The intersection of racism, discrimination, bias, and homophobia toward African American sexual minority patients with cancer within the health care system

Cancer ◽  
2021 ◽  
Author(s):  
Ronit Elk
Keyword(s):  
Health Care ◽  
African American ◽  
Health Care System ◽  
Sexual Minority ◽  
Patients With Cancer ◽  
Care System

scholarly journals Engaging African American Veterans with Health Care Access Challenges in a Community Partnered Care Coordination Initiative: A Qualitative Needs Assessment

2018 ◽  
Vol 28 (Supp) ◽  
pp. 475-484
Author(s):  
Adriana Izquierdo ◽  
Michael Ong ◽  
Felica Jones ◽  
Loretta Jones ◽  
David Ganz ◽  
...  
Keyword(s):  
Health Care ◽  
African American ◽  
Los Angeles ◽  
Health Care System ◽  
Health Care Access ◽  
Veterans Health ◽  
Health Administration ◽  
Health Care Environment ◽  
Care Access ◽  
Care System

Background: Little has been written about engaging potentially eligible members of a health care system who are not accessing the care to which they are entitled. Know­ing more about the experiences of African American Veterans who regularly experi­ence health care access challenges may be an important step toward equitable, coordi­nated Veterans Health Administration (VHA) care. This article explores the experiences of African American Veterans who are at risk of experiencing poor care coordination.Design: We partnered with a community organization to recruit and engage Veterans in three exploratory engagement workshops between October 2015 and February 2016.Participants and Setting: Veterans living in South Los Angeles, CaliforniaMain Outcome Measures: Veterans were asked to describe their experiences with community care and the VHA, a division of the US Department of Veterans Affairs (VA). Field notes taken during the workshops were analyzed by community and academic partners using grounded theory methodol­ogy to identify emergent themes.Results: 12 Veterans and 3 family members of Veterans participated in one or more en­gagement workshops. Their trust in the VA was generally low. Positive themes included: Veterans have knowledge to share and want to help other Veterans; and connecting to VA services can result in positive experi­ences. Negative themes included: functional barriers to accessing VA health care services; insensitive VA health care environment; lack of trust in the VA health care system; and Veteran status as disadvantageous for accessing non-VA community services.Conclusions: Veterans living in underserved areas who have had difficulty accessing VA care have unique perspectives on VA services. Partnering with trusted local com­munity organizations to engage Veterans in their home communities is a promising strategy to inform efforts to improve care access and coordination for vulnerable Vet­erans.Ethn Dis. 2018;28(Suppl 2):475-484; doi:10.18865/ed.28.S2.475.

scholarly journals Smoking Cessation Among African American and White Smokers in the Veterans Affairs Health Care System

2014 ◽  
Vol 104 (S4) ◽  
pp. S580-S587 ◽  
Author(s):  
Diana J. Burgess ◽  
Michelle van Ryn ◽  
Siamak Noorbaloochi ◽  
Barbara Clothier ◽  
Brent C. Taylor ◽  
...  
Keyword(s):  
Health Care ◽  
Smoking Cessation ◽  
African American ◽  
Health Care System ◽  
Veterans Affairs ◽  
Care System

scholarly journals Outcome Disparities in African American Compared with European American Women with ER +HER 2- Tumors Treated within an Equal-Access Health Care System

2016 ◽  
Vol 26 (3) ◽  
pp. 407 ◽  
Author(s):  
Nicholas S. Costantino ◽  
Benjamin Freeman ◽  
Craig D. Shriver ◽  
Rachel E. Ellsworth
Keyword(s):  
Gene Expression ◽  
Health Care ◽  
African American ◽  
Health Care System ◽  
Mortality Rates ◽  
Equal Access ◽  
European American ◽  
American Women ◽  
Pathological Characteristics ◽  
Care System

<p><strong>Purpose: </strong>Breast cancer mortality rates are higher for African American women (AAW) than for any other ethnic group in the United States. Recent reports suggest that outcome disparities between AAW and European American women (EAW) are present in the ER+HER2- subtype. To improve our understanding, pathological characteristics, mortality and molecular profiles from women treated within an equal-access health care system were evaluated. <strong></strong></p><p><strong>Procedures: </strong>All AAW (n=90) and EAW (n=308) with ER+HER2- tumors were identified. Gene expression profiles were generated from primary breast tumors from 57 AAW and 181 EAW. Pathological characteristics, survival and gene expression analysis were evaluated using chi-square analysis, log-rank tests and ANOVA. </p><p><strong>Results: </strong>Tumors from AAW were significantly more likely to be PR-, Ki67+ and of higher grade. Tumor stage, size and lymph node status did not differ significantly, nor did mortality rates (P=.879). At the molecular level, genes PSPHL and CRYBB2P1 were expressed at significantly higher levels in tumor tissues as well as normal stroma and blood from AAW. Polymorphisms controlling expression of each gene were identified with minor allele frequencies differing significantly between populations but not between cases and controls within each population. <strong></strong></p><p><strong>Conclusions: </strong>Survival disparities were not detected in patients with ER+HER2- tumors treated within an equal-access health care system and molecular differences in tumors were not causal. Thus, outcome disparities in AAW with ER+HER2- tumors are largely attributable to socioeconomic factors affecting access to screening and treatment, rather than reflecting underlying biological differences. <em>Ethn Dis. </em>2016;26(3):407-416; doi:10.18865/ed.26.3.407 </p>

scholarly journals Survival of African American and non‐Hispanic white men with prostate cancer in an equal‐access health care system

Cancer ◽  
2020 ◽  
Vol 126 (8) ◽  
pp. 1683-1690 ◽  
Author(s):  
Paul Riviere ◽  
Elaine Luterstein ◽  
Abhishek Kumar ◽  
Lucas K. Vitzthum ◽  
Rishi Deka ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Health Care ◽  
African American ◽  
Health Care System ◽  
White Men ◽  
Equal Access ◽  
Hispanic White ◽  
Care System

scholarly journals Health Care System Distrust, Race, and Surrogate Decision Making Regarding Code Status

2019 ◽  
Vol 2 (1) ◽  
Author(s):  
Sang Yoon Na, BS, MS ◽  
James E. Slaven, MS ◽  
Emily S. Burke, BA ◽  
Alexia M. Torke, MD, MS
Keyword(s):  
Health Care ◽  
African American ◽  
End Of Life ◽  
Health Care System ◽  
End Of Life Care ◽  
Life Care ◽  
Do Not Resuscitate ◽  
Code Status ◽  
Surrogate Decision ◽  
Care System

Background and Hypothesis: Studies have shown African American patients are more likely to prefer aggressive life-sustaining treatments such as cardiopulmonary resuscitation (CPR) at end-of-life compared to non-Hispanic White patients. Given prior racial disparities in healthcare, low trust has been proposed to explain these preferences. We examined factors that influence surrogate decision makers’ preference for Do Not Resuscitate (DNR) status for hospitalized older adults who cannot make their own medical decisions. We explored whether race is associated with surrogate preference for DNR status for a hospitalized older adult. We also examine if race is associated with distrust and if the race/code status relationship is partially explained (mediated) by distrust in the healthcare system. Experimental Design or Project Methods: Analyses were conducted using data from an observational study of patient/surrogate dyads admitted to an ICU in a Midwest metropolitan area. Distrust was assessed using the Revised Health Care System Distrust Scale. A single item asked the surrogate which status they thought was best for the patient, full code or DNR. Results: In bivariate analysis, higher proportion of African American surrogates showed preference for full code (62.4% vs 37.6%, p=0.0001). After adjusting for trust and sociodemographic and psychological covariates, race was still significantly associated with DNR preference (aOR = 1.92; 95% CI: 1.04, 3.55; p=0.0382). Surrogate race did not show significant association with distrust in bivariate or multivariable analysis, which adjusted for sociodemographic and psychological covariates (p=0.3867). Conclusion and Potential Impact: Contrary to previous studies, we observed no association between surrogate race and distrust of the health care system. Differences in code status preference may be due to other factors related to race and culture. In order to ensure patients are receiving end-of-life care that is consistent with their values, more work is needed to understand the cultural complexities behind end-of-life care preference.

scholarly journals Examining the Role of Family History of US Enslavement in Health Care System Distrust Today

2021 ◽  
Vol 31 (3) ◽  
pp. 417-424
Author(s):  
Lorraine T. Dean ◽  
Genee S. Smith
Keyword(s):  
Health Care ◽  
African American ◽  
Family History ◽  
African Americans ◽  
Health Care System ◽  
The United States ◽  
Black African ◽  
The Us ◽  
History Of ◽  
Care System

Objective: Black/African American people have long reported high, albeit warranted, distrust of the US health care system (HCS); however, Blacks/African Americans are not a homogenous racial/ethnic group. Little in­formation is available on how the subgroup of Black Americans whose families suffered under US chattel slavery, here called De­scendants of Africans Enslaved in the United States (DAEUS), view health care institu­tions. We compared knowledge of unethical treatment and HCS distrust among DAEUS and non-DAEUS.Design and Setting: A cross-sectional random-digit dialing survey was adminis­tered in 2005 to Blacks/African Americans, aged 21-75 years, from the University of Pennsylvania Clinical Practices in Philadel­phia, Penn.Participants: Blacks/African Americans self-reported a family history of persons enslaved in the US (DAEUS) or no family history of persons enslaved in the US (non- DAEUS).Main Outcome Measures: HCS distrust was measured by a validated scale assessing perceptions of unethical experimentation and active or passive discrimination.Methods: We compared responses to the HCS distrust scale using Fisher’s exact and t-tests.Results: Of 89 respondents, 57% self-re­ported being DAEUS. A greater percentage of DAEUS reported knowledge of unethical treatment than non-DAEUS (56% vs 21%; P<.001), were significantly more likely to express distrust, and to endorse the pres­ence of covert (eg, insurance-based) than overt forms (eg, race-based) of discrimina­tion by the HCS.Conclusions: DAEUS express greater HCS distrust than non-DAEUS, patterned by awareness of unethical treatment and passive discrimination. Understanding how long-term exposure to US institutions influ­ences health is critical to resolving dispari­ties for all Black/African American groups. Rectifying past injustices through repara­tive institutional measures may improve DAEUS’ trust and engagement with the US HCS.Ethn Dis. 2021:31(3):417-424; doi:10.18865/ed.31.3.417

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