The differential impact of COVID-19 across health service psychology students of color: An embedded mixed-methods study.

OBJECTIVES: Communities of color in the United States systematically experience inequities in physical and mental health care compared to individuals who identify as non-Hispanic White. The coronavirus disease 2019 (COVID-19) pandemic exacerbated these structural drivers of inequity to disproportionate and devastating effects for persons of color. In addition to managing the direct effects of COVID-19 risk, persons of color were also navigating increased racial prejudice and discrimination. For mental health professionals and trainees of color, the effects of COVID-19 racial health disparities and the increase in acts of racism may have been compounded by their work responsibilities. The current study used an embedded mixed-methods approach to examine the differential impact of COVID-19 on health service psychology (HSP) students of color as compared to their non-Hispanic White peers. METHOD: Using quantitative and qualitative data from the Epidemic-Pandemic Impacts Inventory, measures of perceived support and of discrimination, and open-ended questions about students' experiences with racism and microaggressions, we examined the extent to which different racial/ethnic HSP student groups experienced COVID-19-related discrimination, the impacts of COVID-19 felt by students of color, and how these experiences differed from those of their non-Hispanic White peers. RESULTS: HSP students of color endorsed greater impacts of the pandemic on both self and others in the home, perceived themselves as less supported by others, and reported more experiences of racial discrimination than non-Hispanic White HSP students. CONCLUSION: Throughout the graduate experience, HSP students of color and their experiences of discrimination need to be addressed. We provided recommendations to HSP training program directors and students both during and after the COVID-19 pandemic.

Patterns and Impact of Burnout among Women in the Urology Workforce

INTRODUCTION AND OBJECTIVE: Contemporary rates of burnout amongst urologists are reported to be 60-80%. These rates have significant implications on physician well-being and retention. We investigated predictors of burnout in female surgeons. METHOD(S): An electronic census survey was distributed to residents, fellows and practicing urologists by the Society of Women in Urology in the United States and territories via email and social media between February and May 2022. We assessed participant demographics, personal and professional characteristics, practice environment, compensation, and burnout with chi-square and t-test analyses. RESULT(S): There were 379 survey participants with an average age of 42 years (SD 10). A majority identified as cis-gendered heterosexual females (96%) and were practicing urologists (74%), while 10% were fellows and 15% residents/interns. Average reported time in practice was 9 years (SD 9 years). Most respondents reported burnout (273, 72%), with 87% agreeing COVID worsened burnout in the community. Those reporting burnout worked an average of 58 (SD 15) hours per week versus 49 (SD 18) hours (p<0.00001). Table 1 demonstrates significant personal and professional characteristics for participants who reported burnout. On multivariable logistic regression analysis, increased hours worked per week (OR 1.03, p=0.002), Relative Value Unit based pay versus salary (OR 4.4, p=0.007), correlated to burnout and feeling income is comparable to peers (OR 0.4, p=0.03) was inversely related. Common shared experiences included lack of staffing, reduced operating room time, lack of administrative support, predominance of non-operative referrals, gender and racial inequity or microaggressions, electronic health records with increased documentation demands, increased non-clinical administrative duties, and insufficient compensation or lack of financial advancement. CONCLUSION(S): A majority of women in urology report burnout with work-hours and compensation inequity as leading contributing factors. Concerns raised in this study such as lack of support staff, racial and gender inequity, and poor referral patterns should be further evaluated to determine a comprehensive plan to reduce burnout. (Figure Presented).

Exploring Racial Microaggressions Toward Chinese Immigrant Women in Greater Boston During Covid

This study was an initial qualitative exploration to (a) capture varied experiences of racial microaggressions directed at Chinese immigrant women before and during Covid and (b) investigate different forms and levels of microaggressions based on socioeconomic status, age, and other characteristics. Racial microaggressions were examined by interviewing 12 foreign‐born, Chinese immigrant women aged 23 to 80 years old, with most of the participants identified as middle class or above. Building upon previous scholarship on racial and gendered microaggressions, an analytical framework was developed using 12 major themes to identify and interpret discriminatory behaviors. Our main findings suggest that the research sample encountered more blatant hate incidents and expressed heightened concern over their physical safety in the post‐Covid period. Young women, compared to their older counterparts, were more inclined to report microaggres-sion episodes and distinguish more subtle forms of discrimination. These findings could serve as preliminary evidence for future research. © 2023 by the author(s).

Experienced gendered racial microaggressions and psychological distress among Filipino American women

Informed by Racial Microaggressions Theory, this study examined the prevalence and types of experienced gendered racial microaggressions in Filipino American women, level of stress that such experiences generated in relation to their identity, and the effects on their level of psychological distress. This correlational analysis design study surveyed 237 respondents via an online self-administered 63-question survey. Responses were analyzed using Independent Samples t-Tests, correlation, and multiple linear regression statistics. Findings indicated that experienced gendered racial microaggressions predicted psychological distress among Filipino American women, demonstrated a positive relationship between stress associated with experienced gendered racial microaggressions and psychological distress;Filipino American women who reported more experienced gendered racial microaggressions and felt more stress associated with it, reported higher levels of psychological distress among. Implications for social work theory, practice, pedagogy, policy, and future research are discussed. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

Hate-motivated Crime/Incidents Against Asians in the United States of America: A Systematic Review

Although hate-motivated incidents and crimes against Asians are not a new phenomenon, there has been a lack of scholarly attention on the topic. Using a systematic review, we examine, assess, and analyze 23 published peer-reviewed articles that have explored hate-motivated crime/incidents against Asians in the United States of America between 2000 and 2020. We found all studies included in this systematic review examined microaggressions and/or discrimination, and tended to lump all different Asian subgroups into "Asians.” In addition, most studies focused on the consequences of hate-motivated incidents, such as mental and physical health. We suggest a future research agenda and direction that fills the gap in scholarly journal articles on Asian hate-motivated incidents in the United States. © The Author(s) 2022.

No, I Do Belong: How Asian American and Asian Canadian Professionals Defy and Counter Workplace Racial Violence during COVID-19

We explore the different types of racial violence encountered by Asian American and Asian Canadians (whom we refer to as Asians) in the workplace during COVID-19 and how they respond. Using a grounded theory approach, we found that during the COVID-19 pandemic, Asians experienced different types of workplace racial violence, most of which manifested as microaggressions, including a revival of the yellow peril trope, physical manifestations of bordering behaviour, and identity denial. In some cases, manifestations of physical violence also emerged. The data revealed that Asians demonstrated various types of agentic responses to challenge and counter unwanted and incorrect identities conveyed by the racial microaggressions. We enhance theory by shedding light on the experiences of Asians whose voice has largely been ignored in the organizational literature. Our study draws together and contributes to the theory on racial violence and racialized identity by highlighting the different types of racial violence faced by Asians and exploring the challenges they encounter in the face of racial microaggressions. Finally, we discuss practical implications of our study results and offer insight into how organizations can help support their Asian employees.

Hate-motivated Crime/Incidents Against Asians in the United States of America: A Systematic Review

Although hate-motivated incidents and crimes against Asians are not a new phenomenon, there has been a lack of scholarly attention on the topic. Using a systematic review, we examine, assess, and analyze 23 published peer-reviewed articles that have explored hate-motivated crime/incidents against Asians in the United States of America between 2000 and 2020. We found all studies included in this systematic review examined microaggressions and/or discrimination, and tended to lump all different Asian subgroups into "Asians." In addition, most studies focused on the consequences of hate-motivated incidents, such as mental and physical health. We suggest a future research agenda and direction that fills the gap in scholarly journal articles on Asian hate-motivated incidents in the United States.

The impact of diversity, equity, and inclusion training in an independent community oncology practice

Background: Historically, Diversity, Equity, and Inclusion (DEI) efforts have largely been left out of private practice medical facilities - mainly present in large academic hospital centers. Virginia Oncology Associates (VOA), a member of The US Oncology Network, is an independent community oncology and hematology practice specializing in the diagnosis and treatment of cancer and blood disorders. VOA has approximately 600 total employees consisting of physicians and clinical and non-clinical staff. In August of 2020, VOA launched an initiative to foster a culture of inclusion with the creation of its Inclusion Council (IC). Sixteen employees', both clinical (3 physicians) and non-clinical, were chosen to participate. The council reports to VOA's joint policy board. Methods: The council partnered with an outside organization, Virginia's Center for Inclusive Communities, to launch a practice-wide DEI training program focusing on unconscious bias and microaggression. The training was initially planned to be in person, but due to the constraints of the COVID pandemic, the training was performed using a virtual platform. The members of IC attended three two-hour sessions while other staff members and physicians were mandated to participate in at least one training session. After completion of the sessions, a survey was sent to all employees and physicians to measure the impact of DEI training. All employees were also given the opportunity to provide additional, anonymous, written feedback. Results: Table. A total of 169 employees responded. 72% of respondents agreed or strongly agreed that the program increased awareness of unconscious bias and microaggression, 67% felt that the program helps foster a culture of inclusion in the workplace, and 66% of respondents felt that the program met expectations. Conclusions: DEI efforts are vital in all aspects of health care delivery and oncology settings. DEI training met staff expectations and positively fostered a culture of inclusion by bringing attention to unconscious bias and microaggression in a community oncology practice.

ASSESSING PATIENT PERSPECTIVES ON RACIAL BIAS AT THE SFVA DOWNTOWN CLINIC: A TRAINEE-DRIVEN QI PROJECT

STATEMENT OF PROBLEM/QUESTION: Racial bias impacts health outcomes however, little is known about patient perspectives about this at San Francisco VA's Downtown Clinic (DTC), an urban clinic serving a higher proportion of Black and Latinx Veterans. DESCRIPTION OF PROGRAM/INTERVENTION: Patient satisfaction survey responses for DTC have historically been low with 34 patients (4%) completing surveys in 2019-20. To develop a novel survey assessing patient perspectives on satisfaction and the impact of bias and racism on care delivery in DTC, we modified two well-studied instruments, the Interpersonal Processes of Care (IPC-18) and Microaggressions in Health Care Scale (MHCS), and gave opportunities for free text feedback. We surveyed Veterans in 2021. Using root cause analysis, we identified barriers to survey response including those related to: process (surveys only sent via mail but many patients unhoused), patients (low motivation), providers/staff (no unified messaging about surveys, no interprofessional teamwork), and the COVID-19 pandemic (few in-person visits). Our interventions targeted: 1) ease of access: having electronic and paper surveys, and electronic tablets to use;2) maximizing patient engagement: surveys at COVID vaccine clinics and gifts for participation;and 3) communication/teamwork: posters advertising surveys, frequent staff check-ins. MEASURES OF SUCCESS: We assessed survey response rates and analyzed responses. FINDINGS TO DATE: N=236 Veterans completed surveys (25% of all clinic;93% male, 39% White). Overall, participants did not report microaggressions. On a 3-point scale (1=never happened, 2=happened but it didn't bother me, 3=happened & I was bothered by it) mean score on the MHCS=1.05 for the statement: “staff/providers were insensitive about your cultural group when trying to understand/treat your issues” and 1.02 for the statement: “staff/providers seemed to have stereotypes about your cultural group even if they did not express them directly”. Scores varied minimally by race. The Interpersonal Style domain of the IPC was scored the worst by African-American and Mixed Race Veterans, including that they felt the most discriminated against due to race/ethnicity (1.76 on a 1-5 scale, higher=worse). Patient-Centered Decision Making was scored worst by White Veterans, and overall Communication was scored the worst by Asian Veterans. N=18 (12% of respondents) preferred/strongly preferred a racially concordant PCP. N=10 (9%) disagreed/strongly disagreed that police officers at clinic treat all patients fairly with no significant differences by race using Fisher's exact test. Feedback mentioned: Veterans want providers to ask instead of assume about identities related to race, gender, sex, sexuality or those related to disabilities or chronic illnesses. Several suggested more minority representation in staff and trauma-informed care. KEY LESSONS FOR DISSEMINATION: Through accounting for multifactorial barriers to survey participation using Lean principles, we dramatically increased responses. Our survey elicited valuable perspectives to inform leadership.

When the "Model Minority" becomes the "Perpetual Foreigner": Racial discrimination against Asian Americans in retail

According to a report by Stop AAPI Hate (Yellow Horse et al., 2021), racial discrimination against Asian Americans during the COVID-19 pandemic occurred in businesses such as grocery stores, malls, and restaurants (30.1%) and most were in the forms of verbal harassment (63.7%) and shunning (16.5%). In other words, many Asian Americans experienced racial discrimination in retail environments during the pandemic. Yet, despite the negative experiences in retail, studies on the forms of racial discrimination Asian American consumers faced during the pandemic and in their everyday lives have been lacking. The purpose of this study is to close this gap and debunk the assumption that Asian Americans do not experience racial discrimination due to the "model minority" myth (Gee & Peck, 2018). Also, to highlight the experiences of Asian Americans to inform retailers about the consumer group that is increasing in numbers and buying power (Constante, 2018;Nielsen, 2020). Moreover, the researcher proposes and tests a theoretical framework that synthesizes the literature on attributional ambiguity theory, racial microaggressions, and consumer research on attribution, emotions, and behaviors. To answer research questions and test the theoretical model, one-on-one semi-structured interviews were conducted, and 18 East Asian Americans participated in the interviews. Two overt racial discrimination themes emerged from the interviews: No Asians in here please, All you Asians... Seven racial microaggression themes were found: Less than, The perpetual foreigner, Carriers of the virus, Invisible, Not a target customer, Stereotyped customers, and All the same. Three attribution themes were detected: Employee's negative attitude towards Asian Americans, Lack of contact with Asian Americans, and Ambiguous. Moreover, emotional responses were mostly other-directed (e.g., frustrated, irritated, and angry). Lastly, four behavioral response themes were discovered: Negative OCR, Direct complaint, No repatronage, and No action taken against the employee or retailer. Theoretical implications and future research are discussed for researchers and practical implications are provided for retailers and retail employees in terms of retail management. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

Navigating Harm Through Lovingkindness: A Community-Engaged Qualitative Study With Diverse Meditators During COVID-19

Methods: In partnership between university researchers and a community-based meditation center, we conducted virtual focus groups on experiences lovingkindness meditation before and during the COVID-19 pandemic. We used reflexive thematic analysis to analyze focus group data, with a member checking process. Results: 47 people participated in 6 focus groups (mean age 47;62% LGBTQ+;32% white, 23% Asian, 19% Black, 13% Hispanic/Latina/o, 24% multi-racial). Qualitative analysis revealed two central themes: (1) Diverse meditators' participation in a community of practice, including adaptation to virtual-only formats during COVID-19;(2) The use of metta to navigate harmful situations, both individual stressors and systems of oppression. Background: Inclusive research is needed to understand how contemplative practices are used by people across a range of identities. Lovingkindness meditation (LKM) may be particularly relevant for efforts towards equity and justice because of the social nature of the practice. Using community-based participatory research and an intersectional framework, this qualitative study focuses on how people in a diversemeditation community teach and practice lovingkindness or metta meditation. Conclusion: Diverse participants in a meditation community found lovingkindness practice supportive for coping with the stress of microaggressions and structural oppression. They used LKM to navigate hardships caused by the COVID- 19 pandemic, offer compassion to themselves and others, and cultivate the ability to hold multiple difficult emotions. Community-engaged approaches to meditation research are feasible during the COVID-19 pandemic and other times of crisis and should be used more widely. Health Services Research.

The importance of addressing racial microaggression in nursing education.

The Pandemic laid bare how embedded racism is within our structures, institutions and societal systems. We are bearing witness to long standing issues now manifesting as deep inequities that have been overlooked. In both academic and clinical instruction and settings there is a need for a culture shift to empower recipients of racialized aggression and enable allies, active bystanders and leaders to respond in ways that promote values that extend our shared humanity. Using research, experience and observations the authors provide best practices for responding to and dismantling microaggressions. In addition, they discuss the impact of microaggression within nursing education and clinical settings. These include recommendations for student recipients, applicable to classroom and clinical settings, and intervention proposals for allies, active bystanders and leaders.

"Go back to China with your (expletive) virus": A revelatory case study of anti-Asian racism during COVID-19

Since coronavirus disease (COVID-19) emerged at the beginning of 2020, reports of anti-Asian racism have surged, yet little is known in the empirical literature about participants' lived experience of racism during this time. We designed a qualitative, intrinsic, revelatory case study to examine the different types of anti-Asian racism being perpetrated, and the contexts and perpetrators during the first 6 months of COVID-19. We analyzed the online and written responses of 193 self-identified Asian Americans from over 32 states and corroborated their experiences with news articles, journal articles, and reports of anti-Asian hate crimes published during the same period. Our analysis yielded 11 types of racist experiences: (a) No direct personal experience, only vicarious, (b) Stared at, glared at, shunned, (c) Singled out and treated poorly, (d) Indirectly referenced in third person, (e) Was the butt of a racist joke, (f) Blamed for the virus, (g) Stereotyped with racist characterization, (h) Told to go back to an Asian country, (i) Called a racial slur, (j) Hostile verbal assault, and (k) Physically threatened. Regarding the context and perpetrator of anti-Asian racism, our analysis yielded seven subthemes: (a) from friends and family, (b) at school and work, (c) in daily tasks, (d) while commuting, (e) in the socialization of children, (f) in online spaces, and (g) from police and security officers. Our findings showcase the wide range of anti-Asian racism and underscore the need to integrate scientific research with advocacy efforts to enhance awareness of anti-Asian racism. (PsycInfo Database Record (c) 2022 APA, all rights reserved) Impact Statement We designed a qualitative study to examine anti-Asian racism during the first 6 months of COVID-19 in the U.S. We wanted to know what types of racism were being perpetrated, by whom, and in what settings. Our findings revealed a wider range of anti-Asian racism than what has been captured in the scientific literature and advocacy efforts to document Asian American experiences of racism. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

COVID-Related Concerns, the Need for Help, and Perceived Microaggression among Young Ultra-Orthodox Jewish Respondents in Israel.

Minority groups are especially vulnerable to the negative psychological and economic consequences of the COVID-19 pandemic. This study focused on one prominent minority group in Israel: ultra-Orthodox Jews. It examined the rate of exposure to COVID-19, adherence to COVID-19 mitigation guidelines, difficulties with adherence to COVID-19 guidelines, COVID-related concerns, financial hardships, the need for help, and microaggression during the first wave of the pandemic (April-May 2020). It then examined multivariate prediction of COVID-related concerns, the need for help, and microaggression. The sample comprised 252 respondents, with 67% female and a mean age of 32.85 (SD = 10.63). Results showed that 78.8% of the participants knew at least one person who had tested positive for COVID-19, and 31.4% knew at least one person who had passed away from COVID-19. Only 59.7% of the participants reported high adherence to social distancing guidelines. Perceived microaggression was predicted by the difficulties with adherence to COVID-19 guidelines, the level of stress associated with exposure to the media, and financial hardships. The study's implications point to the centrality of perceived microaggression and the necessity of adopting culturally sensitive approaches to engage minorities in public efforts to fight the spread of viruses.

Daily Microaggressions and Related Distress among Black Women Living with HIV during the Onset of the COVID-19 Pandemic and Black Lives Matter Protests.

Black women living with HIV (BWLWH) in the U.S. face microaggressions based on race, gender, HIV-status, and sexual orientation. We examined changes in daily microaggressions and related distress among 143 BWLWH in Miami, FL. Microaggression-related distress increased from 52% at baseline/October, peaked at 70% during the holidays (November/December), declined to 55% in March when COVID-19 social distancing began, and peaked to 83% in June/July 2020 during widespread Black Lives Matters protests. Baseline viral suppression was associated with lower microaggressions across the 9-months. Microaggression-related distress may change due to social context and research is needed on microaggressions and viral load overtime.

RESUMEN: Las mujeres de raza negra que viven con el VIH (MNVV) en los EE. UU. enfrentan microagresiones basadas en la raza, el género, el estado serológico del VIH y la orientación sexual. Examinamos los cambios en las microagresiones diarias y el estrés relacionado entre 143 MNVV en Miami, FL. El estrés relacionado con la microagresión aumentó del 52% en la línea de base/octubre, alcanzó un máximo del 70% durante las vacaciones (noviembre/diciembre), disminuyó al 55% en marzo cuando comenzó el distanciamiento social por el COVID-19 y alcanzó un máximo del 83% en junio/julio de 2020 durante las protestas generalizadas de Black Lives Matters. La supresión viral inicial se asoció con menores microagresiones durante los 9 meses. El estrés relacionada con la microagresión puede cambiar debido al contexto social y se necesitan investigaciones sobre las microagresiones y la carga viral con el tiempo.