We still cannot breathe: Applying intersectional ecological model to COVID-19 survivorship.

PURPOSE/OBJECTIVE: Individuals with historically oppressed identities, such as disabled or racialized minorities, face inequities across all societal institutions, including education, criminal justice, and healthcare. Systems of oppression (e.g., ableism, racism) lead to inequities that have ultimately contributed to disproportionate rates of COVID-19 morbidity and mortality in the United States. In the midst of the COVID-19 pandemic, increased public attention regarding police brutality toward Black people and the reinvigoration of the national Black Lives Matter (BLM) movement further highlighted the detrimental effects of oppressive systems and the urgent need to promote equity in the United States. The disproportionate number of COVID-19-related deaths and police brutality are inextricably connected, as both are products of oppression toward minoritized communities. The co-occurrence of the pandemic and BLM movement protests also creates an opportunity for critical discourse on the intersection of ableism and anti-Black racism specifically within the field of rehabilitation psychology. RESEARCH METHOD/DESIGN: The overarching goals of this review are to apply the Intersectional Ecological Model with the addition of the chronosystem to illustrate how systems of oppression lead to health disparity in COVID-19 survivorship and to provide recommendations to promote health equity. Conclusions/Implication: As the COVID-19 pandemic shifts to an endemic and efforts to eliminate oppressive systems continue, rehabilitation psychologists have an ongoing, evolving, and shared responsibility to employ socially-responsive solutions to promote optimal functioning for patients, families, and communities. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Perceived racial discrimination and polysubstance use among racial/ethnic minority adolescents in the United States.

OBJECTIVE: Polysubstance use among adolescents is a significant public health concern, yet most studies on adolescent substance use focus on a singular substance. This study is one of the first to investigate the association between perceived racial discrimination (PRD) in school and polysubstance use among racial/ethnic minority adolescents using a nationally representative sample. METHODS: Data was from the 2021 Adolescent Behaviors and Experiences Survey. The sample included 4145 racial/ethnic minority adolescents (52.8% female). Hierarchical binary logistic regression was used to examine the association between PRD in school and polysubstance use among racial/ethnic minority adolescents. RESULTS: About 12% of racial/ethnic minority adolescents engaged in polysubstance use and 23.4% reported experiencing PRD in school sometimes/most of the time/always. Controlling for other factors, experiencing PRD in school sometimes/most of the time/always was associated with 1.52 times higher odds of polysubstance use when compared to adolescents who never experienced PRD in school (OR=1.52, p=.044, 95% CI=1.01-2.30). Cyberbullying victimization, symptoms of depression, and being emotionally abused by a parent during COVID-19 were also associated with polysubstance use. CONCLUSION: Controlling for demographic characteristics and psychosocial stressors, PRD in school was significantly associated with higher odds of polysubstance use among racial/ethnic minority adolescents. The findings of this study could inform clinicians and policymakers of the association between PRD in school and polysubstance use, which could contribute to early identification of polysubstance use among racial/ethnic minority adolescents.

COVID-19 Racism and Chinese American Families' Mental Health: A Comparison between 2020 and 2021.

This study compared rates of multiple forms of COVID-19 racism-related discrimination experiences, fear/worries, and their associations with mental health indices among Chinese American parents and youth between 2020 and 2021. Chinese American parents of 4- to 18-year-old children and a subsample of their 10- to 18-year-old adolescents completed surveys in 2020 and 2021. A high percentage of Chinese American parents and their children continued to experience or witness anti-Chinese/Asian racism both online and in person in 2021. Parents and youth experienced less vicarious discrimination in person but more direct discrimination (both online and in person) and reported poorer mental health in 2021 than in 2020. Associations with mental health were stronger in 2021 than in 2020 for parents' and/or youth's vicarious discrimination experiences, perceptions of Sinophobia, and government-related worries, but weaker only for parents' direct discrimination experiences. The spillover effect from parents' vicarious discrimination experiences and Sinophobia perceptions to all youth mental health indices were stronger in 2021 than in 2020. Chinese American families experienced high rates of racial discrimination across multiple dimensions, and the detrimental impacts on their mental health were still salient in the second year of the pandemic. Vicarious and collective racism may have even stronger negative impacts on mental health and well-being later in the pandemic. Decreasing health disparities for Chinese Americans and other communities of color requires extensive, long-term national efforts to eliminate structural aspects of racism.

The impact of anti-Asian racism on routine activities and mental health among Korean American older adults and their caregivers.

Introduction: Reported anti-Asian discrimination has been on the rise since the COVID-19 pandemic. Nevertheless, limited research addresses the health impact of perceived anti-Asian racism on Asian Americans, especially among older adults, during COVID-19. To address the gap, we examined how the novel coronavirus pandemic affected Korean American older adults, one of the largest Asian subgroups. Specifically, this study addressed the magnitude of racism or discrimination related to the pandemic and impact of anti-Asian racism on negative mental health symptoms among Korean American older adults and their caregivers. Methods: We used survey data collected from 175 Korean American older adults with probable dementia and their primary caregivers (female = 62%, mean age = 71 years) who went through eligibility screening for an ongoing randomized controlled trial involving dyads in the Baltimore-Washington and the New York Metropolitan areas (ClinicalTrials.gov Identifier: NCT03909347). Results: Nearly a quarter of the survey sample reported they were fearful for their safety due to anti-Asian racism related to the pandemic. Additionally, 47% of the respondents indicated changes to routine activities due to anti-Asian racism or discrimination related to COVID-19. The most common changes included avoiding walking alone or physical activities outside, followed by avoiding public transportation or leaving the house to go to any public places such as grocery stores, churches, or schools, not carrying out usual social activities, and avoiding going to health care appointments. Multinomial logistic regression revealed that people who reported changes to routine activities were at least five times more likely (adjusted odds ratio = 5.017, 95% confidence interval = 1.503, 16.748) to report negative mental health symptoms than those who did not. Being fearful for their own safety was not associated with experiencing negative mental health symptoms in the survey sample. Discussion: Study findings indicate that the increased reporting of anti-Asian racism during the COVID-19 pandemic has substantially affected Korean American older adults and their caregivers. The mechanism by which changes to routine activities is related to negative mental health symptoms is unclear, future research is needed to elucidate this pathway. Furthermore, our findings highlight the importance of identifying multi-level strategies to raise awareness of and to mitigate the reported surge of racism.

Health Equity and the Impact of Racism on Adolescent Health.

Racism is woven within the fabric of the United States culture, structures, and systems, including its healthcare system. There is extensive research on adults demonstrating racial discrimination's physical and mental health impacts, and the evidence showing similar disproportionate effects for adolescents of color continues to grow. Furthermore, the devastation of the coronavirus pandemic has paralleled the resurgence of white nationalism movements and adverse outcomes associated with the over-policing of Black and Brown communities. Scientific evidence continues to illustrate how sociopolitical determinants of health and experiencing vicarious racism amplify overt racism and implicit bias actions individually and within health care structures. Therefore, evidence-based strategic interventions are desperately needed to ensure the health and well-being of adolescents and young adults.

Anxiety-Related Disorders in the Context of Racism.

PURPOSE OF REVIEW: The literature on racism and anxiety-related disorders, especially social anxiety, specific phobia, and generalized anxiety disorder, is notably lacking. This report aims to review recent evidence demonstrating the link between racial discrimination and various anxiety-related disorders. RECENT FINDINGS: Anxiety-related disorders were the most significant mediator for daily discrimination and suicidal thoughts, above both depression and substance use. Further, studies showed that racial discrimination promotes posttraumatic stress and racial trauma among people of color. Systemic racism puts people of color at a higher risk for anxiety disorders than White people. Clinical case examples provide lived evidence of diverse racial and ethnic individuals suffering from anxiety-related disorders, with the development and worsening of symptoms due to racism and microaggressions. There is a prominent need for recent research on anxiety-related disorders and racism. Recommendations for clinicians and future research directions are provided. These actions are required to address bias and mental health inequities and empower people of color.

The moral filter of patriotic prejudice: How Americans view Chinese in the COVID-19 era.

About one in six Asian Americans have fallen victim to anti-Asian racism during the COVID-19 pandemic [J. Lee, K. Ramakrishnan, aapidata.com/blog/discrimination-survey-2022/]. By examining anti-Asian racism in the United States primarily as a domestic issue, most prior studies have overlooked the connections between shifting US-China relations and Americans' prejudices against the Chinese in China and, by extension, East Asian Americans. This study investigates the patterns and perceptual bases of nationality-based prejudices against Chinese amid the COVID-19 pandemic in the United States. Our nationally representative online survey experiment reveals that Americans assess a hypothetical Chinese person in China as inferior in multiple social and psychological characteristics to an otherwise identical Japanese person in Japan or East Asian American. Furthermore, subjects who perceive China as more threatening to America's national interests assess Chinese more negatively, especially in terms of trustworthiness and morality, suggesting that perceived China threats propel Americans' negative stereotypes about Chinese. A contextual analysis further indicates that counties with a higher share of Trump voters in 2016 tend to perceive all East Asian-origin groups similarly as a racial outgroup. By contrast, residents in predominantly Democrat-voting counties tend to perceive Chinese in China more negatively relative to Asian Americans, despite broadly viewing East Asians more favorably. Overall, this study underscores the often-overlooked relationships between the prevailing anti-Asian sentiments in the United States and the US-China geopolitical tensions and America's domestic political polarization.

The mental health of Asian American adolescents and young adults amid the rise of anti-Asian racism.

Objectives: We describe the perceptions and experiences of anti-Asian racism and violence and depression severity prior to and during the COVID-19 pandemic among a sample of Asian American (AA) adolescents and young adults. Methods: We used data from the Young Asian American Health Survey (YAAHS), an online-recruited sample of AA adolescents (ages 13-17) and young adults (ages 18-29 years) conducted during May 2021 to March 2022. We presented descriptive statistics examining the univariate distribution and bivariate relationships of depression severity, sociodemographic characteristics, and experiences and perceptions of anti-Asian violence. Results: Our sample (n = 176) comprised AA adolescents and young adults from 17 Asian ethnicities. A quarter said that the frequency and/or severity of their personal experiences of anti-Asian harassment had increased since the pandemic started. 76% indicated feeling less safe now than before the pandemic. Two-thirds reported that their depressive symptoms have increased since the pandemic started. Participants who reported feeling less safe now than before the pandemic were more likely to report increased personal experiences with anti-Asian harassment and increased depression severity since the pandemic started than those who reported feeling as safe or safer before the pandemic (p < 0.01 for both). Discussion: Findings illustrate AA adolescent and young adults are experiencing multiple health and social crises stemming from increased anti-Asian racism during the COVID-19 pandemic. We urge policymakers to strengthen data systems that connect racial discrimination and mental health and to institute prevention measures and anti-racist mental health services that are age- and culturally-appropriate for AA adolescent and young adults.

Anti-Black attitudes predict decreased concern about COVID-19 among Whites in the U.S. and Brazil.

RATIONALE: From the earliest days of the COVID-19 pandemic, public health officials and news organizations reported pervasive racial disparities in the infection, morbidity, and mortality of the virus. In both the U.S. and Brazil, Black, Native, and mixed-race individuals were more negatively impacted by COVID-19 than White people. Simultaneously, significant social factions downplayed the threat and insisted on living "normally". We examined how these two factors coexisted. OBJECTIVE: We sought to establish whether Whites' anti-Black attitudes predicted their concern about the pandemic and tendency to behave in ways that exacerbated the pandemic. METHODS: and Results: In five studies, conducted in two countries (total N = 3425), we found that anti-Black attitudes (above and beyond political orientation, White racial identification, and perceptions of racial disparities) were associated with less concern about COVID-19, lower adoption of health and social distancing behaviors, and greater interest in returning to normalcy. DISCUSSION: We discuss how efforts to combat anti-Blackness may improve the health of the general population.

The slow violence of racism on Asian Americans during the COVID-19 pandemic.

Racism against people of Asian descent increased by over 300% after the COVID-19 pandemic outbreak in the United States, with one in five Asian Americans reporting direct experiences with overt discrimination. Large-scale efforts and resources initially, and quite understandably, prioritized investigating the physiological impact of the coronavirus, which has partially delayed research studies targeting the psychological effects of the pandemic. Currently, two studies tracked the unique relationships between psychosocial factors, such as experiencing everyday racism, and the self-reported wellbeing of Asian Americans in the United States and compared these associations with Latinx Americans. Study 1 (April 2020-April 2021) examined how Asian and Latinx Americans varied in their levels of wellbeing, fear of the coronavirus, internalized racism, and everyday experiences with racism. Study 2 (September 2021-April 2022) included the same variables with additional assessments for victimization distress. We used the CDC Museum COVID-19 Timeline to pair collected data from our studies with specific moments in the pandemic-from its known origins to springtime 2022. Results highlighted how slow and deleterious forms of racist violence could wear and tear at the wellbeing of targeted people of color. Overall, this research underscores the possible hidden harms associated with slow-moving forms of racism, as well as some of the unseen stressors experienced by people of color living in the United States.

"What support?": A qualitative study on social support for Asian American victims of racism during the COVID-19 pandemic.

Since the COVID-19 pandemic, anti-Asian racism has surged, yet little is known about Asian Americans' experiences of social support. Therefore, we designed a qualitative, intrinsic, revelatory case study to examine the nature and quality of social support for Asian Americans during the first 6 months of the pandemic. Our sample consisted of 193 Asian Americans (from over 32 U.S. states) disclosing their experiences of inadequate social support. They described their support network as (1) Being unable to relate, (2) Encouraging their silence, (3) Minimizing anti-Asian racism, (4) Denying anti-Asian racism, and (5) Victim-blaming. Regarding our participants' recommendations for increasing social support for Asian Americans, a total of seven recommendations emerged: (1) Legitimize anti-Asian racism, (2) Teach Asian American history, (3) Destigmatize mental health resources to make them accessible for Asian American families (4) Promote bystander intervention trainings, (5) Build solidarity with and beyond Asian Americans to dismantle racism, (6) Increase media attention on anti-Asian racism, and (7) Elect political leaders who will advocate for Asian Americans. Altogether, our findings underscore the need for systemic forms of advocacy to combat anti-Asian racism, and shed light on the injurious nature of social support for Asian American victims of racism.

Asian American nursing students' experiences of racial microaggressions amid the COVID-19 pandemic: Focus group discussions.

AIM: This study aimed to explore the thoughts and feelings of Asian American nursing students regarding Anti-Asian racism that they might anticipate or experience during their clinical training. BACKGROUND: Asian Americans have long been viewed as perpetual foreigners and coronavirus disease 2019 has reinforced that negative view. Asian American nursing students may anticipate and experience racial discrimination during their clinical training, which could negatively affect their mental health. DESIGN: This is a qualitative research study using focus group discussions. METHOD: Focus group discussions were conducted over Zoom and audiotaped. The audiotapes were transcribed and validated for accuracy. A thematic analysis was performed using NVivo10. Emerging themes and subthemes were compared and discussed until agreements were made. RESULTS: Nineteen students participated in four focus group meetings, of which, 13 (68 %) had clinical training and six (32 %) were preclinical students. Four major themes emerged: (a) looking forward to hands-on learning opportunities, (b) enduring racial microaggressions, (c) maintaining professionalism in the face of racial microaggressions and (d) standing up for oneself and other Asian American healthcare workers. Preclinical students were anxiously waiting for clinical training so that they could have hands-on learning experiences. They anticipated that anti-Asian racism in clinical settings would be similar to what they had experienced on the streets and therefore, they were not afraid of it. Students who had clinical training reported experiencing a variety of racial microaggressions that varied from "side-eyes" to "verbal assault" and occurred at three levels: patients, nurses and clinical instructors. They reported that most of the microaggressions were familiar to them, but some, especially coming from their clinical instructors, were unique to clinical settings. CONCLUSION: Asian American nursing students experienced racial microaggressions during their clinical training which came from patients, nurses on the unit and their clinical instructors. Nevertheless, the students strove to maintain professionalism and stand up for themselves and other Asian healthcare workers as they gained confidence in clinical knowledge and skills.

Perceived Racial Discrimination and Mental Health in Diverse Groups of Asian Americans: The Differing Impacts by Age, Education, and Ethnicity.

The aim of this study was to examine how perceived racial discrimination is associated with mental distress among diverse Asian Americans and to explore the potential moderators in the relationship. Based on the 2015 Asian American Quality of Life (AAQoL) survey (n = 2609), direct influences were tested of the contextual (demographic, health-related, and immigration-related) variables and perceived racial discrimination on mental distress, as well as their interactions. About 30% of the sample reported perceived racial discrimination, and 44% fell into the category of having mental distress. Perceived racial discrimination was associated with 1.90 times higher odds of mental distress and had significant interactions with age, education, and ethnicity. The association of mental distress with perceived racial discrimination was higher among those who were 60 or older, less educated, and Vietnamese than among their respective counterparts. Findings can guide strategic and targeted interventions for high-risk groups.

"I Can't Breathe": Biopower in the Time of COVID-19: An Exploration of How Biopower Manifests in the Dual Pandemics of COVID and Racism.

In this article, we apply Agamben's theory of biopower and other related concepts to the COVID-19 pandemic in the United States. We explore the similarities between the COVID-19 pandemic and the pandemic of racism. Concepts such as bios, zoe, homo sacer, and states of exception can be applied to understand inequities among marginalized communities in the COVID-19 pandemic. We recommend that nurses and health care workers use critical conscientization and structural competency to increase awareness and develop interventions to undo the injustices related to biopower faced by many in the COVID-19 pandemic.

Students' perceptions on race in medical education and healthcare.

Major racial disparities continue to exist in our healthcare education, from the underrepresentation of ethnic minorities when teaching about clinical signs to health management in primary and secondary care. A multi-centre group of students discuss what needs to change in medical education to cultivate physicians who are better prepared to care for patients of all backgrounds. We argue that the accurate portrayal of race in medical education is a vital step towards educating medical students to consider alternative explanations to biology when considering health inequities.

Do racial and ethnic disparities in following stay-at-home orders influence COVID-19 health outcomes? A mediation analysis approach.

Racial/ethnic disparities are among the top-selective underlying determinants associated with the disproportional impact of the COVID-19 pandemic on human mobility and health outcomes. This study jointly examined county-level racial/ethnic differences in compliance with stay-at-home orders and COVID-19 health outcomes during 2020, leveraging two-year geo-tracking data of mobile devices across ~4.4 million point-of-interests (POIs) in the contiguous United States. Through a set of structural equation modeling, this study quantified how racial/ethnic differences in following stay-at-home orders could mediate COVID-19 health outcomes, controlling for state effects, socioeconomics, demographics, occupation, and partisanship. Results showed that counties with higher Asian populations decreased most in their travel, both in terms of reducing their overall POIs' visiting and increasing their staying home percentage. Moreover, counties with higher White populations experienced the lowest infection rate, while counties with higher African American populations presented the highest case-fatality ratio. Additionally, control variables, particularly partisanship, median household income, percentage of elders, and urbanization, significantly accounted for the county differences in human mobility and COVID-19 health outcomes. Mediation analyses further revealed that human mobility only statistically influenced infection rate but not case-fatality ratio, and such mediation effects varied substantially among racial/ethnic compositions. Last, robustness check of racial gradient at census block group level documented consistent associations but greater magnitude. Taken together, these findings suggest that US residents' responses to COVID-19 are subject to an entrenched and consequential racial/ethnic divide.

Perceived Racism and Demographic, Mental Health, and Behavioral Characteristics Among High School Students During the COVID-19 Pandemic - Adolescent Behaviors and Experiences Survey, United States, January-June 2021.

Perceived racism in school (i.e., a student's report of being treated badly or unfairly because of their race or ethnicity) is an important yet understudied determinant of adolescent health and well-being. Knowing how perceived racism influences adolescent health can help reduce health inequities. CDC's 2021 Adolescent Behaviors and Experiences Survey (ABES), an online survey of a probability-based, nationally representative sample of U.S. public- and private-school students in grades 9-12 (N = 7,705), was conducted during January-June 2021 to assess student behaviors during the COVID-19 pandemic. CDC analyzed data from ABES to measure perceived racism and the extent to which perceptions of racism are associated with demographic, mental health, and behavioral characteristics. Mental health and behavioral characteristics analyzed included mental health status; virtual connection with others outside of school; serious difficulty concentrating, remembering, or making decisions; and feeling close to persons at school. Demographic characteristics analyzed included sex, race and ethnicity, and grade. Prevalence of perceived racism and associations between perceived racism and demographic, mental health, and behavioral characteristics are reported overall and stratified by race and ethnicity. Approximately one third (35.6%) of U.S. high school students reported perceived racism. Perceived racism was highest among Asian (63.9%), Black (55.2%), and multiracial students (54.5%). Students who reported perceived racism had higher prevalences of poor mental health (38.1%); difficulty concentrating, remembering, or making decisions (44.1%); and not feeling close to persons at school (40.7%). Perceived racism was higher among those students who reported poor mental health than those who did not report poor mental health during the pandemic among Asian (67.9% versus 40.5%), Black (62.1% versus 38.5%), Hispanic (45.7% and 22.9%), and White students (24.5% versus 12.7%). A better understanding of how negative health outcomes are associated with student experiences of racism can guide training for staff and students to promote cultural awareness and antiracist and inclusivity interventions, which are critical for promoting safe school environments for all students.