Black Americans experience stereotyping when receiving care, harming the therapeutic relationship and likely contributing to inequities in hypertension management. Although patients have described these experiences, there is limited understanding from clinicians’ perspectives. We conducted an Interpretive Description study with 30 Minnesota family medicine physicians between July and September 2023 to explore the assumptions associated with hypertensive Black patients, as perceived by the clinicians. Transcripts were analyzed and themes developed using thematic analysis with inductive and deductive approaches. Participants observed that they, or their colleagues (1) viewed Black patients as having hypertension that was more challenging to manage due to factors outside the clinicians’ control, and (2) changed their approach to Black patients’ hypertension management in response to assumed difficulty. Participants viewed Black patients as less willing and able to manage their hypertension due to mistrust and biological, behavioral, and social factors. Perceived barriers to hypertension management overlapped with what participants described as stereotypes of Black patients, and a few participants acknowledged that clinicians may convey their lower expectations of Black patients through disinvestment in their care. Participants viewed Black patients as having greater challenges with hypertension control due to factors that were seen as being indiscriminately assumed of these patients, potentially resulting in reduced clinician engagement. As such, clinicians must balance their knowledge of population-level disparities with an individualized approach to patient care. To reduce stereotyping of Black patients, it is crucial to pay closer attention to how population-level differences are discussed and applied.

The “tough Black man” is expected to be physically strong, emotionally restrictive, resilient, and self-reliant. However, to date, limited research has examined the correlates of endorsing beliefs ...

BACKGROUND: Phthalate exposures are ubiquitous during pregnancy and may contribute to racial and ethnic disparities in preterm birth. OBJECTIVES: We investigated race and ethnicity in the relationship between biomarkers of phthalate exposure and preterm birth by examining: a) how hypothetical reductions in racial and ethnic disparities in phthalate metabolites might reduce the probability of preterm birth; and b) exposure-response models stratified by race and ethnicity. METHODS: We pooled individual-level data on 6,045 pregnancies from 16 U.S. cohorts. We investigated covariate-adjusted differences in nine urinary phthalate metabolite concentrations by race and ethnicity [non-Hispanic White (White, 43%), non-Hispanic Black (Black, 13%), Hispanic/Latina (38%), and Asian/Pacific Islander (3%)]. Using g-computation, we estimated changes in the probability of preterm birth under hypothetical interventions to eliminate disparities in levels of urinary phthalate metabolites by proportionally lowering average concentrations in Black and Hispanic/Latina participants to be approximately equal to the averages in White participants. We also used race and ethnicity-stratified logistic regression to characterize associations between phthalate metabolites and preterm birth. RESULTS: In comparison with concentrations among White participants, adjusted mean phthalate metabolite concentrations were consistently higher among Black and Hispanic/Latina participants by 23%-148% and 4%-94%, respectively. Asian/Pacific Islander participants had metabolite levels that were similar to those of White participants. Hypothetical interventions to reduce disparities in metabolite mixtures were associated with lower probabilities of preterm birth for Black [13% relative reduction; 95% confidence interval (CI): formula presented , 8.6%] and Hispanic/Latina (9% relative reduction; 95% CI: formula presented , 0.8%) participants. Odds ratios for preterm birth in association with phthalate metabolites demonstrated heterogeneity by race and ethnicity for two individual metabolites (mono-n-butyl and monoisobutyl phthalate), with positive associations that were larger in magnitude observed among Black or Hispanic/Latina participants. CONCLUSIONS: Phthalate metabolite concentrations differed substantially by race and ethnicity. Our results show hypothetical interventions to reduce population-level racial and ethnic disparities in biomarkers of phthalate exposure could potentially reduce the probability of preterm birth. https://doi.org/10.1289/EHP12831.

Rates of mental health symptoms, particularly anxiety and depression, have increased significantly in college students in the past decade along with utilization of mental health resources. The COVID-19 pandemic created an additional source of stressors to an already challenging landscape of college transition. COVID-19 has been associated with an increase of anxiety among college students, particularly first year students, entering college in Fall 2020. The shifts in policy (e.g., federal, state, and college) accruing medical data, and vaccine availability between Fall 2020 and Fall 2021 provide an opportunity to examine the role of COVID-19 experiences in the transition to college for these two first-year student cohorts. This study examined two cohorts of first-year students, Fall 2020 and 2021, to better understand the relationship between COVID-19 experiences, psychosocial correlates, and mental health symptoms. Results suggest that for students in our Fall 2020 cohort COVID-19 experiences played a distinct role in the prediction of mental health symptoms while in Fall 2021 COVID-19 experiences did not uniquely contribute to prediction of mental health symptoms. These findings have implications for mental health interventions for first-year students transitioning to college.

Scholars have documented harm associated with positive stereotypes about groups that experience inequality. We surveyed five samples from the United States to explore antecedents to dominant group endorsement of positive stereotypes about women, gay men, Asian Americans, Black Americans, and Native Americans. We found more liberal participants, and those with more close contact with members of these groups, were more internally motivated to respond without prejudice, which was then associated with greater endorsement of positive stereotypes about women, gay men, Black Americans, and Native Americans. In contrast, more conservative participants were more likely to believe in system legitimacy, which was then associated with greater endorsement of positive stereotypes about women and Asian Americans. We theorize that positive stereotypes are used by dominant group members in divergent ways, sometimes to legitimate inequality and other times with concern about inequality. The latter likely involves naivety regarding the harmful nature of positive stereotypes.

Direct-to-consumer genetic ancestry tests measure biogeographic ancestry (BGA), which refers to an individual's ancestral origin in relation to major population groups. There is growing concern that biogeographic information exaggerates both false beliefs about racial genetic differences and, ultimately, racial bias. Across three studies (N = 1317), we find that biogeographic information impacts racial categorization and beliefs about both genetic racial essentialism (i.e., the extent to which people believe that race is genetically derived) and biological race differences. Specifically, we find people are more likely to categorize Black/White biracial targets as Black and believe that a target is more biologically different from White people (e.g., has thicker skin) as the target's percent sub-Saharan African biogeographic ancestry (ABGA) increases (Studies 1 and 2). We also find that people misrepresent BGA as “race genes,” such that they perceive Black/White biracial targets with more ABGA as sharing more genes with Black people, which then predicts greater Black racial categorization of the target and increased beliefs that the target is susceptible to certain physical and mental illnesses (Study 2). Notably, BGA remains a predictor of these outcomes even when people know the target's specific racial ancestry, that is, their exact number of Black grandparents (Study 2). Finally, we find that exposing people to the idea that race is genetically derived, compared to biologically derived, exaggerates beliefs that genes determine both human life (genetic essentialism) and racial categories (genetic racial essentialism; Study 3). We discuss implications for studying psychological essentialism, racial bias, and racial health disparities.

Objective: Self-infrahumanization or perceiving oneself as lacking the experience of uniquely human emotions, and endorsement of Strong Black Woman (SBW) schema, or self-superhumanization, are two forms of dehumanization. Among African American women, SBW schema endorsement is associated with greater negative attitudes toward seeking professional psychological help (ATSPPH) and poorer mental health. Self-infrahumanization is associated with fewer adaptive stress responses and poorer well-being. This research examines the relationship between self-infrahumanization and self-superhumanization on ATSPPH and mental health among African American women. We hypothesized that self-infrahumanization and self-superhumanization will be associated with greater negative ATSPPH and greater mental health symptomatology. We also hypothesized that ATSPPH will mediate the interactive effect of selfinfrahumanization and SBW schema endorsement on mental health symptomatology. Method: Four hundred and forty-nine self-identified African American women (Mage = 37.96; SDage = 15.55; age range: 18–87) completed an online, self-administered Qualtrics survey investigating the social and psychological determinants of health. Results: Self-infrahumanization was not associated with mental health symptomatology. Greater SBW schema endorsement was associated with greater mental health symptomatology. Self-infrahumanization and SBW schema endorsement were not associated with ATSPPH. ATSPPH mediated the interaction between SBW and self-infrahumanization on mental health symptomatology. At high and average—but not low—levels of SBW schema endorsement, greater self-infrahumanization was associated with lower positive ATSPPH, which was then associated with greater mental health symptomatology. Conclusions: Among African American women, believing that one lacks the experience of uniquely human emotions exacerbates the negative effects of endorsing SBW schema. We discuss the role of dehumanization processes in health disparities research.

Purpose: The purpose of this report from the field is to describe the process by which an multidisciplinary workgroup, selected by the CDC Foundation in partnership with maternal health experts, developed a definition of racism that would be specifically appropriate for inclusion on the Maternal Mortality Review Information Application (MMRIA) form. Description: In the United States Black women are nearly 4 times more likely to experience a pregnancy-related death. Recent evidence points to racism as a fundamental cause of this inequity. Furthermore, the CDC reports that 3 of 5 pregnancy related deaths are preventable. With these startling facts in mind, the CDC created the Maternal Mortality Review Information Application (MMRIA) for use by Maternal Mortality Review Committees (MMRC) to support standardized data abstraction, case narrative development, documentation of committee decisions, and analysis on maternal mortality to inform practices and policies for preventing maternal mortality. Assessment: Charged with the task of defining racism and discrimination as contributors to pregnancy related mortality, the work group established four goals to define their efforts: (1) the desire to create a product that was inclusive of all forms of racism and discrimination experienced by birthing people; (2) an acknowledgement of the legacy of racism in the U.S. and the norms in health care delivery that perpetuate racist ideology; (3) an acknowledgement of the racist narratives surrounding the issue of maternal mortality and morbidity that often leads to victim blaming; and (4) that the product would be user friendly for MMRCs. Conclusion: The working group developed three definitions and a list of recommendations for action to help MMRC members provide suggested interventions to adopt when discrimination or racism were contributing factors to a maternal death. The specification of these definitions will allow the systematic tracking of the contribution of racism to maternal mortality through the MMRIA and allow a greater standardization of its identification across participating jurisdictions with MMRCs that use the form.

Vietnam's strong performance on the 2012 and 2015 PISA assessments has led to interest in what explains the strong academic performance of Vietnamese students. Analysis of the PISA data has not shed much light on this issue. This paper analyses a much richer data set, the Young Lives data for Ethiopia, India (Andhra Pradesh and Telangana), Peru and Vietnam, to investigate the reasons for the strong academic performance of 15-year-olds in Vietnam. Differences in observed child and household characteristics explain 37-39 percent of the gap between Vietnam, and Ethiopia, while observed school variables explain only about 3-4 additional percentage points (although an important variable, math teachers' pedagogical skills, is not available for Ethiopia). Differences in observed child and household characteristics explain very little of the gaps between Vietnam and India and between Vietnam and Peru, yet one observed school variable has a large explanatory effect: primary school math teachers' pedagogical skills. It explains about 10-12 percent of the gap between Vietnam and India, raising the overall explained portion to 14-21 percent of the gap. For Peru, it explains most (65-84 percent) of the gap.

This study (N = 780) examines the indirect effects of hardiness—health locus of control (HLOC), health competence (HC), health value (HV)—on past-year healthcare provider visit via attitudes toward seeking and receiving professional healthcare services (ATSRPHS). Across four health domains (dental, general health, mental, vision), ATSRPHS mediated the indirect effect of (1) HV and (2) internal HLoC on past-year healthcare provider visit. ATSRPHS also mediated the indirect effect of external HLoC on past-year visit to healthcare provider visit for general medical, mental, and vision health. ATSRPHS did not mediate any indirect effect of HC on past-year healthcare provider visit. This research contributes to understanding determinants of healthcare service utilization among Black American adults.

This study examines the extent to which older males are willing to offer psychosocial and sexual health promoting support to their younger male partners, as well as the individual and relationship-level factors associated with this willingness to provide support. In total, 324 men over the age of 45, who currently or previously had younger male sexual partners, completed an anonymous online survey. Results show that participants were most willing to provide emotional support to their younger male partners, followed by health-related encouragement, HIV/STI testing support, and financial support. Of note, HIV positive status and being in a “main partnership” were associated with greater willingness to provide financial support. These results suggest that older men are willing to provide psychosocial and health promotive support to younger male partners, which could be leveraged in targeted interventions to reduce HIV transmission.

The emergent wetland species Typha domingensis (cattail) is a native Florida Everglades monocotyledonous macrophyte. It has become invasive due to anthropogenic disturbances and is out-competing other vegetation in the region, especially in areas historically dominated by Cladium jamaicense (sawgrass). There is a need for a quantitative, deterministic model in order to accurately simulate the regional-scale cattail dynamics in the Everglades. The Regional Simulation Model (RSM), combined with the Transport and Reaction Simulation Engine (TARSE), was adapted to simulate ecology. This provides a framework for user-defineable equations and relationships and enables multiple theories with different levels of complexity to be tested simultaneously. Five models, or levels, of increasing complexity were used to simulate cattail dynamics across Water Conservation Area 2A (WCA2A), which is located just south of Lake Okeechobee, in Florida, USA. These levels of complexity were formulated to correspond with five hypotheses regarding the growth and spread of cattail. The first level of complexity assumed a logistic growth pattern to test whether cattail growth is density dependent. The second level of complexity built on the first and included a Habitat Suitability Index (HSI) factor influenced by water depth to test whether this might be an important factor for cattail expansion. The third level of complexity built on the second and included an HSI factor influenced by soil phosphorus concentration to test whether this is a contributing factor for cattail expansion. The fourth level of complexity built on the third and included an HSI factor influenced by (a level 1–simulated) sawgrass density to determine whether sawgrass density impacted the rate of cattail expansion. The fifth level of complexity built on the fourth and included a feedback mechanism whereby the cattail densities influenced the sawgrass densities to determine the impact of inter-species interactions on the cattail dynamics. All the simulation results from the different levels of complexity were compared to observed data for the years 1995 and 2003. Their performance was analyzed using a number of different statistics that each represent a different perspective on the ecological dynamics of the system. These statistics include box-plots, abundance-area curves, Moran’s I, and classified difference. The statistics were summarized using the Nash-Sutcliffe coefficient. The results from all of these comparisons indicate that the more complex level 4 and level 5 models were able to simulate the observed data with a reasonable degree of accuracy. A user-defineable, quantitative, deterministic modeling framework was introduced and tested against various hypotheses. It was determined that the more complex models (levels 4 and 5) were able to adequately simulate the observed patterns of cattail densities within the WCA2A region. These models require testing for uncertainty and sensitivity of their various parameters in order to better understand them but could eventually be used to provide insight for management decisions concerning the WCA2A region and the Everglades in general.

Adverse Childhood Experiences (ACEs) include abuse, neglect, and general household dysfunction. Operating through complex pathways, ACEs exert a strong negative influence on adult health and health behaviors. Yet most of the research on the intragenerational consequences of ACEs examines associations and effects for those who directly experienced the adversity, obscuring how ACEs might be associated with the health and well-being of one's partner. In this paper, we investigate the relationship between respondent and partner ACEs and the associations between respondent's ACEs count and their self-rated health and life satisfaction as well as their partner's health and life satisfaction. Results reveal that people with ACEs tend to partner with others who have ACEs, and that ACEs are positvely associated with lower self-rated health and lower life satisfaction for both respondents and their partners. These findings begin to illuminate unknown consequential intragenerational associations of ACEs for health and well-being beyond those who experienced the adversity firsthand. 3