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Exploring the intersections of structural inequities and health disparities: the challenge and opportunity of recognizing racism as a public health crisis [Editorial]

Lekas, Helen-Maria; López-Cevallos, Daniel; Routen, Ash
Although increasingly being recognized as a driver of poor health and health inequities, there is limited research on the pervasive effects of racism on population health. In this editorial, we set the context and invite contributions for a BMC Public Health Collection of articles titled, "Racism as Public Health Crisis."
PMID: 37491202
ISSN: 1471-2458
CID: 5592082

The Color of Autonomy: Examining Racial Inequity in Coercive Institutional Practices

Lekas, Helen-Maria; Lewis, Crystal; Bradley, Mark V; Pahl, Kerstin
Two articles recently published in this journal identified racial inequities in routine psychiatric practice. This Open Forum discusses the need for a paradigm shift in inequities research. The two articles reviewed here, one by Shea and colleagues on racial-ethnic inequities in inpatient psychiatric civil commitment and one by Garrett and colleagues on racial-ethnic disparities in psychiatric decisional capacity consultations, are examples of the new research gaze. Four topics are identified for enhancing understanding of racism and other forms of structural exclusion in psychiatric practice: medical authority and power imbalance between providers and patients, involuntary psychiatric commitment and requests for decisional capacity consultations as strategic research events, limited use of theory, and limitations of the literature on psychiatric inequities.
PMID: 37143336
ISSN: 1557-9700
CID: 5521572

Crisis Intervention Team (CIT) training and impact on mental illness and substance use-related stigma among law enforcement

Nick, Gilbert A; Williams, Sharifa; Lekas, Helen-Maria; Pahl, Kerstin; Blau, Chloe; Kamin, Don; Fuller-Lewis, Crystal
Limited empirical data and research exists about stigmatizing attitudes and perceptions held by law enforcement officers towards persons with mental illness and substance use issues. Pre- and post-training survey data from 92 law enforcement personnel who attended a 40-hour Crisis Intervention Team (CIT) training was used to investigate training-related changes in mental illness stigma and substance use stigma. Training participant's mean age was 38.35 ± 9.50 years, majority white non-Hispanic race/ethnicity (84.2%), male gender (65.2%), and reported job category as road patrol (86.9%). Pre-training, 76.1% endorsed at least one stigmatizing attitude towards people with mental illness, and 83.7% held a stigmatizing attitude towards those with substance use problems. Poisson regression revealed that working road patrol (RR=0.49, p<0.05), awareness of community resources (RR=0.66, p<0.05), and higher levels of self-efficacy (RR=0.92, p<0.05) were associated with lower mental illness stigma pre-training. Knowledge of communication strategies (RR=0.65, p<0.05) was associated with lower pre-training substance use stigma. Post-training, improvement in knowledge of community resources and increases in self-efficacy were significantly associated with decreases in both mental illness and substance use stigma. These findings highlight the existence of stigma related to both mental illness and substance use pre-training suggesting the need for implicit and explicit bias training prior to the start of active law enforcement duty. These data are consistent with prior reports indicating CIT trainings as a path to address mental illness and substance use stigma. Further research on effects of stigmatizing attitudes and additional stigma-specific training content is warranted.
PMID: 36844168
ISSN: 2772-7246
CID: 5521562

Reckoning with Racism in the Match Process [Editorial]

Drake, Christin; Lewis, Crystal F; Lekas, Helen-Maria
PMID: 35768748
ISSN: 1545-7230
CID: 5281222

Anti-Asian Attitudes in the Context of the COVID-19 Pandemic: an Exploratory Study

Pahl, Kerstin; Wang, John; Sanichar, Navin; Williams, Sharifa; Nick, Gilbert A; Wang, Lisa; Lekas, Helen-Maria
OBJECTIVE:The purpose of this paper was to measure if people with greater "structural literacy," as indicated by greater awareness of racial and socioeconomic disparities in COVID-19 impact, would hold fewer negative attitudes against those perceived to be Asian in the context of the COVID-19 pandemic. METHODS:A survey was administered between April and August 2020 to participants from two longitudinal cohorts in New York State. The survey assessed anti-Asian attitudes relating to COVID-19, awareness of racial and socioeconomic disparities in COVID-19, residential location, socioeconomic status, and other demographic information. The sample included 233 Black, Latinx, and White midlife adults from urban, suburban, and rural New York neighborhoods. Multivariable regression modeling was used to assess associations between COVID-19 disparities awareness, an indicator of structural literacy, and anti-Asian attitudes, adjusting for gender, race/ethnicity, residential location, and socioeconomic disadvantage. RESULTS:Greater awareness of disparities in COVID-19 was associated with lower levels of anti-Asian attitudes after adjustment (adj-slope =  - 0.358, p < 0.001). CONCLUSION/CONCLUSIONS:Greater structural literacy, as measured by awareness of socioeconomic and racial disparities in COVID-19 impact, was associated with fewer anti-Asian attitudes among Black, Latinx, and White adults. IMPLICATIONS/CONCLUSIONS:Increasing structural literacy may reduce anti-Asian attitudes that motivate harmful acts against oppressed groups.
PMID: 35913546
ISSN: 2196-8837
CID: 5287842

The Impacts of COVID-19 on a Statewide Population With Mental Illness

Rodgers, Ian T; Samaranayake, Dhanushki; Anderson, Adrienne; Capobianco, Linda; Cohen, Dana E; Ehntholt, Amy; Feeney, Suzanne; Leckman-Westin, Emily; Marinovic, Sonia; Smith, Thomas E; Dixon, Lisa B; Lekas, Helen-Maria; Lewis-Fernández, Roberto; Saake, Amanda
OBJECTIVE:This survey examined the experiences of individuals receiving treatment in a large public mental health system during the early months of the COVID-19 pandemic. METHODS:The survey, conducted between May and June 2020, assessed four domains: impacts on mental health, experiences with telehealth, access to care and resources, and sources and adequacy of support. Descriptive analyses were conducted. RESULTS:Of 4,046 respondents, 70% reported increases in their anxiety and stress because of the pandemic. A majority (55%) reported experiencing challenges related to the social determinants of health and functional needs. Most respondents reported that their care went undisrupted, with 92% using telehealth and 90% reporting feeling adequately supported. CONCLUSIONS:The pandemic substantially affected individuals with mental illness, particularly with regard to mental health related to the social determinants of health and functional needs. However, respondents felt that their mental health care was maintained and that they were adequately supported.
PMID: 34587787
ISSN: 1557-9700
CID: 5521582

Challenges and opportunities of telehealth digital equity to manage HIV and comorbidities for older persons living with HIV in New York State

Baim-Lance, Abigail; Angulo, Matthew; Chiasson, Mary Ann; Lekas, Helen-Maria; Schenkel, Rachel; Villarreal, Jason; Cantos, Anyelina; Kerr, Christine; Nagaraja, Aarthi; Yin, Michael T; Gordon, Peter
BACKGROUND:Older persons living with HIV (PLWH) need routine healthcare to manage HIV and other comorbidities. This mixed methods study investigated digital equity, constituted as access, use and quality, of HIV and specialty telehealth services for PLWH > 50 years during the initial wave of the COVID-19 pandemic when services transitioned to remote care. METHODS:A survey of closed and open-ended questions was administered to 80 English (N = 63) and Spanish (N = 17) speaking PLWH receiving HIV care at an Academic Medical Center (N = 50) or a Federally Qualified Health Center (N = 30) in New York State. Quantitative analyses examined characteristics predicting telehealth use and visit quality. Qualitative analyses utilized thematic coding to reveal common experiences. Results were integrated to deepen the interpretation. RESULTS:Telehealth access and use were shaped by multiple related and unstable factors including devices and connectivity, technology literacy, and comfort including privacy concerns. Participants demonstrated their substantial effort to achieve the visit. The majority of patients with a telehealth visit perceived it as worse than an in-person visit by describing it as less interpersonal, and resulting in poorer outcomes, particularly participants with less formal education. Technology was not only a barrier to access, but also influenced perceptions of quality. CONCLUSIONS:In the COVID-19 pandemic initial wave, barriers to using telehealth were unequally distributed to those with more significant access and use challenges. Beyond these barriers, examining the components of equity indicate further challenges replicating in-person care using telehealth formats for older PLWH. Work remains to establish telehealth as both equitable and desirable for this population.
PMID: 35524251
ISSN: 1472-6963
CID: 5213952

Internet use and uptake of a web-based prevention and risk reduction intervention for persons who use drugs in New York City - WebHealth4Us study (2013-2016)

Lewis, Crystal Fuller; Williams, Sharifa Z; Tofighi, Babak; Lekas, Helen-Maria; Joseph, Adriana; Rivera, Alexis; Amesty, Silvia C
PMID: 35499405
ISSN: 1547-0164
CID: 5215862

Should a Healthcare System Facilitate Racially Concordant Care for Black Patients?

Taylor, Lauren A; Udeagbala, Osaze; Biggs, Adam; Lekas, Helen-Maria; Ray, Keisha
Addressing racial disparities in health outcomes is an urgent priority for many health care organizations, leading health care managers to explore the potential for organization-level interventions to yield substantive health gains. In recent literature, it is suggested that Black patients who are treated by Black physicians may achieve superior health outcomes in some settings. In this case discussion, we consider a case in which a medical director considers implementing a voluntary program to promote racially concordant care for Black patients. Commentators consider the precedent for such a program, both in current informal care networks and 20th century medical history, as well as the burden such a program may place on Black physicians and the risks of reducing patients' intersectional identities to be solely about race. A subset of commentators suggest that these risks are mitigated by the voluntary nature of the program, whereas others offer caution about relying solely on Black physicians to remedy health disparities. Others view multiple paths as morally defensible but emphasize the need for managers to take proactive steps to communicate and evaluate their choices in the face of such a complex social challenge.
PMID: 34479982
ISSN: 1098-4275
CID: 5061202

Single Room Occupancy Residence: Processes Linking Housing to Not Engaging in HIV Outpatient Care

Lekas, Helen-Maria; Lewis, Crystal; Lunden, Sara; Olender, Susan Aileen; Rosen-Metsch, Lisa
Homelessness and housing instability undermine engagement in medical care, adherence to treatment and health among persons with HIV/AIDS. However, the processes by which unstable and unsafe housing result in adverse health outcomes remain understudied and are the focus of this manuscript. From 2012 to 2014, we conducted qualitative interviews among inpatients with HIV disengaged from outpatient care (n = 120). We analyzed the content of the interviews with participants who reported a single room occupancy (SRO) residence (n = 44), guided by the Health Lifestyle Theory. Although SROs emerged as residences that were unhygienic and conducive to drug use and violence, participants remained in the SRO system for long periods of time. This generated experiences of living instability, insecurity and lack of control that reinforced a set of tendencies (habitus) and behaviors antithetical to adhering to medical care. We called for research and interventions to transform SROs into housing protective of its residents' health and wellbeing.
PMID: 33743114
ISSN: 1573-3254
CID: 4822012