The Enduring Significance of Segregation

2018 ◽  
pp. 58-74
Author(s):  
Jason Q. Purnell

Residential segregation remains a perennial problem in major metropolitan areas across the United States. Many researchers have focused on the effects of segregation on housing patterns, educational disparities, and the geographic concentration of poverty. This chapter explores how these and other results of residential segregation affect population health. Using as its backdrop the St. Louis, Missouri, metropolitan area—one of the most segregated metropolitan areas in the nation—this chapter reviews the scientific literature on segregation and health outcomes. It also discusses potential strategies for addressing segregation in this local context and nationally. Much of the local discussion draws on For the Sake of All, a landmark study on the health and well-being of African Americans in St. Louis. An analysis of the cultural, psychological, political, and practical barriers to integration is also presented.

2020 ◽  
Author(s):  
Jennifer S Jewell ◽  
Charlotte V Farewell ◽  
Courtney Welton-Mitchell ◽  
Angela Lee-Winn ◽  
Jessica Walls ◽  
...  

BACKGROUND The COVID-19 pandemic has had numerous worldwide effects. In the United States, there have been 8.3 million cases and nearly 222,000 deaths as of October 21, 2020. Based on previous studies of mental health during outbreaks, the mental health of the population will be negatively affected in the aftermath of this pandemic. The long-term nature of this pandemic may lead to unforeseen mental health outcomes and/or unexpected relationships between demographic factors and mental health outcomes. OBJECTIVE This research focused on assessing the mental health status of adults in the United States during the early weeks of an unfolding pandemic. METHODS Data was collected from English-speaking adults from early April to early June 2020 using an online survey. The final convenience sample included 1083 US residents. The 71-item survey consisted of demographic questions, mental health and well-being measures, a coping mechanisms checklist, and questions about COVID-19–specific concerns. Hierarchical multivariable logistic regression was used to explore associations among demographic variables and mental health outcomes. Hierarchical linear regression was conducted to examine associations among demographic variables, COVID-19–specific concerns, and mental health and well-being outcomes. RESULTS Approximately 50% (536/1076) of the US sample was aged ≥45 years. Most of the sample was White (1013/1054, 96%), non-Hispanic (985/1058, 93%), and female (884/1073, 82%). Participants reported high rates of depression (295/1034, 29%), anxiety (342/1007, 34%), and stress (773/1058, 73%). Older individuals were less likely to report depressive symptomology (OR 0.78, <i>P</i>&lt;.001) and anxiety symptomology (OR 0.72, <i>P</i>&lt;.001); in addition, they had lower stress scores (–0.15 points, SE 0.01, <i>P</i>&lt;.001) and increased well-being scores (1.86 points, SE 0.22, <i>P</i>&lt;.001). Individuals who were no longer working due to COVID-19 were 2.25 times more likely to report symptoms of depression (<i>P</i>=.02), had a 0.51-point increase in stress (SE 0.17, <i>P</i>=.02), and a 3.9-point decrease in well-being scores (SE 1.49, <i>P</i>=.009) compared to individuals who were working remotely before and after COVID-19. Individuals who had partial or no insurance coverage were 2-3 times more likely to report depressive symptomology compared to individuals with full coverage (<i>P</i>=.02 and <i>P</i>=.01, respectively). Individuals who were on Medicare/Medicaid and individuals with no coverage were 1.97 and 4.48 times more likely to report moderate or severe anxiety, respectively (<i>P</i>=.03 and <i>P</i>=.01, respectively). Financial and food access concerns were significantly and positively related to depression, anxiety, and stress (all <i>P</i>&lt;.05), and significantly negatively related to well-being (both <i>P</i>&lt;.001). Economy, illness, and death concerns were significantly positively related to overall stress scores (all <i>P</i>&lt;.05). CONCLUSIONS Our findings suggest that many US residents are experiencing high stress, depressive, and anxiety symptomatology, especially those who are underinsured, uninsured, or unemployed. Longitudinal investigation of these variables is recommended. Health practitioners may provide opportunities to allay concerns or offer coping techniques to individuals in need of mental health care. These messages should be shared in person and through practice websites and social media.


10.2196/22043 ◽  
2020 ◽  
Vol 4 (10) ◽  
pp. e22043
Author(s):  
Jennifer S Jewell ◽  
Charlotte V Farewell ◽  
Courtney Welton-Mitchell ◽  
Angela Lee-Winn ◽  
Jessica Walls ◽  
...  

Background The COVID-19 pandemic has had numerous worldwide effects. In the United States, there have been 8.3 million cases and nearly 222,000 deaths as of October 21, 2020. Based on previous studies of mental health during outbreaks, the mental health of the population will be negatively affected in the aftermath of this pandemic. The long-term nature of this pandemic may lead to unforeseen mental health outcomes and/or unexpected relationships between demographic factors and mental health outcomes. Objective This research focused on assessing the mental health status of adults in the United States during the early weeks of an unfolding pandemic. Methods Data was collected from English-speaking adults from early April to early June 2020 using an online survey. The final convenience sample included 1083 US residents. The 71-item survey consisted of demographic questions, mental health and well-being measures, a coping mechanisms checklist, and questions about COVID-19–specific concerns. Hierarchical multivariable logistic regression was used to explore associations among demographic variables and mental health outcomes. Hierarchical linear regression was conducted to examine associations among demographic variables, COVID-19–specific concerns, and mental health and well-being outcomes. Results Approximately 50% (536/1076) of the US sample was aged ≥45 years. Most of the sample was White (1013/1054, 96%), non-Hispanic (985/1058, 93%), and female (884/1073, 82%). Participants reported high rates of depression (295/1034, 29%), anxiety (342/1007, 34%), and stress (773/1058, 73%). Older individuals were less likely to report depressive symptomology (OR 0.78, P<.001) and anxiety symptomology (OR 0.72, P<.001); in addition, they had lower stress scores (–0.15 points, SE 0.01, P<.001) and increased well-being scores (1.86 points, SE 0.22, P<.001). Individuals who were no longer working due to COVID-19 were 2.25 times more likely to report symptoms of depression (P=.02), had a 0.51-point increase in stress (SE 0.17, P=.02), and a 3.9-point decrease in well-being scores (SE 1.49, P=.009) compared to individuals who were working remotely before and after COVID-19. Individuals who had partial or no insurance coverage were 2-3 times more likely to report depressive symptomology compared to individuals with full coverage (P=.02 and P=.01, respectively). Individuals who were on Medicare/Medicaid and individuals with no coverage were 1.97 and 4.48 times more likely to report moderate or severe anxiety, respectively (P=.03 and P=.01, respectively). Financial and food access concerns were significantly and positively related to depression, anxiety, and stress (all P<.05), and significantly negatively related to well-being (both P<.001). Economy, illness, and death concerns were significantly positively related to overall stress scores (all P<.05). Conclusions Our findings suggest that many US residents are experiencing high stress, depressive, and anxiety symptomatology, especially those who are underinsured, uninsured, or unemployed. Longitudinal investigation of these variables is recommended. Health practitioners may provide opportunities to allay concerns or offer coping techniques to individuals in need of mental health care. These messages should be shared in person and through practice websites and social media.


Author(s):  
Valeria Marina Valle ◽  
Caroline Irene Deschak ◽  
Vanessa Sandoval-Romero

International migration flows have long been a defining feature of the Americas and have evolved alongside political and phenomenological shifts between 2009 and 2018, creating new patterns in how, when, and why people move. Migration is a determinant of health, and for the nations involved, regional changes create new challenges to defend the universal right to health for migrants. This right is repeatedly guaranteed within the global agenda, such as in the 1948 Universal Declaration of Human Rights by the United Nations; the 1966 International Covenant on Economic, Social, and Cultural Rights; and the 2015 United Nations Sustainable Development Goals (SDGs), especially SDG 3 regarding health and well-being, and SDG 10, which aims to reduce inequalities within and among countries. The 2018 Global Compact for Safe, Orderly and Regular Migration confirms a worldwide partnership highlighting protection of migrants’ right to health and services. The literature reviewed on migration and health in the Americas between 2009 and 2018 identifies two distinct publication periods with different characteristics in the Central and North American subregions: 2009 to 2014, and 2015 to 2018. The first period is characterized by an influx of young adult migrants from Central America to the United States who generally traveled alone. During the second period, the migration flow includes other major groups, such as unaccompanied minors, pregnant women, disabled people, people from the LGBTIQ+ community, and whole families; some Central Americans drew international attention for migrating in large groups known as “caravans.” In South America, the 2010–2015 period shows three defining tendencies: intensification of intra-regional cross-border migration (with an 11% increase in South American migrants from 2010 to 2015 and approximately 70% of intra-subregional migration), diversification of countries of origin and extra-regional destination, and the persistence of extra-continental emigration. Social determinants of health have a foundational relevance to health and well-being for migrants, such as age, housing, health access, education, and policy environment. Guiding theories on migration and health include Push-and-Pull Theory, Globalization Theory, Transnationalism, Relational Cultural Theory, and Theory of Assimilation. Migration and health was analyzed through the lens of five disciplines (Management, Social Work, Communication, Education, Information Science & Library Science, Law): clinical medicine, social sciences, health (general), professional fields, and psychology. There is an overrepresentation of literature in clinical medicine, demonstrating a strong bias towards production in the United States. Another gap perceived in the literature is the minimal knowledge production in South America and the Caribbean, and a clear bias towards publication in the North American continent. At the regional level, the Pan American Health Organization (PAHO)’s agenda serves to highlight areas of success and opportunities for future research, particularly in two areas: strengthening partnerships, networks, and multi-country frameworks; and adopting policies, programs, and legal frameworks to promote and protect the health of migrants. As these strategic lines of action aim to provide the basis for decisions regarding migrant health in the region, they should be considered two important avenues for further academic exploration.


2017 ◽  
Vol 22 (4) ◽  
pp. 909-918 ◽  
Author(s):  
Deanna Kerrigan ◽  
Victoria Chau ◽  
Melissa King ◽  
Emily Holman ◽  
Alain Joffe ◽  
...  

Mindfulness-based stress reduction (MBSR) has been shown to improve health outcomes across populations. We explored the feasibility, acceptability, and initial effects of a pilot MBSR program at a highly-ranked university in the United States. We conducted 23 in-depth interviews with 13 students. Interviews explored stressors and coping mechanisms, experiences with MBSR, and its reported impact and potential future use. Interviews were analyzed using thematic content and narrative analyses. Results indicated that students are exposed to a very high level of constant stress related to the sheer amount of work and activities that they have and the pervasive surrounding university culture of perfectionism. MBSR offered an opportunity to step back and gain perspective on issues of balance and priorities and provided concrete techniques to counter the effects of stressors. We conclude that MBSR and mindfulness programs may contribute to more supportive university learning environments and greater health and well-being among students.


2011 ◽  
Vol 16 (3) ◽  
pp. 181-189 ◽  
Author(s):  
Renea L. Beckstrand ◽  
Jann S. Pickens

Magnesium is an essential mineral necessary for optimal cellular health and well-being. Many adults in the United States fail to get recommended amounts of magnesium from their diets. Even so, symptoms of magnesium deficiency are rarely seen; however, maintaining normal body stores could be preventative against common diseases.


Blood ◽  
2021 ◽  
Vol 138 (Supplement 1) ◽  
pp. 4137-4137
Author(s):  
Syed M. Qasim Hussaini ◽  
Arjun Gupta

Abstract Background: more than 60,000 people die annually from hematologic malignancies in the united states (us). Patients with hematologic malignancies more frequently receive aggressive care toward the end-of-life and are more likely to die in a hospital compared to those with a solid tumor. Appropriate care of such patients is very dependent on an existing healthcare infrastructure. There are notable challenges to rural healthcare in the united states which contains less than 1/5th of all hospices in the us. In this study, we sought to investigate rural-urban disparities in place of death the us in individuals that died from hematologic malignancies. Methods: we utilized the us centers for disease control and prevention wide-ranging online data for epidemiologic research database to analyze all deaths from hematologic malignancies in the us from 2003 to 2019. A population classification utilizing the 2013 us census was made using the national center for health statistics urban-rural classification scheme. These classifications included: large metropolitan area (1 million), small- or medium-sized metropolitan area (50 000-999 999), and rural area (&lt;50 000). We estimated deaths in a medical facility, hospice, home, or nursing care facility. We stratified the results by age, sex, and race/ethnicity. The annual percentage change (apc) in deaths was estimated. All data was publicly available and de-identified. Findings: from 2003-2019, there were a total 1,088,589 deaths form hematologic malignancies in the united states, predominantly in large metropolitan areas (50.2%), followed by small or medium sized metropolitan areas (31.7%) and rural areas (18.2%). All regions noted decreases in medical facility and nursing facility related deaths, and increase in hospice and home deaths. While rural areas demonstrated the quickest uptake of hospice care (apc 61.5), they had the lowest overall presence of hospice care (8.3% of all rural deaths in 2019 vs. 14.9% for small or medium metropolitan vs. 12% for large metropolitan) and larger share of nursing facility related deaths (15.8% of all rural deaths in 2019 vs 12.3% for small or medium metropolitan vs 10.6% for large metropolitan). Discussion: we demonstrate end-of-life disparities in hematologic malignancies based on where an individual resides in the us with rural areas having notably lower share of deaths in hospice facilities. Older infrastructure, inadequate access to care, and financial barriers add to the medical complexity of care for all patients, and especially hematologic patients with high needs and complex treatment planning. These have been aggravated by rural hospital closures in the previous 18 months. The us senate is currently debating a bipartisan infrastructure that may add billions in building rural healthcare infrastructure to state budgets. Our findings are timely in helping inform congressional policy. Figure 1 Figure 1. Disclosures No relevant conflicts of interest to declare.


2020 ◽  
Author(s):  
Nassim Tabri ◽  
Samantha Hollingshead ◽  
Michael Jeremy Adam Wohl

We tested the hypothesis that perceived existential threat of COVID-19 elicits anxious arousal, which can manifest in prejudice toward the perceived source of the threat (Chinese people). Americans (n = 474) were randomly assigned to an experimental condition in which COVID-19 was framed as an existential threat to the United States or a non-existential threat control condition. They then completed self-report measures of anxious arousal and blatant prejudice towards Chinese people. As expected, participants in the threat (vs. control) condition reported greater anxious arousal which, in turn, predicted greater blatant prejudice. Threat (vs. control) condition also indirectly predicted greater prejudice via greater anxious arousal. Results suggest that COVID-19 existential threat may diminish social capital, which would further degrade people’s health and well-being.


Sign in / Sign up

Export Citation Format

Share Document