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Psychol Trauma ; 14(1): 38-46, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-35025578


There is growing evidence that general coping plays a role in the degree to which racial discrimination is associated with mental health symptoms (e.g., posttraumatic stress, depressive symptoms) for people of color. Relatively less is known about the role that race-based coping may play in the associations between racial discrimination and mental health for Black Americans. OBJECTIVE: In this study, we examined whether posttraumatic stress and depressive symptoms differed based on race-based coping style and tested whether these responses moderated associations between racial discrimination and posttraumatic stress. METHOD: Black American adults (n = 401; 56.1% women, x̄ age = 44.02) were recruited from a community hospital setting. Based on a measure assessing race-based coping style, participants were classified as having either a passive, moderate, or active response style. RESULTS: First, we found that posttraumatic stress (F = 5.56, p < .01) and depressive (F = 4.49, p = .01) symptom severity differed based on race-based coping classification, with more severe symptoms found for the passive versus active group. Second, we found that race-based coping moderated racial discrimination's associations with posttraumatic stress (R2Δ = .02, F = 4.08, p = .02) and depressive (R2Δ = .02, F = 3.26, p = .04) symptoms, such that the associations between racial discrimination and symptom severity were only significant for the passive and moderate (but not active) groups. CONCLUSIONS: These results suggest that for Black Americans, coping with racism actively (vs. passively) may buffer the association between racial discrimination and psychological symptom severity. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Racismo , Adaptação Psicológica , Adulto , Afro-Americanos , Feminino , Humanos , Masculino , Saúde Mental , Avaliação de Resultados em Cuidados de Saúde
Nursing ; 52(1): 38-43, 2022 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-34979013


ABSTRACT: This article discusses the interconnection between the syndemic effect of racial inequities and disparities as well as the impact of the COVID-19 pandemic on Black Americans. It also highlights meaningful reforms and priorities to achieve health equity in Black communities.

COVID-19 , Racismo , Disparidades nos Níveis de Saúde , Disparidades em Assistência à Saúde , Humanos , Pandemias , SARS-CoV-2 , Sindemia , Estados Unidos/epidemiologia
J Nurs Educ ; 61(1): 41-45, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-35025677


BACKGROUND: This pilot study examined the association of internal and external motivation of White nursing students to avoid appearing racist while interacting with standardized patients in a simulation-based learning experience (SP-SBLE). The influence of nursing students' preexisting motivations to avoid racism were examined for their effect on clinical performance in their SP-SBLE. METHOD: White nursing students (N = 50) completed measures of motivations to avoid racism prior to their end of semester practical examination. Students were then randomly assigned to an SBLE with a SP portraying chest pain. RESULTS: White students interacting with White SPs performed better than White students interacting with Black SPs. CONCLUSION: Concern about appearing racist may interfere with White students' ability to perform well in a clinical setting because it may draw cognitive resources away from the clinical task. This is a first step in understanding how nursing students' perceptions may contribute to racial inequities in health. [J Nurs Educ. 2022;61(1):41-45.].

Bacharelado em Enfermagem , Racismo , Estudantes de Enfermagem , Competência Clínica , Humanos , Projetos Piloto , Competência Profissional
Br J Soc Psychol ; 61(1): 1-18, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34962301


The unexpected transformations produced by the conjunction of COVID-19, the murder of George Floyd and the resurgence of Black Lives Matter highlight the importance of social psychological understandings and the need for a step change in theorization of the social. This paper focuses on racialization. It considers issues that social psychology needs to address in order to reduce inequalities and promote social justice. It draws on theoretical resources of intersectionality and hauntology to illuminate the ways in which social psychological research frequently makes black people visible in ways that exclude them from normative constructions. The final main part of the paper presents an analysis of an interview with the racing driver Lewis Hamilton to illustrate possible ways of humanizing racialization by giving recognition to the multiplicity and historical location of racialized positioning. The paper argues that, while social psychology has made vital contributions to the understanding of group processes and of racisms, there remains a need to humanize racialization by conducting holistic analyses of black people's (and others') intersectional identities.

COVID-19 , Racismo , Humanos , Psicologia Social , SARS-CoV-2
Res Aging ; 44(1): 96-106, 2022 01.
Artigo em Inglês | MEDLINE | ID: mdl-33472550


Older adults (aged 55+) comprise a rapidly growing population both in number and racial-ethnic diversity. In recent years, substance misuse prevalence among older adults has increased and is expected to continue rising, highlighting the need to understand risk and protective factors in this population. Using nationally representative data, this study examines the association of racial-ethnic identity and racial-ethnic discrimination with alcohol and illicit drug use among Black and Latinx older adults, and whether racial-ethnic identity moderates the relationship between discrimination and substance misuse. Findings show that among Latinx older adults discrimination is associated with increased substance misuse, and higher ethnic identity is associated with decreased illicit drug use. Higher racial-ethnic identity buffers the effects of discrimination on illicit drug use for Latinx, but not for Black respondents. Findings of this study highlight the complex associations between racial-ethnic identity, discrimination, and substance misuse, varying across racial-ethnic group, age, context, and other factors.

Racismo , Idoso , Humanos
J Public Health Manag Pract ; 28(Suppl 1): S27-S37, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-34797258


This article outlines a pathway for public health departments and practitioners to incorporate law into their efforts to advance equity in health outcomes. We assert that examining and applying law can accelerate public health efforts to mitigate structural and systemic inequities, including racism. Recent events such as the COVID-19 pandemic and the community impacts of policing have brought into sharp relief the inequities faced by many populations. These stark and explosive examples arise out of long-standing, persistent, and sometimes hidden structural and systemic inequities that are difficult to trace because they are embedded in laws and accompanying policies and practices. We emphasize this point with a case study involving a small, majority Black community in semirural Appalachia that spent almost 50 years attempting to gain access to the local public water system, despite being surrounded by water lines. We suggest that public health practitioners have a role to play in addressing these kinds of public health problems, which are so clearly tied to the ways laws and policies are developed and executed. We further suggest that public health practitioners, invoking the 10 Essential Public Health Services, can employ law as a tool to increase their capacity to craft and implement evidence-based interventions.

COVID-19 , Equidade em Saúde , Racismo , Humanos , Pandemias , Saúde Pública , Prática de Saúde Pública , SARS-CoV-2
Med Educ Online ; 27(1): 1981803, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34813390


Coronavirus Disease 2019 (COVID-19) and the social justice movement in early 2020 awakened many Americans to the health disparities and health care inequities affecting Black communities. This heightened awareness has strengthened the call to address social determinants of health, like racism. Physicians can play an important role in dismantling racism through knowledge of implicit biases and understanding of historical trauma resulting in medical distrust as a crucial step to help advance the health of minority communities. The purpose of this project was to develop an anti-racism workshop for Graduate Medical Education. Two discussants led 1.5-hour interactive workshops. Content covered microagressions, colorblindness, tokenism, stereotypes, levels of racism, the impact of racism on health, and anti-racism concepts. Facilitated breakout sessions allowed participants to provide examples of witnessed racism and discuss application of anti-racism tools in those settings. Following the workshops, participants were asked to complete a 16-item survey to evaluate workshop effectiveness. Between July and August 2020, four workshops were delivered to 131 attendees. Fifty-nine completed post workshop surveys. Most respondents were White (75%), female (63%), and aged 31-40 (29%). Over half were faculty; 24% were residents, 8% fellows. The majority agreed they could apply knowledge to their work (95%) and found the workshop useful (95%). Over two-thirds reported being able to better identify disparities and better identify and communicate about racism. In open-ended questions, many participants requested an interactive longitudinal curriculum. Developing an antiracism workshop for an academic medical center located in the Deep South provided more insight into tangible next steps to foster an institutional culture centered on antiracism.

COVID-19 , Racismo , Educação de Pós-Graduação em Medicina , Feminino , Humanos , SARS-CoV-2 , Estados Unidos , Universidades
Licere (Online) ; 24(02): 147-172, 20210630. ilus, tab
Artigo em Português | LILACS | ID: biblio-1281359


A discussão sobre o racismo no Brasil é um tema relevante e atual, sendo enfrentado cotidianamente pelos afro-brasileiros. No cenário futebolístico não é diferente e este artigo ocupa-se a fazer uma revisão sistemática qualitativa das produções sobre o negro no futebol brasileiro, publicadas em periódicos científicos com escopo na Educação Física que, no Qualis/Capes do quadriênio 2013-2016, foram classificadas pela área 21 no extrato B2 ou superior. Divididos em cinco temáticas, encontrou-se resultados específicos: os jogos, Preto X Branco buscaram reforçar a integração racial; a imprensa negra atuava no combate ao racismo; a culpa do jogador negro, Barbosa, na derrota de 1950 não se deveu às análises esportivas à época; a cultura negra como atributo fundamental no estilo brasileiro de jogar; por fim, a discriminação racial no meio é uma prática recorrente e as autoridades pouco têm feito para combatê-lo.

Racism in Brazil is a relevant and current discussion, being faced daily by the Afro-Brazilians. As it also happens in the football scenario, this article engages a systematic qualitative review of the scientific productions concerning black people in Brazilian soccer published in academic journals focused on Physical Education, classified in area 21, stratum B2 or higher in Qualis/Capes four-year period 2013-2016. Five subjects compose the specific results found: first, the Black X White games sought to reinforce racial integration; second, the black press acted to fight racism; third, Barbosa's fault, a black player, in 1950's defeat was not due to sports analyses at the time. Fourth, black culture is a fundamental attribute to the Brazilian play style, and lastly, racial discrimination in this environment is an iterant practice, and authorities have done little to fight it.

Futebol , Esportes , Racismo
J. Health NPEPS ; 6(2): 1-17, dez. 2021.
Artigo em Português | LILACS, BDENF - Enfermagem, Coleciona SUS | ID: biblio-1349317


RESUMOObjetivo: conhecer o perfil epidemiológico dos casos de violência contra a população negra no Sudeste brasileiro. Método: estudo epidemiológico descritivo, de caráter quantitativo e comparativo, com dados dos casos de violência contra a população negra no Sudeste brasileiro de janeiro de 2009 a dezembro de 2018 do sistema de informação de agravos de notificação. Resultados: houve 386.373 notificações, e o número anual de casos cresceu no período. A violência contra mulheres foi72,48% dos casos. A idade mais acometida foi de 20 a 29 anos (22,98%). O local com o maior número de notificações de violência foi a residência das vítimas (61,46%), e os principais responsáveis pela violência foram o cônjuge (17,90%), própria pessoa (15,79%) e amigos/conhecidos (12,93%). Os tipos de violência mais comuns foram física (37,82%), de repetição (19,29%) e psico moral (14,90%).Conclusão: o perfil epidemiológico da violência contra a população negra revela um aumento anual no número de notificações nesse período, dados que refletem a opressão e a violência contra essa população, em especial às mulheres negras. Assim, são necessárias políticas públicas que atendam esses indivíduos buscando reduzir preconceitos e desigualdades estruturais.

ABSTRACTObjective: to meet the epidemiological profile of the cases of violence against the black population of brazillian Southeast. Method:descriptive epidemiological study, of quantitative and comparative character, with data from cases of violence against the black population in southeastern Brazil from January 2009 to December 2018 of the notifiable diseases information system. Results:there were 386.373 notifications, and the annual number of cases increased in the period. Violence against women was 72.48% of the cases. The most affected age was 20 to 29 years (22.98%). The place with the highest number of notifications of violence was the victims' residence (61.46%), and the main responsible for the violence were the spouse (17.90%), the person himself (15.79%) and friends / acquaintances (12.93%). The most common types of violence were physical (37.82%), repetitive (19.29%) and psycho-moral (14.90%). Conclusion:the epidemiological profile of violence against the black population reveals an annual increase in the number of notifications in this period, data that reflect oppression and violence against this population, especially for black women. Thus, public policies are needed to assist these individuals seeking to reduce prejudices and structural inequalities.

RESUMENObjetivo: conocer el perfil epidemiológico de los casos de violencia contra la población negra en el sureste de Brasil. Método: estudio epidemiológico descriptivo, de carácter cuantitativo y comparativo, con datos de casos de violencia contra la población negra en el sudeste de Brasil de enero de 2009 a diciembre de 2018 del sistema de información de enfermedades de declaración obligatoria. Resultados:hubo 386,373 notificaciones y el número anual de casos aumentó en el período. La violencia contra la mujer fue del 72,48% de los casos. La edad más afectada fue de 20 a 29 años (22,98%). El lugar con más notificaciones de violencia fue el domicilio (61,46%), y los principales responsables fueron el cónyuge (17,90%), la propia persona (15,79%) y los amigos/conocidos (12,93%). Los tipos de violencia más comunes fueron física (37,82%), repetitiva (19,29%) y psico-moral (14,90%). Conclusión: el perfil epidemiológico de la violencia contra la población negra revela un incremento anual en el número de notificaciones en este período, datos que reflejan la opresión y violenciacontra esta población, especialmente para las mujeres negras. Por lo tanto, se necesitan políticas públicas para reducir los prejuicios y las desigualdades estructurales a estas personas.

Violência , Racismo , Saúde das Minorias Étnicas , Saúde Pública , Epidemiologia
J. Health NPEPS ; 6(2): 1-15, dez. 2021.
Artigo em Inglês | LILACS, BDENF - Enfermagem, Coleciona SUS | ID: biblio-1337842


ABSTRACT Objective:to analyze the epidemiological data of Severe Acute Respiratory Syndrome (SARS), and the access to health of black people in Brazil during the pandemic, comparing them with previous years. Method:epidemiological, descriptive, and quantitative study of SARS cases in black patients, reported in the information system on epidemiological surveillance of influenzaof the Ministry of Health, between 2017 and 2020. Results:it was observed that, in 2020, there was an increase in the prevalence of SARS cases in blacks, in addition to a significant increase in lethality when compared to the general population. Furthermore, it was found that mortality was significantly higher in individuals with SARS who required ventilatory support. Conclusion:skin color is a determinant of several social and health vulnerabilities in Brazil and worldwide, having a direct impact on theincreased morbidity and mortality of the black population during the pandemic.

RESUMEN Objetivo:analizar los datos epidemiológicos del Síndrome Respiratorio Agudo Severo (SRAS) y el acceso a la salud de los negros en Brasil durante la pandemia, comparándolos con años anteriores. Método:estudio epidemiológico, descriptivo y cuantitativo de casos de SRAS en pacientes de raza negra, reportados en el sistema de información de vigilancia epidemiológica de Influenza del Ministerio de Salud, entre 2017 y 2020. Resultados:se observó que, en En 2020, hubo un aumento en la prevalencia de casos de SARS en negros, además de un aumento significativo en la letalidad en comparación con la población general. Además, se encontró que la mortalidad fue significativamente mayor en las personas con SARS que requirieron soporte ventilatorio. Conclusión:color de la piel es un determinante de varias vulnerabilidades sociales y de salud en Brasil y en todo el mundo, teniendo un impacto directo en el aumento de la morbilidad y mortalidad de la población negra durante la pandemia.

RESUMO Objetivo: analisar os dados epidemiológicos da síndrome respiratória aguda grave (SRAG) e o acesso à saúde de pessoas negras no Brasil durante a pandemia, comparando-os com os anos anteriores.Método: estudo epidemiológico, descritivo e quantitativo de casos de SRAG em pacientes negros, notificados no sistema de informação em vigilância epidemiológica da influenza do Ministério da Saúde, entre 2017 e 2020. Resultados: observou-se que, em 2020, houve um aumento da prevalência dos casos de SRAG em negros, além de um aumento significativo da letalidade quando comparada à população em geral. Além disso, verificou-se que a mortalidade foi significativamente maior em indivíduos com SRAG que necessitaram de suporte ventilatório. Conclusão: a cor da pele é um determinante de diversas vulnerabilidades sociais e de saúde no Brasil e no mundo, tendo impacto direto no aumento da morbimortalidade da população negra durante a pandemia.

Infecções por Coronavirus , Síndrome Respiratória Aguda Grave , Determinantes Sociais da Saúde , Disparidades em Assistência à Saúde , Racismo
Proc Natl Acad Sci U S A ; 118(51)2021 12 21.
Artigo em Inglês | MEDLINE | ID: mdl-34903653


We investigated historical redlining, a government-sanctioned discriminatory policy, in relation to cardiovascular health (CVH) and whether associations were modified by present-day neighborhood physical and social environments. Data included 4,779 participants (mean age 62 y; SD = 10) from the baseline sample of the Multi-Ethnic Study of Atherosclerosis (MESA; 2000 to 2002). Ideal CVH was a summary measure of ideal levels of seven CVH risk factors based on established criteria (blood pressure, fasting glucose, cholesterol, body mass index, diet, physical activity, and smoking). We assigned MESA participants' neighborhoods to one of four grades (A: best, B: still desirable, C: declining, and D: hazardous) using the 1930s federal Home Owners' Loan Corporation (HOLC) maps, which guided decisions regarding mortgage financing. Two-level hierarchical linear and logistic models, with a random intercept to account for participants nested within neighborhoods (i.e., census tracts) were used to assess associations within racial/ethnic subgroups (non-Hispanic White, non-Hispanic Black, Hispanic, and non-Hispanic Chinese). We found that Black adults who lived in historically redlined areas had a 0.82 (95% CI -1.54, -0.10) lower CVH score compared to those residing in grade A (best) neighborhoods, in a given neighborhood and adjusting for confounders. We also found that as the current neighborhood social environment improved the association between HOLC score and ideal CVH weakened (P < 0.10). There were no associations between HOLC grade and CVH measures or effect modification by current neighborhood conditions for any other racial/ethnic group. Results suggest that historical redlining has an enduring impact on cardiovascular risk among Black adults in the United States.

Aterosclerose/epidemiologia , Racismo , Características de Residência , Idoso , Idoso de 80 Anos ou mais , Aterosclerose/etnologia , Feminino , Disparidades nos Níveis de Saúde , Fatores de Risco de Doenças Cardíacas , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Meio Social , Estados Unidos/epidemiologia
JAMA Netw Open ; 4(12): e2139533, 2021 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-34913976


Importance: Stereotype threat, or the fear of confirming a negative stereotype about one's social group, may contribute to racial differences in adherence to medications by decreasing patient activation to manage chronic conditions. Objective: To examine whether a values affirmation writing exercise improves medication adherence and whether the effect differs by patient race. Design, Setting, and Participants: The Hypertension and Values trial, a patient-level, blinded randomized clinical trial, compared an intervention and a control writing exercise delivered immediately prior to a clinic appointment. Of 20 777 eligible, self-identified non-Hispanic Black and White patients with uncontrolled hypertension who were taking blood pressure (BP) medications, 3891 were approached and 960 enrolled. Block randomization by self-identified race ensured balanced randomization. Patients enrolled between February 1, 2017, and December 31, 2019, at 11 US safety-net and community primary care clinics, with outcomes assessed at 3 and 6 months. Analysis was performed on an intention-to-treat basis. Interventions: From a list of 11 values, intervention patients wrote about their most important values and control patients wrote about their least important values. Main Outcomes and Measures: The primary outcome of adherence to BP medications was measured using pharmacy fill data (proportion of days covered >90%) at baseline, 3 months, and 6 months. The secondary outcome was systolic and diastolic BP. Patient activation to manage their health was also measured. Results: Of 960 patients, 474 (286 women [60.3%]; 256 Black patients [54.0%]; mean [SD] age, 63.4 [11.9] years) were randomly assigned to the intervention group and 486 (288 women [59.3%]; 272 Black patients [56.0%]; mean [SD] age, 62.8 [12.0] years) to the control group. Baseline medication adherence was lower (318 of 482 [66.0%] vs 331 of 412 [80.3%]) and mean (SE) BP higher among Black patients compared with White patients (systolic BP, 140.6 [18.5] vs 137.3 [17.8] mm Hg; diastolic BP, 83.9 [12.6] vs 79.7 [11.3] mm Hg). Compared with baseline, pharmacy fill adherence did not differ between intervention and control groups at 3 months (odds ratio [OR], 0.91 [95% CI, 0.57-1.43]) or at 6 months (OR, 0.86 [95% CI, 0.53-1.38]). There were also no treatment effect differences in pharmacy fill adherence by patient race (Black patients at 3 months: OR, 1.08 [95% CI, 0.61-1.92]; at 6 months: OR, 1.04 [95% CI, 0.58-1.87]; White patients at 3 months: OR, 0.68 [95% CI, 0.33-1.44]; at 6 months: OR, 0.55 [95% CI, 0.24-1.27]). Immediately after the intervention, the median patient activation was higher in intervention patients than in control patients, but this difference was not statistically significant in an unadjusted comparison (75.0 [IQR, 65.5-84.8] vs 72.5 [IQR, 63.1-80.9]; P = .06). In adjusted models, the Patient Activation Measure score immediately after the intervention was significantly higher in the intervention patients than in control patients (mean difference, 2.3 [95% CI, 0.1-4.5]). Conclusions and Relevance: A values affirmation intervention was associated with higher patient activation overall but did not improve adherence or blood pressure among Black and White patients with hypertension. Trial Registration: Identifier: NCT03028597.

Afro-Americanos/psicologia , Anti-Hipertensivos/uso terapêutico , Atitude Frente a Saúde/etnologia , Hipertensão/tratamento farmacológico , Adesão à Medicação/etnologia , Racismo/psicologia , Valores Sociais/etnologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Colorado , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Disparidades nos Níveis de Saúde , Disparidades em Assistência à Saúde/etnologia , Humanos , Hipertensão/etnologia , Hipertensão/psicologia , Análise de Intenção de Tratamento , Masculino , Adesão à Medicação/psicologia , Pessoa de Meia-Idade , Relações Profissional-Paciente , Método Simples-Cego , Redação , Adulto Jovem
Artigo em Inglês | MEDLINE | ID: mdl-34948709


The populations impacted most by COVID are also impacted by racism and related social stigma; however, traditional surveillance tools may not capture the intersectionality of these relationships. We conducted a detailed assessment of diverse surveillance systems and databases to identify characteristics, constraints and best practices that might inform the development of a novel COVID surveillance system that achieves these aims. We used subject area expertise, an expert panel and CDC guidance to generate an initial list of N > 50 existing surveillance systems as of 29 October 2020, and systematically excluded those not advancing the project aims. This yielded a final reduced group (n = 10) of COVID surveillance systems (n = 3), other public health systems (4) and systems tracking racism and/or social stigma (n = 3, which we evaluated by using CDC evaluation criteria and Critical Race Theory. Overall, the most important contribution of COVID-19 surveillance systems is their real-time (e.g., daily) or near-real-time (e.g., weekly) reporting; however, they are severely constrained by the lack of complete data on race/ethnicity, making it difficult to monitor racial/ethnic inequities. Other public health systems have validated measures of psychosocial and behavioral factors and some racism or stigma-related factors but lack the timeliness needed in a pandemic. Systems that monitor racism report historical data on, for instance, hate crimes, but do not capture current patterns, and it is unclear how representativeness the findings are. Though existing surveillance systems offer important strengths for monitoring health conditions or racism and related stigma, new surveillance strategies are needed to monitor their intersecting relationships more rigorously.

COVID-19 , Racismo , Humanos , SARS-CoV-2 , Estigma Social
J Law Med Ethics ; 49(2): 168-173, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34924053


This narrative provides insight into medical education for Black physicians in South Carolina in the 1960s, during the civil rights movement. It also discusses the many rewards and challenges of being a physician of color, describes what has been done to develop programs that benefit minority communities, and argues that more such programs are needed.

Médicos , Racismo , Atenção à Saúde , Instalações de Saúde , Humanos , Grupos Minoritários