American Women Research Articles

Patient-Provider Satisfaction and Communication in U.S. Prenatal Care: A Systematic Review.

This is a systematic review on patient-provider satisfaction in U.S. prenatal care by addressing the following research question: What factors influence patient-provider satisfaction during prenatal care? Thirty six online databases were searched for peer-reviewed research from February to September of 2018 using 10 key terms published in English on U.S. populations between the years 1993-2018 on the topic of provider communication skills and patient satisfaction in the prenatal context. Searches yielded 2563 articles. After duplicates were reviewed and eligibility determined, 32 articles met criteria and were included in the final content analysis. All reported study variables were entered into EXCEL, data reported in each study were analyzed by two people for inter-rater reliability and included in the qualitative content analysis. Two researchers also utilized assessment tools to assess the quality of the articles. Results indicate the importance of good patient-provider communication, that patients have a need for more information on a plethora of topics, and that Hispanic and African American women reported less satisfaction. We recommend that future studies measure potentially significant themes not adequately present in the reviewed studies such as practitioner demographics (e.g. gender, years of experience, or race/ethnicity), mothers under 18years of age, inclusion of religious minorities, patients with differing immigration statuses, and patients with disabilities.

A novel role for KIFC1-MYH9 interaction in triple-negative breast cancer aggressiveness and racial disparity

African American (AA) women are twice as likely to develop triple-negative breast cancer (TNBC) as women of European descent. Additionally, AA women with TNBC present a much more aggressive disease course than their European American (EA) counterparts. Thus, there is an unmet clinical need to identify race-specific biomarkers and improve survival outcomes in AA patients with TNBC. The minus-end directed microtubule motor protein kinesin family member C1 (KIFC1) promotes centrosome clustering and chromosomal instability and is often overexpressed in TNBC. Previous findings suggest that KIFC1 plays a role in cell proliferation and migration in TNBC cells from AAs and that the levels of nuclear KIFC1 (nKIFC1) are particularly high in AA patients with TNBC. The nuclear localization of KIFC1 in interphase may underlie its previously unrecognized race-specific association. In this study, we found that in TNBC cells derived from AAs, nKIFC1 interacted with the tumor suppressor myosin heavy chain 9 (MYH9) over EA cells. Treatment of AA TNBC cells with commercial inhibitors of KIFC1 and MYH9 disrupted the interaction between KIFC1 and MYH9. To characterize the racial differences in the KIFC1-MYH9-MYC axis in TNBC, we established homozygous KIFC1 knockout (KO) TNBC cell lines. KIFC1 KO significantly inhibited proliferation, migration, and invasion in AA TNBC cells but not in EA TNBC cells. RNA sequencing analysis showed significant downregulation of genes involved in cell migration, invasion, and metastasis upon KIFC1 KO in TNBC cell lines from AAs compared to those from EAs. These data indicate that mechanistically, the role of nKIFC1 in driving TNBC progression and metastasis is stronger in AA patients than in EA patients, and that KIFC1 may be a critical therapeutic target for AA patients with TNBC.Graphical abstract

Perceived Barriers to Pap Screening Influence Adherence to Screening Recommendations Among Black Women.

Objectives: The aim of this study was to determine the Health Belief Model (HBM) constructs associated with Pap screening adherence among a sample of African American and sub-Saharan African immigrant women in the United States. Methods: A descriptive cross-sectional study was conducted via an online survey. Participants were recruited from central Kentucky counties. Ninety-one eligible women participated (mean age 38 ± 12 years), 49.5% identified as African American. Twenty-nine percent indicated never being screened or not being up-to-date. Self-reported demographic data, HBM constructs for Pap screening, and Pap screening history were collected. Bivariate and logistic regressions were performed. Results: There was a significant negative association between perceived barriers and being up-to-date. For every one-point increase in perceived barriers, the odds of being up-to-date decreased by 81%, (p = 0.004; CI: 0.06-0.60), findings from further evaluation of the barrier construct showed that barriers significantly associated with screening include items related to lack of knowledge about where to get a Pap screening, lack of time to attend the screening, screening-associated shame and pain, negligence, and age. There were no other significant HBM constructs associated with up-to-date Pap screening status. There was no difference in perceived barriers between African American and sub-Saharan African women. Conclusions: Despite public health efforts to decrease screening barriers, a perception of barriers exists among Black women. Continued efforts to address screening barriers as well as the perception of barriers are warranted among Black women.

Cross-cultural differences in diet and quality of life between Taiwanese and American women during breast cancer treatment.

e23187 Background: Limited research has examined the role of different food types (vegetables, fruits, meat, fat, and whole grains) on quality of life (QoL) among cancer patients undergoing active treatment. This study aimed to examine what different food intakes are associated with QoL among American and Taiwanese women who are newly diagnosed with breast cancer (BC). Methods: This ongoing observational study enrolled 77 American (Black, Latina, and non-Hispanic White) adult women from MedStar Georgetown University Hospital and 79 Taiwanese women from National Taiwan University Hospital. They were diagnosed with stage 0-III primary BC within six months prior to enrollment, were undergoing surgery, chemotherapy, and radiation, with no other cancers. Patient-reported overall health and QoL were assessed using the two global health items from the EORTC-QLQ30. Three random 24-hour diet recalls (two weekdays and one weekend) were administered using the NIH-developed ASA24 program. Linear regression was conducted to examine the associations between food categories and QoL outcome, adjusting for nationality, age, cancer stage, treatment type, body mass index, physical activities, financial problems, and appetite loss. Results: American and Taiwanese patients displayed differing food intake during BC treatment. Taiwanese patients consumed less starchy vegetables and total fat (both p < .01) than American patients, on average. Multivariate results indicated that QoL was positively associated with higher total vegetable intake (excluding starchy vegetables and legumes; β = 5.38, 95% CI: 0.22, 1.20), controlling for other food types and covariates. Starchy vegetables and legumes showed non-significant negative effects on QoL. QoL was positively associated with total fat intake (β = 0.11, 95% CI: 0.02, 0.21). Total meat, fruit, and whole grain intakes were not significantly associated with QoL. Conclusions: The associations between food intakes and QoL were not affected by nationality, regardless of food type. Non-starchy vegetables and adequate total fat intakes may support BC patients undergoing treatments. More research is needed to verify the identified associations and explore how cancer treatment affects the digestion of certain food types and their potential impact on QoL. This study provides cross-cultural insights into potential nutritional influence on QoL among patients undergoing cancer treatment.

Protocol of the HARMONY study: A culturally relevant, randomized-controlled, stress management intervention to reduce cardiometabolic risk in African American women

BackgroundAfrican American Women (AAW) are at high risk for stress-related cardiometabolic (CM) conditions including obesity, heart disease, and diabetes. Prior interventions lack attention to culturally-nuanced stress phenomena (Superwoman Schema [SWS], contextualized stress, and network stress), which are positively and significantly associated with unhealthy eating and sedentary behavior. PurposeThe HARMONY Study is designed to test a culturally tailored mindfulness-based stress management intervention to address SWS, contextualized stress, and network stress as potential barriers to adherence to healthy exercise and eating goals. The study will help AAW build on their strengths to promote cardiometabolic health by enhancing positive reappraisal, self-regulation, and self-efficacy as protective factors against chronic stress-inducing biobehavioral morbidity and mortality risk. MethodsThis two-arm, randomized-controlled trial will test the effects of two group-based, online interventions. HARMONY 1 includes culturally-tailored exercise and nutrition education. HARMONY 2 includes mindfulness-based stress reduction, exercise, and nutrition education. We aim to recruit 200 AAW ≥ 18 years old with CM risk. ResultsPrimary outcomes (actigraphy and carotenoid levels) and secondary outcomes (body composition, inflammatory markers, glucose metabolism, and stress) are being collected at baseline and 4-, 8-, and 12-months post-intervention. Intent-to-treat, data analytic approaches will be used to test group differences for the primary outcomes. DiscussionThis study is the first to address culturally-nuanced stress phenomena in AAW (SWS, network stress, and contextualized stress) using culturally-tailored stress management, exercise, and nutrition educational approaches to reduce biobehavioral CM risk among AAW. Quantitative and qualitative results will inform the development of scalable and sustainable CM risk-reduction programming for AAW. Trial registrationThe Multiple PIs registered the clinical trial (Identifier: NCT04705779) and reporting of summary results in ClinicalTrials.gov in accordance with the NIH Policy on the Dissemination of NIH-Funded Clinical Trial Information, within the required timelines.

Ethnic disparities in breast cancer: A comprehensive analysis of socio-demographic and clinical characteristics among African American, Hispanic, and Caucasian women.

e13698 Background: Despite advancements in breast cancer therapy leading to a decline in mortality rates within certain ethnic populations, there exists a concerning trend of increasing cancer incidence among African American (AA) and Hispanic women. This persistent rise highlights the urgent need to explore and comprehend the socio-demographic and breast cancer characteristics specific to these populations. Methods: We assembled a 10-year database of women diagnosed with breast cancer in the community hospital in Chicago. After excluding minority ethnic groups, specifically AA, Hispanic, and Caucasian cohorts were included in this study, comprising 786 patient records analyzed. Results: The distribution revealed a predominance of AA patients at 49.7%, Hispanics at 42.1%, and Caucasians at 8.14%. Noteworthy differences across the three ethnic groups were observed in age categories at cancer diagnosis, BMI categories, family history of first-degree relatives with breast cancer, marital status, smoking habits, menopausal status, and alcohol use at the time of diagnosis (p < 0.05). Within the molecular subtypes, 14.5% were identified as triple-negative breast cancer (TNBC), with a higher prevalence of 18.7% among the AA subgroups. 19.6% of patients had advanced disease, proportion was higher in AA ethnic group (22.8%; p = 0.83) compared to other ethnicities. Breast conservative procedures were prevalent in almost half of the patient population on average (52.1 %), with a slightly higher frequency of mastectomies noted in the Hispanic patient group (44.1%, p < 0.05). In logistic regression analysis, compared to the reference AA ethnicity, Hispanics exhibited higher odds of having HER-2 positive breast cancer (OR 1.74; CI 1.04 – 2.94; p < 0.05), as did Caucasians (OR 2.35; CI 1.05 – 5.04; p < 0.05). Conclusions: In summary, our study underscores substantial socio-demographic and breast cancer characteristic differences among AA and Hispanic populations compared to Caucasians, revealing notable ethnic disparities in breast cancer. Despite these variations, our findings highlight promising healthcare equity, with comparable access to surgical and chemotherapy interventions across ethnicities. TNBC demonstrates molecular heterogeneity and a higher prevalence among AA women, contributing to significant racial disparities.

Population attributable fraction of reproductive factors in triple negative breast cancer by race.

10522 Background: Age-adjusted incidence rates of triple negative breast cancer (TNBC) are higher in African American (AA) women than in non-Hispanic White (White) women. The disproportionate incidence of TNBC in AA women partially drives the 40% higher mortality rate from breast cancer in AA women compared to White women. Several studies have identified lack of breastfeeding and younger age at first birth as risk factors for TNBC. There are large differences in breastfeeding uptake and duration in the US: only 44% of AA women breastfeed for 6 months or longer, compared to 60% of White women. To quantify the contribution of differences in breastfeeding patterns and younger age at first birth to disparities in incidence of TNBC, we calculate the population-attributable fraction (PAF), which is the proportion of the incidence of a disease that may be attributable to a particular exposure. Methods: A systematic review was performed to identify relevant case-control studies. Pooled odds ratios (ORs) for breastfeeding for < 6 months and age at first birth < 25 years were calculated from data extracted from studies using a common effect model. PAF was calculated using the Levin formula. Risk factor population prevalences were extracted from national surveys. Pooled ORs were used as estimates of relative risk (RR). A combined PAF was calculated using the polychoric correlation coefficient between breastfeeding duration and age at first birth to account for contributions of multiple risk factors. Results: Using race specific ORs, the PAF of breastfeeding for < 6 months was 12% (95% confidence interval (CI) 5-20%) among White women and 15% (95% CI 3-26%) among AA women. The PAF of having a child before age 25 was not significantly different from zero for White women (2% (CI -6-11%)) but was significantly different from zero for AA women (21% (CI 5-25%)). The combined PAF was 27% for AA women and 17% for all women in the US. Extrapolating to the US population, we estimated that 4,850 annual cases of TNBC (2,421 among White women and 1,533 among AA women) could be attributed to breastfeeding for < 6 months and age at first birth < 25 years. Conclusions: Given the protective role of breastfeeding against TNBC, policy changes aimed at supporting breastfeeding, addressing structural barriers, and promoting a culture shift could reduce racial disparities in TNBC incidence in the US. [Table: see text]

Prognostic value of Oncotype recurrence score (RS) and Mammaprint (MP) in premenopausal patients with hormone positive (HR+) breast cancer (BC) with low genomic risk, stratified by race: A study of the National Cancer Database (NCDB).

551 Background: It is hypothesized that in African American (AA) women, RS has a lower prognostic accuracy. We evaluated this with a large population based national database. Methods: The 2021 NCDB PUF was used to include premenopausal female BC patients aged 18-50 years. Inclusion criteria were N0, M0 patients with any T stage, RS ≤ 15 or MP low risk, estrogen or progesterone receptor+ and HER2-. Patients were stratified by their recorded race (Caucasians vs AA). Univariate analysis was used to study the distribution. Kaplan-Meier (KM) and multivariate (MV) propensity score (PS) weighted Cox model were used to compare survival between the cohorts. Results: 27523 patients had an RS≤15 [Caucasian-25227(91.66%) AA-2296(8.34%)] and 4818 had MP low [Caucasian-4393(91.18%) AA-425(8.82%)]. >99% had regional lymph node surgery and >90% of the patients did not get chemotherapy. >70% of the patients were T1. Majority did get hormonal therapy (HT) [RS≤15 Caucasian-92.97% AA-91.81%, MP low- Caucasian-92.42% AA-89.65%]. On analyzing grade, AA had more poorly differentiated tumors [RS≤15 Caucasian-6.18% AA-9.46% p=<0.001 MP low- Caucasian-9.1% AA-16.02% p=<0.001]. KM survival estimates for RS≤15 at 5 years [Caucasian-99.3(99.2,99.5) %, AA-98.8(98.0,99.3) %] were similar and 10 years [Caucasian-97.5(97.0,97.9) %, AA-94.6(91.6,96.6)] showed a small difference. For MP low, the survival at 5 years [Caucasian- 99.0(98.6,99.3) %, AA-98.9(97.0,99.6) %] and 10 years [Caucasian- 97.0(95.9,97.8) %, AA-95.8(91.0,98.1) %] were almost equal. Adjusted Hazard Ratio estimate for Caucasian vs AA for RS≤15 did not reach significance overall [0.802 (95% CI 0.47-1.37)] nor when stratified by grade, histology, or T stage. Conclusions: Through our analysis, we show that there was no major difference in overall survival between Caucasians and AA among low genomic risk, premenopausal, hormone positive, N0 BC patients. There was a 2.9% difference between the racial groups at 10 years, but this was not seen in the adjusted analysis. The results show that genomic scores like RS and MP retain their prognostic utility even in the low-risk spectrum in both Caucasians and AAs. These results differ from other database studies, where the utility of these tools in the low-risk AA groups were questionable. Confounding associated with retrospective studies could be contributing to this and the predictive ability of genomic scores in varied racial groups needs to be analyzed in prospective models.

Treatment outcomes of the KEYNOTE-522 regimen in an ethnically diverse patient population: A real world experience.

e12663 Background: Pembrolizumab (pembro) in combination with neoadjuvant chemotherapy (NACT) became standard of care for high risk, early stage TNBC on July 26, 2021, as a result of the KEYNOTE-522 trial. Black women are disproportionately affected by TNBC with more advanced stage at diagnosis, however the KEYNOTE-522 did not collect data on race. This retrospective review evaluates response to pembro plus NACT in a racially diverse population to assess the generalizability of the trial findings to potentially under-represented patient populations. Methods: This is a single center, retrospective review of patients with stage II/III TNBC diagnosed between 08/2020 to 08/2023, treated with pembro plus NACT at Maimonides Medical Center, a safety-net hospital in Brooklyn, New York serving a diverse patient population. Exclusion criteria included age < 18 years, ER/PR/Her2 positivity, NACT without pembrolizumab and unreported race. Data were collected from electronic health records and analyzed using SPSS Statistics. Results: 50 patients met inclusion criteria, among whom 40 patients had complete information available for review. 52.5% (95% CI: 38% - 69%) of patients had a pCR. Nearly half of the patient population (47.5%) were African American. Subgroup analysis of ethnicity demonstrated a lower pCR amongst African American women, but this was not statistically significant (table). 5 patients had progression of disease with the development of distant metastasis (2 whilst on treatment and 3 following completion of therapy). 3 patients had grade 3/4 adverse events (pembro associated endocrine and cardiac dysfunction). Notably, lack of complete imaging response to treatment was significantly associated with lack of pCR (p=0.003). Conclusions: In this retrospective review of a racially diverse patient population, the pembrolizumab-NACT regimen was well tolerated with an acceptable side effect profile. While our rate of pCR is lower than the findings of the Keynote-522 trial; 52.5 % (95% CI: 38% - 69%) vs. 64.8% (95% CI: 59.9%-69.5%), our sample size is not large enough to detect a statistically significant difference. Sub-analysis of patient ethnicity demonstrated varying rates of pCR, however findings are limited by a small sample size. Additional data collection is in progress and future analysis will provide insight into a potential correlation between race and therapy response. [Table: see text]

An interdisciplinary critical lens on the herstorical contributions and health outcomes among Filipinx American women.

An interdisciplinary critical lens on the herstorical contributions and health outcomes among Filipinx American women.

Building Missionary-Philanthropic Educational Networks: A Medical School for Women in Constantinople

Abstract The American College for Girls in Constantinople has been credited with playing a significant role in Turkish women’s emancipation and the feminist movement. From its humble origins in a small overseas mission, the institution evolved by 1914 into a U.S.-style college with a campus sponsored by leading American philanthropists. The designs were intended to impress visitors and to control the women students’ bodies, and, as such, were contested by the women at the helm of the institution. By examining the correspondence among various actors involved in the project, as well as the architects’ drawings, this article traces the building process of the campus with a focus on its lesser-known and unrealized medical school. It argues that the building process helped the American women educators of the ACG to establish an educational network that offered them opportunities unavailable to them in the United States.

A systematic review of racial disparity in pivotal poly (ADP-ribose) polymerase (PARP) inhibitor trials.

e13737 Background: Breast cancer is the most common cancer diagnosed worldwide. Breast cancer related mortality has decreased in the US, however this did not extend equally to African American women (AAW). According to CDC mortality rate from breast cancer in AAW is 20% higher than other ethnic groups. Younger age at diagnosis in AAW, higher incidence of triple negative breast cancer (TNBC), and higher incidence of AA males with breast cancer suggest genetic predisposition plays an important role in the disparate outcomes based on race. In an unbiased analysis of TNBC cases, the prevalence of pathogenic germline BRCA 1 & 2 mutations are twice as high as in breast cancer overall. Poly (ADP-ribose) polymerase (PARP) inhibitors have proven to be effective in germline BRCA 1 and BRCA 2 mutation associated breast cancer. However, data regarding the enrollment of racial and ethnic minorities in these pivotal trials that lead to the approval of these drugs is limited. Methods: We examined the demographic data reporting in Phase II/ III clinical trials of PARP inhibitors in breast cancer from 2016 to 2023. In order to highlight the disparities in the enrollment of minority groups we calculated an enrollment percentage of various racial groups in these trials. We conducted a systematic review of Phase II/III clinical trials of PARP inhibitors in BRCA 1 & 2 mutated breast cancer reported studies with sources from PubMed, Embase, Scopus, Clinicaltrials.gov, CENTRAL and Cochrane. 56 full text studies were identified, out of which 14 met inclusion criteria. The total number of patients included was N=5,067. Five trials did not include racial data. Results: Among trials that reported race and ethnicity (N=4004), the enrollment percentage was lowest for racial and ethnic minorities. AA: 3.4%, N=136. Non- Hispanic Whites were the most common to be enrolled: 71.05%, N=2845, Asians were 16.53% N= 662, Hispanics 2.03 %; N=83 and other 6.17%, N=247. Conclusions: Racial minorities are consistently underrepresented in all the pivotal PARP inhibitor trials and contributing to the race-based disparities in breast cancer. [Table: see text]

Innovative assessment of lipid-induced oxidative stress and inflammation in harvested human endothelial cells.

Studying acute changes in vascular endothelial cells in humans is challenging. We studied ten African American women and used the J-wire technique to isolate vein endothelial cells before and after a four-hour lipid and heparin infusion. Dynamic changes in lipid-induced oxidative stress and inflammatory markers were measured with fluorescence-activated cell sorting. We used the surface markers CD31 and CD144 to identify human endothelial cells. Peripheral blood mononuclear cells isolated from blood were used as a negative control. The participants received galantamine (16 mg/day) for 3 months. We previously demonstrated that galantamine treatment effectively suppresses lipid-induced oxidative stress and inflammation. In this study, we infused lipids to evaluate its potential to increase the activation of endothelial cells, as assessed by the levels of CD54+ endothelial cells and expression of Growth arrest-specific 6 compared to the baseline sample. Further, we aimed to investigate whether lipid infusion led to increased expression of the oxidative stress markers IsoLGs and nitrotyrosine in endothelial cells. This approach will expedite the invivo identification of novel pathways linked with endothelial cell dysfunction induced by oxidative stress and inflammatory cytokines. This study describes an innovative method to harvest and study human endothelial cells and demonstrates the dynamic changes in oxidative stress and inflammatory markers release induced by lipid infusion.

Slavery, Capitalism, and Women’s Literature: Economic Insights of American Women Writers, 1852–1869 by Kristin Allukian (review)

Slavery, Capitalism, and Women’s Literature: Economic Insights of American Women Writers, 1852–1869 by Kristin Allukian (review)

Reproductive characteristics, menopausal status, race and ethnicity, and risk of breast cancer subtypes defined by ER, PR and HER2 status: the Breast Cancer Etiology in Minorities study

BackgroundAssociations between reproductive factors and risk of breast cancer differ by subtype defined by joint estrogen receptor (ER), progesterone receptor (PR), and HER2 expression status. Racial and ethnic differences in the incidence of breast cancer subtypes suggest etiologic heterogeneity, yet data are limited because most studies have included non-Hispanic White women only.MethodsWe analyzed harmonized data for 2,794 breast cancer cases and 4,579 controls, of whom 90% self-identified as African American, Asian American or Hispanic. Questionnaire data were pooled from three population-based studies conducted in California and data on tumor characteristics were obtained from the California Cancer Registry. The study sample included 1,530 luminal A (ER-positive and/or PR-positive, HER2-negative), 442 luminal B (ER-positive and/or PR-positive, HER2-positive), 578 triple-negative (TN; ER-negative, PR-negative, HER2-negative), and 244 HER2-enriched (ER-negative, PR-negative, HER2-positive) cases. We used multivariable unconditional logistic regression models to estimate subtype-specific ORs and 95% confidence intervals associated with parity, breast-feeding, and other reproductive characteristics by menopausal status and race and ethnicity.ResultsSubtype-specific associations with reproductive factors revealed some notable differences by menopausal status and race and ethnicity. Specifically, higher parity without breast-feeding was associated with higher risk of luminal A and TN subtypes among premenopausal African American women. In contrast, among Asian American and Hispanic women, regardless of menopausal status, higher parity with a breast-feeding history was associated with lower risk of luminal A subtype. Among premenopausal women only, luminal A subtype was associated with older age at first full-term pregnancy (FTP), longer interval between menarche and first FTP, and shorter interval since last FTP, with similar OR estimates across the three racial and ethnic groups.ConclusionsSubtype-specific associations with reproductive factors overall and by menopausal status, and race and ethnicity, showed some differences, underscoring that understanding etiologic heterogeneity in racially and ethnically diverse study samples is essential. Breast-feeding is likely the only reproductive factor that is potentially modifiable. Targeted efforts to promote and facilitate breast-feeding could help mitigate the adverse effects of higher parity among premenopausal African American women.

Missing themes of manhood and childhood: an analysis of Pakistani and American women writings

Missing themes of manhood and childhood: an analysis of Pakistani and American women writings

Sandra M. Gilbert, Susan Gubar. Still Mad: American Women Writers and The Feminist Imagination, 1950-2020

Sandra M. Gilbert, Susan Gubar. Still Mad: American Women Writers and The Feminist Imagination, 1950-2020

Mental Health Treatment Utilization and Unmet Mental Health Needs Among Black Reproductive-Age Women in the United States.

Black women in the United States experience increased risk for mental disorders and are less likely to have access to appropriate mental health treatment compared with White women. To develop culturally responsive strategies to improve Black women's access to mental health treatment, the authors evaluated social determinants associated with mental health treatment utilization and unmet mental health needs among Black reproductive-age women with serious psychological distress. The authors performed a secondary analysis of data from the National Survey on Drug Use and Health. Data from 2009 to 2019 were pooled and restricted to Black women ages 18-44 years with serious psychological distress (N=4,171). Logistic regressions were conducted to identify personal and social determinants (e.g., education, employment status, poverty, and insurance status) of mental health treatment utilization, alternative mental health treatment utilization (e.g., spiritual support and self-help), and perceived unmet mental health needs. Education and employment status were significantly associated with all three outcomes. Among the women who reported unmet mental health needs, opposition to treatment and cost were the highest endorsed barriers. Differences were found by pregnancy status, with pregnant women being significantly less likely to endorse cost (p<0.001) and more likely to endorse time and transportation as barriers (p<0.01) to receiving mental health treatment. Strategies to improve mental health outcomes for Black women should focus on reducing cost and transportation barriers and on the development of culturally responsive intervention approaches that address Black women's concerns about mental health treatment.

A Sociocultural Exploration of the Impact Body Image Has on Black College-Aged Women’s Mental Health

This study aimed to explore the relationship between Black cultural identity body image and mental well-being among Black Americans and Black immigrant women who attend predominately white universities (PWIs). As part of the Multi-Site University Study of Identity and Culture (MUSIC) survey, participants completed the Brief Inventory of Body Image, which included questions such as “I’m proud of my body,” “I often feel ugly,” ‘I have a good figure,” “I’m ashamed of my body,” and “I am anxious about the way I look.” The results showed that there were several similarities between the subgroups in the correlations between body image and mental health indices, such as social anxiety, depression, psychological well-being, and self-esteem. Both Black American and Black immigrant college-aged women had a positive association between body image and indicators of Black women’s sense of self, like self-esteem and psychological well-being. They also had a negative association between body image and mental health, such as social anxiety and depression. However, there was one key difference in that Black American women had a stronger association between their sense of self and self-esteem and psychological well-being compared to Black immigrant women. These findings support other studies that suggest Black women tend to have a stronger positive body satisfaction relative to their overall mental well-being. The study has important implications for the understanding of Black women, ethnic identity, body image, and mental health, which are discussed in the paper.

Serum Creatinine as an Independent Predictor of Moderate to Severe Fibrosis in Chinese American Non-obese Metabolic Dysfunction-Associated Steatotic Liver Disease.

Metabolic dysfunction-associated steatotic liver disease (MASLD) is closely linked to the obesity epidemic. However, non-obese MASLD (body mass index [BMI] < 25 kg/m2 for Asians) is not uncommon, especially among Asian American populations. Preliminary research has demonstrated sarcopenia, a muscle-wasting syndrome, to be a major risk factor for non-obese Chinese MASLD. This study examined serum creatinine (SCr), a sarcopenia biomarker, and other prominent MASLD biomarkers for their ability to predict moderate to severe fibrosis (≥7.5 kPa or ≥F2 fibrosis) in the Chinese American MASLD population. A total of 296 Chinese American MASLD patients were categorized by BMI and fibrosis severity. As per World Health Organization guidelines for Asians, we identified obese MASLD (BMI ≥ 25 kg/m2) in 191 subjects (64.5%) and non-obese MASLD (BMI < 25 kg/m2) in 105 subjects (35.5%). Multivariate logistic regressions were performed to ascertain which biomarkers served as independent predictors of ≥F2 fibrosis. Wilcoxon signed-rank tests were conducted to compare MASLD cohorts (stratified by gender) and the healthy adult population on SCr distribution. The obese MASLD cohorts had higher rates of ≥F2 fibrosis and type 2 diabetes mellitus compared to their older, non-obese counterparts. For obese MASLD patients, higher age (P < 0.05), increased BMI (P < 0.01), increased AST (P < 0.05), and decreased platelets (P < 0.05) independently predicted ≥F2 fibrosis. For non-obese MASLD patients, lowered SCr (P < 0.05) levels served as the main predictor of≥F2 fibrosis. Female MASLD patients had markedly lower SCr distributions (P < 0.001) compared to the healthy female population, with 26.8% having SCr levels below the normal range. In summary, SCr was the predominant predictor of moderate to severe fibrosis in non-obese Chinese American MASLD patients. The high rate of decreased SCr levels in Chinese American MASLD women suggests that this population may be at higher risk for muscle mass loss, which can lead to liver fat accumulation.