Racism is now widely recognized as a fundamental cause of health inequalities in the United States. As such, health scholars have rightly turned their attention toward examining the role of structural racism in fostering morbidity and mortality. However, to date, much of the empirical structural racism-health disparities literature limits the operationalization of structural racism to a single domain or orients the construct around a White/ Black racial frame. This operationalization approach is incomprehensive and overlooks the heterogeneity of historical and lived experiences among other racial and ethnic groups.To address this gap, we present a theoretically grounded framework that illuminates core mutually reinforcing domains of structural racism that have stratified opportunities for health in the United States. We catalog instances of structural discrimination that were particularly constraining (or advantageous) to the health of racial and ethnic groups from the late 1400s to present. We then illustrate the utility of this framework by applying it to American Indians or Alaska Natives and discuss the framework’s broader implications for empirical health research. This framework should help future scholars across disciplines as they identify and interrogate important laws, policies, and norms that have differentially constrained opportunities for health among racial and ethnic groups.Ethn Dis. 2021;31(Suppl 1):301-310; doi:10.18865/ed.31.S1.301
Despite repeated calls by scholars to critically engage with the concepts of race and ethnicity in US epidemiologic research, the incorporation of these social constructs in scholarship may be suboptimal. This study characterizes the conceptualization, operationalization, and utilization of race and ethnicity in US research published in leading journals whose publications shape discourse and norms around race, ethnicity, and health within the field of epidemiology. We systematically reviewed randomly selected articles from prominent epidemiology journals across five periods: 1995-99, 2000-04, 2005-09, 2010-14, 2015-18. All original human-subjects research conducted in the US was eligible for review. Information on definitions, measurement, coding, and use in analysis was extracted. We reviewed 1050 articles, including 414 (39%) in analyses. Four studies explicitly defined race and/or ethnicity. Authors rarely made clear delineations between race and ethnicity, often adopting an ethno-racial construct. In the majority of studies across time periods, authors did not state how race and/or ethnicity was measured. Top coding schemes included “Black, White” (race), “Hispanic, Non-Hispanic” (ethnicity), and “Black, White, Hispanic” (ethno-racial). Most often, race and ethnicity were deemed “not of interest” in analyses (e.g., control variable). Broadly, disciplinary practices have remained largely the same between 1995-2018 and are in need of improvement.
BackgroundWhile primary care medical clinics have been the most common setting for the delivery of advice about smoking cessation, the hospital emergency department (ED) is a valuable context for counseling medically underserved tobacco users. We conducted a secondary analysis based on a larger audio-recorded study of patient-provider communication about pain and analgesics in the ED. Within a sample of ED patients with back pain, the purpose of this mixed-methods study was to examine how physicians and nurse practitioners capitalize on “teachable moments” for health education to offer spontaneous smoking cessation counseling in the ED.MethodsPatients presenting to an academic ED with a primary complaint of back pain were invited to participate in a study of patient-provider communication. Audio-recorded encounters were transcribed verbatim. Two coders reviewed each transcript to determine whether smoking was discussed and to build a corpus of smoking-related discussions. We then developed inductively generated coding categories to characterize how providers responded when patients endorsed smoking behavior. Categories were refined iteratively to accommodate discrepancies.ResultsOf 52 patient-provider encounters during which smoking was discussed, two-thirds of the patients indicated that they were smokers. Providers missed opportunities for smoking cessation counseling 70% of the time. Eleven encounters contained teachable moments for smoking cessation. We identified four primary strategies for creating teachable moments: 1) positive reinforcement, 2) encouragement, 3) assessing readiness, and 4) offering concrete motivating reasons.ConclusionsMost providers missed opportunities to offer teachable moments for smoking cessation. In encounters that contained teachable moments, providers employed multiple strategies, combining general advice with motivation tailored to the patient’s particular circumstances. Creating motivational links to enhance smoking cessation efforts may be possible with a minimal investment of ED resources.
Objective We examined the direct and indirect means by which patients express a desire for analgesic medication. Methods Back pain patients presenting to an academic ED were invited to participate in a study of patient-provider communication. Audio-recorded encounters were transcribed verbatim and transcripts analyzed using a qualitative approach based on conversation analysis. Results Requests for analgesics were documented in 15 out of 74 interactions (20%). We identified three basic patterns: direct requests, in which the patient explicitly asked for medication; indirect requests, in which the patient hinted at a desire for medication but did not ask for it outright; and no request, in which the provider discussed a prescription without the patient requesting it. Conclusion Most patients did not request analgesics. When they did so, they utilized strategies of mitigation, indirection, and deference that presented themselves as deserving patients while upholding the physician's autonomy. Practice Implications Patients come to the clinical encounter with a variety of expectations, of which a desire for an analgesic may be only part of the picture. Rather than focusing on strategies for inuring providers to inappropriate patient requests, it may be useful to devote clinical resources to examining patients' priorities and expectations for treatment.
When public health considers the health and disease status of Indigenous people, it often does so using a racial lens. In recent decades, public health researchers have begun to acknowledge that commonly employed racial categories represent history, power dynamics, embodiment, and legacies of discrimination and racism, rather than innate biology. Even so, public health has not yet fully embraced an understanding of other components of identity formation for Indigenous people, including political status within Native nations. In this article, we discuss why the continued racial conceptualization of Indigeneity in US public health is inadequate. We begin by providing a brief account of racialization as a tool of colonization, of failure to recognize and acknowledge Indigenous sovereignty, and of common public health practices of Indigenous data collection and interpretation. We then articulate the stakes of racialized health data for Native communities. We end by offering alternative approaches, many drawn from scholarship from Indigenous researchers. (Am J Public Health. 2021;111(11):1969–1975. https://doi.org/10.2105/AJPH.2021.306465 )
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