non-Black Participants Research Articles

P-550. Efficacy and Safety of B/F/TAF in Black Adults with HIV Who Are Treatment Naïve: 5-Year Follow-Up from Two Phase 3 Studies

Abstract Background Black communities are disproportionately affected by HIV and may have a greater lifetime risk of comorbidities compared with non-Black people with HIV (PWH). Despite this, they have historically been underrepresented in clinical studies. Here, we report efficacy and safety through 5 years of first-line therapy with bictegravir/emtricitabine/tenofovir alafenamide (B/F/TAF) in Black PWH. Methods Studies 1489 (NCT02607930; B/F/TAF vs dolutegravir/abacavir/lamivudine [DTG/ABC/3TC]) and 1490 (NCT02607956; B/F/TAF vs DTG+F/TAF) were randomized, double-blind, multicenter, Phase 3 studies in adult PWH. This pooled analysis reports the outcomes of Black and non-Black participants who received B/F/TAF in the 144-week (W) randomization phase and the 96W open-label extension. Baseline demographics and clinical characteristics; proportion of participants with HIV-1 RNA < 50 copies/mL (missing=excluded); adherence; treatment-emergent adverse events (TEAEs); and changes in CD4 count and metabolic and renal parameters are presented. Results Overall, 211 (33.4%) Black and 421 (66.6%) non-Black PWH (91.0% and 54.2% from the US, respectively) received B/F/TAF up to W240. Baseline demographics and clinical characteristics are shown in the Table; 19.9% Black and 18.1% non-Black PWH had HIV-1 RNA > 100,000 copies/mL, 17.5% and 10.0% had CD4 < 200 cells/µL, and 19.4%/8.1% and 13.5%/5.0% had a history of hypertension/diabetes mellitus, respectively. At W240, high proportions of both Black (97.2%) and non-Black PWH (99.3%) had HIV-1 RNA < 50 copies/mL, despite Black PWH being more likely than non-Black PWH to have low (< 85%) adherence (11.2% vs 5.0%; P=0.0074 [Fisher’s exact test]). A smaller proportion of Black vs non-Black PWH experienced study drug–related TEAEs (20.4% vs 31.8%; P=0.0026 [Fisher’s exact test]). Changes in CD4 count, metabolic and renal parameters, and TE hypertension and diabetes were similar between groups (Table). Conclusion At Year 5, B/F/TAF maintained high rates of virologic suppression in Black PWH, despite a greater proportion of Black vs non-Black PWH having low adherence. B/F/TAF was well tolerated, with a smaller proportion of Black vs non-Black PWH with study drug–related TEAEs. These findings further support the long-term use of B/F/TAF in Black PWH. Disclosures Anson K. Wurapa, MD, Gilead: Honoraria|Gilead Sciences, Inc.: Medical writing support provided by Aspire Scientific (Bollington, UK) Jose Ramon Arribas, MD, Alexa: Advisor/Consultant|Gilead Sciences, Inc.: Advisor/Consultant|Gilead Sciences, Inc.: Expert Testimony|Gilead Sciences, Inc.: Grant/Research Support|Gilead Sciences, Inc.: Medical writing support provided by Aspire Scientific (Bollington, UK)|Janssen: Advisor/Consultant|Janssen: Expert Testimony|Lilly: Advisor/Consultant|MSD: Advisor/Consultant|MSD: Expert Testimony|Serono: Advisor/Consultant|Teva: Advisor/Consultant|ViiV: Advisor/Consultant|ViiV: Expert Testimony|ViiV: Grant/Research Support Yazdan Yazdanpanah, MD, PhD, Gilead Sciences, Inc.: Medical writing support provided by Aspire Scientific (Bollington, UK) Chloe Orkin, MBChB, FRCP, MD, AstraZeneca: Grant/Research Support|Gilead Sciences, Inc.: Grant/Research Support|Gilead Sciences, Inc.: Honoraria|Gilead Sciences, Inc.: Medical writing support provided by Aspire Scientific (Bollington, UK)|GSK: Honoraria|MSD: Honoraria|ViiV Healthcare: Grant/Research Support|ViiV Healthcare: Honoraria Hui Liu, PhD, Gilead Sciences, Inc.: Employee; Medical writing support provided by Aspire Scientific (Bollington, UK)|Gilead Sciences, Inc.: Stocks/Bonds (Private Company) Rachel Rogers, Gilead Sciences, Inc.: Employee; Medical writing support provided by Aspire Scientific (Bollington, UK)|Gilead Sciences, Inc.: Stocks/Bonds (Private Company) David Malebranche, MD, MPH, Gilead Sciences, Inc.: Employee; Medical writing support provided by Aspire Scientific (Bollington, UK)|Gilead Sciences, Inc.: Stocks/Bonds (Private Company) Jason Hindman, PharmD, MBA, Gilead Sciences, Inc.: Employee; Medical writing support provided by Aspire Scientific (Bollington, UK)|Gilead Sciences, Inc.: Stocks/Bonds (Private Company) Debbie P. Hagins, MD, FAPCR, AAHIVS, Gilead Sciences, Inc.: Medical writing support provided by Aspire Scientific (Bollington, UK)

Genomic Analysis Reveals Racial and Age-Related Differences in the Somatic Landscape of Breast Cancer and the Association with Socioeconomic Factors.

Cancer genomics consortia have identified somatic drivers of breast cancer subtypes. However, these studies have predominantly included older, non-Black women, and the related socioeconomic status (SES) data is limited. Increased representation and depth of social data are crucial for understanding how health inequity is intertwined with somatic landscapes. Here, we conducted targeted sequencing on primary tumors from the Carolina Breast Cancer Study (N = 357; 52% Black, 47% <50) and compared the results to The Cancer Genome Atlas (N = 948; 18% Black, 27% <50). Race (Black vs. non-Black), age, and SES were evaluated in association with mutations, copy number alterations, and aneuploidy using generalized linear models. Pathway dysfunction was also assessed by aggregating mutation and copy number alterations. Adjusting for age, Black participants (N =350) were significantly more likely to have TP53 and FAT1 mutations and less likely to have PIK3CA, CDH1, DDR2, and GATA3 mutations than non-Black participants. Younger participants had more GATA3 alterations and fewer KMT2C, PTEN, MAP3K1 and CDH1 alterations. Black participants had significant enrichment for MYC (8q) and PIK3CA (3q26) amplifications and higher total aneuploidy, but age was not associated with copy number variation. SES was associated with different patterns of alteration in Black versus non-Black women. Overall, Black participants showed modest differences in TP53, PIK3CA, and other alterations that further varied by SES. Race is a social construct, and varying distributions of etiologic factors across social strata may predispose Black, young, and low SES women to cancer subtypes characterized by these alterations.

Patient Perspectives on Arteriovenous Fistula Placement, Maturation, and Use: A Qualitative Study

Rationale & ObjectiveArteriovenous fistula (AVF) use among U.S. hemodialysis (HD) patients is suboptimal, especially among Black patients. We interviewed a group of predominantly Black HD patients to probe experiences and perspectives surrounding steps along the AVF care continuum, which includes placement, maturation, and use of AVFs. Study DesignIndividual semi-structured interviews. Setting & ParticipantsPatients with kidney failure receiving HD in Birmingham, Alabama. Analytical ApproachTranscripts were coded and thematically analyzed. ResultsWe interviewed 53 Black and 6 White patients at different steps of the AVF care continuum: 29 were dialyzing with a central venous catheter (15 had not undergone AVF placement, 9 had a maturing AVF, and 5 had a non-functional AVF) and 30 were dialyzing with an AVF. We coded transcripts using qualitative thematic analysis. Three themes emerged: (1) the circumstances of dialysis initiation sometimes altered the timeline of AV access placement; (2) patients had variable levels of knowledge of steps along the AVF continuum; and (3) the life impacts of dialysis access were a significant factor in patients’ experience of dialysis. LimitationsSingle-institution study; low number of non-Black participants limited comparison of patient experiences by race. ConclusionsAmong a group of predominantly Black HD patients, perspectives surrounding the AVF care continuum included consideration of the circumstances of dialysis initiation, patient knowledge, and the life impacts of dialysis access. These findings may inform targeted interventions aimed at optimizing dialysis access use and addressing disparities across the AVF continuum.

Safety and Efficacy of Home-Based Walking Exercise for Peripheral Artery Disease

IntroductionHome-based walking exercise is first-line therapy for peripheral artery disease (PAD), but benefits of home-based walking exercise are variable. This study evaluated whether specific clinical characteristics were associated with greater improvement after home-based walking exercise or with higher rates of serious adverse events (SAEs). MethodsData were combined from two randomized clinical trials comparing home-based walking exercise to control in PAD. The home-based exercise interventions used behavioral interventions to help participants adhere to exercise. The primary outcome was the proportion of PAD participants who improved 6-minute walk (6MW) by at least 20 meters. Serious adverse events consisted of overnight hospitalizations or death that occurred during the randomized clinical trial. ResultsOf 376 PAD participants [69.6 years, 54.5% Black, 49.5% women], 217 were randomized to exercise and 159 to control. Home-based exercise improved 6MW by at least 20 meters in 100 (54.9%) participants, compared to 37 (28.0%) in control (Odds Ratio 3.13 (95% CI: 1.94,5.06), P< 0.001. Age, sex, race, comorbidities, baseline 6MW, and income did not significantly alter the effect of home-based exercise on improved 6MW. SAEs occurred in 28.1% and 23.3% of participants randomized to exercise and control, respectively (p=0.29). There were statistically significant interactions, indicating that home-based exercise increased SAE rates, compared to control, in Black compared to non-Black participants (P interaction <0.001), in those with vs. without coronary artery disease (CAD) (P interaction<0.001), and in people with vs. without history of heart failure (P interaction=0.005). ConclusionAmong people with PAD, home-based exercise improved 6MW by at least 20 meters in 54.9% of people. Older age, female sex, Black race, and specific comorbidities were not associated with lower rates of attaining meaningful improvement in 6MW following home-based exercise. Further study is needed to establish whether certain patient characteristics, such as history of coronary artery disease, may affect SAE rates in PAD patients participating in home-based exercise.

Identifying barriers to being offered and accepting a telehealth visit for cancer care: Unpacking the multi-levels of documented racial disparities in telehealth use.

382 Background: The use of telehealth visits in cancer care can improve accessibility, timeliness, and convenience for patients. However, disparities in its use persist with few studies having evaluated both patient- and community-level factors in relation to telehealth visit use in cancer care. Methods: We assembled a cohort of adults with an upcoming healthcare visit related to their cancer treatment at two academic medical centers (one in central NC and one in southeast MI) and their community affiliates. Black adults and those with a scheduled telehealth visit were oversampled during recruitment. Pre-visit surveys administered by telephone (N=773, RR=15%) collected information on sociodemographic characteristics, use of telehealth visits, healthcare access concerns, and patient symptoms/visit goals. We linked participant residential address to community-level measures, including broadband access. The two patient-reported outcomes of interest were 1) whether a choice in visit type (virtual or in-person) was offered and 2) scheduled visit type among those offered a choice. Associations of each outcome with sociodemographic characteristics and barriers (individual- and census tract-level) were assessed through estimation of unadjusted and adjusted prevalence differences (PDs). Results: 773 adults (RR=15%) were included in the cohort, mostly from the central NC site (N=621, RR=23%). After excluding non-recall for being offered a choice, the analytic sample (N=725) was 46% aged &lt;65 years, 42% Black, and 67% women. Black participants were less likely than non-Black participants to be offered a choice (15% vs 23%, PD= -8.7 (-14.4, -3.0), and if offered a choice, less likely to accept a telehealth visit: 20% vs 67%, PD= -47.0 (-62.0, -32.0). Similarly, women were less likely to be offered a choice (16% vs 27%, PD= -10.9 (-17.4, -4.4)) and accept a telehealth visit 42% vs 63%, PD= -20.8 (-36.8, -4.7). Those who expressed technology-related worries were less likely to schedule a telehealth visit, such as those who were worried about internet access: 33% vs 57%, PD adj = -11.9 (-32.9, 9.2). Participants who indicated their insurance did not cover telehealth visits were less likely to be offered a choice (10% vs 24%, PD ad = -9.4 (-23.1, 4.4). Lower community technology access (e.g. broadband ownership) and higher area-level poverty were associated with both outcomes, although these estimates were attenuated after adjustment. Conclusions: Not being offered a choice in visit type and/or not accepting a telehealth visit were associated with individual- and community-level barriers as well as demographic characteristics which may reflect additional unmeasured structural inequities (namely racism and sexism). Interventions to improve access to telehealth visits in cancer care should consider patient- and community-level barriers to care.

Knowledge and Attitudes About HIV Pre-Exposure Prophylaxis Among Sexually Active Black and Latina Cisgender Women: Findings from the 2017 and 2018 New York City Sexual Health Survey.

Pre-exposure prophylaxis (PrEP) is a highly effective tool to prevent HIV, yet it is underutilized among women. The current study aims to evaluate the awareness, attitudes, and perceptions of PrEP among a large survey sample of Black and Latina women in New York City (NYC). Interviewer-administered surveys were conducted in high HIV incidence neighborhoods in NYC among Black, Latina, and Afro-Latina women who reported recent sex with a man in 2017 (n = 398) and 2018 (n = 405). About 40% of participants were aware of PrEP, whereas 30.4% indicated interest in using it. The top reason for not utilizing it was low HIV risk perception. However, most participants supported the idea that using PrEP meant asserting control over their health (94.1%). Primary care providers and obstetricians/gynecologists were participants' preferred sources for PrEP (91.6%). Across survey cycles, compared to non-Black Latina participants, Black participants had significantly higher PrEP awareness (44.4% vs. 29.1%). PrEP awareness was also significantly higher among survey participants in 2018 (45.2%) than in 2017 (34.3%). Less than half of the participants were aware of PrEP, but those who were aware expressed largely positive attitudes toward the medication. Our findings may inform future PrEP implementation strategies to optimize awareness and access to PrEP among women disproportionately affected by HIV, like focusing on personal empowerment instead of risk-based messaging and training women's sexual health care providers in PrEP provision.

Associations of predictive biomarkers, MHC-I and MHC-II, with clinical and molecular features in a diverse breast cancer cohort.

517 Background: The addition of immunotherapy (IO) to chemotherapy in triple negative breast cancer (TNBC) has improved survival outcomes and recent studies have also shown improvements in pCR rates in early high-risk HR+/HER2- breast cancer. However, these improvements are not without toxicities and thus there is a critical need for biomarkers to select patients that are most likely to benefit from immunotherapy. MHC-I and tumor-specific MHC-II (tsMHC-II) expression are candidate biomarkers for predicting PD-(L)1 checkpoint inhibition benefit and have previously shown potential for predicting treatment response in multiple tumor types, including breast cancer. However, the existing data were generated from clinical trials with limited racial/ethnic diversity. Here we report associations between MHC-I and MHC-II expression and clinicopathological features in a large, racially and ethnically diverse breast cancer cohort. Methods: We performed multiplexed immunofluorescent tissue-based analysis of participants in the Carolina Breast Cancer Study (CBCS). Intrinsic subtype and P53 mutant-like status were identified using RNA-based multigene assays. To evaluate MHC-I we ranked all participants based on tumoral MHC-I intensity, with the top 33% categorized as "MHC-IHigh"; MHC-II+ expression on tumor cells was defined as ≥5% of tumor cells. Association between MHC-I/II and clinicopathological features by race was tested using Chi-square test or fisher-exact test and relative frequency difference (RFD) was calculated. Results: This study included 1630 participants (48% Black and 52% non-Black) with Stage I-III breast cancer. Black participants had a higher incidence of TNBC (25% vs. 12.5%, p=&lt;0.001) and Basal-like (29% vs. 14%, p=&lt;0.001) tumors. Basal-like and TP53 mutant tumors were more frequently observed among Black participants with HR+/HER2- tumors (11% vs. 5.5%, p=0.006 for Basal-like; 26% vs. 17%, p=0.003 for p53 mutant-like). While there was a similar distribution of tsMHC-II+ tumors between Black and non-Black participants, the relative frequency of tsMHC-II+ tumors was significantly more common in Black participants with HR+/HER2- breast cancer compared to non-Black participants (7.9% vs. 5%, p=0.04). Moreover, Black participants also were significantly more likely to have MHC-Ihigh tumors (38.9% vs. 28.4%, p=0.01), which, after IHC subtype stratification, was only significant among participants with HR+/HER2- breast cancer (28.2% vs. 22.3%, p=0.02). Conclusions: In this diverse breast cancer cohort, MHC-I and MHC-II expression, candidate predictive biomarkers of IO benefit, were more prevalent in tumors from Black women with HR+/HER2- breast cancer. These results underscore the importance of diverse and equitable clinical trial enrollment in future IO trials, especially in HR+/HER2- breast cancer.

Understanding the influence of single bias reduction strategies on personal and systemic bias outcomes

Social psychological research has used strategies to increase recognition of and motivation to combat personal or systemic bias, but with little attention to whether single strategies might influence both personal and systemic outcomes. We investigated whether single strategies are effective in both bias domains and potential underlying mechanisms. Across two experiments, non-Black participants were exposed to information concerning (a) their personal racial biases, (b) multiple Black individuals’ discrimination experiences across institutional contexts, or (c) race-unrelated information (control condition). Discrimination experiences exposure (vs. control) increased recognition of systemic bias and motivation to combat both systemic and personal bias (Studies 1 and 2), and we found statistical support for empathy as a mediator (Study 2). In contrast, strategies for highlighting personal bias had weaker effects on personal bias outcomes and no effects on systemic bias outcomes. We discuss theoretical and practical implications of discrimination experiences exposure for combatting systemic and personal bias.

Tenofovir-Diphosphate and Emtricitabine-Triphosphate Adherence Benchmarks in Dried Blood Spots for Persons With HIV Receiving Tenofovir Alafenamide and Emtricitabine-Based Antiretroviral Therapy (QUANTI-TAF).

QUANTI-TAF aimed to establish tenofovir-diphosphate (TFV-DP)/emtricitabine-triphosphate (FTC-TP) adherence benchmarks in dried blood spots (DBS) for persons with human immunodeficiency virus (PWH) receiving tenofovir alafenamide/emtricitabine (TAF/FTC)-based antiretroviral therapy (ART). For 16 weeks, PWH received TAF/FTC-based ART co-encapsulated with an ingestible sensor to directly measure cumulative (enrollment to final visit) and 10-day adherence. At monthly visits, intraerythrocytic concentrations of TFV-DP and FTC-TP in DBS were quantified and summarized at steady-state (week 12 or 16) as median (interquartile range). Linear mixed-effects models evaluated factors associated with TFV-DP/FTC-TP. Eighty-four participants (11% female, 4% transgender) predominantly receiving bictegravir/TAF/FTC (73%) were enrolled. Ninety-two percent completed week 12 or 16 (94% unboosted ART). TFV-DP for <85% (7/72), 85%-<95% (9/72), and ≥95% (56/72) cumulative adherence was 2696 (2039-4108), 3117 (2332-3339), and 3344 (2605-4293) fmol/punches. Adjusting for cumulative adherence, TFV-DP was higher with boosted ART, lower body mass index, and in non-Black participants. FTC-TP for <85% (14/77), 85%-<95% (6/77), and ≥95% (57/77) 10-day adherence was 3.52 (2.64-4.48), 4.58 (4.39-5.06), and 4.96 (4.21-6.26) pmol/punches. All participants with ≥85% cumulative and 10-day adherence had TFV-DP ≥1800 fmol/punches and FTC-TP ≥2.5 pmol/punches, respectively. Low-level viremia (HIV-1 RNA 20-199 copies/mL) occurred at 18% of visits in 39% of participants with similar TFV-DP (3177 [2494-4149] fmol/punches) compared with suppressed visits (3279 [2580-4407] fmol/punches). TFV-DP ≥1800 fmol/punches and FTC-TP ≥2.5 pmol/punches represent DBS benchmarks for ≥85% adherence to unboosted TAF/FTC-based ART. Among PWH with high adherence, low-level viremia was common. NCT04065347.

Contributions of Cerebral White Matter Hyperintensities to Postural Instability in Aging With and Without Alcohol Use Disorder

BackgroundBoth postural instability and brain white matter hyperintensities (WMHs) are noted markers of normal aging and alcohol use disorder (AUD). Here, we questioned what variables contribute to the sway path–WMH relationship in individuals with AUD and healthy control participants. MethodsThe data comprised 404 balance platform sessions, yielding sway path length and magnetic resonance imaging data acquired cross-sectionally or longitudinally in 102 control participants and 158 participants with AUD ages 25 to 80 years. Balance sessions were typically conducted on the same day as magnetic resonance imaging fluid-attenuated inversion recovery acquisitions, permitting WMH volume quantification. Factors considered in multiple regression analyses as potential contributors to the relationship between WMH volumes and postural instability were age, sex, socioeconomic status, education, pedal 2-point discrimination, systolic and diastolic blood pressure, body mass index, depressive symptoms, total alcohol consumed in the past year, and race. ResultsInitial analysis identified diagnosis, age, sex, and race as significant contributors to observed sway path–WMH relationships. Inclusion of these factors as predictors in multiple regression analyses substantially attenuated the sway path–WMH relationships in both AUD and healthy control groups. Women, irrespective of diagnosis or race, had shorter sway paths than men. Black participants, irrespective of diagnosis or sex, had shorter sway paths than non-Black participants despite having modestly larger WMH volumes than non-Black participants, which is possibly a reflection of the younger age of the Black sample. ConclusionsLonger sway paths were related to larger WMH volumes in healthy men and women with and without AUD. Critically, however, age almost fully accounted for these associations.

A randomized controlled trial of potential tobacco policies prohibiting menthol flavor in cigarettes and e-cigarettes: a study protocol

BackgroundMenthol cigarette use remains a large public health problem and disproportionately affects Black adults in the United States. The Food and Drug Administration has proposed prohibiting menthol flavor in cigarettes to protect public health. However, e-cigarettes are available in menthol flavor and are a popular alternative product adults might switch to if menthol is prohibited in cigarettes. Research is needed to understand how availability of menthol (vs. tobacco) flavored e-cigarettes could impact cigarette use among adults who smoke menthol cigarettes.MethodsWe will recruit 150 adults who currently smoke menthol cigarettes and will randomize them to 1 of 3 conditions modeling different regulatory scenarios. We will recruit equal numbers of participants identifying as Black vs. non-Black and will stratify randomization by race. To promote standardization and adherence, cigarette and e-cigarette products will be provided for 8 weeks based on the assigned condition: (A) no menthol restriction (menthol cigarette and menthol flavored e-cigarette), (B) menthol prohibited in cigarettes only (non-menthol cigarette and menthol flavored e-cigarette), (C) menthol prohibited in both cigarettes and e-cigarettes (non-menthol cigarette and tobacco flavored e-cigarette). A follow-up visit will occur at week 12 to assess tobacco use status. The study aims are to (1) examine the impact of prohibiting menthol flavor in cigarettes and e-cigarettes on smoking behavior and (2) investigate whether outcomes differ by race to understand the impact of menthol policies on Black (vs. non-Black) individuals given high rates of menthol cigarette use in this population. The primary outcome will evaluate changes in the number of cigarettes smoked per day during the 8-week study period and will examine differences by regulatory scenario. Secondary outcomes will compare percent days smoke-free, changes in nicotine dependence, and motivation, confidence, and intentions to quit smoking by the regulatory scenarios. We will examine whether changes in the outcomes differ by Black vs. non-Black participants to compare the magnitude of the effect of the various menthol policy scenarios by race.DiscussionResults will contribute critical information regarding menthol in cigarettes and e-cigarettes to inform regulatory policies that maximize reductions in cigarette smoking and reduce tobacco-related health disparities.Trial registrationNCT05259566. Yale IRB protocol #2000032211, last approved 12/8/2023.

"It's Tough to Be a Black Man with Schizophrenia": Randomized Controlled Trial of a Brief Video Intervention to Reduce Public Stigma.

Racial discrimination and public stigma toward Black individuals living with schizophrenia create disparities in treatment-seeking and engagement. Brief, social-contact-based video interventions efficaciously reduce stigma. It remains unclear whether including racial identity experiences in video narrative yields greater stigma reduction. We hypothesized that we would replicate findings showing sustained stigma reduction in video-intervention groups vs control and that Black participants would show greater stigma reduction and emotional engagement than non-Black participants only for a racial-insights video presenting a Black protagonist. Recruiting using a crowdsourcing platform, we randomized 1351 participants ages 18-30 to (a) brief video-based intervention, (b) racial-insights-focused brief video, or (c) non-intervention control, with baseline, post-intervention, and 30-day follow-up assessments. In 2-minute videos, a young Black protagonist described symptoms, personal struggles, and recovery from schizophrenia, with or without mentioning race-related experiences. A 3 × 3 ANOVA showed a significant group-by-time interaction for total scores of each of five stigma-related domains: social distance, stereotyping, separateness, social restriction, and perceived recovery (all P < .001). Linear mixed modeling showed a greater reduction in stigma from baseline to post-intervention among Black than non-Black participants in the racial insights video group for the social distance and social restriction domains. This randomized controlled trial replicated and expanded previous findings, showing the anti-stigma effects of a brief video tailored to race-related experiences. This underscores the importance of personalized, culturally relevant narratives, especially for marginalized groups who, more attuned to prejudice and discrimination, may particularly value identification and solidarity. Future studies should explore mediators/moderators to improve intervention efficacy.

The role of trust in reducing confrontation-related social costs.

Confronting, or calling out people for prejudiced remarks, reduces subsequent expressions of prejudice. However, people who confront others incur social costs: Confronters are disliked, derogated, and avoided relative to others who have not confronted. These social costs hurt the confronter and reduce the likelihood of future confrontation. The present studies (N = 1,019) integrate the close relationships and prejudice reduction literatures to examine whether people who are confronted assign fewer social costs when they trust the confronter. Study 1 provided correlational evidence that people who were confronted for making a sexist remark experienced less irritation and annoyance (i.e., negative other-directed affect) if they trusted the confronter, which, in turn, reduced social costs. Manipulation of trust in Study 2 with non-Black participants provided causal evidence that trust buffers against social costs. Being confronted predictably led to more negative other-directed affect and social costs, relative to not-confronted participants; however, these effects were mitigated among participants who underwent a trust-building exercise with the confronter. Study 3 used an ecologically valid context in which non-Black participants who made a stereotypic remark were confronted by an actual friend or stranger. They assigned fewer social costs when confronted by their friend (vs. stranger), and this effect was serially mediated by trust and negative other-directed affect. Importantly, confrontation reduced subsequent stereotyping in all studies. Practically, these studies reveal that when confronters establish trust, they experience fewer social costs. Theoretically, these studies provide a new direction for confrontation research that accounts for interpersonal dynamics. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Prevalence of Cardiometabolic Risk Factors in Women: Insights From the Houston HeartReach Study.

Cardiovascular disease is the leading cause of death among women in the United States. Past research has highlighted the importance of the relationship between female-specific demographics and traditional risk factors. The present analysis aimed to identify the prevalence of modifiable risk factors in women attending a community cardiovascular health screening. Data collected between 2011 and 2019 were obtained from the Houston HeartReach Registry. Participants were classified as having or not having each of 4 traditional cardiometabolic risk factors: hypertension, diabetes, body mass index indicating overweight or obesity, and dyslipidemia. Differences in prevalence were compared using the Pearson χ2 test. Most participants had hypertension, overweight or obesity, and dyslipidemia. Older women (≥65 years) had the highest prevalence of all cardiometabolic risk factors. Black participants had a higher prevalence of hypertension (P = .006) and a lower prevalence of dyslipidemia (P = .009) than non-Black participants. Hispanic participants had a lower prevalence of hypertension (P < .001) and a higher prevalence of overweight or obesity (P = .03) than non-Hispanic participants. Participants in the lowest household income bracket (<$25,000) were more likely to have diabetes (P = .001) and overweight or obesity (P = .004) than participants in the highest income bracket (≥$50,000). Unemployed participants had a higher prevalence of diabetes (P < .001), overweight or obesity (P = .004), and dyslipidemia (P < .001) than employed participants. Comorbidity analysis revealed clustering of multiple cardiometabolic risk factors. Moreover, risk factor hot spots were identified by zip code, which could help select future sites for targeted screening. The analysis found that cardiometabolic risk factor prevalence varies with demographic and socioeconomic status. Geographic areas where cardiometabolic risk factor prevalence was highest were also identified. Further participant recruitment and analysis are required to create predictive models of cardiovascular disease risk in women.

Abstract 14976: Proteomic Measures Linking Social Determinants of Health to Heart Failure Risk: The Atherosclerosis Risk in Communities Study

Introduction: Adverse social determinants of health (SDOH) are risk factors for heart failure (HF), and both disproportionately burden Black adults. The mechanisms linking SDOH to incident HF are unclear. Methods: Among 9910 HF-free participants in the community-based ARIC study with proteomic data (Somascan v4) at Visit 3 (V3; 1993-95), we performed race-stratified (Black and non-Black race) analyses of the association of 4955 plasma proteins with SDOH and incident HF. We derived a SDOH factor based on income, education level, and neighborhood area deprivation index using exploratory factor analysis. We evaluated cross-sectional associations of the SDOH factor with proteins using age- and gender- adjusted linear regression at Bonferroni significance. The association of SDOH-associated proteins with incident HF during 10 years post-V3 was assessed using Cox PH regression further adjusting for cardiovascular co-morbidities, using an FDR &lt;0.05. Mendelian randomization analysis assessed for a possible causal effect on HF among candidate proteins common to both race groups. Results: Of 9910 participants, 1981 reported Black race (age 59±6 years; 60% female) and 7929 non-Black race (60±6; 52% female). The SDOH factor was associated with incident HF in both race strata (adjusted HR 1.29 [95% CI 1.07-1.54] and 1.38 [1.24-1.53] respectively). Among Black participants, 80 proteins associated with the SDOH factor, 52 of which associated with incident HF. Among non-Black participants, 866 proteins associated with the SDOH factor, 188 of which associated with incident HF. Twenty-two proteins were associated with SDOH and HF in both race groups (Figure). Mendelian randomization supported a possible causal effect of C1QTNF1, an inflammation-associated adiponectin paralog, on HF. Conclusions: Large scale proteomics identifies proteins potentially linking SDOH to HF risk. C1QTNF1 associates with SDOH burden, has a possible causal effect on HF, and warrants further study.

53 Healthcare Quality, Race, and Neuropsychological Functioning in Black/African-American Individuals with HIV

Objective:Rates of HIV are disproportionately high among Black individuals in the United States (CDC, 2020). Black individuals are at increased risk for neurocognitive impairment due to HIV (Marquine et al., 2016) and experience health disparities including increased morbidity and mortality (Asari, 2018; Manly et al., 1998). We sought to examine the relationship between perceived quality of healthcare and neuropsychological functioning among people living with HIV (PLWH) who identify as Black compared to those who are non-Black.Participants and Methods:151 PLWH in the Los Angeles area (52% Black, age = 49.85 ± 10.54, education = 13.23 ± 2.11; 87% cisgender men, 8% cisgender women, 1% transgender men, 3% transgender women) completed comprehensive neuropsychological (NP) assessments (from which demographically-corrected domain and global T-scores were derived), psychiatric and sociodemographic interviews, and self-report questionnaires, including a measure of perceived healthcare quality (i.e., QUOTE-HIV). Statistical analyses included chi-square, t-test, ANOVA, and stepwise linear regression.Results:Only 14% of Black PLWH had private healthcare insurance (versus Medicare/Medicaid) compared to 33% of nonBlack PLWH (x2=11.33, p&lt;.01). Black participants were significantly older than nonBlack participants (p&lt;.01), but did not differ on gender, education, income, CD4 count, or HIV viral load. Younger Black participants (based on a median split for age; n = 23) reported the lowest perceived quality of healthcare (i.e., QUOTE-HIV total performance score), while older Black participants (n = 56) reported the highest perceived care (F = 3.80, p = .01), but the same relationship was not observed in nonBlack participants. In a stepwise multivariate regression model, including demographic and virological factors as well as healthcare quality, only household income and overall perceived healthcare quality (i.e., QUOTE-HIV total performance score) were significantly associated with Global NP T-scores among Black PLWH (R2=.12, F(1, 66)=4.46, p=.02).Conclusions:When assessing healthcare quality and healthcare experiences among people living with HIV, race and age are important to consider. Private healthcare coverage may be less accessible to people of color, and in a multivariate model, only income and healthcare quality significantly predicted neuropsychological functioning in Black PLWH. When examining HIV and health outcomes, the complex relationships among quality of healthcare and health disparities, neuropsychological functioning, and structural racism warrant further investigation.

Validation of a Smart Ring Oximeter in Individuals With Dark Skin Pigment

ObjectiveTo evaluate a ring wearable’s accuracy in the measurement of oxyhemoglobin saturation measured by pulse oximeter (SpO2) compared to a simultaneous SaO2 obtained from arterial blood gases (ABGs) because oximeters may overestimate oxyhemoglobin saturation in darkly pigmented individuals resulting in occult hypoxemia. Patients and MethodsCircul+ (Bodimetrics), with a form factor of a ring, measures several variables for cardiorespiratory assessment (SpO2, movement, and heart rate). The design ensures that measurements are made on the palmar surface of the digit, where there is generally less pigment. Twenty-four healthy participants (8 Black, 16 non-Black) had catheters inserted into their radial arteries during the timeframe between August 2020 and January 2022. They were administered nitrogen-rich air that made them hypoxic in steps to an SaO2 of 70%. ABGs was sampled at various levels of hypoxia, and simultaneous readings were obtained from the Circul+. We compared SpO2 from Circul with measurement of ABGs by a medical grade blood gas analyzer. ResultsThere was excellent correlation between SaO2 measured by the ring oximeter and ABGs in both Black (y = 1.0174x − 1.573; R2 = 0.9414) and Non-Black (y = 1.0209x − 2.5607; R2 = 0.9207) participants. No differences were found in comparing the intercept and slopes of the regressions. At ABG of 70% and 100%, the SaO2 measured by the ring was calculated to be 69.6% and 100.2% for the Black participants and 68.9% and 99.5% for the non-Black participants. Bland-Altman analysis found a bias (deviation from the mean) of 0.0 for the Black participants and −0.7% for the non-Black participants. ConclusionResults from this study confirmed that Circul+ oximetry accuracy seems to be independent of skin tone, perhaps because measurements are made on the palmar surface of the digit, where there is generally less pigment.

Racial Differences in Mental Stress-Induced Transient Endothelial Dysfunction and Its Association With Cardiovascular Outcomes.

This study aimed to investigate differences in transient endothelial dysfunction (TED) with mental stress in Black and non-Black individuals with coronary heart disease (CHD), and their potential impact on cardiovascular outcomes. We examined 812 patients with stable CHD between June 2011 and March 2016 and followed through February 2020 at a university-affiliated hospital network. Flow-mediated vasodilation (FMD) was assessed before and 30 minutes after mental stress. TED was defined as a lower poststress FMD than prestress FMD. We compared prestress FMD, post-stress FMD, and TED between Black and non-Black participants. In both groups, we examined the association of TED with an adjudicated composite end point of cardiovascular death or nonfatal myocardial infarction (first and recurring events) after adjusting for demographic, clinical, and socioeconomic factors. Prestress FMD was lower in Black than non-Black participants (3.7 [2.8] versus 4.9 [3.8], p < .001) and significantly declined with mental stress in both groups. TED occurred more often in Black (76%) than non-Black patients (67%; multivariable-adjusted odds ratio = 1.6, 95% confidence interval = 1.5-1.7). Over a median (interquartile range) follow-up period of 75 (65-82) months, 142 (18%) patients experienced either cardiovascular death or nonfatal myocardial infarction. Black participants had a 41.9% higher risk of the study outcome than non-Black participants (95% confidence interval = 1.01-1.95). TED with mental stress explained 69% of this excess risk. Among CHD patients, Black individuals are more likely than non-Black individuals to develop endothelial dysfunction with mental stress, which in turn explains a substantial portion of their excess risk of adverse events.

Plasma Proteomic Associations With Incident Ischemic Stroke in Older Adults: The Cardiovascular Health Study.

Plasma proteomics may elucidate novel insights into the pathophysiology of ischemic stroke (IS), identify biomarkers of IS risk, and guide development of nascent prevention strategies. We evaluated the relationship between the plasma proteome and IS risk in the population-based Cardiovascular Health Study (CHS). Eligible CHS participants were free of prevalent stroke and underwent quantification of 1,298 plasma proteins using the aptamer-based SOMAScan assay platform from the 1992-1993 study visit. Multivariable Cox proportional hazards regression was used to evaluate associations between a 1-SD increase in the log2-transformed estimated plasma protein concentrations and incident IS, adjusting for demographics, IS risk factors, and estimated glomerular filtration rate. For proteins independently associated with incident IS, a secondary stratified analysis evaluated associations in subgroups defined by sex and race. Exploratory analyses evaluated plasma proteomic associations with cardioembolic and noncardioembolic IS and proteins associated with IS risk in participants with left atrial dysfunction but without atrial fibrillation. Of 2,983 eligible participants, the mean age was 74.3 (±4.8) years, 61.2% were women, and 15.4% were Black. Over a median follow-up of 12.6 years, 450 participants experienced an incident IS. N-terminal probrain natriuretic peptide (NTproBNP, adjusted HR 1.37, 95% CI 1.23-1.53, p = 2.08 × 10-08) and macrophage metalloelastase (MMP12, adjusted HR 1.30, 95% CI 1.16-1.45, p = 4.55 × 10-06) were independently associated with IS risk. These 2 associations were similar in men and women and in Black and non-Black participants. In exploratory analyses, NTproBNP was independently associated with incident cardioembolic IS, E-selectin with incident noncardioembolic IS, and secreted frizzled-related protein 1 with IS risk in participants with left atrial dysfunction. In a cohort of older adults, NTproBNP and MMP12 were independently associated with IS risk. We identified plasma proteomic determinants of incident cardioembolic and noncardioembolic IS and found a novel protein associated with IS risk in those with left atrial dysfunction.

Motivational Interviewing Counseling to Increase Endocrine Therapy Adherence in Diverse Patients

Oral endocrine therapy (ET) is an inexpensive and effective therapy for hormone receptor-positive (HR+) breast cancer that prevents recurrence but relies upon long-term adherence for up to ten years. More than 80% of breast cancer patients have an HR+ phenotype and are candidates for ET, but approximately half discontinue or become non-adherent by five years. ET underuse is more prevalent in Black and young (<50 yrs) women, which may contribute to outcome disparities in these groups. The objective of this study was to evaluate the feasibility, acceptability, and utility of a patient-centered counseling intervention to enhance ET adherence, with a focus on the needs of Black and younger women. We conducted a single-arm pilot study of a twelve-month motivational interviewing (MI) intervention consisting of five MI counseling sessions, an interactive workbook, a resource guide, and an educational video developed and revised with iterative patient and clinician input. The eligible participants were >18 years old, English speaking, and with stage I-III HR+ breast cancer. Participants were recruited across a large academic medical center and four community sites. Feasibility and acceptability were assessed by measures of participant recruitment, retention, session participation, and patient-reported satisfaction. ET adherence at 12 months was assessed by self-report and medication event monitoring system (MEMS) caps using a continuous measure of the proportion of days covered (PDC) as well as a dichotomous measure of the optimal adherence, defined as >80% PDC. Forty-two women initiated the intervention, of whom thirty-five participants (83%) completed outcome assessments at 12 months, including thirteen Black and twenty-two non-Black participants. The average participant age was 54.8 years (range: 25-73). Overall, 97% completed at least three MI sessions and 83% completed at least four sessions. Participant retention and satisfaction were high, particularly among Black women. Self-reported adherence at 12 months was 88% overall (100% in Black women and 81% in non-Black women). The majority of women also achieved 80% of days adherent using MEMS caps, with a greater adherence in Black women. This study demonstrates the feasibility, acceptability, and early promise of the effectiveness of an MI counseling-based intervention to promote ET adherence and prevent breast cancer recurrence in diverse populations.