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yeah, let's make sure I know what's up. Yeah, we just had the chair. That's all this. Okay, we're ready.

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So I'm I'm verdict. He. Then I'm just going to get started. I just wanted to acknowledge my co

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researchers, Ryan, Cobb, Whitney, Lasseter, Priddle, and

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Don, who's on.

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So today I'm going to be talking about the black paradox in mental health.

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which is a tendency for African Americans or black Americans generally in the Us. To have equal or better mental health than white Americans, despite their disadvantaged social position.

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And we've looked at the black paradox in a lot of different ways. And today what I'm going to be doing is looking looking to see if that paradox holds when you use different definitions

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of race. our measure rates in different ways.

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And specifically, I'm going to be looking at, observed skin tone or complexion, self-assessed skin tone.

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and the congruence between

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observed and self-assessed

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so briefly when we look at mental health data, whether we're looking at diagnosed.

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mental disorders, or we're looking at general screening scales, we find that across a spectrum of them African Americans are better off. They they appear to be healthier in terms of mental health outcomes, which is not what we'd expect given.

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The kinds of experiences they have in the Us.

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So, as I noted there have been a lot of different investigations trying to figure out what's going on. People have looked at social relationships.

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They've looked at self-esteem which tends to be higher among African Americans, which is again another paradox. And they've also looked at things like religious and spiritual resources, with understanding that

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with these resources African Americans are compensating somehow when they have when they are under stress. And this is what's responsible for their healthier outcomes.

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Now, the

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scholars that work in racial inequality generally

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have been arguing for about the last 2 decades that we need to expand our definitions of race. The way research is done in the United States. We sort of lump everybody into a group. You're white, you're black, your latino.

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And so what they have said is that that's too simplistic. And so they've come up with a number of

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typologies to to expand this definition. One of the more famous ones is by Wendy Roth, and she looks at things like express race, which is the race you usually indicate when you're asked to fill out forms which she calls census race.

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observe race, the race. Others assume you to be an reflected race

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the way she think other people think you are, and she goes on and on. She has a very complex system.

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So they've already that race is mostly dimensional. They've also have done research that shows that people's racial identity changes back and forth.

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 observe, race, what people think you are, changes based on how you dress your your socioeconomic status and so forth.

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And so

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conventional research on the black paradox is based on the census race definition.

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One of the the dimensions that the sort of new race scholarship introduces is the notion of phenotype.

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an idea that experiences within racial groups can vary, depending on physical characteristics such as skin, color and eye, color and hair texture.

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most of this research has focused on skin color because it's sort of the dominant features the thing people most noticed when they first meet an individual.

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and in the African-american community. At least, there is a diverse range of skin towns. There are people who look indistinguishable from white Americans to people that are quite dark in complexion.

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and we know from research on skin tone that experiences vary so experiences reduce discrimination are usually reported at a higher rate. If you are darker in skin tone than if you're lighter in skin tone.

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Now, this is relative. It doesn't. I mean that if you're lighter you just avoid racial discrimination, it's it's a matter matter of relative discrimination.

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And we know that this is linked to mental health outcomes. So discrimination is linked to mental health outcomes and skin color is linked to discrimination.

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So what we wanted to do in this paper is to look at whether, if we replaced a census race, whether you're black versus white, or if we would still observe the

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the the

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paradox, and mental health.

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And so we substituted in a series of equations different measures. We looked at observed skin tones, self-assessed skin tone. And then we looked at the difference between observed and and self-assessed. Because there is literature that's shown that when people perceive you as a different race, not necessarily skin color, but as a different race than you perceive yourself, that leads to stress.

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and at least to depression and depressive symptoms. particularly if they're perceiving you as darker.

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are a less disadvantaged race than how you see yourself. So if you are a white person. And people sort of think you're Mexican, or they sort of think you're something else that leads to stress. And it also leads to depression.

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So we use data from a national survey of American life.

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and we contrasted we had about 3,000 African Americans, and we had about 800 plus white Americans self-identified. So this would be the census category.

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And we looked at our depressive symptoms. major depressive disorder and social anxiety, disorder as mental health outcomes.

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And then we looked at conventional race. We looked at skin tone, which we divided into 3 categories, dark, medium light, and we did it as well observed in self.

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And then we looked at skin tone congruence.

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that difference between those 2.

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And of course we control for a lot of things that we conventionally control, for in sociology to make sure that we didn't have spurious findings.

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So I on this first table, I just want to highlight that we did find that the paradox exists

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that when we look at conventional measures generally, non-hispanic whites had a higher prevalence of these various indicators of of mental health

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than our mental disorder than African Americans.

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And it varied, depending on whether we were doing observed versus self-assessed skin tone which would be clearer when we look at the multivariate analyses.

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So in this first set of models, we looked at the conventional measure of race that's generally used in our research.

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This was for depressive symptoms, and we were looking at incident rate ratios which are sort of interpreted in the same way that ratios are, so that a number that's smaller. A small number under one indicates that African Americans have an advantage

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in terms of depressing symptoms.

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And so, if we go down these various measures, we go from conventional down to observed

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skin tone.

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 And we go down to self-assessed skin tone.

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What we find is that

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paradox is

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there. It's consistent. It doesn't change. We have significant difference from whites, no matter how we measure race

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for depressive symptoms. And the same thing. When we look at where there is congruence between how people see you and how you see yourself so, a very strong findings for depressive symptoms that the paradox holds, no matter how we measure race.

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One interesting finding here is that, contrary to what we expected.

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it was the light of scanned rather than the darker skinned people that were more disadvantaged. So. In other words.

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if we compare life-skinned African-americans to white Americans, they have an advantage, but it is not as great as the advantage, for brown and darker, medium and darker scamp.

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So that was unusual, and we'll come back to that.

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for depressive disorders. We did not find consistency.  The advantage group relative to whites vary, depending on whether we were looking at, observed race

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self-

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our, our, our so self-assessed skin tone. And so these families were the least consistent in terms of our hypothesis that Whether or other question that we're looking at, whether the paradox holds

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when we moved on to look at social anxiety disorders, and I'm going to skip on.

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We looked at social anxiety disorders. The findings are pretty much similar to what we find for depressive symptoms, they are much more consistent.

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no matter how we measure

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race was, it's observed skin tone or self-assessed skin tone, or whether it's confronted. I'm sorry, but a little too fast.

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but at any rate, What we find overall is that

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the mental health paradox for depressing symptoms and social anxiety disorder is supported across the different measures. So we have very strong support

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for that paradox holds. Even when we control for discrimination, which is one of the things that we're. We're basically arguing as a bottom land that we should see differences because African Americans experience different levels of

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of discrimination which then impacts their mental health.

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 the thing that we also find that we didn't expect to find is that paradox is less pronounced for lighter-skinned African Americans.

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and this may have to do with some of the things we've seen in other research, where lighter-skinned African-americans report more discrimination from their fellow African Americans.

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So intra- racial discrimination

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and darker scanned African Americans report more discrimination external to the African-american community. So from white Americans.

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And so one of the things we're going to test is to see well, perhaps doesn't hold when we include those variables. And we are thinking that discrimination from your own group is

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much more hurtful than discrimination from outside. And this is why we are seeing the findings that we are

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but overall. And in conclusion, we would argue that especially mental health research.

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we need to expand, how, how we're viewing race not only for just looking at the paradox, but in general.

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And of course we have limitations.

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One of the limitations that we, we, we we talk about in this research. And I don't. It's cross-sectional. So we can't establish causality, but also the white sample in this

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study. It's is not nationally weapons in it, per, say, because they took people who were at least

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they were, who lived in areas that had some African Americans, which is not the usual thing in America.

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But we've also looked at prevalence of these various disorders in a national data set. We're it's national and representative. And we found that it's about the same. So we're very confident that our findings actually reflect what we would find if we had a more representative population.

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and I'm going to stop there, because I'm sure 10 min are up.

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Thank you very much. Now we are

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yeah presenting doctors.

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The it was rosy from the University of Paris.

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Thank you.

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So good morning, and thank you for inviting me today to for this panel, and also for being here on the Saturday morning.

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 so I want to say a few words about the study that I conducted a couple of years ago. So this is what this this study is about. My paper today analyzes how psychiatrists in the Us routinely use the notion of race to classify patients

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from various no-racial groups. And basically if I had to summarize the study I would say that we, as sociologists, obviously tend to conceptualize race as a social construct. And I include myself

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obviously in this group. And I wanted to test how this definition of race was actually not shared by some mental health practitioners, because they see the variable of race as a biological, as a

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almost a genetic notion in some cases. And so I wanted to see how. you know, these various uses were actually you know, actually played out. And I wanted to also see how sorry.

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See?

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Yes, okay, thank you. I wanted to test really how the various ways. You know, biological racial realism express itself in conversations trying to see how During consultations, also mental health practitioners. viewed this concept

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so The paper today really discusses whether the social preconceptions. that Psychiatrists have influences, their prescription practices during consultations, the way they prescribe drugs. When confronted

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to patients from various Ed, no racial groups, and so just to take a step back and talk a little bit about the backdrop. I conducted this study. while I was a Phd candidate I ucla in California.

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And so, in order to conduct this study I recruited a residence in psychiatry at Ucla. So that's an important An important thing to say, and I come from France, which is a country that does not really question, and does not really interact much with the variable of race. So to me, that was.

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that was, you know, an interesting field work to to conduct anyway. So I recorded for this purpose. for the perhaps of this study I recorded 30 in depth interviews with psychiatry residents who were completing their postgraduate medical training at Ucla in Los Angeles, and or in order to have a bigger sample. Also, we created residents. We were at Ucsf in San Francisco.

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And basically I wanted to question the ways in which this new generation of mental health care professionals because they are residents once again. So they're pretty young, and they've just entered the profession.

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A majority of whom are white. I'm talking here about a a white sample right? engage in differential prescription practices when confronted with racialized patients.

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And so there are multiple reasons explaining why I decided to collect data focusing on early carrier. psychiatrists such as residents.

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One of them is pretty self-explanatory. First, it was a way for me to investigate whether they made decisions according to an authority figure such as their chief resident, or according to what they had learned. Very recently in medical school.

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and since they were early carrier health practitioners, they were also able to remember their medical school programs or other training programs that they had attended. Secondly.

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there was another dimension. I don't want to avoid talking about and I think we all share this dimension, because we are, I think all working in hospital settings or on health sciences, environments gaining entry as a qualitative sociologist into a clinical institution can be a problem. Sometimes. we are met with benevolent ignorance at best, or outright hostility at worst.

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 There may be challenging irb procedures to go through. There may also be a semi-autonomous administrative units that control access to informants formally or correctly

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and historically. it is important to say that physicians have resisted any external review or regulation of their professional perrogatives. And so this might also explain why and how they may also resist giving access to information about themselves and their practices.

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So As I was affiliated with Ucla, it was easier for me to get my foot in the door and start conducting in-depth interviews with residents in that same institution right? and so I used a snowball sampling that obviously brings many biases, but it still remains a convenient method for recruiting informants as ethnographer, and Mario Small has demonstrated

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so To test the notion of race

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and the way it impacts their prescription practices. I have included questions. in my in-depth interview, guide about Bidel for so if you do not know what Bidel is. Well, it was the first

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and actually one of the few medicines approved by the Food and Drugs administration in 2,005 that specifically target black patients in the Us. And it's not a medicine that that is used in psychiatry. Actually, it's used in order to treat cardiovascular diseases right? But I used it. And that's interesting. I used it as a mythological proxy.

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basically to test their definition of race

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as a plastic concept. And here I refer to the definition given by a sociologist and mourning because she she shows in multiple studies that The same individuals may a mix In the same during the same interview, actually, a biological, cultural, and social definitions of race according to what they are talking about.

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And so I wanted using. This proxy was really a way for me to bring up the topic of biological racial realism. By led by letting my informants draw the comparisons.

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Between what they thought by deal was basically, and what their own prescription practices were, and I didn't want, because I'm I'm a sociologist. So they knew that I was going to ask the question quite bluntly, and that I was myself a social constructivist. I didn't want to ask too many questions, and so just letting them talk about Bido was a way for them to also share their own opinions on racialized medicines. Basically.

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So let's take a look at the data. so some psychiatrists, such as Paul, a psychiatry resident at Ucsf. That I interviewed expressed enthusiasm for prescription routines involving vital.

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So here he compares the uses of racialized medicines, such as Bidel to the treatment of specific illnesses, and here it refers to. He gives the example of the Jewish populations affected by Tay Sachs. So, for example, he says that the pharmaceutical industry is trying to individualize treatments.

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and he also says that he has no problem with the Id that people So people meaning the pharmaceutical industry people

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want to do research to help this group of people, and he does not see it as a bias, because, according to him, we need to treat a specific group because they have a need

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And so to him the predicament of not having a treatment adapted to their needs constitutes discrimination.

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And so he says something that is actually very interesting. I wanted to share that with you. He says, if we don't, we discriminate against that group by not addressing their needs, because we say they are not enough of them. We are making them a minority.

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And so here, What we can see is that Paul's justifications of a biological realism is what I call what I called in my dissertation strategic, biological racialization. And I used this stern

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because I, opposite to the term of the biologistization, sorry of race, which very often, you know, in the sociology of medicine, has often been defined as a form of collateral damage

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of contemporary physicians, colorblind practices, or as the theoretical result of racial science, classifying some bodies as inferior to others as in the case of Eugenics, for example.

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So this concept of strategic, biological racialization sheds light on the process by which race is sometimes perceived as a biological variable by health professionals who defend a progressive and anti-racist aim, such as Poll here.

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When he says that it is the pharmaceutical company's duties to respond to groups, specific medical needs, while at the same time reinforcing beliefs. in biological realism.

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And here, obviously, he overlooks the fact that race is, before anything else, an ever-changing category which is rooted in social and political context, and which does not describe nature.

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Here. I'm also referring to the argument proposed by unmorning in a okay, thank you.

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I just want to finish with a second

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a second finding, and then I'll I'll conclude, and we can talk more about that. Some other psychiatrists were more suspicious of racialized medicines, such as Byidel And here I want to share. this. A court by Charlotte, who is an African American resident in psychiatry that I interviewed at Ucla.

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and she explains that to her Bible represents the symbol of historical white oppression towards blacks.

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And so she says, for example, that if she were to use Such a medicine! During consultations her black patients would be suspicion

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suspicious, sorry, And that they would imagine that it was some kind of drug meant to somehow kill black people. And so she also talks about how some of her patients would start imagine the existence of side effects linking them to the medicine to. And so she's actually very conscious that she must adapt her

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on prescribing practices to the negative reaction she might face as a clinician. And so here, obviously, her reactions are connected to issues of medical mistrust

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of etnorrational minorities in medicine regarding the avoidance of health care, utilization in black communities in the Us.

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And also the long-term effects of deeply violent and unethical practices, such as the Tuskegee syphilis

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experiments. And so here and I'm I'm going to conclude here. What I find very interesting here is that Charlotte's criticisms of bidel are less about the threats of biological racial realism, broad by bidal

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and more about the black community's lack of control over a medicine created by

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what what they see as white researchers, basically. And so this also reveals how in certain conditions prescription medicines, prescription practices sorry may rely on the knowledge that racial inequalities and medicine are shaped by longer historical events in collective traumas.

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So I'll stop here. Thank you very much.

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Thank you very much. We can

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invite our next presenter. Oh, sorry.

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What is it?

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This is Dr. Kelly.

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please.

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from

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okay, bye, and Kelly

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from Ohio State University.

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Yeah.

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it's synchronizing.

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It's just.

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I'm counting 12 min, and it's on you with one minutes before focus.

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I'm just going to have to restart ours. And again.

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you have the presentation with you. Yeah, it's frozen again, frozen again.

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We sent technical problem again frozen for it.

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Exactly. I'm going to chat in the

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would you like to start? And then

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to introduce the I don't know. It's because it don't have enough time.

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Yeah, I mean, I'll just start talking and make it all up

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is

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all right. I'm going to try and do this from memory, for now it's not going to go very well. But here we are. I think we all realize we all should have probably gone to the cake. Expo downstairs to begin with. So it's just another

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another vote in favor of that. So what So First I want to acknowledge my colleague, Mike Volo, who is not here with us today, but He is at Ohio State University. I am at Purdue University. and this is what's probably the final paper. from a series of work that we've been doing on the issue of policy and drug overdoses in the United States. as some of you are familiar, but many of you may not be

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The issue of fatal drug overdose has been a major problem in the United States over the course of the past 25 years. Over the last 2 decades over a million Americans have died from drug overdoses, and just last year alone, over 100,000 Americans died from fatal drug overdoses.

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so this has been a very extensive problem. the core of the problem began. with prescription medications. And so there's really 3 waves of drug overdose problems that we witness over the course of the past 25 years. Right? The first wave was a wave of prescription drug overdose medications that were prescribed and often disseminated from legal prescriptions.

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The second wave was a a following wave of heroin overdose that was on the heels of many of the opioid prescriptions. And the most current wave that we've witnessed is the the wave of Fentanyl. Adulteration

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intervene on prescription drugs specifically, but also looking at some of their collateral effects on.

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Okay. yes.

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all right.

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I'm going to skip through this slide.

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So

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 one of the interesting things about the United States for somebody like me who studies drug policy. is that, unlike many other countries around the world? the United States functions in a very heterogeneous fashion.

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We tend to pass most policies related to psychoactive substances, including alcohol and tobacco at the State level, not the national level right? And so it sort of makes the Us. An interesting laboratory for studying all sorts of drug policies, whether it be legal drugs or illegal drugs. because there is constantly different things happening in different States at different times.

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Right? and so what happened during the course of the 2,010 is that States began rapidly implementing a whole series of policies to try to stem the tide of prescription. Drug overdoses

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the problem with that is that all of these policies being passed in rapid succession. It's sort of difficult to tease out. What, exactly, is the thing that's effective? And what's the thing that's perhaps just winning. Politicians points with their constituents?

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 and so. we have been looking at this in terms of the main effects of policy. but we've also been interested, particularly in how These policies that have been passed have been have had specific effects for particular groups. So we can look at this within the context of the theory of fundamental causes. in terms of social inequalities, being durably and persistently related to adverse health outcomes.

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And as Lincoln Phalan, have described in the past, you know, although the specific things that kill us change over time.

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This this link between Things like socioeconomic status and race on one hand and health on the other, are persistent over time. Right? So as we come to intervene on these things, these problems continue to exist.

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And that's because of the existence of flexible resources that are inequitably distributed across the the population. Right? Access to things like education, social capital, social norms, things like differing workplace restraints between, you know, let's say, white and blue-collar workplaces right? And so there are a wide range of factors that come to influence what's going on

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now. One of the interesting things is Lincoln Phalan have long argued within the context of this theory, that low, so socioeconomic status and non-white racial status are disadvantaging people. for a wide variety of conditions over an extended period of time. So then, how would Lincoln fallen? Explain this? This surge in white overdoses that we witnessed?

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within the United States right? And Mike and I are essentially arguing that these are are fundamentally part of the very same processes. Right?

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that when we have scenarios where the privileges afford it. To some within the context of the health care system are the very thing that drives the health problem. We can witness. Things like this occur right? And so part of the issue is that prescription drugs? we. We witnesses in the United States over the course of decades controlled substance prescription drugs have been far more widely available to white Americans than non white Americans. And this is really sort of the core of the problem in terms of how we've witnessed this

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unfolding over the course of time.

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Right? And so we can see a whole range of reasons, things that are happening at the level of the clinical encounter. In terms of how these things unfold in terms of prescribing on a population level, right things like implicit bias amongst physicians, and stereotypes about minority drug use. Despite the fact that we've known for the better part of the last 50 years that white Americans actually have higher rates of substance use than pretty much every other racial group in the United States.

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Right? false beliefs about biological differences in race that that physicians hold right, including things like pain. as well as issues related to disparities and cultural health capital.

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Right? So back to policy, right? We've got this scenario whereby privileged access to medications is creating a problem. So we want to know, can policy intervene broadly? Or are we largely going to see policies intervening on these these effects that are related to pro leverage, right? Because in in many respects many of the policies that have been implemented like prescription. Drug monitoring programs

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are designed specifically to intervene on unnecessary prescriptions, right? These policies are not designed to intervene on prescriptions for people that legitimately need them. Right? It's trying to trim the excess around the edges rather than prevent people who desperately need these medications from gaining access to them right. And so

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we argued that that the surveillance related to prescription drug monitoring programs may lead to more intentional prescribing by physicians within the context of clinical encounters, thus reducing the privileged access that previously went unquestioned for white Americans.

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and so we were specifically looking at prescription drug monitoring programs. from drug monitoring programs are a law that have been passed in pretty much every State in the United States by this point that are designed to essentially log.

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every single prescription of a controlled substance that is made right, and these would be opioids, benzodiazepines, stimulant medications and the prescription drug monitoring programs essentially log. Who's the physician that makes the prescription?

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Who's the pharmacist that fills the prescription? And who's the patient that received the prescription? Right? And so they're documenting 3 specific things.

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And so Again, these laws are designed to reduce unnecessary prescribing right which we would expect to intervene on this excess advantage that white Americans see in the clinical encounter. And so we were curious. Does the impact of Pdmp laws extend specifically to the reduction of overdose mortality? Or are they further, reaching in terms of their impact on the population more broadly.

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So, we pulled together a series of data sources in terms of policy level variables. We drew data from the Us. Census in order to get county contextual effects as well as the Cdc's restricted access mortality files which allowed us to tap into overdose deaths at the county level.

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Right? here's just a quick map in terms of how drug monitoring programs expanded in the United States over the course of about a 15 year period. As the problem surged right? So you could see in 2,000 relatively few States. had them, and by 2,015 every State in the country, with the exception of Missouri, which now has one had implemented a program.

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So the models that we used. We essentially used lead lag models with two-way fixed effects. And so what we wanted to do with League lab models is to determine whether it's whether

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The the implementation of policy is is

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providing an effect over an extended period of time, because we would expect a certain degree of scale up to occur with respect to the types of processes that we were describing.

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So we we analyze a county level overdose mortality. And the 2, I guess 2 way fix effects are county level fixed effects and fixed effects for year, which nets out the time invariant countiness of each Us. County as well as the time trend, because, as we know, the the script and drug problem has grown considerably over the course of time in the Us. Right?

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So this is a figure from an earlier paper that I'm using for illustrative purposes. the red line! that is vertical. In the middle of the figure is the year of implementation, right? And so, as like I mentioned before, all of these, States are implementing policies at different times. And so that's the year of implementation across the different

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States, with the with the time trend being netted out right. And so anything to the left of that. You're left of that red line. would be leading up to policy implementation. And then the years or after, and, as you can see in terms of the general overall population beginning in year 2, we see a persistent effect in terms of a decline in terms of these drug monitoring programs having an impact

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on the population level.

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overdose mortality.

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But, as I mentioned before, it's it's not clear whether or not. This was effective for all racial groups, right? And so we broke this out by 3 major racial ethnic groups in the United States to see. Is this effective for all of them? Or is this just effective for white Americans? So as you can see, these are ov opioid overdose rates

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for white black and Hispanic Americans going from left to right, and similar to what I so I showed you for the overall trend.

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beginning in year 2 for white Americans, we see a significant reduction in overdose mortality with the implementation of these drug monitoring programs that does not exist for black and Hispanic Americans.

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if we look at poly drug use in terms of people using opioids alongside other drugs, we see a similar effect.

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And the key thing about prescription drug monitoring programs is they're not specific to opioids, right? They cover all controlled substances. And so we would expect these types of effect of effects to extend beyond opioids, even though opioids have certainly seen the greatest attention within the United States.

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and we find that for both benzodiazepines, which is a far greater problem than most people talk about in the United States as well as for stimulant drugs. We see this effect occurring largely for white Americans and not black and Hispanic Americans.

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Thank you.

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So to conclude, we have identified that prescription drug monitoring programs have had an impact on overdose mortality. But this

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impact on overdose mortality is specific to a reduction in white deaths. and we contend that this is emerging from the effect of surveillance, reducing the number of unquestioned prescriptions that were made to white patients during the course of clinical encounters. As a result of their relative advantage in these settings.

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 when gaps in health emerge with a quote-unquote reverse inequity. I don't love that term, but I haven't figured out a better one. If anyone's got any suggestions. it's worth questioning whether or not those gaps may be driven by adverse spell over effects of social advantages within the context of clinical encounters

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right? And I think that this is not just about patients themselves. Right? We see widespread distribution of controlled substances in people's social networks. Right? So this is not just about patient-level, overdose mortality.

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Right?

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I think. this is not necessarily an indication that public policies are necessarily problematic. But I think we do need to be critical in terms of how beneficial they are in terms of whether or not they are impacting certain groups and not others, and how these processes are actually functioning. I think one of the key things that we're concerned about is much of the prescription drug overdose problem.

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has been ameliorated with the course of all of these policies that we've been affecting. But, as I mentioned earlier, the current problem in the United States is not quite so much about prescription drugs, but about fentanyl adulteration.

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in the illicit drug markets for cocaine, methamphetamine, etc., etc., and unfortunately we've been seeing a a a gap being closed over the course of the past 5 years in terms of the disparities between white overdose deaths, and those for Black and Hispanics, where where Black and Hispanic Americans are essentially have caught up to white Americans. Unfortunately,

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And we have a serious concerns about this. Now that we've implemented all of these policies that seem to have benefited white Americans as to whether or not many of the health oriented approaches that have been implemented in the United States over the course of the past 20 years may see a bit of a reversal and a more punitive criminal justice oriented approach being taken within the Us. Now that the population level mortality rates

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are shifting accordingly. So

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I realized I went through that fast. If anybody has any questions, I'll be happy to take them during the Q. And a.

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Thank you very much. And please Dr. Yes.

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from Germany

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here.

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May eights and 5 King. the best scene institute in Germany. No. So the next one

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he's Dr. Christier

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from the University of Excess of

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the

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good morning, everyone, as was already noted. My name is Christy Irving. I'm a faculty member in the sociology department, in the Population Research Center at the University of Texas at Austin. And today I'm going to be talking to you about a paper that is still in progress, focused on anticipatory, race-related stress and depressive symptoms among us black women.

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First, I want to acknowledge funding through the Population Research Center, you T. And also my amazing collaborators, Dr. Tiffany Williams, as well as a doctoral student, Alexander, hold an undergraduate student Onion Taylor.

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So I want to begin my talk today by pointing to the broader context in which this research was conducted

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in an era of police brutality in the Black Lives Matter movement. Many black Americans believe that racism is a mainstay of Us. Culture.

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The year 2020, marked a historical moment in the Us. And world history, not only in terms of the COVID-19 pandemic, but the high-profile and senseless murders of black Us. Citizens, George Floyd, Brianna Taylor, Ahmad, Aubrey, and many others at the hands of law enforcement.

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These deaths led to outcry and protests of historical magnitude in the Us. And abroad.

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Black women, however, are often erased from the discussion of, and political advocacy associated with the black Live Matter movement with Brianna Taylor's death being a rare exception. even if not experiencing racial threats or violence directly racial tension can induce stress via anticipatory, race-related stress which in turn may lead to poor mental health.

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Anticipatory race. Related stress may be especially relevant for black women, as their experiences with racism are less commonly featured in the public domain black women may inwardly ponder. Even if I do experience racism. Will anyone care?

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This possibility makes understanding race-related stress among black women all the more important so as to bring their experiences experiences with racism from the margins to the center.

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So, given, the broader context which I just described is perhaps not surprising that race-related stress has received significant empirical attention in the past decade.

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Conceptually race-related stress refers to social stress, attributable at least in part, to belonging to a historically oppressed racial group

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and race-related stress measures in the current sociological mental health. Literature has focused on everyday discrimination or unfair treatment, and more recently, vicarious or second-hand racism.

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for example, moody and colleagues in a 2022 study actually found that vicarious racism was related to psychological distress for black women, but not black men which really emphasizes the importance of thinking about these race-related stressors for black women.

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An entirely separate literature has also explored what's referred to as anticipatory stress which refers to people's concerns about the future that may or may not ever be realized.

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So anticipatory race-related stress which is the focus of today's talk, merges these literatures on race-related stress and anticipatory stress to examine the anticipation of experiencing racism.

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despite exposure to race-related stress, according to a variety of stress theories, including the stress process model and the biocycleocial model of racism. Psychosocial resources may be able to reduce or buffer the psychological harm of stress exposure.

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psychosocial resources include internal as well as external processes that contribute positively to well-being, including, but not limited to, these factors, listed here, mastery, self-esteem, social support, and resilience.

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Mastery refers to the perceived control individuals possessed in response to external conditions.

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Self-esteem conceptualizes, individual self-orientation with respect to their personal regard and their abilities and limitations.

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Social support is a multi-dimensional construct that assesses the extent to which individuals feel loved and cared for for and valued within their social network

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and resilience, broadly speaking, is defined as the ability to overcome and face adversity. These images on the slide depict these psychosocial resources and their association with black womanhood. Within the broader Us. Culture.

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existing research confirms that under certain types of stressful conditions, psychosocial resources are stressed buffers or reduce the effects of stress on mental health. For black women.

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For instance, research by Vernon, Keith, Rio Perry, Kamisha, Spates, and others have suggested that these psychosocial resources are mental health protective for black women in the us.

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So that brings me to the conceptual model that guides this particular study. So we propose that anticipatory, race-related stress will be positively associated with depressive symptoms. That is, those who report higher levels of anticipating racism. They will experience higher depressive symptoms.

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In addition, we also propose that psychosocial resources, these 4 in particular, will be associated with fewer depressive symptoms.

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Moreover, and last, we proposed that psychosocial resources will reduce or buffer the effects of anticipatory race related stress on depressive symptoms

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so stated differently. These are the research questions that guide this particular study first, what is that association between anticipatory race-related stress which I'll also refer to by the acronym, heiress and depressive symptoms, and then do psycho-social resources moderate this association or reduce the effect of stress exposure on depressive symptoms

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data for this study are drawn from the gendered racism and well-being questionnaire, which is a mixed method online survey designed to investigate how gendered racism and racism-related stress is related to mental health among black women attending a historically black College University in the Us. Southeast.

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with the cross-sectional study design. The sample is comprised of 234 black women identified undergraduate and graduate students enrolled at the southeastern Hbcu. At the time of the study

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data collection occurred between September 2020 and April 2021, and the restricted sample for the study that I'll be presenting on today is 207 respondents

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in terms of our measures for depressive symptoms. We use the centers for epidemiological studies, depressive symptoms scale the modified version, which includes 12 items, and I really wanted to hone in on anticipatory, so race-related stress. Because that's kind of the newer measure that we're trying to introduce into the sociological literature. So this particular measure was developed and validated by ootsi and colleagues in a 2,013 study, and the 4 items are listed here, and I'll just read them out just to take time to kind of assess you know. What is this actually measuring?

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So responders were asked to assess their level of agreement with the following statements on a liquor scale, ranging from one to 7 with 7, being the highest level of agreement or endorsement of these statements.

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The first statement is, when I am around white people, I expect them to say or do something. Racist.

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The second item, I believe that most black people will experience some form of racism in the future. The third, I know. If I go where there are mostly white people there's a good chance. I will experience racism. And the last item is, I believe there is a good chance that I will experience racism in the future

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in terms of the cycle. Social resources we use well-validated scales of mastery. resilience, self-esteem and social support.

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and we also control for a variety of associate demographic factors like first-generation, college student status. As this is an Hbcu sample sexual minority, status, age, employment and relationship status

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in terms of the analysis. I'll be reporting the means, proportions, and standard deviations for the key study measures. We perform ols, regression, analysis to assess the association between errors and depressive symptoms. And then we ran statistical interactions between errors and the psycho-social resources to assess those moderating or stress buffering effects.

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So in terms of the descriptive statistics, I just wanted to point out that depressive symptoms are moderate with the mean of about 13.6 on a scale from 0 to 33.

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However, anticipatory race-related stress is quite high. So on a scale from one to 7, the mean is 5.4 6, which indicates a high level of agreement, or at least moderate agreement with those 4 statements that I mentioned earlier

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also in this particular sample of us black women at this particular Hbcu psychosocial resources are also quite high

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now, moving to the first set of analysis which assesses that first research question. So what is that association between anticipatory, race-related stress and depressive symptoms? So model one just includes areas as well as adjustments for the study controls that I mentioned earlier, and we see that there is a positive and significant association, as we had anticipated between areas and depressive symptoms.

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and even after we adjust for the 4 psychosocial resources. We see that that finding remains robust, however, the coefficient for errors is reduced by about 38%.

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So we find that heiress is associated with higher depressive symptoms before and after adjusting for psychosocial resources.

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I also wanted to point out that the effects for 2 psychosocial resources in particular are quite large. So mastery is quite mental health protective for this sample of black women as well as self-esteem.

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Now, moving to that second research question about the stress, suffering, effects of psychosocial resources. So we did not find any evidence of moderation for self-esteem or social support.

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However, we did find evidence of moderation for a sense of mastery as well as resilience, and to facilitate interpretation.

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2 significant interactions that we found we're going to present those as figures which I'm going to show next.

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So here's a graph with that first significant interaction on the X-axis are anticipatory race related stress, including the mean as well as one standard deviation. Above and below the mean and on the Y-axis are the predicted values of depressive symptoms. In this figure which demonstrates those moderating effects of mastery. The association between areas and depressive symptoms is strongest among those with low levels of mastery, as indicated by that blue line

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for those with high mastery, as indicated by that green line. The association between Eri and depressive symptoms is nearly flat or nonexistent, indicating that heiress does not increase depressive symptoms among respondents who have high levels of mastery or a sense of control.

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Now, moving to that second moderating effect.

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In figure 2, we see a similar pattern emerge for resilience specifically among individuals low in resilience, which is the blue line. The association between AI and depressive symptoms is strong and positive

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among individuals high in resilience. The association between areas and depressive symptoms is relatively weaker, as indicated by the almost flat green line.

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In some the moderation analysis reveals that heiress has the most powerful and harmful effects on depressive symptoms among black women with low levels of mastery and resilience.

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So, just to briefly summarize the findings, heiress was associated with higher depressive symptoms, and we did find evidence of stress buffering, so that link between heiress and depressive symptoms was weaker or almost nonexistent for black women with high levels of mastery and weaker for black women with high levels of resilience.

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However, I do want to point out this very important point that my collaborators, and I have been talking quite a bit about building. Mastery and resilience is an individual individual, level kind of intervention to reducing the mental health effects of anticipatory race related stress which is rooted in systemic racism.

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and so as opposed to just focusing on building master and resilience in black women, the broader goal should actually be to eliminate institutional and systemic racism so that they don't have to anticipate racism. In the first place.

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of course, no study was without limitations. This is a cross-sectional design, so we can't really get it. Temporal effects or causality.

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Also, there are a lot of other measures that we wish we had included in the data that could be related to anticipating race-related stress. So vigilance, which is another kind of race-related response to anticipating that you're going to experience. Racism was not available in the data, but may also be important to assess in future research.

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And also when we think about coping kind of intersectional measures of coping. We're not available in the data, but something like expectations for black women to be strong may also kind of interestingly interact with anticipatory race-related stress, and have differential effects and conditional effects in terms of mental health. And the last limitation which I didn't mention here is that, of course, our study is not generalizable to all us black women, but it is very telling that we found these effects for black women at Hbc. Use.

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Thank you so much. I look forward to your questions and comments, and you can reach me on Twitter or via email. Thanks

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us. And the next

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visitation is definitely they shade a point

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from North Carolina University. Thank you very much. And also

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so he's also from North Carolina.

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Good afternoon. We'll be presenting on contextualizing the impact of a neonatal, intensive

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care unit. Read it redesign from open Beta single-family rooms. I'm Stephanie Techsera, quite a sociologist, and all people sending the second half of the presentation. I'm here with my colleague, Bonnie Field, who's a nurse who will be presenting the first half

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in the Us. We have over 400,000 pre-term births annually, and who reported in 2020 an estimated 13.4 million babies were born pre-term worldwide. Thus Nikus are critically important to help outcomes.

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Nicoos began as open bays, large rooms, variable size, that had multiple babies admitted to one room. But today's trend is toward single family rooms with one baby admitted per room and accommodations for at least one parent to stay with the baby.

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We investigated the impact of this trend on outcomes in a nicu transition that occurred in the midst of the COVID-19 pandemic.

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Both our conceptual frameworks, the one from who on the left and the one from the Us. Agency for health, care, research, and quality

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illustrate the complexity of health and health outcomes, both emphasizing the importance of context to get to the heart of this complexity.

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So let's consider the health care context. In the Us. We continue with national health, without national health insurance, despite the Affordable Care Act that was passed in 2010, which was meant to alleviate this issue

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in 2,020, over 3, 30 million remained uninsured.

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We have the highest health care cost per capita in the world, with roughly 11,000 spent per person. But despite these costs, we rank 46 in the world for neonatal deaths, and 50 first for infant mortality.

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Stark racial disparities continue to exist with our infant mortality rate per 1,000 live births at 10.6 for Black

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Infant, and at 4.5 for white. Now, some of these disparities may be explained by residential segregation with differing access to resources that promote well-being

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to employment policies which do not guaranteed, paid parental leave leading to disparities in terms of who benefits from the Family medical Leave Act, and who can room in with their nick, you baby.

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In contrast.

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other nations who report Nikki redesign results have universal or national health insurance. Many have parental leave, some have childcare subsidies or support, and some have basic income programs or social security programs to support mothers.

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Our research hypotheses listed here. The national policies, such as universal health care and parental leave will result in improved health care and outcome measures in the single family room setting

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in the Us. Context. Our second hypothesis is that not all myonates will benefit equally from Nikki redesigns. Black baby outcomes will be worse than white.

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We used multiple data sources triangulating a systemic review of the literature with quantitative analyses of patient records and satisfaction surveys, and also with qualitative results from interviews with nickel nurses.

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Our sample, 1,072, with 489 from Open Bay, and 583 from single family rooms. In terms of race. Our sample was 44% black, 42% white, 14% other.

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We had

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44% female with 56% male. A large percentage was medicaid our public health

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insurance for those with low income. Another large percentage was commercially insured and very few were self-pay.

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Now let's review our results. For 3 of the variables we looked at parent satisfaction, access to providers, and length of stay.

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First for parent satisfaction, our Us. Findings overall indicate increased dissatisfaction with single family rooms. There is increased privacy and more comfort with some concerns expressed, related to socialization

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in other nations. The focus was on fathers with fathers, engagement measured in Canada and the Netherlands. However, these nations have parental leave in Canada, for instance, or partner leave is granted in the Netherlands that these fathers can use. The Netherlands and France also require 16 weeks of maternity leave so 6 weeks before the birth and 10 weeks after birth

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in our results we see 2 trends, first, single family rooms have fewer instances of very poor or poor care compared to open Bay.

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On the other hand, single family rooms also had fewer instances of very good care compared to open bay. 58% of the parents in single family rooms reported very good care compared to 73% in open bay.

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When we looked at access to providers overall, the results were mixed. Some studies found increased access to providers, and others found limited access to staff

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important in both the Us. And Canadian studies was consistency in the caregivers. So, having the same nurse come in was important for that parental support

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in our findings.

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Ratings of nurse family interactions were significantly lower in the single family rooms. Norse's attitudes towards parent request, amount of attention paid to parent needs, and explanations of equipment used with their babies. All were rated approximately 20 percentage points lower in the single family room setting.

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So next we'll review findings for length of stay and compare and contrast the us results to other nations. So in the Us. We tend to have much longer length of stay than in other nations ranging from about 14 to 7 Median days, and we also have tend to have a decrease in length of stay in the single family room compared to the open-based setting. That being said, our particular sample has a much higher sample of black patients compared to white.

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And compared to these particular studies.

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then, when you look at other nations, they tend to have much lower length of stay. The low length of stay tends to be about 5 days, or under, which is in start contracts to what we see in the United States. There also tends to be not much statistical difference between the length of stay in Open Bay versus single-family room studies, and so some scholars suggest that there might be contextual or nicke practice differences in the United States that help explain why we have such longer length of stay compared to other nations.

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So in our particular sample, we see that we have longer length of stay in single-family room settings at 14 days compared to 12 days in the open-based setting.

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We also star stark racial disparities in length of stay in the open-based setting. White babies stayed on average 10 days compared to 15 days for black and other race babies.

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Then, when we looked at single-family room settings, other race babies had the lowest length of stay at 11 days, compared about 14 or 15 days for black or white babies.

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So just putting that into context, you can see that there was no difference in the length of stay for black or African American babies. Between the open bay to single-family room settings they remained consistently having a high length of stay.

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White babies increased their length of, say, from the open bay to single-family room setting from 10 days up to 15 days, and other race babies had the opposite trend, where they decreased their length of stay from 15 days down to 11 days, when we transition to single family rooms. So what helps explain this?

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We ran negative binomial regression models predicting length of stay in the first model we looked at. The single-family room setting the race and income of the babies, and what we noticed that

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single family rooms had higher length of stay than open baby rooms and also black. Babies had higher length of stay than white babies. But then, in the second model, when we control for gestational age, we actually see that the race effect goes away, and it's a decrease in gestational age is associated with higher length of stay.

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So here we think that the single-family room design that helps us understand what's happening with white babies and other race babies because there were differences in policies and procedures, both in the transition to single family rooms and in the COVID-19 context that can help explain their findings. But for gestational days we think that helps us understand what's happening with black babies. In our sample

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as an illustration of that we did regression analyses predicting gestational age, and we see that black race in our sample is the main driver for

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gestational age, where black race is highly correlated with a lower gestational age. And so this is a reminder that it's not race. It's really systemic racism is what we're seeing in our sample

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to give you some context of our local community. If you drive 5 miles north of the health system, there's greater access to resources. You drive 5 miles south of our health system. There's not only less access to resources, but there's also a highly residential, segregated community where a lot of our black families live.

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We've done other analyses with our health system that suggests there's a 15 year difference in life expectancy based on zip code. If you live in either of those 2 neighborhoods.

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And so when we did interview data with nurses, we saw evidence of racial health disparities. So one nurse gave an example. I don't think race plays any part in how we take care of the babies. Oftentimes there was rhetoric of color, blind racism where they said they didn't see race, and they didn't think it mattered at all in terms of their care.

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That being said, we saw a lot of racial bias creep in in those interviews. So, for instance, one nurse said. White males do worse than black girls. We've all known for years that little black girls do. Great. They're probably the ones that do the best, and I think you've got your wimpy white boys that struggle

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so here this rhetoric. It is illustrative of the strong black woman's schema, but also the wimpy white boy syndrome.

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We also saw the impact of contextual factors, nurses talked in depth about the lack of maternity leave and child care. So, for instance, one nurse said, for some parents. Sometimes their babies are there for a month, and they have to actually go home and take care of other kids, and some have to go back to work

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in terms of lack of child care, one person said, and if they have kids at home it's very hard for them to be in the hospital. They don't have someone to watch their children, whatever they need to go.

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So then, what we did was, we presented all of these findings to a stakeholder advisory board that included administrators and providers in our local health system, and they interpreted the design impacts as relating to Nicu changes in policies and procedures when we were in the single family room setting, and because of the COVID-19 context in which this transition occurred, one example is there was reduced bedside rounds, so

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previously, physicians would go in and make direct interaction with the babies every single day in bedside rounds. In this particular single-family room setting, the nurses would go in. Then they would relate information to the physicians, and then the physicians would make decisions on care. So we think that might help explain some of the findings that we're seeing with white babies.

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We also see improved translational services in the single family room service, Us. And single-family rooms.

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They brought a cart wheeled in translation services to every room, so they had enhanced communication with other race babies, families who tended in our sample to be English. As a second language.

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we also are exploring neonatal diagnoses and complications. There are some conditions such as intercrimial hemorrhage and sepsis, for which we expect there to be a longer length of stay.

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And then the Stakeholder Advisory Board also had interpretations of race and gestational age findings relating back to systemic racism. So we talked in depth about disparities and access to prenatal care in our communities, how in racially segregated communities, we don't have as much access to clinics that provide prenatal care. We also test talked about deeply embedded medical racism and trust issues that are in our community. And so, even if someone did have access, they might not want to access the clinic.

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and we also talked about maternity leave policies, and how that might create discrepancies in terms of who can room in.

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And so our next steps were continuing data analyses to unearth mechanisms that reproduce these health inequalities. We are both reporting to that stakeholder Advisory Board and the larger health system and trying to make improvements such as a strategic use of a rock and hold program. Can we get volunteers to sit with the babies and

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provide some support when the parents aren't able to be there. We're also doing a partnership with the health system in the university, including an activation of a mobile health unit and community partners in residentially segregated communities. So we're having a series of events where we provide mobile health units at the events as well as social services to meet people's needs.

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So we'd like to acknowledge both the Daisy Foundation and the National Institutes of Health and United States for sponsoring our research. We really appreciate your time, and we look forward to questions. Thank you all so much.

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Thank you very much for your presentations, and have.

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and I would like to inform that, and invite you to read the papers. They distribute papers. I don't know if the authors are here

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and Dr. Gratuate Beverly from the investor of Royal Hampton, United Kingdom, Andros. A medical book on the left of head for Stride, United Kingdom.

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and the work is racism and clinical decision, making no place to hide so very good. And the other one is to put her well das from the program. University India life in the camp, a study about humans, health in conflicts affected area of with that as some India and the next one William Carban, from New York University Silver School of social work.

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It's a repository for low-income people. The social construction of Bs in the

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Mabias in America, Medicare home health benefits.

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If they are here. I would like to invite them just to say Hello.

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No.

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okay, thank you very much. We can start. Solve the dialogue with sushi.

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Oh, sorry. Hello!

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Hello! Who is that?

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Beverley Brathwaite’s iPad: It's Beverly Breath weight

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Beverley Brathwaite’s iPad: the first distribution paper.

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Okay.

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some minutes about your papers.

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Oh.

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Beverley Brathwaite’s iPad: I was. I wasn't expecting to say anything. When you mentioned my I was oh, that's my name. well, we really a lot of quite a few of the the finally, particularly the last piece of work in the neonatal intensive care.

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Beverley Brathwaite’s iPad: okay, yeah. in the neonat. Sorry. It's 2 30 in the morning in England.

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Beverley Brathwaite’s iPad: Oh, no, maybe 30'clock in the morning. yes, with the

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Beverley Brathwaite’s iPad: issue, with regards to decision making in nursing and looking at how nurses make decisions. the findings that the the

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Beverley Brathwaite’s iPad: contentious issue in in my research in the work looking at this area is

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Beverley Brathwaite’s iPad: the difference between microaggressions and individualized racism in a glass of decision making and the more systemic racism within the educational system and the Nhs

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Beverley Brathwaite’s iPad: complete in in more, in more in more detail in regards to how racism works and the perpetuation of that

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Beverley Brathwaite’s iPad: of that racism within the education system. the nursing education system in in the Uk

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Beverley Brathwaite’s iPad:  nursing in the Uk. Specifically, because I'm a nurse and I teacher in education, in and nursing is very much about individuality and holistic care. and very culturally, focused and trying to get the education system.

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Beverley Brathwaite’s iPad: particularly nursing to consider the issues of both individual and systemic racism probably is one of the most difficult things and helps to

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Beverley Brathwaite’s iPad: perpetuate that decision. Making can be influenced. It can be influenced by a race, because you're always facing against that issue of being thinking about care as an individualized and and very per patient specific, so it can't be racially influenced. So in the last presentation, when she was talking about somebody mentioned about

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Beverley Brathwaite’s iPad: kind of blindness.

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Beverley Brathwaite’s iPad: being a positive thing, or being something that isn't seed is negative. It is very similar. in regards. I mean, that's a nurse, and that's the last in America, and it's very similar. when it comes to nursing in in England.

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Beverley Brathwaite’s iPad: And I think I'll leave you to that. So I wasn't expected to say anything, and also I'm sure there's lots of questions I have a few questions to ask for the other presenters. but thank you for asking me.

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Okay, thank you very much, doctor. So we are starting our dialogue and discussion about the papers presented someone.

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It's like to make questions to our presenters.

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Don't get it.

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Unaccustomed as I am to talking. Yeah, thank you for all the lovely talks I really well appreciate.

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I'm I'm Bruce Cohen from a University of Auckland.

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It was lovely to hear particularly

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as grim as it is actually to give some focus on health professionals

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amongst that as well. So I kind of had a question for all of you, if that's possible, because, like it's nice. Just you'll have a question you know, to answer now it feels, be the first on, and then not get any

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question. So but So it's about

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in terms of, I guess, institutional racism and discrimination. I wondered particularly on the mental health front. I suppose this can be generally to

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health services, anyway. So it covers all your your talks. I was particularly thinking in the case of psychiatry, and and you know, having done some work on this myself about not a lot. What about actually, the psychiatric institutions involvement in labeling because some of the talk seems to leave that out actually of of the variables, the many variables that there might be in terms of

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stress or in terms of what means that somebody might experience this distress or actually feel that they're experiencing a sort of mental illness or actually being given a label of mental illness. psychiatry is a long history

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of institutional racism. including, of course, streptomania. As an obvious example, basically, the labeling of slaves is basically having the disease of wanting to run away from their owners.

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Eugenics movement, of course, German psychiatry and the holocaust labeling of young men as schizophrenic during the civil rights movement. You know they're angry. They're aggressive. God, those. Why, 150

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19 nineties. Violent initiative. These are all in the Us. Of course, high levels of psychiatric incarceration across the Western world and beyond for indigenous communities and for minority communities on the whole, the more labeling with basically schizophrenia, manic depression by power disorder now

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sedated with meds rather than actually being given access to therapy and other, and so on. And so we go on, and I think we all kind of like know some of these statistics. So my my question to all of you is about actually consideration of health professionals, particularly psychiatry when you look in the mental health

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as

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a perpetuators, maybe, of this racialization discourse. If you don't mind speaking to that, and I'm sorry. That was a long question.

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I would like to. My.

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okay.

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thank you very much for this question.

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so the feel work that I did I, Ucla. Actually, I only presented, you know, a very small section of my dissertation. But part of the field work was also about interrogating, or at least discussing, this historical legacy

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of psychiatry and psychiatric programs.

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in the Us. With mental health practitioners to know what they knew about it, to know what they, how they how they also projected sometimes, false ids and beliefs.

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on how progressive the field of psychiatry had become compared to how it was before

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and so what interesting one of the interesting findings that I I had was

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the fact that and actually was in the third slide I wanted to show was the fact that some of these early carrier mental health practitioners were sometimes, reverting to the ways their institutional training had insisted upon the fact that race could be considered as a biological variable still.

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in terms of, you know, for example, differential doses of medication that should be prescribed. And so I minimize that as a way to cover the stigma

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of appearing racist, basically because they were very well aware that I was a sociologist, and I would maybe judge them for saying that.

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and so to them, relying on this institutional authority, was a way to appear progressive by saying, This is what my teachers.

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you know, have told me to do regarding Prozac

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the way we know we those Prozac medication differently based on. If the patient is Asian, American or African American. And so that keep coming back in the interviews. And so I I wanted to. I I also want to insist on the fact that. what we talk about mental health practitioners we have to see, and we have to look at the textbooks and

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look at the way they were trained, and how these social preconceptions of race that they have is not only based on social experiences, but on practices that are rooted, that are historically rooted in the in the medical training programs themselves. And so that reflects the way racism is basically organized. I really want to.

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Beverley Brathwaite’s iPad: I like that point.

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Thanks.

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I'll just be quick. and I can't. I can't speak specifically to the field of psychiatry, but as far as physicians, and prescribing in the Us. More broadly, is concerned.

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I think, beyond the, you know, sense of labeling within the context of, you know, classic labeling theory. And what I I think certainly a a lot of what I'm I've described within my papers is an outgrowth of

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this sort of subjective labeling subconscious labeling that's going on with respect to deserving and undeserving patients. And that's you know. Certainly a lot of what I've shown in terms of the disparities and overdose are are

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an outgrowth of that But you know I I you know I I do want to emphasize that. You know these are really 2 sides of the same coin, right? The the the, the the poor health care that black Americans and and and black Americans and Latino Americans tend to receive in the United States is is part of the very same process. that I'll allowed for and enabled the the the massive wave of prescribing and overdose deaths. for white Americans. And so

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I really don't think that we can sort of disentangle those 2 things. in terms of how these processes unfold. So I'll leave it there.

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Beverley Brathwaite’s iPad: See you still.

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So, going back to your question about

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the racism in psychiatry that extended all the way back to slavery and used to be justified slavery.

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So in the 1980, s. that whole issue of bias in diagnosis was recognized. And so the National Institutes of Health undertook an extensive research program to come up with a a way that would take some of the bias out of

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estimating the prevalence of mental health and mental illness in the United States.

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and this was the launch of a more rigorous, diagnostic, and statistical manual

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that would lay out

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various symptoms of various diagnosis. And along with that they developed these computer programs

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that were defined to yield a diagnosis. So you would ask a series of questions.

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and it would have skip patterns if you said yes to this, and so forth, and that in the end it would yield a diagnosis of, say, major depressive disorder or social anxiety, disorder or whatever.

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And so the idea, the the data that I was using today is based on that concept that these are community-based studies. They go out in the community, sample people door to door and

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yield a more objective

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kind of diagnosis. So we can have a better idea of prevalence. Okay? And so the people who work in what's called psychiatric epidemiology

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which bleeds over into sociologists. That's the kind of data that we're usually working with nowadays. It doesn't.

443
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It doesn't change what happens in your personal encounters.

444
01:29:26.730 --> 01:29:39.849
but what we're hoping for in terms of looking at this kind of data and these kind of statistics that we have. a more A better idea of what

445
01:29:39.860 --> 01:29:42.410
the situation looks like in the community.

446
01:29:42.640 --> 01:29:47.900
And that is why the whole racial paradox

447
01:29:48.270 --> 01:30:02.679
has come to be such a big deal, because for all of those years that we looked at racial differences in psychiatric or mental health or diagnosis. Whatever outcome we were looking at.

448
01:30:02.990 --> 01:30:06.810
People of color always were

449
01:30:07.240 --> 01:30:13.030
worse off, or more likely to be diagnosed with something like schizophrenia.

450
01:30:13.650 --> 01:30:16.480
with these more

451
01:30:16.530 --> 01:30:27.399
less biased surveys, we don't get that anymore. In fact, we get the opposite in many of these diagnosis. Now, whether that's a true finding, we're still

452
01:30:27.470 --> 01:30:30.090
debating that we don't know.

453
01:30:30.180 --> 01:30:36.820
but everything we throw at it is still you those kinds of differences. So I'll leave it at that.

454
01:30:49.910 --> 01:30:59.310
My comments are going to be really brief. But I did want to just point out that Jonathan Metzel has written excessively about kind of the

455
01:30:59.490 --> 01:31:23.679
the racialization and criminalization of mental illness. So his book protest, psychosis is a really great resource for the kinds of issues that you were raising. And another thing I wanted to say about the research team that I'm working with is my co-author. One of my co-authors has a Phd. In counseling psychology. And so it's really interesting to contrast what I perceive to be the training of like an Md. Psychiatrist

456
01:31:23.680 --> 01:31:49.529
compared to someone who has a degree in counseling psychology because she talks about the importance of cultural humility, and that being a cornerstone to the training that she received, especially as someone who is a practitioner now, and working specifically with with black women around issues of systemic oppression. So I do think that you know, some of these ideas around race and racism and cultural humility are a little bit more nuanced and maybe forward thinking.

457
01:31:49.530 --> 01:31:54.349
In counseling psychology programs. In contrast to psychiatry, for instance.

458
01:32:04.340 --> 01:32:11.330
he has that it's Sharina. But he to Sharina online? There are more questions.

459
01:32:13.950 --> 01:32:16.460
no comments.

460
01:32:17.480 --> 01:32:20.820
You have to. Okay.

461
01:32:27.690 --> 01:32:32.160
Shahina Parvin: can I go with my curiosity? It's not actually question.

462
01:32:34.440 --> 01:32:37.660
And there go ahead.

463
01:32:38.059 --> 01:32:49.949
Shahina Parvin: Okay, thank you so much. So I I trust my curiosity, and thank you. the to the thanks to the presenter, all presentation, while, like excellent

464
01:32:49.990 --> 01:32:59.109
Shahina Parvin: I have quick question, and also queries for 3 of the presenter. First one will go to Brian.

465
01:32:59.180 --> 01:33:04.109
Shahina Parvin: that we are from Canada, like I'm from Canada, and

466
01:33:04.190 --> 01:33:17.159
Shahina Parvin: and the part of the similar prospect is a Dr. Arian Hannah, my sister's project she is a associate professor of sociology at Brandon University, and her project is

467
01:33:17.250 --> 01:33:27.609
Shahina Parvin: So the science and Humanities. It's as council funded project, Opioid, crisis, history, science, and regulation. And we have, like single kind of paper that you had.

468
01:33:28.030 --> 01:33:38.040
Shahina Parvin: my! Actually, I am very convinced that with your presentation, if my curiosity may I ask about the funding information of your project.

469
01:33:38.719 --> 01:33:46.700
Shahina Parvin: this is for Brian, and should I ask other questions for the other prisoner, or

470
01:33:46.900 --> 01:33:51.240
Shahina Parvin: I should wait for the answer, and then ask my next question.

471
01:33:55.389 --> 01:34:01.360
I can be quick. The study was funded by the Nationalist to health, specifically the National Institute on Drug Abuse.

472
01:34:04.120 --> 01:34:05.840
Shahina Parvin: I can you

473
01:34:06.799 --> 01:34:16.300
the National Institute on Drug Abuse. It's a wing of the United States National Institutes of Health. Thank you so much.

474
01:34:18.549 --> 01:34:45.370
Shahina Parvin: And my next question is to Christine, Christie, you I'm not sure if I understood correctly or not. about your agreement, that you've said that will you have found that psycho social resources actually in some way reduce the distress or or trace related depressive disorder.

475
01:34:45.420 --> 01:34:50.100
Shahina Parvin: And for component you mentioned

476
01:34:50.160 --> 01:34:53.010
Shahina Parvin: I'm on for like a mastery

477
01:34:53.040 --> 01:35:18.570
Shahina Parvin: residents. So I I'm out about the criticism about this kind of a component, because it's again actually respond putting responsibility to the individual, it to to the individual as an insembly actually dealing with understanding the structural racism or the structure in your qualities or discrimination that actually causes the

478
01:35:18.570 --> 01:35:28.519
Shahina Parvin: stress and depression. So my question to you, have you address this kind of like criticism in your research?

479
01:35:29.040 --> 01:35:47.730
Shahina Parvin: Oh, so that's my question. And another question I have for everybody. Actually, this is also very nice presentation. So I I actually in my dissertation, like psi discussion. This section. I also do some kind research on the

480
01:35:47.900 --> 01:36:10.030
Shahina Parvin: racialized immigrant women use of mental health services in Canada. So I also was critical about the psychiatric, or like biological notion of race, and also biological notion of mental illnesses like, I don't actually use that mental illnesses like mental health or suffering something like that. So my.

481
01:36:10.030 --> 01:36:25.170
Shahina Parvin: and in my dissertation I also offered to rethink about the psychiatric notion of mental illnesses, because it's mostly focusing on the pointing on the biological notion of mental illness, and

482
01:36:25.670 --> 01:36:28.990
Shahina Parvin: 20 individual to fix or take care of that.

483
01:36:29.500 --> 01:36:55.119
Shahina Parvin: So my actually curiosity to you that in your dissertation have you offered to alternative ways to think about the biological notion of race or biological notion of mental illnesses for that informers in your research. And also my question is, did your respondent or informants get access to your dissertation?

484
01:37:07.170 --> 01:37:33.640
Sheena? Thank you so much for your question. So it's interesting that you ask that question. Because in kind of us-based sociological research on mental health, a lot of that research relies on the stress process model developed by Perlin and colleagues. And an entire component of the stress process model is, you know, how do people cope with stress? And so they may employ or utilize these psychosocial resources, like the one that I, you know, measured in my study.

485
01:37:33.830 --> 01:37:51.019
But I think it's really important for me to always round back to many of these racism-related stressors are rooted in systemic issues. And so, you know, I I try to really emphasize that in the way that I write about the the usage of psychosocial resources to reduce the impact of stress.

486
01:37:51.240 --> 01:38:04.059
But then, now, working with the counseling psychologist, what's really interesting is that she finds these findings to be encouraging, because as a counseling psychologist who's working with black women clients.

487
01:38:04.070 --> 01:38:32.079
she can't dismantle racism single-handedly. And so when she's thinking about interventions or ways to help them cope with with racism. That is systemic. It's often using kind of individual level approaches. And so for her. The implication of the work is okay. We need to find ways to build mastery or build resilience in black women. But still recognizing the existence of you know the systemic racism that we can't necessarily get rid of single-handedly. And so I guess that's my

488
01:38:32.250 --> 01:38:40.090
response to that to that query. But I do try to be very thoughtful about how I talk about these psychosocial resources in my work. Thanks.

489
01:38:46.190 --> 01:38:48.070
Thank you for the question.

490
01:38:48.110 --> 01:38:53.980
so I will answer the second one first, and then the first 1 s.

491
01:38:54.240 --> 01:39:24.059
so did they get access to the data? Yes, they did. So actually, the dissertation was published in French by an academic press in in France. So I actually wrote several reports, because I when I was at Ucla I was I was asked by my advisors to complete, you know, an Irb approval.

492
01:39:24.240 --> 01:39:41.029
a procedure. And so I actually filed several reports along the way, and reports were also addressed to the residents that I was able to interview, because to me it was important to also.

493
01:39:41.030 --> 01:39:54.289
we often say, our sociologists. We want to give back to the community where I think that in this case the findings could actually maybe help some of the residents to understand what their views about race

494
01:39:54.290 --> 01:40:12.680
how it could be analyzed, and how they could actually use these findings in their own practices. so that's that's what I did. I don't know to what extent they actually didn't get really any feedback afterwards about the reports. I think some of them and also, that's

495
01:40:12.800 --> 01:40:26.900
always something very interesting when you conduct quality to studies is that you can only get in touch in the end with people who were actually positive about the study in terms of you know, I didn't get access to

496
01:40:26.900 --> 01:40:45.339
to people who refused to talk to me in the first place, so they may have had the most. Maybe bias biases, you know, implicit biases, but I couldn't access them in the first place, so I didn't get any feedback, but at least it was put out there. And about the first question, well.

497
01:40:45.450 --> 01:41:06.859
so my study actually dealt with other things. Then the definition of as a biological variable. I also try to test the ways residents talked about race as a cultural variable. And I looked at the ways. They refer to cultural competency programs.

498
01:41:06.930 --> 01:41:25.610
so that was another. You know another aspect of the research and regarding the ways. I because you, you asked me about the biological definitions of race. Well, I think what what is very interesting is. I got answers, and I tried to conceptualize the ways some of them.

499
01:41:25.610 --> 01:41:48.869
defined race as a biological variable according to the use of according to whether they would use racialized medicines so specific medicines, such as Bidol in psychiatry that does not really exist. So they would just talk about Bidel more than talking about a specific medicine they would use

500
01:41:48.870 --> 01:42:07.519
in their own field. But what was mostly interesting. And I think that's what is very specific about psychiatry is that they would often talk about differential doses. So not specific, you know, racialized drugs that they would give to specific patients, but more in terms of the doses.

501
01:42:07.520 --> 01:42:26.629
And those assumptions were often, as I said earlier, rooted in the belief that you know. there were special needs, special natural needs. So they had these underlying assumptions. But what was very interesting is that when they were talking about those in assumptions, they could not really refer

502
01:42:26.630 --> 01:42:34.879
to any data. So it was more about these imaginaries of how the future of personalized medicine

503
01:42:34.880 --> 01:42:44.130
should be about individualizing treatments by creating a robust categories of race

504
01:42:44.230 --> 01:42:50.160
having to do with biology. But when they refer to the past. And so that's why I really want to

505
01:42:50.200 --> 01:42:54.610
stress out the the need for us as sociologists to also socialize.

506
01:42:54.670 --> 01:43:02.159
provide definitions of race in terms of time, because when they would talk about the past.

507
01:43:02.190 --> 01:43:15.669
they would also always contract themselves and say that because of the the history, the historical legacy of race as this heartful, variable, we should.

508
01:43:15.750 --> 01:43:16.770
you know.

509
01:43:16.930 --> 01:43:27.530
not, talk about race as a magical, variable. So time is a very interesting factor in the way they would talk about these biological, cultural, social definitions of race.

510
01:43:27.800 --> 01:43:28.660
Thank you

511
01:43:35.830 --> 01:43:36.800
much.

512
01:43:37.110 --> 01:43:39.640
There are more questions.

513
01:43:42.140 --> 01:43:44.109
If you don't have. I have.

514
01:43:45.010 --> 01:43:51.140
I have a last question, because we have enough time in Latin America.

515
01:43:51.190 --> 01:43:57.690
We cannot do this research you presented today for us because we don't have

516
01:43:57.940 --> 01:44:08.619
the variable for the question in the forms about ethnic and race, or whatever you want. We don't have the information.

517
01:44:08.710 --> 01:44:12.580
He helped services. I know their administrative data. So.

518
01:44:12.620 --> 01:44:14.430
asking

519
01:44:14.960 --> 01:44:23.499
some forms where in some form it was introduced. But it's not an oath to do the studies you have.

520
01:44:23.640 --> 01:44:24.710
A

521
01:44:25.410 --> 01:44:31.899
that's because people say that it's a Us. Problem with.

522
01:44:31.940 --> 01:44:51.370
we are trying to import to proceed because you are not. No, so it's hiding racism. so we did a research just to, because there was a an implementation of a policy, an integral policy for health of black people in Brazil

523
01:44:51.940 --> 01:44:55.170
produced in 2,009.

524
01:44:55.370 --> 01:45:12.859
Okay? And we have to do the first evaluation in a municipality about the implementation of this and people from the movement to consume them. What is the research you would like to do to evaluate this policy. And they say no one, because you don't have data.

525
01:45:13.960 --> 01:45:20.020
So the first step is to ask why you don't have data

526
01:45:20.100 --> 01:45:25.190
because the policy states that we need to introduce this data in the system.

527
01:45:25.510 --> 01:45:32.330
Okay? So it was, what do we do? We asked the workers in the health services.

528
01:45:32.440 --> 01:45:37.359
even in the forms, in the few forms where they have

529
01:45:37.580 --> 01:45:46.660
the the the question, why? They don't ask, because there are 2 problems, most of the forms doesn't have the question.

530
01:45:46.760 --> 01:45:49.710
And when you have the question they don't ask.

531
01:45:50.680 --> 01:45:59.229
there are 2 kind of problems, and they answer, that's because you are afraid we are offending the patient, asking the race

532
01:45:59.790 --> 01:46:09.679
that we can. they can feel uncomfortable. We can make, they can be angry. We can have problems, etc. So

533
01:46:10.780 --> 01:46:13.619
this result was

534
01:46:13.740 --> 01:46:21.660
delivered to the government. I would like to ask you if you had this problem when you start

535
01:46:22.140 --> 01:46:34.129
in the Us. In the other countries to ask about to introduce this variable in your forms. And how did you overcome? What do you recommend to Latin American countries

536
01:46:34.420 --> 01:46:36.060
to do it.

537
01:46:36.110 --> 01:46:38.580
to start to do it.

538
01:46:38.920 --> 01:46:41.950
Okay, that's my question to you.

539
01:46:42.590 --> 01:46:44.270
We have a different

540
01:46:45.010 --> 01:46:50.609
from the very first in the they have the count

541
01:46:52.410 --> 01:46:55.110
you were not right.

542
01:46:56.830 --> 01:47:00.150
And so it's just building it from the

543
01:47:01.340 --> 01:47:02.790
for that.

544
01:47:07.920 --> 01:47:19.480
I was saying we didn't. We never had that problem in the United States, because from the very beginning there was controversy over how the slaves would be.

545
01:47:20.260 --> 01:47:27.959
and so in the Constitution you would specify that they would be gathered as brutal of the first.

546
01:47:28.310 --> 01:47:35.719
And so we have counted based on race. and we tested. Now, specifics have changed over time.

547
01:47:36.040 --> 01:47:40.579
So one of the things we do in our American classes and race classes

548
01:47:40.610 --> 01:47:50.009
is we talk about how in one circumstances we might be part of a winner group. In another census we might be part of another.

549
01:47:50.190 --> 01:47:53.569
But you're going to be part of some racial group.

550
01:47:53.810 --> 01:47:58.309
and so we've always done that. It was just built into the beginning of our

551
01:47:58.630 --> 01:48:00.510
our country's just.

552
01:48:01.070 --> 01:48:07.479
I don't know what to tell you about Brazil, but we do have. We have had American researchers going to

553
01:48:07.950 --> 01:48:13.779
Brazil and do and and study rights, and people are willing to answer those questions.

554
01:48:13.950 --> 01:48:18.590
So I think your workers may be misunderstanding

555
01:48:19.630 --> 01:48:24.500
how insulted people would be because they didn't have any problems.

556
01:48:25.670 --> 01:48:33.430
It's a perception from data and work here. Yeah, I think some, I mean, no, it's it's it's a different tension. Yeah, I don't want you to

557
01:48:34.480 --> 01:48:38.040
these ones that are on the web.

558
01:48:38.460 --> 01:48:40.960
Thank you very much for having me

559
01:48:41.660 --> 01:48:42.430
that you

560
01:48:44.680 --> 01:48:45.000
thank you very much for.