used data from the Centers for Disease Control and Prevention's Behavioral Risk Factor Surveillance System 2011-2018 to examine trends in poor mental health days in the five months after the U.S Presidential election (November 2016 to March 2017) compared to all other survey months. We conducted difference-in-differences analyses using negative binomial regression models to examine the effect of the five post-election months on the rate of poor mental health days, comparing six population categories: 1) non-Latinx white populations in Trump states, 2) non-Latinx white populations in Clinton states, 3) English-speaking Latinx populations in Trump states, 4) English-speaking Latinx populations in Clinton states, 5) Spanish-speaking Latinx populations in Trump states, and 6) Spanish-speaking Latinx populations in Clinton states. White populations in Clinton states reported more poor mental health days in response to the five months post-election period compared to white populations in Trump states. English-speaking Latinx people living in Trump states experienced higher than expected poor mental health days in November 2016 and February 2017. Spanish-speaking Latinx people, by contrast, reported fewer poor mental health days in the post-election period. The 2016 U.S. presidential election preceded population-level changes in mental health that support a symbolic dis/empowerment framework. We discuss possible explanations and the mental health implications for future major political events.

Diversions: How the Underrepresentation of Research on Advantaged Groups Leaves Explanations for Health Inequalities Incomplete.

We identify a gap in health inequalities research that sociologists are particularly well situated to fill-an underrepresentation of research on the role advantaged groups play in creating inequalities. We name the process that creates the imbalance health-inequality diversions. We gathered evidence from awarded grants (349), major health-related data sets (7), research articles (324), and Healthy People policy recommendations. We assess whether the inequality-generating actions of advantaged groups are considered either directly by capturing their behaviors or indirectly by asking disadvantaged people about discrimination or exploitation from advantaged groups. We further assess whether there is a tendency to locate the problem in the person or group experiencing health inequalities. We find that diversions are prevalent across all steps of the research process. The diversion concept suggests new lines of sociological research to understand why diversions occur and how gaps in evidence concerning the role of the advantaged might be filled.

Conversations between Latina mothers and their child's mental health provider: An observational study of shared decision-making regarding pediatric patient mental health needs.

OBJECTIVE: To evaluate shared decision-making (SDM) and delineate SDM processes in audio-recorded conversations between language congruent Spanish-/English-speaking clinicians and parents of pediatric mental health patients. METHODS: Transcripts from audio-recorded consultations were rated using the 5-Item Observing Patient Involvement in Decision Making (Observer OPTION5) instrument. One hundred encounters between seventeen clinicians and 100 parents were rated. Interrater reliability for total score was 0.98 between two trained coders (ICC range: 0.799-0.879). RESULTS: Scores ranged between 0 and 70 on a 100-point scale, with an average total Observer OPTION5 score of 33.2 (SD = 17.36). This corresponded to modest success at mutual shared decision-making. Clinicians and parents both showed effort at identifying a problem with treatment options and engaging in team talk. However, preference elicitation and integration were largely lacking. CONCLUSION: The present sample performed on par with other populations studied to date. It expands the evaluation of observed SDM to include Latino patients and new clinician populations. PRACTICE IMPLICATIONS: Use of the Observer OPTION5 Item instrument highlights that eliciting and integrating parent/patient preferences is a skill that requires attention when delivering culturally competent interventions.

Fostering Activation Among Latino Parents of Children With Mental Health Needs: An RCT.

OBJECTIVE: Latino families raising children with mental health and other special health care needs report greater dissatisfaction with care compared with other families. Activation is a promising strategy to eliminate disparities. This study examined the comparative effectiveness of MePrEPA, an activation intervention for Latino parents whose children receive mental health services. METHODS: A randomized controlled trial (N=172) was conducted in a Spanish-language mental health clinic to assess the effectiveness of MePrEPA, a four-week group psychoeducational intervention to enhance parent activation among Latino parents, compared with a parent-support control group. Inclusion criteria were raising a child who receives services for mental health needs and ability to attend weekly sessions. Outcomes were parent activation, education activation, quality of school interaction, and parent mental health. Effectiveness of the intervention was tested with a difference-in-difference approach estimating linear mixed models. Heterogeneity of treatment effect was examined. RESULTS: MePrEPA enhanced parent activation (ß=5.98, 95% confidence interval [CI]=1.42-10.53), education activation (ß=7.98, CI=3.01-12.94), and quality of school interaction (ß=1.83, CI=.14-3.52) to a greater degree than did a parent-support control group. The intervention's impact on parent activation and education outcomes was greater for participants whose children were covered by Medicaid and were novices to therapy and those with low activation at baseline. No statistically significant effects were observed in parent mental health. CONCLUSIONS: Activation among Latino parents was improved with MePrEPA, which can be readily incorporated in current practices by mental health clinics. Future work should replicate findings in a large number of sites, adding behavioral measures and distal impacts while examining MePrEPA's effects across settings and populations.

Involving Latina/o parents in patient-centered outcomes research: Contributions to research study design, implementation and outcomes.

BACKGROUND: Comparative effectiveness research (CER) is supported by policymakers as a way to provide service providers and patients with evidence-based information to make better health-care decisions and ultimately improve services for patients. However, Latina/o patients are rarely involved as study advisors, and there is a lack of documentation on how their voices contribute to the research process when they are included as collaborators. OBJECTIVES: The purpose of this article was to contribute to the literature by presenting concrete contributions of Latina/o parent involvement to study design, implementation and outcomes in the context of a CER study called Padres Efectivos (Parent Activation). METHODS: Researchers facilitated a collaborative relationship with parents by establishing a mentor parent group. The contributions of parent involvement in the following stages of the research process are described: (i) proposal development, (ii) implementation of protocols, (iii) analysis plan and (iv) dissemination of results. RESULTS: Mentor parents' contributions helped tailor the content of the intervention to their needs during proposal, increased recruitment, validated the main outcome measure and added two important outcome measures, emphasized the importance of controlling for novice treatment status and developed innovative dissemination strategies. CONCLUSIONS: Mentor parents' guidance to the researchers has contributed to reaching recruitment goals, strengthened the study protocol, expanded findings, supported broad ownership of study implications and enriched the overall study data collection efforts. These findings can inform future research efforts seeking an active Latino parent collaboration and the timely incorporation of parent voices in each phase of the research process.