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Who feels safe calling 911: are prior experiences of anti-Black racial discrimination associated with hesitancy seeking emergency medical services in the event of accidental drug overdose? - a study protocol

Hall, O Trent; Trimble, Candice; Garcia, Stephanie; Grayson, Sydney; Joseph, Lucy; Entrup, Parker; Jegede, Oluwole; Martel, Jose Perez; Tetrault, Jeanette; Mathis, Myra; Jordan, Ayana
BACKGROUND/UNASSIGNED:Racial discrimination is associated with health disparities among Black Americans, a group that has experienced an increase in rates of fatal drug overdose. Prior research has found that racial discrimination in the medical setting may be a barrier to addiction treatment. Nevertheless, it is unknown how experiences of racial discrimination might impact engagement with emergency medical services for accidental drug overdose. This study will psychometrically assess a new measure of hesitancy in seeking emergency medical services for accidental drug overdose and examine prior experiences of racial discrimination and group-based medical mistrust as potential corollaries of this hesitancy. METHOD/UNASSIGNED:Cross-sectional survey of 200 Black adults seeking treatment for substance-use-related medical problems (i.e. substance use disorder, overdose, infectious complications of substance use, etc.). Participants will complete a survey including sociodemographic information, the Discrimination in Medical Settings Scale, Everyday Discrimination Scale, Group-Based Medical Mistrust Scale, and an original questionnaire measuring perceptions of and prior engagement with emergency services for accidental drug overdose. Analyses will include exploratory factor analysis, Cronbach's alpha, and non-parametric partial correlations controlling for age, gender, income, and education. CONCLUSIONS/UNASSIGNED:This article describes a planned cross-sectional survey of Black patients seeking treatment for substance use related health problems. Currently, there is no validated instrument to measure hesitancy in seeking emergency medical services for accidental drug overdose or how experiences of racial discrimination might relate to such hesitancy. Results of this study may provide actionable insight into medical discrimination and the rising death toll of accidental drug overdose among Black Americans.
PMCID:11660366
PMID: 39697058
ISSN: 1365-2060
CID: 5764662

Social complexity of a fentanyl vaccine to prevent opioid overdose conference proceedings: Radcliffe Institute for Advanced Study conference proceedings

Weitzman, Elissa R; ,; Alegria, Margarita; Caplan, Arthur; Dowling, David; Evans, Jay; Fisher, Carl Erik; Jordan, Ayana; Kossowsky, Joe; Landau, Misia; Larson, Heidi; Levy, Ofer; Levy, Sharon; Mnookin, Seth; Reif, Sharon; Ross, Jennifer; Sherman, Amy Caryn
Despite significant public health attention and investment, hundreds of thousands of individuals have suffered fatal opioid overdose since the onset of the opioid crisis. Risk of opioid overdose has been exacerbated by the influx of fentanyl, a powerful synthetic opioid, into the drug supply. The National Institutes of Health Helping End Addiction Long-term (HEAL) Initiative is supporting the development of vaccines targeting fentanyl to protect against overdose. If successful, a vaccine would induce anti-fentanyl antibodies to sequester fentanyl (but not other opioids) in the blood, preventing fentanyl from crossing into the brain and reaching the central nervous system where it can cause overdose. Introduction of an overdose preventing strategy that relies on a vaccine to confer passive protection may be impactful. However, vaccines are poorly understood by the public and politicized. Moreover, the overdose ecosystem is complex and extends across numerous social, economic, medical, and cultural systems. As such, optimal use of a vaccine strategy to address overdose may benefit from multidisciplinary consideration of the social, ethical, and systemic factors that influence substance use and overdose that may also impact the acceptability of a fentanyl vaccine and related implementation strategies. In March 2022, Dr. Elissa Weitzman convened a two-day conference at the Harvard Radcliffe Institute for Advanced Study on the Social Complexity of a Fentanyl Vaccine to Prevent Opioid Overdose. In all, 19 professionals from diverse disciplines (medicine, psychology, history, ethics, immunology, vaccinology, communications, policy) attended the conference and led discussions that centered on population health and epidemiology, history of medicine and frameworks for understanding substance use, ethics, decision-making and attitudes, and operational issues to the question of a novel immunotherapy targeting fentanyl overdose. Participants also debated the risks and benefits of vaccine administration in response to fictional clinical case vignettes. A summary of the conference presentations and discussions follows.
PMID: 39317618
ISSN: 1873-2518
CID: 5763912

Corrigendum to 'Integrative data analysis of clinical trials network studies to examine the impact of psychosocial treatments for Black people who use cocaine: Study protocol' [Contemporary Clinical Trials 133 (2023) 107329]

Haeny, Angela M; McCuistian, Caravella; Burlew, A Kathleen; Ruglass, Lesia M; Espinosa, Adriana; Jordan, Ayana; Roundtree, Christopher; Lopez, Joel; Morgan-Lopez, Antonio A
PMID: 39578191
ISSN: 1559-2030
CID: 5759002

Promoting Race and Ethnic Diversity in a Hospital-Based Randomized Clinical Trial to Address Untreated Alcohol Use Disorder: Initial Lessons Learned

Edelman, E Jennifer; Frankforter, Tami; Rojas-Perez, Oscar F; Ablondi, Karen; Castro, Carla; Corvino, Joanne; Garcia, Isabel; Gordon, Derrick M; Jaramillo, Yudilyn; Johnson, Natrina L; Jordan, Ayana; Nich, Charla; Paris, Manuel; Pagano, David; Weimer, Melissa B; Williams, Emily C; Kiluk, Brian D
OBJECTIVE:This study aimed to describe initial experiences and lessons learned conducting a trial focused on recruiting racially and ethnically diverse hospitalized patients with untreated alcohol use disorder (AUD). METHODS:The parent trial is comparing the effectiveness of strategies including Brief Negotiation Interview (BNI), facilitated initiation of medications for AUD, and computer-based training for cognitive behavioral therapy (CBT4CBT) on AUD treatment engagement post-hospitalization. Guided by the Framework for Reporting Adaptations and Modifications-Enhanced, we catalogued protocol changes and evaluated outcomes using study and electronic medical record data during the first 18 months of recruitment. RESULTS:Recipients: (1) Selected entry criterion to intentionally include individuals most likely impacted by structural racism, (2) developed multipronged recruitment approaches, and (3) selected bilingual, multicultural, and ethnically diverse research staff. Intervention: (1) Added scripts in the BNI to consider how cultural factors influence and how racism may impact, alcohol use, and AUD treatment engagement, (2) offered tablets as a compensation alternative with support for CBT4CBT initiation (as relevant), and (3) anticipate and troubleshoot internet access challenges. Setting: (1) Identified community-based AUD treatment options with Spanish-speaking services and (2) identified resources to address social determinants of health. Study: (1) Audited data to monitor whether diverse enrollment is occurring. Among n = 132 randomized as of March 1, 2024, 25% endorsed Black, 24% endorsed Latine, 58% endorsed White, 1% endorsed Indigenous, and 15% endorsed race not listed or declined to disclose. We observed no difference by race or ethnicity in recruitment or retention experiences. CONCLUSIONS:Multilevel practices within a hospital-based AUD-focused trial can promote recruitment and retention of a racially and ethnically diverse sample.
PMID: 39514895
ISSN: 1935-3227
CID: 5752232

Systemic Racism as a Determinant of Health Inequities for People With Substance Use Disorder

Jegede, Oluwole; Bellamy, Chyrell; Jordan, Ayana
PMID: 38231489
ISSN: 2168-6238
CID: 5699742

Development of a Tool to Measure Student Perceptions of Equity and Inclusion in Medical Schools

Boatright, Dowin; Nguyen, Mytien; Hill, Katherine; Berg, David; Castillo-Page, Laura; Anderson, Nientara; Agbelese, Victoria; Venkataraman, Shruthi; Saha, Somnath; Schoenbaum, Stephen C; Richards, Regina; Jordan, Ayana; Asabor, Emmanuella; White, Marney A
IMPORTANCE/UNASSIGNED:Creating an inclusive and equitable learning environment is a national priority. Nevertheless, data reflecting medical students' perception of the climate of equity and inclusion are limited. OBJECTIVE/UNASSIGNED:To develop and validate an instrument to measure students' perceptions of the climate of equity and inclusion in medical school using data collected annually by the Association of American Medical Colleges (AAMC). DESIGN, SETTING, AND PARTICIPANTS/UNASSIGNED:The Promoting Diversity, Group Inclusion, and Equity tool was developed in 3 stages. A Delphi panel of 9 members identified survey items from preexisting AAMC data sources. Exploratory and confirmatory factor analysis was performed on student responses to AAMC surveys to construct the tool, which underwent rigorous psychometric validation. Participants were undergraduate medical students at Liaison Committee on Medical Education-accredited medical schools in the US who completed the 2015 to 2019 AAMC Year 2 Questionnaire (Y2Q), the administrations of 2016 to 2020 AAMC Graduation Questionnaire (GQ), or both. Data were analyzed from August 2020 to November 2023. EXPOSURES/UNASSIGNED:Student race and ethnicity, sex, sexual orientation, and socioeconomic status. MAIN OUTCOMES AND MEASURES/UNASSIGNED:Development and psychometric validation of the tool, including construct validity, internal consistency, and criterion validity. RESULTS/UNASSIGNED:Delphi panel members identified 146 survey items from the Y2Q and GQ reflecting students' perception of the climate of equity and inclusion, and responses to these survey items were obtained from 54 906 students for the Y2Q cohort (median [IQR] age, 24 [23-26] years; 29 208 [52.75%] were female, 11 389 [20.57%] were Asian, 4089 [7.39%] were multiracial, and 33 373 [60.28%] were White) and 61 998 for the GQ cohort (median [IQR] age, 27 [26-28] years; 30 793 [49.67%] were female, 13 049 [21.05%] were Asian, 4136 [6.67%] were multiracial, and 38 215 [61.64%] were White). Exploratory and confirmatory factor analyses of student responses identified 8 factors for the Y2Q model (faculty role modeling; student empowerment; student fellowship; cultural humility; faculty support for students; fostering a collaborative and safe environment; discrimination: race, ethnicity, and gender; and discrimination: sexual orientation) and 5 factors for the GQ model (faculty role modeling; student empowerment; faculty support for students; discrimination: race, ethnicity, and gender; and discrimination: sexual orientation). Confirmatory factor analysis indicated acceptable model fit (root mean square error of approximation of 0.05 [Y2Q] and 0.06 [GQ] and comparative fit indices of 0.95 [Y2Q] and 0.94 [GQ]). Cronbach α for individual factors demonstrated internal consistency ranging from 0.69 to 0.92 (Y2Q) and 0.76 to 0.95 (GQ). CONCLUSIONS AND RELEVANCE/UNASSIGNED:This study found that the new tool is a reliable and psychometrically valid measure of medical students' perceptions of equity and inclusion in the learning environment.
PMCID:10882418
PMID: 38381434
ISSN: 2574-3805
CID: 5634312

Systems that promote mental health in the teeth of oppression

Fullilove, Mindy Thompson; Dix, Ebony; Hankerson, Sidney H; Lassiter, Jonathan; Jordan, Ayana
Emotional distress can disproportionately disable individuals from minoritized groups, such as Black Americans, due to multiple intersecting factors. Addressing these challenges requires a comprehensive, culturally sensitive approach to mental health care that promotes inclusivity, accessibility, and representation within the field, to foster empowerment and resilience among minoritized communities. Given the weight of negative factors that can lead to psychological distress and mental illness, the wellness of Black Americans and how they support their mental health is important to acknowledge. In this Series paper, we propose that Black Americans have developed systems for managing many of these threats to their survival and wellbeing.
PMID: 38101874
ISSN: 2215-0374
CID: 5589052

The impact of racism on Black American mental health

Cogburn, Courtney D; Roberts, Samuel K; Ransome, Yusuf; Addy, Nii; Hansen, Helena; Jordan, Ayana
Black individuals in the USA experience disparities in mental health that lead to unfavorable health outcomes and increased morbidity from mental illness due to centuries of racism. We emphasize the need to understand the roots of racial injustice to achieve racial equity. Historical factors such as European imperialism, enslavement, the myth of Black inferiority, and scientific racial classification have all perpetuated disparities, leading to the current underestimation, misdiagnosis, and inadequate treatment of mental illness in Black populations. Many of the issues discussed herein apply to Black people globally; however, our focus is on Black Americans and the inequities that result from the current US mental health system. We discuss the limitations of using the DSM-5 classification system and common epidemiological surveys, which do not capture or call for a comprehensive analysis of the systems producing mental health issues, to understand mental illness among Black Americans.
PMID: 38101873
ISSN: 2215-0374
CID: 5589042

Community-based participatory research with Black people and Black scientists: the power and the promise

Breland-Noble, Alfiee; Streets, Frederick J; Jordan, Ayana
Community-based participatory research (CBPR) is a collaborative approach that involves active participation and input from members of the community on all aspects of the research process. CBPR is an important research method as it can empower communities to work with academicians and other scholars for more robust and culturally appropriate interventions. Although CBPR is useful regardless of race or ethnicity, it is particularly important for Black scientists and communities. This is because CBPR seeks to address social and health inequities by engaging with historically excluded communities, as well as to produce research that is relevant to the community. Successful CBPR initiatives can improve Black mental health through collaboration, empowerment, and cultural sensitivity, as the current under-representation of Black scientists hampers mental health equity efforts. Equal funding of Black scientists is key to conducting community-engaged research. We discuss CBPR and its importance for Black mental health, case studies of CBPR conducted by Black scientists, Black leaders, and community members, and what is necessary for Black people to attain mental health in an inherently racist society.
PMID: 38101875
ISSN: 2215-0374
CID: 5589062

Leveraging neuroscience education to address stigma related to opioid use disorder in the community: a pilot study

Kyzar, Evan J; Arbuckle, Melissa R; Abba-Aji, Adam; Balachandra, Krishna; Cooper, Joseph; Dela Cruz, Adriane; Edens, Ellen; Heward, Brady; Jibson, Michael; Jordan, Ayana; Moreno-De-Luca, Daniel; Pazderka, Hannah; Singh, Mohit; Weleff, Jeremy J; Yau, Bernice; Young, Justin; Ross, David A
Opioid use disorder (OUD) and overdose deaths are a public health crisis. One contributing factor is stigma towards people who use opioids. We developed and conducted a public-facing, half-day educational event designed to challenge misperceptions about OUD from a contemporary neuroscience perspective. Participants engaged with three different resources on the neurobiology of addiction, and, at the end of the event, they rated its effectiveness. We also collected and compared pre- and post-event composite OUD stigma scales. Participants rated our approach and the overall event as highly effective. Additionally, OUD stigma scores were lower immediately following the event, and this decrease was primarily driven by decreased internalized stigma. Here, we demonstrate an effective proof-of-concept that an accessible, public-facing, neuroscience education event may reduce OUD stigma in the community.
PMID: 38563031
ISSN: 1664-0640
CID: 5729042