American People Research Articles

4 A Novel Brief Measure of Acculturation and its Association with Subjective and Objective Cognition

Objective:There is equivocal evidence that acculturation is associated with cognition. Various factors may contribute to ambiguous findings in the neuropsychology setting, including psychometric limitations of tools available for assessing acculturation as well as the frequent conflation of bilingualism with acculturation. Additionally, neuropsychological research on acculturation and cognition has largely failed to account for bidimensional models of acculturation, which have greater empirical support over unidimensional models. In response to these limitations and the theoretical literature on acculturation, we developed the Perceived Identity & Ethnicity Scales (PIES), a brief rating scale system to quickly (<2 minutes) capture an individual's perceived acculturative identity across several domains. In the current study, we sought to (1) provide initial psychometric support of the PIES and (2) examine how it relates to cognition in a culturally and linguistically diverse sample.Participants and Methods:We recruited 242 individuals from both university and community samples (age=23.7±7.6, range 18-72; <12 Years of Education=4%; 78% Female; 58% Hispanic/Latin American; 69% middle SES; 22% educated outside the USA). In addition to demographic questionnaires, participants completed the PIES; an established measure of acculturation (the Bicultural Involvement Questionnaire, BIQ) and bilingualism (Bilingual Language Profile, BLP); measures of mood (the Depression, Anxiety, Stress Scales, DASS; Apathy Evaluation Scale, AES); and of self-reported cognitive functioning (Everyday Cognition, ECog). A subsample of Spanish speakers (n=86) also completed a cognitive battery validated for use in this population (the Spanish English Neuropsychological Assessment Scales, SENAS). For the first aim, we examined the reliability, validity, and dimensionality of the PIES in the full sample. In the Spanish-speaking subsample, we examined the relationship between the tool and both subjective and objective cognition using linear regression controlling for age, education, sex/gender, and premorbid intellectual functioning.Results:Measures of internal consistency and dimensionality supported a bidimensional model of acculturation; identification with culture of family origin (PIES-O) was not related to identification with US American culture (PIES-U; r=0.036, p>0.05). Cultural preference scores from the BIQ were associated with PIES-O (r=-0.322) and PIES-U (r=0.277; both ps<0.001) in the expected directions. PIES-O (r=0.350) and PIES-U (r=-0.432) were associated with the ability to speak a language other than English on the BLP (both ps<0.001). PIES-U, but not PIES-O, was also strongly associated with other BIQ and BLP scores as well as with receiving education outside of the USA at medium to large effect sizes (rs=0.3 to 0.6; all ps<0.001). In the subsample, PIES-O and PIES-U were not associated with subjective cognition as measured by the ECog (AR2=0.016, p>0.05); global cognition as measured by the Montreal Cognitive Assessment (MoCA; AR2=0.046, p>0.05); or SENAS cognitive composite scores (AR2=0.016, p>0.05) after controlling for covariates.Conclusions:Findings provide strong initial psychometric support for the utility of the PIES in the assessment of acculturation. Moreover, these results further support the bidimensional model of acculturation. Acculturation as measured by the PIES was not associated with cognitive abilities in this highly educated and mainly female cross-sectional sample. Longitudinal research accounting for acculturation is needed to elucidate these relationships.

69 Influence of Cardiovascular Risk Factors on Neuropsychological Trajectories in Black/African American Adults Living with HIV

Objective:Human immunodeficiency virus (HIV) type 1 (HIV-1), cardiovascular disease, and HIV-associated neurocognitive disorders (HAND) disproportionately affect Black/African American individuals compared to other racial and ethnic groups. Understanding the mechanisms of cognitive health disparities is essential for developing policy and health interventions to combat such disparities. Cardiovascular risk factors/diseases are common comorbidities that likely contribute to cognitive health disparities among Black/African American people living with HIV (PWH), but their impacts on cognition longitudinally in this population are unclear. The current study examines the relationship between cardiovascular risk and cognitive functioning over time in Black/African American adults living with HIV.Participants and Methods:A sample of 122 Black/African American adults with HIV (ages 25-68, M=51.8, SD=7.7; 98% on antiretroviral therapy; 91% with undetectable viral load) were selected from the Drexel/Temple Comprehensive NeuroHIV Center, Clinical and Translational Research Support Core (CTRSC; based at Drexel University College of Medicine) Cohort. They completed longitudinal visits (300 total visits, average follow-up time=4.9 years) that included clinical interviews, medical record review, biometric measurements, and comprehensive neuropsychological assessments. Cardiovascular risk factors of interest were body mass index (BMI), waist-to-height ratio (WHtR), and a total vascular risk burden score (VBS) representing five risk factors: obesity, central obesity, diabetes, hyperlipidemia, and hypertension. Based on a prior principal component analysis, three cognitive domains were examined: (1) verbal fluency, (2) visual memory/visuoconstruction, and (3) motor speed/executive functions. Mixed models were used to examine domain-specific cognitive trajectories in relation to baseline cardiovascular risk factors and changes in cardiovascular risk factors.Results:Overall, cognitive test performance improved over time (p<.003). Baseline VBS was marginally associated with longitudinal change in verbal fluency (p=.06). Participants with low baseline VBS (0-1 risk factors) demonstrated improvement in verbal fluency (p=.002), while those with higher VBS (2-5 risk factors) demonstrated stability in verbal fluency. In contrast, greater increases in BMI and in WHtR predicted more favorable trajectories in motor speed/executive function (both p<.001). Patients with increasing BMI over time improved in this domain (p=.02), while patients with stable or decreasing BMI did not. A similar pattern was observed for WHtR change. No vascular risk factors were associated with trajectories of visual memory/visuoconstruction.Conclusions:Higher total vascular risk burden was associated with less favorable verbal fluency trajectories, reflecting the negative cognitive consequences of disorders such as diabetes, hyperlipidemia, and hypertension. Unexpectedly, greater increases in BMI and WHtR were associated with more favorable trajectories in motor speed and executive functioning. In this population, weight gain may be a proxy for other positive health factors, such as immune reconstitution, which will be examined in future analyses. Taken together, cardiovascular risk factors have heterogeneous associations with cognitive trajectories, emphasizing the importance of examining the mechanisms of these varying relationships. Future research will examine how social determinants of health, such as racial/ethnic discrimination, contribute to disparities in cardiovascular risk factors and cognitive outcomes.

Pathogenic germline variants in patients with endometrial cancer of diverse ancestry.

Racial disparities in outcomes exist in endometrial cancer (EC). The contribution of ancestry-based variations in germline pathogenic variants (gPVs) is unknown. Germline assessment of ≥76 cancer predisposition genes was performed in patients with EC undergoing tumor-normal Memorial Sloan Kettering Cancer Center Integrated Mutation Profiling of Actionable Cancer Targets sequencing from January 1, 2015 through June 30, 2021. Self-reported race/ethnicity and Ashkenazi Jewish ancestry data classified patients into groups. Genetic ancestry was inferred from Memorial Sloan Kettering Cancer Center Integrated Mutation Profiling of Actionable Cancer Targets. Rates of gPV and genetic counseling were compared by ancestry. Among 1625 patients with EC, 216 (13%) had gPVs; 15 had >1 gPV. Rates of gPV varied by self-reported ancestry (Ashkenazi Jewish, 40/202 [20%]; Asian, 15/124 [12%]; Black/African American (AA), 12/171 [7.0%]; Hispanic, 15/124 [12%]; non-Hispanic (NH) White, 129/927 [14%]; missing, 5/77 [6.5%]; p=.009], with similar findings by genetic ancestry (p<.001). We observed a lower likelihood of gPVs in patients of Black/AA (odds ratio [OR], 0.44; 95% CI, 0.22-0.81) and African (AFR) ancestry (OR, 0.42; 95% CI, 0.18-0.85) and a higher likelihood in patients of Ashkenazi Jewish genetic ancestry (OR, 1.62; 95% CI; 1.11-2.34) compared with patients of non-Hispanic White/European ancestry, even after adjustment for age and molecular subtype. Somatic landscape influenced gPVs with lower rates of microsatellite instability-high tumors in patients of Black/AA and AFR ancestry. Among those with newly identified gPVs (n=114), 102 (89%) were seen for genetic counseling, with lowest rates among Black/AA (75%) and AFR patients (67%). In those with EC, gPV and genetic counseling varied by ancestry, with lowest rates among Black/AA and AFR patients, potentially contributing to disparities in outcomes given implications for treatment and cancer prevention. Black women with endometrial cancer do worse than White women, and there are many reasons for this disparity. Certain genetic changes from birth (mutations) can increase the risk of cancer, and it is unknown if rates of these changes are different between different ancestry groups. Genetic mutations in 1625 diverse women with endometrial cancer were studied and the lowest rates of mutations and genetic counseling were found in Black and African ancestry women. This could affect their treatment options as well as their families and may make disparities worse.

ECONOMIC ERRORS OF DR. MARTIN LUTHER KING Jr.

Martin Luther King Jr. was — and still is — one of the most powerful symbols in U.S. history. His message of anti-racism along with the exposing of government corruption are just part of the impact he made on the American people. While these are the more noble and respectable of his works, there exist other areas in which Dr. King erred in his judgement. The topic to which this paper will be devoted to will be the erroneous beliefs that Dr. King advocated regarding the failures of capitalism and the push for a more democratic socialist type of economic system. It is important that readers of this work not subject themselves to the fallacy of argumentum ad verecundium — the mistake of assuming that because Dr. King was an expert in one area (civil rights), he is therefore an expert in another (economics).

The Effects of Race, Ethnicity, and Maternal Education on Infant Mortality.

The state of New Jersey has a large Black/African American (AA) versus White racial disparity in infant mortality and educational level at childbirth. This disparity, measured by rate ratio, increases with greater maternal education among varied racial-ethnic groups. The nature of this disparity measured by rate differences has not been explored. Infant birth and mortality data were used to examine whether racial or ethnic disparities in infant mortality increased with greater maternal education, comparing rate differences and rate ratios. Racial and ethnic variations in the association between maternal education and infant mortality were examined. Data were from the New Jersey State Health Assessment Data for all New Jersey births between 2014 and 2018 stratified by race and ethnicity, maternal education, and infant mortality ( n = 481,333). R software was used to create a data set and estimate additive and multiplicative interactions, rate differences, and rate ratios for infant mortality by maternal race/ethnicity and educational levels among four racial-ethnic groups. Infant mortality was significantly greater for Black/AA and Hispanic mothers than for White mothers. At all educational levels, Black/AA mothers had the highest prevalence of infant mortality compared to other racial or ethnic groups. Rate differences in infant mortality showed a decrease in Black/AA-White differences for mothers with a high school education or less compared to mothers with a college degree. However, rate ratios showed an increase in Black/AA-White ratio with increasing education levels for mothers with high school education or less than mothers with a college degree. Risk ratios comparing infant mortality for Black/AA versus Hispanic or Asian mothers showed more than a twofold greater risk at all education levels for Black/AA infants. Finally, college-educated Black/AA mothers had significantly higher rates of infant mortality than White or Hispanic mothers with a high school education or less. Black/AA mothers with a college degree had a higher infant mortality rate than White, Hispanic, or Asian mothers with a high school education or less. Future research should address contextual/systemic contributors to this disparity.

The dislocation of Nigerian identities as the result of hegemony in Adichie’s Purple Hibiscus

The concept of individuality's sense of self may trigger some conflicts in an ex-colonized country. The British colonized Nigeria for sixty years, and the colonization formally ended after Nigeria declared its independence on the first of October, 1960. A new Nigerian dictatorial government performs hegemony as the remnant of colonization. This phenomenon is represented in Purple Hibiscus, which is based on the military dictatorship in Nigeria between 1980 and 1999. This study aims to find the forms of hegemony and its negative impacts on the dislocation of identity. The research method is qualitative. The data is analyzed by Gramsci's hegemony and is supported by the concept of diaspora in postcolonialism. The data is obtained based on the dominant and subordinate conflicts. Purple Hibiscus presents three forms of hegemony: restricted media, religion, and the English language. The novel shows the negative impacts of hegemony: isolation, no individual choices, oppression, and dislocation of identity. The process of identity dislocation is portrayed through emotional attachment and the realization of life-changing seen through the acceptance and interaction with American people with different backgrounds, diverse cultures, and distinct environments.

Moral Theology and Guns in the United States: Staging an Encounter

Guns hold a vexingly unique place in US American life. The United States has, by far, the highest prevalence of private firearm ownership and firearm-caused death among high-income nations in the world. Yet, there exist few sustained treatments of guns in the United States by moral theologians and Christian ethicists. This essay introduces the Journal of Moral Theology special issue on guns in US American life, which aims to stimulate theological reflection on this timely and pressing issue. It provides a brief overview of existing scholarship on the sociology of guns and moral theological treatments of guns and gun violence, and introduces the volume’s essays.

Competitive Latent Structures for the Comic Style Markers: Developing a Psychometrically Sound Short Version Using Spanish and US American Samples

The Comic Style Markers (CSM) is a questionnaire that allows a fine-grained description of how people differ in the way they display humor in their daily lives. It includes 48 statements capturing eight interrelated, yet distinct comic styles: fun, irony, wit, sarcasm, benevolent humor, satire, nonsense humor, and cynicism. Despite the independent conceptual roots of these humorous domains, the analysis of the CSM scales’ latent structure shows that their empirical distinction needs to be improved. Using the information derived from a competitive latent approach, including confirmatory factor analysis, bifactor analysis, and exploratory structural equation modeling, we proposed and validated a shorter 24-item version of the CSM in a large sample of 925 Spanish individuals (SP-CSM-24). This scale-refinement improved the psychometric differentiation of the eight comic styles without undermining the good internal consistency and the temporal stability of the CSM scores. Strong invariance was held for gender and age groups, and partial scalar invariance for countries also emerged using a sample of 318 U.S. American adults. Structural equation modeling also corroborated a convincing test-criterion validity for the SP-CSM-24, with dispositional expressions of benevolent humor (positively) and cynicism (negatively) outperforming other comic styles in accounting for individuals’ well-being.

Experiences With and Access to Evidence-Based Health Promotion Programs for Older American Indian, Alaska Native, and Native Hawaiian Peoples.

Evidence-based programs (EBPs) work effectively for participants whose characteristics match those of the EBP research participants. However, EBPs have been almost exclusively developed and evaluated for the general U.S. population with limited American Indian, Alaska Native, and Native Hawaiian (AI/AN/NH) community engagement. Thus, an AI/AN/NH Evidence-Based Program Advisory Council sought to identify AI/AN/NH peoples' experiences with and access to EBPs. We held 20 listening sessions with AI/AN/NH Elder services program staff (n = 118) and with AI/AN/NH Elders (n = 82) and conducted a self-administered online survey with Title VI Directors (n = 63). The six themes that emerged from the listening sessions with staff included misunderstanding community engagement, valuing fidelity over flexibility, lack of cultural awareness, assumptions about available infrastructure, unrealistic implementation timelines, and funding restrictions. Listening session themes with Elders included definitions of aging well, participation motivators, preferred activities, participation barriers, and unmet needs. Survey data indicated that programming of greatest interest for Elders as identified by Title VI Directors and staff included and/or addressed cultural activities (81%), socialization (75%), diabetes (73%), caregiving (68%), and nutrition (68%). Seventy-six percent of survey respondents had heard of EBPs and 24% indicated that EBPs were not being implemented in their community. The Advisory Council developed specific action steps with the goal of improving AI/AN/NH communities' access to culturally appropriate and feasible EBPs. The steps require collective action from federal agencies, national partners, EBP program developers and administrators, local organizations, and Elders to ensure EBPs are accessible and culturally appropriate for AI/AN/NH Elders.

Osteonecrosis is associated with APOL1 variants in African Americans with systemic lupus erythematosus

Background/purposeAfrican Americans (AA) with systemic lupus erythematosus (SLE) are at higher risk for both kidney disease and Osteonecrosis (ON). Two Apolipoprotein L1 (APOL1) risk variants (RV), G1 and G2, have been associated with chronic kidney disease (CKD), hypertension, and microvascular disease in AAs, which are independent risk factors for ON. Accordingly, we investigated the association between carriers of the APOL1 risk variants and the prevalence of ON in AA SLE patients.MethodsA cohort of 121 adult participants of self-reported AA ancestry and meeting at least four of the American College of Rheumatology (ACR) revised criteria for SLE were recruited from a high volume urban SLE clinical site. PCR/sequencing was used to stratify participants by APOL1 genotype. Medical records, including clinical notes and imaging reports, were retrospectively reviewed for documentation of ON. Association between the number of APOL1 risk variants with time to first ON was tested.ResultsIn our cohort, 18 individuals developed ON; across the APOL1 genotype groups, 2/37 0RV, 11/59 1RV, and 5/15 2RV participants were affected. The mean time to ON was 27 years, 22 years, and 18 years in 0RV, 1RV, and 2RV carriers, respectively. An adjusted Cox regression model showed that carrying the APOL1 risk variants associated with shorter ON free survival with hazard ratios (HR) of 3.1 (95% CI: 1.6–6.2) and 9.6 (95% CI 2.4–37.8) for 1RV and 2RV carriers, respectively. 2RV carriers more often exhibited multiple and bilateral joint sites affected by ON. Disease duration was longer in ON-affected participants at 20.5 years compared to 9.0 years in those unaffected (p &amp;lt; 0.001). In individuals who had received glucocorticoids, median cumulative prednisone equivalent dose was higher in ON-affected participants, though this did not reach statistical significance (18.7 g vs. 9.0 g; p-value = 0.3).ConclusionOur analysis suggests a higher risk of osteonecrosis among African American SLE patients who carry the APOL1 risk variants. In addition, disease duration increased the rate of ON. Given the high frequency of the APOL1 risk variants in African Americans, APOL1 high-risk genotype carriers may represent an ON-vulnerable subgroup within the AA population. Further work is necessary to uncover the mechanism of this association.

Motivations for violent extremism: Evidence from lone offenders’ manifestos

AbstractThis study explores the motivational drivers of violent extremism by examining references to motivational goals—values—in texts written by lone offenders. We present a new database of manifestos written by lone offenders (N = 103), the Extremist Manifesto Database (EMD). We apply a dictionary approach to examine references to values in this corpus. For comparison, we use texts from a matched quota sample of US American adults (N = 194). Compared to the general population, extremists referred more often to values of security, conformity, tradition, universalism, and power, and less often to values of benevolence, stimulation, and achievement. In extremist manifestos, ingroup descriptions referred more to security and universalism values, whereas power values dominated outgroup descriptions. Non‐extremists referred to the same values in conjunction with “us” and “them” (benevolence and self‐direction). The values that extremists referenced suggest interpersonal detachment and a clear delineation of value narratives around “us” and “them”.

Nutrition facts labels: who is actually reading them and does it help in meeting intake recommendations for nutrients of public health concern?

BackgroundFiber, potassium and calcium are nutrients of public health concern and their intakes in the United States are alarmingly low. The usage of nutrition facts labels has been reported to increase the odds for dietary reference intake of fiber in some studies. The overall evidence, however, is mixed, as some studies suggested that nutrition facts panels have little to no effect on average measures of diet quality. Here, we investigated whether the usage of nutrition facts labels was associated with meeting U.S. intake recommendations for three nutrients of public health concern: fiber, potassium and calcium.MethodsWe used cross-sectional multistage, stratified, clustered and probability sampling design data from the U.S. National Health and Nutrition Examination Surveys 2017–2020 cycle. The sample included 5,416 individuals aged 20 years or older, which may be extrapolated to represent 146,841,866 US Americans. Nutrient intakes were compared among individuals reading nutrition facts panels “frequently”, “sometimes” or “rarely” using applied survey data analyses techniques (including multivariate logistic regression and marginsplots).ResultsWe observed substantial sociodemographic differences between the three groups. Frequent readers were significantly more likely to be female and had higher educational levels. On average, they were also significantly older as compared to rare readers. Fiber intake in g/d was highest in frequent readers (17.09) and lowest in rare readers (14.64). The proportion of participants that met dietary fiber intake recommendations was almost four times higher in the frequent readers group (12.69%) as compared to the rare readers group (3.69%). In a bivariate logistic regression model, frequent label reading significantly increased the odds for meeting the fiber recommendations in Dietary Guidelines for Americans (OR: 2.15, p < 0.001). Rarely reading labels decreased the odds (OR: 0.57, p = 0.003). These odds remained essentially unchanged after adjusting for sociodemographic covariates, diabetes status and body mass index (OR: 1.84, p = 0.004; and OR: 0.62, p = 0.022).ConclusionsNutrition facts panel reading associates with fiber intake. Our findings have potential implications for public health nutrition strategies that may center around educational work.

Comparison of Diagnostic Routines for Suspected Alzheimer’s Disease Patients in US–American and German Primary Care

Aim: Thorough diagnostics are a prerequisite for the optimal treatment of Alzheimer's disease (AD). Biomarker-based diagnostics are standard in academia, data on practitioners' diagnostic workups is scarce. Materials &amp; methods: Surveys in German and US healthcare providers (HCP) were conducted regarding diagnostics in presumed AD patients. A subsample of 153 German and 88 US professionals was analyzed in detail. Results: Fewer German physicians conduct AD diagnostics themselves compared with US colleagues (67% vs 99%; p &lt; 0.0001). German doctors more often order diagnostics at other institutions (65% vs 45%; p &lt; 0.005). No significant differences were found regarding the type of diagnostics ordered at other institutions. Conclusion: Diagnostic routines for suspected AD patients differ between German and US–American healthcare providers.

국제개발협력 목표에 대한 국민인식과 영향요인 분석

Purpose: The purpose of this study is to examine the perception of the Korean and American people on international development cooperation, which has different policy goals, means, and policy targets with domestic policies.&#x0D; Originality: In international relations, a new approach is needed according to the diversification of actors such as the state-market-civil society. It is necessary to pay attention to the perception or values of ordinary citizens, which have been relatively neglected in the existing international relations theories.&#x0D; Methodology: This study conducted a survey of 1,500 people in each country to find out the perception of Korean and American people on ODA. It asked which of the three aid goals, realism, idealism, and global communitarianism, was the most desirable goal. First, the difference in perception between the people of the two countries was analyzed through a chi-square test. Second, a multinomial logistic regression analysis was conducted to find out the factors influencing public perception of ODA goals.&#x0D; Result: First, it was found that conservatives are more likely to pursue realistic goals, and progressives are more likely to pursue global communitarianism. Second, people who are more interested in domestic policy are more likely to see that their country's economic and social interests should be pursued for ODA goals. Third, when the household's economic level did not deteriorate due to COVID-19, the probability of considering the socio-economic development of the recipient country as a more important goal increased. Fourth, it can be interpreted that individuallevel variables have a greater impact in emerging donor countries, while policies and politics variables have a more impact on traditional donor countries.&#x0D; Conclusion and Implication: It is necessary to engage people in international development cooperation as important actors to improve the quality of international development cooperation of South Korea, as a global pivotal country.

Relationships Between Cultural Factors and Engaging in Guided Imagery and Music: An Exploratory Qualitative Study.

Guided Imagery and Music (GIM) is now practiced and taught on every inhabited continent. With this international growth of GIM, both GIM therapists and clients have unique cultural backgrounds that are often different from the US American context in which the method was originally developed. According to this reality, we undertook a cross-cultural study to explore how cultural factors relate to ways in which GIM clients engage in the therapeutic process. This research study is based on a qualitative and interpretivist approach that utilized thematic analysis of semi-structured interviews. Six GIM advanced trainees from three countries (Japan, Spain, and the US) participated in the study. Eight themes emerged that describe significant cultural factors that affected the initial stages of engaging in GIM as clients: personal experiences with non-ordinary states of consciousness (NOSC); spirituality; physical distance; linguistic expression; professional/academic background; socio-economic aspects; social norms/expectations; and non-directive facilitation/attitudes. The first seven of these themes constituted aspects of the participants' individual sociocultural backgrounds that shaped their initial experiences of and expectations for GIM sessions and affected their GIM engagement. The eighth theme emerged as a transcultural factor in which a non-directive approach used by their GIM therapists allowed participants to engage in GIM more readily and form a new set of norms and expectations within their GIM sessions. Our research suggests that as participants developed a new set of norms and expectations as they acclimated to GIM, the therapist's non-directive stance provided a bridge between these two sets of social or cultural norms.

Predictors of All-Cause 30-Day Readmissions in Patients with Heart Failure at an Urban Safety Net Hospital: The Importance of Social Determinants of Health and Mental Health

IntroductionHeart failure (HF) is a frequent cause of readmissions. Despite caring for underresourced patients and dependence on government funding, safety net hospitals frequently incur penalties for failing to meet pay-for-performance readmission metrics. Limited research exists on the causes of HF readmissions in safety net hospitals. Therefore, we sought to investigate predictors of 30-day all-cause readmission in HF patients in the safety net setting. MethodsWe performed a retrospective chart review of patients admitted for HF from October 2018 to April 2019. We extracted data on demographics and medical comorbidities and performed patient-specific review of social determinants and mental health in 4 domains: race/ethnicity, housing status, substance use, and mental illness. Multivariable Poisson regression modeling was employed to evaluate associations with 30-day all-cause readmission. ResultsThe study population included 290 patients, among whom the mean age was 59 years and 71% (n = 207) were male; 42% (120) were Black/African American (AA), 22% (64) were Hispanic/Latino, and 96% (278) had public insurance; 28% (79) were not housed, 19% (56) had a diagnosis of mental illness, and active substance use was common. The 30-day readmission rate was 25.5% (n = 88). Factors that were associated with increased risk of readmission included self-identifying as Black/AA (relative risk 2.28, 95% confidence interval 1.00-5.20) or Hispanic/Latino (2.53, 1.07-6.00), experiencing homelessness (2.07, 1.21-3.56), living in a shelter (3.20, 1.27-8.02), or intravenous drug use (IVDU) (2.00, 1.08-3.70). ConclusionRace/ethnicity, housing status, and substance use were associated with increased risk of 30-day all-cause readmission in HF patients in a safety net hospital. In contrast to prior studies, medical comorbidities were not associated with increased risk of readmission.

A “New Deal” for Addiction Treatment

“I pledge you, I pledge myself, to a New Deal for the American People.” –Franklin D. Roosevelt

Discordance Between Social Vulnerability and Cancer-Related Mortality in Border Counties - A Letter to the Editor Regarding "Local Social Vulnerability as a Predictor for Cancer-Related Mortality Among US Counties".

This letter to the editor remarks on results of a recently published study and highlights the need for multinational and interinstitutional registries so health departments in the US and Latin American countries can accurately capture cancer incidence and mortality data.

Prevalence and Predictors of Medical Mistrust Among African Americans with Serious Mental Illness Receiving Care in an Urban Setting.

Patients with serious mental illness are reported to have a 10-25 year reduction in life expectancy. Medical mistrust may influence their willingness to seek care (Bynum, S. A., Davis, J. L., Green, B. L., & Katz, R. V. (2012). Unwillingness to participate in colorectal cancer screening: Examining fears, attitudes, and medical mistrust in an ethnically diverse sample of adults 50 years and older. American Journal of Health Promotion : Ajhp, 26(5), 295-300. https://doi.org/10.4278/ajhp.110113-QUAN-20 ). This cross-sectional study used baseline data from a SAMHSA funded demonstration project to describe the prevalence and of medical mistrust among a sample of African American adults with serious mental illness. Medical mistrust was identified using the Medical Mistrust Scale. One hundred and fifty-four participants completed the medical mistrust scale. Approximately, a third (34.4%) reported medical mistrust. After adjusting for financial stability, those endorsing medical mistrust reported nearly 3 times the odds of lacking support (AOR [95% CI]: 2.84 [1.01-7.97]) compared to those not endorsing medical mistrust. The study is among the first to describe elevated rates of medical mistrust among a sample of African Americans people with serious mental illness. An association between medical mistrust and lack of social support was demonstrated.

A Republic Goes to War: Federalists, Republicans, and Foreign Influence

AbstractIn the 1790s, the United States faced a series of crises—both domestic and foreign—which many believed threatened the nation’s very existence. These culminated in the Quasi-War with France beginning in 1796. The Federalist majority identified the greatest threats to the Republic as foreigners and their willing or unwitting American allies. Thus, they enacted the Alien and Sedition Acts in 1798 and other laws to allay these threats. Throughout the ensuing debates, Federalists emphasized the dangers of foreign nations who sought to separate the American people from their government. Republicans challenged Federalists’ fears as overblown and defined the real threat as the Federalists themselves who justified the expansion of the general government’s power and the infringement of individual rights in the name of national security. Americans engaged in their first debate about the meaning and limits of liberty and security.