Hispanic Research Articles

Smoking behavior and social identity: Correlates of Phantom Smoking Among Lesbian, Gay, Bisexual, Transgender, and Other Sexual and Gender Diverse Young Adults.

LGBTQ+ populations and people who smoke face stigma. This may lead to distancing oneself from smoking-related stigma by becoming phantom smokers (i.e., reporting smoking, but not identifying as a smoker). We explored correlates of phantom cigarette smoking among LGBTQ+ young adults. Participants were U.S. young adults (18 to 24 years) who identified as LGBTQ+, reported any past 30-day cigarette smoking and had a valid response for smoker self-identification (unique N= 5,545). We incorporated data from participants who completed one or more of the seven surveys from FDA's This Free Life campaign evaluation (February 2016-July 2019). Multivariable panel regression models with unweighted data examined phantom smoking correlates. Over 60% of the sample were phantom smokers. Compared with self-identified smokers, phantom smokers were younger, more likely to be gay men than lesbian/gay women, and more likely to be non-Hispanic White than non-Hispanic Black, Hispanic or non-Hispanic people of other races/ethnicities. Phantom smokers were more likely to have a college plus education (vs. high school or less) and report past 30-day alcohol use. Phantom smokers smoked on fewer of the past 30 days and were less likely to report positive cessation attitudes, nicotine dependence, and current e-cigarette or other tobacco product use. This is the first known study to explore factors associated with phantom smoking among LGBTQ+ young adults. Over half of young adult smokers were phantom smokers. Tobacco education for LGBTQ+ populations should consider phantom smoking and cessation implications to tailor content for phantom and self-identified smokers. We examined predictors of phantom smoking (current smoking but denying smoker identity) among LGBTQ+ young adult smokers, which has not yet been explored among this population. Phantom (vs. self-identified) smokers were less likely to be lesbian/gay women (vs. gay men) or from a racial/ethnic minority group and more likely to report past 30-day alcohol use. Phantom smokers reported less tobacco use, lower nicotine dependence, and less favorable cessation attitudes. Phantom smokers comprised most smokers in our sample. Findings suggest the importance of addressing this unique aspect of LGBTQ+ smoking in research, clinical settings, and tailored tobacco public education messages.

Influenza Activity and Preterm Birth in the Atlanta Metropolitan Area: A Time-Series Analysis from 2010 to 2017.

Annual influenza epidemics lead to substantial public health burden, and pregnant people are vulnerable to severe outcomes. Influenza during pregnancy is hypothesized to increase risk of adverse birth outcomes, but population-based epidemiologic evidence remains limited and inconsistent. We conducted a time-series analysis to estimate short-term associations between community-level seasonal influenza activity and daily counts of preterm births in Atlanta, United States from October 17th, 2010 to July 10th, 2017. We defined weekly influenza exposures four ways: (1) percent test-positive from virologic surveillance, (2) percent of patients with symptoms of influenza-like illness (ILI) in outpatient settings, (3) a composite measure of percent test-positive and ILI, and (4) influenza hospitalization rates. We used Poisson log-linear models to estimate associations, adjusting for time-varying confounders and ongoing at-risk pregnancies. We further examined associations by influenza type and exposure lags, and effect modification by maternal characteristics. We studied a total of 316,253 births. We found consistent positive associations between influenza activity and preterm birth across different exposure measures and exposure lags. An interquartile range increase in composite measure of ILI activity and percent test-positive was associated with a 1.014 (95% confidence interval: 1.001, 1.027) increase in preterm birth during the same week. In stratified analyses, associations were more pronounced among married, non-Black, and Hispanic pregnant people. Periods of high influenza activity were associated with increased risk of preterm birth.

Experiences of the changing illicit drug supply among racial and ethnic minoritized people in three US states: a qualitative study

BackgroundAmidst a national surge in overdose deaths among racial and ethnic minoritized people and people who use stimulants (cocaine or methamphetamines), our objective was to understand how these groups are adapting to a rapidly changing illicit drug supply.MethodsWe conducted semi-structured interviews with 64 people who use drugs and who self-identified as Black, Hispanic, Multiracial, or other Non-White race in three states (Michigan, New Jersey, and Wisconsin). Transcribed interviews were coded thematically.ResultsMost respondents used stimulants alone or in combination with opioids. Respondents perceived that the drug supply had become more unpredictable and dangerous but differed in their personal perception of risk and their adaptations. For example, respondents had very mixed perceptions of their own risk of being harmed by fentanyl, and differing opinions about whether fentanyl test strips would be useful. Xylazine, a novel adulterant in the opioid drug supply that has received public health and media attention, was not well known within the sample.ConclusionOur study highlights the challenges experienced by minoritized people who use drugs in responding to a changing drug supply, underscoring the limits of public health approaches focused solely on individual behavioral change.

Abstract 4125701: Race and Ethnicity Are Associated with Diagnosis and Management of Wolff-Parkinson-White Pattern in Children

Background: Racial and ethnic disparities have been reported in catheter ablation in adults. There are limited data on the impact of race/ethnicity on the diagnosis and management of children with Wolff-Parkinson-White pattern (WPW). Hypothesis: Diagnosis of WPW by electrocardiogram (ECG) and risk stratification by exercise stress test (EST) and electrophysiology study (EPS) will differ by race/ethnicity in children. Methods: We performed a retrospective cohort study of patients 0-21 years old, excluding those with congenital heart disease, at a children’s hospital from 1991-2021. The primary exposure was race/ethnicity. Outcomes were 1) diagnosis of WPW on ECG, 2) undergoing EST, and 3) undergoing EPS. Likelihood and time to outcome were assessed with multivariable logistic regression adjusted for birth year and Cox regression, respectively. Results: The cohort consisted of 1,638,746 patients (White 53.0%, Black 21.0%, Hispanic 6.8%, Asian 4.2%, Multi-racial 2.0%, Other 11.0%, and Missing 1.7%). WPW was diagnosed in 898 patients (0.05%). After adjusting for birth year, Asian, Black, and Other race were associated with lower odds of WPW diagnosis compared to White patients (OR 0.57, 0.66, 0.70; p≤0.01). There was no association between race and age at first diagnosis (p=0.2). A total of 616 WPW patients (69%) underwent EST. Compared with White patients, Asian, Hispanic, and Other race were less likely to undergo EST (OR 0.39, 0.59, 0.62; p≤0.04), and those who did had their EST at later ages (HR 0.59, 0.65, 0.46; p≤0.04). A total of 739 WPW patients (82%) underwent EPS. Compared with White patients, Black, Hispanic, and Other race were less likely to undergo EPS (OR 0.44, 0.53, 0.59; p≤0.02), and those who did had their EPS at later ages (HR 0.60, 0.63, 0.66; p≤0.004). Conclusion: This analysis found that non-White racial and ethnic groups are less likely to be diagnosed with WPW. This may reflect differences in WPW prevalence by race/ethnicity, but differential access to ECG cannot be ruled out. Among WPW patients, however, Asian and Hispanic patients are approximately half as likely to undergo EST, while Black and Hispanic patients are approximately half as likely to undergo EPS, compared to White patients.

De Viva voz: An Intersectional Approach to Assessing Student Experience and Fostering Equity at HSIs

ABSTRACT This research project outlines students’ perceptions of belonging, equity, visibility, representation, and culture at their Hispanic Serving Institution. In Latin America, the saying “De viva voz,” emphasizes acknowledging voz [voice]. Through an intersectional framework, this work acknowledges students’ voices, identities, and lived experiences as foundational to identify the barriers at an HSI at the Mexico-United States borderlands region. In doing so, we are able to propose a series of strategies that respond to the cultural context of the university, and the needs of students in order to eliminate structural barriers. Further, this paper explores what it means to be an HSI and the tenuous relationship between Hispanic culture and students at a US university. The implications of this research project add to the body of the literature that challenges homogeneous notions and conceptualizations of HSIs limited to enrollment of Hispanic and Latinx students. In doing so, “De viva voz” names and challenges the historical forms of discrimination and erasure that Latinx, students of color and other minoritized populations have endured in university settings. Moreover, this work models student-centered research practices for other Hispanic Serving Institutions interested in promoting intersectional practices to improve campus climate and foster belonging, equity, inclusion, and diversity.

Racial and Ethnic Disparities in Referral Rejection from Postacute Care Facilities among People with Opioid Use Disorder in Massachusetts.

The aim of the study was to examine the association between Black, White, and Hispanic or Latino race and ethnicity and referral rejection from private postacute care facilities among hospitalized individuals with opioid use disorder (OUD). In this retrospective cohort study, we linked electronic postacute care referrals from Boston Medical Center in 2018 to electronic medical record data, which we used to ascertain OUD status and race and ethnicity. Using multivariable logistic regression, we examined the association between Black, White, and Hispanic or Latino race and ethnicity and referral rejection, adjusting for individual-level characteristics including medication for opioid use disorder treatment type and for facility-level factors using facility random effects. We identified 159 hospitalizations from 141 individuals with OUD referred to private postacute medical care, corresponding to 1272 referrals to 244 facilities. Hospitalizations comprised 53 (33%) non-Hispanic Black, 28 (18%) Hispanic or Latino, and 78 (49%) non-Hispanic White individuals. In adjusted analyses, referrals for non-Hispanic Black individuals had significantly higher odds of rejection compared to referrals for non-Hispanic White individuals (adjusted odds ratio 1.83, 95% confidence interval [1.24, 2.69], P = 0.002). There were no significant differences between referrals for Hispanic or Latino individuals and non-Hispanic White individuals (adjusted odds ratio 1.11, 95% confidence interval [0.67, 1.84], P = 0.69). Among people with OUD referred to private postacute care in Massachusetts, non-Hispanic Black individuals were more likely to be rejected compared to non-Hispanic White individuals, demonstrating racism in postacute care admissions. Efforts to address discrimination against people with OUD in postacute care admissions must also address racial equity.

Risk Score for Hepatocellular Cancer in Adults Without Viral Hepatitis or Cirrhosis

Hepatocellular carcinoma (HCC) is typically detected only at advanced stages when treatment options are limited. Most of the current HCC risk models focus on patients with viral hepatitis or diagnosed cirrhosis or require variables not routinely available in clinical care. To identify modifiable HCC risk factors in the general population and to develop a risk score to inform HCC screening and risk-factor modification interventions for high-risk individuals without viral hepatitis or decompensated cirrhosis. This cohort study analyzed demographic, clinical, laboratory, and diagnostic data from the US Department of Veterans Affairs (VA) electronic health records. Data were divided into development and validation samples. Veterans aged 30 to 95 years were included, and those with hepatitis B or C virus infection, hepatic decompensation, or prevalent HCC were excluded. Patients were followed up until the occurrence of HCC diagnosis, death, or December 31, 2021. A Cox proportional hazards regression model for 10-year risk of HCC was developed and used to create an HCC risk score, and performance in development and validation samples and in patient subgroups was evaluated. One outpatient visit date per person at least 18 months after VA entry, between October 1, 2007, and March 31, 2020, was randomly selected and used as the index date for the start of follow-up. Analyses were performed from March 2023 to May 2024. Age, sex, race and ethnicity, body mass index, liver fibrosis (detected with Fibrosis-4 Index [FIB-4]), diabetes status, smoking status, and alcohol use. First HCC diagnosis during follow-up. This information was ascertained from VA national cancer registry topography and histology codes and from International Classification of Diseases, Ninth Revision and International Statistical Classification of Diseases, Tenth Revision, Clinical Modification diagnosis codes for the inpatient or outpatient visits. This study of 6 509 288 veterans included 6 048 917 males (92.9%), with a median (IQR) age of 65 (54-74) years, who identified as being of Hispanic (5.3%), non-Hispanic Black (15.0%), non-Hispanic White (68.9%), or other (4.6%) race and ethnicity. Overall, 15 142 patients (0.2%) developed HCC, 69.5% of whom had FIB-4 of 3.25 or lower at baseline. While FIB-4 was the most important variable, age, sex, race and ethnicity, body mass index, diabetes, smoking, and alcohol use were also informative. Discrimination in the development sample was better than FIB-4 alone (C statistic, 0.83 [95% CI, 0.82-0.85] vs 0.79 [95% CI, 0.77-0.80]). The HCC risk score performed consistently well in the validation sample and in all subgroups. A FIB-4 threshold of 3.25 would screen 5.0% of the cohort at a cost of 28 false-positives for every true-positive; a model risk score of 58 would screen 4.7% of the cohort at a cost of 23 false-positives for every true-positive. Results of this study suggest that a multivariable risk score that uses routinely available clinical data outperforms FIB-4 alone in identifying patients at risk of HCC who do not have viral hepatitis or hepatic decompensation at baseline.

A randomized controlled trial of gamification to increase physical activity among black and Hispanic breast and prostate cancer survivors: Rationale and design of the ALLSTAR clinical trial

Survivors of breast and prostate cancer, especially those that are Black and/or Hispanic, are at high risk for cardiovascular events. Physical activity can reduce the risk of cardiovascular events in cancer survivors, but Black and Hispanic people are less likely to engage in routine physical activity. Concepts from behavioral economics have been used to design scalable, low-touch gamification interventions that increase physical activity in individuals at high risk for cardiovascular events, but the effectiveness of these strategies in Black and Hispanic survivors of breast and prostate cancer is uncertain. ALLSTAR (NCT05176756) is a pragmatic, virtual randomized controlled trial designed to evaluate the effectiveness of a gamification intervention informed by behavioral economic concepts to increase daily physical activity in Black and Hispanic breast and prostate cancer survivors who received cardiotoxic therapies and have additional risk factors for cardiovascular disease. Patients are either referred by their cancer care team or identified by electronic health record searches; contacted by letter, email, text message and/or phone; and complete enrollment and informed consent on the Penn Way to Health online platform. Patients are then provided with a wearable fitness tracker, establish a baseline daily step count, set a goal to increase daily step count by 1,500-3,000 steps from baseline, and are randomized 1:1 to control or gamification. Interventions continue for 6 months, with follow-up for an additional 3 months to evaluate the durability of behavior change. The trial has met its enrollment goal of 150 participants, with a primary endpoint of change from baseline in daily steps over the 6-month intervention period. Key secondary endpoints include change from baseline in daily steps over the 3-month post-intervention follow-up period, change in moderate to vigorous physical activity over the intervention and follow-up periods, and change in patient-reported measures of physical function, fatigue, and overall quality of life. ALLSTAR is a virtual, pragmatic randomized clinical trial powered to demonstrate whether gamification is superior to control in increasing physical activity in Black and Hispanic breast and prostate cancer survivors. Its results will have important implications for strategies to promote physical activity in survivors of breast and prostate cancer, specifically among minority populations. clinicaltrials.gov; https://clinicaltrials.gov/study/NCT05176756.

MOUD use among Hispanic clients increased post-ACA, yet differed by heritage and geographic location

BackgroundOverdose death rates for Hispanic people rose 2010-2022. Opioid overdose rates grew faster among Hispanic people than non-Hispanic White people (“White”). Medication for opioid use disorder (MOUD) is an effective but underutilized intervention for decreasing overdose risk. The Affordable Care Act (“ACA”) should have increased MOUD use, but insurance and behavioral health reforms differed by state. We examined to what extent MOUD use increased post-ACA implementation and differed for Hispanic people (overall and by heritage group) compared to White people who used opioids (“clients”). MethodsWe analyzed first annual ambulatory care episodes (TEDS-A, 2009-2019) for working-age Hispanic (N= 76,591) and White (N=444,753) clients. We categorized Hispanic clients by heritage group (Puerto Rican, Mexican, or Other Hispanic). We grouped states by Medicaid expansion status (California, Other Expansion States, and Non-Expansion States). We used logistic regression to compare the odds of MOUD use pre/post ACA within racial/heritage groups, and, separately, between racial/heritage groups using pre-ACA White clients as a reference group. We used linear probability difference-in-differences to confirm changes in MOUD use between Hispanic and White clients. ResultsAmong Hispanic clients in ambulatory care, MOUD use was lowest in the Non-Expansion States and highest in California. Nationally, only Puerto Rican and Other Hispanic heritage clients had higher odds of MOUD post-ACA compared to pre-ACA. Nationally and in Other Expansion States, Hispanic and White clients had similar increases in MOUD use post-ACA. ConclusionsMOUD use among Hispanic clients rose post-ACA, but differences remained between Hispanic heritage groups and between states.

Steatotic Liver Disease Education Enhances Knowledge and Confidence to Adhere to Provider Recommendations in Diverse and Vulnerable Populations

Background and AimsPatient knowledge of steatotic liver disease (SLD) is suboptimal. We assessed the impact of SLD education on patient knowledge and confidence to follow provider recommendations among a diverse vulnerable population. MethodsIn this prospective study from 2/19/2020 to 1/31/2024, 296 adults with SLD were surveyed before and after receipt of formal SLD education. Linear regression (adjusted for age, sex, race) assessed factors associated with baseline SLD knowledge score and its change after education (delta in pre- and post-scores), along with confidence to follow provider recommendations following receipt of education. ResultsParticipant characteristics were: median age 53 years, 40.9% male, 55.1% Hispanic (27.0% Asian and 10.5% White), and 23.8% reported heavy alcohol use. SLD knowledge and confidence to follow provider recommendations increased post-education (all p<0.05). On multivariable analyses, greater than high school education (vs. high school or less) (coef. 0.62), perceived severity of disease (coef. 0.62), treatment efficacy (coef. 1.38), self-efficacy to discuss SLD (coef. 0.71), and perceived susceptibility to disease risk (coef. 0.93) were associated with greater baseline knowledge (all p<0.05). Following education, heavy alcohol use (vs. none) was associated with greater change in knowledge (coef. 0.74), while perceived severity (coef. -0.52) and treatment efficacy (coef. -0.72) were associated with lesser change in knowledge (all p<0.05). While perceived barriers (coef. -0.14) were associated with less confidence, self-efficacy to discuss SLD, older age, Hispanic, and other race was associated with greater confidence to follow provider recommendations (coef. 0.38, 0.18, 0.64, and 1.26, respectively, all p<0.05). ConclusionFormal SLD education enhanced knowledge and confidence to follow provider recommendations in Hispanics and heavy alcohol users. SLD education is integral to SLD management in safety-net populations.

Disparities in COVID-19 vaccine uptake among pregnant people in a diverse urban population with high vaccine acceptance

IntroductionThis study's objective was to compare coronavirus disease 2019 (COVID-19) vaccination rates between pregnant individuals in San Francisco and the city's similar-aged population, and to identify factors associated with vaccine uptake in the pregnant population. MethodsThis was a retrospective cohort study of all patients delivering at two hospitals in San Francisco from 3/15/2021-10/15/2021. Reference COVID-19 vaccination rates for San Francisco were obtained from the California Immunization Registry. The primary outcome was completion of a COVID-19 vaccine series among pregnant individuals compared with the San Francisco general population aged 18-45 years. Secondary outcomes included factors associated with COVID-19 vaccination among pregnant people. ResultsOf 2294 pregnant individuals, 1181 (51.5%) completed a COVID-19 vaccine series by delivery. Pregnant individuals were less likely to be vaccinated than the San Francisco population throughout the study period. Factors associated with lower vaccination rates in pregnant individuals included public insurance (adjusted OR [aOR], 0.21; 95% CI, 0.16-0.27), younger age (aOR 0.74; 95% CI 0.64-0.86), English language preference (aOR 0.58, 95% CI 0.42-0.80), and self-identified Black (aOR 0.26, 95% CI 0.17-0.40; Reference: White), Hispanic (aOR 0.61, 95% CI 0.46-0.81), or Other (aOR 0.50, 95% CI 0.36-0.68) race or ethnicity. ConclusionsCOVID-19 vaccination coverage among pregnant people in San Francisco lagged behind the city's similar-aged population, particularly among those with public insurance and of non-White race. Despite locally high vaccine acceptance, additional efforts are needed to address barriers and reduce disparities in COVID-19 vaccination within the pregnant population.

Dental Coverage and Care When Transitioning From Medicaid to Medicare

Millions of adults with low incomes lose Medicaid eligibility when transitioning to Medicare at age 65 years. However, it remains unclear how this transition is associated with dental care. To examine the consequences of transitions from Medicaid to Medicare on coverage and use of dental services. Cross-sectional data from the Health and Retirement Study from 2014 to 2020 and a regression discontinuity design were used to compare changes in outcomes before and after turning age 65 years among a population likely to be Medicaid-eligible before age 65 years. The sample included adults aged 50 to 90 years who had not attended college in 28 states. Transitions from Medicaid to Medicare at age 65 years. Health insurance (Medicaid, Medicare, dual coverage, private, and uninsurance), dental coverage (Medicaid, Medicare, private, or none), and having a dental visit and out-of-pocket dental spending during the previous 2 years. Of the 15 837 study participants, 9510 (56.2% weighted) were female, 6984 (28.7% weighted) were Black individuals, Hispanic individuals, and individuals of other race (including American Indian, Alaskan Native, Asian, Native Hawaiian, and Pacific Islander individuals), and 8853 (71.3% weighted) were White; the mean (SD) age was 69.2 (10.3) years. Turning age 65 years was associated with an increase in Medicare coverage in states with Medicaid dental benefits (66.5 percentage points [pp]; 95% CI, 58.3-74.7) and those without dental benefits (67.8 pp; 95% CI, 52.6-83.0). There was a concurrent reduction in private coverage, Medicaid, and uninsured rates. For dental outcomes, in states providing Medicaid dental benefits, turning age 65 years was associated with a 13.1-pp decrease in the likelihood of dental coverage (95% CI, 10.7-15.5), largely due to the loss of Medicaid dental coverage. Among adults reporting being Black, Hispanic, or other race, there was a 3.9-pp decline in dental visits during the previous 2 years (95% CI, -6.1 to -1.7). In states without Medicaid dental benefits, turning age 65 years was associated with no change in the likelihood of dental coverage and a 15.6-pp increase in dental visits (95% CI, 6.3-25.0). Out-of-pocket dental spending decreased in both groups of states (-13.0% [95% CI, -24.2 to -0.1] and -19.2% [95% CI, -33.6 to -1.6], respectively). The results of this cross-sectional study suggest that transitioning from Medicaid to Medicare at age 65 years was associated with a lower level of dental coverage and may increase barriers to accessing dental care for beneficiaries who had Medicaid dental coverage before age 65 years. However, for adults living in states without Medicaid dental benefits, the transition was associated with increased use of dental services and no change in overall dental coverage rates.

Exploring United States Hispanic origin groups diagnosed with uterine cancer: Are there disparities?

Exploring United States Hispanic origin groups diagnosed with uterine cancer: Are there disparities?

End-of-life in Hepatocellular Carcinoma: How Palliative Care and Social Factors Impact Care and Cost.

Investigate the impacts of palliative care consults, race, and socioeconomic status on the prevalence of invasive procedures in patients with hepatocellular carcinoma (HCC). Palliative care, race, and socioeconomic status can all influence end-of-life care preferences, but their roles in HCC have not been adequately explored. This is a cross-sectional study of patients with HCC from 2016 to 2019 using the National Inpatient Sample. Terminal and nonterminal hospitalizations were assessed with logistical regression evaluating associations between palliative care, race, income, and procedures along with do-not-resuscitate orders and cost. Procedures included mechanical ventilation, tracheostomy, and cardiopulmonary resuscitation (CPR) among others. A total of 217,060 hospitalizations in patients with HCC were included, 18.1% of which included a palliative care encounter. The mean age was 65.0 years (SD = 11.3y), 73.9% were males and 55.5% were white. Procedures were increased in terminal hospitalizations in black [CPR adjusted odds ratio (aOR) = 2.57, P < 0.001] and Hispanic patients (tracheostomy aOR = 3.64, P = 0.018) compared with white patients. Palliative care encounters were associated with reduced procedures during terminal hospitalizations (mechanical ventilation aOR = 0.47, P < 0.001, CPR aOR = 0.24, P < 0.001), but not in nonterminal hospitalizations. No association between income and end-of-life procedures was found. Palliative care was associated with decreased mean cost in terminal ($23,608 vs $31,756, P < 0.001) and nonterminal hospitalizations ($15,786 vs $19,914, P < 0.001). Palliative care is associated with less aggressive end-of-life care and decreased costs in patients with HCC. Black and Hispanic race were both associated with more aggressive end-of-life care.

Language Dominance and Cultural Identity Predict Variation in Self-Reported Personality in English and Spanish Among Hispanic/Latino Bilingual Adults

Language is a fundamental aspect of human culture that influences cognitive and perceptual processes. Prior evidence demonstrates personality self-report can vary across multilingual persons’ language contexts. We assessed how cultural identification, language dominance, or both dynamically influence bilingual respondents’ self-conception, via self-reported personality, across English and Spanish contexts. During separate English and Spanish conditions, 133 Hispanic/Latino bilingual participants (70 female) completed the Big Five Inventory of personality. We used language use and acculturation surveys completed in both languages to calculate participants’ relative language dominance and identification with U.S.-American and Hispanic culture. Participants reported higher levels of agreeableness, conscientiousness, and neuroticism in English relative to Spanish. Language dominance predicted cross-language differences in personality report, with higher extraversion reported in participants’ dominant language. Within each language, greater endorsement of U.S.-American identity was associated with higher extraversion and conscientiousness and lower reported neuroticism. Agreeableness report in both languages was positively predicted by Hispanic identification. Our results clarify existing literature related to language and cultural effects on personality report among U.S. Hispanics/Latinos. These findings could inform assessments of self-relevant cognitions across languages among bilingual populations and hold relevance for health outcomes affected by cultural processes.

Association Between Social Determinants of Health and Hearing Loss and Hearing Intervention in Older US Adults.

Estimate the prevalence of hearing loss and hearing assistance device use among older adults in the United States, and assess for associations with select social determinants of health (SDOH). Cross-sectional US population-based study using National Health and Nutrition Examination Survey (NHANES) 2017-March 2020 (pre-pandemic) data. Non-institutionalized civilian adult US population. US adults aged ≥70 years who completed NHANES audiometry exams were included. Sample weights were applied to provide nationally representative prevalence estimates of hearing loss and hearing assistance device use. Logistic regression analyses assessed associations between SDOH and both hearing loss and hearing assistance device use. The overall prevalence of hearing loss was 73.7%. Among those with nonprofound hearing loss, the prevalence of hearing assistance device use was 31.3%. Older individuals (odds ratio [OR], 6.3 [3.668-10.694] comparing ages 80+ versus 70-74 yr) and with lower education (OR, 3.8 [1.455-9.766] comparing <ninth grade versus college graduates or above) experienced a significantly elevated prevalence of hearing loss, whereas females (OR, 0.5 [0.326-0.754] versus males) and Blacks (0.5 [0.295-0.841] versus non-Hispanic Whites) had lower prevalence. Although older individuals with hearing loss had a higher prevalence of hearing assistance device use (OR, 2.1 [1.294-3.553] comparing ages 80+ to 70-74 yr), individuals of Black and other Hispanic races had a significantly lower prevalence of hearing assistance device use than non-Hispanic Whites (OR, 0.4 [0.188-0.671]; OR 0.1 [0.012-0.459], respectively), and those with no health insurance had higher prevalence of use than those who were insured (OR, 4.8 [1.307-17.371]). The prevalence of hearing loss among older adults in the United States remains roughly stable compared with previous population-based estimates, whereas the prevalence of hearing assistance device use is slightly increased. Population-level disparities exist both in the prevalence of hearing loss and hearing assistance device use across SDOH.

“(Un)Being a Mother” Media Representation of Motherhood and Female Identity

This research examines the portrayal of (non)motherhood in television series from 2016 to 2022. The title, “(Un)being a Mother”, was deliberately chosen for its polysemic nature, facilitating an exploration of the complexities of motherhood, its absence, and the implications for womanhood. The study thematically analyzes 15 television series from Hispanic, Italian, and Anglo-American cultures to reveal the diverse perspectives on motherhood. Utilizing the frameworks of Intensive Mothering, Good Mothering, Good Enough Mothering, and Non-Mothering (including both childless and childfree women), the research aims to illuminate representations of motherhood, variations in mothering paradigms, and the influence of cultural and geographical contexts. This study introduces an innovative methodological approach by investigating recurring themes of (non)motherhood across different cultural productions, incorporating insights from media sociology, gender media studies, anthropology, and ethnographic media research for a comprehensive understanding of the subject.

Multi-Omics Mendelian Randomization Study Investigating the Impact of PCSK9 and HMGCR Inhibition on Type 2 Diabetes Across Five Populations.

The prevalence of type 2 diabetes (T2D) varies among populations of different race/ethnicity. The influence of genetically-proxied lipoprotein cholesterol (LDL-C) lowering through proprotein convertase subtilisin/kexin 9 (PCSK9) and HMG-CoA Reductase (HMGCR) on T2D in non-European populations is not well established.A drug-target Mendelian randomization (MR) approach was used to assess the effects of PCSK9 and HMGCR inhibition on T2D risk and glycemic traits in five populations: East Asian (EAS), South Asian (SAS), Hispanic (HISP), African (AFR), and European (EUR). Our study did not find relationships between genetically-proxied PCSK9 inhibition and T2D risk in EAS (odds ratio [OR]=1.02, [0.95-1.10]), SAS (OR=1.05, [0.97-1.14]), HISP (OR=1.03, [0.94-1.12]), or EUR (OR=1.04, [0.98-1.11]). However, in AFR, primary analyses suggested an increased risk of T2D due to PCSK9 inhibition (OR=1.53, [1.058-2.22], P-value=0.024), although this was not supported in sensitivity analyses. Genetically-proxied HMGCR inhibition was associated with an increased risk of T2D in SAS (OR=1.44, [1.30-1.61], P-value=9.8×10-12), EAS (OR=1.36, [1.22-1.51], P-value=4.2×10-10), and EUR (OR=1.52, [1.21-1.90], P-value=3.3×10-4). These results were consistent across various sensitivity analyses, including colocalization, indicating a robust finding. The findings indicate a neutral impact of long-term PCSK9 inhibition on T2D and glycemic markers in most non-European populations, with a potential increased risk in AFR cohorts. By contrast, HMGCR inhibition increased the risk of T2D in South Asian, East Asian, and European cohorts, underscoring the need to consider diversity in genetic research on metabolic diseases.

Artificial Intelligence and Machine Learning in Ocular Oncology, Retinoblastoma (ArMOR): Experience with a Multiracial Cohort.

Background: The color variation in fundus images from differences in melanin concentrations across races can affect the accuracy of artificial intelligence and machine learning (AI/ML) models. Hence, we studied the performance of our AI model (with proven efficacy in an Asian-Indian cohort) in a multiracial cohort for detecting and classifying intraocular RB (iRB). Methods: Retrospective observational study. Results: Of 210 eyes, 153 (73%) belonged to White, 37 (18%) to African American, 9 (4%) to Asian, 6 (3%) to Hispanic races, based on the U.S. Office of Management and Budget's Statistical Policy Directive No.15 and 5 (2%) had no reported race. Of the 2473 images in 210 eyes, 427 had no tumor, and 2046 had iRB. After training the AI model based on race, the sensitivity and specificity for detection of RB in 2473 images were 93% and 96%, respectively. The sensitivity and specificity of the AI model were 74% and 100% for group A; 88% and 96% for group B; 88% and 100% for group C; 73% and 98% for group D, and 100% and 92% for group E, respectively. Conclusions: The AI models built on a single race do not work well for other races. When retrained for different races, our model exhibited high sensitivity and specificity in detecting RB and classifying RB.

Emergency Care Use During Pregnancy and Severe Maternal Morbidity

Pregnant individuals who repeatedly use emergency care during pregnancy represent a population who could be disproportionately vulnerable to harm, including severe maternal morbidity (SMM). To explore patterns of unscheduled care visits during pregnancy and ascertain its association with SMM at the time of birth. This cohort study used data from a statewide database that linked hospital records to births and fetal deaths occurring between October 1, 2002, and March 31, 2020, in Massachusetts. Pregnant individuals experiencing births or fetal deaths during the study period were included. Data analysis was conducted from June 2022 to September 2024. The exposure was 4 or more cases of emergency use, defined as either an emergency department visit or observational stay during pregnancy not resulting in hospital admission. Pregnancy episode was ascertained by subtracting the gestational age at birth from the date of birth. The outcome of interest was the odds ratio (OR) for SMM at the time of birth. The algorithm includes 20 conditions or procedures (excluding transfusion) identified through International Classification of Diseases, Ninth Revision and International Statistical Classification of Diseases and Related Health Problems, Tenth Revision codes across the study period. A total of 774 092 pregnant individuals (mean [SD] age, 31.2 [5.8] years; 16.8% Hispanic, 9.3% non-Hispanic Asian or Pacific Islander, 9.5% non-Hispanic Black, 63.1% non-Hispanic White) with emergency care visits during the pregnancy were included; 31.3% of these individuals had at least 1 visit. Overall, 18.1% had 1 visit and 3.3% had 4 or more visits. Four or more unscheduled visits were common among those younger than age 25 years (8.7%), with Hispanic (5.7%) or non-Hispanic Black (4.9%) race and ethnicity, with public insurance (6.5%), or with a comorbidity (19.0%) or an opioid use-related hospitalization (26.8%) in the year prior to pregnancy. Of those with 4 or more unscheduled visits, 43.8% visited more than 1 hospital during pregnancy. In a multivariable analysis of the likelihood of SMM, those with 4 or more unscheduled visits had an adjusted OR of 1.46 (95% CI, 1.29-1.66) compared with those with 0 visits. This cohort study found that high emergency care use during pregnancy was associated with an increased risk for SMM. With a significant proportion of those with frequent unscheduled visits also using multiple hospitals, solutions that are community-based and integrated across health systems may be most beneficial.