Health Disparities In Populations Research Articles

FACTOR STRUCTURE OF THE BRIEF PAIN INVENTORY–SHORT FORM IN AFRICAN AMERICAN OLDER ADULTS WITH OSTEOARTHRITIS

Abstract The Brief Pain Inventory-Short Form (BPI-SF) is a widely used questionnaire designed to assess aspects of cancer pain, such as pain intensity and pain interference. Psychometric properties have rarely been evaluated in other pain conditions such as osteoarthritis. Osteoarthritis is a major contributor to pain and physical disability in African Americans (AA) older adults. Thus, it is important to evaluate the psychometric properties of BPI-SF in this health disparity population. Participants were AA aged 50-94 years with self-reported osteoarthritis. The final convenience sample (N=110) completed surveys including a demographics questionnaire and the validated BPI-SF. Confirmatory Factor Analysis (CFA) was used to evaluate the factor structure. Measurement invariance across two age groups [i.e., young-old (50-69); old-old (70-94)] was examined. CFA revealed that a three-factor model (i.e., pain intensity, activity interference, and affective interference) demonstrated the best fit (χ2/df=1.595, CFI=0.949, RMSEA=0.074) to the data. AAs reported pain intensity (M=4.58, SD=2.01), affective interference (M=3.03, SD=2.54), and activity interference (M=4.19, SD=3.25). The change of CFI between configural and metric invariance is below the cutoff point of .01, supporting the full metric (i.e., factor loadings) invariance across two age groups. However, the full scalar (i.e., items intercepts) invariance was not established. The results support a three-factor structure of BPI-SF that is invariance across two age groups at the full metric level. This suggests that the BPI-SF is an appropriate measure to characterize chronic pain intensity, affective interference, and activity interference for older AAs with osteoarthritis.

Effects of Episodic Food Insecurity on Psychological and Physiological Responses in African American Women With Obesity (RESPONSES): Protocol for a Longitudinal Observational Cohort Study.

Food insecurity is a risk factor for multiple chronic diseases, including obesity. Importantly, both food insecurity and obesity are more prevalent in African American women than in other groups. Furthermore, food insecurity is considered a cyclic phenomenon, with episodes of food adequacy (ie, enough food to eat) and food shortage (ie, not enough food to eat). More research is needed to better understand why food insecurity is linked to obesity, including acknowledging the episodic nature of food insecurity as a stressor and identifying underlying mechanisms. The objective of this study is to investigate the episodic nature of food insecurity as a stressor via responses in body weight and psychological and physiological parameters longitudinally and do so in a health-disparate population-African American women. We enrolled 60 African American women (food-insecure cohort: n=30, 50%; food-secure cohort: n=30, 50%) aged 18-65 years with obesity (BMI 30-50 kg/m2) to measure (1) daily body weight remotely over 22 weeks and (2) psychological and physiological parameters via clinic assessments at the beginning and end of the 22-week study. Furthermore, we are assessing episodes of food insecurity, stress, hedonic eating, and appetite on a weekly basis. We hypothesize that food-insecure African American women with obesity will demonstrate increased body weight and changes in psychological and physiological end points, whereas food-secure African American women with obesity will not. We are also examining associations between changes in psychological and physiological parameters and changes in body weight and performing a mediation analysis on the psychological parameters assessed at the study midpoint. Psychological questionnaires are used to assess stress; executive function, decision-making, and motivation; and affect and nonhomeostatic eating. Physiological measurements are used to evaluate the levels of cortisol, dehydroepiandrosterone-sulfate (DHEA-S), C-reactive protein, thyroid hormones, blood glucose, glycated hemoglobin, and insulin, as well as allostatic load. This study has completed participant recruitment (n=60). At the time of study enrollment, the mean age of the participants was almost 47 (SD 10.8) years, and they had a mean BMI of 39.6 (SD 5.31) kg/m2. All data are anticipated to be collected by the end of 2023. We believe that this is the first study to examine changes in body weight and psychological and physiological factors in food-insecure African American women with obesity. This study has significant public health implications because it addresses the cyclic nature of food insecurity to identify underlying mechanisms that can be targeted to mitigate the adverse relationship between food insecurity and obesity and reduce health disparities in minority populations. ClinicalTrials.gov NCT05076487; https://clinicaltrials.gov/study/NCT05076487. DERR1-10.2196/52193.

Influences of Faith on Rural Appalachian Older Adult Health: An Ethnonursing Study.

Rural Appalachian older adults (RAOAs) constitute a vulnerable population and experience significant health disparities. The combination of age, poverty, rural residence, health care provider shortages, and limited transportation increases risks for poor health outcomes. Spirituality enhances older adult health; however, little is known about spirituality-health linkages of RAOAs. Therefore, the purpose of this study was to discover the influences of spirituality on RAOA health. Culture Care Theory and ethnonursing method guided analysis of 32 RAOA interviews in community settings in East Tennessee. "Faith" is an integral component of RAOA culture and health. Three themes were extrapolated: (a) Relationship with God is personal; (b) faith beliefs and practices influence health, illness, death, and dying; and [the need to] (c) "Open the door" for spiritual care. Faith assessment and spiritual care recommendations contribute to culturally congruent care for RAOAs and may be transferable to care for other older adults.

Abstract C002: Integrating multiomics data to identify African ancestry-informative markers acting as eQTLs in breast cancer

Abstract Ancestry-informative markers (AIMs) are SNPs that are found at relatively higher frequencies in a specific population and can be used to estimate genetic ancestry. Genetic ancestry is becoming more commonly used in biomedical research investigating the genetic basis of diseases. For many cancers, the literature suggests that African ancestry is associated with poor response to treatment, poorer prognosis, and poorer survival. More specifically, African American women with breast cancer are more likely to have more aggressive subtypes of the disease and diagnosed with a later stage of the disease at an earlier age compared to their European American counterparts. Some of this disparity remains after accounting for socioeconomic factors, suggesting a genetic basis for the health disparities observed in many cancers. To evaluate the genetic basis of cancer health disparities in populations of African ancestry, we identified a set of 46,787 African ancestry informative markers (AIMs) using 1000 Genomes Project data from African and European populations. These AIMs were functionally annotated and investigated for potential associations with cancer in the literature, using tools such as VEP, SIFT, and Polyphen. Using multiomics data (RNAseq, genotype, methylation, copy number variation) from The Cancer Genome Atlas and an integrative eQTL modeling approach, we are investigating which of these AIMs act as expression quantitative trait loci in breast cancer. Of the 47K SNPs identified, 0.6% percent was found to be in the coding regions of the genome and AIMS located on chromosomes 8, 10, 11, 15, 18, and 19 were found to be associated with different cancers in the literature including breast and colorectal cancers. Approximately 5K of the AIMs were found in the TCGA breast cancer data and preliminary results identified cis-eqtls in 4 different genes including SERINC2 and ZSCAN23, and trans-eqtls in about 8 genes including CLCN3 and DEDD. These eQTL AIMs are being evaluated for potential association with ancestry-specific differential survival and response to treatment in breast cancer. Citation Format: Samantha Boudeau. Integrating multiomics data to identify African ancestry-informative markers acting as eQTLs in breast cancer [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr C002.

Abstract B148: Colorectal cancer screening uptake and test use for individuals with diabetes in the U.S.: Implications for health equity

Abstract Purpose: Individuals with diabetes mellitus have an estimated 27% elevated risk of developing colorectal cancer (CRC) and are disproportionately from health disparities populations. This study examined associations of race and ethnicity and CRC screening uptake and CRC test type used among individuals with diabetes to identify factors to consider in targeting CRC screening efforts to promote health equity. Methods: Merged Medical Expenditures Panel Survey Household Component (2012-2018) and National Health Interview Survey data sets were used to identify individuals with diabetes (non-Hispanic White (NHW) n=223,046; Hispanic n=54,791; Non-Hispanic Black (NHB) n=54,791). The main outcomes were self-reported up-to-date CRC screening based on United States Preventive Services Taskforce guidelines and screening test used (i.e., blood-stool test or direct visualization). The main independent variable of interest was race and ethnicity. Logistic regression models included socio-demographic and health-related co-variates. Results: Among individuals with diabetes 62.6% reported being up-to-date (UTD) with CRC screening, among the screened 5.8% used blood stool tests only and 56.8% used direct visualization tests. In the final logistic model comparing relative risk of UTD screening to being unscreened, NHBs were more likely to be UTD for CRC screening [RR: 1.3, 95% CI: 1.13-1.53, p=0.001] compared to NHWs. Individuals with no high school degree [RR: 0.8, 95% CI: 0.65-0.99, p=0.3] were less likely to be UTD compared to college educated individuals. Individuals receiving recommended diabetes care were less likely to be unscreened [RR: 0.84, 95% CI: 0.76-0.94, p=0.002]. Among screened individuals, race and ethnicity were insignificant in final models. Low-income individuals were less likely to be screened with direct visualization [RR: 0.73, 95% CI: 0.55-0.97, p=0.03] compared to high-income individuals. Overweight individuals (BMI 26-29) were less likely to be screened with direct visualization [RR:0.75, 95% CI:0.57-0.99, p=0.41] compared to individuals with BMI ≤25. Individuals with five or more comorbidities were more likely to be screened using direct visualization [RR: 3.45, 95% CI: 1.86, 6.43, p<0.001] compared to individuals with 1-2 comorbidities. Conclusions: Among individuals with diabetes, social determinants and health factors associated with UTD and testing type differed. Race, education, and diabetes care quality were determinants of receipt of any UTD CRC testing. Among those screened, lower income and overweight individuals were more likely to use stool-based testing and those with greater comorbidity burdens were more likely to be screened with direct visualization. Efforts to improve CRC screening for patients with diabetes, specifically those in the primary care safety-net, should consider these factors when tailoring CRC prevention and early detection efforts. Citation Format: Denalee M. O'Malley, Pamela Ohman-Strickland, Tracy Andrews, Cilgy Abraham, Benjamin F. Crabtree, Shawna V. Hudson, Anita Y. Kinney. Colorectal cancer screening uptake and test use for individuals with diabetes in the U.S.: Implications for health equity [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr B148.

Examining the Interactive Effect of Cardiovascular Risk Factors and APOE Genotype on Population Health Disparities in dementia risk

AbstractBackgroundThere is a need to better understand the role of modifiable risk factors in the development of racial/ethnic health disparities in Alzheimer’s disease (AD). In particular, research is lacking on how clinical risk scores may interact with genetic liability for dementia in diverse populations. Here, we examined the influence of the Cardiovascular Risk Factors, Aging, and Incidence of Dementia Risk Score (CAIDE) and APOE genotype on MCI/Dementia risk in non‐Latinx White (NLW), Black, and Latinx populations.MethodParticipants were from the National Alzheimer’s Coordinating Center Uniform Dataset who self‐reported as NLW (n = 15,296), Black (n = 2,136), or Latinx (n = 955) who were either cognitively normal or had a clinical diagnosis of MCI/Dementia at baseline (Table 1). CAIDE is comprised of age, gender, years of education, hypertension, obesity, and hypercholesteremia with scores ranging from 0‐14. Logistic regression models stratified by race/ethnicity were used to examine the association between CAIDE, APOE genotype, or their combination (9 categories combining favorable, intermediate, and unfavorable CAIDE scores with APOE e3/e3, e2+, and e4+) on MCI/dementia (Fig. 1‐2). Population differences were determined using Fisher’s z‐score method.ResultsAPOE e2+ was associated with reduced odds of MCI/dementia in NLW participants, while APOE e4+ was associated with increased risk in Latinx, Black, and NLW participants. Higher CAIDE scores were associated with increased risk of MCI/dementia in Latinx and NLW but were non‐significant in Black participants. The association of CAIDE on MCI/dementia in Black participants was significantly different from that in NLW and Latinx participants. Similarly, the effect of APOE e4+ on the risk of MCI/dementia was weaker in Latinx compared to NLW participants. In NLW, increasingly unfavorable modifiable risk profiles attenuated the protective effect of APOE e2+ and accentuated the deleterious impact of APOE e4+ on MCI/dementia. In Black participants, modifiable risk factors did not significantly affect the relationship between APOE genotype and MCI/dementia; in Latinx participants, there was only a moderate effect.ConclusionThe risk associated with APOE on MCI/Dementia is moderated by modifiable risk factors with suggestive population‐specific effects. Addressing health disparities will require risk scores that combine clinical, genetic, and social determinants of health and are applicable across diverse populations.

Primary Care Detection of Cognitive Impairment Leveraging Health & Consumer Technologies in Underserved Communities: The MyCog Strategy

AbstractBackgroundEarly identification of cognitive impairment (CI), including Alzheimer’s disease and related dementias (ADRD), is a top public health priority. Yet in primary care settings that manage the health of most community‐dwelling older adults, less than half of patients with any CI are detected and/or diagnosed. Among community health centers that serve marginalized patients, rates of detection may be far lower. To address this, we sought to test a primary care‐based strategy (‘MyCog’) to improve CI detection as part of an NIH‐sponsored consortium (DetectCID).MethodThe MyCog strategy includes a brief iPad‐based, self‐administered, electronic health record (EHR)‐linked cognitive assessment that leverages two well validated measures from the NIH Toolbox Cognition Battery and has easily interpretable results with ‘turnkey’ recommendations to enhance clinical decision making. Clinician and practice administrator feedback was sought via cognitive interviews and focus groups to ensure the assessment could properly function in typical workflows. Based on this feedback a self‐administered tool was built, with a simple interpretable result (yes or no, cognitive impairment detected). It was then validated in one academic geriatrics practice among 111 older adults.ResultThe refined self‐administered tool was further validated in a geriatric clinical population, with interviewer and self‐administered MyCog versions strongly correlated (Spearman r = 0.75) and similar average response time per trial (0.914 sec. vs. 0.958 sec.). Use of the two tests demonstrated acceptable AUC values separately for detecting CI (0.84 and 0.79, respectively). But combined, these measures provide incremental diagnostic utility (AUC = 0.95).ConclusionWe will launch the MyCog Trial at 24 practices from a national network of primary care centers for older adults on Medicare that will be randomized to MyCog or usual care. Clinics receiving MyCog will utilize a protocol to implement the intervention during Medicare Annual Wellness Visits and whenever a cognitive concern is expressed. Findings from the DetectCID consortium and MyCog Trial will directly inform future standards in primary care settings, especially those that serve health disparate patient populations.

Abstract C065: Developing and sustaining an NCI U54 CPACHE partnership

Abstract Purpose: The South Carolina Cancer Disparities Research Center (SC CADRE) is a mature and vibrant multi-institutional Comprehensive Partnership to Advance Cancer Health Equity (CPACHE) enterprise between South Carolina State University (SCSU), an institution serving underserved health disparity populations and underrepresented students (ISUPS) and the Medical University of South Carolina-Hollings Cancer Center (MUSC-HCC), an NCI-designated Cancer Center. Methods: The SC CADRE was built on a foundational relationship that began in 2009, including three consecutive inter-institutional Department of Defense Summer Undergraduate Prostate Cancer Research Training grants and an NCI CPACHE P20 grant. Awarded in 2017, the inaugural U54 SC CADRE had four main goals: 1) further elucidating the biological and social contributors to cancer disparities; 2) enhancing the pipeline of diverse cancer researchers; 3) increasing the number of NIH research proposals led by SCSU faculty as independent investigators; and 4) including greater community engagement in cancer research. Results: Since 2017, the U54 partnership has produced 77 peer-reviewed publications (8 included inter-institutional co-authors) and, not counting the SC CADRE research project awards, 33 grants have been funded (9 were awarded to SCSU investigators as PIs or MPIs), and a national virtual cancer health equity symposium was established. Four ESIs were hired (three at SCSU). An inaugural Biorepository was created at SCSU. Cancer research education was provided for 640 undergraduate students at SCSU, including 22 SC CADRE Scholars. The SC CADRE team members serve as Advisory Board members of South Carolina’s statewide cancer control consortium, the South Carolina Department of Health and Environmental Control, ISUPS and other colleges/universities in South Carolina, and statewide faith-based, professional, and civic organizations. These combined efforts have led to an overall 30% representation of diverse participants in the MUSC-HCC’s cancer clinical trial accruals. Conclusions: While much work remains, mammography and colorectal cancer screening rates, and HPV vaccination rates, are now higher in South Carolina than in the US. The longstanding academic partnership between SCSU and MUSC-HCC, leveraging each entity’s research and educational strengths and community relationships, has positioned the SC CADRE to transform cancer health outcomes in South Carolina and beyond. Citation Format: Marvella E. Ford, Tammy Loucks, James Stukes, Cammie Berry, Joni Nelson, Kathleen Cartmell, Audrey McCrary-Quarles, Amy Martin, Joseph Tahsoh, Alexander Alekseyenko, Janae Sweeney, Steven Carroll, Debra McAlister, Ellen Gomez, Yaoling Long, David P. Turner, Judith D. Salley. Developing and sustaining an NCI U54 CPACHE partnership [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr C065.

Exploratory analysis of medication adherence and social determinants of health among older adults with diabetes

BackgroundDiabetes is the fifth leading cause of death in the United States (US), affecting approximately 27%, or 15.9 million adults 65 years of age and older. Diabetes is the most expensive chronic condition in the US and accounts for the second largest avoidable healthcare cost. Adherence to long-term medication treatment plans is crucial among patients with diabetes because it decreases risk of developing comorbid conditions and improves quality of life. Greater exposure to adverse social determinants of health (SDOH) over an individual's lifespan can result in worse health outcomes. Hence, it is important to obtain a better understanding of how social determinants of health (SDOH) influence patients' behaviors and affect medication adherence among older adults with diabetes. ObjectivesIdentify and prioritize SDOH associated with medication adherence among a nationally representative sample of older adults with diabetes. Secondary objectives were to characterize SDOH, estimate medication adherence, and explain implications for health disparity populations among older adults in the US who have been diagnosed with diabetes. MethodsThis study used a cross-sectional secondary data analysis to examine the National Health and Nutrition Examination Survey database, identifying associations between SDOH and medication adherence among older adults with diabetes in the US. ResultsA total of 1807 respondents' data were included in the analyses. Nearly three-quarters (73.9%) of patients were considered adherent to their oral diabetes medications. Multivariable analysis revealed significant differences in medication adherence based on disability status (p = 0.016), household balanced meals (p = 0.033), and interview language (p = 0.008). ConclusionsResults revealed those with a disability, those who could not afford a balanced meal, and/or those who spoke English were associated with a higher likelihood of being nonadherent to their diabetes medications in comparison to individuals not in these groups. These findings can assist in developing SDOH-centered medication adherence strategies for pharmacists to implement with older patients with diabetes.

Care Delivery in Community Health Centers Before, During, and After the COVID-19 Pandemic (2019-2022).

Health centers provide primary and behavioral health care to the nation's safety net population. Many health centers served on the frontlines of the COVID-19 pandemic, which brought major changes to health center care delivery. To elucidate primary care and behavioral health service delivery patterns in health centers before and during the COVID-19 public health emergency (PHE). We compared annual and monthly patients from 2019 to 2022 for new and established patients by visit type (primary care, behavioral health) and encounter visits by modality (in-person, telehealth) across 218 health centers in 13 states. There were 1581,744 unique patients in the sample, most from health disparate populations. Review of primary care data over 4 years show that health centers served fewer pediatric patients over time, while retaining the capacity to provide to patients 65+. Monthly data on encounters highlights that the initial shift in March/April 2020 to telehealth was not sustained and that in-person visits rose steadily after November/December 2020 to return as the predominant care delivery mode. With regards to behavioral health, health centers continued to provide care to established patients throughout the PHE, while serving fewer new patients over time. In contrast to primary care, after initial uptake of telehealth in March/April 2020, telehealth encounters remained the predominant care delivery mode through 2022. Four years of data demonstrate how COVID-19 impacted delivery of primary care and behavioral health care for patients, highlighting gaps in pediatric care delivery and trends in telehealth over time.

Psychological Consequences of Chronic Ethnic Discrimination in Male Turkish Immigrants Living in Austria: A 30-Day Ambulatory Assessment Study.

Chronic ethnic discrimination may be associated with negative psychological consequences in ethnic minority groups. However, little is known about the impact of acute discriminatory events on people who experience chronic ethnic discrimination. We examined the impact of chronic and acute ethnic discrimination on the daily lives of Turkish immigrants in Austria, a population often overlooked in discrimination research. Ninety male Turkish immigrants living in Austria (60 experiencing chronic and 30 infrequent ethnic discrimination) reported discriminatory events in real time for 30 days. Additionally, subjective stress, reactivity to daily hassles, affect, and maladaptive coping were assessed daily. Participants experiencing chronic ethnic discrimination indicated higher daily values for stress, negative affect, reactivity to daily hassles, and anticipation and avoidance coping. Negative psychological states increased for all participants on days when discriminatory events occurred, but participants with chronic ethnic discrimination showed significantly stronger increases in maladaptive coping and reactivity to daily hassles, with the latter effect persisting until the next day. Our study is the first to demonstrate interaction effects of chronic and acute ethnic discrimination on psychological factors in daily life. The results may advance the understanding of the mechanisms that lead to health disparities in ethnic minority populations and may inform the development of targeted interventions.

Health disparities in ethnic and racial minority populations with pain and opioid use disorder.

Healthcare providers are not prepared to address health disparities among ethnic and racial minority populations with either persistent and chronic pain or substance use disorder (SUD). Recognizing biases from policies to provide pain management and treatment for SUD in our healthcare systems, from our individual state laws and federal guidelines, is necessary. Biases are embedded in the screening and treatment of patients with chronic pain through the use of screening tools, opioid treatment agreements, and prescription drug monitoring programs. Additionally, the punitive treatment of people of ethnic and racial minority populations who experience persistent and chronic pain, opioid use disorders, or other SUDs needs to be redirected to facilitate solutions rooted in equity.

Optimizing a Technology-Based Body and Mind Intervention to Prevent Falls and Reduce Health Disparities in Low-Income Populations: Protocol for a Clustered Randomized Controlled Trial.

The lack of health care coverage, low education, low motivation, and inconvenience remain barriers to participating in fall prevention programs, especially among low-income older adults. Low-income status also contributes to negative aging self-perceptions and is associated with a high perceived barrier to care. Existing fall prevention intervention technologies do not enable participants and practitioners to interact and collaborate, even with technologies that bring viable strategies to maintain independence, prevent disability, and increase access to quality care. Research is also limited on the use of technology to enhance motivation and help individuals align their perception with physiological fall risk. We developed a novel, 8-week Physio-Feedback Exercise Program (PEER), which includes (1) technology-based physio-feedback using a real-time portable innovative technology-the BTrackS Balance Tracking System, which is reliable and affordable, allows for home testing, and provides feedback and tracks balance progression; (2) cognitive reframing using the fall risk appraisal matrix; and (3) peer-led exercises focusing on balance, strength training, and incorporating exercises into daily activities. This study consists of 3 aims. Aim 1 is to examine the effects of the technology-based PEER intervention on fall risk, dynamic balance, and accelerometer-based physical activity (PA). Aim 2 is to examine the effects of the PEER intervention on fall risk appraisal shifting and negative self-perceptions of aging. Aim 3 is to explore participants' experiences with the PEER intervention and potential barriers to accessing and adopting the technology-based PEER intervention to inform future research. This is an intention-to-treat, single-blinded, parallel, 2-arm clustered randomized controlled trial study. We will collect data from 340 low-income older adults at baseline (T1) and measure outcomes after program completion (T2) and follow-up at 3 months (T3) and 6 months (T4). Participants will be enrolled if they meet all the following inclusion criteria: aged ≥60 years, cognitively intact, and able to stand without assistance. Exclusion criteria were as follows: a medical condition precluding exercise or PA, currently receiving treatment from a rehabilitation facility, plan to move within 1 year, hospitalized >3 times in the past 12 months, and does not speak English or Spanish. As of August 2023, the enrollment of participants is ongoing. This study addresses the public health problem by optimizing a customized, technology-driven approach that can operate in low-resource environments with unlimited users to prevent falls and reduce health disparities in low-income older adults. The PEER is a novel intervention that combines concepts of physio-feedback, cognitive reframing, and peer-led exercise by motivating a shift in self-estimation of fall risk to align with physiological fall risk to improve balance, PA, and negative aging self-perception. ClinicalTrials.gov NCT05778604; https://www.clinicaltrials.gov/ct2/show/study/NCT05778604. DERR1-10.2196/51899.

Primary care detection of cognitive impairment leveraging health and consumer technologies in underserved US communities: protocol for a pragmatic randomised controlled trial of the MyCog paradigm

IntroductionEarly identification of cognitive impairment (CI), including Alzheimer’s disease and related dementias (ADRD), is a top public health priority. Yet, CI/ADRD is often undetected and underdiagnosed within primary care settings,...

The National Cancer Institute's Cancer Disparities Research Partnership Program: a unique funding model 20 years later.

The burden of cancer and access to effective treatment are not experienced equally by all in the United States. For underserved populations that often access the health-care system when their cancers are in advanced disease stages, radiation oncology services are essential. In 2001, the National Cancer Institute's (NCI's) Radiation Research Program created and implemented the Cancer Disparities Research Partnership Program (CDRP). CDRP was a pioneering funding model whose goal was to increase participation of medically underserved populations in NCI clinical trials. CDRP's Cooperative Agreement funding supported for awardees the planning, development, and conduct of radiation oncology clinical research in institutions not traditionally involved in NCI-sponsored research and cared for a disproportionate number of medically underserved, health-disparities populations. The awardee secured and provided support for mentorship from 1 of 2 NCI comprehensive cancer centers named in its application. Six CDRP awards were made over two 5-year funding periods ending in 2013, with the end-of-program accomplishments previously reported. With the current focus on addressing equity, diversity, and inclusion, the 6 principal investigators were surveyed, 5 of whom responded about the impact of CDRP on their institutions, communities, and personal career paths. The survey that was emailed included 10 questions on a 5-point Likert scale. It was not possible to collect patient data this long after completion of the program. This article provides a 20-year retrospective of the experiences and observations from those principal investigators that can inform those now planning, building, and implementing equity, diversity, and inclusion programs.

Sleeping Healthy, Living Healthy: Using Iterative, Participatory Processes to Develop and Adapt an Integrated Sleep Hygiene/Mind-Body Integrative Health Intervention for Urban Adolescents.

Racial and ethnic minority adolescents living in urban settings experience sleep disparities. Few interventions have been developed to address these disparities. Guided by principles of participatory design and inclusion, our team developed a novel intervention that combined sleep hygiene education with mind-body integrative health (MBIH) practices to improve sleep quality among adolescents in New York City. The goal of this article is to describe our iterative development and design process, the final product, and future directions. Our participatory approach incorporated information from formative work with adolescents having lived experience, practitioners, and syntheses of published literature. The final intervention-Sleeping Healthy, Living Healthy-consists of six, 40-minute group sessions and one 20-minute individual session designed for high school students. Each session has a set of learning objectives, combining instruction, group activities, and discussions on sleep hygiene and MBIH topics. Our manualized intervention includes handouts created by a graphic design team that served as a review and reminder for home practice. We describe intervention implementation to two unique cohorts and detail our methods used to fine-tune the intervention between cohorts. Our partnership with and insights from both adolescents and practitioners serve as a guide for researchers aiming to use participatory methods to develop interventions to decrease health disparities in specific populations.

Addressing Oral Health Disparities of a Tribal Population Through a Combined Implementation of Focus Group Discussion, Mobile Technology Networking, and Creating a Supportive Environment: A Prospective Study.

Oral health disparities generally existamong tribal populations, prompting creative solutions to tackle these challenges. By using a combinedimplementation strategy ofincluding focus group discussion (FGD), mobile technology networking (MTN), and creating a supportive environment, this study aims to assess and bring positive changes in oral health in these populations. The current study employed a mixed-method approach on a sample of 100 tribal volunteers.Qualitative assessment included FGD conducted regularly for three months based on themes such as oral hygiene habits, access to oral health, technology in oral health, the relationship of oral health to general health, and the role of diet in oral health. Quantitative evaluation included recording of the oral hygiene index-simplified and gingival index to measure gingival status. Messages on oral health were routinely posted to mobile phones to reinforce oral health education. Appropriate use of indigenous oral hygiene aids (neem and datun) was also taught during the discussion session. Clinical examinations were compared before and after FGD. Data were analyzed using IBMSPSSStatistics for Windows, Version 25 (Released 2017; IBM Corp., Armonk, New York, United States). A paired 't' test was used to find significant differences in gingival status at p<0.05. The FGD sessions deduced observations such as limited access to dental care, inadequate oral hygiene practices such as usage of neem sticks and twigs, and lack of oral health awareness. The implementation of MTN facilitated the dissemination of oral health information and enhanced communication between community members and healthcare providers. The gingival index score significantly improved from pre-FGD to post-FGD with a mean difference of 0.41700 significant at p=0.000. Oral hygiene of the target population shifted from "Fair" oral hygiene status to "Good" oral hygiene status. The combined implementation of FGD, MTN, and creation of a supportive environment demonstrated promising results in addressing oral health disparities among the tribal population. The interventions led to improved gingival status and better utilization of oral hygiene practices. These findings highlight the importance of tailored interventions, community engagement, and mobile technology in addressing oral health disparities in tribal populations. Ongoing support, sustainability, and further research are necessary to ensure the long-term impact and effectiveness of these interventions.

Disparities in the Distribution of Social Programs for Expectant and Parenting Teens (EPTS) in Washington DC - A Review

Background: Although the teen birth rate declined to a low record in 2017 of 18.8 births per 1000 females ages 15-19, compared to other developed countries, it is still high [3,4]. Teen pregnancy can cause emotional, psychological and educational challenges, as well as affect the life and opportunities of young mothers and their children. Access to quality social services, plays an important role in supporting the health and well-being of adolescents and promoting health equity. Some teens face barriers in accessing these services. Geographically, Washington DC has eight wards, with significant disparities in socioeconomic conditions and population health. Aim: The objective of this study is to explore the distribution of community programs for Expectant and Parenting Teens in Washington DC by wards. Materials and Methods: We conducted computerized searches of PubMed, PsycINFO, Sociological Abstracts, CINAHL, and Cochrane Reviews to identify programs in Washington DC that provide services to adolescent parents, published in English from 1990 to December 2022. Search terms include: Washington DC, Ward, Teen parents, Social services, Community program. We identified and compiled locations of social service providers by wards across Washington DC, using findhelp directory (findhelp.org). Results: We identified 34 programs located in the different wards in Washington, District of Columbia. We identified 10 major interventions. These can be categorized into 10 domains of need involving (a) pregnancy and parenting support and services, (b) adoption resources, (c) housing resources for teen parents in foster care, (d) housing resources for teen parents not in foster care, (e) health care resources for young families, (f) education resources, (g) public benefits, (h) childcare resources, (i) early learning resources and (j) resources for fathers. There is a disparity in Program providers and interventions/services by wards in Washington DC.

Biological Embedding of Social Determinants of Health in Early Life and Across Generations

Population health disparities represent one of the most significant public health challenges. These disparities are evident from the earliest stages of life onwards, persist across the life span, are perpetuated across generations, and are strongly influenced by social and environmental factors. Chronic stress and stress-related biobehavioral processes are discussed as one of the major effectors of the causal pathways linking upstream social determinants with health and health disparities. It is evident that the effects of stress exposure can persist over long periods of time, even across the lifespan, and particularly so if exposure occurs during sensitive developmental windows such as the intrauterine period. In this symposium, presenters will address key questions and knowledge gaps regarding biological embedding of social disadvantage and the role of stress in this context, particularly during pregnancy and early life. Tom O’Connor will present data from the ECHO-UPSIDE cohort, a longitudinal pregnancy cohort study of a socio-economically and racially/ethnically diverse sample at elevated psychosocial risk but normal medical risk status. Results indicate that maternal pre-pregnancy adversity in early childhood is associated with prenatal behavioral and physical health markers, including depressive and anxiety symptoms, stress, body mass index (BMI), sleep disturbance, and diet, as well as maternal-fetal-placental biological markers that predict child health outcomes. Laura Scholaske will present results of a multi-site prospective pregnancy study conducted in Germany that includes people of Turkish origin that are among the biggest migrant groups in Germany. Results of the study suggest that pregnant women of Turkish origin exhibit higher psychological stress levels and alterations in stress-related biological systems (i.e., elevated inflammatory levels, blunted cortisol awakening response and flatter diurnal cortisol slope) compared to non-migrant pregnant women. Shannin N. Moody will address the effects of policing inequities that are one of the most harmful sources of systemic racism perpetuated against Black Americans. In three separate studies, she tested how unjust police encounter biologically “get under the skin” in Black youth from infancy to emerging adulthood. Rates of neighborhood stop-and-frisk were associated with shorter telomeres in infants. Children whose mothers experienced unfair treatment from police showed, during the TSST, blunted cortisol stress reactivity, slower cortisol recovery, and altered cortisol-testosterone coupling. Adolescents who experienced police encounters had higher waking cortisol as emerging adults. Taken together, the studies point so some of the potential pathways through which social determinants of health may propagate and transmit persisting health disparities. Elisabeth Shirtcliff will lead a discussion on the potential implications for early prevention and targeted intervention strategies to prevent or reverse biological embedding of social disadvantage in at risk individuals.

Early Life Adversity alters Maternal-Fetal-Placental Biology and may Propagate Population Health Disparities

Research findings dating back decades indicate that prenatal maternal psychological distress can predict poor child health outcomes, with potentially lasting effects. These results have been extensively replicated and have encouraged longitudinal cohort studies to begin before birth; many clinical interventions to promote maternal health in pregnancy are underway. Studies of prenatal maternal distress emphasize in utero effects, likely arising from multiple biological changes. Alternatively, developmental and life history models suggest that prenatal distress likely has pre-pregnancy developmental origins. Studies linking pre-pregnancy adversity to prenatal maternal distress and maternal-fetal-placental biology are underway, but are typically limited in scope. The ECHO-UPSIDE cohort is well-positioned to contribute novel data to this area; it is a prospective pregnancy cohort study of a socio-economically and racially/ethnically diverse sample at elevated psychosocial risk but normal medical risk status (Rochester, NY; n=326). Clinical, socio-demographic, health data and extensive biological samples were collected at each trimester and placentae were collected at birth. Women who experienced higher adversity in early childhood (using Adverse Childhood Experiences [ACE] scale) reported wide-spread differences in prenatal health, with moderate effect sizes (Cohen’s d>.5) for depressive and anxiety symptoms, stress, body mass index (BMI), sleep disturbance, and diet. Higher ACE scores predicted altered (flatter) diurnal cortisol pattern throughout pregnancy (p<.01). There was also limited but significant impact on maternal immune activation from specific immune markers and measures of placenta structure and function. The studies demonstrate potential pathways through which pre-pregnancy adversity may propagate persisting health disparities.