LitCovid-sentences  

PMC:7444865 / 1969-23483 JSONTXT 12 Projects

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Id Subject Object Predicate Lexical cue
T19 0-142 Sentence denotes One of several overarching goals of the Healthy People 2030 initiative is to create conditions that promote health and well-being for all [1].
T20 143-316 Sentence denotes These conditions include social, physical, and economic environments that enable people to stay healthy, and that are grounded in the fundamental principle of health equity.
T21 317-448 Sentence denotes Healthy People 2030 also seeks to eliminate health disparities by addressing the structural drivers of inequities in health [1, 2].
T22 449-628 Sentence denotes To achieve these goals, we must first identify the social determinants of health that are salient to the experiences of people who are socio-economically or racially marginalized.
T23 629-843 Sentence denotes Social determinants of health are the conditions in which people are born, live, age, and work that shape a range of health outcomes including the likelihood of becoming sick, health status, and access to care [3].
T24 844-990 Sentence denotes COVID-19 has exposed how inequities in social, economic, and environmental conditions—social determinants—shape inequities in health outcomes [4].
T25 991-1322 Sentence denotes Between health inequities made bare by COVID-19 and outrage over anti-Black racism and police brutality that followed the murder of George Floyd, understanding how structural racism shapes a range of social and economic conditions that impact the health outcomes of Black, Indigenous, and Latinx communities in the USA is critical.
T26 1323-1372 Sentence denotes Access to care matters for health outcomes [5–7].
T27 1373-1533 Sentence denotes However, given similar access, people who belong to racially marginalized groups and those who are experiencing poverty are less likely to initiate care [8, 9].
T28 1534-1727 Sentence denotes Public hospitals, community health centers or clinics, and safety-net settings are defined by their shared vision to provide care to persons who need it regardless of their ability to pay [10].
T29 1728-2017 Sentence denotes As a result, these facilities are mostly used by people who are socio-economically disadvantaged—majority of whom belong to racial and ethnic minority groups, as well as undocumented persons and immigrants who might experience cost, cultural, language, and other barriers to care [11, 12].
T30 2018-2216 Sentence denotes One very challenging issue in health disparities research is understanding why in urban areas with safety-net clinics, the prevalence of people with unmet need for health care is still high [13–15].
T31 2217-2286 Sentence denotes Mistrust in medical institutions is one cause of unmet need [16, 17].
T32 2287-2464 Sentence denotes A recent publication using data from the Survey of the Health of Urban Residents (SHUR) identified connections between experiences of police brutality and medical mistrust [18].
T33 2465-2686 Sentence denotes That publication continues to receive significant media, policy, and research attention, and researchers are interested in obtaining access to the data amidst intersecting crises of COVID-19, racism, and police brutality.
T34 2687-2756 Sentence denotes In this brief report, we describe the process of developing the SHUR.
T35 2757-2980 Sentence denotes The survey assesses experiences of police brutality, as well as a range of health, health care, social and economic characteristics, and experiences of people who live in urbanized areas in the USA based on the 2010 Census.
T36 2981-3041 Sentence denotes These are areas with a population of at least 50,000 people.
T37 3042-3202 Sentence denotes We hope that this report will facilitate dissemination and further analyses of the data to inform policies and programs needed for addressing health inequities.
T38 3204-3211 Sentence denotes Methods
T39 3213-3231 Sentence denotes Survey Development
T40 3232-3508 Sentence denotes Conceptualization of the survey came from an ongoing partnership between academic researchers, a federally qualified health center (FQHC), and an equity-driven non-profit that serves as a hub for community leadership, empowerment, and transformation through social engagement.
T41 3509-3635 Sentence denotes Our main project focused on exploring the experiences and dimensions of social exclusion and their effects on health outcomes.
T42 3636-3707 Sentence denotes Academic partners analyzed the existing literature on social exclusion.
T43 3708-3797 Sentence denotes The non-profit and FQHC partners organized three focus groups in Allentown, Pennsylvania:
T44 3798-3901 Sentence denotes The first with Latinx populations, the second with Black men, and the third with immigrant populations.
T45 3902-3979 Sentence denotes All partners trained community members who then facilitated the focus groups.
T46 3980-4055 Sentence denotes For example, a Latino man was trained to facilitate the Latinx focus group.
T47 4056-4340 Sentence denotes In these focus groups, we found that participants experienced specific salient stressors that shaped their health outcomes, conditions that were neither regularly captured in our population health surveillance surveys nor were in the broad literature on social determinants of health.
T48 4341-4475 Sentence denotes Using the data from focus groups, academic partners began developing a brief but comprehensive survey that includes these experiences.
T49 4476-4633 Sentence denotes We worked with our non-profit and FQHC partners in a process that involved multiple conversations with community members who have a broad range of expertise.
T50 4634-4859 Sentence denotes They included religious leaders, teachers, students and interns, health care providers, previously incarcerated and justice-involved individuals, and people with multiple chronic conditions, including substance use disorders.
T51 4860-4978 Sentence denotes University partners searched for any existing instruments consistent with the experiences of marginalized communities.
T52 4979-5124 Sentence denotes Community members critiqued some of the existing instruments to ensure that word choices reflected their experiences and co-created new measures.
T53 5126-5134 Sentence denotes Measures
T54 5135-5333 Sentence denotes Novel measures of stressors such as a range of negative encounters with the police and assessments of whether those encounters were necessary were included to assess experiences of police brutality.
T55 5334-5506 Sentence denotes We conceptualize police brutality not merely as the use of force by a police officer, but police action that dehumanizes the victim, even without conscious intent [19, 20].
T56 5507-6045 Sentence denotes Respondents were provided with the following examples of police actions: police cursed at respondent; police searched, frisked, or patted the respondent; police threatened to arrest the respondent; police handcuffed the respondent; police threatened the respondent with a ticket; police shoved or grabbed the respondent; police hit or kicked the respondent; police used pepper spray or another chemical on the respondent; police used an electroshock weapon such as a stun gun on the respondent, and police pointed a gun at the respondent.
T57 6046-6252 Sentence denotes For each of these actions, respondents were asked whether it never happened to them, has happened about once or twice in their lives, happens a few times a year, about once a month, or happens about weekly.
T58 6253-6357 Sentence denotes SHUR also assessed respondents’ evaluations of the necessity of the police actions they had experienced.
T59 6358-6663 Sentence denotes They were asked: “Thinking of your most recent experience(s) with the police, would you say the action of the officer was necessary?” Our focus group participants contend that individual perceptions of the necessity of police actions are important indicators of the dehumanizing impact of police violence.
T60 6664-6929 Sentence denotes We also assessed the likelihood of calling the police if there is a problem, worries about potential police brutality, arrest or incarceration, and cause-specific stressors such as race-related impression management, concerns about housing, food, and medical bills.
T61 6930-7092 Sentence denotes We collected data on reasons for perceived discrimination such as race, language or accent, religion, immigration status, sexual orientation, and gender identity.
T62 7093-7317 Sentence denotes We also assessed spaces and perpetrators of discrimination—whether discrimination was experienced at work, school, or perpetuated by a health care provider, police or security officer, or an individual in one’s neighborhood.
T63 7318-7576 Sentence denotes Other novel measures included in the survey are relational aspects of health care delivery, such as respondents’ perceptions of respect during their clinical encounter, and specifically by receptionists, nurses, medical or nursing assistants, and physicians.
T64 7577-7761 Sentence denotes The survey included three indicators of respondents’ sense of social exclusion, feeling like they are not trusted, often feeling left out, and not feeling like a member of a community.
T65 7762-8014 Sentence denotes We also included existing measures of stressors such as discrimination using the Everyday Discrimination and the Heightened Racial Vigilance scales [21], Group-Based Medical Mistrust scale [22], and the Adverse Childhood Experiences (ACEs) module [23].
T66 8015-8316 Sentence denotes We included the following measures of health status: self-rated health, activity limitations (respondent limited in any way in any activities because of physical, mental, or emotional problems), self-rated mental health, and depression and anxiety using the two-item patient health questionnaire [24].
T67 8317-8564 Sentence denotes Indicators of access to care include usual source of care, health insurance, perceived unmet need for medical care, perceived unmet need for mental health care, past use of mental health services, and the probability of seeking mental health care.
T68 8565-8760 Sentence denotes Sociodemographic data collected include race, gender identity, sexual orientation, age, marital status, level of education, work status, years in the USA if born outside of the USA, and zip code.
T69 8761-8862 Sentence denotes The survey instrument was pre-tested among a small subset of community members in Allentown (n = 11).
T70 8863-9049 Sentence denotes Revisions were made, and the survey was then piloted using a convenient online sample (n = 100) with respondents from 65 zip codes across the country, majority being from the East Coast.
T71 9050-9126 Sentence denotes The final version of the survey, after piloting, is presented in Appendix 1.
T72 9127-9271 Sentence denotes Approval from Lehigh University’s Institutional Review Board was obtained both for the initial social exclusion focus groups and for the survey.
T73 9272-9438 Sentence denotes The focus groups and survey were funded internally by Lehigh University’s Community-engaged Health Research Fellowship and the Faculty Innovation Grant, respectively.
T74 9440-9455 Sentence denotes Data Collection
T75 9456-9675 Sentence denotes The SHUR employed quota sampling, a non-probability sampling approach where we looked for specific characteristics of respondents and then obtained a tailored sample that is representative of the population of interest.
T76 9676-9752 Sentence denotes The target was 4000 respondents living in urban areas in the contiguous USA.
T77 9753-9816 Sentence denotes We assigned quotas for usual source of care and race/ethnicity.
T78 9817-10038 Sentence denotes Black, Indigenous, and people color, as well as those who are poor, are more likely to receive care at specific sites rather than from a specific primary care physician with whom they have established a relationship [25].
T79 10039-10205 Sentence denotes Having a regular source of care, and the kind of place that people go to for usual care matters for relational aspects of care such as perceived respect and mistrust.
T80 10206-10274 Sentence denotes Given this literature, we assigned a quota for usual source of care.
T81 10275-10498 Sentence denotes At least half of the sample (n = 2000) must report a clinic or community health center, an emergency department or urgent care facility as their usual source of care, or report that they did not have a usual source of care.
T82 10499-10548 Sentence denotes The second quota was specific for race/ethnicity.
T83 10549-10691 Sentence denotes Because we needed 4000 respondents, 1000 respondents (at least 25%) must be people of color and no more than 65% should be non-Hispanic White.
T84 10692-10880 Sentence denotes This falls within the range of the US Census and Pew Center estimates of the racial demographics of urbanized areas and provides enough sample sizes to complete analysis by race/ethnicity.
T85 10881-11047 Sentence denotes We contracted with Qualtrics because their panels are relatively more demographically representative than other online survey platforms for convenience sampling [26].
T86 11048-11193 Sentence denotes Qualtrics invited respondents by partnering with over 20 Web-based panel providers to access potential respondents based on the specified quotas.
T87 11194-11333 Sentence denotes Respondents received some form of incentive from panel providers, but the specific value of the incentive was not disclosed to researchers.
T88 11334-11444 Sentence denotes Qualtrics monitored the specified quotas using screening questions on race/ethnicity and usual source of care.
T89 11445-11642 Sentence denotes For example, when enough non-Hispanic Whites had completed the survey, anyone who identified as non-Hispanic White who expressed interest in taking the survey was not redirected to the full survey.
T90 11643-11692 Sentence denotes This process continued until the quotas were met.
T91 11693-11769 Sentence denotes A total of 7495 persons passed the screeners and met the quota requirements.
T92 11770-11850 Sentence denotes Qualtrics performed quality checks on the data and removed incomplete responses.
T93 11851-11926 Sentence denotes They also assessed the time it took for respondents to complete the survey.
T94 11927-11976 Sentence denotes The median time for survey completion was 10 min.
T95 11977-12241 Sentence denotes Respondents who took less than a third of the median time to complete the survey were excluded from the final sample because of the possibility that they were not paying attention to the questions and might have been checking response boxes as quickly as possible.
T96 12242-12305 Sentence denotes After these checks, we were left with 4389 completed responses.
T97 12307-12321 Sentence denotes Survey Results
T98 12322-12412 Sentence denotes We provide a brief description of the survey results by select characteristics in Table 1.
T99 12413-12506 Sentence denotes As shown, non-Hispanic Whites make up just under two thirds of the sample (63.65%, n = 2793).
T100 12507-12627 Sentence denotes Black/African American respondents constitute 14.2% of the sample (n = 623), while 11.62% (n = 510) are Hispanic/Latinx.
T101 12628-12796 Sentence denotes SHUR respondents are disproportionately cisgender women (70.85%, n = 3109), and the majority are under the age of 65; only 8.61% (n = 378) are 65 years of age or older.
T102 12797-13031 Sentence denotes While slightly more than half of the respondents worked full-time or part-time, three in ten were not in the labor force, and about one in ten were in the labor force but were unemployed and looking for work at the time of the survey.
T103 13032-13084 Sentence denotes Table 1 Selected characteristics of SHUR respondents
T104 13085-13110 Sentence denotes Percent Number x̅ (range)
T105 13111-13129 Sentence denotes Race and ethnicity
T106 13130-13161 Sentence denotes   Non-Hispanic White 63.65 2793
T107 13162-13192 Sentence denotes   Non-Hispanic Black 14.20 623
T108 13193-13220 Sentence denotes   Hispanic/Latinx 11.62 510
T109 13221-13265 Sentence denotes   American Indian and Alaskan Native 1.39 61
T110 13266-13282 Sentence denotes   Asian 3.81 167
T111 13283-13308 Sentence denotes   Other/multiple 5.33 234
T112 13309-13324 Sentence denotes Gender identity
T113 13325-13351 Sentence denotes   Cisgender man 24.52 1076
T114 13352-13380 Sentence denotes   Cisgender woman 70.84 3109
T115 13381-13404 Sentence denotes   Gender fluid 3.08 135
T116 13405-13430 Sentence denotes   Transgender man 0.84 37
T117 13431-13458 Sentence denotes   Transgender woman 0.73 32
T118 13459-13471 Sentence denotes Age category
T119 13472-13489 Sentence denotes   18–24 19.25 845
T120 13490-13508 Sentence denotes   25–34 27.59 1211
T121 13509-13526 Sentence denotes   35–44 20.92 918
T122 13527-13544 Sentence denotes   45–54 13.69 601
T123 13545-13561 Sentence denotes   55–64 9.93 436
T124 13562-13585 Sentence denotes   65 and older 8.61 378
T125 13586-13597 Sentence denotes Work status
T126 13598-13633 Sentence denotes   Not in the labor force 32.71 1390
T127 13634-13674 Sentence denotes   Unemployed, looking for work 12.31 523
T128 13675-13725 Sentence denotes   Working for pay, part time < 30 h/week 15.65 665
T129 13726-13778 Sentence denotes   Working for pay, full time > =30 h/week 39.34 1672
T130 13779-13799 Sentence denotes Usual source of care
T131 13800-13843 Sentence denotes   Community clinic/health center 26.59 1167
T132 13844-13872 Sentence denotes   Doctor’s office 42.36 1859
T133 13873-13899 Sentence denotes   Emergency room 11.37 499
T134 13900-13953 Sentence denotes   Outpatient department such as urgent care 11.07 486
T135 13954-13988 Sentence denotes   No usual source of care 7.97 350
T136 13989-14015 Sentence denotes   Some other place 0.64 28
T137 14016-14062 Sentence denotes Reports unmet need for medical care 37.72 1639
T138 14063-14085 Sentence denotes   Often feels left out
T139 14086-14117 Sentence denotes     Strongly disagree 10.64 453
T140 14118-14140 Sentence denotes     Disagree 18.06 769
T141 14141-14174 Sentence denotes     Agree nor disagree 29.56 1259
T142 14175-14194 Sentence denotes     Agree 15.45 658
T143 14195-14222 Sentence denotes   Strongly agree 26.30 1120
T144 14223-14270 Sentence denotes Has experienced racial discrimination 14.42 633
T145 14271-14349 Sentence denotes Consciously acts in ways to make sure you do not live up to racial stereotypes
T146 14350-14368 Sentence denotes   Never 34.04 1464
T147 14369-14391 Sentence denotes   Sometimes 42.46 1826
T148 14392-14411 Sentence denotes   Always 23.51 1011
T149 14412-14433 Sentence denotes Worries about housing
T150 14434-14452 Sentence denotes   Never 31.67 1362
T151 14453-14475 Sentence denotes   Sometimes 41.90 1802
T152 14476-14495 Sentence denotes   Always 26.44 1137
T153 14496-14530 Sentence denotes Worries about paying medical bills
T154 14531-14549 Sentence denotes   Never 41.32 1777
T155 14550-14572 Sentence denotes   Sometimes 39.55 1701
T156 14573-14590 Sentence denotes   Always 7.95 823
T157 14591-14657 Sentence denotes Worries someone they know will become a victim of police brutality
T158 14658-14676 Sentence denotes   Never 53.99 2322
T159 14677-14699 Sentence denotes   Sometimes 33.04 1421
T160 14700-14718 Sentence denotes   Always 12.97 558
T161 14719-14774 Sentence denotes Has had a negative encounter with the police 56.86 2495
T162 14775-14821 Sentence denotes Mean medical mistrust score 4380 29.19 (12–60)
T163 14822-14865 Sentence denotes Mean overall respect rating 4318 7.03(2–10)
T164 14866-15062 Sentence denotes In terms of access to care and health services, most of the respondents had a usual source of care, but they were pretty spread out in terms of the specific places they regularly went to for care.
T165 15063-15218 Sentence denotes For example, four in ten of the respondents received care from the doctor’s office, two in ten at a community clinic, and one in ten at the emergency room.
T166 15219-15312 Sentence denotes More than a third of the respondents reported unmet need for medical care (37.72%, n = 1639).
T167 15313-15436 Sentence denotes Response options on the 12-item group-based medical mistrust index ranged from strongly disagree (1) to strongly agree (5).
T168 15437-15566 Sentence denotes Scores on the medical mistrust scale ranged from 12 to 60, with higher scores indicating greater mistrust of health institutions.
T169 15567-15616 Sentence denotes The mean mistrust score for the sample was 29.19.
T170 15617-15764 Sentence denotes Respondents rated if they felt, in general, that they were treated with a great deal of respect and dignity the last time they received healthcare.
T171 15765-15835 Sentence denotes Ratings could range from 1 (no respect at all) to 10 (utmost respect).
T172 15836-15913 Sentence denotes The range for our sample was 2 to 10, with a mean of 7.03, and a median of 9.
T173 15914-15968 Sentence denotes Feeling left out is one indicator of social exclusion.
T174 15969-16053 Sentence denotes About four in ten respondents agree or strongly agree that they often felt left out.
T175 16054-16124 Sentence denotes Many respondents also reported experiencing salient sources of stress.
T176 16125-16324 Sentence denotes For example, 14.42% of the sample (n = 633) felt hassled, inferior, or discriminated against because of race, accounting for more than half of the respondents who reported any kind of discrimination.
T177 16325-16743 Sentence denotes Almost a quarter of the respondents engaged in race-related impression management—always careful to act in a way that did not consciously live up to the stereotypes of their racial and ethnic groups; 26.4% (n = 1137) were always worried about being able to pay rent/mortgage/housing costs while 19.14% (n = 823) always worried that they would not be able to pay their medical bills if they got sick or had an accident.
T178 16744-16977 Sentence denotes Even though four in ten always or sometimes worried that someone they know would become a victim of police brutality, 56.86% (n = 2495) reported having experienced at least one of the ten listed negative interactions with the police.
T179 16979-17005 Sentence denotes Public Health Implications
T180 17006-17170 Sentence denotes The SHUR is a great resource for researchers and policymakers interested in understanding and addressing factors relevant to the health of marginalized populations.
T181 17171-17372 Sentence denotes Research published using SHUR data can contribute significantly to ongoing conversations around the connections between police brutality and health, especially access to care and medical mistrust [18].
T182 17373-17405 Sentence denotes Nevertheless, there are caveats.
T183 17406-17455 Sentence denotes First, SHUR does not employ probability sampling.
T184 17456-17607 Sentence denotes Therefore, estimates from the survey might be sensitive to systematic errors because respondents might differ from non-respondents in significant ways.
T185 17608-17710 Sentence denotes Second, we did not assess respondents’ perceptions of the necessity of each negative police encounter.
T186 17711-17890 Sentence denotes Instead, we asked respondents to think about their most recent experiences with the police and to state their perceptions about whether the action(s) of the police were necessary.
T187 17891-18085 Sentence denotes While we wanted to capture more recent exposures to police brutality, we think that perceptions about the necessity of negative police encounters might be different for different police actions.
T188 18086-18256 Sentence denotes For example, an individual might perceive the police patting them down before an arrest as necessary and a previous encounter where the police kicked them as unnecessary.
T189 18257-18390 Sentence denotes These actions have implications especially for assessing mental health correlates of police brutality such as anxiety and depression.
T190 18391-18479 Sentence denotes Despite these limitations, SHUR can support health disparities research in several ways.
T191 18480-18862 Sentence denotes First, the survey is informed by the experiences of racialized populations—specifically Black men, Latinxs, and immigrants—and assesses salient conditions including sources and spaces of discrimination, social exclusion, experiences of police brutality and stressful anticipations of these experiences, housing-related stress, as well as stress-related to arrests and incarceration.
T192 18863-19036 Sentence denotes These data can help us identify connections between specific social determinants and a range of indicators of access to care and health status that are included in the data.
T193 19037-19149 Sentence denotes These connections are important for formulating and implementing targeted policies to address health inequities.
T194 19150-19331 Sentence denotes Second, SHUR measures relational aspects of care such as mistrust and perceptions of respect that we know are important indicators of the delivery of patient-centered care [27, 28].
T195 19332-19516 Sentence denotes When patients feel respected, they might then feel supported and empowered to share their own needs, perspectives, and preferences, and therefore engage in shared-decision making [29].
T196 19517-19653 Sentence denotes This might also equalize the inherent power differentials between clinicians and patients, regardless of race and socio-economic status.
T197 19654-19806 Sentence denotes The data have the potential of helping researchers understand factors that shape relational aspects of care to improve engagement and reduce unmet need.
T198 19807-19851 Sentence denotes Third, SHUR includes respondents’ zip codes.
T199 19852-20315 Sentence denotes This presents researchers with the rare opportunity to link the data to zip code-level health system characteristics including the availability of physicians, housing characteristics, foreclosure rates, food insecurity, incarceration rates, voting and other indicators of political participation, as well as population-level indicators of structural racism such as Black to White ratios in rates of unemployment, poverty, health insurance, and college graduation.
T200 20316-20443 Sentence denotes These larger structural factors, including structural racism, shape health beyond individual behaviors and attributes [30, 31].
T201 20444-20543 Sentence denotes Therefore, examining their interaction with individual factors in multi-level analyses is critical.
T202 20544-20758 Sentence denotes In addition, researchers using these data can explore how variation in characteristics of urban areas, including population density, might be associated with variation in a range of experiences and health outcomes.
T203 20759-21130 Sentence denotes The approach employed in SHUR—co-creating measures of salient stressors with communities for which our work bears relevance is important for understanding the mechanisms through which social conditions affect health, the contextual specificity of these mechanisms, and what kinds of interventions might help eliminate health disparities caused by structural inequalities.
T204 21131-21278 Sentence denotes Measures in the current survey are critical for providing evidence needed to inform policies that would improve health among urbanized populations.
T205 21279-21317 Sentence denotes We encourage others to use these data.
T206 21318-21514 Sentence denotes Community-driven approaches to creating measures related to navigating COVID-19 that are salient to the experiences of populations marginalized by structural inequalities are important next steps.