Racial and ethnic disparity in national practice patterns for stress urinary incontinence surgery.

INTRODUCTION AND HYPOTHESIS: There is a paucity of information assessing whether race/ethnicity is associated with differences in surgical treatment of stress urinary incontinence (SUI). The primary objective was to assess for racial/ethnic disparities in SUI surgeries. Secondary objectives were to assess for surgical complication differences and trends over time. METHODS: Using the American College of Surgeons National Surgical Quality Improvement Program database, we conducted a retrospective cohort analysis of patients undergoing SUI surgery from 2010 to 2019. Chi-squared or Fisher's exact test and ANOVA were used for categorical and continuous variables respectively. Breslow day score and multinomial and multiple logistic regression models were used. RESULTS: A total of 53,333 patients were analyzed. Using White race/ethnicity and sling surgery as references, Hispanic patients underwent more laparoscopic surgeries (OR1.17 [CI 1.03, 1.33]) and anterior vesico-urethropexy/urethropexies (OR 1.97 [CI 1.66, 2.34]); Black patients underwent more anterior vesico-urethropexy/urethropexies (OR 1.49 [CI 1.07, 2.07]), abdomino-vaginal vesical neck suspensions (OR 2.19 [CI 1.05-4.55]), and inflatable urethral slings (OR 4.28 [CI 1.23-14.90]). White patients had lower rates of inpatient stay (p < 0.0001) and blood transfusion (p < 0.0001) compared with patients who were Black, indigenous, people of color (BIPOC). Over time, Hispanic and Black patients were more likely to undergo anterior vesico-urethropexy/urethropexies than White patients (RR 2.03:1 [CI 1.72-2.40]) and (RR 1.59 CI [1.15-2.20]) respectively. Adjusting for possible confounders, Hispanic and Black patients had a greater chance of having a nonsling surgery, 37% (p < 0.0001) and 44% (p = 0.0001) greater chances respectively. CONCLUSION: We observed racial/ethnic differences in SUI surgeries. Although causality cannot be proven here, our results confirm previous findings suggesting inequities in care.

Medical educators' perception of race in clinical practice.

BACKGROUND: While several medical societies endorse race as a social construct, it is still often used as a biological trait in medical education. How medical educators employ race while teaching is likely impacted by their beliefs as to what race represents and its relevance in clinical care. Understanding these beliefs is necessary to guide medical education curriculum reform. METHODS: This was a qualitative survey study, conducted in June 2020, of Georgetown University Medical Center faculty. As part of the survey, faculty were asked to rate, on a 5-point Likert scale, the extent to which they perceived race as a biological trait and its importance in clinical care. Self-identified clinical or preclinical faculty (N = 147) who believed that race had any importance were asked to provide an example illustrating its significance. Free-text responses were coded using content analysis with an inductive approach and contextualized by faculty's perspectives on the biological significance of race. RESULTS: There were 130 (88%) responses categorized into two major themes: race is important for [1] screening, diagnosing, and treating diseases and [2] contextualizing patients' experiences and health behaviors. Compared to faculty who perceived race as biological, those who viewed race as strictly social were more likely to report using race to understand or acknowledge patients' exposure to racism. However, even among these faculty, explanations that suggested biological differences between racial groups were prevalent. CONCLUSIONS: Medical educators use race primarily to understand diseases and frequently described biological differences between racial groups. Efforts to reframe race as sociopolitical may require education that examines race through a global lens, accounting for the genetic and cultural variability that occurs within racial groups; greater awareness of the association between structural racism and health inequities; movement away from identity-based risk stratification; and incorporation of tools that appraise race-based medical literature.

Addressing challenges related to the professional practice of abortion post-Roe.

The landmark Roe vs Wade Supreme Court decision in 1973 established a constitutional right to abortion. In June 2022, the Dobbs vs Jackson Women's Health Organization Supreme Court decision brought an end to the established professional practice of abortion throughout the United States. Rights-based reductionism and zealotry threaten the professional practice of abortion. Rights-based reductionism is generally the view that moral or ethical issues can be reduced exclusively to matters of rights. In relation to abortion, there are 2 opposing forms of rights-based reductionism, namely fetal rights reductionism, which emphasizes the rights for the fetus while disregarding the rights and autonomy of the pregnant patient, and pregnant patient rights reductionism, which supports unlimited abortion without regards for the fetus. The 2 positions are irreconcilable. This article provides historical examples of the destructive nature of zealotry, which is characterized by extreme devotion to one's beliefs and an intolerant stance to opposing viewpoints, and of the importance of enlightenment to limit zealotry. This article then explores the professional responsibility model as a clinically ethically sound approach to overcome the clashing forms of rights-based reductionism and zealotry and to address the professional practice of abortion. The professional responsibility model refers to the ethical and professional obligations that obstetricians and other healthcare providers have toward pregnant patients, fetuses, and the society at large. It provides a more balanced and nuanced approach to the abortion debate, avoiding the pitfalls of reductionism and zealotry, and allows both the rights of the woman and the obligations to pregnant and fetal patients to be considered alongside broader ethical, medical, and societal implications. Constructive and respectful dialogue is crucial in addressing diverse perspectives and finding common ground. Embracing the professional responsibility model enables professionals to manage abortion responsibly, thereby prioritizing patients' interests and navigating between absolutist viewpoints to find balanced ethical solutions.

Black-White Inequities in Kidney Disease Mortality Across the 30 Most Populous US Cities.

OBJECTIVES: To examine city-level kidney disease mortality rates and Black:White racial inequities for the USA and its largest cities, and to determine if these measures changed over the past decade. METHODS: We used National Vital Statistics System mortality data and American Community Survey population estimates to calculate age-standardized kidney disease mortality rates for the non-Hispanic Black (Black), non-Hispanic White (White), and total populations for the USA and the 30 most populous US cities. We examined two time points, 2008-2013 (T1) and 2014-2018 (T2), and assessed changes in rates and inequities over time. Racial inequities were measured with Black:White mortality rate ratios and rate differences. RESULTS: Kidney disease mortality rates varied from 2.5 (per 100,000) in San Diego to 24.6 in Houston at T2. The Black kidney disease mortality rate was higher than the White rate in the USA and all cities studied at both time points. In T2, the Black mortality rate ranged from 7.9 in New York to 45.4 in Charlotte, while the White mortality rate ranged from 2.0 in San Diego to 18.6 in Indianapolis. At T2, the Black:White rate ratio ranged from 1.79 (95% CI 1.62-1.99) in Philadelphia to 5.25 (95% CI 3.40-8.10) in Washington, DC, compared to the US rate ratio of 2.28 (95% CI 2.25-2.30). Between T1 and T2, only one city (Nashville) saw a significant decrease in the Black:White mortality gap. CONCLUSIONS: The largest US cities experience widely varying kidney disease mortality rates and widespread racial inequities. These local data on racial inequities in kidney disease mortality can be used by city leaders and health stakeholders to increase awareness, guide the allocation of limited resources, monitor trends over time, and support targeted population health strategies.

Social Vulnerability Index and Surgical Management of Abnormal Uterine Bleeding in Reproductive-age Women.

STUDY OBJECTIVE: To determine whether surgical management of abnormal uterine bleeding (AUB) is associated with social vulnerability index (SVI). DESIGN: A retrospective cohort. SETTING: A total of 7 hospitals and 4 ambulatory surgery centers within a large New York health system. PATIENTS: All patients between 15 and 45 years of age who underwent either a hysterectomy or myomectomy for AUB between January 2019 and October 2021. INTERVENTIONS: None. Home addresses were linked to census tracts and SVI scores. SVI is composed of 4 themes that potentially influence a community's vulnerability to health stressors: socioeconomic status, household composition and disability, minority status and language, and housing type and transportation. Multiple logistic regression analyses were performed to evaluate the association between SVI and surgical procedure/approach, adjusting for age, race and ethnicity, marital status, insurance, language, body mass index, and previous abdominal surgery. MEASUREMENTS AND MAIN RESULTS: A total of 1628 patients were included. On performing regression analysis between SVI quarters and type of surgery, the odds of undergoing laparotomy for the hysterectomy group were not affected by SVI composite score both before and after adjusting for alternative factors (odds ratio [OR] and adjusted OR). Among those who had a myomectomy, individuals in SVI Q3 had 1.86 times (95% confidence interval, 1.27-2.72) higher odds of having a laparotomy than those in SVI Q1. Individuals in SVI Q4 had 1.74 times (95% confidence interval, 1.15-2.62) higher odds of having a laparotomy than those in SVI Q1. Although some unadjusted ORs were statistically significant in the myomectomy group, when adjusted for social, demographic, and economic factors, the results were not statistically significant. CONCLUSION: Patients living in more vulnerable communities are less likely to have minimally invasive hysterectomy or myomectomy for the management of AUB. Neighborhood characteristics are independently associated with surgical procedure and approach.

Moving beyond mistrust: Centering institutional change by decentering the white analytical lens.

The topic of Black mistrust of medical institutions and health care has received a great deal of attention over the course of the Covid-19 pandemic, especially with the arrival of vaccines and the emergence of a gap in vaccination rates by race. This article examines current discourses and debates over medical mistrust, and describes the limitations of the mistrust framework for identifying and addressing the institutional change necessary to remedy racial health inequities. As numerous observers have pointed out, the mistrust discourse largely places the burden of change on historically exploited and mistreated populations, rather than on the medical institutions that committed the violations and continue the mistreatment that are often identified as sources of mistrust. However, even the analytic shift to focus on the trustworthiness of institutions narrows the scope of the issue to the relationships of medical institutions to specific communities. While the mistrust literature has made important contributions to centering and valuing Black perspectives, this framework delimits the focus to Black perceptions and behaviors rather than on medical institutions and the health care system. Whereas the predominately white analytic lens of bioethics scholarship has centered Black populations by making them the subject of study, this article draws a distinction between simply analyzing, versus meaningfully centering and deriving an analysis from the perspective of marginalized populations within scholarship. This article suggests moving beyond the mistrust framework and the assumption of white normativity to conduct the type of institutional analysis necessary for addressing racial health inequities.

Racial inequity in preterm delivery among college-educated women: The role of racism.

BACKGROUND: Non-Hispanic Black (NHB) women face a 50% increased risk of delivering preterm compared to non-Hispanic White (NHW) women in the United States. Sociodemographic and pregnancy risk factors do not fully explain this inequity. This inequity exists even among women with a college education, although recent empirical analysis on racial inequities in preterm delivery (PTD) among college-educated women is lacking. Furthermore, the contribution of preconception risk factors to the racial inequity in PTD has not been examined. OBJECTIVES: To determine whether: (i) there is a NHB-NHW inequity in PTD among college-educated women; (ii) the prevalence of known, measured sociodemographic, pregnancy, and preconception PTD risk factors differs between NHB and NHW college-educated women; (iii) equalising the distribution of risk factors between college-educated NHB and NHW women reduces or eliminates the racial inequity in PTD. METHODS: We analysed US natality data from 2015 to 2016 among women with a college degree or higher (n = 2 326 512). We calculated frequencies of sociodemographic, pregnancy, and preconception risk factors among all women and separately by race/ethnicity. We used modified Poisson regression models to estimate the association between race/ethnicity and PTD controlling for known, measured sociodemographic, pregnancy, and preconception factors. RESULTS: The largest percentage point differences in risk factors between NHW and NHB women were observed for marital status, trimester of care initiation, body mass index, and birth interval. Among college-educated women, the unadjusted risk of PTD for NHB women was 1.77 (95% CI 1.74, 1.79) times the risk for NHW women. After controlling for sociodemographic, pregnancy, and preconception factors, this attenuated to RR 1.47 (95% CI 1.45, 1.49). CONCLUSIONS: A racial inequity in PTD persists among college-educated women. Racism contributes to the NHB-NHW inequity in PTD, in part, through its influence on known sociodemographic, pregnancy, and preconception risk factors for PTD and, in part, through unmeasured pathways.

Racial Equity in Academic Success: The Role of School Climate and Social Emotional Learning.

Many schools and school districts have put significant effort into improving school climate and the social emotional learning (SEL) of students, as they have been shown to be related to improved academic success. Yet, little is known about whether these efforts will contribute to or ameliorate racial differences in academic outcomes. In a series of structural equation models adjusting for school clustering, this study examined mediating and moderating effects of student perceptions of school climate and their own SEL on race differences in self-reported grades. Asian and Latinx students reported slightly more positive perceived school climate while Multiracial students reported significantly less positive perceived school climate compared to White students. Compared to their White peers, all racial groups reported lower levels of SEL. Significant but small indirect standardized effects of race on grades through social emotional competence but not school climate suggest that SEL partially mediates the relationship of race with grades. The association of SEL with grades was significantly stronger for White students compared to other racial groups; the standardized effect size of the association was nearly twice as large for White students as for Black and Native students.

Mediators of Black-White inequities in cardiovascular mortality among survivors of 18 cancers in the USA.

BACKGROUND: This study aims to quantify Black-White inequities in cardiovascular disease (CVD) mortality among US survivors of 18 adult-onset cancers and the extent to which these inequities are explained by differences in socio-economic and clinical factors. METHODS: Survivors of cancers diagnosed at ages 20-64 years during 2007-16 were identified from 17 Surveillance, Epidemiology and End Results registries. Associations between race and CVD mortality were examined using proportional hazards models. Mediation analyses were performed to quantify the contributions of potential mediators, including socio-economic [health insurance, neighbourhood socio-economic status (nSES), rurality] and clinical (stage, surgery, chemotherapy, radiotherapy) factors. RESULTS: Among 904 995 survivors, 10 701 CVD deaths occurred (median follow-up, 43 months). Black survivors were more likely than White survivors to die from CVD for all 18 cancers with hazard ratios ranging from 1.30 (95% CI = 1.15-1.47) for lung cancer to 4.04 for brain cancer (95% CI = 2.79-5.83). The total percentage mediations (indirect effects) ranged from 24.8% for brain (95% CI=-5.2-59.6%) to 99.8% for lung (95% CI = 61.0-167%) cancers. Neighbourhood SES was identified as the strongest mediator for 14 cancers with percentage mediations varying from 25.0% for kidney cancer (95% CI = 14.1-36.3%) to 63.5% for lung cancer (95% CI = 36.5-108.7%). Insurance ranked second for 12 cancers with percentage mediations ranging from 12.3% for leukaemia (95% CI = 0.7-46.7%) to 31.3% for thyroid cancer (95% CI = 10.4-82.7%). CONCLUSIONS: Insurance and nSES explained substantial proportions of the excess CVD mortality among Black survivors. Mitigating the effects of unequal access to care and differing opportunities for healthy living among neighbourhoods could substantially reduce racial inequities in CVD mortality among cancer survivors.

Proceedings of the 2024 Third Annual ASTCT-NMDP ACCESS Initiative Workshop.

The Third Annual Workshop of the American Society for Transplantation and Cellular Therapy (ASTCT) and National Marrow Donor Program (NMDP) ACCESS Initiative occurred on July 23 and 24, 2024. Content from the workshop is provided to inform the hematopoietic cell transplantation (HCT) and cellular therapy (CT) ecosystem about progress and direction of the collaborative. Highlights from the meeting are reviewed, including the inaugural Corporate Roundtable and Advocacy Day, new partnerships with non-profit organizations, and updates on projects from the Awareness, Poverty and Race and Ethnicity Inequity Committees. In addition, the Junior Faculty and Trainee Immersion Program-sponsored efforts in workforce diversity and physician advocacy are presented. Lastly, continued education was provided on patient and caregiver participation as well as community engagement. As it enters its third year, the ASTCT-NMDP ACCESS Initiative will transition from foundation building as a grass roots collaborative to intentional impact in reducing barriers and improving outcome disparities for all patients in need of HCT/CT. Enthusiasm for and participation in the ACCESS Initiative remain high. Both are needed to sustain progress in achieving its goal in enabling all patients in need to receive HCT/CT.

Medical Professional Reports and Child Welfare System Infant Investigations: An Analysis of National Child Abuse and Neglect Data System Data.

Background: Medical professionals are key components of child maltreatment surveillance. Updated estimates of reporting rates by medical professionals are needed. Methods: We use the National Child Abuse and Neglect Data System (2000-2019) to estimate rates of child welfare investigations of infants stemming from medical professional reporting to child welfare agencies. We adjust for missing data and join records to population data to compute race/ethnicity-specific rates of infant exposure to child welfare investigations at the state-year level, including sub-analyses related to pregnant/parenting people's substance use. Results: Between 2010 and 2019, child welfare investigated 2.8 million infants; ∼26% (n=731,705) stemmed from medical professionals' reports. Population-adjusted rates of these investigations stemming doubled between 2010 and 2019 (13.1-27.1 per 1000 infants). Rates of investigations stemming from medical professionals' reports increased faster than did rates for other mandated reporters, such as teachers and police, whose reporting remained relatively stable. In 2019, child welfare investigated ∼1 in 18 Black (5.4%), 1 in 31 Indigenous (3.2%), and 1 in 41 White infants (2.5%) following medical professionals' reports. Relative increases were similar across racial groups, but absolute increases differed, with 1.3% more of White, 1.7% of Indigenous, and 3.1% of Black infants investigated in 2019 than 2010. Investigations related to substance use comprised ∼35% of these investigations; in some states, this was almost 80%. Discussion: Rates of child welfare investigations of infants stemming from medical professional reports have increased dramatically over the past decade with persistent and notable racial inequities in these investigations.

Racial inequality in functional trajectories between Black and White U.S. veterans.

BACKGROUND: Racial inequality in functional trajectories has been well documented in the U.S. civilian population but has not been explored among Veterans. Our objectives were to: (1) assess how functional trajectories differed for Black and White Veterans aged ≥50 and (2) explore how socioeconomic, psychosocial, and health-related factors altered the relationship between race and function. METHODS: We conducted a prospective, longitudinal analysis using the 2006-2016 Health and Retirement Study. The study cohort included 3700 Veterans who self-identified as Black or White, responded to baseline psychosocial questionnaires, and were community-dwelling on first observation. We used stepwise and stratified linear mixed effects models of biannually assessed functional limitations. The outcome measure was as a count of functional limitations. Race was measured as respondent self-identification as Black or White. Demographic measures included gender and age. Socioeconomic resources included partnership status, education, income, and wealth. Psychosocial stressors included exposure to day-to-day and major discrimination, traumatic life events, stressful life events, and financial strain. Health measures included chronic and mental health diagnoses, smoking, rurality, and use of Veterans Affairs services. RESULTS: Black Veterans developed functional limitations at earlier ages and experienced faster functional decline than White Veterans between the ages of 50 and 70, with convergence occurring at age 85. Once we accounted for economic resources and psychosocial stressors in multivariable analyses, the association between race and the number of functional limitations was no longer statistically significant. Lower wealth, greater financial strain, and traumatic life events were significantly associated with functional decline. CONCLUSIONS: Health systems should consider how to track Veterans' function earlier in the life course to ensure that Black Veterans are able to get timely access to services that may slow premature functional decline. Providers may benefit from training about the role of economic resources and psychosocial stressors in physical health outcomes.

"Those Who Need It the Most": Equity Framing in 2021 U.S. Print News About Food Assistance.

Objective: To understand how equity appeared in news about food assistance from 2021. Methods: We assessed a national sample of news articles (N=298) for equity arguments and language about racial and health equity. Results: Only 28% of coverage argued that food assistance programs promote equity. Just 6% mentioned people of color or named racial disparities in food access. Discussion: Narratives that explain how food assistance programs reduce inequities could deepen their policy appeal and broaden public perceptions around recipients. Health Equity Implications: There are opportunities for news coverage to expand the discussion of how food assistance programs improve racial and health equity outcomes.

Racial and Ethnic Inequities in Financial Hardship Among CVD Patients in the USA During the Pre- and Post-Affordable Care Act Era.

The Affordable Care Act (ACA) has substantially expanded access to health insurance coverage, resulting in a reduction in financial hardship, defined as ability to pay medical bills, among cardiovascular disease (CVD) patients in the post-ACA era. However, it is not known whether implementation of the ACA improved the racial and ethnic inequity in financial hardship among CVD patients. As such, using data from the 2011 to 2018 waves of the National Health Interview Survey (NHIS), this paper aims to assess the odds of facing financial hardship among non-Hispanic-White, -Black, -Asian, and Hispanic CVD patients, before and after the implementation of the ACA. Our sample consists of 12,688 CVD patients in pre-ACA (2011-2013), 9128 CVD patients in early (2014-2015), and 11,863 CVD patients in later phase of the ACA (2016-2018). We performed multivariable logistic regressions to examine how the odds, in favor of facing financial hardship, varied between non-Hispanic White and other race/ethnic categories across the pre- and post-ACA periods. Though the overall prevalence of financial hardship was reduced from 22 to 18%, a considerable disparity between Black and Hispanic, and White CVD patients persisted from pre-ACA to post-ACA periods. The odds of experiencing financial hardship for Black and Hispanic CVD patients were, respectively, 2.25 to 2.16 and 1.52 to 1.78 times that of their White counterparts across the periods. Though the ACA is a positive step towards improving healthcare access and affordability, further initiatives are needed to reduce inequities across racial and ethnic minorities.

Caring for Ourselves, Supporting Anti-Racist Programming in Medicine.

Healthcare disparities and racism are finally being addressed in medical education. Medical schools are working to implement anti-racist programming; however, this can have a negative impact on the mental health of doctors and medical students of color. Continually hearing about people of one's racial group suffering from inequity can have a negative personal and performance impact. Specifically, providers of color want to be a part of the anti-racist movement, but it takes a toll on their mental and emotional wellbeing in the process. Through the support of their respective institutions, it is important for these providers to prioritize self-care such as engaging in physical activity, coaching and therapy. By caring for themselves in and outside of the work environment, providers of color will be better able to fight for anti-racism in healthcare. In this essay, we discuss the importance of health disparity education, challenges in implementing successful healthcare disparity curricula, and possible solutions to support providers and trainees of color.

Assessing Medicaid Coverage for Hematopoietic Cell Transplantation and Chimeric Antigen Receptor T Cell Therapy: A Project from the American Society for Transplantation and Cellular Therapy and the National Marrow Donor Program ACCESS Initiative.

The American Society for Transplantation and Cellular Therapy (ASTCT) and the National Marrow Donor Program (NMDP) formed the ACCESS Initiative to address and reduce barriers to hematopoietic cell transplantation (HCT) and cellular therapy (CT) to ensure equal access and outcomes for all patients in need. The 3 committees, addressing awareness, poverty, and racial and ethnic inequity, defined pilot projects focusing on addressing relevant barriers to HCT/CT. Because many socioeconomically disadvantaged HCT/CT recipients receive care through state Medicaid programs, the Poverty Committee conducted a Medicaid scan of all 50 US states with the following objectives: to define beneficiary coverage for allogeneic and autologous HCT and chimeric antigen receptor (CAR) T cell therapy; to define support for travel, temporary lodging, and meals for both beneficiaries and caregivers; and to determine search and cell acquisition payment procedures. Here we summarize the results of the Medicaid scan and highlight significant variations and gaps in coverage for HCT/CT recipients. We also provide an initial roadmap for addressing gaps in Medicaid support for HCT and CAR-T therapy recipients.

Proceedings of the 2023 Second Annual ASTCT-NMDP ACCESS Initiative Workshop.

Here the proceedings from the Second Annual American Society for Transplantation and Cellular Therapy (ASTCT) and National Marrow Donor Program (NMDP) ACCESS Initiative are reviewed to inform the hematopoietic cell transplantation (HCT) and cellular therapy (CT) ecosystem about progress and direction of the collaborative. Highlights from the meeting, including updates on the progress of projects from the Awareness, Poverty, and Racial Inequity Committees, are presented. The ACCESS Initiative continues to evolve and will remain dependent on the HCT/CT ecosystem's continued dedication to reduce barriers and improve outcome disparities for all patients in need of HCT/CT.

Degrees of change: the promise of anti-racist assessment.

Assessment practices in Higher Education remain beholden to the twin pillars of neoliberal economic orthodoxy and White supremacy. The former has given rise to the modularization and commodification of education, wherein student performance is measured according to narrow and often meaningless metrics that foster and maintain ineffective assessment mechanisms. The latter imbues those metrics with a deference to, and valorization of, "Whiteness" as a marker of success, and this manifests in persistent awarding gaps across the sector. Critical Race Theory elucidates the ways in which the "banking model" of education and assessment is implicated in a history of colonial oppression that underpins contemporary experiences of marginalization for racially minoritized students. Furthermore, the rapid proliferation of Artificial Intelligence programs is now throwing into sharp relief the fact that traditional forms of assessment are no longer functional even on their own flawed terms. The authors argue that, at this critical juncture, Anti-Racist assessment, which not only exposes and problematizes racism itself but also embeds formative feedback, drafting, collaboration, and creativity into assessment practices, offers a practical solution that can reconceptualize 'academic excellence' and help to identify and support a different kind of 'good student', reshaping the employability agenda as a force for good and reclaiming the democratizing potential of Higher Education.

Mitigating Racial Inequity by Addressing Racism in the Criminal Justice System: A Behavior Analytic Approach.

Racial inequity in the U.S. criminal justice system is a long-standing problem that has recently garnered international attention. This article frames the problem of racial inequity in a behavior analytic context and offers potential solutions based on existent research and behavior analytic principles. We draw a parallel between the analysis of racist behavior enabled by the definitions provided by Kendi in How to Be an Antiracist and the analysis of verbal behavior made possible by the terminology posited by Skinner in Verbal Behavior in order to highlight the pertinence of applying a behavior analytic approach to the problem of racial inequity upheld by racist behavior. Immediately actionable steps to address racism in the criminal justice system and beyond are offered on a cultural, organizational, and individual level.

Evaluating equity in community-based naloxone access among racial/ethnic groups in Massachusetts.

BACKGROUND: Racial/ethnic minorities have experienced disproportionate opioid-related overdose death rates in recent years. In this context, we examined inequities in community-based naloxone access across racial/ethnic groups in Massachusetts. METHODS: We used data from: the Massachusetts Department of Public Health on community-based overdose education and naloxone distribution (OEND) programs; the Massachusetts Office of the Chief Medical Examiner on opioid-related overdose deaths, and; the United States Census American Community Survey for regional demographic/socioeconomic details to estimate community populations by race/ethnicity and racial segregation between African American/Black and white residents. Race/ethnicity groups included in the analysis were African American/Black (non-Hispanic), Hispanic, white (non-Hispanic), and "other" (non-Hispanic). We evaluated racial/ethnic differences in naloxone distribution across regions in Massachusetts and neighborhoods in Boston descriptively and spatially, plotting the race/ethnicity-specific number of kits per opioid-related overdose death per jurisdiction. Lastly, we constructed generalized estimating equations models with a negative binomial distribution to compare the race/ethnicity-specific naloxone distribution rate by OEND programs. RESULTS: From 2016-2019, the median annual rate of naloxone kits received from OEND programs in Massachusetts per racial/ethnicity group ranged between 160 and 447 per 100,000. In a multivariable analysis, we found that the naloxone distribution rates for racial/ethnic minorities were lower than the rate for white residents. We also found naloxone was more likely to be distributed in racially segregated communities than non-segregated communities. CONCLUSION: We identified racial/ethnic inequities in naloxone receipt by individuals in Massachusetts. Additional resources focused on designing and implementing OEND programs for racial/ethnic minorities are warranted to ensure equitable access to naloxone.