African American Participants Research Articles

Addressing Barriers and Facilitators to African Americans' and Hispanics' Participation in Clinical and Genomic Research Through a Bioethical Sensitive Video.

Research advances on effective methods to prevent, diagnose, and treat cancer continue to emerge through clinical and genomic research. Most clinical trial and genomic research participants identify as White which limits the generalizability of research findings to non-White populations. With the development and access to technology, digital delivery of salient and tailored health education may provide innovative pathways to increase representation of African Americans (AA) and Hispanics in research. This project focused on the creation of a bioethical sensitive education video aimed at increasing participation in clinical trials and genomic research by bringing together experts from the community, healthcare, biomedical research, and public health. The goal was to utilize existing educational resources to create a tailored message to address AA/Hispanics' beliefs, values, and bioethical concerns related to participation in clinical and genomic research. Models of behavior change and communication theories were leveraged to frame key components of the message, which then informed the framework for the animated video. Development of the video consisted of six iterative phases: 1) writing sessions; 2) storyboarding; 3) animating; 4) screening/revisions; 5) acceptability testing; 6) finalization. The final animated video is approximately 5min in length and covers several topics including the goal of clinical research, disparities in research participation, bioethical concerns, and genomic research regulations. Increasing AA and Hispanic participation in clinical and genomic research is imperative to achieving health equity. Tailored messages via short videos may assist in addressing the barriers and facilitators towards research participation and increase intentions to enroll in trials.

Reporting and representation of underserved groups in intervention studies for patients with multiple long-term conditions: a systematic review

Objectives Globally, there is a growing number of people who are living with multiple long-term conditions (MLTCs). Due to complex management needs, it is imperative that research consists of participants who may benefit most from interventions. It is well documented that ethnic minority groups and lower socioeconomic status (SES) groups are at an increased risk of developing MLTCs. Therefore, the aim of this systematic review was to determine the level of reporting and representation of underserved groups (ethnic minority and low SES) in intervention studies addressing MLTCs. Design Systematic review. Four databases including Cochrane Library, MEDLINE, CINAHL and Scopus were searched for intervention studies from North America or Europe published between January 1990 and July 2023. Setting Hospital and community-based interventions. We included interventional studies focusing on improving MLTC-related outcomes. Participants Patients with MLTCs. Main outcome measures Total number of studies reporting on ethnicity and SES. Number and proportion of studies reporting by ethnic/SES group. Results Thirteen studies met the inclusion criteria. Only 4 of 13 studies (31%) recorded and reported ethnicity information. Of these four studies that reported on ethnicity, three studies consisted of primarily White participants. Ethnic minority groups were underrepresented, but one study included a majority of African American participants. Moreover, 12 of 13 studies (92%) reported on SES with income and educational level being the primary measures used. SES representation of higher deprivation groups was varied due to limited data. Conclusions For ethnicity, there was a lack of reporting, and ethnic minority groups were underrepresented in intervention studies. For SES, there was a high level of reporting but the proportion of study samples from across the spectrum of SES varied due to the variety of SES measures used. Findings highlight a need to improve the reporting and representation of ethnic minority groups and provide more detailed information for SES through using consistent measures (e.g. education, income and employment) to accurately determine the distribution of SES groups in intervention studies of people with MLTCs.

499 Physiological and Metabolomic Effects of a Community-Based Cardiorenal Protective Diet Intervention in African Americans with Chronic Kidney Disease and Hypertension

OBJECTIVES/GOALS: Chronic kidney disease (CKD) impacts 15% of US adults and African American (AA) persons are disproportionately affected with more than 3 times higher risk of kidney failure when compared to Caucasian persons. This study evaluated the physiological and metabolomic effects of increased fruits and vegetables (F&V) on cardio-renal risk factors. METHODS/STUDY POPULATION: This pilot trial used a prospective, 2-group, randomized study design to evaluate a F&V intervention (N=46), where participants received a prescribed amount of fresh, base-producing F&V compared to a wait-list control (WL) condition (N=45). All participants were African American adults (≥18 years), had self-reported hypertension, and had CKD (Stage 1-3) on screening spot-urine microalbumin test. Participants were measured at baseline and 6 weeks post-intervention. Clinical data (i.e., systolic and diastolic blood pressure, lipid panel, hemoglobin A1C, BMI [body mass index], and albumin to creatinine ratio) were collected. Targeted metabolomic quantitative analysis was performed followed by LC-MS/MS and FIA-MS/MS. Linear mixed models evaluated analyte expression and clinical data. RESULTS/ANTICIPATED RESULTS: AA participants (N=91) were aged 58 ± 10.2 years, 66% female, and 54% had incomes ≤$50,000. T-tests compared change scores (baseline to 6-weeks) between groups. The F&V group demonstrated a significant reduction in BMI of -4.7 ± 10.5 kg/m² compared to a 1.9 ± 8.3 kg/m² increase in the WL group, p<.01. Further, the F&V group demonstrated a reduction in total cholesterol of -15.4 ± 58.8 mg/dL compared to a 17.7 ± 68.8 mg/dL increase in the WL group, p<.05. Non-significant reductions in hemoglobin A1c were found in the F&V versus the WL group. Metabolomic analysis indicated significant variation with an increase of suggestive key biomarkers for worse CKD in the WL versus F&V groups at 6-weeks. DISCUSSION/SIGNIFICANCE: Consumption of only 2 cups of F&V via a community-based intervention reduced CVD risk factors in AA adults with CKD and HTN and resulted in molecular/biochemical changes which may improve long-term kidney health. Further investigation may lead to development of cost-effective dietary intervention models to improve CKD outcomes in AA persons.

214 Racism-based stress injury and biomarkers of stress: A Feasibility and Correlation study

OBJECTIVES/GOALS: Racial discrimination and its associated stress are well-documented contributors to health disparities among African Americans (AA).This feasibility study aimed to acquire methodological insights and build the infrastructure for a subsequent mindfulness interventional study to reduce the effects of racism-based stress. METHODS/STUDY POPULATION: 20 AA participants ( female 12, male 8 )ages 18-50 were enrolled, and clinical data (blood pressure, waist/hip, BMI, lipids, HbA1c, creatinine) for Allostatic Index were collected. Racism-based stress was measured using RBTSSS and the Everyday Discrimination Scale (EDS). Psychometric measures (Coping, resilience, mindfulness, social connection) and sleep (PSQI) were included. Bivariate analysis explored associations between psychological measures and stress biomarkers, supported by Spearman’s correlation analysis. RESULTS/ANTICIPATED RESULTS: Low discrimination (EDS) was associated with a lower Total cholesterol/HDL ratio (2.99 vs. 4.20, p=0.009) and higher HDL (62 vs. 52, p=0.001). Low EDS participants also had better sleep (mean=3, SD=1.33, vs. mean=5.8, SD=3.99, p=0.05*) but reported less coping through drugs and alcohol (p=0.022*) and higher resilience (p=0.047*). Mindfulness negatively correlated to sleep disturbance (r=-0.477 to r=-0.62), coping and resilience. . EDS correlated with overall life stress and drug and alcohol use. Sleep disturbance was negatively associated with social connection (r=-0.569**) and mindfulness. Sleep disturbance and discrimination correlated positively with drug and alcohol use and overall life stress (r=0.52 and r=0.0.59, respectively), while resilience was negatively correlated with sleep (r=-0.45). DISCUSSION/SIGNIFICANCE: Discrimination was associated with increased stress and unfavorable coping, while mindfulness may offer potential benefits for sleep, coping, and resilience. These preliminary findings provide a foundation for further exploring the potential of mindfulness interventions to address the biopsychological impacts of racism-induced stress.

Apolipoprotein E and Alzheimer’s disease pathology in African American older adults

The apolipoprotein-E4 (APOE*4) and apolipoprotein-E2 (APOE*2) alleles are more common in African American versus non-Hispanic white populations, but relationships of both alleles with Alzheimer’s disease (AD) pathology among African American individuals are unclear. We measured APOE allele and β-amyloid (Aβ) and tau using blood samples and positron emission tomography (PET) images, respectively. Individual regression models tested associations of each APOE allele with Aβ or tau PET overall, stratified by racialized group, and with a racialized group interaction. We included 358 older adults (42% African American) with Aβ PET, 134 (29% African American) of whom had tau PET. APOE*4 was associated with higher Aβ in non-Hispanic white (P < 0.0001), but not African American (P = 0.64) participants; racialized group modified the association between APOE*4 and Aβ (P < 0.0001). There were no other racialized group differences. These results suggest that the association of APOE*4 and Aβ differs between African American and non-Hispanic white populations. Other drivers of AD pathology in African American populations should be identified as potential therapeutic targets.

Characterization of African-American Super-Agers in the National Alzheimer's Coordinating Center cohort.

"Super-agers" are adults aged ≥80 with cognitive performance similar to persons two to three decades younger. Characteristics such as larger hippocampal volume, APOE-ε4 allele absence, higher educational attainment, female sex, and lifelong cognitive stimulation are associated with cognitive performance compatible with super-aging. These findings are based on predominantly white research samples. Limited data are available on African-American super-agers. To fill this gap, we explored potential factors associated with super-aging in older African-American adults. Data from African-American participants aged ≥80 in the National Alzheimer's Coordinating Center (NACC) dataset were analyzed. Using global Clinical Dementia Rating (CDR) scores, participants were first categorized as impaired (score ≥0.5) or non-impaired/normal cognition (NC) (score = 0). From the NC group, super-agers were identified using NACC-data-driven cutoffs. Participants were considered super-agers if their memory performance was similar to persons aged 50-60 with NC, and their performance on other domains was within one standard deviation of the mean for persons aged ≥80. We examined group characteristics (NC, super-ager, impaired) using chi-square and ANOVA with pairwise comparisons. Multinomial logistic regression, adjusted for sex and education, evaluated correlates of super-ager group assignment. Data for 1285 African-American participants aged ≥80 were analyzed. We identified 24.7% (n = 316) NC, 4.8% (n = 61) super-agers, and 70.6% (n = 905) impaired. Super-agers were mostly female and more educated, had similar vascular comorbidities as the other groups, and had less sleep disorders, depression, and alcohol use. After adjusting for sex and education, super-ager group assignment was associated with less sleep disorders, less depression, and moderate alcohol use. Participants with controlled vascular risk, mental health, alcohol use, and sleep disorders tended to be in the super-ager group. These factors may be important focus areas in clinical practice to support cognitive resilience with aging in older African-American adults.

Assessment and Prediction of Energy Expenditure: One-Mile Walks and Runs Among African American

Among ethnicities, African Americans exhibit the highest prevalence of obesity. A more comprehensive grasp of energy expenditure while walking and running can be instrumental in managing and averting obesity. Regrettably, there is a scarcity of research dedicated to scrutinizing energy expenditure in African Americans during walking and running. Consequently, the primary objective of this study was to contrast energy expenditure disparities during a one-mile walk and run between African Americans of normal-weight and those classified as overweight. Additionally, the secondary aim was to formulate and validate a predictive equation for energy expenditure tailored specifically to African Americans. A total of 68 African American participants were involved in this study, comprising 21 individuals classified as normal-weight walkers, 27 as overweight walkers, and 20 as runners. Energy expenditure was assessed using indirect calorimetry. To compare energy expenditure across these groups, an Analysis of Variance (ANOVA) was conducted, followed by a post hoc Scheffe test. Linear regression analysis was employed for predicting energy expenditure. Additionally, a dependent t-test and a Chow test were utilized for cross-validating the predictive equation. The findings revealed that runners exhibited significantly higher energy expenditure compared to normal-weight walkers. When energy expenditure was normalized to body weight, runners expended significantly more energy than both normal-weight and overweight walkers. However, when expressed relative to fat-free mass, normal-weight walkers expended less energy than runners and overweight walkers. A prediction equation tailored specifically for African Americans was formulated as follows: EE = 1.012 BW − 9.233 Gender (M = 1, F = 2) + 47.188. The results from cross-validation tests confirmed the validity of this equation. Consequently, we recommend the use of this energy expenditure prediction equation for calculating energy expenditure during one-mile walks or runs for African American adults, whether they fall within the normal-weight or overweight categories.

Abstract 809: Neighborhood disadvantage and prostate tumor aggressiveness among African American and European American men

Abstract Introduction: African American (AA) men experience greater prostate cancer (PC) incidence and mortality compared to European American (EA) men, but the reasons are not fully understood. Some literature has identified connections between neighborhood disadvantage and aggressive PC, and AA men may be more likely to experience these factors than EA men. However, it is unclear if these associations may vary by race. We tested associations of two neighborhood disadvantage measures (neighborhood socioeconomic deprivation and racial segregation) with prostate tumor aggressiveness, overall and separately by race. We hypothesized that they would be positively associated and that associations would be stronger among AA men. Methods: We leveraged data from the University of Maryland Greenebaum Comprehensive Cancer Center Tumor Registry for AA and EA men who were diagnosed with PC from 2004-2021. We geocoded participants’ addresses at diagnosis to determine census tract-based Area Deprivation Index (ADI) and Racial Isolation Index (RI) values. ADI analyses included men diagnosed in 2005 or later (778 AA men and 687 EA men), and RI analyses included men diagnosed in 2009 or later (606 AA men and 454 EA men) based on data availability. We used logistic regression to model the odds of aggressive PC, defined as a Gleason pattern of 4+3 or a total Gleason score &amp;gt;=8, overall and by race. We fit models with scaled ADI or RI as the exposure variable, adjusting for race, age at diagnosis, and year of diagnosis. We also assessed an interaction between each neighborhood measure and race. Results: Median (interquartile range) ADI scores were 118 (101-137) for AA men and 92 (83-102) for EA men, and RI scores were 0.68 (0.35-0.87) for AA men and 0.11 (0.06-0.20) for EA men, indicating greater neighborhood deprivation and AA residential segregation among AA participants. The greatest values for these scores were concentrated in central and west Baltimore. A one-standard deviation (SD) increase in ADI was associated with significantly greater odds of aggressive tumors for AA men (OR=1.28, 95% CI: 1.10, 1.49; p&amp;lt;0.01), but not for EA men (OR=0.85, 95% CI: 0.67, 1.08; p=0.19), and the p-value for interaction (p&amp;lt;0.01) was statistically significant. Similarly, a one-SD increase in RI was significantly associated with aggressive tumors for AA men (OR=1.24, 95% CI: 1.03, 1.49; p=0.03), but not for EA men (OR=1.23, 95% CI: 0.84, 1.80; p=0.29), although the p-value for interaction was not statistically significant. Conclusions: Neighborhood disadvantage was significantly associated with higher odds of aggressive PC. The association of neighborhood deprivation and tumor aggressiveness was stronger among AA men. Additional analyses will consider other measures, including historical redlining, to further evaluate the relationship of neighborhood disadvantage with prostate tumor aggressiveness. Citation Format: Joseph Boyle, Jessica Yau, Jimmie L. Slade, Derrick A. Butts, Jessica Wimbush, Jong Y. Park, Arif Hussain, Eberechukwu Onukwugha, Cheryl L. Knott, David C. Wheeler, Kathryn Hughes Barry. Neighborhood disadvantage and prostate tumor aggressiveness among African American and European American men [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 809.

Chondroitin Sulfate for Osteoarthritis – Is There a Risk for Cancer: an Analysis of Osteoarthritis Initiative Data

The aim of this study was to evaluate the association between chondroitin   sulfate (CS) use and incidence of self-reported cancer during 6-year follow up in the     publicly available Osteoarthritis Initiative (OAI) cohort participants.&#x0D; Materials and Methods: The current study included analysis of 6-year longitudinal data obtained from the OAI progression (n= 1390) and incidence (n = 3284) subcohorts that are publicly available at https://nda.nih.gov/oai/. The inclusion criteria for OAI were the following: age between 45 and 79 years for both subcohorts, symptomatic tibiofemoral knee osteoarthritis (OA) for the progression subcohort, and the presence of established or putative risk factors for incident knee OA for the incidence subcohort. The OAI participants were recruited and enrolled between February 2004 and May 2006 at four recruitment centres in the United States. This study received ethical approval from each recruitment centre. All participants provided written informed consent. To reduce the risk of bias, only participants who did not take CS at baseline were included in the analysis (a “new-user” design).&#x0D; Results: 570 (18%) new users of CS and 2597 (82%) CS non-users were compared. In the CS user group, 294 (51.6%) participants received CS for more than one year, 291 (33.5%) for more than 2 years, 123 (21.6%) for more than 3 years, and 60 (10.5%) for more than 4 years. None of the participants received CS for more than 5 years. CS users and non-users were of the same age, had similar male/female ratio, and similar body mass index. In the non-user group, there were more African-American participants and there were more current smokers. 160 (6.2%) and 37 (6.5%) cases of incident self-reported cancer in the non-users and user groups were identified. There was no association between the use of CS and incident self-reported cancer in the non-adjusted analyses. The adjustments for age, race and smoking status did not change the results.&#x0D; Conclusion: The results of the current study did not show an association between CS use and self-reported cancers. Considering the complex function of CS in the development and progression of malignant tumors, there is a need for further epidemiological studies evaluating CS effects on specific types of cancers and in different genetic backgrounds.

Respectful Maternity Care in the United States-Characterizing Inequities Experienced by Birthing People.

The purpose of this study is to understand experiences of respectful maternity care (RMC) from the perspective of birthing people in the United States from 2013 to 2018. We conducted an online cross-sectional survey of United States birthing people ages 18-50 in April 2018 using SurveyMonkey Audience. Quantitative survey data consisted of demographics and responses to RMC indicators. Qualitative data consisted of comments from individuals regarding their birth experiences. 1036 birthing people participated in the survey. Most births (95%) occurred in hospitals. 16.3% of Black or African American participants reported discrimination compared to 5.5% of participants who did not identify as Black or African American (p < 0.001). Participants who speak a language other than English were also more likely to report discrimination. 19.5% of all respondents felt neglected during their birth experience. Most prevalent experiences of disrespect and mistreatment were related to neglect (most commonly in postpartum phase of care), poor interpersonal communication, lack of respect for patient wishes, negative experience with breastfeeding services, peripartum complications, and discrimination. Birthing people in the United States experience many forms of mistreatment, particularly those who identify as Black or African American or speak a language other than English. Patients described experiencing neglect most commonly after birth-an opportunity to improve the provision of RMC postpartum. Strategies to improve quality of maternal health care in the United States should include the provision of RMC as part of a larger effort to reduce inequities in maternal health experiences and outcomes.

Uncorrected Refractive Error in the African American Eye Disease Study

Refractive error remains the largest cause of correctable visual impairment in the US. Correction of refractive error will reduce visual impairment and its associated morbidity but also improve quality of life and productivity. To determine the burden of and risk factors (RFs) associated with any uncorrected refractive error (UCRE) and unmet refractive need (URN) in a population-based sample of African American adults. This cross-sectional study, conducted from April 2014 to April 2018, included a population-based sample of self-identified African American participants 40 years and older from 30 contiguous census tracts in Inglewood, California. Participants underwent a complete ophthalmic examination and an in-home-administered questionnaire to assess sociodemographic, lifestyle, biological, medical, and health care and eye care usage RFs associated with UCRE and URN. Measurements of visual acuity (VA) were performed using a standard Early Treatment Diabetic Retinopathy Study protocol. Noncycloplegic automated refraction with supplemental subjective refraction was performed. UCRE was defined as an improvement of 2 or more lines with refraction in the better-seeing eye. URN was defined as an improvement of 2 or more lines with refraction in the better-seeing eye in those persons who were visually impaired. Sex- and age-specific burden of UCRE and URN were calculated, and multiple regression analyses were used to identify independent RFs. Study data were analyzed from May 2018 to December 2023. Presence or absence of correctable refractive error. Self-reported sex- and age-specific prevalence of and risk indicators of UCRE and URN. Of the 7957 eligible participants in the African American Eye Disease Study (AFEDS), 6347 (80%) completed both the in-home interview and the clinical examination. Of these, 6337 participants (mean [SD] age, 61 [11] years; 3997 female [63%]) with complete refractive error data were included in the analysis. Refractive error-related correctable visual impairment was present in over two-thirds of participants with visual impairment (68.7%). The overall prevalence of any UCRE was 14.6% (925 of 6337), and the overall prevalence of any URN was 5.4% (URN1 [those with presenting VA of worse than 20/40 in the better-seeing eye but who could achieve 20/40 or better with correction], 157 of 2893; URN2 [those with presenting VA of worse than 20/40 in the better-seeing eye but who could achieve an improvement of 2 or more lines with refractive correction], 155 of 2891). Results of this cross-sectional study suggest a high burden of refractive error-associated correctable refractive error in African American adults, making it the leading cause of visual impairment in this population. Providing universal coverage for vision care and prescription glasses is an affordable and achievable health care intervention that could reduce the burden of visual impairment in African American adults by over two-thirds and likely raise the quality of life and work productivity, especially in this vulnerable minority population.

“License to Do Evil in the Name of Good”: The Legacy of Anti-Electoral Violence and Organizational Success During the Wilmington Coup of 1898

This paper seeks to analyze the impact of local political actors on the development of the Wilmington coup of 1898, an event that stands out in American history due to the violent overthrow of a sitting city government. The event has been studied more in recent decades by Prather, Gilmore, and the state of North Carolina, and they tend to focus on the aspects of race and gender that pervaded the buildup to the coup against a government with African-American civic participation. I build on the existing scholarship to argue that, while white supremacy and gender hierarchy in the South were important to understand why the participants were convinced to engage in political violence more broadly, the influence that a group of dedicated conspiracists had on the events in Wilmington shows that it took the proper urging and coordination for the coup to unfold and succeed at all. Through comprehensive military planning and the nimble adaptation of rhetoric, Wilmington succeeded where other insurrections failed. I will also argue that the conditions and tactics that allowed Wilmington to succeed can be found in modern acts of political violence, such as the Capitol Insurrection.&amp;nbsp;

Differences in dietary acceptability, restraint, disinhibition, and hunger among African American participants randomized to either a vegan or omnivorous soul food diet

The Nutritious Eating with Soul study was a 24-month, randomized behavioral nutrition intervention among African American adults. This present study, which is a secondary analysis of the NEW Soul study, examined changes in dietary acceptability, restraint, disinhibition, and hunger. Participants (n = 159; 79% female, 74% with ≥ college degree, mean age 48.4 y) were randomized to either a soul food vegan (n = 77) or soul food omnivorous (n = 82) diet and participated in a two-year behavioral nutrition intervention. Questionnaires assessing dietary acceptability (Food Acceptability Questionnaire; FAQ) and dietary restraint, disinhibition, and hunger (Three-Factor Eating Questionnaire; TFEQ) were completed at baseline, 3, 6, 12, and 24 months. Mixed models were specified with main effects (group and time) and interaction effects (group by time) to estimate mean differences in FAQ and TFEQ scores using intent-to-treat analysis. After adjusting for employment, education, food security status, sex, and age, there were no differences in any of the FAQ items, total FAQ score, dietary restraint, disinhibition, and hunger at any timepoint except for one item of the FAQ at 12 months. Participants in the vegan group reported a greater increase in satisfaction after eating a meal than the omnivorous group (mean difference 0.80 ± 0.32, 95% CI 0.18, 1.42; P = 0.01). This is one of the first studies to examine differences in dietary acceptability, hunger, and other eating factors among African American adults randomized to either a vegan or omnivorous soul food diet. The findings highlight that plant-based eating styles are equally acceptable to omnivorous eating patterns and have similar changes in hunger, restraint, and disinhibition. These results suggest that plant-based eating styles can be an acceptable dietary pattern to recommend for cardiovascular disease prevention and may result in greater post-meal satisfaction.

Intergenerational Influence of African American, Caribbean and Hispanic/Latino Adults Regarding Decision to Participate in Health-Related Research.

Introduction: Identifying effective strategies to enroll African American, Caribbean, and Hispanic/Latino adults ≥65 years of age in health research is a public health priority. This study aimed to explore intergenerational influence (IGI) among these populations living throughout Florida. Methods: African American, Caribbean, and Hispanic/Latino adults ≥65years of age and a trusted family member/friend between 25-64years participated in virtual listening sessions (LS). Culturally matched facilitators used a semi-structured guide to lead LS that was recorded, transcribed, and uploaded into NVivo©. The constant comparative method was used for analysis. Results: 363 African American, Caribbean, and Hispanic/Latino participated in LS. Five (5) themes relate to IGI emerged: (1) parent-child relationships; (2) family caregiving/parental illness experiences; (3) historical research maltreatment; (4) transfer of cultural knowledge; and (5) future generations. Discussion: Our findings support that IGI can be leveraged to increase the participation of African American, Caribbean, and Hispanic/Latino older adults in health research.

The impact of a Telehealth-based Behavioral Lifestyle Program on hypertension control in African American participants: results from the HEALS Med-Tech randomized controlled trial.

The HEALS Med-Tech program offers a unique blend of lifestyle changes and technology to improve hypertension (HTN) management in African Americans (AAs), a group disproportionately affected by cardiovascular disease (CVD).Methods: A randomized controlled trial compared HEALS Med-Tech against usual care for uncontrolled hypertension in AAs, focusing on diet, medication adherence, and telehealth. In a study of 61 participants, HEALS Med-Tech significantly reduced systolic blood pressure by 12.95 mm Hg (p = 0.008) and 9.19 mm Hg (p = 0.013) at 3 and 12 months, respectively, demonstrating improved hypertension control. HEALS Med-Tech demonstrates potential in HTN management for AAs, advocating for culturally tailored, tech-integrated healthcare expansion.

Clinical Trial Racial and Ethnic Disparities in Minimally Invasive Gynecologic Surgery

Study ObjectiveTo study racial and ethnicity disparities in randomized clinical trials (RCT) in Minimally Invasive Gynecologic Surgery (MIGS). DesignCross sectional study. SettingOnline review of all published MIGS RCTs in high-impact journals from 2012 to 2023. PatientsJournals included all Q1 Obstetrics & Gynecology journals, as well as The New England Journal of Medicine, The Lancet, The British Medical Journal, and The Journal of the American Medical Association. The National Institutes of Health's PubMed and the ClinicalTrials.gov websites were queried using the following search terms from the American Board of Obstetrics and Gynecology's certifying examination bulletin 2022 to obtain relevant trials: adenomyosis, adnexal surgery, abnormal uterine bleeding, cystectomy, endometriosis, fibroids, gynecology, hysterectomy, hysteroscopy, laparoscopy, leiomyoma, minimally invasive gynecology, myomectomy, ovarian cyst, robotic surgery InterventionsThe United States (US) Census Bureau data was used to estimate the expected number of participants. We calculated the enrollment ratio (ER) of actual to expected participants for US trials with race and ethnicity data available. Measurements and Main ResultsA total of 352 RCTs were identified. Of these, race and/or ethnicity data were available in 65 studies (18.5%). We analyzed the 46 studies that originated in the US, with a total of 4,645 participants. Of these RCTs only 8 (17.4%) reported ethnicity in addition to race. When comparing published RCT data to expected proportions of participants, White participants were overrepresented [70.8% versus 59.6%, ER 1.66, 95% confidence interval (CI) 1.52-1.81], as well as Black or African American participants (15.4% versus 13.7%, ER 1.15, 95% CI 1.03-1.29). Hispanic (6.7% versus 19.0%, ER 0.31, 95% CI 0.27-0.35), Asian (1.7% versus 6.1%, ER 0.26, 95% CI 0.20-0.34), Native Hawaiian or Other Pacific Islander (0.1% versus 0.3%, ER 0.21, 95% CI 0.06-0.74), and Indian or Alaska Native participants (0.2% versus 1.3%, ER 0.16, 95% CI 0.08-0.32) were underrepresented. When comparing race/ethnicity proportions to the 20 states where the RCTs were conducted, Black or African American participants were underrepresented. ConclusionIn MIGS RCTs conducted in the US, White and Black or African American participants are overrepresented compared to other races, and ethnicity is characterized in fewer than one fifth of trials. Efforts should be made to improve racial and ethnic recruitment equity as well as reporting in future MIGS RCTs.

COVID-19 pandemic's relationship with enrollment at US Alzheimer's Disease Research Centers.

We aimed to characterize the COVID-19 pandemic's relationship with enrollment in US Alzheimer's Disease Research Centers (ADRCs). Using data on 10,105 participants from 30 ADRCs, we conducted interrupted time series analyses to assess the relationship of the pandemic with enrollment and calculate projected dates of enrollment recovery. Participants enrolled during the pandemic (vs pre-pandemic) were more likely to have dementia and be referred by health professionals. The pandemic was associated with a 77% drop in enrollment, with projected trend recovery in March 2024 and 100% recovery in September 2024. COVID was associated with a 91% drop in Black/African American participants, compared to 71% in White participants. Enrollment of both Hispanic and female participants was declining 1.4% and 0.3%/month pre-pandemic. Funders and researchers should account for ongoing COVID-19 impact on ADRD research enrollment. Strategies to speed enrollment recovery are needed, especially for Black/African American and Hispanic groups. Tested COVID pandemic association with enrollment at Alzheimer's Disease Research Centers. During versus pre-pandemic enrollees differed on demographic and clinical variables. Interrupted time series analyses: immediate 77% drop in enrollment related to COVID. Recovery projections: trend recovery in March 2024, 100% recovery in September 2024. Enrollment of African American and Hispanic participants should be prioritized.

US Obstetrician-Gynecologists' Perceived Impacts of Post–Dobbs v Jackson State Abortion Bans

Following the Dobbs v Jackson Women's Health Organization decision in June 2022, 17 US states have functionally banned abortion except in narrow circumstances, and physicians found in violation of these laws face felony charges, loss of their medical license, fines, and prison sentences. Patient impacts are being studied closely, but less research has focused on the consequences for obstetrician-gynecologists (OB-GYNs), for whom medically necessary care provision may now carry serious personal and professional consequences. To characterize perceptions of the impact of abortion restrictions on clinical practice, moral distress, mental health, and turnover intention among US OB-GYNs practicing in states with functional bans on abortion. This qualitative study included semistructured, remote interviews with OB-GYNs from 13 US states with abortion bans. Volunteer sample of 54 OB-GYNs practicing in states that had banned abortion as of March 2023. State abortion bans enacted between June 2022 and March 2023. OB-GYNs' perceptions of clinical and personal impacts of abortion bans. This study included 54 OB-GYNs (mean [SD] age, 42 [7] years; 44 [81%] female participants; 3 [6%] non-Hispanic Black or African American participants; 45 [83%] White participants) who practiced in general obstetrics and gynecology (39 [72%]), maternal-fetal medicine (7 [13%]), and complex family planning (8 [15%]). Two major domains were identified in which the laws affected OB-GYNs: (1) clinical impacts (eg, delays in care until patients became more sick or legal sign-off on a medical exception to the ban was obtained; restrictions on counseling patients on pregnancy options; inability to provide appropriate care oneself or make referrals for such care); and (2) personal impacts (eg, moral distress; fears and perceived consequences of law violation; intention to leave the state; symptoms of depression and anxiety). In this qualitative study of OB-GYNs practicing under abortion bans, participants reported deep and pervasive impacts of state laws, with implications for workforce sustainability, physician health, and patient outcomes. In the context of public policies that restrict physicians' clinical autonomy, organization-level supports for physicians are essential to maintain workforce sustainability, clinician health and well-being, and availability of timely and accessible health care throughout the US.

Estimating dementia risk in an African American population using the DCTclock.

The prevalence of Alzheimer's disease (AD) and related dementias (ADRD) is increasing. African Americans are twice as likely to develop dementia than other ethnic populations. Traditional cognitive screening solutions lack the sensitivity to independently identify individuals at risk for cognitive decline. The DCTclock is a 3-min AI-enabled adaptation of the well-established clock drawing test. The DCTclock can estimate dementia risk for both general cognitive impairment and the presence of AD pathology. Here we performed a retrospective analysis to assess the performance of the DCTclock to estimate future conversion to ADRD in African American participants from the Rush Alzheimer's Disease Research Center Minority Aging Research Study (MARS) and African American Clinical Core (AACORE). We assessed baseline DCTclock scores in 646 participants (baseline median age = 78.0 ± 6.4, median years of education = 14.0 ± 3.2, 78% female) and found significantly lower baseline DCTclock scores in those who received a dementia diagnosis within 3 years. We also found that 16.4% of participants with a baseline DCTclock score less than 60 were significantly more likely to develop dementia in 5 years vs. those with the highest DCTclock scores (75-100). This research demonstrates the DCTclock's ability to estimate the 5-year risk of developing dementia in an African American population. Early detection of elevated dementia risk using the DCTclock could provide patients, caregivers, and clinicians opportunities to plan and intervene early to improve cognitive health trajectories. Early detection of dementia risk can also enhance participant selection in clinical trials while reducing screening costs.

The racial disparity in the Major League Baseball draft, 1965–2001

Racism has been a central element in the history of Major League Baseball. And yet, there is an incredibly rich history of African American baseball in the United States encompassing the Negro Leagues and the celebrated era when rigid racial exclusions from Major League Baseball finally fell giving way in quick succession to the transformative arrival of Jackie Robinson, Willie Mays and Henry Aaron. African American participation on Major League Baseball rosters grew steadily in the decades after Jackie Robinson’s debut, but African American representation in Major League Baseball has precipitously declined in recent years. Within that context, this study explores whether African Americans have been subject to disparate treatment in the Major League Baseball draft. An analysis of more than 9000 selections in the Major League Baseball draft from 1965 to 2001 reveals a significant disparity based on race. Relative to White players, African American players were undervalued in the draft. This disparity is not rooted in the drafts of the 1960s, 1970s, and 1980s. Instead, major league teams began significantly undervaluing African American prospects in the 1990s. The implications of this pattern are particularly notable given baseball’s recent decision to shrink the draft to 20 rounds.