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Reproducing Race, an ethnography of pregnancy and birth at a large New York City public hospital, explores the role of race in the medical setting. Khiara M. Bridges investigates how race--commonly seen as biological in the medical world--is socially constructed among women dependent on the public healthcare system for prenatal care and childbirth. Bridges argues that race carries powerful material consequences for these women even when it is not explicitly named, showing how they are marginalized by the practices and assumptions of the clinic staff. Deftly weaving ethnographic evidence into broader discussions of Medicaid and racial disparities in infant and maternal mortality, Bridges shines new light on the politics of healthcare for the poor, demonstrating how the \"medicalization\" of social problems reproduces racial stereotypes and governs the bodies of poor women of color.

Objectives Severe maternal morbidity (SMM) is an important indicator for identifying and monitoring efforts to improve maternal health. Studies have identified independent risk factors, including race/ethnicity; however, there has been limited investigation of the modifying effect of socioeconomic factors. Study aims were to quantify SMM risk factors and to determine if socioeconomic status modifies the effect of race/ethnicity on SMM risk. Methods We used 2008–2012 NYC birth certificates matched with hospital discharge records for maternal deliveries. SMM was defined using an algorithm developed by the Centers for Disease Control and Prevention. Mixed-effects logistic regression models estimated SMM risk by demographic, socioeconomic, and health characteristics. The final model was stratified by Medicaid status (as a proxy for income), education, and neighborhood poverty. Results Of 588,232 matched hospital deliveries, 13,505 (229.6 per 10,000) had SMM. SMM rates varied by maternal age, birthplace, education, income, pre-existing chronic conditions, pre-pregnancy weight status, trimester of prenatal care entry, plurality, and parity. Race/ethnicity was consistently and significantly associated with SMM. While racial differences in SMM risk persisted across all socioeconomic groupings, the risk was exacerbated among Latinas and Asian-Pacific Islanders with lower income when compared to white non-Latinas. Similarly, living in the poorest neighborhoods exacerbated SMM risk among both black non-Latinas and Latinas. Conclusions for Practice SMM determinants in NYC mirror national trends, including racial/ethnic disparities. However, these disparities persisted even in the highest income and educational groups suggesting other pathways are needed to explain racial/ethnic differences.

Investing in community health workers and community-based organizations can help address the social determinants of poor health that disproportionately affect low-income, minority populations and that are magnified during times of crisis.

Background Prior studies have found racial and ethnic disparities in cancer screenings, yet smaller minority ethnic groups are often aggregated. Methods Data from the 2021–2022 Community Health Resources and Needs Assessment (Cancer CHRNA) and the 2017–2020 NYC Community Health Survey (CHS) examined the prevalence of breast, cervical, and colorectal cancer screenings among Eastern European, Afro-Caribbean, Latine, Chinese, Korean, South Asian, and Southwest Asian and North African (SWANA) groups in New York City. Multivariable logistic regression models estimated adjusted relative risks of cancer screening outcomes by group. Results Up-to-date mammogram screening was low (< 70%) among all groups except Afro-Caribbean in the Cancer CHRNA; and among South Asian, Chinese, and Eastern European groups in the CHS. In logistic regression, South Asian and SWANA groups were less likely to have received an up-to-date mammogram compared to the Afro-Caribbean group in the Cancer CHRNA; no group differences were found in the CHS. Up-to-date Pap screening was low (< 70%) among all groups except Latina in the Cancer CHRNA; and among South Asian and Chinese groups in the CHS. In logistic regression, all other groups were less likely to have received an up-to-date Pap test compared to the Latina group in the Cancer CHRNA; and Chinese and South Asian groups were less likely to have received an up-to-date Pap test compared to the Latina group in the CHS. Up-to-date colonoscopy screening was low (< 70%) among all groups in the Cancer CHRNA; and among SWANA, South Asian, Chinese, and Eastern European groups in the CHS. In logistic regression, all groups except Chinese were less likely to have received an up-to-date colonoscopy compared to the Eastern European group in the Cancer CHRNA; and the Chinese and SWANA groups were less likely to have received an up-to-date colonoscopy compared to the Afro-Caribbean group in the CHS. Conclusions Disparities in cancer screenings differed by screening type and survey, with larger disparities found among groups in the Cancer CHRNA. System level efforts are needed to monitor cancer screening disparities by disaggregating diverse groups; culturally tailored strategies should be used to raise awareness to increase screening. Clinical trial information Not applicable.

Objectives. We evaluated use of the Index of Concentration at the Extremes (ICE) for public health monitoring. Methods. We used New York City data centered around 2010 to assess cross-sectional associations at the census tract and community district levels, for (1) diverse ICE measures plus the US poverty rate, with (2) infant mortality, premature mortality (before age 65 years), and diabetes mortality. Results. Point estimates for rate ratios were consistently greatest for the novel ICE that jointly measured extreme concentrations of income and race/ethnicity. For example, the census tract–level rate ratio for infant mortality comparing the bottom versus top quintile for an ICE contrasting low-income Black versus high-income White equaled 2.93 (95% confidence interval [CI] = 2.11, 4.09), but was 2.19 (95% CI = 1.59, 3.02) for low versus high income, 2.77 (95% CI = 2.02, 3.81) for Black versus White, and 1.56 (95% CI = 1.19, 2.04) for census tracts with greater than or equal to 30% versus less than 10% below poverty. Conclusions. The ICE may be a useful metric for public health monitoring, as it simultaneously captures extremes of privilege and deprivation and can jointly measure economic and racial/ethnic segregation.

Background Disparities in lung cancer outcomes persist among Black Americans, necessitating targeted interventions to address screening inequities. This paper reports the development and refinement of Witness Project ® Lung, a community-based initiative tailored to the specific needs of the Black community, aiming to improve awareness and engagement with lung cancer screening. Methods Utilizing a user-centered design and guided by the original Witness Project ® framework – an evidence-based lay health advisor intervention program originally developed to increase knowledge and awareness about breast cancer risk and screening in the Black community and later trans-created to the cervical and colorectal cancer screening contexts - Witness Project ® Lung was developed and refined through qualitative input from key stakeholders in the Black faith community. Guided by the PEN-3 model and the Conceptual Model for Lung Cancer Screening Participation, the program underwent a rigorous development process to ensure cultural relevance and was pilot tested in the New York City metropolitan area in faith-based and community-based organizational sites in the Black community. Results Pilot testing conducted in New York and New Jersey demonstrated high acceptability, satisfaction, and increased knowledge among participants. The community-based approach, culturally sensitive messaging, and partnerships with faith-based organizations were critical to the refinements of Witness Project ® to Witness Project ® Lung. The program’s focus on addressing social determinants of health and its delivery by trained lay health advisors showcased feasibility and potential effectiveness. Witness Project ® Lung presents a promising alternative to traditional health system-based interventions for improving lung screening rates among Black Americans. Conclusions The community-based, culturally tailored approach, coupled with the involvement of trusted community leaders, has the potential to reduce disparities in lung cancer outcomes. Further research is needed to assess the long-term impact and cost-effectiveness of Witness Project ® Lung in promoting lung screening uptake and improving health outcomes within underserved populations.

Alternative tobacco products (ATPs), such as cigars, smokeless tobacco, and electronic nicotine delivery systems (ENDS), have a strong presence in the US retail environment amid declining cigarette consumption. This study documented the promotion of ATPs in tobacco retailers in New York City and examined associations with neighborhood demographics. Data on product availability and advertising were collected from a stratified, random sample of tobacco retailers in 2017 (n = 796). Multilevel models estimated adjusted prevalence ratios (aPRs) for each outcome by neighborhood racial/ethnic composition and median household income. Nearly half (49.8%) of retailers carried 99-cent cigarillos, but availability was significantly greater in neighborhoods in the highest (vs. lowest) quartile for the percentage of Black residents [68.2%, aPR: 1.59 (1.19, 2.11)] and in the lowest (vs. highest) income quartile [67.3%, aPR: 1.56 (1.04, 2.35)]. Conversely, retailers in neighborhoods with the highest percentage of White residents were significantly more likely to carry ENDS [66.4%, aPR: 1.71 (1.11, 2.62)]. Advertisements for ENDS were less common in neighborhoods in the highest (vs. lowest) quartiles for the percentage of Black and Hispanic residents [20.3%, aPR: 0.64 (0.41, 0.99); 22.9%, aPR: 0.62 (0.40, 0.98)]. The marketing of inexpensive, combusted tobacco products disproportionately saturates low-income, minority communities, while potentially lower risk, noncombusted products are more accessible in largely White and higher income neighborhoods. This pattern may exacerbate tobacco-related inequities. Public health policies should prioritize reducing the appeal and affordability of the most harmful tobacco products to help reduce health disparities. Although cigarette promotion at the point-of-sale is well documented in the literature, questions remain about the ways in which alternative tobacco products (ATPs) are marketed in communities. Importantly, these products fall on a continuum of harm, with combusted tobacco overwhelmingly responsible for tobacco-related death and disease. We found that retailers in minority and low-income communities were more likely to carry and advertise inexpensive ATPs such as cigarillos, while potentially less risky, noncombusted products such as smokeless tobacco and e-cigarettes were more accessible in higher income and predominantly White neighborhoods. Policies aligned with product risk may help reduce health disparities.

Objectives. To determine if de facto postpartum Medicaid extension during the Families First Coronavirus Response Act (FFCRA) reduced immigrant versus US-born inequities in uninsurance. Methods. We assessed self-reported uninsurance at 2 to 6 months postpartum among people with Medicaid-paid births using the New York City Pregnancy Risk Assessment Monitoring System (PRAMS), comparing immigrant and US-born people. We created a pre-FFCRA cohort of 2611 births from 2016 to 2019 and a post-FFCRA implementation cohort of 1197 births from 2020 to 2021. We calculated risk differences using log binomial regression. Results. Self-reported postpartum uninsurance among immigrants decreased from 13.6% to 9.3% after FFCRA (adjusted risk difference = −4.9%; 95% confidence interval = −7.8%, −2.0%). Immigrant versus US-born inequities in postpartum uninsurance decreased except among Hispanic birthing people, among whom 1 in 6 reported they were uninsured during FFCRA, despite continued eligibility. Conclusions. De facto postpartum Medicaid extension decreased immigrant inequities in insurance coverage, but Hispanic immigrants may have been unaware of continued coverage. Public Health Implications. Postpartum Medicaid extension policies that are inclusive of all immigrants may decrease inequities, but community-integrated implementation is needed to raise awareness of coverage and advance postpartum maternal health equity. ( Am J Public Health. 2025;115(5):732–735. https://doi.org/10.2105/AJPH.2024.307968 )

Idiopathic pulmonary fibrosis is often initially misdiagnosed. Delays in accessing subspecialty care could lead to worse outcomes among those with idiopathic pulmonary fibrosis. To examine the association between delayed access to subspecialty care and survival time in idiopathic pulmonary fibrosis. We performed a prospective cohort study of 129 adults who met American Thoracic Society criteria for idiopathic pulmonary fibrosis evaluated at a tertiary care center. Delay was defined as the time from the onset of dyspnea to the date of initial evaluation at a tertiary care center. We used competing risk survival methods to examine survival time and time to transplantation. The mean age was 63 years and 76% were men. The median delay was 2.2 years (interquartile range 1.0–3.8 yr), and the median follow-up time was 1.1 years. Age and lung function at the time of evaluation did not vary by delay. A longer delay was associated with an increased risk of death independent of age, sex, forced vital capacity, third-party payer, and educational attainment (adjusted hazard ratio per doubling of delay was 1.3, 95% confidence interval 1.03 to 1.6). Longer delay was not associated with a lower likelihood of undergoing lung transplantation. Delayed access to a tertiary care center is associated with a higher mortality rate in idiopathic pulmonary fibrosis independent of disease severity. Early referral to a specialty center should be considered for those with known or suspected interstitial lung disease.

Background: Black and Latina women in New York City are twice as likely to experi­ence a potentially life-threatening morbid­ity during childbirth than White women. Health care quality is thought to play a role in this stark disparity, and patient-provider communication is one aspect of health care quality targeted for improvement. Perceived health care discrimination may influence patient-provider communication but has not been adequately explored during the birth hospitalization.Purpose: Our objective was to investi­gate the impact of perceived racial-ethnic discrimination on patient-provider com­munication among Black and Latina women giving birth in a hospital setting.Methods: We conducted four focus groups of Black and Latina women (n=27) who gave birth in the past year at a large hospital in New York City. Moderators of concordant race/ethnicity asked a series of questions on the women’s experiences and interactions with health care providers during their birth hospitalizations. One group was conducted in Spanish. We used an integrative analytic approach. We used the behavioral model for vulnerable populations adapted for critical race theory as a starting conceptual model. Two analysts deductively coded transcripts for emergent themes, using con­stant comparison method to reconcile and refine code structure. Codes were catego­rized into themes and assigned to concep­tual model categories.Results: Predisposing patient factors in our conceptual model were intersectional identities (eg, immigrant/Latina or Black/ Medicaid recipient), race consciousness (“… as a woman of color, if I am not assertive, if I am not willing to ask, then they will not make an effort to answer”), and socially assigned race (eg, “what you look like, how you talk”). We classified themes of differential treatment as impeding factors, which included factors overlooked in previ­ous research, such as perceived differential treatment due to the relationship with the infant’s father and room assignment. Themes for differential treatment co-oc­curred with negative provider communica­tion attributes (eg, impersonal, judgmental) or experience (eg, not listened to, given low priority, preferences not respected).Conclusions: Perceived racial-ethnic discrimination during childbirth influences patient-provider communication and is an important and potentially modifiable aspect of the patient experience. Interventions to reduce obstetric health care disparities should address perceived discrimination, both from the provider and patient per­spectives.Ethn Dis. 2020;30(4):533-542;doi:10.18865/ed.30.4.533