Literature Collection

To identify program characteristics that influence the retention of women of reproductive age in the Community-based Addiction Reduction program (CARE), mixed-method analyses of CARE survey data and CARE Peer Recovery Coach (PRC) narrative entries of participant encounters were performed. About 251 women were enrolled in this prospective community-based implementation science intervention. We compared survey responses by race for treatment status, treatment motivation scales, and retention in the program at intake, 2-, 6-, 9-, and 12-month follow ups using Chi-square/T-tests. Qualitative analysis of PRC narrative entries was conducted following thematic analysis and crystallization immersion analytic methods. White compared with Black women in CARE were significantly more likely to be in treatment at intake (P < .001) and more motivated to engage in recovery treatment (P < .001). However, Black women were retained longer in CARE at 2- (P < .006), 6- (P < .011), and 9- (P < .004) months. PRC narrative entries were coded, and emergent themes mapped well to the 4 types of supports provided by PRC as outlined by the Substance Abuse and Mental Health Services Administration: emotional, instrumental, informational, and affiliational. Analysis of narrative entries by race revealed that Black women were given more detailed information, communications with PRC were more encouraging and proactive in identifying and meeting needs, and PRC took a more hands-on approach when assisting and linking to resources. The inclusion of PRC as integral members of SUD recovery programs may preferentially provide Black women with SUD the opportunity to build more trusting relationships with these peer coaches, thereby increasing their participation and retention.

BACKGROUND: Racial and ethnic minorities have experienced a disproportionate burden of severe COVID-19. Whether chronic stress, also disproportionately experienced by racial and ethnic minorities, explains this excess risk is unknown. METHODS: We identified 9577 adults (≥ 18 years) diagnosed with COVID-19 from January 1, 2020, through September 30, 2021, enrolled in Kaiser Permanente Georgia (KPGA) with complete biomarker data. Self-reported race (Black or White) was defined from electronic medical records. Chronic stress, defined as allostatic load (AL), a composite score (scale 0-7) based on seven cardio-metabolic biomarkers, was categorized as below (low AL) or above (high AL) the median. Severe COVID-19 was defined as hospitalization or mortality within 30 days of COVID-19 diagnosis. The association between race, AL, and severe COVID-19 was assessed using multivariable Poisson regression. The mediating effect of AL was assessed using the Valeri and VanderWeele method. All results were expressed as risk ratios (RRs) with 95% confidence intervals. RESULTS: Overall, Black (vs. White) KPGA members had an 18% excess risk of AL (RR: 1.18, 95%CI: 1.14-1.23) and a 24% excess risk of severe COVID-19 (RR: 1.24, 95%CI: 1.12, 1.37). AL explained 23% of the Black-White disparities in severe COVID-19. CONCLUSIONS: In our study, chronic stress, characterized by AL, partially mediated Black-White disparities in severe COVID-19 outcomes.

OBJECTIVE: To assess disparities in medical and surgical management of endometriosis and pelvic pain disorders, focusing on Black individuals and individuals from other racial and ethnic groups within an integrated health care delivery system. METHODS: We conducted a retrospective cohort study of women aged 18 years or older with a pelvic pain disorder, including endometriosis, pelvic pain, dysmenorrhea, and dyspareunia, coded in the electronic health record (EHR) between 2012 and 2019 within Kaiser Permanente Northern California. Demographic, clinical, and treatment characteristics were assessed overall and by patient race and Black compared with other racial and ethnic groups as coded in the EHR. RESULTS: Of 15,164 eligible women, 1,707 (11.3%) were Black and 13,457 (88.7%) were non-Black, including 44.4% White patients, 13.8% Asian patients, 24.8% Hispanic patients, and 5.7% patients from other or unknown racial and ethnic groups. Black compared with non-Black women were younger (median [interquartile range] age 36 years [28-44 years] vs 37 years [30-45 years], P<.001), had a higher median [interquartile range] body mass index (BMI) (29.8 [25.2-35.9] vs 26.0 [22.7-30.7], P<.001), and had similar parity. Compared with non-Black women, a higher proportion of Black women received hormonal therapy (56.2% vs 51.9%, P=.001), pain medications (55.4% vs 44.7%, P=.001), and surgery (25.5% vs 23.0%, P=.02). A smaller proportion of all non-White women were referred to a pelvic pain physician specialist compared with White women (P=.001), with Black women referred at lower rates (14.9% vs 18.4%, P=.001). CONCLUSION: Black women in this integrated health care system received more hormonal, pain, and surgical management for endometriosis than non-Black women. However, there was a lower referral rate to pelvic pain physician specialists among all non-White women compared with White women, which highlights the need to better understand care allocation.