Tracy Lam-Hine (he/him), DrPH, MBA, is a postdoctoral research fellow mentored by Dr. David Rehkopf in the Stanford Medicine Department of Epidemiology and Population Health and the Stanford Center for Population Health Sciences. His research focuses on improving the measurement of structural racism in epidemiologic studies, the cardiopulmonary and mental health of Multiracial people in the United States, and the application of methods in social epidemiology to racial health inequities. Dr. Lam-Hine also collaborates with state and local health jurisdictions in California and Hawaii in applied epidemiology and surveillance projects on topics including structural racism, adolescent health, and COVID-19.
DrPH, University of California, Berkeley, Epidemiology (2022)
MBA, University of Washington, Foster School of Business (2016)
BS, University of California, Berkeley, Economics, Public Policy (2010)
David Rehkopf, Postdoctoral Faculty Sponsor
The Water Surrounding the Iceberg: Cultural Racism and Health Inequities.
The Milbank quarterly
Policy Points Cultural racism-or the widespread values that privilege and protect Whiteness and White social and economic power-permeates all levels of society, uplifts other dimensions of racism, and contributes to health inequities. Overt forms of racism, such as racial hate crimes, represent only the "tip of the iceberg," whereas structural and institutional racism represent its base. This paper advances cultural racism as the "water surrounding the iceberg," allowing it to float while obscuring its base. Considering the fundamental role of cultural racism is needed to advance health equity.Cultural racism is a pervasive social toxin that surrounds all other dimensions of racism to produce and maintain racial health inequities. Yet, cultural racism has received relatively little attention in the public health literature. The purpose of this paper is to 1) provide public health researchers and policymakers with a clearer understanding of what cultural racism is, 2) provide an understanding of how it operates in conjunction with the other dimensions of racism to produce health inequities, and 3) offer directions for future research and interventions on cultural racism.We conducted a nonsystematic, multidisciplinary review of theory and empirical evidence that conceptualizes, measures, and documents the consequences of cultural racism for social and health inequities.Cultural racism can be defined as a culture of White supremacy, which values, protects, and normalizes Whiteness and White social and economic power. This ideological system operates at the level of our shared social consciousness and is expressed in the language, symbols, and media representations of dominant society. Cultural racism surrounds and bolsters structural, institutional, personally mediated, and internalized racism, undermining health through material, cognitive/affective, biologic, and behavioral mechanisms across the life course.More time, research, and funding is needed to advance measurement, elucidate mechanisms, and develop evidence-based policy interventions to reduce cultural racism and promote health equity.
View details for DOI 10.1111/1468-0009.12662
View details for PubMedID 37435779
Racial Differences in Associations Between Adverse Childhood Experiences and Physical, Mental, and Behavioral Health.
medRxiv : the preprint server for health sciences
Introduction: Adverse childhood experiences (ACEs) are associated with poor adulthood health, with individuals experiencing multiple ACEs at greatest risk. Multiracial people have high mean ACEs scores and elevated risk of several outcomes, but are infrequently the focus of health equity research. This study aimed to determine whether this group should be targeted for prevention efforts.Methods: We analyzed Waves 1 (1994-95), 3 (2001-02), and 4 (2008-09) of the National Longitudinal Study of Adolescent to Adult Health (n = 12,372) in 2023, estimating associations between four or more ACEs and physical (metabolic syndrome, hypertension, asthma), mental (anxiety, depression), and behavioral (suicidal ideation, drug use) outcomes. We estimated risk ratios for each outcome in modified Poisson models with a race * ACEs interaction, adjusted for hypothesized confounders of the ACE-outcome relationships. We used the interaction contrast to estimate excess cases per 1,000 individuals for each group relative to Multiracial participants.Results: Excess case estimates of asthma were significantly smaller for White (-123 cases, 95% CI: -251, -4), Black (-141, 95% CI: -285, -6), and Asian (-169, 95% CI: -334, -7) participants compared to Multiracial participants. Black (-100, 95% CI: -189, -10), Asian (-163, 95% CI: -247, -79) and Indigenous (-144, 95% CI: -252, -42) participants had significantly fewer excess cases of and weaker (p < 0.001) relative scale association with anxiety compared to Multiracial participants.Conclusions: Adjusted associations between ACEs and asthma or anxiety appear stronger for Multiracial people than other groups. ACEs are universally harmful but may contribute disproportionately to morbidity in this population.
View details for DOI 10.1101/2023.06.02.23290905
View details for PubMedID 37333236
Clinical Presentation and Outcomes of Kawasaki Disease in Children From Latin America: A Multicenter Observational Study from the REKAMLATINA Network.
The Journal of pediatrics
OBJECTIVES: To describe the clinical presentation, management and outcomes of Kawasaki disease (KD) in Latin America and to evaluate early prognostic indicators of coronary artery aneurysm (CAA).STUDY DESIGN: An observational KD registry-based study was conducted in 64 participating pediatric centers across 19 Latin American countries retrospectively between January 1, 2009, and December 31, 2013, and prospectively from June 1, 2014, to May 31, 2017. Demographic and initial clinical and laboratory data were collected. Logistic regression incorporating clinical factors and maximum coronary artery Z-score at initial presentation (between 10 days before and 5 days after intravenous immunoglobulin [IVIG]) was used to develop a prognostic model for CAA during follow-up (>5 days after IVIG).RESULTS: Of 1,853 patients with KD, delayed admission (>10 days after fever onset) occurred in 16%, 25% had incomplete KD, and 11% were resistant to IVIG. Among 671 subjects with reported coronary artery Z-scores during follow-up (median 79 days [interquartile range 36, 186]), 21% had CAA, including 4% with giant aneurysms. A simple prognostic model utilizing only a maximum coronary artery Z-score ≥2.5 at initial presentation was optimal to predict CAA during follow-up (area under the curve 0.84; 95% confidence interval 0.80, 0.88).CONCLUSION: From our Latin American population, coronary artery Z-score ≥2.5 at initial presentation was the most important prognostic factor preceding CAA during follow-up. These results highlight the importance of early echocardiography during the initial presentation of KD.
View details for DOI 10.1016/j.jpeds.2023.02.001
View details for PubMedID 36775190
Impact of Racial Categorization on Effect Estimates: An HIV Stigma Analysis
AMERICAN JOURNAL OF EPIDEMIOLOGY
2022; 191 (4): 689-695
Suboptimal racial categorization potentially introduces bias in epidemiologic analysis and interpretation, making it difficult to appropriately measure factors leading to racial health disparities. As part of an analysis focused on predictors of experiencing human immunodeficiency status (HIV)-related stigma among men who have sex with men living with HIV in San Francisco, we struggled with the most appropriate ways to categorize people who reported more than 1 racial identity, and we aimed to explore the implications of different methodological choices in this analysis. We fitted 3 different multivariable linear regression models, each utilizing a different approach to racial categorization: the "multiracial," "othering," and "hypodescent" models. We estimated an adjusted risk difference in mean score for reported frequency of experiencing HIV-related stigma on a 4-point scale, adjusting for age, race, gender identity, injection history, housing, mental health concerns, and viral load. Use of a hypodescent model for racial categorization led to a shift in the point estimate through the null for Blacks/African Americans, and it improved precision for that group. However, it obscured the association of increased stigma and race for multiracial people, compared with monoracial counterparts. We conclude that methodological decisions related to racial categorization of participants can dramatically affect race-related study findings in predictor regression models.
View details for DOI 10.1093/aje/kwab289
View details for Web of Science ID 000791049900019
View details for PubMedID 34999778
Severe Acute Respiratory Syndrome Coronavirus 2 and Respiratory Virus Sentinel Surveillance, California, USA, May 10, 2020-June 12, 2021
EMERGING INFECTIOUS DISEASES
2022; 28 (1): 9-19
State and local health departments established the California Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) and Respiratory Virus Sentinel Surveillance System to conduct enhanced surveillance for SARS-CoV-2 and other respiratory pathogens at sentinel outpatient testing sites in 10 counties throughout California, USA. We describe results obtained during May 10, 2020‒June 12, 2021, and compare persons with positive and negative SARS-CoV-2 PCR results by using Poisson regression. We detected SARS-CoV-2 in 1,696 (19.6%) of 8,662 specimens. Among 7,851 specimens tested by respiratory panel, rhinovirus/enterovirus was detected in 906 (11.5%) specimens and other respiratory pathogens in 136 (1.7%) specimens. We also detected 23 co-infections with SARS-CoV-2 and another pathogen. SARS-CoV-2 positivity was associated with male participants, an age of 35-49 years, Latino race/ethnicity, obesity, and work in transportation occupations. Sentinel surveillance can provide useful virologic and epidemiologic data to supplement other disease monitoring activities and might become increasingly useful as routine testing decreases.
View details for DOI 10.3201/eid2801.211682
View details for Web of Science ID 000746318000002
View details for PubMedID 34932449
View details for PubMedCentralID PMC8714231
Outbreak Associated with SARS-CoV-2 B.1.617.2 (Delta) Variant in an Elementary School - Marin County, California, May-June 2021
MMWR-MORBIDITY AND MORTALITY WEEKLY REPORT
2021; 70 (35): 1214-1219
On May 25, 2021, the Marin County Department of Public Health (MCPH) was notified by an elementary school that on May 23, an unvaccinated teacher had reported receiving a positive test result for SARS-CoV-2, the virus that causes COVID-19. The teacher reported becoming symptomatic on May 19, but continued to work for 2 days before receiving a test on May 21. On occasion during this time, the teacher read aloud unmasked to the class despite school requirements to mask while indoors. Beginning May 23, additional cases of COVID-19 were reported among other staff members, students, parents, and siblings connected to the school. To characterize the outbreak, on May 26, MCPH initiated case investigation and contact tracing that included whole genome sequencing (WGS) of available specimens. A total of 27 cases were identified, including that of the teacher. During May 23-26, among the teacher's 24 students, 22 students, all ineligible for vaccination because of age, received testing for SARS-CoV-2; 12 received positive test results. The attack rate in the two rows seated closest to the teacher's desk was 80% (eight of 10) and was 28% (four of 14) in the three back rows (Fisher's exact test; p = 0.036). During May 24-June 1, six of 18 students in a separate grade at the school, all also too young for vaccination, received positive SARS-CoV-2 test results. Eight additional cases were also identified, all in parents and siblings of students in these two grades. Among these additional cases, three were in persons fully vaccinated in accordance with CDC recommendations (1). Among the 27 total cases, 22 (81%) persons reported symptoms; the most frequently reported symptoms were fever (41%), cough (33%), headache (26%), and sore throat (26%). WGS of all 18 available specimens identified the B.1.617.2 (Delta) variant. Vaccines are effective against the Delta variant (2), but risk of transmission remains elevated among unvaccinated persons in schools without strict adherence to prevention strategies. In addition to vaccination for eligible persons, strict adherence to nonpharmaceutical prevention strategies, including masking, routine testing, facility ventilation, and staying home when symptomatic, are important to ensure safe in-person learning in schools (3).
View details for Web of Science ID 000692821000006
View details for PubMedID 34473683
View details for PubMedCentralID PMC8422870
Assessment tool for establishing local pharmaceutical manufacturing in low- and middle-income countries
INTERNATIONAL JOURNAL OF PHARMACY PRACTICE
2018; 26 (4): 364-368
In many low- and middle-income countries (LMICs), limited availability, substandard quality and high prices of pharmaceutical products lead to lack of access to essential medicines and poor health outcomes. Manufacturing pharmaceuticals in LMICs may improve access for patients while increasing the market size for manufacturers.We present a tool for assessment of local manufacturing feasibility of pharmaceuticals, intended for use among key stakeholders during the business development process. The tool consists of five domains: product selection and capacity, market sizing, market entry, funding and quality assurance.The tool is intended to identify barriers and facilitators for local manufacturing and provide a roadmap for decision-making across multiple stakeholders. A case study in Namibia identified key barriers and facilitators to successful manufacturing in that county.Careful consideration of feasibility and potential for success may lead to improved health for the populations of LMIC as well as significant market potential for pharmaceutical manufacturers.
View details for DOI 10.1111/ijpp.12455
View details for Web of Science ID 000437282600011
View details for PubMedID 29732641