Systematic review of how racialized health inequities are addressed in Epidemiologic Reviews articles (1979-2021): a critical conceptual and empirical content analysis and recommendations for best practices.

Critical analysis of the determinants of current and changing racialized health inequities, including the central role of racism, is an urgent priority for epidemiology, for both original research studies and epidemiologic review articles. Motivating our systematic overview review of Epidemiologic Reviews articles is the critical role of epidemiologic reviews in shaping discourse, research priorities, and policy relevant to the social patterning of population health. Our approach was first to document the number of articles published in Epidemiologic Reviews (1979-2021; n = 685) that either: (1) focused the review on racism and health, racial discrimination and health, or racialized health inequities (n = 27; 4%); (2) mentioned racialized groups but did not focus on racism or racialized health inequities (n = 399; 59%); or (3) included no mention of racialized groups or racialized health inequities (n = 250; 37%). We then conducted a critical content analysis of the 27 review articles that focused on racialized health inequities and assessed key characteristics, including (1) concepts, terms, and metrics used regarding racism and racialized groups (notably only 26% addressed the use or nonuse of measures explicitly linked to racism; 15% provided explicit definitions of racialized groups); (2) theories of disease distribution guiding (explicitly or implicitly) the review's approach; (3) interpretation of findings; and (4) recommendations offered. Guided by our results, we offer recommendations for best practices for epidemiologic review articles for addressing how epidemiologic research does or does not address ubiquitous racialized health inequities.

Caregiver Perspectives on Underutilization of WIC: A Qualitative Study.

OBJECTIVES: The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) is a federal program that improves the health of low-income women (pregnant and postpartum) and children up to 5 years of age in the United States. However, participation is suboptimal. We explored reasons for incomplete redemption of benefits and early dropout from WIC. METHODS: In 2020-2021, we conducted semistructured interviews to explore factors that influenced WIC program utilization among current WIC caregivers (n = 20) and caregivers choosing to leave while still eligible (n = 17) in Massachusetts. By using a deductive analytic approach, we developed a codebook grounded in the Consolidated Framework for Implementation Research. RESULTS: Themes across both current and early-leaving participants included positive feelings about social support from the WIC clinic staff and savings offered through the food package. Participants described reduced satisfaction related to insufficient funds for fruits and vegetables, food benefits inflexibility, concerns about in-clinic health tests, and in-store item mislabeling. Participants described how electronic benefit transfer cards and smartphone apps eased the use of benefits and reduced stigma during shopping. Some participants attributed leaving early to a belief that they were taking benefits from others. CONCLUSIONS: Current and early-leaving participants shared positive WIC experiences, but barriers to full participation exist. Food package modification may lead to improved redemption and retention, including increasing the cash value benefit for fruits and vegetables and diversifying food options. Research is needed regarding the misperception that participation means "taking" benefits away from someone else in need.