Minority Access Research Articles

Abstract A27: Diversity in multiple myeloma clinical trials

Abstract Background: Multiple myeloma (MM) accounts for approximately 1% of all cancers and 10% of hematologic malignancies in the United States (U.S.). MM occurs in all races, but the incidence in African Americans is two to three times higher than in non-Hispanic whites. MM is also slightly more frequent in men than women (1.4:1). Many clinical trials lack appropriate representation of specific patient populations, limiting the generalizability of the evidence obtained. Therefore, we determined the representation of ethnic minorities, the elderly, and women in MM clinical trials. Methods: Enrollment data from all therapeutic trials reported as completed in clinicaltrial.gov from 2000 to 2016 were analyzed. Clinical trials including other hematologic malignancies and with recruitment outside of the U.S. were excluded. Enrollment fraction (EF) was defined as the number of enrollees divided by the 2013 SEER database MM complete prevalence. Chi-square test was used to estimate differences in categorical data. Results: Out of 177 MM clinical trials (CT), 78 (44%) reported ethnicity with a total of 12,055 enrollees. Regarding enrollees' ethnic composition, 84% were non-Hispanic White (NHW), 8.6% African American (AA), 2.8% Asian, 1.8% Hispanic, and 0.1% Native American/Alaskan Indian. Out of those 78 CT, 52 (66%) were phase II, 15 (19%) phase III, and 11 (14%) phase I. Most of the results were published from 2012 to 2016 (74%). Forty-six (59%) trials were sponsored by industry, 7 (9%) by NCI, and 25 (32%) were investigator initiated. Participation in CT varied significantly across ethnic groups, NHW were more likely to be enrolled in CT (EF of 0.23) than AA (EF of 0.08, p < 0.0001) and Hispanics (EF of 0.05, p< 0.0001). Males had a higher recruitment rate than females (58% vs. 42%), but this could be explained by the higher incidence of MM in males. Enrollees' median age was 62 years. Younger patients (< 65 years) were more likely to be enrolled in CT than the elderly (66% vs. 34%, p<0.0001). Industry-sponsored trials were less likely to recruit AA compared with investigator-initiated trials (7.6% vs. 12%, p<0.01). Conclusions: Despite the higher incidence of MM in African Americans and the elderly, the former only represented 8.6% of the study participants and 66% of these were less than 65 years of age; therefore, we are lacking data in the tolerability of these new agents in our aging MM population. We also observed that industry studies were less likely to recruit AA patients. Collaborations between investigators, sponsors, and the community are necessary to increase our minority and elderly patients' access to clinical trials. Citation Format: Narjust Duma, Miguel Gonzalez Velez, Jesus Vera-Aguilera, Richardo Parrondo, Veronica Mariotti, Jonas Paludo, Yucai Wang, Ronald Go, Alex Adjei. Diversity in multiple myeloma clinical trials [abstract]. In: Proceedings of the Tenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2017 Sep 25-28; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2018;27(7 Suppl):Abstract nr A27.

PGC‐1α, a Novel Substrate for Protein Arginine Methyltransferase 7?

Peroxisome proliferator‐activated receptor γ coactivator 1α (PGC‐1α) is a protein that plays an important role in the regulation of energy metabolism. It participates in the regulation of both carbohydrate and lipid metabolism and is activated by insulin. For these reasons, it has been implicated in obesity, aging, diabetes and cardiomyopathy. Despite many studies on the role of this master regulator, the precise way it becomes regulated remains unknown. A recent study found that PGC‐1α becomes phosphorylated at Ser570 by kinase B (Akt/PKB) and this stops it from promoting gluconeogenesis and fatty acid oxidation. PGC‐1α is also modified by protein arginine methyltransferase 1 (PRMT1) at several arginine residues, which enhance its regulation. In this study, we set out to determine whether PGC‐1α is modified by PRMT7, another member of the PRMT family. We hypothesize that PRMT7 methylates PGC‐1α because it contains many RXR motifs, a known PRMT7 motif. In addition, they both are active at similar temperatures. To test this hypothesis, truncated constructs corresponding to PGC‐1α and full‐length PRMT7 were expressed and purified in bacterial cells. In vitro methylation reactions using tritiated AdoMet were carried out. Through fluorography of the methylation reactions, it was determined that PRMT7 methylates PGC‐1α within amino acid residues 532–640. Upon confirmation of the methylated arginine residue(s) through immunoblotting and mass spectrometry, further studies will be carried out to investigate the function of arginine methylation by PRMT7. These results will enhance our understanding of PGC‐1α with the broader goal of understanding its regulation in the context of obesity and diabetes.Support or Funding InformationCSULA Minority Access to Research Careers‐Undergraduate Student Training for Academic Research (MARC‐U*STAR), Grant: T34 GM008228 and Louis Stokes Alliance for Minority Participation (LSAMP), Grant: HRD‐1302873This abstract is from the Experimental Biology 2018 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

Impact of the new kidney allocation system A2/A2B → B policy on access to transplantation among minority candidates.

Blood group B candidates, many of whom represent ethnic minorities, have historically had diminished access to deceased donor kidney transplantation (DDKT). The new national kidney allocation system (KAS) preferentially allocates blood group A2/A2B deceased donor kidneys to B recipients to address this ethnic and blood group disparity. No study has yet examined the impact of KAS on A2 incompatible (A2i) DDKT for blood group B recipients overall or among minorities. A case-control study of adult blood group B DDKT recipients from 2013 to 2017 was performed, as reported to the Scientific Registry of Transplant Recipients. Cases were defined as recipients of A2/A2B kidneys, whereas controls were all remaining recipients of non-A2/A2B kidneys. A2i DDKT trends were compared from the pre-KAS (1/1/2013-12/3/2014) to the post-KAS period (12/4/2014-2/28/2017) using multivariable logistic regression. Post-KAS, there was a 4.9-fold increase in the likelihood of A2i DDKT, compared to the pre-KAS period (odds ratio [OR] 4.92, 95% confidence interval [CI] 3.67-6.60). However, compared to whites, there was no difference in the likelihood of A2i DDKT among minorities post-KAS. Although KAS resulted in increasing A2/A2B→B DDKT, the likelihood of A2i DDKT among minorities, relative to whites, was not improved. Further discussion regarding A2/A2B→B policy revisions aiming to improve DDKT access for minorities is warranted.

Safety and Outcomes of Transradial Access in Patients with International Normalized Ratio 1.5 or above

PurposeTo examine the safety and outcomes for patients undergoing transradial noncoronary interventions with international normalized ratio (INR) ≥1.5. Materials and MethodsA retrospective review of 2,271 transradial access (TRA) cases performed from July 2012 to July 2016 was conducted. Criteria for inclusion were moderate bleeding risk cases with preprocedure INR ≥1.5. Within the study period, there were 176 moderate bleeding risk procedures (transarterial chemoembolization: 70/176 [39.8%]; Barbeau B: 121/176 [68.8%]; 5-F sheath: 157/176 [89.2%]) performed on 122 patients (age 61.6 ± 12.1 years, 68.9% male, body mass index 28.0 kg/m2) with INR ≥1.5. ResultsTechnical success was achieved in 98.9% of cases. Grade 1/2 hematomas developed in 10 cases (5.7%). Age ≥65 years (P = .042) and female sex (P = .046) were predictive of access site bleeding complications. Fresh frozen plasma (FFP) transfusion was administered in 11.4% of cases (n = 20). Baseline INR and creatinine were significantly different between transfused and nontransfused cases (P values .006 and .028, respectively). Minor access site bleeding occurred in 3/20 cases (15%) receiving prior FFP transfusion and 7/156 nontransfused cases (4.5%), with no significant difference between these 2 groups (P = .072). ConclusionsTRA in patients with elevated INR appears to be safe in our experience. Age ≥65 years and female sex were associated with increased incidence of access site bleeding. Although INR correction was not standardized in this cohort, preprocedure FFP transfusion did not decrease bleeding complications.

Evaluasi Aksesibilitas Learning Object Berdasarkan Web Content Accessibility Guidelines 2.0

Learning Object (LO) is a representation of interactive content that are used to enrich e-learning activities. The goals of this case study were to evaluate accessibility and compatibility factors from learning objects that were produced by using BINUS E-learning Authoring Tool. Data were compiled by using experiment to 30 learning objects by using stratified random sampling from seven faculties in undergraduate program. Data were analyzed using accessibility and compatibility tests based on Web Content Accessibility Guidelines 2.0 Level A. Results of the analysis for accessibility and compatibility tests of Learning Objects was 90% better than average. The result shows that learning objects is fully compatible with major web browser. This paper also presents five accessibility problems found during the test and provide recommendation to overcome the related problems. It can be concluded that the learning objects that were produced using BINUS E-learning Authoring Tool have a high compatibility, with minor accessibility problems. Learning objects with a good accessibility and compatibility will be beneficial to all learner with or without disabilities during their learning process.
 Index Terms—accessibility, compatibility, HTML, learning object, WCAG2.0, web

Politics of street names and the reinvention of local heritage in the contested urban space of Oradea

Ethnically and culturally diverse settlements in Central and Eastern Europe often witness local power-struggles along ethnic/linguistic boundaries that may centre on the visibility of ethnic groups and minority languages in public space (Kettley, C. 2003; Brubaker, R. et al. 2006; Murzyn, M.A. 2008; Dragoman, D. 2011; Csernicsko, I. and Mate, R. 2017). The majority ethnic group, as the possessor of power is in a more favourable position to control and/or limit the access of minorities to be visually present in the cityscape. The aim of this paper is to show (1) how the public space is re-structured and ethnicised by politics and practices of street naming; and (2) how the contestation over public space contributes to the evolvement of alternative city-text. The research was carried out in Oradea/Nagyvarad, a multi-ethnic town in the Romanian-Hungarian border zone. After describing the spatial features and effects of contestation over street names, based on the analysis of press, interviews and survey data the research shows how the local political deal, the evolved individual/minority coping strategies, and the recent interest in tourism development have contributed to the reinvention of local heritage. Finally, looking at the intensified interest towards local heritage (on behalf of both local government and minority politicians) the question arises: whether heritage might enhance the dissolution of the ongoing conflict centred on street names?

Does the edge effect impact on the measure of spatial accessibility to healthcare providers?

BackgroundSpatial accessibility indices are increasingly applied when investigating inequalities in health. Although most studies are making mentions of potential errors caused by the edge effect, many acknowledge having neglected to consider this concern by establishing spatial analyses within a finite region, settling for hypothesizing that accessibility to facilities will be under-reported. Our study seeks to assess the effect of edge on the accuracy of defining healthcare provider access by comparing healthcare provider accessibility accounting or not for the edge effect, in a real-world application.MethodsThis study was carried out in the department of Nord, France. The statistical unit we use is the French census block known as ‘IRIS’ (Ilot Regroupé pour l’Information Statistique), defined by the National Institute of Statistics and Economic Studies. The geographical accessibility indicator used is the “Index of Spatial Accessibility” (ISA), based on the E2SFCA algorithm. We calculated ISA for the pregnant women population by selecting three types of healthcare providers: general practitioners, gynecologists and midwives. We compared ISA variation when accounting or not edge effect in urban and rural zones. The GIS method was then employed to determine global and local autocorrelation. Lastly, we compared the relationship between socioeconomic distress index and ISA, when accounting or not for the edge effect, to fully evaluate its impact.ResultsThe results revealed that on average ISA when offer and demand beyond the boundary were included is slightly below ISA when not accounting for the edge effect, and we found that the IRIS value was more likely to deteriorate than improve. Moreover, edge effect impact can vary widely by health provider type. There is greater variability within the rural IRIS group than within the urban IRIS group. We found a positive correlation between socioeconomic distress variables and composite ISA. Spatial analysis results (such as Moran’s spatial autocorrelation index and local indicators of spatial autocorrelation) are not really impacted.ConclusionOur research has revealed minor accessibility variation when edge effect has been considered in a French context. No general statement can be set up because intensity of impact varies according to healthcare provider type, territorial organization and methodology used to measure the accessibility to healthcare. Additional researches are required in order to distinguish what findings are specific to a territory and others common to different countries. It constitute a promising direction to determine more precisely healthcare shortage areas and then to fight against social health inequalities.

Evaluating Implementation of the Early College Model through a Theory of Change

Early College is an initiative aimed at helping first-generation, minority, and low-income students access college courses while they are still in high school. Early College was one of the Race to the Top (RttT) initiatives funded in Ohio. Examining Early College through a change theory lens, we present findings from a two-year case study of Ohio's Early College initiative as to the opportunities and challenges of implementing Early College as an innovation for low-performing schools. Findings from the two sites highlight both similarities and differences according to the context, mission, and vision of the leaders implementing the reform.

Impact of language barriers on access to healthcare for official language minority Francophones in Canada.

While there is strong international evidence that language barriers present obstacles to healthcare access, quality and safety, little research has been conducted on the experience of official language minorities in Canada. This multiple method research used on-line and paper-based surveys, combined with semi-structured individual interviews to explore the experience with access to care of Francophone minorities living in four Canadian provinces. The majority of Francophones surveyed reported limited access to French language services and described an environment where low importance is given to addressing language barriers within the health system. Even when services are available, the lack of services in French sometimes results in avoidance of care. Results confirm that many Francophones face similar barriers to care as other language minorities in Canada. Strategies to improve access for official language minorities are discussed.

Democratisation or credentialism? Public policies of expansion of higher education in Latin America

ABSTRACTIn recent decades, many Latin American governments have implemented policies to expand opportunities in higher education, aiming at reducing discrimination and social inequalities. These policies have taken different forms, according to the peculiarities of the respective higher education systems. The purpose of this paper is to explore the scope and limitations of these policies. We develop our analysis of theoretical literature on the subject, and review empirical information available from secondary sources of recent experience in five countries: Argentina, Brazil, Chile, Mexico and Venezuela. Argentina has increased opportunities for disadvantaged social sectors by expanding the public sector. Brazil has attempted to improve access for ethnic and social minorities in both public and private institutions. Chile is a unique case because of the continuing commitment to allow market forces to shape higher education. In Mexico, increased opportunities for access have resulted from the creation of intercultural universities and technical institutions in the public sector, as well as through growth in the private sector. Finally, in Venezuela, expansion occurred through the creation of a new system of universities that operates in parallel to traditional public institutions. We note that, in all cases, the policies reflect an underlying belief that there are only benefits to unlimited expansion, without regard to possible consequences, such as an excess of university graduates in economies with limited job opportunities for them. Moreover, these policies do not take into consideration the deficit of cultural and educational capital of young people who come from the most marginalised social sectors, deficits that may hinder their success. Concepts such as ‘overeducation’ or ‘credencialism’ call into question that optimistic belief and explain the limitations of the coverage expansion in terms of real democratisation.

The Effect of UVB Irradiation on Histone H4

Histone modifications such as phosphorylation, alter chromatin and accessibility to transcription factors. Consequently, they play an important role in gene expression. During normal cell development, histone H4 serine 1 becomes phosphorylated and arginine 3 becomes methylated. Using different proteins, studies have established a crosstalk relationship between these two modifications whereby methylation will block phosphorylation. In histone H4, serine 1 becomes phosphorylated in response to DNA damage. In addition, there is evidence that exposure to ultraviolet light increases the activity of protein arginine methyltransferase 1 (PRMT1), the enzyme responsible for arginine 3 methylation. However, whether phosphorylation or methylation can directly respond to environmental stresses, such as ultraviolet B (UVB) irradiation, remains unknown. It is also not known whether phosphorylation or neighboring arginine methylation respond synergistically or antagonistically to UVB irradiation. Preliminary in vitro studies have confirmed that histone H4 is methylated by PRMT1 at arginine 3. The effects of UVB irradiation will be assessed by directly measuring the amount of serine 1 phosphorylation and arginine 3 methylation of histone H4 under set conditions. In vitro modification reactions and HeLa cells incubated with kinase and methyltransferase inhibitors, will undergo UVB (280 – 315 nm) irradiation through a homemade beam collimating device. Histone H4 will be purified and the amount of phosphorylation and methylation will be detected by immunoblotting. We hypothesize that methylation of arginine 3 at histone H4 will increase in response to UVB irradiation and block neighboring phosphorylation of serine 1. PRMT1 is implicated (along with p300, a lysine acetyltransferase) in a signal transduction pathway that is responsible for the production and function of p53, a tumor suppressor. If the amount of arginine methylation increases in response to ultraviolet light, it will confirm that PRMT1 plays an indirect role in the suppression of tumors via histone modification. Finally, the effect of this modification on serine 1 phosphorylation will lead to a greater understanding of the histone code.Support or Funding InformationThis research was funded through the Minority Access to Research Careers Undergraduate Student Training in Academic Research Fellowship Program (NIH Grant GM008228)

The gap between entitlement and access to healthcare: An analysis of “candidacy” in the help-seeking trajectories of asylum seekers in Montreal

In 2012 the Canadian government made significant cuts to its historically strong federal refugee health coverage plan. While this policy had negligible effects on the level of coverage provided to asylum seekers in Quebec, there is evidence that this group nonetheless experienced reduced healthcare access during the period of polarized national debate that ensued. This study engaged the “candidacy” model of healthcare access to illuminate factors contributing to the observed gap between entitlement and access. Twenty-five semi-structured interviews were conducted with asylum seekers in Montreal to elicit narrative accounts of difficulties encountered in the pursuit of healthcare. Thematic content analysis in conjunction with a holistic examination of help-seeking trajectories revealed several important barriers to obtaining care, including widespread confusion and misinformation about refugee health coverage, cumbersome administrative procedures specific to asylum seekers, and long wait times. Feelings of marginalization and insecurity associated with precarious migratory status appeared to amplify the effects of these barriers to care such that even a minor access difficulty could have dramatic effects on future help-seeking and access outcomes. Demonstrating awareness of public discourses interrogating their deservingness of health coverage, participants often interpreted access difficulties as evidence of health professionals' unwillingness to serve them. Such interpretations conspired with fears associated with the asylum claim process to suppress self-advocacy, further help-seeking, and at times even information-seeking. This finding is particularly significant in that it suggests a mechanism through which hostile public representations of forced migrants–increasingly prevalent in Western host countries–can themselves endanger the physical, psychological, and social health of highly disadvantaged populations, even in the presence of strong entitlement policies. We close with reflections on how theoretical models of healthcare access might be adjusted to better accommodate the unique experiences of precarious status migrants.

Direct percutaneous transaxillary implantation of a novel self-expandable transcatheter heart valve for aortic stenosis.

The aim of this study was to evaluate safety, feasibility, and efficacy of transaxillary TAVI using a novel self-expandable transcatheter heart valve (THV) via a direct percutaneous technique. The analysis comprises 12 consecutive patients with severe aortic stenosis treated with the ACURATE Neo™ THV (Symetis) by direct percutaneous transaxillary access. Patients presented with a mean age of 79.9 ± 6.2 years and high calculated surgical risk (logEuroSCORE I: 19.55 ± 15.00%; STS PROM score: 5.42 ± 3.25%). Transaxillary TAVI was performed in 11/12 via the left and in 1/12 via the right-sided axillary artery. Device success was achieved in all patients (12/12). Mortality rate at 30 days was 0% (0/12). No major and one minor access site complication (1/12) occurred. No major or life-threatening access site-related bleeding resulted. None of the patients suffered from postprocedural stroke/transient ischemic attack. There was no need for a permanent pacemaker. Mean effective orifice area post implantation was 2.1 ± 0.29cm2 and mean aortic gradient 6.2±1.5mmHg. In none of the patients, greater than moderate aortic regurgitation or paravalvular leakage was detected at discharge (0/12). Our study suggests that the implantation of the second-generation self-expandable ACURATE Neo™ via a transaxillary access is technically feasible and safe and yields excellent short-term clinical results. © 2017 Wiley Periodicals, Inc.

Safety and efficacy of the percutaneous transaxillary access for transcatheter aortic valve implantation using various transcatheter heart valves in 100 consecutive patients

ObjectivesTranscatheter Aortic Valve Implantation (TAVI) can be performed via the transaxillary approach, but data about complications and procedural outcome is limited. IntroductionTAVI is an established treatment option for patients at high risk for conventional aortic valve replacement. Nowadays, the transfemoral approach is the most commonly used access for TAVI. Nevertheless, the transfemoral access is not suitable in many patients necessitating alternative approaches. MethodsWe analyzed the outcome of 100 consecutive cases receiving percutaneous transaxillary TAVI at two different hospitals. Data were retrospectively analyzed by means of procedural, hemodynamic and clinical outcome. In addition, 1st versus 2nd generation devices were analyzed. ResultsMean age was 78.2±2.1years and the logEuroSCORE I was 24.6±13.9%. Transaxillary TAVI was performed in 85% via the left and in 15% via the right axillary artery. Device success was achieved in 95%. In general, there was a clear learning curve with this approach. No patient experienced a major and 11% a minor access site complication. There was one procedural death (annular rupture) and one peri-procedural TIA. 23% of the patients received a new pacemaker. At discharge, effective orifice area was 1.94±0.16cm2 and the mean aortic gradient was 6.8±2.1mmHg. Moderate aortic regurgitation/paravalvular leakage was documented in two patients. Mortality rates at 30days and one year were 6% and 14.8%. Last but not least, 2nd generation devices showed improved procedural outcomes. ConclusionsThe percutaneous transaxillary access for TAVI is technically feasible and safe thereby yielding excellent clinical results. Condensed abstractWe investigated In 100 consecutive patients undergoing percutaneous transaxillary transcatheter aortic valve implantation thereby demonstrating that this approach is technically feasible and safe with acceptable numbers of minor vascular complications.

TRAFFIC ACCIDENTS PREDICTION MODEL USING FUZZY LOGIC: ASWAN DESERT ROAD CASE STUDY

Transportation system plays an important role in human life and is one of the main indicators of the standard of living. Traffic accidents represent a major problem threatening people’s lives, health, and property. Also, these accidents on roads can threat the management of transportation system. Being unsafe, this system will be unable to work properly. Therefore, traffic accidents prediction models may help for understanding accident causes and the number of their occurrence under certain circumstances.This study aims at developing a prediction model for Aswan western desert road by using fuzzy logic which is known for its benefits in dealing with uncertainty problems. This is to be carried out by the use of actual accident data obtained from the Egyptian General Authority for Roads, Bridges, and Land Transport (GARBLT) with survey data for pavement conditions, traffic flow presented as average hourly traffic per lane (AHTL), speed, minor access, traffic signs conditions and road width which are the inputs of the model.Several types of model were developed using the Poisson regression model, negative binomial regression model and negative multinomial model based on generalized linear regression technique. On the contrary, the relationship between an accident and the influencing factors is nonlinear and complicated and the using of fuzzy is preferable because fuzzy logic system is good for dealing with nonlinear input and output relationship. The overall results of the study reveal that the predicted results using the proposed fuzzy logic system produce accurate and stable traffic accident predictions.

Femoral artery anatomy-tailored approach in transcatheter aortic valve implantation.

IntroductionThe best techniques for reduction of femoral access site complications after transcatheter aortic valve implantation (TAVI) remain the object of research.AimWe report on a single center’s experience with TAVI performed via the femoral access site.Material and methodsBetween September 2010 and September 2015, 152 consecutive patients underwent TAVI in our department. Of them, 101 patients with CoreValve implantation from the femoral access site were included in the analysis. The femoral artery anatomy-tailored approach was introduced in 2013 in order to reduce the rate of access-site complications. Patients were assigned to percutaneous puncture or surgical cut-down depending on the femoral artery anatomy assessed in computed tomography. The study patients were divided into two subgroups: group A – patients treated before January 2013, before introduction of the tailored approach program (n = 34); and group B – patients treated between January 2013 and April 2015 (n = 67).ResultsThe access site complication rate significantly decreased from 35.3% in group A (n = 12) to 7.5% in group B (n = 5) (p = 0.0012). Both minor and major access site complications were more frequent in group A (p = 0.04 and 0.016, respectively). In-hospital mortality was 8.8% (n = 3) in group A and 1.5% (n = 1) in group B (p = 0.1).ConclusionsThe femoral artery anatomy-tailored approach significantly reduces the incidence of access site complications in TAVI patients.

The opinions of adults about the ban on cigarette sales to minors.

BackgroundSelling of tobacco products to minors has been banned since 1996 by the tobacco control law in Turkey. However, it is also important for the public to support practices that prevent the access of tobacco products to minors. In addition, every individual has the responsibility of carrying out society based programs that restrict access to tobacco products especially to children and the youths. Social sensitivity is considered an important factor in the prevention of tobacco use. This study aims to learn about the opinions and attitudes of adults with regards to minors access to tobacco products.MethodsThe study was a descriptive study conducted in nine city centers in Turkey. The total number of participants reached was 3241. The questionnaire was developed by the research team and consisted of 22 questions concerning knowledge and behaviors of adults on restriction of tobacco sales to minors and their observations with regards tobacco sales to minors. Data was collected through face to face interview. Pearson chi-square test was used for the bivariate analysis whereas logistic regression was investigate the relationship between “the participant’s response against tobacco sales to minors” and the following explanatory variables; “age”, “educational status”, “income level”, “working status”, “minors access to cigarettes”, “smoking ratio in high school” and “sales of tobacco to minors”.ResultsMore than half of the participants (60.5%) belonged to the age group 25–44 years, 61.3% graduated from high school or university. Most of the participants were smoker (39.2%) or ex-smoker (19.1%), and 41.7% of the participants was non-smoker. A greater proportion of the participants (76.2%) believed that smoking prevalence was greater than 40% among high school students. One in four (27.8%) adults did not know that tobacco control law bans sell of tobacco products to minors in Turkey. More than half of the participants (57.1%) ever witnessed tobacco sales to minors and 63.6% of them did not act when confronted with the event. Almost all (96.8%) of the respondents thought that access of minors to tobacco products was not difficult. The results of logistic regression of participant’s response against tobacco sales to minor and related factors for current smokers showed that respondents who believed smoking ratio in high school was 4–5 adolescent out of 10 (aOR: 1.59; 95% CI: 1.09–2.34) were more likely to give a warning or informing the police or other people as compared to respondents whose perception on the smoking ratio among high school students was 6–7 adolescents out of 10. The results of logistic regression of non-smokers’ response against tobacco sales to minor were who are from higher educational level, higher economic status, working status and who believed smoking ratio in high school was 4–5 adolescent out of 10 and 2–3 adolescent out of 10 were more likely to give a warning or informing the police or other people as compared to the others.ConclusionsAlthough laws prohibiting the sale of tobacco products to the under age group is very important with regards to accessibility of minors to tobacco products, most of the study participants believed that minors can still easily access tobacco products, and more than half of the participants did not act when confronted with the event. The education, information and monitoring program most especially as it concerns salesman, should be reviewed and strengthened to obey the rules on sales of tobacco products to minors. Education program should be carried out to increase the knowledge and awareness of the community for sale of tobacco to minors. Social sensitivity is important for the prevention of tobacco use and every individual have a responsibility in carrying out this society based program, most especially as it related to prevention of tobacco usage among children and youths.

Segregation by race and income in the United States 1970–2010

A systematic analysis of residential segregation and spatial interaction by income reveals that as income rises, minority access to integrated neighborhoods, higher levels of interaction with whites, and more affluent neighbors also increase. However, the income payoffs are much lower for African Americans than other groups, especially Asians. Although Hispanics and Asians have always displayed declining levels of minority-white dissimilarity and rising levels of minority-white interaction with rising income, income differentials on these outcomes for blacks did not appear until 1990 and since then have improved at a very slow pace. Given their higher overall levels of segregation and income's limited effect on residential attainment, African Americans experience less integration, more neighborhood poverty at all levels of income compared to other minority groups. The degree of black spatial disadvantage is especially acute in the nation's 21 hypersegregated metropolitan areas.

Racial disparities in birth care: Exploring the perceived role of African-American women providing midwifery care and birth support in the United States.

Midwifery care has been linked to positive birth outcomes. Despite the broad racial disparities in maternal and infant outcomes in the United States (US), little is known about the role of minority women in either providing or receiving this type of care. A vibrant community of minority women, who self-identify as providing these services, exists online. In this exploratory study we ask how they describe their role; view their practice; and position themselves in the broader discussions of racial health disparities in the US. Using an internet mediated qualitative design we analyse online narratives from self-described African-American nurse-midwives, lay midwives and birth assistants; we found 28 unique websites. We collected and analysed narrative material from each site. We used a thematic analysis approach to identify recurrent and emergent themes in relation to the study question. Narratives identified a strong link to the past, as providers viewed their practice in a historical perspective linking African roots, to the diaspora, and to current African-American struggles. Providers engaged both in direct clinical work, and in activist roles. Advocacy efforts sought to expand numbers of minority birth care workers and to extend the benefits of woman-centred birth care to underserved communities. Results demonstrate the continued existence and important role of diverse types of African-American birth care providers in minority communities in the US. Recognition, support, and increasing the number of midwives of colour is important in tackling racial inequalities in health. Further research should explore minority access to woman-centred care.

Impact of Total Vending Machine Restrictions on US Young Adult Smoking.

In an analysis of smoking using a longitudinal sample of US young adults, we extend research on tobacco vending machine restrictions beyond its prior focus on minors by examining the influence of total vending machine restrictions, which apply to adult-only facilities and represents the only remaining vending machine exemption since the enactment of the Family Smoking Prevention and Tobacco Control Act. We identify whether the passage of a restriction influences an individual's smoking on repeated observations, and if the propensity is lower among those who live in locations with a restriction. Combining a repository of US tobacco policies at all geographic levels with the nationally-representative geocoded National Longitudinal Survey of Youth 1997 and Census data, we use multilevel logistic regression to examine the impact of total vending machine restrictions on any past 30-day smoking and past 30-day smoking of one pack per day among young adults (ages 19-31), while accounting for other tobacco control policy, community, and individual covariates. We find that total vending machine restrictions decrease any recent smoking (OR = 0.451; p < .01), net of other covariates. Though the passage of a restriction does not alter an individual's smoking over time, living longer in an area that has a restriction lowers the propensity that an individual will smoke at all (OR = 0.442; p < .05). We find no effect of total vending machine restrictions on smoking a pack daily. Total vending machine restrictions appear to be an effective, yet highly underutilized, means of tobacco control. Past scientific inquiries examining vending machine restrictions have focused upon minor access, adolescent perceptions of availability, and subsequent smoking. The potential for total vending machine restrictions, which extend to adult-only facilities, to influence patterns of smoking among those of legal age, remains significant. Those who are subject to total vending machine restrictions for longer periods are less likely to have recently smoked, but individuals do not change their smoking behavior in response to the passage of a restriction. These restrictions do not affect heavy smokers. Such policies are an effective but underutilized policy mechanism to prevent smoking among young adults.