Minority Groups Research Articles

The Role of Baby-Friendly Designated Hospitals in Breastfeeding Initiation Across Racial/Ethnic Groups in Florida.

Baby-Friendly Hospitals (BFH) in the United States (U.S.) are associated with higher breastfeeding initiation rates. Breastfeeding is associated with a myriad of favorable health outcomes for both mother and child. However, few studies have examined the impact of breastfeeding support resources, like BFH, on breastfeeding initiation among minority groups. The objective of this study is to evaluate the association between birth at a BFH and the breastfeeding initiation in Florida. A retrospective exploratory analysis of BFH and birth certificate data (n=3,321,022 ) from 2004-2022 from Florida was conducted. A logistic regression model was fit to examine the main and interaction effects of race/ethnicity and birth at a BFH on breastfeeding initiation. Time was included as a sequential variable to adjust for temporal effects. Covariates known to impact breastfeeding initiation rates, including maternal education and prenatal care utilization, were included in multivariate analyses. Of births at a BFH, 89% of mothers initiated breastfeeding. Comparatively, of the births at a non-BFH, 84% of mothers initiated breastfeeding. Giving birth at a BFH increased the odds of breastfeeding initiation by at least 42% (OR = 1.42, CI: 1.38-1.45, p <0.001, Hispanic White mothers) in unadjusted models and 10% (OR = 1.10, CI: 1.03-1.17, p = 0.004, other non-Hispanic mothers) in adjusted models. However, BFH may have differential effects by maternal race and ethnicity. In the multivariate model adjusting for relevant covariates, non-Hispanic Black mothers who gave birth at a BFH were 27% less likely to initiate breastfeeding compared to mothers that gave birth at a non-BFH (OR = 0.73, CI: 0.61- 0.88, p < 0.001; interaction term for BFH*maternal race/ethnicity). Similar trends were observed for Hispanic Black, Hispanic White, and other non-Hispanic mothers. Giving birth at a BFH is associated with greater odds of breastfeeding initiation. However, when considering the race and ethnicity of mothers, these odds significantly decline, indicating a need to further explore the barriers that may preclude non-Hispanic Black and Hispanic moms from receiving the same benefits of BFH.

Early phase vs. late phase clinical trials: Trends in enrollment of racial and ethnic minority groups

Early phase vs. late phase clinical trials: Trends in enrollment of racial and ethnic minority groups

Social determinants of health and newer glucose-lowering drugs adoption among US Medicare beneficiaries with type 2 diabetes.

Two classes of newer glucose-lowering drugs (GLDs), sodium-glucose cotransporter-2 inhibitors and glucagon-like peptide-1 receptor agonists, improve cardiovascular and renal outcomes among patients with type 2 diabetes (T2D). However, racial and ethnic minority groups carry higher cardiovascular risks but have lower access to newer GLDs. Contextual-level social determinants of health (SDOH) may be the underlying factor associated with newer GLD adoption. To identify the association between contextual-level SDOH and real-world adoption of newer GLDs among Medicare beneficiaries and to examine the nonstationarity in the associations. Data were from 15% random samples of January 2017 to December 2018 nationwide Medicare beneficiaries. We identified patients with T2D who did not use newer GLDs in the year before the index date-January 1, 2018-and followed the cohort for 1 year to record their status of initiating a newer GLD. We used a geographically weighted multivariable Poisson regression model to determine to what extent the SDOH-newer GLD initiation association (β coefficient) varied geographically. We identified 795,469 eligible Medicare beneficiaries with T2D during the study period from our dataset. Of the study cohort, mean age was 73.1 (SD = 10.5) years, 424,312 (53.3%) were female, 562,994 (70.8%) were non-Hispanic White, 96,891 (12.2%) were non-Hispanic Black, 84,744 (10.6%) were Hispanic, and 29,645 (3.7%) were Asian/Pacific Islander. Newer GLD initiation was negatively associated with the percentage of the population reporting non-Hispanic Black race, Hispanic ethnicity, and unemployment, as revealed by nonspatial regression analyses. The county-level median household income was also associated with higher newer GLD initiation. The spatial analysis presented distinct distributions of local parameter estimates for each contextual-level SDOH. We identified key contextual-level SDOH associated with real-world adoption of newer GLDs and explored their geographic variation through spatially explicit, data-driven analytical approaches. Identifying areas of strong association between SDOH and newer GLD initiation is crucial for policymakers to allocate resources and develop interventions that address structural inequities.

Social and institutional inclusion in multi-ethnic schools enable better intergroup relations for majority youth and higher school achievement for minority youth

Inclusive school climates have been related to more friendly and equal intergroup relations among majority and ethnic minority youth. Yet, comprehensive research distinguishing majority and ethnic minority group perspectives on both social and institutional inclusion, and looking beyond individual perceptions of inclusion is missing. Taking a multi-group and multi-level approach, we assessed the actual social climate (aggregating majority intergroup attitudes within schools) and institutional climate (coding school diversity policies); and we tested associations with intergroup relations (i.e., individual intergroup bias and contact) and school performance (i.e., self-reported Dutch language grades) as individual outcomes for both majority and minority youth. To this end, we draw on a large-scale survey of 1814 native-origin majority and 1068 Turkish- and Moroccan-origin minority youth in the same 65 Flemish-Belgian middle schools. As expected for majority youth, a more inclusive ingroup social climate predicts less intergroup bias; and more social and institutional inclusion jointly predict more intergroup contact with minority peers. For minority youth, an inclusive outgroup social climate predicts higher Dutch grades; yet social and institutional inclusion were unrelated to their intergroup attitudes or contact.

An evaluation of measurement invariance of Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition borderline personality disorder criteria across heterosexual, lesbian, gay, and bisexual adults.

There is a robust, yet poorly understood relationship between nonheterosexual orientation and borderline personality disorder (BPD), with lesbian, gay, and bisexual individuals evidencing greater BPD symptoms compared to heterosexual individuals. Recent evidence suggests possible psychometric bias in BPD diagnostic criteria leading to greater endorsement among sexual minority individuals, which hinders researchers' ability to make valid group comparisons. The present study utilized an epidemiological sample of 35,995 men and women to evaluate the extent of differential item functioning (DIF) among BPD criteria across sexual orientation groups using a multiple indicators multiple causes approach. All criteria except affective instability and emptiness indicated DIF for at least one sexual minority focal group, although both demonstrated DIF in sensitivity analyses. DIF was most consistently indicated for suicidality, efforts to avoid abandonment, and impulsivity. Contrary to predictions, DIF was mostly nonuniform with greater item discrimination for sexual minority groups compared to their heterosexual counterparts. Finally, all estimated effect sizes were small, suggesting that DIF was not practically meaningful and unlikely to impact the validity of group comparisons for BPD criteria across heterosexual and nonheterosexual men and women. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Examining select sociodemographic characteristics of sub-county geographies for public health surveillance

BackgroundMapping health outcomes related to environmental health hazards at the county level can lead to a simplification of risks experienced by populations in that county. The Centers for Disease Control and Prevention’s National Environmental Public Health Tracking Program has developed sub-county geographies that aggregate census tracts to allow for stable, minimally suppressed data to be displayed. This helps to highlight more local variation in environmental health outcomes and risk data. However, we wanted to understand whether the aggregation method used was aggregating sociodemographically similar or dissimilar areas with one another. This analysis attempts to explore whether the distributions of select people who may be at increased risk for exposure to environmental health hazards as identified by the Tracking Program are preserved in these sub-county geographies with the census tracts used as the foundation to create them.MethodsMean values of three sociodemographic characteristics (persons aged 65 years and older, people from racial and ethnic minority groups, and population below the poverty level) for each sub-county geography in five states were calculated and placed into five break groups. Differences in break groups were determined and compared for each sub-county geography and census tract.ResultsThe sociodemographic characteristics among the census tracts and two aggregated sub-county geographies were similar. In some instances, census tracts with a low population or a highly skewed population (e.g., very high percentage of population aged 65 years and older) were aggregated with dissimilar census tracts out of necessity to meet the requirements set by the Tracking Program’s aggregation methodology. This pattern was detected in 2.41-6.59% of census tracts within the study area, depending on the sociodemographic variable and aggregation level.ConclusionsThe Tracking Program’s sub-county aggregation methodology aggregates census tracts with similar characteristics. The two new sub-county geographies can serve as a potential option for health officials and policymakers to develop targeted interventions using finer resolution health outcome and environmental hazard data compared to coarser resolution county-level data.

Health disparities in cirrhosis care and liver transplantation.

Morbidity and mortality from cirrhosis are substantial and increasing. Health disparities in cirrhosis and liver transplantation are reflective of inequities along the entire spectrum of chronic liver disease care, from screening and diagnosis to prevention and treatment of liver-related complications. The key populations experiencing disparities in health status and healthcare delivery include racial and ethnic minority groups, sexual and gender minorities, people of lower socioeconomic status and underserved rural communities. These disparities lead to delayed diagnosis of chronic liver disease and complications of cirrhosis (for example, hepatocellular carcinoma), to differences in treatment of chronic liver disease and its complications, and ultimately to unequal access to transplantation for those with end-stage liver disease. Calling out these disparities is only the first step towards implementing solutions that can improve health equity and clinical outcomes for everyone. Multi-level interventions along the care continuum for chronic liver disease are needed to mitigate these disparities and provide equitable access to care.

Recruitment and Retention in the National Diabetes Prevention Program Lifestyle Change Program in Two Federally Qualified Health Centers in Rural Hawai'i.

Prediabetes disproportionately affects racial and ethnic minority groups in Hawai'i. The National Diabetes Prevention Program lifestyle change program (National DPP LCP) decreases the risk of developing diabetes. However, enrolling and retaining participants is a challenge for program providers. This evaluation aimed to understand factors that influence racial and ethnic minority groups in Hawai'i to enroll in and complete the program. From 2018 through 2023, two federally qualified health centers (FQHCs) in rural Hawai'i administered 6 year-long cohorts. Trained lifestyle coaches, who were FQHC staff members, recruited participants and facilitated the evidence-based curriculum. In 2023, the evaluation team conducted semistructured interviews with 14 of the 40 enrolled participants (35%), all of whom were women aged 25 to 74 years. Six participants identified as Native Hawaiian or Other Pacific Islander and 3 as Filipino. Eight participants reported completing the program. We used qualitative methodology to analyze transcripts. We identified themes around motivators, barriers, facilitators, and suggestions for improvement. Recruitment by trusted individuals in their communities motivated participants to enroll. Caregiving and work obligations were attendance barriers for early withdrawers and graduates. Social support from lifestyle coaches and enrolled friends and family were facilitators for program completion. Suggestions included improving class availability and incorporating culturally relevant recipes. Barriers experienced by Native Hawaiian or Other Pacific Islander and Filipino participants were similar to those reported by racial and ethnic groups in other studies. Program providers in rural communities should use trusted individuals as lifestyle coaches and recruit family and friends, regardless of National DPP LCP eligibility, to reduce caregiving barriers and engage critical support systems to facilitate completion.

Culturally responsive modifications to Gottman's Seven Principles Program for Arab American Adults: A feasibility study

AbstractObjectiveTo assess the feasibility of implementing a culturally responsive version of Gottman's Seven Principles relationship education program in a community‐based setting for married Arab American adults.BackgroundTo provide high‐quality couple and relationship education, it is necessary to acknowledge the population's needs and cultural backgrounds. One ethnic minority group that needs special attention is the Arab American community, which shares protective factors in terms of family support, religious beliefs, resiliency, and collectivist culture.MethodWe adapted Gottman's Seven Principles Program and conducted a qualitative feasibility study to examine recruitment capability, program acceptability, demand, and participant response among 16 Arab American married adults.ResultsThe results emphasize the vital role that thoughtful cultural and linguistic program adaptation played in increasing the acceptability and engagement of Arab American participants. However, results identified the ongoing stigma in Arab American communities against overtly seeking help for marital issues.ConclusionThis feasibility study provides helpful methodological and practical guidance to inform the design of larger scale randomized trials examining the efficacy of culturally responsive marriage education programs.ImplicationsThis study outlined actionable strategies, adaptations, venues, and communication channels to reduce barriers and optimize the delivery of marriage education to Arab American couples and families.

Laboratory-Confirmed Influenza-Associated Hospitalizations Among Children and Adults - Influenza Hospitalization Surveillance Network, United States, 2010-2023.

Seasonal influenza accounts for 9.3 million-41 million illnesses, 100,000-710,000 hospitalizations, and 4,900-51,000 deaths annually in the United States. Since 2003, the Influenza Hospitalization Surveillance Network (FluSurv-NET) has been conducting population-based surveillance for laboratory-confirmed influenza-associated hospitalizations in the United States, including weekly rate estimations and descriptions of clinical characteristics and outcomes for hospitalized patients. However, a comprehensive summary of trends in hospitalization rates and clinical data collected from the surveillance platform has not been available. 2010-11 through 2022-23 influenza seasons. FluSurv-NET conducts population-based surveillance for laboratory-confirmed influenza-associated hospitalizations among children and adults. During the reporting period, the surveillance network included 13-16 participating sites each influenza season, with prespecified geographic catchment areas that covered 27 million-29 million persons and included an estimated 8.8%-9.5% of the U.S. population. A case was defined as a person residing in the catchment area within one of the participating states who had a positive influenza laboratory test result within 14 days before or at any time during their hospitalization. Each site abstracted case data from hospital medical records into a standardized case report form, with selected variables submitted to CDC on a weekly basis for rate estimations. Weekly and cumulative laboratory-confirmed influenza-associated hospitalization rates per 100,000 population were calculated for each season from 2010-11 through 2022-23 and stratified by patient age (0-4 years, 5-17 years, 18-49 years, 50-64 years, and ≥65 years), sex, race and ethnicity, influenza type, and influenza A subtype. During the 2020-21 season, only the overall influenza hospitalization rate was reported because case counts were insufficient to estimate stratified rates. During the 2010-11 to 2022-23 influenza seasons, laboratory-confirmed influenza-associated hospitalization rates varied significantly across seasons. Before the COVID-19 pandemic, hospitalization rates per 100,000 population ranged from 8.7 (2011-12) to 102.9 (2017-18) and had consistent seasonality. After SARS-CoV-2 emerged, the hospitalization rate for 2020-21 was 0.8, and the rate did not return to recent prepandemic levels until 2022-23. Inconsistent seasonality also was observed during 2020-21 through 2022-23, with influenza activity being very low during 2020-21, extending later than usual during 2021-22, and occurring early during 2022-23. Molecular assays, particularly multiplex standard molecular assays, were the most common influenza test type in recent seasons, increasing from 12% during 2017-18 for both pediatric and adult cases to 43% and 55% during 2022-23 for pediatric and adult cases, respectively. During each season, adults aged ≥65 years consistently had the highest influenza-associated hospitalization rate across all age groups, followed in most seasons by children aged 0-4 years. Black or African American and American Indian or Alaska Native persons had the highest age-adjusted influenza-associated hospitalization rates across these seasons. Among patients hospitalized with influenza, the prevalence of at least one underlying medical condition increased with increasing age, ranging from 36.9% among children aged 0-4 years to 95.4% among adults aged ≥65 years. Consistently across each season, the most common underlying medical conditions among children and adolescents were asthma, neurologic disorders, and obesity. The most common underlying medical conditions among adults were hypertension, obesity, chronic metabolic disease, chronic lung disease, and cardiovascular disease. The proportion of FluSurv-NET patients with acute respiratory signs and symptoms at hospital admission decreased from 90.6% during 2018-19 to 83.2% during 2022-23. Although influenza antiviral use increased during the 2010-11 through the 2017-18 influenza seasons, it decreased from 90.2% during 2018-19 to 79.1% during 2022-23, particularly among children and adolescents. Admission to the intensive care unit, need for invasive mechanical ventilation, and in-hospital death ranged from 14.1% to 22.3%, 4.9% to 11.1%, and 2.2% to 3.5% of patients hospitalized with influenza, respectively, during the reported surveillance period. Influenza continues to cause severe morbidity and mortality, particularly in older adults, and disparities have persisted in racial and ethnic minority groups. Persons with underlying medical conditions represented a large proportion of patients hospitalized with influenza. Increased use of multiplex tests and other potential changes in facility-level influenza testing practices (e.g., influenza screening at all hospital admissions) could have implications for the detection of influenza infections among hospitalized patients. Antiviral use decreased in recent seasons, and explanations for the decrease should be further evaluated. Continued robust influenza surveillance is critical to monitor progress in efforts to encourage antiviral treatment and improve clinical outcomes for persons hospitalized with influenza. In addition, robust influenza surveillance can potentially reduce disparities by informing efforts to increase access to preventive measures for influenza and monitoring any subsequent changes in hospitalization rates.

Autism Diagnosis Among US Children and Adults, 2011-2022

An improved understanding of autism spectrum disorder (ASD) prevalence over time and across the lifespan can inform health care service delivery for the growing population of autistic children and adults. To describe trends in the prevalence of ASD diagnoses using electronic records data from a large network of health systems in the US. This cross-sectional study examined annual diagnosis rates in health records of patients in US health systems from January 1, 2011, to December 31, 2022. Eligible individuals were included in the study sample for a given calendar year if they were enrolled in a participating health system for at least 10 months out of the year. Data were extracted from 12 sites participating in the Mental Health Research Network, a consortium of research centers embedded within large, diverse health care systems. Diagnoses of ASD were ascertained using International Classification of Diseases, Ninth Revision (ICD-9) and International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) revision codes. Annual diagnosis rates were calculated as the number of unique members diagnosed, divided by the total members enrolled. A total of 12 264 003 members were enrolled in 2022 (2 359 359 children aged 0 to 17 years [19.2%]; 6 400 222 female [52.2%]; 93 002 American Indian or Alaska Native [0.8%], 1 711 950 Asian [14.0%], 952 287 Black or African American [7.8%], 2 971 355 Hispanic [24.2%], 166 144 Native Hawaiian or Pacific Islander [1.4%], and 6 462 298 White [52.7%]). The ASD diagnosis rate was greatest among 5-to-8-year-olds throughout the study period and increased by 175% among the full sample, from 2.3 per 1000 in 2011 to 6.3 per 1000 in 2022. The greatest relative increase in diagnosis rate from 2011 to 2022 occurred among 26-to-34-year-olds (450%) and increases were greater for female vs male individuals among children (305% [estimated annual percentage change (EAPC), 13.62 percentage points; 95% CI, 12.49-14.75 percentage points] vs 185% [EAPC, 9.63 percentage points; 95% CI, 8.54-10.72 percentage points], respectively) and adults (315% [EAPC, 13.73 percentage points; 95% CI, 12.61-14.86 percentage points] vs 215% [EAPC, 10.33 percentage points; 95% CI, 9.24-11.43 percentage points]). Relative increases were greater in racial and ethnic minority groups compared with White individuals among children, but not adults. In this cross-sectional study of children and adults in the US, ASD diagnosis rates increased substantially between 2011 and 2022, particularly among young adults, female children and adults, and children from some racial or ethnic minority groups. Diagnosis prevalence trends generated using health system data can inform the allocation of resources to meet the service needs of this growing, medically complex population.

&lt;b&gt;The Imposition of Authoritarian State Sexualism:&lt;/b&gt; &lt;b&gt;Theoretical Analysis of State Repression of Sexual Minority Groups Globally&lt;/b&gt;

Numerous countries globally have governments who act to repress alternative sexual lifestyle groups. Such governments’ motives to rule in this manner are authoritarian, they wish to promote state controlled sexualism. Authoritarian state sexualism is the government's creation of a homogenized population who all think and act the same way, decided by the dominant ideology. This would include conformity with an authoritarian government of the day’s choice of sexual preference, which is virtually exclusively heterosexuality. This paper discusses covert and overt social engineering that takes place within authoritarian, socially repressive societies, which effectively drive sexual minority groups underground. Imposition of authoritarian state sexualism on people who live in sexually repressive societies, begins in their early years.

Wayang Potehi and the Resistance of the Chinese Ethnic Minority Group Against Racial Discrimination in Indonesia

Since the colonial era in Indonesia, the Chinese ethnic minority group has often experienced problems of racial discrimination in their lives. As a medium of resistance against racial discrimination, they utilize Wayang Potehi, Chinese glove puppets featured in stage performances. This qualitative research uses cultural identity theory and a critical ethnographic approach to find forms of racism and the implementation of Wayang Potehi as a resistance to racism. The results of this study show that the reason why the Chinese ethnic group uses Wayang Potehi by ignoring the truth of the knight figure is because in Java the Chinese ethnic group is a minority group that only relies on communication. Therefore, communication is built through the Wayang Potehi performance as a form of covert or symbolic resistance to the local community. In addition, the Chinese ethnic community also often experiences verbal violence in the form of insults or harassment.

The Survival and Medical Dilemma of Rare Disease Patients in the Greater Bay Area

The population of rare disease patients in China faces many difficulties in disease diagnosis and treatment, medical security, economic burden, quality of life, social assistance, employment opportunities, mental health, and other aspects. It is of great significance to identify the common problems faced by this group and try to propose possible solutions, calling on all sectors of society to pay attention to the rare disease minority group, help them solve their survival and security difficulties, and enable more patients to return to society. This paper investigates and addresses the survival and security challenges faced by rare disease minority patients in the Guangdong-Hong Kong-Macao Greater Bay Area (GBA) of China. Through a survey of 223 rare disease patients in the Greater Bay Area, the study reveals that these patients face many challenges in diagnosis, treatment, drug access, and economic support. The conclusion emphasizes the necessity of improving diagnostic efficiency, accelerating drug development, and improving the medical insurance system. Thus, it further puts forward practical suggestions.

Your How Short Video Empowers Sexual Minority Groups: A Case Study of the TikTok Platform

This study investigates the empowering effects of short video platforms, particularly TikTok, on sexual minority groups within the cyberspace realm. Through a questionnaire survey, we explore the platform’s role in enhancing visibility, self-expression, and community building for sexual minorities. Our findings reveal that TikTok, with its expansive reach and interactive features, serves as a potent tool for awareness, understanding, and identity formation among these groups. The platform’s algorithmic recommendations and user engagement mechanisms significantly contribute to the dissemination of diverse sexual minority narratives, fostering a broader societal understanding and acceptance. However, challenges such as cyber violence, privacy concerns, and content filtering algorithms necessitate a collaborative approach to harness the full potential of these platforms for empowerment. This research contributes to the discourse on media’s role in social change, offering insights for platform policies, content creators, and societal stakeholders to collectively advance the rights and well-being of sexual minorities in a digital age.

An update on the concept and importance of health literacy in young people

Abstract The burden of non-communicable diseases is a growing public health crisis that requires immediate action. As health literacy (HL) has been strongly linked with health behaviours and health outcomes, it has many potential implications for health care and health education. Although recent research has emphasised the importance of developing HL early in life, much of the research has focused on understanding and improving HL in adult populations. As young people socialise in different contexts and are exposed to different health-related situations, they require different HL competencies. As part of a wider project, this study aims to gather the perceptions of international academics and community-based practitioners on the concept and importance of HL in and for young people. Specifically, the study aims to (i) explore current understandings of the concept of HL in young people; (ii) examine the importance of HL for young people; (iii) identify those at risk of having low levels of HL; and (iv) determine the specific health behaviours that young people are currently struggling with. A stakeholder mapping exercise was used to recruit academic and community-based practitioners to take part in a one-to-one interview (n = 29). Reflexive thematic analysis was used to analyse the data. The preliminary findings suggest that HL is a very broad yet individualised concept that is critical to develop at an early age given the difficulty young people face in adopting healthy behaviours in their social and physical environment. Furthermore, the participants highlighted that minority groups, such as members of the travelling community and refugees, and those from low socioeconomic populations, are at greatest risk of low HL. Finally, the health issues that appeared to be of most concern in young people were vaping, social media use and poor mental health. These findings can be used to inform appropriate interventions and policies to target the HL of young people. Key messages • Health literacy is a very, yet individualised, concept that is critical to develop given the difficulty young people face in adopting healthy behaviours in their social and physical environment. • Minority groups, such as members of the travelling community, refugees, and those from low socioeconomic populations are at greatest risk of low levels of health literacy.

Co-designed study with the Traveller Community in Ireland to determine cancer awareness &amp; attitudes

Abstract Background Irish Travellers are a distinct ethnic minority group (formal recognition March 2017). They experience higher mortality than the general population at all ages for all causes of death. Study Aim To determine cancer awareness and attitudes among the Traveller Community in Ireland, and to identify barriers/enablers to cancer risk reduction behaviours and early diagnosis of cancer. Methods A co-designed multi-method study was developed in collaboration with Pavee Point, a national NGO for Travellers, the National Social Inclusion Office (NSIO) and the National Cancer Control Programme (NCCP) including: 1. Consultation with Pavee Point and NSIO representatives to inform the study proposal and methodology. 2. Co-design of methodology for ethics applications and subsequent data collection plan including interview topic guides and the development of a culturally appropriate version of the NCCP’s 2022 National Survey on Cancer Awareness, adding questions on social determinants of health and screening participation. 3. Collaboration with 12 peer-led Primary Health Care for Travellers Projects (PHCTPs), to provide in-person training for Traveller Community Health Workers to undertake a cross-sectional survey of 380 adult Travellers. 4. Collaboration with PHCTPs to undertake 20 semi-structured interviews with Travellers. 5. Conduct of semi-structured interviews with healthcare professionals to explore perceptions of barriers/enablers for Travellers engaging with the health system. Lessons Learned Working closely and collaboratively with our study partners, we gained valuable insights which enabled effective and efficient data collection across 8 counties, while exceeding our survey target sample size. Implications for Research: Collaborative, trusting, and respectful relationships are critical for all studies, but particularly when working with minority groups. Conclusions The study findings will inform policy for improved cancer outcomes among Travellers in Ireland. Key messages • Formation of a collaborative and respectful relationship with the Traveller community has facilitated successful research. • Traveller Community Health Workers (peer researchers) were key to the success of data collection.

Ethnic minorities who complete cardiac rehabilitation achieve equivalent functional capacity outcomes after cardiac rehabilitation but only half complete

Abstract Background Cardiac rehabilitation (CR) reduces the risk of death and repeat cardiac events and improves multiple patient outcomes. Ethnic minority backgrounds experience significant health disparities, often due to lack of fluency in dominant language and higher rates of cardiovascular disease risk factors. Despite these issues, outcomes for ethnic minorities from CR are rarely differentiated and participation in CR programs infrequently reported. Purpose To compare participation in and exercise outcomes from CR programs for patients from ethnic minorities versus the majority. Methods A secondary analysis from a national CR audit including 2335 CR participants. Ethnic minority was defined as having poor English language fluency requiring an interpreter for CR assessment. Functional capacity was assessed using 6-minute walk test (6MWT) or metabolic equivalent of tasks (METs). Binary logistic regression model was created to identify independent predictors of completion, accounting for baseline variables. Multiple linear regression models were used to determine if ethnic minority status was an independent predictor of change in 6MWT and METs after adjusting for baseline characteristics. Results Of the 2335 participants, 326 (14%) were from ethnic minorities. The mean age was 66.3±12.4 years and 70% males. There were no differences between minority and majority groups in relation to baseline characteristics. The most common referral diagnosis was myocardial infarction (27%), angina (25%), other – arrhythmias, cardiac devices, valve diseases/procedures (24%), and cardiac surgery (24%). Ethnic minorities were half as likely to complete CR (OR 0.49, 95% CI 0.38, 0.65) adjusted for age, sex, diagnosis, minority status, smoking, referral site and wait time (Table 1). Other factors that increase completion likelihood included all other cardiac diagnoses (compared to myocardial infarction as reference) and non-smokers, whereas major referral centre and female sex negatively impacted completion. Patients from ethnic minority backgrounds had less functional capacity at CR entry compared to the majority (379.9±118 versus 430.7±103 metres, p&amp;lt;0.001), though METs were comparable (6.69±2.73 versus 6.46±2.28 mg/kg/min, p=0.69). However, improvements were equivalent for 6MWT: minority 71.03±58.57 versus majority 71.37±61.16 (p=0.96), and for METs: minority 3.01±1.66 versus majority 3.13±1.74 mg/kg/min (p=0.77). Ethnic minority status was not an independent predictor of change in 6MWT and METs after accounting for age, sex, diagnosis, smoking, referral site, and wait time. Conclusion For patients from ethnic minority groups who completed CR, exercise/functional capacity outcomes were equivalent to majority participants, however less than one-in-two completed. CR programs should consider the needs of ethnic minority groups, particularly in relation to language and tailor content and delivery to promote participation and ensure more equitable access.

The Critical Role of Perceived Academic Institutional Support among Students in a Divided Society

Abstract Background To promote health equity, nursing schools must foster student diversity and develop future nurses’ abilities to care for patients from different backgrounds. Although academic experiences play an essential role in promoting multiculturalism, in Israel, where the Jewish-Arab divide is deep and central, this could be challenging. This study examined the attitudes of Israeli Jewish and Arab nursing students concerning their interactions across group lines. Methods In December 2022, 362 undergraduate students completed a survey on the association between cultural intelligence (CQ), satisfaction with the college’s support, and intergroup social interaction. Results The findings revealed that (1) Arab students (minority group) demonstrated higher CQ, especially regarding awareness of cultural differences and motivation for intercultural encounters; (2) Arab students perceived the intergroup encounter with Jewish students as closer and warmer than Jewish students; (3) Arab students’ satisfaction with the college’s support was higher than that of Jewish students; (4) Structural Equation Modeling revealed that (χ2/df=1.61, CFI=.970, TLI=.955, NFI=.927, RMSEA=.041) the support provided by the educational academic setting serves as a primary explanatory factor in the association between CQ and social distance. Conclusions Educational institutions should ensure their students feel supported to facilitate closer social interactions. This emphasizes the importance of proactive measures to encourage diversity and cultural competence in nursing education. Such efforts may positively impact the students’ mental health and enhance patient care. Key messages • To foster student social interaction in divided societies, academia must ensure a high sense of support. • Proactive nursing education promoting diversity and cultural competence may benefit student mental health and patient care.

Confronting racism as a healthcare challenge: A teaching and learning approach

Across the United Kingdom, medical schools are acknowledging the need to respond to inequalities experienced by minority groups, racism within healthcare, and the need to decolonise medical curricula. Understanding the impact of structural racism is increasingly recognised as part of health professionals’ training. In this paper we report the delivery of a new lecture and workshop on racism to first year medical students at Hull York Medical School, aimed to teach students about structural racism and the impact it has on health and healthcare services. Whereas comparable training programmes focus on personal values of inclusivity and diversity, these sessions encourage students to consider the reality of racism as part of health and healthcare experiences. The session includes conceptual content alongside applied examples of microaggression experienced by a healthcare professional. We report the results of student feedback attained through surveys using Likert scales and free text. We conclude by discussing the benefits of teaching medical students about racism, and its impact on patients and staff, rather than just inclusive practice.