Minority Subgroups Research Articles

A Scoping Review of Substance Use Prevalence Rates Amongst Subgroups of People Living with Deafness

ABSTRACT Research indicates that individuals who are deaf or hard of hearing (DHH) experience higher rates of substance use than the general population. However, study limitations often prevent reliable differentiation of prevalence rates between congenital and acquired deafness subgroups. This scoping review aimed to synthesize current data on substance use within these minority subgroups, identifying key gaps in existing research. We conducted a content analysis using a scoping review methodology, systematically searching PubMed, Embase, CINAHL, MEDLINE, Scopus, and other registries. From 926 references initially retrieved, 17 studies met the inclusion criteria following a full-text review in Covidence. The findings underscore that DHH individuals face an elevated risk of substance use disorders (SUD) relative to non-DHH individuals. Key conclusions include: (a) DHH populations have a higher risk for SUDs than non-DHH counterparts, (b) there is limited research on substance use prevalence, specifically beyond alcohol and opioids, within DHH populations, (c) substance use motivations differ between DHH and non-DHH groups, and (d) DHH individuals face unique barriers in accessing effective treatment. Further research is critical to support the development of tailored prevention and treatment strategies and underscore the need for subgroup-specific research to clarify prevalence rates and protective or risk factors.

Prevalence of Cardiac Arrhythmias in Transgender and Nonbinary Adult Community Health Center Patients.

Purpose: Sex differences in cardiac arrhythmias are well established. This study aimed to explore the prevalence of arrhythmias in transgender and nonbinary (TGNB) adults. Methods: This cross-sectional study utilized electronic medical records from a center specializing in TGNB care. Adults aged ≥18 years with ≥2 medical visits between January 1, 2010, and December 31, 2021, were categorized into self-reported gender groups: TGNB (transgender men, transgender women, nonbinary [NB]-assigned male at birth, NB-assigned female at birth), cisgender men, and cisgender women. The primary outcome was any arrhythmia using age- and race-adjusted regression models comparing transgender patients with cisgender men and cisgender women. Prevalence of arrhythmias was explored in transgender people with a gender-affirming hormone therapy (GAHT) prescription. Results: The sample included 49,862 adults, with 7121 (14%) TGNB persons. Median age was 28 years. Prevalence of arrhythmias was low (0.7-1.4% NB persons, 1.4-1.5% transgender persons). After adjustment, transgender women and transgender men had similar odds of any arrhythmia compared with cisgender men (transgender women: adjusted odds ratio [aOR] 0.89, 95% confidence interval [CI] 0.63-1.24, p = 0.52; transgender men: aOR 1.17, 95% CI 0.82-1.62, p = 0.37), but higher odds of any arrhythmia compared with cisgender women (transgender women: aOR 1.65, 95% CI 1.13-2.34, p = 0.01; transgender men: aOR 2.15, 95% CI 1.48-3.04, p < 0.001). Prevalence of arrhythmias appeared similar among transgender adults regardless of GAHT use (transgender men: 1.5% vs 1.9%, transgender women: 1.2% vs 2.1%). Conclusion: Further research examining arrhythmias in TGNB patients and across gender minority subgroups is warranted, including longitudinal studies evaluating the potential impact of GAHT.

Racial Disparities in Genetic Detection Rates for Inherited Retinal Diseases

The association of race and detection of pathogenic variants using wide-panel genetic testing for inherited retinal diseases (IRD), to our knowledge, has not been studied previously. To investigate the genetic detection rates of wide-panel testing in Black and non-Hispanic White patients with IRDs. This 2-group comparison used retrospective patient data that were collected at the University of Michigan (UM) and Blueprint Genetics (BG). At UM, inclusion criteria included having a clinical IRD diagnosis, wide-panel genetic testing, and both parents and the patient self-identifying as the same race (Black or non-Hispanic White). Logistic regression analysis was used; the dependent variable was genetic test result (positive or negative/inconclusive) and the independent variables were race, age, sex, phenotype, and number of genes tested. In the BG database, patients with wide-panel testing and self-reported race were included; detection rate comparison analysis based on race was performed using χ2 test of independence. These data were analyzed from October 30, 2013, through October 26, 2022. Genetic test result was considered positive if pathogenic/likely pathogenic variants were detected. A total of 572 patients were included in UM, 295 were males (51.6%). Mean age was 45 years. There were 54 Black patients (9.4%) and 518 White patients (90.6%). Black race (odds ratio [OR], 0.25; 95% CI, 0.14-0.46; P < .001) and age (OR per 10 years, 0.84; 95% CI, 0.76-0.92; P < .001) were independently associated with decreased odds of a positive test. In the BG database, 142 of 320 of Black patients (44.4%) had a positive/likely positive test result, a proportion lower than White patients (1691 of 2931 [57.7%]) (χ2 = 18.65; df = 1; P < .001). Results from this study highlight a lower genetic detection rate for Black patients than for White patients with IRDs. This supports a concern that the current development of IRD therapeutics is highly dependent on the ability to identify the genetic cause of disease. Patients with no known genetic diagnosis may be disadvantaged in terms of prognostication, inheritance counseling, reproductive decision-making, and eligibility for potential therapeutic options, including clinical trials. As future treatments become available, these findings suggest the need to examine the genetic detection rates across majority and minority subgroups alike.

Conceptualizing bias in EHR data: A case study in performance disparities by demographic subgroups for a pediatric obesity incidence classifier.

Electronic Health Records (EHRs) are increasingly used to develop machine learning models in predictive medicine. There has been limited research on utilizing machine learning methods to predict childhood obesity and related disparities in classifier performance among vulnerable patient subpopulations. In this work, classification models are developed to recognize pediatric obesity using temporal condition patterns obtained from patient EHR data in a U.S. study population. We trained four machine learning algorithms (Logistic Regression, Random Forest, Gradient Boosted Trees, and Neural Networks) to classify cases and controls as obesity positive or negative, and optimized hyperparameter settings through a bootstrapping methodology. To assess the classifiers for bias, we studied model performance by population subgroups then used permutation analysis to identify the most predictive features for each model and the demographic characteristics of patients with these features. Mean AUC-ROC values were consistent across classifiers, ranging from 0.72-0.80. Some evidence of bias was identified, although this was through the models performing better for minority subgroups (African Americans and patients enrolled in Medicaid). Permutation analysis revealed that patients from vulnerable population subgroups were over-represented among patients with the most predictive diagnostic patterns. We hypothesize that our models performed better on under-represented groups because the features more strongly associated with obesity were more commonly observed among minority patients. These findings highlight the complex ways that bias may arise in machine learning models and can be incorporated into future research to develop a thorough analytical approach to identify and mitigate bias that may arise from features and within EHR datasets when developing more equitable models.

Brain Health Outcomes in Sexual and Gender Minority Groups: Results From the All of Us Research Program.

Sexual and gender minority (SGM) groups have been historically underrepresented in neurologic research, and their brain health disparities are unknown. We aim to evaluate whether SGM persons are at higher risk of adverse brain health outcomes compared with cisgender straight (non-SGM) individuals. We conducted a cross-sectional study in the All of Us Research Program, a US population-based study, including all participants with information on gender identity and sexual orientation. We used baseline questionnaires to identify sexual minority (lesbian, gay, bisexual, diverse sexual orientation; nonstraight sexual orientation) and gender minority (gender diverse and transgender; gender identity different from sex assigned at birth) participants. The primary outcome was a composite of stroke, dementia, and late-life depression, assessed using electronic health record data and self-report. Secondarily, we evaluated each disease separately. Furthermore, we evaluated all subgroups of gender and sexual minorities stratified by sex assigned at birth. We used multivariable logistic regression (adjusted for age, sex assigned at birth, race/ethnicity, cardiovascular risk factors, other relevant comorbidities, and neighborhood deprivation index) to assess the relationship between SGM groups and the outcomes. Of 413,457 US adults enrolled between May 31, 2017, and June 30, 2022, we included 393,041 participants with available information on sexual orientation and gender identity (mean age 51 [SD 17] years), of whom 39,632 (10%) belonged to SGM groups. Of them, 38,528 (97%) belonged to a sexual minority and 4,431 (11%) to a gender minority. Compared with non-SGM, SGM persons had 15% higher odds of the brain health composite outcome (odds ratio [OR] 1.15, 95% CI 1.08-1.22). In secondary analyses, these results persisted across sexual and gender minorities separately (all 95% CIs > 1). Assessing individual diseases, all SGM groups had higher odds of dementia (SGM vs non-SGM: OR 1.14, 95% CI 1.00-1.29) and late-life depression (SGM vs non-SGM: OR 1.27, 95% CI 1.17-1.38) and transgender women had higher odds of stroke (OR 1.68, 95% CI 1.04-2.70). In a large US population study, SGM persons had higher odds of adverse brain health outcomes. Further research should explore structural causes of inequity to advance inclusive and diverse neurologic care.

Identifying the ‘Miserable Minority’ Among Pediatric Patients Following Concussion

ObjectivesTo investigate whether there are empirically-detectable subgroups of concussion severity and recovery across three consecutive concussions, as well as to define risk factor and clinical assessment differences across subgroups. MethodsThe present study was a retrospective chart review of 202 adolescents 13.17 ± 1.99 years old who presented to a concussion specialty clinic within 30 days of injury for multiple injuries between 2019 and 2020. Participants included patients from a specialty clinic for two (n = 202) or three (n = 68) total concussions. Latent class analysis (LCA) was used to identify subgroups based upon concussion symptom severity and recovery time. Risk factors (sex, age at first injury, and histories of anxiety, depression, migraine, motion sickness, ocular dysfunction, and attention-deficit/hyperactivity disorder [ADHD] or learning disability [LD]) were compared across subgroups. ResultsA two-class solution yielded one group of 163 participants characterized by lower symptoms and shorter recovery times (80.7%, “normal”) and 39 participants (19.3%, “miserable minority”) characterized by higher symptoms and longer recovery times. Only female sex (OR = 4.91, p = 0.005) was a significant predictor of class membership. The miserable group presented for treatment nearly 4 days later (9.41 days) compared to the normal group (5.74 days) for the first injury, and almost 2 days later for the second injury (7.33 vs 5.26 days). ConclusionsApproximately 1 in 5 patients who presented to a concussion specialty clinic for a repeat concussion were classified in the miserable minority subgroup. This subgroup was characterized by markedly higher initial symptom burdens and over double the recovery time. Level of EvidenceRetrospective cohort study, Level III evidence.

Associations Between Sexual Orientation Dimensions and Cardiometabolic Diseases: Data From the National Epidemiologic Survey on Alcohol and Related Conditions-III (NESARC-III).

Sexual orientation can be measured across identity, attraction, and behavior. Sexual minorities are at increased risk of cardiovascular disease (CVD) and diabetes; however, it is not known whether cardiometabolic disease risk varies across these dimensions. We analyzed cross-sectional data from 36,309 adults who participated in the National Epidemiologic Survey on Alcohol and Related Conditions-III (NESARC-III; 2012-2013). Participants were categorized as heterosexual (reference), lesbian/gay, or bisexual across identity, attraction, and behavior using structured clinical interview data. Prevalent CVD (myocardial infarction, stroke, angina, or arteriosclerosis) and diabetes were assessed by self-report. Demographics (age, sex, race/ethnicity, education, and income) adjusted logistic regression models revealed bisexual behavior (i.e., people reporting sexual activity with both man- and woman-identifying individuals), but not lesbian/gay behavior (i.e., people reporting sexual activity exclusively with same-sex individuals), was associated with an increased odds of prevalent CVD (OR = 1.44, 95% CI = 1.08-1.91, p = .013) and prevalent diabetes (OR = 1.39, 95% CI = 1.09-1.77, p = .007). Contrastingly, sexual minority identity (i.e., self-concept) and attraction (i.e., one's sexual/romantic feelings) were not associated with prevalent CVD or diabetes. Our results in a nationally representative sample indicate that the sexual orientation dimension of behavior is linked with prevalent CVD and diabetes. This finding suggests that assessing multiple sexual orientation dimensions may aid in identifying sexual minority subgroups in greatest need of cardiometabolic disease prevention efforts. Although mechanisms such as stigma and minority stress have been proposed, future studies are required to elucidate mechanisms underlying the bisexual behavior-cardiometabolic disease relationship.

Hierarchies of Elitism among Urban and Rural Palestinian Students in Israel

This research investigates Palestinian students residing in both urban and rural areas who are enrolled in an elite high school located in a mixed Arab-Jewish city in northern Israel. We investigate how these divergent backgrounds influence their experiences and perceptions of their elite identities and how elite identities within national minority sub-groups (urban and rural) impact the formation and perpetuation of intra-group hierarchies. We find that elite identities are influenced by geographic positionality, that hierarchies exist within the same minority elite and that these factors shape both personal and collective identities.

7833 Gestational Diabetes Mellitus (GDM): A Weighted Spectrum of Clinical Outcomes

Abstract Disclosure: M. Moazzami: None. N. Venkatesan: None. K.S. Rajagopalan: None. A.V. Vella: None. A. Egan: None. Gestational diabetes mellitus (GDM) affects approximately 10% of pregnancies, with rates almost doubling in minority subgroups. Higher body mass index (BMI) is a significant GDM risk factor, and BMI ≥ 25kg/m2 is often used as a criterion in risk factor-based screening programs. However, up to 60% of individuals with GDM have a normal BMI, and it is unclear if this offers protection against associated adverse outcomes. Furthermore, many prior studies fail to address the fact that those of Asian descent require a lower BMI cut-off, given their different distribution of body fat. Our study evaluated GDM pregnancy outcomes using BMI as a risk indicator. We compared individuals with BMIs &amp;lt; 25 kg/m2, 25-30 kg/m2, and &amp;gt; 30 kg/m2. For individuals that self-identified as Asian, we adjusted BMI categories: &amp;lt;23 kg/m2 for normal weight, 23-30 kg/m2 for overweight, and &amp;gt;30 kg/m2 for obese. We identified 2212 subjects diagnosed with GDM via universal screening and Carpenter and Coustan criteria at our institution from 2018 - 22. In total, 508 (23.0%) were normal weight, 611 (27.6%) overweight, and 1093 (49.4%) obese. The average maternal age was 31 years. Higher proportions identified as Hispanic and non-White race in overweight and obese categories. Maternal adverse outcomes were higher in obese compared to overweight or normal BMI categories (cesarian delivery: normal 26.7 v overweight 28.3 v obese 22.7%, p&amp;lt;0.001; hypertensive disorders: normal 13.2 v overweight 12.5 v obese 22.7%, p &amp;lt;0.001). Pharmacological therapy was required in 50% with obesity versus 24.8% in normal, and 28.7% in overweight categories (p&amp;lt;0.001). While there were no differences in live birth rates across categories, infants born to mothers with obesity had a higher birthweight (normal 3.30 v overweight 3.38 v obese 3.45kg, p&amp;lt;0.001) and were more likely to have neonatal hypoglycemia (normal 28.7 v overweight 25.5 v obese 43.8%, p&amp;lt;0.001) and require intensive care unit admission (normal 8.4 v overweight 5.5 v obese 12.7%, p&amp;lt;0.001). Attendance at postpartum glucose testing varied across BMI categories with lower attendance in mothers with obesity followed by normal weight BMI (normal 40.75 v overweight 45.99 v obese 36.2%, p&amp;lt;0.001). Compared to overweight individuals, those with normal weight exhibited higher rates of postpartum glucose intolerance (12.4 v 6.9%, p =0.002). However, those with obesity had the highest rates of glucose intolerance (20.7%, p&amp;lt;0.0002). Individuals with normal weight had the highest rates of breastfeeding (normal 95.9 v overweight 92.8 v obese 91.4% p=0.006). This study highlights the nuanced relationship between BMI and pregnancy outcomes in GDM. While maternal obesity was associated with the poorest outcomes, those with normal BMI were not protected compared to overweight individuals, and experience higher rates of postpartum glucose intolerance. Presentation: 6/2/2024

Levels and outcomes of 12-step participation among sexual and gender minority subgroups

IntroductionSexual minority (e.g., bisexual, gay, lesbian, queer) and gender minority (e.g., transgender, non-binary, gender expansive) individuals (SGMI) experience higher rates of alcohol and other substance use disorders than their heterosexual and cisgender (i.e., non-transgender) counterparts. 12-Step programs are currently the most common source of support for alcohol and other substance use-related problems in the United States. Little is known about rates and levels of participation and outcomes of SGMI in 12-Step programs. Examining SGMI with a lifetime alcohol or other substance use disorder, this study aims to: 1) describe lifetime attendance rates (any vs. none) and levels of participation (number of program activities) in 12-Step groups among SGMI overall and compare rates of attendance and levels of participation across sexual and gender minority identities and 2) determine how lifetime level of participation in 12-Step programs relates to past-year alcohol and other substance use outcomes. MethodsWe used data collected through The PRIDE Study, a national, large-scale, longitudinal health study of adult SGMI, administering supplemental questions to assess alcohol and other substance use disorders and 12-step participation. Zero-Inflated Negative Binomial models (N = 1353) run with sexual and gender identities as predictors of lifetime 12-step attendance (yes/no) and level of 12-Step participation determine if greater levels of 12-Step participation were associated with lower levels of past-year Alcohol and Substance Use Disorder (AUD & SUD) symptoms. The study ran models for those with lifetime AUD (n = 1074) and SUD (n = 659) separately. ResultsParticipants who engaged in greater levels of 12-Step participation had lower levels of past-year AUD and SUD symptoms. Gay and queer respondents with AUD were more likely and lesbian respondents with SUD were less likely than other participants to have ever participated in 12-Step programs. All other associations between sexual/gender identities and 12-Step participation disappeared when age was added to the model. ConclusionsThis study provides preliminary evidence that 12-Step participation may be an effective resource for reducing AUD and SUD symptoms among SGMI. Younger SGMI and SGMI holding sexual/gender identities other than gay and queer may require additional support to initiate participation in 12-Step programs.

Racial/ethnic differences in pre-pregnancy conditions and adverse maternal outcomes in the nuMoM2b cohort: A population-based cohort study.

To determine how pre-existing conditions contribute to racial disparities in adverse maternal outcomes and incorporate these conditions into models to improve risk prediction for racial minority subgroups. We used data from the "Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-be (nuMoM2b)" observational cohort study. We defined multimorbidity as the co-occurrence of two or more pre-pregnancy conditions. The primary outcomes of interest were severe preeclampsia, postpartum readmission, and blood transfusion during pregnancy or up to 14 days postpartum. We used weighted Poisson regression with robust variance to estimate adjusted risk ratios and 95% confidence intervals, and we used mediation analysis to evaluate the contribution of the combined effects of pre-pregnancy conditions to racial/ethnic disparities. We also evaluated the predictive performance of our regression models by racial subgroup using the area under the receiver operating characteristic curve (AUC) metric. In the nuMoM2b cohort (n = 8729), accounting for pre-existing conditions attenuated the association between non-Hispanic Black race/ethnicity and risk of severe preeclampsia. Cardiovascular and kidney conditions were associated with risk for severe preeclampsia among all women (aRR, 1.77; CI, 1.61-1.96, and aRR, 1.27; CI, 1.03-1.56 respectively). The mediation analysis results were not statistically significant; however, cardiovascular conditions explained 36.6% of the association between non-Hispanic Black race/ethnicity and severe preeclampsia (p = 0.07). The addition of pre-pregnancy conditions increased model performance for the prediction of severe preeclampsia. Pre-existing conditions may explain some of the association between non-Hispanic Black race/ethnicity and severe preeclampsia. Specific pre-pregnancy conditions were associated with adverse maternal outcomes and the incorporation of comorbidities improved the performance of most risk prediction models.

Depression and Anxiety Among Sexual Minorities in the United States: A Cross-Sectional Analysis of the National Health Interview Survey.

Background and objective Sexual minorities experience large-scale mental health disparities, yet recent national data on them remains scarce. This study aimed to examine the prevalence of depressive and anxiety symptoms by sexual orientation in a nationally representative sample of adults in the United States (US). Methods This cross-sectional analysis utilized data from 26,311 adults in the 2022 National Health Interview Survey. Sexual orientation was classified as sexual minority (gay/lesbian, bisexual, or other non-heterosexual identity) or heterosexual. Self-reported depression was assessed using the eight-item Patient Health Questionnaire (PHQ-8), and anxiety was evaluated using the seven-item Generalized Anxiety Disorder Scale (GAD-7). Logistic regression models were employed to compare mental health outcomes between sexual minority and heterosexual respondents. Results Sexual minorities comprised 6.6% of the weighted sample. Compared to heterosexuals, sexual minorities were younger, more often female, unmarried, and had higher poverty despite greater employment (all p<0.001). Approximately half of sexual minorities screened positive for depression (49.0%) and anxiety (44.3%), compared to 19.5% and 16.4% of heterosexuals, respectively. After covariate adjustment, sexual minorities had over three-fold higher odds of depression [odds ratio (OR): 3.27; 95% confidence interval (CI): 2.86-3.73] and anxiety (OR: 2.97; 95% CI: 2.57-3.42). The prevalence was highest among sexual minority youth, with depression in 54.9-61.1% and anxiety in 49.0-59.2%, depending on income levels. Conclusions In this nationally representative study, sexual minorities demonstrated a high burden of depression and anxiety symptoms compared to heterosexuals. Sexual orientation independently predicted mental health disparities beyond other sociodemographic characteristics. Targeted interventions are recommended to address psychiatric disease disparities that disproportionately impact vulnerable sexual minority subgroups.

Association between serum 25-hydroxyvitamin D concentrations and respiratory tract infections requiring hospital admission: analysis of ethnic groups from the UK Biobank cohort

Vitamin D status has been found to be inversely associated with risk of respiratory tract infections (RTIs)(1). It varies by ethnicity, with several ethnic minority groups in the United Kingdom (UK) reported to be at a higher risk of vitamin D deficiency (serum 25-hydroxyvitamin D (25(OH)D) concentrations &lt;25 nmol/L) compared to their white counterparts(2, 3). However, the relationship between serum 25(OH)D concentrations and incidence of RTIs by ethnicity in the UK remains unclear. This study aimed to investigate the association between serum 25(OH)D concentrations and likelihood of hospitalisation for RTI in UK ethnic groups.A nested, case-control study was conducted using data from UK Biobank, which has data for 500k adults for serum 25(OH)D and hospital episodes from linked records. Binary logistic regression models were used to explore the association between serum 25(OH)D concentrations and likelihood of RTIs overall, and by ethnicity.Of the 36,772 participants included in the analysis, 12,638 (34%) were white Caucasian, 10,311 (28%) Asian, 7,138 (19%) black, 4,034 (11%) other, and 2,651 (7%) of mixed ethnicity. In fully adjusted models, compared to participants with a serum 25(OH)D concentration &lt;15 nmol/L (severe deficiency), those with 25-49 nmol/L, 50-74 nmol/L, and ≥75 nmol/L were found to have statistically significantly lower odds of RTI hospitalisation, with odds ratios (ORs) of 0.53 (95% CI: 0.37, 0.75), 0.61 (95% CI: 0.40, 0.92) and 0.54 (95% CI: 0.30, 0.97), respectively. In the subgroup analysis, ethnic minorities and white individuals with vitamin D deficiency (&lt;25 nmol/L) were more likely to be hospitalised with RTI compared to those that were not deficient, with ORs of 1.36 (95% CI: 1.02, 1.81) and 2.03 (95% CI: 1.30, 3.17), respectively. This association was not statistically significant within ethnic minority subgroups when analysed separately.Serum 25(OH)D concentrations above 25 nmol/L are associated with lower likelihood of RTI hospitalisation among UK adults. This finding was noted across white and ethnic minority groups, although ethnic minorities with vitamin D deficiency had a lower likelihood of RTIs compared to white individuals. Further studies are warranted to validate these findings and explore the mechanisms underlying the association between vitamin D status and RTIs in different ethnic groups.AcknowledgementsThis project was conducted using the UK Biobank resource under project 15168.

Resilience and Concussion Recovery in Minority Women: Promoting Health Equity.

Resilience is associated with the degree to which post-concussion symptoms (PCS) are experienced. However, the role of resilience in the recovery trajectory of minority women, who tend to have prolonged concussion recovery, is poorly characterized. We evaluated the association between resilience and PCS, to determine if the association differed by race. A secondary data analysis was performed. Resilience was assessed using the Resilience Scale and PCS with the Rivermead questionnaire. Both variables were evaluated 6-10 weeks post-injury. Baseline demographics, spearman correlation, and multivariable linear regression models were used to determine the association between resilience and PCS. Seventy-seven women (mean age 28 ± 7.6) were included, 57% were White, and 43% were Black or Hispanic. The overall cohort had a moderate association between resilience and PCS (R = -0.304, p = 0.007). The association was present in minorities (R = -0.486, p = 0.004), and was stronger for Blacks (R = -0.745, p < 0.001). After adjusting for religion as a covariate separately, resilience (β = -0.156, 95% confidence interval [CI]: -0.285, -0.026; p = 0.019) and mood (β = 1.082, 95% CI: 0.847, 1.317; p < 0.001), were both independent predictors of PCS. The adjusted associations were stronger for the minority subgroup for both resilience (β = -0.231, 95% CI: -0.413, -0.050; p = 0.014) and mood (β = 1.122, 95% CI: 0.753, 1.491; p < 0.001). Our findings show that compared with Whites, minority individuals with higher resilience have greater resolution of PCS. However, mood is also of importance in this association. Thus resilience-based interventions must also target mood. Interventions that strengthen resilience may have promise in promoting equitable recovery in the setting of female concussions.

Evaluating the Psychometric Properties of the Sexual and Gender Minority Adverse Childhood Experiences Scale Among Sexual Minority Men and Women.

Adverse childhood experiences (ACEs) are known determinants of negative health outcomes. Sexual and gender minority (SGM) individuals have higher ACE scores than non-SGM individuals. The SGM-ACE scale was developed to better assess this population but is not yet validated in SGM subgroups. This study aims to validate the sexual and gender minority adverse childhood experiences (SGM-ACE) scale among sexual minority men (SMM) and sexual minority women (SMW), while testing measurement invariance across both groups. A cross-sectional survey included 530 sexual minority adults (265 men, 265 women) in the United States. Cronbach's alpha established internal consistency reliability. Validity was assessed via confirmatory factor analysis (CFA) for the SGM-ACE's theoretical structure and Pearson's correlations for concurrent validity with substance use outcomes (alcohol, cannabis, and drugs). Multigroup structural equation modeling (SEM) determined measurement invariance between SMM and SMW. The CFA of the original model exhibited good fit. Fit was improved after removing the institutionalization item, chi-square (χ2) = 14.26, degrees of freedom (df) = 9, p = 0.113, minimum discrepancy (CMIN/df) = 1.59, comparative fit index (CFI) = 0.99, root mean square error of approximation (RMSEA) = 0.03, 90% confidence interval (CI): (0.00-0.06), and standardized root mean square residual (SRMR) = 0.02. Internal consistency reliability was established (α = 0.78). SGM-ACE exhibited weak, yet significant relationships with each substance use outcome. Multigroup SEM indicated measurement invariance between SMM and SMW. This study provides psychometric validation of the SGM-ACE, establishing measurement invariance between SMM and SMW. Future research should explore its utility in diverse SGM minority subgroups.

Designing pareto-optimal selection systems for multiple minority subgroups and multiple criteria.

Currently used Pareto-optimal (PO) approaches for balancing diversity and validity goals in selection can deal only with one minority group and one criterion. These are key limitations because the workplace and society at large are getting increasingly diverse and because selection system designers often have interest in multiple criteria. Therefore, the article extends existing methods for designing PO selection systems to situations involving multiple criteria and multiple minority groups (i.e., multiobjective PO selection systems). We first present a hybrid multiobjective PO approach for computing selection systems that are PO with respect to (a) a set of quality objectives (i.e., criteria) and (b) a set of diversity objectives where each diversity objective relates to a different minority group. Next, we propose three two-dimensional subspace procedures that aid selection designers in choosing between the PO systems in case of a high number of quality and diversity objectives. We illustrate our novel multiobjective PO approaches via several example applications, thereby demonstrating that they are the first to reveal the complete gamut of eligible PO selection designs and to faithfully capture the Pareto trade-off front in case of more than two objectives. In addition, a small-scale cross-validation study confirms that the resulting PO selection designs retain an advantage over alternative designs when applied in new validation samples. Finally, the article provides a link to an executable code to perform the new multiobjective PO approaches. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Abstract 50: Factors Associated With Obesity Pharmacotherapy Prescription Among Ambulatory Patients With Excess Weight

Background: Semaglutide, liraglutide (GLP1-RA), and tirzepatide (GLP1/GIP-RA) are potent anti-obesity pharmacotherapies resulting in marked weight loss and improved cardiometabolic outcomes. Limited insurance coverage is a well-understood barrier to these new therapies; thus, we sought to characterize additional clinical and sociodemographic factors associated with the prescription of these medications. Hypothesis: Likelihood of prescription of novel anti-obesity medications will be lower for individuals within racial and ethnic minority and lower SES subgroups. Methods: We identified adults who have obesity (BMI ≥30), existing insurance coverage for anti-obesity medications, and received outpatient care at Johns Hopkins from January 2023 to September 2023. We used multivariable logistic regression to evaluate factors associated with prescription of anti-obesity pharmacotherapies. Results: We included 18,164 patients (mean age 51 years, 64% female, 54% White, 35% Black, 5% Asian, mean BMI 36 kg/m 2 ). About 3% of eligible adults were prescribed anti-obesity medications. The likelihood of prescription was lower among Black adults (OR: 0.76, 95%CI [0.61-0.96]), males (OR: 0.54 [0.42-0.68]), and adults younger and older than 40-50 years of age; and higher for those with higher BMI (per 1-unit higher BMI, OR: 1.06 [1.05-1.07]). Living in a neighborhood with a higher area deprivation index or lower income was not independently associated with the likelihood of prescription. Clinically, those with diabetes (OR: 3.52 [2.78-4.44]) and hypertension (OR: 1.36 [1.08-1.71]) were more likely to be prescribed novel obesity pharmacotherapies. Conclusion: Among those with existing insurance coverage, the likelihood of obesity pharmacotherapy prescription differs by sociodemographic factors and cardiometabolic comorbidities. Understanding the mechanisms of these differences may have key implications for obesity management in diverse populations, and ultimately for cardiometabolic health equity.

Autoimmune rheumatic diseases and COVID-19 vaccination: a retrospective cross-sectional study from Astana.

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus has had an unprecedented impact on people around the world, particularly those who were suffering from autoimmune rheumatic diseases (AIRDs). The world community acknowledges the significance of COVID-19 vaccination in patients with autoimmune disorders and emphasizes the priority of this category to receive vaccination over the general population. Although many studies have been published since the first phases of vaccination all over the world, multiple related factors still need to be further investigated. We investigated the COVID-19 vaccination status in patients with AIRDs, by performing a cross-sectional, interview-based study filled in by patients attending their clinics in the Astana city, capital of Kazakhstan, from April to July 2023. The survey questionnaire consisted of a set of questions, concerning patient characteristics, treatment details, accepted vaccines and characteristics of COVID-19 infection. The study objectives were to evaluate vaccine hesitancy, adverse effects, breakthrough infections and flare of underlying rheumatic disease in this population subgroup. There were 193 participants, with a median age of 50.3 ±12.9 years. Among them, 62 (32.1%) were vaccinated with at least single dose of vaccine, 16 (25.8%) of whom were fully vaccinated. The commonest (89; 68%) reason for vaccine hesitancy was a fear of autoimmune disease worsening. Vaccine-related adverse effects (AEs) were reported by 66.7% of patients. We found that vaccination provoked AIRD exacerbation in 19% of patients with AEs. Eight patients reported flare of pre-existing rheumatic disease after vaccination. The incidence of breakthrough infections was similar in the groups of vaccinated individuals (n = 12), 12.9% of whom were partially and 6.5% fully vaccinated. The vaccination was found to be safe in patients with rheumatic diseases. Fear of autoimmune status was the major reason for vaccine reluctance. All reported adverse events were minor. The minority subgroup within the sample had subsequent breakthrough infections or autoimmune disease flare-ups.

Mental Disorders and Suicidality by Sexual Orientation Status Among First-Year College Students in France

ABSTRACT Studies indicate that non-heterosexual young adults experience higher rates of mental health problems in various settings. This study seeks to further explore these associations, distinguishing heterosexual, gay/lesbian, bisexual and individuals questioning their sexual identity. Data were drawn from the French portion of the World Mental Health International College Student survey initiative (n = 3,545). Logistic regressions were performed to estimate the associations of sexual orientation with 12-month mental disorders and suicidal ideation and behaviors. Overall, 81.6% (n = 2,894) of students identified as heterosexual, 2.9% (n = 103) as gay/lesbian, 8.5% (n = 302) as bisexual and 6.9% (n = 246) stated questioning their sexual orientation. In adjusted models, compared to heterosexuals, students identifying as bisexual reported greater odds of major depression, panic disorder, drug use disorder and suicidality, gay/lesbian students were more likely to present with panic disorder, suicidal ideation and plans, and students questioning their sexual orientation were at greater risk for generalized anxiety disorder, suicidal ideation, and plans. The study confirmed higher rates for mental health disorders for non-heterosexual young adults, with little evidence of significant differences between minority subgroups.

Comparing Stroke Risk Factors Among Sexual Minority Groups in Texas.

Knowledge gaps remain on stroke risk and disparities between sexual minority (SM) subgroups. In this study, stroke risk between SM subgroups, specifically gay/bisexual men and lesbian/bisexual women (G/BM and L/BW), was assessed. Data were collected in June 2022 using a bilingual (English and Spanish) cross-sectional paper-and-pen survey distributed among 183 SM individuals attending the 2022 Houston Pride Parade and Festival, as well as across Texas via phone call or online format. Relevant sociodemographic and stroke risk factors were compared between G/BM and L/BW using chi-square (or Fisher's exact, when appropriate) and two-sample t-tests. Sexual orientation was used to predict stroke risk using multiple binomial logistic regression, adjusting for other sociodemographic determinants. While comparing the stroke risk factors between G/BW and L/BW, statistically significant differences were found in hypertension (p = 0.047), age (p < 0.001), smoking status (p = 0.043), cholesterol level (p < 0.001), and HIV (p = 0.038). G/BM were 2.79 times more likely to have a higher stroke risk compared to L/BW (aOR = 2.79; CI, 1.11-6.05, p = 0.032), after adjusting for other sociodemographic factors. This pilot study, conducted in Texas, adds to the existing scientific literature on stroke risk among the SM population and revealed that G/BM might have a higher stroke risk compared to L/BW. These findings can inform future research and intervention designs tailored to G/BM and L/BW communities and improve their overall health.