British Asian Research Articles

CYP2C19 loss-of-function alleles are not associated with higher prevalence of gastrointestinal bleeds in those who have been prescribed antidepressants: Analysis in a British-South Asian cohort.

CYP2C19 is a hepatic enzyme involved in the metabolism of antidepressants associated with increased gastrointestinal bleed (GIB) risk. The aim of our study was to explore a possible association between loss-of-function CYP2C19 genotypes and GIB in South Asian ancestry participants prescribed antidepressants. Genes & Health participants with a record in Barts Health NHS Trust (N 22 753) were studied using a cross-sectional approach. CYP2C19 diplotypes were assessed and metabolizer type inferred from consortia guidance. Fisher's exact test was used to compare the prevalence of GIB in different metabolizer categories. Multivariable regression was used to test for association between antidepressant prescriptions and GIB, and between CYP2C19 metabolizer state and GIB in the subcohort prescribed antidepressants. Antidepressants were frequently prescribed (47%, N = 10 612). A total of 864 participants (4%) had a GIB; 534 (62%) had been prescribed a CYP2C19 metabolized antidepressant. There was an independent association between antidepressant prescriptions and GIB events (odds ratio 1.8, confidence interval 1.5-2.0, P < 0.0001). There was no relationship between CYP2C19 inferred poor (P 0.56) or intermediate (P 0.53) metabolizer status and GIB in those prescribed an antidepressant in unadjusted analysis. A multivariable logistic regression model did not show an independent association between poor (P 0.54) or intermediate (P 0.62) CYP2C19 metabolizers and GIB in the subcohort prescribed antidepressants. CYP2C19 dependent antidepressants are associated with increased GIB prevalence. GIB appeared independent from CYP2C19 metabolizer genotype in individuals who had been prescribed antidepressants. Precision dosing based on CYP2C19 genetic information alone is unlikely to reduce GIB prevalence.

A linear adjustment-based approach to posterior drift in transfer learning.

We present new models and methods for the posterior drift problem where the regression function in the target domain is modelled as a linear adjustment, on an appropriate scale, of that in the source domain, and study the theoretical properties of our proposed estimators in the binary classification problem. The core idea of our model inherits the simplicity and the usefulness of generalized linear models and accelerated failure time models from the classical statistics literature. Our approach is shown to be flexible and applicable in a variety of statistical settings, and can be adopted for transfer learning problems in various domains including epidemiology, genetics and biomedicine. As concrete applications, we illustrate the power of our approach (i) through mortality prediction for British Asians by borrowing strength from similar data from the larger pool of British Caucasians, using the UK Biobank data, and (ii) in overcoming a spurious correlation present in the source domain of the Waterbirds dataset.

Experiences of pain and pain management in advanced disease and serious illness for people from South Asian communities in Leeds and Bradford: a qualitative interview study

BackgroundPain is a significant problem for many people with advanced disease or a serious illness. Culture and ethnicity can affect the experience and management of pain. However, there is limited research in South Asian communities in the UK on their experiences of pain. The aim of this study is to explore the experiences and attitudes of patients and family carers from South Asian communities about pain and its management within advanced disease or serious illness.MethodsQualitative thematic analysis based on descriptive phenomenology (Sundler et al. 2019). Qualitative semi-structured interviews with patients or family carers from South Asian communities (N = 15). Interviews were recorded, transcribed and analysed using an inductive approach. Public and Patient Involvement representatives from British South Asian communities were consulted for guidance.ResultsThere were five key themes from the interviews: The importance of communication about pain with healthcare professionals; Concerns about taking pain medication; Personal resilience, privacy and self-management; Gender, culture and pain; Home pain management as struggle and frustration.ConclusionTo improve pain management for people from South Asian communities with advanced disease or a serious illness, there are a number of important issues for healthcare professionals from palliative and primary care services to address. These include: greater awareness around people’s fears and concerns about pain medication; their potential use of alternative pain management strategies; and cultural issues such as resilience, privacy, dignity and gender roles. Effective communication between doctors, patients and family members could be improved by using a ‘cultural humility’ model; providing clear and accessible pain medication information; understanding and taking account of people with both low, and medium levels, of English language proficiency; and improving patient trust. Additionally, improvements to out of hours services could improve pain management for all patients managing their pain at home.

Exploratory RCT of a group psychological intervention for postnatal depression in British mothers of South Asian origin – ROSHNI-D

BackgroundPostnatal depression (PND) is a global public health problem. There is a high prevalence of PND amongst ethnic minority women and major ethnic inequalities in mental health care in the U.K. Language and cultural barriers pose a significant challenge for access to timely treatment and interventions for British South Asian (BSA) women with PND. MethodsThe study, carried out in Manchester and Lancashire, England, was a two-arm single-blind exploratory randomised controlled trial. BSA women (N = 83) having a baby <12 months were randomised either to the group receiving the culturally adapted Positive Health Programme (PHP) (n = 42) or to the group receiving treatment as usual (TAU) (n = 41). Follow-up assessments were at 3 months (end of intervention) and 6 months after randomisation. ResultsUsing an intention to treat analysis, there was no significant difference between PHP intervention and TAU groups in depression measured using Hamilton Depression Rating Scale both at 3 and 6 months follow up. Using modified intention to treat analysis, women who attended four or more sessions showed significant reduction in depression in the PHP group compared to the TAU group and the greater number of sessions attended was associated with greater reductions in depression scores. LimitationsThe sample was relatively small and the study was conducted in one geographical area in Northwest England; hence, these results may not be generalizable to other regions and populations. ConclusionThe recruitment and trial retention figures highlighted the ability of the research team to engage with BSA women, having implications in planning services for this group. Trial registrationClinicaltrials.govNCT01838889.

Ethnicity, hypermobility syndrome and Ehlers-Danlos syndrome: A study based on hospital admissions

The purpose of the study was to identify any evidence of different patterns of disease for Ehlers Danlos Syndrome (EDS) and Hypermobility Syndrome (JHS) in the White British and South Asian communities in England. The numbers of hospital in-patients in ten NHS Trusts, between 2016 and 2020, in whom a diagnosis of EDS or JHS had been recorded were identified through Freedom of Information (FOI) requests. The condition was either the primary diagnosis or a secondary one, incidental to the reason for admission. The ten Trusts were selected because they served areas with a significant South Asian population and had been involved in previous studies of discrimination in the delivery of care. The study also assessed whether there was evidence of any of the Trusts underserving their South Asian community with lesser levels of recognition of EDS and JHS. Overall South Asian patients were almost four times more likely to have been diagnosed as having JHS. This proportion was statistically significant (z = -11.69, p &lt;0.00001). In Burton and Derby, Cambridge and Leicester the proportion of South Asian patients diagnosed as having EDS was significantly lower than in other Trusts (z = 9.4, p &lt;0.00001). This was also the case for JHS (z = 8.09, p &lt; 0.00001). This would indicate that in these three Trusts both conditions are underdiagnosed in the South Asian community. The significance of these findings is discussed.

The impact of race/ethnicity on the clinical outcomes of people with type 2 diabetes admitted to hospital with COVID-19: an observational multi-national analysis

Aims: To describe the relationship between race/ethnicity and adverse outcomes related to coronavirus disease 2019 (COVID-19) in adults with T2DM admitted to hospital in the UK, France and USA. Methods: Study data from the UK ABCD nationwide COVID- 19 audit, the French CORONADO nationwide initiative and the USA AMERICADO multi-centre study were analysed to assess the association between race/ethnicity and severe COVID-19. Severe COVID-19 was defined as death in hospital and/or admission to the intensive care unit (ICU). Logistic regression models were used to generate age-adjusted odds ratios. Results: Data from 3,471 patients in the ABCD audit, from 2,451 CORONADO patients and from 9,321 AMERICADO patients admitted with COVID-19 and T2DM were analysed. Race/ethnicity data were available for 3,410 (98%), 2,173 (89%) and 8,893 (95%) patients, respectively. In the UK ABCD audit cohort, Asian and Black race/ethnicity were associated with an increased risk of death/ICU admission compared to White when adjusted for age and sex (OR 2.14; 1.38-3.29 and OR 2.09; 1.17-3.74, respectively). When adjusted for additional confounders the association was stronger (Asian OR 2.88; 1.72-4.82 and Black OR 2.20; 1.12-4.30). In the CORONADO cohort Middle Eastern/North African race/ethnicity was protective against death/ICU admission (OR 0.57; 0.36-0.91). There was no association between ethnicity and death alone in the AMERICADO dataset. Conclusion: In those with T2DM admitted to hospital with COVID-19, a non-White race/ethnicity was associated with higher risk of death/ICU admission in the UK ABCD data but not in French CORONADO or USA AMERICADO datasets. Further research is required to improve our understanding of the observed discrepancies in outcomes.

#5010 INCIDENCE AND CLINICAL PRESENTATION OF ANCA ASSOCIATED VASCULITIS AMONGST INDO-ASIAN PATIENTS IN LANCASHIRE, UK

Abstract Background and Aims ANCA associated vasculitis (AAV) is a rare autoimmune condition that is predominately seen in white Caucasian populations [1]. Across the UK, Europe and the USA, the prevalence of AAV is between 4.6 -18.4 per 100,000. Studies have shown significant geographical differences in the presentation and phenotype of AAV. PR3 positivity and granulomatosis with polyangiitis (GPA) is more common in Northern European countries at higher latitudes. In contrast MPO positivity is seen more frequently in Japanese, Chinese and Southern European populations [1]. Comparatively, few studies have looked at the incidence, phenotype and outcomes in ethnic minority patients in particular Indo-Asian populations. Method We completed a retrospective cohort study of patients with AAV from a central referral centre in Lancashire, UK between December 2010 and December 2022. Patients with a diagnosis of AAV according to the Chapel Hill consensus conference and who belonged to the following ethic groups; ‘Indian, British Indian, Pakistani, British Pakistani, Asian or Asian British’, were included. Using data from the 2021 census, available from the Office of National Statistics, denominator populations were obtained [2]. Patients ethnic group were determined by self-reported ethnicity records on hospital e-health records or via GP summary care records. Ethical approval was obtained (IRAS 257174). Results Using 2021 census data, the total population of Lancashire (Fig. 1), aged &amp;gt;18 years old was 1,149,826. Of this population, the majority identified as white (1,059,000) and the second most common ethnic group was Asian / Asian British (74,523). Black/ African/ Caribbean/ Black British made up &amp;lt;1% of the population and mixed / multiple ethnic groups and other ethnic groups made up just over 1%. Eighteen Indo-Asian patients with newly diagnosed AAV were identified. The mean age was 46 ±16.7 yrs, which is younger than our cohort of white patients who had a mean age of 65.1 ± 14.6 yrs. There was an equal gender split, the majority were PR3 positive (n = 12, 67%) and 6 patients had MPO positive AAV. Nine patients had renal involvement, with only 2 having renal limited disease and 1 requiring dialysis at presentation. Over half of the patients (n = 11, 61%) had ENT involvement. The crude incidence of AAV in Indo-Asian patients in Lancashire was 20.1 per million person years (95% CI 10.7, 28.5). This is higher than that reported in other areas of the UK [3]. When compared to age and gender matched white patients, white patients had more renal involvement (89.5% V's 50%, P = 0.01) and more renal limited disease (31.6% V's 11.1% P = 0.13). Pulmonary involvement was similar between the ethnic groups whereas ENT involvement was more prevalent in Indo-Asian patients (61.1% V's 26.3%, P = 0.03). Conclusion Our findings demonstrate that whilst the crude incidence of AAV is lower in Indo-Asian populations compared to white Caucasians, there is a significantly high incidence rate in the Lancashire area, which is greater than in other areas of the UK. Pearce et al. reported an incidence of 10.6 per million person years in Nottingham which was almost half that seen in our cohort [3]. Our Indo-Asian patients were on average younger and had less renal involvement compared to our cohort white patients. This contrasts some studies which report Indo-Asian populations to have more PR3 positivity and higher rates or renal involvement [1]. This may reflect an under diagnosis of extra renal disease and non-renal phenotypes in Indian subcontinent populations. There remains a gap in our understanding as to the genetic role in the pathogenesis and clinical phenotype of AAV disease. Further research is needed to determine if the differences seen between ethnic minorities are due to genetic or environmental factors.

The Use of Digital Health by South Asian Communities: Scoping Review.

South Asian individuals experience a higher burden of chronic diseases and limited access to health care services compared with their Caucasian peers. Digital health interventions can enhance the delivery of health care, minimize health inequities, and consequently improve health status among minority ethnic groups. However, it is unclear how South Asian people view and perceive the use of digital health technologies to support their health needs. The aim of the review is to identify South Asian individuals' experiences and attitudes of digital health and explore the barriers and facilitators affecting their use of digital health services. The Arksey and O'Malley methodological framework was used to guide this scoping review. Five electronic databases were examined for pertinent papers, which were augmented by searching bibliographies of the retrieved papers and gray literature. A total of 1328 potentially relevant papers were retrieved from the initial search, and the supplemental search added 7 papers to the final list of potentially included papers. Each paper on the initial inclusion list was independently reviewed, leaving 15 papers to be included in the review. Data were analyzed thematically leading to the development of two overarching themes: (1) barriers to uptake of digital health and (2) facilitators of use of digital health services. There was a general consensus that South Asian communities still struggle with inadequate access to digital health technologies. Some studies suggest multiple initiatives to improve accessibility and acceptability of digital health services within South Asian communities in order to mitigate health disparities and develop a more inclusive health care system. These include the development of multiple-language and culturally sensitive interventions and digital skill development sessions. Most studies were conducted in South Asian countries, focusing on measurable outcomes of digital health interventions. Few explored the experiences and views of South Asian community members residing in the West as a minority ethnic group, for example, British South Asians. Literature mapping proposes that South Asian people frequently struggle with a health care system that may limit their access to digital health services, and sometimes fails to consider social and cultural needs. There is growing evidence that digital health interventions have the potential to facilitate supported self-management, which is part of the plans to adopt person-centered care. These interventions are particularly important for overcoming some of the challenges, for example, time constraints, safety, and gender sensitivity, associated with the delivery of health care interventions in minority ethnic groups such as South Asians in the United Kingdom, and thus to improve minority ethnic groups' access to health care services to support individual health needs, and consequently enhance health status.

"You Can't Be Too Skinny. You Can't Be Too Fat. I Don't Know What You Are Supposed To Be.": A qualitative focus group study exploring body image experiences of South Asian women in the UK

British South Asian women may experience unique appearance pressures associated with their intersecting (racialised and gendered) identities; yet qualitative investigations of intersectional understandings of their body image are scarce. The aim of this study was to explore sociocultural factors influencing British South Asian women’s body image using an intersectional framework. Seven focus groups were conducted with 22 women of South Asian heritage living in the UK between the age of 18 and 48 years old who were comfortable speaking in English. Data were analysed using reflexive thematic analysis. We generated four themes (1) navigating (often marriage-related) appearance pressures from South Asian elders and aunties (2) negotiating cultural and societal standards across different aspects of one’s identity (3) representation of South Asian women in the wider context and (4) forms of healing from the pressures imposed on South Asian women. The findings have important implications for the body image experiences of South Asian women by acknowledging the need for tailored and nuanced responses to their complex needs in the sociocultural, political and relational context such as family, peers, education, health, media and the wider consumer landscape.

Stillbirth risk and smallness for gestational age according to Hadlock, INTERGROWTH-21st, WHO, and GROW fetal weight standards: analysis by maternal ethnicity and body mass index

Appropriate growth charts are essential for fetal surveillance, to confirm that growth is proceeding normally and to identify pregnancies that are at risk. Many stillbirths are avoidable through antenatal detection of the small-for-gestational-age fetus. In the absence of an international consensus on which growth chart to use, it is essential that clinical practice reflects outcome-based evidence. This study investigated the performance of 4 internationally used fetal weight standards and their ability to identify stillbirth risk in different ethnic and maternal size groups of a heterogeneous population. We analyzed routinely collected maternity data from more than 2.2 million pregnancies. Three population-based fetal weight standards (Hadlock, Intergrowth-21st, and World Health Organization) were compared with the customized GROW standard that was adjusted for maternal height, weight, parity, and ethnic origin. Small-for-gestational-age birthweight and stillbirth risk were determined for the 2 largest ethnic groups in our population (British European and South Asian), in 5 body mass index categories, and in 4 maternal size groups with normal body mass index (18.5-25.0 kg/m2). The differences in trend between stillbirth and small-for-gestational-age rates were assessed using the Clogg z test, and differences between stillbirths andbody mass index groups were assessed using the chi-square trend test. Stillbirth rates (per 1000) were higher in South Asian pregnancies (5.51) than British-European pregnancies (3.89) (P<.01) and increased in both groups with increasing body mass index (P<.01). Small-for-gestational-age rates were 2 to 3-fold higher for South Asian babies than British European babies according to the population-average standards (Hadlock: 26.2% vs 12.2%; Intergrowth-21st: 12.1% vs 4.9%; World Health Organization: 32.2% vs 16.0%) but were similar by the customized GROW standard (14.0% vs 13.6%). Despite the wide variation, each standard's small-for-gestation-age cases had increased stillbirth risk compared with non-small-for-gestation-age cases, with the magnitude of risk inversely proportional to the rate of cases defined as small for gestational age. All standards had similar stillbirth risk when the small-for-gestation-age rate was fixed at 10% by varying their respective thresholds for defining small for gestational age. When analyzed across body mass index subgroups, the small-for-gestation-age rate according to the GROW standard increased with increasing stillbirth rate, whereas small-for-gestation-age rates according to Hadlock, Intergrowth-21st, and World Health Organization fetal weight standards declined with increasing body mass index, showing a difference in trend (P<.01) to stillbirth rates across body mass index groups. In the normal body mass index subgroup, stillbirth rates showed little variation across maternal size groups; this trend was followed by GROW-based small-for-gestation-age rates, whereas small-for-gestation-age rates defined by each population-average standard declined with increasing maternal size. Comparisons between population-average and customized fetal growth charts require examination of how well each standard identifies pregnancies at risk of adverse outcomes within subgroups of any heterogeneous population. In both ethnic groups studied, increasing maternal body mass index was accompanied by increasing stillbirth risk, and this trend was reflected in more pregnancies being identified as small for gestational age only by the customized standard. In contrast, small-for-gestation-age rates fell according to each population-average standard, thereby hiding the increased stillbirth risk associated with high maternal body mass index.

SLCO1B1*5 is protective against non-senile cataracts in cohort prescribed statins: analysis in a British-South Asian cohort.

Reported association between statin use and cataract risk is controversial. The SLCO1B1 gene encodes a transport protein responsible for statin clearance. The aim of this study was to investigate a possible association between the SLCO1B1*5 reduced function variant and cataract risk in statin users of South Asian ethnicity. The Genes & Health cohort consists of British-Bangladeshi and British-Pakistani participants from East London, Manchester and Bradford, UK. SLCO1B1*5 genotype was assessed with the Illumina GSAMD-24v3-0-EA chip. Medication data from primary care health record linkage was used to compare those who had regularly used statins compared to those who had not. Multivariable logistic regression was used to test for association between statin use and cataracts, adjusting for population characteristics and potential confounders in 36,513 participants. Multivariable logistic regression was used to test association between SLCO1B1*5 heterozygotes or homozygotes and cataracts, in subgroups having been regularly prescribed statins versus not. Statins were prescribed to 35% (12,704) of participants (average age 41 years old, 45% male). Non-senile cataract was diagnosed in 5% (1686) of participants. An apparent association between statins and non-senile cataract (12% in statin users and 0.8% in non-statin users) was negated by inclusion of confounders. In those prescribed a statin, presence of the SLCO1B1*5 genotype was independently associated with a decreased risk of non-senile cataract (OR 0.7 (CI 0.5-0.9, p 0.007)). Our findings suggest that there is no independent association between statin use and non-senile cataract risk after adjusting for confounders. Among statin users, the SLCO1B1*5 genotype is associated with a 30% risk reduction of non-senile cataracts. Stratification of on-drug cohorts by validated pharmacogenomic variants is a useful tool to support or repudiate adverse drug events in observational cohorts.

Tackling the Complexities of the Obesity Pandemic Among the BAME Population in the UK Through Identification of the Social Determinants of Mental Health and Wellbeing

Obesity's multifaceted causes give rise to a complex and diverse range of health associated morbidities and comorbidities, including diabetes, hypertension, and cardiovascular disease, particularly among British Asian and Minority Ethnic (BAME) populations within in the UK. As found within the recent COVID-19 pandemic these can have wider reaching implications including increased risk of mortality within this population group. Understanding the potential social determinants of the causes of obesity is essential if effective strategies are to be developed to tackle this. A comprehensive search of the CINAHL, ASSIA and Web of Science databases was undertaken with 148 papers identified. Through application of inclusion and exclusion criteria two papers were included within this review. Inductive content analysis was undertaken, through which four conceptual categories were identified: impact of social culture, the "limitless" consequences of empowerment, the power of knowledge, and external elements. Social determinants such as culture, perception, family, and mental health have been found to impact significantly on the ability of many individuals within the BAME population to effectively engage with obesity and weight loss strategies. A greater understanding of these social determinants is needed if future strategies aimed at addressing the obesity pandemic within this population is to be effective.

ADAMS project: a genetic Association study in individuals from Diverse Ancestral backgrounds with Multiple Sclerosis based in the UK

PurposeGenetic studies of multiple sclerosis (MS) susceptibility and severity have focused on populations of European ancestry. Studying MS genetics in other ancestral groups is necessary to determine the generalisability of...

PO-01-226 RACIAL DIFFERENCES AND SIMILARITIES IN ATRIAL FIBRILLATION EPIDEMIOLOGY, RISK FACTORS, AND MORTALITY IN COMMUNITY-BASED COHORTS: RESULTS FROM THE KOREAN NHIS-HEALS AND UK BIOBANK STUDIES

Atrial fibrillation (AF) is associated with mortality, morbidity, and medical costs. Despite the increasing public health importance of AF, race-specific disease distributions and associations between clinical risk factors and AF have received limited attention. This study aimed to compare established associations between risk factors and AF in white Europeans from the UK Biobank and Asian subjects from the Korean NHIS-HEALS (National Health Insurance Service-Health Screening) study. This study included 402,229 and 484,406 patients without a diagnosis of nonvalvular AF from the Korean NHIS-HEALS cohort and UK Biobank, respectively. The incidence of AF, its associations with mortality, common risk factors, biomarkers, prevalent cardiovascular disease, and their attributable risk by race were examined. The median follow-up time was 11.8 years (interquartile range [IQR] 11.1–12.6) in the UK Biobank and 7.6 years (IQR 7.0–8.2) in the Korean NHIS-HEALS. Fewer AF cases were observed in Korean NHIS-HEALS (N=9182; 2.3%) than in the UK Biobank (N=25312; 5.2%). Cardiovascular risk factors, comorbidities, and glucose levels were associated with an increased risk of new-onset AF in both cohorts, with significant interactions by country for associations with body mass index (BMI), economic status, smoking history, history of heart failure, and cholesterol level. BMI was more strongly related to new-onset AF in UK Biobank [hazard ratio (HR), 1.31; 95% confidence interval (CI), 1.29–1.33] compared to Korean NHIS-HEALS (HR, 1.11; 95% CI, 1.09–1.14), with a relative risk ratio of 1.18 (95% CI, 1.15–1.21). Total cholesterol was inversely associated with incident AF in both cohorts (HR, 0.86; 95% CI, 0.85–0.87 versus 0.91; 95% CI, 0.89–0.93 in Korean NHIS-HEALS), relative risk ratio 0.95 (95% CI, 0.92–0.97). Attributable risk proportion of most classical risk factors were similar in both the studies. In this first large-scale comparison of Caucasian and Asian populations, the cumulative risk of developing AF was higher in the UK than in Korea over most of their lifespan. Higher BMI, smoking, history of heart failure, and lower total cholesterol levels were associated with a higher risk of AF in the UK than in Asians.

What’s cooking? The normalization of meat in YouTube recipe videos consumed by South Asian British Muslims

ABSTRACT Muslim consumers in the UK eat more meat than the national average. Individuals from ethnic minority backgrounds, particularly South Asian communities, experience poorer health outcomes, including diabetes and cardiovascular disease, associated with meat consumption. According to a YouGov survey, British Pakistani and Bangladeshi consumers use television cookery programs and social media (particularly YouTube) as their main digital sources of dietary information. Against this background, this study uses a mixed-method approach to show how meat is normalized in YouTube recipe content. Using quantitative analysis of 77 recent recipe videos presented by four leading British chefs (Jamie Oliver, Gordon Ramsay, Nigella Lawson and Nadiya Hussain) and halal recipe videos, we find that meat-based recipes overwhelmingly outnumber vegetarian/vegan ones, and that, whereas environmental or animal welfare concerns are hardly mentioned, health narratives feature in some videos. Using critical discourse analysis of a sample of videos, we show how meat consumption is rationalized by the “absenting” of meat’s animal origins (making it “normal”), the “defaultization” of meat (making it “natural” and “necessary”), and “positive emotional routines” (making it “nice” and “necessary”). We consider how these representations of meat serve to overcome the “meat paradox” and legitimize, and thereby normalize, meat consumption among British Muslims.

Barriers to colonoscopy in UK colorectal cancer screening programmes: Qualitative interviews with ethnic minority groups.

People from ethnic minority backgrounds are less likely to attend colonoscopy, following faecal immunochemical test screening, and are more likely to be diagnosed with colorectal cancer at an advanced stage as a result. The aim of this research was to explore the barriers and facilitators to attending colonoscopy, perceived by ethnic minority groups living in the United Kingdom. Semi-structured online and telephone interviews were conducted with thirty men and women of Black-African (n=5), Black-Caribbean (n=5), South Asian (n=10) and White British (n=10) descent. Participants were eligible for screening, but had not necessarily been invited for colonoscopy. All interviews were conducted in the participant's first language and were assessed using Framework-analysis, in line with a conceptual framework developed from previous interviews with healthcare professionals. Five thematic groups of barriers and facilitators were developed: 'Locus of control', 'Cultural attitudes and beliefs', 'Individual beliefs, knowledge and personal experiences with colonoscopy and cancer', 'Reliance on family and friends' and 'Health concerns'. Differences were observed, between ethnic groups, for: 'Locus of control', 'Cultural attitudes and beliefs' and 'Reliance on family and friends'. Black and South Asian participants frequently described the decision to attend colonoscopy as lying with 'God' (Muslims, specifically), 'the doctor', or 'family' (Locus of control). Black and South Asian participants also reported relying on friends and family for 'language, transport and emotional support' (Reliance on family and friends). Black-African participants, specifically, described cancer as 'socially taboo' (Cultural attitudes and beliefs). The results highlight several targets for culturally-tailored interventions to make colonoscopy more equitable.

Happily Ever After or Not? Marital Quality among Culturally Diverse Older-Aged Canadian Parents

The quality of partnered relationships is integral to individual and family health and well-being over the life span. Significant shifts in ethno-cultural diversity, parental roles, and family life contribute to more complex partnership experiences in North American society. Drawing from a socio-cultural life course lens, we examine parental marital satisfaction/quality in later life in terms of ethnicity, socio-demographic variables (e.g., ethnic identity, gender, age, health status) and family context (e.g., presence of children at home, intergenerational relations, retirement status). Data are drawn from a sample of 454 married/partnered adults aged 50+ with a least one child aged 19–35 who reside in Metro Vancouver, British Columbia, from four cultural groups: British, Chinese, Persian/Iranian, and South Asian. Using Ordinary Linear Regression, we model predictors of three dependent variables: global marital satisfaction and two sub-scales, including positive and negative emotional/cognitive appraisals of relationship quality. Several ethnic group contrasts were supported, with Chinese reporting lower global marital satisfaction than the South Asians and Persian/Iranians reporting lower levels of positive marital appraisals than the South Asians. In addition, these associations were nuanced by interactions between ethnicity and gender, revealing distinct relationships with the dependent variables. Results also support associations for several covariates. In particular, greater income satisfaction and those reporting lower conflict with their children had higher marital quality; and males and those reporting better health only had positive associations with the global marital satisfaction scale. Implications for theorizing relationship quality in later life and recommendations for those who work with culturally diverse older adults (e.g., mental health care professionals, community service providers) are discussed.

Public service media and race relations in postcolonial Britain: BBC and immigrant programming, 1965–1988

This article explores how British Asians negotiated the politics of race in the formative years of British broadcasting from the 1960s to the 1980s. Marked by significant changes within the BBC and British society at large, this period saw the first institutional initiatives oriented towards Caribbean and Asian communities. Drawing on primary research materials from the BBC Written Archives, we analyse the Immigrant Programmes Unit and the Immigrant Programme Advisory Committees as sites where ideas of race, ethnicity and citizenship were continually debated and worked out. We argue that the BBC functioned as a profoundly asymmetrical contact zone in which British Asians’ efforts to counter assimilationist ideas and programmes were stymied by senior managers working with deeply ingrained ideas of cultural, ethnic and racial differences. Immigrants would be accommodated, but in ways that would not challenge the viewing habits of the majority or imagine solidarities across racial, ethnic and national lines.

European Cancer Summit 2022 submission for Special Network: Impact of the Covid-19 Pandemic on CancerImpact of the COVID-19 Pandemic on Cancer Surgery and Cancer Mortality in England

BackgroundDuring the pandemic there has been an impact on the number of patients entering the cancer pathway, because of changes in patients presenting and GP referral behaviours. The aim was to understand whether different groups in our society have been disproportionately affected by the pandemic in terms of the care they have received for their cancer. MethodsThe study looked specifically at elective admissions from the Hospital Episode Statistics data for all cancers combined and separately for breast, bowel, lung, and prostate cancers to investigate the number of patients admitted for cancer surgery over time. The ONS Mortality Dataset was used to investigate the place of death for patients who had died from cancer.Mortality rates were calculated to identify whether there was a rise in in-hospital mortality during the pandemic. Deaths were defined as an in-hospital death for a patient admitted with a primary diagnosis of cancer. Age-standardised mortality rates were created across the last five years, broken down by cancer type, sex and deprivation quintile. ResultsThe analysis shows a decrease in patients undergoing surgery at the start of the pandemic for all demographic groups. At the start of the pandemic, the largest decreases for all cancers combined by ethnicity could be seen in White (42.6%) and Asian or Asian British (44.6%). While by age, the largest decrease was seen in women aged 40-49.For lung cancer surgery, there were differences by deprivation quintile during the recovery period, showing a 42.0% increase in the least deprived compared to a 27.6% increase in the most deprived. However, changes at the beginning of the pandemic were similar across all quintiles.Age standardised mortality rates showed an increase in in-hospital deaths following the start of the pandemic. ConclusionsWhile we know that there are inequalities in access to cancer surgery, particularly by age, for the most part, the results of our analysis indicate that the recovery period of the COVID-19 pandemic has not exacerbated these inequalities. However, it is difficult to understand the extent to which any variation in access to cancer services is unwarranted.

Relationship of Estradiol and Progesterone with Partnership and Parity Among Bangladeshi and British Women of European Origin.

Recent studies in social endocrinology have explored the effects of social relationships on female reproductive steroid hormones-estradiol and progesterone-investigating whether they are suppressed in partnered and parous women. Results have been mixed for these hormones although evidence is more consistent that partnered women and women with young children have lower levels of testosterone. These studies were sequential to earlier research on men, based on Wingfield's Challenge Hypothesis, which showed that men in committed relationships, or with young children, have lower levels of testosterone than unpartnered men or men with older or no children. The study described here explored associations between estradiol and progesterone with partnership and parity among women from two different ethnicities: South Asian and white British. We hypothesized that both steroid hormones would be lower among partnered and/or parous women with children ≤3 years old, regardless of ethnicity. In this study we analyzed data from 320 Bangladeshi and British women of European origin aged 18 to 50 who participated in two previous studies of reproductive ecology and health. Levels of estradiol and progesterone were assayed using saliva and/or serum samples and the body mass index calculated from anthropometric data. Questionnaires provided other covariates. Multiple linear regressions were used to analyze the data. The hypotheses were not supported. We argue here that, unlike links between testosterone and male social relationships, theoretical foundations for such relationships with female reproductive steroid hormones are lacking, especially given the primary role of these steroids in regulating female reproductive function. Further longitudinal studies are needed to explore the bases of independent relationships between social factors and female reproductive steroid hormones.