American Participants Research Articles

The Effects of Age and Cultural Differences on the Relationship Between Aging Anxiety and Ageism: Focusing on Social Identity Theory.

This study aims to test the hypothesis that the association between aging anxiety and ageism will be enhanced by age differently in the United States and in Japan. Data were obtained from online surveys in the United States (Mage = 40.44, SD = 14.98; 39.7% women; n = 886) and in Japan (Mage = 50.32, SD = 16.38; 52.7% women; n = 556). Our findings illuminate that the levels of aging anxiety in the Japanese participants were positively associated with their levels of ageism regardless of their age. On the other hand, for the American participants, the level of aging anxiety was positively associated with higher ageism only among older adults, and not among younger adults. Differences in lifespan or traditional values are thought to have alleviated the strength of the association between aging anxiety and ageism.

Abstract 4122694: The ICAM1 p.K56M Variant and Risk of Heart Failure Among Individuals with Chronic Kidney Disease

Background: Intercellular adhesion molecule-1 (ICAM-1) is a cell-surface protein that facilitates inflammation through leukocyte adhesion. Approximately 35% of African American individuals carry at least one copy of an ICAM1 missense variant (rs5491; p.K56M), which has been associated with increased risk of heart failure with preserved ejection fraction (HFpEF). Individuals with chronic kidney disease (CKD) are at high risk for HF, but whether the risk of HFpEF conferred by rs5491 extends to individuals with prevalent CKD is unknown. Hypothesis: We hypothesized that in a CKD population, rs5491 is specifically associated with HFpEF, but not HF with reduced ejection fraction (HFrEF). Methods: In the Chronic Renal Insufficiency Cohort (CRIC), participants were enrolled based upon an estimated glomerular filtration rate (eGFR) of 20 to 70 mL/min/1.73m 2 . We estimated associations of rs5491 with incident HF and HF subtypes among African American individuals who were free from HF at baseline in CRIC. Models were adjusted for age, sex, systolic blood pressure, eGFR, body mass index, smoking, diabetes, C-reactive protein, the first 10 principal components of ancestry, and study site. Results: Among 1267 African American participants without HF at baseline (mean age 57±11 years, 51% female, mean eGFR 45±15 mL/min/1.73m 2 ), 464 (37%) had at least one copy of rs5491. During a median follow-up of 10.3 years (IQR: 4.7 – 15.0 years), there were 309 incident overall HF hospitalizations (160 HFpEF, 111 HFrEF, and 38 HF with unknown EF). Each additional rs5491 allele was significantly associated with incident HFpEF (HR 1.35 [95% CI: 1.03-1.76], P=0.029; Figure). The rs5491 variant was not associated with incident overall HF (HR 1.14, 95% CI: 0.93-1.39, P = 0.20) or incident HFrEF (HR 0.76, 95% CI: 0.53-1.10, P=0.15). Conclusion: The ICAM1 p.K56M variant specifically confers increased risk of incident HFpEF among individuals with CKD.

Participant and group facilitator perspectives on a novel culturally tailored diabetes self-management program for African Americans.

African Americans with type 2 diabetes experience disparities in their care and diabetes health-related outcomes. Diabetes self-management programs such as Healthy Living with Diabetes (HLWD) are important but do not account for the unique cultural experiences of African Americans. Also, a culturally tailored program focused on addressing sociocultural beliefs and providing race-congruent peer support, Peers LEAD (Peers Supporting Health Literacy, Self-Efficacy, Self-Advocacy, and Adherence) was implemented in two midwestern cities to improve medication adherence but does not include diabetes self-management topics included in HLWD. In an attempt to fill the gaps from both HLWD and Peers LEAD, Peers EXCEL (Peers' Experience in Communicating and Engaging in Healthy Living) was designed to integrate both programs. Our study explored the perceptions of African American participants and facilitators of the separate HLWD and Peers LEAD programs, on the proposed new Peers EXCEL program using focus groups and interviews. Findings were analyzed by research assistants trained in qualitative research using deductive and inductive open coding approaches. Participants appreciated the cultural fit of Peers EXCEL for African American communities which is a feature that was lacking in HLWD. They shared the need to include topics such as the relationships between systemic racism and diabetes. Participants' feedback of Peers EXCEL reveals the importance of including various community members' perspectives in the design of new diabetes self-management programs tailored for African Americans.

Genetic variants for Alzheimer's disease and comorbid conditions.

Alzheimer's disease and related dementias (ADRD) frequently co-occur with comorbidities such as diabetes and cardiovascular diseases in elderly populations. Utilize a life-course approach to identify genetic variants that are associated with the co-occurrence of ADRD and another comorbid condition. Research data from African American participants of the Indianapolis-Ibadan Dementia Project (IIDP) linked with electronic medical record (EMR) data and genome-wide association study (GWAS) data were utilized. The age of onset for ADRD was obtained from longitudinal follow-up of the IIDP study. Age of onset for comorbid conditions was obtained from EMR. The analysis included 1177 African Americans, among whom 174 were diagnosed with ADRD. A semi-parametric marginal bivariate survival model was used to examine the influence of single nucleotide polymorphisms (SNPs) on dual time-to-event outcomes while adjusting for sex, years of education, and the first principal component of GWAS data. Targeted analysis of 20 SNPs that were reported to be associated with ADRD revealed that six were significantly associated with dual-disease outcomes, specifically congestive heart failure and cancer. In addition, eight novel SNPs were identified for associations with both ADRD and a comorbid condition. Using a bivariate survival model approach, we identified genetic variants associated not only with ADRD, but also with comorbid conditions. Our utilization of dual-disease models represents a novel analytic strategy for uncovering shared genetic variants for multiple disease phenotypes.

Culprits or Victims? Social Media Use, Mediated Ethnic Blame, and Asian American Mental Health During COVID-19

ABSTRACT The present study aims to understand whether and how social media use negatively affected Asian Americans’ mental health during the COVID-19 pandemic. We build on previous research on media framing, stigma, and stereotyping to understand whether social media messages about Asians as culprits to blame for the pandemic, direct experiences of racism, or media coverage of victims of anti-Asian hate crimes led to mental health outcomes for this racial group. We use an online survey of Asian American participants (N = 527) conducted in 2020 to test the role of (a) mediated ethnic blame (MEB), (b) direct stigma, and (c) indirect stigma in explaining the relationship between social media use and mental health among Asian Americans during the COVID-19 pandemic. Our results demonstrate that mediated ethnic blame, but not direct or indirect stigma experiences, is associated with Asian Americans’ mental health. Implications for media framing, health communication, and journalism are discussed.

Culturally responsive modifications to Gottman's Seven Principles Program for Arab American Adults: A feasibility study

AbstractObjectiveTo assess the feasibility of implementing a culturally responsive version of Gottman's Seven Principles relationship education program in a community‐based setting for married Arab American adults.BackgroundTo provide high‐quality couple and relationship education, it is necessary to acknowledge the population's needs and cultural backgrounds. One ethnic minority group that needs special attention is the Arab American community, which shares protective factors in terms of family support, religious beliefs, resiliency, and collectivist culture.MethodWe adapted Gottman's Seven Principles Program and conducted a qualitative feasibility study to examine recruitment capability, program acceptability, demand, and participant response among 16 Arab American married adults.ResultsThe results emphasize the vital role that thoughtful cultural and linguistic program adaptation played in increasing the acceptability and engagement of Arab American participants. However, results identified the ongoing stigma in Arab American communities against overtly seeking help for marital issues.ConclusionThis feasibility study provides helpful methodological and practical guidance to inform the design of larger scale randomized trials examining the efficacy of culturally responsive marriage education programs.ImplicationsThis study outlined actionable strategies, adaptations, venues, and communication channels to reduce barriers and optimize the delivery of marriage education to Arab American couples and families.

Effect of Whole Blood Dietary Mineral Concentrations on Erythrocytes: Selenium, Manganese, and Chromium: NHANES Data.

Selenium (Se), Manganese (Mn), and Chromium (Cr) are dietary minerals ingested from specific grains, vegetables, and animal meats. Prior research showed that these minerals affect animal erythrocyte health but have unknown effects on human red blood cells (RBCs) and hematology. This study evaluated the effects of these dietary minerals on RBC count, hematocrit, and hemoglobin. We conducted a cross-sectional analysis of 23,844 American participants from the 2015-2016 and 2017-2020 National Health and Nutrition Examination Survey. We evaluated sex, age, ethnicity, education, income, and smoking status as covariates. Linear regression analyses were conducted to evaluate the effect of Cr, Se, and Mn on RBC count, hematocrit, and hemoglobin levels. We employed subpopulation-exclusion regressions further to explore the distinct effects of mineral elevation and deficiency. Additional analyses were performed to examine the relationship between Mn and RBC hemoglobin, RBC distribution width, transferrin receptor concentrations, transferrin saturation, and serum iron levels to support the interpretation of our findings. Optimizable ensemble machine learning models were used to corroborate regression results. Adjusting for covariates, Cr was inversely associated with RBC count (Exp(b) = 0.954), hemoglobin (Exp(b) = 0.868), and hematocrit (Exp(b) = 0.668). Conversely, Se was positively associated with RBC count (Exp(b) = 1.003), hemoglobin (Exp(b) = 1.012), and hematocrit (Exp(b) = 1.032). Mn was positively associated with RBC count (Exp(b) = 1.020) but inversely associated with hemoglobin (Exp(b) = 0.945) and hematocrit (Exp(b) = 0.891). Cr was harmful to RBC health in all subpopulations, whereas Se was protective. Mn appears to contribute to the development of microcytic anemia, but only in subjects with clinically elevated Mn levels. Thus, excessive consumption of foods and supplements rich in Cr and Mn may harm human erythrocyte health and hematology.

An Eastern Look at a Western Dilemma: Cross-Cultural Differences in Action-Balanced Trolley Dilemmas

Moral judgment has been extensively studied utilizing traditional trolley-like sacrificial dilemmas. However, by building on Western philosophies and relying on WEIRD samples, this approach has potentially introduced a Western-centric bias to our understanding of the morality of sacrificial harm, by (a) assuming an inherent opposition between utilitarian and deontological morality and (b) underestimating cultural differences on the moral value of inaction. To address this bias, our study examined cross-cultural differences in moral judgment using an adapted methodology that equally weighs action/inaction framing and considers utilitarian and deontological choices separately. The findings demonstrate that Chinese participants ( n = 273) embraced a more holistic moral construct with utilitarian and deontological moral approaches being positively correlated, whereas American participants ( n = 240) viewed them as opposing to each other. Moreover, we also found that Chinese participants were more, rather than less utilitarian than American participants in trolley-like dilemmas when balancing action and inaction.

Fear of appearance discrimination and its influence on well‐being across cultures

AbstractLookism encompasses discrimination based on a person's physical appearance. In a society where lookism is prevalent, the question arises concerning the impact of the fear of lookism on one's well‐being. To address this issue, we assessed the fear of anticipated appearance discrimination by constructing a new Fear of Lookism Scale (FLS). By testing 400 Japanese participants, we developed a three‐factor seven‐item scale and confirmed its convergent validity by establishing significantly positive correlations among its subscales (exclusion/devaluation, romantic rejection and insult) and related measures (physical appearance perfectionism and social appearance anxiety) in Study 1. In Study 2a, we gathered data from 312 Japanese participants to assess the scale's test–retest reliability. In Study 2b, combining data from 401 American participants with data from Study 2a, we verified FLS measurement invariance in the United States and Japan. Japanese participants scored higher on the FLS than Americans, particularly for exclusion/devaluation and insult. Across cultures, romantic rejection and insult were positively associated with physical appearance perfectionism, which, in turn, decreased subjective happiness through impacting self‐esteem (or increased loneliness) and increased subjective happiness through impacting self‐esteem (or decreased loneliness) respectively.

B cell immune repertoire sequencing in tobacco cigarette smoking, vaping, and chronic obstructive pulmonary disease in the COPDGene cohort.

Cigarette smoking (CS) impairs B cell function and antibody production, increasing infection risk. The impact of e-cigarette use ('vaping') and combined CS and vaping ('dual-use') on B cell activity is unclear. To examine B cell receptor sequencing (BCR-seq) profiles associated with CS, vaping, dual-use, COPD-related outcomes, and demographic factors. BCR-seq was performed on blood RNA samples from 234 participants in the COPDGene study. We assessed multivariable associations of B cell function measures (immunoglobulin heavy chain (IGH) subclass expression and usage, class-switching, V-segment usage, and clonal expansion) with CS, vaping, dual-use, COPD severity, age, sex, and race. We adjusted for multiple comparisons using the Benjamini-Hochberg method, identifying significant associations at 5% FDR and suggestive associations at 10% FDR. Among 234 non-Hispanic white (NHW) and African American (AA) participants, CS and dual-use were significantly positively associated with increased secretory IgA production, with dual-use showing the strongest associations. Dual-use was positively associated with class switching and B cell clonal expansion, indicating increased B cell activation, with similar trends in those only smoking or only vaping. We observed significant associations between race and IgG antibody usage. AA participants had higher IgG subclass proportions and lower IgM usage compared to NHW participants. CS and vaping additively enhance B cell activation, most notably in dual-users. Self-reported race was strongly associated with IgG isotype usage. These findings highlight associations between B cell activation and antibody transcription, suggesting potential differences in immune and vaccine responses linked to CS, vaping, and race.

Affective Experiences of U.S. School Personnel in the Sociopolitical Context of 2021: Reflecting on the Past to Shape the Future

This study aims to explore the self-reported affective experiences of U.S. school personnel during 2021. This year found school personnel balancing remote learning, health emergencies, a global pandemic, and intense political upheaval. We contextualize school personnel experiences within the current sociopolitical context. In this sample, school personnel (n = 8052) represent all U.S. states and territories alongside representation of diverse racial and ethnic identities (n = 1901). Participants were surveyed before completing a free virtual course on emotion management. The survey included open-ended questions and scale items. Participants reported primary feelings, sources of stress and joy, and perceptions of personal and social and emotional support for themselves and students. Findings are presented in five cohorts of school personnel across the year. The primary feelings were being anxious, stressed, and overwhelmed, the stressors were lack of support, time, and resources, as well as COVID-19, and workload, and the sources of joy were students, coworkers, and teaching. Anxiety and gratitude decreased throughout the year while happiness increased. Responses differed across time and between racial groups, with Black and African American participants reporting the highest percentages of being stressed by COVID-19 and community fluctuated over time as a source of joy. Implications for the education system and opportunities for emotion management are discussed.

El impacto del COVID-19 en la calidad de vida de los latinoamericanos en Nueva Zelanda

Introduction: This research explored how COVID-19 has negatively affected the quality of life for Latin Americans in New Zealand. No study has yet been conducted on this topic. Objective: This is a pilot study that describes the effects of the pandemic on the quality of life of the Latino community in that country. According to the academic literature, the concept of quality of life is broad and encompasses objective and subjective factors. Methodology: This is a qualitative study that used digital ethnography as a methodological approach. In this way, the observation of the participants through Facebook (as digital ethnography) and semi-structured interviews were used as data collection methods. Ten Latin American participants from Argentina, Colombia, Ecuador, Peru, and Venezuela participated in this study. Participants were recruited through Facebook ads. Thematic analysis was used to analyse the qualitative data produced by this research. Results: The findings of this study show that COVID-19 has not seriously affected the quality of life of the participants. Conclusions: Despite the fact that CVID-19 has somehow impacted the quality of life of Latin Americans in New Zealand, they think that their current quality of life in that country is positive, happy and pleasant.

Disentangling three valence-related dimensions of emotion valuation: The good, the pleasant, and the desirable.

People place value on emotion categories that inform which emotions to cultivate and which to regulate in life. Here, we examined how people's beliefs about emotion categories varied along three valence-related dimensions: evaluation (good, bad), hedonic feeling (pleasure, displeasure), and desirability (want to feel, do not want to feel). In Studies 1A and 1B, we found that evaluative (good/bad) and hedonic (pleasant/unpleasant) ratings were distinct for certain emotions including lust, anger, shame, fear, and guilt. In Study 2, we found that emotion valuation depended on cultural background in a sample of Asian Americans and Caucasian Americans. Overall, Asian American participants evaluated certain emotions (including, but not limited to, anger, sadness, guilt, and shame) more positively than Caucasian American participants, and this difference was more pronounced on the evaluative rating dimension. Finally, in Study 3, we examined how evaluative and hedonic dimensions further relate with the desire to experience certain emotions and the emotions that people believe they feel in everyday life. Our findings support a model in which evaluative and hedonic dimensions of emotion valuation predict desired emotional states, which in turn predicts beliefs about the reported frequency of emotions experienced in everyday life. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

The relationship between existential isolation and suicidal ideation among formerly incarcerated individuals

Background and purpose Formerly incarcerated people die by suicide at a rate 6.75 times higher than the general population. In this study we ask whether existential isolation, the feeling of being alone in one’s subjective experiences, offers new insights into this staggering statistic. We specifically ask whether existential isolation predicts suicidal ideation among formerly incarcerated individuals even after accounting for their levels of interpersonal isolation, emotional support, and instrumental support. Method We examined cross-sectional survey data from American participants (n = 946) recruited over the Amazon Mechanical Turk (MTurk) platform. Results Consistent with prediction, we found that people with an incarceration history reported more existential isolation, but not more interpersonal isolation, than those without an incarceration history. A hierarchical regression analysis revealed that existential isolation explained additional variance in suicidal ideation beyond what was explained by interpersonal isolation, instrumental support, and emotional support. Fisher’s r-to-z transformations demonstrated that the magnitude of the relationship between existential isolation and suicidal ideation was stronger among those with an incarceration history than among those without. Finally, existential isolation mediated the relationship between incarceration and suicidal thoughts, even when holding constant other predictors of suicidal ideation. Conclusion Reentry programs may target existential isolation among formerly incarcerated individuals to improve emotional wellbeing.

The liver fibrosis-8 index is a predictor for all-cause mortality in cardiovascular disease patients: A cohort study.

Participants with cardiovascular diseases (CVD) often exhibit liver function abnormalities, hepatic fibrosis and cirrhosis. The extent of liver fibrosis is closely related to the prognosis of CVD. However, the association between the liver fibrosis-8 (FIB-8) index, a marker of liver fibrosis, and all-cause mortality in CVD participants remains unclear. This study aims to investigate the relationship between the FIB-8 index and all-cause mortality among individuals with CVD. A total of 1727 CVD American participants were enrolled from the National Health and Nutrition Examination Survey (NHANES) spanning from 1999 to 2018. Initially, we constructed weighted COX regression models and performed sensitivity analyses to examine the correlation between the FIB-8 index and all-cause mortality in CVD participants. Subsequently, we employed restricted cubic spline (RCS) to visualize their linear relationship. Finally, the stratified analyses and interaction tests of covariates were performed and presented in the forest plot. A total of 1727 participants were included in our study, with a mean age of 61.68 ± 0.47 years, with men accounting for 59.19%. After adjustment for relevant covariables, weighted COX regression models indicated that the hazard ratio (HR) and 95% confidence interval (95% CI) for the association between the FIB-8 index and all-cause mortality in CVD participants was 1.21 (1.12, 1.30). Sensitivity analysis was then conducted, revealing that the results remained stable. In fully adjusted model, individuals in quartiles 3 and 4 demonstrated significant statistical differences compared to the lowest FIB-8 index quartile, with HR (95% CI) values of 1.88 (1.23, 2.87) and 2.17 (1.33, 3.53), respectively. Subsequently, RCS showed a linear relationship between the FIB-8 index and all-cause mortality among CVD participants. Finally, the interaction test revealed that no other covariables had significant interactions with the FIB-8 index in this study. A positive and linear correlation was observed between the FIB-8 index and all-cause mortality among CVD adult participants in NHANES from 1999 to 2018. Our findings indicated that the FIB-8 index could serve as an excellent indicator for assessing all-cause mortality within the CVD population. The lower the FIB-8 index, the lower the all-cause mortality among CVD participants.

Efficacy and safety of olezarsen in lowering apolipoprotein C-III and triglycerides in healthy Japanese Americans

BackgroundOlezarsen is a GalNAc3-conjugated, hepatic-targeted antisense oligonucleotide that lowers apolipoprotein C-III (apoC-III) and triglyceride levels. The efficacy and safety of olezarsen has not previously been studied in ethnically diverse American populations. The aim of this study is to assess the effect of olezarsen in healthy Japanese Americans.MethodsA randomized, placebo-controlled, double-blind phase 1 study was performed in 28 healthy Japanese American participants treated with olezarsen in single-ascending doses (SAD; 30, 60, 90 mg) or multiple doses (MD; 60 mg every 4 weeks for 4 doses). The primary, secondary, and exploratory objectives were safety and tolerability, pharmacokinetics, and effects of olezarsen on fasting serum triglycerides and apoC-III, respectively.ResultsThere were 20 participants (16 active:4 placebo) in the SAD part of the study, and 8 participants (6 active:2 placebo) in the MD part of the study. For the primary endpoint, no serious adverse events or clinically relevant laboratory abnormalities were reported. The majority of olezarsen plasma exposure occurred within 24 h post-dose. In the SAD cohorts at Day 15 the percentage reduction in apoC-III/TG was − 39.4%/ − 17.8%, − 60.8%/ − 52.7%, and − 68.1%/ − 39.2% in the 30, 60 and 90 mg doses, respectively, vs 2.3%/44.5% increases in placebo. In the MD cohort, at Day 92 the percentage reduction in apoC-III/TG was − 81.6/ − 73.8% vs − 17.2/ − 40.8% reduction in placebo. Favorable changes were also present in VLDL-C, apoB and HDL-C.ConclusionsSingle- and multiple-dose administration of olezarsen was safe, was well tolerated, and significantly reduced apoC-III and triglyceride levels in healthy Japanese Americans.

Automated image transcription for perinatal blood pressure monitoring using mobile health technology.

This paper introduces a novel approach to address the challenges associated with transferring blood pressure (BP) data obtained from oscillometric devices used in self-measured BP monitoring systems to integrate this data into medical health records or a proxy database accessible by clinicians, particularly in low literacy populations. To this end, we developed an automated image transcription technique to effectively transcribe readings from BP devices, ultimately enhancing the accessibility and usability of BP data for monitoring and managing BP during pregnancy and the postpartum period, particularly in low-resource settings and low-literate populations. In the designed study, the photos of the BP devices were captured as part of perinatal mobile health (mHealth) monitoring programs, conducted in four studies across two countries. The Guatemala Set 1 and Guatemala Set 2 datasets include the data captured by a cohort of 49 lay midwives from 1697 and 584 pregnant women carrying singletons in the second and third trimesters in rural Guatemala during routine screening. Additionally, we designed an mHealth system in Georgia for postpartum women to monitor and report their BP at home with 23 and 49 African American participants contributing to the Georgia I3 and Georgia IMPROVE projects, respectively. We developed a deep learning-based model which operates in two steps: LCD localization using the You Only Look Once (YOLO) object detection model and digit recognition using a convolutional neural network-based model capable of recognizing multiple digits. We applied color correction and thresholding techniques to minimize the impact of reflection and artifacts. Three experiments were conducted based on the devices used for training the digit recognition model. Overall, our results demonstrate that the device-specific model with transfer learning and the device independent model outperformed the device-specific model without transfer learning. The mean absolute error (MAE) of image transcription on held-out test datasets using the device-independent digit recognition were 1.2 and 0.8 mmHg for systolic and diastolic BP in the Georgia IMPROVE and 0.9 and 0.5 mmHg in Guatemala Set 2 datasets. The MAE, far below the FDA recommendation of 5 mmHg, makes the proposed automatic image transcription model suitable for general use when used with appropriate low-error BP devices.

Patient perspectives towards skin of color clinics: results from a survey study.

Skin of color clinics (SOCCs) are dermatology clinics that provide specialized care for patients with melanated skin. Little is known about patient perceptions and attitudes toward these clinics. We sought to perform a survey study to assess the opinions of patients of color previously seen in our dermatology department toward SOCC. A 14-question survey was sent by email to patients of color seen at our institution between January 1, 2015 and December 31, 2021. Out of 264 participants who completed the survey, 176 (66.7%) indicated they would prefer to be seen in a SOCC and 88 (33.3%) preferred to be seen in a general dermatology clinic (GDC). Clinic choice varied significantly by ethnicity, with Black/African American participants being the most likely to prefer SOCC over GDC than other races/ethnicities. Those interested in SOCC were primarily motivated by a search for expertise in the skin of color (SOC) and did not have a preference for the skin color of the SOCC dermatologist. Those interested in GDC were happy with their current care. This study was limited by the single-center design and sample bias. Our results overall provide positive patient feedback for the creation of SOCCs as centers for expertise in SOC. The preference for SOCC varied by race/ethnicity, highlighting that clinic choice is best left to the patient.

Language-based exclusion associations with racial and ethnic disparities in thyroid cancer clinical trials

BackgroundRacial and ethnic disparities in thyroid cancer care may be mitigated by improving enrollment of more diverse patient populations in clinical trials. We studied trial eligibility criteria and enrollment to assess barriers to equitable representation. MethodsClinicalTrials.gov was searched for studies on thyroid cancer treatment conducted between 1993 and 2023. The inclusion and exclusion criteria of each study were examined. For published studies, reported demographic information was collected. Observed enrollment by race was compared with the expected distribution as determined using data from the US Census and the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) databases. Over- and under-representation was defined as the ratio of observed to expected (O/E) enrollment by the race and ethnicity group. ResultsOf 309 thyroid cancer–related trials, 23 (7.4%) used language as an exclusion criterion. Most were interventional (n = 239, 77.3%), university-initiated (194, 62.8%), and drug/device-focused (195, 63.1%). Of studies that excluded by language, 20 (87.0%) were university-initiated. Eighty-eight trials were subsequently published, with 16 (18.2%) reporting race and/or ethnicity distributions. When comparing O/E ratios, White American participants were over-represented (O/E ratio: 1.2, P < .0001). Under-represented groups included Asian/Native Hawaiian (O/E ratio: 0.6, P = .0085), Black (0.6, P = .014), Native American (0.2, P = .072), and Hispanic patients (0.2, P < .0001). ConclusionOver the last 3 decades, 1 in 13 thyroid cancer–related clinical trials excluded patients based on language. In the fraction of published studies to report on racial and ethnic demographics, Asian/Native Hawaiian, Black, and Hispanic patients were under-represented. Improved reporting of demographics in published studies and elimination of exclusion criteria such as language that hinder enrollment of minority patients could improve equitable representation of patients in thyroid cancer clinical trials.

Mediating effects of BMI on the association between DNA methylation regions and 24-h blood pressure in African Americans.

DNA methylation is an important epigenetic mechanism that may influence blood pressure (BP) regulation and hypertension risk. Obesity, a major lifestyle factor associated with hypertension, may interact with DNA methylation to affect BP. However, the indirect effect of DNA methylation on 24-h BP measurements mediated by obesity-related phenotypes such as BMI has not been investigated. Causal mediation analysis was applied to examine the mediating role of BMI in the relation between DNA methylation and 24-h BP phenotypes, including SBP, DBP and mean arterial blood pressure (MAP), in 281 African American participants. Analysis of 38 215 DNA methylation regions, derived from 1 549 368 CpG sites across the genome, identified up to 138 methylation regions that were significantly associated with 24-h BP measurements through BMI mediation. Among them, 38 (19.2%) methylation regions were concurrently associated with SBP, DBP and MAP. Genes associated with BMI-mediated methylation regions are potentially involved in various chronic diseases such as coronary artery disease and renal disease, which are often caused or exacerbated by hypertension. Notably, three genes ( CDH4 , NOTCH1 and COLGALT1 ) showed both direct associations with 24-h BP measurements and indirect associations through BMI after adjusting for age and sex covariates. Our findings suggest that DNA methylation may contribute to the regulation of 24-h BP in African Americans both directly and indirectly through BMI mediation.