Keisha L. Bentley-Edwards

Background: This study examined whether religious coping modified the longitudinal associations between lifetime discrimination and subclinical atherosclerotic cardiovascular disease risk among Black individuals, and if these effects differed by sex. Methods: Data were collected from 753 Black adult participants (44.5% men; mean age=49.3 years) in the Healthy Aging in Neighborhoods of Diversity across the Life Span study. Carotid intima‐media thickness (CIMT) was measured using ultrasonography at baseline (Wave 1: 2004–2009) and a subsequent follow‐up visit (Wave 4: 2013–2017). Abnormal CIMT was defined as ≥1.0 mm of plaque buildup. Religious coping, racial discrimination, and burden of lifetime discrimination were self‐reported at baseline. Results: Mixed‐effects multivariable logistic regression analyses estimated the longitudinal associations between a 3‐way interaction term (discrimination, religious coping, and sex) and abnormal CIMT in models adjusted for age and socioeconomic status. For Black men, those who engaged in religious coping the least had higher odds of abnormal CIMT for both racial (OR=1.22, 95% CI [1.02–1.48], P =0.03) and burden of lifetime discrimination (OR=1.75, 95% CI [1.14–2.69], P =0.01). The associations were attenuated at higher levels of religious coping. No associations were found among women. Conclusions: The effects of discrimination on abnormal CIMT lessened as religious coping increased for Black men. Future research is needed to disentangle how aspects of religious coping might yield benefits linked with atherosclerotic cardiovascular disease risk for this group and identify alternative psychosocial resources effective in mitigating discrimination effects on health for Black women.

An abstract is unavailable. This article is available as a PDF only.

The concept and social media hashtag, #BlackGirlMagic, is used to demonstrate the ability of Black women and girls to create paths and to succeed despite intersectional racism, sexism, and classism. Conversely, the concept of Black Girl Magic and Strong Black Woman schemas have been used to glorify struggle, undermine support, and victim-blame. Therefore, resiliency for Black women and girls requires clarification on how and why it is used and understood by researchers and practitioners. This article examines the experiences of Black women and girls by (a) evaluating the use of resiliency research and theoretical frameworks (Luthar et al., 2000; Spencer, 2005); (b) exploring unrecognized strengths and vulnerabilities across the lifespan; and (c) providing recommendations for researchers, interventionists, and practitioners to rethink resilience for Black women and girls. Black feminist thought and womanism frameworks are integrated to promote sustained healthy development for Black women and girls. Resiliency can only be promoted in Black women and girls if (a) immediate psychosocial and physical needs are addressed while (b) concurrently eliminating systemic barriers and social norms that allow Black women and girls to experience outsized adversity. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

While clinical research intends to improve health outcomes for all, access to research participation is often limited and inequitable. Geographic proximity is a recognized barrier, thus, systemic infrastructure solutions through federal programs including General Clinical Research Centers and Clinical and Translational Science Awards have sought to improve accessibility. Even with such support, academic medical centers often have limited clinical research-dedicated space apart from shared exam rooms in difficult-to-navigate hospitals or clinics. In 2019, the Duke University School of Medicine looked beyond its medical center campus to identify free-standing sites within Durham communities for participant study visits. Catalyzed by the COVID-19 pandemic, Duke Research at Pickett, a 22 000-square-foot building with a laboratory, 30 exam rooms, and on-site parking, opened in October 2020 to support vaccine and treatment trials. Upon the lifting of many COVID-19 restrictions, and in partnership with the Research Equity and Diversity Initiative (READI) Community Advisory Council, the building was transformed to encourage community gatherings, education, and training programs. To date, Duke Research at Pickett has hosted 2692 participants in 78 research trials and 14 community-engaged activities.

Background: In the United States, Black and Latino children with asthma are more likely than White children with asthma to require emergency department visits or hospitalizations because of an asthma exacerbation. Although many cite patient-level socioeconomic status and access to health care as primary drivers of disparities, there is an emerging focus on a major root cause of disparities—systemic racism. Current conceptual models of asthma disparities depict the historical and current effects of systemic racism as the foundation for unequal exposures to social determinants of health, environmental exposures, epigenetic factors, and differential healthcare access and quality. These ultimately lead to biologic changes over the life course resulting in asthma morbidity and mortality. Methods: At the 2022 American Thoracic Society International Conference, a diverse panel of experts was assembled to identify gaps and opportunities to address systemic racism in childhood asthma research. Panelists found that to examine and address the impacts of systemic racism on children with asthma, researchers and medical systems that support biomedical research will need to 1) address the current gaps in our understanding of how to conceptualize and characterize the impacts of systemic racism on child health, 2) design research studies that leverage diverse disciplines and engage the communities affected by systemic racism in identifying and designing studies to evaluate interventions that address the racialized system that contributes to disparities in asthma health outcomes, and 3) address funding mechanisms and institutional research practices that will be needed to promote antiracism practices in research and its dissemination. Results: A thorough literature review and expert opinion discussion demonstrated that there are few studies in childhood asthma that identify systemic racism as a root cause of many of the disparities seen in children with asthma. Community engagement and participation in research studies is essential to design interventions to address the racialized system in which patients and families live. Dissemination and implementation studies with an equity lens will provide the multilevel evaluations required to understand the impacts of interventions to address systemic racism and the downstream impacts. To address the impacts of systemic racism and childhood asthma, there needs to be increased training for research teams, funding for studies addressing research that evaluates the impacts of racism, funding for diverse and multidisciplinary research teams including community members, and institutional and financial support of advocating for policy changes based on study findings. Conclusions: Innovative study design, new tools to identify the impacts of systemic racism, community engagement, and improved infrastructure and funding are all needed to support research that will address impacts of systemic racism on childhood asthma outcomes.

Prior research highlights that rural populations have been historically underrepresented/excluded from clinical research. The primary objective of this study was to describe the inclusion of rural populations within our research enterprise using Clinical Research Management System demographic information at a large academic medical center in the Southeast. This was a cross‐sectional study using participant demographic information for all protocols entered into our Clinical Research Management System between May 2018 and March 2021. Descriptive statistics were used to analyze the representation of rural and non‐rural participants and demographic breakdown by age, sex, race, and ethnicity for our entire enterprise and at the state level. We also compared Material Community Deprivation Index levels between urban and rural participants. Results indicated that 19% of the research population was classified as rural and 81% as non‐rural for our entire sample, and 17.5% rural and 82.5% urban for our state‐level sample. There were significant differences in race, sex, and age between rural and non‐rural participants and Material Community Deprivation Indices between rural and non‐rural participants. Lessons learned and recommendations for increasing the inclusion of rural populations in research are discussed.

Keisha Bentley-Edwards and colleagues argue that systemic racism and economic inequality are at the root of disparity in covid-19 outcomes and suggest how to distribute resources more equitably.

Objective: Scalable strategies to reduce the time burden and increase contact tracing efficiency are crucial during early waves and peaks of infectious transmission. Design: We enrolled a cohort of SARS-CoV-2-positive seed cases into a peer recruitment study testing social network methodology and a novel electronic platform to increase contact tracing efficiency. Setting: Index cases were recruited from an academic medical center and requested to recruit their local social contacts for enrollment and SARS-CoV-2 testing. Participants: A total of 509 adult participants enrolled over 19 months (384 seed cases and 125 social peers). Intervention: Participants completed a survey and were then eligible to recruit their social contacts with unique “coupons” for enrollment. Peer participants were eligible for SARS-CoV-2 and respiratory pathogen screening. Main Outcome Measures: The main outcome measures were the percentage of tests administered through the study that identified new SARS-CoV-2 cases, the feasibility of deploying the platform and the peer recruitment strategy, the perceived acceptability of the platform and the peer recruitment strategy, and the scalability of both during pandemic peaks. Results: After development and deployment, few human resources were needed to maintain the platform and enroll participants, regardless of peaks. Platform acceptability was high. Percent positivity tracked with other testing programs in the area. Conclusions: An electronic platform may be a suitable tool to augment public health contact tracing activities by allowing participants to select an online platform for contact tracing rather than sitting for an interview.

Background: The COVID-19 pandemic led to widespread college campus closures in the months of March to June 2020, endangering students’ access to on-campus health resources, including reproductive health services. Objective: To assess contraceptive access and use among undergraduate and graduate students in North Carolina during the COVID-19 pandemic. Methods: We conducted a cross-sectional web-based survey of undergraduate and graduate students enrolled at degree-granting institutions in North Carolina. Participants were recruited using targeted Instagram advertisements. The survey queried several aspects of participants’ sexual behavior, including sex drive, level of sexual experience, number of sexual partners, digital sexual experience, dating patterns, and types of contraception used. Participants were asked to compare many of these behaviors before and after the pandemic. The survey also assessed several sociodemographic factors that we hypothesized would be associated with contraceptive use based on prior data, including educational background, sexual orientation and gender minority status (ie, lesbian, gay, bisexual, transgender, queer), health insurance status, race, ethnicity, degree of sensation seeking, religiosity, and desire to become pregnant. Results: Over 10 days, 2035 Instagram users began our survey, of whom 1002 met eligibility criteria. Of these 1002 eligible participants, 934 completed the survey, for a 93% completion rate. Our respondents were mostly female (665/934, 71%), cisgender (877/934, 94%), heterosexual (592/934, 64%), white (695/934 75%), not Hispanic (835/934, 89%), and enrolled at a 4-year college (618/934, 66%). Over 95% (895/934) of respondents reported that they maintained access to their preferred contraception during the COVID-19 pandemic. In a multivariable analysis, participants who were enrolled in a 4-year college or graduate program were less likely to lose contraceptive access when compared to participants enrolled in a 2-year college (risk ratio [RR] 0.34, 95% CI 0.16-0.71); in addition, when compared to cisgender participants, nonbinary and transgender participants were more likely to lose contraceptive access (RR 2.43, 95% CI 1.01-5.87). Respondents reported that they were more interested in using telehealth to access contraception during the pandemic. The contraceptive methods most commonly used by our participants were, in order, condoms (331/934, 35.4%), oral contraception (303/934, 32.4%), and long-acting reversible contraception (LARC; 221/934, 23.7%). The rate of LARC use among our participants was higher than the national average for this age group (14%). Emergency contraception was uncommonly used (25/934, 2.7%). Conclusions: Undergraduate and graduate students in North Carolina overwhelmingly reported that they maintained access to their preferred contraceptive methods during the COVID-19 pandemic and through changing patterns of health care access, including telehealth. Gender nonbinary and transgender students and 2-year college students may have been at greater risk of losing access to contraception during the first year of the COVID-19 pandemic.

Ensuring equity in research is a critical step in advancing health equity. In this perspective, the authors introduce a guiding framework for advancing racial equity in research processes, environments, and among the research workforce, the 5Ws of Racial Equity in Research. Centering their discussion on the 5Ws: Who, What, When, Where, and Why, they use historical and contemporary examples of research inequities to demonstrate how these five simple questions can encourage open discussion and proactive planning for equity in research. They close with an acknowledgment of the framework's broad utility and a researcher-directed call to action.