non-Hispanic White Americans Research Articles

B cell immune repertoire sequencing in tobacco cigarette smoking, vaping, and chronic obstructive pulmonary disease in the COPDGene cohort.

Cigarette smoking (CS) impairs B cell function and antibody production, increasing infection risk. The impact of e-cigarette use ('vaping') and combined CS and vaping ('dual-use') on B cell activity is unclear. To examine B cell receptor sequencing (BCR-seq) profiles associated with CS, vaping, dual-use, COPD-related outcomes, and demographic factors. BCR-seq was performed on blood RNA samples from 234 participants in the COPDGene study. We assessed multivariable associations of B cell function measures (immunoglobulin heavy chain (IGH) subclass expression and usage, class-switching, V-segment usage, and clonal expansion) with CS, vaping, dual-use, COPD severity, age, sex, and race. We adjusted for multiple comparisons using the Benjamini-Hochberg method, identifying significant associations at 5% FDR and suggestive associations at 10% FDR. Among 234 non-Hispanic white (NHW) and African American (AA) participants, CS and dual-use were significantly positively associated with increased secretory IgA production, with dual-use showing the strongest associations. Dual-use was positively associated with class switching and B cell clonal expansion, indicating increased B cell activation, with similar trends in those only smoking or only vaping. We observed significant associations between race and IgG antibody usage. AA participants had higher IgG subclass proportions and lower IgM usage compared to NHW participants. CS and vaping additively enhance B cell activation, most notably in dual-users. Self-reported race was strongly associated with IgG isotype usage. These findings highlight associations between B cell activation and antibody transcription, suggesting potential differences in immune and vaccine responses linked to CS, vaping, and race.

Differential Item Functioning and Clinical Utility of the Subjective Memory Complaints Questionnaire in a Multi-Ethnic Cohort

Introduction: This study evaluated the psychometric properties of the Subjective Memory Complaints Questionnaire (SMCQ) in a non-Hispanic White (NHW) and Mexican American (MA) sample from Texas in the USA. Methods: Data were obtained from the Health and Aging Brain Study – Health Disparities (HABS-HD; N = 1,691, age = 66.5 ± 8.7, education = 12.4 ± 4.8, 60.6% female, 33.2% MA Spanish speaking). Unidimensionality of the SMCQ was evaluated with confirmatory factor analysis. Differential item functioning (DIF) of the SMCQ was assessed across age, sex, education, and ethnicity/language using item response theory/logistic ordinal regression. Associations of the SMCQ in relation to cognitive status, Alzheimer’s disease (AD) blood-based biomarkers, and psychological distress were examined. Results: The SMCQ showed excellent fit in a single-factor model (CFI = 0.97, TLI = 0.97, RMSEA [95% CI] = 0.05 [0.04, 0.05], SRMR = 0.07). Significant item-level DIF was detected by education level and ethnicity/language, but not by age or sex; when detected, DIF was not salient (i.e., adverse). The SMCQ was associated with greater psychological distress, worse Clinical Dementia Rating scores, and greater disease burden as measured by total tau and neurofilament light. Conclusions: Practically negligible item-level bias was identified across education and ethnicity/language. Detected DIF can be described as benign, indicating that some items manifested differently between groups but had minimal impact on measurement properties. These results demonstrate that the SMCQ performs appropriately across demographic variables. Our findings also provide support for the associations of SMCQ scores with self-reported mood, cognitive status, and AD blood-based biomarkers.

Abstract C092: Transcriptome analysis of human endogenous retroviral elements in tumor microenvironment of prostate cancer patients of different ancestry

Abstract Background: Prostate cancer (PCa) poses unique challenges for Non-Hispanic Black Americans (BA), who often face poorer outcomes than Non-Hispanic White Americans (WA). Even after adjusting for socioeconomic factors, BAs are diagnosed younger and experience more severe clinical effects, potentially due to the tumor microenvironment. Within PCa, Endogenous Retroviruses (ERVs) have been shown to regulate immune response genes and have prognostic value in PCa. Despite constituting 8% of the human, ERVs' role in the tumor microenvironment remains incompletely understood. These findings highlight the need to target microenvironment dysregulation in solid tumor therapies, especially for ERV expression in prostate cancer. Methods: Using RNA-sequencing, we investigated the expression of ERVs in BA (n=18) and WA (n=14) tumor adjacent stroma (TAS) samples. We analyzed reads by mapping them to the human genome (hg38). We then used bedtools and data from the Human Endogenous Retrovirus database (HERVd) to calculate the number of reads at each ERV locus (n=519,060). Differentially expressed ERV elements were then identified in an Audic Claverie Test (fold- change cutoff of 2 and padj < 0.05). The expression of protein-coding genes in the same BA (n=18) and WA (n=14) TAS samples was investigated using RNA-sequencing. Regulation of significant ERV elements were compared to the regulation of nearby immune response genes between the two races. We developed primary stroma (carcinoma associated fibroblast, CAFs) culture of different races with PCa using fresh prostatectomy tissues. To investigate the biological functions of ERVs in CAFs, we developed FANA oligonucleotides (synthetic single- stranded nucleic acid analogs that can modulate gene expression by enzymatic degradation of a target RNA) and corresponding primers to knock down specific ERV sequences near key immune response genes in prostate cancer. Results: We examined 32 prostatectomy specimens of BA (n=18) and WA (n=14) PCa. Of the 5,786 statistically significant differentially expressed ERV elements between BA and WA TAS that were identified, 3,274 elements had an increase in ERV expression for BA TAS, and 2,512 elements had a decrease in ERV expression for BA TAS. 61 MER41 elements were found to be differentially expressed between the two races. The MER family sequences contain binding sites for transcription factors that are crucial in cancer, such as STAT1. This transcription factor can regulate genes involved in cell proliferation, apoptosis, and DNA repair. MER41 is in close proximity (within 5000 base pairs) to IFNA6, an immune response gene. We found both MER41 and IFNA6 to be downregulated in BA TAS, as compared to their WA counterparts. We developed FANA oligonucleotides to knockdown MER41E, MER61-Int, HERVL-Int, MLT1A, and LTR61E1 to investigate their effect on nearby gene expression. Conclusion: The CAF models from PCa patients of different races can be used to explore the biological function of ERV inactivation on anti-tumor immune response genes within the tumor microenvironment. Citation Format: Tara S. K. Jennings, Vinay Kumar, Anton N. Nguyen, Michael M. Ittmann, Patricia Castro, Farah Rahmatpanah. Transcriptome analysis of human endogenous retroviral elements in tumor microenvironment of prostate cancer patients of different ancestry [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr C092.

Abstract A133: The Church Study: Bridging the gap in colorectal cancer screening of Black patients

Abstract Introduction: Colorectal cancer (CRC) is the second leading cause of cancer death in the US, disproportionately affecting Black Americans with a 25% higher risk and 40% greater mortality than non-Hispanic White Americans. Data on CRC screening preferences among Black patients is limited. We conducted a survey to evaluate CRC screening preferences and barriers to screening after a culturally tailored educational talk among Black churchgoers. Aim: The aim of this study is to assess the preferences and barriers to CRC screening among Black Americans, utilizing culturally tailored educational interventions to enhance screening uptake. Methods: Participants aged 45-85, at average CRC risk, were recruited from three predominantly Black churches in disadvantaged areas of Atlanta, excluding high-risk individuals and those outside the age range. CRC education, vetted for cultural sensitivity, was provided. Informed consent was waived by Morehouse IRB but ensured through educational sessions with opportunities for questions. A 30-question survey covered Demographics, Medical History, Screening Experience, and Preferences. Participants received a $25 Amazon gift card post-survey. Descriptive statistics were applied to demographics and CRC screening preferences, categorized per NCCN guidelines. Results: Out of 101 participants, 64% preferred blood-based screenings and 19% preferred fecal-based testing. Over 73% reported being up-to-date with CRC screening, with more than 61% having a colonoscopy as their most recent CRC screening test. Additionally, 30% of participants were willing to be CRC awareness advocates. Healthcare provider access was high, with 94% reporting having a primary care provider. Trust in providers was approximately 92%, with 4% expressing distrust and 4% uncertain. Conclusions: Despite being in underserved areas, participants reported no significant barriers to CRC screening, with most up-to-date on prevention. Their active participation and willingness to advocate underscore the effectiveness of church settings in health education for Black communities. Preferences for blood-based screenings indicate openness to less invasive options, highlighting the need for tailored interventions. High trust in healthcare providers challenges the narrative of mistrust among African Americans, demonstrating that culturally sensitive, community-focused engagement enhances preventive health participation. The willingness of 30% to become CRC awareness advocates demonstrates strong potential for community-driven health initiatives. Citation Format: Toni M. Jackson, John Onyekaba, Kingsley K. Njoku, Ankita Shah, Carrie Smith, Chima Amadi, Kapil Chandora, Daniela Ortegasantori, Hafsa Gundroo, Temitope Tobun, Daniel Hommes, Julia Liu. The Church Study: Bridging the gap in colorectal cancer screening of Black patients [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr A133.

Abstract A011: PVT1 risk variant rs127920247 for colorectal cancer is shared by African American and Hispanic colorectal cancer patients

Abstract Background: Colorectal cancer, one of the most lethal and prevalent cancers across the world, is in large part due to genetic mutations. The plasmacytoma variant translocation 1 (PVT1) gene has an established association with many cancers, including colorectal cancer. There is increasingly abundant data on the mechanisms of action of PVT1 leading to the initiation and progression of these cancers. Identifying PVT1 variants linked to cancer may lead to uncovering their utility as diagnostic or prognostic biomarkers. The All of Us Research hub contains a diverse set of data from hundreds of thousands of participants. Stratifying and comparing risk variants across racial and ethnic demographics may provide insight into disparities underlying disparate incidence of colorectal cancer amongst minoritized and medically underserved communities. The All of Us database provides a novel opportunity to study PVT1 variation in a large cohort of patients from racial backgrounds with demonstrated greater incidence, prevalence, and worse outcomes from colorectal cancer. Methods: We conducted a retrospective cohort study of patients in the All of Us Research hub. The cohort studied comprised 930 patients ranging in age from 18 to 70 years with colorectal cancer, and no additional cancer diagnosis noted. Racial and ethnic backgrounds were selected if there were at least 100 patients of identified background with colorectal cancer. These consisted of patients of: African American, non-Hispanic white, and Hispanic backgrounds. We extracted data from short-read whole genome sequencing. A filtered matrix was built comparing the genetic sequence of our cohort of cancer patients to the reference genome GRCh38. We then stratified the different variants by allelic frequency across the sample cohort to report the variants with the greatest frequencies. All analyses were conducted using Python on Jupyter Notebook in the All of Us Research platform. Results: The top 5 PVT1 variants with the greatest frequency in patients of the three chosen racial and ethnic backgrounds were identified and compared to find commonalities. Rs127920247 was a PVT1 risk variant shared by African American and Hispanic patients as the 2nd highest risk variant for both. The most frequent risk variants for each group is as follows: Rs128085054 for African Americans, Rs128139524 for Non-Hispanic White Americans, and Rs127870242 for Hispanic Americans. Conclusion: PVT1 risk variants in colorectal cancer can be uncovered from data in the All of Us Research hub. Thus, genetic risk variants for cancers can be uncovered from analysis of data available in the All of Us Research hub. Identification of specific PVT1 variants similarly prevalent in colorectal cancer amongst distinct racial and ethnic communities is a significant first step towards developing them as potential diagnostic or prognostic tools. Citation Format: Sujay Singh, Olorunseun Ogunwobi. PVT1 risk variant rs127920247 for colorectal cancer is shared by African American and Hispanic colorectal cancer patients [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr A011.

Racial and Ethnic Differences in the Prevalence of Severe Aortic Stenosis by Echocardiography.

Understanding the burden of aortic stenosis (AS) across diverse racial and ethnic populations is important to ensure equitable resource allocation. This study explored whether severe AS rate varies by race and ethnicity. The rates of severe AS, stratified by race and ethnicity, were calculated among 615,038 adults with a transthoracic echocardiogram. Logistic regression analysis was performed to identify factors associated with severe AS. Severe AS rates ranged from 0.08% in adults < 50 years old to 3.8% in those ≥ 90 years old. Compared to non-Hispanic White and Asian American [adjusted odds ratio (aOR) = 0.47, 95% confidence interval (CI): 0.42-0.53] and non-Hispanic Black (aOR = 0.44, 95% CI: 0.39-0.50) patients were less likely to have severe AS, whereas Hispanic patients (aOR = 0.91, 95% CI: 0.87-0.98) had near similar likelihood. Age was the strongest risk factor for severe AS (compared to age < 50 years, aOR = 21.8, 95% CI: 17.8-26.6 for age 80-89 years, and aOR = 43.8, 95% 35.5-54.0 for age ≥ 90 years). Additional factors associated with severe AS included male sex (aOR = 1.38, 95% CI: 1.30-1.46) and diabetes (aOR = 1.23, 95% CI: 1.15-1.31). Asian American and non-Hispanic Black adults had lower rates of severe AS compared to White and Hispanic patients. The rate of severe AS progressively increases with age in all racial and ethnic groups, with higher rates in men compared with women. With a demographic shift toward an aging and more diverse population, the burden of AS is anticipated to rise. Ensuring adequate allocation of resources to meet the evolving needs of a diverse population remains a shared health care imperative.

Racial and ethnic composition of peer recovery community members and barriers to acquiring funding for organizations in the ecosystem of recovery

IntroductionOrganizations in the “ecosystem of recovery”—most often non-profits led and staffed by individuals with lived substance use disorder (SUD) experience—offer peer services, group counseling, and a wide variety of programs to help those struggling with SUD. The efforts of such organizations are effective in transitioning those suffering from SUD into long-term recovery. Despite well-established evidence depicting inequitable access to SUD treatment between BIPOC and non-Hispanic White Americans, there has been no empirical undertaking of whether organizations in the ecosystem of recovery face barriers to fund their operations based on the racial and ethnic composition of their community members. MethodsIn this 2022 needs assessment, “Optimizing Recovery Funding,” we combined the results of quantitative and qualitative data for a mixed methods analytic approach. The study employs bivariate descriptive statistics and inferences along with thematic analyses. From an initial list of 537 organizations across U.S. states and territories, 145 leaders of these organizations comprise our survey analytic sample. A total of 85 leaders participated in one of 16 focus groups, with 10 based on geography and 6 based on population identity. This needs assessment produced comprehensive data on the operations of organizations in the ecosystem of recovery. ResultsA lack of training and existing organizational funding, as well as non-inclusive language in funding requests for proposals contributed to some organizations' decisions not to pursue certain grants and funding mechanisms. There were no statistical differences in applying for, nor success in receiving, federal and state funding between organizations serving predominantly BIPOC community members and those serving mostly non-Hispanic White community members. However, there were key instances of—at times inexplicable—inequity in funding outcomes. ConclusionsAll leaders of organizations in the ecosystem of recovery who participated in the needs assessment made it clear that there are fundamental issues to accessing peer recovery operational and programmatic funding. Innovative strategies for developing inclusive and culturally responsive funding approaches that prioritize organizations predominantly serving historically marginalized communities are needed.

Changes in mortality due to Chronic Liver Diseases (CLD) during the COVID-19 pandemic: Data from the United States' National Vital Statistics System.

We assessed chronic liver disease (CLD)-related mortality in the U.S. using death data (2011-2021) obtained from National Vital Statistics System (NVSS). The average annual percentage change (AAPC) from the models selected by Joinpoint regression analysis over the pre-pandemic (2011-2019) and the 2019-2021 were reported because non-linear trend in death rates were observed over the 2011-2021. Liver-specific death was defined as an underlying cause of death and Chronic liver disease (CLD)-related death was defined as any cause of death. During the pre-pandemic, age-standardized HCC- and cirrhosis-specific death rates were annually increased by AAPC = +1.18% (95% confidence interval, 0.34% to 2.03%) and AAPC = +1.95% (1.56% to 2.35%). In contrast, during the 2019-2021, the AAPC in age-standardized cirrhosis-specific death rate (per 100,000) accelerated by up to AAPC +11.25% (15.23 in 2019 to 18.86 in 2021) whereas that in age-standardized HCC-specific death rate slowed to -0.39 (-1.32% to 0.54%) (3.86 in 2019 to 3.84 in 2021). Compared to HCC-specific deaths, cirrhosis-specific deaths were more likely to be non-Hispanic white (72.4% vs. 62.0%) and non-Hispanic American Indian and Alaska native (AIAN) (2.2% vs. 1.1%) and have NAFLD (45.3% vs. 12.5%) and ALD (27.6% vs. 22.0%). During the 2019-2021, the age-standardized HCV- and HBV-related death rate stabilized, whereas the age-standardized NAFLD- and ALD-related deaths rate increased to 20.16 in 2021 (AAPC = +12.13% [7.76% to 16.68%]) and to 14.95 in 2021 (AAPC = +18.30% [13.76% to 23.03%]), which were in contrast to much smaller incremental increases during the pre-pandemic (AAPC = +1.82% [1.29% to 2.35%] and AAPC = +4.54% [3.97% to 5.11%]), respectively). The most pronounced rise in the age-standardized NAFLD-related death rates during the pandemic was observed among AIAN (AAPC = +25.38%), followed by non-Hispanic White female (AAPC = +14.28%), whereas the age-standardized ALD-related death rates during the pandemic were highest among AIAN (AAPC = +40.65%), followed by non-Hispanic Black female (AAPC = +26.79%). COVID-19 pandemic had a major negative impact on cirrhosis-specific and CLD-related mortality in the U.S. with significant racial and gender disparities.

Proteomic networks and related genetic variants associated with smoking and chronic obstructive pulmonary disease

BackgroundStudies have identified individual blood biomarkers associated with chronic obstructive pulmonary disease (COPD) and related phenotypes. However, complex diseases such as COPD typically involve changes in multiple molecules with interconnections that may not be captured when considering single molecular features.MethodsLeveraging proteomic data from 3,173 COPDGene Non-Hispanic White (NHW) and African American (AA) participants, we applied sparse multiple canonical correlation network analysis (SmCCNet) to 4,776 proteins assayed on the SomaScan v4.0 platform to derive sparse networks of proteins associated with current vs. former smoking status, airflow obstruction, and emphysema quantitated from high-resolution computed tomography scans. We then used NetSHy, a dimension reduction technique leveraging network topology, to produce summary scores of each proteomic network, referred to as NetSHy scores. We next performed a genome-wide association study (GWAS) to identify variants associated with the NetSHy scores, or network quantitative trait loci (nQTLs). Finally, we evaluated the replicability of the networks in an independent cohort, SPIROMICS.ResultsWe identified networks of 13 to 104 proteins for each phenotype and exposure in NHW and AA, and the derived NetSHy scores significantly associated with the variable of interests. Networks included known (sRAGE, ALPP, MIP1) and novel molecules (CA10, CPB1, HIS3, PXDN) and interactions involved in COPD pathogenesis. We observed 7 nQTL loci associated with NetSHy scores, 4 of which remained after conditional analysis. Networks for smoking status and emphysema, but not airflow obstruction, demonstrated a high degree of replicability across race groups and cohorts.ConclusionsIn this work, we apply state-of-the-art molecular network generation and summarization approaches to proteomic data from COPDGene participants to uncover protein networks associated with COPD phenotypes. We further identify genetic associations with networks. This work discovers protein networks containing known and novel proteins and protein interactions associated with clinically relevant COPD phenotypes across race groups and cohorts.

Racial disparities in the utilization and outcomes of robotic bariatric surgery: an 8-year analysis of Metabolic and Bariatric Surgery Accreditation Quality Improvement Program data

BackgroundRobotic surgery utilization has been increasing across surgical specialties; however, racial disparities in patient access to care and outcomes have been reported. ObjectivesIn this study, we examined racial disparities in the utilization and outcomes of robotic bariatric surgery over an 8-year period. SettingMetabolic and Bariatric Surgery Accreditation Quality Improvement Program (MBSAQIP) centers of excellence across the United States. MethodsThe MBSAQIP database was used to identify adult patients who underwent robotic bariatric surgery between 2015 and 2022. Patients were stratified according to race and ethnicity into non-Hispanic White, non-Hispanic Black or African American (AA), Indigenous, Asian, and Hispanic patients. Multivariable analyses were used to assess predictors of robotic surgery use, odds of minor and major complications, prolonged length of stay (prolonged length of stay (pLOS): ≥3 days), readmissions, reoperations, and mortality within 30 days. ResultsOut of 1,288,359 patients included, robotic surgery was utilized in 196,314 patients (15.2%), with a mean age of 44 ± 12 years and 80.6% females. Rates of robotic surgery increased to 30% by 2022. Compared to White patients, Black/AA patients were more likely to undergo robotic surgery (adjusted odds ratio (aOR) = 1.22, 95% confidence interval (CI) = 1.21-1.24, P < .001). The safety of robotic bariatric surgery improved for both White and Black patients with decreased odds of major complications, readmissions, reoperations, and pLOS over the study period. However, Black/AA patients were more likely to experience minor and major complications, readmissions and have pLOS compared with White patients in 2022 (aOR:1.26, 95% CI:1.19-1.34, P < .001; aOR:1.22, 95% CI:1.06-1.41, P = .006; aOR:1.44, 95% CI:1.28-1.62, P < .001; aOR:2.26, 95% CI:2.06-2.47, P < .001, respectively). ConclusionThe utilization of robotic bariatric surgery has increased significantly over the past 8 years with continued improvements in its safety profile. While Black/AA patients have improved access to robotic surgery, their clinical outcomes continue to be worse than those of White patients. Efforts to address racial disparities in bariatric surgery outcomes must remain a priority to achieve health equity.

Race-Ethnicity, Rurality, and Age in Prospective Preferences and Concerns Regarding Closed-Loop Implanted Neural Devices.

Responsive and human-centered neurotechnology development requires attention to public perceptions, particularly among groups underserved by existing treatments. The authors conducted a preregistered nationally representative survey (https://osf.io/ej9h2) using the NORC at the University of Chicago AmeriSpeak panel. One vignette compared an implanted neural device with surgical resection in a scenario involving epilepsy, and another compared an implanted neural device with medications in a scenario involving mood disorders. The survey also contained questions about respondents' confidence that a device would be available if needed and confidence that enough research has been conducted among people like themselves. Responses were entered into nested survey-weighted logistic regression models, including a base demographic model (to test the overall effect of demographic factors) and an adjusted model that also included socioeconomic, religious and political, and health care access predictors. A total of 1,047 adults responded to the survey, which oversampled Black non-Hispanic (N=214), Hispanic (N=210), and rural (N=219) Americans. In the base demographic model, older Americans were more likely to prefer an implanted device in the two scenarios, and non-Hispanic Black Americans were less likely than non-Hispanic White Americans to prefer a device; rural Americans were less confident than urban or suburban Americans in having access, and non-Hispanic Black and rural Americans were less confident that enough research has been conducted among people like themselves. In adjusted models, income was a key mediator, partially explaining the effect of age and the contrast between Black and White non-Hispanic respondents on preferences for a device in the epilepsy scenario and fully explaining the effect of rurality on confidence in access. Demographic differences in prospective preferences and concerns highlight the importance of including members of underserved communities in neurotechnology development.

Character-Audience Racial Matching, Prescription Opioid Misuse Experience, and the Effectiveness of Anti-Prescription Opioid Messages: The Mediating Roles of Identification and Perceived Severity

ABSTRACT An online experiment was conducted among a convenience sample of non-Hispanic young Black and White Americans to test the impact of character-audience racial matching on intentions to avoid (mis)using prescription opioids while considering the mediating roles of identification and perceived severity and the moderating role of prescription opioid misuse experience. It found that the racial matching had a positive overall impact on the behavioral intentions. The impact was partly explained by three pathways: 1) identification, 2) perceived severity, and 3) the sequential pathway of identification and perceived severity. It also found that prescription opioid misuse experience moderated the impact of the racial matching on identification. As a result, the racial matching was found to influence the behavioral intentions of participants with different prescription opioid misuse experience via somewhat different routes. These findings have a number of theoretical and practical implications.

Ethnic bias, economic achievement and trust between large ethnic groups: A study in Germany and the U.S

Evidence for ingroup bias is extensive, yet the distinct patterns of discrimination among dominant ethnic groups in the diverse societies of modern industrial nations such as the United States and Germany remain largely unexplored. Incentivized trust games in nationally-representative samples from both countries reveal biases of roughly equal size by non-Hispanic White Americans, Hispanic Americans, and African Americans against each outgroup. In Germany, the majority demonstrates twice as much bias against Turkish minorities compared to Eastern Europeans. Interestingly, both minority groups send similar amounts to ethnic Germans and members of their own groups. We examine the notion that outgroup discrimination by majority group members stems from stereotypes of minorities as economically unsuccessful, employing trust games with high-income counterparts. We find that majority senders’ bias against minority receivers declines when receivers are known to have high incomes, in line with that idea. Interestingly, some minority groups, especially Turkish descendants, display a negative propensity to transfer to rich members of their ingroup in comparison with outgroup members, relative to baseline. While we focus on differences in sending by ethnic pairing, we note that all participants send less to second movers identified as high income, and discuss possible explanations. We estimate that four-fifths of the observed ingroup bias is taste-based rather than due to expected trustworthiness differences. This estimation is robust to identifying the purely altruistic component of trust game sending toward each ethnic group, including one's own.

Lay down your sword? Christian nationalism, race, and opposition to requiring gun permits

ABSTRACT Christian nationalism and race are both important predictors of firearm policy preferences in the United States, and a growing body of research argues that ideas about gun control tend to be racially coded. Building on these findings, we use data from the 2021 General Social Survey to examine how race and ethnicity moderate the association between Christian nationalism and firearm policy preferences – specifically requiring a police permit to purchase a gun. Analyses show strong, racially divergent associations between Christian nationalism and opposition to requiring gun permits. Christian nationalism is associated with higher opposition to requiring gun permits for non-Hispanic White Americans, but lower opposition for non-Hispanic Black Americans. Moreover, accounting for biblical literalism attenuates the association for White Americans but amplifies the association for Black Americans. These findings support the conceptualization of Christian nationalism as a racialized ideology, i.e. one which has different meanings and effects across ethno-racial identities.

Racial disparities in colorectal cancer outcomes and access to care: a multi-cohort analysis.

Non-Hispanic Black (NHB) Americans have a higher incidence of colorectal cancer (CRC) and worse survival than non-Hispanic white (NHW) Americans, but the relative contributions of biological versus access to care remain poorly characterized. This study used two nationwide cohorts in different healthcare contexts to study health system effects on this disparity. We used data from the Surveillance, Epidemiology, and End Results (SEER) registry as well as the United States Veterans Health Administration (VA) to identify adults diagnosed with colorectal cancer between 2010 and 2020 who identified as non-Hispanic Black (NHB) or non-Hispanic white (NHW). Stratified survival analyses were performed using a primary endpoint of overall survival, and sensitivity analyses were performed using cancer-specific survival. We identified 263,893 CRC patients in the SEER registry (36,662 (14%) NHB; 226,271 (86%) NHW) and 24,375 VA patients (4,860 (20%) NHB; 19,515 (80%) NHW). In the SEER registry, NHB patients had worse OS than NHW patients: median OS of 57 months (95% confidence interval (CI) 55-58) versus 72 months (95% CI 71-73) (hazard ratio (HR) 1.14, 95% CI 1.12-1.15, p = 0.001). In contrast, VA NHB median OS was 65 months (95% CI 62-69) versus NHW 69 months (95% CI 97-71) (HR 1.02, 95% CI 0.98-1.07, p = 0.375). There was significant interaction in the SEER registry between race and Medicare age eligibility (p < 0.001); NHB race had more effect in patients <65 years old (HR 1.44, 95% CI 1.39-1.49, p < 0.001) than in those ≥65 (HR 1.13, 95% CI 1.11-1.15, p < 0.001). In the VA, age stratification was not significant (p = 0.21). Racial disparities in CRC survival in the general US population are significantly attenuated in Medicare-aged patients. This pattern is not present in the VA, suggesting that access to care may be an important component of racial disparities in this disease.

Navigating disparities: Insights from a colorectal cancer screening program in federally qualified community healthcare centers.

1537 Background: Colorectal cancer (CRC) is the second leading cause of cancer deaths in Georgia. Despite evidence for the effectiveness of CRC screening, disparities in access are prevalent in underserved populations. Georgia’s Federally Qualified Health Centers (FQHCs) struggle with low screening rates (42.8%), partly due to Georgia’s lack of Medicaid expansion, poor access to health services in rural areas, and deficiencies in coordinated strategies. The Georgia Colorectal Cancer Control Program (GCRCCP) was funded by the Centers for Disease Control and Prevention to implement evidence-based interventions (EBIs) in qualifying FQHCs across South Georgia. Here, we assess the program's impact on clinic-level screening rates (SR). Methods: Fourteen clinics with 12,159 CRC-eligible patients (ages 50-75) were enrolled from East Georgia Healthcare Center (EGHC) and Albany Area Primary Health Center (AAPHC). FQHC clinics had to have a SR below 60% to participate in the program. In addition to the EBIs (provider assessment and feedback, provider reminders, patient reminders, reducing structural barriers), the GCRCCP integrated provider education using the ECHO Model and navigation through a nationally recognized, evidence-based patient navigation program. We compared baseline (2020 and 2021) and follow-up data (2022) to determine the average change in SR over time, overall, and by demographic sub-groups. Results: The overall change in SR for the 14 clinics was +6.7%, from a baseline average of 45.3% to 52% in 2022. The average change in SR for EGHC clinics (n=9) was +11.5% (from 32.2 to 43.7%). Women had a higher SR (44.9%) than men (41.8%), but both realized an increase in SR, +10.5% and +9.1%. Non-Hispanic Black Americans (NHBA) experienced a higher increase in SR, +13.7% (from 37.2 to 50.9%) than their Non-Hispanic White (NHW) counterparts (+7.5% (from 29.8 to 37.3%)). The uninsured vs. insured followed a similar pattern (+15.3% (from 17.8 to 33.1%)) vs. +2.1 (from 45.9 to 48%). The average change in SR for AAPHC clinics (n=5) was +1.8% (from 58.4 to 60.2%). There was a decline in SR for men, -8.6% (from 64 to 55.4%), and an increase for women, +3.8% (from 58.2 to 62%). NHBA had a decrease in SR, -0.8% (from 61.2 to 61%), while NHW Americans had an increase in SR, +0.2% (from 53.8 to 54.2%). The uninsured and insured groups realized minimal increases of +0.6% (from 46 to 46.6%) and +0.8% (from 62 to 62.8%), respectively. Conclusions: The implementation of EBIs and patient navigation show varied potential to reduce disparities in accessing CRC screening in underserved populations. FQHC clinics that sustain implementation activities and workflow processes can benefit communities long-term and improve health equity.

Analysis of gene expression in the postmortem brain of neurotypical Black Americans reveals contributions of genetic ancestry

Ancestral differences in genomic variation affect the regulation of gene expression; however, most gene expression studies have been limited to European ancestry samples or adjusted to identify ancestry-independent associations. Here, we instead examined the impact of genetic ancestry on gene expression and DNA methylation in the postmortem brain tissue of admixed Black American neurotypical individuals to identify ancestry-dependent and ancestry-independent contributions. Ancestry-associated differentially expressed genes (DEGs), transcripts and gene networks, while notably not implicating neurons, are enriched for genes related to the immune response and vascular tissue and explain up to 26% of heritability for ischemic stroke, 27% of heritability for Parkinson disease and 30% of heritability for Alzheimer’s disease. Ancestry-associated DEGs also show general enrichment for the heritability of diverse immune-related traits but depletion for psychiatric-related traits. We also compared Black and non-Hispanic white Americans, confirming most ancestry-associated DEGs. Our results delineate the extent to which genetic ancestry affects differences in gene expression in the human brain and the implications for brain illness risk.

COVID-19 vaccine intentions and attitudes in Black American emerging adults with asthma

BackgroundEmerging adults (aged 18–29) are less likely to receive the COVID-19 vaccine than any other adult age group. Black Americans are less likely than non-Hispanic white Americans to be fully vaccinated against COVID-19. This study explored factors which affect vaccine intention and attitudes in Black American emerging adults with asthma.MethodsParticipants were recruited from an NHLBI-funded clinical trial to improve asthma control. Fifty-nine Black American emerging adults completed a Qualtrics survey that assessed asthma control, intention to vaccinate, and factors which may affect the decision to vaccinate. Twenty-five participants also completed a semi-structured interview via Zoom. Bivariate correlations and descriptive statistics, including Chi Square analyses, were run using SPSS. Interview thematic analyses were conducted via QDA Miner.ResultsOf the 59 Black American emerging adults with asthma who completed surveys, 32.2% responded that they were highly unlikely to receive the COVID-19 vaccine, while 50.8% responded that they were highly likely to receive it. Increased asthma control was significantly correlated with a higher likelihood to discuss the COVID-19 vaccine with their healthcare provider (ρ = 0.339, α = 0.011). Concerns about immediate (ρ= -0.261, α = 0.050) and long-term (ρ= -0.280, α = 0.035) side effects were inversely correlated with intention to vaccinate. Only 17% of the participants who were unemployed stated that they were highly likely to receive the vaccines compared to 65% of the participants who were employed; however, interview participants who were unemployed stated not needing the vaccine because they were protecting themselves by social distancing. When deciding whether to receive the vaccine, safety, efficacy, and immediate side effects were the top three factors for 91%, 54%, and 49% of the participants, respectively. Beliefs about the vaccines’ safety and efficacy, information gathering, personal factors, and societal factors emerged as important themes from the interviews.ConclusionOnly half of the surveyed Black American emerging adults with asthma were highly likely to receive the COVID-19 vaccine. Safety and efficacy were important for the majority of the participants, regardless of vaccine intention. Greater asthma control, but not access to asthma-related healthcare, was correlated with intention to discuss the vaccine with their healthcare provider.

Parent-Child Relationship Typologies and Associated Health Status Among Older Adults in the United States and China: A Cross-Cultural Comparison.

Cultural differences in intergenerational relationships have been well established in prior research. However, cross-national comparison evidence on the parent-child relationship and its health implications remains limited. Data from the 2014 U.S. Health and Retirement Study and the 2015 Health and Retirement Longitudinal Study in China were used (N US, non-Hispanic Whites only = 3,918; N China = 4,058). Relationship indicators included coresidence, living nearby, having weekly contact, receiving assistance with daily activities, providing grandchild care, and financial transfer to/from children. Latent class and regression analyses were conducted. Four classes were identified for non-Hispanic White older Americans: (1) distant and uninvolved (6.58%), (2) geographically proximate with frequent contact and downward support (47.04%), (3) coresident with frequent contact and upward support (13.1%), and (4) geographically proximate with frequent contact (33.28%). Three classes were identified among older Chinese: (1) coresident with frequent contact and upward support (37.46%), (2) coresident/interdependent (25.65%), and (3) geographically proximate with frequent contact and upward financial support (36.89%). For non-Hispanic White older Americans, providing downward support was associated with fewer functional limitations and better cognition. Receiving instrumental support from children was associated with more depressive symptoms, more functional limitations, and poorer cognition among older Chinese. Cultural contrasts were evident in parent-child relationship typologies and their health implications. Compared to the U.S. non-Hispanic Whites, parent-child relationships in China tended to be closerand associated with poorer health status. The findings call for culturally relevant strategies to improve parent-child relationships and ultimately promote the health of older adults.

What Caused the Narrowing of Black-White COVID-19 Vaccination Disparity in the US? A Test of 5 Hypotheses

Despite differential uptake of COVID-19 vaccination between Black and non-Hispanic White Americans early in the pandemic, the gap narrowed over time. We tested five hypotheses that could explain the reduction in the disparity. Using a national probability panel of over 1800 individuals surveyed from April 2021 to July 2022, we assessed receipt of recommended doses of COVID-19 vaccines along with (a) reported exposure to deaths due to COVID-19, (b) trust in US health authorities, such as the CDC, (c) knowledge about the safety and efficacy of COVID-19 vaccination, (d) media use as a source of information, and (e) access to COVID-19 vaccines. Only increases in knowledge about the safety and efficacy of COVID-19 vaccines uniquely mediated the increase in vaccination uptake among non-Hispanic Black compared to White, Asian and Hispanic panelists. While trust in CDC and exposure to COVID-19 deaths were related to vaccination acceptance at baseline, those factors were not associated with change in reported vaccination coverage. In addition, neither differential access nor media use explained the increase. Enhanced knowledge about the safety and efficacy of COVID-19 vaccination transmitted from within the Black community likely helped to increase vaccination relative to other racial-ethnic groups.