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Introduction: Poor communication is a leading root cause of preventable maternal mortality in the United States. Communication challenges are compounded with the presence of biases, including racism. Hospital administrators and clinicians are often aware that communication is a problem, but understanding where to intervene can be difficult to determine. While clinical leadership routinely reviews incident reports and acts on them to improve care, we hypothesized that reviewing incident reports in a systematic way might reveal thematic patterns, providing targeted opportunities to improve communication in direct interaction with patients and within the healthcare team itself. Methods: We abstracted incident reports from the Women's Health service and linked them with patient charts to join patient's race/ethnicity, birth outcome, and presence of maternal morbidity and mortality to the incident report. We conducted a qualitative content analysis of incident reports using an inductive and deductive approach to categorizing communication challenges. We then described the intersection of different types of communication challenges with patient race/ethnicity and morbidity outcomes. Results: The use of incident reports to conduct research on communication was new for the health system. Conversations with health system‐level stakeholders were important to determine the best way to manage data. We developed a thematic codebook based on prior research in healthcare communication. We found that we needed to add codes that were equity focused, as this was missing from the existing codebook. We also found that clinical and contextual expertise was necessary for conducting the analysis—requiring more resources to conduct coding than initially estimated. We shared our findings back with leadership iteratively during the work. Conclusions: Incident reports represent a promising source of health system data for rapid improvement to transform organizational practice around communication. There are barriers to conducting this work in a rapid manner, however, that require further iteration and innovation. [ABSTRACT FROM AUTHOR]

Competing Interests: Conflict of Interest and Sources of Funding: None declared.

This paper examines empathetic behavior in the United States, a strongly individualistic country, as contrasted with Hungary and Ethiopia, which are moderately individualistic and strongly collectivistic respectively. It suggests that empathy may have a wider than originally perceived application in diverse settings to combat factors of ethnic bias and discrimination that adversely impact health. Models that distinctly focus on the development of healthcare provider empathic care are needed to enable the needs of resource scarce regions of the world to be met, including pockets of the U.S. More investigation is warranted on how empathic behavior can positively impact health outcomes and disparities. [ABSTRACT FROM AUTHOR]

Socio-economic and geographical inequalities in breast cancer mortality have been widely described in European countries and the United States. To investigate the combined effects of geographic access and socio-economic characteristics on breast cancer outcomes, a systematic review was conducted exploring the relationships between: (i) geographic access to healthcare facilities (oncology services, mammography screening), defined as travel time and/or travel distance; (ii) breast cancer-related outcomes (mammography screening, stage of cancer at diagnosis, type of treatment and rate of mortality); (iii) socioeconomic status (SES) at individuals and residential context levels. In total, n = 25 studies (29 relationships tested) were included in our systematic review. The four main results are: The statistical significance of the relationship between geographic access and breast cancer-related outcomes is heterogeneous: 15 were identified as significant and 14 as non-significant. Women with better geographic access to healthcare facilities had a statistically significant fewer mastectomy (n = 4/6) than women with poorer geographic access. The relationship with the stage of the cancer is more balanced (n = 8/17) and the relationship with cancer screening rate is not observed (n = 1/4). The type of measures of geographic access (distance, time or geographical capacity) does not seem to have any influence on the results. For example, studies which compared two different measures (travel distance and travel time) of geographic access obtained similar results. The relationship between SES characteristics and breast cancer-related outcomes is significant for several variables: at individual level, age and health insurance status; at contextual level, poverty rate and deprivation index. Of the 25 papers included in the review, the large majority (n = 24) tested the independent effect of geographic access. Only one study explored the combined effect of geographic access to breast cancer facilities and SES characteristics by developing stratified models. [ABSTRACT FROM AUTHOR]

Motor vehicle crashes (MVCs) are the leading cause of fatal work-related injuries in the United States. Research assessing sociodemographic risk disparities for work-related MVCs is limited, yet structural and systemic inequities at work and during commutes likely contribute to disproportionate MVC risk. This paper summarizes the literature on risk disparities for work-related MVCs by sociodemographic and employment characteristics and identifies worker populations that have been largely excluded from previous research. The social-ecological model is used as a framework to identify potential causes of disparities at five levels-individual, interpersonal, organizational, community, and public policy. Expanded data collection and analyses of work-related MVCs are needed to understand and reduce disparities for pedestrian workers, workers from historically marginalized communities, workers with overlapping vulnerabilities, and workers not adequately covered by employer policies and safety regulations. In addition, there is a need for more data on commuting-related MVCs in the United States. Inadequate access to transportation, which disproportionately affects marginalized populations, may make travel to and from work less safe and limit individuals' access to employment. Identifying and remedying inequities in work-related MVCs, whether during the day or while commuting, will require the efforts of industry and multiple public sectors, including public health, transportation, and labor.

The COVID-19 pandemic has accelerated acceptance of learning from other countries, especially for high-income countries to learn from low- and middle-income countries, a practice known as global learning. COVID-19’s rapid disease transmission underscored how connected the globe is as well as revealed stark health inequities which facilitated looking outside of one’s borders for solutions. The Global Learning for Health Equity (GL4HE) Network, supported by Robert Wood Johnson Foundation, held a 3-part webinar series in December 2021 to understand the current state of global learning and explore how global learning can advance health equity in the post-COVID-19 era. This paper reflects on these cutting-edge discussions about the current state of global learning, drawing upon the highlights, perspectives, and conclusions that emerged from these webinars. The paper also comments on best practices for global learning, including adapting for context, addressing biases, funding considerations, ensuring bidirectional partnerships, community engagement, and adopting a multidisciplinary approach. [ABSTRACT FROM AUTHOR]

Purpose: Self-rated physical health (SRPH) and self-rated mental health (SRMH) are both linked to excess morbidity and premature mortality and can vary across rural and urban contexts. This can be particularly problematic for rural residents who have less access to important health care infrastructure. In this paper, we assess the prevalence of and rural-urban disparities at the intersection of SRPH and SRMH, specifically self-rated physical/mental multimorbidity (SRPMM) overall and across rural-urban contexts. Methods: Using a cross-sectional demographically representative national dataset of over 4000 working age adults in the U.S., we expose rural-urban differences in the prevalence of SRPMM and explore individual-level factors that may explain this disparity. Results: Approximately 15 percent of working age adults reported SRPMM, but rural adults were at higher risk than their urban counterparts. However, this disadvantage disappeared for remote rural working-age adults and was attenuated for metro-adjacent rural working-age adults when we controlled for the fact that rural adults had lower household incomes. Conclusion: Findings reveal a higher risk of SRPMM among rural adults, in part because of lower incomes among this group. This work acts as the foundation for facilitating research on and addressing rural-urban disparities in SRPMM. [ABSTRACT FROM AUTHOR]

Background: The state of evidence-based transgender healthcare in the United States has been put at risk by the spread of misinformation harmful to transgender people. Health science librarians can alleviate the spread of misinformation by identifying and analyzing its flow through systems that affect access to healthcare. Discussion: The author developed the theory of the Misinformation - Legislation Pipeline by studying the flow of antitransgender misinformation from online echo chambers through a peer-reviewed article and into policy enacted to ban medical treatments for transgender people in the state of Florida. The analysis is precluded with a literature review of currently accepted best practices in transgender healthcare, after which, the author analyzes the key report leveraged by Florida's Department of Health in its ban. A critical analysis of the report is followed by a secondary analysis of the key peer-reviewed article upon which the Florida Medicaid authors relied to make the decision. The paper culminates with a summation of the trajectory of anti-transgender misinformation. Conclusion: Misinformation plays a key role in producing legislation harmful to transgender people. Health science librarians have a role to play in identifying misinformation as it flows through the Misinformation - Legislation Pipeline and enacting key practices to identify, analyze, and oppose the spread of harmful misinformation. [ABSTRACT FROM AUTHOR]

Collecting meaningful race and ethnicity data must be part of the national agenda and must be one of its primary objectives in order to achieve public good and support public interests. Yet, Australia does not collect data on race and ethnicity, and prefers the use of collective cultural groups, whose information is not consistently collected and reported at all levels of government and service delivery. This paper examines the current discrepancies in race and ethnicity data collection in Australia. The paper begins with examining the current practices related to collecting race and ethnicity data and then moves on to examine the various implications and public health significance of not collecting data on race and ethnicity in Australia. The evidence suggests that (1) race and ethnicity data matter, are imperative to ensuring proper advocacy and to reducing inequities in health and social determinant factors; (2) that White privilege is constructed as realized or unrealized personal and systemic racism; and (3) the use of non-committal collective terminologies makes visible minorities invisible, leads to the distorted allocation of governmental support, and legitimises and institutionalises racism and othering, hence perpetuating exclusion and the risk of victimisation. There is an urgent need for the collection of customized, culturally competent racial and ethnicity data that can be consistently integrated into all policy interventions, service delivery and research funding across all levels of governance in Australia. Reducing and eliminating racial and ethnic disparities is not only an ethical, social, and economic imperative, but must also be a critical item on the national agenda. Bridging the racial and ethnic disparities will require concerted whole-of-government efforts to collect consistent and reliable data that depict racial and ethnic characteristics beyond collective cultural groupings.

Background: Reducing health inequities in marginalized populations, including people with Medicaid insurance, requires care transformation to address medical and social needs that is supported and incentivized by tailored payment methods. Collaboration across health care stakeholders is essential to overcome health system fragmentation and implement sustainable reform in the United States (U.S.). This paper explores how multi-stakeholder teams operationalized the Roadmap to Advance Health Equity model during early stages of their journey to (a) build cultures of equity and (b) integrate health equity into care transformation and payment reform initiatives., Methods: Advancing Health Equity: Leading Care, Payment, and Systems Transformation is a national program in the U.S. funded by the Robert Wood Johnson Foundation that brings together multi-stakeholder teams to design and implement initiatives to advance health equity. Each team consisted of representatives from state Medicaid agencies, Medicaid managed care organizations, and health care delivery organizations in seven U.S. states. Between June and September 2021, semi-structured interviews were conducted with representatives ( n = 23) from all seven teams about experiences implementing the Roadmap to Advance Health Equity model with technical assistance from Advancing Health Equity., Results: Facilitators of building cultures of equity included (1) build upon preexisting intra-organizational cultures of equity, (2) recruit and promote diverse staff and build an inclusive culture, and (3) train staff on health equity and anti-racism. Teams faced challenges building inter-organizational cultures of equity. Facilitators of identifying a health equity focus area and its root causes included (1) use data to identify a health equity focus and (2) overcome stakeholder assumptions about inequities. Facilitators of implementing care transformation and payment reform included (1) partner with Medicaid members and individual providers and (2) support and incentivize equitable care and outcomes with payment. Facilitators of sustainability planning included (1) identify evidence of improved health equity focus and (2) maintain relationships among stakeholders. Teams faced challenges determining the role of the state Medicaid agency., Conclusions: Multi-stakeholder teams shared practical strategies for implementing the Roadmap to Advance Health Equity that can inform future efforts to build intra- and inter-organizational cultures of equity and integrate health equity into care delivery and payment systems., Competing Interests: MC co-chairs the Centers for Medicare and Medicaid Services Health Care Payment Learning and Action Network Health Equity Advisory Team and he is a member of the Bristol-Myers Squibb Company Health Equity Advisory Board and Blue Cross Blue Shield Health Equity Advisory Panel. SP and AS were employed by the company Center for Health Care Strategies. JM was employed by the company Institute for Medicaid Innovation. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Thorndike, Peterson, Spitzer, Patel, Smithey, Moore, Cook and Chin.)

In 2015, the Robert Wood Johnson Foundation introduced the Culture of Health (CoH) action model to inform its grantmaking decisions in the United States. The essential principles of this model fall into four action dimensions: 1) making health a shared value, 2) fostering cross-sector collaboration, 3) creating more equitable communities, and 4) transforming healthcare systems. Although considerable success has been achieved since introduction of the CoH model, the pace of progress has been slower on the fourth dimension, since work in this area involves shifting mindsets from the acute care paradigm to one that focuses on prevention, by addressing the "upstream factors", including social and behavioral determinants impacting health. Moreover, despite its academic prominence, the CoH model remains restricted to the research realm, with limited translation to practice. By comparison, the Quadruple Aim (QA) is a four-dimensional framework that has been successfully translated into primary healthcare practice. Introduced in 2008, the QA entails the adoption of four principles in delivering healthcare: 1) improved patient experience, 2) population health, 3) lower costs, and 4) care team well-being, to achieve value in healthcare. The four principles of the QA could be viewed as analogous to the four principles of the CoH, given the inherent synergies in the underlying philosophy of the two frameworks. It is also noteworthy that both healthcare leadership (physician champions) and legislative reform had significant roles to play in the successful translation of the QA into mainstream practice. This in turn suggests that the primary healthcare system has potential to play an instrumental role in accelerating the pace of progress towards a culture of health by extending the scope of influence of the QA. This paper explores the inherent synergies between the QA and CoH models, and the untapped potential of the QA to foster a culture of health in the United States. [ABSTRACT FROM AUTHOR]

The differential impact of the COVID‐19 pandemic on communities of color in the United States along with the civil unrest taking place in 2020 in response to the killing of unarmed Black men and women by the police have increased awareness of the structural racism pervading US society. These developments have reraised the issue of reparations for Black Americans, usually proposed in the context of providing financial compensation for the injustices of slavery to the descendants of those who were enslaved. This paper will discuss the systematic racial inequality and structural racism in US society that have significantly disadvantaged racial and ethnic minorities while giving advantages to white Americans, which most recently have resulted in significantly higher mortality and morbidity among Black, Hispanic, and Native Americans during the pandemic. The paper will conceptualize reparations within the context of theories of reparative justice. It will also consider whether reparations are owed, and if so, by whom, to whom, and in what form. The final section will offer a proposal for collective reparations to the Black community and other people of color. [ABSTRACT FROM AUTHOR]

Black women are disproportionately affected by cardiovascular disease with an excess burden of cardiovascular morbidity and mortality. In addition, the racialized structure of the United States shapes cardiovascular disease research and health care delivery for Black women. Given the indisputable evidence of the disparities in health care delivery, research, and cardiovascular outcomes, there is an urgent need to develop and implement effective and sustainable solutions to advance cardiovascular health equity for Black women while considering their ethnic diversity, regions of origin, and acculturation. Innovative and culturally tailored strategies that consider the differential impact of social determinants of health and the unique challenges that shape their health-seeking behaviors should be implemented. A patient-centered framework that involves collaboration among clinicians, health care systems, professional societies, and government agencies is required to improve cardiovascular outcomes for Black women. The time is "now" to achieve health equity for all Black women., Competing Interests: Funding Support and Author Disclosures Dr Ogunniyi has received institutional research grants from AstraZeneca, Boehringer Ingelheim, and Zoll; and has been an advisory board member for Pfizer. Dr Fatade is supported by the Stimulating Access to Research in Residency of the National Institutes of Health under award number R38AI140299. Dr Quesada is supported by the National Institutes of Health under award number K23 HL151867. Dr Mattina has received speaker fees from Zoll. Dr Ovbiagele is supported by research grants from the National Institutes of Health; and is a consultant and an advisory board member for AstraZeneca. The contents of this paper are solely the responsibility of the authors and do not necessarily represent official views of the National Heart, Lung, and Blood Institute, the National Institutes of Health, or the U.S. Department of Health and Human Services. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose., (Copyright © 2022 American College of Cardiology Foundation. All rights reserved.)

Objective The primary aim of this paper is to accelerate the number of randomized experimental studies of the reliability and validity in-home tele-neuropsychological testing (tele-np-t). Method We conducted a critical review of the tele-neuropsychology literature. We discuss this research in the context of the United States' public and private healthcare payer systems, including the Centers for Medicare & Medicaid Services (CMS) and Current Procedural Terminology (CPT) coding system's telehealth lists, and existing disparities in healthcare access. Results The number of tele-np publications has been stagnant since the onset of the COVID-19 pandemic. There are less published experimental studies of tele-neuropsychology (tele-np), and particularly in-home tele-np-t, than other tele-np publications. There is strong foundational evidence of the acceptability, feasibility, and reliability of tele-np-t, but relatively few studies of the reliability and validity of in-home tele-np-t using randomization methodology. Conclusions More studies of the reliability and validity of in-home tele-np-t using randomization methodology are necessary to support inclusion of tele-np-t codes on the CMS and CPT telehealth lists, and subsequently, the integration and delivery of in-home tele-np-t services across providers and institutions. These actions are needed to maintain equitable reimbursement of in-home tele-np-t services and address the widespread disparities in healthcare access. [ABSTRACT FROM AUTHOR]

Background: In high income countries struggling with escalating health care costs and persistent lack of equity, there is growing interest in searching for innovative solutions developed outside national borders, particularly in low- and middle-income countries (LMICs). Engaging with global ideas to apply them to local health equity challenges is becoming increasingly recognized as an approach to shift the health equity landscape in the United States (US) in a significant way. No single name or set of practices yet defines the process of identifying LMIC interventions for adaptation; implementing interventions in high-income countries (HIC) settings; or evaluating the implementation of such projects., Objectives: This paper presents a review of the literature describing the practice of adapting global ideas for use in the US, particularly in the area of health equity. Specifically, the authors sought to examine; (i) the literature that advocates for, or describes, adaption of health-related innovations from LMICs to HICs, both generally and for health equity specifically, and (ii) implementation practices, strategies, and evidence-based outcomes in this field, generally and in the area of health equity specifically. The authors also propose terminology and a definition to describe the practice., Methods: The literature search included two main concepts: global learning and health equity (using these and related terms). The search consisted of text-words and database-specific terminology (e.g., MeSH, Emtree) using PubMed, Embase (Elsevier), CINAHL (Ebsco), and Scopus in March 2021. The authors also contacted relevant experts to identify grey literature. Identified sources were categorized according to theme to facilitate analysis. In addition, five key interviews with experts engaged with global ideas to promote health equity in the United States were conducted to develop additional data., Results: The literature review yielded over ninety (n = 92) sources relating to the adaptation of global ideas from low resource to higher resource settings to promote health equity (and related concepts). Identified sources range from those providing general commentaries about the value of seeking health-related innovations outside the US border to sources describing global projects implemented in the US, most without implementation or outcome measures. Other identified sources provide frameworks or guidance to help identify and/or implement global ideas in the US, and some describe the role of the World Health Organization and other international consortia in promoting a global approach to solving domestic health equity and related challenges., Conclusions: The literature review demonstrates that there are resources and commentary describing potential benefits of identifying and adapting novel global ideas to address health equity in the US, but there is a dearth of implementation and evaluation data. Terminology is required to define and frame the field. Additional research, particularly in the area of implementation science and evidence-based frameworks to support the practice of what we define as 'global learning' for health equity, is necessary to advance the practice., Competing Interests: The authors have no competing interests to declare., (Copyright: © 2022 The Author(s).)

Rising poverty in suburbs has led to increased interest in how well suburban safety nets function. Apart from public assistance programs, community-based nonprofit health and human service organizations play a central role in suburban efforts to address racial and economic inequalities. Understanding how nonprofit services are distributed across the suburban and urban landscape, therefore, is critical to assessing how communities may be able to address need. In this paper, we examine the presence and volatility of nonprofit health and human service expenditures in suburban and urban counties across the United States from 2000 to 2017. We find the nonprofit safety net to be more responsive in urban centers than in suburban places, and less robust in suburban areas experiencing high rates of poverty or with a larger share of residents who are Black. Nonprofit health and human service spending also appears less countercyclical than is commonly understood. Suburban-urban disparities in nonprofit health and human service spending persist after controlling for several county-level demographic and socioeconomic factors. [ABSTRACT FROM AUTHOR]

Black women in the United States (U.S.) disproportionately experience adverse pregnancy outcomes, including maternal mortality, compared to women of other racial and ethnic groups. Historical legacies of institutionalized racism and bias in medicine compound this problem. The disproportionate impact of COVID-19 on communities of color may further worsen existing racial disparities in maternal morbidity and mortality. This paper discusses structural and social determinants of racial disparities with a focus on the Black maternal mortality crisis in the United States. We explore how structural racism contributes to a greater risk of adverse obstetric outcomes among Black women in the U.S. We also propose public health, healthcare systems, and community-engaged approaches to decrease racial disparities in maternal morbidity and mortality. [ABSTRACT FROM AUTHOR]

Background: Positive airway pressure (PAP) is a highly effective treatment for obstructive sleep apnea (OSA), but adherence limits its efficacy. In addition, coverage of PAP by CMS (Centers for Medicare & Medicaid Services) and other insurers in the United States depends on adherence. This leaves many beneficiaries without PAP, disproportionally impacting non-white and low socioeconomic position patients with OSA and exacerbating sleep health disparities. Methods: An inter-professional, multidisciplinary, international committee with various stakeholders was formed. Three working groups (the historical policy origins, impact of current policy, and international PAP coverage models) met and performed literature reviews and discussions. Using surveys and an iterative discussion-based consensus process, the policy statement recommendations were created. Results: In this position paper, we advocate for policy change to CMS PAP coverage requirements to reduce inequities and align with patient-centered goals. We specifically call for eradicating repeat polysomnography, eliminating the 4-hour rule, and focusing on patient-oriented outcomes such as improved sleepiness and sleep quality. Conclusions: Modifications to the current policies for PAP insurance coverage could improve health disparities. [ABSTRACT FROM AUTHOR]

Cancer displays some of the largest health-equity concerns of all diseases. This paper draws attention to how health economics research can assess strategies to reduce or even eliminate health disparities and provides pivotal examples of existing research as well as areas for future contributions. The paper also highlights critical data limitations that currently restrain the impact health economics research could have. We then explore new areas of inquiry where economic research is sparse but could have an important impact on health equity, particularly in topics involving Medicare and Medicaid policies that expand reimbursement and generosity of coverage. Health economics studies are notably absent from policies and practices surrounding clinical trials, representing an opportunity for future research. We urge health economics researchers to consider experiments, interventions, and assessments through primary data collection; we further encourage the formulation of multidisciplinary teams to ensure that health economics skills are well melded with other areas of expertise. These teams are needed to maximize novelty and rigor of evidence. As policies are promulgated to address disparities in cancer, involvement of economics in a multidisciplinary context can help ensure that these policies do not have unintended impacts that may deepen inequities., (© The Author(s) 2022. Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

In the wake of the racial injustices laid bare in 2020, on top of centuries of systemic racism, it is clear we need actionable strategies to fundamentally restructure health care systems to achieve racial/ethnic health equity. This paper outlines the pillars of a health equity framework from the Institute for Healthcare Improvement, overlaying a concrete example of telemedicine equity. Telemedicine is a particularly relevant and important topic, given the growing evidence of disparities in uptake by racial/ethnic, linguistic, and socioeconomic groups in the United States during the COVID-19 pandemic, as well as the new standard of care that telemedicine represents post-pandemic. We present approaches for telemedicine equity across the domains of: (1) strategic priorities of a health care organization, (2) structures and processes to advance equity, (3) strategies to address multiple determinants of health, (4) elimination of institutional racism and oppression, and (5) meaningful partnerships with patients and communities., (© 2022 Annals of Family Medicine, Inc.)

Public health departments are on the frontlines of protecting vulnerable groups and working to eliminate health disparities through prevention interventions, disease surveillance and community education. Exploration of the roles national, state and local health departments (LHDs) play in advancing climate change planning and actions to protect public health is a developing arena of research. This paper presents insights from local public health departments in California, USA on how they addressed the barriers to climate adaptation planning with support from the California Department of Public Health's Office of Health Equity Climate Change and Health Equity Section (OHE), which administers the California Building Resilience Against Climate Effects Project (CalBRACE). With support from the U.S. Centers for Disease Control and Prevention (CDC) Climate-Ready States and Cities Initiative (CRSCI), CalBRACE initiated an adaptation project to seed climate planning and actions in county health departments. In this study, we compared the barriers and strategies of twenty-two urban and rural LHDs and explored potential options for climate change adaptation in the public health framework. Using key informant interviews and document reviews, the results showed how engagement with CalBRACE's Local Health Department Partnership on Climate Change influenced the county departments' ability to overcome barriers to adaptation through the diversification of funding sources, the leveraging strategic collaborations, extensive public education and communication campaigns, and the development of political capital and champions. The lessons learned and recommendations from this research may provide pathways and practices for national, state and local level health departments to collaborate in developing protocols and integrating systems to respond to health-related climate change impacts, adaptation and implementation.

Health inequities in the United States are well-documented. However, research that is focused on solutions, rather than just describing the problem, and research that is designed explicitly to inform needed policy and practice change, is still too rare. The Robert Wood Johnson Foundation Interdisciplinary Research Leaders (IRL) program launched in 2016 with the goal of filling this gap: to generate community-engaged research to catalyze policy action in communities, while promoting leadership among researchers and community partners. In this paper, we describe the creation and implementation of a curriculum for IRL program participants over the first 5 years of the program. The curriculum-spanning domains of leadership, policy, communication, community engagement, and research methodologies-was designed to cultivate leaders who use research evidence in their efforts to promote change to advance health equity in their communities. The curriculum components implemented by IRL might be applied to other educational programs or fellowships to amplify and accelerate the growth of leaders nationwide who can use research and action to respond to grave and ongoing threats to community health., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Gollust, Call, Moon, Cluxton and Bailey.)

Introduction: Share buybacks, when a corporation buys back its own shares, are recognised as having potentially harmful impacts on society. This includes by contributing to economic inequalities, and by impeding investments with the potential to protect and promote the welfare of various stakeholders. Share buybacks, however, have received minimal analytical attention in the public health literature. This paper aimed to explore the potential influence of share buybacks on population health and health inequity using a socio-ecological determinants of health lens. Methods: We conducted a descriptive analysis of share buybacks made by corporations listed on United States (US) stock exchanges between 1982 and 2021, using quantitative data sourced from Compustat. We examined annual trends in share buyback expenditure, including comparisons to dividend, net income, capital expenditure, and research and development expenditure data. We then purposively sampled a set of corporations to provide illustrative examples of how share buybacks potentially influence key socio-ecological determinants of health. The examples were: i) three COVID-19 vaccine manufacturers; ii) five of the world's largest fossil fuel corporations; and iii) US car manufacturer General Motors. For these, we conducted an analysis of data from Compustat, company reports and grey literature materials, focusing on key sources of profits and their allocation to share buybacks and particular investments. Results: US-listed corporations spent an estimated US$9.2 trillion in real terms on share buybacks between 2012 and 2021 (nearly 12 times more than from 1982 to 1991). The contribution of share buybacks to total shareholder 'returns' increased from 11% in 1982 to 55% in 2021, with expenditure on shareholder returns increasing considerably relative to capital, research and development expenditure over this period. The three examples illustrated how some corporations have prioritised the short-term financial interests of their shareholders, including via implementing large share buyback programs, over investments with considerable potential to protect and promote the public's health. Conclusion: The potentially substantial impacts of share buybacks on health warrant increased research and policy attention. Arguably, more must be done to regulate share buybacks as part of efforts to address the corporate drivers of ill-health and inequity. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic has revealed deeply entrenched structural inequalities that resulted in an excess of mortality and morbidity in certain racial and ethnic groups in the United States. Therefore, this paper examines from the US perspective how structural racism and defective data collection on racial and ethnic minorities can negatively influence the development of precision public health (PPH) approaches to tackle the ongoing COVID-19 pandemic. Importantly, the effects of structural and data racism on the development of fair and inclusive data-driven components of PPH interventions are discussed, such as with the use of machine learning algorithms to predict public health risks. The objective of this viewpoint is thus to inform public health policymaking with regard to the development of ethically sound PPH interventions against COVID-19. Particular attention is given to components of structural racism (eg, hospital segregation, implicit and organizational bias, digital divide, and sociopolitical influences) that are likely to hinder such approaches from achieving their social justice and health equity goals., (©Lester Darryl Geneviève, Andrea Martani, Tenzin Wangmo, Bernice Simone Elger. Originally published in JMIR Public Health and Surveillance (https://publichealth.jmir.org), 04.03.2022.)

Differences in health outcomes across racial groups are among the most commonly reported findings in health disparities research. Often, these studies do not explicitly connect observed disparities to mechanisms of systemic racism that drive adverse health outcomes among racialized and other marginalized groups in the United States. Without this connection, investigators inadvertently support harmful narratives of biologic essentialism or cultural inferiority that pathologize racial identities and inhibit health equity. This paper outlines pitfalls in the conceptualization, contextualization, and operationalization of race in quantitative population health research and provides recommendations on how to appropriately engage in scientific inquiry aimed at understanding racial health inequities. Race should not be used as a measure of biologic difference, but rather as a proxy for exposure to systemic racism. Future studies should go beyond this proxy use and directly measure racism and its health impacts. VISUAL ABSTRACT Appeared as Annals "Online First" article., (© 2022 Annals of Family Medicine, Inc.)

Historically, the United States has struggled to provide accessible healthcare to all Americans. Now, due to the COVID-19 pandemic, the country must rebuild its healthcare system to account for the devastating loss of healthcare personnel and the impending physician shortage. This paper discusses four U.S. laws that were intended to increase accessibility and how their history can guide the nation to better healthcare. [ABSTRACT FROM AUTHOR]

Health disparities are a significant cause of concern globally and in the United States. Disparities have been additionally highlighted throughout the ongoing COVID-19 pandemic during which populations of color have been the most affected by the disease. Social determinants of health, race, ethnicity, and gender have all contributed to disparate outcomes and disparities spanning all age groups. Multiple socio-ecological factors contribute to disparities and different strategies have been proposed. The purpose of this paper is to provide an overview of disparities in pediatric treatment and outcomes, with a focus on children with endocrine disorders. [ABSTRACT FROM AUTHOR]

The fairness of health services is an important indicator of the World Health Organization's performance evaluation of health services, and the fairness of health resource allocation is the prerequisite for the fairness of health services. The research in this article aims to explore how to use health and medical resources fairly and effectively to allocate health resources in different fields, populations and projects, in order to achieve the maximization of social and economic benefits of health and medical resources. In the study of the distribution and equity of public health and medical resources, we comprehensively apply Gini coefficient, Theil index, Lorentz curve and difference index, based on the theory of health resource allocation and the theory of health equity, the province's health service resources have been researched and evaluated, combined with regional health planning theories and public health theories, a variety of scientific methods were used to analyze community health service resources at all levels across the country. At the same time, we reviewed the journal literature about the treatment of patients and children, and analyzed the patients admitted to medical institutions in various regions. The research in this paper found that from 2016 to 2020, the Gini coefficient of the province's health institutions according to population distribution has been fluctuating between 0.14 and 0.17. During this 5-year period, the Gini coefficient of the distribution of medical and health expenditures by population shows a downward trend year by year. From 2019, reach below 0.1, this shows that the fairness of the allocation of health resources according to population has a clear trend of improvement., Competing Interests: The author declares that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Pu.)

Background: Longitudinal follow-up, resource utilization, and health disparities are top congenital heart research and care priorities. Medicaid claims include longitudinal data on inpatient, outpatient, emergency, pharmacy, rehabilitation, home health utilization, and social determinants of health-including mother-infant pairs., Objectives: The New York Congenital Heart Surgeons Collaborative for Longitudinal Outcomes and Utilization of Resources linked robust clinical details from locally held state and national registries from 10 of 11 New York congenital heart centers to Medicaid claims, building a novel, statewide mechanism for longitudinal assessment of outcomes, expenditures, and health inequities., Methods: The authors included all children <18 years of age undergoing cardiac surgery in The Society of Thoracic Surgeons Congenital Heart Surgery Database or the New York State Pediatric Congenital Cardiac Surgery Registry from 10 of 11 New York centers, 2006 to 2019. Data were linked via iterative, ranked deterministic matching on direct identifiers. Match rates were calculated and compared. Proportions of the linked cohort trackable over 3, 5, and 10 years were described., Results: Of 14,097 registry cases, 59% (n = 8,322) reported Medicaid use. Of these, 7,414 were linked to New York claims, at an 89% match rate. Of matched cases, the authors tracked 79%, 74%, and 65% of children over 3, 5, and 10 years when requiring near-continuous Medicaid enrollment. Allowing more lenient enrollment criteria, the authors tracked 86%, 82%, and 76%, respectively. Mortality over this time was 7.7%, 8.4%, and 10.0%, respectively. Manual validation revealed ∼100% true matches., Conclusions: This establishes a novel statewide data resource for assessment of longitudinal outcome, health expenditure, and disparities for children with congenital heart disease., Competing Interests: Funding Support and Author Disclosures This work was supported by the National Institutes of Health/National Heart Lung and Blood Institute (R01 HL150044). The views and opinions expressed in this article are those of the authors and do not necessarily reflect the official policy or position of the National Institutes of Health or the New York State Department of Health. Examples of analysis performed within this article are only examples. They should not be utilized in real-world analytic products. The authors have reported that they have no relationships relevant to the contents of this paper to disclose., (Copyright © 2021 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)

Exploring methods that value diverse perspectives is critical to better understand the value of health equity in value assessment frameworks. In this paper, we examined emerging value assessment frameworks in the United States and present examples where evidence on outcomes and preferences for value do not take into consideration diverse perspectives. We identify possible solutions to improve existing value assessment methods and illustrate-using a hypothetical shared decision-making case study-an alternative to current value-assessment frameworks, "equitable multicriteria decision analysis," which could be implemented in the context of the value-based assessment of prevention choices for women at high risk of developing breast cancer. These proposed alternatives and solutions can be used by researchers and decision makers to incorporate health equity into value assessment. DISCLOSURES: No funding was received for this study. The authors have no conflicts of interest to report.

The COVID‐19 pandemic has had a disproportionate impact on the health of Black Americans, Latinx or Hispanic Americans, and American Indians. These disparities are deeply unjust, in part, because they are the causal result of racism at both the interpersonal and structural levels. This paper argues, however, that establishing a causal connection between racism and health disparities is not the only way to explain the injustice of these disparities. The COVID‐19 health disparities are arguably unjust because health equity is a "free‐standing" demand of justice, an obligation of reparative justice, a remedy to structural injustice, and part of dismantling pernicious racial concepts. Identifying multiple accounts of injustice may lower the evidentiary bar for our normative claims and help us to identify alternative policy pathways for ending health inequity. [ABSTRACT FROM AUTHOR]

The article discusses the results of a study on how to lower the health disparities of the effect of air pollution on racial/ethnic communities in the U.S. Topics mentioned include the use of race-specific concentration-response functions (CRFs) in calculating the link between exposure to fine particulates and mortality for Asian, African American, and Hispanic Americans, the impact of federal policies to improve air quality on communities of color, and the various aspects of systemic racism.

Introduction: Healthcare organizations are under increasing pressure from policymakers, payers, and advocates to screen for and address patients’ health-related social needs (HRSN). The emergency department (ED) presents several challenges to HRSN screening, and patients are frequently not screened for HRSNs. Predictive modeling using machine learning and artificial intelligence, approaches may address some pragmatic HRSN screening challenges in the ED. Because predictive modeling represents a substantial change from current approaches, in this study we explored the acceptability of HRSN predictive modeling in the ED. Methods: Emergency clinicians, ED staff, and patient perspectives on the acceptability and usage of predictive modeling for HRSNs in the ED were obtained through in-depth semi-structured interviews (eight per group, total 24). All participants practiced at or had received care from an urban, Midwest, safety-net hospital system. We analyzed interview transcripts using a modified thematic analysis approach with consensus coding. Results: Emergency clinicians, ED staff, and patients agreed that HRSN predictive modeling must lead to actionable responses and positive patient outcomes. Opinions about using predictive modeling results to initiate automatic referrals to HRSN services were mixed. Emergency clinicians and staff wanted transparency on data inputs and usage, demanded high performance, and expressed concern for unforeseen consequences. While accepting, patients were concerned that prediction models can miss individuals who required services and might perpetuate biases. Conclusion: Emergency clinicians, ED staff, and patients expressed mostly positive views about using predictive modeling for HRSNs. Yet, clinicians, staff, and patients listed several contingent factors impacting the acceptance and implementation of HRSN prediction models in the ED. [ABSTRACT FROM AUTHOR]

Background: Sickle cell disease (SCD) exemplifies many of the social, racial, and healthcare equity issues in the United States. Despite its high morbidity, mortality, and cost of care, SCD has not been prioritized in research and clinical teaching, resulting in under-trained clinicians and a poor evidence base for managing complications of the disease. This study aimed to perform a needs assessment, examining the perspectives of medical trainees pursuing hematology/oncology subspecialty training regarding SCD-focused education and clinical care. Method: Inductive, iterative thematic analysis was used to explore qualitative interviews of subspecialty hematology-oncology trainees' attitudes and preferences for education on the management of patients with SCD. Fifteen trainees from six programs in the United States participated in 4 focus groups between April and May 2023. Results: Thematic analysis resulted in 3 themes: 1. Discomfort caring for patients with SCD. 2. Challenges managing complications of SCD, and 3. Desire for SCD specific education. Patient care challenges included the complexity of managing SCD complications, limited evidence to guide practice, and healthcare bias. Skill-building challenges included lack of longitudinal exposure, access to expert clinicians, and didactics. Conclusions: Variations in exposure, limited formal didactics, and a lack of national standardization for SCD education during training contributes to trainees' discomfort and challenges in managing SCD, which in turn, contribute to decreased interest in entering the SCD workforce. The findings underscore the need for ACGME competency amendments, dedicated SCD rotations, and standardized didactics to address the gaps in SCD education. [ABSTRACT FROM AUTHOR]

Artificial intelligence models represented in machine learning algorithms are promising tools for risk assessment used to guide clinical and other health care decisions. Machine learning algorithms, however, may house biases that propagate stereotypes, inequities, and discrimination that contribute to socioeconomic health care disparities. The biases include those related to some sociodemographic characteristics such as race, ethnicity, gender, age, insurance, and socioeconomic status from the use of erroneous electronic health record data. Additionally, there is concern that training data and algorithmic biases in large language models pose potential drawbacks. These biases affect the lives and livelihoods of a significant percentage of the population in the United States and globally. The social and economic consequences of the associated backlash cannot be underestimated. Here, we outline some of the sociodemographic, training data, and algorithmic biases that undermine sound health care risk assessment and medical decision-making that should be addressed in the health care system. We present a perspective and overview of these biases by gender, race, ethnicity, age, historically marginalized communities, algorithmic bias, biased evaluations, implicit bias, selection/sampling bias, socioeconomic status biases, biased data distributions, cultural biases and insurance status bias, conformation bias, information bias and anchoring biases and make recommendations to improve large language model training data, including de-biasing techniques such as counterfactual role-reversed sentences during knowledge distillation, fine-tuning, prefix attachment at training time, the use of toxicity classifiers, retrieval augmented generation and algorithmic modification to mitigate the biases moving forward. [ABSTRACT FROM AUTHOR]

Objective: Worsening rates of infant and maternal mortality in the United States serve as an urgent call for multi-modal intervention. Infant Well Child Visits (WCVs) provide an opportunity for prevention, however not all infants receive the recommended schedule of visits, with infants of low-income and Black families missing a higher portion of WCVs. Due to diverse experiences and needs of under-resourced communities throughout the United States, caregiver voice is essential when designing improvement efforts. Methods: Purposeful sampling and interviewing of 10 caregivers in Cincinnati, OH was performed by community peer researchers. Interview transcripts were evaluated by the research team, with identification of several important themes. Results: Nine out of 10 caregivers self-identified as Black. All young children of the interviewed caregivers had Medicaid as their insurance provider. All interviews highlighted rich perspectives on caregiver hopes for their child, family, and selves. Establishing trust through empathy, shared decision making, and the nurturing of interpersonal patient-practitioner relationships is crucial for fostering a positive healthcare experience. Levels of mistrust was perceptibly high across several interviews, with lack of racial concordance between medical provider and family exacerbating the issue for some caregivers. Caregivers voiced a tendency to rely on family and community members for when to seek out health care for their children, and additionally cited racism and perceptions of being rushed or judged as barriers to seeking further care. Conclusion: This study emphasizes the importance of being community-informed when considering interventions. Prior research on the topic of missed WCV's often focused on material resource availability and limitations. While that was commented on by caregivers in this study as well, equal—if not more—attention was directed toward interpersonal relationship formation, the presence or absence of trust between practitioner and caregiver, and the importance of social-emotional support for caregivers. We highlight several opportunities for systemic improvements as well as future directions for research. [ABSTRACT FROM AUTHOR]

The article presents the discussion on evidence revealing continuous challenging gaps in the global COVID19 vaccine equity. Topics include global recognition of long-standing social inequities related to race, disability, class, caste and gender; and addressing the issue on ‘business as usual approach' encompassing COVID19 vaccines procurement.

Background: Police violence is increasingly recognized as an urgent public health problem. Basic questions about police violence, however, remain unanswered, including which types of law enforcement agency are responsible for fatal police violence deaths. Methods: We estimated the proportion of police violence deaths in the U.S. (2013–2022) that were attributable to local, county, state, federal, or tribal police agencies, using mapping police violence data. We examined proportions overall, by decedent race/ethnicity, and by state. Results: Nationally, 60% of decedents were killed by municipal, 29% by county, 8% by state, and 3% by federal, police, with < 1% killed by tribal or other officers. These proportions varied by race/ethnicity, with 56% of Native American decedents killed by municipal police compared to 70–75% among other racially minoritized people. While municipal police were responsible for most deaths in most states, in the Southeast, county police predominated. In some Northeastern states (and Alaska), state police were responsible for > 40% of deaths. Conclusions: We identify wide geographic & racial/ethnic variation in the agencies responsible for fatal police violence. Findings suggest that the budgetary and infrastructural shifts required to prevent fatal police violence need to occur at multiple levels of government. [ABSTRACT FROM AUTHOR]

Background: The literature on menstruation defines period poverty as the inability to access sufficient period products, education, and sanitary facilities needed to manage menstruation healthily and effectively. While research has identified shortcomings of healthcare in the carceral setting, period poverty behind bars has remained largely absent from criminal legal discourse. Objectives: The current study examines the interplay of period poverty and carceral control to introduce the novel concept of menstrual victimization, defined as the physical, emotional, and financial victimization that results from period poverty perpetuated through carceral control. Methods: The study uses qualitative content analysis to systematically gather and code journalistic accounts pertaining to the menstrual experiences of incarcerated and previously incarcerated females, criminal justice practitioners, and journalists. The analysis uses literary pieces (n = 99), which were coded deductively and guided by concepts related to structural violence and radical feminist criminology. Results: The findings shed light on the unique structural harms incarcerated menstruators face and reveal the dearth of needed empirical research on period poverty in carceral spaces. The narratives in the sample revealed how manufactured scarcity of period products within carceral spaces is used as a means of oppression by institutional agents. The emergent themes highlight how the intersection of period poverty and carceral control led to menstrual victimization characterized through shame, humiliation, control, and coercion. Conclusion: Potential outcomes associated with understanding menstrual victimization in the carceral setting are discussed, including reducing menstrual stigma, disseminating health education, minimizing health disparities, and ultimately, shifting modes of holding accountability away from oppressive, retributive, and controlling tactics. Plain Language Summary: Exploring how access to period products is used to harm people who menstruate in correctional facilities using an analysis of journalistic accounts Period poverty is defined as the inability to access sufficient period products, education, and sanitary facilities needed to manage menstruation healthily and effectively. Research reveals the shortcomings of healthcare in prisons and jails but period poverty in prisons is largely unexplored. The current study uses published media and research reports discussing menstruation in correctional facilities to examine how the control of period products, access to washrooms, and medical care impacts is used to harm people who menstruate experiencing incarceration. The findings suggest correctional staff leverage access to menstrual health resources to control, coerce, shame, and humiliate incarcerated menstruators. In conclusion, we offer potential reforms are discussed including reducing menstrual stigma, providing health education and care, and ultimately, holding staff accountable and shifting away from oppressive, punitive, and controlling tactics. [ABSTRACT FROM AUTHOR]

Background. One in 5 people in the United States live with disability; however, the public health needs of this community have been largely overlooked. Although U.S. law mandates the availability of accessible medical exam equipment, people with mobility disabilities (PWMD) frequently encounter barriers that require self-advocacy to receive basic primary care. Objective. The purpose of this study was to qualitatively explore the impact of healthcare access barriers—specifically, the experiences of the need to self-advocate and factors that inform decisions to make accommodation requests—for PWMD. Methods. Qualitative semistructured interviews were performed across two phases of data collection with each of the 6 participants. Interpretative phenomenological analysis was used to highlight the essence of participants' experiences in making decisions to request healthcare accommodation. Results. Participants included a purposive sample of self-advocates with physical disabilities (3 men and 3 women). While individual approaches to self-advocacy varied, participants identified a process of "recognizing the normalization of disability discrimination and disability stigma" which necessitates the development of "agency in self-advocacy." This process has a lasting impact on people that includes a shared embodied experience of disability, as well as a sense of empowerment based on their collective and individual identities. Conclusions. Findings have implications for supporting individual disability consumer advocacy efforts as well as the need to address the normalization of disability discrimination within healthcare systems levels. [ABSTRACT FROM AUTHOR]

PURPOSE This mixed methods study sought to describe the extent to which family physicians in urban communities serve socially vulnerable patients and to better understand their practices, their challenges, and the structural supports that could facilitate their patient care. METHODS We conducted a quantitative analysis of questionnaire data from 100% of US physicians recertifying for family medicine from 2017 to 2020. We conducted qualitative analysis of in-depth interviews with 22 physician owners of urban, small, independent practices who reported that the majority of their patients were socially vulnerable. RESULTS In 2020, in urban areas across the United States, 19.3% of family physicians served in independent practices with 1 to 5 clinicians, down from 22.6% in 2017. Nearly one-half of these physicians reported that >10% of their patients were socially vulnerable. Interviews with 22 physicians who reported that the majority of their patients were socially vulnerable revealed 5 themes: (1) substantial time spent addressing access issues and social determinants of health, (2) minimal support from health care entities, such as independent practice associations and health plans, and insufficient connection to community-based organizations, (3) myriad financial challenges, (4) serious concerns about the future, and (5) deep personal commitment to serving socially vulnerable patients in independent practice. CONCLUSIONS Small independent practices serving vulnerable patients in urban communities are surviving because deeply committed physicians are making personal sacrifices. Health equity–focused policies could decrease the burden on these physicians and bolster independent practices so that socially vulnerable patients continue to have options when seeking primary care. [ABSTRACT FROM AUTHOR]

Introduction: Gastric cancer ranks as the 5th most prevalent cancer and the 4th leading cause of cancer-related deaths worldwide. Various treatment modalities, including surgical resection, chemotherapy, and radiotherapy, are available for gastric cancer patients. However, disparities related to age, sex, race, socioeconomic factors, insurance status, and demographic factors often lead to delayed time to treatment. Methods: In this retrospective study, conducted between 2004 and 2019, we utilized data from the National Cancer Database (NCDB) to investigate the factors contributing to disparities in the time to first treatment, surgery, chemotherapy, and radiotherapy among gastric cancer patients. Our analysis incorporated several variables, and statistical analysis was conducted to provide valuable insights into these disparities. Results: We observed notable disparities in the timing of treatment for various demographic groups, including age, sex, race, insurance status, geographic location, and facility type. These disparities include longer time to treatment in males (32.67 vs 30.75), Native Americans (35.10 vs 31.09 in Asians), low-income patients (32 vs 31.15), patients getting treatment in an academic setting (36.11 vs 29.61 in community setting), significantly longer time to chemotherapy in 70+ age group (51.13 vs 40.38 in <40 y age group), black race (55.81 vs 47.05 in whites), low income people (49.64 vs 46.74), significantly longer time to radiotherapy in females (101.61 vs 79.75), blacks and Asians (109.68 and 113.96 respectively vs 92.68 in Native Americans) etc. There are various other disparities in time to surgery, chemotherapy, and radiotherapy. Conclusions: Understanding these disparities is crucial in developing targeted strategies to improve timely access to appropriate treatments and enhance outcomes for gastric cancer patients. Future research with updated data and prospective study designs can provide a more comprehensive understanding of the factors influencing patient outcomes in gastric cancer. [ABSTRACT FROM AUTHOR]

INTRODUCTION Tobacco control laws that raise the minimum age of tobacco sales to 21 years (T21) play a pivotal role in youth tobacco prevention, yet empirical data are sorely needed to inform enforcement, compliance efforts, and future legislation. METHODS Spatial analysis was conducted at the zip code level by geocoding the states and localities that adopted T21 ordinances from 2015 to 2019. A multi-level logistic regression model was conducted to examine disparities in neighborhood socioeconomic status (SES), FDA retail inspection, and state-level tobacco control policies associated with T21 adoption. RESULTS T21 adoption at the state and local level increased considerably from 1.4% of zip codes in 2015 to 40.2% in 2019. However, the T21 ordinances were disproportionally adopted in New England (82.6%) and Pacific (73.6%) regions with scarce coverage in East South Central (<0.1%), Mountain (1.6%), and West North Central regions (6.1%). The T21 policies were more likely to be adopted in areas with stronger tobacco control policies, urban areas (vs rural, adjusted odds ratio, AOR=1.25, p=0.005), areas with a larger Hispanic (AOR=1.19, p<0.0001) or Asian population (AOR=1.12, p<0.0001), and in areas where the population had higher levels of education (AOR=1.05, p<0.0001). It was less likely to be adopted in areas with larger proportions of American Indians, youths, and young adults. Nearly 40% of zip codes with tobacco retailers did not receive annual FDA tobacco retail inspections for underage sales in 2019. The average retail violation rate of underage sales of tobacco products in T21 regions was lower than in non-T21 regions. CONCLUSIONS Disparities in T21 adoption, retail inspections, and retail compliance may limit the policy impact. Unified enforcement of youth tobacco access restrictions with resources and interventions in vulnerable communities is needed to reduce tobacco-related health disparities. [ABSTRACT FROM AUTHOR]

Quality care in healthcare is a multifaceted concept that encompasses the execution of effective medical treatments and the patient's overall experience. It involves a multitude of factors, including effectiveness, safety, timeliness, equity, and patient centeredness, which are important in shaping the healthcare landscape. This cross-sectional study used the data from the Health Information National Trends Survey 6 (HINTS 6), which collects data on various aspects of health communication and information-seeking behaviors, to investigate the factors associated with quality care among White and Hispanic populations. All adults who participated in HINTS 6 and visited healthcare service at least once in the past 12 months were included in this study. Multivariable logistic regression was used to determine the association between quality care and delay or discriminated care with the adjustment of all other sociodemographic variables. We analyzed a total of 3611 participants. Poor social determinants of health (SDOHs) (OR 0.61, CI 0.43–0.88, p = 0.008), delayed needed medical care (OR 0.34, CI 0.26–0.43, p < 0.001), and discriminated care (OR 0.29, CI 0.15–0.54, p < 0.001) were all negatively associated with optimal quality care. Negative SDOHs could also be positively associated with delayed care and discriminated care. [ABSTRACT FROM AUTHOR]

Background: One practice in healthcare implementation is patient engagement in quality improvement and systems redesign. Implementers in healthcare systems include clinical leadership, middle managers, quality improvement personnel, and others facilitating changes or adoption of new interventions. Patients provide input into different aspects of health research. However, there is little attention to involve patients in implementing interventions, especially in the United States (U.S.), and this might be essential to reduce inequities. Implementers need clear strategies to overcome challenges, and might be able to learn from countries outside the U.S. Methods: We wanted to understand existing work about how patients are being included in implementation activities in real world U.S. healthcare settings. We conducted an environmental scan of three data sources: webinars, published articles, and interviews with implementers who engaged patients in implementation activities in U.S. healthcare settings. We extracted, categorized, and triangulated from data sources the key activities, recurring challenges, and promising solutions using a coding template. Results: We found 27 examples of patient engagement in U.S. healthcare implementation across four webinars, 11 published articles, and seven interviews, mostly arranging patient engagement through groups and arranging processes for patients that changed how engaged they were able to be. Participants rarely specified if they were engaging a population experiencing healthcare inequities. Participants described eight recurring challenges; the two most frequently identified were: (1) recruiting patients representative of those served in the healthcare system; and (2) ensuring processes for equitable communication among all. We matched recurring challenges to promising solutions, such as logistic solutions on how to arrange meetings to enhance engagement or training in inclusivity and power-sharing. Conclusion: We clarified how some U.S. implementers are engaging patients in healthcare implementation activities using less and more intensive engagement. It was unclear whether reducing inequities was a goal. Patient engagement in redesigning U.S. healthcare service delivery appears similar to or less intense than in countries with more robust infrastructure for this, such as Canada and the United Kingdom. Challenges were common across jurisdictions, including retaining patients in the design/delivery of implementation activities. Implementers in any region can learn from those in other places. [ABSTRACT FROM AUTHOR]

Non-profit hospitals have long been required to provide certain benefits to the community in which they reside in order to maintain tax-exempt status. The nature of these community benefits has evolved since the mid-twentieth century, but "charity care"--free or discounted care for patients who are unable to pay for it--is the quintessential hospital community benefit. Although the Patient Protection and Affordable Care Act of 2010 (ACA) extended eligibility for subsidized health coverage to many more people living in the United States, some noncitizens--including those without a valid immigration status-- were excluded. As a result, this group is disproportionately likely to need financial assistance to afford health care because they lack insurance. However, some hospitals exclude noncitizens from eligibility for charity care because of their immigration status. This Article explores the development of prohibitions against discrimination on the basis of immigration status in hospital charity care programs in certain states and the relative inaction by the majority of the states and the federal government. When non-profit hospitals exclude patients from charity care on the basis of immigration status, they contribute to health care inequity among noncitizens--the population in the United States least likely to have access to health care. These actions contravene the longstanding tradition of non-profit, taxexempt hospitals providing benefits to the community of people living in the geographic areas from which the hospitals draw their patients. Congress, state legislatures, and hospitals themselves are in a position to prohibit discrimination in charity care programs; failure to act further entrenches the exclusion of noncitizens from the threadbare health care "safety net" and perpetuates inequity in access to health care for noncitizens. [ABSTRACT FROM AUTHOR]

Background: Long COVID symptoms – which include brain fog, depression, and fatigue – are mild at best and debilitating at worst. Some U.S. health surveys have found that women, lower income individuals, and those with less education are overrepresented among adults with long COVID, but these studies do not address intersectionality. To fill this gap, we conduct an intersectional analysis of the prevalence and outcomes of long COVID in the U.S. We posit that disparities in long COVID have less to do with the virus itself and more to do with social determinants of health, especially those associated with occupational segregation and the gendered division of household work. Methods: We use 10 rounds of Household Pulse Survey (HPS) data collected between June 2022 and March 2023 to perform an intersectional analysis using a battery of descriptive statistics that evaluate (1) the prevalence of long COVID and (2) the interference of long COVID symptoms with day-to-day activities. We also use the HPS data to estimate a set of multivariate logistic regressions that relate the odds of having long COVID and activity limitations due to long COVID to a set of individual characteristics as well as intersections by sex, race/ethnicity, education, and sexual orientation and gender identity. Results: Findings indicate that women, some people of color, sexual and gender minorities, and people without college degrees are more likely to have long COVID and to have activity limitations from long COVID. Women have considerably higher odds of developing long COVID compared to men, a disparity exacerbated by having less education. Intersectional analysis by gender, race, ethnicity, and education reveals a striking step-like pattern: college-educated men have the lowest prevalence of long COVID while women without college educations have the highest prevalence. Daily activity limitations are more evenly distributed across demographics, but a different step-like pattern is present: fewer women with degrees have activity limitations while limitations are more widespread among men without degrees. Regression results confirm the negative association of long COVID with being a woman, less educated, Hispanic, and a sexual and gender minority, while results for the intersectional effects are more nuanced. Conclusions: Results point to systematic disparities in health, highlighting the urgent need for policies that increase access to quality healthcare, strengthen the social safety net, and reduce economic precarity. [ABSTRACT FROM AUTHOR]

In 2020, the U.S. Department of Defense officially disclosed a set of ethical principles to guide the use of Artificial Intelligence (AI) technologies on future battlefields. Despite stark differences, there are core similarities between the military and medical service. Warriors on battlefields often face life-altering circumstances that require quick decision-making. Medical providers experience similar challenges in a rapidly changing healthcare environment, such as in the emergency department or during surgery treating a life-threatening condition. Generative AI, an emerging technology designed to efficiently generate valuable information, holds great promise. As computing power becomes more accessible and the abundance of health data, such as electronic health records, electrocardiograms, and medical images, increases, it is inevitable that healthcare will be revolutionized by this technology. Recently, generative AI has garnered a lot of attention in the medical research community, leading to debates about its application in the healthcare sector, mainly due to concerns about transparency and related issues. Meanwhile, questions around the potential exacerbation of health disparities due to modeling biases have raised notable ethical concerns regarding the use of this technology in healthcare. However, the ethical principles for generative AI in healthcare have been understudied. As a result, there are no clear solutions to address ethical concerns, and decision-makers often neglect to consider the significance of ethical principles before implementing generative AI in clinical practice. In an attempt to address these issues, we explore ethical principles from the military perspective and propose the "GREAT PLEA" ethical principles, namely Governability, Reliability, Equity, Accountability, Traceability, Privacy, Lawfulness, Empathy, and Eutonomy, for generative AI in healthcare. Furthermore, we introduce a framework for adopting and expanding these ethical principles in a practical way that has been useful in the military and can be applied to healthcare for generative AI, based on contrasting their ethical concerns and risks. Ultimately, we aim to proactively address the ethical dilemmas and challenges posed by the integration of generative AI into healthcare practice. [ABSTRACT FROM AUTHOR]

BACKGROUND: Recently enacted environmental justice policies in the United States at the state and federal level emphasize addressing place-based inequities, including persistent disparities in air pollution exposure and associated health impacts. Advances in air quality measurement, models, and analytic methods have demonstrated the importance of finer-scale data and analysis in accurately quantifying the extent of inequity in intraurban pollution exposure, although the necessary degree of spatial resolution remains a complex and context-dependent question. OBJECTIVE: The objectives of this commentary were to a) discuss ways to maximize and evaluate the effectiveness of efforts to reduce air pollution disparities, and b) argue that environmental regulators must employ improved methods to project, measure, and track the distributional impacts of new policies at finer geographic and temporal scales. DISCUSSION: The historic federal investments from the Inflation Reduction Act, the Infrastructure Investment and Jobs Act, and the Biden Administration's commitment to Justice40 present an unprecedented opportunity to advance climate and energy policies that deliver real reductions in pollution-related health inequities. In our opinion, scientists, advocates, policymakers, and implementing agencies must work together to harness critical advances in air quality measurements, models, and analytic methods to ensure success. [ABSTRACT FROM AUTHOR]