The COVID-19 pandemic compounds stressors of daily life among American Indian/Alaska Natives. This study investigated the impact of COVID-19 among American Indian/Alaska Natives and non-Hispanic whites by examining depressive symptoms, overall stress, resilience, and coping, utilizing the Transactional Model of Stress and Coping. Of the 207 individuals participating in this study, 109 identified as American Indian/Alaska Native and 98 as non-Hispanic white. Despite demographic similarities, American Indian/Alaska Natives exhibited more stressors related to COVID-19 as well as higher depressive symptom scores compared to non-Hispanic whites. Furthermore, COVID-19 stressors were more positively correlated with depressive symptoms for American Indian/Alaska Natives than non-Hispanic whites. For American Indian/Alaska Natives, the predominant coping processes identified were planful problem solving, escape-avoidance, and self-controlling. This study provides data to support programs and policies centered on improving the psychosocial health for American Indians/Alaska Natives and decreasing COVID-19-related health disparities.
This study was conducted to identify processes of coping with COVID-19 and determine their impact on emotional well-being for women of color in the United States. Data were collected from 368 women between May and July 2020 using an online survey guided by the Transactional Model of Stress and Coping, which included an assessment of COVID-19 stressors, Brief Encounter Psychosocial Instrument (BEPSI), 10-item Connor-Davidson Resilience Scale (CD-RISC-10), Ways of Coping Questionnaire (WCQ), and Center for Epidemiologic Studies Depression Scale (CES-D). Over half of the women were depressed (59.0%) and felt ill (69.3%) from the stress of COVID-19. Planful problem solving (M = 4.58, SD = 2.70) was the primary way to cope with COVID-19. A small, positive correlation existed between COVID-19 stressors and depressive symptoms (r = 0.27, p < .001). COVID-19 had a significant impact on the increase of stress (MI = 0.53, p < .001) and depressive symptoms (MI = 5.90, p < .001) as well as the decrease of resilience (MD = 2.17, p < .001) for women of color in the United States. These results can be translated into actionable care plans for clinicians and public health professionals that inform the development of tailored, culturally appropriate, equitable, and gender-specific mental health care for women of color in the age of COVID-19.
The COVID pandemic cast a harsh light on the structural and systemic health inequalities that exist in American society and in U.S. medical education. Black and Brown communities were disproportionately affected, and the pandemic highlighted the need for a diverse physician and healthcare workforce. Both the lack of equitable, high-quality healthcare in underrepresented communities and the obstacles that students who are underrepresented in medicine (URiM) experience in medical school are direct consequences of the structural racism that flourishes in U.S. medical schools and healthcare institutions. In this article, we explain structural racism and how it has manifested itself in medical education, including the lack of diversity among faculty and leadership, implicit biases and stereotypes about people of color, and discriminatory language used in evaluations of URiM students. We conclude with potential solutions for addressing structural racism in medical education. These include increasing diversity among faculty and leadership, implementing antiracist curricula, and providing mentorship and support for URiM students. Ultimately, we aim to promote discussion and action to eliminate structural racism in medical education in America.
The Southern United States (U.S.) accounts for more than half of new HIV cases annually and African Americans make up the majority of new HIV diagnoses in this region. Pre-Exposure Prophylaxis (PrEP) is an effective biomedical HIV prevention strategy that is underutilized. Few studies have examined the PrEP prescribing practices of primary care providers (PCPs), particularly in the Southern U.S. This cross-sectional survey, driven by the Transtheoretical Model (TTM), examined the prescribing practices of Southern U.S. PCPs. Relationships between PCPs personal and practice variables were examined, together with TTM decisional balance variables. Participants (n=223) who had more African American patients in their practice were more likely to be in a higher TTM stage of change (p = .002) and were more likely to have written a PrEP prescription (p = .001). Access to PrEP resources (OR = 1.85, p = .001), streamlined insurance prior authorization processes (OR = 1.52, p = .010), working with staff who have PrEP knowledge (OR = 1.51, p = .033), having PrEP training (OR = 40.26, p < .001) and having patients who are motivated to take PrEP (OR = 2.19, p = .007) were significant facilitators to PrEP prescribing. Significant barriers to PrEP prescribing included a lack of provider PrEP training (OR = 0.43, p = .003), lack of clinical leadership regarding PrEP (OR = 0.65, p = .018), lack of insurance (OR = 2.74, p = .002), and likelihood of low patient adherence to PrEP (OR = 0.53, p = .001). Findings indicate that this sample of PCPs were more likely to be at a higher TTM stage of change and have written a PrEP prescription if they saw more African American patients in their practice. Further, significant facilitators of PrEP prescribing included access to PrEP resources, streamlined insurance prior authorization processes, working with staff who have PrEP knowledge, having PrEP training, and having patients who are motivated to take PrEP. Significant barriers to PrEP prescribing included a lack of PrEP training, a lack of clinical leadership regarding PrEP, patient lack of insurance, and likelihood of low patient adherence. This study contributes to the body of knowledge regarding PCP PrEP prescribing practices. Findings from this study may inform future interventions that aim to enhance PrEP prescribing among primary care providers who serve Southern African American individuals at risk for acquisition of HIV disease.
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