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The COVID-19 pandemic has drastically changed lives in ways that will forever shape human history. Few previous pandemics have unleashed the level of devastation in disease and death as the coronavirus pandemic has.Declared a global public health emergency in March 2020, the total number of COVID-19 positive cases in the United States skyrocketed to over 4 million by late Summer 2020 and continued to climb to now more than 29 million infected and more than 500,000 deaths as of March 2021, the one year anniversary of the COVID-19 pandemic. African American/Black, Latino and Indigenous people experienced disproportionately higher rates of disease, death and negative social impacts.The Program for Multicultural Health, a division of the Community Health Services Department at Michigan Medicine, analyzed available information and data to understand the impact of COVID-19 on communities of color.Reports show Native Hawaiians/Pacific Islanders were most likely to have contracted COVID-19, while Black/African American people were most likely to have died from the virus, according to data retrieved from the COVID Tracking Project at Boston University.As of March 2021, more than 73,000 Black lives were lost to COVID-19 in the U.S.In Michigan, the cumulative COVID-19 case rate has been 40% higher for Black Michiganders than white residents and the death rate for Black residents has been more than three times the rate in white residents. Given the inequitable disease distribution of the disease, equitable distribution of the COVID19 vaccine is critical. The percent of vaccinated people who are Black has more than tripled between the first three weeks and the last week of vaccination (0.5% to 3.8%), but the proportion of vaccinated adults 16 and older who are Black is far lower than the proportion of Black residents (14%) in Michigan.For this analysis, social-ecological framework was used to understand the racial health gap as it considers multi-level systemic factors (i.e., individual, institutional and socio-historical) as impactful on the quality of life of individuals. Experts attribute the racial gap in coronavirus death, for example, to several societal factors including: the over-representation of Black workers in essential jobs, mass incarceration, residential segregation, wealth inequality, and a host of other structural inequities that have long affected Black, Indigneous and Latino communities. A recent study found, for example, that Black people were six times more likely to be turned away from COVID testing once they arrived at the hospital.Like the problem, viable societal solutions must be multifactorial to best ameliorate inequitable and negative impacts of COVID-19. Because pandemics rarely affect all people in society in a uniform way, it is essential to address the ways in which major social institutions such as health systems entrench and perpetuate broader societal power hierarchies, resulting in differential and inequitable health outcomes.Experts suggest an intersectional approach that analyzes "within group differences" by measuring the interaction between and across specific demographic data (race, sex, age, location, etc.) to expose hidden inequities.Solutions should reflect a systems approach that recognize healthcare and other societal institutions as products of broader societal systems. What must also be acknowledged is that sociocultural and historical contexts shape health inequities. Individuals do have a responsibility to engage in behaviors that enhance their own health, but individual responsibilities must be understood in the context of opportunities that exist within communities in which many people of color live."Vaccine reluctancy", influenced by past and current experience with discrimination, is especially important considering the higher COVID-19 infection and death rates in communities of color. However, we must also recognize that structural barriers, such as lack of transportation and lack of proximity to vaccination sites, decide access to the vaccine as well.In sum, our team recommends six concrete multi-level systems strategies:1. Develop translational interventions through community engaged research and practice.Research practices must center the community in creating interventions that reinforce trust and positive engagement to produce optimum health outcomes among marginalized communities.&nbsp;Community-university partnered research such as the recent Ypsilanti COVID-19 Study led by a collaboration between Eastern Michigan University Family Empowerment Program, the Washtenaw County Racial Equity Office and the Center for Equitable Family &amp; Community Well-Being within the U-M School of Social Work, demonstrate equitable research practice and impactful outcomes by engaging community in all steps of the research process.2. Incorporate experiential and measurable anti-racism training, education and other measures for providers.Training must be incorporated into medical school curriculum and mandated health provider training with deliverables that demonstrate first, effective treatment of bias and discriminatory practices and second, improved reports that people of color are receiving respectful, trusted and equitable healthcare.3. Support grassroots community and non-profit organizations' efforts to elevate social and economic status for people of color.To amplify positive health impact, it is critical to identify and support community-focused, grassroots organizations and efforts that target the upstream causes of structural and systematic inequities which manifest themselves in downstream social and health disparities.4. Advocate for policy changes at all levels across multiple institutions that highlight and dismantle systemic inequities.Government institutions and communities need to work in partnership and use coordinated strategies to ensure laws, policies, and practices alter systemic inequities. &nbsp; &nbsp;5. Track and prioritize for COVID-19 infection and vaccination data and distribution.Because Black and Brown communities have been disproportionately affected by COVID-19, "improving the race and ethnicity data being collected for vaccinations is critical for ensuring equitable administration of the vaccine," says Joneigh Khaldun, the chief medical executive and chief deputy for health in Michigan. The Social Vulnerability Index, or SVI, helps prioritize high-risk individuals and communities by using U.S. Census Bureau data to identify certain 'vulnerability indicators' (e.g. economic or minority status).6. Promote individual introspective review and address personal biases and misconceptions. &nbsp;Self-education is an important first step in understanding roles and impact on achieving social justice. Individuals are also encouraged to think about their own social identity and racial group membership and recognize how it positions or has positioned them for access to structures of opportunity, power or resources. &nbsp; &nbsp;The Program for Multicultural Health at Michigan Medicine supports the educational needs of staff, faculty and the community by analyzing and discussing effective strategies for addressing the disproportionate impact of the pandemic on communities of color. To learn more, visit the <a data-mce-href="https://www.facebook.com/UMHSProgramForMulticulturalHealth" href="https://www.facebook.com/UMHSProgramForMulticulturalHealth">Program for Multicultural Health's Facebook page.</a>

Addressing the Cumulative Cost of COVID-19 for Communities of Color

Abstract Background: Persistent racial disparities in breastfeeding show that African American women breastfeed at the lowest rates. Return to work is a critical breastfeeding barrier for African American women who return to work sooner than other ethnic groups and more often encounter unsupportive work environments. They also face psychosocial burdens that make breastfeeding at work uniquely challenging. Participants share personal struggles with combining paid employment and breastfeeding and suggest workplace and personal support strategies that they believe will help continue breastfeeding after a return to work. Objective: To explore current perspectives on ways to support African American mothers’ workplace breastfeeding behavior. Methods: Pregnant African American women (n = 8), African American mothers of infants (n = 21), and lactation support providers (n = 9) participated in 1 of 6 focus groups in the Greater Detroit area. Each focus group audiotape was transcribed verbatim. Thematic analysis was used to inductively analyze focus group transcripts and field notes. Focus groups explored thoughts, perceptions, and behavior on interventions to support African American women’s breastfeeding. Results: Participants indicate that they generally believed breastfeeding was a healthy option for the baby; however, paid employment is a critical barrier to successful breastfeeding for which mothers receive little help. Participants felt breastfeeding interventions that support working African American mothers should include education and training for health care professionals, regulation and enforcement of workplace breastfeeding support policies, and support from peers who act as breastfeeding role models. Conclusion: Culturally appropriate interventions are needed to support breastfeeding among working African American women.Get full access to this article View all access and purchase options for this article:https://journals.sagepub.com/doi/full/10.1177/0890334415573001References 1. Centers for Disease Control. Progress in increasing breastfeeding and reducing racial/ethnic differences, United States, 2000-2008 births. MMWR Morb Mortal Wkly Rep. 2013;62(5):77-80. PubMed Web of Science Google Scholar 2. McDowell M, Wang CY, Stephenson J. Breastfeeding in the United States: Findings from the National Health and Nutrition Examination Surveys, 1999-2006. Hyattsville, MD: Centers for Disease Control and Prevention, National Center for Health Statistics; 2008. Google Scholar 3. Li RW, Hsia J, Fridinger F, Hussain A, Benton-Davis S, Grummer-Strawn L. Public beliefs about breastfeeding policies in various settings. J Am Diet Assoc. 2004;104(7):1162-1168. Crossref PubMed Google Scholar 4. 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Exploring large employers’ and small employers’ knowledge, attitudes, and practices on breastfeeding support in the workplace. J Hum Lact. 2001;17(1):39-46. Crossref PubMed Google Scholar 18. Thompson PE, Bell P. Breast-feeding in the workplace: how to succeed. Issues Comp Ped Nurs. 1997;20(1):1-9. Crossref PubMed Google Scholar 19. Dunn BF, Zavela KJ, Cline AD, Cost PA. Breastfeeding practices in Colorado businesses. J Hum Lact. 2004;20(2):170-177. Crossref PubMed Web of Science Google Scholar 20. Kitzinger J. Qualitative research: introducing focus groups. BMJ. 1995;311(7000):299-302. Crossref PubMed Web of Science Google Scholar 21. Morgan DL. Focus Groups as Qualitative Research. Thousand Oaks, CA: SAGE; 1996. Google Scholar 22. Glaser B, Strauss A. The Discovery of Grounded Theory: Strategies for Qualitative Research. New Brunswick, NJ: Transaction Publishers; 1999. Google Scholar 23. Stewart DW, Shamdasani PN, Rook DW. Focus Groups: Theory and Practice. 2nd ed. Thousand Oaks, CA: SAGE; 2000. Google Scholar 24. Krueger RA. Focus Groups: A Practical Guide for Applied Research. Thousand Oaks, CA: SAGE; 2009. Google Scholar 25. Tong A, Sainsbury P, Craig J. Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. Int J Qual Health Care. 2007;19(6):349-357. Crossref PubMed Web of Science Google Scholar 26. Bloor M, Frankland J, Thomas M, Robson K. Focus Groups in Social Research. Thousand Oaks, CA: SAGE; 2001. Crossref Google Scholar 27. Krueger R, Casey M. Focus Groups: A Practical Guide for Applied Research. 3rd ed. Thousand Oaks, CA: SAGE; 2000. Crossref Google Scholar 28. Creswell JW. Qualitative Inquiry and Research Design: Choosing among Five Approaches. 3rd ed. Thousand Oaks, CA: SAGE; 2013. Google Scholar 29. Rabiee F. Focus-group interview and data analysis. Proc Nutr Soc. 2004;63(4):655-660. Crossref PubMed Web of Science Google Scholar 30. Thomas DR. 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Analyzing the Social Context of Disparate Breastfeeding Outcomes through Intersectional Paradigms: Lessons Learned from a Qualitative Study of African American mothers [dissertation]. East Lansing: Department of Sociology, Michigan State University; 2010. Google Scholar 41. Giscombe CL, Lobel M. Explaining disproportionately high rates of adverse birth outcomes among African Americans: the impact of stress, racism, and related factors in pregnancy. Psychol Bull. 2005;131(5):662-683. Crossref PubMed Google Scholar 42. Canady RB, Bullen BL, Holzman C, Broman C, Tian Y. Discrimination and Symptoms of depression in pregnancy among African American and white women. Womens Health Issues. 2008;18(4):292-300. Crossref PubMed Web of Science Google Scholar 43. Siefert K, Finlayson TL, Williams DR, Delva J, Ismail AI. Modifiable risk and protective factors for depressive symptoms in low-income African American mothers. Am J Orthopsychiatry. 2007;77(1):113-123. 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Crossref PubMed Web of Science Google Scholar 53. Johnson A, Rosalind K, Rosenblum L, Muzik M. Enhancing breastfeeding rates among African American women: a systematic review of current psychosocial interventions [published online November 25, 2014] Breastfeed Med. Crossref Web of Science Google Scholar 54. Galler JR, Harrison RH, Ramsey F, Chawla S, Taylor J. Postpartum feeding attitudes, maternal depression, and breastfeeding in Barbados. Infant Behav Dev. 2006;29(2):189-203. Crossref PubMed Web of Science Google Scholar 55. Schulz AJ, Gravlee CC, Williams DR, Israel BA, Mentz G, Rowe Z. Discrimination, symptoms of depression, and self-rated health among african american women in detroit: results from a longitudinal analysis. Am J Public Health. 2006;96(7):1265-1270. Crossref PubMed Web of Science Google Scholar 56. Dennis CL, McQueen K. The relationship between infant-feeding outcomes and postpartum depression: a qualitative systematic review. Pediatrics. 2009;123(4):e736-e751. Crossref PubMed Web of Science Google Scholar 57. Dennis CL, McQueen K. Does maternal postpartum depressive symptomatology influence infant feeding outcomes? Acta Paediatr. 2007;96(4):590-594. Crossref PubMed Web of Science Google Scholar 58. Ystrom E. Breastfeeding cessation and symptoms of anxiety and depression: a longitudinal cohort study. BMC Pregnancy Childb. 2012;12:36. Crossref PubMed Web of Science Google Scholar 59. United States Department of Health and Human Services. The Surgeon General’s Call to Action to Support Breastfeeding. Rockville, MD: US DHHS; 2011. Google Scholar 60. Wambach KA, Aaronson L, Breedlove G, Domian EW, Rojjanasrirat W, Yeh HW. A randomized controlled trial of breastfeeding support and education for adolescent mothers. Western J Nurs Res. 2011;33(4):486-505. Crossref PubMed Web of Science Google Scholar 61. Pugh LC, Serwint JR, Frick KD, et al. A randomized controlled community-based trial to improve breastfeeding rates among urban low-income mothers. 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Overcoming Workplace Barriers: A Focus Group Study Exploring African American Mothers’ Needs for Workplace Breastfeeding Support

Enhancing Breastfeeding Rates Among African American Women: A Systematic Review of Current Psychosocial Interventions

Mixed race girl with mother in library, looks over shoulder

Did you know that maternal and child health is one of the best indicators for a society’s health? Did you also know that the World Health Organization (WHO) considers breastfeeding the best source of nutrition for babies and that the American Academy of Pediatrics, considers breastfeeding one of the most beneficial health behaviors for mothers and their children?Over the past few decades, multiple studies have confirmed that breastfeeding has positive effects for mother and child from a nutritional, physiological, and developmental perspective.Simultaneously, overall breastfeeding rates in the United States have risen, most likely reflecting various legislative changes specifically addressing health, economics, employment, and welfare policies and practices with a unifying goal of providing systemic support for mothers to breastfeed. The Innocenti Declaration (1990) and U.S. legislations, including the Family Medical Leave Act (1993), Personal Responsibility Welfare and Work Opportunity Act (1996), the Affordable Care Act (2010), and the Healthy People Act (2010) have resulted in national policies such as the Surgeon General’s Call to Action to Support Breastfeeding (2011) and the Baby-Friendly Hospital Initiative (BFHI) However, despite these many breastfeeding initiatives and the apparent overall success of enhancing U.S. breastfeeding rates over the past 25 years, African American mothers—have persistently lagged behind, showing, by far, the lowest breastfeeding rates. This puts African American mothers and their babies at higher risk for poor postnatal outcomes and may be a substantial contributor to the origins of health disparities among African Americans across the lifetime.&nbsp;Persistent disparities in breastfeeding rates among African American mothers raise concerns that socially disadvantaged mothers and babies may be at increased risk for poor postnatal outcomes. In a recent study (Johnson et al) published November 25, 2014 in the Journal Breastfeeding Medicine, a systemic review was conducted to identify effective breastfeeding interventions. The results of this study highlight that current breastfeeding interventions reflect approaches that are often not effective because they are disjointed and don’t address the complexity of social and health challenges many mothers and their children face.Viable Solutions Johnson et al (2014) found that effective breastfeeding support initiatives must function comprehensively, operate seamlessly from the societal level of national-, state-, and local-level policies, and be incorporated throughout major institutions such as hospitals, workplace, schools, and churches. In this way, researchers say, “mothers may benefit from authentic breastfeeding education and care from healthcare providers and community lactation groups necessary to attain heightened breastfeeding standards and outcomes among all mothers, but especially African American women”.&nbsp;More Action is Needed! Effective breastfeeding Interventions should:Recognize and address the conscious and unconscious racial bias that exist within breastfeeding inequities by creating more peer breastfeeding counselors, increasing the racial diversity of health and medical professionals, and by providing training for all medical personnel; Provide workplace breastfeeding support in the form of pumping and storing stations, protected break-time for pumping, and flexible work schedules; Support maternity leave as a mechanism for enhancing breastfeeding behavior; Provide psychological and social support that target all mothers and especially those at risk for stress and depression; Provide virtual support available through social media, internet, text-based programs combined with other services. In sum, important community breastfeeding support systems will include personal networks, employers, healthcare institutions, faith-based organizations, and other stakeholders who daily engage with African American and other at risk mothers and children.More research is needed that includes a cross-section of mothers from a diversity of socio-economic levels to help discern those barriers related to economic factors versus those factors related to racial and cultural experiences. Research should also help target the development of culturally appropriate interventions that mirror the psychological, social, cultural, and societal needs of African American mothers and other at risk mothers and their children.This study was supported by a grant from the National Center for Advancing Translational Sciences through the Michigan Institute for Clinical Health Research and the Department of Psychiatry at the University of Michigan. Additional support was provided by the Program for Multicultural Health at the University of Michigan Health System. Share this: &nbsp;X &nbsp;Facebook &nbsp; &nbsp; This entry was posted in Breastfeeding, Maternal Health, Pediatric Health and tagged Affordable Care Act, American Academy of Pediatrics, Baby-Friendly Hospital Initiative, breastfeeding, breastfeeding support, Family Medical Leave Act, health disparity, health equity, Health People Act, Innocenti Declaration, Michigan Institute for Clinical Health Research, multicultural health, National Center for Advanced Translational Sciences, Personal Responsibility Welfare and Work Opportunity Act, PMCH, Program for Multicultural Health, UM Department of Psychiatry, UMHS, University of Michigan Health System by angejohn. Bookmark the permalink.

Enhancing Breastfeeding Support for At Risk Mothers Requires Systemic Support

gp discussing patient's prescription medicine

Abstract Background: Recruiting minority women into clinical research remains a significant challenge to conducting ethnically representative research. The main objective of this Office on Women's Health, DHHS-funded e-health database evaluation project was to examine African American women 's thoughts and perceptions about the clinical research process and about participation in the University of Michigan Women's Health Registry research database. Methods: Thirty-one African American women were recruited from the community to participate in a total of five 90-minute focus group discussions. All sessions were audiotaped and transcribed verbatim. Thematic content analysis was used to identify relevant themes about participation in clinical research and the Women's Health Registry. Results: Ten common trends were identified. (1) Information about the Women's Health Registry is not reaching the community. (2) Research is perceived as biased to benefit Caucasians. (3) Community involvement by the research team is critical for trust to develop. (4) Research directly relevant to African Americans or their community will encourage participation. (5) Researchers should use existing networks and advertise in appropriate locations. (6) The community needs more information concerning research. (7) Compensation is important. (8) Research that addresses a personal or family medical problem encourages involvement. (9) Minority representation on the research team is a motivator to participation. (10) There is limited time for healthcare-related activities. Conclusions: Successful recruitment strategies for African American women should feature community-based, culturally appropriate approaches. Online research databases for subject recruitment will likely be successful only if implemented within a broader community-oriented program.

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Publications

Addressing the Cumulative Cost of COVID-19 for Communitie...

Overcoming Workplace Barriers: A Focus Group Study Explor...

Enhancing Breastfeeding Rates Among African American Wome...

Enhancing Breastfeeding Support for At Risk Mothers Requi...

Perceptions of Clinical Research Participation among Afri...