American Participants Research Articles

Association between Serum Vitamin D Concentrations and Life's Essential 8 score in American adolescents

IntroductionThis study sought to use the latest Life's Essential 8 scoring tool to obtain information on the relationship between serum vitamin D concentration and adolescent cardiovascular health (CVH).Material and methodsA total of 1,819 teenagers aged 16–19 were enrolled. Associations between serum vitamin D concentrations and CVH ratings were estimated using multiple linear regression and multinomial logistic regression methods, and the dose–response relationship was examined by restricted cubic spline analysis.ResultsAfter adjusting for all confounding factors, serum vitamin D concentrations were positively correlated with CVH scores (β=0.12; 95% CI: 0.09-0.14, p<0.001). Among the sex and race subgroups, the correlation was stronger in male, Mexican American and Non-Hispanic Black participants, with ORs of 1.05 (95% CI: 1.03-1.07), 1.06 (95% CI: 1.04-1.08), p=0.002), 1.07 (95% CI: 1.03-1.11), 1.09 (95% CI: 1.05-1.14), p=0.01, 1.04 (95% CI: 1.01-1.06), and 1.05 (95% CI: 1.02-1.09), p=0.01, respectively. Serum vitamin D concentrations had a nonlinear relationship with CVH ratings. CVH scores grew with serum vitamin D concentrations up to the inflection point (86 nmol/L) (β=0.17 (95% CI: 0.135-0.206, p<0.001). When serum vitamin D concentrations exceeded 86 nmol/L, CVH scores were not associated with serum vitamin D concentrations.ConclusionsThe study identifies a nonlinear relationship between serum vitamin D levels and CVH in US adolescents aged 16-19, with an inflection point at 86 nmol/L. These findings underscore the importance of vitamin D in adolescent cardiovascular health and suggest the need for targeted health strategies, particularly in high-risk groups such as male, Mexican American, and Non-Hispanic Black teenagers.

Rationale, design, and participant characteristics of the FAITH! Heart Health+ study: An exploration of the influence of the social determinants of health, stress, and structural racism on African American cardiovascular health

BackgroundAfrican Americans (AAs) face cardiovascular health (CVH) disparities linked to systemic racism. The 2020 police killing of Mr. George Floyd in Minneapolis, Minnesota, alongside the COVID-19 pandemic, exacerbated adverse psychosocial factors affecting CVH outcomes among AAs. This manuscript describes the study protocol and participant characteristics in an ancillary study exploring the relationship between biopsychosocial factors and CVH among AAs. MethodsUsing a community-based participatory approach, a mixed-methods ancillary study of 58 AA participants from an overarching randomized control trial (RCT) was conducted. Baseline RCT health assessments (November 2020) provided sociodemographic, medical, and clinical data. Subsequent health assessments (February–December 2022) measured sleep quality, psychosocial factors (e.g., high-effort coping), biomarkers (e.g., cortisol), and cardiovascular diagnostics (e.g., cardio-ankle vascular index). CVH was assessed using the American Heart Association Life's Simple 7 (LS7) (range 0 to 14, poor to ideal) and Life's Essential 8 (LE8) scores (range 0 to 100, low to high). Correlations between these scores will be examined. Focus group discussions via videoconferencing (March to April 2022) assessed psychosocial and structural barriers, along with the impact of COVID-19 and George Floyd's killing on daily life. ResultsParticipants were predominantly female (67%), with a mean age of 54.6 [11.9] years, high cardiometabolic risk (93% had overweight/obesity and 70% hypertension), and moderate LE8 scores (mean 57.4, SD 11.5). ConclusionThis study will enhance understanding of the associations between biopsychosocial factors and CVH among AAs in Minnesota. Findings may inform risk estimation, patient care, and healthcare policies to address CVD disparities in marginalized populations.

A Tale of Three Advantages: Cross-Cultural Recognition of Basic Emotions Through Virtual Stickers

This study examined recognition of the six basic emotions communicated by 72 stickers provided on Chinese and American social media. Results demonstrate that sadness, happiness, and anger are recognized more accurately than disgust, fear, and surprise. An in-group advantage exists among Chinese instead of American participants, as the latter group recognizes emotions rendered by American and Chinese stickers with similar accuracy. Women outperform men in recognizing anger and fear expressed by stickers. A dynamic advantage manifests in recognizing anger, fear, and happiness rendered by animated stickers, in relation to static stickers. Three-way interaction effects show that emotions rendered by Chinese static stickers are more easily recognized compared to American static stickers. Moreover, women and Chinese participants recognize emotions rendered by Chinese and American animated stickers at similar accuracy levels. By contrast, men and American participants deliver better performances in recognizing emotions expressed by American animated stickers than Chinese animated stickers.

To all the employees who hurt me before: racial discrimination by retail employees against Asian Americans

ABSTRACT Racial discrimination by employees in the retail context is an under-researched area; this is especially true regarding the Asian American experience. Motivated by this lack of research, we explore 1) the forms of overt and subtle racial discrimination Asian Americans face in retail and 2) the behavioral responses of Asian American customers after experiencing discrimination.A transcendental phenomenological framework was used to examine one-on-one semi-structured interviews of 18 Asian American participants. The results show nine racial discrimination themes against Asian American customers: No Asians in here please, All you Asians … ,Less than, The perpetual foreigner, Carriers of the virus, Invisible, Not a target customer, Stereotyped customers, and All the same. Moreover, four behavioral response themes were derived: No action taken against the employee or retailer, No repatronage, Negative OCRs, and Direct complaint.The findings provide important implications for researchers and retailers.

A genome-wide association study of mass spectrometry proteomics using the Seer Proteograph platform.

Genome-wide association studies (GWAS) with proteomics are essential tools for drug discovery. To date, most studies have used affinity proteomics platforms, which have limited discovery to protein panels covered by the available affinity binders. Furthermore, it is not clear to which extent protein epitope changing variants interfere with the detection of protein quantitative trait loci (pQTLs). Mass spectrometry-based (MS) proteomics can overcome some of these limitations. Here we report a GWAS using the MS-based Seer Proteograph™ platform with blood samples from a discovery cohort of 1,260 American participants and a replication in 325 individuals from Asia, with diverse ethnic backgrounds. We analysed 1,980 proteins quantified in at least 80% of the samples, out of 5,753 proteins quantified across the discovery cohort. We identified 252 and replicated 90 pQTLs, where 30 of the replicated pQTLs have not been reported before. We further investigated 200 of the strongest associated cis-pQTLs previously identified using the SOMAscan and the Olink platforms and found that up to one third of the affinity proteomics pQTLs may be affected by epitope effects, while another third were confirmed by MS proteomics to be consistent with the hypothesis that genetic variants induce changes in protein expression. The present study demonstrates the complementarity of the different proteomics approaches and reports pQTLs not accessible to affinity proteomics, suggesting that many more pQTLs remain to be discovered using MS-based platforms.

Black/African American participation in cancer clinical trials: A qualitative study of community members, patients with cancer, and survivors (Detroit, MI) using CBPR.

e13743 Background: Black/African Americans (B/AA) have a disproportionate cancer burden and the highest mortality rates of any racial/ethnic group for most cancers. Racial/ethnic variation in cancer burden reflects health inequities, differences in risk factors, heredity and genomic diversity, and lack of access to and participation in cancer prevention, screening, treatment, and clinical trials. Twelve percent of the United States population are B/AA; however, only about 5% B/AA participate in clinical trials. As a result, data regarding tumors from B/AA are not equally represented in new drug discovery efforts. Methods: Participatory Action for Access to Clinical Trials (PAACT) used a Community Based Participatory Research (CBPR) approach to support a partnership between Henry Ford Health (HFH) and eight African American, Caribbean, and continental African community-based organizations (CBOs). Focus group data were collected in-person and virtually with representatives from the CBOs and HFH cancer survivors. CBOs participated in Steering Committee meetings throughout the project and two community forums to obtain feedback on recommendations identified through the qualitative data. Results: Factors contributing to participation in cancer clinical trials included systemic issues related to racism, health disparities and trust in government, health systems, and clinical research. Other factors included personal experiences with healthcare systems, healthcare provider-patient communication, socio-economic barriers (e.g., time away from work, family), and perceptions of future benefits from trials for B/AA communities. Recommendations included: 1) on-going health system outreach to B/AA communities regarding cancer prevention and treatment, as well as clinical trials. 2) B/AA community liaisons and cancer survivors as providers of information related to clinical trials; 3) two-way provider-patient communication to address questions and concerns about treatment options and trial information; 4) monetary compensation for indirect trial costs; 5) information on the importance of diversity within trials; and 6) ensuring information is provided to patients’ support networks. Conclusions: CBPR is effective in the identification of factors that influence participation in clinical trials. Building trust between patients and the healthcare system begins before patients walk into a clinic and every interaction contributes to institutional worthiness of community and patient trust. It is possible and imperative for health systems to work with B/AA communities and jointly identify and implement recommendations to ensure informed decision-making regarding trial participation. We are currently designing intervention strategies based on the recommendations for implementation at HFH.

Weight-Reduction Preferences Among OBSERVE Study Participants With Obesity or Overweight: Opportunities for Shared Decision-Making

ObjectiveLimited recent evidence exists regarding weight-reduction preferences among people with obesity in the United States (US). We assessed preferred magnitudes of weight reduction among adults with obesity and how these preferences differ by participant characteristics. MethodsThe Perceptions, Barriers, and Opportunities for Anti-obesity Medications in Obesity Care: A Survey of Patients, Providers and Employers was a cross-sectional study assessing perceptions of obesity and anti-obesity medications among people with obesity, healthcare providers, and employers in the US. Adults with obesity and overweight with obesity-related complications self-reported current weight and weight they associated with 5 preferences (“dream,” “goal,” “happy,” “acceptable,” and “disappointed.”) Preferred percent weight reductions for each preference were calculated. Multivariable regression analyses were performed identifying associations between weight-reduction preferences and participant characteristics. ResultsThe study included 1007 participants (women: 63.6%; White: 41.0%; Black or African American: 28.9%; Asian: 6.5%; Hispanic: 15.3%; and median body mass index (BMI): 34.2 kg/m2). Median preferred percent weight reductions were dream = 23.5%; goal = 16.7%; happy = 14.6%; acceptable = 10.3%; and disappointed = 4.8%. Women reported higher preferred weight reductions than men. Preferred weight reductions among Black/African American participants were lower than White participants. Regression analyses indicated significant associations, with higher preferred magnitudes of weight reduction within females, higher weight self-stigma, and BMI class in Hispanic participants compared to White. ConclusionIn this large, real-world study, preferred magnitudes of weight reduction exceeded outcomes typically achieved with established nonsurgical obesity treatments but may be attained with bariatric procedures and newer and emerging anti-obesity medications. Respecting patients’ preferences for treatment goals with obesity management could help support shared decision-making. Evaluating for an individual’s contributors to weight preferences, such as weight self-stigma, can further benefit holistic obesity care.

Confounding association between plasma HDL-C levels and increased fracture risk: A correspondence.

This article explores the association between fractures, particularly in the elderly, and elevated plasma high-density lipoprotein cholesterol (HDL-C) levels. The study challenges the conventional idea of HDL-C as "good cholesterol" by revealing its potential role as a risk factor for fractures. Factors contributing to fractures in the elderly, such as diminishing bone strength due to aging-related tissue breakdown, are discussed. Sedentary lifestyles, low bone mineral density (BMD), and habits like smoking and alcohol consumption compound fracture susceptibility. The study delves into mechanisms linking elevated HDL-C to fractures, using data from the ASPREE-Fracturesub-study of the ASPREE trial involving Australian and American participants aged 65 and above. The study showed that over a 4-year period, elevated HDL-C levels in healthy older people were linked to a 14% higher fracture risk. This revelation expands the understanding of fracture risk factors beyond the established norms. The article emphasizes the need to reconsider HDL-C's traditional role as an indicator of cardiovascular health, particularly in light of medications like Statins and Anacetrapib that raise HDL-C levels. It calls for further exploration into the relationship between HDL-C, fractures at varying sites, and different age groups. Practical implications involve incorporating fracture risk associated with high HDL-C into clinical considerations, alongside advocating lifestyle changes for optimal HDL-C levels. In summary, this study prompts a reevaluation of HDL-C's implications in clinical practice, demanding further investigation into the intricacies of this relationship.

Racial disparities and survival outcome of patients with locally advanced cervix cancer in the international randomised phase 3 OUTBACK trial (ANZGOG 0902, RTOG 1174, NRG 0274).

1594 Background: OUTBACK was an international multi-center phase 3 trial investigating adjuvant chemotherapy following definitive chemoradiation in locally advanced cervix cancer. We analysed if baseline characteristics were associated with survival outcome. More specifically, we determined whether race held prognostic significance relative to established clinical factors. Methods: We compared baseline characteristics (encompassing demographics, biomarkers and participants’ self-ratings of EORTC QLQ-C30 scores) between racial groups using chi-squared tests. We then explored relationships between baseline characteristics and survival outcomes using univariable and multivariable Cox proportional hazards regression models with stepwise selection. Results: Black or African American participants accounted for 13% (n=121/919) of the OUTBACK study population. There were no evident differences in the proportion of Black or African American participants, as compared to other racial groups, across most baseline characteristics, except for country of residence (USA vs non-USA, p<0.01). When examining the impact of race (Black or African American vs other racial groups) on survival outcomes in locally advanced cervix cancer, we found no evident associations with overall survival (HR 1.2; 95%CI,0.84 – 1.72; p=0.32) or progression free survival (HR 1.29; 95%CI, 0.95 – 1.75; p=0.10). Multivariable analysis identified several independent prognostic factors for overall survival, including performance status (HR 1.43; 95%CI, 1.04-1.95; p=0.03), FIGO stage (HR 2.02; 95%CI, 1.48-2.75; p<0.01), nodal involvement (HR 1.59; 95%CI, 1.18-2.14; p<0.01), and elevated white cell count (HR 1.68; 95%CI, 1.21-2.33; p<0.01). Role function, social function, financial difficulties and eGFR showed significance in univariable analysis for overall survival but did not retain significance in multivariable analysis. These findings were consistent when examining progression-free survival. Conclusions: No discernible disparities in survival outcomes were observed between Black or African American participants and other racial groups undergoing primary treatment for locally advanced cervix cancer. The primary prognostic determinants for this disease continue to be cancer staging and clinical performance status. Enrolment into a clinical trial may have abrogated the historical disparities seen among ethnic and racial groups. Clinical trial information: 12610000732088.

Integration policies shape ethnic-racial majorities' threat reactions to increasing diversity.

Increasing ethnic and racial diversity often fuels feelings of threat among ethnic-racial majorities (e.g., self-identified white Americans and European nationals). We contend that these threat perceptions depend on the policy context. Across four studies, we test whether more inclusive immigrant integration policies attenuate ethnic-racial majorities' threat reactions. Studies 1 to 3 (n = 469, 733, and 1745, respectively) used experimental methods with white American participants in the United States. Study 4 (n = 499,075) used secondary analysis of survey data comparing attitudes of nationals in 30 European countries and measured the impact of actual changes in diversity and policies over 10 years. Our results show that integration policies shape threat reactions even in those situations when increasing diversity could be seen as the most threatening: when narratives highlight the majority's impending minority position or when diversity suddenly increases. When policies are more inclusive toward immigrants, ethnic-racial majority participants report less threat (or no threat) in response to increasing diversity.

Latin American Participation in the Current Process of Economic Globalization

From World War II to the present, Latin America has participated in the current process of economic globalization to varying degrees. The Washington Consensus of the late twentieth century supplanted the region’s earlier model of state-led development and increased its participation in the global capitalist regime. However, Latin America has shown minimal participation in the current process of economic globalization since the late 2000s and, instead, espouses regionalization. Nevertheless, regionalization has proven to be an arduous undertaking in Latin America, especially with China’s increasing regional influence. Variations of benefits are discussed, and recommendations are offered. While the future of Latin America’s participation in the current process of economic globalization has yet to be determined, the region is aware of its toolbox to guide its development in the rest of the twenty-first century.

Latin American Participation in the Current Process of Economic Globalization

From World War II to the present, Latin America has participated in the current process of economic globalization to varying degrees. The Washington Consensus of the late twentieth century supplanted the region’s earlier model of state-led development and increased its participation in the global capitalist regime. However, Latin America has shown minimal participation in the current process of economic globalization since the late 2000s and, instead, espouses regionalization. Nevertheless, regionalization has proven to be an arduous undertaking in Latin America, especially with China’s increasing regional influence. Variations of benefits are discussed, and recommendations are offered. While the future of Latin America’s participation in the current process of economic globalization has yet to be determined, the region is aware of its toolbox to guide its development in the rest of the twenty-first century.

P.006 Barriers and risk factors for emergency room visits vs smartphone app use for migraine in Canada and the United States

Background: Migraine affects more than 1 billion people, with attacks triggered by a variety of factors. Knowledge of environmental triggers for migraine attacks is limited, and has mostly been studied via emergency room (ER) visits. There are significant barriers and delays for attending ER for migraine treatment, which create challenges for estimating causal links to environmental exposures. We assessed whether smartphone app records may have fewer barriers and reduced lags. Methods: American and Canadian participants completed an online survey about their migraine attacks, smartphone app use, and ER visits. Results: Among 308 participants, barriers to visiting ER were similar in both countries, except for financial concerns in the US. About half of participants who attended ER also recorded the attack in a diary or app. Whereas migraine patients often present to ER 7+ days after onset, records in a smartphone app dataset were created within 2 days of onset. Conclusions: Although not all severe migraine attacks are recorded by smartphone users, smartphone app records may have fewer barriers to creation and shorter time lags compared to ER visit records, making them a rich source of data for research on transient neurologic health outcomes and environmental exposures.

The Impact of Emojis on Verbal Irony Comprehension in Computer-Mediated Communication: A Cross-Cultural Study

This study examines the influence of emojis on the comprehension of verbal irony in computer-mediated communication (CMC), with a focus on cross-cultural comparisons between Chinese and American participants. Verbal irony, often reliant on paralinguistic cues absent in text-based communication, poses comprehension challenges in CMC. Emojis, as nonverbal cues, are hypothesized to aid in conveying and interpreting ironic intent. The research involved 96 participants, equally divided between the two cultures, who were presented with scenarios containing verbal irony accompanied by either a winking or smiling emoji, or no emoji. The findings suggest significant cross-cultural differences in irony comprehension facilitated by emojis. American participants showed improved irony comprehension with the winking emoji, aligning with its conventional association with sarcasm in Western cultures. Conversely, Chinese participants better understood irony when paired with the smiling emoji, highlighting cultural variations in emoji interpretation. The study underscores the complex role of cultural context in digital communication.

Understanding marital stability through work–family experiences in proximal and distal contexts: Comparing United States and Japan

AbstractObjectiveGuided by Gottman's framework of marital stability and the ecological theories, the present study aims to understand the relationships between work–family spillover and marital stability within two levels of context—the relational and social cultural contexts.BackgroundThe relational context of marriage is manifested by spousal relationships—spousal support and strain, which would moderate the relationship between work–family spillover and marital stability. Identified relationships also unfold within sociocultural contexts.MethodThis study uses data from the Midlife in the United States 2 (MIDUS 2) and Midlife in Japan (MIDJA) projects to explore these dynamics. The current study involved 500 Japanese and 1,800 American participants who were married and employed at the time of data collection.ResultsResults from multigroup path models revealed cultural differences. The relational context—spousal support and strain—played moderating roles in the associations between work–family spillover and marital stability in both countries. However, distinct sociocultural patterns emerged as spousal strain showed a stronger association among Japanese participants, whereas spousal support was more prominent among Americans in relation to marital stability.ConclusionThe results support Gottman's contention that positive and negative features of marriage are related to marital stability directly and indirectly by shaping the impacts of work–family spillover and sociocultural expectations of work and family.ImplicationsPractitioners and organizations should recognize the role of spouses in addressing the negative effects of work–family spillover in marriage, as well as incorporating clients' or employees' cultural backgrounds when addressing marital concerns.

Longitudinal Associations of Family Relationship Quality with Chronic Pain Incidence and Persistence Among Aging African Americans.

This study examines how family relationships convey risk or resilience for pain outcomes for aging African Americans, and to replicate and extend analyses across two nationally representative studies of aging health. African American participants in Midlife in the United States (MIDUS, N = 755) and the Health and Retirement Study (HRS, N = 2585) self-reported chronic pain status at 2006 waves and then again 10 years later. Logistic regression was used to estimate the odds of pain incidence and persistence explained by family, intimate partner, and parent-child strain and support, as well as average support and average strain across relationships. On average, MIDUS participants were younger (M = 52.35, SD = 12.06; 62.1% female) than HRS (M = 66.65, SD = 10.92; 63.7% female). Family support and average support were linked to a decreased odds of pain incidence in MIDUS, but only when tested without accounting for strain, while parent-child strain was a risk factor for pain incidence in HRS, as was average strain. Family support protected against pain persistence in MIDUS, while average support was linked to a reduced odds of pain persisting in HRS. Chronic pain outcomes are worse for African Americans for a number of reasons, but parent-child strain may contribute to the risk of new pain developing over time for older adults. Conversely, family support may offer a protective benefit for pain incidence and persistence among aging African Americans. Findings implicate family relationships as a potential target of pain management interventions.

Mental Contrasting Strategies Promote the Pursuit of Difficult Goals: Japanese Cultural Context.

We examined whether mental contrasting inhibits the pursuit of difficult goals in an Eastern culture-Japan-rooted in self-improvement. Our pilot study found that, compared with American participants, Japanese participants did not perceive a difficult situation as a cue to abandon their goal and pursue alternative objectives. Studies 1a-1c found that mental contrasting encouraged Japanese participants to pursue difficult goals. When Japanese participants perceived their own goals as unattainable, they were more likely to pursue these goals if they mentally contrasted their desired future with the inhibiting reality than if they simply imagined their desired future. Study 2 showed that mental contrasting encouraged Japanese (but not American) participants to pursue difficult goals. Study 3 evidenced the causal effect of beliefs about difficulties on the impact of mental contrasting on motivation to pursue difficult goals. Culturally formed beliefs about difficulties underlie the effect of mental contrasting on difficult goal pursuit.

Associations between hysterectomy and metabolic syndrome: the Multi-Ethnic Study of Atherosclerosis

Metabolic syndrome is linked to an increased risk of incident cardiovascular disease and all-cause mortality. Notable associations exist between hysterectomy with bilateral salpingo-oophorectomy and metabolic syndrome. However, there is emerging evidence that even with ovarian conservation, hysterectomy may be independently associated with long-term cardiovascular disease risk. To examine the associations between hysterectomy with ovarian preservation and metabolic syndrome risk in a multiethnic cohort. We studied 3367 female participants in the Multi-Ethnic Study of Atherosclerosis who had data on self-reported history of hysterectomy, oophorectomy, hystero-oophorectomy, and metabolic syndrome at baseline (2000-2002). We used adjusted logistic regression to assess the cross-sectional associations between hysterectomy and or oophorectomy subgroups and prevalent metabolic syndrome at baseline. Furthermore, we investigated 1355 participants free of baseline metabolic syndrome and used adjusted Cox regression models to evaluate incident metabolic syndrome from examinations 2 (2002-2004) to 6 (2016-2018). The mean age was 59.0±9.5 years, with 42% White, 27% Black, 19% Hispanic, and 13% Chinese American participants. 29% and 22% had a history of hysterectomy and oophorectomy, respectively. Over a median follow-up of 10.5 (3.01-17.62) years, there were 750 metabolic syndrome events. Hysterectomy (hazard ratio, 1.32 [95% confidence interval, 1.01-1.73]) and hystero-oophorectomy (hazard ratio, 1.40 [95% confidence interval, 1.13-1.74]) were both associated with incident metabolic syndrome compared with having neither hysterectomy nor oophorectomy. Hysterectomy, even with ovarian preservation, may be independently associated with a higher risk of metabolic syndrome. If other studies confirm these findings, screening and preventive strategies focused on females with ovary-sparing hysterectomies and the mechanisms underpinning these associations may be explored.

Oldest old's travel mode choice and new mobility technology acceptance: case in America and China.

The oldest olds (aged 85 and over) are the fastest-growing age segment. However, our understanding of their mobility is limited. To address this gap, we invited 19 U.S. and 30 Chinese "oldest old" to take part in focus groups and complete a mobility questionnaire. We focus on travel mode choice, which includes changes in travel modes, frequency of usage, and perceptions of comfort. Older adults' familiarity and acceptance of new mobility technologies (e.g., ridesharing, carsharing, and autonomous vehicles) were measured by questionnaire and focus group. Word clouds were also used to illustrate people's reasons for choosing their primary mode of transportation. The results show that both panels of older adults similarly feel some extent of travel limitations. But the responses among the two groups differ: 18 American participants chose "drive myself" as their primary option a decade ago, while 11 chose it now; no Chinese participants selected it either a decade ago or now. Both currently and 10 years ago, there was a significant difference in mode choice between participants in China and the United States. However, this gap has narrowed over the past decade. Participants in China have significantly changed their transportation preferences compared to 10 years ago, while participants in the US have remained nearly unchanged. American respondents consider "ease" as an important factor, while Chinese respondents pay more attention to "safety" and "no other option to get around" when making travel mode choices. Compared to Chinese participants, American participants were more comfortable with driving an autonomous vehicle. These differences may result from the various developmental stages and transportation policies of the two countries. This study supports the development of new mobility technologies for the oldest old to improve their quality of life.

Assessing Patient Experiences With Patient-Centered and Inclusive Care in Academic Obstetrics and Gynecology Outpatient Clinics [ID 2683581

INTRODUCTION: Ensuring patient satisfaction remains an important objective for obstetrics and gynecology care. To address a research gap in this field, we aimed to assess patient satisfaction with culturally competent and respectful care in our obstetrics and gynecology clinics after initiation of diversity, equity, and inclusion programming. METHODS: From September 2021 to February 2022, we surveyed outpatient ob-gyn visitors about their experiences, using a 21-item survey that assessed cultural competency, treatment discussions, clinic accommodations, and comfort during sensitive exams, using a Likert scale. Participants also self-reported demographic information. RESULTS: Out of 246 returned surveys, participants generally reported positive interactions with clinic staff and health care providers, feeling heard (91%), respected (95%), and having their cultural/spiritual beliefs considered in treatment (95%). Most felt respected and comfortable during sensitive exams (96%) and were satisfied with treatment discussions (84%). However, those with a high-school education (79%) were less likely than college or graduate degree holders (93%) to feel administrative staff listened to them and their families (P<.05). Experiences with culturally competent care varied by race/ethnicity. Black/African American participants were less likely to feel staff understood their cultural experiences (55% versus 67–88%; P<.05) and that they recognized differences within their racial/ethnic group (50% versus 82–88%; P<.01). Black/African American individuals reported the highest incidence of race-based unfair treatment (20% versus 0–2%; P<.01). CONCLUSION: Lower satisfaction among Black/African American participants indicates care can be improved. Enhanced education for clinical teams can foster respectful, inclusive, and culturally competent care. Future qualitative research can offer further insights into inclusive practices in obstetrics and gynecology care.