American Participants Research Articles

The effects of contemporary redlining on the mental health of Black residents

Understanding how structural racism, including institutionalized practices such as redlining, influence persistent inequities in health and neighborhood conditions is still emerging in urban health research. Such research often focuses on historical practices, giving the impression that such practices are a thing of the past. However, mortgage lending bias can be readily detected in contemporary datasets and is an active form of structural racism with implications for health and wellbeing. The objective of the current study was to test for associations among multiple measures of mental health and a measure of contemporary redlining. We linked a redlining index constructed using Home Mortgage Disclosure Act data (2007–2013) to 2021 health data for Black/African American participants in the Study of Active Neighborhoods in Detroit (n = 220 with address data). We used multilevel regression models to examine the relationship between redlining and a suite of mental health outcomes (perceived stress, anxiety, depressive symptoms, and satisfaction with life), accounting for covariates including racial composition of the neighborhood. We considered three mediating factors: perceived neighborhood cohesion, aesthetics, and discrimination. Although all participants lived in redlined neighborhoods compared to the complete Detroit Metropolitan area, participants with very low income, low levels of experienced discrimination, and lower perceptions of neighborhood aesthetics resided in highly redlined neighborhoods (score ≥5). We observed that higher resident-reported neighborhood aesthetics were found in neighborhoods with lower redlining scores and were associated with higher levels of satisfaction with life. We found that lower levels of redlining were significantly associated with higher levels of perceived discrimination, which was significantly, positively associated with anxiety, depressive symptoms, and perceived stress scores. Our findings highlight that contemporary redlining practices may influence the aesthetics of the built environment because these neighborhoods experience less investment, with implications for residents’ satisfaction with life. However, areas with lower redlining may be areas where Black/African American people experience increased perceived discrimination.

Evil perceptions mediate the association between trait anger and generic conspiracy beliefs

Building on research that has suggested that perceiving conspirators to have evil intentions and that trait anger relates to conspiracy beliefs, the present research tested the hypothesis that these evil perceptions mediate the relationship between trait anger and generic conspiracy beliefs. American participants (N = 828; M = 34.02, SD = 15.65) completed established questionnaires that assessed trait anger and hostility as well as generic conspiracy beliefs; they also completed a novel questionnaire that assessed how evil the conspirators were perceived to be. Results from three studies supported this primary novel hypothesis. In addition to testing this primary hypothesis, the studies also tested whether hostility, a more cognitive component of aggression associated with resentment and suspicion, related to evil perceptions and conspiracy beliefs, and whether evil perceptions mediated the hostility-conspiracy beliefs relationship. Results also supported this hypothesis. In addition, we tested whether humility, which has been found to be antithetical to anger, would relate negatively with conspiracy beliefs and evil perceptions. Results partially supported this hypothesis. These findings suggest that individuals who score higher in trait anger are more likely to have generic conspiracy beliefs and that the perception of evil intentions on the part of the conspirators mediates this trait anger-conspiracy beliefs relationship.

Not just if, but how much: Children and adults use cost and need to make evaluations about generosity across contexts

Evaluations of others' generosity are critical for selecting quality social partners, yet the factors which systematically affect these evaluations and whether they vary across development are still relatively unclear. Here, we establish that two key dimensions adults and children (aged 4 to 7 years) consider are the cost associated with a giving action and the need of the recipient, through six pre-registered experiments with Canadian and U.S. American participants. Experiments 1 and 2 demonstrate that adults' and children's third-party evaluations of generosity are sensitive to variations in each factor, across several operationalizations of cost and need in both comparative and standalone contexts, suggesting cost and need can be spontaneously evoked. However, children's responses were more consistent for need scenarios than cost scenarios. In Experiments 3 and 4, we modified our scenarios to evaluate whether variations in cost and need are considered simultaneously in both generosity evaluations and affiliative preferences. Adults' and older children's (ages 6 to 7) evaluations of generosity and affiliative preferences were sensitive to both factors, but younger children did not utilize this information systematically. Importantly, in Experiments 5 and 6, adults' and older children's generosity evaluations were only sensitive to information about cost and need when the giver's actions conferred utility to a recipient, but not when actions were self-serving. Taken together, we establish robust evidence that cost and need are considered in generosity evaluations by demonstrating that Canadian and U.S. American adults and children utilize this information consistently, spontaneously, and simultaneously.

Parental Factors Associated With Intentions to Initiate a Family-Based Pediatric Weight Management Program.

Background: Childhood obesity can be addressed through family-based pediatric weight management; however, treatment enrollment in the United States is low. This study aimed to identify parental factors associated with intentions to initiate a family-based pediatric weight management program. Methods: Cross-sectional survey data were collected from an online panel of US parents with at least one 5- to 11-year-old child identified as likely to have overweight or obesity. Participants viewed a video about a hypothetical family-based pediatric weight management program, rated their 30-day initiation intentions for that program, and answered additional related questionnaires. Results: Participants (n = 158) identified as White/Caucasian (53%) or Black/African American (47%), were primarily female (61.4%) and married/cohabitating (81.6%) with children who were predominantly girls (53.2%) and, on average, 9-year-olds. Higher parents' perception of program effectiveness predicted initiation intentions (p < 0.001), while concern for their child's weight and parent depression and anxiety levels did not. Higher initiation intentions and perceived program effectiveness were reported by Black/African American participants (p < 0.01) and those with at least a bachelor's degree (p < 0.01) compared to White/Caucasian participants and those without a bachelor's degree, respectively. Initiation intentions were higher for those with greater financial security (p = 0.020) and fewer than three children in the home (p = 0.026). Participants endorsed initiation barriers of time constraints (25%), possible lack of enjoyment for the child (16.9%), and lack of family support (15%). Conclusions: Future program enrollment efforts may need to focus on strategies to increase perceived program effectiveness, although further research is needed that measures actual enrollment in real-world contexts.

Systemic Markers of Lung Function and Forced Expiratory Volume in 1 Second Decline across Diverse Cohorts.

Rationale: Chronic obstructive pulmonary disease (COPD) is a complex disease characterized by airway obstruction and accelerated lung function decline. Our understanding of systemic protein biomarkers associated with COPD remains incomplete. Objectives: To determine what proteins and pathways are associated with impaired pulmonary function in a diverse population. Methods: We studied 6,722 participants across six cohort studies with both aptamer-based proteomic and spirometry data (4,566 predominantly White participants in a discovery analysis and 2,156 African American cohort participants in a validation). In linear regression models, we examined protein associations with baseline forced expiratory volume in 1 second (FEV1) and FEV1/forced vital capacity (FVC). In linear mixed effects models, we investigated the associations of baseline protein levels with rate of FEV1 decline (ml/yr) in 2,777 participants with up to 7 years of follow-up spirometry. Results: We identified 254 proteins associated with FEV1 in our discovery analyses, with 80 proteins validated in the Jackson Heart Study. Novel validated protein associations include kallistatin serine protease inhibitor, growth differentiation factor 2, and tumor necrosis factor-like weak inducer of apoptosis (discovery β = 0.0561, Q = 4.05 × 10-10; β = 0.0421, Q = 1.12 × 10-3; and β = 0.0358, Q = 1.67 × 10-3, respectively). In longitudinal analyses within cohorts with follow-up spirometry, we identified 15 proteins associated with FEV1 decline (Q < 0.05), including elafin leukocyte elastase inhibitor and mucin-associated TFF2 (trefoil factor 2; β = -4.3 ml/yr, Q = 0.049; β = -6.1 ml/yr, Q = 0.032, respectively). Pathways and processes highlighted by our study include aberrant extracellular matrix remodeling, enhanced innate immune response, dysregulation of angiogenesis, and coagulation. Conclusions: In this study, we identify and validate novel biomarkers and pathways associated with lung function traits in a racially diverse population. In addition, we identify novel protein markers associated with FEV1 decline. Several protein findings are supported by previously reported genetic signals, highlighting the plausibility of certain biologic pathways. These novel proteins might represent markers for risk stratification, as well as novel molecular targets for treatment of COPD.

"Survival classes for a neurotypical world": What French autistic adults want and need after receiving an autism diagnosis.

Adults receiving an autism diagnosis might not react the same depending on their countries or cultures. We also know that autistic people are rarely asked what they think would be best for them following this diagnosis. In this study, we asked 12 French autistic adults about their experiences of receiving an autism diagnosis as well as what they thought might be useful afterwards. Overall, we found that some experiences were similar to experiences related by English or American participants, but some were specific to the French culture, suggesting that such research should expand into new territories and cultures, especially non-European ones. Our participants also had quite a few ideas as to what would be useful for people in the same situation. Some of the suggestions can be put into action by peers and professionals alike, while others are wishes relating to how our participants would like society to behave toward them and people like them, for example. This article allows for a better comprehension of how cultural differences can impact the experience of receiving an autism diagnosis as an adult and provides some insight into what these adults want and desire following such a diagnosis.

544-P: Effect of Organization Type on Priority Population Outcomes in the National Diabetes Prevention Program (National DPP)

In 2012, the CDC Diabetes Prevention Recognition Program approved its first recognized organization. Since then, it has recognized 4,000+ organizations to deliver the National DPP lifestyle change program to 600,000+ participants at type 2 diabetes risk. This analysis examined data from 624,422 participants to determine the impact of 5 organization types on priority population outcomes: community centers, higher education, government, healthcare providers, and for-profit/insurers. Most participants (65.7%) enrolled in for-profit/insurer organizations. Community centers enrolled the highest percentage of participants who identified as Hispanic/Latino (20.8%) and Native Hawaiian/other Pacific Islander (3%), and government organizations the highest percentage of Black/African American (17.7%) and American Indian/Alaska Native participants (10.8%). Higher education organizations enrolled the highest percentage of Asian/Asian American participants (3.4%). Men primarily enrolled in for-profit/insurer organizations (25.3%), and those aged 65+ enrolled mainly in healthcare-based programs (30.6%). Time in the program is associated with type 2 diabetes risk reduction. Those enrolled in higher education organizations stayed in the program the longest, with a mean of 233 days. Community centers and government organizations, which lead in the enrollment of some priority populations, had means of 196 and 218 days, respectively. Native Hawaiian/other Pacific Islander participants stayed in community center programs above the mean of 226 days. In government organizations, Black/African American and American Indian/Alaska Native participants remained for an average of 227 and 219 days, respectively. Understanding which types of organizations better serve priority populations, and assisting them in recruitment and retention, is key to reducing the risk of developing type 2 diabetes among these groups and reducing disparities in outcomes. Disclosure S.Bowen: None. E.O.Landau: None. E.Ely: None.

214-LB: Plasma Proteomic Markers of Iron and Risk of Diabetes in a Biracial Cohort

Higher levels of iron have been linked to increased diabetes risk among European and European American (EA) populations; whether this is true for other populations where anemia is more common is unknown. Ferritin is an iron storage protein linked to diabetes risk; transferrin transports catalytic iron, reducing its oxidative damage. We tested whether proteomic measurements of ferritin and transferrin were associated with diabetes risk in a biracial cohort of current and former smokers. EA and African American (AA) participants from the COPDGene Cohort who were free of diabetes (n=4,671) at study baseline were followed for the incidence of diabetes. The Somascan was used on plasma measured at followup to determine relative amounts of proteins among participants. Logistic regression was used to calculate OR (95% CIs) of the cross-sectional relationship of natural log transformed ferritin and transferrin with diabetes risk. During an average of 5.6 years of follow-up, the incidence of diabetes was 7.9%. Ferritin was associated with increased diabetes risk (OR=1.29, 1.04-1.61), while higher transferrin linked with decreased risk (OR=0.19, 0.06-0.56) controlling for age, sex, BMI, hepcidin and smoking. When stratified by race, increased risk was associated with higher ferritin only among AA (OR=1.46, 1.07-2.01) and not for EA (OR=1.11, 0.81-1.52). Stratification by sex revealed that the relationship of ferritin was similar among AA men and women and EA women, with non-significant ORs ranging from 1.49-1.55; but null association among EA men (OR = 1.00, 0.65-1.52). Similarly, ORs for transferrin non-significantly ranged from 0.24-0.29 for AA men and women and EA women, but for EA men there was a significant 93% decreased risk for each natural long increase in transferrin (OR=0.07, 0.001-0.60). Our data suggest that higher body iron stores, as measured by ferritin, increases diabetes risk among both AA and EA. Ferritin may be a better marker for AA men and women and EA women while transferrin is a better marker for EU men. Disclosure R. B. Conway: None. K. Young: None. K. A. Pratte: None. G. L. Kinney: None. E. Austin: None. Y. Li: None. R. Bowler: None. D. A. Mcclain: None. J. Crappo: None. Funding National Heart, Lung, and Blood Institute (U01HL089897, U01HL089856); AstraZeneca; Bayer Pharmaceuticals; Boehringer Ingelheim; Genentech; GlaxoSmithKline; Novartis; Pfizer Inc.; Sunovion

From oppression to opportunity: a pilot study of an intervention program for vulnerable first generation college students.

The purpose of this pilot study was to examine the impact of a 10-week psycho-educational group intervention entitled "Oppression to Opportunity Program" (OOP), which was designed to enhance the academic adjustment of vulnerable, first-generation college students. Participants in the pilot group also experienced multiplicative vulnerabilities as result of the intersecting identities of race, ethnicity, income, religious affiliation, disabilities, sexual orientation, and gender identity. The OOP intervention consisted of eight modules, plus an orientation and a closing session, designed to lessen key barriers (e.g., lack of knowledge of resources, lack of access to high quality mentorships, feelings of isolation) to academic success. The modules incorporated written worksheets and experiential exercises to foster group discussion, participant self-reflection, and community belongingness. Each group met once weekly for 1 h each session over 10 weeks, and was facilitated by an advanced graduate student in counseling. Participants completed the College Self-Efficacy Inventory and Student Adaptation to College Questionnaire as a pretest and post-test, and qualitative after session questionnaires. MANOVA results did not demonstrate a significant difference between OOP (n = 30) and comparison group (n = 33) undergraduates on efficacy and student adaptation. However, ANCOVA results show the impact of group (OOP vs. comparison) on post-tests of self-efficacy and adaptation, while controlling for pre-tests as covariates. Male participants rated the module pertaining to goal setting and establishing role models as most favorable, while the emotional management module was most preferred by female participants. African American participants rated the module pertaining to identity affirmation as most beneficial and the emotional management module was most preferable for Hispanic Americans. Lastly, Caucasian Americans rated the module on finding and sustaining supportive relationships as most favorable. Preliminary results were promising, however, the OOP program needs to be replicated in larger samples. Recommendations were offered including lessons learned regarding challenges associated with the implementation of a pre-post non-equivalent group design. Lastly, the significance of being flexible while building a sense of community, and the importance of providing food, supportive counseling, and peer mentoring were emphasized.

Computerized Cognitive Training in Mild Cognitive Impairment: Findings in African Americans and Caucasians

BackgroundAfrican Americans with MCI may be at increased risk for dementia compared to Caucasians. The effect of race on the efficacy of cognitive training in MCI is unclear.MethodsWe used data from a two-site, 78-week randomized trial of MCI comparing intensive, home-based, computerized training with Web-based cognitive games or Web-based crossword puzzles to examine the effect of race on outcomes. The study outcomes were changes from baseline in cognitive and functional scales as well as MRI-measured changes in hippocampal volume and cortical thickness. Analyses used linear models adjusted for baseline scores. This was an exploratory study.ResultsA total of 105 subjects were included comprising 81 whites (77.1%) and 24 African Americans (22.8%). The effect of race on the change from baseline in ADAS-Cog-11 was not significant. The effect of race on change from baseline to week 78 in the Functional Activities Questionnaire (FAQ) was significant with African American participants’ FAQ scores showing greater improvements at weeks 52 and 78 (P = 0.009, P = 0.0002, respectively) than white subjects. Within the CCT cohort, FAQ scores for African American participants showed greater improvement between baseline and week 78, compared to white participants randomized to CCT (P = 0.006). There was no effect of race on the UPSA. There was no effect of race on hippocampal or cortical thickness outcomes.ConclusionsOur preliminary findings suggest that web-based cognitive training programs may benefit African Americans with MCI at least as much as Caucasians, and highlight the need to further study underrepresented minorities in AD prevention trials. (Supported by the National Institutes of Health, National Institute on Aging; ClinicalTrials.gov number, NCT03205709.)

You’re heartless, I’m less: self-image and social norms in moral judgment

Are moral judgments to sacrificial dilemmas shaped by a latent social norm? The present research addresses this issue. We report a set of six studies (plus a supplementary one) which question the existence of a social norm in the longstanding deontism/utilitarian debate by relying on two original tools, namely substitution technique and self-presentation paradigm. Study 1 showed that American participants asked to answer like most Americans would do gave more utilitarian responses than control participants who answered in their own name (Study 1). Study 2 showed that participants instructed to answer in a disapproval fashion were more utilitarian than both participants instructed to answer in an approval fashion and control participants. Importantly, no difference was observed between the approval and control conditions, suggesting that participants naturally align their moral judgments with a latent norm they think is the most socially desirable. Studies 3–5 explored in addition the effect of the activation of a deontism-skewed norm using the substitution instruction on subsequent impression formation. For the latter task, participants were instructed to evaluate a random participant selected from a previous study who gave utilitarian-like responses (Studies 3a–3b), or to evaluate a fictitious politician who endorsed either a deontic or utilitarian orientation (Studies 4–5). Although we consistently replicated the effect of substitution instruction, we failed to show that attempts to activate a norm in a given individual shaped their evaluation of other people who do not align with this norm. Finally, we report a mini meta-analysis targeting the pooled effect and homogeneity among our studies.

Understanding Barriers and Facilitators to Signing Up for a Mobile-Responsive Registry to Recruit Healthy Volunteers and Members of Underrepresented Communities for Alzheimer’s Disease Prevention Studies

BackgroundAlzheimer’s disease (AD) disproportionately affects Black/African American and Hispanic/Latino adults, yet they are underrepresented in AD studies. Recruitment challenges for these populations limit generalizability of findings.ObjectivesThis study explores barriers and facilitators to signing up for an AD participant recruitment registry website intended to optimize recruitment of these adults. The registry is geared toward recruitment on smartphones and tablets (mobile devices), as research suggests that mobile-first approaches may be more successful within these populations.DesignIn 2020, we conducted four focus groups (n = 39) and an online survey (n = 1010) with Black/African American and Hispanic/Latino adults. The survey also included Whites as a comparison group.SettingFocus groups were in-person at research facilities in New Orleans, Louisiana, and Los Angeles, California. The online survey was distributed by a survey panel company to participants nationwide.ParticipantsBlack/African American (n = 360), Hispanic/ Latino (n = 359), or White (n = 330) individuals, 45–75 years old, who self-reported not having mild cognitive impairment (MCI), dementia, or AD.MeasurementsBarriers and facilitators explored in the focus groups and survey were related to health and AD (e.g., AD-related concerns and past participation/willingness to participate in health or AD studies); current use of mobile devices (e.g., comfort using devices and receptivity to the AD recruitment registry); and participant characteristics and beliefs (e.g., demographics, health literacy level, and trust in government and the scientific community).ResultsThe focus groups and survey revealed similar findings. Participants commonly use mobile devices to go online and perform health-related activities. They were aware of AD, expressed concerns with developing it, and were willing to participate in AD-related studies (motivated by personal connection to AD, altruism, and compensation). When presented with the AD recruitment registry, most provided positive feedback (e.g., easy to use and informative) and shared an interest in joining. Barriers to joining the registry with a mobile device included complex or multistep enrollment processes, beliefs that studies are primarily for those with a specific disease, and confusion about how studies can prevent AD among those low-risk for AD. The focus groups also revealed that Black/African American participants expressed more hesitation than Hispanic/Latinos in joining the registry due to greater distrust in the government and scientific community.ConclusionsRecruiting more Black/African American and Hispanic/Latino participants into AD studies is vitally important. This mixed methods study suggests that adults in these underrepresented groups are motivated to prevent AD and willing to sign up for an AD participant recruitment registry using mobile devices. Most barriers to joining a registry can be addressed through slight modifications to the registry’s design and functionality and by adding content. These findings can help enhance the appeal of joining AD recruitment registries to ultimately enroll more diverse, representative groups of participants and increase the generalizability of AD study findings.

Evaluation of feasibility and acceptability of a web-based diabetes prevention program (DPP) for diabetes risk reduction in Chinese Americans in New York City.

Intensive lifestyle intervention remains an effective modality to reduce diabetes incidence and delay the progression to type 2 diabetes. The primary aim of this study was to pilot-test the feasibility and acceptability of a culturally and linguistically tailored web-based DPP intervention among Chinese Americans with prediabetes living in New York City. Thirteen Chinese American participants with prediabetes were recruited to complete a 1-year web-based Diabetes Prevention Program (DPP) lifestyle intervention. Quantitative and qualitative measures such as retention rate and data collected from web-based questionnaires and focus groups were collected and analyzed to assess study feasibility and acceptability. Participants were receptive to the program through high engagement, retention and satisfaction. Retention rate was 85%. 92% of participants completed at least 16 sessions out of 22 sessions. Post-trial surveys indicated high satisfaction of 27.2/32 based on Client Satisfaction Questionnaire (CSQ-8) score. Participants expressed the program increased their knowledge and methods to prevent onset of type 2 diabetes such as incorporating healthy eating habits and increasing physical activities. Although not a primary outcome, there was a significant weight reduction of 2.3% at the end of month 8 of the program (p < 0.05). The culturally and linguistically adapted DPP via online platform successfully demonstrated feasibility and acceptability among Chinese Americans with prediabetes. Further evaluation of the web-based Chinese Diabetes Prevention Program in a larger trial is warranted.

Community research liaison role in increasing participation of African Americans in cognitive research: A case study

AbstractBackgroundRacial and ethnic underrepresentation in aging research and need for effective recruitment strategies is well documented. A Community Research Liaison (CRL) role created under a NIA award is demonstrating the value of embedding staff from underrepresented communities in the research infrastructure.MethodsThe role and qualifications for a CRL were developed with individuals from an African American community. The CRL hired from this community is engaging in outreach to understand barriers to and discuss the value of research with community members. Through the CRL, community input is being translated into changes in recruitment methods that reflect the concerns, interests and needs of potential African American participants. This case study reports on recruitment outcomes for a study on markers of cognitive decline in older adults requiring 2 hours in an MRI, 5 for testing, and 3 for travel. Recruitment data are compared 6 months before and 3 months after the CRL was engaged.ResultIn the 6 months prior to the CRL’s involvement, 309 individuals passed an initial screening and 156 were found potentially eligible after a second screening. Five (3.2%) of the 156 were African American. Of these, one was found ineligible, one was lost to follow‐up and the 3 participated in the study. In the first 3 months after the CRL was engaged, 35 were referred to the study after recruitment by the CRL. All were African American, 15 (43%) were eligible and enrolled, 9 (26%) were ineligible, and 9 (26%) are still in the screening process.ConclusionThe case study demonstrates the promise of a CRL who is a member of an African American community in increasing African American participation in research. The CRL dramatically increased the number of older African Americans recruited despite potential participation barriers. The increase was due in large part to the CRL’s understanding of and recognition as a trusted member of the community and to changes she recommended to promotional materials and logistics based on community feedback. Data on recruitment effectiveness are continuing to be evaluated across a range of aging research studies and clinical trials in which the CRL is engaged.

Early identification of cognitive impairment among vulnerable older adults living at home

AbstractBackgroundAfrican Americans are twice as likely as Caucasians to develop Alzheimer’s Disease and Related Dementias (AD/ADRD) and less likely to seek a diagnosis before experiencing a crisis. This study evaluated the impact of adding Mini‐Cog© screenings to Area Agency on Aging (AAA) assessments on early detection of cognitive impairment among low‐income older adults.MethodMini‐Cog™ assessments were offered to new and existing clients of a AAA Neighborhood Advisor. Clients with scores indicating impairment were referred to an academic geriatric practice for comprehensive evaluation. Inclusion criteria were age 65 or older, English speaking, living at home in the Advisor’s service area, and not previously diagnosed as AD/ADRD. Data collected over 9 months included Mini‐Cog™ scores, age, race, ethnicity, and geriatric referrals. Quantitative analysis included bivariate descriptive statistics (significance alpha of .10) and simple linear regression (significance alpha of .05).ResultsOf 69 study participants, 84% were female, 54% African American, and 93% non‐Hispanic. Mean age was 74.7 years and mean Mini‐Cog™ score was 3.61 (range: 0‐5). Independent t‐tests show that African American participants had lower Mini‐Cog™ scores than Caucasians (3.35±.23 vs 3.91±.22, p = .092). Caucasian males were younger with higher cognition scores than Caucasian women and African American males were younger with lower scores than African American females. Participants qualifying for referral (18 or 26%) were significantly older than those who did not (74.4 vs 70.0, p&lt;.05). Of 11 participants offered referrals, all Caucasians (3) declined and 5 of 8 African Americans (62%) accepted. Regression analysis determined that Mini‐Cog™ scores were associated with older age (β* = ‐0.255, SE = 0.02, p&lt;.05) and being African American (β* = ‐0.261, SE = .344, p&lt;.05) but not with sex, ethnicity, or living alone.ConclusionResults show that 25% of participants were identified with previously undetected cognitive impairment and that trained social service providers can effectively administer the Mini‐Cog™ instrument to assess cognitive impairment. Large scale studies are needed to further evaluate use of the Mini‐Cog™ instrument in early detection of cognitive impairment in minority and economically vulnerable older adults in non‐clinical settings.

Description of the ARMADA (assessing reliable measurement in Alzheimer’s disease) general population study cohorts

AbstractBackgroundGiven the growing population of aging adults, and subsequently individuals with dementia, there is a need for instruments that can detect cognitive impairment in early stages. The NIH Toolbox® for Assessment of Neurological and Behavioral Function (NIHTB) is a computerized battery of assessments measuring multiple domains cognition, emotion, sensation, and motor abilities. The goal of the ARMADA study is to validate the NIHTB in individuals with mild cognitive impairment (MCI) and dementia of the Alzheimer type (DAT). Here, we describe the demographic and clinical characteristics of participants ages 65 to 85 from the general population sample.MethodNormal control (NC), MCI, and DAT groups racially proportional to the US population were recruited from existing cohorts across nine Alzheimer’s Disease Research Centers and sites with cognitive aging studies. Diagnoses were based on the Uniform Data Set methodology, and included multiple clinical and cognitive assessments. Participants completed the NIH Toolbox at baseline, 12‐, and 24‐month visits.ResultGroups were matched with respect to multiple demographic characteristics. There were some differences in age and sex, such that the NC group had more female participants and was the youngest. Dementia severity levels differed as expected, with the DAT group demonstrating greater cognitive and functional impairment compared to the MCI group, and the NC group demonstrating minimal cognitive or functional symptoms. Additionally, the DAT group reported more neuropsychiatric symptoms compared to the NC and MCI groups. There was no difference in reported family history of cognitive impairment across groups. Many participants across groups had at least one Alzheimer biomarker collected.ConclusionThe study cohorts included in the ARMADA study accurately reflect their respective clinical syndromes for validating the NIHTB across the cognitive aging spectrum. The goals for the ARMADA study include comparing performance on all four modules of the NIHTB across groups, evaluating the relationship between Alzheimer biomarkers and NIHTB measures, and measuring changes in performance longitudinally. Special emphasis groups, including individuals over age 85, African American participants, and Spanish‐Speaking participants, were also recruited and are reported elsewhere.

Loneliness and cognitive decline in the community: Examining demographic and APOE4 status differences

AbstractBackgroundLimited information exists regarding patterns of loneliness and relationships among subgroups of older adults in the community. We evaluated demographic and APOE4 status differences in associations between loneliness and cognitive decline in older adults.MethodParticipants (N = 7,696) were selected from the Chicago Health and Aging Project (CHAP), a longitudinal population‐based study, who completed at least two measurement time points of neuropsychological testing, including individual tests of episodic memory, perceptual speed, and the Mini‐Mental State Examination (MMSE). The mean of individual test scores was taken to calculate composite global cognitive function. Loneliness was measured using an item from the Center for Epidemiologic Studies‐Depression Scale (modified). Mixed effects regression models evaluated associations between loneliness and decline in global cognitive function and individual tests, by race, sex, and APOE4 (one or more copies of e4 allele (any) vs. none). Modeling included adjustments such as sex, race, age, education, chronic conditions, cognitive activities, statin prescription, and interactions with time for each.ResultA higher percentage of participants that were female (74% vs. 61%), African American compared to Non‐Hispanic White (72% vs. 63%), with older mean age (74 vs. 72 years) reported loneliness. The prevalence of loneliness was similar across APOE4 status. The interaction/ synergy of loneliness with time had statistically significant associations with global cognition (β = ‐0.010, p = 0.005), episodic memory (β = ‐0.010, p = 0.017), and MMSE (β = ‐0.015, p = 0.000) for women. This interaction was statistically significant in associations with global cognition (β = ‐0.012, p = 0.001), episodic memory (β = ‐0.011, p = 0.012), and MMSE (β = ‐0.018, p = 0.000) among African American participants. This interaction also showed the following statistically significant associations by APOE4 status: any (β = ‐0.012, p = 0.034) and none (β = ‐0.007, p = 0.049) for global cognition, none (β = ‐0.009, p = 0.039) for episodic memory, and any (β = ‐0.017, p = 0.009) and none (β = ‐0.011, p = 0.004) for MMSE.ConclusionLoneliness is differentially associated with global cognitive decline based on race and sex but not APOE4 status. More research is needed to understand relationships between loneliness and biological mechanisms and how to best account for demographic characteristics when intervening on loneliness.

Self‐report sleep duration associates with plasma Aβ42/40 rate of change in late middle‐aged, African American Adults

AbstractBackgroundSleep abnormalities may play a prominent role in the pathogenesis or exacerbation of Alzheimer’s disease (AD). Sleep is considered a modifiable target for prevention and treatment. Racial sleep health disparities exist, and may contribute to the disproportionately increased risk for developing AD associated with being African American. Yet, the relationships between sleep health and AD pathophysiology in African American individuals are under‐studied. This investigation was designed to address research gaps by evaluating the associations of self‐report sleep duration, sleep disturbances, and daytime sleepiness with change in plasma‐derived amyloid β 42/40 ratio (Aβ42/40) in an African American sample.MethodArchival data from African American participants enrolled in the Wisconsin Registry for Alzheimer’s Prevention study and the Wisconsin Alzheimer’s Disease Research Center were utilized. Data included the Medical Outcomes Study Sleep Scale (MOS‐Sleep), Epworth Sleepiness Scale (ESS), and demographic information. Sleep duration was determined by MOS‐Sleep #2, sleep disturbances were captured by a related MOS‐Sleep subscale (SLPD4), and ESS assessed daytime sleepiness. Participants provided plasma samples across multiple timepoints. PrecivityADTM assays quantified Aβ42/40. Aβ42/40 rate of change (Aβ42/40_ROC) was computed for follow‐up collections to serve as the primary outcome measure. Aβ42/40_ROC was computed as the difference in Aβ42/40 between follow‐up and first collection divided by years between collections. Linear mixed‐effects models determined associations with Aβ42/40_ROC. Observations were nested within participant. Fully adjusted models included age at collection, gender, BMI, education, parental history of dementia, and APOEe4 carrier status.ResultData included 339 follow‐up collections from 143 participants. Women provided 70.8% of collections, with average age at collection = 66.6 ± 8.84 years, Aβ42/40_ROC = ‐0.0005 ± 0.003, and sleep duration = 6.35 ± 1.00 hours. Sleep duration significantly associated with Aβ42/40_ROC in the fully adjusted model (β = ‐0.0005; SE = 0.0002; p = 0.02) (Figure 1). Associations between SLPD4 and ESS with Aβ42/40_ROC were nonsignificant.ConclusionLonger self‐report sleep duration associated with a steeper reduction rate for plasma Aβ42/40, a biomarker for amyloid pathology. Further research is necessary to clarify the relationships between sleep health components and changes in AD‐related biomarkers within African American adults to identify focal risk factors and interventional strategies.

Evaluating Demographic Representation in Clinical Trials: Use of the Adaptive Coronavirus Disease 2019 Treatment Trial (ACTT) as a Test Case.

Clinical trials initiated during emerging infectious disease outbreaks must quickly enroll participants to identify treatments to reduce morbidity and mortality. This may be at odds with enrolling a representative study population, especially when the population affected is undefined. We evaluated the utility of the Centers for Disease Control and Prevention's COVID-19-Associated Hospitalization Surveillance Network (COVID-NET), the COVID-19 Case Surveillance System (CCSS), and 2020 United States (US) Census data to determine demographic representation in the 4 stages of the Adaptive COVID-19 Treatment Trial (ACTT). We compared the cumulative proportion of participants by sex, race, ethnicity, and age enrolled at US ACTT sites, with respective 95% confidence intervals, to the reference data in forest plots. US ACTT sites enrolled 3509 adults hospitalized with COVID-19. When compared with COVID-NET, ACTT enrolled a similar or higher proportion of Hispanic/Latino and White participants depending on the stage, and a similar proportion of African American participants in all stages. In contrast, ACTT enrolled a higher proportion of these groups when compared with US Census and CCSS. The proportion of participants aged ≥65 years was either similar or lower than COVID-NET and higher than CCSS and the US Census. The proportion of females enrolled in ACTT was lower than the proportion of females in the reference datasets. Although surveillance data of hospitalized cases may not be available early in an outbreak, they are a better comparator than US Census data and surveillance of all cases, which may not reflect the population affected and at higher risk of severe disease.

‘Once and For All’: The Fourth UN World Conference on Women and the Institutionalisation of Women's Human Rights in American Foreign Policy

AbstractThough the slogan predates the Fourth UN World Conference on Women, ‘women's rights are human rights’ has become inextricably linked to US First Lady Hillary Rodham Clinton's keynote address at the 1995 Conference in Beijing. The speech turned a line socialised by transnational feminist organisers into a State Department mantra with long‐lasting policy ripples still felt today. This article uses new sources from the Office of the First Lady to examine the intra‐departmental dynamics, policy architecture and domestic political considerations that shaped the content of the speech and the Clinton Administration's conception of women's rights as human rights. Early documents show that a focus on human rights was not inevitable, as other policy areas were better developed with more public support. But fear of rollback from previous international standards, external pressures from civil society, a desire to link foreign policy with domestic political aims and ultimately a strong backlash to American participation at the Conference on the basis of China's human rights record all elevated women's human rights as a US delegation priority.