Alaska Research Articles

Perceived Discrimination, Retention, and Diabetes Risk Among American Indians and Alaska Natives in a Diabetes Lifestyle Intervention.

Objectives: To examine the association of perceived discrimination with participant retention and diabetes risk among American Indians and Alaska Natives. Methods: Data were drawn from the Special Diabetes Program for Indians-Diabetes Prevention Demonstration Project (N = 2553). Results: Perceived discrimination was significantly and negatively associated with short-term and long-term retention and diabetes risk without adjusting. After controlling for socioeconomic characteristics and clinical outcomes, perceived discrimination was not associated with retention but was significantly associated with less improvement in body mass index (BMI) and high-density lipoprotein (HDL) cholesterol. Every unit increase in the perceived discrimination score was associated with 0.14kg/m2 less BMI reduction (95% CI: [0.02, 0.26], p = 0.0183) and 1.06mg/dl lower HDL at baseline (95% CI: [0.36, 1.76], p = 0.0028). Discussion: Among racialized groups, improving retention and health in lifestyle interventions may require investigating perceived discrimination and the broader context of structural racism and colonialism.

Food Insecurity and Associated Challenges to Healthy Eating Among American Indians and Alaska Natives With Type 2 Diabetes: Multiple Stakeholder Perspectives.

Objective: To examine stakeholder perspectives on food insecurity and associated challenges to healthy eating among American Indian and Alaska Native (AI/AN) adults with type 2 diabetes (T2D). Methods: Focus groups and interviews were conducted with purposively selected stakeholders: AI/ANs with T2D, their family members, healthcare administrators, nutrition and diabetes educators, and national content experts on AI/AN health. Two coders analyzed transcripts using the constant-comparison method. Results: Key themes included (1) rural- and urban-dwelling AI/ANs experience different primary food security and associated challenges; (2) factors contributing to food insecurity extend beyond cost of healthy food; and (3) barriers to consuming fresh, healthy food include cost, preparation time, limited cooking knowledge, and challenges with gardening. Discussion: Resources for AI/ANs with T2D who experience food insecurity and associated challenges to healthy eating should be tailored based on urban versus rural location and should address cost and other barriers to consumption of fresh fruits and vegetables.

The Association of Cultural Participation and Social Engagement With Self-Reported Diagnosis of Memory Problems Among American Indian and Alaska Native Elders.

Objective: This study examines the association of cultural participation and social engagement with self-reported diagnosis of memory problems among older American Indians and Alaska Natives (AI/ANs). Method: We conducted a cross-sectional study of 14,827 AI/ANs using data from the 2014-2017 cycle of the Identifying Our Needs: A Survey of Elders (ION). Logistic regression was used to examine the association of cultural participation and social engagement with self-reported diagnosis of memory problems. Results: Compared to older AI/ANs who reported high cultural participation and/or high social engagement, those characterized by low cultural participation and/or low social engagement exhibited significantly higher odds of a self-reported diagnosis of memory problems (OR = 1.863, 95% CI: [1.269, 2.734], p = .001). Discussion: Older AI/ANs who described either or both low cultural participation and low social engagement endorsed far more self-reported diagnoses of memory problems, suggesting a strong association that warrants further study for potential causality.

Reconstructing historical baseline catches along Highway 101: U.S. West Coast marine fisheries, 1950–2017

The United States of America, as most other countries, emphasizes commercial fisheries when reporting statistics to the Food and Agriculture Organization of the United Nations (FAO), and excludes data from other sectors, such as recreational fisheries. Our study is a first attempt to account comprehensively for all sources of total U.S. marine catches from the Exclusive Economic Zone waters along the West Coast of the continental USA from 1950 to 2017 in one dataset, i.e., excluding the states of Alaska and Hawaii. Total reconstructed catches for 1950–2017 were 1.2 times higher than the data reported by the USA to the FAO. Commercial landings dominated catches, with 65% from large-scale, industrial fisheries and 31% from small-scale, commercial fisheries. Recreational fisheries accounted for 4% of the total catch, after accounting for post-release mortality. Total catches were highest in 1950 at around 750,000 t and declined to 570,000 t by 2017. Internationally unreported discards increased from 24,000 t in 1950 to 86,000 t in 1989, but declined after the introduction of bycatch reduction devices to around 10,000 t year−1 by the mid-2010s. Total catches by taxonomic category suggest a decline in the diversity in catches. Levels of reporting for total catches is excellent for recent decades, with around 95% of total catches accounted for by the mid-2010s, but around 40% of catches were missing from data reported to the FAO between the late 1960s and early 1990s. This discrepancy was largely driven by industrial catches of North Pacific hake (Merluccius productus) that were not in the officially reported data. Our results suggest that recreational fisheries and discards can make up a considerable component of total catches over time. We suggest that the USA include their recreational catch estimates in their annual data submission to the FAO, retroactively to 1950.

American Indians and Alaska Natives in the COVID-19 Pandemic: The Grave Burden We Stand to Bear.

The United States is bearing witness as a crisis-within-a-crisis unfolds across Indian Country, where a persistently underfunded system with inadequate resources and outdated facilities set the stage for coronavirus disease 2019 (COVID-19) to overwhelm Tribes. Now is the time to reimagine our way forward as a country beyond the pandemic. To address these issues, we recommend that (1) the federal government appropriately fund the Indian Health Service and work more closely with tribal governments, and (2) programs that recruit, train, and retain American Indian and Alaska Native (AIAN) health professionals be expanded. We offer guidance on decisive and impactful steps that can be taken, together, today.

Diversifying the Ocean Sciences: Thoughts on the Challenge Ahead

The lack of diversity in the ocean sciences is not a particularly big secret or a recent issue. In his inaugural column in 2000 for The Oceanography Classroom, Dean McManus wrote: “A particular challenge for higher education is to include more members of underrepresented groups in the study of the ocean. Fifteen years from now, 40% of the traditional undergraduate-age population will consist of these underrepresented groups, but today the ocean sciences have the lowest participation by underrepresented groups of any science.” Despite this prescient statement from McManus, little progress has been made in diversifying the ranks of the ocean sciences. In a recent National Science Foundation survey of current graduate students in the ocean sciences, approximately 8.8% of those surveyed identify as coming from a group that is considered part of a minority community in the United States (Black, Hispanic/Latinx, Native Alaskan, Native American, Pacific Islander). As might be expected, these numbers are even worse for the professional ranks of agencies, nonprofits, and university programs that focus on the ocean sciences. The lack of these communities’ representation in ocean science careers is underscored by the past year’s news reports, brimming as they have been with the brutality and injustices that those in BIPOC (Black, Indigenous, People of Color) communities face daily. The STEM community, including the ocean sciences, is now, more than ever, being forced to confront the ways in which its institutions and culture contribute to the inequities facing BIPOC communities. Here, I draw upon my dual identity as a member of the ocean science and Latinx communities to discuss how the ocean sciences can enact meaningful changes around improving diversity, equity, and inclusion (DEI).

New Drug Formulary Management and Utilization: Evidence in Sex, Race, and Ethnicity: 2019-2020.

It is well established that females and persons of racial and ethnic minorities are frequently underrepresented in clinical trials. These disparities are potentially important aspects of evidence-based formulary management and drug utilization review (DUR) processes. The purpose of this study was to review the demographic composition of pivotal trials and post-approval study requirements for recent FDA-approved drugs, analyzing the representation of minority groups and its generalizability to the US population or corresponding disease state. Drugs approved between July 2019 and June 2020 were identified and demographic data including race, ethnicity, and sex was extracted from their pivotal trials. Demographic data was compared to US demographics and/or the disease state demographics for the respective approved drug. There were a total of 85 drugs and 142 pivotal trials included in the study. Compared to the estimated US population, the minority groups with a statistically significant underrepresentation across all pivotal trials included Black or African Americans and American Indian or Alaska Natives. The Hispanic/Latinx population had a statistically significant underrepresentation in 55.4% of trials. Females had a statistically significant underrepresentation in 21.2% of trials when compared to the disease state demographics of the respective approved drug. Persons of minorities are underrepresented in the generation of evidence of safety and efficacy for many new drugs. Formulary management and DUR offer an integrated strategic opportunity for the clinical community to formally and carefully consider the data on sex, race, and ethnicity to address disparities in health care.

Looking Back to Leap Forward: A Framework for Operationalizing the Structural Racism Construct in Minority Health Research.

Racism is now widely recognized as a fundamental cause of health inequalities in the United States. As such, health scholars have rightly turned their attention toward examining the role of structural racism in fostering morbidity and mortality. However, to date, much of the empirical structural racism-health disparities literature limits the operationalization of structural racism to a single domain or orients the construct around a White/Black racial frame. This operationalization approach is incomprehensive and overlooks the heterogeneity of historical and lived experiences among other racial and ethnic groups. To address this gap, we present a theoretically grounded framework that illuminates core mutually reinforcing domains of structural racism that have stratified opportunities for health in the United States. We catalog instances of structural discrimination that were particularly constraining (or advantageous) to the health of racial and ethnic groups from the late 1400s to present. We then illustrate the utility of this framework by applying it to American Indians or Alaska Natives and discuss the framework's broader implications for empirical health research. This framework should help future scholars across disciplines as they identify and interrogate important laws, policies, and norms that have differentially constrained opportunities for health among racial and ethnic groups.

Racial and ethnic representation trends in United States oncology training programs.

6519 Background: Utilizing race and ethnicity data from the Accreditation Council for Graduate Medical Education (ACGME), this study aims to assess representation trends across American Society of Clinical Oncology (ASCO) participant specialties from the past five academic years in order to characterize current needs and effectively address these needs moving forward. Methods: Self-reported ethnicity/race data from the ACGME database books were collected from academic years 2015-16 to 2019-2020 for the following oncologic training programs: hematology and medical oncology, medical oncology, gynecologic oncology, pediatric hematology and oncology, radiation oncology, complex general surgical oncology. Summary statistics and chi-square analysis were conducted to compare underrepresented minority (URM) trends across programs. URM groups were cross-referenced with definitions provided by the AAMC and included those who identify as Hispanic, Latino or of Spanish origin, Black or African American, and Native American or Alaskan. Results: Over the study period, only 1,250 (9.0%) of 13,853 oncology trainees identified as URM. Chi-square analysis demonstrated no significant change in URM representation in all oncology specialties combined between 2015-16 and 2019-20 (8.9% [95% CI, 7.8%-10.0%] vs. 9.7% [95% CI, 8.7%-10.8%]; P=.31). Between 2015-16 and 2019-20, Hematology and oncology (+1.3%), pediatric hematology and oncology (+0.3%) all demonstrated insignificant increasing trends in representation while radiation oncology (-0.3%), complex general surgical oncology (-4.0%) had statistically insignificant decreasing trends in representation. Gynecologic oncology (+6.0%) demonstrated a significant increasing trend in representation. Conclusions: This is the first study to characterize the vast disparities in representation in oncologic training programs in the United States. There is a demonstrated lack of representation across all oncology training programs and a lack of significant improvement over the study period. A multiprong approach is needed to improve diversity and representation across the spectrum of the oncology workforce in the United States.

Dermatologic diagnoses in oncology patients of color on anticancer therapy: Five-year retrospective review of outpatient dermatology consultations.

12084 Background: Dermatologic toxicities from cancer treatments affecting patients from racial and ethnic minority backgrounds or skin of color (SOC) patients is an understudied area of research. These patients are also significantly underrepresented in therapeutic clinical trials, limiting complete understanding of toxicities associated with cancer therapies. Current treatment algorithms for dermatological adverse events (dAE) also do not take into account possible biologic differences in different skin types affecting toxicity presentation and treatment response. In this study we summarize the demographic, clinical, and treatment characteristics of oncology patients from racial and ethnic minority backgrounds who developed dermatologic adverse events related to cancer therapies. Methods: We performed a retrospective review of all SOC patients (Asian, Black, Hispanic) on active cancer therapy who received outpatient dermatology consultation at Memorial Sloan Kettering Cancer Center from January 1, 2014 to December 31, 2019. Electronic health record information for 2917 patients was obtained. A computational keyword-based text analysis of medical chart text, developed in consultation with a board-certified dermatologist, was performed to determine dermatologic diagnoses categories for each patient. All analyses were conducted using R statistical programming software, version 4.2.06. Results: There were 2917 outpatient dermatology consultations. Our population consisted of 1992 (68.29%) females and 925 (31.71%) males with a mean age of 53 (range 0-97). There were 35.55% Black, 41.28% Asian, 1.02% (30) Native American or Alaskan Native, 0.17% (5) Native Hawaiian or Other Pacific Islander. 729 were Hispanic ethnicity of which 641 were Caucasian. A total of 4,026 dermatologic diagnoses occurred in the study population. Bacterial infections were the most commonly observed, occurring in 15% of patients. Nail disorders were the second most common dAE, occurring in 14% of the study population, followed by eczema/eczematous reactions at 9%. In all racial groups, eczema/eczematous reactions, nail disorders, and dermatomyositis were in the top five most common observed dAEs. Asian patients made up the largest proportion of those who had morbilliform rash dAEs (55%) while Black patients made up the largest proportion of those with hyperpigmentation dAEs (54%) and vascular insufficiency dAEs (47%). Conclusions: The findings from our study indicate that pigmentary changes, bacterial infections, eczema/eczematous reactions, and nail disorders are the most common dAE types that occurred in our group of SOC patients. We hope to use this information to aid in the development of specific management strategies within the field of supportive oncodermatology to meet the needs of minority patient populations.

Parental Educational Attainment, the Superior Temporal Cortical Surface Area, and Reading Ability among American Children: A Test of Marginalization-Related Diminished Returns.

Background: Recent studies have shown that parental educational attainment is associated with a larger superior temporal cortical surface area associated with higher reading ability in children. Simultaneously, the marginalization-related diminished returns (MDRs) framework suggests that, due to structural racism and social stratification, returns of parental education are smaller for black and other racial/ethnic minority children compared to their white counterparts. Purpose: This study used a large national sample of 9–10-year-old American children to investigate associations between parental educational attainment, the right and left superior temporal cortical surface area, and reading ability across diverse racial/ethnic groups. Methods: This was a cross-sectional analysis that included 10,817 9–10-year-old children from the Adolescent Brain Cognitive Development (ABCD) study. Parental educational attainment was treated as a five-level categorical variable. Children’s right and left superior temporal cortical surface area and reading ability were continuous variables. Race/ethnicity was the moderator. To adjust for the nested nature of the ABCD data, mixed-effects regression models were used to test the associations between parental education, superior temporal cortical surface area, and reading ability overall and by race/ethnicity. Results: Overall, high parental educational attainment was associated with greater superior temporal cortical surface area and reading ability in children. In the pooled sample, we found statistically significant interactions between race/ethnicity and parental educational attainment on children’s right and left superior temporal cortical surface area, suggesting that high parental educational attainment has a smaller boosting effect on children’s superior temporal cortical surface area for black than white children. We also found a significant interaction between race and the left superior temporal surface area on reading ability, indicating weaker associations for Alaskan Natives, Native Hawaiians, and Pacific Islanders (AIAN/NHPI) than white children. We also found interactions between race and parental educational attainment on reading ability, indicating more potent effects for black children than white children. Conclusion: While parental educational attainment may improve children’s superior temporal cortical surface area, promoting reading ability, this effect may be unequal across racial/ethnic groups. To minimize the racial/ethnic gap in children’s brain development and school achievement, we need to address societal barriers that diminish parental educational attainment’s marginal returns for middle-class minority families. Social and public policies need to go beyond equal access and address structural and societal barriers that hinder middle-class families of color and their children. Future research should test how racism, social stratification, segregation, and discrimination, which shape the daily lives of non-white individuals, take a toll on children’s brains and academic development.

The Ninth Circuit Court of Appeals and Jail-Based Competency Evaluation and Restoration.

The U.S. Ninth Circuit is the largest of the federal appeals courts, encompassing the states of Alaska, Washington, and Oregon to the north, Hawaii, Guam, and the Northern Mariana Islands to the west, California and Arizona to the west and southwest, along with the three intermountain states of Idaho, Montana, and Nevada. The landmass within the Ninth Circuit represents great diversity of geography, climate, population density, and cultural and political traditions. This article considers two landmark Ninth Circuit decisions, one from Oregon and the other from Washington, two states that share geography, culture, and political orientation. Informed by these decisions, we consider how the Ninth Circuit might view the jail-based competency evaluation and restoration programs in the state of Arizona. We explore: the due process rights of jail detainees who are awaiting an evaluation of trial competency; and the time necessary for admission to, and the adequacy of, Arizona's jail-based competency restoration programs after a finding of incompetency.

Racial/Ethnic Health Disparity in the U.S.: A Decomposition Analysis

Following recent econometric developments, we use self-assessed general health on a Likert scale conditioned by several objective determinants to measure health disparity between non-Hispanic Whites and minority groups in the United States. A statistical decomposition analysis is conducted to determine the contributions of socio-demographic and neighborhood characteristics in generating disparities. Whereas, 72% of health disparity between Whites and Blacks is attributable to Blacks’ relatively worse socio-economic and demographic characteristics, it is only 50% for Hispanics and 65% for American Indian Alaska Natives. The role of a number of factors including per capita income and income inequality vary across the groups. Interestingly, “blackness” of a county is associated with better health for all minority groups, but it affects Whites negatively. Our findings suggest that public health initiatives to eliminate health disparity should be targeted differently for different racial/ethnic groups by focusing on the most vulnerable within each group.

Disparities in Dental Service Use among Adult Populations in the United States.

This article aims to examine the disparities in dental service utilization among 3 age groups: younger adults (20-49 y), middle-aged adults (50-64 y), and older adults (65+ y), among Whites, Hispanics, Blacks, Asians, American Indians or Alaska Natives (AIAN), and Native Hawaiian or other Pacific Islanders (NHOPI). Weighted logistic regression models were conducted to analyze 9 waves of cross-sectional survey data (2002-2018) from the Behavioral Risk Factor Surveillance System. We estimated age group- and race/ethnic-specific prevalences of dental service utilization adjusting sociodemographics and self-rated health for each wave and compared with crude analysis. Next, we performed linear regression analysis of the trend of adjusted prevalences over time and the average level by race/ethnicity and age groups. Racial/ethnic disparities increased with age, even though the adjusted prevalences of dental service utilization were less apparent than the crude analysis. The all-wave average prevalence was 71%. Black older adults had the lowest level of dental service utilization (65%) as compared with the 2 highest groups: White older adults (79%) and Asian older adults (76%). The general younger adult populations had low prevalences, with the lowest among Asian younger adults (65%). AIAN and NHOPI individuals from all age groups tended to have average or below average prevalences. In addition, a decreasing trend of dental service utilization was observed among White individuals of all age groups (0.2%-0.3% lower per year, P < 0.01) and AIAN younger adults (0.5% lower per year, P < 0.01). Health policy, federal funding, and community-based programs should address the needs of dental service utilization for racial/ethnic minorities including Blacks, AIANs, and NHOPIs. Our study offers insights into our understanding of disparities in dental service utilization among minority racial/ethnic groups. As health policy, federal funding, and community-based programs seek to improve oral health, there is a need to address access to and utilization of dental service for Blacks, American Indians or Alaska Natives, and Native Hawaiian or other Pacific Islanders.

American Indian and Alaska Native Enrollment in Clinical Studies in the National Institutes of Health's Intramural Research Program.

Clinical studies conducted by the National Institutes of Health's Intramural Research Program (NIH-IRP) provide eligible individuals with access to innovative research treatments that may not otherwise be available. The NIH-IRP's mission is to include all Americans, including American Indians and Alaska Natives, in its clinical research. This study is the first to provide data about inclusion of American Indians/Alaska Natives in NIH-IRP clinical studies. We analyzed data from the more than 1,800 NIH-IRP protocols active in 2014 and 2017. We found that the absolute number of American Indian/Alaska Native enrollees increased between 2014 and 2017 but remained at 1% of all participants, a disproportionately low level. The number of clinical studies that enrolled American Indian/Alaska Native individuals similarly did not change. NIH efforts to expand participation of American Indians/Alaska Natives in clinical studies has often focused on research within their communities or on health needs specific to these groups. Those efforts should expand to include processes and protections for the proportionate and ethical inclusion of American Indians and Alaska Natives who individually enroll in studies that are not specific to American Indians, Alaska Natives, or their tribal nations.

The Great Recession and Economic Outcomes for Indigenous Peoples in the United States

This article examines the earnings and employment experience of American Indians and Alaska Natives (AIAN) and Native Hawaiians and Pacific Islanders (NHPI) residing in the United States during and after the Great Recession. I compare these populations to non-Hispanic whites over the same time period with respect to median earnings and inequality, labor force participation rates, earnings by location, educational attainment, and occupational status. I find that the AIAN population has the lowest median earnings and highest level of earnings inequality. NHPI and AIAN experience a sharp increase in earnings inequality over the Great Recession and AIAN have a pronounced drop in labor force participation; these inequality measures remained elevated and stable over the recovery period especially for the AIAN population. Indigenous peoples employed in food services occupations experienced the least amount of earnings decline over the Great Recession, while those employed in construction and sales experienced larger declines. Labor force participation rates dropped most dramatically for the AIAN population over the Great Recession and remained at a new lower level in the recovery period. The analysis shows that there are stark differences across time, space, and occupation for these groups.

Alaska

The Alaska State Legislature was scheduled to convene its Second Regular Session of the Thirty-First Legislative Session from January 21, 2020, through May 20, 2020. However, on March 29, 2020, the Alaska State Legislature, like other state legislatures, suspended its session effective immediately, in response to the coronavirus pandemic (“COVID-19”). While the suspension was initially continued through May 18, 2020, the Alaska Legislature formally adjourned on May 20, 2020. Given the adjournment, the legislature did not pass any substantive oil and gas legislation.

Checklists of the Hymenoptera of Canada, Alaska and Greenland – Introduction

The distribution of described, extant species of the insect order Hymenoptera recorded from northern North America will be published in a series of ten checklists. In total, 9250 species in 27 superfamilies and 84 families are recorded from Canada, the state of Alaska (USA) and Greenland (Denmark). Within northern North America, 8933 species are recorded in Canada (96.6% of the total species), Alaska has 1513 (16.4%) and Greenland has 205 (2.2%). Within Canada, Ontario is the province with the most species recorded (5322, 57.5% of all species in northern North America), followed by Quebec (4207, 45.5%) and British Columbia (4063, 43.9%). At the family level, Ontario has 82 of the 84 recorded families, Quebec has 76 and British Columbia has 71. The most species-rich superfamilies in northern North America are Ichneumonoidea (4438 species, 48.0% of the total); Apoidea (1438, 15.5%) and Chalcidoidea (1246, 13.5%). The largest families are Ichneumonidae (3201 species, 34.6% of the total), Braconidae (1237, 13.4%), Tenthredinidae (573, 6.2%), Eulophidae (379, 4.1%) and Pteromalidae (309, 3.3%). Overall species richness of the Hymenoptera in northern North America is compared with surveys in Russia, Germany, Finland and the British Isles.

Drum-Assisted Recovery Therapy for Native Americans (DARTNA): Results from a feasibility randomized controlled trial

Alcohol and other drug (AOD) use among American Indians and Alaska Natives (AI/ANs) is a significant health issue in the United States. However, few evidence-based substance use interventions that utilize AI/AN traditional practices, such as drumming, exist. The current study is a feasibility randomized controlled trial (RCT) analyzing the potential benefits of DARTNA (Drum-Assisted Recovery Therapy for Native Americans) among 63 AI/AN adults seeking substance use treatment within an urban area in southern California. We compared DARTNA participants to usual care plus, which involved an integrated multimedia health educational program and usual care from providers for AOD use. At end of treatment, DARTNA participants reported significantly lower cognitive impairment and lower counts of physical ailments. Given that this was a feasibility trial, we also used Cohen's d = 0.20 or odds ratio = 2 or 0.5 to determine clinical significance. At end of treatment, we found promising benefits for DARTNA participants related to better physical health, fewer drinks per day, and lower odds of marijuana use in the past 30 days compared to the control group. Using these criteria, at 3-month follow-up, DARTNA participants reported less adoption of 12-step principles, less cognitive impairment, and lower anxiety with relationships. However, DARTNA participants reported more drinks per day and more cigarettes compared to the control group. Overall, this study demonstrates feasibility of conducting an RCT with AI/AN people in urban settings and highlights how a substance use treatment intervention utilizing drumming may help to meet the diverse needs of AI/AN people seeking substance use treatment.

In Search of Workforce Diversity? A Program's Successful Approach.

The persistence of health care disparities along racial and ethnic lines highlights the complex and multifactorial nature of this national concern. The paucity of physicians ethnically underrepresented in medicine to treat an ever-growing heterogeneous population inherently contributes to these ongoing disparities. The authors proposed an approach to improve the representation of physicians underrepresented in medicine in their plastic surgery residency program. With a renewed commitment to ethnic diversity and inclusion, a multifaceted recruitment and retention approach was implemented at the University of Pennsylvania plastic and reconstructive surgery residency program from 2015 to 2020 (5 academic years). A retrospective review of the demographics of the program's residents was then assessed over the past 9 academic years for comparison (2011 to 2020). The representation of underrepresented-in-medicine residents within the plastic and reconstructive surgery residency program steadily increased with the implementation of this multifaceted approach, reaching an unprecedented high. Currently, 29 percent of all residents are underrepresented in medicine and 29 percent are female, some of whom are also underrepresented in medicine. Although the female representation is on par with the national average, the underrepresented-in-medicine representation is far greater than the national average. As a result of this multifaceted approach, the representation of African American and Latino plastic surgery residents at the University of Pennsylvania now far exceeds current national averages. Unfortunately, the representation of Native American and Alaskan Natives is still lacking, despite the program's broadened recruitment efforts. The success of this experience describes a successful strategy that institutions can implement to enhance underrepresented-in-medicine representation among its plastic surgery trainees.