Racial Disparities in Health Among College-Educated African Americans: Can Attendance at Historically Black Colleges or Universities Reduce the Risk of Metabolic Syndrome in Midlife?

We expand on existing understandings of health disparities among middle-class African Americans by examining how the postsecondary educational context gives rise to the unequal distribution of health. We used panel data (1994-2009) from the National Longitudinal Study of Adolescent to Adult Health (Add Health) to estimate whether the risk of developing metabolic syndrome by midlife significantly differs for African Americans who attended Historically Black College or Universities (HBCUs) versus predominantly White institutions. We found that HBCU enrollment was associated with a 35% reduction in the odds of metabolic syndrome. Furthermore, we demonstrate that HBCU attendees who grew up in more segregated environments experienced the greatest reductions in the likelihood of developing metabolic syndrome. Our results underscore the important role that HBCUs play in the lives of African Americans and suggest their impacts go far beyond traditional benchmarks of socioeconomic achievement to include key health outcomes.

Low Birth Weight and Preterm Birth Among Arab-American Women in Ohio.

OBJECTIVE: There is limited evidence about prevalence and odds of adverse birth outcomes among Arab American women in the United States. We estimated the prevalence of low birth weight (LBW < 2500 g) and preterm birth (PTB < 37 completed weeks' gestation) among Arab American women in Ohio and studied the association between ethnicity, Arab American nativity (foreign or US born) and odds of LBW and PTB. METHODS: We identified Arab American women based on birth certificate data from live singleton births from 2007-2010 to 2013-2015 and a name algorithm. We compared the prevalence of LBW and PTB by ethnicity (Arab American vs. non-Hispanic White) and by nativity (foreign-born Arab American vs. US-born Arab American). Logistic regression models were used to estimate the unadjusted and adjusted effects of ethnicity and mother's nativity on study outcomes. RESULTS: 31,744 Arab American women (2.5% of all births in Ohio) were identified over a 7-year period. 24,129 Arab American women with complete data were included in the analysis after applying exclusion criteria. Prevalence of LBW was 5.2% (non-Hispanic White), 6.1% (Arab American), 6.4% (US-born Arab American) and 5.6% (foreign-born Arab American). Prevalence of PTB was 7.2% (non-Hispanic White), 7.0% (Arab American), 7.3% (US-born Arab American), and 5.4% (foreign-born Arab American). In adjusted models, which controlled for mother demographics, health behaviors, and pregnancy risk factors, Arab Americans had 33% higher odds of LBW (odds ratio [OR] 1.33; 95% Confidence Intervals[CI] 1.26-1.41) than non-Hispanic Whites. Foreign born Arab American women had 15% lower odds of PTB (OR 0.85; 95% CI 0.75-0.95) than US-born Arab Americans. CONCLUSIONS FOR PRACTICE: Our main findings were that LBW is influenced by Arab ethnicity while PTB is influenced by nativity among Arab American women. These findings may be informative for developing and implementing strategies for adverse birth outcomes for a growing US ethnic minority population.

High-Effort Coping and Cardiovascular Disease among Women: A Systematic Review of the John Henryism Hypothesis.

African-American women living in the United States experience higher cardiovascular disease risk (CVD) mortality compared to White women. Unique mechanisms, including prolonged high-effort coping in the face of discriminatory stressors might contribute to these racial disparities. The John Henryism hypothesis is a conceptual framework used to explain poor health outcomes observed among individuals with low resources who repeatedly utilize active coping to overcome barriers. The aims of our study were to summarize the literature related to John Henryism and CVD-related factors with a particular focus on women and to identify gaps for areas of future inquiry. We searched MEDLINE, EMBASE, Scopus, and CINAHL to identify literature that used the John Henryism Active Coping scale. Reviewers independently reviewed eligible full-text study articles and conducted data extraction. We qualitatively summarized the literature related to John Henryism and cardiovascular disease (CVD)-related health behaviors (e.g., smoking or physical activity) and risk factors (e.g., hypertension) with a focus on study populations inclusive of women. Our review included 21 studies that used the John Henryism Active Coping scale, of which 10 explicitly reported on the interaction between John Henryism and socioeconomic status (SES) and CVD-related factors. With respect to the original hypothesis, three studies reported results in line with the hypothesis, four were null, and three reported findings in opposition to the hypothesis. The remaining studies included in the review examined the main effects of John Henryism, with similarly mixed results. The literature related to the interaction between John Henryism and SES on CVD-related factors among women is mixed. Additional studies of John Henryism that incorporate biological measures, varied indicators of resources, and larger study populations may illuminate the relationship between coping and deleterious health outcomes among women.

A History Of The Impacts Of Discriminatory Policies On Housing And Maternal And Infant Health In An Ohio Neighborhood.

Community-level disinvestment and de facto segregation rooted in decades of discriminatory race-based policies and racism have resulted in unacceptably large infant mortality rates in racial minority neighborhoods across the US. Most community development and housing work, implemented with the goal of addressing health and social inequities, is designed to tackle current challenges in the condition of neighborhoods without a race-conscious lens assessing structural racism and discrimination. Using one historically segregated neighborhood-Linden, in Columbus, Ohio-we detail how state and local policies have affected the neighborhood and shaped neighborhood-level demographics and resources during the past 100 years. We explore how structural racism- and discrimination-informed strategic community reinvestment could provide a solution and yield lasting change.

Structural Racism, Social Determinants of Health, and Provider Bias: Impact on Brain Development in Critical Congenital Heart Disease.

Critical congenital heart disease (cCHD) has neurodevelopmental sequelae that can carry into adulthood, which may be due to aberrant brain development or brain injury in the prenatal and perinatal/neonatal periods and beyond. Health disparities based on the intersection of sex, geography, race, and ethnicity have been identified for poorer pre- and postnatal outcomes in the general population, as well as those with cCHD. These disparities are likely driven by structural racism, disparities in social determinants of health, and provider bias, which further compound negative brain development outcomes. This review discusses how aberrant brain development in cCHD early in life is affected by reduced access to quality care (ie, prenatal care and testing, postnatal care) due to divestment in non-White neighbourhoods (eg, redlining) and food insecurity, differences in insurance status, location of residence, and perceived interpersonal racism and bias that disproportionately affects pregnant people of colour who have fewer economic resources. Suggestions are discussed for moving forward with implementing strategies in medical education, clinical care, research, and gaining insight into the communities served to combat disparities and bias while promoting cultural humility.

"I just want us to be heard": A qualitative study of perinatal experiences among women of color.

OBJECTIVES: Long-standing racial disparities, particularly between White and Black women, in maternal and birth outcomes necessitate an examination of the factors influencing these disparities. This study aimed to understand the experiences of women of color as they relate to pregnancy and/or birth complications to inform policy and strategy to decrease racial and ethnic health disparities. METHODS: Six focus groups were conducted with women (n = 31) who were identified as a woman of color, were 18 years or older, self-identified as having experienced pregnancy or birth complications after 2016, and who spoke English. A focus group guide co-created with the research team, community partners, and peer researchers from the local community was utilized to elicit discussions related to barriers, successes, and existing opportunities to provide equitable care and services to families throughout the perinatal period. An inductive and iterative approach to qualitative analyses of the focus group transcripts was used to identify key themes. RESULTS: The seven themes identified include: lack of knowledge, mental health, communication with providers, support systems, representation, social determinants of health, and discrimination and stigma. Women shared a variety of experiences related to their health care from before pregnancy into their post-partum period, revealing many areas for improvement to extant systems. CONCLUSION: The inclusion of voices of the populations most deeply affected by health disparities is crucial to understanding how care and services provided can be improved. This analysis suggests the need for change at multiple levels of the health care and social services systems. These experiences provide valuable insight into some of the many struggles and barriers that women of color face during pregnancy and beyond.

Neighborhood-Level Lead Paint Hazard for Children under 6: A Tool for Proactive and Equitable Intervention.

Lead is well known for its adverse health effects on children, particularly when exposure occurs at earlier ages. The primary source of lead hazards among young children is paint used in buildings built before 1978. Despite being 100% preventable, some children remain exposed and state and local policies often remain reactive. This study presents a methodology for planners and public health practitioners to proactively address lead risks among young children. Using geospatial analyses, this study examines neighborhood level measurement of lead paint hazard in homes and childcare facilities and the concentration of children aged 0-5. Results highlight areas of potential lead paint hazard hotspots within a county in the Midwestern state studied, which coincides with higher concentration of non-white children. This places lead paint hazard in the context of social determinants of health, where existing disparity in distribution of social and economic resources reinforces health inequity. In addition to being proactive, lead poisoning intervention efforts need to be multi-dimensional and coordinated among multiple parties involved. Identifying children in higher lead paint hazard areas, screening and treating them, and repairing their homes and childcare facilities will require close collaboration of healthcare professionals, local housing and planning authorities, and community members.

The Health Opportunity Index: Understanding the Input to Disparate Health Outcomes in Vulnerable and High-Risk Census Tracts.

The Health Opportunity Index (HOI) is a multivariate tool that can be more efficiently used to identify and understand the interplay of complex social determinants of health (SDH) at the census tract level that influences the ability to achieve optimal health. The derivation of the HOI utilizes the data-reduction technique of principal component analysis to determine the impact of SDH on optimal health at lower census geographies. In the midst of persistent health disparities and the present COVID-19 pandemic, we demonstrate the potential utility of using 13-input variables to derive a composite metric of health (HOI) score as a means to assist in the identification of the most vulnerable communities during the current pandemic. Using GIS mapping technology, health opportunity indices were layered by counties in Ohio to highlight differences by census tract. Collectively we demonstrate that our HOI framework, principal component analysis and convergence analysis methodology coalesce to provide results supporting the utility of this framework in the three largest counties in Ohio: Franklin (Columbus), Cuyahoga (Cleveland), and Hamilton (Cincinnati). The results in this study identified census tracts that were also synonymous with communities that were at risk for disparate COVID-19 related health outcomes. In this regard, convergence analyses facilitated identification of census tracts where different disparate health outcomes co-exist at the worst levels. Our results suggest that effective use of the HOI composite score and subcomponent scores to identify specific SDH can guide mitigation/intervention practices, thus creating the potential for better targeting of mitigation and intervention strategies for vulnerable communities, such as during the current pandemic.

Human papillomavirus vaccine and Pap tests on college campuses: How do historically black colleges and universities (HBCUs) measure up?

OBJECTIVE: The availability of cervical cancer prevention services at college health centers was compared between historically black colleges and universities (HBCUs) and non-HBCUs. METHODS: Four-year, non-primarily distant learning colleges, matching HBCUs with randomly selected non-HBCUs within the same states (N = 136) were examined. Data were collected (2014-2015 academic year) on the availability of human papillomavirus (HPV) vaccine and Pap tests at college health centers. HBCUs were compared with non-HBCUs using conditional logistic regression, and correlates of offering these services were identified. RESULTS: Many institutions did not offer HPV vaccine or Pap tests. Fewer HBCUs offered HPV vaccine (18% vs 53%) and Pap tests (50% vs 76%) compared with non-HBCUs. In multivariable analyses, HBCUs remained less likely than non-HBCUs to offer HPV vaccine (odds ratio [OR] = 0.07, 95% confidence interval [CI]: 0.02-0.26) and Pap tests (OR = 0.19, 95% CI: 0.06-0.61). CONCLUSIONS: Greater effort is needed to make cervical cancer prevention services available at colleges, especially at HBCUs.