Blacks Research Articles

Identifying Population-Level and Within-Hospital Disparities in Surgical Care.

The lack of consensus on equity measurement and its incorporation into quality-assessment programs at the hospital and system levels may be a barrier to addressing disparities in surgical care. This study aimed to identify population-level and within-hospital differences in the quality of surgical care provision. The analysis included 657 National Surgical Quality Improvement Program participating hospitals with over 4 million patients (2014-2018). Multi-level random slope, random intercept modeling was used to examine for population-level and in-hospital disparities. Disparities in surgical care by Area Deprivation Index (ADI), race, and ethnicity were analyzed for five measures: all-case inpatient mortality, all-case urgent readmission, all-case postoperative surgical site infection, colectomy mortality, and spine surgery complications. Population-level disparities were identified across all measures by ADI, two measures for Black race (all-case readmissions and spine surgery complications), and none for Hispanic ethnicity. Disparities remained significant in the adjusted models. Prior to risk-adjustment, in all measures examined, within-hospital disparities were detected in: 25.8-99.8% of hospitals for ADI, 0-6.1% of hospitals for Black race, and 0-0.8% of hospitals for Hispanic ethnicity. Following risk-adjustment, in all measures examined, fewer than 1.1% of hospitals demonstrated disparities by ADI, race, or ethnicity. Following risk adjustment, very few hospitals demonstrated significant disparities in care. Disparities were more frequently detected by ADI than by race and ethnicity. The lack of substantial in-hospital disparities may be due to the use of postoperative metrics, small sample sizes, the risk adjustment methodology, and healthcare segregation. Further work should examine surgical access and healthcare segregation.

Looking in the mirror held up by North Carolina slave narratives: White folks confronting the psychosocial legacy of slavery

AbstractU.S. citizens are debating whether slavery and white supremacy are core constituents of the United States, whether white (This is a chapter in my forthcoming book White Work: Radical Genealogy as a Path to Racial Reparations. In an earlier chapter, I trace the ways in which the early colonists to Virginia began to think of themselves as “white.” Initially, they primarily self‐identified with being English and Christian. They used being Christian as a way to differentiate themselves from and elevate themselves above the Africans whom they were enslaving since 1619. Soon, however, more enslaved African people began to arrive from the Caribbean where they had been exposed to Christianity and adopted it. A new way to assume their superiority was needed by the colonists. Gradually, they began to claim whiteness as a central part of their identity and as a sign of their self‐appointed superiority. Like “race,” “whiteness” was a created construct used to justify slavery and the abuses of the enslaved by colonists.) children should be troubled by learning the brutalities of slavery and life under Jim Crow laws, and whether racial reparations are due to African Americans for the centuries of economic, political, and social oppression they have endured. While many white folks prefer to ignore or demean calls for reparations, others have turned to reparative genealogy. They are inquiring deeply into their ancestors' relationships to chattel slavery and white supremacy, committed to reckoning with their own and their ancestors' racial debts. They seek to develop what sociologist W. E. Du Bois called “double consciousness.” In order to protect themselves, African Americans had to try and see through the eyes of white people, as well as their own. But white folks too rarely attempt to see themselves through the eyes of Black people. During slavery, how were whites seen by Blacks? Philosopher George Yancy urges white people to engage in the work of developing double consciousness so they can see, as most people of color do, the pernicious white and class advantages that haunt us. My ancestors were enslavers in North Carolina. I turned to slave narratives from Black North Carolinians to distill what they observed about white people. Their descriptions point to individual and cultural pathologies: dehumanizing, pathological narcissism, authoritarian character, greed, cruelty, sadism, the policing of racial borders, paranoia, absence of deserved shame and moral injury. These understandings underline some of the psychosocial tasks before us as white people.

Racioethnic disparities in comorbidities and outcomes following head and neck oncologic surgery

AbstractObjectivesRacial disparities persist despite attempts to establish an egalitarian framework for surgical care. This study aimed to investigate racioethnic disparities in comorbidities and outcomes following surgery for head and neck tumors.MethodsThis retrospective study included adult patients who underwent head and neck oncologic surgery between 2008 and 2020 from the National Surgical Quality Improvement Program. Multivariable regression analyses were conducted to explore the association of the following racioethnic categories with postoperative outcomes: White, Black, Hispanic, and Asian.ResultsA total of 113,234 patients were included in the study, comprising 78.3% White, 8.7% Black, 6.9% Hispanic, and 6.0% Asian patients. Black patients had higher rates of pre‐existing comorbidities compared to White patients. Specifically, the rates of comorbidities such as diabetes mellitus (19.8% vs. 12.4%), hypertension (57.5% vs. 41.5%), smoking history (18.8% vs. 15.0%), dyspnea (7.4% vs. 5.7%), and preoperative anemia (43.6% vs. 36.5%) were higher among Black patients. On regression analyses, Black race was not associated with major morbidity following head and neck oncologic surgeries (odds ratio, 1.098, 95% confidence interval, 0.935–1.289) when compared to White patients. However, there were significant associations between the comorbidities associated with the Black race and an increased risk of major morbidity.ConclusionsBlack patients undergoing head and neck oncologic surgery face a significant challenge due to a higher burden of comorbidities. These comorbidities, in turn, have been found to be associated with postoperative major morbidity.

National Outpatient Sexually Transmitted Infection Testing in Pregnant Patients in the United States.

Introduction: Sexually transmitted infections (STIs) continue to increase in the United States and pregnant patients who acquire STIs are at risk for serious complications. This study estimated the utilization of preventative STI testing among pregnant outpatients on a national scale. Methods: This was a retrospective, cross-sectional study of outpatient visits in the National Ambulatory Medical Care Survey from 2014 to 2016 and 2018 to 2019. All patients reported as pregnant were included to assess STI testing for chlamydia, gonorrhea, hepatitis, and HIV. STI testing was described per 1,000 total visits overall and by subpopulations. Data weights were applied to generate national estimates. Results: Over 177 million visits were included, of which 87.5 per 1,000 included an STI test. Chlamydia testing was the most common, followed by HIV, gonorrhea, and hepatitis (58.0 vs. 42.3 vs. 41.5 vs. 20.3 per 1,000). STI testing rates varied across subpopulations (72.1-236.6 per 1,000 visits). Patients of Hispanic ethnicity, Black race, age ≤25 years old, and those seen by an obstetrics and gynecology (OB/GYN) provider had the highest rates of STI testing. Independent predictors of STI testing included: Black race (adjusted odds ratio [aOR]: 2.24, 95% confidence interval [95% CI]: 2.23-2.24), first trimester (aOR: 5.15, 95% CI: 5.14-5.16), government and private insurance (aOR: 1.90, 95% CI: 1.89-1.91 and aOR: 1.70, 95% CI: 1.69-1.71), and an OB/GYN provider specialty (aOR: 2.93, 95% CI: 2.93-2.94). Conclusions: STI testing in United States outpatient physician offices varied by subpopulations and across individual test types. Certain patient attributes, such as race, provider specialty, and payment source, were predictive of testing.

Comparison of the characteristics of the population eligible for lung cancer screening under 2013 and population newly eligible under 2021 US Preventive Services Task Force recommendations.

In 2021, the United States Preventive Services Task Force (USPSTF) revised their 2013 recommendations for lung cancer screening eligibility by lowering the pack-year history from 30+ to 20+ pack-years and the recommended age from 55 to 50years. Simulation studies suggest that Black persons and females will benefit most from these changes, but it is unclear how the revised USPSTF recommendations will impact geographic, health-related, and other sociodemographic characteristics of those eligible. This cross-sectional study employed data from the 2017-2020 Behavioral Risk Factor Surveillance System surveys from 23 states to compare age, gender, race, marital, sexual orientation, education, employment, comorbidity, vaccination, region, and rurality characteristics of the eligible population according to the original 2013 USPSTF recommendations with the revised 2021 USPSTF recommendations using chi-squared tests. This study compared those originally eligible to those newly eligible using the BRFSS raking-dervived weighting variable. There were 30,190 study participants. The results of this study found that eligibility increased by 62.4% due to the revised recommendations. We found that the recommendation changes increased the proportion of eligible females (50.1% vs 44.1%), Black persons (9.2% vs 6.6%), Hispanic persons (4.4% vs 2.7%), persons aged 55-64 (55.8% vs 52.6%), urban-dwellers(88.3% vs 85.9%), unmarried (3.4% vs 2.5%) and never married (10.4% vs 6.6%) persons, as well as non-retirees (76.5% vs 56.1%) Respondents without comorbidities and COPD also increased. It is estimated that the revision of the lung cancer screening recommendations decreased eligibility disparities in sex, race, ethnicity, marital status, respiratory comorbidities, and vaccination status. Research will be necessary to estimate whether uptake patterns subsequently follow the expanded eligibility patterns.

Ethnic disparities in quality of diabetes care in Scotland: A national cohort study.

The aim of this study is to compare quality of diabetes care in people with type 2 diabetes by ethnicity, in Scotland. Using a linked national diabetes registry, we included 162,122 people newly diagnosed with type 2 diabetes between 2009 and 2018. We compared receipt of nine guideline indicated processes of care in the first-year post-diabetes diagnosis using logistic regression, comparing eight ethnicity groups to the White group. We compared annual receipt of HbA1c and eye screening during the entire follow-up using generalised linear mixed effects. All analyses adjusted for confounders. Receipt of diabetes care was lower in other ethnic groups compared to White people in the first-year post-diagnosis. Differences were most pronounced for people in the: African, Caribbean or Black; Indian; and other ethnicity groups for almost all processes of care. For example, compared to White people, odds of HbA1c monitoring were: 44% lower in African, Caribbean or Black people (OR 0.56 [95% CI 0.48, 0.66]); 47% lower in Indian people (OR 0.53 [95% CI 0.47, 0.61]); and 50% lower in people in the other ethnicity group (OR 0.50 [95% CI 0.46, 0.58]). Odds of receipt of eye screening were 30%-40% lower in most ethnic groups compared to the White group. During median 5 year follow-up, differences in HbA1c monitoring and eye screening largely persisted, but attenuated slightly for the former. There are marked ethnic disparities in routine diabetes care in Scotland in the short- and medium-term following diabetes diagnosis. Further investigation is needed to establish and effectively address the underlying reasons.

Solidarity and gender in protest novels: Bessie Head’s <i>The Cardinals</i> and Miriam Tlali’s <i>Muriel at Metropolitan</i>

This article analyses the critical role of gender within racial solidarity in anti-apartheid protest writing by comparing Bessie Head’s The Cardinals and Miriam Tlali’s Muriel at Metropolitan. Both novels depict the protagonist’s experience of being the only Black woman at a white-collar workplace during apartheid. The workplace relationships explored within the novels illustrate the complex role of gender in forming alliances and nurturing solidarity. Although Tlali’s novel prioritises solidarity between Black people in the face of apartheid, areas of significant gender inequalities are present. Head’s The Cardinals, on the other hand, explicitly explores the fissures in Black anti-apartheid alliances created by gender inequalities. The juxtaposition of these two novels challenges a uniform understanding of Black anti-apartheid solidarity, while also elucidating depictions of the competing relationships of solidarity for Black working women in female-authored protest writing. By forcing the reader to consider the place of gender in relation to both collectives of solidarity and to anti-apartheid protest, the novels trigger a rethinking of what traditionally male-dominated protest writing was and could be.

Black Youth Rising: Understanding Motivations and Challenges in Young Adult Activism

Black young adults participate in activism to challenge and transform oppressive systems. In this qualitative study, we employed thematic analysis and used the framework of sociopolitical development (SPD) to explore their motivations and challenges to participation amid the COVID-19 pandemic and the summer of 2020 in the United States. Semi-structured interviews with 22 Black young adults in early 2022 revealed that social identities, sense of legacy, impact, and morals drove their participation. Further, contending with systemic oppression, impact, harm, and working with others challenged their participation. This study holds valuable insights for stakeholders as they support and empower young Black activists navigating social justice efforts in our dynamic and evolving sociopolitical landscape. Further, this work highlights the enduring tradition of activism within the Black community and emphasizes the need to empower young Black activists as change agents in the pursuit of a more equitable society.

Singing Blackness

In this article I propose the exploration of racial discourse in recent Black Caribbean rap and hip-hop productions. Rap and hip-hop are often used as a sociopolitical tool that—through writing and language—achieve to create activist movements. Specifically, I study the work of the Cuban hip-hop group Obsesión [Obsession] and of Cuban rapper Robe L Ninho and the work of Dominican rappers Circuito Negro and JNoa. I particularly focus on some of their songs that make of the genre an opportunity to approach the racial topic in their communities and a way to celebrate Blackness. This way, these hip-hop and rap songs break the most commercial, common, and expected pattern of lyrics that focus on topics that oversexualize the female (Black) body, that often objectify women, and that reproduce a patriarchal and heteronormative discourse. Instead, these songs, through the topics that they explore, aim to create community and craft a space for social activism. They do so, for example, by singing about hair (Obsesión and Robe L Ninho) and by singing about their Afro-Caribbean communities and their existence as Black people in their neighborhoods (Circuito Negro, JNoa). Among a variety of tracks, I mainly focus on songs that are connected in topic and that represent a continuumin the production of approximately the last decade. So, for example I analyze the songs “Los pelos [Hair]” by Obsesión (2014) and “N.E.G.R.O. [N.E.G.R.O.]” by Robe L Ninho (2022) that focus on Afro hair, celebrate the beauty of it, and denounce the prejudices against it almost a decade apart from each other. Then, I focus on the song “Revolufunk” by Circuito Negro (2011) and the song “Qué fue[What Happened?]” (2022) by JNoa. In this case also there is a generational gap between the artists that symbolize both the evolution of the genre and the consistency of the topics that they cover and that are connected to Blackness. In addition to the racial discourse and the connection of topics across the last decade, these songs also create an inter-Caribbean discourse that transcends the concept of nation and nationality and instead identifies with and shapes a message for Black Spanish-speaking Caribbean people. These songs reveal a poetic that adds urban sounds to a spoken word tradition and that mixes writing, oral tradition, and language in lieu to create a sociopolitical activist movement for Afro-Caribbean people. Also, by focusing on race in countries where the Black communities are often made invisible, they shed light on minorities that usually are relegated to the lowest layers of society. Thus, through their music, these artists raise awareness on their Blackness and on their communities, but they also create a transversal Afro-Caribbean narrative that connects and creates a sense of community among Blacks in the Caribbean in their native Spanish language. This study, so, represents an opportunity to shift a US-centered discourse on Blackness and race and opens new ways of living and understanding the African diaspora in other geographies.

The Roles of Race and Mental Health in the On-scene Outcomes of Public Mass Shootings

AbstractMass shootings are most frequently committed by white men. Yet, these white perpetrators often do not meet the same fatal fate as Black people who have committed lesser crimes, particularly in the United States. Furthermore, Black people with mental health issues in such situations are more commonly met with lethal force. This study investigates if disparities exist in the likelihood of being apprehended, taking one’s own life, or being killed by police or others during a public mass shooting incident based on one’s race and known mental health status. Using the Violence Project data, this study aids understanding of the causes and consequences of mass violence.

The Safety of Outpatient Health Care : Review of Electronic Health Records.

Despite considerable emphasis on delivering safe care, substantial patient harm occurs. Although most care occurs in the outpatient setting, knowledge of outpatient adverse events (AEs) remains limited. To measure AEs in the outpatient setting. Retrospective review of the electronic health record (EHR). 11 outpatient sites in Massachusetts in 2018. 3103 patients who received outpatient care. Using a trigger method, nurse reviewers identified possible AEs and physicians adjudicated them, ranked severity, and assessed preventability. Generalized estimating equations were used to assess the association of having at least 1 AE with age, sex, race, and primary insurance. Variation in AE rates was analyzed across sites. The 3103 patients (mean age, 52 years) were more often female (59.8%), White (75.1%), English speakers (90.8%), and privately insured (70.4%) and had a mean of 4 outpatient encounters in 2018. Overall, 7.0% (95% CI, 4.6% to 9.3%) of patients had at least 1 AE (8.6 events per 100 patients annually). Adverse drug events were the most common AE (63.8%), followed by health care-associated infections (14.8%) and surgical or procedural events (14.2%). Severity was serious in 17.4% of AEs, life-threatening in 2.1%, and never fatal. Overall, 23.2% of AEs were preventable. Having at least 1 AE was less often associated with ages 18 to 44 years than with ages 65 to 84 years (standardized risk difference, -0.05 [CI, -0.09 to -0.02]) and more often associated with Black race than with Asian race (standardized risk difference, 0.09 [CI, 0.01 to 0.17]). Across study sites, 1.8% to 23.6% of patients had at least 1 AE and clinical category of AEs varied substantially. Retrospective EHR review may miss AEs. Outpatient harm was relatively common and often serious. Adverse drug events were most frequent. Rates were higher among older adults. Interventions to curtail outpatient harm are urgently needed. Controlled Risk Insurance Company and the Risk Management Foundation of the Harvard Medical Institutions.

HIV Screening Among Young Black Men Who Have Sex with Women in New Orleans, LA.

There are significant disparities in HIV acquisition, with Black individuals facing disproportionately more new diagnoses. Per Centers for Disease Control and Prevention (CDC), all people aged 13-64 should be tested at least once in their lifetime, and men at increased risk (e.g., those who have male sexual contact, multiple partners, have partners with multiple partners, or share drug injection equipment) should be tested annually. The study included young Black men who have sex with women (MSW), aged 15-26, and who live in New Orleans, LA. Survey data was used to elicit the frequency and factors associated with three self-reported outcomes: (1) history of ever HIV testing, (2) HIV screening in the last year among those who were recommended per CDC, and (3) HIV positivity. Of the 1321 men included, 694/1321 men (52.5%) reported ever having been HIV tested. There were 708/1321 (54.2%) men who met the recommendation for annual screening and 321/708 (45.3%) of these eligible men reported being tested in the previous year. Of those ever tested, 44/694 (6.3%) self-reported testing positive. In logistic regression analysis, older age (OR: 1.27, p < 0.001), prior STI testing (OR: 6.45, p < 0.001), and prior incarceration (OR:1.70, p = 0.006) were positively associated with having ever received an HIV test, and ever having a male partner (OR: 3.63, p = 0.014) was associated with HIV positivity. Initiatives to improve HIV testing rates among young Black men who have sex with women are needed to reduce the burden of HIV and help the End the Epidemic initiative.

“Advocates for Each Other”: The creation and evaluation of a pragmatic peer navigation program for black patients in primary care with uncontrolled hypertension

BackgroundBlack individuals in the U.S. and in our primary care clinic experience worse control of blood pressure compared to White individuals. ObjectiveTo address this inequity, our objectives were to (1) elicit from patients and community members their ideas for barriers and facilitators to blood pressure control; and (2) use their input to design and pilot a navigator program for Black patients in our clinic to improve blood pressure management. Patient involvementWe conducted three focus groups with 27 individuals and identified two main areas of need that informed the peer navigator program: (1) community-based services and (2) skill development for hypertension self-management. MethodsPeer navigators from the Black community called participants at least monthly for 6–12 months and connected them with medical and social services. Available blood pressure data was used as the primary outcome to measure change pre- to post-peer navigation program. ResultsAmong 499 eligible patients in the clinic, 53 (10.6%) enrolled in the peer navigation program. For those with baseline and follow-up blood pressure data, mean systolic blood pressure decreased from 155.9 to 142.4 mmHg after the program (change of −13.6, 95% CI −24.7 to −2.4) for the enrolled patients (N = 17) and from 139.1 to 137.1 mmHg (change of −2.5, −4.8 to 1.9) for unenrolled, comparison patients (N = 183). DiscussionThis community-informed peer navigation program to support Black patients with uncontrolled hypertension led to a 11.1 mmHg greater decrease in average systolic blood pressure for enrolled patients compared to the comparison group. However, the enrolled group started with a significantly higher systolic blood pressure at baseline with more room for improvement. While this study was conducted during the pandemic years, low uptake of this program needs to be addressed in expansion efforts. Practical valueClinic-based peer navigation for hypertension improved blood pressure control and was highly regarded by the subset of enrolled patients. Increasing uptake and sustainable funding for non-billable clinic roles remain areas of need. FundingGrant from the Pacific Hospital Preservation & Development Authority.

Exploring ethnic differences in the distribution of blood test results in healthy adult populations to inform earlier cancer detection: a systematic review.

In primary care, health professionals use blood tests to investigate nonspecific presentations to inform referral decisions. Reference ranges for the commonly used blood tests in western countries were developed in predominately White populations, and so may perform differently when applied to non-White populations. Knowledge of ethnic variation in blood test results in healthy/general populations could help address ethnic inequalities in cancer referral for diagnosis and outcomes. This systematic review explored evidence of ethnic differences in the distribution of selected blood test results among healthy/general populations to inform future research aimed at addressing inequalities in cancer diagnosis. We searched PubMed and EMBASE to identify studies reporting measures of haemoglobin, MCV, calcium, albumin, platelet count, and CRP in nondiseased adults from at least 2 different ethnic groups. Two reviewers independently screened studies, completed data extraction and quality assessment using an adapted Newcastle-Ottawa scale. Participants were stratified into White, Black, Asian, Mixed, and Other groups. Data were synthesised narratively and meta-analyses were conducted where possible. A total of 47 papers were included. Black men and women have lower average values of haemoglobin, MCV, and albumin, and higher average values of CRP relative to their White counterparts. Additionally, Black men have lower average haemoglobin than Asian men, whereas Asian women have lower average CRP values when compared with White women. There is evidence of ethnic differences in average values of haemoglobin, MCV, CRP, and albumin in healthy/general populations. Further research is needed to explore the reasons for these differences. Systematic review registration: CRD42021274580.

Enhancing diversity, equity, and inclusion within agricultural higher education: Insights from Black faculty and administrators in agricultural colleges at United States land grant institutions

The experiences of Black faculty as leaders and administrators in the field of agriculture have not been widely studied nor reported. The goal of this research focused on Black faculty leaders' experiences in agriculture to gain firsthand insights regarding the enhancement of diversity, equity, and inclusion within agricultural higher education. The central research question guiding the study was: What are the experiences of Black faculty leaders at Colleges of Agriculture at Predominantly White Institutions (PWIs)? Counter-storytelling was used to explore the personal narratives of eight participants. These experiences fall within the tenets of Critical Race Theory. Three primary themes emerged: Navigating Leadership: Microaggressions in the Midst; Inequities: Is Everyone Really Equal; and Isolation: The Lone Ranger. Findings of this study hold valuable implications for practitioners, policymakers, and academic institutions seeking to enhance diversity, equity, and inclusion within agricultural higher education. Recommendations for policy and practice include providing support for leadership mentoring and professional development, conducting robust research on the intersection of race, ethnicity, and gender for faculty of color, and establishing collaborative initiatives between academic institutions, industry partners, and community organizations to address historical disparities and stimulate interest in agriculture among Black communities.

Police killings of unarmed Black persons and suicides among Black youth in the US: A national time-series analysis

IntroductionSuicide deaths among Black youth in the US have increased rapidly over the past decade. Direct or vicarious racial trauma experienced through exposure to police brutality may underlie these concerning trends. MethodsWe obtained nationally aggregated monthly counts of suicides for non-Hispanic Black and White youth (age ≤ 24 years) and adults (age > 24 years) from the National Mortality Vital Statistics restricted-use data files provided by the Centers for Disease Control and Prevention, from 2013 to 2019. Monthly counts of Black youth suicides constituted our main outcome. We defined our exposure as the monthly counts of police killings of unarmed Black persons over 84 months (2013 to 2019), retrieved from the Mapping Police Violence database. We used ARIMA (AutoRegressive Integrated Moving Average) time-series analyses to examine whether Black youth suicides increased within 0 to 3 months following police killings of unarmed Black persons, controlling for autocorrelation and corresponding series of White youth suicides. ResultsSuicides among Black youth increase by ∼1 count three months following an increase in police killings of unarmed Black persons (exposure lag 0 coefficient = 0.16, p > 0.05; exposure lag 1 coefficient = −0.70, p > 0.05; exposure lag 2 coefficient = −0.54, p > 0.05; exposure lag 3 coefficient = 0.95, p < 0.05). The observed increase in suicides concentrates among Black male youth (exposure lag 3 coefficient = 0.88, p < 0.05).

Acceptable dark skinned women and egotistical light skinned women: black women speak on colorism and colorist microaggressions within the black community on campus

ABSTRACT This study focuses on Black undergraduate women’s perspectives and experiences with colorism and colorist microaggressions in Black communities at a Historically Predominantly White University (HPWI). Previous studies demonstrate that Black undergraduate women’s experiences are shaped by their race and gender together. Our study highlights how their skin tone, colorism, and colorist microaggressions also shape their college experiences. Twenty-five Black undergraduate women were interviewed about their experiences with discrimination on campus. The perspectives on colorism from dark and light skinned Black women show that colorist ideals are present within the campus’ Black Community and impact Black student interactions. Colorist microaggressions experienced by light-skinned Black women were rooted in objectification and fetishization; whereas the colorist microaggressions endured by dark-skinned Black women were enmeshed in anti-Black constructions of darkness with masculinity and deviance. This study demonstrates the importance of centering skin tone when exploring and analyzing Black undergraduate women’s experiences with discrimination.

An Estimation of the Prevalence of Smoking and e-Cigarette Use among U.S. Adults If Menthol Cigarettes and Flavored Cigars Are Banned

Introduction People’s reaction to the FDA’s ban on flavored cigarettes and cigars may be modified by a concurrent ban on flavored e-cigarettes. We aim to estimate the prevalence of smoking and e-cigarette use among U.S. adults under various ban scenarios. Methods We collected the reactions of people who used cigarettes, cigars, and e-cigarettes reactions to three hypothetical ban scenarios, (1) restricting menthol cigarettes and flavored cigars only, or (2) further restricting e-cigarettes with any flavors except menthol or tobacco, or (3) further restricting e-cigarettes with all flavors. The above data were analyzed to identify determinants of reactions and to estimate and calibrate the probabilities of quitting and switching to non-flavored cigarettes and cigars. Afterward, the probabilities were applied to 2018–2019 TUS-CPS respondents to estimate the prevalence of smoking and e-cigarette use. Results Compared with the baseline, the prevalence of smoking decreased from 12.6% to 10.5%, and e-cigarette use increased from 2.6% to 3.8% in Scenario No.1. In Scenario No.2 and No.3, the prevalence of smoking was 10.5% and 10.7%, and the prevalence of e-cigarette use were 3.1% and 2.4%, respectively. For black people, the prevalence of smoking decreased from 14.2% in baseline to 8.1%-8.8% in three scenarios. Conclusions The result indicated that for a ban on menthol cigarettes and flavored cigars, a concurrent ban on flavored e-cigarettes with an exemption of menthol flavor could be more effective in encouraging people to quit smoking. Black people may see a disproportionate benefit from all ban scenarios compared with other race/ethics groups.

Relevance of antinuclear antibody in diagnosis and characteristics of multiple sclerosis

BackgroundCriteria for multiple sclerosis (MS) diagnosis rely upon clinical and paraclinical data that are supportive of MS in the absence of a better explanation. Patients referred for consideration of a MS diagnosis often undergo an extensive serologic workup including antinuclear antibody (ANA) testing, even when an individual already meets diagnostic criteria for MS. It is unclear whether ANA serostatus is associated with clinical outcomes in MS. The present study aims to determine if ANA seropositivity in those referred with concern for MS differs in those who meet 2017 revised McDonald criteria compared to those who did not receive a diagnosis of MS. Associations between ANA seropositivity and clinical or radiological phenotype of MS patients are also explored. MethodsThe cohort included people at least 18 years old, referred to our tertiary care MS center with concern for MS (regardless of prior diagnosis) who had an ANA test with known titer completed within one year of first evaluation. Electronic health record (EHR) charts were manually reviewed, and MRIs underwent blinded review by a radiologist with training in neuroradiology. Diagnosis of MS was determined by a neuroimmunologist and was based on 2017 revised McDonald Criteria. Results are reported as odds ratios from multivariable logistic regression analyses adjusted for age, sex at birth, race, smoking history, personal history of comorbid autoimmune conditions, and family history of autoimmunity. Within the MS cohort, similar analytical models were performed to assess association between ANA and clinical and radiological characteristics. ResultsA final cohort of 258 patients was analyzed (out of 542 referrals): 106 nonMS and 152 with MS. There was no association between MS (vs. nonMS) diagnosis and ANA status (ANA positive n = 74) in the multivariable models (OR 1.5, 95 % CI 0.82, 2.72, p = 0.20). Among those with MS, there was no association of ANA seropositivity with the odds of atypical brain MRI features, number of cardinal MRI areas involved, location of MRI lesions, or of having an atypical presentation of first demyelinating event. Black race (OR 2.8, 95 % CI 1.27, 6.26, p = 0.01) and family history of autoimmunity (OR 2.1, 95 % CI 1.09, 3.98, p = 0.03) were independently associated with increased odds of ANA positivity. Within the MS cohort analysis, progressive MS (PMS; vs relapsing-remitting MS), a covariate in the model, appeared to be at higher odds of being ANA positive (OR 3.6, 95 % CI 1.03, 13.05, p = 0.046) but only when assessing mean area of cardinal MS locations. ConclusionsWhile ANA testing does not appear to be useful in distinguishing MS from non-MS, it remains less clear as to whether it may be associated with differences in the clinical course of MS (relapsing-remitting vs progressive). Future studies should aim to systematically evaluate whether those who are ANA positive are more likely, in well-designed and representative prospective cohorts, to be diagnosed with or develop progressive MS. Whether a positive ANA early in MS is associated with increased risk over time of developing or diagnosing another systemic autoimmune disease would also be of interest.

Racial and Ethnic Disparities in All-Cause and Cause-Specific Mortality Among US Youth

Mortality rates in US youth have increased in recent years. An understanding of the role of racial and ethnic disparities in these increases is lacking. To compare all-cause and cause-specific mortality trends and rates among youth with Hispanic ethnicity and non-Hispanic American Indian or Alaska Native, Asian or Pacific Islander, Black, and White race. This cross-sectional study conducted temporal analysis (1999-2020) and comparison of aggregate mortality rates (2016-2020) for youth aged 1 to 19 years using US Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research database. Data were analyzed from June 30, 2023, to January 17, 2024. Pooled, all-cause, and cause-specific mortality rates per 100 000 youth (hereinafter, per 100 000) for leading underlying causes of death were compared. Injuries were classified by mechanism and intent. Between 1999 and 2020, there were 491 680 deaths among US youth, including 8894 (1.8%) American Indian or Alaska Native, 14 507 (3.0%) Asian or Pacific Islander, 110 154 (22.4%) Black, 89 251 (18.2%) Hispanic, and 267 452 (54.4%) White youth. Between 2016 and 2020, pooled all-cause mortality rates were 48.79 per 100 000 (95% CI, 46.58-51.00) in American Indian or Alaska Native youth, 15.25 per 100 000 (95% CI, 14.75-15.76) in Asian or Pacific Islander youth, 42.33 per 100 000 (95% CI, 41.81-42.86) in Black youth, 21.48 per 100 000 (95% CI, 21.19-21.77) in Hispanic youth, and 24.07 per 100 000 (95% CI, 23.86-24.28) in White youth. All-cause mortality ratios compared with White youth were 2.03 (95% CI, 1.93-2.12) among American Indian or Alaska Native youth, 0.63 (95% CI, 0.61-0.66) among Asian or Pacific Islander youth, 1.76 (95% CI, 1.73-1.79) among Black youth, and 0.89 (95% CI, 0.88-0.91) among Hispanic youth. From 2016 to 2020, the homicide rate in Black youth was 12.81 (95% CI, 12.52-13.10) per 100 000, which was 10.20 (95% CI, 9.75-10.66) times that of White youth. The suicide rate for American Indian or Alaska Native youth was 11.37 (95% CI, 10.30-12.43) per 100 000, which was 2.60 (95% CI, 2.35-2.86) times that of White youth. The firearm mortality rate for Black youth was 12.88 (95% CI, 12.59-13.17) per 100 000, which was 4.14 (95% CI, 4.00-4.28) times that of White youth. American Indian or Alaska Native youth had a firearm mortality rate of 6.67 (95% CI, 5.85-7.49) per 100 000, which was 2.14 (95% CI, 1.88- 2.43) times that of White youth. Black youth had an asthma mortality rate of 1.10 (95% CI, 1.01-1.18) per 100 000, which was 7.80 (95% CI, 6.78-8.99) times that of White youth. In this study, racial and ethnic disparities were observed for almost all leading causes of injury and disease that were associated with recent increases in youth mortality rates. Addressing the increasing disparities affecting American Indian or Alaska Native and Black youth will require efforts to prevent homicide and suicide, especially those events involving firearms.