Current Events
Written works that describe a situation in modern medicine and its overall impact on the Texan population.
Decomposing Medical Mistrust
Sriya Kakarla and Ananya Srivastava
Rice University
Introduction
Medical mistrust has been broadly defined as "the lack of trust in or suspicion of medical organizations” (Andrade et al., 2020). Recent media attention has been centered around medical mistrust and continues to explore the issue as it relates to vaccine hesitancy. Though the issue of medical mistrust has recently entered the public eye concerning vaccine hesitancy and the vaccine rollout, the issue is more expansive and has been slowly developing for centuries due to chronic racial inequalities and social injustices (Ojikutu et al., 2022). Shifting the mistrust from just vaccines to the medical hierarchy as a whole shows that the issue extends into the effectiveness of medical visits, pharmaceuticals, and ultimately, the outcomes of care. A 2015 poll shows that trust in medicine, including attitudes about the aforementioned components, decreased from 73 percent in 1966 to 34 percent in 2012 (Taber et al., 2012). This drastic erosion of public trust despite the healthcare industry's increasing capacity and success shows that the problem is more deeply rooted and requires looking at the healthcare industry through the lens of history. Understanding the presence of mistrust requires investigating critical events in American history. Minority populations, especially African Americans, have faced a more complicated past with the medical field from years before the Civil War. Slaves were often used for unethical medical experiments performed without proper consent or medical ethics practices. For example, J. Marion Sims, reputed as the father of modern gynecology, conducted many of his experiments on enslaved Black women without anesthesia or proper care (Wall et al., 2006). Such use of African Americans as test subjects continued with the infamous Tuskegee experiments, where African American men were misinformed on the purpose of a syphilis study and never given adequate treatment when it eventually became available (Wall et al., 2006). While changes have been made to prevent future occurrences of such egregious events, these past events continue to shape the perspectives of minority populations on the healthcare system. Such mistrust has severe consequences for healthcare interactions. Specifically, the patient-physician relationship is delicate because it involves deeply personal and sensitive information. A lack of trust compromises this relationship and leaves physicians without crucial information to support the decisions that are best for their patients. In fact, mistrust in the healthcare system could render visits to a doctor useless because mistrust has been linked with low treatment adherence. Furthermore, patient satisfaction with a physician has even been linked to overall treatment outcomes, illustrating that even if some level of treatment adherence is present, the treatment still may not be successful due to the pervasive mistrust (Martin et al., 2013). Thus, medical mistrust is a vital issue which plays a pivotal role in the success of healthcare. It is essential to delve into the contemporary reasoning underlying medical mistrust to better understand how physicians can address the nuanced factors that play into medical mistrust and ensure improved outcomes. This review will focus on exploring studies that investigate the critical causes of medical mistrust, which include lack of proper communication between providers and patients, perceived racism, and belief in conspiracy theories.
Causes of Medical Mistrust
Lack of Proper Communication
Communication is the bedrock of patient-physician interactions and sets the tone for information discussed during appointments and treatment outcomes. Medical professionals often share access to private information and must discuss sensitive health information with their patients. Hence, their communication – both verbal and non-verbal – must be well thought-out and meticulous. Nervous patients often look to their provider for signs of how they should behave and feel during appointments, so the presence of certain cues or lack thereof profoundly impacts how patients feel about the care they are receiving. This phenomenon can be seen in a study conducted with White and African American patients who have hypertension. This study intended to assess the importance of interpersonal communication on patient trust within racial groups. The study took place in community health centers providing primary care to low-income or minority populations. Prior to the study, 75% of the patients had established relationships with their physician. Overall, the authors tested the effects of informational behaviors, affective behaviors, and process measures on patients’ trust for their physician. Different aspects of patient interaction were derived and coded for using the Roter Interaction Analysis System. Informational behaviors, such as providing biomedical information or patient education, were measured based on the frequency of occurrence. Meanwhile, affective behaviors, rapport building, and emotional statements were measured by adding together scores from 1-6 for interest, friendliness, assertiveness, empathy, responsiveness, and hurried nature (Martin et al., 2013). Finally, process measures – which included the ratio between psychosocial exchange and biomedical exchange – were rated where a value above one showed a greater patient focus than physician interest. Patient trust was then measured using the Trust in Physicians scale, where patients rate their level of agreement with five statements. When analyzed, these measures provided significant insight into physician-patient interactions. Two-thirds of the patients demonstrated a high degree of trust in their physicians, with the affect score having the strongest correlation with the degree of trust. However, Black patients reported significantly lower trust. This was potentially explained by physicians using fewer partnership-building statements in visits with Black patients and having shorter visits with a higher speech rate (Martin et al., 2013). Overall, these results clearly demonstrate that taking the extra time to build rapport with patients is crucial to establishing trust. Activities such as soliciting patient opinions during visits, showing interest, and appearing less hurried were attributed to higher trust in physicians, which provides a potential direction of improvement in the healthcare field. The disparity in trust and interaction between White and Black patients is demonstrative of the microaggressions that drive medical mistrust in healthcare, and it also illustrates the impacts of various forms of communication.
Another similar study illustrates the importance of communication through a different channel. Molina et al. (2015) tests the effect of navigators on patient satisfaction and the overall link between medical mistrust and self-efficacy. This study used a random sample of Black women who were accessing mammography services and separated them into two groups: one with a healthcare navigator and the other that received standard care. Navigators, who acted as mediators of patient-provider interactions, met with their assigned patients at least twice. This study intended to measure socioeconomic factors, general medical mistrust using the Health Care System Distrust Scale, healthcare self-efficacy using a Communication and Attitudinal Self-efficacy scale, and patient satisfaction using a comprehensive questionnaire. After combining the results, they were not as expected .While those with navigators received better communication about their treatment process, recipients with high healthcare mistrust reported lower care satisfaction with navigators. Instead, patients who interacted directly with their providers reported more satisfaction and self-efficacy, direct indicators of trust (Molina et al., 2014).
These results suggest that a direct provider-patient relationship is indispensable, regardless of outside services that are available to supplement communication. Additionally, it proved the importance of such communication between providers and patients by promoting self-efficacy so individuals believed they could improve their healthcare outcomes. Taken together, these two studies show the direct relationship between communication and patient care, and emphasize the importance of establishing direct and effective communication between patients and providers.
Belief in Conspiracy Theories
Conspiracy theories have been prevalent throughout history, especially during periods of crises and changes, due to the false feeling of control they provide (Lolic et al., 2021). The field of healthcare is especially prone to conspiracy theories because of the complexities inherent in understanding medical treatments along with the “infodemic,” which has led to people being overwhelmed with the vast amount of information available on the Internet and not understanding which sources to trust (Grimes et al., 2021). Additionally, conspiracy theories tend to predominate in situations where fear or human suffering is involved, as they offer an alternative solution by providing the opportunity to find meaning for an otherwise random coincidence (Molina et al., 2014). Overall, these beliefs in conspiracy theories have been a significant cause of medical mistrust and have even been termed a public health crisis (Ojikutu et al., 2022). For example, this impact of conspiracy theories on medical mistrust is shown in a study which sought to find the connection between HIV conspiracy beliefs and medical mistrust as well as treatment non-adherence. The study took a longitudinal sample of 214 African American men with HIV, aiming to assess their degree of agreement with HIV conspiracy beliefs and medication adherence by using a medication event monitoring system (MEMS) that reports medication-taking patterns. Exploratory Factor Analysis extracted two main factors from the questionnaires: genocidal conspiracies and treatment conspiracies. Additionally, background information was collected to determine socio-demographic factors and healthcare barriers. The majority of the participants were unemployed and low-income, of which two-thirds believed in at least one HIV conspiracy theory, and 44 percent believed that HIV was man-made. Data compilation from the MEMS system showed that 68 percent of the participants took only the prescribed doses of their antiviral, and 22 percent had optimal adherence to the treatment plan (inclusive of lifestyle changes). Bivariate tests demonstrated that strong conspiracy beliefs were associated with decreased treatment adherence and lower trust in the treatment plan. However, among the conspiracy theories, only conspiracies relating to treatments were associated with non-adherence. These results demonstrate that belief in conspiracy theories is a fundamental cause of medical mistrust and has severe consequences in treatment adherence. Without proper treatment adherence, conditions such as HIV cannot be managed, which curtails the ability to work and quality of life (Taber et al., 2014).
Meanwhile, Westergaard et al., (2014) illustrated a different side of the same issue. They conducted a cross-sectional study among African American, Mexican American, and White participants selected randomly in select Chicago grocery stores that attempted to identify how conspiracy theories affect medical mistrust and participation in clinical trials. The participants were given a 235-item survey that sought to identify socioeconomic status, healthcare access and utilization, perceived discrimination, and general attitudes about medicine. These answers referred to the broad question, “How willing would you be to join a study of a vaccine to prevent HIV infection if the study began tomorrow?” The combined results showed that African Americans and Mexican Americans were more likely to agree with HIV conspiracy theories; however, these beliefs were not correlated with their willingness to participate in clinical trials. In fact, Mexican Americans and African American participants showed a greater likelihood to participate in clinical trials, contradicting other studies which stated that racial and ethnic minorities were often underrepresented in clinical trials (Westergaard et al., 2013). It was hypothesized that this contradiction was a result of incentives provided by the study rather than a measure of medical mistrust. This hypothesis was furthered by the fact that the correlation between medical mistrust and conspiracy beliefs was upheld; participants of all three populations who exhibited strong or medium belief in conspiracy theories were more likely to have strong medical mistrust. This shows that the connection of clinical trial participation cannot be considered as a byproduct of medical trust/mistrust and must be examined separately. However, the ultimate connection between conspiracy beliefs and the presence of medical mistrust is underlined once again through this study. Both of these studies emphasize that conspiracy theories are affecting treatment and patient outcomes, and thus must be immediately addressed. While the second study took a slightly different turn towards clinical trials, they both addressed conspiracy theories at their core as they related to healthcare. Though few studies point to the approach of directly addressing conspiracy theories to improve trust between patients and providers, the results of the previously mentioned studies provide potential support for this conclusion and suggest that future research in this area is warranted (Van Prooijen et al., 2017).
Perceived Discrimination
Though many of the studies investigating medical mistrust focus on minority populations, the effects of perceived discrimination are often missed (Lopéz-Cevallos et al., 2014). A cross sectional study from 2014 sought to find the correlation between medical mistrust and perceived discrimination amongst rural Latinos (Bazargan et al., 2021). The study used the behavioral model for vulnerable populations to measure satisfaction with health care, medical mistrust, and perceived discrimination. These measures were obtained using questionnaires that asked for degree of agreement with certain statements and computed results using multivariable models. The results showed that perceived discrimination is strongly associated with negative satisfaction in healthcare and the trust in their physicians. The participants in this study had higher rates of healthcare usage than previous studies suggested. Participants showed higher agreements with statements like “My physician has my best interest in mind” and “My physician will recommend the best treatment option for me” (Wall et al., 2006). This study showed that patients who believe that their physicians are discriminating against them, or have had past experiences with medical discrimination, are less likely to trust recommendations given by their physician and express less satisfaction with their care, whereas patients with positive experiences are likely to comply with treatment plans.
Similar trends can be seen in another study that examined the relationship between discrimination and medical mistrust in a broader population in California. This study, unlike the previous one, included participants from multiple age groups and ethnic backgrounds in order to study this correlation. A random sample of Californian households were given a survey that measured demographic information, self-rated health status, the presence of a primary care physician relationship, and perceived discrimination (Jaiswal et al., 2019). As shown in the previous study, a strong link between medical mistrust and discrimination was found, with Black and Hispanic students reporting the greatest occurrences of discrimination and mistrust. Specifically, ethnic and language discrimination appeared to drive mistrust in the Latino population while more broad discrimination underlay mistrust in African American participants (Ojikutu et al., 2022). These studies approached the impact of discrimination in healthcare in distinct ways; the first study looked specifically into a small subset of participants who were mostly students, while the second study was more comprehensive and representative of the U.S. population. Despite the difference in their approaches and samples, both studies pointed to the same thing - implicit bias in healthcare has an important influence on crucial healthcare decisions and interactions.
Conclusion
The studies reviewed point to the fact that medical mistrust can be created through multiple channels including faulty communication, conspiracy theories, and perceived discrimination. Virtually all of the studies discussed highlight the importance of trust for patient satisfaction and treatment adherence. Thus, when developing a comprehensive curriculum for medical school and training for residency, it is important to teach medical students and physicians how to build and foster trusting relationships with their patients (Westergaard et al., 2013). However, a key limitation of many of these studies entails their small sample sizes. Furthermore, the people who are sampled may not be representative of the entire population of people who do not trust the medical system, as many of the individuals who have severe reservations with the healthcare system tend to also mirror the same sentiment around other institutions and feel uncomfortable participating in studies. Additionally, all six studies talk about individuals who have sought out healthcare to a certain degree; however, this excludes the population that does not, who may be the most severely distrustful of the healthcare system. These limitations must be addressed in future studies to create more impactful change.
Overall, these studies illustrate that a multitude of factors impact medical mistrust. Though the issue of medical mistrust is nuanced, it is essential that communication between providers and patients is improved, conspiracy theories are disproved, and providers become culturally conscious and avoid being perceived as discriminatory towards their patients, as it is only when these factors are properly addressed that the trust in the healthcare system improves and treatments are successful.
References
Andrade, G. (2020). Medical conspiracy theories: cognitive science and implications for ethics. Medicine, Health Care and Philosophy, 23(3), 505-518. https://doi.org/10.1007/s11019-020-09951-6
Bazargan, M., Cobb, S., & Assari, S. (2021). Discrimination and Medical Mistrust in a Racially and Ethnically Diverse Sample of California Adults. Annals of Family Medicine, 19(1), 4-15. https://doi.org/10.1370/afm.2632
Bogart, L.M., Wagner, G., Galvan, F.H., & Banks, D. (2010). Conspiracy Beliefs about HIV Are Related to Antiretroviral Treatment Nonadherence among African American Men with HIV. Journal of Acquired Immune Deficiency Syndromes, 53(5), 648-655. https://doi.org/10.1097/qai.0b013e3181c57dbc
Centers for Disease Control and Prevention. (2023). Tuskegee Study and Health Benefit Program. CDC.gov. Retrieved February 13, 2023, from https://www.cdc.gov/tuskegee/index.html
Grimes, D.R. (2021). Medical disinformation and the unviable nature of COVID-19 conspiracy theories. PLOS One, 16(3). https://doi.org/10.1371/journal.pone.0245900
Hostetter, M., Klein, S. (2021). Understanding and Ameliorating Medical Mistrust Among Black Americans. The Commonwealth Fund. Retrieved February 13, 2023, from https://www.commonwealthfund.org/publications/newsletter-article/2021/jan/medical-mistrust-among-black-americans
Jaiswal, J., & Halkitis, P.N. (2019). Towards a More Inclusive and Dynamic Understanding of Medical Mistrust Informed by Science. Behavioral Medicine, 45(2),79-85. https://doi.org/10.1080/08964289.2019.1619511
Leonard, M.J., & Philippe, F.L. (2021). Conspiracy Theories: A Public Health Concern and How to Address It. Frontiers in Psychology, 12. https://doi.org/10.3389/fpsyg.2021.682931
Lolic, M., Araojo, R., Okeke, M., & Temple, R. (2021). U.S. racial and ethnic participation in global clinical trials by Therapeutic Areas. Journal of Clinical Pharmacy and Therapeutics, 46(6), 1576-1581. https://doi.org/10.1111/jcpt.13532
López-Cevallos, D.F., Harvey, S.M., & Warren, J.T. (2014). Medical Mistrust, Perceived Discrimination, and Satisfaction With Health Care Among Young-Adult Rural Latinos. The Journal of Rural Health, 30(4), 344-351. https://doi.org/10.1111/jrh.12063
Martin, K.D., Roter, D.L., Beach, M.C., Carson, K.A., & Cooper, L.A. (2013). Physician Communication Behaviors and Trust among Black and White Patients with Hypertension. Medical Care, 51(2), 151-157. https://doi.org/10.1097%2FMLR.0b013e31827632a2
Molina, Y., Kim, S., Berrios, N., & Calhoun, E.A. (2014). Medical mistrust and patient satisfaction with mammography: The mediating effects of perceived self-efficacy among navigated African American women. Health Expectations,18(6), 2941-2950. https://doi.org/10.1111/hex.12278
Ojikutu, B.O., Bogart, L.M., & Dong L. (2022). Mistrust, Empowerment, and Structural Change: Lessons We Should Be Learning From COVID-19. American Journal of Public Health,112(3), 401-404. https://doi.org/10.2105/AJPH.2021.306604
Pascoe, E.A., & Smart Richman, L. Perceived Discrimination and Health: A Meta-Analytic Review. (2009). Psychological Bulletin, 135(4), 531-554. https://doi.org/10.1037/a0016059
Taber J.M., Leyva B., & Persoskie A. (2014). Why do people avoid medical care? A qualitative study using national data. Journal of General Internal Medicine, 30(3), 290-297. https://doi.org/10.1007/s11606-014-3089-1
Van Prooijen, J.W., & Douglas, K.M. (2017). Conspiracy theories as part of history: The role of societal crisis situations. Memory Studies, 10(3), 323-333. https://doi.org/10.1177/1750698017701615
Wall, L.L. (2006). The medical ethics of Dr J Marion Sims: a fresh look at the historical record. Journal of Medical Ethics, 32(6), 346-350. https://doi.org/10.1136/jme.2005.012559
Westergaard, R.P., Beach, M.C., Saha, S., & Jacobs, E.A. (2013). Racial/ethnic differences in trust in health care: HIV conspiracy beliefs and vaccine research participation. Journal of General Internal Medicine, 29(1),140-146. https://doi.org/10.1007/s11606-013-2554-6
Equity in the Trenches
Jacob Harper and David Clark
The University of Texas Medical Branch–John Sealy School of Medicine
For nearly forty years, the students of The University of Texas Medical Branch have been serving the low-income, uninsured population of Galveston through a student-led clinic called St. Vincent’s House. Recently, a small team of these students began the uphill battle of helping uninsured patients suffering from the Hepatitis C Virus (HCV) to receive free treatment that would normally cost these patients nearly $100,000. These student volunteers and the people they help face innumerable challenges along this journey to healing. Income restrictions, transportation needs, and chronic alcohol and drug use are just some of the many hurdles that emerge through every step of this process. Despite these challenges, the patient-student healer relationships have overcome the obstacles, and several patients have completed the rigorous process and achieved virus-free status at the conclusion of the treatment regimen.
These victories are nothing short of miraculous. There is life-altering treatment available for this condition. A number in a bank account serves as a gatekeeper to healing. Without programs like this one, these patients—real people with real lives and families—would be unable to access this second chance at life.
For the students, every treatment-denial letter stings. Every missed appointment is heartbreaking. The steep learning curve of navigating this bureaucratic landscape and the hours spent at volunteer clinic are well worth it when a patient bursts into tears because they feel hope; they feel loved and cared for, they finally have a teammate on their road to recovery.
In the eternal battle to eradicate disease and promote health and healing, there is a historical ebb and flow. Prevalence of one disease can fall in concert with a separate ailment appearing and rising in the same population. Such is the case for HCV. While many infections have been greatly reduced or even eliminated in the US over the past several decades, HCV is on a steady climb. From 2013 to 2020, cases of acute HCV infection more than doubled (Centers for Disease Control and Prevention [CDC], 2022). Texas is not exempt from this trend, seeing a near doubling of confirmed cases over the past decade (Texas Department of State Health Services [DSHS], 2021). Incidence statistics are likely under-reported because so many infections occur in the unhoused and incarcerated populations (Hofmeister et al., 2019).
The rate of acute infections becoming chronic infections is incredibly high, with some studies suggesting it may be up to 85% (World Health Organization [WHO], 2022). Chronic HCV can be fatal when it leads to cirrhosis and cancer. Mortality rates show that the disease disproportionately affects ethnic and racial minority groups, especially the Black and Native American populations (CDC, 2021).
Treatment for HCV can cost nearly $100,000, an untouchable number for many patients in high-risk, often uninsured populations (Henry, 2018). This all too often leaves afflicted patients without an option, barricaded by a number in their bank account and condemned by a system that frequently abandons the most vulnerable.
Luckily, there are people committed to addressing this disparity. Students at the John Sealy School of Medicine at UTMB launched a Community Hepatitis C Program three years ago. Since then, the program has steadily grown, treating more and more patients each year. The program is simple, and the results are life changing.
The program identifies at-risk patients at a free, student-run clinic in Galveston, Texas. These patients are screened for HCV and other frequent comorbidities for free. If a positive result returns, the patient is placed into a protocol developed by student volunteers under the direction of in-house physicians. Questionnaires are administered, physical exams are performed, and paperwork is submitted. The manufacturers of select HCV medications offer Patient Assistance Programs (PAP) that allow these students to provide life-altering medication for free to the patients who qualify.
There are still holes in the system, and people frequently fall through the cracks. Many patients come from vulnerable populations – low income, unhoused, high incidence of drug use, etc. These patients face additional barriers such as access to telephones to communicate with the clinic, transportation, and the social support required to successfully obtain and complete a rather rigorous daily treatment regimen. If patients have insurance, their PAP is likely to be denied, leaving them with copays of thousands of dollars that these patients simply do not have.
Fortunately, many patients are approved for this program; more are being treated each year. While red tape, technicalities, and logistical limitations prevent some individuals from getting the treatment they need, we rejoice in knowing that none of these patients would have access to the medications without the efforts of so many committed healthcare volunteers.
For those who dare to tread in the waters of addressing inequity, it is a daunting task. You find yourself staring down the barrel of systems and industries built to maintain the status quo. There are simply too many issues, gaps, and failings for one person, organization, or program to tackle. Although we cannot pretend to solve all issues of equity, we can fight in the trenches for our patients. We reach out to vulnerable demographics and lift where we stand. It does not take a Herculean effort. These seemingly small efforts and initiatives change lives, and when viewed in their totality, they are changing the world.
References
Centers for Disease Control and Prevention. (2021). Table 3.8. Number and rates* of deaths with hepatitis C virus infection listed as a cause of death† among residents, by demographic characteristics — United States, 2015–2019. CDC.gov. https://www.cdc.gov/hepatitis/statistics/2019surveillance/Table3.8.htm
Centers for Disease Control and Prevention. (2022). Figure 3.1 – Part 1 of 2. Number of reported cases of acute hepatitis C virus infection and estimated infections† United States, 2013–2020. CDC.gov. https://www.cdc.gov/hepatitis/statistics/2020surveillance/hepatitis-c/figure-3.1.htm
Henry B. (2018). Drug Pricing & Challenges to Hepatitis Treatment Access. Journal of health & biomedical law, 14, 265-283. PMCID: PMC6152913
Hofmeister, M. G., Rosenthal, E. M., Barker, L. K., Rosenberg, E. S., Barranco, M. A., Hall, E. W., Edlin, B. R., Mermin, J., Ward, J. W., & Ryerson, A. B. (2019). Estimating Prevalence of Hepatitis C Virus Infection in the United States, 2013-2016. Hepatology (Baltimore, Md.), 69(3), 1020-1031. https://doi.org/10.1002/hep.30297
World Health Organization. (2022). Hepatitis C. Retrieved September 12, 2022, from
https://www.who.int/news-room/fact-sheets/detail/hepatitis-c
“They Ain’t Alright”: A Historical Perspective on the Demonization of Black Children and Its Impact on Black Youth and Adolescent Health Today
Jasmine Jones
The University of Texas Medical Branch–John Sealy School of Medicine
At birth, Black lives are readily shaped by stereotypes, biases, and racial doctrine. An old saying goes, “before they knew whether you were going to be male or female, they knew you were going to be Black.” While a significant portion of racism and discrimination may be experienced in adulthood, Black children and adolescents do not go unscathed. In fact, the depiction of Black children as abnormal, deviant, and “super-predators” has a historical timeline connected to clinical medicine and its response to drug addiction, violence, and racialized crime. In this essay, I will explain the formation of the “crack baby” image, analyze its influence in the demonization of Black children and adolescents, and discuss the socio-medical consequences of racialized ideas on present day adolescent health for Black youth. What initially was thought to be a healthy concern for prenatal cocaine usage has had a devastating impact on the societal and medical views of Black children concerning development.
The “crack baby” can be defined as an infant born to a mother addicted to crack cocaine during the “crack epidemic” of the 1980’s. During this time, the explosion of concern of the long-term sequelae of prenatal cocaine exposures led researchers to publish their findings, often stating that the “crack baby” would have long-term physical, mental, and social disabilities while consuming governmental resources. Not only were the scientific studies limited, but their predictions were wrong. A study by Singer et al. showed reliable scientific evidence illustrating the adverse effects of prenatal tobacco and alcohol usage on the development of children, but there was a lack of sufficient evidence proving the effects of prenatal cocaine exposure on the development of babies (Becker, 2001). In fact, few studies possessed the accurate methodology and external validity to correctly draw conclusions, let alone make predictions pertaining to the development of prenatally cocaine-exposed infants. Even when peer-reviewed studies were conducted, the data was often misinterpreted. Some studies would go as far as to draw ill-supported conclusions such as, “[crack kids] are permanently damaged cognitively, but also morally, and emotionally troubled,” which further stigmatized and portrayed crack babies as remedial, uncivilized, and emotionally inept, consistent with the historical, stereotypical representation of Black people (Becker, 2001).
The urgency to create false narratives – cocaine being the key culprit for potential child developmental delay in “crack babies” – maintains racial myths concerning blackness and its deviance from societal norms, further criminalizes Black adolescents, and absolves proven, structural inequities as the true culprits they are. In The Prenatal Cocaine Exposure, the researcher extrapolates outside of the pertinent medical findings (e.g., neonatal respiratory function decline) to say that infants exposed “may never function normally in society.” This perpetuates pseudoscientific ideas about what it means to function in society as a Black child with cocaine exposure, while failing to acknowledge relevant sociodemographic factors
(e.g., poverty, lack of healthcare access, community violence, racial profiling) that influence behavior and development (Mayes, 1992; Zuckerman, 2002).
As time progressed, we saw the emergence of a new image outside of the crack baby in the 1990’s: the child super-predator. Super-predators were defined “as dangerously violent youth” that were responsible for the increased incidence of violent crimes, seen particularly in the South and West Coast. This label almost exclusively referred to Black children. In “The Coming of the Super-Predators,” DiLulio writes, “[They] made no mistake…the trouble will be the greatest in Black inner-city neighborhoods,” which was said to explain the “nearly [doubling] of violent crime” (1995). This failed to account for Black targeting– targeting due to societal bias and discrimination, not because of an innate characteristic or pathology within the Black community. DuLulio goes even further to describe young, Black men as “beefy big guys” in attempts to strip Black boys of their youth (1995). Here, we must recognize that language is a central component of the adultification and overcriminalization of Black adolescents. The War on Drugs propaganda, or what some would say “The War on Thugs,” was key in fueling our race-based incarceration problem beginning just at the tail of the 1970’s. During this time, Black incarceration was growing at record-breaking numbers congruent with a nationwide mass incarceration agenda. Young Black males were incarcerated four times more than Whites for drug and violent charges (Delaney, n.d.). This is consistent with today’s trends as well. According to The Sentencing Project, “despite long-term declines in youth incarceration, the disparity at which black and white youth are held in juvenile facilities has grown” (Rovner, 2021). Currently, Black youth are at least 3.4 times more likely to be detained or incarcerated than their White peers despite Black children making up only 14% of the child population compared to their White counterparts at 61% (Delaney, n.d.; Rovner, 2021).
What does this mean for Black child and adolescent health today? In addition to ostracization and discrimination, Black children have consistently been neglected as society has failed to acknowledge their physical and mental health needs more-so now than ever. During a time where virtually no individual has gone unharmed from the wrath of the COVID-19 pandemic, Black youth has borne the brunt of it. In a society where systemic racism has operated as a pre-existing condition, inequality has disproportionately impacted minority families, especially children. Studies have shown that Black youth have experienced higher rates of familial death, are more likely to attend schools and live in communities that have fewer economic resources and are experiencing elevated levels of stress compared to their White counterparts (Gaylord-Harden, 2020). Medically, Black children have had significantly lower rates in COVID-19 testing and vaccinations since the start of the pandemic (Artiga, 2021). Psychologically, Black children’s experiences during the pandemic have also been compounded by trauma (e.g., police brutality, domestic violence). Coupled with a rather large disruption in daily routines that reduce contact with familial and peer support, Black children are likely at a higher risk for psychological distress during such a turbulent time (“Racial and Ethnic...", 2018).
The historical picture of how Black children have been demonized helps us understand why it has been rather easy to neglect our Black youth. From a historical perspective, we failed to see them as human. Literature and mass media has painted Black children to be villains, savages, and a nuisance to society. This essay is a call for immediate attention and intervention on the behalf Black children and adolescents because they ain’t alright.
References
Artiga, S., Hill, L., & Ndugga, N. (2021). Racial Disparities in COVID-19 Impacts and Vaccinations for Children. Kaiser Family Foundation. https://www.kff.org/racial-equity-and-health-policy/issue-brief/racial-disparities-in-covid-19-impacts-and-vaccinations-for-children/
Becker, E. (2001, February 9). As Ex-Theorist on Young 'Superpredators,' Bush Aide Has Regrets. The New York Times.
Delaney, R., Subramanian, R., Shames, A., & Turner, N. (n.d.). American History, Race, and Prison. Vera Institute of Justice. https://www.vera.org/reimagining-prison-web-report/american-history-race-and-prison
DiLulio, J. (1995). The Coming of The Super -- Predators. Washington Examiner. www.washingtonexaminer.com/weekly-standard/the-coming-of-the-super predators
Gaylord-Harden, N., Adams-Bass, V., Bogan, E., Francis, L., Scott, J., Seaton, E., & Williams, J. (2020). Addressing Inequities in Education: Considerations for Black Children and Youth in the Era of COVID-19. Society for Research in Child Development. https://www.srcd.org/research/addressing-inequities-education-considerations-black-children-and-youth-era-covid-19
Mayes, L.C., Granger, R.H., Bornstein, M.H., & Zuckerman, B. (1992). The Problem of Prenatal Cocaine Exposure: A Rush to Judgment. Journal of the American Medical Association, 267(3), 406-408. https://doi.org/10.1001/jama.1992.03480030084043
Racial and Ethnic Composition of the Child Population. (2018). Child Trends. https://www.childtrends.org/indicators/racial-and-ethnic-composition-of-the-child-population
Rovner, J. (2021). Black Disparities in Youth Incarceration. The Sentencing Project. https://www.sentencingproject.org/publications/black-disparities-youth-incarceration/
Zuckerman B., Frank, D.A., & Mayes, L. (2002). Cocaine-Exposed Infants and Developmental Outcomes: "Crack Kids" Revisited. Journal of the American Medical Association, 287(15), 1990-1991. https://doi.org/10.1001/jama.287.15.1990