National Institute On Minority Health And Health Disparities Research Articles

Abstract PO5-09-08: Cancer Health Disparities among non-Hispanic African women: A systematic review of the disparities, reasons and probable intervention

Abstract Health equity places health inequities in historical and social context and calls for action to address injustice and enhance health. As an ethical and human rights value that drives us to end health inequities, health equality is defined as everyone having a fair and just opportunity to be as healthy as feasible. According to this perspective, structural discrimination and marginalization cause health disparities that can be avoided. If these issues are not resolved, social and economic injustices, bias, and unfavorable outcomes that affect all of us will continue to exist. The idea of cancer health equality recognizes that there is still considerable work to be done to change the social structures and historical momentum that have contributed to different cancer outcomes, and that this work can only succeed if it is done. In USA, non-Hispanic black women experience a complicated and multifaceted disparity in breast cancer incidence and outcome. It's possible that social, economic, and behavioral variables contribute to discrepancies. Black women are less likely to breastfeed after childbirth, statistically more likely to have diabetes, heart disease, and obesity, all of which are risk factors for breast cancer. Compared to white women, they are more likely to lack adequate health insurance or access to medical facilities, which could have an impact on screening, follow-up treatment, and therapy completion. It has become evident via more study that biology also plays a part. Black women are more likely to be diagnosed at younger ages and at higher rates with more aggressive subtypes of breast cancer, such as triple-negative breast cancer (TNBC) and inflammatory breast cancer. The National Institute on Minority Health and Health Disparities (NIMHD) established a research framework to characterize the multiple domains of influence (biological, behavioral, physical environment, sociocultural environment, and health care system) that may act across various levels of influence to impact health. A literature search was conducted using the National Library of Medicine's PubMed search engine. Triple negative breast cancer (TNBC) is a common malignancy in African American women. The incidence of TNBC is higher in women of African ancestry and is associated with overall poor prognosis. This disparity is due to the presence/absence of oncogenes/tumor suppressor genes, mutations and altered signaling pathways that might predispose premenopausal African American women to TNBC. Multiple socioeconomic factors influence the access to standard care, novel treatments and inclusion in clinical trials and contribute to overall prognoses. This review focuses on the epidemiology, molecular alterations, and treatment-related disparities in African Americans with breast cancer. This poster will elaborate the racial disparity in terms of breast cancer among the African-American women in USA, the reasons and it's effects on health equity. Citation Format: Tasnuva Khan Efa. Cancer Health Disparities among non-Hispanic African women: A systematic review of the disparities, reasons and probable intervention [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO5-09-08.

Leveraging large language models to foster equity in healthcare.

Large language models (LLMs) are poised to change care delivery, but their impact on health equity is unclear. While marginalized populations have been historically excluded from early technology developments, LLMs present an opportunity to change our approach to developing, evaluating, and implementing new technologies. In this perspective, we describe the role of LLMs in supporting health equity. We apply the National Institute on Minority Health and Health Disparities (NIMHD) research framework to explore the use of LLMs for health equity. We present opportunities for how LLMs can improve health equity across individual, family and organizational, community, and population health. We describe emerging concerns including biased data, limited technology diffusion, and privacy. Finally, we highlight recommendations focused on prompt engineering, retrieval augmentation, digital inclusion, transparency, and bias mitigation. The potential of LLMs to support health equity depends on making health equity a focus from the start.

NIMHD INVESTMENTS IN RESEARCH ON OLDER ADULTS EXPERIENCING HEALTH DISPARITIES: 2018–2022

Abstract The National Institute on Minority Health and Health Disparities (NIMHD) is the nation’s leading institute on the health of populations experiencing health disparities. These populations include individuals with low socioeconomic status (SES), those living in rural areas, sexual and gender minorities (SGM), and racial and ethnic minorities. Despite the need to advance research on these populations, particularly in old age when health disparities may be most salient, there has been no analysis of NIMHD funding on older adults to date. This portfolio analysis synthesized and described NIMHD’s investments in research on older adults using data from fiscal years 2018 through 2022. The Research, Condition, and Disease Categorization system was used to identify funded projects in the area of Aging; manual review confirmed project eligibility. In-depth project characteristics were extracted and topic areas evaluated. Findings demonstrate that NIMHD funded a total of 98 unique research projects focused on older adults. Of these, 47% focused on the etiology of health disparities, 38% on interventions, and 15% on methods and measurement. The most specified population was racial and ethnic minorities (91%), followed by individuals with low SES (21%), rural older adults (11%), and SGM older adults (8%). Projects focused on diagnostic or clinical care (16%), care coordination (6%), caregivers (6%), and shared decision-making (4%) were limited. Findings highlight opportunities for future research to advance health care and reduce health disparities for the growing proportion of older adults from populations experiencing health disparities.

PERCEPTIONS AND EXPERIENCES OF FAMILY CAREGIVERS OF OLDER FIRST-GENERATION CHINESE AMERICANS WITH DEMENTIA

Abstract Family caregivers of individuals with dementia are precious assets whose health is related to the health of their care recipients. First-generation Chinese American older adults are a growing population; the research about their family caregivers’ experience is scarce. Guided by the Health Belief Model (HBM) and the National Institute on Minority Health and Health Disparities (NIMHD) framework, this study examined how the Chinese sociocultural background shapes family caregivers’ perception of dementia, caring behaviors, and caring experiences during the COVID-19 pandemic. Data were collected from 16 family caregivers through one-on-one interviews in three languages with the thematic analysis applied. Findings indicated most caregivers could not differentiate dementia from natural cognitive degeneration. Despite the unclarity, the cultural value of filial respect essentially obligated caregivers to unconditionally devote their time and efforts to provide care. Individual coping skills toward care burden were associated with their knowledge, attitude, access to supportive families/friends and reliable community-based organizations (CBOs), and access to government social services. The care recipients’ motivation and functional status affected the difficulty of providing care. The pandemic disturbed families’ care plans and limited community activities. In addition, the heightened Asian xenophobia atmosphere raised concerns for caregivers to be outdoors. Implications for practice include providing culturally appropriate educational resources on dementia care and incorporating CBOs to promote governmental service referral. Larger studies for Chinese American older adults born outside the US and studies of dementia care burden on their family caregivers’ health are needed to address social and health inequities for historically marginalized cohorts.

Affective Science Research: Perspectives and Priorities from the National Institutes of Health.

Affective science is a broad and burgeoning field, and the National Institutes of Health (NIH) support research on a similarly broad range of topics. Across NIH, funding is available for basic, translational, and intervention research, including research in non-human animals, healthy populations, and those with or at risk for disease. Multiple NIH Institutes and Centers have specific programs devoted to topics within the affective science umbrella. Here, we introduce the funding priorities of these six: the National Cancer Institute (NCI), National Center for Complementary and Integrative Health (NCCIH), National Institute of Mental Health (NIMH), National Institute on Aging (NIA), National Institute on Drug Abuse (NIDA), and National Institute on Minority Health and Health Disparities (NIMHD). We then discuss overlapping themes and offer a perspective on promising research directions.

Health equity is not possible without addressing disparities.

Health equity is the aspirational assurance of optimal health for all. Synonymous with fair and just opportunities for physical and mental health, equity work reflects intentional efforts to remove access barriers and allocate high-quality, need-based resources. Health equity is not possible without meaningful reductions in disparities-and evaluating progress goes further to describe, assess, and continuously evaluate fairness and social justice within structures, community contexts, and healthcare. The National Institute on Minority Health and Health Disparities (NIMHD) has a longstanding and deep commitment to advancing health equity. This article describes efforts in two specific areas: workforce diversity, equity, and inclusion (DEI) and scientific initiatives. We also summarize five actionable strategies for health equity promotion in health psychology-relevant research and practice, including increasing workforce DEI, inclusive research participation, cultural competence and humility, applying community-engaged research principles, and going beyond "do no harm." Meaningful equity work often requires major shifts in approaches, dedicated resources, and targeted efforts toward social justice. The current emphasis on addressing health disparities and understanding the structural factors underlying them presents unequivocal opportunities for changes in clinical practice and research. NIMHD seeks to support innovative health psychology and behavioral medicine research with the potential to transform health via effective and equitable interventions/treatments, systems changes, and policies. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Addressing racial and ethnic disparities in US liver cancer care

HCC, the most common form of primary liver cancer, is the fastest rising cause of cancer-related death in the United States. HCC disproportionately affects racial and ethnic minorities in the United States. A practical framework is needed to organize the complex patient, provider, health system, and societal factors that drive these racial and ethnic disparities. In this narrative review, we adapted and applied the National Institute on Minority Health and Health Disparities (NIMHD) Research Framework to the HCC care continuum, as a step toward better understanding and addressing existing HCC-related disparities. We first summarize the literature on HCC-related disparities by race and ethnicity organized by the framework’s 5 domains (biological, behavioral, physical/built environment, sociocultural environment, and health care system) and 4 levels (individual, interpersonal, community, and societal) of influence. We then offer strategies to guide future research initiatives toward promotion of health equity in HCC care. Clinicians and researchers may help mitigate further inequities and better address racial and ethnic disparities in HCC care by prioritizing the following in HCC research: (1) increasing racial and ethnic minority representation, (2) collecting and reporting HCC-related data by racial and ethnic subgroups, (3) assessing the patient experience of HCC care by race and ethnicity, and (4) evaluating HCC-specific social determinants of health by race and ethnicity. These 4 priorities will help inform the development of future programs and interventions that are tailored to the unique experiences of each racial and ethnic group.

Synthetic glycovaccines elicit cross-protection against Chagas disease and tegumentary leishmaniasis in a murine co-infection model

Abstract Chagas disease (CD) and tegumentary leishmaniasis (TL) are two of the World Health Organization’s (WHO) top 20 neglected tropical diseases. These diseases are caused by the protozoan trypanosomatids, Trypanosoma cruzi and Leishmania spp., respectively. Although historically restricted to Central and South American, there are currently, ~7 million people infected with CD worldwide, with ~300,000 chronically infected patients in the US. Between 700,000 and 1.2 million new cases of TL occur worldwide yearly. Chemotherapeutic agents are available for the treatment of both diseases; however, they may cause serious adverse events, ultimately resulting in premature treatment interruption. Moreover, no effective vaccine for either disease is currently available. Due to the evolutionary loss of the α1,3-galactosyltransferase (α1,3GT) gene in humans and Old-World nonhuman primates, α-Gal epitopes, abundantly expressed on both Trypanosoma cruzi and Leishmania spp. cell surfaces, are highly immunogenic. We, therefore, hypothesize that a synthetic glycan-based vaccine could provide effective cross-protection against a T. cruzi and L. major co-infection. Here we use an α1,3GT-knockout (α1,3GT-KO) murine model to evaluate the efficacy of two new synthetic neoglycoproteins, NGP28b and NGP29b, containing nonreducing, terminal α-Gal and β-Galf glycotopes, respectively, as potential vaccine candidates against CD and TL. Our data indicate that both vaccine candidates induce a strong cross-protective immune response, significantly reducing parasite burden and increasing animal survival in this co-infection experimental model This study was partially supported by a grant NIH-U54MD007592 (to Robert A. Kirken (PI), ICA (Co-I)), from the National Institute on Minority Health and Health Disparities (NIMHD). We would like to thank the staff of the Border Biomedical Research Center (BBRC) Biomolecule Analysis Omics Unit (BAOU). BAOU was supported by the NIMHD grant 5U54MD007592. CDK was supported by the UT System LSAMP program which is funded by the National Science Foundation grant number HRD-1202008.

Abstract P377: The Restore Health Equity Research Network: An American Heart Association-Funded Initiative to Prevent Hypertension in Black Communities

Introduction: The RESTORE Network is an American Heart Association-funded health equity research network that is testing the implementation of evidence-based interventions for hypertension prevention in community settings. The goals are to: (1) Work with Black communities to mitigate the negative impact of social determinants of health on blood pressure (BP) in Black adults; (2) Develop and test strategies for implementing evidence-based lifestyle interventions in Black communities; (3) Disseminate findings to policy makers, payors and stakeholders to promote adoption of effective hypertension prevention strategies in Black communities; and (4) Train early-career scientists in health equity and hypertension research. Methods: RESTORE Network investigators across eight institutions are conducting five hybrid implementation-effectiveness trials to test scalable, sustainable, and potentially cost-effective implementation strategies to mitigate adverse social determinants of health that contribute to the high prevalence of hypertension in Black communities. The implementation strategies include the use of: 1) trained community health workers (Alabama, Baltimore, Detroit); 2) community-based organizations as portals of food access and patient navigation (New York City, Alabama, Boston, Detroit); 3) patient activation via home BP monitoring (Baltimore); and 4) digital technologies (Baltimore, Detroit). The social determinants of health targeted are: poor access to care, low health literacy, food insecurity, barriers to physical activity, neighborhood deprivation, under-insurance, and inadequate linkage to medical and social services. The five projects are based on the National Institute on Minority Health and Health Disparities (NIMHD) Research Framework, and evaluation of each implementation strategy is guided by the RE-AIM (Reach, Effectiveness, Adoption, Implementation and Maintenance) implementation research framework. The projects are supported by five highly-integrated cores (BP Measurement, Statistical, Intervention, Community Engagement, Training). RESTORE will advance the career of early stage investigators in hypertension, health equity, implementation science and community-engaged research; trainees will work on network projects, develop their own projects, complete rotations across network sites, and attend lectures and workshops. Synergy across projects will facilitate economic and scale-up analyses to inform policy makers on the strategies being tested. Discussion: The RESTORE Network will advance health equity in the U.S. by identifying community-driven, sustainable and effective implementation strategies to deliver lifestyle interventions that prevent hypertension in Black adults. The strong infrastructure of the network will support new collaborations and ancillary studies that are aligned with our mission.

Racial and ethnic disparities in postpartum weight retention: A narrative review mapping the literature to the National Institute on Minority Health and Health Disparities Research Framework.

A Review of the Literature Using the National Institutes of Health, National Institute on Minority Health and Health Disparities (NIMHD) Research Framework to Create a Roadmap of the Studies Investigating Racial and Ethnic Disparities in Excess Weight Retained After Pregnancy. Three out of four people who give birth retain excess weight at 1-year post-pregnancy. This is concerning, as weight that is retained following pregnancy is associated with increased risk for the development of disease. People from racial and ethnic minority groups experience weight retention more frequently post-pregnancy. Black and Hispanic/Latina/o/x birthing people are more likely to begin pregnancy overweight or obese. They are also more likely to retain excess weight following pregnancy. Investigating these risks in people from racially/ethnically diverse backgrounds may be an important way to address disparities in excess weight retained post-pregnancy. This review of the literature used a tool called the National Institute on Minority Health and Health Disparities (NIMHD) Research Framework to map the literature to date on racial and ethnic disparities in excess weight retained post-pregnancy. We used the NIMHD Research Framework as a visual guide of the existing research about excess weight retained following pregnancy. Results illustrate the levels and domains at which research has been investigated. These results reveal that efforts have been focused at the individual level, with most attention given to diet and activity. Mapping the literature to the NIMHD Research Framework sheds light on gaps in the research. Mapping the literature has revealed a need for investigations that make connections between the levels and domains of the Framework, so that we may understand underlying factors that contribute to health disparities.

Promoting Latinx health equity through community-engaged policy and practice reforms in North Carolina.

The Latinx Advocacy Team & Interdisciplinary Network for COVID-19 (LATIN-19) is a unique multi-sector coalition formed early in the COVID-19 pandemic to address the multi-level health inequities faced by Latinx communities in North Carolina. We utilized the National Institute on Minority Health and Health Disparities (NIMHD) Research Framework to conduct a directed content analysis of 58 LATIN-19 meeting minutes from April 2020 through October 2021. Application of the NIMHD Research Framework facilitated a comprehensive assessment of complex and multidimensional barriers and interventions contributing to Latinx health while centering on community voices and perspectives. Community interventions focused on reducing language barriers and increasing community-level access to social supports while policy interventions focused on increasing services to slow the spread of COVID-19. Our study adds to the literature by identifying community-based strategies to ensure the power of communities is accounted for in policy reforms that affect Latinx health outcomes across the U.S. Multisector coalitions, such as LATIN-19, can enable the improved understanding of underlying barriers and embed community priorities into policy solutions to address health inequities.

Expansion of Content in the Phenx Toolkit for Sickle Cell Disease Pain

Background: Common measures and common data elements (CDEs) for sickle cell disease (SCD) are needed to help improve data quality and data comparability necessary for meta-analyses, guidelines development, comparative effectiveness research, and implementation science. In 2014, the National Heart, Lung, and Blood Institute (NHLBI) launched the PhenX (consensus measures for Phenotypes and eXposures) Measures for Sickle Cell Disease Research Project to establish a framework for data sharing across different SCD research projects. As a result of this project, a Core Collection and two Specialty Collections (Cardiovascular, Pulmonary, and Renal; Neurology, Quality of Life, and Health Services) of standard measure protocols were added to the PhenX Toolkit. The PhenX Toolkit (https://www.phenxtoolkit.org/) is a Web-based catalog of standard protocols and associated interoperability resources to help investigators improve quality of data collection and identify opportunities for collaborative research. In 2019, NHLBI provided additional funding to expand the collections of sickle cell disease measurement protocols in the PhenX Toolkit. Under the guidance of a Sickle Cell Disease Research and Scientific Panel (SRSP), six additional collections of protocols for use in SCD research will be added to the PhenX Toolkit. One of these collections of protocols relates to research involving SCD Pain. Methods: The SCD Pain Working Group (WG), consisting of 10 SCD experts, was convened to select high priority protocols for inclusion in the Toolkit. The SCD Pain WG selected representative protocols available in published literature using a consensus process which included input from the scientific community. Protocols were selected based on availability, protocol burden, and validity, with emphasis on measures being well established and broadly validated. Several included protocols had been previously validated in populations with SCD. For each measure, the Toolkit provides a description of the measure, the rationale for its inclusion, detailed protocol(s), and supporting documentation. The Toolkit also provides data collection worksheets and data dictionaries to help integrate PhenX measures into their study design. To support investigators who want to collect data via the Web, PhenX protocols are available as REDCap Instrument Zip files. Results: The SCD Pain collection of protocols was released into the Toolkit (https://www.phenxtoolkit.org/sub-collections/view/28) in May 2022. The SCD Pain WG identified a set of 23 protocols that encompass the burden of pain on an individual's day-to-day life, the magnitude of pain experienced by an individual, the location of the pain experienced, the extent to which the pain interferes with the person's daily life, the individual's overall physical mobility, the specific subjective sensations associated with pain, and the coping strategies employed by the individual (Table 1). For many of the measures, separate adult and child protocols were identified. These protocols, including the process, criteria, and rationale for their selection, will be presented. Implications: Consistent use of these protocols in future clinical and epidemiologic studies will allow clinicans and researchers to quantify how SCD impacts a patient's everyday life and develop more effective interventions. For researchers, adoption and use of PhenX protocols will facilitate cross-study analysis domestically and internationally, accelerate translational research, and lead to greater understanding of SCD pain phenotypes. For clinicians, using PhenX measures in routine clinical practice will help improve patient care and quality of life. Consistent use of these standard measures will establish a common currency to help better understand the etiology, progression, and treatment of SCD. Funding was provided by a Genomic Research Grant (U41HG007050) from NHGRI, with current or prior funding support from the National Institute on Drug Abuse (NIDA); Office of Behavioral and Social Sciences Research (OBSSR); National Institute of Mental Health (NIMH); National Heart, Lung, and Blood Institute (NHLBI); National Institute on Minority Health and Health Disparities (NIMHD); and Tobacco Regulatory Science Program (TRSP). Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

A New Phen X Collection: Sickle Cell Disease Psychosocial and Social Determinants of Health Protocols

Background: The PhenX (Phenotypes and eXposures) Toolkit (https://www.phenxtoolkit.org) is a web-based catalog of recommended measurement protocols and associated bioinformatics tools to assist with study design and facilitate cross-study data integration and analyses. The PhenX Toolkit currently includes measurement protocols from 29 research domains (e.g., Rare Genetic Conditions) and six collections that add depth to the Toolkit (e.g., Blood Sciences Research) and has over 4,200 registered users. Although an established resource that continues to expand content for investigators, the PhenX Toolkit does not currently contain measurement protocols specific to Sickle Cell Disease (SCD) Psychosocial or Social Determinants of Health (SDoH) outcomes. These outcomes were identified as key indicators by the National Academies of Sciences, Engineering and Medicine 2020 Report "Addressing Sickle Cell Disease: A Strategic Plan and Blueprint for Action.” This effort is supported by the National Heart, Lung, and Blood Institute (NHLBI) of the National Institutes of Health (NIH) through co-funding to the "PhenX Toolkit-Expansion and Sustainability” project award. Methods: PhenX protocols are recommended by domain experts using a consensus-based process that includes scientific community input. To identify protocols for the new collection, the PhenX SCD Research and Scientific Panel (SRSP) provided a list of scope elements for consideration and selected investigators with relevant expertise in psychology, behavioral science, hematology, and nursing to form a Psychosocial and SDoH Working Group (WG). A modified Delphi process was used to develop consensus on the topics and protocols. A set of 18 scope elements was initially developed and distributed to the WG (round 1). In round 2, preliminary consensus was reached on 12 topics via a virtual WG meeting. In round 3, WG members virtually presented background and recommendations for measurement protocols for the 12 topics and discussed these and other related protocols already included in the PhenX Toolkit. Consensus was reached on 12 primary protocols to move to the next phase, community outreach. Preliminary protocols will be shared with the scientific community for a 2-week period in which the community will have the opportunity to review and comment on the proposed protocols. The Psychosocial and SDoH WG will consider the outreach feedback in selecting final protocols to include in the SCD Research Collections. Results: The 12 measurement protocols recommended to-date include transition readiness (e.g., Sickle Cell Transition Intervention Program - Readiness for Transition (TIP-RFT)), self-management, impact of early aging (e.g., reactions to loss), stigma, trust in medical care and research, resilience, spirituality, and responses to stress. Some measures include multiple versions (e.g., parent/caregiver, child, adolescent, adult). Another 7 protocols were suggested as appropriate for supplemental information for this collection (e.g., American Society of Hematology Sickle Cell Disease Transition Readiness Assessment). Conclusion: This presentation will review the outreach data and the final recommendations of the WG and SRSP. These additional protocols will enhance the existing SCD Research Collections and the individual and structural SDoH protocols in the PhenX Toolkit. Furthermore, these recommendations will promote the use of valid and reliable measurement tools to investigate psychosocial constructs and social determinants of health in SCD. Funding was provided by a Genomic Research Grant (U41HG007050) from NHGRI, with current or prior funding support from the National Institute on Drug Abuse (NIDA); Office of Behavioral and Social Sciences Research (OBSSR); National Institute of Mental Health (NIMH); National Heart, Lung, and Blood Institute (NHLBI); National Institute on Minority Health and Health Disparities (NIMHD); and Tobacco Regulatory Science Program (TRSP).

Adding a One Health approach to a research framework for minority health and health disparities.

The National Institute on Minority Health and Health Disparities (NIMHD) has developed a framework to guide and orient research into health disparities and minority health. The framework depicts different domains of influence (such as biological and behavioral) and different levels of influence (such as individual and interpersonal). Here, influenced by the "One Health" approach, we propose adding two new levels of influence - interspecies and planetary - to this framework to reflect the interconnected nature of human, animal, and environmental health. Extending the framework in this way will help researchers to create new avenues of inquiry and encourage multidisciplinary collaborations. We then use the One Health approach to discuss how the COVID-19 pandemic has exacerbated health disparities, and show how the expanded framework can be applied to research into health disparities related to antimicrobial resistance and obesity.

Twenty Years of Research into the Health Impacts of Native-themed Mascots: A Scoping Review.

Despite their recent high-profile removal by a handful of professional sports teams, Native-themed mascots continue to be a mainstay of professional, college, and youth athletics. To determine the extent of the literature on the health impacts on American Indians and Alaska Natives (AI/ANs) as a result of Native-themed mascots, we conducted a scoping review of primary research articles, utilizing the National Institute on Minority Health and Health Disparities (NIMHD) research framework as a guide to define health impacts broadly to include impacts on determinants of health and health disparities. Three databases were utilized, MEDLINE/PubMed, PsycINFO, and JSTOR, to identify the peer-reviewed literature for a twenty-year period that studied the health impacts of Native-themed mascots. We found 26 articles and books in the peer-reviewed literature and additional gray literature during the time period of 1999-2019. To better identify the relationship between Native-themed mascots and health impacts, we reviewed the articles by their focus on three groups: AI/ANs generally, AI/AN youth, and those that studied all races/ethnicities. The majority of research included in this review illustrates overall negative impacts of Native-themed mascots on health and its determinants that influence health and health disparities. Public health efforts should include review and replacement of harmful Native-themed mascots in professional and academic sports to avoid negative health impacts on AI/AN adults and youth.

Addressing Disparities for Intersectional BIPOC Communities: The Hood Medicine Initiative Case Study.

†Dr. Hudson and Emily Hotez are co-first authors.The COVID-19 pandemic shed light on and exacerbated health disparities experienced by Black, Indigenous, and People of Color (BIPOC) [1Wrigley-Field E Garcia S Leider JP Van Riper D. COVID-19 Mortality At The Neighborhood Level: Racial And Ethnic Inequalities Deepened In Minnesota In 2020: Study examines COVID-19 racial and ethnic inequalities in Minnesota communities.Health Aff (Millwood). 2021; 40: 1644-1653Crossref PubMed Scopus (0) Google Scholar, 2Norris K Gonzalez C. COVID-19, health disparities and the US election.EClinicalMedicine. 2020; 28100617Summary Full Text Full Text PDF PubMed Scopus (6) Google Scholar, 3Rusoja EA Thomas BA. The COVID-19 pandemic, Black mistrust, and a path forward.EClinicalMedicine. 2021; 35100868Summary Full Text Full Text PDF PubMed Scopus (6) Google Scholar], particularly BIPOC with multiple and intersectional marginalized identities (BIPOC/MIMI) [[4]Samra R Hankivsky O. Adopting an intersectionality framework to address power and equity in medicine.The Lancet. 2021; 397: 857-859Summary Full Text Full Text PDF PubMed Scopus (10) Google Scholar]. Indeed, disparate access to vaccination during the early rollout and persistent disparate access to quality health care are especially pronounced for BIPOC with intellectual and/or developmental disabilities, those who identify as lesbian, gay, bisexual, transgender, and/or queer, as well as myriad other marginalized groups [[5]Rodriguez-Seijas C Eaton NR Pachankis JE. Prevalence of psychiatric disorders at the intersection of race and sexual orientation: Results from the National Epidemiologic Survey of Alcohol and Related Conditions-III.J Consult Clin Psychol. 2019; 87: 321Crossref PubMed Scopus (42) Google Scholar]. During the pandemic, Hood Medicine Initiative (HMI)—a nonprofit public health collective comprised of experts in science, policy, technology, and marketing—was born out of the need to tackle health disparities for BIPOC/MIMI. In response to The Lancet's commitment to anti-racism, we highlight HMI as a scalable model for combating the heightened inequities for BIPOC/MIMI spurred by the pandemic. In June 2020, the racial inequities amplified by the pandemic converged with the murder of George Floyd and the expansion of the Black Lives Matter movement. Despite heightened public discourse on their increased risk of COVID-19 infection, hospitalization, and mortality [[1]Wrigley-Field E Garcia S Leider JP Van Riper D. COVID-19 Mortality At The Neighborhood Level: Racial And Ethnic Inequalities Deepened In Minnesota In 2020: Study examines COVID-19 racial and ethnic inequalities in Minnesota communities.Health Aff (Millwood). 2021; 40: 1644-1653Crossref PubMed Scopus (0) Google Scholar], public health officials were challenged to effectively communicate to BIPOC/MIMI. Indeed, traditional public health messaging has historically lacked the nuance required to reach a marginalized populace, attributable to both systematic medical malfeasance and a lack of data-driven communication approaches. It was therefore not surprising that tracking by the Kaiser Family Foundation and other researchers confirmed significant rates of vaccine hesitancy and inequitable vaccine access in BIPOC communities [1Wrigley-Field E Garcia S Leider JP Van Riper D. COVID-19 Mortality At The Neighborhood Level: Racial And Ethnic Inequalities Deepened In Minnesota In 2020: Study examines COVID-19 racial and ethnic inequalities in Minnesota communities.Health Aff (Millwood). 2021; 40: 1644-1653Crossref PubMed Scopus (0) Google Scholar, 2Norris K Gonzalez C. COVID-19, health disparities and the US election.EClinicalMedicine. 2020; 28100617Summary Full Text Full Text PDF PubMed Scopus (6) Google Scholar, 3Rusoja EA Thomas BA. The COVID-19 pandemic, Black mistrust, and a path forward.EClinicalMedicine. 2021; 35100868Summary Full Text Full Text PDF PubMed Scopus (6) Google Scholar]. Given the unmet needs of BIPOC/MIMI, HMI coalesced around a mission to develop innovative ways of using media and technology to improve communication of the benefits of vaccination. HMI began to create and disseminate live podcasts (https://tinyurl.com/Hood-Med-Chats-YouTube) featuring health professionals and community activists to target these groups directly. HMI quickly expanded its programming over the course of the pandemic to include infographics and compelling public health messaging. Currently, HMI develops culturally tailored public health messaging for BIPOC/MIMI. HMI forges authentic collaborations with grassroots stakeholders to influence public health behaviors and aid diverse communities in practical and actionable ways. These efforts are complemented by efforts to create, translate, and disseminate sustainable research-driven solutions for diverse BIPOC sub-segments. HMI seeks to integrate these efforts across health disciplines—including maternal and child health, preventive medicine, genetic counseling, and community education—to address widespread disparities in BIPOC/MIMI. To further disseminate this tailored approach, HMI developed the HMI Framework (Figure 1)—geared towards scientists, practitioners, and policymakers—that describes the process of developing culturally-tailored public health messages. The HMI Framework—adapted from the National Institute on Minority Health and Health Disparities (NIMHD) [[6]National Minority Health and Health Disparities Research Framework. NIMHD. Accessed October 12, 2021. https://www.nimhd.nih.gov/researchFrameworkGoogle Scholar] and grounded in social psychology, communication, and Human Centered Design—posits that creating effective public health messaging necessitates establishing a sustainable connection to BIPOC/MIMI, which requires addressing the underlying structural issues facing specific sub-segments. The HMI Framework guides the creation of public health messages for BIPOC/MIMI at the community and population levels, via the following sequential process:1)Identify the target population and sub-segments: The cornerstone of HMI's approach is a nuanced and strategic approach to reaching BIPOC/MIMI. This necessitates a messaging approach that conceptualizes marginalized communities as heterogeneous rather than monolithic.2)Identify barriers and challenges: HMI identifies barriers and challenges for the overall target population as well as the target sub-segment(s), prioritizing stakeholder and community outreach in order to accomplish this goal. This may include the deployment of a diverse range of participatory strategies—including stakeholder interviews, system mapping, and qualitative research—selected based on existing resources and project goals.3)Determine target outcomes: Taking into account the population and sub-segment needs, experiences, and challenges, HMI devises messaging approaches to achieve Public Health Emergency Preparedness (PHEP) outcomes to facilitate the effectiveness of messaging on behavioral change [[7]Revere D Nelson K Thiede H Duchin J Stergachis A Baseman J. Public Health Emergency Preparedness and Response Communications with Health Care Providers: A Literature Review.BMC Public Health. 2011; 11: 337Crossref PubMed Scopus (22) Google Scholar]. HMI also deploys a range of strategies to maximize effectiveness across all steps.1)Community connection: HMI engages with trusted messengers and community organizers at each step. HMI also signals allyship to the target communities and provides a platform to collaborate on messaging. This ensures that approaches are aligned with communities’ needs and promote activism within communities.2)Data-driven approaches: HMI integrates data-driven and algorithmic approaches to complement community-oriented efforts. This includes the use of natural processing research protocols to analyze digital chatter, understand messages that are most resonant with population sub-segments, and iteratively revise the messaging strategy.3)Wide-scale dissemination strategies: HMI utilizes multiple virtual and technological platforms, including podcasts, blogging, targeted social media engagement, satellite radio programming, webinars, and video infographics (examples provided in Table 1). In these efforts, partnerships with media platforms and civic organizations have promoted viewership, engagement, and increased access to relevant audiences.Table 1HMI Infographics SamplesMessaging FocusDescriptionExampleHealth & Science LiteracyCommunicating information pertaining to the COVID-19 virus and vaccine, public health and safety, and government regulations and guidelines in an accessible and easy-to-understand manner.“COVID-19 Vaccines & Herd Immunity.” (Posted on 4/29/2021; https://www.instagram.com/p/COQe1W2Liki/?utm_source=ig_web_copy_link)Personal HealthEmphasizing conscious decisions to improve physical, mental, and spiritual self-care, including safe hygiene and health practices.“There are 3 holes in yo face. Cover ALL of them. This ain't it fam.” (Posted on 4/3/2021; https://www.instagram.com/p/CNOESHDrgXc/?utm_source=ig_web_copy_link)Common GroundCentering the issues of COVID-19 as shared challenges faced by all communities, as well as the importance of addressing possible inequities together.“Vaccine Diplomacy. A look at the pandemic crisis in India and the importance of ensuring global vaccine equity.” (Posted on 6/7/2021; https://youtu.be/VU9yFmCOAms)Self-AdvocacyPromoting individuals and communities to practice and fight for equitable and safe standards within their respective settings.“Making sure your school is doing the MOST.” (Posted on 7/27/2021; https://www.instagram.com/p/CR2SnnNqHFc/?utm_source=ig_web_copy_link)Community Care & AdvocacyPromoting the health and advocacy of underserved communities and highlighting the individual's potential role and impact they may have on their community, and vice-versa.“COVID is not the only plague of our era…hate is just as contagious as COVID. Stop spreading it!” (Posted on 4/11/2021; https://www.instagram.com/p/CNiWFV4LkYZ/?utm_source=ig_web_copy_link)Translated ContentTranslating English content into other languages to improve accessibility for non-English speaking communities.“La ivermectina no esta aprobada para COVID (Ivermectin is not approved for COVID).” (Posted on 9/4/2021; https://www.instagram.com/p/CTLXuA3oOqH/)Herd ImmunityEducating individuals on the science of herd immunity and the importance of vaccinations to protect oneself and others in the community, especially immunocompromised individuals and those without access to the vaccine yet.“If it were the zombie virus…you would eat your whole family! Stop giving the virus new hosts!” (Posted on 7/5/2021; https://www.instagram.com/p/CQ8_7M_KYXU/)Define IssuesDefining both the explicit and implicit social, political, and public health issues that contribute to inequities with regard to the COVID-19 pandemic and vaccination efforts.“Equitable care starts with CARE providers…you AREN'T a good doctor if you can't diagnose your own biases.” (Posted on 4/28/2021; https://www.instagram.com/p/COOHtCaqFM2/)Informed ChoicesEncouraging individuals to make scientifically informed and healthy decisions that are specific to themselves as well as their families and communities.“The CDC updated mask & social distancing guidelines…they say…if you're fully vaccinated…you can take your mask off indoors & outdoors. But do you really want to?” (Posted on 7/2/2021; https://www.instagram.com/p/CQ6Nb92qfZo/)Empathy & Social SupportOffering supportive resources (including emotional and mental comfort) in light of sociopolitical and public health challenges and disparities.“Pump Up Those Antibodies! COVID-19 vaccines are safe for pregnant & lactating mothers...” (Posted on 8/29/2021; https://www.instagram.com/p/CTLLqGgKCiY/)PHEP & ResponseBroadcasting of Public Health Emergency Preparedness communications and response to ensure individuals are adequately prepared throughout the pandemic.“CAUTION. There are still settings where you should mask regardless. There are still mutant variants…everywhere, which could cause these guidelines to change.” (Posted on 5/19/2021; https://www.instagram.com/p/CPEQsr6lFkF/)Identify Villain(s)Identifying the causes or antagonists that perpetuate dis/misinformation, inequities, and other barriers for BIPOC/MIMI.“We get it. You don't want to get vaccinated. Feels a lot like Tuskegee… Tuskegee is just one of America's many crimes against humanity involving unethical human experimentation & patient cruelty. It's hard to separate the instinctive apprehension these acts provoke in all of us from the reality of how science is conducted in the modern era. Contemporary medical bias, racism, and lingering apartheid have corrupted our trust in health professionals…” (Posted on 7/27/2021; https://www.instagram.com/p/CR1Vhuolckr/)Examples of segmented messaging relating to the PHEP and other health behavior outcomes. Posting dates refer to the organizational Instagram account (https://www.instagram.com/hood_medicine/). Open table in a new tab 4)Iterative message refinement: HMI messaging is continually refined via ongoing collaborations and dialogues with community members and leaders as well as epidemiological findings. Examples of segmented messaging relating to the PHEP and other health behavior outcomes. Posting dates refer to the organizational Instagram account (https://www.instagram.com/hood_medicine/). The pandemic was a stark reminder of the persistent structural disparities endured by BIPOC/MIMI. Targeted mal/dis/misinformation by various anti-vaccine organizations and other actors further accelerated inequities [[8]Covid's devastation of Black community used as “marketing” in new anti-vaccine film. Accessed August 27, 2021. https://www.nbcnews.com/news/nbcblk/covid-s-devastation-black-community-used-marketing-new-anti-vaxxer-n1260724Google Scholar]. Ultimately, both non-governmental and governmental organizations (e.g., the Rockefeller Foundation) stepped in to try to address these inequities and the Biden Administration formed a Health Equity Task Force—comprised of senior leadership in health equity [[9]Biden Picks Dr. Nunez-Smith to Lead Health Equity Task Force - The New York Times. Accessed August 27, 2021. https://www.nytimes.com/2021/01/08/health/coronavirus-marcella-nunez-smith.htmlGoogle Scholar,[10]New Vaccine Equity Cooperative Launches to Advance Covid-19 Vaccine Access and Readiness. The Rockefeller Foundation. Accessed August 27, 2021. https://www.rockefellerfoundation.org/news/new-vaccine-equity-cooperative-launches-to-advance-covid-19-vaccine-access-and-readiness/Google Scholar]—in August 2021 to address COVID-19 inequities. With this increased momentum, we must prioritize approaches that are both community-oriented and data-driven. Adapting and scaling the HMI model holds potential for combating health disparities for BIPOC/MIMI during and post-pandemic. The authors have no declarations to make.

Correlates of tobacco use among Asian and Pacific Islander youth and young adults in the U.S.: A systematic review of the literature.

Rates of tobacco product use, including the use of combustible and electronic cigarettes, remain high in youth and young adults within the U.S. Though a substantial body of work has examined risk factors associated with initiation and ongoing use of tobacco products, research on tobacco use and associated correlates among Asian and Pacific Islanders (APIs) has been more limited despite high rates in select API subgroups. This systematic review outlines recent research (2010-2020) on the correlates of tobacco use in APIs aged 9-29. To better understand determinants of tobacco use and identify gaps in the literature, we framed correlates based on the National Institute on Minority Health and Health Disparities (NIMHD) multidimensional research framework. Database and author-focused searches were conducted, followed by article abstract and full-text reviews, much of which were guided by a discrete set of inclusionary and exclusionary criteria related to tobacco use and youth/young adults. A total of 24 articles were included in this review. The majority of articles focused on individual-level correlates, with a high number of studies demonstrating association between behavioral and sociocultural factors and tobacco product use behavior. Interpersonal factors also made up a substantial portion of the literature, commonly focusing on peer, family, and social norms. Gaps related to the NIMHD model are addressed. Future research should examine biological and community/societal factors associated with API smoking to better understand unique correlates in this population and to inform tobacco prevention and intervention approaches. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Association between human immunodeficiency virus serostatus and the prevalence of atrial fibrillation.

Atrial fibrillation (AF) leads to increased risk for stroke. Human immunodeficiency virus (HIV) is associated with cardiovascular disease (CVD), although it is unclear if HIV is associated with AF. The purpose of this study was to evaluate the association between HIV serostatus and the prevalence of AF in the Multicenter AIDS Cohort Study.A cross sectional study was conducted among 1674 HIV-infected (HIV+) and uninfected (HIV–) men who completed resting 12-lead electrocardiograms, and/or ambulatory electrocardiogram monitoring. Multivariable logistic regression was used to evaluate the association between AF, defined as the presence of either AF or atrial flutter, and HIV+ serostatus. Associations were adjusted for demographic variables, and then also for CVD risk factors.HIV+ men were younger than HIV– men (median 55.5 vs 61.7 years, P < .001) and were more frequently African-American (30.5% vs 17.8%, P < .001). Most HIV+ men (81%) had undetectable viral load. The age and race adjusted prevalence of AF was 3.0% in HIV+ and 3.3% in HIV– men. There was only 1 case of AF among African-American men. There were no associations between AF and HIV serostatus after adjusting for demographic factors (odds ratio 0.76; 95% CI 0.37 to –1.58; P = .47) or after further adjustment for CVD risk factors (odds ratio 0.84; 95% CI 0.39 to –1.81; P = .66).We found no association between HIV and AF in this cohort in which viral replication among the HIV+ men is generally suppressed. The overall prevalence of AF was low and was rare in African-American men.

Socioeconomic deprivation and genetic ancestry interact to modify type 2 diabetes ethnic disparities in the United Kingdom.

BackgroundType 2 diabetes (T2D) is a complex common disease that disproportionately impacts minority ethnic groups in the United Kingdom (UK). Socioeconomic deprivation (SED) is widely considered as a potential explanation for T2D ethnic disparities in the UK, whereas the effect of genetic ancestry (GA) on such disparities has yet to be studied.MethodsWe leveraged data from the UK Biobank prospective cohort study, with participants enrolled between 2006 and 2010, to model the relationship between SED (Townsend index), GA (clustering principal components of whole genome genotype data), and T2D status (ICD-10 codes) across the three largest ethnic groups in the UK – Asian, Black, and White – using multivariable logistic regression.FindingsThe Asian group shows the highest T2D prevalence (17·9%), followed by the Black (11·7%) and White (5·5%) ethnic groups. We find that both SED (OR: 1·11, 95% CI: 1·10–1·11) and non-European GA (OR South Asian versus European: 4·37, 95% CI: 4·10–4·66; OR African versus European: 2·52, 95% CI: 2·23–2·85) are significantly associated with the observed T2D disparities. GA and SED show significant interaction effects on T2D, with SED being a relatively greater risk factor for T2D for individuals with South Asian and African ancestry, compared to those with European ancestry.InterpretationThe significant interactions between SED and GA underscore how the effects of environmental risk factors can differ among ancestry groups, suggesting the need for group-specific interventions.FundingThis work was supported by the National Institutes of Health (NIH) Distinguished Scholars Program (DSP) to LMR and the Division of Intramural Research (DIR) of the National Institute on Minority Health and Health Disparities (NIMHD) at NIH.

The Obesity-COVID-19 Relationship: How Much Do Diabetes and Age Matter?

Background: Obesity and diabetes have been independently linked to COVID-19 severity, but their joint impact has not been extensively investigated. This study examines the joint and mediating role of diabetes and weight in COVID-19 severity and mortality in a large sample of patients treated in a large urban hospital located in Southern California.Methods: A retrospective observational cohort study of patients who tested positive for COVID-19 between March 8, 2020 and January 25, 2021 was implemented. Participants were patients with a diagnosis of SARS-CoV-2 infection who received care within the Cedars-Sinai Health System in Los Angeles, CA. Inclusion criteria required objectively measured height, weight, and diabetic status to be present in the patients’ medical record (N=4224). Univariable and multivariable logistic regression models were used to identify associated risk factors, and a regression causal mediation analysis examined the role of diabetes in the association between obesity and illness severity. All analyses were stratified by age (Findings: Among individuals younger than 65yo, diabetes accounted for 19-30% of the associations between obesity and COVID-19 illness severity. In both age groups, those with both obesity and diabetes had the highest odds of increased disease severity. Among patients 65yo and older, being underweight (BMI Interpretation: Our findings have clinical implications in documenting which patients may be at elevated risk for hospitalization and adverse outcomes. More in-depth prospective studies are needed to capture how glycemic regulation before and after infection influence prognosis.Funding Statement: This work is supported by the National Cancer Institute (1U54CA260591-01; Cheng/Figueiredo). The manuscript was partially supported by the National Institute on Minority Health and Health Disparities (NIMHD) Obesity Health Disparities Research Center (U54MD0000502; Salvy/Dutton), the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD; R01HD092483; Salvy/de la Haye) and the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) Eris M. Field Chair in Diabetes Research (P30-DK063491; Goodarzi). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NCI, NIMHD, NICHD or NIDDK. Declaration of Interests: We declare no competing interests.Ethics Approval Statement: The CSMC institutional review board approved all protocols for the current study (Proposal # Pro00056865).