Experiencing racism and anti-immigrant discrimination has a negative impact on health, including healthcare utilization. A growing body of research has connected vicarious experiences of racism and anti-immigrant discrimination to health decline; however, there is a dearth of literature examining the impact of these vicarious experiences on healthcare utilization. Using data from the 2023 and 2024 California Health Interview Survey (n = 46,481), we examined the association between vicarious experiences of hate incidents in the last 12 months motivated by race or skin color and immigration status and indicators of healthcare utilization in the past 12 months. Logistic regression models were used to calculate adjusted odds ratios (AORs) of all study outcomes. Analyses were stratified by white and Black, Indigenous, and People of Color (BIPOC) for hate incidents motivated by race or skin color, and by United States (US) born citizens, naturalized citizens, and noncitizens for hate incidents motivated by immigrant status. After accounting for confounders, among all participants, witnessing a hate incident motivated by the race or skin color of the target was associated with higher odds of foregoing or delaying healthcare services, receiving care from telemedicine, and visiting the emergency room. Among the entire sample, witnessing a hate incident motivated by immigration status of the target was associated with higher odds of foregoing or delaying healthcare services and receiving care from telemedicine. Witnessing hate incidents motivated by race, skin color, or immigrant status has a negative impact on healthcare utilization for everyone, regardless of racial background or citizenship status.

A growing number of researchers use public health critical race praxis (PHCRP), an antiracism framework derived in part from critical race theory, to conceptualize racism as a public health problem and examine its contributions to health and health care inequities. Critical race scholars define racism as “the state-sanctioned and/or extralegal production and exploitation of group-differentiated vulnerability to premature death,” as stated by Ruth Gilmore in her 2007 book Golden Gulag . Despite solid evidence for the prevalence and potential effects of racism, few studies provide data to guide the development, implementation, and evaluation of antiracism interventions in diverse settings (e.g., community, health care), activities that we refer to in this review as practice. A central focus of PHCRP is to guide evidence-based action to disrupt racism; therefore, the framework may be useful in guiding antiracism practice. However, evidence for its use for practice has not been established. To encourage the development, implementation, and evaluation of antiracism solutions, this review examines the evidence applying PHCRP to practice-focused research. The findings provide a baseline assessment to guide future evidence-based antiracism mitigation efforts. We offer recommendations to support future practice-focused work.

Background: Climate change is intensifying and poses an increased threat to health. However, limited attention has been paid to the social patterning of exposure to extreme weather events, specifically among socially marginalized communities such as people with disabilities, LGBTQ people, those in rural areas, and racialized minorities. Methods: Data from the 2023 California Health Interview Survey, a survey of California adults, were used to examine if exposure to any extreme weather events varied across a range of sociodemographic and health-related characteristics (e.g., sexual orientation, race/ethnicity, gender, rurality, have any health conditions), and if these exposures to these weather-related events were associated with physical or mental health impacts for anyone in the household. Multivariable logistic regression models were used. Results: Respondents who identified as American Indian or Alaska Native, bisexual and pansexual, lower income, completed some college or more, living in rural areas, had a health condition, having experienced psychological distress, or had a disability had higher odds of reporting that someone in their household had experienced an extreme weather event. In terms of health harm from weather events, bisexual people, pansexual people, transgender people, people with disabilities, people with health conditions, and those living in rural areas were more likely to experience harm. Discussion: Human-fueled climate change is set to have devastating impacts on health in the coming decades. This study suggests that these impacts will disproportionately fall on structurally marginalized communities.

The increasing efforts among public health researchers to examine the connections between police violence and health outcomes has resulted in growing discoveries about the implications for both direct and vicarious exposure as well as disparities by race and ethnicity. To date, the conceptualization of police violence and health has largely focused on single causes and/or mechanisms at one point in time and focused on individuals most proximal to impact. However, the prevailing conceptualizations are limited in scope. They are relatively linear, do not account for multiple dimensions of harm, and are void of temporal factors that span across communities and generations-all factors that are sustained by forms of structural racism. We offer a reconceptualization guided by the Public Health Critical Race Praxis (PHCRP), a public health offshoot of Critical Race Theory, that offers public health professionals a framework and semi-structured process for centering racism in their analyses and implications of police violence on health. Our conceptualization is supported by multiple case studies, and we conclude with concrete recommendations for public health professionals to draw on as strategies to address police violence and advance health equity.

BACKGROUND:Adverse childhood experiences (ACEs) have been associated with poor health and underuse of preventive health services. However, less is known about how ACEs are associated with quality of care that children receive, like care that involves shared decision-making. METHODS:Using data from the 2021-2022 National Survey of Children's Health (n = 47 179) the association between ACEs, both individual and cumulative and (1) needing medical decisions made in the past 12 months and (2) three different measures of always receiving care that involved shared decision-making. Logistic regression models were used to calculate odds of each outcome. Each of the 11 ACEs and the cumulative number of ACEs served as independent variables each in separate models. RESULTS:After accounting for confounders, the number of ACEs experienced, and most individual ACE items were associated with higher odds of needing medical decisions made, and lower odds of receiving health care that involved providers always engaging in the three measures of shared decision-making. CONCLUSIONS:This study expands the research showing a deleterious impact of ACEs on utilization of health care by showing that ACEs are associated with lower quality health care. This can be particularly determinantal to children with a history of ACEs because they have a greater need for health care and are less likely to use many types of health care. Efforts to improve health care quality for all children will be of particular benefit to vulnerable groups, like those with a history of ACEs.

BACKGROUND:Community-based doulas, who provide nonclinical perinatal support and are often from the same communities as the families they serve, are increasingly recognized as a strategy to ameliorate racialized perinatal health inequities. However, little is known about the successful implementation and sustainability of community-based doula programs. METHODS:Using an explanatory sequential mixed methods design, we examined the implementation and health outcomes of a community-based doula program serving low-income families and the barriers and facilitators that influence these outcomes. We analyzed programmatic and health outcome data among all families enrolled in the program from January 2016 through December 2022. Four in-depth listening sessions with the program's direct service providers were conducted and analyzed using thematic analysis. RESULTS:Among the over 1800 families served, the majority of whom identified as either Asian, Black, Indigenous, Latina/e/x, or multiracial, there were 14,672 total home visits that totaled 17,774 h. Over $87,000 in direct funds and 7000 tangible items (e.g., diapers) were dispersed to families. Preterm birth ranged from 4% to 9% across programs and most participants (> 94%) were breastfeeding/chestfeeding at birth. Direct service providers identified holistic, culturally-matched services and "doula-ing the doula" (organizational infrastructure to support doulas) as facilitators. Barriers included the intersecting systems of oppression that underlie the primary challenges faced by birthing families and direct service providers, including lack of community resources and power asymmetries within birth settings, that can lead to provider burnout. CONCLUSIONS:These findings document the positive impact of community-based doula programs and bolster calls for increased compensation and structural supports for doulas.

Rationale: Immigrants represent a rapidly growing proportion of the population, yet the many ways in which structural inequities, including racism, xenophobia, and sexism, influence their health remains largely understudied. Perspectives from immigrant women can highlight intersectional dimensions of structural gendered racism and the ways in which racial and gender-based systems of structural oppression interact. Objective: This study aims to show the multilevel manifestations of structural gendered racism in the health experiences of immigrant women living in New York City. Method: Semi-structured, in-depth interviews were conducted in 2020 and 2021 with 44 cisgender immigrant women from different national origins in New York City to explore how immigrant women experienced structural gendered racism and its pathways to their health. Interviews were thematically analyzed using a constant comparative approach. Results: Participants expressed intersectional dimensions of structural gendered racism and the anti-immigrant climate through restrictive immigration policy and issues related to citizenship status, disproportionate immigration enforcement and criminalization, economic exploitation, and gendered interpersonal racism experienced across a range of systems and contexts. Participants weighed their concerns for safety and facing racism as part of their life course and health decisions for themselves and their families. Conclusions: The perspectives and experiences of immigrant women are key to identifying multilevel solutions for the burdens of structural gendered racism, particularly among individuals and communities of non-U.S. national origin. Understanding how racism, sexism, xenophobia, and intersecting systems of oppression impact immigrant women is critical for advancing health equity.

Historically, the US immigration system (ie, institutions, agencies, and laws) has served the goals and principles of white supremacy through its treatment of globally displaced people and this appears to have continued through the COVID pandemic. Yet, the implications for immigrant health are not routinely addressed in mainstream public health discourse, and especially so in regard to public health disasters. This study conducted a series of focus groups with participants from social justice organizations working with immigrants, migrants, undocumented persons, refugees, persons seeking asylum, and persons detained in immigration jails to collect stories on how the immigration system undermined efforts to control the spread of COVID-19 and exacerbated health inequity within immigrant jails and across related community contexts during the pandemic. Focus groups were conducted to explore issues related to immigrants and immigration detention during the COVID-19 pandemic. There was a total of N 1 / 4 14 participants across the 4 focus groups with a dedicated focus group on perspectives of Black immigrants/from Black immigrant organizations only. Each focus group consisted of 3 to 4 participants. Five key themes emerged: 1) dehumanization of immigrants and migrants and devaluation of their lives; 2) inhumane conditions of confinement that propagate risk of disease; 3) denial of resources for COVID-19 prevention and mitigation; 4) expansion of intersecting oppressive systems; and 5) community -based resistance and mobilization against immigration policies and enforcement. Our findings highlight the harms from policing, criminalization, and exclusion that racialized communities face as a result of the (in)actions within the immigration system during a public health disaster including the COVID context

BackgroundMost studies capturing the health effects of police violence focus on directly impacted individuals, but a burgeoning field of study is capturing the indirect, community-level health effects of policing. Few empirical studies have examined neighbourhood-level policing, a contextual and racialised gendered stressor, in relation to preterm birth risk among Black and other racially minoritised people.MethodsWe spatially linked individual birth records (2017–2019) in Seattle, Washington (n=25 909) with geocoded data on police stops for three exposure windows: year before pregnancy, first and second trimester. We fit race-stratified multilevel modified Poisson regression models predicting preterm birth (<37 gestational weeks) across tertiles of neighbourhood stop rates controlling for individual and neighbourhood-level covariates. For the second trimester exposure window, birth was operationalised as a time-to-event outcome using multilevel Cox proportional hazard models.ResultsNeighbourhood stop rates of Black residents was higher compared with White residents, and Black and Asian pregnant people were exposed to the highest median neighbourhood-level stop rates. Black birthing people living in neighbourhoods with more frequent police stops had increased risk of preterm birth across all exposure windows including the year before pregnancy (adjusted risk ratio (aRR): 1.38, 95% CI 1.02 to 1.85), first trimester (aRR:1.74, 95% CI 1.17 to 2.57) and second trimester (aHR: 1.66, 95% CI 1.14 to 2.42). We found null or inverse associations among Asian, Hispanic and White people.ConclusionOur study adds to the growing evidence documenting associations of higher risk of preterm birth with neighbourhood police stops among Black birthing people. These findings suggest that routine police practices are one aspect of structural racism contributing to racialised perinatal health inequities.

INTRODUCTION:Screening for adverse childhood experiences (ACEs) in the clinical setting is set to become more commonplace with continued efforts to reimburse clinicians for screening. However, an examination of disparities in ACEs screening and related attitudes and beliefs is needed.METHODS:Using the 2021 California Health Interview Survey (CHIS), this study examined if several measures of socioeconomic status, access to care and identities were associated with 3 outcomes: 1) getting screened for ACEs by a clinician; 2) beliefs about the importance of screening and 3) satisfaction with efforts to address the impacts of ACEs. Logistic regressions were used to estimate odds of the outcomes.RESULTS:Black, Latinx, and Asian individuals had lower odds of being screened for ACEs than non-Hispanic Whites. A recent doctor's visit, higher burden of ACEs, and serious psychological distress were associated with higher odds of being screened. Latinx individuals, women, bisexual individuals, those with a recent doctor's visit and those with serious psychological distress had higher odds of believing clinicians asking about ACEs was very important, relative to their counterparts. Latinx individuals, American Indian or Alaska native individuals, Asian individuals, those with higher educational attainment and those with serious psychological distress had lower odds of being very satisfied with providers' efforts to address the impact of ACEs, relative to their counterparts.CONCLUSIONS:Efforts to expand ACEs screening should consider the disparities in screening that currently exist. Given the wide-ranging impacts that ACEs have on health, an equitable approach to screening is necessary.

the disabling impact of COVID-19 is still ongoing, and its totalizing effect will be researched from this moment on. and is still yet to come, we are struck by how the central premise that motivated this series at the beginning still holds so true at this juncture. The beginning of this pandemic was centuries in the making, and it is a challenge to say which historical and/or contemporary colonial, white supremacist, patriarchal, or antilabor event was more relevant than any other in defining the trajectory of our planet since March 2020, as SARS Coronavirus-2 began to spread rapidly across the United States and the world. In the end, all events culminated in a system illprepared and ill-intentioned when it came to disaster and crisis preparedness. The system showed itself to be fully committed and fundamentally designed to maintain a counterproductive and, as some would argue, destructive control over people's lives. Not surprisingly, the system was destructive even for those it claims to serve and benefit, so much so

Historically, the US immigration system (ie, institutions, agencies, and laws) has served the goals and principles of white supremacy through its treatment of globally displaced people and this appears to have continued through the COVID pandemic. Yet, the implications for immigrant health are not routinely addressed in mainstream public health discourse, and especially so in regard to public health disasters. This study conducted a series of focus groups with participants from social justice organizations working with immigrants, migrants, undocumented persons, refugees, persons seeking asylum, and persons detained in immigration jails to collect stories on how the immigration system undermined efforts to control the spread of COVID-19 and exacerbated health inequity within immigrant jails and across related community contexts during the pandemic. Focus groups were conducted to explore issues related to immigrants and immigration detention during the COVID-19 pandemic. There was a total of N=14 participants across the 4 focus groups with a dedicated focus group on perspectives of Black immigrants/from Black immigrant organizations only. Each focus group consisted of 3 to 4 participants. Five key themes emerged: 1) dehumanization of immigrants and migrants and devaluation of their lives; 2) inhumane conditions of confinement that propagate risk of disease; 3) denial of resources for COVID-19 prevention and mitigation; 4) expansion of intersecting oppressive systems; and 5) community-based resistance and mobilization against immigration policies and enforcement. Our findings highlight the harms from policing, criminalization, and exclusion that racialized communities face as a result of the (in)actions within the immigration system during a public health disaster including the COVID context.

Between October 2023 and April 2024, more than 30,000 Palestinians were killed, and countless others injured, displaced, and traumatized, in the fifth major Israeli assault on the Gaza Strip since 2006. Recent events, along with the trajectory of events over the past 75 years, demonstrate that using a public health framework could help recognize racism as a structural and social determinant of Palestinian health. Using the principles of health equity, we show how Palestinian health inequities are rooted in settler colonialism and racism, amounting to violence and oppression against Palestinian Arabs as a racialized group, regardless of religion or citizenship. Structural racism should be recognized as a driver of Palestinian health inequities.

INTRODUCTION:Equity-oriented efforts to mitigate and prevent COVID-related disparities are hindered due to methodological limitations of the categorization of racial and ethnic groups, including Arabs and Middle Eastern and North African (MENA) communities, which remain invisible in national data collection efforts. This study highlights the disparities in COVID-related outcomes in Toronto, Canada and supports ongoing calls to collect public health data among MENA communities in the United States. METHODS:Data on racial/ethnic identity and hospitalizations were collected by the Toronto Public Health (TPH) of the Ontario Ministry of Public Health Case between May 20, 2020, and September 30, 2021 from people with a confirmed or probable case of COVID-19. RESULTS:The reported COVID-19 infection rate for Arab, Middle Eastern, West Asians (i.e., categories used to self-identify as MENA in Canada) relative to Whites in Toronto was 3.51. The age-standardized hospitalization rate ratio between Arab, Middle Eastern, West Asians and Whites was 4.59. DISCUSSION:Data from Toronto highlight that Arab, Middle Eastern, and West Asians have higher rates of COVID-19 infections and hospitalizations than their White counterparts. Comparable studies are currently not possible in the United States due to lack of data that can disaggregate MENA individuals. This study underscores the critical need to collect data among MENA communities in the United States to advance our field's goal of promoting and advancing equity.

Background Although surveillance systems used to mitigate disasters serve essential public health functions, communities of color have experienced disproportionate harms (eg, criminalization) as a result of historic and enhanced surveillance. Methods To address this, we developed and piloted a novel, equity-based scoring system to evaluate surveillance systems regarding their potential and actual risk of adverse effects on communities made vulnerable through increased exposure to policing, detention/incarceration, deportation, and disruption of access to social services or public resources. To develop the scoring system, we reviewed the literature and surveyed an expert panel on surveillance to identify specific harms (eg, increased policing) that occur through surveillance approaches. Results Scores were based on type of information collected (individual and/or neighborhood level) and evidence of sharing information with law enforcement. Scores were 0 (no risk of harm identified), 1 (potential for risk), 2 (evidence of risk), and U (data not publicly accessible). To pilot the scoring system, 44 surveillance systems were identified between June 2020 and October 2020 through an environmental scan of systems directly related to COVID-19 (n=21), behavioral and health-related services (n=11), and racism and racism-related factors (n=12). A score of 0-2 was assigned to 91% (n=40) of the systems; 9% were scored U; 30% (n=13) scored a 0. Half scored a 1 (n=22), indicating a “potential for the types of harm of concern in this analysis.” “Evidence of harm,” a score of 2, was found for 12% (n=5). Conclusions The potential for surveillance systems to compromise the health and well-being of racialized and/or vulnerable populations has been understudied. This project developed and piloted a scoring system to accomplish this equity-based imperative. The nobler pursuits of public health to improve the health for all must be reconciled with these potential harms.

The conventional use of racial categories in health research naturalizes “race” in problematic ways that ignore how racial categories function in service of a White-dominated racial hierarchy. In many respects, racial labels are based on geographic designations. For instance, “Asians” are from Asia. Yet, this is not always a tenable proposition. For example, Afghanistan resides in South Asia, and shares a border with China and Pakistan. Yet, people from Afghanistan are not considered Asian, but Middle Eastern, by the US Census. Furthermore, people on the west side of the Island of New Guinea are considered Asian, whereas those on the eastern side are considered Pacific Islander. In this article, we discuss the complexity of the racial labels related to people originating from Oceania and Asia, and, more specifically, those groups commonly referred to as Pacific Islander, Middle Eastern, and Asian. We begin with considerations of the aggregation fallacy. Just as the ecological fallacy refers to erroneous inferences about individuals from group data, the aggregation fallacy refers to erroneous inferences about subgroups (eg, Hmong) from group data (ie, all Asian Americans), and how these inferences can contribute to stereotypes such as the “model minority.” We also examine how group averages can be influenced merely by the composition of the subgroups, and how these, in turn, can be influenced by social policies. We provide a historical overview of some of the issues facing Pacific Islander, Middle Eastern, and Asian communities, and conclude with directions for future research.

Background:Racism persists, underscoring the need to rapidly document the perspectives and experiences of Black, Indigenous and People of Color (BIPOC) groups as well as marginalized populations (eg, formerly incarcerated people) during pandemics.Objective:This methods paper offers a model for using Public Health Critical Race Praxis (PHCRP) and related critical methodologies (ie, feminist and decolonizing methods) to inform the conceptualization, methods, and dissemination of qualitative research undertaken in response to the evolving COVID-19 pandemic.Sample:Using purposive snowball sampling, we identified organizations involved with health equity and social justice advocacy among BIPOC and socially marginalized populations. Focus group participants (N=63) included community members, organizers, activists, and health workers.Design:We conducted topic-specific (eg, reproductive justice) and population-specific (eg, Asian and Pacific Islander) focus groups (N=16 focus groups) in rapid succession using Zoom software.Methods:A self-reflexive, iterative praxis guided theorization, data collection and analysis. We obtained community input on study design, the semi-structured discussion guide, ethical considerations and dissemination. Applying PHCRP, we assessed our assumptions iteratively. We transcribed each interview verbatim, de-identified the data, then used two distinct qualitative techniques to code and analyze them: thematic analysis to identify unifying concepts that recur across focus groups and narrative analysis to keep each participant's story intact.Results:The praxis facilitated relationship-building with partners and supported the iterative assessment of assumptions. Logistical constraints included difficulty ensuring the confidentiality of virtual discussions.Conclusions:These novel approaches provide an effective model for community-engaged qualitative research during a pandemic.