Racial Minority Groups Research Articles

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 Review of Cutaneous Extraintestinal Manifestations of Inflammatory Bowel Disease in Skin of Color.

The incidence of inflammatory bowel disease (IBD) is increasing in racial and ethnic minority groups. Cutaneous extraintestinal manifestations (EIMs) of IBD are well-known comorbid conditions that can occur in both active and quiescent IBD. Historically, cutaneous EIMs of IBD are described in White skin with a lack of literature describing these conditions in darker skin tones. This potentially creates a knowledge gap and awareness among providers in recognizing these conditions and offering therapy in a timely manner to non-White patients. This review aims to describe the cutaneous manifestations of IBD in a wide range of skin tones with several examples to improve awareness. With further awareness, this review will enable to provide equitable care to IBD patients with cutaneous EIMs.

Racial and ethnic minority representation in dementia risk factor research: a scoping review of cohort studies

BackgroundDespite a potentially greater burden of dementia, racial and ethnic minority populations around the world may be more likely to be excluded from research examining risk factors for incident dementia....

Perceived Vulnerability to Disability-Related Victimization in People With Multiple Sclerosis: Community Survey on Risk and Protective Factors.

The perception that one is at increased risk of interpersonal victimization or violence can deleteriously affect community participation and quality of life. Race, sex, and disability status, often associated with use of an assistive mobility device (AD), are known correlates of perceived risk of victimization; however, almost no research has explored how these variables intersect for individuals with multiple sclerosis (MS), and none have sought to identify potential risk and protective factors. Data for the present study come from a single time point derived from a 10-year longitudinal survey of 446 individuals with MS. Lifetime trauma exposure, personal resilience and self-efficacy, control over participation, and perceived risk of interpersonal victimization due to disability were all assessed via self-report. Statistical analyses included analysis of covariance with participants stratified by race/ethnicity, sex, and AD use. After controlling for lifetime trauma exposure and severity of physical impairment, the use of an AD was significantly associated with greater perceived risk of victimization due to disability. Further, people with MS from racial and ethnic minority groups who used ADs had the highest perceived risk relative to all other groups. Higher levels of perceived risk were associated with a lower sense of control over community participation, lower resilience, and lower disease management self-efficacy. Visible indicators of disability may contribute to perceptions of vulnerability, especially among people with MS who are racially and ethnically marginalized. Clinicians should be aware of how perceived vulnerability may impact a sense of control over community participation, particularly when educating patients on AD use.

Abstract A120: Cancer screening uptake among Hispanic survivors of adolescent and young adult cancer

Abstract Introduction: Advances in treatment have significantly improved the survival rates of adolescent and young adult (AYA) cancer patients, with a five-year survival rate reaching 86%. However, these survivors remain at increased risk for developing secondary cancers later in life. Racial and ethnic minority groups, such as Hispanics, often experience significant healthcare disparities, including lower cancer screening rates. Cancer survivors, particularly those who are Hispanic and diagnosed as AYAs, may face unique barriers in adhering to recommended cancer screening guidelines. This study examines the uptake rates of colon, breast, and cervical cancer screenings among Hispanic survivors of AYA cancer compared to their age- and sex-matched Hispanic non-cancer controls. Methods: The National Health Interview Survey data (years 2000 - 2021) [R1] were analyzed to identify Hispanic survivors of AYA cancer and Hispanic age- and sex-matched non-cancer controls. Data on cancer screening, including whether patients were up- to-date and ever screened for colon, breast, and cervical cancers, were assessed. The US Preventive Services Task Force recommendations were used to determine whether survivors were up-to-date for the cancer screening tests. The sample included 92 colon cancer survivors, 113 breast cancer survivors, and 313 cervical cancer survivors, matched with 920, 1130, and 3130 controls, respectively. Weighted percentages and odds ratios (OR) were calculated, adjusting for age at survey, sex, marital status, education, poverty status, and insurance. Results: Colon cancer screening uptake was significantly higher among survivors, with 26.1% up-to-date versus 11.5% of controls (OR=2.49, 95% CI=1.17-5.30, p=0.019). For breast cancer, 14.6% of survivors were up-to-date compared to 5.1% of controls [R2] (OR=2.51, 95% CI=1.33-4.72, p=0.005), and 82.6% of survivors were ever screened versus 38.7% of controls (OR=7.41, 95% CI=4.43-12.41, p<0.001). Cervical cancer screening showed the most pronounced difference, with 40.6% of survivors up-to-date compared to 19.0% of controls (OR=3.36, 95% CI=2.43- 4.65, p<0.001), and 71.2% of survivors ever screened compared to 28.6% of controls (OR=14.16, 95% CI=8.56-23.40, p<0.001). Conclusion: Hispanic AYA cancer survivors exhibit significantly higher cancer screening rates compared to matched controls. Despite these positive findings, the overall low screening rates highlight the need for targeted interventions to ensure that all survivors adhere to recommended screening guidelines. Enhancing access to healthcare and ensuring continuity of care are critical steps toward reducing disparities and improving health outcomes for this vulnerable population. Citation Format: Eunju Choi, Amy M. Berkman, Clark R Andersen, Michael E. Roth. Cancer screening uptake among Hispanic survivors of adolescent and young adult cancer [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 A120.

Telehealth Utilization to Address Health Care Disparities Among Asian Americans, Native Hawaiians, and Pacific Islanders: A Scoping Review.

Research has reported health care disparities, including low rates of health care utilization, among racial and ethnic minority groups compared to Whites. Asian Americans, Native Hawaiians, and Pacific Islanders (AANHPIs) have experienced these disparities, attributed to various barriers such as limited access to linguistically and culturally concordant health care services. Telehealth may offer a viable mode of health service delivery for AANHPIs. The coronavirus disease of 2019 (COVID-19) pandemic sparked the adoption of technology for receiving health services. However, the literature on telehealth utilization before and during the COVID-19 pandemic among AANHPIs is limited. To address this gap, we conducted a scoping review of telehealth intervention empirical studies serving AANHPIs published between January 2010 and February 2024, using five databases. Twenty-four articles met our inclusion criteria, which required the use of a telehealth intervention program, provision of disaggregated AANHPIs, and targeting of physical and/or mental health outcomes. Our review revealed positive findings of telehealth interventions in helping AANHPIs access health care, with a primary focus on education and consultation for self-management. The review highlighted a range of technological platforms used in AANHPIs telehealth interventions, including web-based, mobile, and blended approaches. Additionally, the review emphasized the need for improved access to technology and reduction in digital exclusion. The findings affirm the usefulness and potential of telehealth interventions, providing implications for how health professionals can serve AANHPIs. Telehealth technology offers the ability for greater accessibility and individualization to address health care disparities in AANHPIs.

Menopausal Hormone Therapy Use Among Postmenopausal Women

Menopausal hormone therapy (MHT) is the treatment of choice for symptoms of menopause. However, its adoption is hindered by the risk-benefit trade-off in relation to acute and chronic diseases. To evaluate trends in and correlates of MHT use among postmenopausal women in the US from 1999 to March 2020. This serial cross-sectional analysis of MHT use used data from the nationally representative National Health and Nutrition Examination Survey (NHANES). Participants included noninstitutionalized US postmenopausal women from 10 NHANES study cycles (1999-2000 to 2017-March 2020 [pre-COVID-19 pandemic]). Data were analyzed from December 2023 to April 2024. NHANES study cycle. Prevalence of MHT use was extracted from the prescription medication data collected during NHANES household interviews. MHT formulations were determined by hormone type. Data on 13 048 US postmenopausal women (47.1% ≥65 years old) were analyzed. From 1999 to 2020, the prevalence of MHT use decreased among women of all age groups, from 26.9% (95% CI, 22.6%-31.7%) in 1999 to 4.7% (95% CI, 3.4%-6.5%) in 2020. Until 2002, MHT use was highest among women aged 52 to 65 years, but since 2005, MHT use has been highest among women younger than 52 years. MHT use decreased by 23.5% (95% CI, 11.4%-35.6%), 31.4% (95% CI, 23.4%-39.5%), and 10.6% (95% CI, 6.3%-14.8%) for women younger than 52 years, 52 years to younger than 65 years, and 65 years and older, respectively. Prevalence of MHT use decreased from 13.8% (95% CI, 8.5%-21.7%) to 2.6% (95% CI, 1.5%-4.6%) for Hispanic women, 11.9% (95% CI, 8.5%-16.3%) to 0.5% (95% CI, 0.2%-1.1%) for non-Hispanic Black women, and 31.4% (95% CI, 27.1%-36.1%) to 5.8% (95% CI, 4.1%-8.2%) for non-Hispanic White women. Non-Hispanic White women consistently had the highest prevalence of MHT use. Estrogen-only formulation accounted for more than 50% of the MHT for most study periods. The prevalence of MHT use varied by family income-to-poverty ratio, health insurance coverage in all racial and ethnic groups, weight, and smoking status among non-Hispanic White women, as well as by education attainment among non-Hispanic Black and Hispanic women. Results of this cross-sectional study show that over the past 2 decades, MHT use declined among US postmenopausal women of all age and racial and ethnic groups. Women of racial and ethnic minority groups had lower prevalence of MHT use compared to non-Hispanic White women.

Trends in Racial and Ethnic Differences in Declined Surgery for Resectable Malignancies in the United States.

To assess trends in patients' decisions to decline cancer surgery in the United States by race and ethnicity. Racial and ethnic differences in declining potentially curative cancer surgery are suggested to be due to systemic inequities in healthcare access and mistrust of healthcare systems, among other factors. Despite ongoing national efforts to address these inequities, it is unknown whether differences in rates of declined cancer surgery have improved. Using population-based data from the US Surveillance, Epidemiology, and End Results Program from 2000 to 2019, we studied individuals with non-metastatic cancer who were recommended surgery. Racial and ethnic differences in risk-adjusted rates of declined surgery were evaluated by year and cancer site using mixed-effects logistic regression. Of 2,740,129 patients with resectable, non-metastatic cancer, Black patients had the highest rates of declined surgery (2.10% [95% CI, 1.91-2.31%]) while White patients had the lowest (1.04% [95% CI, 0.95-1.14%]). From 2000 to 2019, racial and ethnic differences in declined surgery did not change significantly, except for a decrease in the difference between Hispanic and White patients (difference-in-difference, -0.4% [95% CI, -0.71% to -0.09%]). When stratified by cancer site, Black-White differences in rates of declined surgery decreased significantly (but were not eliminated) for four of fifteen sites (esophageal, pancreatic, lung, and kidney) ( P <0.001). Patients from racial and ethnic minority groups were more likely to decline surgical intervention for potentially curable malignancies and these differences have persisted over time. Further work is needed to understand the causes of these differences and identify opportunities for improvement.

Understanding Food Insecurity and Participation in Food Assistance Programs among Hispanic/Latino Residents of Hialeah, Florida, before and during the COVID-19 Pandemic

The 63.6 million Hispanic individuals living in the United States constitute the largest ethnic or racial minority group in the country. Hispanic/Latino households report a high prevalence of food insecurity, and often, food-insecure individuals cope by turning to emergency and federal food assistance programs for immediate or long-term assistance. This paper focuses on Hialeah, Florida, a predominantly Hispanic/Latino city in Miami-Dade County. It examines which demographic factors influence participation in food assistance programs and the occurrences of periods of disrupted food access. This study examines two questions: (1) What factors are associated with participation in food assistance programs? (2) To what extent did study participants use food assistance programs before and during the COVID-19 pandemic? We conducted a survey and collected 684 responses from April to August 2022. We gathered data on participants’ identities, household attributes, and their usage of federal and emergency food assistance programs. We used Pearson’s chi-square tests to identify significant associations between food assistance usage, food access, and respondents’ demographic characteristics. We also used binary logistic regression models to assess probabilities. The findings of this research are significant, indicating that the COVID-19 pandemic exacerbated food access challenges in Hispanic/Latino households in 2022. The data also revealed that low-income households, respondents below the age of 40, individuals born in the United States, those with low educational attainment, and those living in multifamily households had the highest likelihood of using food assistance programs. Single- and non-single-parent households, employment status, languages spoken at home, and number of children in the household were also statistically significant factors in predicting food assistance usage. This research provides valuable insights into how individuals in a city responded to the pandemic by utilizing food assistance programs.

A Few Doctors Will See Some of You: The Critical Role of Underrepresented in Medicine (URiM) Family Physicians in the Care of Medicaid Beneficiaries.

Despite being key to better health outcomes for patients from racial and ethnic minority groups, the proportion of underrepresented in medicine (URiM) physicians remains low in the US health care system. This study linked a nationally representative sample of family physicians (FPs) with Medicaid claims data to explore the relative contributions to care of Medicaid populations by FP race and ethnicity. This descriptive cross-sectional study used 2016 Medicaid claims data from the Transformed Medicaid Statistical Information System and from 2016-2017 American Board of Family Medicine certification questionnaire responses to examine the diversity and Medicaid participation of FPs. We explored the diversity of FP Medicaid patient panels and whether they saw ≥150 beneficiaries in 2016. Using logistic regression models, we controlled for FP demographics, practice characteristics, and characteristics of the communities in which they practiced. Of 13,096 FPs, Latine, Hispanic, or of Spanish Origin (LHS) FPs and non-LHS Black FPs saw more Medicaid beneficiaries compared with non-LHS White and non-LHS Asian FPs. The patient panels of URiM FPs had a much greater proportion of Medicaid beneficiaries from racial and ethnic minority groups. Overall, non-LHS Black and LHS FPs had greater odds of seeing ≥150 Medicaid beneficiaries in 2016. These findings clearly show the critical role URiM FPs play in caring for Medicaid beneficiaries, suggesting physician race and ethnicity are correlated with Medicaid participation. Diversity in the health care workforce is essential for addressing racial health inequities. Policies need to address problems in pathways to medical education, including failures to recruit, nurture, and retain URiM students.

Climate emotions, parenting plans, and racial difference in the United States

IntroductionIncreasing attention is being paid to the relationship between climate change, emotional and mental distress, and feelings about raising children. These studies often overlook the role of demographics, race in particular, despite evidence that racial minority groups in the U.S. experience more detrimental climate impacts and express more climate concern than do white communities. This survey was conducted to elucidate the relationship between race, climate emotions, and parenting plans in the U.S. MethodsWe surveyed 2489 people in the U.S. between the ages of 22 and 35 in September 2021. Because we were interested in the role of race, we oversampled those who identified as non-white/people of color. The survey assessed participants’ emotions with respect to climate change, and their emotions with respect to birthing and raising children (parenting) in the context of climate change. ResultsNonwhite respondents were more likely than white respondents to report feeling traumatized as a response to climate change, and to plan to have fewer future children than they wanted as a result of their climate-related emotions. They were also more likely to report feeling more optimistic and hopeful in response to climate change and in response to raising existing children in the context of climate change. White women were least likely to report any positive emotions with respect to parenting during climate change. White men were most likely to report non-feeling emotions such as numbness, indifference, or being checked out. Christian respondents were more likely to report feeling positive emotions overall. ConclusionThis study highlights race as a statistically significant factor in the reporting of climate emotions and parenting plans. It demonstrates that climate change has contradictory impacts on the emotions of nonwhite people of color, while having a negative impact on childbearing plans. We call for further research into the role of race in climate-related emotions and parenting plans, particularly with respect to the impacts of traumatized feelings, as well as the roles of religion and positive emotions.

Changing the narrative: Addressing American Indian/Alaska Native mental health needs through academic holistic support

American Indian/Alaska Natives (AIAN) have some of the highest health disparities and poorest outcomes of all racial or ethnic minority groups in the United States. Across all age groups, suicide is 2.5 times higher in AIANs than the national average (National Indian Council on Aging, 2019). Cultural and institutional barriers prevent AIAN undergraduate and graduate college students from seeking mental health services, and many serious mental health problems remain untreated.While numerous barriers to mental health services exist for AIAN students, Indigenous faculty and support staff who share deep understanding of history, culture and traditional view of health and wellness can reduce the barriers and promote mental health and wellness for students. Shifting the focus to introduce a new narrative gives way to greater recognition of factors that create health and may help academic institutions provide holistic support for AIAN and other underrepresented students. The new narrative includes holistic strength-based support, social support, and fostering cultural identity and pride enhances mental health and success. Indigenization of the doctoral nursing curriculum supports faculty who are committed to decolonizing course content and institutionalized pedagogy.Improved health outcomes for Indigenous individuals and other underrepresented students will positively affect communities through increasing diversity of APRNs, nursing faculty, and nursing scholars.

Improving diversity, equity, and inclusion in chiropractic education and profession: Report from three 2020-2021 summit meetings.

Racial and ethnic minority groups are underrepresented in chiropractic education and the profession, and are less likely than individuals identifying as White to have access to or use chiropractic care. Stakeholders with leadership positions in USA-based chiropractic colleges and organizations participated in 3 online diversity, equity, and inclusion (DEI) summit meetings to foster a deeper understanding of DEI, identify DEI objectives, and develop action steps and drive change. Summit I (51 attendees) comprised 3 presentations that provided background about DEI in chiropractic education and practice. Summit II (32 attendees), comprised 4 breakout sessions addressing organizational issues in DEI. Summit III (65 attendees) comprised 5 collaborative sessions focused on implementation of DEI objectives. We use aggregate data and qualitative summaries to provide a descriptive narrative. Data sources include pre/post-summit quantitative surveys, items from open-ended questionnaires, and a spreadsheet of recommendations for increasing organizational DEI. Before attending Summit I, 48% rated their understanding of DEI issues as "moderately" or "very" high, compared with 74% afterward. Summit II participants suggested actions that should be taken by their institutions and the profession. Summit III participants stressed the need for DEI-supportive data, policies, and resources. They identified > 150 action steps to address DEI objectives. A listserv was established to facilitate ongoing institutional collaboration. Summit participants recognized the importance of developing a diverse, culturally aware chiropractic workforce. The summits provided structure and support for stakeholders to effectively plan for and implement DEI in their organizations and institutions.

Improving cardiac rehabilitation referral rates in patients with coronary heart disease from diverse communities using an electronic order system

Background: Despite the benefits of cardiac rehabilitation (CR), local and national CR referral and participation rates remain low when compared to established cardiovascular therapies especially amongst racial/ethnic groups. Objectives: This study investigated the effects of the implementation of a CR program and electronic order set (EOS) in a large health system on CR referral and participation rates among a diverse group of patients with coronary heart disease (CHD). Methods: A total of 360 patients from UCSD Health who presented with ACS were prospectively evaluated during initial hospitalization and 6- and 12-weeks post-discharge. Multivariable logistic regression model assessed referral and participation rates by week-1 and -12 post-discharge, adjusting for gender, age, race, ethnicity, geography, and referring physician subspecialty. Results: UCSD CR program implementation led referral rates to increase at week-1 (Pre- 38.6% and Post-54.9%, p = 0.003) and week-12 (Pre- 54.1% and Post- 59.8%, p = 0.386). Post-CR referrals were more likely at week-1 (OR: 1.93, 95% CI 1.27-2.95) and week-12 (OR: 1.26, 95% CI 0.79-2.00). EOS implementation increased referral rates at week-1 (Pre- 40.3% and Post- 58.7%, p&lt;0.001) and week-12 (Pre- 54.9% and Post- 60.4%, p=0.394) with referrals more likely at week-1 (OR: 2.1, 95% CI 1.35-3.29) and week-12 (OR: 1.25, 95% CI 0.795-1.98). Participation in CR following EOS was more likely at both week-1 and week-12. Multivariable analysis revealed disparities in referral based on race, geographic location, and referring physician subspecialty. Conclusion: A CR program and EOS implementation were shown to increase referral rates with long-term potential for increasing referral and participation rates. Condensed Abstract: This prospective study investigated the implementation of a cardiac rehabilitation (CR) program and electronic order set (EOS) within the same health system on CR referral and participation rates. 360 patients with ACS were evaluated over a period of 12 weeks. UCSD CR program and EOS implementation led referral rates to increase at week-1 and -12. CR participation was more likely to increase at week-1 and -12 following EOS. Multivariable analysis revealed disparities in referrals disproportionally affecting racial and ethnic minority groups and rural communities. CR and EOS implementation may increase CR referral rates for diverse patients with CHD.

Financial distress and medical financial hardship among young adult survivors of blood cancer.

The long-term financial impact of cancer care has not been adequately addressed in young adults. As part of a remote intervention study, we describe medical financial distress and hardship among young adult survivors of blood cancer at study entry. Young adults were recruited from 6 US hospitals. Using a Research Electronic Data Capture link, young adults confirmed their eligibility-namely, currently 18 to 39 years of age, blood cancer diagnosis 3 or more years ago, off active treatment, and not on parent's insurance. Following consent, the baseline assessment was sent. The primary outcome measure, the Personal Financial Wellness Scale, measured financial distress (scored as severe, 1-2; high, 3-4; average, 5-6; and low to no, 7-10). Medical financial hardship encompassed material hardship, psychological impact, and coping behaviors. Descriptive summary statistics and linear regression were used. Among the 126 participants, 54.5% came from minority racial or ethnic groups. Median time since diagnosis was 10 years (interquartile range = 6-16 years), with 56% having received a diagnosis when they were between 18 and 39 years of age. The overall mean (standard deviation) Personal Financial Wellness Scale score was 5.1 (2.4), but 49% reported severe or high distress. In multivariable analysis, female sex, Hispanic ethnicity, and lower income were strongly associated with worse Personal Financial Wellness Scale scores. Among participants with severe financial distress (n = 26), 72% reported 2 or more household material hardships, had worse scores across all psychological domains, and altered survivorship care because of cost (68%). Nearly half of long-term young adult cancer survivors reported severe or high levels of financial distress. Individuals with severe or high distress also reported more medical financial hardship than other participants. This finding highlights the need for ongoing financial intervention in this vulnerable population. NCT05620979.

Enemy of My Enemy? An Examination of Potential Religious Group Threat Effects on Racial Attitudes

ABSTRACT Group threat theories postulate that when majority group members feel threatened by minority racial groups, they develop prejudice. However, it is possible that feeling threatened by those perceived as outgroups of racial minorities can lead to support for racial minorities. The threat offered by conservative Christians to progressives can lead those progressives to become more supportive of racial minorities, perceiving those minorities as allies. Data from the 2021 Baylor Religion Survey examined the predictive power of feeling threatened by Republicans, African Americans, conservative Christians, Muslims, atheists, and Buddhists on progressive racial attitudes. After basic social and demographic controls, feeling threatened by conservative Christians and political conservatives was associated with higher support for progressive racialized attitudes, while feeling threatened by Muslims and blacks was associated with lower support for progressive racial attitudes. This research extends theories about group threat theory by focusing on the symbolic threat tied to our current culture war.

Infection burden, periodontal pathogens, and their interactive association with incident all-cause and Alzheimer's disease dementia in a large national survey.

Relationships and interplay of an infection burden (IB) and periodontal pathogens or periodontal disease (Pd) markers with Alzheimer's disease (AD) and all-cause dementia among US adults were examined. Less than or equal to 2997 participants from the National Health and Nutrition Survey III were linked to CMS-Medicare [≥45 years (1988-1994); ≤30 years follow-up]. Hepatitis C (hazard ratio=3.33, p=0.004) and herpes simplex virus 2 were strongly associated with greater all-cause dementia risk. Porphyromonas gingivalis and Streptococcus oralis were associated with greater AD risk at higher IB. The red-green periodontal pathogen cluster coupled with higher IB count increased the risk of all-cause dementia among minority racial groups. Pocket probing depth associated with dementia risk at lower IB in the overall sample. Select viruses and bacteria were associated with all-cause and AD dementia, while the IB interacted with Pd markers in relation to these outcomes. Interplay of infection burden (IB) and periodontal disease with dementia was tested. ≤2997 participants from NHANES III were linked to Medicare. Hepatitis C and herpes simplex virus 2 strongly associated with dementia risk. Tetanus sero-positivity increased Alzheimer's disease (AD) risk. Porphyromonas gingivalis and Streptococcus oralis associated with AD at higher IB. Red-green periodontal cluster at high IB, increased dementia in racial minorities. Pocket probing depth associated with dementia risk at lower IB.

Disparities and Determinants of Online Medical Record Access among Cancer Survivors.

Access to online medical records (OMRs) can help enhance cancer patient engagement and improve their health outcomes. This study investigates disparities in OMR access among cancer survivors and examines the association between OMR access and health perceptions. We conducted a cross-sectional analysis using data from the National Cancer Institute's Health Information National Trends Survey (HINTS) from 2017 to 2022. The sample included 4713 cancer survivors. We employed regression analysis to assess the associations between the different factors. Overall, 18.78% of participants accessed their OMRs once or twice, while 36.69% accessed them three times or more. Gender minority groups (β = -0.0038, p = 0.01), older adults (β = -0.1126, p < 0.001), and racial minority groups (β = -0.059, p < 0.001) were less likely to access their OMRs. Additionally, higher education levels (β = 0.274, p < 0.001), insurance coverage (β = 0.365, p < 0.001), and higher incomes (β = 0.115, p < 0.001) were associated with increased OMR access. Positive health perceptions were significantly associated with OMR usage, including perceived good health (β = 0.148, p < 0.001), quality of care (β = 0.15, p = 0.026), and self-efficacy (β = 0.178, p = 0.002). Disparities in OMR access among cancer survivors are influenced by socio-economic factors and health perceptions. Interventions targeting vulnerable groups, enhancing digital health literacy, and improving health perceptions could promote equitable OMR usage.

Exposure to fine particulate matter in the New York City subway system during home-work commute.

The New York City (NYC) subway system accommodates 5.5 million daily commuters, and the environment within the subway is known to have high concentrations of fine particulate matter (PM2.5) pollution. Naturally, subway air pollution varies among individuals according to their mobility patterns, introducing the possibility of inequality in PM2.5 exposure. This study aims to evaluate individual and community-level exposure to subway PM2.5. We simulated the intracity home-to-work trip patterns using the Longitudinal Employer-Household Dynamics (LEHD) records of 3.1 million working commuters across 34,169 census blocks in four boroughs (Manhattan, Brooklyn, Queens, and the Bronx) of NYC. We incorporated the on-platform and on-train measured PM2.5 concentration data for the entire subway system. The mean underground platform concentration in the city was 139 μg/m3 with a standard deviation of 25 μg/m3, while the on-train concentration when underground was 99 μg/m3 with a standard deviation of 21 μg/m3. Using a network model, we determined the exposure of individual commuters during their daily home-work trips. We quantified the mean per capita exposure at the census block level by considering the proportion of workers within the blocks who rely on the subway for their work commute. Results indicate statistically significant weak positive correlation between elevated subway PM2.5 exposure and economically disadvantaged and racial minority groups.

Underrepresented Populations on Public Health Data Dashboards: Design Considerations for Improving Usability and Usefulness.

Representation of racial and ethnic minority groups and sexual and gender minority groups is limited on public health data dashboards. The small size of these populations leads to data being aggregated or suppressed to produce stable estimations and preserve individuals' information privacy. This might, however, limit the usefulness of the represented data for identifying individuals' risk factors and allocating services. To explore public health practitioners' concerns about underrepresented populations on public health data dashboards that emerged during a usability evaluation study. 20 public health practitioners from New York State, US. Virtual Zoom meetings were conducted to monitor the participants' use of a public health dashboard and ask about their experience using it. The collected data, in the form of researchers' notes and audio transcripts, were analyzed using the thematic analysis approach. Participants were very concerned about the underrepresentation of sexual and gender minority groups and racial and ethnic minority groups on public health data dashboards. Four themes emerged regarding the consequences of the underrepresentation: (1) misinterpretation of risk for underrepresented groups, (2) exacerbating the mistrust between underrepresented populations and the government, (3) a potential disservice to underserved populations if the data is used as the basis for allocating resources, and (4) and unknown impact for the individuals whose demographic information is unknown. We propose considerations for displaying underrepresented populations on public health data dashboards to improve the utility of the represented data.