Exploring Nature Dose Attainment across Racial Groups in Urban Parks and Trails

CONTEXT: Structural factors are fundamental drivers of racial health inequity. Structural competency (SC) offers a paradigm for training health professionals to recognize and respond to the impact of structural factors. Despite national advocacy, curricula have been inconsistently implemented and evaluated. OBJECTIVE: To study the incorporation of Anti-Racism structural competency curricula and how it impacts Black, Indigenous, and people of color (BIPOC) vs non-BIPOC learners. STUDY DESIGN AND ANALYSIS: A cross-sectional mixed-methods study. Grounded theory analysis on the open-ended responses identified key themes. Both quantitative and qualitative analyses are by BIPOC vs non-BIPOC. SETTING: Pre and post survey was disseminated using Qualtrics in the 2021-2022 academic year. POPULATION STUDIED: All first year medical students at an academic medical teaching hospital. INTERVENTION: Adapted structural competency curriculum from Bay Area Working Group. Curriculum was delivered in six 2-hour teaching sessions, involving a mix of whole-classroom presentations and self-selected racial affinity small discussion groups, and were accompanied by pre-reading, follow-up informal discussion groups, and post-session written reflective assignments. OUTCOME MEASURES: Knowledge, attitudes, career choice, burnout, empowerment, and empathy. RESULTS: 182 completed surveys: PRE: 36 BIPOC and 48 Non-BIPOC and POST: 46 BIPOC and 52 Non-BIPOC. Both groups had similar knowledge and attitudes towards the SC curriculum. Regarding more time being dedicated to these topics, the percent who responded Strongly Agree for BIPOC and Non-BIPOC increased by 36% (33 to 69%) and 22% (42 to 64%) from pre to post surveys, respectively. BIPOC students reported an increase in commitment to medicine rather than a change in career choice, and Non-BIPOC students indicated the course helped them better understand their profession. Many students noted they entered medicine because of their values related to equity and justice, though BIPOC-identified students noted more often-feeling burnout. Non-BIPOC students reported awareness of their BIPOCs’ peer burnout. Finally, we found an increase in empathy for patients and in self-empowerment across both groups. CONCLUSIONS: SC curriculum at this scale and early in the curriculum remains critical to creating a community of practice addressing racial equity in medicine.

Background and ObjectivesAbundant evidence documents racial/ethnic disparities in access, quality of care, and quality of life (QoL) among nursing home (NH) residents who are Black, Indigenous, and people of color (BIPOC) compared with White residents. BIPOC residents are more likely to be admitted to lower quality NHs and to experience worse outcomes. Yet, little is known about processes for differences in QoL among residents receiving care in high-proportion BIPOC NHs. This study presents an examination of the processes for racial/ethnic disparities in QoL in high-proportion BIPOC facilities while highlighting variability in QoL between these facilities.Research Design and MethodsGuided by the Minority Health and Health Disparities Research Framework and the Zubritsky framework for QoL in NHs, we employ a concurrent mixed-methods approach involving in-depth case studies of 6 high-proportion BIPOC NHs in Minnesota (96 resident interviews; 61 staff interviews; 614 hours of observation), coupled with statewide survey data on residents’ QoL linked to resident clinical Minimum Data Set assessments.ResultsQuantitative findings show that BIPOC residents experience lower QoL than White residents across various domains. Qualitative findings reveal variability in BIPOC residents’ QoL between high-proportion BIPOC facilities. In some facilities, BIPOC residents experienced worse QoL based on their race/ethnicity, whereas in others BIPOC residents QoL was not directly affected by their race/ethnicity or they had mixed experiences.Discussion and ImplicationsThe findings highlight variability in racial/ethnic disparities in QoL across NHs with a high proportion of BIPOC residents. We identify health equity initiatives, including engaging with community BIPOC organizations and volunteers, and providing more resources to high-proportion BIPOC facilities to support staff training, additional staffing, and culturally specific programming. Given the increasing racial/ethnic diversity of NHs, ensuring equity in QoL for BIPOC residents is an urgent priority for NHs to remain relevant in the future.

“Imposter syndrome” is a term used to describe feelings of pervasive self‐doubt despite evident success. It is the lay version of “imposter phenomenon,” a concept that was proposed as an explanation for why highly accomplished (mostly white and middle‐ to upper‐class) women persisted in believing that their success was due to luck or a mistake despite evidence to the contrary. However, the experience of imposter syndrome in genetic counseling, particularly among Black, Indigenous, and People of Color (BIPOC) individuals, remains underexplored. This study investigates the etiologies and impacts of imposter syndrome among BIPOC genetic counseling students with the aim of elucidating how the term is used and identifying potential interventions. We conducted semi‐structured interviews with 26 participants who were part of a longitudinal constructivist grounded theory study investigating the training experiences of BIPOC genetic counseling students. Using reflexive thematic analysis, we constructed themes related to self‐doubt, classroom and clinical performance, identity, and disclosing imposter syndrome feelings to others. Participants described imposter syndrome as arising from concerns that they were unprepared for their training program, less qualified than their peers, or admitted by accident or due to their BIPOC identity. Some participants attributed imposter syndrome to being a BIPOC student in a predominantly white profession. Comparisons to classmates and practicing genetic counselors, academic struggles, and anxiety about clinical rotations exacerbated imposter syndrome. Our findings underscore the multifaceted nature of imposter syndrome among BIPOC genetic counseling students and the need for a multipronged approach to mitigate its harmful effects. For BIPOC students, training programs should recognize that imposter syndrome is intertwined with racial inequities within the field that position them as imposters. We propose that supportive relationships with classmates, BIPOC mentors, and other BIPOC students can reduce imposter syndrome and enhance student well‐being and academic success.

In observance of July as Black, Indigenous and People of Color (BIPOC) Mental Health Month, Mental Health America (MHA) has commenced its public education campaign dedicated to addressing the needs of this population. This year's theme, “Strength in Communities,” highlights alternative mental health supports created by BIPOC and queer and trans BIPOC (QTBIPOC).

Advancing Antiracism in Community-Based Research Practices in Early Childhood and Family Mental Health

Children in America are suffering from an abundance of trauma that many bring to school with them daily. Children, teens, and their families, who are Black, Indigenous, and People of Color (BIPOC), may have experienced historical racial trauma which is unique to students of color. Professionals working with students of color (SOC) must develop cultural competency around racial trauma in their understanding of trauma informed pedagogy to meet the needs of student populations that are becoming increasingly diverse. The overall purpose of this chapter is to provide professionals working with BIPOC children and teens the necessary skills to meet their needs.

Psychedelic-assisted psychotherapy (PAP) is gaining renewed interest as a treatment for various mental disorders. However, there has been limited Black, Indigenous, and People of Color (BIPOC) representation in PAP clinical trials, signaling the need for culturally consonant communication about the efficacy and safety of PAP. We randomly assigned 321 BIPOC and 301 non-Hispanic White participants to four different modes of psychoeducation (didactic, visual, narrative, hope-based) and tested effects on likelihood of seeking and referring others to PAP using ANCOVAS. The influences of different psychoeducation components on these likelihoods were also tested using hierarchical regression modeling. Regardless of psychoeducation mode, BIPOC participants were more likely to seek PAP than non-Hispanic White participants after psychoeducation. Further, information on physical safety and success rate of PAP uniquely predicted BIPOC participants’ likelihood of seeking and referring others to PAP after psychoeducation. Our findings suggest that once provided psychoeducation, BIPOC participants are receptive to seeking or referring others to PAP. BIPOC participants also appear to prioritize physical safety and rate of success of PAP in these decisions. Stigma against PAP is likely not the primary barrier to recruitment of BIPOC individuals into PAP trials. Instead, researchers should conduct more psychoeducational outreach to diversify future trials.

The act of living in the world for Black, Indigenous, and people of Color (BIPOC) is a creative one. Creative acts have been a premise for BIPOC theories of survival, thriving, and movement away from entanglements with whiteness or “creative disruptions.” Creativity, we argue, is a premise for theorizing and engaging in education research. In this paper, we make a case for creativity and stitch together word and image as an exploration of the importance of BIPOC arts in theories of justice in educational research. We explore the political importance of the serious engagement of BIPOC youth arts as well as the use of arts by BIPOC scholars in their analysis and theory building. Connected to this ability to see and resist differently through art, is joy and healing. Creativity promotes healing and allows our work to persist, grow, and transform ourselves (and others) and to transform systems.

BackgroundCannabis social equity programs intend to redress inequities experienced by low income and Black, Indigenous, and People of Color (BIPOC) during cannabis prohibition in the United States. In Los Angeles County (LA), the approach is to increase cannabis outlet licensure and employment for low income and BIPOC communities. Monitoring locations of both licensed and unlicensed outlets over time is critical to informing how local social equity programs may affect communities.MethodsWe identified locations of licensed and unlicensed cannabis outlets in LA, from February to April 2019 and again from March to April 2020, and calculated the number and type of outlets by socio-demographic characteristics of census tracts (race/ethnicity, poverty, education, unemployment) using the 2013–2017 American Community Survey 5-year estimates.ResultsLicensed outlets increased in LA from 162 in 2019 to 195 in 2020; unlicensed outlets decreased from 286 to 137 over the same time period. In 2020, more licensed outlets were in tracts with majority white residents and adults with at least a bachelor’s degree; fewer licensed outlets were in tracts with larger Latinx or Black populations, whereas 71% of unlicensed outlets in 2020 were in low-income tracts, and more unlicensed outlets were in predominately Latinx tracts, high poverty and high unemployment tracts, and tracts with more single female-headed households.ConclusionsNeighborhood-level analyses are an important first step, but more data are needed for comprehensive evaluations of social equity programs—from individual businesses to the communities living nearby—to understand the impacts on low income and BIPOC populations.

Objective: Research on mental health interventions, largely from observational studies, suggests that individuals who are Black, Indigenous, and People of Color (BIPOC) have lower treatment engagement than non-Latino Whites. This systematic review focuses on prospective, experimental treatment trials, which reduce variability in patient and intervention characteristics and some access barriers (eg, cost), to examine the association of race/ethnicity and engagement. Data Sources: A systematic search of PubMed and PsycINFO through May 2020 using terms covering mental health treatment, engagement, and race/ethnicity. Study Selection: US-based, English-language, prospective experimental (including quasi-experimental) trials of adults treated for DSM-defined mental disorders were included. Studies had to compare engagement (treatment initiation and retention, medication adherence) across 2 or more ethnoracial groups. Fifty-five of 2,520 articles met inclusion criteria. Data Extraction: Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and the Cochrane Collaboration bias-risk assessment tool were used to report study findings. Results: Twenty-nine articles (53%) reported significant ethnoracial engagement differences, of which 93% found lower engagement among BIPOC groups compared largely to non-Latino Whites. The proportion of significant findings was consistent across quality of studies, covariate adjustments, ethnoracial groups, disorders, treatments, and 4 engagement definitions. Reporting limitations were found in covariate analyses and disaggregation of results across specific ethnoracial groups. Conclusions: Prospective experimental treatment trials reveal consistently lower BIPOC engagement, suggesting persisting disparities despite standardized study designs. Future research should improve inclusion of understudied groups, examine covariates systematically, and follow uniform reporting and analytic practices to elucidate reasons for these disparities.

SIMON WILE SYMPOSIUM: FOCUS ON DIVERSITY AND EQUITY THROUGH A PEDIATRIC COLLABORATIVE AND INTEGRATED CARE LENS

Background: Nonbinary people experience marginalization through discrimination, rejection, microaggressions, and stigma as a result of not always conforming to societal gender norms embedded in the gender binary. There is limited research about how nonbinary Black, Indigenous, and People of Color (BIPOC) living in the United States navigate societally enforced binary gender norms, which is especially important to understand given how racism and Euro-colonization have enforced the gender binary. Better understanding the internal strategies nonbinary people use to cope, embody affirmation, and regulate emotions in response to marginalizing experiences could increase understanding of how to best prevent and address the health disparities experienced by nonbinary people. Aim: Drawing on the practices of interrogating norms central to queer theory with a sensitization to racism and settler colonialism, this study aimed to identify a framework to understand nonbinary peoples’ processes of navigating gender norms internally through their lived experiences with an awareness of how context impacts these processes. Method: This qualitative interview study utilized construcitivist grounded theory methodology, guided by queer theory. Twenty-one nonbinary individuals were interviewed over Zoom with 15 being BIPOC. Results: Participants navigated binary gender norms internally by self-defining affirmative nonbinary ways of being, noticing affirmation in a chosen community that allowed them to experience existing authentically outside of binary gender norms, and internally connecting to an embodied, authentic sense of gender within themselves and in community with other nonbinary people. These internal processes were influenced by two contextual factors: societal and cultural expectations of gender; and the contextual impacts of holding multiple marginalized identities. Discussion: Understanding the contexts of the gender binary, racism, and cissexism that impact nonbinary people on a daily basis is crucial for mental health professionals, researchers, policy makers, and creators of gender inclusive education and support programs to support and affirm nonbinary people.

In recent years, public discourse on pesticide impacts has increasingly recognized institutional and structural racism as key drivers of health disparities in Black, Indigenous, and People of Color (BIPOC) communities. While pesticides are vital for crop protection from causing yield losses, extensive research highlights their adverse effects on environmental quality and human health. These impacts disproportionately burden BIPOC populations, making pesticides a major environmental justice (EJ) concern like many other environmental pollutants. Despite progress in understanding these effects and advancing EJ, significant technical, social, and policy gaps remain. The objective of this review is to systematically examine critical gaps in technical, social, and policy dimensions, as well as the environmental and human health impacts of pesticide exposure on BIPOC communities in the United States, through the lens of environmental justice. This review synthesizes 128 sources peer-reviewed articles, books, reports on pesticides, EJ, and BIPOC communities in the U.S. Key findings reveal uneven distribution of pesticide-related health and environmental burdens along racial, ethnic, and socioeconomic lines. Non-Hispanic Blacks and Mexican Americans exhibit higher pesticide biomarkers and greater exposure risks than non-Hispanic Whites. Structural racism and classism, rooted in historical systems, perpetuate these inequities, compounded by regulatory failures and power imbalances. In addition, the EPA has flagged 31 pesticide manufacturing facilities for “Significant Violations” of key environmental laws, including the Clean Air Act, Clean Water Act, and Resource Conservation and Recovery Act. These systemic issues underscore urgent needs for transparency, accountability, and equitable policy reform. An EJ framework exposes critical knowledge gaps and calls for structural changes to ensure equal protection and responsive policies for the most affected communities.

Although the issues of diversity and representation are often discussed within academic librarianship in Canada and the United States, the field has made little headway in being inclusive of the Black, Indigenous, and People of Color (BIPOC) who work within it. If academic libraries are to become truly authentic and inclusive spaces where BIPOC are central not only to shaping the values of a library but also to determining how those values are accomplished, we must examine the traditional ways in which libraries function. One of these traditions is a reliance on bureaucracy and its associated practices such as structured group work and meetings, which are presumed to be inherently neutral and rational ways of working. Critical examinations of bureaucracy within higher education reveal how its overadoption is absurdly at odds with the social justice–oriented missions of most libraries. Furthermore, not all who are involved in libraries are equally harmed through this overreliance on bureaucracy; this article employs Critical Race Theory to uncover the insidious and specific deleterious impacts bureaucracies can have on BIPOC library workers. The antithesis of a neutral system, bureaucracy instead functions to force assimilation into a system entrenched in whiteness.

Science communication has taken center stage in Science, Technology, Engineering, and Math (STEM) disciplines in the context of public outreach and citizen science. Developing practical communication skills is imperative for all scientists to be highly successful in their careers and more so for underrepresented and Black, Indigenous, and People of Color (BIPOC) professionals in STEM. The program, led by the Engineering and Science Librarian at the University of Victoria (UVic) Libraries, aimed to equip students and early career scientists with critical communication skills by leveraging the unique voices and lived experiences of BIPOC speakers in STEM disciplines. Through this program, a unique toolkit with engaging modules consisting of 30 short videos, each three minutes long (30 x 3) by BIPOC speakers was created to provide broad foundational skills in verbal and visual communication, using an Equity, Diversity, Inclusion, and Social Justice (EDISJ) lens. A two-day conference offered networking and communication development opportunities to students and early-career scientists in STEM disciplines by connecting them with BIPOC STEM leaders and visionaries who promote STEM advocacy. This paper will discuss the methods used in the creation of the toolkit and conference using an EDISJ lens.