non-Hispanic Black Youth Research Articles

Predictors of Cigar, Cigarillo, and Little Cigar Initiation Among Hip Hop-Identifying Youth

Background: We explored predictors of cigar product initiation among Hip Hop-identifying U.S. youth using data from the U.S. Food and Drug Administration’s Fresh Empire evaluation. Participants were Hip Hop-identifying youth living in evaluation markets who had not initiated cigar product use at their first survey. Objectives: We modeled cigar product initiation odds using discrete time survival analysis logistic regression models as a function of factors related to one’s large social, physical, social/normative, and intrapersonal environment, and other tobacco use. Results: In the unique sample, 26.2% initiated cigar product use. Factors associated with higher cigar product initiation odds included: current/former (vs. non-susceptible never) cigarette smoking (odds ratio [OR]=5.35; p=.008); cigarette experimentation (vs. non-susceptible never smoking) (OR=3.26; p<.001); current (vs. never) e-cigarette use (OR=2.06; p<.001) and hookah use (OR=1.83; p=.011); having at least one friend who uses marijuana (OR=1.43; p=.008); high music use (OR=1.32; p=.035); household tobacco use (OR=1.26; p =.042); increased age (OR=1.18; p< .001); and higher sensation seeking (OR=1.16; p=.018). Youth reporting higher perceived smoking risks had lower cigar product initiation odds (OR=0.86; p=.029) as did Hispanic (OR=0.53; p<.001) and non-Hispanic Other youth (OR= 0.68; p=.023) (vs. non-Hispanic Black youth). Conclusions: The finding that high music use predicted cigar product initiation should be considered in light of cigar brand sponsorship of musical artists and events and indicates a potential opportunity for counter messaging. Peer crowd segmentation in this study identified unique and differing factors that influence tobacco use risk among Hip Hop-identifying youth that are not found in the general population.

Racial and Ethnic Disparities in the Diagnosis and Early Treatment of First-Episode Psychosis.

Despite recognition that early intervention for first-episode psychosis (FEP) improves outcomes, Black youth with FEP continue to experience critical disparities in care. A historical lack of scientific focus on racial and ethnic factors in the study of psychosis and scant investigations among publicly insured (ie, Medicaid-enrolled) youth hinder our ability to understand and address factors that contribute to disparities in early FEP care. Strategies for improving FEP services for Black youth are reliant on more precise identification of who faces disparities and when during the early course of illness disparities are experienced. A retrospective longitudinal analysis of Ohio Medicaid claims data was performed for 987982 youth aged 15-24 years between 2010 and 2020 to examine: (1) the likelihood of FEP diagnosis, (2) the type of psychotic disorder diagnosis received, and (3) receipt of treatment following psychosis onset. Non-Hispanic Black (NHB) youth, relative to non-Hispanic White (NHW) peers, were more likely to be diagnosed with a psychotic disorder and were further more likely to receive a diagnosis of schizophrenia relative to an affective psychotic disorder. In the first year following FEP diagnosis, NHB youth were also less likely to receive psychotherapy than NHW youth; this disparity was no longer present when examined at 2 years following FEP. In this study, Black youth experienced disparities in both the diagnosis and early treatment of FEP. Additional efforts are needed to understand and address these observed disparities and to promote equitable access to FEP care during the critical early illness phases.

Improving equity in diabetes technology use: Voices of youth and their parents.

There are marked inequities in clinical outcomes and rates of diabetes technology use among youth with type 1 diabetes (T1D). The quantitative data from our mixed methods cohort study identified significant improvements in glycaemia and quality of life in participants. We aimed to use qualitative methods to provide further insight into our quantitative findings in the setting of underlying health disparities. Fifteen publicly insured, insulin pump-naïve non-Hispanic Black youth aged 6-21 years with T1D and baseline haemoglobin A1c (HbA1c) ≥86 mmol/mol (10%) and their parents participated in a mixed methods cohort study. Semi-structured interviews were conducted separately with parents and youth after completion of 6 months of HCL use. Three topic areas were explored: (1) Experience using HCL, (2) barriers to HCL and (3) facilitators to accessing HCL. Semantic content analysis and consensus coding involving two team members were used to generate themes. Thematic saturation was achieved. Youth (Medianage 14.9 years, 67% female) and parents (92% female) were interviewed. Youth and their parents reported that access to HCL provides a new outlook on living with T1D, although managing T1D is still hard. They felt that diabetes technology is most helpful for those struggling with management. Participants experienced barriers to access including misconceptions of HCL systems, clinician bias and systemic racism. They suggested these barriers can be overcome by offering diabetes technology education for all people with T1D, increasing awareness of HCL in the community and providing resources to overcome barriers created by social determinants of health. The voices of historically minoritised youth with suboptimal T1D control and their parents provide important, previously unreported experiences and perspectives on barriers and facilitators to using HCL that will shape interventions to improve equity in access to diabetes technology.

Utilizing an Intersectional Approach to Examine Experiences of Hunger Among Adolescents During COVID-19: Considering Race/Ethnicity, Sexual Identity, and Employment Disparities in a Nationally Representative Sample.

This study examines correlates of experiences of hunger among adolescents in the United States (U.S) by the intersectionality of race/ethnicity with sociodemographic characteristics (gender, sexual identity, and adolescent/parent job loss) with the aim of identifying subgroups most at risk for hunger during the COVID-19 pandemic. This cross-sectional study uses nationally representative data from the Adolescent Behaviors and Experiences Survey (ABES) collected from January to June 2021. The analytic sample was high school students aged 14-17 with complete data (n = 6023). Descriptive statistics, bivariate, and multivariate logistic regression models were used to examine associations between sociodemographic factors and hunger (1-item measure) among adolescents during the pandemic for the analytic sample and stratified by race/ethnicity. The prevalence of hunger was 24.1% for the analytic sample and was highest among American Indian/Alaskan Native/Other Pacific Islander youth (37.2%), followed by non-Hispanic Black (31.8%) and Hispanic (28.4%) youth, and lowest among Non-Hispanic White youth (18.6%). In the analytic sample, there were significant differences in experiences of hunger by race/ethnicity, sexual identity, and adolescent/parent job loss during the pandemic (p < 0.05). When stratified by race/ethnicity, there were differential associations of hunger with sexual identity, and adolescent/parent job loss. These findings provide evidence of differential experiences of hunger during the pandemic among adolescents by sociodemographic factors. Results highlight the need for taking an intersectional approach when examining issues such as hunger. Future policies and programs should be mindful of factors associated with hunger and should prioritize using an equity-informed approach when engaging with multiply-marginalized adolescents.

Police killings of unarmed Black persons and suicides among Black youth in the US: A national time-series analysis

IntroductionSuicide deaths among Black youth in the US have increased rapidly over the past decade. Direct or vicarious racial trauma experienced through exposure to police brutality may underlie these concerning trends. MethodsWe obtained nationally aggregated monthly counts of suicides for non-Hispanic Black and White youth (age ≤ 24 years) and adults (age > 24 years) from the National Mortality Vital Statistics restricted-use data files provided by the Centers for Disease Control and Prevention, from 2013 to 2019. Monthly counts of Black youth suicides constituted our main outcome. We defined our exposure as the monthly counts of police killings of unarmed Black persons over 84 months (2013 to 2019), retrieved from the Mapping Police Violence database. We used ARIMA (AutoRegressive Integrated Moving Average) time-series analyses to examine whether Black youth suicides increased within 0 to 3 months following police killings of unarmed Black persons, controlling for autocorrelation and corresponding series of White youth suicides. ResultsSuicides among Black youth increase by ∼1 count three months following an increase in police killings of unarmed Black persons (exposure lag 0 coefficient = 0.16, p > 0.05; exposure lag 1 coefficient = −0.70, p > 0.05; exposure lag 2 coefficient = −0.54, p > 0.05; exposure lag 3 coefficient = 0.95, p < 0.05). The observed increase in suicides concentrates among Black male youth (exposure lag 3 coefficient = 0.88, p < 0.05).

Weight misperception and weight-related behaviors in non-Hispanic Black youth.

Current literature is conflicting regarding whether accurate weight perception encourages healthy weight-related behaviors. This study examined the prevalence of weight misperception and explored associations between weight misperception and weight-related behaviors among 353 Black adolescents in Broward County, Florida. Overall, 44.8% of participants misperceived their weight, with boys more often misperceiving their weight than girls (52.2% vs 40.2%). Students who misperceived their weight were more likely to try to lose weight but less likely to be adequately physically active. Adolescents who underestimated their weight were less likely to be physically active and excessively play video or computer games or use a computer. There was no association between weight misperception and daily physical education attendance or excessive television watching. Weight misperception appears to be a risk factor for obesity in adolescents, as weight misperception was associated with lower engagement in physical activity.

Trends in Substance-Related Visits Among Youth to US Children’s Hospitals, 2016–2021: An Analysis of the Pediatric Health Information System Database

PurposeThis study evaluates recent trends in substance-related visits among youth visiting children’s hospitals. MethodsWe conducted a cross-sectional study of substance-related visits to pediatric hospitals within the Pediatric Health Information System database of youth aged 12–21 years from 2016 through 2021. Substance-related visits were defined as acute visits for International Classification of Diseases, 10th Revision Clinical Modification codes related to substance ‘use’, dependence, or overdoses for alcohol, cannabis, nicotine, opioids, sedatives, stimulants, hallucinogens, or other substances. Cumulative growth rate and stratified substance-related trends were calculated using generalized estimating equations. Predicted number of visits during the COVID-19 pandemic was generated using an auto-regressive time series analysis. ResultsThere were 106,793 substance-related visits involving 84,632 youth. From 2016 to 2021, substance-related visits increased by 47.9% and increased across all ages, demographics, regions, and payors. Visits of Hispanic youth experienced the greatest percentage growth (63.3%, p < .05) when compared to Non-Hispanic (NH) White (46.2%) or NH Black (49.8%) youth. All substances except sedatives experienced an increase in growth in visits. Cannabis accounted for the largest percentage of visits (52.2%) and experienced the greatest percentage growth during the study period (82.4%, p < .001). During the pandemic, publicly insured, female, NH Black, and Hispanic youth experienced a greater-than-predicted number of substance-related visits. DiscussionSubstance-related visits to children’s hospitals are increasing for all demographics and nearly all substances. There were substantial increases in visits for most minoritized youth with a disproportionate rise among Hispanic youth. Visits over the pandemic were concentrated among publicly insured, female, NH Black, and Hispanic youth. Equitable large-scale investment is needed to address the rising morbidity of substance use among adolescents.

Community Partnership to Co-Develop an Intervention to Promote Equitable Uptake of the COVID-19 Vaccine Among Pediatric Populations

Community Partnership to Co-Develop an Intervention to Promote Equitable Uptake of the COVID-19 Vaccine Among Pediatric Populations

Projected impact of anti-obesity pharmacotherapy use on racial and ethnic disparities in adolescent obesity.

Paediatric obesity disproportionately impacts individuals from minoritized racial and ethnic backgrounds. Recent guidelines support use of anti-obesity pharmacotherapy for adolescents with obesity, but the potential impact on disparities in obesity prevalence has not been evaluated. To model changes in obesity prevalence with increasing utilization of anti-obesity pharmacotherapy among adolescents. Data representative of American adolescents ages 12-17 years were obtained from the National Health and Nutrition Examination Survey, cycles 2011 through pre-pandemic 2020. A body mass index (BMI) reduction of 16.7% was applied to each participant based on clinical trial results of weekly subcutaneous semaglutide 2.4 mg among adolescents. Utilization disparities were based on utilization of the same medication class among adults. Obesity prevalence was calculated assuming utilization of 10%-100%, stratified by race and ethnicity. Among 4442 adolescents representing 26 247 384 American adolescents, projected overall obesity prevalence decreased from 22.2% to 8.4% with 100% utilization. However, disparities increased relative to Non-Hispanic White youth, with prevalence among Non-Hispanic Black and Mexican American youth ranging from 40%-60% higher to 90%-120% higher, respectively. Increasing utilization of anti-obesity pharmacotherapy may widen relative disparities in obesity, particularly if utilization is unequal. Advocacy for equitable access is needed to minimize worsening of obesity-related disparities.

Trends in youth opinions about police agencies in the United States, 2017–2021

IntroductionAs civil unrest about policing in the United States (US) continue, research on changing opinions about police agencies is needed, especially among younger populations. These opinions may be associated with distress and other health outcomes that come with public health implications. MethodsWe aggregated and used yearly 2017 to 2021 data on 12th-grade youth living in the US from the Monitoring the Future cross-sectional study (n = 7132). We categorized opinions about police agency job performance into 1) very poor/poor (hereafter: poor), 2) fair/good/very good, and 3) no opinion. To examine trends in policy agency opinions over time, we conducted logistic regression between year and opinions, adjusted for age, sex, and race and ethnicity, and included a two-way interaction between year and race and ethnicity to determine differences across racial and ethnic groups by year. ResultsFrom 2017 to 2020, the proportion of youth who believed police did a poor job remained constant. However, from 2020 to 2021, this proportion increased from 24.4% to 50.0%. Results from regression models showed that year 2021 (vs. 2017) was associated with nearly three times higher odds of perceiving police agencies do a poor job (OR: 2.90, 95% CI: 1.87–4.52). The interaction between year and race and ethnicity indicated that each racial and ethnic group in 2021 had higher odds of perceiving police agencies do a poor job compared to 2017, with associations strongest for non-Hispanic Black (OR: 6.46, 95% CI: 3.74–11.18) and non-Hispanic multiracial (OR: 7.38, 95% CI: 2.99–18.25) youth. ConclusionsNegative opinions about police agencies increased from 2017 to 2021, and differences were observed by race and ethnicity. Shifting youth views about police agencies in the US reflect the greater social context of the period, with potential implications for public health.

Abstract 17035: Relationship Between Neighborhood Level Deprivation and Blood Pressure Among 122,177 Adolescents, Analysis of PEDSnet Data

Introduction: Hypertension (HTN) begins in youth and accounts for ~80% of the cardiovascular disease burden in the US. Socio/environmental factors are critical, and greater knowledge of the relationship between neighborhood level deprivation and blood pressure (BP) in youth is needed. Hypothesis: We hypothesized that greater neighborhood deprivation is associated with intermediate/poor BP status in adolescents even after adjusting for other factors. Methods: Data from 2009 to 2019 were extracted from PEDSnet (a PCORI-funded aggregate of pediatric health data). We modeled the relationship between BP and neighborhood deprivation based on national Area Deprivation index (ADI; scaled 1-100) tertiles (ADI&lt;25=best/low, 25-52, &gt; 52=worst/high). The BP status of each youth was coded as good (BP score: 80-100) or intermediate/poor (BP score: 0-80) where BP score=100 if median BP &lt;120/80mmHg and score=75 if median BP 120-129/&lt;80mmHg. Analyses were carried out using SAS 9.4 with p&lt;0.05 considered significant. The outcome of interest was poor/intermediate BP score. Results: Data from 122,177 youth, 13-17 years of age were analyzed. 51% were female, 58% were non-Hispanic white, and 22% non-Hispanic Black. 24% lived in neighborhoods with ADI &lt;25; 35% lived in neighborhoods with ADI &gt; 52. In a multivariate logistic model, ADI &gt; 52 was associated with a 49% greater odds of intermediate/poor BP score. Due to significant interactions between ethnicity-race and ADI, compared to non-Hispanic Black youth, non-Hispanic White and Other youth had lower odds of intermediate/poor BP score by univariate analysis, but greater odds in the full model (Table). Female sex was associated with lower odds of HTN. The model’s goodness of fit was strong with a ROC, AUC of 0.73 (Figure). Conclusions: Higher neighborhood deprivation is associated with greater odds of hypertension in adolescents. Greater emphasis on measures to mitigate this risk are needed.

Racial and Ethnic Disparities in Mental Health Problems and Tobacco and Cannabis Use Among US Emerging Adults.

Mental health problems in emerging adulthood are linked to tobacco and cannabis use, but whether race and ethnicity modifies these associations is unclear. We used data from wave 4 of the Population Assessment of Tobacco and Health Study (youth n = 6898, young adult n = 10,304) to conduct latent class analysis (LCA) of six past 30-day tobacco and cannabis use indicators (i.e., cigarettes, electronic nicotine delivery systems (ENDS), cigars, blunts, cannabis vaping, other cannabis). We estimated associations between past 30-day internalizing and externalizing (i.e., low (referent), moderate, high) problems and latent classes of tobacco/cannabis use (vs. never/former use) using adjusted multinomial logistic regression. We explored whether associations varied by race and ethnicity through stratification. We identified four exclusive use latent classes and two dual/poly use latent classes for both youth and young adult samples. Race/ethnicity-stratified models identified associations between internalizing/externalizing problems and most use classes for Hispanic and non-Hispanic White youth/young adults, with mixed results for non-Hispanic Black youth/young adults. For example, Hispanic (OR: 2.50, 95% CI: 1.09-5.74) and non-Hispanic White (OR: 1.90, 95% CI: 1.18-3.06) youth with high internalizing problems had higher odds of ENDS + cannabis vaping. Externalizing problems were not associated with use among non-Hispanic Black youth while internalizing problems were not associated with use among non-Hispanic Black young adults. We observed racial/ethnic variation in mental health problems and tobacco and cannabis use. Understanding mental health problem and tobacco product and cannabis use comorbidity may better inform culturally relevant interventions aimed to prevent and reduce use.

Disparities in Youth Arrest Across Racial and Ethnic Subgroups

An extensive body of research suggests that youth of color are more likely to experience an arrest than their White counterparts. Theoretically, these findings have been understood, at least in part, as the result of the differential deployment of law enforcement to areas with higher Black and Hispanic concentrations as well as stereotyped attributions of dangerousness and threat implicitly assigned to these suspects by police before and during encounters. However, previous studies typically have employed conventional racial/ethnic categorizations, which might obscure potential nuances in arrest disparities across subgroups. Using data on a statewide representative sample of adolescents from the 2018 Florida Youth Substance Abuse Survey ( N = 54,611), these analyses reveal that the likelihood of a self-reported arrest is greatest among Haitian, West Indian/Caribbean, Dominican, and non-Hispanic Black youth. Further, Mexican and Puerto Rican adolescents have a higher risk of experiencing an arrest than members of other Hispanic subgroups.

1145-P: Hybrid Closed-Loop (HCL) Technology Improves Glycemic Control among Historically Marginalized Youth with Type 1 Diabetes (T1D)

Background: Non-Hispanic Black (NHB) youth with T1D are more likely to have suboptimal glycemic control and less likely to use HCL systems or to be included in clinical trials. We evaluated changes in glycemic control with use of Tandem t:slim X2 insulin pump with Control-IQ technology in this historically underrepresented population in T1D research. Methods: This prospective non-randomized pilot study enrolled 15 pump naïve, publicly insured, NHB youth (Mage 14.6 ± 3.7) with T1D and A1c ≥10% in a 6 month trial of HCL use. Changes in A1c (n=13) and CGM-measured glycemia at baseline versus the final 90 days of the study for those with &amp;lt;70% wear time (n=12) were assessed using paired t-tests and Wilcoxon signed rank tests. Results: Thirteen participants (87%) completed the study; one was removed after 2 episodes of diabetic ketoacidosis (DKA) and the other for protocol non-adherence. A1c decreased from 11.7±1.3% to 9.6±1.6% (p=0.001). Average sensor glucose decreased from 281±53 to 225±30 mg/dL and time in range (TIR) increased by 4.5±8.5 hours/day from 18.5±15.0% to 37.1±10.3% (p=0.007). Time above range (TAR) &amp;lt;180 mg/dL decreased by 4.6±4.5 hours/day from 81.3±15.4% to 62.0±10.3% (p=0.007). There were no changes in time below range &amp;lt;70 mg/dL (p=0.72). DKA did not increase (0.67 episodes/person-year pre-enrollment vs 0.58 episodes/person-year during study intervention). Conclusions: Tandem t:slim X2 insulin pump with Control-IQ technology use in NHB youth with suboptimal T1D control was associated with improvements in average glucose, TIR, and TAR. The theoretical risk for increased risk of DKA is frequently cited as a barrier to HCL use in this population, however there was no increase in rates of DKA during the study period. These glycemic improvements without increased risk emphasize the importance of supporting equitable access to diabetes technology among all people with T1D. Disclosure B.E.Marks: Research Support; Tandem Diabetes Care, Inc., Dexcom, Inc., Medtronic. J.Grundman: Research Support; American Diabetes Association, Dexcom, Inc. S.Meighan: Speaker's Bureau; Dexcom, Inc. M.Monaghan: Employee; National Institute of Diabetes and Digestive and Kidney Diseases, Research Support; American Diabetes Association. R.Streisand: None. A.G.Perkins: Research Support; Tandem Diabetes Care, Inc., Dexcom, Inc. Funding National Institutes of Health (K23DK129827); Tandem Diabetes Care, Inc. (TDC20210226); Dexcom, Inc.

1091-P: Genetic Ancestry Influences Metformin Treatment Response in Youth with Type 2 Diabetes

In youth with type 2 diabetes (T2D), glycemic response to metformin varies by racial and ethnic group. In the Treatment Options for Type 2 Diabetes in Adolescents and Youth (TODAY) study metformin failure rates were lower in non-Hispanic White (NHW) youth by self-report compared with non-Hispanic Black (NHB) and Hispanic youth. Understanding and addressing the mechanisms for differences in response are critical to reducing health disparities. We aimed to examine the association between genetic ancestry and risk for metformin treatment failure and evaluate whether individual global ancestry proportions predict metformin response in TODAY participants. Global ancestry proportions were estimated using FastStructure. Cox-proportional hazards analysis with genetic ancestry as a covariate was performed with the primary outcome the need for insulin or A1C ≥ 8%. Age, sex, BMI Z score, baseline A1C, and treatment arms were the other covariates. After quality control, 506 participants of mean age 14±2 y, 65% female, mean BMI Z score 2.2±0.5 kg/m2 and mean baseline A1C 6.0±0.7% were analyzed. Similar to by self-report, when stratified by genetic ancestry NHB youth had significantly higher treatment failure rates compared with other groups (P=0.02). The proportion of European ancestry in self-reported ethnic strata of admixed participants was associated with improved metformin response in the NHB (n=185) and Hispanic (n=208) groups (HR 0.4, 95% CI 0.16-0.98, P=0.04). Proportion of Native American ancestry was associated with worse response (HR 1.5, 95% CI 1.02-2.2, P=0.04) across all participants and associations with proportion African ancestry were not significant. In sum, genetic ancestry influences metformin response with greater proportion of European and Native American ancestry associated with improved and worse glycemic response respectively in TODAY. These differences could be related to biological, social or cultural factors and should be examined to reduce health disparities in T2D. Disclosure S.Srinivasan: None. T.I.Pollin: None. A.Manning: None. J.C.Florez: Consultant; AstraZeneca, Novo Nordisk, Other Relationship; AstraZeneca, Merck &amp; Co., Inc. L.Chen: None. M.M.Kelsey: Other Relationship; Boehringer Ingelheim Inc., Janssen Pharmaceuticals, Inc., Rhythm Pharmaceuticals, Inc., Lilly. J.Todd: None. S.A.Arslanian: Advisory Panel; Novo Nordisk, Eli Lilly and Company, Consultant; Société des Produits Nestlé SA,, Other Relationship; Eli Lilly and Company, AstraZeneca, Research Support; Novo Nordisk, Eli Lilly and Company. N.T.Chang: None. L.M.Laffel: Advisory Panel; Medtronic, Lilly Diabetes, Novo Nordisk, Vertex Pharmaceuticals Incorporated, Roche Diagnostics, Provention Bio, Inc., Consultant; Dexcom, Inc., Janssen Pharmaceuticals, Inc., Medscape. L.L.Levitsky: None. J.E.Sprague: Research Support; Eli Lilly and Company, Rhythm Pharmaceuticals, Inc. Funding National Institutes of Health (K23DK120932)

1137-P: Improvements in Diabetes-Related Quality of Life (DRQL) and Emotional Distress with Hybrid Closed-Loop (HCL) Technology in Marginalized Families with Suboptimally Controlled Type 1 Diabetes (T1D)

Background: Prior HCL studies enrolling participants with well-controlled T1D and limited financial, racial-ethnic, and socioeconomic diversity have shown limited success in improving patient-reported outcomes (PROs). We evaluated changes in PROs among marginalized youth with T1D and their parents after 6 months of Tandem t:slim X2 insulin pump with Control-IQ technology use. Methods: This non-randomized 6-month pilot study enrolled 15 publicly insured, non-Hispanic Black (NHB) youth with T1D and hemoglobin A1c (HbA1c) ≥10% (Mage 14.6 ± 3.7 yrs, MT1Dduration 8.5 ± 4.8 yrs, MA1c11.9±1.4%). Youth and parent PROs at baseline and 6-months were compared using paired t-tests. The following constructs were assessed using validated PROs: DRQL using T1D and Life (T1DAL), emotional distress using Problem Areas in Diabetes (PAID), positive expectancy of technology using INSPIRE, and self-management behaviors using Diabetes Management Questionnaire (DMQ). Results: Thirteen participants completed the study. HbA1c decreased from 11.7±1.3% to 9.6±1.6% over 6 months (p=0.001). TIDAL scores increased among parents and youth (p-T1DAL +7.1 to 70±13, p=0.01; y-T1DAL +8 to 69±12, p=0.03). PAID scores decreased among parents and youth (p-PAID -25 to 43±30, p=0.01; y-PAID -19.4 to 23±19, p=0.02). There were no changes in parent or child INSPIRE (p=0.23, p=0.88) or DMQ scores (p=0.44, p=0.16). Conclusions: Six months of Tandem t:slim X2 insulin pump with Control-IQ technology in marginalized youth with T1D improved HbA1c, DRQL, and diabetes-related distress among parents and youth despite no change in diabetes self-management behaviors or decrease in positive expectancy of HCL. Including diverse populations in T1D research and supporting equal access to HCL technology for all people with T1D may demonstrate psychosocial benefits with no additional burden for youth and their parents. Disclosure A.G.Perkins: Research Support; Tandem Diabetes Care, Inc., Dexcom, Inc. J.Grundman: Research Support; American Diabetes Association, Dexcom, Inc. S.Meighan: Speaker's Bureau; Dexcom, Inc. M.Monaghan: Employee; National Institute of Diabetes and Digestive and Kidney Diseases, Research Support; American Diabetes Association. R.Streisand: None. B.E.Marks: Research Support; Tandem Diabetes Care, Inc., Dexcom, Inc., Medtronic. Funding Tandem Diabetes Care, Inc. (TDC20210226); National Institutes of Health (K23DK129827); Dexcom, Inc.

Differences in positive expectancy of hybrid closed loop (HCL) insulin delivery systems do not explain racial differences in HCL use

AimsHybrid closed loop (HCL) insulin delivery systems improve glycemia and quality of life among youth with type 1 diabetes (T1D), however there are inequities in use. We aimed to evaluate whether differences in positive expectancy of HCL systems may explain differences in use. MethodsFifteen publicly-insured, non-Hispanic Black (NHB) youth with hemoglobin A1C (HbA1c) ≥ 10% enrolled in a study exploring changes in glycemia and person reported outcomes (PRO) during 6 months of Tandem t:slim X2 insulin pump with Control-IQ technology. At baseline youth and parents completed PROs, including Insulin Delivery Systems: Perceptions, Ideas, Reflections and Expectations (INSPIRE) survey assessing positive expectancy of HCL use, and Problem Areas in Diabetes (PAID) survey assessing diabetes-related distress. Differences between this cohort and the Tandem Control-IQ pediatric pivotal trial (DCLP5) cohort were assessed. ResultsAs compared to the DCLP5 cohort (0% NHB, 10% publicly-insured), baseline glycemic indicators were suboptimal (MHbA1c 11.9 ± 1.4% vs 7.6 ± 0.9%, p < 0.0001; continuous glucose monitor (CGM) time-above-range > 180 mg/dL 82 ± 15% vs 45 ± 18%, p < 0.0001). INSPIRE scores in both cohorts were equally high among youth (80 ± 10 vs 77 ± 13, p = 0.41) and parents (88 ± 14 vs 85 ± 11, p = 0.37). PAID scores were higher among parents (68 ± 19 vs 43 ± 16, p < 0.0001), but not youth (43 ± 16 vs 35 ± 16, p = 0.09) in the historically marginalized cohort as compared to the DCLP5 cohort. ConclusionsDespite differences in glycemic control and diabetes related burden, positive expectancy of HCL systems is comparable among historically marginalized youth with T1D and the predominantly non-Hispanic White, privately insured DCLP5 cohort. These findings suggest that differences in perceptions of HCL technology may not explain inequities in use.

Differential Item Functioning in Reports of Delinquent Behavior Between Black and White Youth: Evidence of Measurement Bias in Self-Reports of Arrest in the Adolescent Brain Cognitive Development Study.

Youth self-reports are a mainstay of delinquency assessment; however, making valid inferences about delinquency using these assessments requires equivalent measurement across groups of theoretical interest. We examined whether a brief 10-item delinquency measure exhibited measurement invariance across non-Hispanic White (n = 6,064) and Black (n = 1,666) youth (ages 10-11 years old) in the Adolescent Brain Cognitive Developmentsm Study (ABCD Study®). We detected differential item functioning (DIF) in two items. Black youth were more likely to report being arrested or picked up by police than White youth with the same score on the latent delinquency trait. Although multiple covariates (income, urgency, and callous-unemotional traits) reduced mean-level difference in overall delinquency, they were generally unrelated to the DIF in the Arrest item. However, the DIF in the Arrest item was reduced in size and no longer significant after adjusting for neighborhood safety. Results illustrate the importance of considering measurement invariance when using self-reported delinquency scores to draw inferences about group differences, and the utility of measurement invariance analyses for helping to identify mechanisms that contribute to group differences generally.

Negative affect and loss-of-control eating in relation to adiposity among non-Hispanic youth identifying as black or white

Negative affect and loss-of-control (LOC)-eating are consistently linked and prevalent among youth identifying as non-Hispanic Black (NHB) and non-Hispanic White (NHW), particularly those with high weight. Given health disparities in high weight and associated cardiometabolic health concerns among NHB youth, elucidating how the association of negative affect with adiposity may vary by racial/ethnic group, and whether that relationship is impacted by LOC-eating, is warranted. Social inequities and related stressors are associated with negative affect among NHB youth, which may place this group at increased risk for excess weight gain. Across multiple aggregated protocols, 651 youth (13.0 ± 2.7 y; 65.9 % girls, 40.7 % NHB; 1.0 ± 1.1 BMIz; 37.6 % LOC-eating) self-reported trait anxiety and depressive symptoms as facets of negative affect. LOC-eating was assessed by interview and adiposity was measured objectively. Cross-sectional moderated mediation models predicted adiposity from ethno-racial identification (NHB, NHW) through the pathway of anxiety or depressive symptoms and examined whether LOC-eating influenced the strength of the pathway, adjusting for SES, age, height, and sex. The association between ethno-racial identity and adiposity was partially mediated by both anxiety (95 % CI = [0.01, 0.05]) and depressive symptoms (95 % CI = [0.02, 0.08]), but the mediation was not moderated by LOC-eating for either anxiety (95 % CI = [−0.04, 0.003]) or depressive symptoms (95 % CI = [−0.07, 0.03]). Mechanisms underlying the link between negative affect and adiposity among NHB youth, such as stress from discrimination and stress-related inflammation, should be explored. These data highlight the need to study impacts of social inequities on psychosocial and health outcomes.

Healthcare Provider Screening for Tobacco Product and Electronic Cigarette Use Among Youth in the United States

PurposeHealthcare providers play a critical role in curbing youth tobacco use through screening and counseling. Current rates of tobacco use screening by healthcare providers among US youth are unknown. MethodsWe used 2020 National Youth Tobacco Survey data to examine the prevalence of healthcare provider screening for tobacco and e-cigarette use among US youth. Using multivariable logistic regression, we examined the factors associated with being screened for tobacco use. ResultsOf 13,434 individuals who reported past 12-month visits to any healthcare professional, 47.5% (44.8%–50.1%) reported being screened for any tobacco use, while 31.5% (29.2%–40.0%) reported e-cigarette–specific screening. The odds of tobacco use screening were lower among males (odds ratio [OR]: 0.81 [0.73–0.89]) and middle schoolers (OR: 0.39 [0.33–0.44]) compared to females and high schoolers, respectively. In addition, non-Hispanic Black (OR: 0.71 [0.56–0.89]), Hispanic (OR: 0.76 [0.63–0.92]), and Asian youth (OR: 0.48 [0.37–0.63]) had lower odds of being screened than non-Hispanic White youth. DiscussionThere are missed opportunities in tobacco screening by healthcare providers, particularly among males, middle schoolers, and racial/ethnic minority youth.