Health Disparities In Populations Research Articles

Health Literacy, Health Outcomes and Equity: A Trend Analysis Based on a Population Survey.

Health literacy continues to be an issue among minority groups. Population surveys are one strategy used to help better understand health disparities. The Behavioral Risk Factor Surveillance System (BRFSS) in Kansas added health literacy questions to the survey in 2012. This study examined population health literacy levels and health trends from 2012 to 2018. The health status variables included health care coverage status, general health rating, presence of chronic conditions, and length of time since the last check-up. The percentage of individuals reporting low health literacy decreased from 67% in 2012 to 51% in 2018. The percentage of participants with income levels less than $15 000 was 9% in 2012 and 7% in 2018. Health literacy was lowest among the age group 18 to 24-year-olds, those who identified as multiracial, separated, not graduated from high school, out of work for more than 1 year, income less than $10 000, with other living arrangements, and living in a suburban county of metropolitan statistical area. Additionally, many health conditions improved, and those reporting health insurance increased slightly. The study demonstrates how health literacy continues to be an issue, and how education and primary prevention are necessary to improve limited health literacy and health outcomes. Findings from both state-level and national BRFSS population surveys can help educate the public health and clinical health services workforce to provide better care and address health disparities for highrisk populations.

Peer-Facilitated Tobacco Cessation in a Prison Setting: A Proof of Concept Study.

Despite the vast human and economic costs associated with tobacco use among U.S. inmates, smoking remains a largely ignored public health epidemic. Incarcerated individuals smoke at 3 to 4 times the rate of the general population and face tobacco-related health disparities. This paper reports results from a single arm, pre/post pilot study designed to test the feasibility and initial effectiveness of an inmate-administered group tobacco cessation intervention within a men's pre-release program run by the Arizona Department of Corrections. Corrections staff and inmate peer mentors were trained in the DIMENSIONS: Tobacco Free Program, a manualized 6-session tobacco cessation group curriculum. Group sessions used evidence-based interventions for assisting inmates develop skills to live tobacco and nicotine free. In 2019-2020, 39 men who reported tobacco use voluntarily participated in one of three cessation groups. Wilcoxen signed-rank tests evaluated changes across group sessions in frequency of tobacco use and attitudes about nicotine-free living post release. Most participants attended all six group sessions (79%) and made one or more quit attempts (78%). Overall, 24% of the sample reported quitting tobacco, and significant reductions in tobacco use were reported after only two sessions. Participants further reported significant positive changes in knowledge, plans, support, and confidence to live tobacco-free lives post-release. To our knowledge, this is the first study to demonstrate that, with minimal investment, implementation of an evidence-based, peer-led tobacco free program is feasible and effective within an incarcerated population uniquely vulnerable to the burden of tobacco.

EFFECTS OF DISCRIMINATION/VICTIMIZATION ON HEALTHCARE UTILIZATION VIA HEALTHCARE BARRIERS

Abstract Aging lesbian, gay, bisexual, and transgender (LGBT) adults are a health disparate population with unique healthcare challenges. Using data from the Aging with Pride: National Health, Aging, Sexuality/Gender Study (NHAS; N = 2,560), we examined contextual factors that influence the healthcare utilization of LGBT middle-aged and older adults. Causal indirect, direct, and total causal effects based on counterfactuals were computed to assess mediational links between discrimination/victimization and healthcare utilization via healthcare barriers. Discrimination/victimization had an indirect effect on health screenings via fear accessing health services both inside and outside of the LGBT community, financial barriers to care or medication, and being uninsured. Discrimination/victimization also had an effect on routine checkups and having a regular provider, via fear seeking health services outside of the LGBT community, financial barriers and being uninsured. Findings can be utilized in LGBT cultural competency trainings for health and human service providers serving aging LGBT people.

Depression, perceived stress, and distress during pregnancy and EV-associated miRNA profiles in MADRES

BackgroundMicroRNA (miRNA) circulating in plasma has been proposed as biomarkers for a variety of diseases and stress measures, including depression, stress, and trauma. However, few studies have examined the relationship between stress and miRNA during pregnancy. MethodsIn this study, we examined associations between measures of stress and depression during pregnancy with miRNA in early and late pregnancy from the MADRES cohort of primarily low-income Hispanic women based in Los Angeles, California. Extracellular-vesicle- (EV-) associated miRNA were isolated from maternal plasma and quantified using the Nanostring nCounter platform. Correlations for stress-associated miRNA were also calculated for 89 matching cord blood samples. ResultsFifty miRNA were nominally associated with depression, perceived stress, and prenatal distress (raw p < 0.05) with 17 miRNA shared between two or more stress measures. Two miRNA (miR-150-5p and miR-148b-3p) remained marginally significant after FDR adjustment (p < 0.10). Fifteen PANTHER pathways were enriched for predicted gene targets of the 50 miRNA associated with stress. Clusters of maternal and neonate miRNA expression suggest a link between maternal and child profiles. LimitationsThe study evaluated 142 miRNA and was not an exhaustive analysis of all discovered miRNA. Evaluations for stress, depression and trauma were based on self-reported instruments, rather than diagnostic tools. ConclusionsDepression and stress during pregnancy are associated with some circulating EV miRNA. Given that EV miRNA play important roles in maternal-fetal communication, this may have downstream consequences for maternal and child health, and underscore the importance of addressing mental health during pregnancy, especially in health disparities populations.

HEALTH RISKS AMONG OLDER ADULTS ACCORDING TO PRIMARY LANGUAGE: EVIDENCE FROM MEDICARE ANNUAL WELLNESS VISITS

Abstract Emerging evidence suggests that older adults benefit from the Medicare Annual Wellness Visit (AWV). Lind and colleagues found that between 2011 and 2016, utilization of the AWV increased from 8.1% to 23.0%. However, compared with non-Hispanic whites, AWV utilization is 11.6% points lower for Hispanic/Latinos and 10.2% lower for non-Hispanic Blacks. AWV differences by primary language have not been previously reported. We examined the rate of AWV utilization for older adults with English vs. Limited English Proficiency (LEP) among patients seen at a large urban health system in northeastern Ohio. Using Bonferroni-corrected chi-square and t-tests, we also evaluated the association between LEP and health risks (e.g., depression, falls, activities of daily living, cognitive status) assessed during the AWV. Using the electronic health record, we identified 41,262 Medicare patients aged 65+ who were eligible for the AWV. Of those identified, 42.8% completed an AWV between 2019 to 2021. Persons who were white (41.7%), Hispanic (37%), male (39.9%), Spanish-speaking (37.2%) or other LEP (41.2%) had lower utilization of AWVs (p&amp;lt;.001). Pain and fatigue ratings, depressive symptoms, and oral health problems and were similar between language groups, while cognitive impairment (p&amp;lt;.001), functional independence (p&amp;lt;.001), and self-rated health (p&amp;lt;.001) were substantially worse among non-English speakers. LEP is associated with a lower rate of AWV utilization and worse self-rated health. A clearer understanding of how speaking a different language from that in which the AWV is conducted is important for clarifying discrepancies and disparities in minority population health.

Anxiety sensitivity and reasons for smoking among Black smokers

Black smokers demonstrate higher nicotine dependence and experience higher rates of smoking-related diseases and mortality relative to European American/White smokers. A potential factor relevant to race-specific smoking health disparities may be smoking motives (i.e., motivational basis of smoking). Yet, little research has been conducted to understand psychological factors that may be associated with specific smoking motives among Black smokers. To address this gap in the literature, the current study explored the association between anxiety sensitivity and smoking motives within a subset sample of Black smokers who were interested in participating in a smoking cessation trial (N = 105; 70.5 % male; Mage = 44.8 years, SD = 11.6 years). Hierarchical regression analyses indicated anxiety sensitivity was associated with smoking motives related to habit (β = 0.39, p <.001), negative affect reduction (β = 0.32, p <.001), stimulation (β = 0.31, p <.001), and sensorimotor manipulation (β = 0.26, p =.008). Limited support was found for the effect of motives on past quit attempt engagement. These results may broaden understanding of the psychological mechanisms related to smoking motivation among Black smokers and may inform future intervention efforts to reduce smoking motivation among this health disparities population.

Love Your Neighbor Collaborative: A Multi-Sector Collaborative to Target Health Disparities for Vulnerable Populations

The Love Your Neighbor Collaborative (LYNC) is a multi-sector collaborative of nonprofit community-based organizations, faith communities, educational institutions, local government, and local supportive businesses to target health disparities for the vulnerable population of individuals in homelessness, and near homelessness, throughout the city of Riverside, California.. The goal of LYNC is to reduce and prevent homelessness by building a coalition of RAOs, academic institutions, and nonprofit organizations to work collaboratively with the city of Riverside to create a stronger, more integrated collective effort resourcing those who are in homeless situations or, at risk of losing their home.

Burden of Cardiovascular Disease in South Asians: Risk Factors Prevention and Early Screening is the Key

Cardiovascular diseases (CVD) have declined over the past two decades.1 However, despite improvements in population health, marked racial and ethnic disparities in longevity and CVD management persist. South Asians (SAs), people with ancestors from the Indian subcontinent constitute 1/5 of the world's population. During the late 1980s, the term “double burden of disease” was first used and can be defined as the burden of non-communicable diseases on top of infectious diseases that remain undefeated.2 Coronary artery disease (CAD), also called heart disease, stood out as the most common cause of this increasing double burden of diseases. The first study that was published related to South Asians and CAD risk was in 1991 by McKeigue et al.3 The study assessed the relation of central obesity and insulin resistance with high type 2 diabetes mellitus prevalence and CAD risk in immigrant SAs. A sample of industrial workers and general practitioners in the United Kingdom were shown to have a higher prevalence of diabetes, higher blood pressure, higher fasting and post-glucose serum insulin concentrations, higher plasma triglyceride (TG), and lower high-density lipoprotein (HDL). This study confirms the existence of an insulin resistance syndrome in SAs.

Rural‐urban and gender differences in the prevalence of metabolic syndrome among older Indians

AbstractBackgroundThe clinical significance of metabolic syndrome (MetS) as a risk factor for cardiovascular disease, cerebrovascular disease, and dementia is becoming increasingly prominent. However, there is a dearth of studies from India on the prevalence of MetS, especially in the aging population. We aimed to estimate MetS prevalence and associated comorbidities in two prospective, aging cohorts from rural and urban India.MethodOur study sample includes aging (≥ 45 years) individuals – 2171 from the rural (SANSCOG) cohort and 332 from the urban (TLSA) cohort. These older Indian adults have contrasting population characteristics, which echo the stark rural‐urban divide in the country. Data from baseline clinical and biochemical assessments were used to calculate the prevalence of MetS in both the above cohorts using two well‐established criteria, namely consensus criteria and NCEP‐ATP III criteria. Further, we compare rural‐urban, gender‐ and age‐wise differences in the prevalence of MetS as per the consensus criteria.ResultPrevalence of MetS was 46.2% and 54.8% as per consensus criteria in rural and urban subjects, respectively; corresponding numbers using NCEP‐ATP III criteria were 40.3% and 45.1%. Rural‐dwelling older adults had a significantly lesser prevalence of all individual MetS parameters except impaired triglycerides and high‐density lipoprotein levels. Rural women had a significantly higher prevalence than rural men, whereas there was no significant difference among urban subjects. We did not observe any consistent age‐wise trend when comparing both these cohorts. There was a high burden of comorbidities among both groups, mostly undiagnosed in rural subjects.ConclusionRoughly 1 in 2 older Indians have MetS, urban significantly more than rural, reaching an alarming 63.1% among urban subjects aged 65‐74 years. The very high prevalence of undiagnosed co‐morbidities in rural Indians is extremely concerning, calling for urgent public health measures including ramping up the primary health care system in this marginalized and health disparate population.

Association of Affirming Care with Chronic Disease and Preventive Care Outcomes among Lesbian, Gay, Bisexual, Transgender, and Queer Older Adults

Experiences of discrimination and bias in healthcare contribute to health disparities for lesbian, gay, bisexual, transgender, and queer populations. To avoid discrimination, many go to great lengths to find healthcare providers who they trust and who are knowledgeable about their health needs. This study examines whether access to an affirming provider improves health outcomes for lesbian, gay, bisexual, transgender, and queer populations across a range of preventive health and chronic disease management outcomes. This cross-sectional study uses Poisson regression models to examine original survey data (n=1,120) from Wave 1 of the Vanderbilt University Social Networks, Aging, and Policy Study, a panel study examining older (aged 50-76 years) lesbian, gay, bisexual, transgender, and queer adults' health and aging, collected between April 2020 and September 2021. Overall, access to an affirming provider is associated with greater uptake of preventive health screenings and improved management of mental health conditions. Participants with an affirming provider are more likely to have ever and recently received several types of preventive care than participants reporting a usual source of care that is not affirming, including past year provider visit, influenza vaccination, colorectal cancer screening, and HIV test. Access to an affirming provider is also associated with better management of mental health conditions. Inclusive care is essential for reducing health disparities among lesbian, gay, bisexual, transgender, and queer populations. Health systems can reduce disparities by expanding continuing education opportunities; adopting nondiscrimination policies for patients and employees; and ensuring that necessary care is covered by health insurance.

Social Media and Cardiovascular Health: Implications for Women.

Cardiovascular disease (CVD) is the leading cause of mortality in adult women in the USA, yet CVD is underrecognized in women. Disparities in care are further pronounced in women of racial/ethnic minority backgrounds. In this review, we discuss the role of social media (SoMe) as a tool to (i) promote women's cardiovascular (CV) health and (ii) address and potentially reduce gaps in care, particularly in general cardiology (targeting atherosclerotic cardiovascular disease), cardio-oncology, and cardio-obstetrics. We also briefly discuss women's CV health as a common, although not unique, focus of women in cardiology on SoMe. Studies have suggested the utility of social media to help advance subspecialties of cardiology. Leaders within general cardiology, cardio-oncology, and cardio-obstetrics have curated social media strategies to advance their respective fields and call attention to cardiovascular health disparities in female populations and racial/ethnic minorities. In addition to these types of uses, women in cardiology also frequently use SoMe to encourage a career in cardiology and to share experiences, challenges, and resources for support and career advancement as healthcare professionals; men in cardiology and especially those who are allies for sex and racial/ethnic minorities also use SoMe for these means. Herein, we highlight the role and myriad applications of social media in the promotion of women's cardiovascular health. We discuss five primary roles of social media: increasing public awareness, disseminating medical literature in a rapid and accessible fashion, facilitating professional networking, serving as a platform for medical conferences, and empowering patients. These core strategies are discussed through the lens of general cardiology, cardio-oncology, and cardio-obstetrics. We also demonstrate how these applications can be leveraged to increase representation of women in cardiology, also supporting an increased focus on women's cardiovascular health.

Participant recruitment and retention from vulnerable populations in clinical trials is a matter of trust

Clinical research sites can struggle with recruiting and retaining vulnerable populations. Vulnerable research participants often have significant trauma histories making traditional approaches to recruitment and retention tenuous. Due to these difficulties, vulnerable populations are often intentionally excluded from clinical research due to the additional time and work involved. While it is important to provide protections for any participant that has decreased autonomy or increased susceptibility to coercion, it is equally important to assure that individuals in vulnerable populations have access to any clinical research that might pertain to them. In addition, the new trends in the drug development industry including early-stage development, risk-identification, preventative care, and disease spread modeling are likely to include health disparate patient populations that have increased probability of vulnerability. In this article we discuss the roots of many vulnerabilities and how to foster trust for more effective recruitment and retention of vulnerable populations.

Meeting the information and communication needs of health disparate populations.

Meeting the information and communication needs of health disparate populations in a culturally congruent and health literate manner is foundational to advancing health equity, health status, and health-related quality of life. The Journal of the American Medical Informatics Association has published seminal papers on this topic over the last 15 years.1–10 Papers have addressed important factors related to meeting information and communication needs including health literacy, numeracy, and graph literacy1,2,4; described innovative solutions for meeting information and communication needs3–10; and conducted comparative evaluations of visual strategies.6–9 In this editorial, I briefly summarize 5 papers that contribute to the literature on these topics. In 2 papers, the authors report user studies of data visualizations of longitudinal data, that is, systolic blood pressure values11 and patient-reported outcomes (PROs) that include measures of health and graph literacy.12 A review paper focuses on the natural language processing literature for automatic simplification of existing biomedical text for consumers and identifies strategies for addressing challenges to progress in the field.13 As the foundation for public health dashboards that effectively communicate with a variety of audiences including the lay public, Ansari and Martin14 describe formative work for the creation of a heuristic evaluation checklist for public health dashboards. In the fifth paper, Valdez et al15 highlight the disability community as a health disparate population and offer a set of guidelines for effective engagement to create digital health technologies that more fully meet the information and communication needs of all disabled individuals.

Using Backward Design in Dysphagia Management: A Paradigm Shift Toward More Culturally Responsive Care

Purpose: Marginalized communities have an increased predisposition to disease where dysphagia is often associated. While commonly used as paradigms in health care and dysphagia management, the biomedical model and forward design do not adequately support equitable, inclusive, and quality care for individuals of culturally and linguistically diverse (CLD) backgrounds. A more-narrow focus on curative and impairment-based management may actually be detrimental to patients' personal and cultural identities. Therefore, it is crucial to broaden the focus of service delivery to provide culturally responsive, patient-centered care. This tutorial describes the application of backward design to dysphagia management, with practical strategies and tools offered to increase the quality of care for persons of CLD backgrounds. Conclusion: Clinicians need to prioritize the individual cultural dynamics of each patient. Personalized ethnocentric care requires clinicians to become aware of their own worldviews and biases while understanding better their patients' identities. Clinicians should consider adopting a more holistic lens and beginning the dysphagia management process with the patient's end goal in mind. Through this critical first step, clinicians will be better equipped to inform appropriate assessment and intervention selections that leverage all aspects of the biopsychosocial framework, helping to reduce health disparities in CLD populations.

Allostatic load predicts racial disparities in intracerebral hemorrhage cognitive outcomes

A large portion of stroke disparities remains unexplained, even after adjusting for demographic, comorbidity, and health care access variables. There is a critical need to close this knowledge gap by investigating novel factors that may contribute to stroke disparities. Allostatic load (AL) is the lifetime adverse physiologic impact of needing to adjust to socially structured stressors such as racism. AL has been shown to increase health vulnerability and worsen outcomes in marginalized populations. We sought to assess the differential impact of AL on cognitive outcomes post intracerebral hemorrhage (ICH) across race-ethnicity. The Intracerebral Hemorrhage Outcomes Project (ICHOP) prospectively collected data from patients presenting to Columbia Medical Center with ICH from 3/2009 to 5/2016. Data included demographics, stroke scores, labs, complications, neuroimaging, medical history, and discharge data. Five markers of AL (HbA1c, WBC, SBP, HR, ALB) were obtained. An AL score was generated by summing the elements in each patient that fell outside normal ranges, with AL score ranging 0–5. A linear regression model, adjusted for stroke severity and ICH volumes, was used to evaluate the relationship between AL and Modified Telephone Interview for Cognitive Status (TICS-m) at discharge, stratified by race-ethnicity. Among 248 white, 195 black, and 261 Hispanic ICH patients, neither mean AL nor mean TICS differed by race/ethnicity (p = 0.51, p = 0.79 respectively). In the overall cohort AL did not predict TICS at discharge (Beta -1.0, SE 1.1, p = 0.353). In Whites (beta 1.18, SE 2.5, p = 0.646) and Hispanics (beta -0.95, SE 1.6, p = 0.552) AL was not associated with TICS at discharge. In Black patients, higher AL was associated with a decrease in TICS at discharge (beta -3.2, SE 1.5, p = 0.049). AL is an important determinant of post ICH outcomes for certain minority populations. AL may explain some of the unexplained health disparities in stroke populations.

S112 Implications of Butyrate Kinase and Intestinal Microbiota on Diabetes Risk in a Community Enriched With Native Hawaiians

Introduction: The incidence of type 2 diabetes mellitus (T2DM) within the Native Hawaiian population among the highest of any major ethnic group within the state of Hawaii. Modern research is beginning to mechanistically understand ancient Hawaiian concepts and practices demonstrating the importance of environment to human health. Environmental factors, such as socioeconomic status, toxicants, diet/nutrition, etc, contribute to individual risk of T2DM, where impacts on the gut microbiome may play key roles in inflammatory and metabolic dysregulation characteristic of diabetes. In this study, we focused on understanding the relationship between the gut microbiome and T2DM risk in the Native Hawaiian population. Methods: The study enrolled a cohort of Hawaii residents (16 years or older) in a community enriched with Native Hawaiians. Microbial DNA was isolated from self-collected stool samples of all participants and used for 16S amplicon-based sequencing for metagenomic analyses and for quantifying microbial-specific butyrate kinase (BUK) gene expression levels using qPCR approaches. From each participant, anthropometric measures and blood levels of HbA1c, a diagnostic indicator of T2DM, were taken. Blood was collected by venous puncture from which plasma was isolated to measure inflammatory and metabolic biomarkers. Herein, we identified and describe significant differences between diabetic and non-diabetic microbiome composition and diversity. Results: Consistent with other studies, we observed increased levels of CRP (p< 0.01) and decreased levels of leptin (p=0.04) in the plasma of diabetic compared to non-diabetic participants. Additionally, we observed that BUK levels were negatively correlated with that of HbA1c (R=-0.18, p=0.04), and positively correlated with that of metabolic hormones PYY (R=0.30; p=0.007) and GLP-1 (R=0.19; p=0.04), which were largely attributed to diabetes status. Higher plasma levels of PYY and GLP-1 have previously been associated with reduced T2DM risk. Conclusion: Altogether, our data suggest a role for butyrate-producing gut bacteria in the maintenance of the homeostatic inflammatory and metabolic states that are dysregulated in the progression of T2DM and implicates novel targets for reducing T2DM risk among health disparate populations.

Inclusion of Social and Structural Determinants of Health to Advance Understanding of their Influence on the Biology of Chronic Disease.

Social Determinants of Health (SDOH) consider social, political, and economic factors that contribute to health disparities in patients and populations. The most common health-related SDOH exposures are food and housing insecurity, financial instability, transportation needs, low levels of education, and psychosocial stress. These domains describe risks that can impact health outcomes more than health care. Epidemiologic and translational research demonstrates that SDOH factors represent exposures that predict harm and impact the health of individuals. International and national guidelines urge health professionals to address SDOH in clinical practice and public health. The further implementation of these recommendations into basic and translational research, however, is lagging. Herein, we consider a precision health framework to describe how SDOH contributes to the exposome and exacerbates physiologic pathways that lead to chronic disease. SDOH factors are associated with various forms of stressors that impact physiological processes through epigenetic, inflammatory, and redox regulation. Many SDOH exposures may add to or potentiate the pathologic effects of additional environmental exposures. This overview aims to inform basic life science and translational researchers about SDOH exposures that can confound associations between classic biomedical determinants of disease and health outcomes. To advance the study of toxicology through either qualitative or quantitative assessment of exposures to chemical and biological substances, a more complete environmental evaluation should include SDOH exposures. We discuss common approaches to measure SDOH factors at individual and population levels and review the associations between SDOH risk factors and physiologic mechanisms that influence chronic disease. We provide clinical and policy-based motivation to encourage researchers to consider the impact of SDOH exposures on study results and data interpretation. With valid measures of SDOH factors incorporated into study design and analyses, future toxicological research may contribute to an evidence base that can better inform prevention and treatment options, to improve equitable clinical care and population health. © 2022 Wiley Periodicals LLC.

Addressing Health Inequities: An Exploratory Assessment of Extension Educators' Perceptions of Program Demand for Diverse Communities.

Land grant universities are a key provider of community-based health promotion programs through the Cooperative Extension Service. However, Extension's current approach to addressing systemic social determinants of health is incomplete and inconsistent. The purpose of this study was to explore Extension health educators' perceptions of demand for health promotion programming targeting audiences most likely to experience health inequities. Health educators within 2 state Extension systems were invited to complete an online survey based on a capacity building model. Survey questions included rating perceptions of demand for programming for health disparate populations: low-income; Black and African American; Hispanic, Latino/a, Latinx; persons with disabilities; immigrants and refugees; and lesbian, gay, bisexual, and transgender. Analysis of variance and Bonferroni post hoc testing was used to determine differences in perceived demand between populations. Ninety-six educators completed the survey. Perceived demand for low-income population programming was significantly higher than for other populations. Perceived programming demand for immigrants and refugees and lesbian, gay, bisexual, and transgender people was significantly lower than for other populations. Individual and organizational-level factors, including racism and Extension's historical scope, likely contribute to the results. Engaging historically excluded Extension audiences requires time and resources to improve the Extension system and educator capacity for relationship building, trust building, and communication.

Retrospective Assessment of Human-Chemical Interactions in Health-Disparity Populations: A Process Evaluation of Life History Calendars.

Life-history calendars (LHCs) can produce retrospective data regarding numerous events, exposures, and sequences that have occurred across participants’ lifespans. In this mixed-quantitative-and-qualitative-methods study, processes of LHC administration were evaluated in two populations experiencing health disparities: foreign-born agricultural workers (n = 41) and Indigenous people who used injection drugs (IPWIDS) (n = 40). LHC administrator and participant perspectives were elicited during follow-up survey activities. In both agricultural workers and IPWIDs, over half of participants reported that the LHC made it easier to remember things about the past, and participant age was associated with cumulative experience in different domains of interest. Qualitative findings suggested that data-collector training and the development of concise interview guides are critical for improving LHC data quality. Participants described ethical themes, including utilitarian, cathartic, and reflective aspects, of LHC participation. Future iterations of the LHC may benefit from providing free-form and open-ended spaces for participants to reflect on the LHC activity following LHC administration.

Anxiety sensitivity and its association with perceived barriers for quitting, smoking inflexibility, and severity of quit problems among Black smokers

Black individuals who smoke in the United States experience health disparities related to tobacco use (e.g., greater nicotine dependence, less success in quitting smoking) and interoceptive distress (e.g., somatic symptoms, anxiety). Individual difference factors that amplify interoceptive distress and contribute to poorer smoking behaviors and outcomes warrant further attention and investigation. Thus, the present study sought to explore the association between anxiety sensitivity and clinically-relevant smoking variables of perceived barriers for quitting, smoking inflexibility, and problems experienced during past quit attempts. Participants in the current study included 98 Black adult smokers (71.4% male; Mage = 44.08 years, SD = 11.44 years). Results indicated greater levels of anxiety sensitivity were associated with greater levels of perceived barriers for quitting smoking (b = 0.10, SE = 0.08, p = 0.01), smoking inflexibility (b = 0.02, SE <.001, p <.001), and problems experienced during past smoking quit attempts (b = 0.17, SE = 0.07, p = 0.02). Clinical implications and future directions are further discussed as it relates to anxiety sensitivity and efforts to reduce or quit smoking for this health disparities population.