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Abstract Background As a driver of racial and health inequities, racism is deeply ingrained in the interconnected systems that affect health and well-being. Currently, no common frame is employed across researchers, interventionists, and funders to design, implement, and evaluate comprehensive interventions to address racism. Consequently, there is a need to examine the characteristics of interventions implemented in the United States that address racism across social and structural determinants of health and socio-ecological levels. Additionally, we utilized a Health Equity Action Research (HEART) framework to assess how interventions integrate equity principles. Methods This scoping review examined the characteristics of multi-level interventions that addressed racism and appraised the interventions using a Health Equity Action Research frame. A comprehensive search strategy was conducted across nine electronic databases between 24 October 2022 through 15 November 2022. Records were included if they were available in English, discussed or evaluated a multi-level intervention or program conducted in the United States, and discussed or evaluated the intervention or program regarding the health and well-being of racialized and ethnically minoritized groups. Results A total of 13,391 records were identified, of which 91 met the eligibility criteria and were included in the analysis. Most records reported the racialized group impacted by an intervention, of which the majority were racialized as African American or Black (n = 42) and Hispanic or Latino/a/x (n = 18). Eighty-one (89%) of interventions reported health outcomes and concentrated on the individual level. Most funders reported across the records, and 86 (51%) were a federal agency or department. A further 43 (25%) were private foundations, 12 (7%) were nonprofit organizations, 10 (6%) were private universities, and 4 (2%) were public universities. Regarding alignment with the HEART framework, 14% of interventions reported a mixed-methods approach, 45% reported community engagement, and less than 1% reported researcher self-reflection. Conclusions Most interventions prioritized people who are racialized as Black and report health outcomes. Since intervention designs, objectives, and methodological approaches vary, no standard frame defines racism and health equity. Applying the HEART framework offers a standard approach for interventionists and researchers to examine power, integrate community voice, and self-reflect to advance health equity.

AbstractBackground Opioid overdoses have continued to increase at higher rates among Black Americans compared to people from other racial groups. Despite demonstrated effectiveness of MOUD in reducing risk of opioid overdose, Black Americans face decreased access to and uptake of MOUD. The current study aimed to examine the knowledge, perceptions, and experiences with MOUD among a sample of Black adults who use prescription opioids nonmedically in order to inform tailored efforts to improve MOUD uptake.Methods Data were derived from a larger study assessing cultural and structural influences on drug use and drug treatment among people who use prescription opioids nonmedically. Semi-structured qualitative interviews were conducted with 34 Black men and women across four generational cohorts: born 1955–1969; 1970–1979; 1980–1994; and 1995–2001. Participant responses were analyzed using thematic analysis.Results Nearly half of participants (44.1%) reported no knowledge or experience with MOUD. Among participants who had any knowledge about MOUD, four major themes regarding their perceptions emerged: MOUD Helps with Recovery; Not Needed for Level of Drug Use; Side Effects and Withdrawal; Equivalence with Illicit Drug Use. The majority reported negative perceptions of MOUD (52.6%), and the youngest cohort (born 1995–2001) had a higher proportion of negative perceptions (80%) relative to other age cohorts (born 1980–1994: 50%; 1970–1979: 75%; 1955–1969: 16.6%).Discussion Findings indicate a significant knowledge gap and clear points of intervention for improving MOUD uptake. Interventions to improve communication of health information in ways that are culturally relevant and tailored by age group can be used in conjunction with efforts to improve MOUD access among Black individuals who use opioids nonmedically.

Introduction: Older adults racialized as Black experience higher rates of dementia than those racialized as White. Structural racism produces socioeconomic challenges, described by artist Marvin Gaye as ?hang ups, let downs, bad breaks, setbacks? that likely contribute to dementia disparities. Robust dementia literature suggests socioeconomic factors may also be key resiliencies. Methods: We linked state-level data reflecting the racialized landscape of economic opportunity across the 20th Century from the U.S. Census (1930?2010) with individual-level data on cognitive outcomes from the U.S. Health and Retirement Study participants racialized as Black. A purposive sample of participants born after the Brown v. Board ruling (born 1954?59) were selected who completed the modified Telephone Interview for Cognitive Status between 2010 and 2020 (N=1381). We tested associations of exposure to structural racism and resilience before birth, and during childhood, young-adulthood, and midlife with cognitive trajectories in mid-late life using mixed-effects regression models. Results: Older adults born in places with higher state-level structural socioeconomic racism experienced a more rapid cognitive decline in later life compared to those with lower levels of exposure. In addition, participants born in places with higher levels of state-level structural socioeconomic resilience experienced slower cognitive change over time than their counterparts. Discussion: These findings reveal the impact of racist U.S. policies enacted in the past that influence cognitive health over time and dementia risk later in life.

Background: Opioid overdoses have continued to increase at higher rates among Black Americans compared to people from other racial groups. Despite demonstrated effectiveness of MOUD in reducing risk of opioid overdose, Black Americans face decreased access to and uptake of MOUD. The current study aimed to examine the knowledge, perceptions, and experiences with MOUD among a sample of Black adults who use prescription opioids nonmedically in order to inform tailored efforts to improve MOUD uptake. Methods: Data were derived from a larger study assessing cultural and structural influences on drug use and drug treatment among people who use prescription opioids nonmedically. Semi-structured qualitative interviews were conducted with 34 Black men and women across four generational cohorts: born 1955-1969; 1970-1979; 1980-1994; and 1995-2001. Participant responses were analyzed using thematic analysis. Results: Nearly half of participants (44.1%) reported no knowledge or experience with MOUD. Among participants who had any knowledge about MOUD, four major themes regarding their perceptions emerged: MOUD Helps with Recovery; Not Needed for Level of Drug Use; Side Effects and Withdrawal; Equivalence with Illicit Drug Use. The majority reported negative perceptions of MOUD (52.6%), and the youngest cohort (born 1995-2001) had a higher proportion of negative perceptions (80%) relative to other age cohorts (born 1980-1994: 50%; 1970-1979: 75%; 1955-1969: 16.6%). Discussion: Findings indicate a significant knowledge gap and clear points of intervention for improving MOUD uptake. Interventions to improve communication of health information in ways that are culturally relevant and tailored by age group can be used in conjunction with efforts to improve MOUD access among Black individuals who use opioids nonmedically. [ABSTRACT FROM AUTHOR]

The prevalence of depressive symptoms has rapidly accelerated among recent US adolescent birth cohorts, yet there remains little understanding of trends among racialized and minoritized groups. These groups may experience depressive symptoms due to the deleterious effects of structural racism. Using 2005-2020 Monitoring the Future survey data, we examine all racialized groups using within-group analyses to observe trends in high levels of depressive symptoms across cohorts. Generally, across racialized groups and ages, the odds of high depressive symptoms increased in recent birth cohorts. For example, among 15- to 16-year-old students racialized as American Indian or Alaska Native and Black Hispanic/Latine, the 2003-2006 birth cohort had 3.08 (95% CI, 2.00-4.76) and 6.95 (95% CI, 2.70-17.88) times' higher odds, respectively, of high depressive symptoms as compared with the 1987-1990 birth cohorts. Moreover, in a given year, 15- to 16-year-olds generally experienced the highest depressive symptoms compared with 13- to 14-year-olds and 17- to 18-year-olds, suggesting that age effects peaked during midadolescence. Depressive symptoms increased among US adolescents by birth cohort, within all racialized and minoritized groups assessed. Public health efforts to reduce disparities may consider barriers such as structural racism that may impact the mental health of racialized/minoritized adolescents while increasing access to culturally competent mental health providers and school-based services. This article is part of a Special Collection on Mental Health. [ABSTRACT FROM AUTHOR]

Objective: To explore differences in depressive symptoms for older adults (Black, Latinx, and White) by cognitive status during the 2020 COVID-19 pandemic. Methods: Data from the Health and Retirement Study identified older adults as cognitively normal, cognitively impaired without dementia (CIND), and persons living with dementia (PLWD). Multiple linear regression analyses examined associations between cognitive status and depressive symptoms among these racialized groups. Results: Compared to the cognitively normal older adults racialized as Black, those with CIND reported higher depressive symptoms during the pandemic (overall and somatic) and PLWD had higher somatic symptoms (p <.01). Older adults racialized as White with CIND reported higher somatic (p <.01) symptoms compared to cognitively normal older adults racialized as White. Discussion: The COVID-19 pandemic was a challenging event among older adults racialized as Black with CIND and PLWD. Future studies should examine if these depressive symptoms persist over time. [ABSTRACT FROM AUTHOR]

Objectives: On average, adults racialized as non-Hispanic Black and Hispanic sleep more poorly than adults racialized as non-Hispanic White (hereafter, Black, Hispanic, White), but associations between factors that may moderate sleep-memory associations in these groups, such as neighborhood conditions, are unclear. Poorer neighborhood conditions (e.g. lower neighborhood cohesion) may be negatively associated with sleep quality and multiplicatively influence sleep-memory associations. We hypothesized lower ratings of neighborhood conditions would be associated with poorer sleep quality and moderate the association between sleep quality and episodic memory, especially in Black and Hispanic adults, who are disproportionately situated in poor neighborhood conditions. Design: Seven-hundred-thirty-six adults across the adult lifespan (27-89 years) were recruited from the northern Manhattan community as a part of the Offspring Study of Racial and Ethnic Disparities in Alzheimer's disease. Sleep quality was assessed using a modified version of the Pittsburgh Sleep Quality Index, and episodic memory was evaluated with the Buschke Selective Reminding Test. With multiple regression models, we measured associations between perceived neighborhood conditions and sleep quality and the interaction between sleep quality and neighborhood conditions on episodic memory stratified by racial/ethnic and gender identity groups. Results: Overall, poorer neighborhood conditions were associated with poorer sleep quality. In Black and Hispanic women, the sleep-memory association was moderated by neighborhood conditions. With more favorable neighborhood conditions, Black women showed an association between higher sleep quality and higher memory performance, and Hispanic women showed a protective effect of neighborhood (higher memory even when sleep quality was poor). Conclusion: Poorer neighborhood experiences may contribute to poorer sleep quality across groups. In Black and Hispanic women, the association between sleep quality and episodic memory performance was dependent upon neighborhood conditions. These findings may inform tailored, structural level sleep interventions, aimed to improve neighborhood experiences and thereby sleep quality and episodic memory. [ABSTRACT FROM AUTHOR]

Psychometrics is a branch of psychology concerned with the measurement of mental attributes, behavior, and performance, in addition to the design and analysis of tests and other instruments. The origins of this field are rooted in the explorations of 18th century scientists concerned with capturing phenomena in empirical ways. Less discussed is the use of tests and assessments to validate racialization, which thrusts persons racialized as Black into the early discourse on psychometrics. Scholars, scientists, and psychometricians racialized as Black have long engaged psychometrics providing two major contributions: infrastructure via personnel and training programs built by persons racialized as Black; and interdisciplinarity, which include disciplinary standards and knowledge production. This commentary names these important figures and describes their contributions to the field of psychometrics. Plain language summary: This commentary names these important Black figures and describes their contributions to the field of psychometrics. [ABSTRACT FROM AUTHOR]

The current study examined the relationship between PTSD and nonmedical use of benzodiazepines (BZDs) based on level of John Henry Active Coping (JHAC) among African American incarcerated men. Data were derived from the Helping Incarcerated Men (HIM) Study (n = 208). Nonmedical use of BZDs was measured for the 30 days before incarceration. Current PTSD diagnosis and JHAC were determined using DSM-5 criteria and the JHAC Scale. Adjusted logistic regression analyses showed PTSD diagnosis was significantly associated with nonmedical BZD use (p =.011), but that JHAC did not significantly mitigate this relationship. African American incarcerated men may experience an unmet need with regards to mental health treatment. [ABSTRACT FROM AUTHOR]

As we age, the ability to move is foundational to health. Life space is one measure of a person's ability to move and engage in activity beyond the home. A separate but related concept is activity space, a measurement of a person's spatial behaviors and visited locations that include social networks, neighborhoods, and institutions. In this article, we integrate the literature on life space and activity space, discussing how physical function is not only determined by individual capabilities, but also by the surrounding social and environmental factors, which may limit their agency. We show how structural racism contributes to inequities within this paradigm linking related concepts of movement, agency, belonging, and timing. We also explore implications for research and theory for mobility, social connection, and activity. [ABSTRACT FROM AUTHOR]

We investigate Alzheimer's disease and related dementia (ADRD) prevalence, incidence rate, and risk factors in individuals racialized as Asian and/or Asian‐American and assess sample representation. Prevalence, incidence rate, risk factors, and heterogeneity of samples were assessed. Random‐effects meta‐analysis was conducted, generating pooled estimates. Of 920 records across 14 databases, 45 studies were included. Individuals racialized as Asian and/or Asian‐American were mainly from Eastern and Southern Asia, had higher education, and constituted a smaller sample relative to non‐Hispanic white cohorts. The average prevalence was 10.9%, ranging from 0.4% to 46%. The average incidence rate was 20.03 (12.01‐33.8) per 1000 person‐years with a range of 75.19–13.59 (12.89‐14.33). Risk factors included physiological, genetic, psychological, behavioral, and social factors. This review underscores the systemic underrepresentation of individuals racialized as Asian and/or Asian‐American in ADRD research and the need for inclusive approaches accounting for culture, language, and immigration status. Highlights: There is considerable heterogeneity in the prevalence of ADRD among studies of Asian‐Americans.There is limited data on group‐specific risk factors for ADRD among Asian–Americans.The average prevalence of (ADRD) among Asian–Americans was found to be 7.4%, with a wide range from 0.5% to 46%. [ABSTRACT FROM AUTHOR]

As a living being that was passed down the role of storytelling, I describe the conditions under which individuals find themselves. Science, and specifically public health research, affords me the opportunity to deploy my storytelling skills toward advocacy and intervention for communities that disproportionately bear the burden of poor health. Although neither role makes space for the emotional toll of this work. Neither allows me to rest long enough to move through the emotional mist of what it means to be perceived as a queer, Black, cisgender woman, and storytelling scientist in a stratified and hateful world where I am so much more. This poem pools from various worlds within me for each stanza. The poem seeks to reconcile for my whole self, and others who experience marginality, why our colleagues, countrypersons, and community members see it fit to perpetuate notions of human difference along racialized, socioeconomic, sexualized, gendered, able-bodied, and other stratified lines—to the detriment of our lives. How can my colleagues, countrypersons, and community members be willing to receive the privileges of a democratic society but discard the lives from which that society was built? How can my colleagues, countrypersons, and community members be willing to receive our science but discard our health? This poem brings together multidisciplinary discourse from the humanities and the social and biological sciences to state plainly what many others have academically. May this poem be paired with existing literature on the falsity of biologized race, reparations, and methodologies of reflexivity in science. To view the original version of this poem, see the Supplemental Material section of this article online. [ABSTRACT FROM AUTHOR]

It is well documented that Black/African American (Black) women's health is impacted by socioeconomic status (SES). Self-care can improve health but this is also contingent upon SES; though it is unclear which activities are impacted. This cross-sectional study performed differential item functioning with 47 self-care activities rated by 223 Black women. Participants were compared across activities by SES group—a composite score encompassing personal income, highest degree obtained, employment status, and number of dependents. Findings suggest SES impacts half of self-care activities with most being practiced significantly more by Black women with the highest SES as opposed to the lowest. The activities that were most influenced by SES included striving for balance, scheduling regular activities with their children, and finding ways to laugh. Such differences speak to the impact of SES on the overall health of Black women. Research on Black women's health would benefit from targeting the impact of SES on self-care in order to better increase the health of Black women.

Stress leads to poor self-rated health for many black women because of racial and economic discrimination which results in psychological distress and restricted access to resources. Resilience factors such as self-care may be able to buffer the impact of stress; however, the role of self-care in reducing the effect of stress on self-rated health has not been explored. Self-care involves the utilization of self-awareness and agency to seek remedy for imbalance and to sustain equilibrium. Despite anecdotal exploration of these factors, there has not been a systematic investigation of whether self-awareness and agency indeed predict self-care. Subsequently, this study sought to provide evidence that self-awareness and resilience predict self-care, and self-care can mediate the negative relationship between stress and self-rated health. A cross-section of 223 black women living in the United States completed a battery of assessments of self-care, mindfulness, perceived stress, resilience, and self-rated health. Through a series of regression analyses exploring mediating effects, a path emerged. Findings indicate that awareness and resilience do predict self-care, and self-care mediates the negative relationship between stress and health. These analyses suggest that the role of stress on black women’s health can be reduced by the implementation of awareness and resilience.

INTRODUCTION: With the rapid expansion of the aging population, the burden of Alzheimer's disease related dementias (ADRD) is anticipated to increase in racialized and minoritized groups who are at disproportionately higher risk. To date, research emphasis has been on further characterizing the existence of racial disparities in ADRD through comparisons to groups racialized as White that are assumed to be normative. Much of the literature on this comparison insinuates that racialized and minoritized groups experience poorer outcomes due to genetics, culture, and/or health behaviors. METHODS: This perspective shines a light on a category of ADRD research that employs ahistorical methodological approaches to describe racial disparities in ADRD that puts us on a merry‐go‐round of research with no benefits to society. METHODS: This commentary provides historical context for the use of race in ADRD research and justification for the study of structural racism. The commentary concludes with recommendations to guide future research. [ABSTRACT FROM AUTHOR]

Introduction: The projected growth of Alzheimer's disease (AD) and AD‐related dementia (ADRD) cases by midcentury has expanded the research field and impelled new lines of inquiry into structural and social determinants of health (S/SDOH) as fundamental drivers of disparities in AD/ADRD. Methods: In this review, we employ Bronfenbrenner's ecological systems theory as a framework to posit how S/SDOH impact AD/ADRD risk and outcomes. Results: Bronfenbrenner defined the "macrosystem" as the realm of power (structural) systems that drive S/SDOH and that are the root cause of health disparities. These root causes have been discussed little to date in relation to AD/ADRD, and thus, macrosystem influences, such as racism, classism, sexism, and homophobia, are the emphasis in this paper. Discussion: Under Bronfenbrenner's macrosystem framework, we highlight key quantitative and qualitative studies linking S/SDOH with AD/ADRD, identify scientific gaps in the literature, and propose guidance for future research. Highlights: Ecological systems theory links structural/social determinants to AD/ADRD.Structural/social determinants accrue and interact over the life course to impact AD/ADRD.Macrosystem is made up of societal norms, beliefs, values, and practices (e.g., laws).Most macro‐level determinants have been understudied in the AD/ADRD literature. [ABSTRACT FROM AUTHOR]

Policy PointsDespite decades of research exposing health disparities between populations and communities in the US, health equity goals remain largely unfulfilled. We argue these failures call for applying an equity lens in the way we approach data systems, from collection and analysis to interpretation and distribution. Hence, health equity requires data equity.There is notable federal interest in policy changes and federal investments to improve health equity. With this, we outline the opportunities to align these health equity goals with data equity by improving the way communities are engaged and how population data are collected, analyzed, interpreted, made accessible, and distributed.Policy priority areas for data equity include increasing the use of disaggregated data, increasing the use of currently underused federal data, building capacity for equity assessments, developing partnerships between government and community, and increasing data accountability to the public. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic has exacerbated the adverse influence of structural racism and discrimination experienced by historically marginalized communities (e.g., Black, Latino/a/x, Indigenous, and transgender people). Structural racism contributes to trauma-induced health behaviors, increasing exposure to COVID-19 and restricting access to testing and vaccination. This intersection of multiple disadvantages has a negative impact on the mental health of these communities, and interventions addressing collective healing are needed in general and in the context of the COVID-19 pandemic. The S hare, T rust, O rganize, and P artner COVID-19 California Alliance (STOP COVID-19 CA), a statewide collaborative of 11 universities and 75 community partners, includes several workgroups to address gaps in COVID-19 information, vaccine trial participation, and access. One of these workgroups, the Vaccine Hesitancy Workgroup, adopted an anti-racist community-partnered praxis to implement restorative circles in historically marginalized communities to facilitate collective healing due to structural racism and the COVID-19 pandemic. The project resulted in the development of a multilevel pre-intervention restorative process to build or strengthen community–institutional partnerships when procurement of funds has been sought prior to community partnership. This article discusses this workgroup's role in advancing health justice by providing a community-based mental health intervention to marginalized communities in Southern California while using an antiracist praxis tool to develop a successful community–institutional partnership and to live up to the vision of community-based participatory research. [ABSTRACT FROM AUTHOR]

Discrimination in the lives of Black women often leads to maladaptive coping strategies that negatively influence health. Self-care encompasses practices that promote well-being; however, little is known about how Black women conceptualize and practice self-care. This article reports qualitative findings from 10 semi-structured interviews conducted with 10 Black women subject-matter experts (SMEs) from throughout the US. There were eight individual interviews with SMEs who provided self-care services/content to other Black women and two group interviews with SME organizations that provided self-care and other wellness programs to Black women. This approach utilized both expert and personal lived experiences of SMEs. Using the constant comparison analysis method, there was saturation with four concepts that describe the role of structural racism and sexism on the health outcomes of Black women, and the potential for self-care to mediate the negative relationship of these stressors on health. SME practices of self-care overlapped, comprising a 5-part theory of self-care. Ultimately, self-care may help to combat the impact of structural influences on the health of Black women. Using self-care as a healthier approach to coping with stress can aid in the reduction of health disparities. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Many prior studies have compared the acuity of Emergency Department (ED) patients who have Left Without Being Seen (LWBS) against non-LWBS patients. A weakness in these studies is that patients may walk out prior to the assignment of a triage score, biasing comparisons. We report an operational change whereby acuity was assessed immediately upon patient arrival. We hypothesized more patients would receive acuity scores with EQAS. We also sought to compare LWBS and non-LWBS patient characteristics with reduced bias. METHODS: SETTING: urban, academic medical center. Retrospective cohort study, electronic chart review, collecting data on all ED patients presenting between 4/1/2010 and 10/31/2011 ("Traditional Acuity Score" period, TAS) and from 11/1/2011 to 3/31/2012 ("Early Quick Acuity Score" period, EQAS). We recorded disposition (LWBS versus non-LWBS), acuity and demographics. For each subject during the EQAS period, we calculated how many prior ED visits and how many prior walkouts the subject had had during the TAS period. RESULTS: Acuity was recorded in 92,275 of 94,526 patients (97.6%) for TAS period, and 25,577 of 25,760 patients (99.3%) for EQAS period, a difference of 1.7% (1.5%, 1.8%). LWBS patients had acuity scores recorded in 5,180 of 7,040 cases (73.6%) during TAS period, compared with 897 of 1,010 cases (88.8%) during the EQAS period, a difference of 15.2% (14.8%, 15.7%). LWBS were more likely than non-LWBS to be male, were younger and had lower acuity scores. LWBS averaged 5.3 prior ED visits compared with 2.8 by non-LWBS, a difference of 2.5 (1.5, 3.5). LWBS averaged 1.3 prior ED walkouts compared with 0.2 among non-LWBS, a difference of 1.1 (0.8, 1.3). CONCLUSIONS: EQAS resulted in a higher proportion of patients receiving acuity scores, particularly among LWBS. This offers more complete data when comparing LWBS and non-LWBS patient characteristics. The comparison reinforced findings from prior studies.

Se evaluó la posibilidad de predecir una probable estructura secundaria para el Receptor Opioide Kappa 2 humano tomando como base la secuencia de aminoácidos del Receptor Opioide Kappa 1 humano. La estructura predicha mostró ser compatible con los datos que se poseen acerca de este tipo de receptores. Con esta prueba inicial, el proyecto que tiene como objetivo principal diseñar un análogo proteico para el Receptor Opioide Kappa 2 humano, ha mostrado el nivel mínimo de viabilidad necesario para ser continuado.

Background: Research shows that substance use may be a way individuals cope with psychosocial stressors. Less is known about whether discrimination contributes to prescription drug misuse. Methods: Using a national sample of Black Americans, we examined whether two psychosocial stressors (i.e., everyday and lifetime major discrimination) were associated with lifetime prescription drug misuse (i.e., opioids, tranquilizers, sedatives, or stimulants). Results: Our logistic regression models separately examining the influence of everyday and major discrimination controlling for relevant demographic, health, and other drug use variables showed that only everyday discrimination was associated with higher odds of prescription drug misuse. In the model simultaneously considering both types of discrimination, only unit increases in everyday discrimination were associated with higher odds of prescription drug misuse. Conclusions: Encounters with everyday discrimination may be an important psychosocial stressor linked to prescription drug misuse in Black adults and possibly other racial-ethnic minorities. Intervention strategies aiming to reduce prescription drug misuse should consider developing ways to curb the negative health-related consequences of discriminatory experiences. Strategies to combat discrimination-related prescription drug misuse and limitations of this study are discussed. [ABSTRACT FROM AUTHOR]

There have been over 100 years of literature discussing the deleterious influence of racism on health. Much of the literature describes racism as a driver of social determinants of health, such as housing, employment, income, and education. More recently, increased attention has been given to measuring the structural nature of a system that advantages one racialized group over others rather than solely relying on individual acknowledgement of racism. Despite these advances, there is still a need for methodological and analytical approaches to complement the aforementioned. This commentary calls on epidemiologists and other health researchers at large to engage the discourse on measuring structural racism. First, we address the conflation between race and racism in epidemiologic research. Next, we offer methodological recommendations (linking of interdisciplinary variables and data sets and leveraging mixed-method and life-course approaches) and analytical recommendations (integration of mixed data, use of multidimensional models) that epidemiologists and other health researchers may consider in health equity research. The goal of this commentary is to inspire the use of up-to-date and theoretically driven approaches to increase discourse among public health researchers on capturing racism as well as to improve evidence of its role as the fundamental cause of racial health inequities. [ABSTRACT FROM AUTHOR]

Incarcerated African American men who use marijuana are vulnerable to polysubstance use, which is associated with greater risk for negative health and psychosocial outcomes than marijuana use alone. It is imperative to understand risk and protective factors for polysubstance use among this vulnerable population to inform the development of culturally tailored substance use interventions. The current study examined the association between John Henryism Active Coping (JHAC), family social support, psychiatric symptoms, and polysubstance use among African American incarcerated men who frequently use marijuana. Results indicated that higher John Henryism Active Coping (JHAC) is associated with decreased likelihood of engaging in polysubstance use, while psychiatric symptoms are associated with increased likelihood of polysubstance use. Incorporating elements of JHAC into concurrent mental health and substance use treatment may reduce risk for overdose and reincarceration among African American incarcerated men upon release into the community. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic revealed weaknesses in the public health infrastructure of the United States, including persistent barriers to engaging marginalized communities toward inclusion in clinical research, including trials. Inclusive participation in clinical trials is crucial for promoting vaccine confidence, public trust, and addressing disparate health outcomes. A long-standing body of literature describes the value of community-based participatory research in increasing marginalized community participation in research. Community-based participatory research emphasizes shared leadership with community members in all phases of the research process, including in the planning and implementation, interpretation, and dissemination. Shared leadership between academic and industry with marginalized communities can assist with inclusive participation in vaccine trials and increase public trust in the development of the vaccines and other therapies used during public emergencies. Nevertheless, epidemiologic and clinical research do not yet have a strong culture of community partnership in the scientific process, which takes time to build and therefore may be difficult to develop and rapidly scale to respond to the pandemic. We outline practices that contribute to a lack of inclusive participation and suggest steps that trialists and other researchers can take to increase marginalized communities' participation in research. Practices include planning for community engagement during the planning and recruitment phases, having regular dialogues with communities about their priorities, supporting them throughout a study, and navigating complex structural determinants of health. Additionally, we discuss how research institutions can support inclusive practices by reexamining their policies to increase participation in clinical trials and instilling institutional trustworthiness. [ABSTRACT FROM AUTHOR]