Reliability and Validity of the Perceived Racism Scale-Racism on the Job Subscale-in a Sample of Black Nurses.

Background and Purpose: We utilized the Perceived Racism Scale-Racism on the Job subscale-to assess how frequently Black nurses experienced racism on the job in the past year (ROTJ-Y) and throughout their lifetime (ROTJ-L). We aimed to assess the reliability and assess construct validity of each subscale in a sample of 53 nurses. Methods: Reliability was evaluated using coefficient alphas, item correlations, and interitem correlations. Construct validity was examined using exploratory factor analysis. Results: Results demonstrated that the subscales are reliable and valid. Coefficient alphas for the ROTJ-Y and ROTJ-L were .93 and .91, respectively. Exploratory factor analysis revealed a unidimensional factor for both subscales. Conclusion: This study demonstrated that the Racism on the Job subscales are psychometrically sound measures of workplace racism among Black nurses.

Racial and Ethnic Bias in the Diagnosis of Alcohol Use Disorder in Veterans.

OBJECTIVE: Studies show that racially and ethnically minoritized veterans have a higher prevalence of alcohol use disorder (AUD) than White veterans. The investigators examined whether the relationship between self-reported race and ethnicity and AUD diagnosis remains after adjusting for alcohol consumption, and if so, whether it varies by self-reported alcohol consumption. METHODS: The sample included 700,012 Black, White, and Hispanic veterans enrolled in the Million Veteran Program. Alcohol consumption was defined as an individual's maximum score on the consumption subscale of the Alcohol Use Disorders Identification Test (AUDIT-C), a screen for unhealthy alcohol use. A diagnosis of AUD, the primary outcome, was defined by the presence of relevant ICD-9 or ICD-10 codes in electronic health records. Logistic regression with interactions was used to assess the association between race and ethnicity and AUD as a function of maximum AUDIT-C score. RESULTS: Black and Hispanic veterans were more likely than White veterans to have an AUD diagnosis despite similar levels of alcohol consumption. The difference was greatest between Black and White men; at all but the lowest and highest levels of alcohol consumption, Black men had 23%-109% greater odds of an AUD diagnosis. The findings were unchanged after adjustment for alcohol consumption, alcohol-related disorders, and other potential confounders. CONCLUSIONS: The large discrepancy in the prevalence of AUD across groups despite a similar distribution of alcohol consumption levels suggests that there is racial and ethnic bias, with Black and Hispanic veterans more likely than White veterans to receive an AUD diagnosis. Efforts are needed to reduce bias in the diagnostic process to address racialized differences in AUD diagnosis.

Examining Race-Based Discrimination, Depression, and Occupational Stress in Black Registered Nurses.

Nursing is a highly stressful and demanding profession that can negatively affect mental health, as shown by nurses' high rate of depression. Furthermore, Black nurses may experience additional stress due to race-based discrimination in the work environment. This research aimed to examine depression, experiences of race-based discrimination at work, and occupational stress among Black nurses. To better understand associations between these factors, we conducted multiple linear regression analyses to assess whether (1) past-year or lifetime experiences of race-based discrimination at work and occupational stress predicted depressive symptoms; and (2) controlling for depressive symptoms, past-year and lifetime experiences of race-based discrimination at work predicted occupational stress in a cohort of Black registered nurses. All analyses controlled for years of nursing experience, primary nursing practice position, work setting, and work shift. The results indicated that both past-year and lifetime experiences of race-based discrimination on the job were significant predictors of occupational stress. However, experiences of race-based discrimination at work and occupational stress were not significant predictors of depression. The results of the research highlighted the predictive effect of race-based discrimination on occupational stress in Black registered nurses. This evidence can inform the development of organizational and leadership strategies to improve the well-being of Black nurses in the workplace.

What does critical race theory have to do with academic medicine?

Critical Race Theory (CRT) has recently become a target of national attention due to recent Presidential Executive Orders and state and local governmental bodies banning its use in public school settings. However, such attention has only led to critical race theory being misconstrued by the media and misunderstood by the common lay person. Critical Race Theory is a specific pedagogical and theoretical approach to understand how racialized historical contexts influence contemporary society. Clarifying and positioning CRT in a manner within which to understand health inequities experienced by racialized groups in the United States is paramount for the field of academic medicine and medical practice. A critical examination of the historical and contemporary issues of race and racism in America provides the necessary context within which to understand the long-standing and persistent existence of health disparities experienced among racial/ethnic populations in the United States. Ignoring historical and contemporary political and social influences of race and racism on health will only hinder the country's ability to narrow expanding gaps in racial/ethnic health disparities. Academic medicine has a professional and ethical responsibility to educate its trainees and health professionals on the history of medicine - including its ugly side - and to critically examine how historical and contemporary political and social factors have created racial/ethnic health disparities. Until such reckoning occurs the field of medicine's ability to achieve health equity for all will continue to be futile.

A View of Health Disparities among African Americans Through a COVID-19 Lens.

COVID-19 has disproportionately impacted African Americans. Political and social determinants of health-the impact of the environments where people play, work, and live-account for up to 80% of individual and population health risk. This article provides an overview of how historical and contemporary systemic structural violence and racist structures embedded within the political and social determinants of health have led to African Americans experiencing high rates of morbidity and mortality due to COVID-19.

COVID-19 and the impact on rural and black church Congregants: Results of the C-M-C project.

The COVID-19 pandemic has had devastating effects on Black and rural populations with a mortality rate among Blacks three times that of Whites and both rural and Black populations experiencing limited access to COVID-19 resources. The primary purpose of this study was to explore the health, financial, and psychological impact of COVID-19 among rural White Appalachian and Black nonrural central Kentucky church congregants. Secondarily we sought to examine the association between sociodemographics and behaviors, attitudes, and beliefs regarding COVID-19 and intent to vaccinate. We used a cross sectional survey design developed with the constructs of the Health Belief and Theory of Planned Behavior models. The majority of the 942 respondents were ≥36 years. A total of 54% were from central Kentucky, while 47.5% were from Appalachia. Among all participants, the pandemic worsened anxiety and depression and delayed access to medical care. There were no associations between sociodemographics and practicing COVID-19 prevention behaviors. Appalachian region was associated with financial burden and delay in medical care (p = 0.03). Appalachian respondents had lower perceived benefit and attitude for COVID-19 prevention behaviors (p = 0.004 and <0.001, respectively). Among all respondents, the perceived risk of contracting COVID was high (54%), yet 33.2% indicated unlikeliness to receive the COVID-19 vaccine if offered. The COVID-19 pandemic had a differential impact on White rural and Black nonrural populations. Nurses and public health officials should assess knowledge and explore patient's attitudes regarding COVID-19 prevention behaviors, as well as advocate for public health resources to reduce the differential impact of COVID-19 on these at-risk populations.

Challenges and Considerations Related to Studying Dementia in Blacks/African Americans.

Blacks/African Americans have been reported to be ∼2-4 times more likely to develop clinical Alzheimer's disease (AD) compared to Whites. Unfortunately, study design challenges (e.g., recruitment bias), racism, mistrust of healthcare providers and biomedical researchers, confounders related to socioeconomic status, and other sources of bias are often ignored when interpreting differences in human subjects categorized by race. Failure to account for these factors can lead to misinterpretation of results, reification of race as biology, discrimination, and missed or delayed diagnoses. Here we provide a selected historical background, discuss challenges, present opportunities, and suggest considerations for studying health outcomes among racial/ethnic groups. We encourage neuroscientists to consider shifting away from using biologic determination to interpret data, and work instead toward a paradigm of incorporating both biological and socio-environmental factors known to affect health outcomes with the goal of understanding and improving dementia treatments for Blacks/African Americans and other underserved populations.

Local smoke-free public policies, quitline call rate, and smoking status in Kentucky.

PURPOSE: The study investigated the relationships among local smoke-free public policies, county-level quitline call rate, and adult smoking status. DESIGN: A retrospective cross-sectional examination of demographic characteristics, smoking status of Kentuckians, and data from the Kentucky Tobacco Quitline were used to investigate the relationship of local smoke-free ordinances or Board of Health regulations together with county-level quitline use rates and population-level adult smoking status. SETTING: One hundred and four Kentucky counties. SUBJECTS: The sample was comprised of 14,184 Kentucky participants with complete demographic information collected from the 2009-2010 Behavioral Risk Factor Surveillance System (BRFSS). MEASURES: Individual-level demographics and smoking status from the BRFSS; county-level urban/rural status; quitline rates; and smoke-free policy status. ANALYSIS: Given the hierarchical structure of the dataset, with BRFSS respondents nested within county, multilevel modeling was used to determine the predictors of smoking status. RESULTS: For every 1-unit increase in the county-level call rate the likelihood of current smoking status decreased by 9%. Compared to those living in communities without a policy, those in communities with a smoke-free public policy were 18% less likely to be current smokers. Limitations include quitline call rate as the sole indicator of cessation demand, as well as the cross-sectional design. CONCLUSION: Communities with smoke-free policies and higher rates of quitline use have lower rates of adult smoking.

Racially classified social group differences in cigarette smoking, nicotine dependence, and readiness to quit.

The purpose was to determine racially classified social group differences in smoking, nicotine dependence, and readiness to quit between African American and Caucasian smokers. The cross-sectional study included 53 African American and 839 Caucasian smokers participating in a larger population-based cessation intervention study. Data were analyzed from the interview conducted before the intervention; half of the participants were in the treatment group, recruited from those who had joined a cessation contest, whereas control group participants were recruited using random-digit dialing and were not in the contest. African Americans began smoking later, smoked fewer cigarettes daily, reported lower nicotine dependence, and had greater readiness to quit smoking than Caucasians. Of those who had ever used an evidence-based method, African American smokers were more likely to only use evidence-based quit methods, whereas Caucasian smokers were more likely to mix evidence-based with "cold turkey." Controlling for demographics and treatment group, racially classified social group was a predictor of readiness to quit smoking. Later, age of initiation, positive partner support, and using evidence-based quit methods also predicted greater readiness to quit.

Cultural protective factors for community risks and substance use among rural African American adolescents.

Relatively little attention has been afforded to protective factors for community-level risks among non-urban populations. This study examined the extent to which traditional cultural attitudes and behaviors of 137 African American adolescents (ages 12-17) from a rural community moderated the relationship between perceived community disorganization and substance use behaviors. Results from hierarchical linear regression revealed that traditional cultural attitudes and behaviors were differentially related to community disorganization and adolescent substance use. In terms of protective influences, religious beliefs and practices and traditional family practices moderated the effect of community disorganization on substance use. Specifically, religious beliefs and practices demonstrated a protective-stabilizing effect as community disorganization increased; traditional family practices demonstrated a protective but reactive effect. Attitudes of cultural mistrust increased youth's susceptibility to substance use as community disorganization worsened--vulnerable and reactive. The findings underscore the importance of examining the link between cultural and contextual factors in an attempt to understand the etiology of substance use among rural African American adolescents.

Are age of smoking initiation and purchasing patterns associated with menthol smoking?

AIMS: The purpose of this study was to examine the relationship between age of cigarette smoking initiation and cigarette purchasing patterns on menthol smoking among current smokers. DESIGN: Secondary analyses were conducted using logistic regression with balanced replicated weights. SETTING: Data from the 2003 and 2006/07 Tobacco Use Supplement (TUS) to the Current Population Survey (CPS), collected by the National Cancer Institute, the Centers for Disease Control and Prevention and the Census Bureau, formed the basis for this investigation. PARTICIPANTS: A total of 66,145 current smokers who participated in the TUS CPS administration in 2003 and 2006/07 were examined. MEASUREMENTS: Demographic characteristics (gender, race/ethnicity, age, education and income), smoking frequency, purchase type (pack, carton, or both), age of initiation and menthol cigarette use were assessed. FINDINGS: One-quarter of the sample smoked menthol cigarettes; most purchased their cigarettes by the pack when rather than by the carton; average age of cigarette smoking initiation was 18 years; and females, ethnic/racial minorities and younger participants were more likely to smoke menthol cigarettes compared with males, whites or older respondents. Other demographic factors associated with menthol cigarette use among current smokers included a high school education (the prevalence of menthol use among this cohort was greater than either those with less education or those with more). The multivariate logistic model only marginally revealed that age of smoking initiation predicted menthol smoking: findings are suggestive that the longer the delay of initiation the more likely that an individual smoked menthol cigarettes [odds ratio (OR) = 1.01; 95% confidence interval (CI): 1.00-1.01]. In addition, relative to those who purchased cigarettes by the pack, smokers who purchased cigarettes by the carton were less (OR = 0.86; 95% CI: 0.81-0.91) likely to be menthol smokers. CONCLUSIONS: Menthol smokers in the United States are more likely to be female, younger, from ethnic minority groups, and to have a high school education. The findings that menthol smokers in the U.S. tend to start smoking later than smokers of other types of cigarettes are suggestive only and require further study.

Menthol smoking, smoke-free policies and cessation services.

AIMS: This study examined whether menthol cigarette smoking is related to exposure to smoke-free home and work-place policies, availability of cessation services at work and knowledge of cessation resources among current smokers. DESIGN: Secondary analysis was conducted using logistic regression of cross-sectional data. SETTING: The 2003 and 2006/07 Tobacco Use Supplement (TUS) to the Current Population Survey, administered by the National Cancer Institute, the Centers for Disease Control and Prevention (CDC) and the Census Bureau, formed the basis for this investigation. PARTICIPANTS: A total of 66,145 current smokers who participated in the TUS CPS administrations in 2003 and 2006/07. MEASUREMENTS: Demographic characteristics (gender, race/ethnicity, age, education, income), smoking frequency, menthol cigarette use, status of smoking bans in the work-place and at home, availability of cessation services at work and knowledge of quitting resources were assessed. FINDINGS: Among all current smokers with an indoor job, with no smoke-free restrictions at either work or home as the reference, those who smoked menthol cigarettes were about one-third as likely to have a smoke-free policy at both work and home [odds ratio (OR) = 0.32; 95% confidence interval (CI): 0.27-0.38]. In the comparison of those with an indoor smoke-free policy at work only versus those with no restrictions, menthol status was a risk factor for not having a work-place restriction (OR = 0.79; 95% CI: 0.67-0.93); similarly, within this sample, menthol use was a risk factor for not having a home restriction (OR = 0.38; 95% CI: 0.31-0.46). Among all current smokers, the use of menthol cigarettes was a risk factor for not having a smoking restriction at home (OR = 0.93; 95% CI: 0.88-0.98). Menthol smoking was not related to availability of cessation services offered at work or knowledge of cessation services. CONCLUSIONS: This study suggests that menthol smoking is associated with lack of policy protection from second-hand smoke exposure. Policymakers and tobacco control professionals should monitor tobacco control efforts to ensure that policies and interventions reach all menthol smokers.

Race-related stress and smoking among pregnant African-American women.

OBJECTIVES: To examine the association between the psychosocial construct of race-related stress and smoking among pregnant African-American women. DESIGN: Inferential statistical analyses were performed. SETTING: Participants were recruited primarily at a medical clinic as well as through word-of-mouth consistent with the snowball sampling technique. POPULATION: Seventy pregnant self-identified African-American women (32 smokers and 38 non-smokers) 18 years or older participated in the study. METHODS: Participants completed self-report measures of the Index of Race-Related Stress and an investigator-developed demographic and smoking questionnaire. MAIN OUTCOME MEASURES: Smoking status of each participant was established through self-report. RESULTS: Significant associations were found between the smoking status of pregnant African-American women and the frequency and perceptions of overall race-related stress (p < 0.03 and 0.02, respectively), the frequency and perceptions of both individual and cultural race-related stress (p < 0.01, 0.03, 0.05, and 0.03, respectively). No associations were found between institutional race-related stress and smoking status. CONCLUSIONS: The findings suggest that integrating race-related stress relieving and coping activities into smoking cessation intervention programs for pregnant African-American women may reduce smoking and subsequent smoking-related reproductive health disparities in the population.

End-of-treatment smoking cessation among African American female participants in the Breathe Free for Women smoking cessation program: results of a pilot study.

OBJECTIVE: Quitting smoking is particularly imperative for African American women due to their disproportionate rates of smoking-related morbidity and mortality. However, very few smoking cessation interventions have demonstrated successful quit rates for African American women. This study sought to examine the Breathe Free for Women (BFFW) smoking cessation lifestyle program among African American female smokers. The primary objective of the pilot project was to examine end-of-treatment quit rates, and the secondary objective sought to obtain feedback from African American female participants on the acceptability of the intervention in this population. METHODS: A total of 42 African American females were recruited to participate in 1 of 6 intervention cohorts. Each intervention cohort participated in 9 group sessions presented over a period of 4 weeks. Participants complete an investigator developed survey assessing current smoking status as well as impressions of each intervention session. RESULTS: An end-of-treatment quit rate of 19% was achieved with an average study retention rate of 70%. In addition, participants' feedback indicated that the BFFW intervention offers a highly promising model for enhanced tailoring by incorporating socioculturally relevant methods, materials, and content. CONCLUSIONS: Future research must address the critical public health need for socioculturally relevant adaptations of existing and promising smoking cessation programs for African American women.

Smoking risk and the likelihood of quitting among African-American female light and heavy smokers.

While African-American females are more likely to be light smokers compared to their counterparts of other racially classified social groups (RCSGs), they are more likely to carry a heavier burden of smoking-related morbidity and mortality. Thus, it is critical that African-American female light smokers are targeted to engage in smoking cessation. Research has revealed that African-American women are less likely to have a successful quit attempt following a cessation intervention than females from other RCSGs. It has been postulated that the low smoking cessation rates among African-American female light smokers may be due to the lack of appropriate psychosocioculturally tailored cessation interventions that address issues of stress and coping that explain why they smoke and continue to smoke that may differ from their heavy smoker counterparts. The purpose of this study was to ascertain whether African-American female light smokers differed from their heavy smoker counterparts on psychosociocultural stress and coping factors. Findings revealed no differences in the sociodemographic variables of age, income, education and BMI; in the psychosociocultural measures of acculturative stress, race-related stress and coping; or in the smoking characteristics of menthol smoking status, cotinine level and CYP2A6 metabolic functioning between light and heavy smokers. However, the study found that African-American female light smokers take longer to smoke their first cigarette of the day, have a lower smoking risk, are more likely to quit, and exhibit lower carbon monoxide levels than African-American female heavy smokers. The current study suggests that other than the obvious factors of greater likelihood of quitting, lower smoking risk, longer latency to smoke and lower carbon monoxide levels, specific smoking cessation programs may not need to be differentially psychosocio-culturally tailored for African-American female light smokers compared to their heavy-smoking counterparts.

Addressing tobacco-related health disparities.

AIMS: The aim of this review is to outline a transdisciplinary research framework for identifying, explaining and intervening to address tobacco-related health disparities (TRHD). We will show the importance of an approach that integrates the human life-cycle (developmental) and tobacco addiction cycle (behavioral) for interventions that address group-specific vulnerabilities. METHODS: The existing empirical knowledge base on tobacco-related health disparities is mapped onto a conceptual framework built around life-cycle and addiction cycle trajectories for disparate population groups. FINDINGS: Current knowledge about developmental trajectories of tobacco use is based on general population studies with minimal information on group differences. At the national level, early onset of tobacco use is associated with a high level of tobacco dependence, low number of quit attempts, long-term smoking history and tobacco-related health harm. These relationships cannot be assumed for all population groups: African Americans and Asian Americans typically have a later age of tobacco use onset compared to European Americans, yet health consequences of smoking are higher among African Americans but not Asian Americans. Even less is known about group differences in the temporal progression from smoking onset to daily smoking. Determining the time-frame from initial to regular smoking seems crucial for targeted secondary prevention, before the establishment of addictive tobacco use patterns. Group-specific data characterizing the duration from daily tobacco use to a quit attempt or request for cessation treatment are also scant. CONCLUSIONS: A comprehensive, integrated, transdisciplinary framework is needed to guide efforts to understand tobacco-related health disparities and to increase the effectiveness of evidence-based interventions delivered in culturally appropriate and economically practicable ways, while optimizing the balance between demand for and access to services.

A biopsychosocial approach to examining tobacco-related health disparities among racially classified social groups.

AIMS: To articulate a broader, multi-causal model that incorporates psychosocial and environmental factors that can differ systematically across racially classified social groups (RCSGs) and impact biological pathways related to the development of tobacco-related diseases. METHODS: This paper is built upon a review of the existing scientific literature on selected biopsychosocial factors (diet/nutrition, obesity, alcoholic intake, psychosocial stress, occupational/environmental exposures and exposure to other diseases and illnesses) and tobacco use in examining the biological contributions to differences in tobacco-related health outcomes among RCSGs. FINDINGS: Recent work has focused on RCSG genetic variations as a possible explanation for differences in tobacco-related health disparities. It is argued in this paper that, given the genetic heterogeneity 'within' RCSGs, it is unlikely that across RCSG genetic variations are likely to be the major source of differences impacting biological pathways in tobacco-related health outcomes. The evidence shows that results, even at the level of within-population genetic variations, have been limited and often inconsistent. A conceptual framework is proposed to account for biological pathways related to the development of tobacco-related diseases. CONCLUSIONS: Determinants of tobacco-related health disparities are not understood clearly. The contribution of biological factors may be important. Current efforts to determine biological differences in tobacco use and related diseases among RCSGs have focused primarily on genetic variations. However, this approach has limitations. An alternative biopsychosocial framework that examines the potential biological mechanisms through which life experiences and behavior might affect tobacco use and health outcomes in these population groups is needed, including those of life-style (e.g. diet/nutrition, obesity, physical exercise, alcohol consumption), psychosocial (e.g. stress and coping), occupational/environmental exposures and the presence of other diseases/illnesses.

Identifying health disparities across the tobacco continuum.

AIMS: Few frameworks have addressed work-force diversity, inequities and inequalities as part of a comprehensive approach to eliminating tobacco-related health disparities. This paper summarizes the literature and describes the known disparities that exist along the tobacco disease continuum for minority racial and ethnic groups, those living in poverty, those with low education and blue-collar and service workers. The paper also discusses how work-force diversity, inequities in research practice and knowledge allocation and inequalities in access to and quality of health care are fundamental to addressing disparities in health. METHODS: We examined the available scientific literature and existing public health reports to identify disparities across the tobacco disease continuum by minority racial/ethnic group, poverty status, education level and occupation. FINDINGS: Results indicate that differences in risk indicators along the tobacco disease continuum do not explain fully tobacco-related cancer consequences among some minority racial/ethnic groups, particularly among the aggregate groups, blacks/African Americans and American Indians/Alaska Natives. The lack of within-race/ethnic group data and its interactions with socio-economic factors across the life-span contribute to the inconsistency we observe in the disease causal paradigm. CONCLUSIONS: More comprehensive models are needed to understand the relationships among disparities, social context, diversity, inequalities and inequities. A systematic approach will also help researchers, practitioners, advocates and policy makers determine critical points for interventions, the types of studies and programs needed and integrative approaches needed to eliminate tobacco-related disparities.