Sirry Alang

Social determinants of health (SDOH) greatly impact an individual’s health, yet health care professionals are undereducated on addressing SDOH when identified. While many factors influence and drive educational practices, there is a lack of guidance in understanding best practices in teaching SDOH in online undergraduate health programs. This study examines the use of discussion board posts and peer to peer learning to increase knowledge of SDOH in an online, undergraduate course. Specific aims were to (1) examine students’ perceptions and understanding of SDOH and associated health outcomes in their communities, and (2) assess peer to peer discussions as one method for teaching SDOH in online, undergraduate programs. Discussion board posts and reflections were qualitatively reviewed using thematic analyses. Overall, students expressed positive and negative perceptions of certain SDOH domains. Discussion board posts with peer responses can provide valuable insight into how students perceive and engage with SDOH in relation to community health issues. Students demonstrated learning and understanding of the complex ways SDOH both support and hinder health outcomes, and the intricacies of the relationship between health and SDOH, such as hierarchies or the role of culture. Integrating SDOH activities in curriculum through discussion board posts is one effective teaching strategy to build knowledge in online, undergraduate health courses.

Introduction Viral outbreaks such as COVID-19 have historically and disproportionately impacted low SES communities and communities of color. African Americans were disproportionately impacted by COVID-19 compared to others. At the height of the pandemic, vaccination was critical to mitigating the impact of the highly transmissible SARS-CoV2 virus. Despite this, hesitancy contributed to poor vaccination rates among adults in the United States. African Americans were more likely to report hesitancy and hesitancy associated with medical mistrust and structural barriers. Since vaccination is multifaceted and context specific, factors influencing vaccination should be considered within the appropriate context. Study Purpose The current study examines perspectives of COVID-19 vaccination efforts among African American Community Health Workers (CHWs) in HHS Region 4 through Critical Discourse Analysis (CDA) using an ecological framework. Results Findings indicate equitable vaccination efforts empowered underserved communities. Moreover, findings imply equitable vaccination efforts improved trustworthiness of government and public health officials despite political tensions. Findings also revealed CHWs tend to trust COVID-related information provided by the CDC which is associated with acceptance. Despite religious tensions around vaccination, “The Church” emerged as a trustworthy location to receive COVID-19 information and vaccination. Conclusion This research highlights the importance of community-centered public health interventions and trustworthiness. Community Health Workers (CHWs) hold established trust within marginalized communities. “The Church” is a trusted and uniquely positioned institution able to facilitate health interventions and deliver essential health-related services.

A likely determinant of cognitive function is incarceration. Structural racism directs adverse policing to differentially patrol groups racialized as Black increasing the chances of incarceration, leading to disproportionate representation in prisons. Direct and indirect exposure to incarceration produces chronic stress and trauma for adults racialized as Black. Due to the unique expansion of U.S. prisons after the Violent Crime Control and Law Enforcement Act of 1994, we examined the association between the 10-year average racialized disparity in prison population for the decade succeeding the Crime Bill, 1995–2005, with the overall 14-year cognitive test performance for older adults racialized as Black living in the same county between 2006 and 2020. This observational study linked the average county-level racialized disparity in U.S. prisons to biannual cognitive performance interviews for mid-to-late life adults racialized as Black (> 50 years; N = 1784) from the Health and Retirement Study using baseline county of residence. Cognitive performance was assessed using a 27-item global cognitive score from the modified Telephone Interview for Cognitive Status administered in-person or online. Mixed-effects regressions estimated that greater incarceration of people racialized as Black in prisons was associated with lower overall cognitive test performance among participants racialized as Black (mean difference per 1000 more incarcerated people per 1000 population racialized as Black vs White = − 0.172, 95% CI = − 0.331, − 0.014). As artist Marvin Gaye sang in his song Flyin’ High (in the Friendly Sky), “I go to the place where danger waits me,” which describes how structural racism via incarceration disparities occurring in one’s surroundings increases cognitive health for people racialized as Black irrespective of population size.

People experiencing addiction, houselessness, or who have a history of incarceration have worse health outcomes compared with the general population. This is due, in part, to practices and policies of historically White institutions that exclude the voices, perspectives, and contributions of communities of color in leadership, socio-economic development, and decision-making that matters for their wellbeing. Community-based participatory research (CBPR) approaches hold promise for addressing health inequities. However, full engagement of people harmed by systemic injustices in CBPR partnerships is challenging due to inequities in power and access to resources. We describe how an Allentown-based CBPR partnership—the Health Equity Activation Research Team of clinicians, researchers, and persons with histories of incarceration, addiction, and houselessness—uses the Radical Welcome Engagement Restoration Model (RWERM) to facilitate full engagement by all partners. Data were collected through participatory ethnography, focus groups, and individual interviews. Analyses were performed using deductive coding in a series of iterative meaning-making processes that involved all partners. Findings highlighted six defining phases of the radical welcome framework: (a) passionate invitation, (b) radical welcome, (c) authentic sense of belonging, (d) co-creation of roles, (e) prioritization of issues, and (f) individual and collective action. A guide to assessing progression across these phases, as well as a 32-item radical welcome instrument to help CBPR partners anticipate and overcome challenges to engagement are introduced and discussed.

Colonialism underlies the commodification of health care in the United States and continues to harm well-being among Black Americans. We present four recommendations for addressing its health consequences: (1) Investments in epigenetic research to improve our understanding of how systemic oppression becomes biology. (2) Centering Black experiences and knowledge traditions in education, practice, and policy. (3) Support for Black scholars, trainees, and practitioners when they critic disciplinary tenets and practices. (4) Expansion of preventive care. Our health care system is a for-profit industry that exploits workers and harms the most marginalized, much like colonialism. Advancing health equity requires dismantling colonial legacies.