American Participants Research Articles

Ethnic Identity Protects and Internalized Racism Harms Health and Coping in Asian Americans Following COVID-19 Discrimination: A Mixed-Methods Study.

Mechanisms underlying the link between COVID-19 anti-Asian racial discrimination and psychological health are underexplored. This mixed-methods study examined the moderating effects of ethnic identity and internalized racism on the relationship between COVID discrimination and behavioral health outcomes among Asian Americans. We hypothesized that individuals with lower ethnic identity and higher internalized racism levels would demonstrate more adverse outcomes, including worsened psychological trauma and identity-avoidant behaviors, post-discrimination. Asian American participants (N = 215) responded to a Qualtrics survey, including qualitative and quantitative questions on COVID-related racism experiences, ethnic identity, internalized racism, trauma, and other subsequent effects. For qualitative analysis, participants were sorted into four subgroups defined by low- and/or high-ethnic identity and internalized racism scores, and we explored themes in participant reports of identity-related coping effects after racism. We additionally used hierarchical multiple regression analyses to quantitatively assess the moderating impact of ethnic identity and internalized racism on the relationship between COVID discrimination and trauma. Analyses revealed no moderating effects from the two identity variables. However, qualitative analyses identified themes of identity-promoting and identity-avoidant behavioral responses, and moderation analyses revealed that ethnic identity had a main effect on mitigating racial trauma, while internalized racism exacerbated both racial trauma and PTSD levels. This study identified ethnic identity and internalized racism as underlying causes to behavioral health outcomes for Asian Americans. Results offer mental health providers serving Asian clients insight into identity-related influences to help optimize culturally appropriate interventions and support initiatives of identity promotion to foster community engagement for this population.

Reporting and representation of underserved groups in intervention studies for patients with multiple long-term conditions: a systematic review.

Globally, there is a growing number of people who are living with multiple long-term conditions (MLTCs). Due to complex management needs, it is imperative that research consists of participants who may benefit most from interventions. It is well documented that ethnic minority groups and lower socioeconomic status (SES) groups are at an increased risk of developing MLTCs. Therefore, the aim of this systematic review was to determine the level of reporting and representation of underserved groups (ethnic minority and low SES) in intervention studies addressing MLTCs. Systematic review. Four databases including Cochrane Library, MEDLINE, CINAHL and Scopus were searched for intervention studies from North America or Europe published between January 1990 and July 2023. Hospital and community-based interventions. We included interventional studies focusing on improving MLTC-related outcomes. Patients with MLTCs. Total number of studies reporting on ethnicity and SES. Number and proportion of studies reporting by ethnic/SES group. Thirteen studies met the inclusion criteria. Only 4 of 13 studies (31%) recorded and reported ethnicity information. Of these four studies that reported on ethnicity, three studies consisted of primarily White participants. Ethnic minority groups were underrepresented, but one study included a majority of African American participants. Moreover, 12 of 13 studies (92%) reported on SES with income and educational level being the primary measures used. SES representation of higher deprivation groups was varied due to limited data. For ethnicity, there was a lack of reporting, and ethnic minority groups were underrepresented in intervention studies. For SES, there was a high level of reporting but the proportion of study samples from across the spectrum of SES varied due to the variety of SES measures used. Findings highlight a need to improve the reporting and representation of ethnic minority groups and provide more detailed information for SES through using consistent measures (e.g. education, income and employment) to accurately determine the distribution of SES groups in intervention studies of people with MLTCs.

Numbers of prenatal cell-free DNA screens performed: Results of a 2022 CAP exercise.

Determine current analytical methods and number of cell-free (cf) DNA prenatal screening tests performed for common trisomies. The College of American Pathologists 2022-B Noninvasive Prenatal Testing exercise was distributed in December 2022 to 93 participants in 22 countries. Supplemental questions included the number of tests performed in a recent month and the proportion of samples originating outside the United States (US). Eighty-three participants from three continents returned results; 74 (89%) were suitable for the analyses. Nine manufacturer/platform combinations were identified, most commonly Illumina/Nextseq (55%). The most common methodology was whole genome sequencing (76%). Annualized cfDNA tests were 2.80 million, with Asian, European and North American participants representing 10.6%, 6.5% and 82.9% of tests, respectively. When restricted to US in-country tests, the annualized rate was 2.18 million, with four of 20 participants testing 79.2%. Among 73 respondents, 63 (86%) were for-profit, eight (11%) were non-profit academic or government supported and the remaining two included hospital-based and private non-profit. Eighteen (25%) supported relevant academic training. In 2011, screening for common trisomies was based on serum/ultrasound markers with an estimated 2.96 million US pregnancies screened in 131 laboratories. In 2022, cfDNA-based screening was offered by 20 laboratories testing 2.18 million US pregnancies.

“It Wasn’t Just in My Head”: A Qualitative Study on Nurturing the Racial Literacy of Mexican American Aspiring School Leaders in South Texas

This qualitative study centers on interview data from ten Mexican American aspiring school leaders as they developed their racial literacy across two sociocultural foundations courses in a principal preparation program at a Hispanic Serving Institution in South Texas. The theoretical perspectives framing this study include notions of racial literacy and the subtractive schooling of Mexican school children in the United States. Findings illustrate how coursework strengthened Mexican American participants’ racial literacy in several ways. The discussion elaborates on racial literacy from theory to practice and the contextual elements that promote anti-racial literacy in P-20 settings in South Texas.

The College-Going Experiences of Mexican American Participants Who Graduated from a College Preparatory Program

Despite educational levels improving in the Latinx community overall, Latinx adults continue to fall behind other racial and ethnic groups. The increases in educational attainment we have seen fall along gender lines, with Latinas graduating from college at a higher rate than Latinos. Despite these disparities, there is still a lack of knowledge about the intersectional education journey of Latinx students. This phenomenological study explores the gendered experiences of first-generation, documented, higher education students of Mexican origin who participated in a college preparatory program created for Latinx students and families. Utilizing the theory of community cultural wealth, students’ strengths are highlighted to demonstrate how their skills apply to higher education experiences. Findings indicate that long-term, holistic, mentoring from trusted adults was key to bolstering the educational success of students. The gendered analysis suggests Latinas may have increased opportunities to engage in on-campus programming than Latinos.

How does Stigma Affect the Mental Health and Overall Well-Being of Individuals with Physical Disabilities? What is the Difference Cross Country (China and America)

This study examines the understudied issue of stigma and how it affects people with physical impairments' mental health and overall well-being in China and America. The study investigates how stigma is felt and internalized and how it impacts the mental health of people with physical limitations. The influence of cultural norms and social perspectives on impairments on mental health outcomes and stigma experiences in these two different cultural contexts is also investigated. The intersectionality theory is used in the study to comprehend how many facets of identity, including disability, interact and influence stigma experiences and mental health consequences. It acknowledges the nuanced role that identity dynamics and group classifications play in shaping stigma experiences in both China and the United States. Utilizing surveys and semi-structured interviews, the study technique combines quantitative and qualitative methodologies to capture a thorough picture of stigma, physical disability, and mental health in both nations. Considerations for sampling guarantee variety and an adequate sample size. To evaluate stigma and mental health, the study uses standardized measurements emphasizing coping skills and social support. Research instruments are culturally appropriated and translated to ensure they are pertinent for Chinese and American participants. The complicated link between stigma and mental health across cultural contexts is explored through data analysis, which includes statistical assessment and thematic analysis. This study advances theoretical knowledge by shedding light on the intricate relationship between stigma, physical impairment, and mental health. It broadens the corpus of research in stigma studies and offers cross-cultural insights into how social perspectives and cultural norms affect stigma experiences. The study has practical ramifications for mental health professionals and legislators, providing culturally informed therapies and raising awareness of the stigma associated with disabilities. In the end, this study offers the foundation for creating more inclusive communities and enhancing the quality of life for people with physical impairments in various cultural contexts.

TOMM40 and APOC1 variants differentiate the impacts of the APOE ε4 allele on Alzheimer's disease risk across sexes, ages, and ancestries.

The variability in apolipoprotein E (APOE) ε4-attributed susceptibility to Alzheimer's disease (AD) across ancestries, sexes, and ages may stem from the modulating effects of other genetic variants. We examined associations of compound genotypes (CompGs) comprising the ε4-encoding rs429358, TOMM40 rs2075650, and APOC1 rs12721046 polymorphisms with AD in White (7181/16,356 AD-affected/unaffected), Hispanic/Latino (2305/2921), and Black American (547/1753) participants across sexes and ages. The absence and presence of the rs2075650 and/or rs12721046 minor alleles in the ε4-bearing CompGs define lower- and higher-AD-risk profiles, respectively, in White participants. They differentially impact AD risks in men and women of different ancestries, exhibiting an increasing, decreasing, flat, and nonlinear-with lower risks at ages younger than 65/70 years and older than 85 years compared to the ages in between-patterns across ages. The ε4-bearing CompGs have a potential to differentiate biological mechanisms of sex-, age-, and ancestry-specific AD risks and serve as AD biomarkers. Younger White women carrying the lower-risk (LR) CompG are at small risk of AD.Black carriers of the LR CompG are at negligible risk of AD at 85 years and older.The higher-risk (HR) CompGs confer high AD risk in Whites and Blacks at 70 to 85 years.AD risk decreases with age for Hispanic/Lation women carrying the HR CompGs.Hispanic/Lation carriers of the LR CompG but not HR CompGs have higher AD risk than Blacks.

Apolipoprotein E and Alzheimer’s disease pathology in African American older adults

The apolipoprotein-E4 (APOE*4) and apolipoprotein-E2 (APOE*2) alleles are more common in African American versus non-Hispanic white populations, but relationships of both alleles with Alzheimer’s disease (AD) pathology among African American individuals are unclear. We measured APOE allele and β-amyloid (Aβ) and tau using blood samples and positron emission tomography (PET) images, respectively. Individual regression models tested associations of each APOE allele with Aβ or tau PET overall, stratified by racialized group, and with a racialized group interaction. We included 358 older adults (42% African American) with Aβ PET, 134 (29% African American) of whom had tau PET. APOE*4 was associated with higher Aβ in non-Hispanic white (P < 0.0001), but not African American (P = 0.64) participants; racialized group modified the association between APOE*4 and Aβ (P < 0.0001). There were no other racialized group differences. These results suggest that the association of APOE*4 and Aβ differs between African American and non-Hispanic white populations. Other drivers of AD pathology in African American populations should be identified as potential therapeutic targets.

Assessment and Prediction of Energy Expenditure: One-Mile Walks and Runs Among African American

Among ethnicities, African Americans exhibit the highest prevalence of obesity. A more comprehensive grasp of energy expenditure while walking and running can be instrumental in managing and averting obesity. Regrettably, there is a scarcity of research dedicated to scrutinizing energy expenditure in African Americans during walking and running. Consequently, the primary objective of this study was to contrast energy expenditure disparities during a one-mile walk and run between African Americans of normal-weight and those classified as overweight. Additionally, the secondary aim was to formulate and validate a predictive equation for energy expenditure tailored specifically to African Americans. A total of 68 African American participants were involved in this study, comprising 21 individuals classified as normal-weight walkers, 27 as overweight walkers, and 20 as runners. Energy expenditure was assessed using indirect calorimetry. To compare energy expenditure across these groups, an Analysis of Variance (ANOVA) was conducted, followed by a post hoc Scheffe test. Linear regression analysis was employed for predicting energy expenditure. Additionally, a dependent t-test and a Chow test were utilized for cross-validating the predictive equation. The findings revealed that runners exhibited significantly higher energy expenditure compared to normal-weight walkers. When energy expenditure was normalized to body weight, runners expended significantly more energy than both normal-weight and overweight walkers. However, when expressed relative to fat-free mass, normal-weight walkers expended less energy than runners and overweight walkers. A prediction equation tailored specifically for African Americans was formulated as follows: EE = 1.012 BW − 9.233 Gender (M = 1, F = 2) + 47.188. The results from cross-validation tests confirmed the validity of this equation. Consequently, we recommend the use of this energy expenditure prediction equation for calculating energy expenditure during one-mile walks or runs for African American adults, whether they fall within the normal-weight or overweight categories.

Latin American gossip or Caribbean Basin intelligence sharing?: operation PBFORTUNE, 1952

ABSTRACT This article reexamines the rise and fall of Operation PBFORTUNE by restoring the contributions of its Latin American participants. In 1952, a loose network of Caribbean Basin regimes sought to overthrow Jacobo Arbenz’s democratically-elected government in Guatemala. At the same time, the U.S. government’s State Department and CIA held the same goal. Lobbied by Nicaraguan dictator Anastasio Somoza on behalf of Guatemalan counterrevolutionary Colonel Carlos Castillo Armas, the Truman Administration inadvertently approved what Caribbean Basin officials interpreted as their own scheme. Although the CIA would be regularly notified of meetings among Latin American actors, Assistant Secretary of State Edward Miller grew increasingly frustrated as Caribbean Basin officials contacted State Department officials whom Miller intended to keep unaware. When the State Department ended the program, U.S. officials blamed their Latin American counterparts in order to maintain plausible deniability and circumvent any discussions about their respective department’s role in Operation PBFORTUNE.

Abstract 2214: Impacts of habitual and recent alcohol intake on gut microbiome diversity and composition among Black Americans

Abstract Background: Alcohol intake can alter the gut microbiome, which may play a role in the development of cancer and other chronic diseases. However, there have been limited population-based studies investigating the associations of habitual and recent alcohol intake with the gut microbiome, particularly among Black Americans. Methods: We investigated the association of alcohol intake with the gut microbiome among 538 Black American participants of the Southern Community Cohort Study (150 men and 388 women). Habitual and recent alcohol intake was assessed at cohort baseline (2002-2009) and stool collection (2018-2021), respectively. DNA was extracted from fecal samples for gut microbiome profiling using shotgun metagenomic sequencing. Generalized linear models were employed to evaluate the associations between alcohol intake and gut microbiome diversity and composition, with adjustments for sociodemographic characteristics, other lifestyle factors, and comorbidities. False discovery rate (FDR)&amp;lt;0.1 was considered statistically significant. Results: The mean age at enrollment was 53.2 ± 7.7 years, with a mean interval of 13.8 years (range: 9.0-18.1 years) between baseline and stool collection. Neither habitual nor recent alcohol intake was associated with microbiome diversity indices, and recent alcohol intake was not associated with microbial taxa abundance either. However, habitual alcohol intake, both total amount and subtypes, showed significant associations with microbial taxa abundance primarily in men, including Actinobacteria, Proteobacteria, Firmicutes, and classes Bacilli and Clostridia within these phyla (all FDR&amp;lt;0.1). Specifically, total alcohol and red wine intakes were inversely associated with genus MGYG-HGUT-02719 in class Clostridia; beer consumption was inversely associated with genus Anaerostipes; white wine intake showed negative associations with order RF32 and genus Eubacterium and a positive association with genus Paenibacillus. Most of these associations remained significant after adjusting for BMI and history of cardiometabolic diseases or cancer. Conclusion: We identified gut microbiome taxa associated with habitual alcohol intake among Black American men, including several with anti- or pro-gastrointestinal-cancer properties. However, the magnitudes of these associations were generally small. Further research is needed to determine if these bacteria play a mediating or modifying role in alcohol-disease relationships. Citation Format: Lili Liu, Sang Nguyen, Qiuyin Cai, Martha Shrubsole, Wei Zheng, Danxia Yu. Impacts of habitual and recent alcohol intake on gut microbiome diversity and composition among Black Americans [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 2214.

Abstract P493: A Multivariate Analysis of Genetic Risk Scores for Heart Failure and Left Ventricular Mass Derived From Multi-Ancestry Populations and Left Ventricular Mass Amongst African Americans: The Jackson Heart Study

Background: Increased left ventricular (LV) mass is an outcome of LV remodeling that can result in development of left ventricular hypertrophy (LVH), a maladaptive disorder that increases the risk of heart failure. Elevated LV mass is a sensitive predictor of adverse cardiovascular events. African Americans experience a disproportionate burden of heart failure risk and development of LVH. The influence of genetics on this health disparity is unclear and a topic of interest. Genome-wide association studies (GWAS) have uncovered many variants associated with numerous adverse cardiovascular outcomes, such as heart failure and LV phenotypes. However, the relevance of these studies for African Americans may be limited as these analyses have been conducted in multi-ancestry populations with limited representation of African heritage. The question of whether these genetic risk variants can be used to predict LV phenotypes in an independent African American population remains unanswered. Hypothesis: Variant loci that have been associated with heart failure and LV mass in multi-ancestry populations will be associated with LV mass amongst African Americans in the Jackson Heart Study (JHS). Methods: Thirty-nine (39) SNPs associated with heart failure and ten (10) SNPs associated with LV mass were identified from two published studies in which participants of African ancestry or Black individuals comprised less than 15% and 2%, respectively. Using the published effect size estimates, genetic risk scores (GRSs) for heart failure and LV mass were computed for 2,175 African American participants (mean age 55, 63% female) in the JHS with complete data and consent for genetic research. We assessed the linear association of heart failure and LV mass GRSs with LV mass indexed to height (LVM h ) and indexed to body surface area (LVM bsa ). A multivariate general linear model was fit to both LVM h and LVM bsa containing both GRS predictors and accounting for age, sex, BMI (mean 31.5), diabetes (22%), and hypertension (52%). No multicollinearity was noted among these explanatory variables using variance inflation factors. Due to non-constant error variance, a log transformation was conducted on both LV mass response variables. Type III MANOVA Pillai tests were run to assess the effects of the GRSs on the log LVM bsa and log LVM h values. Conclusion: When accounting for age, BMI, sex, diabetes, and hypertension, we found that neither the heart failure GRS (p-val = 0.4012) nor the LV mass GRS (p-val = 0.8332) had an effect on both log LVM bsa and log LVM h . There is insufficient evidence to suggest that heart failure and LV mass variants derived from predominantly European multi-ancestry populations are linearly associated with log LV mass amongst African Americans in the Jackson Heart Study. Our work highlights the need for greater recruitment and targeted studies of populations with African ancestry for GWAS of LV phenotypes.

Do People From Different Cultures Vary in How Much Positive Emotions Resonate in Day-to-Day Social Interactions? Examining the Role of Relational Mobility

Positivity resonance, defined as a co-experienced kind-hearted positive emotion, is commonly observed to strengthen relationships in the United States. However, it is unclear whether levels of positivity resonance differ across cultures. Prior research suggests that in cultures that are perceived as offering more freedom and choice in social ties (defined as high relational mobility cultures), individuals more frequently engage in adaptive strategies to build relationships. We hypothesized that positivity resonance, achieved via such adaptive strategies, might be similarly linked to cultural variation in relational mobility. Across two studies ( N = 5,711) we found supportive evidence for our prediction that, compared with European American participants, East Asian participants showed lower levels of positivity resonance with strong social ties. Such differences were in part explained by lower levels of perceived relational mobility among East Asian participants. Comparable effects were not present for weak social ties. Implications for theories of culture and emotion are discussed.

Association of cardiovascular health with subclinical coronary atherosclerosis progression among five racial and ethnic groups: The MASALA and MESA studies

Background and aimsSouth Asian adults (SA) are at higher risk for atherosclerotic cardiovascular disease (ASCVD) compared with other racial/ethnic groups. Life's Simple 7 (LS7) is a guideline-recommended, cardiovascular health (CVH) construct to guide optimization of cardiovascular risk factors. We sought to assess if the LS7 metrics predict coronary artery calcium (CAC) incidence and progression in asymptomatic SA compared with four other racial/ethnic groups. MethodsWe assessed the distribution of CVH metrics (inadequate: score 0–8, average: 9–10, optimal: 11–14, and per 1-unit higher score) and its association with incidence and progression of CAC among South Asians in the Mediators of Atherosclerosis in South Asians Living in America (MASALA) study compared with other race/ethnic groups from the Multiethnic Study of Atherosclerosis (MESA). ResultsWe included 810 SA, 2622 Non-Hispanic White (NHW), and 4192 Other adults (collectively 1893 Black, 1496 Hispanic and 803 Chinese American participants, respectively). SA and White participants compared to Other race/ethnicity groups were more likely to have optimal CVH metrics (26% SA vs 28% White participants vs 21% Other, respectively, p < 0.001). Similar to NHW and the Other race/ethnic group, SA participants with optimal baseline CVH were less likely to develop incident CAC on follow-up evaluation compared to participants with inadequate CVH metrics, optimal CVH/CAC = 0: 24% SA, 28% NHW, and 15% Other (p < 0.01). In multivariable linear and logistic regression models, there was no difference in annualized CAC incidence or progression between each race/ethnic group (pinteraction = 0.85 and pinteraction = 0.17, respectively). Optimal blood pressure control was associated with lower CAC incidence among SA participants [OR (95% CI): 0.30 (0.14–0.63), p < 0.01] and Other race and ethnicity participants [0.32 (0.19–0.53), p < 0.01]. ConclusionsOptimal CVH metrics are associated with lower incident CAC and CAC progression among South Asians, similar to other racial groups/ethnicities. These findings underscore the importance of optimizing and maintaining CVH to mitigate the future risk of subclinical atherosclerosis in this higher risk population.

Historical Trauma, Health Care Distrust, and the Legacy of Tuskegee: Implications for Nurse Practitioner Practice and Research

Nurse practitioners (NPs) represent a strong cadre of healers and researchers active in a global quest to eliminate health disparities and create health equity. Barriers to health care result in a disproportionate burden of disease/disability on marginalized groups. Historical trauma results in or contributes to health care distrust manifested as a unique type of barrier with implications for nurse practitioners in research and practice. The legacy of Tuskegee is a reminder and a sentinel exemplar of how Black American male participants in “The Tuskegee Study of Untreated Syphilis in the Negro Male” (the United States Public Health Services Study at Tuskegee) experienced historical trauma and how intergenerational trauma is linked to negative health care outcomes.

Mixture of regressions with multivariate responses for discovering subtypes in Alzheimer's biomarkers with detection limits.

There is no gold standard for the diagnosis of Alzheimer's disease (AD), except from autopsies, which motivates the use of unsupervised learning. A mixture of regressions is an unsupervised method that can simultaneously identify clusters from multiple biomarkers while learning within-cluster demographic effects. Cerebrospinal fluid (CSF) biomarkers for AD have detection limits, which create additional challenges. We apply a mixture of regressions with a multivariate truncated Gaussian distribution (also called a censored multivariate Gaussian mixture of regressions or a mixture of multivariate tobit regressions) to over 3,000 participants from the Emory Goizueta Alzheimer's Disease Research Center and Emory Healthy Brain Study to examine amyloid-beta peptide 1-42 (Abeta42), total tau protein and phosphorylated tau protein in CSF with known detection limits. We address three gaps in the literature on mixture of regressions with a truncated multivariate Gaussian distribution: software availability; inference; and clustering accuracy. We discovered three clusters that tend to align with an AD group, a normal control profile and non-AD pathology. The CSF profiles differed by race, gender and the genetic marker ApoE4, highlighting the importance of considering demographic factors in unsupervised learning with detection limits. Notably, African American participants in the AD-like group had significantly lower tau burden.

Robust reference group normative data for neuropsychological tests accounting for primary language use in Asian American older adults.

The present study aimed to develop neuropsychological norms for older Asian Americans with English as a primary or secondary language, using data from the National Alzheimer's Coordinating Center (NACC). A normative sample of Asian American participants was derived from the NACC database using robust criteria: participants were cognitively unimpaired at baseline (i.e., no MCI or dementia) and remained cognitively unimpaired at 1-year follow-up. Clinical and demographic characteristics were compared between Primary and Secondary English speakers using analyses of variance for continuous measures and chi-square tests for categorical variables. Linear regression models compared neuropsychological performance between the groups, adjusting for demographics (age, sex, and education). Regression models were developed for clinical application to compute demographically adjusted z-scores. Secondary English speakers were younger than Primary English speakers (p < .001). There were significant differences between the groups on measures of mental status (Mini-Mental State Examination, p = .002), attention (Trail Making Test A, Digit Span Forward Total Score, p <.001), language (Boston Naming Test, Animal Fluency, Vegetable Fluency, p < .001), and executive function (Trail Making Test B, p = .02). Separate normative data are needed for Primary vs. Secondary English speakers from Asian American backgrounds. We provide normative data on older Asian Americans to enable clinicians to account for English use in the interpretation of neuropsychological assessment scores.

Gender vs gender identity: which influences word-of-mouth communication more, and its implications for self-brand connection? In the case of Airbnb

PurposeThis study aims to explore the relationships between gender, gender identity and Word of Mouth (WOM). There are three objectives of this study. The first was to observe the impact of gender identity on WOM. The second was to examine the mediation role of self-brand connection (SBC) bridging the relationship between gender identity and WOM. The final one was to test the moderating role of gender.Design/methodology/approachThe conceptual model was tested by analyzing data collected via Mturk from Americans participants who use Airbnb. Confirmatory factor analysis was conducted to evaluate the psychometric property. To test hypotheses, the structural equation model was assessed. Further, Hayes’ PROCESS was adopted to examine the mediation role of SBC. The moderation role of gender was examined by the chi-square difference test.FindingsThe research outcomes elucidated that feminine gender identity exerted a noteworthy influence on WOM communication, whereas masculine gender identity appeared to bear no significant impact on WOM. It was determined that SBC operates as a potent mediator bridging the relationship between gender identity and WOM. Gender did not demonstrate a significant moderating effect on any part of the WOM communication pathway in the context of this study.Practical implicationsThe conclusions drawn from this research underscore that practitioners in the field of brand management should not overlook the crucial role of consumers' gender identity. It is imperative to cultivate robust, positive relationships with consumers as a strategic measure to engender favorable WOM communication.Originality/valueThis investigation distinguishes itself as one of the relatively scarce studies interrogating the relationship between gender identity, gender and WOM, specifically through the mediating lens of SBC. Consequently, the discoveries made herein have the potential to furnish unprecedented insights into comprehending consumer behavior in the hospitality industry with respect to WOM communication, particularly as it pertains to the dimension of gender identity.

The Correlation between Metal Mixed Exposure and Lung Function in Different Ages of the Population.

Herein, we explored the overall association between metal mixtures and lung functions in populations of varying ages and the relationship among the associated components. The 2007-2012 National Health and Nutrition Examination Survey data of 4382 American participants was analyzed, and generalized linear, elastic net, quantile g-computation, and Bayesian kernel machine regression models were used to evaluate the relationship between exposure to the metal mixture and lung function at various ages. The results of barium exposure at distinct stages revealed that children and adolescents exhibited greater lung function changes than those in adults and the elderly. Additionally, compared with children and adolescents, cadmium- and arsenic-containing metabolites contributed to nonconductive lung function changes in adults and the elderly exposed to metal mixtures. The results showed that the effects of exposure to metal mixtures on lung function in children and adolescents were predominantly caused by lead and barium. Altogether, children and adolescents were found to be more susceptible to metal-exposure-mediated lung function changes than adults and the elderly.

Respectful Maternity Care in the United States-Characterizing Inequities Experienced by Birthing People.

The purpose of this study is to understand experiences of respectful maternity care (RMC) from the perspective of birthing people in the United States from 2013 to 2018. We conducted an online cross-sectional survey of United States birthing people ages 18-50 in April 2018 using SurveyMonkey Audience. Quantitative survey data consisted of demographics and responses to RMC indicators. Qualitative data consisted of comments from individuals regarding their birth experiences. 1036 birthing people participated in the survey. Most births (95%) occurred in hospitals. 16.3% of Black or African American participants reported discrimination compared to 5.5% of participants who did not identify as Black or African American (p < 0.001). Participants who speak a language other than English were also more likely to report discrimination. 19.5% of all respondents felt neglected during their birth experience. Most prevalent experiences of disrespect and mistreatment were related to neglect (most commonly in postpartum phase of care), poor interpersonal communication, lack of respect for patient wishes, negative experience with breastfeeding services, peripartum complications, and discrimination. Birthing people in the United States experience many forms of mistreatment, particularly those who identify as Black or African American or speak a language other than English. Patients described experiencing neglect most commonly after birth-an opportunity to improve the provision of RMC postpartum. Strategies to improve quality of maternal health care in the United States should include the provision of RMC as part of a larger effort to reduce inequities in maternal health experiences and outcomes.