African American Groups Research Articles

Abstract C037: Bile acid modulation of immune cell interactions in the colonic microenvironment

Abstract Colorectal cancer (CRC) is the third most frequent cancer in both women and men, particularly among African Americans (AA). Factors such as ethnicity group, gut microbiota, and Western diet play a significant role in CRC development. However, the impact of ethnicity on the immunological mechanisms involved in CRC is poorly understood. In our study, we collected stool and serum samples from high-risk and low-risk AA and NHW subjects to analyze the fecal bile acid metabolome. We found that certain bile acid isoforms, particularly in allo-bile acids, were significantly reduced in the stool compared to Non-Hispanic White (NHW) females. Clinical mucosal RNA data we generated via the NanoString nCounter platform, revealed in both AA and NHW low-risk female groups, the expression of FoxP3, correlated with immune checkpoints including PDCD1, IDO1, CTLA4 and LAG3 were lowered. Recent findings suggest that allo-bile acids influence the balance between pro-inflammatory TH17 cells and anti-inflammatory Tregs through specific signaling pathways. Based on our data and existing literature, we propose that bacterial-derived allo-bile acids modulate interactions between other myeloid-lineage immune cells, thereby affecting the inflammatory environment of the colon and potentially influencing CRC development. Citation Format: Hanchu Dai, Patricia Wolf, Ece Mutlu, Lisa Tussing-Humphreys, Jason Ridlon, Rex Gaskins. Bile acid modulation of immune cell interactions in the colonic microenvironment [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 C037.

Functional genomic studies in diverse populations to characterize risk loci for Alzheimer Disease

AbstractBackgroundAs part of the ADSP Functional Genomics consortium, we aim to unravel ancestry specific effects of genomic regulation of AD loci. African Americans (AA) and Hispanics (HI) are at higher risk for Alzheimer’s disease (AD) compared to non‐Hispanic whites (NHW). Even though AA, HI and other diverse groups make up 40% of the US population, over 90% of participants in large‐scale genomic research studies have been NHW, representing European (EU) ancestry. Recent AD research including diverse groups has shown that genes and variants contributing to disease can have different risk effect dependent on the ancestral background they reside on (i.e. APOE). Together these clearly indicate a need to expand genome‐wide and gene‐specific analyses of genomic organization and regulation for other ancestries contributing to diverse, admixed populations, such as African (AF) or Amerindian (AI) ancestries.MethodWe analyzed interaction of variants in the APOE region with AD risk in WGS of diverse populations to identify modifiers of the APOEɛ4 risk effect. Additionally, to assess overall differences in chromatin regulation genome‐wide across ancestries, we performed bulk and single cell chromatin accessibility (ATAC‐seq) and bulk chromatin interaction (Hi‐C) assays in brains from admixed individuals with high EU, AF (>95%) or AI (>75%) ancestry contribution.ResultWe identified both close‐by and distant modifier variants (in the downstream PSG gene family region) inferring protection against the APOEɛ4 risk on the AF ancestry. Single cell ATAC‐seq data in brain showed higher accessibility of the APOE region and large regions of chr19 in astrocytes, but not microglia, of EU versus AF ancestry. Lastly, bulk Hi‐C analyses in brain strongly supported the hypothesis of ancestry dependent regulation by genome‐wide detection of differential chromatin interactions comparing EU to AF ancestry.ConclusionOur analyses using complementary functional genomic assay methods show clear differences of genome regulation between EU and AF ancestry. Overall, these data support genome regulation to be strongly influenced by ancestral origin. The generated data on samples with high single ancestral contributions will help elucidate risk effects seen for AD related genes in different population groups, as we describe for the APOE region.

Metabolomic profiles associated with physical activity in White and African American adult men.

Physical activity (PA) is associated with various health benefits, especially in improving chronic health conditions. However, the metabolic changes in host metabolism in response to PA remain unclear, especially in racially/ethnically diverse populations. This study is to assess the metabolic profiles associated with the frequency of PA in White and African American (AA) men. Using the untargeted metabolomics data collected from 698 White and AA participants (mean age: 38.0±8.0, age range: 20-50) from the Louisiana Osteoporosis Study (LOS), we conducted linear regression models to examine metabolites that are associated with PA levels (assessed by self-reported regular exercise frequency levels: 0, 1-2, and ≥3 times per week) in White and AA men, respectively, as well as in the pooled sample. Covariates considered for statistical adjustments included race (only for the pooled sample), age, BMI, waist circumstance, smoking status, and alcohol drinking. Of the 1133 untargeted compounds, we identified 7 metabolites associated with PA levels in the pooled sample after covariate adjustment with a false discovery rate of 0.15. Specifically, compared to participants who did not exercise, those who exercised at a frequency ≥3 times/week showed higher abundances in uracil, orotate, 1-(1-enyl-palmitoyl)-2-oleoyl-GPE (P-16:0/18:1) (GPE), threonate, and glycerate, but lower abundances in salicyluric glucuronide and adenine in the pooled sample. However, in Whites, salicyluric glucuronide and orotate were not significant. Adenine, GPE, and threonate were not significant in AAs. In addition, the seven metabolites were not significantly different between participants who exercised ≥3 times/week and 1-2 times/week, nor significantly different between participants with 1-2 times/week and 0/week in the pooled sample and respective White and AA groups. Metabolite responses to PA are dose sensitive and may differ between White and AA populations. The identified metabolites may help advance our knowledge of guiding precision PA interventions. Studies with rigorous study designs are warranted to elucidate the relationship between PA and metabolites.

Abstract 13609: Racial Disparities and In-Hospital Outcomes of Atrial Fibrillation Ablations in Hypertrophic Cardiomyopathy: A 5-year Nationwide Inpatient Sample Analysis

Introduction: Atrial fibrillation (AF) is a common supraventricular arrhythmia observed in patients with hypertrophic cardiomyopathy (HCM). However, there is a dearth of data regarding racial disparities and in-hospital outcomes specifically among HCM patients undergoing AF ablation. Methods: National Inpatient Sample database from 2016 to 2020 was queried for patients with HCM undergoing AF ablation using appropriate diagnostic and procedural ICD codes. These were further divided into African American (AA) and non-African American (non-AA) groups. Logistic regression was used to compare baseline characteristics and in-hospital outcomes. Results: A total of 610 HCM patients underwent AF ablation between 2016-2020. Out of these, 45 (7.4%) were AA. Compared to non-AA patients, AA patients undergoing AF ablation were younger (mean age: 61-vs-64 years), more often female (56%-vs-54%, p=0.28) and had a higher burden of comorbidities (Table 1). AA patients had lower length of stay (4.1-vs-4.7 days, p=0.008) and total hospital cost ($113,564-vs-158,904, p<0.001). The AA group had a higher prevalence of hypertension (44.4% -vs- 36.3%, p<0.001), obstructive sleep apnea (55.6% -vs- 21.2%, p<0.001), heart failure with reduced ejection fraction (22.2% -vs- 3.5%, p<0.001), alcohol use (11.1% -vs- 0.9%, p<0.001) and class I obesity (11.1% -vs- % 6.2%, p<0.001). This group also had higher in-hospital mortality (11.0% -vs- 0.9%, p<0.001) and worse in-hospital outcomes including acute pericarditis, cardiogenic shock, and requiring mechanical ventilation (Table 1). Conclusions: Despite lower length of stay and hospital cost, AA patients with HCM that underwent AF ablation had higher in-hospital mortality and complications compared to non-AA patients. These observed disparities warrant further research to gain a deeper understanding of the underlying factors contributing to these outcomes.

Abstract 17493: Racial/Ethnic Under-Representation in Early Phase Clinical Trials

Introduction: There is severe underrepresentation of racial and ethnic groups in many cardiovascular clinical trials. Early-phase clinical trials examine the action and safety limits of treatment and thus, underrepresentation may have particularly deleterious effects. Hypothesis: Ethnic and Racial groups are underrepresented in early-phase trials. Methods: Using the clinicaltrials.gov database, we examined the racial and ethnic representation in Phases 1, 2, 3, and 4 in completed heart failure clinical trials (N=89) with reported results from 2016-2021. We examined the proportion of trials with a representation equal or greater than % U.S. Census population (12% for African American (AA), 19% for Hispanic/Latino (HL), and 7% for Asian (AN)) and determined the median trial representation percentage for AA, HL, and AN groups. Using Chi-square analysis we compared the percent representation across the trial phases. Results: We found that 49%, 91%, and 87% Phase 1 and 2 trials have a lower AA, HL, and AN representation, respectively, compared to that in the U.S. Population (Table 1). HL and AN representation in Phase 1 and 2 trials is particularly low. There is significant variation in AA, HL, and AN representation across all trial phases(p<0.001). Conclusions: Significant underrepresentation of racial and ethnic groups persist in contemporary Phase 1 and 2 trials. Efforts to create a standard for collecting and reporting demographics along with increasing racial and ethnic group representation closer to US population may reduce the risk of future adverse events.

Evaluating the effectiveness of community health worker interventions on glycaemic control in type 2 diabetes: a systematic review and meta-analysis

BackgroundInterventions with community health workers, trained to provide basic medical education and holistic support, have been used to enhance type 2 diabetes outcomes in various settings. Evidence of their effectiveness is poor because of variations in intervention design and duration. We did a systematic review of randomised trials evaluating the effectiveness of community health worker interventions integrated into conventional care to improve glycaemic control in adults with diabetes. MethodsIn this systematic review and meta-analysis, we included randomised trials of community health worker interventions of at least-12 months’ duration in adults with type 2 diabetes that compared HbA1c levels with usual care. We searched Ovid MEDLINE, the Cochrane Central Register of Controlled Trials, CINAHL and the Web of Science Core Collection for studies published in English between Jan 1, 2000, and March 1, 2023, for studies containing “community health worker” or “lay health worker”, and “type 2 diabetes”. We extracted both qualitative and quantitative data to assimilate community health worker intervention characteristics. We did a meta-analysis comparing changes in HbA1c levels from baseline between intervention groups and usual care groups. To be included in the meta-analysis, studies had to have HbA1c values at baseline and after 12 months and a patient dropout rate of less than 25% at 12 months follow-up. The main outcome was the mean weighted difference of % change in HbA1c after at least 12 months, assessed using Revman, the inverse variance-weighted average model (IVW). Quality was assessed using the Cochrane Rob2 tool. FindingsSeven of 86 retrieved studies were eligible for inclusion; six studies were conducted in the USA and one study in Indigenous Australia. Participants in all studies were recruited from Latino, African American and Indigenous Australian ethnic minority groups. The meta-analysis of six studies including 1280 participants (mean age 52·6 years [SD 3·68]; 832 [65%] female and 448 [35%] male) showed a significant improvement in HbA1c level at 12 months follow-up, with a mean weighted difference of 0·5% (95% CI 0·31–0·68) in the community health worker intervention group (p<0·0001), that reached the generally accepted minimal clinically important difference (≥0·5%). Outcome heterogeneity was low. InterpretationCommunity health worker interventions showed a significant reduction in HbA1c level adjunct to usual care, but caution must be taken given the point effect estimate is only just the MCID, and the true effect could be smaller. Given the current resource constraints faced by primary care, community health worker interventions could be innovative in informing the primary and secondary management of diabetes care in UK practice. A cost-effectiveness analysis of these interventions is required before implementation in routine diabetes care can be recommended. FundingNone.

1 Race, Ethnicity, Education, Sex and Gender Effects on Neuropsychological Test Scores: Limitations of Current Evidence and Impact on Clinical Trials and Clinical Practice

Objective:Interpretation of neuropsychological (NP) tests depends on the quality of the normative standards available for the tests. Co-norming across tests is necessary when interpreting differences between scores on different tests. The relevance of specific norms for an individual examinee further depends on multiple design features of the standardization studies, including: when the studies were conducted, sampling strategy, inclusion/exclusion criteria, age, sex/gender, education, race and ethnicity, socioeconomic status, and region. This paper examines the standardization studies of the most widely used NP tests, identifies their strengths and weaknesses, and makes recommendations for interpretive caveats based on these analyses.Participants and Methods:We reviewed the standardization strategies and coded information about the sampling frames, inclusion/exclusion criteria, stratification methods, demographic characteristics, and sample sizes overall and within each stratum where relevant. These methods were applied to the WAIS-IV, WMS-IV, CVLT3, D-KEFS, Pearson Advanced Clinical Solutions (ACS), Rey Complex Figure Test, WCST, Symbol Digit Modalities Test, RBANS, BVMT-R, HVLT, Halstead-Reitan (“Heaton et al”) Norms for Boston Naming, Finger Tapping, Grooved Pegboard), MOANS, and MOAANS (Boston Naming, Trail Making Test, Judgement of Line Orientation). We calculated multiple indexes for each test, including standard errors and confidence intervals for scaled scores.Results:Most tests used age only as a stratification factor, providing “age corrected” scores for selected age bands. The sample sizes for the age strata range from 1 to ∼200 but were usually less than 100 participants/stratum. Sex differences were rarely reported and some studies had markedly uneven distributions of sex. Education was not used as a stratification factor in any study, and few norms attempted corrections for education. The possible interactions of age and education on test scores are seldom reported and cell sizes for combinations of age and education may be too small to enable robust estimates of scores, especially at lower levels of education and older ages. The possible impact of race and ethnicity are rarely interrogated except in ACS, Heaton and MOAANS norms, which all focus on “African American” participants. Discrepancies in scores across ACS, Heaton and MOAANS suggest marked sampling differences.Conclusions:Existing norms have major limitations which may impact the clinical assessment of individuals and result in inappropriate treatment recommendations as well as lead to inappropriate classification in clinical trials, which may include score “cutoffs” based on widely used normative standards. Most norms use only age as a stratification factor, despite robust impacts of education on scores. Race and ethnicity are poorly represented, fail to reflect current demographic characteristics of the United States, and existing norms present major conflicts for African American groups, with the same raw scores differing by a full standard deviation depending only on the source of normative data. Sex differences are examined infrequently and it remains unclear to what extent sex or gender differences may affect some scores. There is an urgent need for new, preferably “dynamic” normative standards, that include sampling by socially and demographically meaningful metrics, to provide greater precision in assessment of neuropsychological scores and score discrepancies, and for evaluating the inclusion/exclusion criteria, and criteria for efficacy in clinical trials that use neurocognitive endpoints.

A - 41 The Association between Education, Literacy, and Performance on the Loewenstein-Acevedo Scale for Semantic Interference and Learning (LASSI-L) in African American (AA) Older Adults.

The LASSI-L, a cognitive challenge test, has been found to be highly discriminative between AA elders with amnestic mild cognitive impairment (aMCI) versus cognitively unimpaired (CU) counterparts. Given potentially lower levels of formal education and literacy in some AA groups, it is important to determine whether such factors might adversely influence performance. 41 AA adults (53.7% males), with a mean age of 63.9 (SD = 5.1years, range = 54-83) were deemed to be CU after a clinical interview resulted in a CDR = 0, and scores from a neuropsychological battery were deemed normal by experienced neuropsychologists. The LASSI-L was not used in diagnosis. Level of educational attainment was 13.3 (SD = 2.3years: range = 9-20). Level of reading literacy, as assessed by the WRAT-4, yielded an average grade equivalent (GE) of 9.6 (SD = 3.5 range = 2.0-12.9); substantially lower than reported educational attainment. Association between formal education and literacy was 0.52 which accounted for 27% of the shared variance. There were no statistically significant correlations between formal education or WRAT-4 scores in any LASSI-L variables, including initial learning (Cued Recall 2 List A), proactive semantic interference (PSI) (Cued List B1-List B2), failure to recover from PSI, or semantic intrusion errors. Performance on the LASSI-L among AA-CU did not suggest biases associated with formal education or word literacy, making it a promising tool for research. Many neuropsychological measures do not have acceptable diagnostic accuracy when used among individuals that are racially diverse, have lower-education levels, and lower socioeconomic status. This is important in consideration for potential use of LASSI-L in clinical settings.

Racial Difference in Outcomes in Breast Cancer Patients with Residual Nodal Disease after Neoadjuvant Chemotherapy

African Americans (AA) requiring neoadjuvant chemotherapy (NAC) have been associated with worse outcomes. Residual nodal disease (ypN+) after NAC represents a highly unfavorable risk factor. We hypothesized that even within this unfavorable subgroup, that racial differences in outcome would persist. An IRB-approved retrospective review of breast cancer (BC) patients in a multi-institutional study was performed between 2005-2018 to identify ypN+ patients (excluding metastatic or inflammatory BC). Clinico-pathologic parameters stratified by race were collected and analyzed. For molecular subtype analyses, patients were stratified into triple negative (TN), hormone receptor (HR)+/HER2-, and HR+/HER2+, and HR-/HER2+ subtypes. Overall survival (OS), disease free survival (DFS) and recurrence outcomes were obtained, and univariate and multivariate (MVA) logistic regression models were constructed and analyzed. Among 404 ypN+ patients, 107 (26%) were AA, and 297 (74%) were non-AA. Median follow-up for the non-AA group was 3.8 years (y) (IQR 2.4-6.3) and 3.5y (IQR 2.0-6.2) for the AA group. Clinical and pathologic patient characteristics (age, molecular subtypes, BRCA status, histology, grade, smoking status, primary surgery type, axillary/reconstruction surgery rates, margin status, stage) were without significant statistical differences between the non-AA and AA group, except the non-AA group had proportionally more cN3 disease (10.5% vs. 5.1%; p = .01). Despite this, AA demonstrated worse OS and DFS outcomes (Table). AA also had significantly worse local (15% vs. 6.7%, p = .02), regional (11.2% vs. 5.1%, p = .05) and distant recurrences (32.7% vs. 22.6%, p = .05) compared to non-AA. On MVA for OS and DFS, HR+ status, clinical stage, and AA race (HR 2.1 (CI 1.3-3.4), p = .004 and HR 1.7 (CI 1.1-2.6), p = .01 respectively) remained significant. Molecular subtype analysis demonstrated that AA with HR+/HER2- but not the TN subtypes demonstrated significantly worse outcomes (Table). Utilization of endocrine therapy was not different between AA and non-AA patients (94% vs. 97%, p = 0.3) to explain this discrepancy. Worse outcomes in HER2 subtype for AA group was suggested but could not be statistically verified due to insufficient sample size. There was no discernible difference in chemotherapy and radiation therapy regimen or compliance between the AA and non-AA groups. AA patients who fail to achieve nodal clearance with NAC had higher local, regional and distant recurrence, and worse survival compared to non-AA, particularly those with non-TN status. These differences could not be readily explained by therapeutic disparity, or compliance. These hypothesis generating findings suggest need to explore biological implications, and alternative therapeutic strategies for this unfavorable subgroup.

Parental psychological control and child anxiety in a multiethnic sample of youth with autism spectrum disorder

BackgroundThis study examined the relation between parental psychological control (PC) and child anxiety in a sample of white non-Latin American (WNLA), Hispanic/Latin American (H/LA), and African American (AA) youth with autism spectrum disorder (ASD). It was hypothesized that for youth with higher IQs, PC would be positively associated with anxiety for the WNLA group, but not for the H/LA and AA groups. MethodsArchival data from 603 youth diagnosed with ASD were used to test hypotheses. PC was measured by summing responses to items on an intake form indicative of parenting practices reflecting PC. ResultsResults of a hierarchical regression predicting child anxiety indicated a significant three-way interaction between PC, ethnicity (WNLA vs AA), and IQ. The graph of the interaction and tests of slopes showed that in the high IQ group, PC was positively associated with anxiety for the WNLA group and negatively associated with anxiety for the AA group. In the low IQ group, PC was positively associated with anxiety for the WNLA and AA groups. ConclusionsThese findings indicate that cultural variations in the relation between PC and child anxiety found in typically developing youth are applicable to youth with ASD but only for those with higher IQs.

Bone Mineral Density During and After Lactation: A Comparison of African American and Caucasian Women

During lactation, changes in maternal calcium metabolism are necessary to provide adequate calcium for newborn skeletal development. The calcium in milk is derived from the maternal skeleton through a process thought to be mediated by the actions of parathyroid hormone-related protein (PTHrP) in combination with decreased circulating estrogen concentrations. After weaning, bone lost during lactation is rapidly regained. Most studies of bone metabolism in lactating women have been performed in Caucasian subjects. There are well-documented differences between African American (AA) and Caucasian (C) bone metabolism, including higher bone mineral density (BMD), lower risk of fracture, lower 25-hydroxyvitamin D (25(OH) D), and higher PTH in AA compared to C. In this prospective paired cohort study, BMD and markers of bone turnover were compared in self-identified AA and C mothers during lactation and after weaning. BMD decreased in both AA and C women during lactation, with similar decreases at the lumbar spine (LS) and greater bone loss in the C group at the femoral neck (FN) and total hip (TH), demonstrating that AA are not resistant to PTHrP during lactation. BMD recovery compared to the 2 week postpartum baseline was observed 6 months after weaning, though the C group did not have complete recovery at the FN. Increases in markers of bone formation and resorption during lactation were similar in AA and C. C-terminal telopeptide (CTX) decreased to 30% below post-pregnancy baseline in both groups 6 months after weaning, while procollagen type 1 N-terminal (P1NP) returned to baseline in the AA group and fell to below baseline in the C group. Further investigation is required to determine impacts on long term bone health for women who do not fully recover BMD before a subsequent pregnancy.

Racial disparities in new-onset diabetes mellitus in prostate cancer patients on androgen deprivation therapy: a retrospective analysis of TriNetX data.

Prostate cancer (PCa) is the most common cancer in men in the US and androgen deprivation therapy (ADT) is the most frequently used systemic therapy for PCa. Data suggest that ADT is associated with an increased risk of new-onset diabetes mellitus (NODM) and cardiovascular complications. As the incidence and mortality of PCa are highest among the African American (AA) population, it is important to evaluate the difference in the incidence of NODM and ischemic heart disease (IHD) between AA men compared to Caucasian men. This is a retrospective cohort study utilizing the TriNetX database to assess NODM and IHD risk, risk difference, and risk ratio (RR) after recent ADT initiation in an AA cohort and a Caucasian cohort of patients with PCa. Propensity score matching (PSM) was performed by age, BMI, and confounding comorbidities. After matching, the cohort included 1159 AA patients and 843 Caucasian patients with NODM after ADT initiation. The IHD cohort included 1269 AA patients and 1248 Caucasian patients. The risk of incidence of NODM is higher among AA men at 11.6% risk compared to Caucasian men at 7.4%. The risk difference is 4.1% (95% CI = 3.4, 4.9) p = 0.000. The RR is 1.56 (95% CI = 1.43, 1.70). In contrast, risk difference and risk ratio of IHD was not significant between AA and Caucasian groups. ADT exposure increases the risk of NODM in men with PCa, especially among AA men compared with Caucasian men. Men receiving ADT should be monitored routinely for signs and symptoms of metabolic syndrome and diabetes. Targeted close monitoring of AA men on ADT would be critical to prevent and treat metabolic complications with potential of reducing disparities in PCa morbidity.

Impact of heat on emergency hospital admission in Texas: geographic and racial/ethnic disparities.

Studies exploring the racial/ethnicity disparity of the impact of heat on hospital admission are notably limited, especially in Texas, a state with a diverse population and consistently ranking among the top ten U.S. states for heat-related deaths per capita from 2018 to 2020. Our objective is to determine the correlation between elevated temperatures and emergency hospital admissions for various causes and age groups across 12 Metropolitan Statistical Areas(MSAs) in Texas. Additionally, we aim to investigate health inequalities in the five largest MSAs in Texas between 2004 and 2013. We used MSA-level hospital admission and weather data to estimate the relationship between heat and emergency hospital admissions. We applied a Generalized Additive Model and random effects meta-analysis to calculate MSA-specific associations and overall correlation, repeating the analysis for age groups and specific causes of admission. We also investigated health disparities across racial and ethnic groups and performed a sensitivity analysis. The results showed that a 1 °C increase in temperature was associated with a 0.50% (95% CI [0.38%, 0.63%]) increase in all-cause emergency hospital admissions. Heat's impact on hospital admissions varied among age groups and causes, with children under 6 years showing the highest effect estimate (0.64% (95% CI [0.32%,0.96%])). Statistically significant associations were found for Cardiovascular Diseases (0.27% (95% CI [0.07%,0.47%])), Ischemic Heart Diseases (0.53% (95% CI [0.15%,0.92%])), Pneumonia (0.70% (95% CI [0.25%,1.16%])), and Respiratory Diseases (0.67% (95% CI [0.18%,1.17%])). Health disparities were found among racial and ethnic groups in the five largest MSAs. Studies exploring the impact of heat on hospital admission in Texas are notably limited. Our research provided a comprehensive examination of the connection between heat and emergency hospital admissions throughout Texas. Furthermore, we are the first to examine racial/ethnic disparities, identifying African American and Hispanic groups as disproportionately affected. These insights provide valuable insights for policymakers to allocate resources and implement strategies to mitigate the negative consequences of rising temperatures.

Sociocultural and structural influences on HIV Pre-Exposure Prophylaxis (PrEP) Engagement and Uptake among African American Young adults

BackgroundPre-exposure prophylaxis (PrEP) demonstrates effectiveness in decreasing new cases of HIV. However, few African Americans use PrEP, despite being disproportionately impacted by HIV. Understanding the influence of sociocultural and structural factors on PrEP use among multiple priority groups of African Americans, including but not limited to men who have sex with men, may improve PrEP engagement and uptake. The social ecological model (SEM) as a framework guided the understanding of how these factors operate on multiple levels to influence PrEP use among this population.MethodsThis study derived data from the Afya PrEP study consisting of eleven focus groups (N = 63) with 18-29-year-old African American sexual and gender minority and heterosexual individuals at heightened behavioral vulnerability to HIV. We employed constructivist grounded theory processes to inductively analyze the data. A pooled kappa score of 0.90 indicated excellent inter-rater agreement.ResultsFactors impacting PrEP engagement among African American young adults included: (1) Community/social network influences; (2) medical mistrust; (3) stigma; (4) PrEP availability and accessibility, which had two sub-categories: (a) cost and (b) where to obtain PrEP; and (5) PrEP engagement strategies, which had two sub-categories: (a) current AIDS service organizations’ PrEP engagement practices and (b) recommended future PrEP engagement strategies. Categories one through three represent sociocultural factors, and categories four and five represent structural factors that influence perceptions and attitudes of African American young adults regarding PrEP.ConclusionOur study highlights sociocultural and structural factors that act as barriers and facilitators to PrEP engagement. The SEM guided the understanding of how these factors operated on multiple levels. One of the sociocultural factors, community/social network influences operated at the interpersonal level of the SEM; the other two, stigma and medical mistrust, operated at the community level. The structural factors (PrEP availability, accessibility, and engagement strategies) operated at the institutional/organizational level. Thus, multi-level interventions are warranted to improve PrEP engagement among various African American young adult priority groups.

Bullying Victimization and Associations With Substance Use Among US Middle School Students: 2019 Youth Risk Behavior Survey.

Research shows associations between bullying victimization and substance use for teens. However, more research about this relationship for younger adolescents and across race/ethnicity is needed. Prevalence and pooled logistic regression analyses of 2019 Middle School Youth Risk Behavior Survey data from 13 states (N = 74,059 students) examined associations between self-reported bulling victimization (at school, electronically, and both) and having ever tried cigarette smoking, alcohol, or marijuana; used an electronic vapor product; or misused prescription pain medicine. Regression analyses were adjusted by age and sex/race/ethnicity. All 3 measures of bullying victimization were significantly associated (p < .05) with the 5 substance use behaviors examined (adjusted prevalence ratios ranged from 1.29 to 2.32). These associations held across sexes. Significant associations were found within all 7 race/ethnicity categories, with the most associations reported for the non-Hispanic (NH) white, NH black or African American, Hispanic/Latino, and NH Asian groups. The association between bullying and substance use by middle school is a highly relevant issue to consider as students return to classrooms.

Trends in Drug Tests among Children: A 22-Year Retrospective Analysis.

There are several pathophysiological outcomes associated with substance abuse including metabolic disbalance, neurodegeneration, and disordered redox. Drug use in pregnant women is a topic of great concern due to developmental harm which may occur during gestation and the associated complications in the neonate after delivery. We sought to determine what the trajectory of drug use is like in children aged 0-4 years and mothers of neonates. Urine drug screen (UDS) results were obtained of our target demographic during 1998-2011 and 2012-2019 from LSU Health Sciences Center in Shreveport (LSUHSC-S). Statistical analysis was performed using R software. We observed an increase in cannabinoid-positive UDS results in both Caucasian (CC) and African American (AA) groups between 1998-2011 and 2012-2019 periods. Cocaine-positive UDS results decreased in both cohorts. CC children had higher UDS positive results for opiates, benzodiazepines, and amphetamines, while AA children had a higher percentage for illicit drugs such as cannabinoids and cocaine. Neonate's mothers had similar UDS trends to that in children during 2012-2019. Overall, while percentage of positive UDS results for both AA and CC 0-4 year old children started to decline for opiate, benzodiazepine, and cocaine during 2012-2019, cannabinoid- and amphetamine (CC)-positive UDS steadily increased. These results suggest a shift in the type of drug use by mothers from opiates, benzodiazepines, and cocaine to cannabinoids and/or amphetamines. We also observed that 18-year-old females who tested positive for opiates, benzodiazepine, or cocaine had higher than average chances of testing positive for cannabinoids later in life.

Assessing SARS-CoV-2 Testing Adherence in a University Town: Recurrent Event Modeling Analysis.

Healthy Davis Together was a program launched in September 2020 in the city of Davis, California, to mitigate the spread of COVID-19 and facilitate the return to normalcy. The program involved multiple interventions, including free saliva-based asymptomatic testing, targeted communication campaigns, education efforts, and distribution of personal protective equipment, community partnerships, and investments in the local economy. This study identified demographic characteristics of individuals that underwent testing and assessed adherence to testing over time in a community pandemic-response program launched in a college town in California, United States. This study outlines overall testing engagement, identifies demographic characteristics of participants, and evaluates testing participation changes over 4 periods of the COVID-19 pandemic, distinguished by the dominant variants Delta and Omicron. Additionally, a recurrent model is employed to explore testing patterns based on the participants' frequency, timing, and demographic characteristics. A total of 770,165 tests were performed between November 18, 2020, and June 30, 2022, among 89,924 (41.1% of total population) residents of Yolo County, with significant participation from racially or ethnically diverse participants and across age groups. Most positive cases (6351 of total) and highest daily participation (895 per 100,000 population) were during the Omicron period. There were some gender and age-related differences in the pattern of recurrent COVID-19 testing. Men were slightly less likely (hazard ratio [HR] 0.969, 95% CI 0.943-0.996) to be retested and more likely (HR 1.104, 95% CI 1.075-1.134) to stop testing altogether than women. People aged between 20 and 34 years were less likely to be retested (HR 0.861, 95% CI 0.828-0.895) and more likely to stop testing altogether (HR 2.617, 95% CI 2.538-2.699). However, older age groups were less likely to stop testing, especially those aged between 65-74 years and 75-84 years, than those aged between 0 and 19 years. The likelihood of stopping testing was lower (HR 0.93, 95% CI 0.889-0.976) for the Asian group and higher for the Hispanic or Latino (HR 1.185, 95% CI 1.148-1.223) and Black or African American (HR 1.198, 95% CI 1.054-1.350) groups than the White group. The unique features of a pandemic response program that supported community-wide access to free asymptomatic testing provide a unique opportunity to evaluate adherence to testing recommendations and testing trends over time. Identification of individual and group-level factors associated with testing behaviors can provide insights for identifying potential areas of improvement in future testing initiatives.

Deep roots of admixture-related cognitive differences in the USA

This study attempted to determine if the association between genetic admixture and cognitive ability among African, European, and Amerindian descent groups in the USA holds across a large time period. First, we used the large and nationally representative Adolescent Brain Cognitive Development Study (ABCD) sample to examine the association between cognitive ability and parental-reported race, genetically-predicted color, and genetic ancestry among Puerto Ricans, non-Hispanic Whites, Blacks, and American Indians in the 21st century. Second, we use the 1850 to 1930 US censuses to trace ancestry-associated cognitive differences back to the early 19th and early 20th century among African American, American Indian, and Puerto Rican groups by using age-heaping-based numeracy as a proxy for cognitive ability. In the ABCD sample, we found that European ancestry is positively associated with cognitive ability within race/ethnic groups. In the census data, among African Americans and American Indians but not Puerto Ricans, we find that greater apparent European admixture is associated with higher numeracy and this holds when we subset by age, sex, and literacy status. The implications of these findings are discussed.

Deep roots of admixture-related cognitive differences in the USA

This study attempted to determine if the association between genetic admixture and cognitive ability among African, European, and Amerindian descent groups in the USA holds across a large time period. First, we used the large and nationally representative Adolescent Brain Cognitive Development Study (ABCD) sample to examine the association between cognitive ability and parental-reported race, genetically-predicted color, and genetic ancestry among Puerto Ricans, non-Hispanic Whites, Blacks, and American Indians in the 21st century. Second, we use the 1850 to 1930 US censuses to trace ancestry-associated cognitive differences back to the early 19th and early 20th century among African American, American Indian, and Puerto Rican groups by using age-heaping-based numeracy as a proxy for cognitive ability. In the ABCD sample, we found that European ancestry is positively associated with cognitive ability within race/ethnic groups. In the census data, among African Americans and American Indians but not Puerto Ricans, we find that greater apparent European admixture is associated with higher numeracy and this holds when we subset by age, sex, and literacy status. The implications of these findings are discussed.

Deep roots of admixture-related cognitive differences in the USA

This study attempted to determine if the association between genetic admixture and cognitive ability among African, European, and Amerindian descent groups in the USA holds across a large time period. First, we used the large and nationally representative Adolescent Brain Cognitive Development Study (ABCD) sample to examine the association between cognitive ability and parental-reported race, genetically-predicted color, and genetic ancestry among Puerto Ricans, non-Hispanic Whites, Blacks, and American Indians in the 21st century. Second, we use the 1850 to 1930 US censuses to trace ancestry-associated cognitive differences back to the early 19th and early 20th century among African American, American Indian, and Puerto Rican groups by using age-heaping-based numeracy as a proxy for cognitive ability. In the ABCD sample, we found that European ancestry is positively associated with cognitive ability within race/ethnic groups. In the census data, among African Americans and American Indians but not Puerto Ricans, we find that greater apparent European admixture is associated with higher numeracy and this holds when we subset by age, sex, and literacy status. The implications of these findings are discussed.