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BACKGROUND: Real or perceived discrimination contributes to lower quality of care for Black compared to white patients. Some forms of discrimination come from non-physician and non-nursing (non-MD/RN) staff members (e.g., receptionists). METHODS: Utilizing the Burgess Model as a framework for racial bias intervention development, we developed an online intervention with five, 30-min modules: (1) history and effects of discrimination and racial disparities in healthcare, (2) implicit bias and how it may influence interactions with patients, (3) strategies to handle stress at work, (4) strategies to improve communication and interactions with patients, and (5) personal biases. Modules were designed to increase understanding of bias, enhance internal motivation to overcome bias, enhance emotional regulation skills, and increase empathy in patient interactions. Participants were non-MD/RN staff in nine primary care clinics. Effectiveness of the intervention was assessed using Implicit Association Test and Symbolic Racism Scale, to measure implicit and explicit racial bias, respectively, before and after the intervention. Acceptability was assessed through quantitative and qualitative feedback. RESULTS: Fifty-eight non-MD/RN staff enrolled. Out of these, 24 completed pre- and post-intervention assessments and were included. Among participants who reported characteristics, most were Black, with less than college education and average age of 43.2 years. The baseline implicit bias d-score was 0.22, indicating slight pro-white bias. After the intervention, the implicit bias score decreased to −0.06 (p=0.01), a neutral score indicating no pro-white or Black bias. Participant rating of the intervention, scored from 1 (strongly disagree) to 5 (strongly agree), for questions including whether “it was made clear how to apply the presented content in practice” and “this module was worth the time spent” was ≥4.1 for all modules. CONCLUSIONS: There was a decrease in implicit pro-white bias after, compared with before, the intervention. Intervention materials were highly rated. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s11606-022-07464-x.

Background: Coronary heart disease (CHD) mortality has long been higher among US blacks compared with whites, especially among younger individuals. Recent progress on eliminating these disparities has not been reported. Methods: We examined CHD mortality in the REGARDS study, a 30,239-member national prospective cohort study that oversampled blacks (41%) and residents of the southeastern US, recruiting from 2003-7. Baseline data included interviews and in-home collection of physiologic and medication data. Telephone follow-up was conducted every 6 months to detect endpoints, triggering medical record retrieval and expert adjudication. Deaths prompted interviews with next-of-kin or proxies, collection of medical records and death certificates. We examined risks for definite or probable CHD mortality overall, and separately for in-hospital and out-of-hospital CHD death. Cox models stratified on age 65 estimated hazard ratios (HR) for CHD mortality for blacks compared with whites, adjusting for sociodemographics and CHD risk factors. Results: We analyzed 14,992 participants 65 years of age (38% blacks). There were 126 CHD deaths among those age 65 over a mean follow-up of 4.2+1.5 SD years. Adjusting for age and region of residence, excess risks among blacks were generally more pronounced for those age 65 years of age (Table). Conclusions: Risks for CHD mortality were higher among blacks, largely attributable to higher risk factor burden especially among the young, suggesting that targeted intervention efforts are needed to overcome this disparity. The excess risk for in-hospital mortality among older blacks warrants further attention.

Objectives: African Americans (AA) have higher risk for coronary heart disease (CHD) outcomes than Whites. This racial disparity has been attributed to differences in risk factors such as hypertension, diabetes, smoking, and inactivity. Depression has been associated with CHD risk, both through behavioral factors and possibly through more direct mechanisms. Yet, the role of depressive symptoms in racial disparities in risk of CHD is not clear. Using the REGARDS Study, we examined the association between depressive symptoms and incident CHD. Hypothesis: Depressive symptoms are associated with incident CHD among AA, but not Whites. Methods: REGARDS is a national cohort of US community-dwelling adults aged >45 recruited from 2003 to 2007. Longitudinal associations of depressive symptoms with incident acute CHD (fatal CHD or nonfatal myocardial infarction or coronary revascularization) by race were examined among 24,261 participants (AA = 10,265; Whites =13,996) free of CHD at baseline, and observed through 12/31/09. Baseline depressive symptoms were defined by the 4-item Centers for Epidemiological Studies Depression Scale (CES-D), with continuous scores (0-12 range) dichotomized as normal ( Results: Overall mean follow-up was 4.2+1.5 years, CHD incidence was 8.3 events per 1000 person-years (n=366 events) among AA and 8.8 events per 1000 person-years (n=613 events) among Whites, p=0.0015. Depressive symptoms were more prevalent among AA (13.1%) than among Whites (8.5%), p Conclusions: Depressive symptoms were associated with risk of incident CHD among AA but not Whites. Efforts to reduce racial disparities in CHD may need to address environmental and psychosocial factors that place AA at higher risk.

Objective To examine self-reported weight discrimination and differences based on race, sex, and BMI in a biracial cohort of community-based middle-aged adults. Design and Methods We report on 3,466 participants (mean age=50 years, mean BMI=30 kg/m2) of the Coronary Artery Risk Development in Young Adults (CARDIA) Study who completed the 25-year examination of this epidemiological investigation in 2010–11. The sample included normal weight, overweight, and obese participants. CARDIA participants are distributed into four race-sex groups, with about half being African-American and half White. Participants completed a self-reported measure of weight discrimination. Results Among overweight/obese participants, weight discrimination was lowest for White men (12.0%) and highest for White women (30.2%). The adjusted odds ratio (95% CI) for weight discrimination in those with class 2/3 obesity (BMI≥35 kg/m2) versus the normal-weight was most pronounced: African American men, 4.59(1.71–12.34); African American women, 7.82(3.57–17.13); White men, 6.99(2.27–21.49); and White women, 18.60(8.97–38.54). Being overweight (BMI=25–29.9 kg/m2) vs. normal weight was associated with increased discrimination in White women only: 2.10(1.11–3.96). Conclusions We provide novel evidence for a race-sex interaction on perceived weight discrimination, with White women more likely to report discrimination at all levels of overweight and obesity. Pychosocial mechanisms responsible for these differences deserve exploration.

Background: Uninsured individuals and those living in federally designated Health Professional Shortage Areas (HPSA) face considerable access barriers and, consequently, may receive less cardiovascular disease (CVD) preventive care. Methods: REGARDS is a national cohort of 30,239 African American (AA) and White community dwelling individuals >45 years of age recruited between 2003 and 2007. We investigated 5 CVD prevention guidelines: 1) aspirin in those with coronary heart disease (CHD), 2) beta-blockers (BB) following myocardial infarction, 3) angiotensin converting enzyme inhibitors (ACEI) or angiotensin receptor blockers in those with diabetes or CVD and either hypertension or chronic kidney disease, 4) statins in those with diabetes or CHD, and 5) warfarin for atrial fibrillation. We compared use of these medications by insurance status and HPSA county residence, adjusting for sociodemographics, health behaviors, and health status. Counties with partial HPSA status were excluded. Results: Mean age of participants was 64±9 years, 42% were AA, 55% were women, 93% were insured; 2,548 participants resided in complete HPSA counties and 17,441 in non-HPSA counties, representing 340 of 842 complete HPSA and 1,145 of 1,792 non-HPSA counties nationally. The odds of receiving aspirin, BBs, and ACEI by were similar by HPSA county type and insurance status. However, the odds of receiving statin therapy were lower among uninsured participants, regardless of county type (Table). Conclusions: Residence in HPSA counties was not associated with less CVD prevention. However, a combination of lack of insurance and residence in a HPSA county defined those with the lowest recommended statin use, suggesting lack of access to newer, more expensive therapies among those with both financial and geographic barriers to primary care. Adjusted OR * (95% CI) for Recommended Medications Compared to Insured Residents of non-HPSA Counties Aspirin Beta-Blockers ACEI or ARB Statin Warfarin Insured residents of HPSA counties 1.19 (0.79-1.80) 1.05 (0.75-1.47) 1.08 (0.90-1.30) 1.01 (0.84-1.21) 1.42 (0.93-2.17) Uninsured residents of non-HPSA counties 1.33 (0.66-2.64) 1.47 (0.78-2.74) 0.98 (0.75-1.28) 0.74 (0.57-0.96) 1.44 (0.65-3.21) Uninsured residents of HPSA counties 0.92 (0.26-3.24) 1.01 (0.31-3.25) 0.98 (0.58-1.65) 0.54 (0.33-0.90) ** * Adjusted for age, race, gender, education, income, percent of county population below poverty, medication adherence, functional capacity, and depressive symptoms. ACEI=angiotensin converting enzyme inhibitor, ARB=angiotensin receptor blocker, CVD=Cardiovascular Disease, HPSA=Health Professional Shortage Area. ** Adjusted OR not available due to few available individuals; unadjusted OR=0.14 (0.02-1.08).