US college students’ perceptions of social determinants of health,health equity and racial health disparities

Abstract

Objective:

Healthy equity (HE) implies the highest possible standard of health for all people while giving special attention to the needs of those at greatest risk of poor health, based on social conditions. The social determinants of health (SDH) are conditions within the environment in which people live that shape their opportunity to attain good health. Despite efforts to promote HE and address SDH, there is limited research on college students’ perceptions of these concepts. The purpose of this study was to understand college students’ perceptions, awareness and education on HE and SDH with a specific focus on racial health disparities.

Methods:

A 28-item questionnaire was distributed electronically to a cross-sectional, campus-wide convenience sample of undergraduates at a large public university in the southeast USA.

Results:

While many students reported having knowledge or understanding about HE, SDH and related concepts, most had negative attitudes and beliefs about them. Students reported good understanding of these terms, but also believed that health disparities were due to individual behaviours.

Conclusion:

The contradiction in results show that while college students may think they have a good understanding of HE and SDH, their education on the topics could be improved. Study findings should encourage health education specialists to shift their focus from merely providing information to promoting the application of that knowledge. By so doing, students may be able to bridge the gap between understanding health equity and applying their knowledge in everyday life.

Keywords

College students health education health equity social determinants of health social justice

Introduction

A basic principle of public health is that all people have a right to health (Bleich et al., 2012). The pursuit of healthy equity means striving for the highest possible standard of health for all people and giving special attention to the needs of those at greatest risk of poor health, based on social conditions. Yet, health inequities continue to persist. These are disparities in health that are avoidable, unfair and unjust (Whitehead, 1992). The root of their existence lies in the unequal, systematic distribution of the social and structural determinants of health, namely, social, power and economic inequalities (Gaskin et al., 2013; Sadana and Blas, 2013). Oftentimes referred to as social determinants of health, these are conditions in the environments in which people live that shape opportunities to attain good health.

To teach college students about the social determinants of health, it is necessary to acknowledge the social and cultural factors that influence these issues. For example, in order for students to understand today’s racial health disparities, they should be given the background information regarding US society’s history of racism, as well as contemporary forms and patterns of racism (Feagin and Bennefield, 2014). The modern structures which are in place based on centuries of slavery, as well as the disparities which they cause, should be explained in order for educational efforts and future research to ‘publicly voice experiences of people of color’ (Feagin and Bennefield, 2014: 13).

However, the challenges faced when teaching and learning about health disparities must be acknowledged. These efforts often result in discussions of disparities in care, when dialogue about the broader contexts which cause inequality and disparities would be much more effective (Chokshi, 2010). Teaching with the social determinants of health as the framework for discussion would ‘broaden students’ perspectives on reducing health disparities’ (Chokshi, 2010). This shift from approaching education on health disparities with a bottom-up mind-set to a more upstream way of viewing the issue can prove difficult, since many undergraduate health courses focus on the cause and spread of disease largely through a biomedical lens.

Background

Despite efforts to promote health equity and address social determinants of health, there is limited research on college students’ perceptions of key concepts. For several years, academics have worked to not only better understand concepts such as health equity but have also attempted to apply and share them with students, community members and other audiences (Dean et al., 2013; Tarantola et al., 2015). Different approaches have been used, such as is evident in qualitative studies of the incorporation of books, like The Immortal Life of Henrietta Lacks and The Spirit Catches You and You Fall Down, to discuss the effect of the social determinants of health and provide a deeper understanding of health disparities in university and college classrooms (Dimaano and Spigner, 2016; Uy and Dimaano, 2020).

However, only a few studies have sought to understand these concepts from the student’s perspective. In one study, the perceptions and experiences of a campus cultural climate among 578 undergraduates at a large mid-Atlantic university were examined (Ancis et al., 2000). The investigators explored students’ comfort with their own race/ethnicity, sensitivity to racial/ethnic differences, perceived pressure to conform to stereotypes and overall satisfaction with the university environment. Findings showed that African American students felt more pressure to conform to stereotypes and experienced less equitable treatment by faculty, staff and teaching assistants, while White students reported a campus climate that was characterised by respect for diversity (Ancis et al., 2000).

Most research on student perceptions or experiences with health equity and social determinants of health has focused on students’ learning through service-learning projects and programme evaluations (Kamau-Small et al., 2015; Sabo et al., 2015). Other studies have focused on specific health issues, as opposed to adopting a health equity broadly approached (Lindstrom Johnson et al., 2018; Slawson et al., 2015). There is a dearth of literature on students’ overall understanding of health equity and related concepts. Two documented examples exist.

A study by Thompson et al. (2013) assessed the knowledge of 68 freshmen nursing students in Hawaii regarding social determinants of health, health equity and subjective social status. The students identified three key issues that adversely affected health: substance abuse, diet/nutrition and cancer. Most believed that the US health care system was inadequate and that social determinants of health adversely affected the health of the university’s surrounding, low-income community.

Another study examined whether fourth-year medical students in San Francisco had observed health care disparities and barriers and facilitators to addressing them during the previous year (Glaser et al., 2019). It found that among the 103 students interviewed, most (65%) had observed instances of health care disparities in treatment, either sometimes or often. When asked about their reactions to the differences in care, most students indicated a number of barriers to action, including the following: fear of poor evaluations, hierarchy/powerlessness, the desire to be a team player, limited clinical experience and the perception of doctors as ‘good people’ who provide disparate care unintentionally.

Several studies have examined college students’ perceptions of racism and discrimination on campus. Black students have identified a lack of trust in public health institutions and a lack of health insurance as factors linked to health disparities (Zekeri and Habtemariam, 2006). Latinx college students have reported feelings of fear and uncertainty of their future due to current racist nativist discourse (Gomez and Perez Huber, 2019). College students of colour are acutely aware of these issues on their campuses and the need for health equity education for all students. Other studies have examined educational needs when teaching health equity and identified clear definitions as necessary for students to have a strong understanding (Braveman, 2014).

In the light of the above research, there is a pressing need to examine students’ exposure to and perceptions of health equity, health disparities, social determinants and other related concepts.

Purpose

The purpose of this study was to examine college student perceptions, awareness and education on health equity and social determinants of health. Given current discussion regarding discrimination, racism and health disparities, we hypothesised that many students would be aware of health equity and social determinants of health as they relate to racial health disparities. It was also hypothesised that if students had taken a course or attended a seminar or workshop covering these topics, they may have a higher level of understanding.

Methods

Items for a web-based questionnaire were developed that addressed college students’ perceptions of social determinants of health, health equity, discrimination and structural racism in the USA. A demographic component was included at the beginning of the questionnaire. Participants were then asked questions concerning their understanding of the terms: health disparity, health equity, social justice and social determinants of health. Responses were provided on Likert-type scales.

Following the completion of the items addressing the participants’ understanding of those terms, they were presented with a number of definitions prepared by the research team (Figure 1). Having been given the definitions, the participants proceeded to respond to the remaining items addressing beliefs and attitudes regarding the causes of health disparities.

Figure 1.

Definitions of key concepts provided in the study.

The next items on the questionnaire addressed participants’ beliefs in the following statements: ‘naming and giving attention to health disparities is a tool for dividing racial/ethnic groups’, ‘structural racism and discrimination do not exist in the USA’, ‘naming and calling attention to health disparities is a political act’ and ‘health disparities exist because of the deficient behaviour of individuals’.

The remaining items asked participants for their level of agreement with statements about discrimination, social determinants of health, comfort discussing health equity and the social determinants of health with others, personal biases and prejudices, societal biases and prejudices, and willingness to educate themselves about diverse groups. One item asked participants to rank the social determinants of health in US society, and another asked them to select sources from which they have received education on health equity and social determinants of health. A final item in the questionnaire asked the participants whether or not they were taking/had ever taken a course, seminar or workshop addressing health disparities, social justice or anything of that nature. The 28-item questionnaire was created in Qualtrics.

When the questionnaire was deemed complete and prior to implementation of the study, a pilot test was undertaken with four undergraduate students. Students were asked to complete the questionnaire and were timed to assess how long the questionnaire would take future participants. Upon completion, the students were asked if any terminology was unclear, if there were any leading questions and if they had any other general comments or concerns. The pilot test yielded positive results. Students found the questionnaire clear, of appropriate length and not leading. Only a few minor changes were made regarding question wording or readability. Pilot-test participants’ responses were not included in final data analysis.

The final questionnaire was approved by the Institutional Review Board at the University of Alabama, and a copy of it can be found in the online supplemental material. The questionnaire was then included as an option for the Psychology Department Subject Pool for the Spring 2018 semester at the University of Alabama, where it was made available for 2 months. It was also distributed to the authors’ students, though no incentives were given for completing the survey. Statistical analyses, such as cross-tabulations, one-way analysis of variance (ANOVA) and t-tests, were conducted using SPSS.

Results

Demographic characteristics

Over the course of the semester, 561 students completed the questionnaire. Of the 561 participants, 79 were public health majors, and 199 participants reported that they were taking or had previously taken a college course, seminar or workshop that had covered health equity and/or similar social justice–related issues. Of the 199 participants who said they had taken such a course, 65 were public health majors.

Of participants, 57.4% were first-year students, 21.5% were second-year students, 11.6% were third-year students and 8.7% were fourth-year students. Regarding where students had grown up, 68.6% had grown up in suburban settings, 17.8% in rural settings and 13.5% in urban environments. Of all participants, 74.3% considered themselves middle class, 5.3% lower class and 20.3% upper class. Participants were asked to report their sex, and 74.5% said female, while 25.3% said male. While sexuality is known to be a key contributor and social determinant of health, this study’s focus on racial disparities meant items concerning participants’ sexual orientation/preference were not included in the questionnaire.

When asked their race/ethnicity, 77.4% said White, 16.4% Black or African American, 2.7% Hispanic or Latinx, 1.1% Asian or Pacific Islander and 0.7% American Indian or Alaska Native; 1.8% of participants selected the ‘other’ option and wrote in their race/ethnicity, such as ‘mixed, white and Asian’, ‘multiple races’, ‘bi-racial’ and ‘middle eastern’. While these demographics are not entirely representative of the racial/ethnic breakdown of the USA, they are representative of the campus on which the study took place.

Beliefs, knowledge and attitudes

Among those participants who strongly disagreed that they have biases and prejudices related to race or ethnicity, 40.1% somewhat agree that they believe naming and calling attention to health disparities is a political act.

The understanding scores of participants who strongly agreed, agreed, neither agreed nor disagreed, disagreed and strongly disagreed with the statement, ‘I believe naming and giving attention to health disparities is a tool for dividing racial and ethnic groups’, were compared using ANOVA. A significant difference in understanding was found among those levels of agreement, F(4, 528) = 3.83, p < .05, as seen in Table 1. Tukey’s honestly significant difference (HSD) test was used to determine the nature of those differences (Table 2). This post hoc test showed that participants who reported that they somewhat agreed with the previously mentioned statement had a significantly higher understanding score (M = 1.96, SD = .856) than students who reported that they strongly disagreed with the statement (M = 1.56, SD = .807). In addition, participants who neither agreed nor disagreed with the statement had a higher understanding score (M = 1.94, SD = .855) than those who strongly disagreed (M = 1.56, SD = .807).

Table 1.

ANOVA comparing the understanding scores of participants with varying levels of agreement with the statement, ‘I believe naming and giving attention to health disparities is a tool for dividing racial and ethnic groups’.

Understanding	Sum of squares	df	Mean square	F	Significance
Between groups	10.644	4	2.661	3.825	.004
Within groups	367.349	528	0.696
Total	377.992	532

ANOVA: analysis of variance.

Table 2.

Multiple comparisons: Difference in understanding scores among levels of agreement with the statement, ‘I believe naming and giving attention to health disparities is a tool for dividing racial/ethnic groups’.

Dependent variable: Understanding					95% confidence interval
(I) I believe naming and giving attention to health disparities is a tool for dividing racial/ethnic groups	(J) I believe naming and giving attention to health disparities is a tool for dividing racial/ethnic groups	Mean difference (I – J)	Standard error	Significance	Lower bound	Upper bound
Strongly agree	Somewhat agree	−.30626	.12374	.098	−.6450	.0324
	Neither agree nor disagree	−.28538	.12640	.161	−.6314	.0606
	Somewhat disagree	−.20635	.13293	.529	−.5702	.1575
	Strongly disagree	.09342	.14983	.971	−.3167	.5035
Somewhat agree	Strongly agree	.30626	.12374	.098	−.0324	.6450
	Neither agree nor disagree	.02089	.09593	1.000	−.2417	.2835
	Somewhat disagree	.09991	.10438	.874	−.1858	.3856
	Strongly disagree	.39968*	.12520	.013	.0570	.7424
Neither agree nor disagree	Strongly agree	.28538	.12640	.161	−.0606	.6314
	Somewhat agree	−.02089	.09593	1.000	−.2835	.2417
	Somewhat disagree	.07903	.10752	.948	−.2153	.3733
	Strongly disagree	.37879*	.12783	.026	.0289	.7287
Somewhat disagree	Strongly agree	.20635	.13293	.529	−.1575	.5702
	Somewhat agree	−.09991	.10438	.874	−.3856	.1858
	Neither agree nor disagree	−.07903	.10752	.948	−.3733	.2153
	Strongly disagree	.29977	.13428	.169	−.0678	.6673
Strongly disagree	Strongly agree	−.09342	.14983	.971	−.5035	.3167
	Somewhat agree	−.39968*	.12520	.013	−.7424	−.0570
	Neither agree nor disagree	−.37879*	.12783	.026	−.7287	−.0289
	Somewhat disagree	−.29977	.13428	.169	−.6673	.0678

Tukey’s honestly significant difference (HSD) post hoc test was used.

The mean difference is significant at the .05 level.

Health equity and social justice courses

Participants who had taken/were taking a college course, seminar or workshop about health equity and/or similar social justice–related issues showed significantly lower understandings of terms related to health equity and social determinants of health (Table 3 and 4). These students also showed significantly higher belief scores when answering questions such as ‘I believe naming and calling attention to health disparities is a political act’, ‘I believe naming and giving attention to health disparities is a tool for dividing racial/ethnic groups’ and ‘I believe health disparities exist because of the deficient behaviour of individuals’.

Table 3.

Group statistics of participants who have taken a course in health equity/social justice issues and those who have not.

	Have you taken (or are you currently taking) a college course, seminar or workshop that covered health equity and/or similar social justice–related issues?	N	M	SD	Standard error of mean
Understanding	Yes	198	1.4545	.69476	.04937
Understanding	No	335	2.0836	.83641	.04570

Table 4.

Independent samples t-test: Differences in understanding scores between participants who have taken a course in health equity/social justice issues and those who have not taken such a course.

		Levene’s test for equality of variances		t-Test for equality of means
		F	Significance	t	df	Significance (two-tailed)	Mean difference	Standard error of difference	95% confidence interval of the difference
		F	Significance	t	df	Significance (two-tailed)	Mean difference	Standard error of difference	Lower	Upper
Understanding	Equal variances assumed	1.329	.249	−8.918	531	.000	−.62904	.07053	−.76760	−.49048
Understanding	Equal variances not assumed			−9.350	473.940	.000	−.62904	.06728	−.76123	−.49684

Of those who had taken/were taking a health equity–related course, over half ranked access to affordable housing as 3–6 on the scale of things that determines the health of our society, with 1 being most strongly determines and 6 being least strongly determines. Access to transport and a safe neighbourhood environment were also ranked very low by those students who had taken a health equity–related course. The things most often ranked as 1 by students who had taken a course were an adequate living wage and access to good quality health care services. These students ranked attaining an education at all numbers of importance on the scale.

Structural racism

Of those participants who strongly agreed that the overall health of our society is determined by individuals’ opportunity to achieve power and wealth regardless of race, class, gender and other potential forms of difference, most (58.3%) indicated that they think structural racism exists in the USA, as did the majority (81.8%) of participants who strongly disagreed with the former statement. Among those who strongly agreed that in our society people are discriminated against on the basis of their race or ethnicity, 84.7% stated that structural racism exists. Similarly, of those who strongly agree that people’s health status can be influenced by their race or ethnicity, 83.8% agreed that structural racism exits.

Comparisons of race/ethnicity

Results showed that 53.6% of Black or African Americans and 50% of Hispanic or Latinx in the sample strongly agreed that in US society, people’s health status can be influenced by their race or ethnicity, while only 21.6% of Whites agreed. In addition, Black or African American students were most likely to strongly agree that they have biases and prejudices related to race or ethnicity – 11.9%, compared to 0% for American Indian or Alaska Native, Asian or Pacific Islander, and Hispanic or Latinx, and 1.4% of Whites).

Public health majors

Over 85.7% of students following public health majors who completed the survey had very low understanding scores, strongly disagreeing with the statements, ‘I have a clear understanding of the meaning of the term health disparity’, ‘I have a clear understanding of the meaning of the term health equity’, ‘I have a clear understanding of the term social justice’ and ‘I have a clear understanding of the meaning of the term social determinants of health’.

Findings indicated that while many (77.2%) students self-reported having knowledge or understanding about health equity, the social determinants of health and related concepts, most (50.6%) held negative attitudes and beliefs about them. For instance, among those who reported understanding of these concepts, many (41.4%) did not believe discussing them would help; rather, they believe doing so exacerbated the problem. In addition, while many (38.8%) reported they believed people are discriminated against on the basis of their race or ethnicity, they also thought health disparities were mostly determined by the individuals’ behaviour. Overall, these findings demonstrate their lack of understanding of these concepts despite exposure to or self-reported understanding of them.

Discussion

There is growing recognition for the need of well-trained public health education professionals, including health education specialists, to address health inequities (American Public Health Association, 2016). Currently, the health education occupation is one of the fastest growing occupations in the USA (US Department of Labor, 2019). Those in health education/promotion are expected to be able to apply principles of diversity and cultural competence (National Commission for Health Education Credentialing, Inc., 2019). To this end, it is often the hope of health educators and other public health professionals that the growing number of undergraduates in the field is a promising sign for the future. It is entirely possible that this is true; increasing the number of students who are even slightly aware of health disparities and the need for health equity and social justice has to increase the odds of a brighter tomorrow. However, findings from this study show that while college students may think they have a good understanding of health equity and the social determinants of health, their education on the topics could be improved.

Existing research has shown that when the voices of people of colour are heard in the classroom, the wider context of the social determinants of health can be more deeply understood by students (Chokshi, 2010; Feagin and Bennefield, 2014). However, the results of this study show that many students believe naming disparities and giving attention to these issues is divisive and ‘political’.

Another important finding was the fact that students who had taken a health equity or social justice course or seminar reported significantly lower understanding of terms related to these issues than students who reported that they had not taken such a course. It is possible that a Dunning–Kruger effect is present here, since this phenomenon often causes people who learn less to report feeling more competent, and vice versa (Dunning et al., 2003). This is something that could be investigated further in future studies.

Addressing social justice, health disparities and health equity as part of health education and promotion efforts is not a new concept, and teaching health education and promotion courses with these concepts in mind can help to foster culturally competent students and future professionals (McKenzie et al., 2018). Just as access to health care and the presence of reliable sources of information are values held widely within the field of public health, so is health equity. However, it is clear that these issues of teaching about social determinants of health and health equity require additional attention and further research.

Limitations

Some limitations to the study must be acknowledged. Although the study sample was broadly representative of the campus population on which it was conducted, the sample was not very diverse with regard to race or socioeconomic status, and it was mostly female. Most participants were White, middle- or upper-class students. For this reason, findings should not be generalised to the wider US context but should encourage similar studies to be carried out at other colleges and universities and in other parts of the country. The survey was distributed to researchers’ own students, as well as the Psychology Research Pool, so selection bias and desirability of responses could have been a limitation as well.

Because the study focused mainly on racial and ethnic health disparities, further research is needed to analyse college students’ perceptions of other health disparities such as gender, sexuality or socioeconomic status. When discussing health disparities in a public health context, racial and ethnic disparities are certainly not the only type to be addressed. Future studies could also take this investigation a step further and include qualitative data collection. This would allow for a deeper understanding of why students respond in the ways that they do when asked questions about health disparities or structural racism.

Implications

Many people, including health professionals, assume that with improved knowledge or understanding, improvements in attitudes will naturally follow. Often, changes in knowledge, understanding and attitudes occur together, but on complex and sometimes controversial issues such as social justice, this is not always the case. With continued education and awareness over time, it may be possible to see cultural shifts and changes in attitudes.

Including concepts such as health disparity, health equity and social determinants of health in health disparities courses across a range of health education programmes allows students to take one step towards understanding each other. However, study findings show that for students at this university, knowledge is not enough. Students should be encouraged to apply these terms to their everyday lives, as well as the profession that they plan to pursue. By putting these terms to practice and identifying what they might mean with regard to the lives of marginalised groups, students may be able to begin to bridge the gap between knowledge and attitudes.

Addressing these discrepancies should involve ensuring that students encounter realistic examples of the social determinants of health affecting their lives and the lives of their peers. This may be achieved through readings and books (e.g. Dimaano and Spigner, 2016; Uy and Dimaano, 2020) as well as through teaching and learning strategies that allow the voices of people of colour to be heard.

Findings from this study encourage health educators to adjust their teaching strategies so as to focus more clearly on the application of knowledge. They may also be used to spark conversation between students and teachers, students and their peers and between teachers themselves. Creating more opportunities to discuss social justice issues and social determinants of health can foster room for the systemic change needed to increase awareness of health disparities and to promote health equity.

Conclusion

Study findings signal that at a time of divisive rhetoric at the national level, when many students of colour feel distrust towards health professionals and fear for their future (Gomez and Perez Huber, 2019; Zekeri and Habtemariam, 2006), the belief that disparities are due to individual behaviour and that perceptions of social determinants of health are negative may be common attitudes among college students. Students know that people are discriminated against based on race or ethnicity, and they acknowledge that structural racism exists in our society, but there exist misunderstandings about what determines health.

There are strong features of this study which allow the results to be taken into consideration in future curriculum development, teaching and research. First, the sample size was large and diverse in major and geographic origin of students. Second, participants were asked directly about what they believed to be true. And finally, questionnaire items were developed from the literature on health equity and social determinants of health, specifically the few studies that have included college students’ perceptions.

It is also worth acknowledging that this study focused on students’ attitudes. Typically, knowledge and behaviour are the main focus of studies on college students’ health. This study examined college students’ positive and negative attitudes about racism, health disparities and other social justice issues. By analysing these perceptions and how they relate to attitudes, this study adds to the minimal body of literature that was previously described and provides direction to move students from the negative attitudes and lack of understanding that they currently possess towards a more knowledgeable future.

Supplemental Material

HEJ-19-0304.R2-Supplementary-file – Supplemental material for US college students’ perceptions of social determinants of health, health equity and racial health disparities

Supplemental material, HEJ-19-0304.R2-Supplementary-file for US college students’ perceptions of social determinants of health, health equity and racial health disparities by Rebecca Rich and Angelia Paschal in Health Education Journal

Footnotes

Funding

The author(s) received no financial support for the research, authorship and/or publication of this article.

ORCID iD

Rebecca Rich

Supplemental material

Supplemental material for this article is available online.

References

American Public Health Association (2016) The role of health education specialists in a post-health reform environment. Available at: https://www.apha.org/policies-and-advocacy/public-health-policy-statements/policy-database/2016/01/27/13/58/role-of-health-education-specialists

Ancis

Sedlacek

Mohr

(2000) Student perceptions of campus cultural climate by race. Journal of Counseling & Development 78: 180–185.

Bleich

Jarlenski

Bell

, et al. (2012) Health inequalities: Trends, progress, and policy. Annual Review of Public Health 33: 7–40.

Braveman

(2014) What are health disparities and health equity? We need to be clear. Public Health Reports 129(2): 5–8.

Chokshi

(2010) Teaching about health disparities using a social determinants framework. Journal of General Internal Medicine 25(2): 182–185.

Dean

Williams

Fenton

(2013) Applying social determinants of health to public health practice. Public Health Reports 128(3): 1–4.

Dimaano

Spigner

(2016) Teaching from The Immortal Life of Henrietta Lacks: Student perspectives on health disparities and medical ethics. Health Education Journal 76(3): 259–270.

Dunning

Johnson

Ehrlinger

, et al. (2003) Why people fail to recognize their own incompetence. Current Directions in Psychological Science 12(3): 83–87.

Feagin

Bennefield

(2014) Systemic racism and U.S. health care. Social Science & Medicine 103: 7–14.

10.

Gaskin

Thorpe

McGinty

, et al. (2013) Disparities in diabetes: The nexus of race, poverty, and place. American Journal of Public Health 104(11): 2147–2155.

11.

Glaser

Pfeffinger

Quan

, et al. (2019) Medical students’ perceptions of and responses to health care disparities during clinical clerkships. Academic Medicine 94: 1190–1196.

12.

Gomez

Perez Huber

(2019) Examining racist nativist microagressions on DACAmented college students in the Trump era. California Journal of Politics and Policy 11(2): 1–16.

13.

Kamau-Small

Joyce

Bermingham

, et al. (2015) The impact of the care equity project with community/public health nursing students. Public Health Nursing 32(2): 169–176.

14.

Lindstrom Johnson

Bottiani

Waasdorp

, et al. (2018) Surveillance or safekeeping? How school security officer and camera presence influence students’ perceptions of safety, equity, and support. Journal of Adolescence Health Care 63: 732–738.

15.

McKenzie

Pinger

Seabert

(2018). An Introduction to Community and Public Health. 9th ed. Burlington, MA: Jones & Bartlett Learning.

16.

National Commission for Health Education Credentialing, Inc. (2019) Responsibilities and competencies for health education specialist. Available at: http://www.nchec.org/responsibilities-and-competencies

17.

Sabo

de Zapien

Teufel-Shone

, et al. (2015) Service learning: A vehicle for building health equity and eliminating health disparities. American Journal of Public Health 105: S38–S43.

18.

Sadana

Blas

(2013) What can public health programs do to improve health equity. Public Health Reports 128(3): 12–20.

19.

Slawson

Dalton

III Dula

, et al. (2015) College students as facilitators in reducing adolescent obesity disparity in Southern Appalachia. Nursing Education Perspectives 35(3): 144–149.

20.

Tarantola

Camargo

Gruskin

(2015) Searching for justice and health. American Journal of Public Health 105(8): 1511–1513.

21.

Thompson

Jarvis

Sparacino

, et al. (2013) Perception of health equity and subjective social status among baccalaureate nursing students engaged in service-learning activities in Hawai’i. Hawaii Journal of Medicine and Public Health 72(10): 339–345.

22.

US Department of Labor (2019) Health educators and community health workers. Available at: https://www.bls.gov/ooh/community-and-social-service/health-educators.htm

23.

Dimaano

(2020) Lessons learned from The Spirit Catches You and You Fall Down: Student perspectives on how cultural differences can lead to health disparities. Health Education Journal 79: 73–81.

24.

Whitehead

(1992) The concepts and principles of equity and health. International Journal of Health Services 22(3): 429–445.

25.

Zekeri

Habtemariam

(2006) African American college students’ perceptions of psychosocial factors influencing racial disparities in health. College Student Journal 40(4): 901–915.

Supplementary Material

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