Intersectionality and developing evidence-based policy

Qureshi, Irtiza; Gogoi, Mayuri; Al-Oraibi, Amani; Wobi, Fatimah; Pan, Daniel; Martin, Christopher; Chaloner, Jonathan; Woolf, Katherine; Pareek, Manish; Nellums, Laura B

doi:10.1016/s0140-6736(21)02801-4

Cited by 12 publications

(12 citation statements)

References 6 publications

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“…Also, the traditional prevention strategy framework recognizes that children with higher risk should be prioritized to receive prevention treatments (Brennan et al, 2020 ). The traditional prevention strategy often consider race, sex, sexual orientation, sexual identity, socioeconomic status and age independently and therefore fails to address the multiple intersecting needs of the individuals (Qureshi et al, 2022 ). While the finding of this research calls for critical examination of the underlying structure and factors that contributed to the disparities and how the prevention programs could be tailored to multiple intersecting higher-than-average needs of the minority populations who are likely belong multiple disadvantaged groups.…”

Section: Discussionmentioning

confidence: 99%

Psychometric evaluation of an Adverse Childhood Experiences (ACEs) measurement tool: an equitable assessment or reinforcing biases?

Mei

et al. 2022

Health Justice

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Background Utilizing Adverse Childhood Experiences (ACEs) measurement scales to assess youths’ adversities has expanded exponentially in health and justice studies. However, most of the ACEs assessment scales have yet to meet critical psychometric standards, especially for key demographic and minority groups. It is critical that any assessment or screening tool is not reinforcing bias, warranting the need for validating ACEs tools that are equitable, reliable and accurate. The current study aimed to examine the structural validity of an ACEs scale. Using data from the 2019 Behavioral Risk Factor Surveillance System (BRFSS), which collected of 97,314 responses collected from adults across sixteen states. This study assessed the psychometric properties and measurement invariance of the ACEs tool under the structural equation modeling framework. Results We found the 11-item ACEs screening tool as a second-order factor with three subscales, all of which passed the measurement invariance tests at metric and scalar levels across age, race, sex, socioeconomic status, gender identity, and sexual orientation. We also found that minority groups experienced more childhood adversity with small effect size, with the exception of the gender identity. Conclusion The ACEs measurement scale from the BRFSS is equitable and free from measurement bias regardless of one’s age, race, sex, socioeconomic status, gender identity, and sexual orientation, and thus is valid to be used to compare group mean differences within these groups. The scale is a potentially valid, viable, and predictive risk assessment in health and justice and research settings to identify high-risk groups or individuals for treatments.

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Section: Discussionmentioning

confidence: 99%

Psychometric evaluation of an Adverse Childhood Experiences (ACEs) measurement tool: an equitable assessment or reinforcing biases?

Mei

et al. 2022

Health Justice

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“…Furthermore, multiple areas of inequity or marginalisation may intersect. 46 Some factors such as bereavement, both personal and collective, have been exacerbated by the pandemic. 47 This underlines the importance of employers being aware of communities most affected, and of compassion and flexibility (e.g.…”

Section: Discussionmentioning

confidence: 99%

Mental health in a diverse sample of healthcare workers during the COVID-19 pandemic: cross-sectional analysis of the UK-REACH study

Melbourne

Guyatt

Nellums

et al. 2022

Preprint

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ObjectivesTo investigate how ethnicity and other sociodemographic, work, and physical health factors are related to mental health in UK healthcare and ancillary workers (HCWs), and how structural inequities in these factors may contribute to differences in mental health by ethnicity.DesignCross-sectional analysis of baseline data from the UK-REACH national cohort studySettingHCWs across UK healthcare settings.Participants11,695 HCWs working between December 2020-March 2021.Main outcome measuresAnxiety or depression symptoms (4-item Patient Health Questionnaire, cut-off >3), and Post-Traumatic Stress Disorder (PTSD) symptoms (3-item civilian PTSD Checklist, cut-off >5).ResultsAsian, Black, Mixed/multiple and Other ethnic groups had greater odds of PTSD than the White ethnic group. Differences in anxiety/depression were less pronounced. Younger, female HCWs, and those who were not doctors had increased odds of symptoms of both PTSD and anxiety/depression. Ethnic minority HCWs were more likely to experience the following work factors that were also associated with mental ill-health: workplace discrimination, feeling insecure in raising workplace concerns, seeing more patients with COVID-19, reporting lack of access to personal protective equipment (PPE), and working longer hours and night shifts. Ethnic minority HCWs were also more likely to live in a deprived area and have experienced bereavement due to COVID-19. After adjusting for sociodemographic and work factors, ethnic differences in PTSD were less pronounced and ethnic minority HCWs had lower odds of anxiety/depression compared to White HCWs.ConclusionsEthnic minority HCWs were more likely to experience PTSD and disproportionately experienced work and sociodemographic factors associated with PTSD, anxiety and depression. These findings could help inform future work to develop workplace strategies to safeguard HCWs’ mental health. This will only be possible with adequate investment in staff recruitment and retention, alongside concerted efforts to address inequities due to structural discrimination.Summary boxWhat is already known on this topicThe pandemic is placing healthcare workers under immense pressure, and there is currently a mental health crisis amongst NHS staffEthnic inequities in health outcomes are driven by structural discrimination, which occurs inside and outside the workplaceInvestigating ethnic inequities in the mental health of healthcare workers requires large diverse studies, of which few existWhat this study addsIn UK-REACH (N=11,695), ethnic minority staff had higher odds of Post-Traumatic Stress Disorder symptoms; we report many other factors associated with mental-ill health, including those experienced disproportionately by ethnic minority staff, such as workplace discrimination, contact with more patients with COVID-19, and bereavement due to COVID-19These findings underline the moral and practical need to care for staff mental health and wellbeing, which includes tackling structural inequities in the workplace; improving staff mental health may also reduce workforce understaffing due to absence and attrition

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“…Most research and policy looking at social inequalities has analysed it as separate and disentangled phenomena [ 11 , 12 ]. However, more recent perspectives acknowledge the interwoven nature of social inequalities, and the non-uniform effects that the influencing context may have on populations’ health [ 5 , 11 ].…”

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confidence: 99%

“…In addition, an intersectional approach helps us to shift the focus from individual risk factors to social power dynamics, reinforcing the importance of structural interventions that address social causes [ 7 ]. It also promotes proportionate universalism approaches that avoid “victim-blaming” as it is often done in individual approaches [ 11 ].…”

mentioning

confidence: 99%

Multimorbidity, social determinants and intersectionality in chronic patients. Results from the EpiChron Cohort

et al. 2023

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Background Multimorbidity is influenced in an interconnected way, both in extent and nature, by the social determinants of health. We aimed at implementing an intersectional approach to analyse the association of multimorbidity with five important axes of social inequality (i.e. gender, age, ethnicity, residence area and socioeconomic class). Methods We conducted a cross-sectional observational study of all individuals who presented with at least one chronic disease in 2019 (n = 1 086 948) from the EpiChron Cohort (Aragon, Spain). Applying intersectional analysis, the age-adjusted likelihood of multimorbidity was investigated across 36 intersectional strata defined by gender, ethnicity, residence area and socioeconomic class. We calculated odds ratios (OR) 95% confidence interval (CI) using high-income urban non-migrant men as the reference category. The area under the receiver operator characteristics curve (AUC) was calculated to evaluate the discriminatory accuracy of multimorbidity. Results The prevalence of multimorbidity increased with age, female gender and low income. Young and middle-aged low-income individuals showed rates of multimorbidity equivalent to those of high-income people aged about 20 years older. The intersectional analysis showed that low-income migrant women living in urban areas for >15 years were particularly disadvantaged in terms of multimorbidity risk OR = 3.16 (95% CI = 2.79-3.57). Being a migrant was a protective factor for multimorbidity, and newly arrived migrants had lower multimorbidity rates than those with >15 years of stay in Aragon, and even non-migrants. Living in rural vs. urban areas was slightly protective against multimorbidity. All models had a large discriminatory accuracy (AUC = 0.7884-0.7895); the largest AUC was obtained for the model including all intersectional strata. Conclusions Our intersectional approach uncovered the large differences in the prevalence of multimorbidity that arise due to the synergies between the different socioeconomic and demographic exposures, beyond their expected additive effects.

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Intersectionality and developing evidence-based policy

Cited by 12 publications

References 6 publications

Psychometric evaluation of an Adverse Childhood Experiences (ACEs) measurement tool: an equitable assessment or reinforcing biases?

Psychometric evaluation of an Adverse Childhood Experiences (ACEs) measurement tool: an equitable assessment or reinforcing biases?

Mental health in a diverse sample of healthcare workers during the COVID-19 pandemic: cross-sectional analysis of the UK-REACH study

Multimorbidity, social determinants and intersectionality in chronic patients. Results from the EpiChron Cohort

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