Factors That Contribute to the Mental Health of Black Youth during COVID-19 Pandemic (2024)

1. Introduction

2. Methodology

Our research utilized a community-based participatory (CBP) approach informed by Critical Race Theory (CRT) and an intersectional framework. By incorporating intersectionality, which is a key concept within CRT, we analyzed how various social factors such as race, gender, and income intersect to shape health outcomes for Black youth. Intersectionality, rooted in CRT, places a central focus on race and power dynamics [15]. We are also cognizant that these experiences are situated along power axes. We go beyond single-issue framing and also seek to capitalize on the agency of Black youth as productive members of society. By incorporating CRT and emphasizing intersectionality, our discourse on racism extends beyond mere acknowledgment to actively promote racial justice. This includes a nuanced understanding of power relations and reflexivity, highlighting the importance of relationality in addressing systemic inequalities.

The CBP research involves researchers working with a specific identified community towards the emancipatory goal of empowering individuals within that community to address systemic barriers and advocate for meaningful social change [18,19]. We followed our earlier approach to CBP research with Black youth, with a focus on community engagement, decolonization, and empowerment [20]. The impetus for this project is our earlier work with Black youths, which identified barriers to accessing mental health services in Alberta, and further research exploring the multifaceted factors influencing the mental health of Black youth in the region, including issues such as racial discrimination, intergenerational tensions, academic pressures, and positive contributors like mental health openness and supportive relationships [11,21]. At the beginning of the project, we set up a 14-member advisory committee of Black youth comprised of intersectional representations (age, gender, sexual orientation, (dis)ability, health, language, and region). Six Black youth were hired as research assistants and co-researchers. These youth collected data, supported data analysis, and contributed to knowledge mobilization (including presentation, guest speaking, and co-authorship on this manuscript). Black youth research assistants met with a postdoctoral fellow on the project every week for effective mentorship. Advisory committee members also met with the team approximately every three months.

We obtained ethics approval from the University of Alberta Research Ethics Board. We recruited participants through advisory committee members on the project, Black youth co-researchers, and advertisem*nts to Black community organizations across Canada. We interviewed Black youths aged 16 to 30 who live in Canada between February 2022 and May 2022. We conducted qualitative interviews with 48 Black youth to understand the factors that contributed to their mental health during the COVID-19 pandemic. Our sample size was based on data saturation. Interviews were conducted online (via Zoom) and were open-ended and semi-structured interviews. Interviews occurred after participants had fully read an informed consent document and had their questions answered. Interviews were semi-structured, lasted approximately 1 h, and were audio-recorded and transcribed verbatim. Participants also completed a demographic form.

Data collection and analysis for interviews occurred iteratively. Audio-recorded data was transcribed verbatim. Data analysis was completed using thematic analysis aided by NVivo 12 qualitative data analysis software. Thematic analysis is a method for identifying, analyzing, and reporting patterns within a dataset [22]. Our thematic analysis encompasses several steps: (1) familiarizing ourselves with data through repeated readings of the transcripts; (2) generating initial codes; (3) searching for themes based on identified codes; (4) reviewing, expanding, and refining identified themes; (5) defining and naming the themes; and (6) writing the final report [22]. The intersectional theory enabled us to consider intersecting and multifactorial influences on the mental health of Black youth. We also kept a reflexive memo to examine our positionalities and our emerging awareness in the field.

3. Results

The 48 Black-identifying participants interviewed were between the ages of 16 and 30 years old, with 25 male and 23 female participants, of whom 38 were Christians, 4 were Muslims, and 6 were non-religious or other. Our findings highlight the structural and systemic factors of the COVID-19 pandemic, the main themes being: 1. experience of online schooling; 2. experiencing lockdowns and the sub-theme of the closures of recreational and sports centers; 3. financial burdens, which demonstrated three sub-themes: food insecurity, precarious employment and housing, and lack of funding from the government; and 4. experiencing intersections of anti-Black racism, police brutality, and COVID-19. These factors are unique to the COVID-19 pandemic and have contributed to mental health challenges for Black youth.

4. Discussion

The first theme that emerged in the research was the experience of online learning. Participants experienced numerous challenges with distance learning, including, higher stress levels, low motivation, difficulty focusing, and poor mental and emotional health. Verlenden et al. [27] conducted a probability-based survey of parents of children aged 5–12 in the US to understand if changes in modes of instruction during the pandemic have presented psychosocial stressors. They found that virtual instruction might present more mental health and emotional health risks than in-person instruction [27]. The findings of our study support the body of literature suggesting that online instruction poses more risks than in-person learning related to a child’s mental and emotional health and wellbeing. The findings of our study also suggest that mental health challenges faced by students because of online learning were further exacerbated as they felt that their wellness practices were taken away due to the containment strategies put in place by the government to slow the spread of the virus. Schools are essential to supporting children not only by way of education, but also through opportunities to participate in activities that support cognitive, psychosocial, and physical health and wellbeing. Therefore, the disruption of school-based services and extracurricular activities contributed to the worsening of mental health outcomes among Black youth and adolescents. Additionally, the experience of stress coupled with the lack of educator support that the youth reported had several negative psychological impacts. Educators and school counselors are important emotional supports for youth and adolescents, as they are often the first to note warning signs of mental health challenges. As professionals working directly with youth, educators have an ethical responsibility to recognize warning signs and intervene when a mental health crisis arises. However, the transition to online learning reduced their ability to provide emotional support, observe crisis warning signs, and interfere with youth at risk during a time when students needed them more than ever before. Finally, our findings suggest that students experienced higher levels of stress related to the challenges of online learning during the pandemic. Early-life toxic stress can negatively affect the physical and mental health of children, especially Black children, who are more likely to experience racial discrimination, poverty, unstable housing, or residential segregation and less likely to have access to social and economic supports [28]. Children who experience early-life toxic stress are at risk of long-term adverse health outcomes that may not present themselves until adulthood. Adverse health outcomes include negative coping mechanisms, poor stress management, unhealthy lifestyle choices, mental and emotional health issues, and chronic illnesses such as cardiovascular disease, cancer, asthma, and depression [29].

The challenges of online learning and the COVID-19 pandemic are particularly detrimental to Black students, as they are already at a higher risk of dropping out of secondary school education and are less likely to apply to post-secondary education [30,31,32]. Consequently, the mental health struggles and issues related to online learning and the pandemic may exacerbate an already tenuous academic path for Black students. Further research is needed to understand the long-term impacts of the pandemic and online instruction across the lifetimes of Black children and adolescents.

The second theme that emerged in the research was the theme of experiencing lockdowns and the sub-theme of the closures of recreational and sports centers. Black youth expressed that they did not have the resources that they needed to cope with the pandemic, particularly with the closures of recreational centers like gyms and basketball courts. Recreational physical activity plays an important role in the management of mental health issues, especially depression and anxiety [33]. Zulyniak et al. [34] examine the associations between recreational and non-recreational physical activity and mental health outcomes among Canadian youth. They found that recreational physical activity was associated with positive mental health for youth; however, non-recreational physical activity showed generally small and insignificant associations with mental health outcomes. Such findings emphasize how detrimental recreational facility closure was to Black youth. The youth in our study particularly highlighted the importance of basketball and the basketball community to their mental health. Ogden and Hilt [35] describe how sports serve as an area for social and racial resistance. In thinking with Early [36] our findings show that basketball is a medium through which Black communities express their rebellion and resistance to social and economic oppression. Further, Boyd [37] explains how basketball “create[s] a space of resistance and free expression that announces a relative notion of empowerment, while at the same time acknowledging the racial and class hierarchies that still dominate sports and society as a whole” (p. 133). The inability to play sports then was particularly harmful to the mental health of Black youth. While recreational facility closures impacted all youth, Black youth felt this harm in greater ways as they experienced over-surveillance of spaces where Black youth frequented. As Dryden [38] explains, the attempt to slow the spread of the virus brought together policing and public health. Dryden draws on the destruction of Africville, Nova Scotia, to demonstrate why Black folks are nefarious of public health measures. In the 1960’s, one of the explanations for the destruction of Africville, Nova Scotia, was the public health claim that the community was at a health risk as there was no sewage system. Instead of providing the necessary services, the community was forcibly removed. Evidently, then, the feeling of being targeted as a Black person in the name of public health follows a long history of public health serving as an extension of policing [38,39].

The third theme that emerged in our findings was experiencing financial burdens, which were related to issues of food insecurity, precarious employment and housing, and a lack of funding from the government. The COVID-19 pandemic has limned the ways in which health disparities cannot be extricated from socio-economic precarity. Specifically, subjugated populations have been disproportionately affected by the pandemic due to state austerity, ecological insecurity, the hierarchical identity-based composition of homelessness, and the overall unequal allocation of health resources. In 2016, according to the market basket measure of low income, 27% of Black children younger than age 15 in Canada were living in poverty. This proportion was half as high among other children (14%) [40]. Our findings suggest that Black youths’ mental health suffered because of the experience of food insecurity during the pandemic. Dhunna and Tarasuk [41] found that the prevalence of food insecurity is 3.5 times higher in Black households compared to White households across Canada, even after adjusting for factors like immigration status, education level, and homeownership. They concluded that in Canada, the overruling determinant of vulnerability to household food insecurity is whether one is racialized as Black [41]. Dabone et al. [42] assessed the food insecurity conditions of African, Caribbean, and Black populations globally during the COVID-19 pandemic. They found that the COVID-19 pandemic doubly burdened African, Caribbean, and Black populations, both with the disease and food insecurity within Canada and globally. In fact, according to Food Secure Canada [43], it is expected that food insecurity will double from the existing 4.4 million, with disproportionate impacts on Black and other racialized groups. As such, future public policy on food insecurity in Canada post pandemic must consider the role of systemic and institutionalized racism [43]. Furthermore, from February to April 2020, about 5.5 million Canadians employed were affected by the COVID-19 containment strategies that mandated the closure of all non-essential businesses [44]. This included a drop in employment of 3.0 million jobs [44]. As an attempt to reduce the impact of the economic fallout, Canada implemented the Canada Emergency Response Benefit (CERB), which provided financial support to employed and self-employed Canadians who were directly affected by COVID-19 [45]. This financial support, however, was lower than the usual income of many individuals and many households that received it, meaning many households saw a significant reduction in their income [46]. Participants in our study shared that limited access to government funding or CERB during the pandemic caused mental health challenges for them. Canada Food Banks saw an increase in food bank use (20% to 28%) across the country [47]. As such, financial support implemented during the peak of the COVID-19 pandemic was insufficient to prevent increases in poverty and food insecurity. This has been particularly harmful to the mental health of Black youth, who are already disproportionately affected by poverty and food insecurity.

Youth in our study talked about housing challenges, including not being able to pay rent, losing housing, or finding themselves homeless because they were not able to pay rent. Housing is a social determinant of health, and COVID-19 has made it apparent that housing and health are intrinsically interlinked. Nearly five million people in Canada currently live in poverty [48] and prior to the emergence of COVID-19, Canada was facing a homelessness and housing crisis [49]. However, the socio-spatial patterning of the virus indicates that such a crisis is not a mere reflection of an irresponsible, failed liberal subjectivity but rather a direct consequence of an institutional failure to accommodate and preserve lives. Such institutional negligence functions through the social ordering of populations through hegemonic modalities of gender, race, class, sexuality, and ability, making some bodies more vulnerable to precarious housing situations than others. When COVID-19 was officially declared an international pandemic, public health professionals urged Canadians to stay at home and practice “social distancing” to flatten the curve. Access to shelter proves imperative in any attempt to follow such public health advice, emphasizing the importance of housing as a social determinant of health. However, race-based economic inequalities force individuals into tighter dwellings, creating an increased risk of transmission [50,51]. Additionally, overpolicing of racialized communities has also placed Black men and women in the closed quarters of detention centers, which similarly increases the risk of exposure and transmission [52]. In such conditions, people are forced to sleep inches away from each other, creating an environment conducive to the spread of disease and making the isolation of those infected impossible. Our findings show us that housing is health care and has rendered visible the fragilities of the public sector with respect to low-income Black folks.

The final theme that emerged in our findings was experiencing the “multiple pandemics” of anti-Black racism, police brutality, and COVID-19 [26]. In 2020, following the murder of George Floyd by Officer Derek Chauvin, the largest racial justice protests in the United States since the Civil Rights Movement erupted [53]. BLM protests went far beyond American borders; global action was spurred. Black youth in our study discussed how incidents of anti-Black racism and police brutality, most notably the killing of George Floyd, impacted their mental health negatively. Additionally, our findings showed that Black youth live in constant fear of the police. Williams [54] reported that Black youth constantly fearing for their lives, feel hopeless and alienated from society at large, given the lack of support from social institutions such as law enforcement.

The feelings of alienation constantly felt by Black youth are of concern as a sense of belonging is crucial to child development [55]. Since the murder of George Floyd, anxiety and stress among Black populations have increased at higher rates than any other racial group. Suicide rates for Black youth were already rising at startling rates. To such a great degree that Black youth under 13 are two times more likely to die by suicide than their white counterparts [56]. Interventions are needed to meet the post-pandemic mental health needs of Black youth, who are constantly experiencing an epidemic of racism. Such interventions must be guided by accessibility and cultural competency.

5. Limitations

Although this study has provided important insights into the mental health of Black youth, it is important to note that the sample was not representative of the entire population of Black youth in Canada. Specifically, the study had a low representation of Black youth who are involved in the justice system or who are out of school and out of work. The generalizability of our findings to this population is limited.

It is important to recognize that the primary objective of this study was not to achieve generalizability, but rather to facilitate the transferability of our findings. Through the inclusion of verbatim quotes and detailed context in the methodology, we have taken steps to enhance the transferability of our study, with the hope that our findings will inform future research, policies, and regulations aimed at supporting the mental health of Black youth in Canada.

6. Implications for Policy and Practice

Our findings underscore several critical areas where current policy and practice can be informed to better meet the needs of Black youth in Canada and globally. The experiences highlighted by our participants reveal the compounded effects of financial burdens, food insecurity, precarious employment and housing, a lack of sustainable government support, and systemic racism during the COVID-19 pandemic. Addressing these intersecting issues requires a comprehensive and multifaceted approach.

Firstly, economic support programs should provide stable financial assistance for Black youth, particularly during and after crises like the COVID-19 pandemic. Policies must ensure access to unemployment benefits, housing subsidies, and food assistance programs to alleviate financial stressors disproportionately affecting Black youth. Specific initiatives targeting food security, stable employment, and accessible housing are paramount to mitigating economic challenges and enhancing mental health outcomes.

Secondly, it is crucial to develop and implement mental health services that are culturally sensitive and accessible to Black youth. Training mental health professionals in cultural competence and addressing systemic barriers that prevent Black youth from seeking help are essential steps. Creating environments where Black youth feel understood and supported will make mental health services more effective in addressing their specific needs.

Thirdly, educational policies need to focus on enhancing the virtual learning experience for Black youth. This includes addressing issues of technology access, providing robust teacher support, and instilling effective coping mechanisms for the challenges posed by online schooling. Initiatives that reduce barriers to higher education and create job opportunities, such as scholarships, internships, and mentorship programs, will help mitigate some of the economic challenges faced by Black youth.

Fourthly, community-based support systems must be strengthened to provide a safety net for Black youth. Funding for community organizations that offer mental health services, mentorship programs, and other resources tailored to the needs of Black communities is vital. These organizations play a critical role in providing support and fostering resilience among Black youth, especially during lockdowns and periods of social isolation.

Additionally, anti-racism and mental health awareness campaigns can play a pivotal role in addressing the interconnected issues of racial disparities, police brutality, and mental health challenges. The COVID-19 pandemic has highlighted the urgent need for these campaigns to combat systemic racism and its detrimental impact on mental health.

Finally, advocating for policy reforms that address systemic racism and its impact on health and wellbeing is crucial. Reforms in healthcare, education, and economic systems are needed to ensure they are equitable and just. This includes addressing the root causes of systemic inequities and implementing policies that promote social justice and equality.

Globally, these findings underscore the importance of international collaboration and knowledge sharing to address the unique challenges faced by marginalized communities during health emergencies. By applying the principles of Critical Race Theory (CRT) and intersectionality, policymakers and practitioners can develop more effective strategies to support Black youth and other marginalized groups worldwide. This holistic approach, combining educational, community-based, financial, awareness, and policy-focused interventions, will foster the mental well-being of Black youth during the unique challenges posed by the COVID-19 pandemic and beyond.

7. Conclusions

In conclusion, this study sheds light on the intricate interplay of systemic factors impacting the mental health of Black youth during the COVID-19 pandemic. From the challenges of online schooling and the mental health ramifications of lockdowns to financial burdens and the intersectionality of anti-Black racism, police brutality, and the pandemic, the findings underscore the multifaceted nature of the struggles faced by Black youth. The implications drawn from these insights suggest a comprehensive approach encompassing educational interventions, community support programs, financial assistance initiatives, anti-racism and mental health awareness campaigns, and policy reforms. By addressing these key areas, there is potential to mitigate the mental health disparities experienced by Black youth and foster resilience in the face of adversity. As we move forward, it is imperative to recognize and act upon these insights to create a more equitable and supportive environment for Black youth navigating the challenges of pandemics and difficult situations.

Author Contributions

Conceptualization, B.S., J.H., H.A.H., J.K. and D.V.M.; Methodology, B.S., O.A., S.O., J.H., H.A.H., J.K. and D.V.M.; Data curation, O.A., S.O., O.F.O. and K.P.; Writing—original draft, B.S., A.N.M., S.O. and O.F.O.; Writing—review and editing, B.S., A.N.M., O.F.O., K.P., J.H., H.A.H., J.K. and D.V.M.; Supervision, B.S.; Project administration, B.S.; Funding acquisition, B.S., K.P., J.H., H.A.H., J.K. and D.V.M. All authors have read and agreed to the published version of the manuscript.

Funding

The study was funded by the Canadian Institute of Health Research (CIHR) (459016).

Institutional Review Board Statement

The study was conducted in accordance with the Declaration of Helsinki, and approved by the University of Alberta Research Ethics Board (approval code: Pro00116630; approval date: 27 January 2022).

Informed Consent Statement

Informed consent was obtained from all participants involved in the study. Written informed consent has been obtained from the participants to publish this paper.

Data Availability Statement

Individuals interested in accessing the data can contact the first author at [emailprotected].

Conflicts of Interest

The authors declare no conflicts of interest.

References

1. World Health Organization. Comprehensive Mental Health Action Plan 2013–2030; World Health Organization: Geneva, Switzerland, 2021.
2. World Health Organization. Mental Health. Available online: https://www.who.int/news-room/fact-sheets/detail/mental-health-strengthening-our-response (accessed on 21 February 2024).
3. Compton, M.T.; Shim, R.S. The Social Determinants of Mental Health. Focus 2015, 13, 419–425. [Google Scholar] [CrossRef]
4. Cooper, S.M.; Brown, C.; Metzger, I.; Clinton, Y.; Guthrie, B. Racial Discrimination and African American Adolescents’ Adjustment: Gender Variation in Family and Community Social Support, Promotive and Protective Factors. J. Child Fam. Stud. 2013, 22, 15–29. [Google Scholar] [CrossRef]
5. Williams, D.R.; Mohammed, S.A. Discrimination and Racial Disparities in Health: Evidence and Needed Research. J. Behav. Med. 2009, 32, 20–47. [Google Scholar] [CrossRef] [PubMed]
6. Gaylord-Harden, N.K.; Cunningham, J.A. The Impact of Racial Discrimination and Coping Strategies on Internalizing Symptoms in African American Youth. J. Youth Adolesc. 2009, 38, 532–543. [Google Scholar] [CrossRef] [PubMed]
7. Snowden, L.R. Barriers to Effective Mental Health Services for African Americans. Ment. Health Serv. Res. 2001, 3, 181–187. [Google Scholar] [CrossRef] [PubMed]
8. Marks, A.K.; Woolverton, G.A.; Garciacutea Coll, C. Risk and Resilience in Minority Youth Populations. Annu. Rev. Clin. Psychol. 2020, 16, 151–163. [Google Scholar] [CrossRef]
9. Banks, A. Black Adolescent Experiences with COVID-19 and Mental Health Services Utilization. J. Racial Ethn. Health Disparities 2022, 9, 1097–1105. [Google Scholar] [CrossRef]
10. Okoro, O.; Vosen, E.C.; Allen, K.; Kennedy, J.; Roberts, R.; Aremu, T. COVID-19 Impact on Mental Health, Healthcare Access and Social Wellbeing—A Black Community Needs Assessment. Int. J. Equity Health 2022, 21, 137. [Google Scholar] [CrossRef]
11. Salami, B.; Idi, Y.; Anyieth, Y.; Cyuzuzo, L.; Denga, B.; Alaazi, D.; Okeke-Ihejirika, P. Factors That Contribute to the Mental Health of Black Youth. CMAJ Can. Med. Assoc. J. 2022, 194, E1404–E1410. [Google Scholar] [CrossRef]
12. Cénat, J.M.; Farahi, S.M.M.M.; Dalexis, R.D. Prevalence and Determinants of Depression, Anxiety, and Stress Symptoms among Black Individuals in Canada in the Context of the COVID-19 Pandemic. Psychiatry Res. 2023, 326, 115341. [Google Scholar] [CrossRef]
13. Bauer, G.R. Incorporating Intersectionality Theory into Population Health Research Methodology: Challenges and the Potential to Advance Health Equity. Soc. Sci. Med. 2014, 110, 10–17. [Google Scholar] [CrossRef] [PubMed]
14. Hankivsky, O.; Cormier, R. Intersectionality and Public Policy: Some Lessons from Existing Models. Political Res. Q. 2011, 64, 217–229. [Google Scholar] [CrossRef]
15. Crenshaw, K.W. Mapping the Margins: Intersectionality, Identity Politics, and Violence against Women of Color. Stanf. Law Rev. 1991, 43, 1241–1299. [Google Scholar] [CrossRef]
16. Crenshaw, K.W. Demarginalizing the Intersection of Race and Sex: A Black Feminist Critique of Antidiscrimination Doctrine, Feminist Theory and Antiracist Politics; The University of Chicago Law School: Chicago, IL, USA, 1989. [Google Scholar]
17. Delgado, R.; Stefancic, J. Critical Race Theory (Third Edition) An Introduction, 3rd ed.; NYU Press: New York, NY, USA, 2017; Volume 20, ISBN 9781479846368. [Google Scholar]
18. McTaggart, R. Principles for Participatory Action Research. Adult Educ. Q. 1991, 41, 168–187. [Google Scholar] [CrossRef]
19. Letiecq, B.; Schmalzbauer, L. Community-Based Participatory Research with Mexican Migrants in a New Rural Destination: A Good Fit? Action Res. 2012, 10, 244–259. [Google Scholar] [CrossRef]
20. Salami, B. Decolonizing Research with Black Youths. Nurs. Philos. 2023, 24, e12435. [Google Scholar] [CrossRef] [PubMed]
21. Salami, B.; Denga, B.; Taylor, R.; Ajayi, N.; Jackson, M.; Asefaw, M.; Salma, J. Access to Mental Health for Black Youths in Alberta. Health Promot. Chronic Dis. Prev. Can. 2021, 41, 245–253. [Google Scholar] [CrossRef]
22. Braun, V.; Clarke, V. Thematic Analysis: A Practical Guide; SAGE Publications: Thousand Oaks, CA, USA, 2021. [Google Scholar]
23. Hassan, S.; Daniel, B.-J. During a Pandemic, the Digital Divide, Racism, and Social Class Collide: The Implications of COVID-19 for Black Students in High Schools. Child Youth Serv. 2020, 41, 253–255. [Google Scholar] [CrossRef]
24. Wallace, D. Post-Traumatic Stress Disorder in Australia: 2020. Australas. Psychiatry 2020, 28, 251–252. [Google Scholar] [CrossRef]
25. Canada Revenue Agency. COVID-19 Benefits from the CRA: Canada Emergency Response Benefit (CERB). Available online: https://www.canada.ca/en/revenue-agency/services/benefits/apply-for-cerb-with-cra.html (accessed on 22 March 2024).
26. Bernard, T.W. When Two Pandemics Collide: Racism, COVID-19 and the Association of Black Social Workers Emergency Response. Can. Soc. Work. Rev. 2020, 37, 175–183. [Google Scholar] [CrossRef]
27. Verlenden, J.V.; Pampati, S.; Rasberry, C.N.; Liddon, N.; Hertz, M.; Kilmer, G.; Heim Viox, M.; Lee, S.; Cramer, N.K.; Barrios, L.C.; et al. Association of Children’s Mode of School Instruction with Child and Parent Experiences and Well-Being during the COVID-19 Pandemic—COVID Experiences Survey, United States, October 8–November 13, 2020. MMWR Morb. Mortal. Wkly. Rep. 2021, 70, 369–376. [Google Scholar] [CrossRef] [PubMed]
28. Morsy, L.; Rothstein, R. Toxic Stress and Children’s Outcomes African American Children Growing up Poor Are at Greater Risk of Disrupted Physiological Functioning and Depressed Academic Achievement Report; Economic Policy Institute: Washington, DC, USA, 2019. [Google Scholar]
29. Johnson, S.B.; Riley, A.W.; Granger, D.A.; Riis, J. The Science of Early Life Toxic Stress for Pediatric Practice and Advocacy. Pediatrics 2013, 131, 319–327. [Google Scholar] [CrossRef] [PubMed]
30. James, C.E.; Turner, T. The Schooling of Black Students in the Greater Toronto Area towards Race Equity in Education; York University: Toronto, ON, USA, 2017. [Google Scholar]
31. Frenette, P.S.; Atweh, G.F. Sickle Cell Disease: Old Discoveries, New Concepts, and Future Promise. J. Clin. Investig. 2007, 117, 850–858. [Google Scholar] [CrossRef]
32. Bajwa, U.; Gastaldo, D.; Di Ruggiero, E.; Knorr, L. The Health of Workers in the Global Gig Economy. Global Health 2018, 14, 127. [Google Scholar] [CrossRef] [PubMed]
33. Street, G.; James, R.; Cutt, H. The Relationship between Organised Physical Recreation and Mental Health. Health Promot. J. Aust. 2007, 18, 236–239. [Google Scholar] [CrossRef] [PubMed]
34. Zulyniak, S.; Williams, J.V.A.; Bulloch, A.G.M.; Lukmanji, A.; Patten, S.B. Physical Activity and Mental Health: A Cross-Sectional Study of Canadian. J. Can. Acad. Child Adolesclent Psychiatry 2020, 29, 241–252. [Google Scholar]
35. Ogden, D.C.; Hilt, M.L. Collective Identity and Basketball: An Explanation for the Decreasing Number of African-Americans on America’s Baseball Diamonds. J. Lewis Res. 2003, 35, 213–227. [Google Scholar] [CrossRef]
36. Early, G. Why Baseball Was the Black National Pastime. In Basketball Jones; Boyd, T., Shropshire, K.L., Eds.; New York University Press: New York, NY, USA, 2000; pp. 27–50. [Google Scholar]
37. Boyd, T. The Day the nigg*z Took over: Basketball, Commodity, Culture, and Black Masculinity. In Out of Bounds; Baker, A., Boyd, T., Eds.; Indiana University Press: Bloomington, IN, USA, 1997; pp. 123–142. [Google Scholar]
38. Dryden, O. Dryden: Racist Responses to COVID-19 Continue to Place All of Us at Greater Risk. Available online: https://medicine.dal.ca/news/2020/09/03/dryden__racist_responses_to_covid_19_continue_to_place_all_of_us_at_greater_risk.html (accessed on 10 March 2024).
39. Bain, B.; Dryden, O.; Walcott, R. The Coversation. April 2020. Available online: https://theconversation.com/coronavirus-discriminates-against-black-lives-through-surveillance-policing-and-the-absence-of-health-data-135906?utm_source=twitter&utm_medium=bylinetwitterbutton (accessed on 10 March 2024).
40. Statistics Canada Black History Month 2023. by the Numbers. Available online: https://www.statcan.gc.ca/en/dai/smr08/2023/smr08_270 (accessed on 22 January 2024).
41. Dhunna, S.; Tarasuk, V. Black–White Racial Disparities in Household Food Insecurity from 2005 to 2014, Canada. Can. J. Public Health 2021, 112, 888–902. [Google Scholar] [CrossRef]
42. Dabone, C.; Mbagwu, I.; Muray, M.; Ubangha, L.; Kohoun, B.; Etowa, E.; Nare, H.; Kiros, G.; Etowa, J. Global Food Insecurity and African, Caribbean, and Black (ACB) Populations during the COVID-19 Pandemic: A Rapid Review. J. Racial Ethn. Health Disparities 2022, 9, 420–435. [Google Scholar] [CrossRef]
43. Food Secure Canada. Growing Resilience and Equity: A Food Policy Action Plan in and the Context of COVID-19; Food Secure Canada: Montreal, QC, Canada, 2020. [Google Scholar]
44. Statistics Canada. Economic Impacts and Recovery Related to the Pandemic; Statistics Canada: Ottawa, ON, Canada, 2021.
45. Morissette, R.; Turcotte, M.; Bernard, A.; Olson, E. Workers Receiving Payments from the Canada Emergency Response Benefit Program in 2020; Statistics Canada: Ottawa, ON, Canada, 2021.
46. Zhang, X.; Bernard, A. The Contribution of Pandemic Relief Benefits to the Incomes of Canadians in 2020; Statistics Canada: Ottawa, ON, Canada, 2022.
47. Badets, N. Food Insecurity and Family Finances during the Pandemic; The Vanier Institute of the Family: Ottawa, ON, Canada, 2020. [Google Scholar]
48. Community Food Centres Canada. Backgrounder: Poverty and Food Insecurity in Canada; Community Food Centres Canada: Toronto, ON, Canada. Available online: https://cfccanada.ca/en/News/Publications/Backgrounders/Poverty-and-food-insecurity-in-Canada (accessed on 17 April 2024).
49. Maretzki, M.; Geiger, R.; Buxton, J.A. How COVID-19 Has Impacted Access to Healthcare and Social Resources among Individuals Experiencing Homelessness in Canada: A Scoping Review. BMJ Open 2022, 12, e058233. [Google Scholar] [CrossRef]
50. Wherry, A. One Country, Two Pandemics: What COVID-19 Reveals about Inequality in Canada. Canadian Broadcasting Corporation (CBC) News. 2020. Available online: https://www.cbc.ca/news/politics/pandemic-covid-coronavirus-cerb-unemployment-1.5610404 (accessed on 10 December 2023).
51. Bowden, O.; Cain, P. Black Neighbourhoods in Toronto Are Hit Hardest by COVID-19—And It’s ‘Anchored in Racism’: Experts. Global News, 2020. [Google Scholar]
52. Robertson, L.J.; Maposa, I.; Somaroo, H.; Johnson, O. Mental Health of Healthcare Workers during the COVID-19 Outbreak: A Rapid Scoping Review to Inform Provincial Guidelines in South Africa. S. Afr. Med. J. 2020, 110, 1010–1019. [Google Scholar] [CrossRef] [PubMed]
53. Silverstein, J. The Global Impact of George Floyd: How Black Lives Matter Protests Shaped Movements around the World. CBS News, 2021. [Google Scholar]
54. Williams, D.R. Stress and the Mental Health of Populations of Color: Advancing Our Understanding of Race-Related Stressors. J. Health Soc. Behav. 2018, 59, 466–485. [Google Scholar] [CrossRef] [PubMed]
55. Centers for Disease Control and Prevention (CDC). Vital Signs: Current Cigarette Smoking among Adults Aged ≥18 Years with Mental Illness—United States, 2009–2011. MMWR Morb. Mortal. Wkly. Rep. 2013, 62, 81–87. [Google Scholar]
56. Nutt, A.E. Suicide Rates for Black Children Twice That of White Children, New Data Show. Washington Post, 2018. [Google Scholar]