OBJECTIVE:Culturally appropriate (CA) interventions have been linked to improved health and social outcomes among minoritized groups. However, there remains no clear consensus on what constitutes 'appropriateness' in a culture, particularly within Black culture. This critical literature review examines the conceptualization of cultural appropriateness in research, interventions, care and support designed for Black communities. DESIGN:We searched several databases (including PubMed, PsycINFO, CINAHL, Scopus, Web of Science, Black Thought and Culture and Google Scholar) and used a combination of keywords (cultural appropriateness, interventions, and Black) to identify articles that described cultural appropriateness and its related terms such as cultural competence, cultural humility, cultural safety, cultural tailoring, and cultural relevance as it relates to Black-focused interventions, including social, clinical and policy. FINDINGS:The review clarifies the meaning of cultural appropriateness and its relationship to terms such as cultural competence, cultural humility, cultural safety, cultural tailoring and cultural relevance. Culturally appropriate interventions incorporate salient cultural features, experiences and values of the target population and involve cultural elements like language and local context to enhance credibility, legitimacy, and access. Yet, despite widespread use of the label 'culturally appropriate,' existing evaluation tools often measure providers' competence rather than the appropriateness of the intervention itself for specific groups. Also, the often single 'Black culture' lens applied in the literature disregards the heterogeneity and distinct identities, histories, and needs within the Black population and foregrounds an awareness of Black diversity and tailoring programs to specific Black groups. CONCLUSION:Overall, cultural appropriateness remains a contested and fluid concept. The interchangeable use of related terms contributes to conceptual ambiguity and hinders the development of effective, community-grounded interventions. Advancing intersubjective understanding and conceptual clarity is therefore warranted for improving research, policy, and practice in culturally responsive care for Black communities.
Black populations in the United States are increasingly diverse due to immigration, yet population health research frequently aggregates U.S.-born and foreign-born Black adults, obscuring important intraracial heterogeneity. This study examines whether migration timing, duration of U.S. residence, ethnic origin, and regional settlement are associated with obesity as an indicator of cardiometabolic risk among Afro-Caribbean immigrants. We analyzed data from the National Survey of American Life (N = 976), a nationally representative survey of Black adults in the United States. Guided by a racialized incorporation framework, migration characteristics were conceptualized as indicators of differential exposure to racialized institutional contexts across the life course rather than proxies for cultural assimilation. Weighted logistic regression models estimated associations between obesity (BMI ≥30 kg/m2), migration characteristics, and socioeconomic and demographic factors. Modified Poisson regression models were estimated as sensitivity analyses. Earlier age at migration, residence in the Northeast, lower household income, and female gender were associated with greater odds of obesity. Obesity also varied across Caribbean-origin groups, with respondents from Trinidad and Tobago exhibiting lower odds than Jamaican immigrants. Although shorter duration of U.S. residence generally corresponded with lower obesity prevalence, these associations were not consistently statistically significant. Sensitivity analyses produced substantively similar findings. These findings demonstrate substantial intraracial heterogeneity in cardiometabolic risk, as reflected by obesity, among Afro-Caribbean immigrants. Interpreted through a racialized incorporation framework, the results suggest that migration timing and settlement patterns may reflect differential exposure to racialized institutional contexts that shape cardiometabolic health over the life course. Disaggregating Black immigrant populations can advance understanding of structural processes contributing to cardiometabolic inequities within the increasingly diverse U.S. Black population.
BACKGROUND:Chinese immigrant mothers in Canada may face unique challenges navigating weight change during and after pregnancy due to cultural expectations, migration related barriers, and limited access to culturally appropriate prenatal care. Although gestational weight gain and postpartum weight retention are important indicators of maternal health, little is known about how immigrant women experience and manage these changes within the Canadian context. METHODS:This qualitative study used a Reflective Lifeworld Research approach to explore Chinese immigrant mothers' experiences of weight change during and after pregnancy. A convenience sample of eighteen mothers who had given birth within the previous twelve months participated in in-depth telephone interviews conducted in Mandarin. Data were analysed through an iterative process between parts and the whole, with findings organized using the Socioecological Model to capture influences across multiple levels. RESULTS:Mothers' experiences were shaped by interacting influences across individual, interpersonal, community, organizational, and policy levels. At the individual level, limited knowledge, body image concerns, and traditional postpartum practices such as Zuo Yue Zi (a traditional Chinese postpartum practice emphasizing rest, dietary regulation, and behavioural guidelines during the first month after childbirth) influenced weight-related behaviours. Interpersonally, inconsistent partner support and migration related separation from family members affected mothers' ability to prioritize their own wellbeing. At the community level, low awareness of maternal health programs limited access to credible guidance. Organizationally, differences between Chinese and Canadian healthcare systems created uncertainty around healthy weight change. At the policy level, mothers highlighted the absence of centralized, culturally relevant resources. CONCLUSIONS:Chinese immigrant mothers' experiences of pregnancy and postpartum weight change reflect a complex interaction of cultural, relational, and structural influences. These findings highlight the importance of clearer provider communication and culturally responsive maternity care to support immigrant mothers during pregnancy and the postpartum period.
OBJECTIVE:This study (1) examined associations between probable anxiety and depression with probable eating disorders (ED) among East Asian American young adults ages 18-25 years; and (2) assessed mental health service use patterns among East Asian American young adults with probable EDs and probable depression and/or anxiety. METHODS:Multivariable logistic models were employed to estimate the association between the outcome of a probable ED and the exposure variables of probable depression and anxiety, and the association between the outcome of lifetime mental health service use and the exposures of a probable ED and probable depression and/or anxiety. RESULTS:East Asian American young adults (N = 17,276) with a probable ED had 1.27 times the odds (95% CI: 1.21, 1.35) of receiving counseling for a mental health concern compared to those without a probable ED. Those with probable depression and/or anxiety had 2.19 times the odds (95% CI: 2.09, 2.30) of receiving counseling compared to those without probable depression and/or anxiety. The interaction term between probable ED and probable depression and/or anxiety indicated that those with both probable depression and/or anxiety and a probable ED had a lower than expected odds of receiving counseling. DISCUSSION:Probable depression and anxiety are associated with probable EDs among East Asian American young adults. East Asian American young adults with probable EDs have a lower probability of lifetime mental health service use than young adults with probable depression and/or anxiety. Future research should examine barriers to accessing counseling and ED-specific treatment obstacles experienced by this group.
OBJECTIVE:Previous research indicates that non-Hispanic Black adults are more likely to report extremes in sleep duration and worse levels of sleep quality compared to their White counterparts. However, studies examining predictors of sleep among Black adults are limited. This study addressed this gap by examining sociodemographic and health-related factors associated with sleep duration and sleep problems among non-Hispanic Black adults. METHODS:Data from 3,367 non-Hispanic Black adults in the United States, aged ≥20 years, were obtained by combining the 2015-2016 and 2017- March 2020 cycles of the National Health and Nutrition Examination Survey. Logistic regression models were fit to examine factors associated with sleep duration and sleep problems (history of trouble sleeping or excessive daytime sleepiness). RESULTS:The prevalence of recommended (7-9 h), short (<7 h), and long sleep duration (>9 h) was 53.9%, 33.0%, and 13.1%, respectively. The prevalence of sleep problems was 40.5%. Short sleep duration was positively associated with male gender, some college education, working ≥45 h per week, and history of sleep problems, and negatively associated with unemployment. Long sleep duration was positively associated with less than a college education, a family monthly poverty level index ≤1.30, being unemployed or retired, and fair or poor self-rated health, and negatively associated with female gender, age ≥45 years, and working ≥45 h per week. Sleep problems were positively associated with unemployment, mild to severe depressive symptoms, chronic medical conditions, fair or poor self-rated health, heavy alcohol consumption, and negatively associated with male gender, age ≥45 years, being foreign-born, and having a high school education or less. CONCLUSION:This study identified several sociodemographic and health-related factors associated with sleep, which can inform future research and policy and support the development of tailored clinical and public health interventions aimed at improving sleep health among non-Hispanic Black adults.
OBJECTIVES:Latiné populations in the United States face a persistent health and mental health burden, in part driven by stressors associated with social determinants of health. In response, it is critical to develop a nuanced understanding of Latiné communities' perceptions of government- and community-based social safety-net services, both as distinct and interacting systems, designed to support health and social needs of Latiné adults. DESIGN:We conducted semi-structured interviews with Latiné adults (N = 13) in English and Spanish to explore perceptions of and experiences with government-sponsored and community-based safety-net services, as well as the implications for health and wellbeing. A thematic analysis approach was used to identify emergent themes. RESULTS:Themes highlight shared and unique factors that enable and inhibit access to safety-net services from government- and community-based systems. Awareness of safety-net services and their benefits facilitated access to both systems, but knowledge of rights surrounding eligibility enabled access to government-based services in particular. In contrast, limited awareness of service availability and concerns about quality of services created barriers to access across both community- and government-based services. Unique to government-based services, complex and burdensome application processes, mistrust, and stigma associated with using public assistance were highlighted as barriers. CONCLUSION:Findings provide critical insights to improve Latiné communities' access to safety-net systems to support health and wellbeing. Our results highlight the need to: strengthen communication strategies to inform resource awareness and counteract misinformation; rebuild trust between government institutions and communities; reduce stigma and shame surrounding safety-net service utilization; simplify bureaucratic processes for using government safety-nets; and foster connections between community and government systems to enhance access to services that address upstream social determinants of health. These strategies represent steps towards building more accessible safety-net systems to support the health and wellbeing of Latiné communities.
BACKGROUND:The Latine population is at least two times more likely to be food insecure compared to the non-Hispanic white population. Challenges in accessing sufficient, culturally preferred, and healthy foods, particularly for those in rural areas, include limited financial resources and transportation difficulties. Additionally, this population commonly has low enrollment in food assistance programs, an effective method in reducing food insecurity (FI). Obesity, diabetes, cardiovascular diseases (CVD), and depression are frequently associated with FI; the Latine population carries a disproportionately high burden or risk of these diseases. OBJECTIVES:We aimed to understand the prevalence of FI, FI as a predictor and outcome variable, and health conditions associated with FI among the Latine population in rural, western North Carolina. METHODS:We conducted a cross-sectional survey in community settings using purposive sampling. Data were analyzed using descriptive statistics, bivariate analysis, and multivariable binary logistic regressions. RESULTS:Among 193 participants, 47% reported FI. Those identifying as food insecure were more likely to report a household income under $35,000 (OR 5.49, 95% CI: 1.37, 22.06), low educational attainment (OR 3.85, 95% CI: 1.23, 12.04), and being unmarried (OR 3.53, 95% CI: 1.01, 12.20). When modeled as a predictor, FI was associated with higher odds of reporting symptoms of CVD (OR 3.95, 95% CI: 1.43, 12.14) and depression (OR 5.01, 95% CI: 1.45, 21.52). CONCLUSION:Our study demonstrates a high prevalence of FI and significant relationships between FI and a myriad of variables in a region of rural, western NC and contributes to a dearth of literature about the experience of FI among the Latine population. Understanding the predictors of FI in this context can better support efforts to increase food security among this population.
OBJECTIVE:Black men experience the highest incidence and mortality rates from colorectal cancer (CRC) in Louisiana. Limited awareness of screening guidelines, low perceived risk, and structural barriers to care contribute to delayed detection. This study assessed CRC awareness, risk perceptions, screening intentions, and communication preferences among Black men aged 30-44 in Louisiana to inform targeted intervention strategies. METHODS:We conducted a statewide cross-sectional survey of English-speaking individuals who identified as male, African American or Black, were aged 30-44 and resided in Louisiana. Measures included CRC awareness, perceived risk, prior screening recommendations, screening intentions, exposure to CRC-related messaging, social media use, and trusted sources of health information. Descriptive statistics were used to summarize responses. RESULTS:We analyzed a total of 403 responses. Most participants did not perceive CRC as a significant personal health threat. Although 40% reported receiving a physician's recommendation for screening, only 70% of those individuals completed screening. Fewer than half recalled exposure to CRC-related messages, and message recall was generally low. Social media use was widespread (97%), with 58% reporting regular engagement with influencers. Doctors, teachers, coaches, and pastors were identified as the most trusted sources of health information. CONCLUSION:Findings highlight low perceived risk of CRC alongside high engagement with digital platforms. These results support the development of culturally tailored, lead-time messaging strategies that increase both perceived severity and susceptibility, leverage trusted messengers, and utilize digital media to promote timely CRC screening among young Black men.
INTRODUCTION:The COVID-19 pandemic had deleterious effects across healthcare. People who gave birth during this time experienced increases in mental health challenges compared to their non-pandemic counterparts. Given Hawai'i's geographical location, people who gave birth there may have experienced additional impacts not experienced on the US mainland. The purpose of this study was to investigate experiences of becoming a mother in Hawai'i during COVID-19. METHODS:Story inquiry, a qualitative research method that is culturally appropriate, was used. Inclusion criteria were that participants had to be 18 or older, English-speaking, living in Hawai'i, and had to have been pregnant or given birth during COVID-19. Participants were recruited via social media and interviewed via phone to assess the experience of becoming a mother (BAM) during the pandemic. RESULTS:Interviews with 15 participants revealed stories that began with discussions of the Perinatal Care Environment overall and how it could be both welcoming and lonely due to policy during the pandemic. From there, participants described cultural and geographically specific factors relating to their BAM experiences. The story then transitioned to plot points of new mothering challenges, which included missing out on key features of BAM due to COVID-19 and the isolation that happened because of the pandemic. From there, after birth, shared stories moved on to describe navigating COVID-19-specific mental health challenges. DISCUSSION:Shared plot points that emerged reinforce that healthcare environments and healthcare providers have the ability to support more positive birth experiences and influence mental health outcomes for new mothers. Plot points are also highlighted culturally, and geographically specific factors related to the experiences of becoming a mother, either positively or negatively, in Hawai'i, including spirituality and o'hana. Implications for policy and practice are discussed related to recommendations for mental health practice and policy in the wake of acute stress events like the COVID-19 pandemic.
OBJECTIVES:Latino/a immigrants evidence a relative health advantage compared to US-born counterparts, a trend that dissipates as they navigate a myriad of challenges tied to the immigration and adaptation process known as acculturative stressors. Recognizing the vast heterogeneity situated within the Latino/a immigrant population, experiences of acculturative stress differ among immigrant groups based on a range of demographic, social, and migration-related factors. DESIGN:In a sample of adult immigrants (ages 18-44; N = 391) residing in an emerging immigrant community, we conducted a cluster analysis to identify classes of respondents (i.e. 'clusters of acculturative stressors') and evaluated differences among these clusters across demographic, social support, and acculturation level variables. RESULTS:Results revealed that participants fell into one of three clusters: (a) high in family and systemic acculturative stress; (b) high in marital and parental stress; or (c) low in acculturative stress in general. Participants in the first group tended to be unauthorized immigrants, thereby facing more acculturative stress. Participants in the third group tended to have higher English proficiency, education, income, health insurance, and emotional and instrumental support, highlighting the buffering impact of residing within positive social contexts. CONCLUSION:These findings underscore the need for interventions that could be tailored to distinct subgroups of immigrants such as those which could increase familial and social connectedness and support, especially for those who are isolated and marginalized (cluster 1) as well as those experiencing familial and parenting stress (cluster 2). For those who endure comparatively less acculturative stress (cluster 3), low-touch interventions that maintain resilience may be important to maintain the wellbeing of this subset of immigrants. Together, these strategies have the potential to improve the health of this population and thereby reduce inequities.
OBJECTIVE:It has been well established that racial discrimination has detrimental consequences for well-being. However, less is known about this relationship in non-Western settings, and there is limited research examining factors that may moderate it. This study investigates the association between perceived racial discrimination and life satisfaction across four non-Western countries, as well as the role of migration as a potential moderator. DESIGN:A total of 3,600 respondents living in Ghana, Indonesia, Kenya, and Ukraine participated in an online survey on racial discrimination and its association with life satisfaction. Participants also reported their migration status, including whether they had migrated and the duration of their residence outside their country of origin. RESULTS:We found a negative association between perceived racial discrimination and life satisfaction across the four countries, although the strength of this relationship varied by context. Importantly, we found that years since migration attenuate the negative association between perceived racial discrimination and life satisfaction, potentially reflecting coping strategies and adaptation processes developed over time. CONCLUSION:While a negative association between perceived racial discrimination and life satisfaction is observed in these non-Western contexts, the strength of this relationship varies across countries and is moderated by individuals' migration experiences. These findings open new avenues for research on how discrimination and migration jointly shape well-being across diverse national and individual contexts.
BACKGROUND:Black women in the United States continue to experience inequitable preventive health care shaped by racism, gender discrimination, and medical mistrust. While prior research has examined historical foundations of mistrust or individual attitudes, less attention has focused on how Black women interpret and navigate bias as it unfolds in everyday clinical encounters. OBJECTIVE:To examine how Black women understand their health care interactions, how they experience bias in preventive care, and the strategies they use to protect their well-being and sustain engagement in care. METHODS:Seventeen self-identified Black women, including both U.S. born and immigrant participants aged 21-65 years, completed in-depth semi structured interviews between February and April 2023. Interviews explored participants' interpretations of clinical interactions, perceptions of being unheard or dismissed, and the responses they enacted to preserve their dignity and health. A thematic analytic approach guided the interpretation of the data. RESULTS:Three major themes emerged: (1) participants described biased encounters ranging from subtle dismissive cues to overt discrimination connected to race, gender, class, immigration, and religion; (2) these experiences carried emotional and psychological demands, contributing to constant self-monitoring during care; and (3) women employed strategies such as modifying their behavior, selectively choosing providers, and self-advocacy, while acknowledging the personal limits and emotional toll of continually having to protect themselves in clinical spaces. These findings illustrate how mistrust is not only historically rooted but continually reinforced through routine interactions that communicate who is valued within health care systems. CONCLUSIONS:Black women's accounts demonstrate that mistrust emerges from lived experiences within health care, not only historical memory. Improving preventive care requires meaningful change in provider communication, institutional responsiveness to bias, and system level commitments that demonstrate trustworthiness. Strengthening trust will depend on whether health systems can consistently honor Black women's dignity, voice, and safety in care.
ObjectivesEvidence has highlighted that the COVID-19 pandemic worsened ongoing mental health inequity among population groups, such as those with pre-existing mental health problems. This is further compounded for ethnic minority communities. Research emphasises the importance of coping strategies in lessening the negative impacts of the pandemic; however, there is a scarcity of research among ethnic minority communities. DesignTo explore the experiences of coping during the COVID-19 pandemic among ethnic minority individuals with existing mental health difficulties and to identify changes and continuity in coping strategies across two different timepoints. A secondary thematic analysis was conducted of interviews with ethnic minority individuals with mental health conditions, using a cross case comparison approach to analyse interviews conducted at two timepoints during the COVID-19 pandemic. ResultsSeeking social support, implementing new habits, and self-care approaches to mental health, as well as access to and experience of mental health services, were adaptive coping strategies used, further highlighting the importance of these strategies being culturally sensitive. Several expressed difficulties with access to mental health services. ConclusionsWhilst the pandemic has ended, this research highlights that there is still a need for future studies exploring the experiences of ethnic minority groups, and focus should be placed on developing solutions that facilitate uptake among people with mental health problems from these communities. This should involve adaptive, culturally appropriate coping strategies and implementing modifications for effective mental health care for future public health crises or other social stressors.
OBJECTIVE:This study aims to investigate how the components of social cognitive theory (SCT), namely personal, behavioral, and environmental factors, mediate the relationship between barriers to regular glucose monitoring and the frequency of blood sugar testing in Black/African American men with type 2 diabetes (T2D). DESIGN:This cross-sectional observational survey study utilized an internet-based survey to assess barriers to glucose monitoring, SCT components, and monitoring frequency among 1,225 Black/African American men with T2D. Data were analyzed using Structural Equation Modeling (SEM) to examine direct and indirect relationships between these factors. RESULTS:Outcome expectations had a significant positive direct effect (path estimate) on the frequency of glucose testing (β = 0.02, p = 0.005), although they did not mediate the relationship between barriers and testing (β = -0.01, p = 0.183). Observational learning exhibited a significant positive direct effect on testing frequency (β = 0.19, p < 0.001), with barriers partially mediating monitoring frequency through observational learning (β = 0.01, p < 0.001). Self-efficacy showed a significant positive direct effect on testing frequency (β = 0.02, p < 0.001), with the relationship between barriers and testing frequency fully mediated by self-efficacy (β = -0.01, p < 0.001). CONCLUSION:Both observational learning and self-efficacy partially or fully mediate the relationship between barriers and testing. These findings underscore the importance of interventions aimed at enhancing social support and observational learning to overcome barriers and improve adherence to glucose monitoring among Black/African American men with T2D.
OBJECTIVES:This longitudinal study investigated how theorized cultural-, interpersonal/familial-, and individual-level experiences during initial years after immigrating to the United States may relate to changes in psychological distress over time among young adult Latina women in Miami-Dade County, Florida, United States (U.S.). METHODS:Using latent growth curve modeling, we examined trajectories of psychological distress reported by 530 Latina women (aged 18-23 years) during their initial years in the U.S. The sample's mean length of time in the United States since immigration was 11.52 months (SD = 9.94) at baseline assessment. Trajectories of distress were measured over a three-year time period. We investigated whether cultural- (immersion to dominant society/assimilation, immersion to ethnic society/enculturation, acculturative stress, marianismo), interpersonal/familial- (trust and communication with parents, peers, partner), and individual- (immigration authorization status, education level, relationship status) level determinants experienced soon after immigration predicted changes in participants' distress over a subsequent two-year time period. RESULTS:At baseline assessment, participants' psychological distress was associated with higher levels of acculturative stress (β = .63, p < .001). Over time, the average level of women's distress significantly declined (b = -.10, p = .001). Steeper declines in distress over time were reported by women who reported more baseline acculturative stress (β = -.80, p < .001) and less baseline trust and communication with their parents, peers, and partners (β = .52, p = .002). CONCLUSIONS:Findings inform theoretical and empirical knowledge bases concerning determinants of psychological distress during initial years after immigration among foreign-born young Latina women in the U.S. The study provides a longitudinal examination of psychological distress during the rarely studied time period of initial years in the U.S. Results elucidate the substantive influence of acculturative stress and interpersonal/familial relationship dynamics soon after immigration. Mental health interventions should attend to these modifiable factors during young Latina women's early years in the U.S. to reduce psychological distress and promote well-being soon after immigration and subsequent years.
OBJECTIVES:Tuberculosis (TB) remains a major global public health concern that disproportionately affects Indigenous people. Contact tracing and early identification of those exposed to TB is essential for TB control. This study assesses the engagement of Indigenous populations for TB control against international and national TB guidelines. DESIGN:A scoping review was conducted using five databases: PubMed, EMBASE, Global Health, Web of Science, and Google Scholar. Medical Subject Headings (MeSH) were used depending on the search engine and functionality. Key search terms included 'Tuberculosis,' 'Contact tracing' and 'Indigenous population/people(s),' and Indigenous populations by name including Māori, Native American, Aboriginal, First Nations, Inuit, Torres Strait, American Indian, Alaska Native, Native Hawaiian and Pacific Islanders. Articles published between 1 January 2000 and 1 July 2024, in the English language, were included. Grey literature was examined for relevant guidelines on Indigenous engagement in TB control and articles were scored against key indicators found in the guidelines. RESULTS:Twenty-eight studies from eight countries were reviewed and assessed against five key indicators identified in the international guidelines and national guidelines. Many studies provided limited details on how they engaged with Indigenous populations, which resulted in low scores. No study met all five key indicators, and 32% did not meet any of the five indicators. CONCLUSION:This review highlights the lack of consistency in the engagement of Indigenous populations in published TB control efforts, as well as differences between national TB guidelines. These findings underscore the urgent need to strengthen and align national guidelines with international standards as part of progress towards TB elimination.
INTRODUCTION:American Indian communities were disproportionately impacted by the COVID-19 pandemic, with the highest COVID-19 mortality rate of all racial and ethnic groups in the United States. In particular, American Indian adolescents faced unique challenges due to the COVID-19 pandemic. OBJECTIVES:This manuscript presents the self-reported experiences, interpersonal relationship perspectives, and behaviors of American Indian adolescents aged 14 to 18 living on the Fort Peck Reservation in Northeastern Montana during the COVID-19 pandemic. METHODS:Semi-structured interviews (n = 31) investigated the ecological factors influencing the American Indian adolescents during the COVID-19 pandemic, including: (1) tribal governance, economics, environment; (2) protection from COVID-19; (3) social impact of COVID-19; (4) relationships; and (5) access to services. Inductive analyses were conducted within each of these aforementioned categories. RESULTS:Our findings suggest that participants' perspectives varied widely on how well the Fort Peck Tribes handled transmission mitigation strategies. Participants also described how the COVID-19 pandemic had a predominantly negative impact on relationships with peers and their academic performance, and a mixed impact on their ability to access services. Our most striking finding was the positive impact of the COVID-19 pandemic on family connectedness, communication within the family, and the use of traditional medicines and ceremonies among American Indian adolescents. CONCLUSION:These findings support the importance of promoting family connectedness, parent/caregiver-adolescent communication, and the use of traditional American Indian healing practices to mitigate risk and promote health and wellness during future pandemics.
INTRODUCTION:Despite having intentions to quit, people with severe mental illness (SMI) often struggle to abstain from tobacco/nicotine use. This study explored the interplay between gender and race/ethnicity in relation to time to abstain from tobacco/nicotine use and the factors associated with successful quitting. MATERIALS AND METHODS:A population-based sample of 3,914 individuals was drawn from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC-III, 2012-2013). Survival modeling methods were used to examine differences in time to abstain across gender-race/ethnicity groups and explore associated factors. RESULTS:Among smokers with SMI, 31.7% had abstained from tobacco/nicotine use, with significant variation across gender-race/ethnicity groups (χ² = 32.2, p < 0.001). Non-Hispanic White females had the highest cessation rate (35.3%), while non-Hispanic Black males had the lowest (22.3%). Hispanic females had the shortest duration of use (33-39 years) and the highest likelihood of abstinence (HR = 2.07, p < 0.05), compared to non-Hispanic Black males, who had the longest use duration (45-54 years). Low social support and high levels of stressful life events were significantly associated with lower cessation rates, particularly among non-Hispanic Black males. CONCLUSIONS:Findings suggest that psychiatric nurses should consider personal and demographic factors when designing cessation programs for individuals with SMI.
Introduction: Racial differences in exposure to area-level social determinants of health (SDoH) may contribute to distinct vulnerability profiles among people living with dementia. Methods: This cross-sectional study used data from the OCHIN Community Health Equity Database to examine SDoH factors among patients with dementia and mild cognitive impairment. SDoH measures encompassed social, environmental, and climate vulnerability factors. We trained Random Forest classifiers to identify the most influential SDoH features distinguishing racial groups. Results: Common SDoH factors - those ranking among the top features across multiple racial groups - included percentage of minority populations, limited English proficiency, exposure to diesel particulate matter or fine particulate matter, impaired watershed, and frequency of extreme heat and wildfire smoke days. Distinct SDoH factors - those identified as top-ranked for only one or two groups - included unemployment and disability rates in ZIP codes where American Indian and/or Alaska Native patients lived; lack of walkability in areas where Asian patients resided; hurricane occurrences in ZIP codes where Black patients lived; low educational attainment in Native Hawaiian or other Pacific Islander communities; and housing cost burden, lack of internet access, and older housing stock in areas where Multiracial patients lived. Discussion: These findings highlight the importance of incorporating multidimensional SDoH measures when assessing structural contexts in dementia research.
Background: With increasing health needs, public-care systems rely highly on family members to provide caregiving. Despite a rapid increase in multicultural populations, there is limited cross-cultural research on family caregivers, particularly their perceptions of social support. The current paper explores similarities and differences in the correlates of perceived social support between Australian family caregivers of culturally diverse backgrounds (CALD) and those primarily of Anglo-Celtic ancestry (non-CALD). Methods: Cross-sectional anonymous survey of family caregivers aged ≥18 years, who self-identified as CALD (n = 349) and non-CALD (n = 302). Perceived social support was assessed using the Expressed Social Support (ESS) scale. Demographic, caregiving, and health-related correlates of perceived social support amongst both groups were assessed using descriptive and inferential statistical techniques. Results: Although the total ESS scores were similar in both group of caregivers (mean 15.4 ± 5.0 vs. 16.0 ± 4.9), there was some variation across the eight ESS items between the two groups. In multivariable regression, after adjusting for demographic, carer and health covariates, mental health score was the most significant covariate of perceived social support in both groups. Other significant covariates included older age (≥60 years) and education in CALD caregivers and being a primary carer in non-CALD caregivers. Conclusion: Our study highlights similarities and differences amongst correlates of perceived social support across two culturally distinct groups of Australian family caregivers, which include demographic, care-related and health-related factors, including mental health. Future research using longitudinal mixed methods approaches would be valuable in better understanding trajectories of care associated with personal, cultural, and structural factors and how its influences perceptions of social support across the diversity of family caregivers.
