Ethnic Minority Groups Research Articles

Maternal childhood polyvictimization and neglect of their children: Evidence among Salar Muslim women

BackgroundLimited research has been conducted on child neglect among ethnic minority groups in China. The Salar, a Turkic-Muslim ethnic minority predominantly residing in western China, face unique challenges in this regard. Influenced by their ethnicity, Islam, and Chinese Confucianism, Salar women are particularly vulnerable to various forms of childhood victimization. These victimizations further compound the difficulties they face in providing adequate care for their children. ObjectiveThe 3-D polyvictimization theory introduced three key concepts to measure polyvictimization: invasiveness, exploitativeness, and severity. These concepts aim to provide a nuanced understanding of an individual’s victimization experiences. In light of this theory, this study aims to test a hypothesis regarding the relationship between childhood polyvictimization experienced by Salar mothers and the neglect of their children. MethodA probability proportional to size (PPS) sampling approach was used to collect a random representative multi-stage cluster sample of 201 married Salar women in 2022. Random effects Poisson regression models were used to test the five hypotheses. ResultsThe participants reported a 65.6% rate of child neglect, and all the mothers included in the study had a history of childhood polyvictimization. The Poisson regression in the main effect model demonstrated that invasive and exploitative of the childhood polyvictimization are associated with child neglect. Moreover, a two-way interaction between invasiveness and exploitativeness, as well as exploitativeness and severity of the childhood polyvictimization, showed a strong positive association with child neglect. Lastly, a three-way interaction involving invasiveness, exploitativeness, and severity of the childhood polyvictimization was also strongly positively associated with child neglect. ConclusionsThis research indicates that a history of maternal childhood polyvictimization is associated with an increased risk of child neglect, especially when the experiences of polyvictimization involved high levels of invasiveness and exploitativeness. It emphasizes the importance of considering the nuanced nature of polyvictimization in understanding its relationship with child neglect.

Leadership Preferences, Minimum Acceptable Nationalist Demands, and Duration of Ethno-territorial Civil Wars

In standard conflict bargaining models, internal ethno-territorial dispute outcomes should be influenced not only by status quo conditions and relative military power, but also by leadership preferences. Since direct, large-sample measures of leadership preferences on both sides of conflicts have not hitherto been available, statistical research typically diverges from case study research in omitting leadership preferences. This paper utilizes a database that measures the ideological nationalist dimension of variation in state and ethnic minority group leadership preferences by examining and ranking leaders’ minimum acceptable nationalist demands. Controlling for the impact of other factors, more extreme minimum nationalist demands, on both the state and the rebel group sides, are robust predictors of longer war duration.

A model of prevention of mother-to-child transmission and health management team for improving adverse outcomes of pregnancy syphilis in Ningxia, China

Regional variations exist in the implementation of Syphilis Mother-to-Child Transmission Prevention (PMTCT). Thus, it is crucial to assess the effectiveness of this model in the Ningxia region and explore the supplementary role of Health Management Teams (HMT). This study established the PMTCT + HMT model and examined its impact on adverse outcomes in pregnant women with syphilis infection. The majority of participants were urban residents, married, had a minimum high school education, and held public positions; 36.7% and 26.7% were from minority ethnic groups. The PMTCT + HMT model enhanced participants’ knowledge, rates of voluntary counseling, and testing. The incidence of adverse pregnancy outcomes (miscarriages, preterm births, stillbirths) significantly decreased, and adverse neonatal outcomes (low birth weight, neonatal mortality, congenital syphilis) were notably reduced. Simultaneously, we identified factors associated with adverse outcomes, including non-residency, unmarried status, lower educational attainment, minority ethnicity, primary syphilis, and positive titers. Thus, HMT may be an effective intervention to enhance the effect of PMTCT for syphilis. The unique population structure in Ningxia is closely linked to adverse outcomes, highlighting the significance of providing equitable treatment for vulnerable populations.

Differences in SARS-CoV-2 antibody prevalence at the end of the pre-vaccination period between age groups: A cross-sectional analysis of the multi-ethnic population-based HELIUS study.

During the first waves of the COVID-19 pandemic, SARS-CoV-2 antibody prevalence (seroprevalence) was lower in older compared to younger adults. We studied age group differences in SARS-CoV-2 seroprevalence, across ethnic groups, and assessed the explanatory value of factors that increase the exposure to the virus, and factors related to susceptibility, given the level of exposure. We analysed cross-sectional data from 2,064 participants from the multi-ethnic HELIUS study (Amsterdam, The Netherlands). SARS-CoV-2 seroprevalence at the second wave of infections was compared between age groups (<40, 40-54, and ≥55 years), within ethnic groups, using Poisson regression with robust standard errors. To determine whether age group differences were explained by differences in exposure and in susceptibility, we sequentially adjusted for exposure (job setting, occupation level, health literacy, household size, household member with suspected infection), education level, and susceptibility (vitamin D intake, BMI, systolic blood pressure, haemoglobin level, number of comorbidities). SARS-CoV-2 seroprevalence did not statistically differ across age groups (p>0.05), but age patterns varied across ethnic groups. Age group differences in SARS-CoV-2 seroprevalence were most pronounced in the Dutch majority group, with the highest prevalence ratio in the youngest group (2.55, 95%CI 0.93-6.97) and the lowest in the oldest group (0.53, 95%CI 0.16-1.74), compared to the middle-aged group. In ethnic minority groups, age group differences were smaller. In all groups, patterns did not substantially change after adjustments for exposure and susceptibility variables. We found no evidence of age group differences in SARS-CoV-2 seroprevalence, particularly for ethnic minority groups, even when accounting for exposure and susceptibility. While early prevention strategies particularly aimed at protecting older adults against SARS-CoV-2 infections, seroprevalence was similar across age groups in ethnic minority groups. Thus, older adults in ethnic minority groups may pose a target group for additional prevention strategies for future infectious disease outbreaks.

Minority ethnic older adults’ perception and behaviour towards COVID-19 public health campaigns in the UK

In the UK, minority ethnic groups were reported to face the greatest risk from COVID-19. Yet, little is known about their perception and behaviour towards COVID-19 campaigns. This study used 35 semi-structured, in-depth interviews with minority ethnic adults aged 60 or over in England and Wales to explore their motivations for complying with or disregarding official guidance and their evaluations of various campaign content and channels used early in the pandemic. Using Template Analysis, key themes in the interviewees’ discourse were identified, which were subsequently analysed using the Theory of Planned Behaviour (TPB). This study found that the predominant motivations for non-compliant behaviour included fatigue from information overload, government- and socially-induced distrust, as well as self-reported personality traits. In contrast, compliant individuals emphasised community-based obligations and their trust in official communications. Although participants recognised the pandemic as a challenging time, they were generally unsatisfied with the credibility, consistency, and accessibility of public health messaging. This investigation contributes to health communications studies by adopting a qualitative approach and providing insights into an under-researched demographic.

Race and ethnicity and self-reported racial/ethnic discrimination in breast cancer patient interactions with providers in the Pathways Study.

To examine the association of race and ethnicity groups with self-reported racial/ethnic discrimination in patient-provider interactions during the diagnosis and treatment for breast cancer. We analyzed data from the Pathways Study, a prospective cohort of women diagnosed with breast cancer from 2006-2013 in the Kaiser Permanente Northern California Health Care System. Racial/ethnic discrimination in patient-provider interactions was assessed with two questions from the Interpersonal Processes of Care survey at baseline and 6-months and 24-months post-diagnosis. Logistic regression was performed to compare women who self-identified as racial or ethnic minorities with Non-Hispanic White (NHW) women. Covariates included age at diagnosis, country of origin, education level, income, marital status, and medical provider's race/ethnicity. Our sample included 1836 participants: 1350 NHW women and 486 women (87 Black, 208 Asian American, 153 Hispanic, 38 American Indian/Alaskan Native/Pacific Islander [AIANPI]) from racial or ethnic minority groups. In multivariate analysis, minority women were more likely to report racial/ethnic discrimination in patient-provider interactions than NHW women (adjusted odds ratio [aOR]: 4.73; 95% confidence interval [CI] 3.45-6.50). Specifically, Black women were most likely to self-report racial/ethnic discrimination in patient-provider interactions (aOR: 9.65; 95% CI 5.92-15.70), followed by Asian (aOR: 5.39; 95% CI 3.46-8.40), Hispanic (aOR: 2.55; 95% CI 1.54-4.14), and AIANPI (aOR: 1.74; 95% CI 0.58-4.25) women, compared with NHW women. Racial/ethnic discrimination was more likely self-reported from minority women diagnosed with breast cancer. Additional studies are needed to understand the mechanisms and impact of racial/ethnic discrimination in patient-provider interactions on disparities.

Association of genetic ancestry with pre-eclampsia in multi-ethnic cohorts of pregnant women

ObjectivesMaternal self-reported ethnicity is recognised as a risk factor for pre-eclampsia in clinical screening tools and models. This study investigated whether ethnicity is acting as a proxy for genetic variants in this context. Study designA total of 436 women from multi-ethnic backgrounds recruited to two UK observational pregnancy hypertension cohort studies were genotyped. Genetically-computed individual ancestry estimates were calculated for each individual through comparison to the multi-ethnic 1000 Genomes reference panel genotypes. Regression models for pre-eclampsia using clinical risk factors including self-reported ethnicity with and without ancestry estimates were built and compared using Likelihood Ratio Tests (LRT). Main outcome measuresPre-eclampsia (early- and late-onset). ResultsIn these multi-ethnic cohorts (mean age 34.9 years; 41.3 % White, 34.2 % Black, 13.1 % Asian ethnic backgrounds; 82.6 % chronic hypertension), discrepancies between self-reported ethnicity and genetically-computed individual ancestry estimates were present in all ethnic groups, particularly minority groups. Genetically-computed pan-African ancestry percentage was associated with early-onset (< 34 weeks) pre-eclampsia in adjusted models (aOR 100 % vs 0 % African ancestry: 3.81, 95 % CI 1.04–14.14, p-value 0.044) independently of self-reported ethnicity and established clinical risk factors. Addition of genetically-computed African ancestry to a clinical risk factor model including self-reported ethnicity, improved model fit (Likelihood ratio test p-value 0.023). ConclusionsSelf-reported maternal ethnicity is an imperfect proxy for genetically-computed individual ancestry estimates, particularly in ethnic minority groups. Genetically-computed African ancestry percentage was associated with early-onset pre-eclampsia independently of self-reported maternal ethnicity. Well-powered studies in multi-ethnic cohorts are required to delineate the genetic contribution to pre-eclampsia.

Association between ethnicity and emergency department visits in the last three months of life in England: a retrospective population-based study using electronic health records

IntroductionEmergency department (ED) visits are distressing yet common in the last months of life and many could be avoided. The association between ethnicity and ED visits in the last months...

Survival Difference of Colorectal Adenocarcinoma Among Racial and Ethnic Minority Groups: A SEER Database Study.

Despite advances in diagnosis and treatment, racial disparities continue to exist in colorectal cancer (CRC) survival. This study aims to characterize the CRC survival differences among racial and ethnic minority groups. The Surveillance, Epidemiology, and End Results (SEER) database was used to identify adults diagnosed with CRC from 2015 to 2019. Demographics, disease characteristics, surgical treatment, stages, and survival data for individuals who are Hispanic, Black, Southeast Asian, Chinese, American Indian and Alaskan Native (AIAN), Asian Indian and Pakistani (AIP), and Native Hawaiian and Other Pacific Islanders (NHOPI) were extracted. Survival analysis was done using the Kaplan-Meier survival curve. Multivariate analysis was done with the Cox proportional hazard model. There were 40 091 individuals with CRC. NHOPI had the youngest median age of 59 years, while Chinese individuals had the oldest median age of 65 years. From the total sample of their respective subgroups, 43.8% of Black patients and 36.7% of AIAN patients had a median household income of <$60 000, while 55.3% of Southeast Asian patients, 59.7% of Chinese patients, 55.8% of AIP patients, and 65.6% of NHOPI patient had a median household income >$70 000. The 1-year survival rate was lower for patients who were Hispanic (62.0%), Black (60.9%), and AIAN (63.1%). Even after multivariate analysis, Black patients had a significant hazard ratio (HR) of 1.21 (95% confidence interval [95% CI]: 1.05-1.38), while AIP had a HR of 0.68 (95% CI 0.55-0.84), compared to AIAN. Other significant variables that were linked with survival included older age, advanced stage of CRC, a median household income <$60 000, male sex, no surgery, subtotal colectomy/hemicolectomy, and total colectomy. Further studies are needed to elucidate the specific causes of these differences and create appropriate strategies to reduce this survival disparity.

Multisite Randomized Controlled Trial of CareSTEPS: A Supportive Care Intervention for the Family Caregivers of Patients With Advanced Lung Cancer

ObjectivesPatients with advanced lung cancer (LC) face significant physical, psychological, and functional challenges, increasing their reliance on caregivers. This study evaluates the efficacy of CareSTEPS (Self-Care, Stress management, Symptom management, Effective communication, Problem-solving, and Social support), a 6-week telephone-delivered intervention designed to improve psychological functioning (depression and anxiety symptoms) and reduce caregiver burden among family caregivers of patients with advanced LC. MethodsIn this multisite, open-label, parallel-group randomized controlled trial, 174 caregivers (74.1% female individuals, 40.2% from a racial or ethnic minority group) of patients with stage IIIB or IV NSCLC or extensive-stage SCLC completed baseline surveys and were randomly assigned to CareSTEPS (n = 87) or usual care (n = 87) using stratified block randomization. Caregivers in the CareSTEPS arm received a manual with information on self-care, stress management, symptom management, effective communication, problem-solving, and social support. They also participated in six weekly telephone sessions with Masters-level trained interventionists with a mental health background, who provided psychoeducation, skills training, and support. Eight weeks after baseline, caregivers completed a follow-up survey. ResultsUsing an intent-to-treat framework, analyses of covariance were conducted to assess the efficacy of CareSTEPS, with p values lower than 0.05 indicating significant differences. Caregivers who received CareSTEPS reported improved psychological functioning and lower burden compared with those who received usual care, with effect sizes ranging from small to large (depression d = −0.55, anxiety d = −0.81, burden d = −0.37). ConclusionsThe CareSTEPS intervention reports great promise in meeting the critical support needs of the family caregivers of patients with advanced LC, significantly improving caregivers' psychological functioning and reducing their burden. Overall, the findings emphasize the importance of incorporating caregiver support into the comprehensive management of advanced LC. Clinical Trial RegistrationClinicalTrials.gov NCT02414672.

Assessing racial disparities in gender-affirming surgery utilization and hospital-level experience

Racial and ethnic minority groups, as well as gender minorities seeking gender-affirming care and surgery have historically had difficulties with healthcare access and experience. The intersection of these two groups may result in deficient healthcare for patients of minority racial and ethnic groups seeking gender-affirming surgery. The present study sought to explore differences in gender-affirming genital surgery experience by race. The 2018-2021 Healthcare Utilization Project National Inpatient Survey was queried for gender-affirming surgeries. Demographic, inpatient safety, and hospital-level characteristics were collected. Results were stratified by race and evaluated for significant differences. A total of 4,605 patients were included in the study, 3,345 patients were identified as White (73%), 320 as Black/African American (7%), 485 as Hispanic/Latino (11%), and 110 as Asian/Pacific Islander (2%). Black/African American patients experienced a higher rate of inpatient medical complications than the overall population (1% vs. 3%, P=0.004) and had a longer length of stay (3 vs. 5 days, P<0.001). The highest total charges were observed among Black/African American patients ($130,873, IQR $119,235, P<0.001). Black/African American patients also less often experienced routine discharge (94% vs. 81%, P<0.001) and more often required a higher level of care upon discharge, such as home health care or transfer to another facility (6% vs. 17%, P<0.001). While the healthcare population is becoming more diverse, healthcare disparities still exist among non-White individuals receiving gender-affirming genital surgery. The present data suggest that Black/African American patients receiving gender-affirming genital surgery have more complicated hospital and discharge courses, and experience higher total hospital charges.

Pathways to specialist community perinatal mental health services: a two-site longitudinal retrospective service evaluation.

During pregnancy and the postpartum period, women's mental health can deteriorate quickly. Timely and easy access to services is critically important; however, little is known about the pathways women take to access services. Previous research has shown that women from ethnic minority groups in the United Kingdom experience more access issues compared to the White British women. To describe pathways taken to specialist community perinatal mental health services and explore how they vary across services and ethnic groups. This is a two-site, longitudinal retrospective service evaluation conducted in Birmingham and London during 6 months (1 July-31 December 2019). Electronic records of 228 women were accessed and data were extracted on help-seeking behaviour, referral process and the type of pathway (i.e. simple or complex). Data were collected using the adapted World Health Organization encounter form and analysed using uni- and multivariable analyses. The median time from the start of perinatal mental illness to contact with perinatal mental health services was 20 weeks. The majority of patients accessed perinatal mental health services through primary care (69%) and their pathway was simple, that is they saw one service before perinatal mental health services (63%). The simple pathway was used as a proxy for accessible services. In Birmingham, compared to London, more referrals came from secondary care, more women were experiencing current deterioration in mental health, and more women followed a complex pathway. Despite differences between ethnic groups regarding type of pathway and duration of patient journey, there was no evidence of difference when models controlled for confounders such as clinical presentation, general characteristics and location. The service's location was the strongest predictor of the type of pathway and duration of patient journey. The heterogeneity among categorised ethnic groups; data extracted from available electronic records and not validated with patient's own accounts of their pathways to care; unanalysed declined referrals; the study was conducted before the COVID-19 pandemic and pathways may be different in the post-COVID-19 period. The study provides important insights into how patients find their way to community perinatal mental health services. It shows that there is a great degree of variability in the time taken to get into these services, and the pathway taken. This variation does not come from different needs of patients or different clinical presentations but rather from service-level factors. The studied community perinatal mental health services in the United Kingdom operate with a significant degree of variability in the types and characteristics of patient pathways. Future research should explore these issues on the national and international levels. Additionally, future research should explore the reasons for the different pathways taken and the outcomes and risks associated with them. This article presents independent research funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme as award number 17/105/14.

Decoding Online Narratives and Unraveling Complexities in the Rohingya Refugee Crisis

The Rohingya refugee crisis, a humanitarian tribulation involving the persecution of the Rohingya Muslim ethnic minority group in Myanmar, has led to a massive exodus of refugees, primarily women and children, to neighboring Bangladesh. Analyzing public opinion toward the Rohingya crisis poses a challenge due to the time complexity of manually assessing individual expressions from the vast amount of text on online platforms. This research focuses on identifying hidden patterns in online discussions surrounding the Rohingya refugee crisis, employing topic modeling and a thematic sentiment analysis-based approach. It represents the first comprehensive exploration of public views on internet spaces to support this community. In the experiment, we identified 15 coherent topics from 6,840 unique documents with a high coherence score of about 0.60. The key themes explored encompass familial resilience, the urgency of addressing the refugee crisis, complexities within the Rohingya situation, religious and cultural elements, and geopolitical considerations. Sentiment analysis revealed nuanced emotional tones, with positive sentiments in discussions about refugee support and international aid and mixed or negative sentiments in topics concerning religious dynamics and women’s protection. The implications of this research extend to guiding policymakers, humanitarian organizations, and advocacy groups in developing targeted interventions, communication strategies, and informed policy initiatives. In addition, the findings emphasize the importance of understanding and responding effectively to the multifaceted challenges faced by the Rohingya community.

Towards assiminationalism? The right-wing populists’ transformative storytelling on an ethnic minority in Estonia

ABSTRACT While right-wing populists are typically antagonizing the ethnic Other, there are situations where select ethnic minority groups are depicted in a more favourable light or even incorporated among the People the right-wing populists claim to represent. This article aims to uncover, how right-wing populists utilize storytelling to create a favourable association between the conservative values of an ethnic minority and the anti-gender and xenophobic discourse of the far right. Focused on the Estonian right-wing populist party EKRE, we introduce the concept of assiminationalism to explain, how the party negotiates its nativist and xenophobic stances towards the Russian minority with the mutual conservative values and aversion toward gendered and racialized minorities. Even the seemingly more inclusionary stories are told primarily from the vantage point of prioritizing the majority rights, by creating in-group and inter-group hierarchies, appealing to a sense of shame and yearning to belong among the Russian minority, and by depoliticizing cultural rights issues. This suggests that while the rhetoric of right-wing populists regarding specific ethnic minorities may become more moderate, it does not entail a clean break with their nativist and xenophobic past.

Methodology for the generation of normative data for the U.S. adult Spanish-speaking population: A Bayesian approach.

Hispanics are the largest growing ethnic minority group in the U.S. Despite significant progress in providing norms for this population, updated normative data are essential. To present the methodology for a study generating normative neuropsychological test data for Spanish-speaking adults living in the U.S. using Bayesian inference as a novel approach. The sample consisted of 253 healthy adults from eight U.S. regions, with individuals originating from a diverse array of Latin American countries. To participate, individuals must have met the following criteria: were between 18 and 80 years of age, had lived in the U.S. for at least 1 year, self-identified Spanish as their dominant language, had at least one year of formal education, were able to read and write in Spanish at the time of evaluation, scored≥23 on the Mini-Mental State Examination, <10 on the Patient Health Questionnaire- 9, and <10 on the Generalized Anxiety Disorder scale. Participants completed 12 neuropsychological tests. Reliability statistics and norms were calculated for all tests. This is the first normative study for Spanish-speaking adults in the U.S. that uses Bayesian linear or generalized linear regression models for generating norms in neuropsychology, implementing sociocultural measures as possible covariates.

Hospital Strain During the COVID-19 Pandemic and Outcomes in Older Racial and Ethnic Minority Adults

Marginalized populations have been disproportionately affected by the COVID-19 pandemic. Critically ill patients belonging to racial and ethnic minority populations treated in hospitals operating under crisis or near-crisis conditions may have experienced worse outcomes than White individuals. To examine whether hospital strain was associated with worse outcomes for older patients hospitalized with sepsis and whether these increases in poor outcomes were greater for members of racial and ethnic minority groups compared with White individuals. In this cross-sectional study, multivariable regression analysis was conducted to assess differential changes in all-cause 30-day mortality and major morbidity among older racial and ethnic minoritized individuals hospitalized with sepsis compared with White individuals and changes in hospital strain using Medicare claims data. Data were obtained on patients hospitalized between January 1, 2016, and December 31, 2021, and analyzed between December 16, 2023, and July 11, 2024. Time-varying weekly hospital percentage of inpatients with COVID-19. Composite of all-cause 30-day mortality and major morbidity. Among the 5 899 869 hospitalizations for sepsis (51.5% women; mean [SD] age, 78.2 [8.8] years), there were 177 864 (3.0%) Asian, 664 648 (11.3%) Black, 522 964 (8.9%) Hispanic, and 4 534 393 (76.9%) White individuals. During weeks when the hospital COVID-19 burden was greater than 40%, the risk of death or major morbidity increased nearly 2-fold (adjusted odds ratio [AOR], 1.90; 95% CI, 1.80-2.00; P < .001) for White individuals compared with before the pandemic. Asian, Black, and Hispanic individuals experienced 44% (AOR, 1.44; 95% CI, 1.28-1.61; P < .001), 21% (AOR, 1.21; 95% CI, 1.11-1.33; P < .001), and 45% (AOR, 1.45; 95% CI, 1.32-1.59; P < .001) higher risk of death or morbidity, respectively, compared with White individuals when the hospital weekly COVID-19 burden was greater than 40%. In this cross-sectional study, older adults hospitalized with sepsis were more likely to die or experience major morbidity as the hospital COVID-19 burden increased. These increases in adverse outcomes were greater in magnitude among members of minority populations than for White individuals.

Association between sugar-sweetened beverage consumption and constructs of the Health Belief Model in young adult students at the University of Chester

BackgroundYoung adults are reported as one of the major consumers of sugar-sweetened beverages (SSBs) globally and the consumption of SSBs is associated with long-term medical conditions. The Health Belief Model (HBM) has been applied to understand SSB consumption by children and adolescents through the use of its constructs. There is a gap in knowlege of HBM application to SSB consumption of young adults. Therefore, the present study was undertaken to fill this gap.ObjectiveThe primary objective of the study was to determine if an association existed between SSB consumption status and the constructs of the HBM: perceived susceptibility, perceived severity, perceived barriers, perceived benefits, self-efficacy, and cues in young adult students.MethodsDesign: Cross-sectional data were obtained using an online self-administered structured questionnaire. Descriptive statistics and Chi-squared (X2) test for association were used to analyse the data.Setting: Participants were recruited via email and WhatsApp.Participants: Seventy young adult students aged 18 to 30 years studying at the University of Chester, England.ResultsThe mean age of the participants was 25.5 years (SD: 3.0). 53% consumed SSBs on a given day. Postgraduates (58%), Blacks (52%), and Asian students (70%) had the greater percentages of SSB consumers. There was a very strong significant association between SSB consumption status and level of perceived severity of diseases from a high intake of SSBs, X2 (1, N = 70) = 6.94, P = 0.01, Cramer’s V = 0.32. Also, a very strong association existed between SSB consumption status and self-efficacy level to control SSB intake, X2 (1, N = 70) = 8.83, P = 0.00, Cramer’s V = 0.36.ConclusionsA high percentage of young adult students especially those from minority ethnic groups in the UK consumed SSBs which indicates that targeted initiatives at these groups are required to control their intake. Interventions to control SSB intake in young adult students should consider increasing their level of perceived severity of diseases from a high intake of SSBs and self-efficacy to control SSB intake. We recommend actions that can further increase their awareness of how serious diseases from a high intake of SSBs are. We also recommend measures intended to increase the confidence of young adultstudents in their ability to avoid SSBs when they are stressed, after writing exam, when they are eating, and when they engage in sedentary activities. In particular, modifying their environment to prevent the availability of SSBs at home and regulating the promotion and cost (via taxation) of SSBs in stores would help to increase their self- efficacy level. Further studies to determine why a greater percentage of postgraduate students are consuming SSBs despite their level of education is required. More comprehensive research on SSB consumption in young adults using the HBM is necessary.

북한과 중국의 설화 분야 비물질문화유산 지정 현황과 시사점

The purpose of this paper is to examine the current status and implications of folktales as cultural heritage North Korea and China to find a way to designate folktales as national intangible cultural heritage. To achieve this, we reviewed the current status of folk tales designated as intangible cultural heritage in North Korea and China, focusing on their content, selection criteria, and selection methods. North Korea began designating intangible cultural heritage in 2012, and China in 2006, with folktales accounting for more than 10% of the total list. North Korea has confirmed the designation of 13 folktales as national and local intangible cultural heritage, while China has designated 167 folktales as national intangible cultural heritage. In North Korea, the first criterion for designating a folktale as an intangible cultural heritage is the fact that Kim Il-sung, Kim Jong-il, and Kim Jong-un showed interest in the tale and mentioned it. Second, it is material with content that can be used as a means of public education. Third, it is material that uniquely reflects the historical and local characteristics of North Korea. Fourth, the target of designation is the recreated current publication rather than the narrative prototype of the folktale text. The characteristics that can be confirmed through the list of designations in the field of Chinese folk tales are: First, materials from minority ethnic groups are given priority over oral literature from the Han Chinese, the mainstream ethnic group. Second, the designation is based on the region where the tale is handed down. Third, for tales that are handed down in a wide area, all of the regions where the tale is handed down are designated. Fourth, if additional areas for the transmission of folk tales designated as primary are discovered, the areas for transmission are expanded and additionally designated. Fifth, the designation targets are comprehensively designated as single works or groups of tales, and also include historical records and modern publications. The designation of Korean folktales as intangible cultural heritage can be attempted in various directions. It requires passionate efforts from the national administration and academia with an open perspective regarding the cases of North Korea and China.

Indigenous, Black, and Latine Adolescents Disproportionately Experience Barriers to Pediatric Gender-Affirming Care

Although prior studies have explored the barriers that transgender and nonbinary (TNB) adolescents experience in receiving gender-affirming medical care (GAMC), few have sought to understand how these barriers may differ among racial and ethnic minority groups. Accordingly, this study used data from a survey of TNB young adults (ages 18–20 years) to explore how barriers to GAMC during adolescence varied by race and ethnicity. Differences in the impact of 11 potential barriers when comparing the members of each racial and ethnic group with those who did not identify with that racial or ethnic group were evaluated usingttests. The results showed that Indigenous respondents indicated that parental unwillingness to consent for GAMC and attend a clinic visit and not being able to find a clinic contributed significantly more compared with those who did not identify as Indigenous. Black respondents indicated that not knowing it was possible to receive GAMC during adolescence and previous negative experiences in healthcare related to race or ethnicity contributed significantly more to their inability to receive GAMC during adolescence compared with those who did not identify as Black. Latine respondents indicated that parental unwillingness to consent for GAMC and attend a clinic visit, worries about cost, and previous negative experiences in healthcare due to race or ethnicity contributed significantly more compared with those who did not identify as Latine. Overall, the results suggest disproportionate barriers in access to GAMC during adolescence among Indigenous, Black, and Latine TNB individuals and illustrate a need for additional resources and interventions to promote more equitable access.

A pilot study testing a new transition of care model from hospital to the community for Hispanic/Latino adults with diabetes to reduce emergency department visits and hospital re-admissions

BackgroundHispanic/Latino populations have the second highest prevalence of diabetes (12.5%) among ethnic minority groups in the USA. They also have higher rates of uncontrolled diabetes and diabetes-related complications. Approximately 29% of diabetes care costs are attributed to inpatient hospital care. To reduce hospital length of stay and re-admission rates for diabetes, the American Diabetes Association (ADA) recommends a “structured discharge plan tailored to the individual patient with diabetes.” However, limited research exists on the feasibility and applicability of a transition of care model specifically tailored for the Hispanic/Latino population.MethodsWe conducted a 2-year pilot study to develop a practical, patient-centered, and culturally competent transition of care (TOC) model for Hispanic/Latino adults with diabetes discharged from the hospital to the community. Feasibility outcomes included recruitment rates, questionnaire completion rates, adherence to a 30-day post-discharge phone call, and resource needs and utilization for study implementation. Participant-centered outcomes included 30-day post-discharge emergency department (ED) visits, 30-day post-discharge unplanned re-admissions, follow-up visits within 2 weeks of discharge, and patient satisfaction with the TOC model.ResultsTwelve participants were enrolled over the study period, with weekly enrollment ranging from 0 to 4 participants. Participants’ average age in years was 47 (± 11.6); the majority were male (85%), and 75% had type 2 diabetes. Recruitment involved the support of 4 bilingual staff. The estimated time to review the chart, approach participants, obtain informed consent, complete questionnaires, and provide discharge instructions was approximately 2.5 h. Of the 10 participants who completed the 30-day post-discharge phone call, none had ED visits or unplanned hospital re-admissions within 30 days post-discharge, and all had a follow-up with a medical provider within 2 weeks.ConclusionsImplementing a patient-centered and culturally competent TOC model for Hispanic/Latino adults with diabetes discharged from the hospital to the community is feasible when considering key resources for success. These include a bilingual team with dedicated and funded time, alignment with existing discharge process and integration into the Electronic Medical Record (EMR) systems.