The mediating effects of socio-behavioral factors on the needs for help among Asian American breast cancer survivors

Background: Breast cancer survivors often report their high needs for help during the transition to cancer survivorship. During the COVID-19 pandemic, technology-based programs are increasingly popular because of their high flexibility and accessibility in delivering information and coaching/support to address the current needs for help among cancer survivors. Yet, little is known about how socio-behavioral factors influence the effects of a technology-based intervention on the needs for help of racial/ethnic minority breast cancer survivors, especially Asian American breast cancer survivors. Purpose(s): The purpose of this secondary analysis was to examine the multiple socio-behavioral factors (including attitudes, self-efficacy, perceived barriers, and social influences related to breast cancer survivorship) mediated the effects of a technology-based intervention on the needs for help among Asian American breast cancer survivors. Method(s): This analysis was conducted with the data from 199 Asian American breast cancer survivor women who were recruited from January 2017 to June 2020 through online and offline communities/groups. The needs for help were measured using the Support Care Needs Survey-34 Short Form (SCNS) with five domains on psychological, information, physical, support, and communication needs. Mediation analysis was conducted using the PROCESS macro within SPSS. The analysis determined the mediating effects of four socio-behavioral mediators on the needs for help at pre-test [T0 ], post 1-month [T1 ], and post 3-months [T2 ] of a technology-based intervention. Result(s): Overall, all the mediators had statistically significant mediation effects on all types of needs for help (p < .05) at different points. Attitudes and social influence presented statistically significant mediation effects on the total needs for help score over 3 months (T0 , T1 , and T2 ). Perceived Barriers had mediation effects on all types of needs for help over 1 month (T0 , T1 ). Self-efficacy mediated the effects on all types of needs for help only at post 1 month (T1 ). Conclusion(s): The findings supported that all the socio-behavioral factors (attitudes, self-efficacy, perceived barriers, and social influences) mediated the effects of a technology-based intervention on the needs for help of Asian American breast cancer survivors. Future research and practice should consider socio-behavioral factors to reduce their needs for help during their survivorship process.

Grandparent-grandchild relationships and ethnic identity in asian and asian american undergraduate students

This study examined how Asian and Asian American grandparent-grandchild relationships related to ethnic identity in the context of COVID-19-related racial discrimination. Asian and Asian American grandchildren (N = 102) answered questions about discrimination, ethnic identification, grandparent-grandchild relationships, and ethnic behaviors. There was no significant relationship between exposure to discrimination and strength of ethnic identity, but strength of ethnic identity was a significant predictor of frequency of synchronous contact with grandparents and ethnic behaviors. Findings suggest that stronger ethnic identities in Asian and Asian American undergraduate students could be related to better relationships with their grandparents. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Changes in familial discussions among East Asian American families during the COVID-19 pandemic

Objective: We examined the degrees of change in familial discussions about racial issues (i.e., race, ethnicity, racism, and discrimination) due to the surge of anti-Asian discrimination during the COVID-19 pandemic.Background: Asian American family racial-ethnic socialization that teaches the values, information, and perspectives about racial-ethnic group membership and race relations carry great implications for youth development. However, little is known about how anti-Asian sentiments may have contributed to the degrees of change in racial issues.Method: The participants included 143 second-generation East Asian American youth (e.g., Chinese, Korean, Japanese, and Taiwanese) ages 11-18 years (M = 14.96, SD = 1.98). Youth were attending middle (38%) or high (62%) schools in the United States.Results: Latent profile analysis identified four profiles of degrees of change in familial discussions: (a) moderate change in racial discussions about other ethnicities, (b) much change in racial discussions, (c) moderate change in racial discussions about own ethnicities, and (d) little change in racial discussions.Conclusion: Our findings provide a snapshot of the ways East Asian American families' racial discussions are changing, which in turn shape youth's experiences in navigating their social contexts.Implications: The findings provide valuable directions for research and interventions to promote important racial discussion among East Asian American families.

Racism, Risk, and Supply: U.S. Policies Toward COVID-19 and Asia, and Current and Future Impacts on Asian Americans

COVID-19 illuminates the contradictions of U.S. relations with Asia economically, culturally, and socially in relation to Asian immigrant labor, goods and manufacturing, and with Asian Americans. We explore the importance of Asia as a supplier of labor and goods to the U.S. health system in order to analyze how the U.S. navigates its interdependence with Asia while demonizing Asians/Americans and attempting to protect its borders metaphorically and materially. We analyze how Asian American nurses are fighting the battle against the pandemic on the frontlines while also fighting the stereotypes and stigma that some Americans may have against them because they associate Asian Americans with the spread of COVID-19. © The Author(s), under exclusive license to Springer Nature Switzerland AG 2022.

Addressing Anti-Asian Racism and Stigma Towards Therapy: A Clinical Intervention Guideline

Asian Americans (AA) in the United States, and throughout the world, commonly hold a negative connotation or stigma regarding seeking mental health services. Unique cultural stigmas and beliefs of AA play an important role when examining why this population group is less likely to engage in therapy. This article explains why these cultural stigmas and beliefs contribute to the lack of mental health help seeking. Through examining these stigmas, perception of therapy, loss of face, and parental control among AA will allow therapists to have a better understanding when they are working with this population. Also, the consideration is given of how the increase of Anti-Asian racism due to the COVID-19 pandemic affects AA and the challenges it creates. This article includes a case example that provides information on how stigmas impact an AA family who have differing cultural values and expectations while experiencing discrimination from COVID-19. [ FROM AUTHOR] Copyright of Family Journal is the property of Sage Publications Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

Covid-19 Bivalent Booster Effectiveness in People with and without Immune Dysfunction

Background: Data on the effectiveness of the bivalent booster vaccine against COVID-19 breakthrough infection and severe outcomes is limited. Method(s): Using patient-level data from 54 sites in the U.S. National COVID Cohort Collaborative (N3C), we estimated bivalent booster effectiveness against breakthrough infection and outcomes between 09/01/2022 (bivalent vaccine approval date) to 12/15/2022 (most recent data release of N3C) among patients completed 2+ doses of mRNA vaccine. Bivalent booster effectiveness was evaluated among all patients and patients with and without immunosuppressed/compromised conditions (ISC;HIV infection, solid organ/ bone marrow transplant, autoimmune diseases, and cancer). We used logistic regression models to compare the odds of breakthrough infection (COVID-19 diagnosis after the last dose of vaccine) and outcomes (hospitalization, ventilation/ECMO use, or death <=28 days after infection) in the bivalent boosted vs. non-bivalent boosted groups. Models controlled for demographics, comorbidities, geographic region, prior SARS-CoV-2 infection, months since the last dose of non-bivalent vaccine, and prior non-bivalent booster. Result(s): By 12/15/2022, 2,414,904 patients had received 2+ doses of mRNA vaccination, 75,873 of them had received a bivalent booster vaccine, and 24,046 of them had a breakthrough infection. At baseline, the median age was 52 (IQR 36-67) years, 40% male, 63% white, 10% Black, 12% Latinx, 3.5% Asian American/Pacific Islander, and 14% were patients with ISC. Patients received a bivalent booster were more likely to be female and had comorbidities. Bivalent booster was significantly associated with reduced odds of breakthrough infection and hospitalization (Figure). The adjusted odds ratios comparing bivalent vs. non-bivalent group were 0.28 (95% CI 0.25, 0.32) for all patients and 0.33 (95% CI: 0.26, 0.41) for patients with ISC. Compared to the nonbivalent group, the bivalent group had a lower incidence of COVID-19-related hospitalization (151 vs. 41 per 100,000 persons), invasive ventilation/ECMO use (7.5 vs. 1.3 per 100,000 persons), or death (11 vs. 1.3 per 100,000 persons) in all patients during the study period;the incidence of severe outcomes after bivalent boosting was similar among patients with and without ISC. Conclusion(s): A bivalent booster vaccine was highly effective against COVID-19 breakthrough infection and severe outcomes among patients received 2+ doses of mRNA vaccine and offered similar protection in patients with and without ISC. (Figure Presented).

The Why and Whither of Asian American Studies: Toward a Reckoning

Yuri Kochiyama (1921–2014) On March 11, 2020, roughly three months after the first death attributed to the newly discovered SARS-CoV-2 (COVID-19) virus was confirmed in Wuhan, China, the World Health Organization elevated its characterization of the ensuing outbreaks from "public health emergency of international concern" (PHEIC) to global pandemic. [...]we editors, along with the contributors to this special issue, acknowledge from the outset that the formation of Asian American studies—along with ethnic studies and gender/sexuality studies—was first and foremost a paradigmatic endeavor, one that, as Lisa Lowe productively characterizes it, remains "key to thinking in comparative relational ways about race, power, and interconnected colonialisms. More than a few students found themselves spending more time in the community than in school. [...]were born a host of Asian American community organizations and services, as well as an increasing vector of Asian American political activism in defense of our communities. "4 Such reckonings, intimately tied to the formation of Asian American studies as a critical race-based interdiscipline born out of 1960s civil rights movements and liberation fronts, encapsulate the field's aspirational politics.

Asian Americans and grief in the COVID-19 pandemic: A critical analysis of the literature

The present study is a critical analysis of the literature about Asian Americans and grief during the COVID-19 pandemic. This dissertation provides an inclusive review and impression of the existing literature on Asian Americans' grief reactions during the COVID-19 pandemic, including the discussion of the need to disaggregate Asian American data. The literature provides a history of Asian American immigration and demographics. Current literature identifies how Asian American subgroups differ in grief responses and the increase in xenophobia towards Asian Americans since the start of the COVID-19 pandemic. Recommendations are made regarding the continued efforts to disaggregate Asian American data and complete further research on the grief response of Asian Americans during the COVID-19 pandemic. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

A/Moral Divide: Questions for an Asian American Studies Research Paradigm

Research for the community ultimately aims to effect social change. Transpacific studies offers an analysis about global power, war and colonial presence, and unequal exchanges between nations that explores the transnational ties of Asian Americans.11 For instance, Laura Kina and Wei Ming Dariotis's work examines the intersection of American empire and the racialized/gendered representations of mixed-race Amerasians. The promise of transpacific studies and critical refugee studies is that they not only assess the traumas, needs, and conditions of Asian American communities, but they also examine the subjectivities, hopes, and futures of migrants and refugees as active, creative agents themselves.14 For example, transpacific scholar Wesley Ueunten writes about resistance to the construction of an American military base in Okinawa: Old people, as old and tiny as my Baban [grandmother] in my memories of her, have come to sit on the beach every day in quiet but unrelenting resistance to American Manifest Destiny and Japanese fatalistic dependency on that Destiny. In theory then, the genealogical and discursive analyses of transpacific studies and critical refugee studies would shed light on how we view social realities, and illuminate what's often missing in the analysis of these concepts.

Editors' Preface

[...]many authors suggest that the ideas and critiques and activist struggles that established the field either remain or, having shifted away, are now being revisited. Yê´n Lê Espiritu, in her article in this issue, looks at the ways critical refugee studies demands the global study of race, imperialism, and war, beyond the domestic landscape of what some consider Asian American studies. Jean-Paul R. Contreras deGuzman, and Douglass Ishii in a separate essay, share candid reflections on the life of contingent labor in the university and what is being asked of a field that claims to center critiques of power and work for transformative justice.

From Yellow Peril to Model Minority and Back to Yellow Peril

During the COVID-19 pandemic, some perceptions of Asian Americans in the United States shifted as anti-Asian hate crimes escalated. However, little is known about how these shifting views manifest in K-12 schools. This qualitative case study uses Asian critical race theory to examine how two Southeast Asian American students faced exclusion and erasure before and during the COVID-19 pandemic and how their Southeast Asian American teacher advocated for them at a public elementary school in the Pacific Northwest. Implications include how researchers can pursue inquiries about Asian American students' holistic development and how in-service and pre-service teachers can address anti-Asian xenophobia.

Paradoxes of the Canadian mosaic: "being, feeling and doing Canadian "

This autoethnographic narrative shows how discourses of belonging for racialized identities within Canada's mosaic are bounded by history, cultural politics, and attendant social struggles. Using an intersectional framework of Asian Critical theory, politics of location, and cultural capital, this paper demonstrates how ideologies of belonging are sustained by processes of cultural and institutional socialization which maintain hierarchies privileging some social groups over others and produce racial/ized difference and inequities within Canadian citizenry. As a second-generation of Chinese ancestry born and raised in Vancouver, Canada, my lived experiences in a predominantly white English-speaking environment illustrate how my status as "model minority " or "honorary white " has been a precarious position. Bonilla-Silva warns us that "honorary white " positioning may be revoked in times of economic, racial or ethnic tension. Dramatic increases in anti-Asian hate incidents during the 2020 Coronavirus pandemic-earning Vancouver, BC, the title of the "anti-Asian hate capital of North America "-is an example of how these racialized statuses are paradoxical designations which deny the existence of social inequities. Critical research must interrogate how the continued use of mis-aggregated data that essentializes diverse population groups and perpetuates harmful distortions of Canadian citizenry contribute to, rather than dismantle, discourses of race in "multicultural " Canada.

Psychological Well-Being in Asian and Asian American University Students: Impacts of Discrimination During the COVID-19 Pandemic.

PURPOSE: The aim of this study is to determine what modifiable behavioral and sociological factors were predictive of psychological distress and suicide risk in Asian and Asian American students, the ethnic group with the highest unmet mental health need in collegiate populations. We also compared these relationships in Fall 2019 to Fall 2020 to better understand how the impact of these factors changed during the COVID-19 pandemic and concurrent increase in Anti-Asian discrimination. METHODS: We used factor analysis to extract a wide range of predictor variables from the Fall 2019 and Fall 2020 American College Health Association's National College Health Assessment III. Next, we used structural equation modeling to identify significant drivers of psychological distress (Kessler-6 scale) and suicidality (Suicide Behavior Questionnaire-Revised scale) in Asian and Asian American students (n = 4,681 in 2019 and 1,672 in 2020). RESULTS: When compared to 2019, experiencing discrimination in 2020 had a substantially larger effect on both psychological distress and suicidality among Asian and Asian American university students. Loneliness and depression were also significant drivers of negative mental health outcomes both years, and their effect magnitudes remained largely unchanged. Being well rested had a protective effect against psychological distress both years. DISCUSSION: During the COVID-19 pandemic, discrimination was an important driver of psychological distress and suicidality in Asian and Asian American students. These findings suggest that organizations should enhance culturally competent mental healthcare services, while also working at the systems level to reduce bias and discrimination.

Shifting mediates gendered racial microaggressions and perceived racism among Asian American women.

INTRODUCTION: Microaggressive attacks on Asian American women increased during the COVID-19 pandemic. The present study tested whether Asian American women's shifting, a coping strategy employed by some women of color to alter their self-presentation in response to perceived racism, mediated the association between gendered racial microaggressions and self-perceived subtle and blatant racism. METHODS: A convenience sample of 253 Asian American adult women completed the gendered racial microaggressions scale for Asian American women (GRMSAAW), the Asian American women's shifting scale (AsAWSS), and the subtle and blatant racism scale for Asian American college students (SABR-A2 ). RESULTS: Results from a structural equation model indicated a partial mediation effect; experiences with increased gendered racial microaggressions were associated with greater levels of shifting, which in turn, were associated with greater perceived subtle and blatant racism. DISCUSSION: These data extend our understanding of the shifting coping mechanism used by some Asian American women. Implications for clinical practice and future research are also discussed.

The Racial Differences in Impact and Knowledge of COVID-19 Among Patients with Psychiatric Illnesses

Introduction: COVID-19 pandemic has been associated with increased rates of de-pression, anxiety, and suicidal ideation. Individuals with mental illnesses are disproportionately affected by additional complex health issues. This study aims to examine the knowledge and impact of COVID-19 among patients with mental disorders at the Harris County Psychiatric Center (HCPC). Method(s): A retrospective review of surveys was conducted for patients with mental illness at HCPC. Participants were surveyed on demographics, COVID-19 knowledge, and COVID-19 healthcare impact. The data were analyzed with SPSS 20 for Windows at a 0.05 significance level. Result(s): A total of 46 patients were included in the study. We found that the patient population with mental disorders has different methods of obtaining information regarding COVID-19 and practices varying safety measures. To be precise, more women (52.2%) than men (21.7%) learned about COVID-19 through family and friends (p=0.032). More Hispanic (21.4%) compared to non-Hispanic (0%) patients learned about COVID-19 through resources from the World Health Organization (WHO) (p=0.032). Fewer African American (AA) patients avoided contact with people who were sick (39% vs. 81%) Caucasian (p=0.01) and (100%) Asian/Native American/Pacific Islander [ANAPI] patients (p=0.04). We found more non-Hispanic (50.0%) vs. Hispanic (7.1%) patients reported that their personal time (time outside of work) was unchanged by COVID-19 (p=0.007). More Hispanic (57.1%) vs. non-Hispanic (17.9%) patients reported increased time with family members (p=0.009). Compared to Hispanic patients, more non-Hispanic patients reported unchanged difficulty scheduling appoint-ments (46.4% vs. 7.1%) (p=0.015), obtaining prescription (71.4% vs. 35.7%) (p=0.045), and finding housing placement (53.6% vs. 21.4%) (p=0.047). Furthermore, more Caucasian compared to AA patients reported more changes in how they feel (35.7% vs. 76.2%) (p=0.033), anxiety (52.6% vs. 0%) (p=0.002), stress (47.4% vs. 7.7%) (p=0.024), and sadness (30% vs. 0%) (p=0.031). Finally, more ANAPI (67%) compared to AA patients (0%) reported increased anxiety (p=0.025). Conclusion(s): Our findings suggest that African American patients report less knowledge of COVID-19 prevention and less impact on their mental health by the pandemic compared to other racial groups. Our findings suggest that African American patients may have limited knowledge of COVID-19 prevention compared to other races, Caucasian and Asian/Native American/Pacific Islander patients may have increased mood changes, and Hispanic patients may be experiencing more healthcare inequality amidst the pandemic. However, further inves-tigation of the impending ramifications of the pandemic is warranted.Copyright © 2023 Bentham Science Publishers.

Asian American mental health amidst COVID-19 anti-Asian racism: Internalized racism and generational status as moderators

In a national sample of 565 Asian Americans, this study investigates whether direct experiences of coronavirus disease (COVID-19) racism or vicarious exposure (e.g., witnessing, news reports, videos, and stories) of others experiencing COVID-19 racism lead to adverse mental health outcomes above and beyond the impact of general COVID-19 stressors. We used moderated moderation models to test our hypotheses of main effects and three-way interaction effects using the PROCESS Macro in SPSS (Hayes, 2017). Our results showed that both direct and vicarious experience of COVID-related racism significantly and positively predicted depressive, anxiety, and somatic symptoms, above and beyond the impact of general COVID-related stressors. In addition, the three-way interaction of COVID-related racism, internalized racism, and generational status was significant in three out of four models. There was a significant interaction effect such that higher levels of internalized racism mitigated the strength of the relation of COVID-related direct and vicarious racism on depression and anxiety symptoms for 1.5 and 2nd+ generation Asian Americans. For 1st generation Asian Americans, internalized racism exacerbated the impact of vicarious COVID-related racism on somatic symptoms. Our findings revealed the nature of how immigration generational status and internalized racism moderated the relations between COVID-related racism and psychological wellbeing for Asian Americans during a public health crisis. (PsycInfo Database Record (c) 2023 APA, all rights reserved) Impact Statement What is the public significance of this article?-The study shows that direct and vicarious COVID-19-related racism was detrimental to Asian Americans' mental health. Additionally, the study revealed that the risk for adverse mental health outcomes depends on internalized racism beliefs and generational status, jointly. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Rise of anti-Asian violence and the COVID-19 pandemic for Asian Americans

The COVID-19 pandemic has been accompanied by a rise in anti-Asian hate crimes as well as other forms of discrimination. As a result, Asian Americans have had to contend with not just the isolation, illness, and economic difficulties of the pandemic but also the rise in anti-Asian sentiment. In order to spotlight the ways in which Asian Americans have coped, the Asian American Journal of Psychology provides a two-part special issue on Asian Americans and the COVID-19 pandemic. This article serves to introduce Part 1. The articles in this collection not only provide a close look at the experiences of Asian Americans but also examine the protective variables that moderate and/or mediate the link between the experiences of discrimination and well-being. (PsycInfo Database Record (c) 2022 APA, all rights reserved) Impact Statement What is the public significance of this article?-This article provides an overview of the special issue on Asian Americans and the COVID-19 pandemic. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

Asian Americans and the impact of anti-Asian racism during the COVID-19 pandemic: Part II

The COVID-19 pandemic has disrupted lives around the world. For Asian Americans, the disruptions due to illness, as well as isolation and economic insecurity, have been compounded by the rise in anti-Asian racism. In response, the Asian American Journal of Psychology has curated a special issue on Asian America and the COVID-19 Pandemic, spread over two issues. Part I showcased a collection of articles that described the impact of the pandemic and the rise in anti-Asian violence on Asian Americans, guiding readers through the protective factors that helped attenuate the negative impact of the pandemic. In this Part II of the special issue, we bring together a collection of articles that focus on the experiences of Asian Americans during the pandemic. The first set of articles explores the differences in impact when anti-Asian racism is experienced in myriad ways (direct, vicarious, etc.). The second set of articles investigates the impact of anti-Asian violence on the identity development of Asian Americans, from identity exploration to the types of ethnic-racial socialization practiced by the parents. The last set of articles provides not only a review of the research on supporting the mental health of Asian Americans but also provides guidelines for practitioners and nonpractitioners moving forward. Taken together, these articles bring together a wide range of articles that explore the lasting impact of the pandemic but also offer glimpses of what the future might hold for Asian American mental health and racial-ethnic identity. (PsycInfo Database Record (c) 2023 APA, all rights reserved) Impact Statement What is the public significance of this article?-Asian Americans have had to struggle with not just the negative impact of the COVID-19 pandemic but also contend with the rise in anti-Asian racism. The special issue on Asian America and the COVID-19 Pandemic spotlights the impact of these struggles. This article provides a summary and introduction to Part II of this special double issue. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Science, Medicine, and Cytology: A Pilot Program of the ASC Diversity Equity and Inclusion (DEI) Committee

Introduction: The percentage of pathology trainees who are underrepresented minorities is low. The DEI committee established a Science, Medicine, and Cytology summer pilot program to improve exposure to cytopathology focusing on DEI. Material(s) and Method(s): An online course was developed during the Covid-19 pandemic targeting underrepresented minorities at the high school and college level, and consisted of several didactic sessions, presenting the most common procedures involving cytologists, including fine-needle aspiration, rapid onsite evaluation, and smearing techniques. Interviews of cytopathologists were also included. Participants were surveyed for their demographic information and for an evaluation of the course. Result(s): 23 participants completed the survey (Table 1). The highest level of education was high school 16 (70%), college 6 (26%), and other 1 (4%). Self-identified demographics included 2 (9%) Hispanic, 9 (36%) Asian/Asian American, 2 (8%) Black / Black American, 6 (24%) White/Caucasian, 2 (8%) African, 1 (4%) Muslim American and 1 (4%) Sudanese. Household highest level of education was high school 2 (9%), some college 1 (4%), completed college 9 (39%), completed graduate program 9 (39%), 2 (9%) preferred not to answer. 14 (61%) participants have a family member in healthcare. The program met expectations for 20 (87%). The program format was effective and appropriate for their level of education for 23 (100%). The content helpful for 22 (96%). 13 (57%) considered healthcare as a potential career. 5 (22%) considered cytology as a career (Table 2). Conclusion(s): Evaluations were excellent, generating awareness of medicine and cytopathology. Individuals with families in healthcare were overrepresented, as there were barriers in reaching underrepresented minorities. The population that signed up was influenced by our ability offer the course online. Expansion to a wider audience would increase the number of attendees. (Table Presented).

Stand against anti-Asian racial discrimination during COVID-19: A call for action

Racial discrimination against people of Chinese and other Asian ethnicities has risen sharply in number and severity globally amid the COVID-19 pandemic. This rise has been especially rapid and severe in the United States, fueled by xenophobic political rhetoric and racist language on social media. It has endangered the lives of many Asian Americans and is likely to have long-term negative impacts on the economic, social, physical, and psychological well-being of Asian Americans. This essay reviews the prevalence and consequences of anti-Asian racial discrimination during COVID-19 and calls for actions in practice, policy, and research to stand against it. (PsycInfo Database Record (c) 2023 APA, all rights reserved)