Nadia ScD Abuelezam

The COVID-19 pandemic has accentuated racial and socioeconomic disparities that have existed in the U.S. because of structural racism. We aimed to understand how the legacy of historical redlining policies was associated with COVID-19 incidence in Boston ZIP code tabulation areas (ZCTAs) from March 2020 to December 2022. Data were extracted from the Institute for Social Research at the University of Michigan, the Boston Public Health Commission, the Boston Planning & Development Agency, and the American Community Survey. We ran a generalized linear model accounting for time to explore the association between historical redlining, characterized as Homeowners’ Loan Corporation (HOLC) grade, and monthly COVID-19 incidence rate. Models were adjusted for the proportion of the ZCTA population identified as non-White, were older than 75, homeowners, and foreign-born. We also accounted for the median household value in each ZCTA. We found no significant association between HOLC grade and monthly COVID-19 incidence rate in Boston (IRR: 0.95; 95% CI: 0.80, 1.12). Downstream effects of redlining, such as gentrification and higher median home value, were associated with a higher monthly COVID-19 incidence (IRR: 1.12; 95% CI: 1.01, 1.25). These results highlight the unique ways Boston’s historical racist policies have manifested themselves in health outcomes today. Place-based context and history is important when examining redlining in public health research.

Racialized, socio-spatial disparities between most metropolitan areas and their suburbs, especially with regards to education, mobility, and health outcomes, are largely due to the rise of 20th cen...

Research examining Arab and Middle Eastern and North African (MENA) health disparities faces several research limitations. These obstacles include unrepresentative national data due to the absence of a MENA identifier on the US Census, and a lack of Arab/MENA American participant trust in surveying bodies. This research hesitancy prompts the need for targeted investigation of the barriers preventing Arab/MENA Americans from participating in health research. Using community- and patient-centered methods, we created and disseminated a patient-facing survey to identify barriers to Arab/MENA American research participation. Through regular meetings and collaboration with stakeholders on research instrument development and participant recruitment, a novel quantitative survey was created (April–May 2023) to identify barriers affecting Arab/MENA American participation in health research and to explore their experiences and opportunities for improvement in the healthcare sector. The survey instruments assessed interest in research, as well as the motivators and barriers to clinical research participation. The data were analyzed quantitatively using descriptive statistics and logistic regression models. A total of 149 respondents had non-missing values on both outcomes. The study sample was largely college educated and foreign-born. Over three quarters of respondents (77.5%) felt they knew what health research was while slightly less than three quarter of respondents (72.5%) would accept to participate in a health research study in the future. Those who were foreign-born, in lower income levels (< $65 k), or had low English proficiency or acculturation were less likely to report knowing what health research was. Facilitators to participating in research included a belief that participation would improve health, the idea of contributing to science, if monetary compensation was available, and if participation could be withdrawn at any time. These data further enhance our knowledge of Arab/MENA American comfortability with health research participation and can help inform future interventions. Immigration and sociodemographic factors are related to knowledge and willingness to participate as are several ideals including a desire to improve community health.

Background Heightened anti-Arab/Middle Eastern and North African (MENA) xenophobia in the United States (US) coupled with the addition of a MENA category on the next US Census call into attention the health needs of this minoritized population. Targeted research is needed to better understand the factors that influence Arab/MENA American participation in US-based health research and health care. Methods A novel qualitative interview guide was constructed to better understand the health research experiences, health care experiences and needs of Arab/MENA patients nationally. Patients were recruited through the Arab American Health Network Alliance (AAHNA) community connections. Semi-structured interviews were conducted virtually in English and Arabic, and qualitative data was interpreted through iterative thematic analysis using inductive reasoning. Results A total of seventeen interviews (n = 17) were completed (14 in English, 3 in Arabic). Notably, the majority identified as female (82%) and have resided in the US for 18 years or longer (53%). Three main themes were identified (1) Individual-level Comfortability and Access to Research Participation, (2) Advancing Community Health Outcomes and Participation, and (3) Structural Barriers as Drivers of Health Disparities. Conclusion The health research and health care experiences explored in this project have the potential of informing future inquiries on Arab/MENA American health. For instance, we suggest building community trust, providing equitable compensation and support, increasing health workforce diversity, and advocating for affordable health care, all to improve Arab/MENA patient participation in health research.

Little is known about vaccine willingness in Arab Americans. It stands to reason that factors such as increased risks of experiencing xenophobia and discrimination and limited social support, particularly among new immigrants, may influence COVID-19 vaccine willingness among Arab Americans. We qualitatively investigate the psychological, social, and physical impacts of the COVID-19 pandemic on Arab Americans and explore how these experiences may have influenced COVID-19 vaccine perceptions and behaviors. We conducted a qualitative study following an interpretivist, inductive paradigm among a subset of Arab Americans (N=23) living in the US between April and July 2021. We identified four broad categories of themes: individual factors contributing to COVID-19 vaccine willingness, perceptions of the US government and the public health response, the impact of media on the COVID-19 pandemic and perceptions about the COVID-19 vaccine, and perceived COVID-19 severity. COVID-19 vaccine willingness was based on participants’ perception of the severity of the COVID-19 pandemic, protecting their health and that of others in their social circle, a work or school requirement, or fulfilling a greater social responsibility. Though our study disproportionately represented those who were vaccine-willing, participants referenced stories about people in their immediate and distal networks who were unwilling to be vaccinated. There are complex connections between individual well-being, community identity and belonging, and health for Arab Americans that deserve additional attention.

Youth Sexual Health and HIV/STI Prevention in Middle Eastern and North African Communities (YSMENA) is the first community-based research study in Canada to explore key determinants of sexual health among diaspora Middle Eastern and North African (MENA) women living in Canada. Our objectives were to identify the factors influencing sexual health for MENA youth and grow an evidence base to strengthen the sexual health response for MENA communities. Using mixed- method design, data were gathered through a quantitative socio-demographic survey and qualitative focus groups with 24 women-identifying MENA youth (16–29 years) living in Ontario, Canada. Six (6) focus groups were held virtually via Zoom, with heterosexual, lesbian, bisexual and queer (LBQ), and trans women. Members of each group participated in two sessions as per the sequential critical dialogical method and transcripts were coded in NVIVO. While participants identified with diverse sexual orientations and across the trans-feminine gender spectrum, key commonalities surfaced, namely the pressures to conform to familial expectations and the barriers faced when accessing healthcare. The trans group experienced compounded levels of exclusion given their unique positioning. Although the challenges faced by the group were deeply entrenched in patriarchy, heteronormativity and internalized shame, many participants demonstrated resilience and self-acceptance that enabled them to forge pathways to health. Findings have important and valuable implications for community-based health programs targeting MENA women as well as healthcare practitioners and service providers.

Between October 2023 and April 2024, more than 30,000 Palestinians were killed, and countless others injured, displaced, and traumatized, in the fifth major Israeli assault on the Gaza Strip since 2006. Recent events, along with the trajectory of events over the past 75 years, demonstrate that using a public health framework could help recognize racism as a structural and social determinant of Palestinian health. Using the principles of health equity, we show how Palestinian health inequities are rooted in settler colonialism and racism, amounting to violence and oppression against Palestinian Arabs as a racialized group, regardless of religion or citizenship. Structural racism should be recognized as a driver of Palestinian health inequities.