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Background: In the United States, Black and Latino children with asthma are more likely than White children with asthma to require emergency department visits or hospitalizations because of an asthma exacerbation. Although many cite patient-level socioeconomic status and access to health care as primary drivers of disparities, there is an emerging focus on a major root cause of disparities-systemic racism. Current conceptual models of asthma disparities depict the historical and current effects of systemic racism as the foundation for unequal exposures to social determinants of health, environmental exposures, epigenetic factors, and differential healthcare access and quality. These ultimately lead to biologic changes over the life course resulting in asthma morbidity and mortality. Methods: At the 2022 American Thoracic Society International Conference, a diverse panel of experts was assembled to identify gaps and opportunities to address systemic racism in childhood asthma research. Panelists found that to examine and address the impacts of systemic racism on children with asthma, researchers and medical systems that support biomedical research will need to 1) address the current gaps in our understanding of how to conceptualize and characterize the impacts of systemic racism on child health, 2) design research studies that leverage diverse disciplines and engage the communities affected by systemic racism in identifying and designing studies to evaluate interventions that address the racialized system that contributes to disparities in asthma health outcomes, and 3) address funding mechanisms and institutional research practices that will be needed to promote antiracism practices in research and its dissemination. Results: A thorough literature review and expert opinion discussion demonstrated that there are few studies in childhood asthma that identify systemic racism as a root cause of many of the disparities seen in children with asthma. Community engagement and participation in research studies is essential to design interventions to address the racialized system in which patients and families live. Dissemination and implementation studies with an equity lens will provide the multilevel evaluations required to understand the impacts of interventions to address systemic racism and the downstream impacts. To address the impacts of systemic racism and childhood asthma, there needs to be increased training for research teams, funding for studies addressing research that evaluates the impacts of racism, funding for diverse and multidisciplinary research teams including community members, and institutional and financial support of advocating for policy changes based on study findings. Conclusions: Innovative study design, new tools to identify the impacts of systemic racism, community engagement, and improved infrastructure and funding are all needed to support research that will address impacts of systemic racism on childhood asthma outcomes.

The objective of this study was to estimate the effect of geographic variation in historic slavery on perinatal outcomes (chronic hypertension, hypertensive disorders of pregnancy [HDP], very preterm birth [VPTB], or very low birth weight birth [VLBW]) among Black people living in states where slavery was legal in 1860; and to test mediation by Black homeownership. We linked data on the proportion of enslaved residents from the 1860 Census to natality data on outcomes (2013-2021) using resident county. The percentage of Black residents in a county who owned their home was a potential mediator. We fit log binomial models to estimate risk ratios (RRs) representing total and controlled direct effects (accounting for Black homeownership) of the proportion enslaved on outcomes, accounting for potential confounding, using marginal structural models. Among 2 443 198 included births, 8.8% (213 829) experienced HDP, 4.1% (100 549) chronic hypertension, 3.3% (81 072) VPTB, and 2.6% (62 538) VLBW. There was an increase in chronic hypertension and VPTB risk, but not HDP or VLBW, in counties with a 10% greater proportion of enslaved residents in 1860 (adjusted RR [95% CI], chronic hypertension: 1.06 [1.02-1.1]; VPTB: 1.02 [1.00-1.05]; HDP: 1.00 [0.98-1.02]; and VLBW: 1.01 [1.00-1.03]). There was not evidence of mediation by Black homeownership. We conclude that historic slavery remains relevant for perinatal health. [ABSTRACT FROM AUTHOR]

Background: Indigenous Peoples in Canada bear a disproportionate burden of disease and experience poorer health outcomes as compared to non-Indigenous populations within Canada; these conditions are said to be mediated and exacerbated by pervasive and uninterrupted anti-Indigenous racism. Third and fourth-year medical students at a Canadian medical school were asked to reflect on their experiences working with Indigenous patients in clinical settings, and how their preclinical Indigenous health curriculum impacted these experiences. Method: Phenomenology was used, guided by Goffman's theory of social stigma. Eleven undergraduate medical students were recruited using purposeful sampling. Semi-structured phone interviews were conducted to gain an in-depth understanding of the participants' experiences. Interviews were recorded and transcribed verbatim. Data were analyzed using the four main processes for phenomenological analysis. Results: Four main themes emerged from students' descriptions of clinical experiences involving Indigenous patients: 1) students describe how their Indigenous patients encounter the health care system and their own lack of cultural sensitivity in this context; 2) racism was evident in students' clinical interactions with Indigenous patients, but students do not always perceive these biases nor the impact of this on patient care; 3) identifying the impact of racism on care is complicated by situational clinical encounters; and 4) practicality of preclinical Indigenous health education is desired by students to prepare them for working with Indigenous patients in the clinical setting. Conclusions: In their clinical experiences, students witness racism against Indigenous peoples yet are unprepared to stand up against it. Findings highlight the importance of enhancing undergraduate medical training to allow students to better understand the unique experiences and perspectives of Indigenous patients. The results support the need for ongoing Indigenous health education, to foster culturally sensitive experiences while learning about Indigenous patients. [ABSTRACT FROM AUTHOR]

Much has been written about the school-to-prison pipeline and the larger punitive turn within schools in the United States. This research has documented disturbing racialized disparities and disproportionate impacts on youth who are diagnosed with disabilities. While this scholarship has highlighted how marginalized youth encounter exclusionary forms of punishment, what is often missing is an understanding of how practitioners experience the policies, practices, and consequences of the school-prison nexus. In this study, the unique career experiences of individuals who worked as both teachers and juvenile justice practitioners in the Southwestern United States are analyzed. The reflections of practitioners who worked at both ends of the school-to-prison pipeline uncover a range of exclusionary practices in schools that is broader than what current conceptions suggest. This study adds important nuance to the literature by revealing how some educators facilitate school dropout through passive modes of racialized exclusion in addition to those that actively push out minoritized students. The article outlines three distinct categories of racialized school exclusion, examines their impacts, discusses how subtle modes of exclusion may relate to more overt punishments, and explores the broader context under which this range of "passive" to "active" modes of educational exclusion develops and operates. [ABSTRACT FROM AUTHOR]

Systemic racism is a public health crisis that needs to be urgently and effectively addressed. Historical racism, contemporary biases, and prejudicial attitudes have persistently affected and damaged the mental health of people of color (POC) throughout the world. Although the 2021 apology from American Psychological Association (APA) acknowledged the profession's contribution to racism, much more work needs to be done to rectify and address past and current harm. A comprehensive, actionable, and concrete plan is needed to catalyze change. Adopting a socioecological approach can help tackle the multiple levels in which discrimination and unequal treatment take place. This necessitates more than just addressing the social determinants of illness, but also transforming the cultural competence of providers, organizations, and the mental health delivery system. Key to improving outcomes for POC domestically and abroad is increasing the affordability and access to care, diversifying and improving the cultural competence of the mental health workforce, and developing culturally adapted and effective care tailored to meet the culture-specific needs of diverse communities. Progress can only happen through proactive action and utilization of an anti-racist stance that commits significant financial and scientific resources to promote institutional, structural, systemic, and policy changes. [ABSTRACT FROM AUTHOR]

In 2020, the American Psychological Association undertook the task of examining the deleterious effects of systemic racism on people of color in the United States. This extensive examination led to the passing of three historic resolutions in October 2021, by the APA Council of Representatives, including the resolution, Role of Psychology, and APA in Dismantling Systemic Racism Against People of Color in the United States. In the resolution, there was a focus on education, science, healthcare, work and economic opportunities, criminal and juvenile justice, early childhood development, and government and public policy. These resolutions set a foundation for the field in moving forward. To effectively address systemic racism, there must be dedication and deliberate action to address the policies, structures, and practices that contribute to inequities. The primary focus of this paper is advocacy; specifically, political advocacy for psychologists to address these policies and structures, in achieving the goals of dismantling systemic racism and creating a more equitable society. [ABSTRACT FROM AUTHOR]

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The sociological literature on race operates under the progressive ideological assumption that systemic racism is the predominant cause of racial disparities. This assumption has become "paradigmatic," shaping the selection of research questions and the interpretation of research results. Consequently, the literature offers a rather narrow "Overton window" concerning what we, as sociologists, know about: (1) the causes of racial disparities, (2) the accuracy and motivation behind the public's views on race-related issues, and (3) race-related policy preferences. A paradigm shift is needed to improve our understanding of racial disparities and devise more effective ways to address them. To achieve this end, sociologists should broaden their perspectives beyond attributing all racial disparities to systemic racism and consider additional hypotheses. From a policy perspective, to reduce racial disparities we should reconsider addressing social class and related factors early in life. [ABSTRACT FROM AUTHOR]

Although the psychological study of men and masculinities (PSMM) field has continued to develop (Addis et al., 2010; Valentine & Wong, 2023), notions of white masculinities have remained mostly uninterrogated (Liu, 2017; Wong & Wang, 2022). In this article, we emphasize the unexamined "whiteness" and assumed Americanness of masculinities research and scholarship (Liu, 2017) and use a racial–spatial framework to explore how systemic racism renders differential racialized experiences for white men when compared with the racialized experiences of men of Color (Liu et al., 2023). We critique the use of intersectionality to understand the asymmetric dominance of white men and masculinities. Additionally, we describe how the construction and maintenance of whiteness in the United States and the protections offered to white men, due to their whiteness, provide them with spaces of comfort and privileges that are unique to them and their masculinities. We contend that future psychological research in men and masculinities could be conceptualized within a racial–spatial framework of systemic racism wherein white racial power and privileges are explicitly interrogated. We offer seven recommendations that underscore the critical examination and naming of whiteness in researchers' and practitioners' theoretical assumptions, methods, practices, and positionalities. Public Significance Statement: This article discusses the unexamined "white" of masculinities research and scholarship (Liu, 2017), and explores how "whiteness" renders differential racialized experiences for white men when compared with the racialized experiences of men of Color (Liu et al., 2023). [ABSTRACT FROM AUTHOR]

This study uses a sample of police leaders from across the United States to explore the extent to which their support for civilian oversight boards and implicit bias training, as two aspects of police reform intended to improve racial injustices, relate to their belief that systemic racism is an issue in criminal justice. Presented in the context of symbolic racism theory, we assess how respondents' willingness to acknowledge systemic racism in criminal justice relates to more supportive perceptions of civilian oversight boards and implicit bias training. These relationships remain significant even when controlling for other individual and agency-level factors that are known to affect perceptions of systemic racism and support for public policies designed to improve racial justice. This study discusses the need for additional research and consideration of how police officers' racialized attitudes relate to their support for common reform recommendations. [ABSTRACT FROM AUTHOR]

Objectives: To examine the association between social mobility and tooth loss in adults from the 1982 Pelotas Birth Cohort Study and whether race modifies this association. Methods: The Oral Health Study used data from 541 individuals who were followed up to 31 years of age. Social mobility, composed of the participants' socioeconomic position (SEP) at birth and at age 30, was categorized as never poor, upwardly mobile, downwardly mobile and always poor. The outcome was the prevalence of at least one tooth lost due to dental caries when the participants were examined at 31 years of age. The effect modifier was race (Black/Brown versus white people). Log‐binomial regression models were used to estimate crude and sex‐adjusted prevalence ratios (PR) and to determine whether the association varied with race. Statistical interactions were tested using an additive scale. Results: The prevalence of any tooth loss was 50.8% (n = 274). In social mobility groups, the prevalence of at least one tooth lost in the never‐poor group was about 31% points higher for Black/Brown (68.2%) than for white people (37.4%). Antagonistic findings were found for the interaction between race and social mobility (Sinergy Index = 0.48; 95% CI 0.24, 0.99; and relative excess of risk due to the interaction = −1.38; 95% CI −2.34, −0.42), suggesting that the observed joint effect of race and social mobility on tooth loss was lower than the expected sum of these factors. The estimates for Black/Brown people were smaller for those who were always poor during their lives, relative to their white counterparts. Conclusions: The findings suggest a higher prevalence of at least one tooth lost among people in the downward mobile SEP group and Black/Brown people. Greater racial inequity was found among Black/Brown people who had never experienced episodes of poverty, with Black/Brown people having a greater prevalence of at least one tooth lost than their white counterparts. [ABSTRACT FROM AUTHOR]

While there is broad support among education scholars for the assertion that inequities of race, gender, and class within education are systemic and intersectional, many education researchers continue to publish research, especially in highly influential journals, like those of the American Educational Research Association (AERA), that either ignore systemic intersectional inequities or treat the inequities as mere variables. In contrast, we provide a proposed intersectionality-based research framework and a methodology that emphasizes systemic inequities in public schooling, including racism, sexism/patriarchy, and classism. We discuss this framework, describe our methodology (drawn mainly from Matias), and illustrate how it could be applied to research on three White teachers. For each of these teachers, we discuss some possibly new insights or "suppositions" that were yielded by the application of our framework and methodology. We then call on other researchers to strongly center systemic intersectional inequities in research and in research methodologies. [ABSTRACT FROM AUTHOR]

Until 1962, Canada was legally a Eurocentric racial state. After abandoning state-sanctioned racism in 1967, politicians soon realized that institutional entrenchment of racism would need more than laws-based anti-racism. Today, institutional racism, however, remains entrenched in Canadian institutions despite various mitigating processes by all levels of governments since the 1970s. In this qualitative paper, we analyze the marginalizing effects of system anti-Black racism and the dissonances between strategies and attitudes of system professionals and African-Canadian grassroots youth workers. From our findings, we conclude that effective youth workers prioritize behavior-in-time (experience-based) over behavior-in-discourse (text-based) in service provision. [ABSTRACT FROM AUTHOR]

This article reflects on the challenges of developing anti-racist commitments in a UK university during and 'post' pandemic and re-envisions pedagogic failure in this context. Tackling racism requires that our conversations start from a recognition that we are always situated in relationship not just to others but to the structures and cultures of our environments and communities. There are long histories of empathy and its role, risks and limits in intersectional understandings of the transformation of inequalities. We contend that empathy is integral to anti-racist pedagogies because it: centres relationality in critical and reflective learning; has the capacity to be subversive through its challenge to the 'dominant transmission model of education prevalent in the neoliberal colonial university'; reveals how the university acts upon and works to erase consciousness of our emotional and embodied selves, and has the capacity to unsettle our epistemic horizons to reveal our complicity in colonial practices. Developing a dialogue between the co-authors who worked on a small, funded project on anti-racist learning within a UK Russell Group university in 2022–2023, the article explores the barriers experienced, along with the possibility of constituting 'generative and fulfilling spaces'. [ABSTRACT FROM AUTHOR]

Delegitimizing Blackness is an attempt to remove one's power or authority. Our reflections within this article discuss the various attempts to remove one's legitimation and power. The power of oneself to own his/her story, the power of children and families to understand their needs, and the power of managing and confidently stepping into one's own Blackness are discussed. Reflecting on navigating this process within human services with three social work professionals with over 30 years of experience, cumulatively, is highlighted. Our Blackness often compounds our experiences either due to unjust policies, micro-aggressive interpersonal relationships, or unprofessional/inadequate leadership experiences. The cumulative journey of these reflections will be discussed, along with implications for practice. [ABSTRACT FROM AUTHOR]

The compounding effects of the COVID-19 pandemic alongside racial unrest in 2020 created an unrelenting need for scholarly analysis of the internal and external impact these experiences had on my life. My daily struggles of being a Black woman in America intensified during these unprecedented societal shifts which impacted my experience as a Black mental health clinician in a predominantly white workspace. This scholarly personal narrative conceptualizes these historical events, examined through the lens of Critical Race Theory. The two vignettes provided are lived experiences and illustrate the ways in which white privilege intersects with prolonged racial unrest--compounded by the deleterious effects of COVID-19 on Black clinicians. This scholarly analysis highlights the negative impact that racial injuries can have on Black clinicians who lack protection from repeated racial offenses. Recommendations for critical self-care practices and implications for future research are provided. [ABSTRACT FROM AUTHOR]

Native Hawaiians and Pacific Islanders (NHPIs) are peoples diverse in culture and history who are too often represented as a monolithic entity, a tendency that undermines efforts to ameliorate health inequities. The current study represents a partnership between academic researchers and a community organization serving NHPIs, in which space was held for five multigenerational NHPI families (N = 15 family members) to share their experiences with educational and healthcare systems, including issues of discrimination and barriers to accessing services. Qualitative analysis of the interviews identified four themes: Cultural Values and Strengths; Mental Health—Past, Present, and Future Directions; Systemic Racism and Discrimination; and Need for Culturally Informed and Linguistically Accessible Healthcare. These results, including the importance of family systems within NHPI cultures, positive intergenerational shifts in mental health, and the pervasive impacts of colonization on health, are discussed in terms of implications for the health of NHPI communities. [ABSTRACT FROM AUTHOR]

The US is the world leader in imprisoning immigrants. Its mass immigration detention system emerged as an extension of mass incarceration, rooted in a legacy of racist US immigration and criminal laws. Immigration policy is a structural determinant of health that negatively affects the health of imprisoned immigrants, their families, and their communities. The systemic harms of detention facilities, which we refer to as immigration prisons, have been extensively documented, yet incrementalist reforms have failed to result in improved outcomes for immigrants. We argue that ending the practice of immigrant imprisonment is the most effective solution to mitigating its harms. Community-based programs are safer and less expensive than imprisonment, while also being effective at ensuring compliance with government requirements. We identify several priorities for researchers and policy makers to tackle the health inequities resulting from this structurally racist system. These include applying a critical, intersectional lens to studying the policies and practices that drive imprisonment, engaging affected communities in research and policy development, and creating an accountable and transparent system of data collection and release to inform health interventions. The reliance of the US on immigrant imprisonment is a policy choice with immense social and economic costs; dismantling it is critical to advancing health equity.

Abstract Background The transition to menopause is a significant event affecting health, well-being, and quality of life. Menopause typically occurs between the ages of 44–57, accompanied by symptoms such as hot flashes, mood changes, and sleep disturbances. Being postmenopausal also increases the risk of cardiovascular disease, stroke, and osteoporosis. Despite its importance, menopause is under-researched and under-discussed, particularly concerning the impact of chronic psychosocial stress. Methods A scoping review of qualitative, quantitative, and mixed methods research was conducted to map existing literature on the transition to menopause among populations experiencing chronic psychosocial stress in the United States. The review followed the PRISMA-ScR methodology, systematically searching literature in PubMed and SCOPUS databases using MeSH terms. Studies were included which focused on menopausal symptoms and psychosocial stressors. Data extraction and charting were performed using Covidence software. Results Fifteen studies were included, highlighting relationships between socioeconomic status, intimate partner violence, childhood abuse, and racial disparities which influenced menopausal experiences. Lower- income, higher perceived stress, and negative attitudes towards menopause were associated with increased psychological and somatic symptoms and early onset of menopause (prior to age 45). African American women were found to experience earlier onset and more severe vasomotor symptoms compared to their White counterparts. Women veterans used hormone therapy more frequently than the general population, particularly those with mood or anxiety disorders. The review also identified a geographic bias, with most studies conducted in the Northeast, Midwest, and Western regions of the United States. Conclusions This review underscores the necessity of considering social, cultural, and environmental factors in understanding menopausal experiences and addressing health disparities. Future research should aim to include diverse populations and adopt longitudinal and qualitative study designs to capture the dynamic nature of menopausal experiences. Policies and interventions directed at improving the well-being of women experiencing menopause in the context of chronic psychosocial stress are warranted. Trial Registration N/A.

The highly publicized killing of Black people in spring 2020 sparked a national and global social movement to address racial violence. This led to heightened national discourse about the deeply entrenched nature of systemic racism in American institutions, prompting organizations to make public statements supporting racial justice. While an essential first step in addressing systemic inequities within the workplace, these statements are primarily performative and do little to combat systemic racist practices and policies within their ranks. For instance, research has shown that women of color, and particularly Black women, experience daily racial and gendered aggressions that negatively impact their career trajectories. Through in-depth semi-structured interviews of twenty Black women lawyers, this article demonstrates how systemic racism is deeply entrenched in white spaces, preventing a genuine and effective path to diversity, equity, and full inclusion. Moreover, it theorizes how emotional, cognitive, financial, and relational labors amount to an inclusion tax levied against Black women professionals in white spaces. The article concludes with practical implications and ethical considerations on how to address this dynamic across various occupations and industries. [ABSTRACT FROM AUTHOR]

Background: The transition to menopause is a significant event affecting health, well-being, and quality of life. Menopause typically occurs between the ages of 44–57, accompanied by symptoms such as hot flashes, mood changes, and sleep disturbances. Being postmenopausal also increases the risk of cardiovascular disease, stroke, and osteoporosis. Despite its importance, menopause is under-researched and under-discussed, particularly concerning the impact of chronic psychosocial stress. Methods: A scoping review of qualitative, quantitative, and mixed methods research was conducted to map existing literature on the transition to menopause among populations experiencing chronic psychosocial stress in the United States. The review followed the PRISMA-ScR methodology, systematically searching literature in PubMed and SCOPUS databases using MeSH terms. Studies were included which focused on menopausal symptoms and psychosocial stressors. Data extraction and charting were performed using Covidence software. Results: Fifteen studies were included, highlighting relationships between socioeconomic status, intimate partner violence, childhood abuse, and racial disparities which influenced menopausal experiences. Lower- income, higher perceived stress, and negative attitudes towards menopause were associated with increased psychological and somatic symptoms and early onset of menopause (prior to age 45). African American women were found to experience earlier onset and more severe vasomotor symptoms compared to their White counterparts. Women veterans used hormone therapy more frequently than the general population, particularly those with mood or anxiety disorders. The review also identified a geographic bias, with most studies conducted in the Northeast, Midwest, and Western regions of the United States. Conclusions: This review underscores the necessity of considering social, cultural, and environmental factors in understanding menopausal experiences and addressing health disparities. Future research should aim to include diverse populations and adopt longitudinal and qualitative study designs to capture the dynamic nature of menopausal experiences. Policies and interventions directed at improving the well-being of women experiencing menopause in the context of chronic psychosocial stress are warranted. Trial Registration: N/A. [ABSTRACT FROM AUTHOR]

The experiences of Black students in Canadian higher education shed light on the societal and institutional challenges that influence their social and economic aspirations. In today's societal and economic context, obtaining a postsecondary education degree is not just preferred but essential for securing the employment opportunities that most young people desire. For Black communities in particular, a university degree is often seen as the primary pathway to upward social mobility. However, Black students' journeys toward higher education are frequently hindered by systemic barriers and institutional challenges. While there is extensive literature detailing the systemic forces that obstruct access to higher education for Black Canadians, there is limited academic focus on how these forces continue to affect Black students once they enter higher education. This article addresses this gap by investigating the educational experiences of Black students in Canadian universities, emphasizing the challenges posed by systemic racism and institutional barriers. Utilizing data from interviews and focus groups with Black undergraduate and graduate students from a university in the Greater Toronto Area (GTA), the study explores how historical and contemporary issues of anti-Black racism shape their academic journeys. It discusses the broader implications of these experiences and highlights the need for comprehensive institutional reforms to create genuinely inclusive and equitable educational environments. By centering the voices of Black students, this research aims to contribute to the ongoing dialog on racial equity in higher education. [ABSTRACT FROM AUTHOR]

This essay is based on a case study of international medical graduates (IMGs) in Canada who migrated from sub-Saharan Africa. The chapter examines how narratives of race are situated and deployed in the field of medicine and can produce some aversive social–psychological landscapes in the credentialing and the professional-entry process as it relates to persons of African descent. It will show that, often without predetermination or intent, professionals of African descent in Canada are highly susceptible to implicit racial associations and implicit racial stereotyping in relation to evaluations of character, credentials, and culture. The article exposes some of the critical intersections of common experience, such as: (a) cultural deficit bias—Whiteness as an institutionalized cultural capital attribute; (b) confirmation bias—reaching a negative conclusion and working backwards to find evidence to support it; (c) repurposed sub-Saharan Blackness stereotypes—binary forms of techno-scamming and fraud; and (d) biased deception judgement—where the accuracy of deception judgements deteriorates when made across cultures. These social psychological phenomena result in significantly disproportionate returns on their foreign education and labour market experience for Black medical professionals that require decisive efforts in changing the narratives. [ABSTRACT FROM AUTHOR]

Drawing a connection between the "repetition compulsion" and reparations movements' demand for a "guarantee of non‐repeat," this essay examines some of the psychological workings of implication in systemic racism by highlighting individual, familial, and collective histories, and by looking at some of what is currently taking place in psychoanalytic institutions. [ABSTRACT FROM AUTHOR]

The Association of Professors of Gynecology and Obstetrics created the Diversity, Equity, and Inclusion Guidelines Task Force to develop best practices to establish a diverse physician workforce and eliminate racism in medical education. Using the guidelines, educators are impacting their communities and, in some areas, leading their institutions toward greater diversity and inclusion. The guidelines are organized by 4 domains: learning environment, grading and assessment, pathway programs, and metrics. This manuscript uses that framework to highlight the work of individual educators who are moving the needle towards racism-free health care and aims to inspire others contemplating incorporation into their programs. [ABSTRACT FROM AUTHOR]

This article aims to know the perception of women on obstetric violence from a racial perspective. This was a qualitative study carried out in a public maternity hospital with 25 women in the city of Salvador, Bahia, Brazil. Data were collected through semi-structured interviews and participant observation from November 2021 to February 2022. Content analysis was used to organize the data obtained through the interviews. The results were analyzed through the theoretical contributions of intersectionality, focusing on the interaction between obstetric violence and obstetric racism. The narratives discuss issues of obstetric violence, institutional racism, and how these experiences are permeated by issues of race, gender, and class. Questions related to the feelings of these women regarding the experience of violence at the time of childbirth care were also highlighted. Obstetric racism denies reproductive rights and hinders access to respectful and equitable care for black women. [ABSTRACT FROM AUTHOR]

In a recent issue of Child Maltreatment (2023 vol. 28 (4)), an editorial by Palusci et al. and a commentary by Briggs et al. were published. These two publications express the American Professional Society on the Abuse of Children (APSAC) Board's and the Child Maltreatment editorial team's stance relative to Diversity, Equity, Inclusion and Justice (DEIJ). The current commentary expresses a range of concerns regarding how APSAC and Child Maltreatment plan to advance DEIJ through their editorial policies. [ABSTRACT FROM AUTHOR]

This commentary advocates for a comprehensive approach to addressing the Black maternal and infant health crisis, utilizing the collective impact model with health equity at its center. Black women in the United States face alarmingly high rates of maternal morbidity and mortality compared to white women. Black women are twice as likely to have premature and low birthweight babies than white women, exposing both the expectant woman and child to various health risks. This crisis stems from systemic racism, implicit bias in healthcare, and a lack of targeted health communications for pregnant Black women. The urgency of this situation requires a bold and unified response through collaboration and coordination among healthcare providers, local and grassroots community-based organizations (CBOs), and digital health communicators. A comprehensive Black maternal and infant health campaign embedded within the collective impact model and led by a dedicated backbone organization would facilitate the coordination and involvement of diverse stakeholders. Central to these efforts should be the acknowledgment that systemic racism perpetuates health inequities. Consequently, any initiatives to improve health outcomes should prioritize health equity by valuing and incorporating Black women's perspectives. This involves crafting a responsive strategy and placing Black women at the forefront of content creation, program strategy, and evaluation. Through a collaborative effort involving healthcare partners, CBOs, and health communicators, we can have an impact far more significant than any single initiative. Immediate action is needed to dismantle systemic barriers and ensure every Black woman and infant receives the care and support they deserve. Black maternal health disparities in the United States have been widely acknowledged and studied. It is well-established that Black women face significantly higher rates of maternal morbidity and mortality compared to their white counterparts, indicative of a severe healthcare crisis. This opinion piece contributes to the discourse by proposing a comprehensive solution grounded in the collective impact model, which emphasizes collaboration and coordination across various stakeholders. This approach represents a shift from past siloed efforts, aiming to tackle the urgent issue of Black maternal and infant health with a multidisciplinary approach centered on health equity. Significance: Black maternal health disparities in the United States have been widely acknowledged and studied. It is well-established that Black women face significantly higher rates of maternal morbidity and mortality compared to their white counterparts, indicative of a severe healthcare crisis. This opinion piece contributes to the discourse by proposing a comprehensive solution grounded in the collective impact model, which emphasizes collaboration and coordination across various stakeholders. This approach represents a shift from past siloed efforts, aiming to tackle the urgent issue of Black maternal and infant health with a multidisciplinary approach centered on health equity. [ABSTRACT FROM AUTHOR]

Behavior analysts are becoming increasingly aware of and involved in the study of issues related to sex, gender, and racial prejudice and discrimination. In the current article, we conceptualized sexism and gender bias informed by the framework of the nested sociobehavioral model of racism developed by Belisle et al. Behavior Analysis in Practice, 15(4), 1134–1150 (2022), including implicit bias, selective gender norms, and systemic oppression, while integrating feminist and queer theories. We then conducted a model-dependent scoping review of research in major behavior analytic journals from 2000 to 2022 related to racism and sexism categorized using the nested models and the theory-to-impact framework developed by Dixon et al. Perspectives on Behavior Science, 41(1), 241–267 (2018). Of the 10 journals included for the scoping review, nine contained research related to racism or sexism and an overall increasing trend appears to be occurring in the field. Inconsistencies were evident between conceptual work that emphasized systemic oppression versus experimental work that emphasizes implicit bias and relational framing. Only three studies met the criteria for "applied" or "implementation" research, suggesting that significantly more research is needed to inform the development and dissemination of applied technologies. We conclude with a discussion of the current state of this research in multiple areas and recommendations for future research. [ABSTRACT FROM AUTHOR]

Systemic racism is pervasive in US society and disproportionately limits opportunities for education, work, and health for historically marginalized and minoritized racial and ethnic groups, making it an urgent issue of social justice. Because systemic racism is a social determinant of health prevalent across multiple social and institutional structures, it requires multilevel intervention approaches using effective designs and analytic methods to measure and evaluate outcomes. Racism is a fundamental cause of poor health outcomes, including mental health outcomes; thus, mental health services and programs that address racism and discrimination are key to promoting positive mental health of racial and ethnic minority youth. While multilevel interventions are well-suited for improving outcomes like youth mental health disparities, their evaluation poses unique methodological challenges, requiring specialized design and analytic approaches. There has been limited methodological guidance provided to researchers on how to test multilevel interventions using approaches that balance methodological rigor, practicality, and acceptability across stakeholder groups, especially within communities most affected by systemic racism. This paper addresses this gap by providing an example of how to rigorously evaluate a hypothetical, theoretically based, multilevel intervention promoting mental health equity in three US school systems using an anti-racist approach intervening at the macro- (i.e., school system), meso- (i.e., school), and micro- (i.e., family and student) levels to improve mental health in adolescents. We describe the design, sample size considerations, and analytic methods to comprehensively evaluate its effectiveness while exploring the extent to which the components interact synergistically to improve outcomes. The methodological approach proposed can be adapted to other multilevel interventions that include strategies addressing macro-, meso-, and micro-levels of influence. [ABSTRACT FROM AUTHOR]

Introduction: Support for anti‐racism policies such as mandatory diversity training and affirmative action varies by race. Research in the racial resentment and symbolic racism traditions focuses on whites' endorsements of stereotypes that blame blacks for their unequal position in society, causing whites to be less supportive of anti‐racism policies. Systemic racism theory suggests an additional hypothesis: People who believe whites are not doing enough to dismantle the systemically racist system that disadvantages blacks and other groups should be more supportive of anti‐racism policies. Methods: We examine both hypotheses using data from a national YouGov survey of 1125 U.S. adults gathered in 2021. Results: Race differences in support for anti‐racism policies are accounted for by race differences in endorsements of both anti‐black and anti‐white stereotypes. Conclusion: Future studies of support for anti‐racism policies should consider the influence of both anti‐black and anti‐white stereotypes. [ABSTRACT FROM AUTHOR]

Introduction: Systemic racism theory has become a central part of academic and public discussions about criminal justice institutions and reforms. Little, however, is known about the association between people's belief in the ubiquity of systemic racism and their attitudes toward criminal justice institutions and reforms. Methods: To fill this gap, we examine the association between systemic racism beliefs and support for police, police reform, and the BLM movement using a national YouGov sample of 1125 U.S. adults. Results: Systemic racism beliefs are associated with Americans' attitudes toward all three outcomes, net of a wide range of controls, including negative experiences with police, political ideology, and most notably, racial resentment. Conclusion: Our study provides compelling evidence that belief in systemic racism is an important driver of Americans' support for police, police reforms, and BLM. [ABSTRACT FROM AUTHOR]

Battling cancer of a spouse during a worldwide pandemic is a unique phenomenon. While the world experienced hardships such as stay‐at‐home orders, masking mandates, or the COVID‐19 infection, caregivers supported their loved ones who were diagnosed with terminal diseases. Racism compounded trauma as Black caregivers were not provided with the same level of respect and care for their loved ones during the COVID‐19 pandemic. Racial trauma is experienced by Black Americans, even during the pandemic and while grieving losses of loved ones. An autoethnographic approach draws upon my lived experience of racial trauma while caring for my dying husband during the COVID‐19 pandemic. This autoethnography informs the role of counselor education programs to prepare future counselors to support minoritized clients who may have suffered from systemic racism, while grieving the loss of loved ones, especially during the COVID‐19 pandemic, and which could also have contributed to racial trauma. [ABSTRACT FROM AUTHOR]

Decades of research has documented the consequences of allocating school students into a hierarchy of classes with narrow ranges of mathematics attainment, a process known as streaming, tracking, setting, or "ability" grouping. The purported benefits of streaming are inconsistent and disputed, but the harms are clear, in particular, (1) the limiting curriculum often available in low streams and (2) the loss of self-confidence that results from being positioned in a low stream. Building on this foundation, we discuss streaming in mathematics as tied to systemic racism in Aotearoa New Zealand, where the harmful effects of streaming fall most heavily on Māori and Pasifika students. Previous analyses of race and streaming have focused primarily on the racial composition of streamed classes, bias in stream allocation, and racialised teacher expectations in streamed settings. In contrast, we focus on the emotional consequences of streaming, arguing that streaming produces racialised emotions of shame and entitlement as unintended but predictable consequences. We illustrate the racialised production of entitlement and shame through collaborative storying, interweaving our own biographies with a re-analysis of student interviews from two prior studies. [ABSTRACT FROM AUTHOR]

This article is based on a months-long investigation and aims to contribute to the scientific understanding of the process of racialisation of the sub-Saharan migrants in Tunisia. The starting point of our research was the speech given by the Tunisian president, Kais Saied, in February 2023. In the light of new negotiations with the EU for technical, administrative, and financial support in the management of migration in the Mediterranean, the president emphasised the importance of Tunisia being and remaining Arab and Muslim. The sub-Saharan migrants who have penetrated the Mediterranean area in large numbers, mostly via Libya or Algeria, are black. Many of them are also Christians. The Tunisian case regarding the racialisation of migrants is similar to the dynamics of political discourses and actions of systemic racialisation in European countries. Our thesis is that racialisation based on religion and/or skin colour is part of a more complex dynamic, defined by the capitalist mode of production, which, due to its inner contradictions, simultaneously requires and expels human labour force. We claim that the permanently expelled constitute surplus populations that are, due to not being disciplined by the capitalist markets, considered dangerous, which is why they fall under police jurisdiction. This process of policing surplus populations is what constitutes contemporary systemic racism as a special mode of state politics, whereby "race" is the result of said process and not determined by its biological, religious, ethnic, or cultural characteristics. We support our thesis by a fieldwork study consisting of qualitative interviews with Tunisian experts, conducted based on purposive sampling and subsequent qualitative coding, as well as of three personal narrative interviews, which were conducted with sub-Saharan migrants from Cameroon, who had been living in a refugee "village" in the north of Tunisia for more than a year. [ABSTRACT FROM AUTHOR]

Existing literature examines the effectiveness of civilian oversight in reducing police misconduct. However, little-to-no quantitative research explores possible adverse consequences of this accountability mechanism. Utilizing time series analysis of administrative data on aggregate monthly civilian complaints and police behavior in the largest American city, this article offers evidence of racial inequality in police response to civilian complaints. For White civilians, complaint against the police abates subsequent police stops. For Black civilians, complaint is associated with subsequent intensification of police stops. This intensification only follows complaints against White officers, is conditional upon officer knowledge of the complaint, is confined to stops involving greater officer discretion to perform the stop, and is only observed in police precincts with large Black populations. [ABSTRACT FROM AUTHOR]

Despite growing interest in the health-related consequences of racially discriminatory institutional policies and practices, public health scholars have yet to reach a consensus on how to measure and analyze exposure to institutional racism. The purpose of this paper is to provide an overview of the conceptualization, measurement, and analysis of institutional racism in the context of quantitative research on minority health and health disparities in the United States. We begin by providing definitions of key concepts (e.g., racialization, racism, racial inequity) and describing linkages between these ideas. Next, we discuss the hypothesized mechanisms that link exposure to institutional racism with health. We then provide a framework to advance empirical research on institutional racism and health, informed by a literature review that summarizes measures and analytic approaches used in previous studies. The framework addresses six considerations: (1) policy identification, (2) population of interest, (3) exposure measurement, (4) outcome measurement, (5) study design, and (6) analytic approach. Research utilizing the proposed framework will help inform structural interventions to promote minority health and reduce racial and ethnic health disparities.

BACKGROUND: The association of historical redlining policies, a marker of structural racism, with contemporary heart failure (HF) risk among White and Black individuals is not well established. METHODS: We aimed to evaluate the association of redlining with the risk of HF among White and Black Medicare beneficiaries. Zip code-level redlining was determined by the proportion of historically redlined areas using the Mapping Inequality Project within each zip code. The association between higher zip code redlining proportion (quartile 4 versus quartiles 1-3) and HF risk were assessed separately among White and Black Medicare beneficiaries using generalized linear mixed models adjusted for potential confounders, including measures of the zip code-level Social Deprivation Index. RESULTS: A total of 2 388 955 Medicare beneficiaries (Black n=801 452; White n=1 587 503; mean age, 71 years; men, 44.6%) were included. Among Black beneficiaries, living in zip codes with higher redlining proportion (quartile 4 versus quartiles 1-3) was associated with increased risk of HF after adjusting for age, sex, and comorbidities (risk ratio, 1.08 [95% CI, 1.04-1.12]; P

BACKGROUND: Historical mortgage redlining, a racially discriminatory policy designed to uphold structural racism, may have played a role in producing the persistently elevated rate of severe maternal morbidity (SMM) among racialised birthing people. OBJECTIVE: This study examined associations between Home-Owner Loan Corporation (HOLC) redlining grades and SMM in a racially and ethnically diverse birth cohort in California. METHODS: We leveraged a population-based cohort of all live hospital births at ≥20 weeks of gestation between 1997 and 2017 in California. SMM was defined as having one of 21 procedures and diagnoses, per an index developed by Centers for Disease Control and Prevention. We characterised census tract-level redlining using HOLCs security maps for eight California cities. We assessed bivariate associations between HOLC grades and participant characteristics. Race and ethnicity-stratified mixed effects logistic regression models assessed the risk of SMM associated with HOLC grades within non-Hispanic Black, Asian/Pacific Islander, American Indian/Alaskan Native and Hispanic groups, adjusting for sociodemographic information, pregnancy-related factors, co-morbidities and neighbourhood deprivation index. RESULTS: The study sample included 2,020,194 births, with 24,579 cases of SMM (1.2%). Living in a census tract that was graded as Hazardous, compared to census tracts graded Best and Still Desirable, was associated with 1.15 (95% confidence interval [CI] 1.03, 1.29) and 1.17 (95% CI 1.09, 1.25) times the risk of SMM among Black and Hispanic birthing people, respectively, independent of sociodemographic factors. These associations persisted after adjusting for pregnancy-related factors and neighbourhood deprivation index. CONCLUSIONS: Historical redlining, a tool of structural racism that influenced the trajectory of neighbourhood social and material conditions, is associated with increased risk of experiencing SMM among Black and Hispanic birthing people in California. These findings demonstrate that addressing the enduring impact of macro-level and systemic mechanisms that uphold structural racism is a vital step in achieving racial and ethnic equity in birthing peoples health.

BackgroundStructural racism contributes to racial disparities in adverse perinatal outcomes. We sought to determine if structural racism is associated with adverse outcomes among Black preterm infants postnatally.MethodsObservational cohort study of 13,321 Black birthing people who delivered preterm (gestational age 22-36 weeks) in California in 2011-2017 using a statewide birth cohort database and the American Community Survey. Racial and income segregation was quantified by the Index of Concentration at the Extremes (ICE) scores. Multivariable generalized estimating equations regression models were fit to test the association between ICE scores and adverse postnatal outcomes: frequent acute care visits, readmissions, and pre- and post-discharge death, adjusting for infant and birthing person characteristics and social factors.ResultsBlack birthing people who delivered preterm in the least privileged ICE tertiles were more likely to have infants who experienced frequent acute care visits (crude risk ratio [cRR] 1.3 95% CI 1.2-1.4), readmissions (cRR 1.1 95% CI 1.0-1.2), and post-discharge death (cRR 1.9 95% CI 1.2-3.1) in their first year compared to those in the privileged tertile. Results did not differ significantly after adjusting for infant or birthing person characteristics.ConclusionStructural racism contributes to adverse outcomes for Black preterm infants after hospital discharge.Impact statementStructural racism, measured by racial and income segregation, was associated with adverse postnatal outcomes among Black preterm infants including frequent acute care visits, rehospitalizations, and death after hospital discharge. This study extends our understanding of the impact of structural racism on the health of Black preterm infants beyond the perinatal period and provides reinforcement to the concept of structural racism contributing to racial disparities in poor postnatal outcomes for preterm infants. Identifying structural racism as a primary cause of racial disparities in the postnatal period is necessary to prioritize and implement appropriate structural interventions to improve outcomes.

Background Indigenous Peoples in Canada bear a disproportionate burden of disease and experience poorer health outcomes as compared to non-Indigenous populations within Canada; these conditions are said to be mediated and exacerbated by pervasive and uninterrupted anti-Indigenous racism. Third and fourth-year medical students at a Canadian medical school were asked to reflect on their experiences working with Indigenous patients in clinical settings, and how their preclinical Indigenous health curriculum impacted these experiences.Method Phenomenology was used, guided by Goffman’s theory of social stigma. Eleven undergraduate medical students were recruited using purposeful sampling. Semi-structured phone interviews were conducted to gain an in-depth understanding of the participants’ experiences. Interviews were recorded and transcribed verbatim. Data were analyzed using the four main processes for phenomenological analysis.Results Four main themes emerged from students’ descriptions of clinical experiences involving Indigenous patients: 1) students describe how their Indigenous patients encounter the health care system and their own lack of cultural sensitivity in this context; 2) racism was evident in students’ clinical interactions with Indigenous patients, but students do not always perceive these biases nor the impact of this on patient care; 3) identifying the impact of racism on care is complicated by situational clinical encounters; and 4) practicality of preclinical Indigenous health education is desired by students to prepare them for working with Indigenous patients in the clinical setting.Conclusions In their clinical experiences, students witness racism against Indigenous peoples yet are unprepared to stand up against it. Findings highlight the importance of enhancing undergraduate medical training to allow students to better understand the unique experiences and perspectives of Indigenous patients. The results support the need for ongoing Indigenous health education, to foster culturally sensitive experiences while learning about Indigenous patients.

The lack of diversity in professional nursing education curricula, practices, and policies is reflective of its colonialist history. Despite increasing calls for action and organizational position statements affirming the importance of advancing diversity, equity, inclusion, and belonging, this deeply rooted history has led to embedded structural racism and other forms of bias that have remained rife in the discipline. The desire to maintain a status quo that ignores the institutional and structural effects of bias has even led some states to defund and disempower institutions historically charged with advancing knowledge and fostering inclusive education. Ongoing inattentiveness to addressing bias and practices that center idealized Whiteness diminishes our disciplinary capacity for innovation and reduces the likelihood of achieving key nursing aims such as the optimization of health for all and the adequate preparation of a civically engaged and socially conscious workforce. The following commentary examines how centering diversity, equity, inclusion, and belonging as key values provides a basis for a culture change that can decolonize the discipline. • Structural bias limits disciplinary expansion and effective care. • Advancing diversity, equity, inclusion, and belonging requires culture change. • The nursing process is an effective template for a culture change process. • The equity assessment provides a means of problem identification and goal setting. [ABSTRACT FROM AUTHOR]