African Caribbean Blacks Research Articles

Barriers to and enablers of the early diagnosis of breast cancer among women from ethnic minority backgrounds in the UK: protocol for a qualitative evidence synthesis

IntroductionBreast cancer is the most commonly diagnosed cancer in women of all ethnic groups in the UK. The largest single ethnic groups in the UK are white, Indian, Pakistani, black...

Social determinants of health and long-term conditions in people of Black African and Black Caribbean ethnicity living with HIV in London: Aqualitative study.

People living with human immunodeficiency virus (HIV) are disproportionately impacted by socioeconomic deprivation and are at increased risk of developing other long-term conditions (LTCs). These illnesses require transformative action to tackle the adverse effects on their health. Data on lived experiences of LTCs among people living with HIV of Black African and Black Caribbean ethnicities are sparse, and how people with LTCs are impacted by social determinants of health (SDoH). Through a phenomenological study design this qualitative study, conducted in 2022, comprised four focus group discussions (FGDs) with 20 people of Black ethnicities living with HIV were purposively invited from a community organisation (CO) in London, including four semistructured interviews with CO staff. Following transcription, qualitative data were analysed thematically and measures to validate the findings were implemented. The findings are presented in terms of the following four levels of SDoH: (1) individual determinants (such as the impact of SDoH on lifestyle modification and self-management); (2) interpersonal determinants (such as positive experiences of accessing healthcare for LTCs); (3) clinical determinants (such as care pathway barriers)and (4) systemic determinants (such as systemic barriers related to race/ethnicity). It is necessary to provide ongoing and interactive education to community members who live with HIV, focusing on risks and management of LTCs. Additionally, individuals would benefit from support to navigate increasingly complex and fragmented health services. Health Service staff require cultural competence when caring for patients of Black African and Black Caribbean ethnicities with complex health and psychosocial needs. The research team collaborated with an HIVCOin South London from the very start of the project to agree the study design and learn about the realities of their daily lived experiences. Community collaborators helped to develop the semistructured interview and FGDtopic guides, and were directly involved in the data gathering, analysis and validation.

Race and Ethnicity, Deprivation, and Infant Mortality in England, 2019-2022

England has one of the highest infant mortality rates in Europe. Much of the variation in infant mortality rates between races and ethnicities may be due to socioeconomic factors, but how deprivation and race and ethnicity are associated with infant mortality is unclear. To investigate the association of infant race and ethnicity with the infant mortality rate in England, adjusted for preterm birth and level of deprivation. This cohort study included children who died younger than 1 year of age, born at or after 22 weeks' gestation, occurring from April 1, 2019, to March 31, 2022, in England. Characteristics of the infant were derived from death notifications. The racial and ethnic groups were derived from National Health Service data and were reported by the parents and characterized using the Office of National Statistics classification: Asian or Asian British (Bangladeshi, Chinese, Indian, Pakistani, or any other Asian background), Black or Black British (African, Caribbean, or any other Black background), multiracial (White and Asian, White and Black African, White and Black Caribbean, or any other multiracial background), White or White British (British, Irish, any other White background, or Gypsy or Irish Traveler), and other (Arab or any other racial or ethnic group). Risk of death for all racial and ethnic groups and relative risk of death compared with the reference group (White) were calcuated. Analyses were repeated, adjusting for deprivation, gestational age of infants, and region of England. A total of 5621 infants who died younger than 1 year of age were reported to the National Child Mortality Database. A total of 2842 of 5130 infants (55.4%) were male; the median gestational age was 33 weeks (IQR, 25-38 weeks); of 5149 infants, 927 (18.0%) were Asian, 448 (8.7%) were Black, 3318 (64.4%) were White, 343 (6.7%) were multiracial, and 113 (2.2%) were from other racial and ethnic groups; and the median deprivation score was 4 (IQR, 3-5). In the unadjusted analysis, the relative risk of death compared with White infants was higher for Black (1.93 [95% CI, 1.75-2.13]) and Asian (1.67 [95% CI, 1.55-1.80]) infants. The population attributable risk fraction for all mortality rates among infants who were not White was 12.0% (95% CI, 10.3%-13.8%) (unadjusted), 9.8% (95% CI, 8.0%-11.7%) (adjusted for deprivation), 7.7% (95% CI, 5.9%-9.5%) (adjusted for gestational age at birth), and 12.8% (95% CI, 11.0%-14.5%) (adjusted for region of England). This cohort study suggests that the proportion of infants who died before 1 year of age is associated with race and ethnicity, with a population attributable risk fraction of 12.0%. An overconservative adjustment for deprivation did not explain the overall patterns seen. Approximately half the population attributable risk fraction may be due to increased risk of preterm birth in Asian and Black communities. Work is needed to identify what can be done to reduce this incidence of infant mortality.

Cross-sectional study of the associations between circulating vitamin D concentrations and insulin resistance in children aged 9–10 years of South Asian, black African Caribbean and white European origins

BackgroundLower circulating vitamin D 25-hydroxyvitamin D (25(OH)D) concentrations are associated with higher type 2 diabetes risk in adults, although causality remains uncertain. However, associations between 25(OH)D and type 2 diabetes...

Intersections of race, COVID-19 pandemic, and food security in Black identifying Canadian households: A scoping review

Although studies have identified food insecurity as a racialized inequity issue disproportionately affecting Black identifying Canadians, research exploring how anti-Black racism across multiple systems create inequities including increased risk for food insecurity among African Caribbean Black identifying households in Canada, is limited. Using an intersectionality lens, this scoping review addresses this knowledge gap by elucidating the intersectionality of race with multiple social determinants of health that directly and indirectly impedes Black people (both of African and Caribbean descent) from accessing adequate and appropriate food, resulting in disproportionate health and social outcomes. Critical analyses of twelve journal articles identified systematically and the review of government and organizational reports and websites reveal that food security in Black identifying individuals in Canada is a racialized emergent public health issue rooted in structural and systemic racism that intersects with multiple determinants of health to produce grave social and economic inequities. The recent COVID-19 pandemic intensified these inequities by increasing food insecurity in Black identifying households in Canada. Cultural food security, referring to the ability to acquire and access culturally appropriate foods to one’s ethnic origins as fulfilment to cultural identity, is an interrelated and foundational pillar to food security yet one that is grossly unacknowledged in current actions. National policies are thus needed that recognize cultural food security, and address root causes through increased social support and sustainable food systems. A reasonable first step to ensure the cultural relevance of policies and initiatives is the active engagement of Black communities.

The profile study: Prostate cancer screening in men of Black African and African Caribbean ancestry—Early results.

306 Background: Heritable risk factors account for a significant proportion of prostate cancer (PrCa) risk, of which only a minority are high risk Mendelian traits. Men of Black African and African Caribbean ancestry are at higher risk of developing PrCa in their lifetime (1 in 4) compared with the general population in the United Kingdom (1 in 8). PROFILE is a multi-cohort study of targeted screening for groups of men at higher risk of developing PrCa: 1) men of European ancestry with family history of PrCa, 2) men of black African and African Caribbean ancestry regardless of family history and 3) men with known rarer higher risk gene mutations for PrCa. This abstract concentrates on group 2. The aim is to investigate the role of targeted PrCa screening in men at higher genetic risk and its association with specific genetic profiles and biomarkers. Methods: Healthy men aged 40-69 are invited to participate. Inclusion Criteria: Both parents and all four grandparents must be of either black African or African Caribbean ancestry. Arm 1: PSA only – once PSA is below an age-related threshold (aged 40-49 and PSA ≥0ng/ml, aged 50-69 PSA >/= 2ng/ml) they continue on the study with annual PSA, only triggering a prostate MRI and Biopsy if the PSA is above the threshold. Arm 2: Regardless of PSA men opt for prostate mpMRI and biopsy. Polygenic risk score (PRS) calculated based on 230 SNPs including latest AA specific variants. Results: Arm 1: 121 enrolled PSA only (this has triggered 8 biopsies with 3 cancers). Arm 2: 58 enrolled MRI and biopsy, 58 MRIs and 36 biopsies carried out, PrCa detected in 15 men (42%). 22% are Gleason score ≥7. Association between PRS and MRI/Biopsy results will be presented. Conclusions: We will continue to perform MRI and biopsies on men, we will also carry out polygenic risk scores on these men to verify whether a genetic PRS can help guide enhanced screening for certain men in the population. Although data are early, a significant proportion of biopsies are positive for PrCa that needs radical treatment. Clinical trial information: NCT02543905 .

Black men's experiences of support following treatment for prostate cancer in England: A qualitative study.

Prostate cancer is a leading cause of death in black men in the United Kingdom (UK). Evidence suggests that unmet supportive care needs are prevalent in contemporary healthcare, particularly for men with advanced prostate cancer, whilst less has been written specifically about the supportive care needs of black men. Therefore this study will examine black men's experiences of support following prostate cancer treatment in England. A qualitative research design was employed. Twenty black African and black Caribbean men were interviewed on a face-to-face basis to obtain insightful information about their experiences of prostate cancer. Interviews were recorded and transcribed. Data were analysed using thematic analysis which allowed for emergent themes. In this study there were six emergent themes. These were: dealing with the treatment effect, support from loved ones, individuals and organisations, healthcare support, spirituality, and positivity. Black men used different coping strategies to deal with the side effects of treatment. Black men experienced a range of supportive care needs. Some men felt that their individual needs as black men were not met by healthcare professionals, although no specific reasons were forthcoming as to why they felt this way. Healthcare professionals should be aware of the support mechanisms that black men have used throughout the prostate cancer journey and to consider these approaches when treating and caring for black men.

Ethnic differences in COVID-19 mortality in the second and third waves of the pandemic in England during the vaccine rollout: a retrospective, population-based cohort study

BackgroundEthnic minority groups in England have been disproportionately affected by the COVID-19 pandemic and have lower vaccination rates than the White British population. We examined whether ethnic differences in COVID-19 mortality in England have continued since the vaccine rollout and to what extent differences in vaccination rates contributed to excess COVID-19 mortality after accounting for other risk factors.MethodsWe conducted a retrospective, population-based cohort study of 28.8 million adults aged 30–100 years in England. Self-reported ethnicity was obtained from the 2011 Census. The outcome was death involving COVID-19 during the second (8 December 2020 to 12 June 2021) and third wave (13 June 2021 to 1 December 2021). We calculated hazard ratios (HRs) for death involving COVID-19, sequentially adjusting for age, residence type, geographical factors, sociodemographic characteristics, pre-pandemic health, and vaccination status.ResultsAge-adjusted HRs of death involving COVID-19 were elevated for most ethnic minority groups during both waves, particularly for groups with lowest vaccination rates (Bangladeshi, Pakistani, Black African, and Black Caribbean). HRs were attenuated after adjusting for geographical factors, sociodemographic characteristics, and pre-pandemic health. Further adjusting for vaccination status substantially reduced residual HRs for Black African, Black Caribbean, and Pakistani groups in the third wave. Fully adjusted HRs only remained elevated for the Bangladeshi group (men: 2.19 [95% CI 1.72–2.78]; women: 2.12 [1.58–2.86]) and Pakistani men (1.24 [1.06–1.46]).ConclusionsLower COVID-19 vaccination uptake in several ethnic minority groups may drive some of the differences in COVID-19 mortality compared to White British. Public health strategies to increase vaccination uptake in ethnic minority groups would help reduce inequalities in COVID-19 mortality, which have remained substantial since the start of the vaccination campaign.

Improving adult behavioural weight management services for diverse UK Black Caribbean and Black African ethnic groups: a qualitative study of insights from potential service users and service providers.

A significantly higher proportion of UK Black ethnic adults live with overweight or obesity, compared to their White British counterparts. The role of obesity in excess infection rates and mortality from COVID-19 has increased the need to understand if weight management interventions are appropriate and effective for Black ethnic groups. There is a paucity of existing research on weight management services in Black populations, and whether anticipated or experienced institutional and interpersonal racism in the healthcare and more widely affects engagement in these services. Understanding the lived experience of target populations and views of service providers delivering programmes is essential for timely service improvement. A qualitative study using semi-structured interviews was conducted in June-October 2021 among 18 Black African and Black Caribbean men and women interested in losing weight and 10 weight management service providers. The results highlighted a positive view of life in the United Kingdom (UK), whether born in the UK or born abroad, but one which was marred by racism. Weight gain was attributed by participants to unhealthy behaviours and the environment, with improving appearance and preventing ill health key motivators for weight loss. Participants relied on self-help to address their overweight, with the role of primary care in weight management contested as a source of support. Anticipated or previously experienced racism in the health care system and more widely, accounted for some of the lack of engagement with services. Participants and service providers agreed on the lack of relevance of existing services to Black populations, including limited culturally tailored resources. Community based, ethnically matched, and flexibly delivered weight management services were suggested as ideal, and could form the basis of a set of recommendations for research and practice. Cultural tailoring of existing services and new programmes, and cultural competency training are needed. These actions are required within systemic changes, such as interventions to address discrimination. Our qualitative insights form the basis for advancing further work and research to improve existing services to address the weight-related inequality faced by UK Black ethnic groups.

"Entrepreneurship Challenges of Black African Caribbean Diaspora (BACD) in the United Kingdom: A Critical Race Theory Approach "

"There is a paucity of research on the institutionalised racial challenges facing minority entrepreneurs despite their contribution to the economy and society. Thus, the purpose of the study described here was to examine the entrepreneurship challenges faced by the Black, African, and Caribbean Diaspora (BACD) within the UK. Using the lens of critical race theory and the qualitative phenomenological interpretive approach, the data for the study was based on 27 interviews with BACD entrepreneurs to gain a greater understanding of the constraints and challenges they experience. Access to funding remains an issue, and the findings show that although BACD have a greater propensity to become entrepreneurs, they are more likely to be structurally and systemically constrained, perpetuating limited opportunities, social capital, and access to resources. Issues associated with BACD entrepreneurship, including racial discrimination, structural inequalities, institutionalised poverty, and systematic oppression, have significant implications for inclusive policies and practices as well as for recognising diversity. While generalising the findings may be constrained by its limited sample size, this paper provides new empirical insight into the challenges faced by BACD entrepreneurs in the UK and adds to a body of knowledge that can be utilised by entrepreneurs, policymakers, and the government. This is a departure from previous studies within the area of entrepreneurship. It also introduces a new selfcontradictory construct now presented as the Race Paradox."

The COEQUAL Registry: Creating Opportunities to Increase Health Equity & Equality for Persons at Risk for AD/ADRD

AbstractBackgroundCommunities with the highest disease burden from Alzheimer’s disease and related dementias (ADRD) often experience considerable health disparities. These disparities are due to systematic and structural racism, classism, ageism, and social determinants of health, leading to distrust of and lower engagement with biomedical research. These injustices exacerbate disparities, ultimately leading to less generalizability of research findings. Therefore, we hypothesized that creating a culturally appropriate ADRD research registry called COEQUAL would increase underrepresented communities' engagement in ADRD research.MethodsOur NIH‐funded community and patient‐engaged study aims to identify and enhance current practices to promote high‐yield engagement and retention of diverse participants in ADRD research in St. Louis, Missouri. Based at the Washington University Knight Alzheimer’s Disease Research Center, our partners include Saint Louis University, Wesley House (a social service organization), the Greater Missouri Chapter of the Alzheimer’s Association, and Health Literacy Media. We have a 20‐member Governance Board to create a culturally appropriate research registry. Before creating the COEQUAL registry, we plan to conduct a community needs assessment with listening sessions and a pre/posttest survey of n = 160 community members, patients, caregivers, and healthcare providers aged 45+. We will use direct/indirect recruitment methods like posts in the health system patient portal, social media, and emails/mailers to recruit participants. Our facilitator’s guide and a pre/posttest survey will contain validated and culturally appropriate items to gauge perceptions, practices, and knowledge related to ADRD, willingness to participate in an ADRD research registry, and ways to engage and retain diverse participants. We will oversample participants who self‐identify as Black (African American, African, African Caribbean, or African Ancestry). Findings from the community needs assessment will be used to inform recruitment, ongoing engagement with, and retention of, individuals in ADRD research.ResultWe anticipate gaining knowledge of the perceptions and practices of engaging community members, patients, and providers in creating a culturally appropriate ADRD research registry.ConclusionThe feasibility of creating a culturally appropriate ADRD research registry in St. Louis is critical to ensure justice and generalizability in research. Moreover, using a community and patient‐engaged research approach increases the cultural appropriateness of ADRD research.

Ethnic differences in COVID-19 mortality in the second and third waves of the pandemic in England during the vaccine roll-out.

ObjectivesThis study aims to assess whether ethnic differences in COVID-19 mortality in England have continued into the third wave and to what extent differences in vaccination rates contributed to excess COVID-19 mortality after accounting for other risk factors. ApproachThis Cohort study of 28.8 million adults living in private households or communal establishments in England is based on data from the Office for National Statistics (ONS) Public Health Data Asset (PHDA). The ONS PHDA is a linked dataset combining the 2011 Census, mortality records, the General Practice Extraction Service (GPES) Data for Pandemic Planning and Research (GDPPR), Hospital Episode Statistics (HES) and vaccination data from the National Immunisation Management System (NIMS). We calculated hazard ratios (HRs) for death involving COVID-19 during the second (8 December 2020 to 12 June 2021) and third wave (13 June 2021 to 1 December 2021) of the pandemic separately for males to females to assess the association between ethnic group and death involving COVID-19 in each wave, sequentially adjusting for age, residence type, geographical factors, sociodemographic characteristics, pre-pandemic health, and vaccination status. ResultsAge-adjusted HRs of death involving COVID-19 were higher for most ethnic minority groups than the White British group during both waves, particularly for groups with lowest vaccination rates (Bangladeshi, Pakistani, Black African and Black Caribbean). In both waves, HRs were attenuated after adjusting for geographical factors, sociodemographic characteristics, and pre-pandemic health. Further adjusting for vaccination status substantially reduced residual HRs for Black African, Black Caribbean, and Pakistani groups in the third wave. The only groups where fully-adjusted HRs remained elevated were the Bangladeshi group (men: 2.19, 95% CI 1.72 to 2.78; women: 2.12, 95% CI 1.58 to 2.86) and men from the Pakistani group (1.24, 95% CI 1.06 to 1.46). ConclusionPublic health strategies to increase vaccination uptake in ethnic minority groups could reduce disparities in COVID-19 mortality that cannot be accounted for by pre-existing risk factors.

Adapting a breast cancer early presentation intervention for Black women: A focus group study with women of Black African and Black Caribbean descent in the United Kingdom.

Black women in the United Kingdom are more likely than White women to be diagnosed with advanced breast cancer and have lower survival rates. We consulted women of Black Caribbean and Black African descent in the United Kingdom on how the Promoting Early Presentation (PEP) booklet and intervention could be adapted for Black women to promote early presentation with breast cancer symptoms. Focus groups with 22 women of Black African and Black Caribbean descent, of whom five had been treated for breast cancer. The participants were recruited from a large UK breast cancer charity and community settings. Data were analysed using Framework Analysis. Four themes summarised the participants' views on how the booklet and intervention could be adapted: Justify the focus on Black women, Black people do not talk about cancer, Make interventions inclusive and engaging, and Engage Black communities to deliver interventions. Breast cancer behaviour change interventions need to be more inclusive, illustrate how breast cancer symptoms manifest on black skin, and emphasise that breast cancer is curable to increase awareness and reduce cancer fear. Researchers should involve Black communities in the design and delivery of interventions to address appropriately cultural barriers to early presentation.

Experiences of children and young people from ethnic minorities in accessing mental health care and support: rapid scoping review

Background Mental health problems are common among children and young people in the UK. Some young people from ethnic minority backgrounds experience mental health problems in different ways from those from non-ethnic minority backgrounds. Furthermore, those from ethnic minority backgrounds often experience greater difficulties in accessing mental health support and variable levels of engagement with services, and may prefer different support to their white British peers. Objective To describe the nature and scope of qualitative research about the experiences of children and young people from ethnic minority backgrounds in seeking or obtaining care or support for mental health problems. Data sources We searched seven bibliographic databases (Applied Social Sciences Index and Abstracts, Cumulative Index to Nursing and Allied Health Literature, MEDLINE, PsycInfo®, Health Management Information Consortium, Social Policy and Practice, and Web of Science) using relevant terms on 23 June 2021. Methods The scoping review included qualitative research about young people’s experiences of seeking or engaging with services or support for mental health problems. Included studies were published from 2012 onwards, were from the UK, were about those aged 10–24 years and were focused on those from ethnic minority backgrounds (i.e. not white British). Study selection, data extraction and quality assessment (with ‘Wallace’ criteria) were conducted by two reviewers. We provide a descriptive summary of the aims, scope, sample, methods and quality of the included studies, and a selected presentation of authors’ findings (i.e. no formal synthesis). Results From 5335 unique search records, we included 26 papers or reports describing 22 diverse qualitative studies. Most of the studies were well conducted and clearly described. There were studies of refugees/asylum seekers (n = 5), university students (n = 4) and studies among young people experiencing particular mental health problems (n = 14) (some studies appear in multiple categories): schizophrenia or psychosis (n = 3), eating disorders (n = 3), post-traumatic stress disorder (n = 3, in asylum seekers), substance misuse (n = 2), self-harm (n = 2) and obsessive–compulsive disorder (n = 1). There were also three studies of ethnic minority young people who were receiving particular treatments (cognitive–behavioural therapy, multisystemic therapy for families and a culturally adapted family-based talking therapy). Most studies had been conducted with young people or their parents from a range of different ethnic backgrounds. However, nine studies were conducted with particular ethnic groups: asylum seekers from Afghanistan (n = 2), and black and South Asian (n = 2), black African and black Caribbean (n = 2), South Asian (n = 1), Pakistani or Bangladeshi (n = 1) and Orthodox Jewish (n = 1) people. The studies suggested a range of factors that influence care-seeking and access to mental health care, in terms of the beliefs and knowledge of young people and their parents, the design and promotion of services, and the characteristics of care professionals. Poor access was attributed to a lack of understanding of mental health problems, lack of information about services, lack of trust in care professionals, social stigma and cultural expectations about mental resilience. Limitations As this was a rapid scoping review, there was only a basic synthesis of the research findings. Future work Future research about young people from ethnic minorities could cover a wider range of ethnic minorities, sample and analyse experiences from particular ethnic minorities separately, cover those accessing different services for different needs, and adopt multiple perspectives (e.g. service user, carer, clinician, service management). Study registration This study is registered as https://osf.io/wa7bf/. Funding This project was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery programme and will be published in full in Health and Social Care Delivery; Vol. 10, No. 22. See the NIHR Journals Library website for further project information.

Understanding ethnic inequalities in stillbirth rates: a UK population-based cohort study

ObjectivesTo investigate inequalities in stillbirth rates by ethnicity to facilitate development of initiatives to target those at highest risk.DesignPopulation-based perinatal mortality surveillance linked to national birth and death registration (Mothers...

'They Are Kids, Let Them Eat': A Qualitative Investigation into the Parental Beliefs and Practices of Providing a Healthy Diet for Young Children among a Culturally Diverse and Deprived Population in the UK.

In the UK, ethnic minority children are at greater risk of obesity and weight-related ill health compared to the wider national population. The factors that influence the provision of a healthy diet among these populations remain less understood. An interpretive qualitative study with a phenomenological perspective comprised of 24 single sex semi-structured focus groups was conducted with 110 parents (63 mothers and 47 fathers) of young children (aged 0–5 years). The participants were recruited from deprived and ethnically diverse wards in Luton, UK and self-identified as being white British, Pakistani, Bangladeshi, black African–Caribbean or Polish. The findings highlighted a wide range of inter-relating psychological and sociocultural factors that underpin parental beliefs and practices in providing children with a healthy diet. Parents, whilst aware of the importance of providing children with a healthy diet, faced challenges such as lack of time and balancing competing responsibilities, which were clear barriers to providing children with a healthy diet. Access to and affordability of healthy food and the overexposure of cheap, convenient, and unhealthy processed foods made it increasingly difficult for parents to provide a healthy diet for their growing families. Household food practices were also found to be situated within the wider context of sociocultural and religious norms around cooking and eating, along with cultural identity and upbringing.

Social determinants of diabetes, hypertension, stroke, and coronary heart disease in Black Caribbean and Black African women aged 40 years or older in south London: findings from 70 582 primary care records from 2000–18

BackgroundThe contribution of social determinants, such as deprivation and health-related behaviours, to Black African and Black Caribbean–White differences in cardiovascular risks is uncertain. MethodsPrimary care records from 44 practices in Lambeth (Lambeth DataNet) from Jan 1, 2000, to Oct 27, 2018, for women aged 40 years or older were analysed using multilevel logistic regression models adjusted for age, income deprivation, lifestyles, health-care access, comorbidities (Quality and Outcome Framework disease registers) and medications, and for clustering of patients within practices. FindingsWe studied 70 582 women aged 40 years or older from White (n=35 297), Black African (n=11 206), and Black Caribbean (n=9193) ethnic groups. In women aged 40–69 years, smoking levels were similar in White and Black Caribbean groups (approximately 19%), but much lower in Black African groups (6·1%). In both age groups, obesity levels (ie, a body-mass index of ≥30 kg/m2) in Black Caribbean women (44·3%) and Black African women (48·9%) were around double that in White women (20·8%). Levels of missing data were low (2–10%), and were included as a separate category in each variable. Adjusted for age and income deprivation and compared with White women, excess risks observed at age 40–69 years (n=59 132) for Black African women were diabetes (odds ratio [OR] 2·94, 95% CI 2·69–3·20; p<0·0001), hypertension (3·80, 3·56–4·05; p<0·0001), and stroke (1·43, 1·11–1·85; p=0·006), and for Black Caribbean women were diabetes (3·10, 2·84–3·39; p<0·0001), hypertension (3·57, 3·34–3·82; p<0·0001), and stroke (1·53, 1·17–1·99; p=0·002). In women aged 70 years and older (n=11 450), the excess risks for Black African women were diabetes (2·62, 2·27–3·03; p<0·0001), hypertension (2·13, 1·84–2·47; p<0·0001), and stroke (1·48, 1·12–1·95; p=0·006), and for Black Caribbean women, were diabetes (4·36, 3·88–4·91; p<0·0001), hypertension (3·02, 2·65–3·44; p<0·0001), and stroke (2·01, 1·65–2·47; p<0·0001). Significantly lower coronary heart disease risks were observed only for Black African women aged 40–69 years (0·80, 0·62–1·05; p=0·105), and women aged 70 years or older (0·57, 0·44–0·74; p<0·0001). Adjusting for deprivation accounted for approximately 10–15% attenuation of excess risk in these models. Additional adjustments for smoking and overweight led to further attenuation of excess risk for hypertension and stroke by 2–14% in both groups, and an increase in deficit of 4–15% for cardiovascular disease in Black African women. Among Black Caribbean women, ORs for cardiovascular disease remained non-significant compared with White women in the group aged 40–69 years, but became significantly lower among women aged 70 years or older (0·79, 0·65–0·95; p=0·0110), mainly due to smoking. InterpretationDeprivation and health-related behaviours made notable contributions to differences in cardiovascular risks between Black African, Black Caribbean, and White ethnic groups, consistent with earlier studies. FundingNational Institute of Health Research, Research for Patient Benefit Programme (NIHR202769).

Sunburn Prevalence is Underestimated in UK-Based People of African Ancestry.

BackgroundEumelanin, the primary pigment in human epidermis, has a well-established photo-protective role. It can confer a protection factor of up to approximately 13.4 in some individuals. However, the protection eumelanin affords is not absolute and, further, the susceptibility of human skin to the harmful effects of UV radiation is more complex than skin pigmentation alone.ObjectiveOur survey explored the lifetime prevalence of sunburn in people of African Ancestry based in the UK (Black African or Black Caribbean).ResultsA significant number of respondents, 52.2% (n=222), reported a history of sunburn. Interestingly, there was a significant increase in frequency of sunburn in those with a lighter skin tone (self-classified from dark, medium and light – 47.3%, 53.5% and 71.4%, respectively). In total 69% reported that the episode of sunburn occurred when they were not using sunscreen, and another 10% could not recall whether sunscreen was used. A large proportion of respondents (59%) indicated that they had been sunburnt while away from the UK in hot/sunny climates, raising the question of whether intermittent sun exposure at high UV indices is a key factor in sunburn risk for those living in temperate climates.ConclusionOur findings do not support the hypothesis of a simplistic relationship between skin colour and sun sensitivity and encourage us to re-examine this relationship and its implications for public health promotion. It also adds to a body of evidence revealing the need for more up-to-date and appropriate systems to assess the risk UV radiation poses to diverse populations.

Access to mental healthcare in the year after first fit note: a longitudinal study of linked clinical records

ObjectivesSickness absence is strongly associated with poor mental health, and mental disorders often go untreated. In this population-based cohort study, we identified people receiving fit notes from their general practitioner...

A constructivist grounded theory study on decision-making for treatment choice among Black African and Black Caribbean prostate cancer survivors.

Despite Black African (BA) and Black Caribbean (BC) men having a disproportionately high risk (1 in 4) of developing prostate cancer (CaP), there is limited understanding of their decision-making for treatment choice. This study explored decision-making for treatment choice among BA/BC men treated for CaP. Using constructivist grounded theory, face-to-face, Skype and telephone interviews were conducted with 25 Black men (8 BA, 17 BC) recruited in England between October 2016 and March 2018. Data were analysed using constant comparison until saturation was achieved. Data analysis yielded three broad categories: 'coming to terms with the prostate cancer diagnosis', 'getting empowerment through information-seeking' and 'choosing a treatment option'. Priority for survival substantially motivated BA/BC men to take up radical treatment for their CaP. However, decision-making for a particular treatment option was a more complex process which was shaped by an intersection between biological, behavioural, medical, personal and cultural factors. Healthcare providers need to consider the complexity of decision-making process for CaP treatment among BA/BC men and tailor cancer care services to reflect cultural sensitivity and person-centredness. This could potentially minimise treatment decision regrets and improve men's psychological wellbeing along the CaP survivorship pathway.