non-Hispanic White Caregivers Research Articles

Abstract TP73: Outcomes in Mexican American Informal Stroke Caregivers and Differences by Ethnicity

Background: Informal home care is the most prevalent type of post-acute care (PAC) in Mexican American (MA) stroke survivors, but data on the impact on caregivers is not available. The objective was to investigate strain, positive aspects of caregiving, familial obligations/support, and depression in stroke caregivers and ethnic differences in a population-based study. Methods: Data are from Brain Attack Surveillance in Corpus Christi PAC Study. Community-dwelling stroke survivors and their caregivers were recruited (n=307). Caregiver eligibility included: 1) residence in study county, 2) not cognitively impaired, 3) not providing care pre-stroke. Caregiver interviews at ~90 days included sociodemographics, dyad characteristics, Modified Caregiver Strain Index (MCSI range 0-26, higher more), PAC scale by Tarlow et al (range 5-45, higher more), familial obligations/support scales by Sabogal et al (range 1-5, higher greater), and PHQ-8 (range 0-30, higher worse). Patient data were from interviews and medical records. Propensity score (PS) methods were used to balance caregiver and patient factors among MA and non-Hispanic white (NHW) caregivers by fitting a model with ethnicity of caregiver as the outcome and predictors being caregiver sociodemographics, patient-caregiver dyad characteristics, and patient sociodemographics and disability. PS were then included as a covariate in regression models considering the association between ethnicity and outcomes. Results: MA caregivers were younger, more likely female, and more likely a child than NHWs. Median MCSI, PAC scale, PHQ-8 were 11 (IQR:6-17), 36 (IQR:30-40), and 11 (IQR:9-15) in MAs and 13.5 (IQR:9-18.3), 30 (IQR:25-36.3) and 13 (IQR:10-16) in NHWS. MA ethnicity was associated with less caregiver strain (β=-2.22, 95% CI:-4.19, -0.26) and depression (β=-2.05, 95% CI:-3.48, -0.63) and more positive aspects of caregiving (β=2.96, 95% CI:0.91, 5.01), but not associated with familial obligations/support. Conclusions: Informal stroke caregivers report moderate levels of strain and depressive symptoms, with NHW caregivers reporting higher levels. MA caregivers report greater positive aspects of caregiving suggesting a possible intervention target to improve outcomes in MAs.

Associations Among Family Caregivers' Perceptions of Loneliness, Choice, and Purpose: a Comparative Analysis Between Non-Hispanic Black Caregivers and Non-Hispanic White Caregivers in a Population-Based Sample.

Loneliness is a frequent experience among family members engaging in caregiving responsibilities and may vary across racial and ethnic groups. This study aimed to examine (a) the difference in loneliness between non-Hispanic Black and non-Hispanic White caregivers, (b) the associations between loneliness and perceptions of choice and purpose in caregiving, and (c) whether those associations with loneliness differ by caregivers' race. Descriptive statistics and ordinal logistic regression were conducted in a population-based sample of 1000 caregivers (Black caregivers, n = 199; White caregivers, n = 801) from the 2020 Caregiving in the U.S. The survey design was properly addressed. Key variables included loneliness (level of feeling alone about being a caregiver), choice (whether or not reporting a choice in taking on the caregiver responsibility), sense of purpose (level of purpose/meaning in life from caregiving), and race (Black/White). Models adjusted for caregiving characteristics (e.g., hour of caregiving) and sociodemographic characteristics (e.g., age and education). Black caregivers had lower odds of reporting a higher level vs. a lower level of loneliness than White caregivers (aOR = 0.67, 95%CI = 0.47, 0.96). Reporting having no choice was associated with higher odds of a higher level of loneliness (aOR, 0.77, 95%CI = 0.67, 0.88). Higher sense of purpose scores were associated with lower odds of a higher level of loneliness (aOR = 0.81, 95%CI = 0.71, 0.93). No significant moderation effects of race were found. Black caregivers reported lower loneliness scores than White caregivers. Reporting no choice and lower sense of purpose were associated with higher loneliness in both racial groups.

CAREGIVERS’ INTERACTIONS WITH HEALTH CARE PROVIDERS AND THEIR WELL-BEING BY RACE AND ETHNICITY AND GENERATION

Abstract Black and Hispanic family caregivers often face higher levels of care demands than White caregivers, due to factors such as limited resources, cultural differences, and systemic and structural inequalities. Family caregivers from different generations (Baby Boomer vs. Generation X & Millennial ) may approach and experience caregiving process and its health effects to a different extent. Caregivers often interact with healthcare providers on behalf of their care recipients, and these experiences can vary based on caregiver background (race and ethnicity and generation). The current study aimed to explore these interactions and their impact on caregivers’ well-being using nationally representative data from the National Study of Caregiving (NSOC, round 11 (N=1,455; 418 Black caregivers, 926 Non-Hispanic White caregivers, and 111 Hispanic caregivers)). Most caregivers were adult children (70%) and female (70%), with approximately 68% were from the baby boomer generation. While Black and Hispanic caregivers were significantly less likely than White caregivers to communicate with medical providers (χ2(df=2)=12, p<.001), baby boomer caregivers provided more assistance with speaking to medical providers than caregivers from younger generations (χ2(df=1)=4, p<.05). Our regression results indicate that Hispanic caregivers who had more frequent communication with medical professionals reported more depressive symptoms and poorer health, while Black caregivers who rarely communicated with providers reported worse outcomes. Future research should examine the nature and quality of these interactions with healthcare providers to improve caregivers’ well-being.

FAMILY CAREGIVER COMFORT WITH TELEHEALTH TECHNOLOGIES: DIFFERENCES BY RACE/ETHNICITY IN A CROSS SECTIONAL SURVEY

Abstract Telehealth has seen widespread use since the onset of the COVID-19 pandemic, and 82% patients required assistance in accessing their telehealth appointments. This assistance commonly comes from a family caregiver who may or may not be comfortable using the technologies associated with telehealth. The objective of our study was to analyze a demographically representative survey of US family caregivers to understand the level of comfort using telehealth technologies among family caregivers through a secondary analysis of survey data collected during the COVID-19 pandemic in 2020. Level of caregiver comfort using computers, smartphones, and tablets was determined through three Likert-style questions. Proportional odds logistic regression was used to understand the associations between demographic variables and level of caregiver comfort using each technology, when adjusting for covariates. A total of 340 caregivers were included in the analysis. Compared to Non-Hispanic White caregivers, Asian caregivers had a higher odds (OR 3.14; 95%CI 1.36, 8.02; p=0.01) of expressing comfort using computers; Black caregivers (OR 0.46; 95%CI 0.21, 0.98; p=0.04) and Hispanic caregivers (OR 0.36; 95%CI 0.17, 0.79 p=0.01) expressed lower odds of comfort using smartphones; and Asian caregivers had a higher odds (OR 4.64; 95%CI 2.05, 11.69; p=0.001) of expressing comfort using tablets. : There are identified disparities in level of technological comfort using computers, smartphones, and tablets by different racial and ethnic groups. Health systems should consider early stakeholder involvement in the design of telehealth technologies and culturally responsive training materials on telehealth technology use to reduce disparities in comfort using telehealth technologies.

A Community-Based Study of Cognitive Impairment Caregiving Outcomes Pre- and During the COVID-19 Pandemic.

The impact of the COVID-19 pandemic on informal caregiving was examined in a Mexican American (MA) and Non-Hispanic White (NHW) population-based cohort. 395 participants age > 65years were recruited via door-to-door and phone recruitment as part of the Brain Attack Surveillance in Corpus Christi-Cognitive (BASIC-C) project. Both recipients and caregivers answered questions regarding the recipient's health and the COVID-19 pandemic. 15% of caregivers saw their caregiving recipient less than before the pandemic and 18% saw their recipient more than before. 55% of caregivers reported a slight to severe impact of the pandemic on their caregiving, and 45% reported no impact. For most caregivers, their caregiving role did not change markedly during the pandemic. MA and NHW caregivers had similar survey responses.

Family Caregiver Comfort with Telehealth Technologies: Differences by Race and Ethnicity in a Cross-Sectional Survey.

Background: Telehealth has seen widespread use since the onset of the COVID-19 pandemic, and 82% patients required assistance in accessing their telehealth appointments. This assistance commonly comes from a family caregiver who may or may not be comfortable using the technologies associated with telehealth. The objective of our study was to analyze a demographically representative survey of U.S. family caregivers to understand the level of comfort using telehealth technologies among family caregivers. Methods: A secondary analysis of survey data collected during the COVID-19 pandemic in 2020. Level of caregiver comfort using computers, smartphones, and tablets was determined through three Likert-style questions. Proportional odds logistic regression was used to understand the associations between demographic variables and level of caregiver comfort using each technology, when adjusting for covariates. Results: A total of 340 caregivers were included in the analysis. Compared with non-Hispanic white caregivers, Asian caregivers had higher odds (odds ratio [OR] 3.14; 95% confidence interval [CI] 1.36, 8.02; p = 0.01) of expressing comfort using computers; black caregivers (OR 0.46; 95% CI 0.21, 0.98; p = 0.04) and Hispanic caregivers (OR 0.36; 95% CI 0.17, 0.79; p = 0.01) expressed lower odds of comfort using smartphones; and Asian caregivers had higher odds (OR 4.64; 95% CI 2.05, 11.69; p = 0.001) of expressing comfort using tablets. Conclusion and Implications: There are identified disparities in the level of technological comfort using computers, smartphones, and tablets by different racial and ethnic groups. Health systems should consider early stakeholder involvement in the design of telehealth technologies, culturally responsive training materials on telehealth technology use to reduce disparities in comfort using telehealth technologies.

Use of Caregiving Support Services Among Diverse Dementia Caregivers by Geographic Context.

Little is known about how race/ethnicity and geographic context relate to support service use among dementia caregivers. Our objectives were to investigate (a) whether the use of at least one formal caregiving service-support groups, respite care, and training-differed by race/ethnicity and across metro and nonmetro areas; and (b) whether predisposing, enabling, and need characteristics influenced support service use by race/ethnicity. Data were analyzed from a sample of primary caregivers of care recipients aged 65 years or older with probable dementia (n = 482) in the 2017 National Health and Aging Trends Study and National Study of Caregiving. We calculated weighted prevalence estimates and then used the Hosmer-Lemeshow goodness of fit statistic to find the best-fitting logistic regression models. Among minority dementia caregivers, support service use was higher in metro than nonmetro areas (35% and 15%); the trend was reversed for non-Hispanic White caregivers (47% nonmetro and 29% metro). The best-fitting regression models included predisposing, enabling, and need factors for both minority and non-Hispanic White caregivers. Younger age and more disagreement within the family were consistently associated with more service use in both groups. Among minority caregivers, better caregiver and care recipient health were associated with using support services. Among non-Hispanic White caregivers, nonmetro geographic context and caregiving interfering with valued activities were associated with using support services. Geographic context differently affected support service use and the influence of predisposing, enabling, and need factors varied by race/ethnicity.

Financial Toxicity in Dementia Caregiving (P14-6.006)

<h3>Objective:</h3> Estimate the prevalence of financial toxicity in dementia caregiving and assess its sociodemographic correlates. <h3>Background:</h3> Dementia caregiving is associated with significant financial costs, contributing to caregiver burden. The term “financial toxicity” has been used in a variety of care settings to describe the negative effects of medical expenses on both financial security and health-related quality of life. In this study we utilize the validated COmprehensive Score for financial Toxicity (COST) to examine the experience of financial toxicity in dementia caregiving. <h3>Design/Methods:</h3> We conducted a nationally representative survey of 317 US dementia caregivers, oversampling non-Hispanic Black (n = 75) and Hispanic (n = 61) caregivers, including the COST questionnaire. Based on prior literature, financial toxicity was defined as COST &lt;26 and further categorized as mild (COST ≥14 &amp; &lt;26), moderate (COST &gt;0 &amp; &lt;14), or severe (COST = 0) according to the measure’s predetermined cut points. <h3>Results:</h3> COST scores ranged between 0 and 44, with a survey-weighted mean of 24.57 and standard deviation of 9.8. Weighted analysis revealed 52.7% of American caregivers experience some degree of financial toxicity. Of those who experience financial toxicity, 73.1% are classified as mild, 25.7% as moderate, and 1.2% as severe. Financial toxicity was identified in 69.5% of non-Hispanic Black, 54.1% of Hispanic, and 42.3% of non-Hispanic White caregivers, with non-Hispanic Black caregivers significantly more likely to experience financial toxicity compared to their non-Hispanic White counterparts (p = 0.017). <h3>Conclusions:</h3> Most dementia caregivers in the US experience financial toxicity. Our findings indicate racial differences in the experience of financial toxicity among American dementia caregivers. <b>Disclosure:</b> Miss Hart has nothing to disclose. Mr. Leggins has nothing to disclose. Mrs. Sanches has nothing to disclose. The institution of Dr. Chiong has received research support from the National Institutes of Health. The institution of Dr. Chiong has received research support from the Dana Foundation. Dr. Chiong has received personal compensation in the range of $500-$4,999 for serving as a member, NeuroEthics Working Group with National Institutes of Health.

475 Financial Toxicity in Dementia Caregiving

OBJECTIVES/GOALS: Financial toxicity describes the adverse effects of medical expenses on financial security and health related quality of life. Though dementia caregiving carries serious costs, financial toxicity has not been studied in this context. Here we assess the prevalence of financial toxicity in dementia caregiving and its sociodemographic correlates. METHODS/STUDY POPULATION: We utilized the COmprehensive Score for financial Toxicity (COST)— 12-item questionnaire validated to quantify financial toxicity in patients and their caregivers— to conduct a nationally representative survey of 317 US dementia caregivers, oversampling non-Hispanic Black (n = 75) and Hispanic (n = 61) caregivers. Participants were required to be currently providing unpaid care to someone 50 years or older with dementia. Financial toxicity was defined as COST 0 &amp; RESULTS/ANTICIPATED RESULTS: COST scores ranged between 0 and 44, with a survey-weighted mean of 24.57 and standard deviation of 9.8. Weighted analysis revealed 52.7% of American dementia caregivers experience some degree of financial toxicity. Of those who experience financial toxicity, 73.1% are classified as mild, 25.7% as moderate, and 1.2% as severe. Financial toxicity was identified in 69.5% of non-Hispanic Black, 54.1% of Hispanic, and 42.3% of non-Hispanic White caregivers, with non-Hispanic Black caregivers significantly more likely to experience financial toxicity compared to their non-Hispanic White counterparts (p = 0.017). DISCUSSION/SIGNIFICANCE: Most US dementia caregivers experience financial toxicity, though prevalence varies significantly by caregiver race. Discerning the pervasiveness of financial toxicity in this population and significant correlates will inform the development and expedient delivery of resources for patients and families.

Psychosocial impact of COVID-19 on caregivers and adolescents and young adult survivors of childhood cancer.

Caregivers and adolescents and young adult (AYA) cancer survivors may be at greater psychosocial risk from the COVID-19 pandemic than healthy peers due to complex and traumatic medical histories. This study describes COVID-19-related event exposures, impact, and distress among a large sample of caregivers and AYA cancer survivors and the relationship of these variables to demographic and cancer characteristics. From May 2020 to December 2021, 422 caregivers and 531 AYA survivors completed the COVID-19 Exposures and Family Impact Survey (CEFIS) and CEFIS-AYA, respectively. Total COVID-19-related exposures, average COVID-19-related impact, and COVID-19-related distress were calculated. Conventional content analysis was used to analyze free-text responses about the negative and positive effects of COVID-19. Caregivers and AYA reported an average of 7.4-7.8 COVID-19 exposures to pandemic-related events and a slightly negative impact of COVID-19 across psychosocial domains, with some positive impacts reported. COVID-19-related distress was moderate and clinically meaningful (4.9-5.2/10) for AYA and caregivers. Racial and ethnically minoritized AYA and caregivers reported higher COVID-19-related distress than non-Hispanic white caregivers. For AYA, distress was also higher among female, college-age (18-22 years), and long-term survivors compared with males, younger AYA, White and those recently off treatment. CEFIS outcomes remained relatively stable over time. COVID-19 had a significant and consistent negative impact on caregivers and AYA survivors. Racial and ethnically minoritized families and female, college-age, and long-term AYA survivors may require additional psychosocial support. Assessing for COVID-19 impact and distress is important in pediatric oncology to evaluate adjustment and plan targeted interventions.

Characteristics of Asian American Family Caregivers of Older Adults Compared to Caregivers of Other Racial/Ethnic Groups: Behavioral Risk Factor Surveillance System 2015-2020.

Asian Americans (AAs) are the fastest-growing racial/ethnic minority group in the United States. While otherwise highly heterogeneous, AAs overall value filial piety and eldercare. This study compared the health and caregiving experiences of AA caregivers of older adults to AA non-caregivers and caregivers of older adults across racial/ethnic groups. We used 2015-2020 Behavioral Risk Factor Surveillance System data for 315 AA caregivers and 3822 AA non-caregivers, plus 395 American Indian/Alaska Native, 1883 Black, 1292 Hispanic, and 20,321 non-Hispanic White caregivers. Among AAs, 4.3% were caregivers, a lower proportion than in other racial/ethnic groups. Most AA caregivers were female (59%), married (71%), in excellent/very good/good health (76%), and with at least one chronic health condition (66%). Other than relationship to care recipients, caregivers' experiences were similar across racial/ethnic groups: most cared for <20 hours/week and provided household and personal care. Efforts to support AA caregivers should be attentive to cultural practices.

Characterizing Caregiver Outcomes in a Culturally Diverse Sample

AbstractBackgroundCaring for a family member with cognitive impairment is accompanied by challenges that place caregivers at risk for significant health problems. Yet the study of racially/ethnically diverse caregivers across the spectrum of Alzheimer’s disease and related dementias (from mild cognitive impairment: MCI to dementia) is understudied. In this study, we characterize caregiver stress and burden and examine their role on caregiver self‐rated health and depressive symptoms.MethodsWe enrolled 158 adults (non‐Hispanic White (NHW): 66%; Latino: 16%; Black: 9%; Asian: 8%) caring for a family member with MCI (35%) or dementia (65%). Approximately 37% were recruited from an Alzheimer’s Disease Research Center (ADRC) and 63% from the community. Caregivers completed demographic and psychosocial questionnaires online or by paper in English or Spanish. Linear regression models were used to assess associations between perceived stress and burden and caregiver outcomes (depressive symptoms and self‐rated health), controlling for caregiver demographics.ResultsBlack caregivers reported less burden (mean = 23.7) than NHW caregivers (mean = 35.4), p = .007. There was no difference in perceived stress by race/ethnicity (p = .2). Burden was higher (p = .001) for caregivers of individuals with dementia (mean = 35.9) than those with MCI (mean = 27.6), as was perceived stress (dementia caregivers: mean = 16.0; MCI caregivers: mean = 13.6), p = .03.Higher caregiver burden (p&lt;.001) and perceived stress (p&lt;.001) were positively associated with depressive symptoms. Caregiver burden was not associated with self‐rated health (p = .1); but higher perceived stress was associated with poorer self‐rated health (p&lt;.001).ConclusionsCaregivers of persons with cognitive impairment suffer a substantial burden emotionally and physically. Our results indicate that dementia caregivers may have greater challenges in caring for their family member compared to those caring for someone in the early or milder stages of illness. The racial/ethnic difference may be due to the fact that NHW caregivers actually experience more burden in caregiving; an alternative explanation is that burden may not be felt or manifested in the same way in Black caregivers. Lastly, perceived stress is an important determinant of caregiver health and mental health outcomes. More research is needed to understand the variety of factors associated with caregiver outcomes and how they may differ across racial/ethnic groups.

Racial and ethnic disparities in cancer caregiver burden and potential sociocultural mediators

PurposeBlack and Hispanic cancer patients experience many worse care quality and health outcomes than non-Hispanic White patients, yet less is known about disparities in caregiving responsibilities and burden among cancer caregivers.MethodsWe analyzed cross-sectional data from Cancer Care Outcomes Research and Surveillance consortium, a large multi-regional, population-based study of colorectal and lung cancer patients and their caregivers. Bivariate and multivariable regression models assessed differences by racial and ethnic groups in caregiving responsibilities and social/emotional, financial, and health burdens. Structural equation models estimated whether sociocultural resources (social support, caregiving preparedness, caregiver–patient communication) mediated racial and ethnic differences in caregiver burden.ResultsCompared with non-Hispanic White caregivers (N = 1,169), Black (N = 220) and Hispanic (N = 84) caregivers spent more time caregiving (18 vs. 26 vs. 26 h/week; P < 0.001), completed more tasks (6.8 vs. 7.6 vs. 8.7; P < 0.05), and reported greater financial burden (P = 0.02). Yet, compared to non-Hispanic Whites, Hispanic caregivers reported similar social/emotional and health burdens, while Black caregivers reported lower levels (P < 0.01). In adjusted models, disparities in financial burden disappeared, and Hispanic caregivers had less health burden than non-Hispanic White caregivers (P = 0.01). Social support and/or caregiving preparedness partially mediated the Black–White gap for all three types of burdens.ConclusionsBlack and Hispanic cancer caregivers perform more caregiving and report greater financial burden than non-Hispanic White caregivers, but experience lower or equivalent social/emotional and health burdens. Racial differences in caregivers’ social support and caregiving preparedness levels partially explain Black–White burden differences. Research and policy should address Black and Hispanic caregivers’ increased financial burden.

Financial stress and burden among caregivers of cancer survivors in the United States.

12027 Background: United States caregivers perform annual services equating to nearly $500 billion, with three-quarters of family caregivers utilizing personal funds. Nearly a third of all caregivers of cancer survivors report using all or most of their savings to contribute to the cost of cancer care. Prior studies indicate the duration of caregiving is associated with an increase in caregiving burden. This study aims to further describe the financial stress and burden in relation to caregiving duration for people who provide care to cancer survivors. Methods: A retrospective cross-sectional study was conducted using the 2015 and 2020 National Alliance for Caregiving and American Association of Retired Persons survey data. Multivariable logistic regressions were used to examine differences in reporting financial stress between various racial/ethnic groups while adjusting for education, income, and employment. Results: A total of 2,998 caregivers were included, where 208 of them were caring for cancer patients. Caregivers of cancer patients who provided care &gt; 21 hours/week were statistically more likely to be less educated, lower income, single, and unemployed compared to those who provided &lt; 21 hours/week. Caregiving for &gt; 21 hours/week compared to &lt; 21 hours/week is associated with being more likely to report communicating with healthcare professionals about a recipient's care (87.7% vs. 75.9%; p = 0.038). It is borderline significant that caregivers who provided care for &gt; 21 hours/week were more likely to advocate for recipients (68.7% vs. 56.8%; p = 0.086) and monitor condition severity to adjust care needs (84.9% vs. 70.7%; p = 0.100). After controlling for confounders (education, income, and employment), Non-Hispanic Black (odds ratio (OR) = 1.30; 95% CI: 1.02-1.65), Hispanic (OR = 1.39; 95% CI: 1.02-1.89), and Asian (OR = 1.51; 95% CI: 1.02-2.24) cancer caregivers had increased odds of reporting increased financial stress compared to Non-Hispanic White caregivers. Conclusions: Longer duration of caregiving to cancer survivors is associated with a greater burden for caregivers. Financial stress disparities related to caregiving exist between racial/ethnic groups, with non-white caregivers being more likely to report increased financial strain. Special financial programs are needed to assist caregivers of cancer survivors, a growing but understudied population.

Stress-Busting Program for Family Caregivers: Validation of the Spanish version using biomarkers and quality-of-lifemeasures.

Hispanic family caregivers of people with dementia experience higher levels of stress compared to non-Hispanic white caregivers. Long-term stress causes depression, caregiver burden, cellular aging, and dysregulation of the immune, nervous, and endocrine systems. The purpose of this study was to determine the validity of the Spanish version of the English Stress-Busting Program (SBP) for Family Caregivers by determining changes in quality-of-life measures and biomarkers. Thirty-six caregivers completed the SBP in the language of their choice (14 Spanish-speaking Hispanics [HS], 8 English-speaking Hispanics [HE], and 14 non-Hispanic English [NHE] speakers). Quality-of-life measures included the Perceived Stress Scale, the Screen for Caregiver Burden, and the Center for Epidemiologic Studies Depression Scale. Assessment of oral health and immunity included salivary flow rate, pH, buffer capacity, total protein, and secretory immunoglobulin A (sIgA). Indicators of stress (salivary cortisol), inflammation (C-reactive protein), and cellular aging (leukocyte telomere length) were assessed. Following completion of the SBP, the Spanish-speaking group had less depression and caregiver burden along with improved oral health and reduced cellular aging. When comparing baseline values to post-intervention, all three groups showed significant improvement in subjective caregiver burden. When the data from all three groups were combined, biomarkers that showed improvement after nine weeks of SBP included the stress hormone cortisol, salivary pH, and leukocyte telomere length. The results indicate that the Spanish SBP reduces caregiver stress as assessed by quality-of-life indicators and biomarkers. The Spanish SBP can help to mitigate health disparities in Hispanic Spanish-speaking caregivers.

Access to Broadband Internet and its Utilization for Health Information Seeking and Health Communication among Informal Caregivers in the United States.

Informal caregivers provide unpaid care to their physically or mentally ill loved ones and play a critical role in the healthcare delivery. eHealth tools, including the broadband internet, can facilitate care processes and impact the caregiving burden through seeking health information and health communication. This study examines the predictors of access to broadband internet and the factors associated with health information seeking and health communication among informal caregivers with broadband internet. We used data from cycles 1 and 2 of the Health Information National Trends Survey (HINTS 5) and employed generalized linear regression models with the maximum likelihood estimation. Specifically, we performed a two-part model: (1) a logistic regression model of broadband internet access among all caregivers (n = 929) and (2) a logistic regression model of health information seeking and health communication among caregivers with broadband internet access (n = 404). We found that caregivers who were younger (18-34years versus 45+ years), female (versus male), and those who were divorced/widowed/separated (versus singles) were less likely to have broadband internet access. While those who were married/living as married (versus singles), with higher incomes (≥$100,000 versus <$35,000), and those living in metropolitan areas were more likely to have broadband internet access. Among caregivers with broadband internet access, younger, female, non-Hispanic white caregivers, and those with higher levels of education and income, as well as those who cared for cancer patients, were more likely to seek health information for someone else. Additionally, caregivers aged 35-39years and those with more education were more likely to look for health information for themselves than their counterparts. Furthermore, caregivers who were aged 40-44years, females, divorced/widowed/separated, those with higher incomes, and those who cared for patients with Alzheimer's, confusion, and dementia were more likely to communicate electronically with a provider. The results suggest disparities in broadband internet access and indicate variations in factors associated with health information seeking and health communication. The findings underscore the need to address barriers attributed to the digital divide among informal caregiving groups.

Racial and ethnic variations in caregiving-related physical, emotional, and financial strain during COVID-19 among those caring for adult cancer patients.

PurposeCancer caregiving is shown to be a burdensome experience in typical times. The purpose of this study was to describe cancer caregivers’ emotional, physical, and financial strain during the COVID-19 pandemic and compared to preCOVID-19, and explore racial and ethnic variations in caregiver strain.MethodsWe conducted a cross-sectional online survey using Lucid, LLC, incorporating quotas for race, ethnicity, gender and age. Caregivers had to be adults living in the USA and currently providing unpaid care to an adult cancer patient (i.e., during COVID-19) and prior to the pandemic. We assessed the caregivers’ emotional, physical, and financial strain and asked them to compare to preCOVID-19 caregiving. Analyses included descriptive and linear regression adjusting for sociodemographic and caregiving-related variables.ResultsA total of 285 caregivers met eligibility, and most were nonHispanic white (72.3%) and female (59.6%). Based on a scale of “1: Much lower” to “5: Much higher”, the financial, physical and emotional strain/stress experienced by caregivers compared to preCOVID-19 was, on average, 3.52 (SD: 0.82; range: 1–5) for financial strain, 3.61 (SD: 0.86; range: 1–5) for physical strain, and 3.88 (SD: 0.89; range: 1–5) for emotional stress. NonHispanic black caregivers were significantly more likely than nonHispanic white caregivers to indicate that caregiving-related financial strain was higher than preCOVID-19. Moreover, Hispanic caregivers compared to nonHispanic white caregivers reported caregiving-related emotional stress was higher than preCOVID-19.ConclusionThese findings suggest a need to be attentive to racial and ethnic variations in emotional and financial strain and provide targeted support in clinical care and via public policy during a public health crisis.

Abstract B135: Health literacy disparities among Hispanic caregivers of children with newly diagnosed cancer

Abstract Objective: Health literacy (HL) is the ability to understand process and act on health-related information to function effectively in a healthcare environment. Thirty-six percent of U.S. adults have limited HL and Hispanics have the lowest among all racial/ethnic groups. Individuals with limited HL have higher healthcare utilization and poorer health status. Caregivers of children with cancer must process complex information about the disease to effectively navigate the healthcare system. Research on HL in the pediatric cancer setting is lacking. We assessed HL in Hispanic and non-Hispanic White (NHW) caregivers (primarily parents) of children with newly diagnosed cancer and the correlation of different measures of HL among each other. Additionally, we assessed socio-demographic factors and acculturation levels in Hispanic caregivers as covariates. Methods: Sixty-one caregivers of children with cancer (ages 0-17 y), newly diagnosed at Rady Children’s Hospital-San Diego were enrolled. To assess HL, we used the English or Spanish form of the 1) Short-form of the Test of Functional Health Literacy Assessment (S-TOFHLA), 2) Newest Vital Sign (NVS), 3) Parental Health Literacy Activities Test (PHLAT), 4) Rapid Estimate of Adult Literacy in Medicine (REALM) or Short Assessment of Health Literacy for Spanish Adults (SAHLSA-50), and 5) Brief Health Literacy Screen (BHLS). To measure acculturation, we used the Hispanic Acculturation Questionnaire (SASH). Two-sample t-tests, univariate/multivariate linear regression, and Pearson-correlation analyses were used for statistical analysis. Results: Hispanic caregivers had significantly lower HL, as measured by the NVS, than NHWs (p&amp;lt;0.001). In caregivers, lower HL levels (measured by the NVS and S-TOFHLA) were positively correlated with older age (p&amp;lt;0.001), lower education level (p&amp;lt;0.001), informal employment (p&amp;lt;0.006), and Spanish primary language (p&amp;lt;0.001). Additionally, S-TOFHLA was significantly correlated with NVS (p&amp;lt;0.001). The odds of having adequate HL decreased by 94% in caregivers with low acculturation compared to caregivers with high acculturation (95% CI: 83%, 98%, p&amp;lt; 0.001). Conclusion: We show significant differences in HL levels between Hispanic and NHW caregivers of children with newly diagnosed cancer. NVS was correlated with S-TOFLHA and could serve as a rapid assessment of HL in the clinical setting for caregivers. Cancer treatment is complex, involving intensive treatments, enrollment in clinical trials, and requiring advanced caregiver knowledge about the disease. By identifying caregivers with limited HL, we can help them navigate cancer therapy effectively. Future research should test culture and language-appropriate interventions, including the systematic use of teach-back, pictorial instruction, and patient navigation. Effective HL interventions may improve cancer care for underserved children and help mitigate disparities in outcomes. Citation Format: M. Elena Martinez, Paula Aristizabal, Bianca Perdomo, Nassim Durali, Shilpa Nataraj, Jesse Nodora. Health literacy disparities among Hispanic caregivers of children with newly diagnosed cancer [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr B135.

Evaluation of measurement equivalence of the Family Satisfaction with the End-of-Life Care (FAMCARE): Tests of differential item functioning between Hispanic and non-Hispanic White caregivers.

Although the psychometric properties of the Family Satisfaction with End-of-Life Care measure have been examined in diverse settings internationally; little evidence exists regarding measurement equivalence in Hispanic caregivers. The aim was to examine the psychometric properties of a short-form of the FAMCARE in Hispanics using latent variable models and place information on differential item functioning (DIF) in an existing family satisfaction item bank. The graded form of the item response theory model was used for the analyses of DIF; sensitivity analyses were performed using a latent variable logistic regression approach. Exploratory and confirmatory factor analyses to examine dimensionality were performed within each subgroup studied. The sample included 1,834 respondents: 317 Hispanic and 1,517 non-Hispanic White caregivers of patients with Alzheimer's disease and cancer, respectively. There was strong support for essential unidimensionality for both Hispanic and non-Hispanic White subgroups. Modest DIF of low magnitude and impact was observed; flagged items related to information sharing. Only 1 item was flagged with significant DIF by both a primary and sensitivity method after correction for multiple comparisons: "The way the family is included in treatment and care decisions." This item was more discriminating for the non-Hispanic, White responders than for the Hispanic subsample, and was also a more severe indicator at some levels of the trait; the Hispanic respondents located at higher satisfaction levels were more likely than White non-Hispanic respondents to report satisfaction. The magnitude of DIF was below the salience threshold for all items. Evidence supported the measurement equivalence and use for cross-cultural comparisons of the short-form FAMCARE among Hispanic caregivers, including those interviewed in Spanish.

Infant formula and toddler milk marketing and caregiver's provision to young children.

The World Health Organization International Code of Marketing of Breast‐milk Substitutes prohibits claims and other marketing that may confuse caregivers about benefits of formula and other milk‐based drinks for infants and toddlers, but such marketing is common in the United States. This study assessed caregivers' provision of milk‐based products to their infants and toddlers and potential confusion about product benefits and appropriate use. Online survey of 1,645 U.S. caregivers of infants (6–11 months) and toddlers (12–36 months). Respondents identified infant formula and toddler milk products they served their child (ren) and provided relative agreement with common marketing claims. Logistic regression assessed relationships between agreement and serving these products, controlling for individual characteristics. Over one‐half of caregivers of infants (52%) agreed that infant formula can be better for babies' digestion and brain development than breastmilk, and 62% agreed it can provide nutrition not present in breastmilk. Most caregivers of toddlers (60%) agreed that toddler milks provide nutrition toddlers do not get from other foods. Some caregivers of infants (11%) reported serving toddler milk to their child most often. Agreement with marketing claims increased the odds of serving infant formula and/or toddler milks. For caregivers of toddlers, odds were higher for college‐educated and lower for non‐Hispanic White caregivers. Common marketing messages promoting infant formula and toddler milks may mislead caregivers about benefits and appropriateness of serving to young children. These findings support calls for public health policies and increased regulation of infant formula and toddler milks.