Afro-Asian Research Articles

Racial disparities in post-operative pain experience and treatment following cesarean birth

Objective To evaluate racial/ethnic differences in post-operative pain experience and opioid medication use (morphine milligram equivalent) in the first 24 h following cesarean birth. Methods This study was a single-center retrospective cohort of birthing persons who underwent cesarean deliveries between 1/1/16 and 12/31/17. A total of 2,228 cesarean deliveries were analyzed. The primary outcome was average pain, which was the mean of all documented self-reported pain scores (0–10 scale) during the first 24 h post-delivery. The secondary outcome included oral morphine equivalents used in the first 24 h post-delivery. Linear regression was performed to examine whether the race/ethnicity of the birthing parent was associated with mean pain scores and oral morphine equivalents, controlling for confounding variables. Results In multivariate analyses non-Hispanic Black birthing persons reported higher mean pain scores (Coefficient: 0.61, 95% confidence interval [0.39–0.82], p < .001]) than non-Hispanic White birthing persons, but received similar quantities of morphine milligram equivalent (Coefficient: −0.98 mg, 95% confidence interval [−5.93–3.97], p = .698]). Non-Hispanic Asian birthing persons reported similar reported mean pain scores to those of non-Hispanic White birthing persons (Coefficient: 0.02 mg, 95% confidence interval [−0.17–0.22], p = .834]), but received less morphine milligram equivalent (Coefficient: −5.47 mg, 95% confidence interval [−10.05 to −0.90], p = .019). When controlling for reported mean pain scores, both non-Hispanic Black (Coefficient: −6.36 mg, 95% confidence interval [−10.97 to −1.75], p = .007) and non-Hispanic Asian birthing persons (Coefficient: −5.66 mg, 95% confidence interval [−9.89 to −1.43], p = .009) received significantly less morphine milligram equivalents. Conclusion Despite reporting higher mean pain scores, non-Hispanic Black birthing persons did not receive higher quantities of morphine milligram equivalent. Non-Hispanic Asian birthing persons received lower quantities of morphine milligram equivalent despite reporting similar pain scores to non-Hispanic White birthing persons. These differences suggest disparities in post-operative pain management for birthing persons of color in our study population.

A Mixed-Methods Evaluation of “The Quest,” A Health and Well-Being Intervention for British-Based Black, Asian and Minority Ethnic Gay and Bisexual Men

ABSTRACT This article provides an evaluation of a health and well-being workshop-based intervention, “The Quest” for gay and bisexual men from British Black Asian and Minority Ethnic (BAME) communities. A quantitative component assessed reported and intended sexual risk, drugs and alcohol use alongside measures of psychological well-being with pre and post-program data collected from 26 men. Fourteen men participated in focus groups that discussed experiences of the intervention. Significant improvements were found on measures of internalized homophobia, self-esteem and self-efficacy but not for health behaviors including safer sex or substance use. Qualitative feedback was generally positive especially around enhanced psychological well-being, identity integration, and enhanced self-awareness. There were some concerns over group size and whether non-BAME gay men were appropriate as facilitators. Theoretically informed, culturally competent interventions can demonstrate significant potential in enhancing the well-being of BAME gay and bisexual men but follow-up data are needed to show longer-term benefits.

Searching for Black Freedom in the South

The freedom struggle for Black Americans has cycled through American history. This reflection aims to recount lessons from the civil rights movement through a Black feminist lens from three scholars that grew up in South Carolina, home to years of racial tension and divide. To connect the Civil Rights Movement to the current Black Lives Matter movement, it is imperative to address the unsung heroes who made strides to dismantle the anti-Black narratives, laws, and policies that reinforce notions of racial inferiority. As such, Black women have been in the pits of the anti-Black struggle during both the civil rights movement and the Black Lives Matter movement. Black women have the unique lived experience of being Black and women, when race and gender are often focused on separately. These intersections are extremely important in considering the behind-the-scenes roles of women during the civil rights movement compared to women's roles at the forefront of the current Black Lives Matter movement. This work applies Black feminist thought toward a historical discussion on movements of social change for Black people. Additional reflections on the current role of Black women and adult education on voter rights toward the 2020 election and reflections on the recent Vice President-elect Kamala Harris as the first Black and South Asian woman to hold that title are included.

The racialisation of British citizenship

The history of British citizenship is a history of state racism – from the differential treatment of ‘non-patrial’ citizens who acquired citizenship through a colony rather than through British ancestry, which led to the ‘East African Asians’ scandal of 1968, and the quiet withdrawal of British citizenship from former colonial citizens when their countries became independent, which led to the Windrush scandal, through the dilution of the right of citizenship by birth in the UK ( ius soli) in 1981, to current laws which apply the logic of deportation and exclusion to black and brown citizens. British citizens are divided into those claiming only British citizenship, who can never lose it whatever they do, and those who, although they may have been born here, have another citizenship and can lose British citizenship on the say-so of a minister. The latter group, with a second-class, disposable, contingent citizenship, are mostly from ethnic minorities – and the changes to citizenship law which have created these classes of citizenship were brought in to target British Muslims of South Asian and Middle Eastern heritage. While the government claims that only those whose actions pose grave threats to national security, or who have committed abhorrent crimes, will lose their citizenship, the division of citizens into those with secure and insecure status affects vastly more people.

1331P Regional variation in early diagnosis, multimorbidity and death in English males and females of different ethnicity with incident lung cancer from 2014-2019

Regional variation in treatment and outcomes of lung cancer (LC) exists in England suggesting a need for more effective and personalised disease management. However, population level data on patterns of multimorbidity (MM) at diagnosis (Dx), early Dx and mortality in LC across English regions by gender and ethnicity is scarce. From the National Cancer Registration Dataset 235208 people aged ≥ 15 years (53% male) with incident LC (2014-2019) across 21 Cancer Alliances (CA) were analysed by gender and in White, Black and South Asian (SA) ethnicities. Regional variation in the proportion with early Dx (Stage 1/2), MM (Charlson Index ≥ 1) and 1-year crude mortality rate / 100 person years (PY) was estimated. Average Percent Change (APC, %)) was estimated to assess temporal changes. The proportion of Early Dx was low but increased over time with regional variation in males (24 to 28%; APC mean (min, max): 2.8 (0.4, 7.5)%), females (28 to 34%; APC mean (min, max): 4.0 (1.2, 8.6)%), White (26 to 31%; APC mean (min, max): 3.6 (1.5, 7.3)%), Black (23 to 31%; APC mean (min, max): 6.3 (1.1, 10.1)%), and SA ethnicities (25 to 31%; APC mean (min, max): 4.6 (-0.3, 12.1)%). MM at Dx increased across all regions in males (19 to 25%; APC mean (min, max): 4.9 (0.7, 8.7)%) and females (15 to 21%; APC mean (min, max): 6.5 (0.2, 10.2)%), with SA having the highest increase in MM burden (22 to 30%; APC mean (min, max): 5.9 (3.3, 20.7)%) among all ethnicities. Crude mortality rates declined in male (124 to 104/100 PY; APC mean (min, max): -3.5 (-1.1, -7.1)%) and female (100 to 81/100 PY; APC mean (min, max): -4.6 (-1.5, -10.6)%), male having significantly higher rate (p<0.05). Correlation of early Dx with death rate reduction was not observed, with 25% regions with >28% early diagnosis but >100/100 PY death rate. High regional variations in early Dx, MM and death rate were observed across all incident lung cancer population stratum, over the analysed time period. While the early Dx and mortality reduction in lung cancer is marginal and heterogeneous across English regions, there is an urgent need to further optimise early Dx and care management pathways in multi-ethnic society with increasing multimorbidity.

Association of cardio-metabolic risk factors with elevated basal heart rate in South African Asian Indians.

The aim of this study was to determine the association of increasing basal heart rate (BHR) with cardio-metabolic risk in a community sample of Asian Indians from South Africa, due to lack of population-based data on the interaction between heart rate and cardiovascular factors. Data drawn from 1349 randomly selected participants was collected using the WHO STEPS questionnaire. Anthropometry, blood pressure, physical examination and laboratory analyses of venous blood samples and definition of cardiometabolic derangements were performed according to established guidelines. BHR classified into three categories, i.e., <60 bpm; 60-89 bpm and ≥90 bpm. Stepwise backward regression models were constructed for determination of association between increasing BHR and cardiometabolic parameters. A ROC was constructed to determine the AUC and to determine their sensitivity and specificity for discriminating increasing BHR levels. In 379 men (mean age 42±15 years; mean HR 79±13 bpm) and 970 women (mean age 46±12 years; mean HR 87±7.8 bpm), with BHR significantly higher in women (P<0.0001). The distribution of HR was: <60 bpm (2.7%); HR 60-89 bmp (75.8%); HR≥90 bpm (20.1%). In the adjusted logistic regression model fasting plasma glucose (P=0.02; OR 95% CI: 1.18 [1.02-1.4]); age (P=0.01 OR 95% CI: 0.97 [0.96-0.99]); systolic blood pressure (P<0.001 OR 95% CI: 0.95 [0.9-0.97]), and diastolic blood pressure (P≤0.001 OR 95% CI: 1.1 [1.06-1.1]) emerged as independently associated with increasing BHR. The highest AUC for discriminating increasing BHR was for mean diastolic blood pressure (AUC=0.618; P<0.001), and fasting blood glucose (AUC=0.595; P<0.0001). Increasing BHR was independently associated with derangements in fasting blood glucose and blood pressure.

Recording of 'COVID-19 vaccine declined': a cohort study on 57.9 million National Health Service patients' records in situ using OpenSAFELY, England, 8 December 2020 to 25 May 2021.

BackgroundPriority patients in England were offered COVID-19 vaccination by mid-April 2021. Codes in clinical record systems can denote the vaccine being declined.AimWe describe records of COVID-19 vaccines being declined, according to clinical and demographic factors.MethodsWith the approval of NHS England, we conducted a retrospective cohort study between 8 December 2020 and 25 May 2021 with primary care records for 57.9 million patients using OpenSAFELY, a secure health analytics platform. COVID-19 vaccination priority patients were those aged ≥ 50 years or ≥ 16 years clinically extremely vulnerable (CEV) or ’at risk’. We describe the proportion recorded as declining vaccination for each group and stratified by clinical and demographic subgroups, subsequent vaccination and distribution of clinical code usage across general practices.ResultsOf 24.5 million priority patients, 663,033 (2.7%) had a decline recorded, while 2,155,076 (8.8%) had neither a vaccine nor decline recorded. Those recorded as declining, who were subsequently vaccinated (n = 125,587; 18.9%) were overrepresented in the South Asian population (32.3% vs 22.8% for other ethnicities aged ≥ 65 years). The proportion of declining unvaccinated patients was highest in CEV (3.3%), varied strongly with ethnicity (black 15.3%, South Asian 5.6%, white 1.5% for ≥ 80 years) and correlated positively with increasing deprivation.ConclusionsClinical codes indicative of COVID-19 vaccinations being declined are commonly used in England, but substantially more common among black and South Asian people, and in more deprived areas. Qualitative research is needed to determine typical reasons for recorded declines, including to what extent they reflect patients actively declining.

Health Care Experiences of Patients Discontinuing or Reversing Prior Gender-Affirming Treatments

Medical education, research, and clinical guidelines are available to support the initiation of gender-affirming care for transgender and nonbinary people. By contrast, little is known about the clinical experiences of those who discontinue or seek to reverse gender-affirming medical or surgical interventions due to a change in gender identity, often referred to as detransition. To examine the physical and mental health experiences of people who initiated medical or surgical detransition to inform clinical practice. Using constructivist grounded theory as a qualitative approach, data were collected in the form of in-depth interviews. Data were analyzed using an inductive 2-stage coding process to categorize and interpret detransition-related health care experiences to inform clinical practice. Between October 2021 and January 2022, individuals living in Canada who were aged 18 years and older with experience of stopping, shifting, or reversing a gender transition were invited to partake in semistructured virtual interviews. Study advertisements were circulated over social media, to clinicians, and within participants' social networks. A purposive sample of 28 participants who discontinued, shifted, or reversed a gender transition were interviewed. In-depth, narrative descriptions of the physical and mental health experiences of people who discontinued or sought to reverse prior gender-affirming medical and/or surgical interventions. Among the 28 participants, 18 (64%) were assigned female at birth and 10 (36%) were assigned male at birth; 2 (7%) identified as Jewish and White, 5 (18%) identified as having mixed race and ethnicity (which included Arab, Black, Indigenous, Latinx, and South Asian), and 21 (75%) identified as White. Participants initially sought gender-affirmation at a wide range of ages (15 [56%] were between ages 18 and 24 years). Detransition occurred for various reasons, such as an evolving understanding of gender identity or health concerns. Participants reported divergent perspectives about their past gender-affirming medical or surgical treatments. Some participants felt regrets, but a majority were pleased with the results of gender-affirming medical or surgical treatments. Medical detransition was often experienced as physically and psychologically challenging, yet health care avoidance was common. Participants described experiencing stigma and interacting with clinicians who were unprepared to meet their detransition-related medical needs. This study's results suggest that further research and clinical guidance is required to address the unmet needs of this population who discontinue or seek to reverse prior gender-affirming interventions.

"My life isn't my life, it's the systems": A qualitative exploration of women's experiences of day-to-day restrictive practices as inpatients.

WHAT IS KNOWN ON THE SUBJECT?: Sometimes someone needs to be in hospital because they are struggling with their mental health and need some extra support but being in hospital can also be a difficult experience. There are a lot of restrictions in place in hospital, like locked doors, rules to follow and not much choice about what happens to you. Other research has found that these restrictions can feel difficult and stressful for people and so more research is needed about this. We wanted to know what being in hospital felt like for women in particular. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: We interviewed women who were in hospital because of their mental health about what it was like for them in hospital. The women told us that they felt powerless while they were in hospital. They sometimes felt like they were being punished and this could affect their mood and could lead to them hurting themselves. They also said that they were not always listened to by staff, and they found it difficult being away from their family and friends while they were in hospital. The women also told us that being in hospital could sometimes help them to feel safe. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Women should be looked after in hospital in a way that helps them to feel in control of what happens to them. They should be supported to be able to go outside the hospital on leave, to keep in touch with their family and friends, and they should be listened to by staff. A project called "safewards" has suggested some ways for helping to make hospital wards safer. They have suggested that everyone should be clear about what the rules are when they go into hospital and ways that staff could communicate more clearly with the people they are working with. Our research supports using these techniques. ABSTRACT: Introduction Inpatient care often involves restrictive interventions such as seclusion and restraint and restrictive practices that limit the person's freedom, rights and daily activities. Restrictive practice has not been the explicit focus in previous research; however, it often appears as an important theme, with participants identifying it can have a detrimental effect on their well-being. More research specifically on this topic in an inpatient setting is, therefore, needed. Women might be particularly vulnerable to adverse effects of restrictive practices compared to men as women generally occupy less powerful positions in society and more often experience abuse. Aims The study aimed to explore women's experiences of routine restrictive practices in mental health inpatient settings. Methods Twenty-two women who were currently inpatients on mental health wards were interviewed about their experiences of restrictive practices in hospital. Interviews were analysed using thematic analysis. Results An overarching theme emerged of powerlessness. Four key sub-themes were also identified: restrictions perceived as punitive, having no voice, impact of restrictions on relationships and restrictions providing safety and support. Discussion Although restrictive practices were found to provide the women with a sense of safety, they were also found to impact upon the women's well-being, leading to increases in self-harm and over-reliance on restrictions. Implications for practice This research highlights the importance of gender-informed inpatient services for women that foster independence, empowerment and allow women to have their voices heard. Safewards interventions such as clear mutual expectations and soft words could contribute to mitigating the impact of restrictive practices.

Psychological flexibility, birth satisfaction and postnatal trauma symptoms in women with abnormally invasive placenta

ABSTRACT Background Abnormally Invasive Placenta is an obstetric condition resulting in significant physical complications and shown to increase the likelihood of developing Post Traumatic Stress Disorder. Dissatisfaction with the care experienced increases the likelihood of Post Traumatic Stress Disorder. Psychological flexibility has been shown to reduce the severity of Post Traumatic Stress Disorder, but there is no research regarding either of these in women with Abnormally Invasive Placenta. Aim To investigate if there is a relationship between trauma experience in women with a diagnosis of Abnormally Invasive Placenta, psychological flexibility, and birth satisfaction. Method Using a retrospective questionnaire, 126 participants age range 18–45, comprising the Birth Satisfaction Scale Revised Indicator (BSS-RI), Impact of Events Scale Revised (IES-R) and Acceptance and Action Questionnaire (AAQ-2) was completed. A hierarchical regression assessed the predictive relationship of Psychological Flexibility and Birth Satisfaction on Trauma symptoms Results The relationship between Birth Satisfaction measured using the BSS-RI and likelihood of Post Traumatic Stress Disorder (IES-R) was not supported (r (124) = −.08, p = .36). Results did show that Psychological Flexibility (AAQ-2) correlated with Trauma Score (IES-R) (r (124) = .68, p < .001) in women who had experienced Abnormally Invasive Placenta and explained 45.3% of the variance. Conclusion The results suggest that Post Traumatic Stress Disorder in those with Abnormally Invasive Placenta is as high as 1 in 2 and can be mediated by psychological flexibility. In turn, this suggests that interventions to increase Psychological Flexibility in those with the diagnosis may reduce trauma symptom severity.Abbreviations: AAQ-2 - Acceptance and Action QuestionnaireAIP - Abnormally Invasive PlacentaBAME – Black Asian or other Minority EthnicitiesBSS-RI Birth Satisfaction Scale Revised IndicatorEPH – EPH Gestosis (Pre eclampsia/Eclampsia)DSM – Diagnostic Statical ManualIES-R - Impact of Events Scale RevisedPAS - Placenta Accreta SpectrumPTSD – Post Traumatic Stress Disorder

Impact of Age and Gender on Quality of Life Among General Otolaryngology Patients.

The combined effects of age and gender on health-related quality of life (HRQoL) in otolaryngology patients are unclear. This study tested the hypothesis that the effect of age on HRQoL differs by gender in otolaryngology patients. Patients seen in a general otolaryngology clinic were included in this retrospective chart review. HRQoL was measured by the SF-6D score. Patient characteristics, including demographics and category of chief otolaryngology complaint, were extracted from medical records. A multivariable linear regression analysis was used to analyze the combined effect of age and gender on HRQoL. The model was adjusted for race, ethnicity, number of complaint categories, and number of medications. The study included 728 patients (age mean=52, SD=18; 48% male). Multivariable linear regression models found a significant interaction effect between age and gender (β= 0.213, p < 0.05). For younger patients, female gender was protective; however, at age greater than 35 years, female gender was a risk factor for decreased HRQoL. Compared to Black patients, Asian and other race patients reported significantly greater HRQoL (β= 0.207, p < 0.05 for Asian; β= 0.126, p < 0.05 for other races). Additionally, an antagonistic interaction effect was found between age and number of category of otolaryngology complaints in moderating HRQoL (β= 0.468, p < 0.001). Age affects HRQoL differently in men than in women. Among otolaryngology patients, women experience a greater decrease in HRQoL as they age. 4 Laryngoscope, 133:801-806, 2023.

Nurse workforce diversity and reduced risk of severe adverse maternal outcomes

Racial and ethnic diversification of the physician and nurse workforce is recommended as a leverage point to address the impact of structural racism in maternal care, but empirical evidence supporting this recommendation is currently lacking. This study aimed to assess the association between state-level registered nurse workforce racial and ethnic diversity and severe adverse maternal outcomes during childbirth. This population-based cross-sectional study analyzed 2017 US birth certificate data. Severe adverse maternal outcomes included eclampsia, blood transfusion, hysterectomy, or intensive care unit admission. Proportions of minoritized racial and ethnic registered nurses in each state were abstracted from the American Community Survey (5-year estimate, 2013-2017). This proportion was categorized into 3 terciles, with the first tercile corresponding to the lowest proportion and the third tercile corresponding to the highest proportion. Crude and adjusted odds ratios and 95% confidence intervals of severe adverse maternal outcomes associated with terciles of the state proportion of minoritized racial and ethnic nurses were estimated using logistic regression models. Of the 3,668,813 birth certificates studied, 29,174 recorded severe adverse maternal outcomes (79.5 per 10,000; 95% confidence interval, 78.6-80.4). The mean state proportion of minoritized racial and ethnic nurses was 22.1%, ranging from 3.3% in Maine to 68.2% in Hawaii. For White mothers, the incidence of severe adverse outcomes was 85.3 per 10,000 for those who gave births in states in the first tercile of the proportion of minoritized racial and ethnic nurses and 53.9 per 10,000 for those who gave birth in states in the third tercile (risk difference, -31.4 per 10,000; 95% confidence interval, -34.4 to -28.5). It corresponds to a 37% decreased risk of severe adverse maternal outcomes associated with giving birth in a state in the third tercile (crude odds ratio, 0.63; 95% confidence interval, 0.60-0.66). A decreased risk of severe adverse maternal outcomes was observed for Black mothers (crude odds ratio, 0.65; 95% confidence interval, 0.61-0.70), Hispanic mothers (crude odds ratio, 0.51; 95% confidence interval, 0.48-0.54), and Asian and Pacific Islander mothers (crude odds ratio, 0.65; 95% confidence interval, 0.58-0.72) but not for Native American mothers (crude odds ratio, 0.89; 95% confidence interval, 0.72-1.09) or mothers with >1 race (crude odds ratio, 1.44; 95% confidence interval, 0.72-1.09). After adjustment for patients and hospital characteristics, giving birth in states in the third tercile was associated with a reduced risk of severe adverse outcomes as follows: 32% for White mothers (adjusted odds ratio, 0.68; 95% confidence interval, 0.59-0.77), 20% for Black mothers (adjusted odds ratio, 0.80; 95% confidence interval, 0.65-0.99), 31% for Hispanic mothers (adjusted odds ratio, 0.69; 95% confidence interval, 0.58-0.82), and 50% for Asian and Pacific Islander mothers (adjusted odds ratio, 0.50; 95% confidence interval, 0.38-0.65). The associations of the proportion of minoritized racial and ethnic nurses with the risk of severe adverse maternal outcomes were not statistically significant for Native American mothers and more than 1 race mothers. Results were similar when blood transfusion was excluded from the outcome measure. A diverse state registered nurse workforce was associated with a reduced risk of severe adverse maternal outcomes during childbirth.

Facilitators and barriers to COVID-19 vaccination uptake among ethnic minorities: A qualitative study in primary care.

IntroductionCOVID-19 vaccination effectively reduces severe disease and death from COVID-19. However, both vaccine uptake and intention to vaccinate differ amongst population groups. Vaccine hesitancy is highest amongst specific ethnic minority groups. There is very limited understanding of the barriers and facilitators to COVID-19 vaccine uptake in Black and South Asian ethnicities. Therefore, we aimed to explore COVID-19 vaccination hesitancy in primary care patients from South Asian (Bangladeshi/Pakistani) and Black or Black British/African/Caribbean/Mixed ethnicities.MethodsPatients from the above ethnicities were recruited using convenience sampling in four London general practices. Telephone interviews were conducted, using an interpreter if necessary, covering questions on the degree of vaccine hesitancy, barriers and potential facilitators, and decision-making. Interviews were transcribed verbatim and thematically analysed. Data collection and analysis occurred concurrently with the iterative development of the topic guide and coding framework. Key themes were conceptualised through discussion with the wider team.ResultsOf thirty-eight interviews, 55% (21) of these were in Black or Black British/African/Caribbean/Mixed ethnicities, 32% (12) in Asian / British Asian and 13% (5) in mixed Black and White ethnicities. Key themes included concerns about the speed of vaccine roll-out and potential impacts on health, mistrust of official information, and exposure to misinformation. In addition, exposure to negative messages linked to vaccination appears to outweigh positive messages received. Facilitators included the opportunity to discuss concerns with a healthcare professional, utilising social influences via communities and highlighting incentives.ConclusionCOVID-19 has disproportionately impacted ethnic minority groups. Vaccination is an effective strategy for mitigating risk. We have demonstrated factors contributing to vaccine reluctance, hesitancy and refusal and highlighted levers for change.

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.

Visual image of God/gods during early childhood.

This study examined whether Japanese children have a different visual image of God/gods than children from Western countries, who have an image of an old White man. Study 1 comprised 183, 4-7-year-old Japanese children (93 girls), who had to choose a face that looked like God/gods from among pictures of faces that differed on age (e.g., young Asian man vs. old Asian man), race (e.g., White woman vs. Black woman vs. Asian woman), or gender (e.g., Asian man vs. Asian woman). Children's responses were relatively biased toward old or White faces, but only boys were weakly biased toward male faces. Study 2 confirmed that children did not have a strong gender bias. Japanese children conceptualise God/gods as old or White.

Maternal race and pre-eclampsia: Cohort study and systematic review with meta-analysis.

To examine the association between race and pre-eclampsia and gestational hypertension after adjustment for factors in maternal characteristics and medical history in a screening study from the Fetal Medicine Foundation (FMF) in England, and to perform a systematic review and meta-analysis of studies on pre-eclampsia. Prospective observational study and systematic review with meta-analysis. Two UK maternity hospitals. A total of 168 966 women with singleton pregnancies attending for routine ultrasound examination at 11-13 weeks of gestation without major abnormalities delivering at 24 weeks or more of gestation. Regression analysis examined the association between race and pre-eclampsia or gestational hypertension in the FMF data. Literature search to December 2021 was carried out to identify peer-reviewed publications on race and pre-eclampsia. Relative risk of pre-eclampsia and gestational hypertension in women of black, South Asian and East Asian race by comparison to white women. In black women, the respective risks of total-pre-eclampsia and preterm-pre-eclampsia were 2-fold and 2.5-fold higher, respectively, and risk of gestational hypertension was 25% higher; in South Asian women there was a 1.5-fold higher risk of preterm pre-eclampsia but not of total-pre-eclampsia and in East Asian women there was no statistically significant difference in risk of hypertensive disorders. The literature search identified 19 studies that provided data on several million pregnancies, but 17 were at moderate or high-risk of bias and only three provided risks adjusted for some maternal characteristics; consequently, these studies did not provide accurate contributions on different racial groups to the prediction of pre-eclampsia. In women of black and South Asian origin the risk of pre-eclampsia, after adjustment for confounders, is higher than in white women.

Abstract 511: Prognostic relevance of 3q amplification in squamous cell carcinoma of the lung

Abstract Introduction: Amplification of 3q is the most common genetic alteration identified in squamous cell carcinoma of the lung (LUSC) with the most frequent amplified region being 3q26-3q28. It has been described in preinvasive and invasive LUSC and represents one of the most striking molecular differences between LUSC and adenocarcinoma. Many studies evaluated the prognostic value of 3q amplification; however, they either studied the entire region (~40 genes) or 1-2 genes of biological relevance (e.g SOX-2, p63). In this analysis, we aim to describe the prognostic relevance of 3q by focusing on a minimal common region (MCR) of amplification within 3q constituted of 25 genes. Additionally, we examined the association between MCR amplification and other genetic alterations commonly found in LUSC, such as CDKN2A deletion. Results: We conducted an analysis of 499 cases of LUSC from The Cancer Genome Atlas (TCGA). The majority identified as white (90.2%) and 9.8% as African American (AA) or Asians; 73.7% were males, 7 patients had stage IV disease. We found amplification of MCR (chr3:181,711,924-183,428,101) ~1.7MB within a large amplified region between (chr3:170,169,718-187,736,569) ~17.5MB on chr 3q. All 25 genes within MCR were found to be frequently amplified. Molecular data was available for 476 patients in CBioPortal, amplification of MCR was found in 221 (44.3%) cases whereas 255 (51%) cases had no amplification. Median disease specific survival of MCR-amplified cases was significantly longer than non-amplified cases (NR versus 9.25 years; 95% LowerCI: 5.24; log-rank p&amp;lt;0.05). Median progression-free interval for amplified cases was 8 years (95% LowerCI: 5.1) versus 4.9 years (95% LowerCI: 3.5) for non-amplified cases (Log-rank p&amp;lt;0.05). In multivariable analysis, MCR amplification was associated with significantly improved progression-free survival (HR for progression 0.67, CI 0.47-0.95, p=0.024) and disease specific survival (HR for death 0.59, CI 0.38-0.94, p=0.025). CDKN2A homozygous deletion, a common genetic alteration in lung cancer, was detected in 126 patients, 70 with MCR amplification and 56 with no amplification. CDKN2A deletion was associated with MCR amplification (Fisher’s exact test p=0.02121; OR: 1.64, 95% CI: 1.07-2.54). Conclusion: Amplification of the 25-gene MCR within 3q was present in 44% of this cohort mainly composed of Caucasian patients with early stage LUSC. It was also associated with lower risk of progression and better disease specific survival. This analysis is a strong indicator for the prognostic relevance of the 25-gene MCR within 3q. We are further evaluating its prognostic relevance in a racially diverse patient population with advanced LUSC. Citation Format: Fawzi Abu Rous, Rebecca Chacko, Shannon Carskadon, Shanker Kalyana-Sundaram, Pin Li, Sunny Singh, Laila Poisson, Shirish Gadgeel, Nallasivam Palanisamy. Prognostic relevance of 3q amplification in squamous cell carcinoma of the lung [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 511.

Abstract 2182: Ancestry inference and population-specific disparities in a real-world clinical sequencing cohort

Abstract Accurate ancestry inference is crucial for identifying genetic determinants of cancer disparities among specific populations. While methods to infer genetic ancestry and admixture have historically relied upon genome-wide markers from broad-scale next-generation sequencing (NGS), the adaptation to targeted NGS panels presents an opportunity to prospectively incorporate ancestry inference as part of routine clinical diagnosis. Here we show that global ancestral contributions and admixture of African (AFR), European (EUR), East Asian (EAS), Native American (NAM) and South Asian (SAS) populations can be reliably inferred using markers from genomic regions covered by the FDA-authorized clinical NGS panel, MSK-IMPACT. We also show that individuals with Ashkenazi Jewish (ASJ) ancestry can be inferred with 97% accuracy using a set of ASJ ancestry-informative markers. We apply these methods to infer genetic ancestry for over 45,000 patients from the AACR GENIE v10.0-public cohort who were profiled using MSK-IMPACT. We observed 98% concordance between self-reported race and genetic ancestry for non-admixed individuals and were able to quantitatively infer ancestral contributions for individuals from recently admixed populations such as African American and Latin American. Of the discordant cases, manual review of clinical and family histories revealed the vast majority to represent clinical encoding errors where the inferred ancestry was confirmed correct. As self-reported race is not available for 17% of patients in the GENIE cohort, the ability to accurately infer genetic ancestry enables broader analysis of population-specific genomic and clinical features. We systematically evaluated the frequency of somatic and germline alterations in up to 468 genes for each cancer type and recapitulated known differences among ancestral populations. For example, we observed significantly higher frequency of EGFR somatic alterations in EAS (65%) and SAS (66%) compared to non-ASJ EUR (21%) with lung adenocarcinoma, a difference that remained significant even when limiting to never-smokers. Additionally, we found that the frequency of harboring at least one known BRCA founder mutation (BRCA1 68_69delAG, BRCA1 5266dupC, or BRCA2 5946delT) was 26x higher in genetically determined ASJ (5.1%) compared to non-ASJ (0.2%). Strikingly, while the overall rate of driver alterations in solid tumors was similar across different populations, we found that the proportion of patients with clinically actionable somatic alterations (OncoKB Level 1, 2, 3A, or 3B) was lowest in AFR (47%) patients compared to EUR, EAS and SAS (50% each). While this result is partially explained by different cancer type and subtype distributions in different populations in this real-world cohort, it highlights the urgency for greater equity in drug development programs to target alterations represented across all diverse populations. Citation Format: Kanika Arora, Thinh N. Tran, Yelena M. Kemel, Miika Mehine, Ying Liu, Shaleigh A. Smith, Subhiksha Nandakumar, Irina Ostrovnaya, Thomas C. Reynolds, Kenneth Offit, David Solit, Marc Ladanyi, Nikolaus Schultz, Ahmet Zehir, Carol L. Brown, Debyani Chakravarty, Zsofia K. Stadler, Chaitanya Bandlamudi, Michael F. Berger. Ancestry inference and population-specific disparities in a real-world clinical sequencing cohort [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 2182.

Clinical utility of widespread germline testing of cancer patients in a diverse community cancer clinic.

e18537 Background: Identification of germline mutations can determine prognosis, inform targeted therapies, allow risk-reducing interventions, and suggest additional cancer screenings in patients and their biological relatives. Large prospective cohort studies have been historically skewed towards wealthier socioeconomic populations that lack ethnic diversity and vastly underrepresent African Americans. Recently, small studies outside of standard clinical guidelines reveal detection of pathogenic variants in germline testing with significant clinical ramifications. We present our single center experience of prospective germline testing in a small community clinic in suburban and rural South Carolina with understudied real-world populations. Methods: We performed germline testing, outside of guidelines, in patients presenting at earlier age or with either rare tumors, or recurrent/multiple malignancies. This prospective, observational cohort included a suburban and rural underserved population where approximately 30% identify as African American. Patients were counselled about testing that performed outside of guidelines. Results: We identified 67 individuals outside the guidelines concordance, compromising of 45 male and 22 female patients, within the first 6 months of this prospective, observational cohort. Patients reported race as African American (14), White (50), or Asian American (3). Rare germline findings included Li Fraumeni syndrome, Fanconi’s syndrome, Perelman’s disease, and Von Hippel Lindau’s disease. We summarize our findings in the attached table. Conclusions: There are limited studies that report prevalence of germline findings in cancer patients who are unselected by clinical practice guidelines. Studies also lack representation of ethnic minorities. Recently published data on the clinical utility of broad-based germline testing of all incoming patients suggest current practice of guidelines and genetic counselor recommended testing should be re-examined for broader testing for all incoming cancer patients in a more inclusive manner.[Table: see text]

The perception and emotional reaction to genetic test results in cancer patients in an immigrant enriched hospital.

e24128 Background: Genetic testing detects hereditary cancer syndromes and guides prophylactic surgery, intensive surveillance and family member testing. Despite its surge in use, research studies exploring the cancer patient’s perception and emotional reactions of their genetic test result is sparing. We hypothesized that the patient’s perception may be influenced by their ethnicity, educational level and English speaking status. Methods: Cancer patients who had genetic testing performed in the last 10 years were consented to take a questionnaire survey. The correctness of understanding their genetic test results were studied and compared among various ethnic groups, education levels and first spoken languages. We also evaluated the patient’s emotional reaction towards the result. Results: The data for the first 100 patients were analyzed. The primary tumor sites were breast (n = 71), gynecological (n = 16), gastrointestinal (n = 7), genitourinary (n = 5) and lung (n = 1). Eighteen patients were mutation carriers. The correctness in understanding mutation status was 65.7%, 54.2%, 70% and 45.5% in African American, Asian, Caucasian and Hispanics respectively. The correctness was 60%, 64.5% and 66.67% in patients with education levels of grade school or below, high school, or college or higher respectively. None of the 3 patients who carried a mutation with education level of grade school or lower understood the implications of their mutations. Details of correctness in understanding in patients with and without mutation are provided in the table. The correctness was 61.72% and 63.15% in English speaking vs non-English speaking patients. Patients could recall pre-test counseling in 76% and posttest counseling in 67% of cases. Among mutation carriers, 22.2% had anxiety or stressful feelings about the test result, while in patients with no mutation, 20.7% had anxiety/depression. 67% patients carried out prophylactic surgery as recommended. Conclusions: The correctness of understanding their genetic test results across all ethnic groups, education levels and language was below 70%. Patients with education level below grade school encountered in the immigrant population need more attention. Improvement in communication and patient education is imperative in order to carry out recommendations. Structured emotional support to the patient should always complement genetic counseling and testing.[Table: see text]