Asian American Pacific Islander Research Articles

Characterizing "collateral damage" in men and women with metastatic breast cancer (mBC) from diverse racial and ethnic backgrounds in New York City.

Patients from diverse racial, ethnic, and socio-economic backgrounds may be particularly vulnerable to experiencing undue social and financial burdens ("collateral damage") from a metastatic breast cancer (mBC) diagnosis; however, these challenges have not been well explored in diverse populations. From May 2022 to May 2023, English- or Spanish-speaking adults with mBC treated at four New York-Presbyterian (NYP) sites were invited to complete a survey that assessed collateral damage, social determinants of health, physical and psychosocial well-being, and patient-provider communication. Fisher's exact and the Kruskal-Wallis rank-sum tests assessed differences by race and ethnicity. Of 87 respondents, 14% identified as Hispanic, 28% non-Hispanic Black (NHB), 41% non-Hispanic White (NHW), 7% Asian American Pacific Islander (AAPI), and 10% other/multiracial. While 100% of Hispanic, NHW, and AAPI participants reported stable housing, 29% of NHB participants were worried about losing housing (p = 0.002). Forty-two percent of Hispanic and 46% of NHB participants (vs. 8%, NHW and 0%, AAPI, p = 0.005) were food insecure; 18% of Hispanic and 17% of NHB adults indicated lack of reliable transportation in the last year (vs. 0%, NHW/AAPI, p = 0.033). Participants were generally satisfied with the quality of communication that they had with their healthcare providers and overall physical and mental well-being were modestly poorer relative to healthy population norms. In our study, NHB and Hispanic mBC patients reported higher levels of financial concern and were more likely to experience food and transportation insecurity compared to NHW patients. Systematically connecting patients with resources to address unmet needs should be prioritized to identify feasible approaches to support economically vulnerable patients following an mBC diagnosis.

Disparities in Mentorship and Implications for US Surgical Resident Education and Wellness.

Many surgeons cite mentorship as a critical component of training. However, little evidence exists regarding factors associated with mentorship and the influence of mentorship on trainee education or wellness. To evaluate factors associated with surgical trainees' perceptions of meaningful mentorship, assess associations of mentorship with resident education and wellness, and evaluate programmatic variation in mentorship. A voluntary, anonymous survey was administered to clinically active residents in all accredited US general surgery residency programs following the 2019 American Board of Surgery In-Service Training Examination. Data were analyzed from July 2019 to July 2022. Residents were asked, "Do you have a mentor who genuinely cares about you and your career?" Resident characteristics associated with report of meaningful mentorship were evaluated with multivariable logistic regression. Associations of mentorship with education (clinical and operative autonomy) and wellness (career satisfaction, burnout, thoughts of attrition, suicidality) were examined using cluster-adjusted multivariable logistic regression controlling for resident and program factors. Residents' race and ethnicity were self-identified using US census categories (American Indian or Alaska Native, Asian, Black or African American, Native Hawaiian or Other Pacific Islander, and White), which were combined and dichotomized as non-Hispanic White vs non-White or Hispanic. A total of 6956 residents from 301 programs completed the survey (85.6% response rate); 6373 responded to all relevant questions (2572 [40.3%] female; 2539 [39.8%] non-White or Hispanic). Of these, 4256 (66.8%) reported meaningful mentorship. Non-White or Hispanic residents were less likely than non-Hispanic White residents to report meaningful mentorship (odds ratio [OR], 0.81, 95% CI, 0.71-0.91). Senior residents (postgraduate year 4/5) were more likely to report meaningful mentorship than interns (OR, 3.06; 95% CI, 2.59-3.62). Residents with meaningful mentorship were more likely to endorse operative autonomy (OR, 3.87; 95% CI, 3.35-4.46) and less likely to report burnout (OR, 0.52; 95% CI, 0.46-0.58), thoughts of attrition (OR, 0.42; 95% CI, 0.36-0.50), and suicidality (OR, 0.47; 95% CI, 0.37-0.60) compared with residents without meaningful mentorship. One-third of trainees reported lack of meaningful mentorship, particularly non-White or Hispanic trainees. Although education and wellness are multifactorial issues, mentorship was associated with improvement; thus, efforts to facilitate mentorship are needed, especially for minoritized residents.

Serving Asian American, Native Hawaiian, and Pacific Islander Students: Examining How Asian American and Native American Pacific Islander- Serving Institutions Build Students’ Capacities

This study examines how Asian American and Native American Pacific Islander-Serving Institutions (AANAPISI) serve Asian American, Native Hawaiian, and Pacific Islander (AA&NHPI) students. Through a two-site case study of a community college on the west coast and a regional comprehensive university on the east coast, this study details the processes that are undertaken to serve and enhance the educational experiences of AA&NHPI students by building their capacities. Findings suggests that federally-funded AANAPISIs design and implement their programs in a manner that reflects the lived experiences and realities of AA&NHPI students through academic coursework, co-curricular programming, and research opportunities, in an intentional and strategic multilayered process, which resembles a developmental nested design focused on five thematic domains. Implications for policy, practice, and research are also offered to advance the work of AANAPISIs.

Multicultural Considerations for the Psychometrics of the Brief Pornography Screen.

Problematic pornography use (PPU) is a burgeoning area of clinical interest. The Brief Pornography Screen (BPS) is a new PPU measure. The BPS has not been psychometrically studied within specific race/cultural groups. We sought to broaden the PPU literature by examining the confirmatory factor analysis (CFA) fit, measurement invariance, and structural invariance of the BPS across eight identity groups. Participants came from a survey administered at three U.S. universities. In total, n = 2,475 participants were analyzed, with the following identity group breakdowns: Asian American/Pacific Islander (AAPI) male = 268, AAPI female = 303, Black male = 101, Black female = 189, Latin male = 208, Latin female = 372, White male = 432, and White female = 602. BPS CFA fit was good across all groups. Measurement invariance analyses suggested metric, but not scalar invariance across all groups. We then split participants by sex assignment, full residual invariance was evident across groups for male participants and partial residual invariance was evident for female participants. Structural invariance analyses indicated anxiety as a weak positive BPS correlate in AAPI, Latin, and White male participants (β's = 0.25-0.27), but not meaningfully related in the other groups. Pornography viewing frequency was positively correlated with BPS scores across most groups with a wide range (β's = 0.29-0.52), except for Black male participants (β = 0.15). Our results suggest that the BPS is an appropriate PPU measure across the tested identity groups. While between-group measurement is relatively accurate within sex assignment groups, correlates differed in strength, meaning different variables likely predict PPU for different groups of people.

What's not in the grant: An exploration of project directors’ experiences at two‐year Asian American and Native American Pacific Islander serving institutions in the Midwest

AbstractThis article explores the experiences of project directors at two‐year Asian American and Native American Pacific Islander serving institutions in the Midwest. Specifically, we examined how project directors faced racialized campus environments, navigated support structures (or the lack thereof), and continually combatted misperceptions about the Asian American and Pacific Islander (AA/PI) communities and the Midwest. We discussed the isolation, myths, lack of institutional support, and campus climate for project directors and AA/PI communities. We end with recommendations.

Mentorship matters: Supporting and growing the Asian American Pacific Islander women’s health nurse practitioner pipeline

In the dynamic and diverse landscape of the nursing profession, mentorship can play a pivotal role in leading aspiring nurse practitioners along their career path.

Abstract TMP22: Removing Disparities Related to Thrombectomy Transfers Within an Integrated Healthcare System Across Fourteen Primary Stroke Centers

Introduction: Patients who present to a PSC with a large vessel occlusion are often transferred to hospitals with thrombectomy capability. Inequities in rates of hospital transfer amongst patients across various gender, racial background, and socioeconomic status are well established. A common metric used to determine quality of care in such transfers is the Door In Door Out (DIDO) time. We hypothesized that there would be no difference in the DIDO using an established systematic approach to transfers in our 14-hospital integrated healthcare system. Methods: All interhospital transfers for thrombectomy across our 14 PSCs were examined from 10/2020 - 4/2023. Age, gender, race/ethnicity, and insurance status were abstracted and used to assess if disparities in DIDO were present. ANOVA and Chi-Square were used for statistical analysis. Results: 307 patients were identified over a 3-year period across all our sites. 48.9% were female with a mean age of 69.7 (±16.2). The median NIHSS was 13 (IQR 7 - 20) and the median DIDO was 96 mins (IQR 74 - 131 mins). There was no difference in median DIDO between females 94 mins (IQR 74 - 132 mins) and males 98 mins (IQR 73 - 98 mins) (p = 0.2). When compared to White patients, there was no difference in median DIDO for Asian American/Pacific Islander (AAPI) (12.6 mins, p = 0.6), Black (-2.1 mins, p = 1.0), or Hispanic patients (7.6 mins, p = 0.7). The insurance status of our patient population was predominantly Medicare (56.4%), followed by Commercial (26.4%), Medicaid (8.1%), and Self- Pay (2.9%). The remainder were classified as Other/Missing (6.2%). When compared to the remainder of the population, we found no difference in median DIDO for patients on Medicare (-2.0 mins, p = 0.7) or Medicaid (10.8 mins, p = 0.3). Conclusions: A Southern California integrated healthcare system’s approach to thrombectomy transfers enables the removal of disparities in DIDO regardless of gender, racial background, and insurance status.

Exploring Patient Needs and Preferences in CKD Education: A Cross-Sectional Survey Study.

Despite efforts to educate individuals with chronic kidney disease (CKD) and thereby improve outcomes, studies have shown that a significant number of patients still report poor CKD knowledge. Thus, understanding patient needs and preferences is crucial for the development and implementation of an effective CKD educational program. A paper survey was distributed to CKD patients ≥ 21 years at a tertiary care hospital's outpatient nephrology clinic in Rochester, New York. Data on patient demographics, print and technological literacies, and preferences regarding topics, instructors, class formats, session frequency, duration, and peer support were gathered. Of the 337 patients, the mean age was 65 years (± 12.33 years), and the self-identified races were: American Indian or Alaska Native (<1%), Asian (3%), Black or African American (12.17%), Native Hawaiian or other Pacific Islander (<1%), White (83%), and Other (2%). Most patients (69%) never needed help with health instructions and 68% of patients used a smartphone or computer everyday. Key topics identified by patients included the definitions of CKD, creatinine, GFR and kidney diet. 73% of patients desired more than basic CKD information with 1 in 5 even wanting to know "everything a doctor knows." 46% were willing to attend classes and 33% preferred using digital (video, computer, smartphone) modalities. Patients were willing to attend an average of 3.6 classes and, most preferred hour-long classes. Most patients (46%) preferred a doctor as educator and 53% expressed interest in connecting with fellow patients for peer support. Most CKD patients are interested in comprehensive education about their disease. This research may offer insights into the optimal content and delivery of CKD educational programs by elaborating on patients' needs and the integration of online modalities to deliver content. Future person-centered educational programs for people with CKD are needed.

Financial hardship experienced in adults with metastatic breast cancer (MBC) from diverse racial, ethnic, and socio-economic backgrounds.

276 Background: MBC profoundly impacts physical, psychosocial, and financial well-being. With treatment advances, patients often manage ongoing treatment for extended durations, which has employment and financial implications (e.g., missed work for appointments). As part of a study evaluating the “collateral damage” of MBC, we sought to describe employment and financial challenges, with a focus on Black and Hispanic adults living with MBC. Methods: From 5/22-5/23, English or Spanish speaking adults with MBC (de novo stage IV or recurrent) treated at 4 New York Presbyterian (NYP) sites (Weill Cornell Medicine-Manhattan, NYP-Brooklyn Methodist, NYP-Queens, and NYP-Columbia) were invited to complete a survey that included a measure of collateral damage (SHINE-financial and employment concerns) and social determinants of health. Fisher’s Exact tests were used to assess differences by race and ethnicity. Results: Of 87 respondents, 14% identified as Hispanic, 28% non-Hispanic Black (NHB), 41% non-Hispanic White (NHW), 7% Asian American Pacific Islander (AAPI), and 10% other/multiracial; 41% did not have a college degree, 32% were employed, 19% unemployed, 9% homemakers, 27% retired, and 13% disabled. Employment concerns were prevalent across racial and ethnic groups; Black, Hispanic, and AAPI participants were more likely to report financial concerns (Table). While 100% of Hispanic, NHW, and AAPI participants reported having stable housing, 29% of NHB participants were worried about losing housing (p=.002). 42% of Hispanic and 45% of NHB participants (vs. 8%, NHW and 0%, AAPI, p=.007) were food insecure; 18% of Hispanic and 17% of NHB adults indicated lack of reliable transportation in the last year (vs. 0%, NHW/AAPI, p=.041). Conclusions: NHB and Hispanic MBC patients report higher levels of financial concern and are more likely to experience food and transportation insecurity, compared to NHW patients. Evaluating the role of screening to systematically connect patients with resources to address unmet social and financial needs should be prioritized in an effort to identify feasible approaches to support economically vulnerable patients following an MBC diagnosis.[Table: see text]

Determinants of American Adults' Use of Digital Health and Willingness to Share Health Data to Providers, Family, and Social Media: A Cross-sectional Study.

With the global pandemic driving the adoption of digital health, understanding the predictors or determinants of digital health usage and information sharing gives an opportunity to advocate for broader adoption. We examined the prevalence and predictors of digital health usage and information-sharing behaviors among American adults. Data were from the Health Information National Trends Survey 5 Cycle 4. More than two-thirds used a digital resource for health-related activities (eg, to check test results). About 81% were willing to share their digital data with their provider, 75% with family, and 58% with friends. Only 14% shared health information on social media. Gender, education, device types, and performance expectancy of digital health were common factors associated with both digital health usage and information-sharing behaviors. Other predictors included rurality, patient portal access, income, and having a chronic disease. Of note, we found that Asian American Pacific Islanders, compared with Whites, were less likely to share information with providers. Performance expectancy was a significant determinant of information sharing. Those diagnosed with diabetes were 4% less likely to share information with their providers. With the growing digital divide, there is a need to advocate for more usable and accessible digital health to assist with person-centered care.

Addressing Data Aggregation and Data Inequity in Race and Ethnicity Reporting and the Impact on Breast Cancer Disparities.

Collecting and reporting data on race and ethnicity is vital to understanding and addressing health disparities in the United States. These health disparities can include increased prevalence and severity of disease, poorer health outcomes, decreased access to healthcare, etc., in disadvantaged populations compared with advantaged groups. Without these data, researchers, administrators, public health practitioners, and policymakers are unable to identify the need for targeted interventions and assistance. When researching or reporting on race and ethnicity, typically broad racial categories are used. These include White or Caucasian, Black or African American, Asian American, Native Hawaiian or Other Pacific Islander, or American Indian and Alaska Native, as well as categories for ethnicity such as Latino or Hispanic or not Latino or Hispanic. These categories, defined by the Office of Management and Budget, are the minimum standards for collecting and reporting race and ethnicity data across federal agencies. Of note, these categories have not been updated since 1997. The lack of accurate and comprehensive data on marginalized racial and ethnic groups limits our understanding of and ability to address health disparities. This has implications for breast cancer outcomes in various populations in this country. In this paper, we examine the impact data inequity and the lack of data equity centered processes have in providing appropriate prevention and intervention efforts and resource allocations.

4.48 Perceptions of Microaggressions by Asian American Pacific Islander Mental Health Providers

4.48 Perceptions of Microaggressions by Asian American Pacific Islander Mental Health Providers

A Large National Study on Racial Disparities among Asian American, Native Hawaiian, and Other Pacific Islander Cancer Patients Who Refuse Radiation Therapy and Surgery

Asian Americans (AAs) are the only race for whom cancer is the leading cause of death in the US. Despite radiation therapy (RT) and surgery being curative treatments, prior work demonstrated AAs refuse RT/surgery at a higher rate than other races. Given AAs are often aggregated with Native Hawaiians and other Pacific Islanders (NHPIs), rates of RT/surgery refusal within this community are poorly understood. We aimed to 1) assess RT/surgery refusal on overall survival (OS) using propensity-score (PS) matched groups, 2) identify AA and NHPI populations that refuse RT/surgery and 3) determine predictors of refusing RT/surgery. A US hospital-based retrospective cohort study of the National Cancer Database was conducted. Patients included were ≥18 years old, AA by ethnogeographic region (South AA, East AA, and Southeast AA) or NHPI race, with a confirmed diagnosis of 1 of the 10 most common US cancers during 2004-2017 who were recommended for RT/surgery. Cox proportional hazard models with adjusted Hazard Ratios (aHR) assessed propensity-score matched groups (1:10) based on age, race, cancer stage, comorbidity index, rurality, facility type, facility location, and year of diagnosis. Adjusted odds ratios (aOR) were calculated and 95% confidence intervals (95% CI) for treatment refusal using logistic regression. Population heterogeneity for treatment refusal by race was assessed with likelihood ratio tests (p-heterogeneity). The cohort of 147,685 patients who met the inclusion criteria were predominantly East AA (43%), diagnosed with breast cancer (42%), and had a <2 comorbidity index (99%). Median age was 61 years. Median follow-up was 58 months. Overall, 2,888 (5%) patients refused RT, and 1,073 (1%) refused surgery. RT refusal by race was 5.7% (East AA), 7.9% (NHPI), 4.6% (South AA), and 4.6% (Southeast AA). Surgery refusal rates were 1.5% (East AA), 1.9% (NHPI), 1.1% (South AA) and 1.2% (Southeast AA). RT refusal significantly predicted poorer OS (aHR = 1.15, 95% CI = 1.06-1.25) whereas surgery refusal did not. Compared to East AA, NHPIs had a higher risk of RT refusal (aOR = 1.44, 95% CI = 1.27-1.62), whereas South AA (aOR = 0.85, 95% CI = 0.75-0.95) and Southeast AA (aOR = 0.82, 95% CI = 0.75-0.90) had a significantly lower risk (p-heterogeneity<.0001). Predictors of RT refusal were older patient age, high comorbidity index, oral cavity cancer, urban-rural residence, Midwest or West US region, and diagnosis 2011-2017. Among AA and NHPI patients with cancers in the US, RT refusal predicted poorer OS. NHPI had the highest risk of RT refusal. Given AA and NHPI are not monolithic groups, data disaggregation is necessary to understand racial/ethnic disparities for treatment refusal. Sociocultural and historical contexts of AA and NHPI populations on treatment refusal are necessary to improve cancer outcomes among these populations.

Racial/Ethnic Disparities in Outcomes After Percutaneous Coronary Intervention

Asian American/Pacific Islanders (AAPIs) and Hispanics are growing minority United States populations, but are poorly represented in the cardiovascular literature. This study examines guideline adherence and outcomes in AAPIs and Hispanics compared with non-Hispanic Whites (NHWs) in a quaternary care center after inpatient percutaneous coronary intervention (PCI). The primary end points were inpatient post-PCI bleed, heart failure, cardiogenic shock, and all-cause mortality, whereas the secondary end point was the prescription rate of post-PCI guideline-directed medical therapy including aspirin, statins, P2Y12 receptor blockers, and cardiopulmonary rehabilitation. Intergroup differences were assessed through analysis of variance or two-way chi-square tests, and the association of race with binary outcomes was examined through logistic regression with NHW as the reference group. Compared with NHW, AAPIs, and Hispanics had higher odds of diabetes mellitus, and AAPIs had higher odds of hypertension and being on dialysis. Hispanics had higher odds of post-PCI mortality versus NHW, both in acute coronary syndrome (odds ratio [OR] 2.04, p=0.03) and elective PCI (OR2.51, p=0.04). AAPI also trended toward higher mortality than NHW in both categories. AAPIs were found to have higher odds of statin prescription (OR1.91, p=0.04). Hispanics had lower odds of ticagrelor prescription versus NHW (OR0.65, p=0.04), and AAPIs trended toward such. No differences were found for cardiopulmonary rehabilitation prescriptions in groups. This study suggests that despite quality improvement efforts, disparities remain in postprocedural outcomes in minority groups in comparison with NHW.

Inpatient Care Utilization Following Mobile Crisis Response Encounters Among Racial/Ethnic Minoritized Youth

There has been an increase in youth psychiatric emergencies and psychiatric inpatient hospitalizations in recent years. Mobile crisis response (MCR) services offer an opportunity to meet acute youth mental health needs in the community and to provide linkage to care. However, an understanding of MCR encounters as a care pathway is needed, including how patterns of subsequent care may vary by youth race/ethnicity. The current study examines racial/ethnic differences in the rates of inpatient care use following MCR among youth. Data included Los Angeles County Department of Mental Health (LACDMH) administrative claims for MCR in 2017 and psychiatric inpatient hospitalizations and outpatient services from 2017-2020 for youth aged 0 to 18 years. In this sample of 6,908 youth (70.4% racial/ethnic minoritized youth) who received an MCR, 3.2% received inpatient care within 30 days of their MCR, 18.6% received inpatient care beyond 30 days of their MCR, and 14.7% received repeated inpatient care episodes during the study period. Multivariate models revealed that Asian American/Pacific Islander (AAPI) youth were less likely to receive inpatient care, whereas American Indian/Alaska Native (AI/AN) youth were more likely to receive inpatient care following MCR. Youth age, primary language, primary diagnosis, and insurance status also predicted future inpatient episodes. Findings highlight differential rates of inpatient use following MCR among AAPI and AI/AN youth relative to youth from other groups. Alternative interpretations for the findings are offered related to differential levels of need and disparate penetration of community-based outpatient and prevention-focused services.

Racial Disparities among Asian American, Native Hawaiian, and Other Pacific Islander Patients with Cancer Who Refuse Recommended Radiation Therapy or Surgery.

Despite radiation therapy (RT) and surgery being the curative treatments, prior work demonstrated that the aggregated Asian American (AA) and Native Hawaiian and Other Pacific Islanders (NHPI) population refuse RT and surgery at a higher rates than other races. Given that AA and NHPI are distinct groups, data disaggregation is necessary to understand racial and ethnic disparities for treatment refusal. We aimed to (1) compare RT and surgery refusal rates between AA and NHPI populations, (2) assess RT and surgery refusal on overall mortality, and (3) determine predictors of refusing RT and surgery using the United States (U.S.) National Cancer Database. Adjusted odds ratios (aOR) and 95% confidence intervals (95%CI) for treatment refusal were calculated using logistic regression. Adjusted hazard ratios (aHR) were calculated for overall survival using Cox proportional hazard models among propensity score-matched groups. The overall rate of RT refusal was 4.8% and surgery refusal was 0.8%. Compared to East AA patients, NHPI patients had the highest risk of both RT refusal (aOR = 1.38, 95%CI = 1.21-1.61) and surgery refusal (aOR = 1.28, 95%CI = 1.00-1.61). RT refusal significantly predicted higher mortality (aHR = 1.17, 95%CI = 1.08-1.27), whereas surgery refusal did not. Predictors of RT and surgery refusal were older patient age, high comorbidity index, and cancer diagnosis between 2011-2017. The results show heterogenous treatment refusal patterns among AA and NHPI populations, suggesting areas for targeted intervention.

Assessing the validity of race and ethnicity coding in administrative Medicare data for reporting outcomes among Medicare advantage beneficiaries from 2015 to 2017.

To assess the validity of race/ethnicity coding in Medicare data and whether misclassification errors lead to biased outcome reporting by race/ethnicity among Medicare Advantage beneficiaries. In this national study of Medicare Advantage beneficiaries, we analyzed individual-level data from the Health Outcomes Survey (HOS) and the Consumer Assessment of Healthcare Providers and Systems (CAHPS), race/ethnicity codes from the Medicare Master Beneficiary Summary File (MBSF), and outcomes from the Medicare Provider Analysis and Review (MedPAR) files from 2015 to 2017. We used self-reported beneficiary race/ethnicity to validate the Medicare Enrollment Database (EDB) and Research Triangle Institute (RTI) race/ethnicity codes. We measured the sensitivity, specificity, and positive and negative predictive values of the Medicare EDB and RTI codes compared to self-report. For outcomes, we compared annualized hospital admission, 30-day, and 90-day readmission rates. Data for Medicare Advantage beneficiaries who completed either the HOS or CAHPS survey were linked to MBSF and MedPAR files. Validity was assessed for both self-reported multiracial and single-race beneficiaries. For beneficiaries enrolled in Medicare Advantage, the EDB and RTI race/ethnicity codes have high validity for identifying non-Hispanic White or Black beneficiaries, but lower sensitivity for beneficiaries self-reported Hispanic any race (EDB: 28.3%, RTI: 85.9%) or non-Hispanic Asian American or Native Hawaiian Pacific Islander (EDB: 56.1%, RTI: 72.1%). Only 8.7% of beneficiaries self-reported non-Hispanic American Indian Alaska Native are correctly identified by either Medicare code, resulting in underreported annualized hospitalization rates (EDB: 31.5%, RTI: 31.6% vs. self-report: 34.6%). We find variation in 30-day readmission rates for Hispanic beneficiaries across race categories, which is not measured by Medicare race/ethnicity coding. Current Medicare race/ethnicity codes misclassify and bias outcomes for non-Hispanic AIAN beneficiaries, who are more likely to select multiple racial identities. Revisions to race/ethnicity categories are needed to better represent multiracial/ethnic identities among Medicare Advantage beneficiaries.

How does exposure to masked individuals affect White Americans' attitudes toward Asian American and Pacific Islanders?

AbstractAcross three studies, conducted between Spring 2020 and Spring 2021, we tested whether exposure to an Asian American/Pacific Islander (AAPI) target person wearing a face mask would increase or decrease White Americans' perceived threat from and positivity toward AAPI individuals. Although results varied by study, a single‐paper meta‐analysis revealed that the masked (compared to unmasked) AAPI target resulted in greater positivity toward AAPIs, due to reduced perceptions of both symbolic threat to group values and realistic threat to group health. Positivity toward AAPIs did not reliably differ after exposure to a masked versus unmasked White target. Implications for interventions that encourage COVID‐safe behaviors and combat anti‐AAPI attitudes are discussed.

Ethnicity, Coronavirus Disease-Related Stress, and E-cigarette Use and Cigarette Smoking Among Young Adults: A Longitudinal Study.

Research has rarely examined ethnic differences in exposure to coronavirus disease (COVID)-related stress in relation to smoking and e-cigarette use. Using pre- and post-COVID data from a sample of predominantly Asian American (AA) and Native Hawaiian and Pacific Islander (NHPI) young adults, this study aimed to test the effects of ethnicity on cigarette smoking and e-cigarette use through exposure to COVID-related stress. Young adults from Hawaii who provided pre-COVID data in or before January 2020 were followed up with in March-May 2021. N = 1907 (mean age = 24.9 [SD = 2.9], 56% women) provided complete data relevant to the current analysis at both waves of data collection. Structural equation modeling was used to test the effects of ethnicity (white, Asian [eg, Japanese, Chinese], Filipino, NHPI, and other) on pre- to post-COVID changes in cigarette and e-cigarette use via effects on COVID-related stress. Relative to Asian young adults, members of all other ethnic groups (NHPI, Filipino, white, and other) indicated greater exposure to COVID-related stress. Higher levels of COVID-related stress were associated with increased dual-use status and increased current e-cigarette and cigarette use frequencies. Higher COVID-related stress mediated the effects of NHPI, Filipino, and other ethnicity on increased dual-use status. The current data indicate that young adults of vulnerable ethnic groups who experience higher COVID-related stress are at increased risk for dual use of cigarettes and e-cigarettes. The findings imply that tobacco use prevention and treatment efforts may need to pay increased attention to racial or ethnic groups that have experienced greater adverse impact of the COVID-19 pandemic.

Representativeness of patients with lung cancer in an integrated health care delivery system.

e13600 Background: Lung cancer is the leading cause of cancer death in the US, and research is critical to reducing its morbidity and mortality. Minoritized groups (e.g., low income) that face higher lung cancer burden are underrepresented in clinical trials, which are often conducted at NCI-designated cancer centers (NCICCs). Large integrated health systems such as Kaiser Permanente Northern California (KPNC) may be well-positioned to produce research findings that are more representative of patient populations in important clinical and demographic characteristics. In this study, we evaluated the representativeness of lung cancer patients from KPNC compared to those from NCICCs and non-NCICCs in Northern California. Methods: We extracted individual and neighborhood data from the California Cancer Registry, California Neighborhoods Data System, and CalEnviroScreen 4.0 for patients with invasive lung cancer diagnosed from 2015 through 2019 within the KPNC catchment area. We compared these characteristics among patients from KPNC, NCICCs (Stanford, UC Davis, UCSF), and all other non-NCICCs. Results: Of 27,288 patients, 31% are from KPNC, 8% from NCICCs, and 61% from other non-NCICCs (Table). KPNC patients are more similar to other non-NCICC patients and the total lung cancer population than to NCICC patients on most characteristics. KPNC patients are slightly older, more likely to be female, and less likely to be Asian American/Pacific Islander (AAPI), compared to other non-NCICC patients. In contrast, NCICC patients are younger, less likely to be female or non-AAPI minoritized racial and ethnic groups, and present with less stage IV disease and more adenocarcinoma at diagnosis. Both KPNC and NCICC patients are more likely to reside in neighborhoods with the highest socioeconomic status (SES) and lowest pollution burden than other non-NCICC patients. Given large numbers, all differences were statistically significant (p&lt;0.001). Conclusions: These analyses demonstrate that lung cancer patients in KPNC are more broadly representative of the overall lung cancer population than those in NCICCs, and can produce generalizable research findings to improve outcomes for all lung cancer patients. [Table: see text]