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1.
J Appl Psychol ; 106(1): 1-3, 2021 Jan.
Article in English | MEDLINE | ID: covidwho-1593023

ABSTRACT

It is impossible to write this editorial without recognizing that we are living in challenging times. Unprecedented changes in how, when, where, and with whom we work have occurred in response to the COVID-19 pandemic. In addition to the threat to human life, the pandemic is expected to increase poverty and deepen preexisting inequalities for vulnerable groups such as women (United Nations, 2020) and individuals living in poorer countries (United Nations Development Programme, 2020). In the United States, the pandemic has disproportionately negatively affected racial and ethnic minority group members (https://www.cdc.gov/coronavirus/2019-ncov/community/health-equity/race-ethnicity.html). For example, in the United States infection and mortality rates are especially high among African Americans (Yancy, 2020). These sobering realities, along with the recent deaths of George Floyd, Ahmaud Arbery, and Breonna Taylor, and so many others, are vivid and wrenching reminders of longstanding social injustice and systematic racism, both in the United States and around the globe. When preparing my candidate statement and vision for the journal, a global pandemic and widespread social protest were the furthest thing from my mind. However, several aspects of my vision for JAP are highly relevant to the current context. This includes increasing representation and supporting diversity, as well as improving the translation of our science for the public good. Other elements of my vision for the journal include enhancing the review process and promoting open science. (PsycInfo Database Record (c) 2021 APA, all rights reserved).


Subject(s)
COVID-19/psychology , Poverty/psychology , Psychology, Applied/methods , Racism/psychology , Social Justice/psychology , /psychology , Humans , Minority Groups/psychology , Pandemics , SARS-CoV-2 , Socioeconomic Factors , United States
2.
CMAJ Open ; 9(4): E998-E1004, 2021.
Article in English | MEDLINE | ID: covidwho-1524570

ABSTRACT

BACKGROUND: Asian Canadians and Asian Americans face COVID-19-related discrimination. The objective of this qualitative study was to explore the experiences of Asian health care workers dealing with discrimination, with a focus on racial micro-agressions, in Canada and the United States during the COVID-19 pandemic. METHODS: We adopted a qualitative descriptive approach. We used convenience and snowball sampling strategies to recruit participants. We conducted individual, in-depth semistructured interviews with Asian health care workers in Canada and the US via videoconferencing between May and September 2020. Eligible participants had to self-identify as Asian and be currently employed as a health care worker with at least 1 year of full-time employment. We used an inductive thematic approach to analyze the data. RESULTS: Thirty participants were recruited. Fifteen (50%) were Canadians and 15 (50%) were Americans; there were 18 women (60%), 11 men (37%) and 1 nonbinary person. Most of the participants were aged 25-29 years (n = 16, 53%). More than half were nurses (n = 16, 53%); the other participants were attending physicians (n = 5), physiotherapists (n = 3), resident physicians (n = 2), a midwife, a paramedic, a pharmacist and a physician assistant. Two themes emerged from the data: a surge of racial microaggressions related to COVID-19 and a lack of institutional and public acknowledgement. Participants noted that they have experienced an increase in racial microaggressions during the COVID-19 pandemic. They have also experienced threats of violence and actual violence. The largely silent organizational response to the challenges being faced by people of Asian descent and the use of disparaging terms such as "China virus" in the early stages of the pandemic were a substantial source of frustration. INTERPRETATION: Asian health care workers have experienced challenges in dealing with racial microaggressions related to COVID-19 in the US and Canada. More research should be done on the experiences of Asian Americans and Asian Canadians, both during and after the pandemic, and supportive measures should be put in place to protect Asian health care workers.


Subject(s)
Asian Americans/psychology , COVID-19/psychology , Health Personnel/psychology , Racism/psychology , Adult , Canada , Female , Humans , Interviews as Topic , Male , Pandemics , Qualitative Research , SARS-CoV-2 , United States , Workplace Violence/psychology , Xenophobia/psychology
3.
PLoS One ; 16(11): e0259803, 2021.
Article in English | MEDLINE | ID: covidwho-1511832

ABSTRACT

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.


Subject(s)
COVID-19/epidemiology , Health Status Disparities , Pandemics , Racism/psychology , African Americans/psychology , Aged , COVID-19/psychology , COVID-19/virology , Humans , Income , Mediation Analysis , Middle Aged , Minority Groups/psychology , Outcome Assessment, Health Care/standards , SARS-CoV-2/pathogenicity
6.
Proc Natl Acad Sci U S A ; 118(36)2021 09 07.
Article in English | MEDLINE | ID: covidwho-1379372

ABSTRACT

Mounting reports in the media suggest that the COVID-19 pandemic has intensified prejudice and discrimination against racial/ethnic minorities, especially Asians. Existing research has focused on discrimination against Asians and is primarily based on self-reported incidents or nonrepresentative samples. We investigate the extent to which COVID-19 has fueled prejudice and discrimination against multiple racial/ethnic minority groups in the United States by examining nationally representative survey data with an embedded vignette experiment about roommate selection (collected in August 2020; n = 5,000). We find that priming COVID-19 salience has an immediate, statistically significant impact: compared to the control group, respondents in the treatment group exhibited increased prejudice and discriminatory intent against East Asian, South Asian, and Hispanic hypothetical room-seekers. The treatment effect is more pronounced in increasing extreme negative attitudes toward the three minority groups than decreasing extreme positive attitudes toward them. This is partly due to the treatment increasing the proportion of respondents who perceive these minority groups as extremely culturally incompatible (Asians and Hispanics) and extremely irresponsible (Asians). Sociopolitical factors did not moderate the treatment effects on attitudes toward Asians, but prior social contact with Hispanics mitigated prejudices against them. These findings suggest that COVID-19-fueled prejudice and discrimination have not been limited to East Asians but are part of a broader phenomenon that has affected Asians generally and Hispanics as well.


Subject(s)
Asian Americans/psychology , COVID-19/psychology , Prejudice , Attitude , COVID-19/ethnology , Humans , Intention , Minority Groups/psychology , Pandemics , Prejudice/ethnology , Racism/ethnology , Racism/psychology , United States
7.
Int J Equity Health ; 20(1): 192, 2021 08 28.
Article in English | MEDLINE | ID: covidwho-1376584

ABSTRACT

BACKGROUND: Research indicates the adverse impacts of perceived discrimination on health, and discrimination inflamed by the COVID-19 pandemic, a type of social exclusion, could affect the well-being of the Chinese diaspora. We analyzed the relationship and pathways of perceived discrimination's effect on health among the Chinese diaspora in the context of the pandemic to contribute to the literature on discrimination in this population under the global public health crisis. METHODS: We analyzed data from 705 individuals of Chinese descent residing in countries outside of China who participated in a cross-sectional online survey between April 22 and May 9, 2020. This study utilized a structural equation model (SEM) to evaluate both direct and indirect effects of perceived discrimination on self-rated health (SRH) and to assess the mediating roles of psychological distress (namely, anxiety and depression) and social support from family and friends. RESULTS: This online sample comprised predominantly young adults and those of relatively high socioeconomic status. This study confirmed the total and direct effect of recently perceived discrimination on SRH and found the indirect effect was mainly mediated by depression. Mediating roles of anxiety and social support on the discrimination-health relationship were found insignificant in this SEM. CONCLUSIONS: Our findings suggest discrimination negatively affected the well-being of the Chinese diaspora, and depression acted as a major mediator between the discrimination-health relationship. Therefore, interventions for reducing discrimination to preserve the well-being of the Chinese diaspora are necessary. Prompt intervention to address depression may partially relieve the disease burden caused by the surge of discrimination.


Subject(s)
COVID-19 , Diagnostic Self Evaluation , Emigrants and Immigrants , Pandemics , Racism , Adolescent , Adult , Anxiety/epidemiology , COVID-19/epidemiology , China/ethnology , Cross-Sectional Studies , Depression/epidemiology , Emigrants and Immigrants/psychology , Emigrants and Immigrants/statistics & numerical data , Female , Humans , Male , Middle Aged , Racism/psychology , Social Support , Surveys and Questionnaires , Young Adult
8.
Sch Psychol ; 36(5): 325-334, 2021 Sep.
Article in English | MEDLINE | ID: covidwho-1368915

ABSTRACT

The COVID-19 pandemic transformed the context and delivery of early childhood education, yet little is known about its impact on exclusionary discipline (e.g., suspension, expulsion), which nationally representative evidence has shown disproportionately impacts Black boys. Using one experiment, we test how preschool providers respond to three hypothetical vignettes about a Black boy's behaviors. Participants (N = 60) were randomly assigned to read vignettes set in either distance learning or in-person classroom contexts. Then, participants completed measures about discipline and COVID-19. Results indicated there was an interaction between context and the sequence of vignettes on providers' troubled feelings and endorsements of discipline. Providers showed heightened troubled feelings and endorsements of discipline severity in the distance learning context, as compared to an in-person context, as vignettes progressed. Additionally, the more providers feared COVID-19, the more they felt troubled over the course of the vignettes across conditions. Practitioners can use this research to inform consultative interventions that mitigate discipline by directly addressing providers' pandemic fears and classroom contexts. (PsycInfo Database Record (c) 2021 APA, all rights reserved).


Subject(s)
COVID-19 , Child Behavior/psychology , Education, Distance , Racism/psychology , School Teachers/psychology , Social Interaction , Students/psychology , Adult , Child , Child, Preschool , Female , Humans , Male , Schools
9.
Am Psychol ; 76(4): 627-642, 2021.
Article in English | MEDLINE | ID: covidwho-1364573

ABSTRACT

Anti-Asian racism has spiked since the outbreak of the coronavirus 2019 (COVID-19) pandemic, creating compounded threats to Asian Americans' psychological wellbeing on top of other pandemic stressors (e.g., fears of infection, financial insecurity, or quarantine isolation). COVID-19 anti-Asian racism signifies the relevance of race and racism during public health crises and highlights the importance of examining the psychological impacts of racialized stress and avenues for resilience during a pandemic. This article describes a conceptual model that emphasizes the importance of rechanneling the experience of COVID-19 anti-Asian racism toward resilience. Specifically, the proposed model identifies a tripartite process of collective psychosocial resilience, comprised of (a) critical consciousness of discrimination as a common fate, (b) critical consciousness-informed racial/ethnic identity, and (c) advocacy, for empowering Asian Americans and protecting them against the harmful effects of COVID-19 anti-Asian racism during and beyond the pandemic. Theoretical and empirical underpinnings of the proposed tripartite process for cultivating resilience against COVID-19 anti-Asian racism are delineated. Practice implications and future research directions, as informed and revealed by the conceptual model, are discussed. (PsycInfo Database Record (c) 2021 APA, all rights reserved).


Subject(s)
Asian Americans , COVID-19 , Pandemics , Racism , Asian Americans/psychology , COVID-19/epidemiology , COVID-19/psychology , Humans , Models, Psychological , Racism/psychology , Resilience, Psychological , Stress, Psychological/ethnology , Stress, Psychological/psychology , United States/epidemiology
10.
Am Psychol ; 76(4): 643-657, 2021.
Article in English | MEDLINE | ID: covidwho-1364572

ABSTRACT

This study examines adjustment patterns among a group neglected in developmental science-Asian American students in high-achieving schools. National reports have declared such schools to connote risk for elevated problems among teens. Asian American students are commonly referred to as model minorities, but little is known about adjustment issues within academically competitive settings, specifically. Guided by past research on culturally salient issues, multiple U.S. high schools were examined to (a) determine areas of relative strength versus weakness in adjustment of Asian Americans compared with Whites, and (b) more importantly, to illuminate salient within-group processes related to Asian Americans' well-being. Risk modifiers examined were perceptions of ethnic discrimination, parent perfectionism, internalized achievement pressure, authenticity in self-presentation, and closeness to school adults. Outcome variables included depression, anxiety, and isolation at school. Results demonstrated that Asian Americans fared better than Whites on anxiety and school isolation, but with low effect sizes. By contrast, they fared more poorly on almost all risk modifiers, with a large effect size on discrimination. Regression results showed that among Asian Americans the most consistent associations, across cohorts and outcomes, were for discrimination and authenticity. Findings underscore the need for greater recognition that discrimination could be inimical for students not typically thought of as vulnerable-Asian Americans in high-achieving schools; these issues are especially pressing in light of increased racism following coronavirus disease 2019 (COVID-19). Results also suggest that feelings of inauthenticity could be a marker of generalized vulnerability to internalizing symptoms. Implications for future theory and interventions are discussed. (PsycInfo Database Record (c) 2021 APA, all rights reserved).


Subject(s)
Asian Americans , COVID-19 , Racism , Resilience, Psychological , Self Concept , Adolescent , Asian Americans/psychology , Asian Americans/statistics & numerical data , COVID-19/epidemiology , Humans , Racism/psychology , Risk , Schools , Students/psychology , Students/statistics & numerical data , United States/epidemiology
12.
ANS Adv Nurs Sci ; 44(3): 183-194, 2021.
Article in English | MEDLINE | ID: covidwho-1354311

ABSTRACT

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.


Subject(s)
Attitude to Health , COVID-19/epidemiology , Health Personnel/statistics & numerical data , Health Status Disparities , Racism/statistics & numerical data , COVID-19/psychology , Health Personnel/psychology , Humans , Public Health , Racism/psychology , Social Environment , United States
14.
Cancer Epidemiol Biomarkers Prev ; 30(8): 1455-1458, 2021 08.
Article in English | MEDLINE | ID: covidwho-1301742

ABSTRACT

Since the start of the COVID-19 pandemic, Asian Americans have been subjected to rising overt discrimination and violent hate crimes, highlighting the health implications of racism toward Asian Americans. As Asian Americans are the only group for whom cancer is the leading cause of death, these manifestations of anti-Asian racism provoke the question of the impact of racism across the cancer continuum for Asian Americans. In this Commentary, we describe how the myth of the "model minority" overlooks the diversity of Asian Americans. Ignoring such diversity in sociocultural trends, immigration patterns, socioeconomic status, health behaviors, and barriers to care masks disparities in cancer risk, access to care, and outcomes across Asian American populations. We recommend cancer epidemiologists, population science researchers, and oncology providers direct attention toward: (i) studying the impacts of structural and personally mediated racism on cancer risk and outcomes; (ii) ensuring studies reflect the uniqueness of individual ethnic groups, including intersectionality, and uncover underlying disparities; and (iii) applying a critical race theory approach that considers the unique lived experiences of each group. A more nuanced understanding of cancer health disparities, and how drivers of these disparities are associated with race and differ across Asian American ethnicities, may elucidate means through which these disparities can be alleviated.


Subject(s)
Asian Americans/statistics & numerical data , Ethics, Research/education , Healthcare Disparities , Neoplasms/therapy , Racism/prevention & control , Asian Americans/psychology , Health Behavior , Humans , Racism/ethnology , Racism/psychology , Social Class
15.
Health Educ Behav ; 48(3): 371-375, 2021 06.
Article in English | MEDLINE | ID: covidwho-1269854

ABSTRACT

Anti-Asian racism and violence dramatically increased during the COVID-19 pandemic. As a result, recent studies and reports are showing that the health and well-being of Asian Americans are negatively affected. To address this urgent problem, the field of health education and public health must be equipped with the critical frameworks and concepts to analyze racism and White supremacy and how it affects the health and well-being of Asian Americans. We argue that using an ethnic studies lens in health education can help educators, researchers, and practitioners teach and train health educators to address racism experienced by Asian Americans during COVID-19 in relation to their health. We will discuss the elements of ethnic studies and demonstrate how to use it as a lens in understanding health disparities in the Asian American population influenced and exacerbated by the COVID-19 pandemic.


Subject(s)
Asian Americans/education , COVID-19/ethnology , Cultural Competency , Health Education/organization & administration , Racism/psychology , Health Education/standards , Humans , Pandemics , SARS-CoV-2 , Social Determinants of Health/ethnology , United States
16.
J Nurs Adm ; 51(6): 299-301, 2021 Jun 01.
Article in English | MEDLINE | ID: covidwho-1266231

ABSTRACT

This past year brought the deadliest pandemic of our time and a huge social awakening and movement for racial justice. It became clear to me in late spring that I needed to learn more about structural racism, White supremacy, racial healthcare disparities, unconscious bias, and my own prejudices that govern my attitudes, values, behaviors, and decisions as a nurse leader, faculty member, board member, and a human being. To that end, I began to read, watch, and listen to both scholarly and lay journals and media that provide historical and current empirical accounts and studies of how racism and White supremacy have dominated our society, organizations, and communities in the United States for hundreds of years.


Subject(s)
Friends/psychology , Racism/psychology , Social Justice/standards , Cultural Diversity , Humans , Pandemics , Social Justice/trends
17.
Psychosom Med ; 83(4): 309-321, 2021 05 01.
Article in English | MEDLINE | ID: covidwho-1254936

ABSTRACT

OBJECTIVE: This review highlights the scope and significance of the coronavirus disease 2019 (COVID-19) pandemic with a focus on biobehavioral aspects and critical avenues for research. METHODS: A narrative review of the published research literature was undertaken, highlighting major empirical findings emerging during the first and second waves of the COVID-19 pandemic. RESULTS: Interactions among biological, behavioral, and societal processes were prominent across all regions of the globe during the first year of the COVID-19 emergency. Affective, cognitive, behavioral, socioeconomic, and technological factors all played a significant role in the spread of infection, response precautions, and outcomes of mitigation efforts. Affective symptoms, suicidality, and cognitive dysfunction have been widely described consequences of the infection, the economic fallout, and the necessary public health mitigation measures themselves. The impact of COVID-19 may be especially serious for those living with severe mental illness and/or chronic medical diseases, given the confluence of several adverse factors in a manner that appears to have syndemic potential. CONCLUSIONS: The COVID-19 pandemic has made clear that biological and behavioral factors interact with societal processes in the infectious disease context. Empirical research examining mechanistic pathways from infection and recovery to immunological, behavioral, and emotional outcomes is critical. Examination of how emotional and behavioral factors relate to the pandemic-both as causes and as effects-can provide valuable insights that can improve management of the current pandemic and future pandemics to come.


Subject(s)
COVID-19/psychology , COVID-19/prevention & control , Fear , Humans , Life Style , Mental Health/statistics & numerical data , Pandemics , Racism/psychology , Social Determinants of Health , Suicide/psychology
18.
Public Health Rep ; 136(4): 508-517, 2021.
Article in English | MEDLINE | ID: covidwho-1243754

ABSTRACT

OBJECTIVES: Experiences of vicarious racism-hearing about racism directed toward one's racial group or racist acts committed against other racial group members-and vigilance about racial discrimination have been salient during the COVID-19 pandemic. This study examined vicarious racism and vigilance in relation to symptoms of depression and anxiety among Asian and Black Americans. METHODS: We used data from a cross-sectional study of 604 Asian American and 844 Black American adults aged ≥18 in the United States recruited from 5 US cities from May 21 through July 15, 2020. Multivariable linear regression models examined levels of depression and anxiety by self-reported vicarious racism and vigilance. RESULTS: Controlling for sociodemographic characteristics, among both Asian and Black Americans, greater self-reported vicarious racism was associated with more symptoms of depression (Asian: ß = 1.92 [95% CI, 0.97-2.87]; Black: ß = 1.72 [95% CI, 0.95-2.49]) and anxiety (Asian: ß = 2.40 [95% CI, 1.48-3.32]; Black: ß = 1.98 [95% CI, 1.17-2.78]). Vigilance was also positively related to symptoms of depression (Asian: ß = 1.54 [95% CI, 0.58-2.50]; Black: ß = 0.90 [95% CI, 0.12-1.67]) and anxiety (Asian: ß = 1.98 [95% CI, 1.05-2.91]; Black: ß = 1.64 [95% CI, 0.82-2.45]). CONCLUSIONS: Mental health problems are a pressing concern during the COVID-19 pandemic. Results from our study suggest that heightened racist sentiment, harassment, and violence against Asian and Black Americans contribute to increased risk of depression and anxiety via vicarious racism and vigilance. Public health efforts during this period should address endemic racism as well as COVID-19.


Subject(s)
African Americans/psychology , Anxiety/ethnology , Asian Americans/psychology , COVID-19/psychology , Depression/ethnology , Racism/psychology , Adult , Anxiety/etiology , Cross-Sectional Studies , Depression/etiology , Female , Humans , Linear Models , Male , Racism/statistics & numerical data , United States/epidemiology
19.
Cell ; 184(11): 2797-2801, 2021 05 27.
Article in English | MEDLINE | ID: covidwho-1241746

ABSTRACT

The COVID-19 pandemic has highlighted structural inequalities and racism promoting health disparities among communities of color. Taking cardiovascular disease as an example, we provide a framework for multidisciplinary efforts leveraging translational and epidemiologic approaches to decode the biological impacts of inequalities and racism and develop targeted interventions that promote health equity.


Subject(s)
COVID-19/epidemiology , Health Equity , Health Promotion/methods , Racism , Stress, Physiological/immunology , COVID-19/immunology , COVID-19/metabolism , COVID-19/psychology , Cardiovascular Diseases/epidemiology , Cardiovascular Diseases/immunology , Cardiovascular Diseases/metabolism , Cardiovascular Diseases/psychology , Gene Expression Regulation/genetics , Gene Expression Regulation/immunology , Gene Expression Regulation/physiology , Humans , Hypothalamo-Hypophyseal System/immunology , Hypothalamo-Hypophyseal System/physiology , Racism/psychology , Risk Factors , Sympathetic Nervous System/immunology , Sympathetic Nervous System/physiology
20.
J Health Commun ; 25(10): 819-826, 2020 Oct 02.
Article in English | MEDLINE | ID: covidwho-1236154

ABSTRACT

Developing a COVID-19 vaccine is a critical strategy for combatting the pandemic. However, for vaccination efforts to succeed, there must be widespread willingness to vaccinate. Prior research has found that Black Americans, who are disproportionately impacted by COVID-19, report lower intentions to get a vaccine than do other populations. We investigate two potential contributors to this disparity: COVID-19 vaccine-related behavioral beliefs and trust in four COVID-19 information sources (mainstream media, social media, President Trump, and public health officials and agencies). Using a nationally-representative survey (n= 889), we demonstrate that differences in vaccination beliefs explain the lower vaccination intentions reported by Black participants, compared to non-Black participants. However, while trust in information sources is associated with vaccination beliefs, differences in trust do not account for the observed differences in vaccination beliefs by race. Furthermore, we find that race moderates the relationships between trust in two sources (Trump and public health officials and agencies) and vaccination beliefs. The effects of trusting these sources on COVID-19 vaccine-related beliefs are smaller among Black participants; thus trust in these sources is less consequential to their pro-vaccination beliefs. Our results suggest that trust in information sources alone does not explain the observed relationship between race and vaccination beliefs.


Subject(s)
African Americans/statistics & numerical data , COVID-19 Vaccines/therapeutic use , Health Behavior/ethnology , Health Communication , Patient Acceptance of Health Care/ethnology , Trust , African Americans/psychology , Health Status Disparities , Humans , Intention , Patient Acceptance of Health Care/psychology , Patient Acceptance of Health Care/statistics & numerical data , Patient Education as Topic , Racism/psychology , Surveys and Questionnaires
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