Major Health Disparity Research Articles

Abstract A166: Towards Health Justice: Implementing Structural Competency in Women's Healthcare Education Towards Health Justice

Abstract Introduction: Significant health disparities persist in women's health, particularly among marginalized groups like racial/ethnic minorities, LGBTQ+ individuals, and those with disabilities. Addressing these inequities requires training healthcare providers in structural competency to recognizing how social, economic, political, and cultural structures influence health outcomes beyond just individual factors. Objectives: The purpose of this study is to conduct a comprehensive evaluation of the literature on structural competence in connection to health inequalities in women's health. The objectives include: (1) Reviewing the role of structural competence in addressing health disparities among in reproductive health ; (2) Analysing instructional methodologies related to structural competencies; and (3) Developing a strategic framework to address racial health disparities in women's health through structural competence. Methodology: A literature review was conducted using the Scopus, Google Scholar, and Web of Science databases. After applying specific inclusion and exclusion criteria, 463 publications were retained from 905 articles published between 2010 and 2023. Findings: Major health disparities experienced by women include lack of access to quality healthcare services, discrimination from providers, higher rates of chronic illnesses, mental health issues, and lack of autonomy in reproductive health decisions and influenced by cultural norms and expectations. Racial/ethnic minority women face additional disparities due to language/cultural barriers, provider biases, impact of social determinants, and discrimination.Structural competency approaches highlighted include using community health workers (CHWs), analyzing electronic health record (EHR) data to identify disparities, advocating for policy changes targeting social determinants, and integrating structural competency training in medical curricula.While no specific successful policy examples are provided, recommendations include expanding healthcare coverage, supporting community clinics, and addressing socioeconomic inequities through systemic interventions. Conclusion: Integrating structural competency into medical education holds transformative potential for alleviating persistent health disparities in women's health by equipping providers to recognize and confront the underlying structural factors perpetuating these inequities. Citation Format: Daina Charnelle Fougang, Dianne Wepa A/P Wepa, Charles Charnelle Mpofu. Towards Health Justice: Implementing Structural Competency in Women's Healthcare Education Towards Health Justice [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr A166.

Standards for levels of lead in soil and dust around the world

Abstract Lead poisoning is a serious environmental health problem in every country in the world. Exposure to lead results in neurocognitive and behavioral changes, has adverse effects on the immune system, causes anemia, hypertension and perturbs other organ systems. The effects of lead poisoning are most critical for children because their bodies are growing and developing, and particularly because agents that reduce cognitive function and attention span as well as promote disruptive behavior will have life-long consequences. Lead exposure, especially to children, is a major health disparity issue. If the next generation starts with reduced cognitive ability, there will be significant barriers for development of skills and country-wide development. While there are many sources of exposure to lead, the commonest source is lead in soil and dust. Since lead is an element, it does not go away and past releases of lead into the environment remain as soil and dust contamination. This is an especially important route of exposure to children because children regularly play in soil and are exposed via hand-to-mouth activity. In addition to indoor sources of lead, contaminated soil is tracked on shoes or feet and blown by air currents into homes, accumulating in household dust which is a major source of exposure for both children and adults. The purpose of this review is to determine standards presumed to be health protective for lead and dust in different countries. We find that many countries have no standards for lead in soil and dust and rely on standards set by the World Health Organization or the US Environmental Protection Agency, and these standards may or may not be enforced. There is considerable variation in standards set by other countries.

A Scoping Review of Trends in the Size of Lesbian, Gay, and Bisexual Tobacco Use Disparities, 1996-2020, United States and Canada.

Purpose: Tobacco use is a major health disparity for lesbian, gay, bisexual, and transgender (LGBT) populations compared with heterosexual/cisgender populations. In this scoping review, we aimed to determine if LGBT tobacco use disparities are improving or worsening over time and if trends in disparities differed across subgroups. Methods: We included articles that longitudinally explored youth and adult LGB tobacco use in the United States and Canada after searching four databases and capturing records through July 2022. Two reviewers independently screened the title/abstract and full text of 2326 and 45 articles, respectively. Eleven articles from 18 larger assessments met inclusion criteria, spanning data collection from 1996 to 2020. Results: All studies consistently demonstrated tobacco disparities for LGB populations. No articles examined longitudinal transgender tobacco disparities. Most studies focused on smoking combustible cigarettes. Disparities in heavy or daily use for all LGB youth subgroups compared with heterosexual samples appear to be shrinking longitudinally. Results for early-onset, current, and lifetime smoking were less consistent. Adult evidence was relatively sparse; however, after 2010, studies show diminishing disparities over time, except for current smoking by bisexual women. Conclusions: Large tobacco use disparities persist for LGB populations, although the size of disparities may be decreasing for some groups. Initiatives for lesbian and bisexual women and girls should be prioritized, in addition to interventions addressing LGB smoking broadly. Surveillance instruments should uniformly and consistently assess LGBT identities and tobacco use behaviors.

Challenges in Evaluating a Community-Level Intervention to Address Root Causes of Youth Violence

Violence disproportionately impacts Black American youth, representing a major health disparity. Addressing the possible root causes of structural inequities to reduce violence may increase the impact of prevention strategies. However, efforts to evaluate the impact of such interventions pose numerous methodological challenges, particularly around selecting an effective evaluation design to detect change at the community level, with adequate power and sampling, and appropriate constructs and measurement strategies. We propose a multiple baseline experimental design to evaluate the impact of a community-level youth violence and suicidality prevention strategy. A multiple baseline experimental design with multiple community units balances the need for scientific rigor with practical and values-based considerations. It includes randomization and plausible counterfactuals without requiring large samples or placing some communities in the position of not receiving the intervention. Considerations related to the conceptualization of the logic model, mechanisms of change, and health disparity outcomes informed the development of the measurement strategy. The strengths and weaknesses of a multiple baseline experimental design are discussed in comparison to versions of randomized clinical trials. Future health disparity intervention evaluation research will benefit from (1) building a shared sense of urgent public need to promote health; (2) respecting the validity of values- and partnership-based decision-making; and (3) promoting community-based and systems-level partnerships in scientific grant funding. The described study has been registered prospectively at clinicaltrials.gov, Protocol Record 21–454.

Abstract PR007: Patient derived organoids as a model to study estrogen mediated endometrial cancer

Abstract The purpose of our study was to develop a more optimal in vitro model to study the mechanisms of hormone action on endometrial cancer. Endometrial cancer (EC) represents a major health disparity with a 21% increase in mortality in African American women. The cause for this excess mortality is unknown. Endometrial cancer is commonly characterized by histological subtype into Endometrioid or Non-Endometrioid with estrogen being a driver for many endometroid type tumors. Most EC cell lines do not have high expression of estrogen receptor or do not respond to physiological levels of hormones in vitro; this lack of functional experimental models has hampered progress in the study of this disease. We have developed Patient Derived Organoids (PDOs) from 9 patient-derived xenografts (PDX) that are from both African American and Non-Hispanic Caucasian women with various stages and subtypes of EC, as a model to study EC. This model system captures the characteristics of different histological and molecular subtypes in vitro, as they maintain not only EC tumor cells but also cells from the adjacent tumor stroma. Our developed PDOs were derived from multiple molecular subtypes of EC that have different characteristics and genomic features, allowing us to observe differences in the basal properties of each tumor in vitro. The use of this organoid model system is advantageous for studying EC because growth characteristics are similar to an in vivo model, with the organoids preserving the genotype and phenotype of the native EC, allowing us to observe cellular interactions. We have observed inter-organoid variation of protein expression of β-catenin, E-cadherin, and vimentin, proteins playing a pivotal role in cellular contact, signaling, and epithelial-mesenchymal transition (EMT). Using qPCR and Western blot analysis we have observed high expression levels of estrogen receptor and progesterone receptor in endometrioid type PDOs to begin the exploration of hormonal signaling in this model. Treatment of these same PDOs with β-estradiol resulted in an increase in proliferation of the stromal cells. Single cell RNA sequencing was performed on two PDO’s that had the highest expression of progesterone and estrogen receptors. This analysis demonstrated cell population heterogeneity with multiple cell clusters forming with differential gene expression. From this analysis we can see that the cells recapitulate the gene expression from the tumor of origin, with cells containing the same genetic mutation as the original patient. These results make this model potentially good for studying hormone signaling cascades seen in EC patients that have not been previously observed in established EC cell lines. These studies will also aid in the opportunity to explore the function of differential cell types in the pathogenesis of this disease. Citation Format: Breanna M.W. Jeffcoat, Andrew B. Galdden, Russell R. Broaddus. Patient derived organoids as a model to study estrogen mediated endometrial cancer [abstract]. In: Proceedings of the AACR Special Conference on Endometrial Cancer: Transforming Care through Science; 2023 Nov 16-18; Boston, Massachusetts. Philadelphia (PA): AACR; Clin Cancer Res 2024;30(5_Suppl):Abstract nr PR007.

Native Hawaiians' Views on Depression and Preferred Behavioral Health Treatments: a Preliminary Qualitative Investigation.

Behavioral health issues, especially depression, are a major health disparity concern for Native Hawaiians in Hawai'i. Following the cultural safety framework and contextual behavioral science approach to intervention development, the present preliminary qualitative investigation aimed to gather better insight into Native Hawaiians' views of depression and its causes as well as their preferred forms of behavioral health services. Data were initially collected from a 2-hour virtual focus group with three behavioral health service providers working with Native Hawaiians, followed by a total of 38 online one-on-one in-depth interviews with Native Hawaiian clients with depression (n = 19), behavioral health service providers working with Native Hawaiian adults (n = 9), and Native Hawaiian cultural leaders (n = 10). Our qualitative data suggested that Native Hawaiians tend to view depression contextually and socioculturally as the manifestation of one's vital connection to the 'āina (land), 'ohana (family; continuity from ancestry and future generations), community, culture/spirituality, and one's authentic self being disrupted. Our findings also suggested that Native Hawaiians often attribute these disruptions to disparities due to the ongoing impact of colonization, historical trauma, and cultural loss. As a preferred form of treatment for depression, participants recommended various Hawaiian cultural practices to be integrated into existing behavioral health services to nurture the above-mentioned vital connection.

Weight stigma among dental professionals and in the dental setting: a scoping review

AbstractBackground Weight stigma refers to discriminatory acts and ideologies targeted towards individuals because of their body weight and/or size. Weight stigma in healthcare settings generates major health disparities. To date, there have been no previous reviews exploring the issue of weight stigma among dental professionals (DPs) and in the dental setting.Aims To synthesise current evidence on weight stigma among DPs and in dental care settings via a scoping review.Methods A comprehensive search was carried out across four relevant electronic databases (Medline, Scopus, Psychinfo and Cinahl). A total of 25 full-text papers were included in the scoping review.Results Most papers addressed the subject of weight stigma as a secondary finding (20 papers). Both quantitative and qualitative study methods were used to explore weight stigma across the broad categories of attitudes and beliefs about obesity, weight-based discussions, obesity education and training and service implications of obesity. Recommendations regarding weight stigma among DPs and in the dental setting were proposed but have not been formally assessed.Conclusion Further studies addressing weight stigma in dental settings, including causes and consequences among DPs, are required to better inform and address this issue.

Identification and characterization of the long non-coding RNA NFIA-AS2 as a novel locus for body mass index in American Indians

BackgroundGenome-wide association studies have shown that body mass index (BMI), an estimate of obesity, is highly polygenic. Individual variants typically have small effect sizes, making it challenging to identify unique loci in under-represented ethnic groups which lack statistical power due to their small sample size. Yet obesity is a major health disparity and is particularly prevalent in southwestern American Indians. Here, we identify and characterize a new locus for BMI that was detected by analyzing moderate associations with BMI obtained in a population-based sample of southwestern American Indians together with the well-powered GIANT dataset.MethodsGenotypes for 10.5 million variants were tested for association with BMI in 5870 American Indians and 2600 variants that showed an association P < 10−3 in the American Indian sample were combined in a meta-analysis with the BMI data reported in GIANT (N = 240,608). The newly identified gene, NFIA-AS2 was functionally characterized, and the impact of its lead associated variant rs1777538 was studied both in-silico and in-vitro.ResultsRs1777538 (T/C; C allele frequency = 0.16 in American Indians and 0.04 in GIANT, meta-analysis P = 5.0 × 10−7) exhibited a large effect in American Indians (1 kg/m2 decrease in BMI per copy of C allele). NFIA-AS2 was found to be a nuclear localized long non-coding RNA expressed in tissues pertinent to human obesity. Analysis of this variant in human brown preadipocytes showed that NFIA-AS2 transcripts carrying the C allele had increased RNA degradation compared to the T allele transcripts (half-lives = 9 h, 13 h respectively). During brown adipogenesis, NFIA-AS2 featured a stage-specific regulation of nearby gene expression where rs1777538 demonstrated an allelic difference in regulation in the mature adipocytes (the strongest difference was observed for L1TD1, P = 0.007).ConclusionOur findings support a role for NFIA-AS2 in regulating pathways that impact BMI.

Restoring Balance: a physical activity intervention for Native American cancer survivors and their familial support persons.

Exercise interventions among Native American cancer survivors are lacking, despite major cancer health disparities in survivorship. The purpose of this study was to evaluate a 12-week randomized controlled trial (RCT) of culturally tailored exercise on cancer risk biomarkers and quality of life among Native American cancer survivors and family members. Participants were randomized to immediate start versus 6-week waitlist control at two rural and two urban sites. Participants enrolled in a small feasibility pilot study (only cancer survivors evaluated, n=18; cohort 1) or larger efficacy pilot study where cancer survivors (n=38; cohort 2) and familial supporters (n=25; cohort 3) were evaluated concurrently. Resistance, aerobic, flexibility, and balance exercises were tailored by cultural experts representing ten tribes. Exercises was supervised on-site one day per week and continued in home-based settings two to five days per week. Fat mass, blood pressure, hemoglobin A1c, 6-min walk, sit-to-stand test, and quality of life (Patient-Reported Outcomes Measurement Information System Global Health short form and isolation subscale) were measured. Mixed effects models evaluated differences between RCT arms from baseline to 6 weeks, and 12-week intervention effects in combined arms. There were no consistent differences at 6 weeks between randomized groups. Upon combining RCT arms, 6-min walk and sit-to-stand tests improved in all three cohorts by 12 weeks (both survivors and familial support persons, p<0.001); social isolation was reduced in all three cohorts (p≤0.05). Familial support persons additionally improved blood pressure and HbA1c (p≤0.05). Exercise improved cardiorespiratory fitness and physical function among Native American cancer survivors and familial supporters. A longer intervention may influence other important health outcomes among Native American survivors. Additional improvements demonstrated among Native American family members may have a meaningful impact on cancer prevention in this underserved population with shared heritable and environmental risks.

Disparities in the Diagnosis and Management of Anaphylaxis.

The goal of this review is to characterize health disparities impacting the recognition and treatment of anaphylaxis. Previous research has identified major health disparities related to atopic conditions including asthma, atopic dermatitis, and food allergies (FA); however, disparities related to anaphylaxis have yet to be examined in depth. We found widespread health disparities in the incidence and severity of anaphylaxis, as well as in the management of allergies (particularly food allergies) that place individuals at risk of anaphylaxis. Sociodemographic factors are associated with numerous negative health outcomes related to anaphylaxis. We highlight several key steps that must be taken to address these disparities.

Cancer Education Interventions in Adolescents: A Systematic Review of Scope and Content.

Given the long induction time of many cancers and the fact that modifiable risk factors (e.g., cigarette smoking) including preventive factors (e.g., human papillomavirus [HPV] vaccination, healthy dietary and physical activity patterns) are influenced in adolescence, educating adolescents about cancer causation and risk reduction may have a large impact on reducing the cancer burden. We conducted a systematic review of literature evaluating the impact of cancer education interventions on adolescent knowledge of cancer risk reduction. We searched for articles published from 2000 to 2019 and identified 33 studies meeting our criteria. Given the methodological heterogeneity across studies, we briefly assessed effectiveness but focused on examining the design of the intervention and study. The majority of studies took place outside of the United States (67%). Most studies solely addressed skin or cervical cancer (67%) with only 18% (n = 6) discussing multiple cancers. The majority of interventions were a single-session (55%), did not involve a control or comparison group (67%), and were evaluated using a pre-test and a single post-test (61%); some studies administered multiple post-tests. Few studies (12%) investigated adolescents' knowledge of lifestyle and environmental risk factors at both the individual and community level. Most studies (94%) reported improvement in knowledge following an intervention. Our review revealed wide methodological variation and a deficit in research evaluating interventions that address multiple cancer types and risk factors. Future research should robustly test whether comprehensive cancer education for adolescents can reduce the cancer burden, particularly in communities with major cancer health disparities.

Landscape of clinical trial activity focusing on Indigenous health in Australia: an overview using clinical trial registry data from 2008-2018

BackgroundAboriginal and Torres Strait Islander peoples (hereafter respectfully referred to as Indigenous Australians) represent about 3% of the total Australian population. Major health disparities exist between Indigenous and Non-Indigenous Australians. To address this, it is vital to understand key health priorities and knowledge gaps in the current landscape of clinical trial activity focusing on Indigenous health in Australia.MethodsAustralian-based clinical trials registered on the Australian New Zealand Clinical Trials Registry or ClinicalTrials.gov from 2008 to 2018 were analysed. Australian clinical trials with and without a focus on Indigenous health were compared in terms of total numbers, participant size, conditions studied, design, intervention type and funding source.ResultsOf the 9206 clinical trials included, 139 (1.5%) focused on Indigenous health, with no proportional increase in Indigenous trials over the decade (p = 0.30). Top conditions studied in Indigenous-focused trials were mental health (n = 35, 28%), cardiovascular disease (n = 20, 20%) and infection (n = 16, 16%). Compared to General Australian trials, Indigenous-focused trials more frequently studied ear conditions (OR 20.26, 95% CI 10.32–37.02, p < 0.001), infection (OR 3.11, 95% CI 1.88–4.85, p < 0.001) and reproductive health (OR 2.59, 95% CI 1.50–4.15, p < 0.001), and less of musculoskeletal conditions (OR 0.09, 95% CI 0.00–0.37, p < 0.001), anaesthesiology (OR 0.16, 95% CI 0.01–0.69, p = 0.021) and surgery (OR 0.17, 95% CI 0.01–0.73, p = 0.027). For intervention types, Indigenous trials focused more on prevention (n = 48, 36%) and screening (n = 18, 13%). They were far less involved in treatment (n = 72, 52%) as an intervention than General Australian trials (n = 6785, 75%), and were less likely to be blinded (n = 48, 35% vs n = 4273, 47%) or have industry funding (n = 9, 7% vs 1587, 17%).ConclusionsTrials with an Indigenous focus differed from General Australian trials in the conditions studied, design and funding source. The presented findings may inform research prioritisation and alleviate the substantial burden of disease for Indigenous population.

Evidence-based practice strategies for faculty professional development in clinical translational research at Institutional Development Award (IDeA) state institutions in the Mountain West.

The Mountain West Clinical Translational Research - Infrastructure Network (MW CTR-IN), established in 2013, is a research network of 13 university partners located among seven Institutional Development Award (IDeA) states targeting health disparities. This is an enormous undertaking because of the size of the infrastructure network (encompassing a third of the US landmass and spanning four time zones in predominantly rural and underserved areas, with populations that have major health disparities issues). In this paper, we apply the barriers, strategies, and metrics to an adapted educational conceptual model by Fink (2013). Applying this model, we used four tailored approaches across this regional infrastructure network to: (1) assess individual faculty specific needs, (2) reach out and engage with faculty, (3) provide customized services to meet the situational needs of faculty, and (4) utilize a "closed communication feedback loop" between Professional Development (PD) core and MW CTR-IN faculty within the context of their home institutional environment. Summary statement results from participating faculty show that these approaches were positive. Grounded in best educational practice approaches, we have an opportunity to refine and build from this sound foundation with implications for future use in other CTR-IN networks and institutions in the IDeA states.

916. Finding the Missing Millions and Addressing Health Disparities: Automated Hepatitis B Screening and Linkage to Care

BackgroundGlobally, HBV is the most common blood-borne infection. An estimated 1.2 million people in the US and 350 million worldwide lived with HBV, a primary driver of liver cancer. It is endemic in many parts of the world and is a major health disparity in immigrant communities, including the US, which has the largest immigrant population in the world. Asian American Pacific Islanders are 5% of the total population in the US, but represent 50% of people living with HBV. In 2016, WHO set a goal of hepatitis elimination by 2030 but with only 10% of those living with HBV diagnosed, screening must be scaled up.MethodsModifications were made in the electronic medical record (EMR) to automate screening, with HBV (HBsAg) orders triggered by a patient’s country of birth or race. The began in the Emergency Department and later expanded to the Inpatient setting. Automated notifications are sent to nurse for eligible patients and then to the patient navigator (PN) for positive tests. The PN contacts the patient to provide education and arrange linkage-to-care (LTC) for evaluation and care.ResultsFrom Mar 2018 to Mar 2021, we conducted 23,883 HBV screenings. The patients originated from 173 countries based on registration; top 5 countries of origin were Haiti, Jamaica, Ecuador, Guyana, and Portugal. We found 228 (1.0%) patients with HBV infection, 101 (47%) were newly diagnosed and 182 (85%) were linked to care. We examined race and insurance status for any association with those previously tested versus newly diagnosed. Blacks were more likely to be newly identified HBV versus Asians (61.6% vs. 28.9%, p< .001), as were self-pay (uninsured) versus insured patients (66.7% vs 47.2%, p=0.043). Compared to the approximately 0.4% HBV prevalence in the US, the HBV prevalence in several towns around our hospital in Essex County is two to four times higher.Table 1. The HBV Prevalence in Towns of Essex County ConclusionOur community is diverse and social determinants of health, like race and insurance status, may contribute to provider behaviors of HBV screening with blacks receiving less screening than Asians. Automated testing programs can address health disparities and scale up screening. Such micro-elimination approaches are important for achieving global hepatitis elimination by 2030.Disclosures Su Wang, MD MPH, Gilead Sciences (Grant/Research Support)Gilead Sciences (Grant/Research Support)

Outreach and recruitment of African Americans for Alzheimer’s disease studies during the COVID‐19 pandemic

BackgroundRecruiting African Americans in AD studies remains a challenge, particularly during a pandemic, where major health disparities in this population are illuminated. The recruitment literature suggests myriad factors that contribute to the underrepresentation of AAs, including, but not limited to “mistrust” in researchers and their institutions. Maintaining a continuous presence in the AA community builds trust even when traditional outreach methods are not allowed. We continued to provide outreach and recruitment opportunities through COVID education and food for families as we educated them about AD, and opportunities for study participation.MethodWhile our traditional outreach methods for recruiting AAs were interrupted, we continued to conduct AD outreach using virtual platforms, mobile phone calls, family conference calls and food distributions. We hosted nine webinars on COVID‐19 to maintain a presence in local and national AA communities and to remain connected to existing AD participants. We reached over 160,000 persons through webinars and social media. We established new relationship new faith leaders in the AA community who co‐hosted COVID‐19 webinars and also expressed interest in forming partnerships on AD education. In addition, we hosted food drives in AA communities that not only addressed food insecurity and COVID prevention, but also AD education and AD research opportunities. At the food drives we distributed bags with masks, hand sanitizers, AD brochures, booklets and study participation information.ResultBetween October and December of 2020, 64 AAs who attended food drives expressed interest in AD studies that required blood draws and cognitive testing. Fifteen enrolled in our genetic study, 15 requested additional follow‐up and 13 expressed interest in participating in more than one study.ConclusionPrior research suggests that recruiting AAs into AD studies requires continuous engagement. We used multiple strategies to maintain contact with the AA community and existing research participants, and successfully increased enrollment in the last quarter of the year. Maintaining consistent and continuous engagement facilitates trustworthiness with AAs and yields positive recruitment outcomes, even in a pandemic where traditional recruitment methods are limited.

Culturally and linguistically diverse mothers accessing public health nursing: A narrative review.

Culturally and linguistically diverse (CALD) families with young children are less likely to seek out healthcare services in comparison with the mainstream population. A lack of appropriate access and engagement with public health nursing (PHN) service contributes to major health disparities for CALD mothers. To describe and synthesize the available literature on the factors that promote or hinder CALD mothers' access to and engagement with PHN services and in particular sustained nurse home-visiting (SNHV) programs. This paper identifies gaps and new areas of needed research inquiry to support best provision of PHN for CALD mothers. A narrative review of the literature was conducted. Databases searched included PubMed, CINAHL, MEDLINE, Cochrane, and Scopus with year of publication between 2000 and 2020. Of 463 total articles, 12 met inclusion criteria. The key barriers and facilitators identified were grouped in three major themes. These include mother-related issues, experiences with interpreters, and program and program delivery related issues. The review demonstrates that CALD mothers with limited English proficiency (LEP) are experiencing multiple challenges in accessing and engaging with PHN and SNHV services. More research is needed to understand nurse-mother-interpreter relationships and policy and practice issues.

924The landscape of clinical trial activity focusing on Indigenous health in Australia from 2008-2018

Abstract Background There are major health disparities between Indigenous and non-Indigenous Australians. To address this, it is vital to understand the landscape of Indigenous trial activity. Methods We extracted data from all Australian trials registered between 2008-2018 on the Australian New Zealand Clinical Trials Registry or ClinicalTrials.gov. Indigenous-focused trials were identified by searching for relevant terms such as ‘Indigenous’ and ‘Aboriginal’. Indigenous versus non-Indigenous trials and Australian trials overall were compared by conditions studied, intervention type, study design and funding. Results Of the 9206 included trials, 139 (1.5%) focused on Indigenous health, and these were mostly in ‘Public Health’ (n = 69, 50%), ‘Mental Health’ (n = 35, 25%) and ‘Cardiovascular’ (n = 25, 18%) (Figure). Compared to other Australian trials, Indigenous trials more frequently studied ear conditions (OR 16.47, 95%CI=8.43-29.99) and public health (OR 4.87, 95%CI=3.65-6.41), and were more likely to focus on screening (OR 3.57, 95%CI=2.10-5.70) and prevention (OR 2.24, 95%CI=1.61-3.08) rather than treatment (OR 0.40, 95%CI =0.30-0.52). They were less likely to be blinded (OR 1.72, 95%CI=1.20-2.49), or have any industry involvement (OR 2.52, 95%CI=1.54-4.43). Conclusions Indigenous trials differed from other Australian trials in health conditions studied, intervention focus, blinding and industry involvement. Relative to population size and burden of disease, the number of trials focusing on Indigenous health is low. Key messages Trial registries can be used to explore whether research appropriately addresses diverse populations such as Indigenous Australians. This can inform future research prioritisation.

Early Childhood Caries in Indigenous Communities.

The oral health of Indigenous children of Canada (First Nations, Inuit, and Métis) and the United States (American Indian and Alaska native) is a major child health disparity when compared with the general population of both countries. Early childhood caries (ECC) occurs in Indigenous children at an earlier age, with a higher prevalence, and at much greater severity than in the general population. ECC results in adverse oral health, affecting childhood health and well-being, and may result in high rates of costly surgical treatment under general anesthesia. ECC is an infectious disease that is influenced by multiple factors, but the social determinants of health are particularly important. This policy statement includes recommendations for preventive and clinical oral health care for infants, toddlers, preschool-aged children, and pregnant women by primary health care providers. It also addresses community-based health-promotion initiatives and access to dental care for Indigenous children. This policy statement encourages oral health interventions at early ages in Indigenous children, including referral to dental care for the use of sealants, interim therapeutic restorations, and silver diamine fluoride. Further community-based research on the microbiology, epidemiology, prevention, and management of ECC in Indigenous communities is also needed to reduce the dismally high rate of caries in this population.

Sex and Race-Related DNA Methylation Changes in Hepatocellular Carcinoma.

Hepatocellular carcinoma (HCC) is the sixth most common cancer and fourth leading cause of cancer-related death worldwide. The number of HCC cases continues to rise despite advances in screening and therapeutic inventions. More importantly, HCC poses two major health disparity issues. First, HCC occurs more commonly in men than women. Second, with the global increase in non-alcoholic fatty liver diseases (NAFLD), it has also become evident that HCC is more prevalent in some races and/or ethnic groups compared to others, depending on its predisposing etiology. Most studies on HCC in the past have been focused on genetic factors as the driving force for HCC development, and the results revealed that genetic mutations associated with HCC are often heterogeneous and involve multiple pathogenic pathways. An emerging new research field is epigenetics, in which gene expression is modified without altering DNA sequences. In this article, we focus on reviewing current knowledge on HCC-related DNA methylation changes that show disparities among different sexes or different racial/ethnic groups, in an effort to establish a point of departure for resolving the broader issue of health disparities in gastrointestinal malignancies using cutting-edge epigenetic approaches.

Cross-border mobility in European countries: associations between cross-border worker status and health outcomes

BackgroundMobility of workers living in one country and working in a different country has increased in the European Union. Exposed to commuting factors, cross-border workers (CBWs) constitute a potential high-risk population. But the relationships between health and commuting abroad are under-documented. Our aims were to: (1) measure the prevalence of the perceived health status and the physical health outcomes (activity limitation, chronic diseases, disability and no leisure activities), (2) analyse their associations with commuting status as well as (3) with income and health index among CBWs.MethodsBased on the ‘Enquête Emploi’, the French cross-sectional survey segment of the European Labour Force Survey (EU LFS), the population was composed of 2,546,802 workers. Inclusion criteria for the samples were aged between 20 and 60 years and living in the French cross-border departments of Germany, Belgium, Switzerland and Luxembourg. The Health Index is an additional measure obtained with five health variables. A logistic model was used to estimate the odds ratios of each group of CBWs, taking non-cross border workers (NCBWs) as the reference group, controlling by demographic background and labour status variables.ResultsA sample of 22,828 observations (2456 CBWs vs. 20,372 NCBWs) was retained. The CBW status is negatively associated with chronic diseases and disability. A marginal improvement of the health index is correlated with a wage premium for both NCBWs and CBWs. Commuters to Luxembourg have the best health outcomes, whereas commuters to Germany the worst.ConclusionCBWs are healthier and have more income. Interpretations suggest (1) a healthy cross-border phenomenon steming from a social selection and a positive association between income and the health index is confirmed; (2) the existence of major health disparities among CBWs; and (3) the rejection of the spillover phenomenon assumption for CBWs. The newly founded European Labour Authority (ELA) should take into account health policies as a promising way to support the cross-border mobility within the European Union.