non-Hispanic White Populations Research Articles

The Association between Modifiable Lifestyle Behaviors and Depression among Asian Americans with Chronic Hepatitis B by Medication Status.

Asian Americans are disproportionately affected by chronic hepatitis B (CHB), with incidence and mortality rates well above those experienced by non-Hispanic white populations. The goal of this study was to examine the association between depression and modifiable lifestyle behaviors among Asian Americans with CHB, with a comparison between those on hepatitis medication and those not on medication. In total, 313 Asian Americans with CHB were recruited through outpatient clinics and community-based organizations to participate in an in-person baseline assessment. We collected data on participants’ sociodemographic characteristics, health-related behaviors, depression symptoms, and modifiable lifestyle behaviors. Bivariate analyses (two sample t-test and chi-square test of independence) and multivariable logistic regression were conducted. We found a high prevalence of depression among individuals living with CHB (41.81% among those not on antiviral medication and 39.71% among those on medication). Multivariate logistic regression results showed that Chinese ethnicity (vs. Vietnamese) and lack of physical activity were significantly associated with a higher risk of mild/severe depression, regardless of medication status. However, the protective effect of physical activity was strong for those on antiviral medication. Furthermore, being employed was significantly associated with a lower risk for depression among Asian Americans on medication, while younger age and being currently married were significantly associated with lower risk of depression among those not on medication. Our findings highlight the significance of physical activity among Asian Americans with CHB, especially for those on antiviral medication. Future prospective research efforts are needed to better identify the potential behavioral mechanisms of depression and provide insights for the psychopharmacological management in this vulnerable population.

Intent to Change Sun-Protective Behaviors Among Hispanic People After a UV Photoaging Intervention: Cohort Study.

Mortality rates from melanoma are higher among Hispanic populations than non-Hispanic White (NHW) populations. Interventions to improve sun safety are needed. The Reveal Imager is a camera that uses standard cross-polarized flash photography to record surface and subsurface skin conditions. This study aims to determine the intervention's effectiveness in increasing awareness of sun damage and exposure reduction between Hispanic and NHW populations. A cohort of 322 participants, aged ≥18 years, were recruited from community events in 2018. Baseline information was collected on demographics, sun exposure, and perception of risk factors. A facial image was then captured using the Reveal Imager. The results were explained and counseling on sun safety was given, followed by filling out an immediate postimage survey. Chi-square tests, analysis of variance, Wilcoxon signed-rank test, McNemar tests, and multivariable logistic regression were used. At follow-up, 125 of 141 (89%) Hispanic participants reported that viewing the UV photoaged image influenced intent-to-change sun protection behaviors, compared to 88 of 121 (73%) NHW participants (odds ratio 2.9, 95% CI 1.5-5.6). Of 141 Hispanic participants, 96 (68%) reported that they intended to increase sunscreen use, compared to only 41 of 121 (34%) NHW participants (P<.001). We demonstrated an application of Reveal Imager for education and risk assessment. The Reveal Imager was especially helpful in motivating intention to change sun exposure among Hispanic populations.

The 2020 US Census Differential Privacy Method Introduces Disproportionate Discrepancies for Rural and Non-White Populations.

The recently finalized changes to the disclosure avoidance policies of the U.S. Census Bureau for the 2020 census, grounded in differential privacy, have faced increasing criticism from demographers and other social scientists. Scholars have found that estimates generated via Census-released test data are accurate for aggregate total population statistics of larger spatial units (e.g. counties), but introduce considerable discrepancies for estimates of subgroups. At present, the ramifications of this new approach remain unclear for rural populations. In this brief, we focus on rural populations and evaluate the ability of the finalized differential privacy algorithm to provide accurate population counts and growth rates from 2000 to 2010 across the rural-urban continuum for the total, non-Hispanic white, non-Hispanic Black, Hispanic or Latino/a, and non-Hispanic American Indian population. We find the method introduces significant discrepancies relative to the prior approach into counts and growth rate estimates at the county level for all groups except the total and non-Hispanic white population. Further, discrepancies increase dramatically as we move from urban to rural. Thus, the differential privacy method likely introduced significant discrepancies for rural and non-white populations into 2020 census tabulations.

Helicobacter pylori Prevalence and Risk Factors in Three Rural Indigenous Communities of Northern Arizona.

Helicobacter pylori (H. pylori) is one of the most common bacterial stomach infections and is implicated in a majority of non-cardia gastric cancer. While gastric cancer has decreased in the United States (US), the incidence in the Navajo Nation is nearly four times higher than surrounding Non-Hispanic White populations. Little is known about H. pylori prevalence in this population or other Indigenous communities in the lower 48 states. In this cross-sectional study, 101 adults representing 73 households from three Navajo Nation chapter communities completed surveys and a urea breath test for active H. pylori. Accounting for intrahousehold correlation, H. pylori prevalence was 56.4% (95% CI, 45.4–66.8) and 72% of households had at least one infected person. The odds of having an active infection in households using unregulated water were 8.85 (95% CI, 1.50–53.38) that of the use of regulated water, and males had 3.26 (95% CI, 1.05–10.07) higher odds than female. The prevalence of H. pylori in Navajo is similar to that seen in Alaska Natives. Further investigation into factors associated with prevention of infection is needed as well as understanding barriers to screening and treatment.

Abstract IA-48: A brief overview of lung and colorectal cancer disparities in American Indian and Alaska Native populations

Abstract Lung cancer and colorectal cancer (CRC) are leading causes of cancer morbidity and mortality among US American Indian and Alaska Native (AI/AN) men and women. For most AI/AN communities, disparities in these cancers occur compared to their non-Hispanic White (NHW) counterparts. This presentation provides a brief overview of the epidemiology of lung and colorectal cancers among AI/AN, and serves as background for talks regarding the impact of revised eligibility criteria for implementing screening programs among AI/AN. In recent years, lung cancer incidence rates among AI/AN persons were 12% higher than rates among NHW in counties with relatively high proportions of AI/AN residents. By region, rates were 17% to 3 times higher in AI/AN than NHW in Pacific Coast, Alaska, and Northern and Southern Plains, in contrast to the Southwest and Eastern US where AI/AN rates were 35% lower. While lung cancer incidence is decreasing overall in both populations, the rate of decrease is slower for AI/AN. Generally, lung cancer occurs at younger ages and at more advanced stages for AI/AN compared with NHW, and AI/AN persons with lung cancer have worse survival. Little is known about the experience of lung cancer screening (LCS) in health care systems that serve AI/AN communities. LCS has not been a mandatory reporting measure for the Indian Health Service. Models of expanded eligibility for LCS suggest that AI/AN will have a higher relative increase in eligible persons compared with NHW, but information on implementation is scarce. Disparities in CRC are also notable among AI/AN. In recent years, incidence rates among AI/AN were 41% higher than among NHW in counties with relatively high proportions of AI/AN residents. CRC incidence rates also vary regionally, but AI/AN in general had higher CRC incidence rates than did NHW. CRC incidence rates have been decreasing overall among both AI/AN and NHW populations, but at a slower pace for AI/AN. Notably, CRC incidence increased among AI/AN in the Southwest. CRC incidence rates have also increased among persons younger than 50 years for both AI/AN and NHW, but more than 1 in 7 CRC cases among AI/AN were diagnosed at ages younger than 50 years, compared with less than 1 in 10 among NHW. AI/AN were more likely to have late-stage diagnoses than were NHW, and AI/AN men had the worst survival than men in other racial groups. Factors encountered in implementing programs to improve lung and CRC screening among AI/AN health care systems will be discussed follow this presentation. Citation Format: Dorothy A. Rhoades. A brief overview of lung and colorectal cancer disparities in American Indian and Alaska Native populations [abstract]. In: Proceedings of the AACR Virtual Conference: 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2021 Oct 6-8. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr IA-48.

COVID-19 through a cultural lens

COVID-19 through a cultural lens

Cat and/or Dog Ownership, Cardiovascular Disease, and Obesity: A Systematic Review.

Pet ownership, the most common human–animal interaction, is believed to bestow positive health benefits onto pet owners. However, there is limited research on substantiating these assertions. The aim of this review was to systematically identify, evaluate, and summarize primary research on the relationship between cat and/or dog ownership and cardiovascular disease (CVD), type 2 diabetes (T2D), and obesity to inform future research on pet ownership and chronic disease. How pet ownership was defined/measured, and identification of the chronic disease variables and health behaviors most often measured were emphasized. Two researchers independently searched PubMed and Web of Science, where One Health literature are mostly likely to be indexed, for peer-reviewed literature on pet ownership and CVD, T2D, and obesity. A review of 4541 titles and abstracts for relevance resulted in 34 manuscripts eligible for full-text review. Two researchers assessed each eligible manuscript and extracted data only from those that met the inclusion criteria (n = 14). Ten studies on CVD, four studies on obesity, and zero studies on T2D met the study criteria. The CVD and obesity variables varied and were not well described. The relationship between pet ownership and CVD and obesity varied (positive, negative, mixed effects, and no effect). Generalizability lacked across all studies: most studies were with Non-Hispanic White populations. Other areas of weakness were quality of study outcomes and instrument validity. Operationalization of pet ownership varied (from no verification to confirmed pet registration). Integration of the evidence-based influence of the human–animal connection through pet ownership on CVD and obesity may make prevention, mitigation, and treatment strategies more robust.

Association of Social Relationships and Depression Among Older Mexican Adults: Does a Rural or Urban Context Matter?

Social characteristics such as strong community and family ties have been associated with positive mental health outcomes in older adults. However, this evidence is based primarily on non-Hispanic White populations and may vary according to living in a rural versus urban community. We hypothesize that the positive impact of available social networks, perceived support, and social participation on older Mexican adults’ likelihood for high depressive symptoms (i.e., depression) will be greater for those living in rural (community < 2,500 people) than urban communities. Data came from the 2012 Wave of the Mexican Health and Aging Study. Depressive symptoms were measured using a 9-item version of the Center for Epidemiologic Studies Depression Scale. Social participation is the respondent’s self-reported participation in hobbies, religious activities, volunteering, and visits with neighbors. Available social network is measured as having relatives and/or good friends living in the neighborhood. Perceived support is the respondent’s perception of friends/family’s willingness to help with finances and personal care. The final sample of 6,266 respondents was majority (62.4%) female, mean age of 69 years, 17.8% lived in a rural community, and 34.5% with depression. Logistic regression models stratified by rural/urban indicated that available social network and perceived social support were not associated with depression in rural or urban communities. In general, the social participation activities were associated with significantly lower odds of depression for older adults living in urban but not rural communities. This research highlights the influence of older adults’ community on their social relationships and mental health.

Admixture mapping identifies novel regions influencing Alzheimer disease in African Americans.

African Americans (AA) are substantially underrepresented in Alzheimer's disease (AD) genetic studies, yet their admixed genetic ancestry (African and European) provides a unique opportunity to identify novel genetic factors associated with AD related to genetic ancestry. Admixture mapping (AM) provides a more powerful approach than SNP-based genome-wide association studies (GWAS) in admixed populations in part due to the lower multiple testing burden. In this study we used AM to identify regions associated with AD in AA individuals. Our analyses included 10,271 individuals from 17 AD Sequencing Project and AD Genetics Consortium cohorts. We estimated global ancestry (GA) using the GENESIS software. To infer local ancestry (LA), the target AA dataset was combined with appropriate reference-population samples from HGDP reference panel, and LA was estimated using SHAPEIT followed by RFMix. Then, we performed AM using the GENESIS software separately on each cohort. We meta-analyzed the AM results with the random effect approach (RE2). We calculated the significance threshold using STEAM software. Finally, we performed logistic regression of genotype on affection status for variants across the prioritized regions from AM for fine-mapping. The regression model included LA and genotype as main effects and term for their interaction, along with GA, sex and age as covariates, and used permutation-based testing approach for multiple test correction (N=10,000). AM identified two genome-wide significant loci on chromosomes 17p13.2 (pv=2.2 x10-5 ) and 18q21.33 (pv=1.22x10-5 ). 17p13.2 region was identified as a genome-wide significant in two previous studies in non-Hispanic White population. To fine map this region we conducted ancestry-aware regression analysis. LA x genotype interaction model found the MINK1 gene (rs72835013) on the 17p13.2 region significantly associated with AD (pv = 1x10-4 ). Our results confirmed an AD associated region on the chromosome 17p13.2 and showed that the 17p13.2 region increases AD risk in AA individuals with the European LA. This region includes genes previously indicated in AD such as SCIMP through association studies and the MINK1 and SLC25A11 genes through brain expression studies.

Life Expectancy Trends Among Integrated Health Care System Enrollees, 2014-2017.

Introduction:The Centers for Disease Control and Prevention (CDC) has reported downward trends in life expectancy and racial/ethnic differences between 2014 and 2017.Objective:To determine the life expectancy of the Kaiser Permanente Mid-Atlantic States (KPMAS) insured population as compared to the CDC National Vital Statistics data from 2014 to 2017. We also aimed to highlight the utilization of membership data to inform population statistical estimates such as life expectancy. We examine whether national trends in life expectancy are reflected in an insured population with relatively uniform access to care.Methods:This retrospective, data only study examined life expectancy between 2014 and 2017. Data from electronic medical records and the National Death Index were combined to construct complete life tables by race and sex for the KPMAS population, which was compared to the CDC National Vital Statistics data.Results:From 2014 to 2017, the overall KPMAS population life expectancy at birth varied between 84.6 and 85.2 years compared to the CDC reported national average of 78.6-78.9 years (p < 0.001). While the CDC dataset reported a 3.5- to 3.7-year life expectancy gap between non-Hispanic White and non-Hispanic Black populations, in the KPMAS population, this gap was significantly smaller (0.0-0.9 years). The gap in life expectancy between males and females was consistent across KPMAS and the CDC data; however, overall KPMAS male and female patient life expectancy was extended in comparison.Conclusion:Among members who disclosed their race/ethnicity, KPMAS Hispanic, non-Hispanic Black, and non-Hispanic White members had significantly higher life expectancies than the CDC dataset in all years reported.

Disparities in Air Pollution Exposure in the United States by Race/Ethnicity and Income, 1990-2010.

Background:Few studies have investigated air pollution exposure disparities by race/ethnicity and income across criteria air pollutants, locations, or time.Objective:The objective of this study was to quantify exposure disparities by race/ethnicity and income throughout the contiguous United States for six criteria air pollutants, during the period 1990 to 2010.Methods:We quantified exposure disparities among racial/ethnic groups (non-Hispanic White, non-Hispanic Black, Hispanic (any race), non-Hispanic Asian) and by income for multiple spatial units (contiguous United States, states, urban vs. rural areas) and years (1990, 2000, 2010) for carbon monoxide (CO), nitrogen dioxide (), ozone (), particulate matter with aerodynamic diameter (; excluding year-1990), particulate matter with aerodynamic diameter (), and sulfur dioxide (). We used census data for demographic information and a national empirical model for ambient air pollution levels.Results:For all years and pollutants, the racial/ethnic group with the highest national average exposure was a racial/ethnic minority group. In 2010, the disparity between the racial/ethnic group with the highest vs. lowest national-average exposure was largest for [54% ()], smallest for [3.6% ()], and intermediate for the remaining pollutants (13%–19%). The disparities varied by U.S. state; for example, for in 2010, exposures were at least 5% higher than average in 63% of states for non-Hispanic Black populations; in 33% and 26% of states for Hispanic and for non-Hispanic Asian populations, respectively; and in no states for non-Hispanic White populations. Absolute exposure disparities were larger among racial/ethnic groups than among income categories (range among pollutants: between 1.1 and 21 times larger). Over the period studied, national absolute racial/ethnic exposure disparities declined by between 35% (; ) and 88% (; CO); relative disparities declined to between (; i.e., nearly zero change) and (CO; i.e., a reduction).Discussion:As air pollution concentrations declined during the period 1990 to 2010, absolute (and to a lesser extent, relative) racial/ethnic exposure disparities also declined. However, in 2010, racial/ethnic exposure disparities remained across income levels, in urban and rural areas, and in all states, for multiple pollutants. https://doi.org/10.1289/EHP8584

Predictive Value of Sequential Organ Failure Assessment Score across Patients with and without COVID-19 Infection

RationaleSequential organ failure assessment (SOFA) scores are commonly used in crisis standards of care policies to assist in resource allocation. The relative predictive value of SOFA by coronavirus disease (COVID-19) infection status and among racial and ethnic subgroups within patients infected with COVID-19 is unknown.ObjectivesTo evaluate the accuracy and calibration of SOFA in predicting hospital mortality by COVID-19 infection status and across racial and ethnic subgroups.MethodsWe performed a retrospective cohort study of adult admissions to the University of Miami Hospital and Clinics inpatient wards (July 1, 2020–April 1, 2021). We primarily considered maximum SOFA within 48 hours of hospitalization. We assessed accuracy using the area under the receiver operating characteristic curve (AUROC) and created calibration belts. Considered subgroups were defined by COVID-19 infection status (by severe acute respiratory syndrome coronavirus 2 polymerase chain reaction testing) and prevalent racial and ethnic minorities. Comparisons across subgroups were made with DeLong testing for discriminative accuracy and visualization of calibration belts.ResultsOur primary cohort consisted of 20,045 hospitalizations, of which 1,894 (9.5%) were COVID-19 positive. SOFA was similarly accurate for COVID-19–positive (AUROC, 0.835) and COVID-19–negative (AUROC, 0.810; P = 0.15) admissions but was slightly better calibrated in patients who were positive for COVID-19. For those with critical illness, maximum SOFA score accuracy at critical illness onset also did not differ by COVID-19 status (AUROC, COVID-19 positive vs. negative: intensive care unit admissions, 0.751 vs. 0.775; P = 0.46; mechanically ventilated, 0.713 vs. 0.792, P = 0.13), and calibration was again better for patients positive for COVID-19. Among patients with COVID-19, SOFA accuracy was similar between the non-Hispanic White population (AUROC, 0.894) and racial and ethnic minorities (Hispanic White population: AUROC, 0.824 [P vs. non-Hispanic White = 0.05]; non-Hispanic Black population: AUROC, 0.800 [P = 0.12]; Hispanic Black population: AUROC, 0.948 [P = 0.31]). This similar accuracy was also found for those without COVID-19 (non-Hispanic White population: AUROC, 0.829; Hispanic White population: AUROC, 0.811 [P = 0.37]; Hispanic Black population: AUROC, 0.828 [P = 0.97]; non-Hispanic Black population: AUROC, 0.867 [P = 0.46]). SOFA was well calibrated for all racial and ethnic groups with COVID-19 but estimated mortality more variably and performed less well across races and ethnicities without COVID-19.ConclusionsSOFA accuracy does not differ by COVID-19 status and is similar among racial and ethnic groups both with and without COVID-19. Calibration is better for COVID-19–infected patients and, among those without COVID-19, varies by race and ethnicity.

Hispanic or Latin American Ancestry Is Associated with a Similar Genomic Profile and a Trend Toward Inferior Outcomes in Newly Diagnosed Multiple Myeloma As Compared to Non-Hispanic White Patients in the Multiple Myeloma Research Foundation (MMRF) CoMMpassstudy

IntroductionLarge clinical data sets suggest that the natural history and prognosis of newly diagnosed multiple myeloma (NDMM) differs between patients of European and African ancestry, with the latter group exhibiting an earlier age at onset and poorer overall prognosis in some studies. The use of next generation sequencing (NGS) to characterize the genomic landscape of multiple myeloma (MM) suggests that the observed phenotypic differences between these groups of patients may reflect distinct underlying genomic profiles and mutational processes. Thus far, characterizations of this type have focused principally on patients of African ancestry (AA). Here, we characterize the genomic features and outcomes of a large series of patients of Hispanic or Latin American ancestry (HL) as compared to their Non-Hispanic white (NHW) counterparts.MethodsSubjects were selected from the MMRF CoMMpass SM trial, a study that includes 1,154 patients with updated outcome data as of March, 2020. Within this data set, 760 patients had information on race and ethnicity. Among these, 55 HL patients and 478 NHW patients possessed complete clinical and genomic information.We analyzed baseline whole exome sequencing (WES) and long insert whole genome sequencing (WGS) as previously described (Walker, et al. Blood 2019). Our analysis focused on 63 known driver mutations in multiple myeloma and 39 sites of common copy number variation across the study population. Complex structural variants and tumor telomere length were called using previously described bioinformatic tools (Boyle et al. Leukemia 2021). Survival analysis was undertaken using the Kaplan-Meier method with hazard ratios determined by the Cox proportional hazards model.ResultsIn a comparison of clinical features between the Hispanic and NHW population, we did not identify any differences in age of onset, gender, presenting cytogenetics, International Staging System Score (ISS), and IMWG Risk Category. The proportion of patients undergoing autologous stem cell transplantation was similar between groups. We identified no statistically significant differences in the presence of characteristic translocations involving IgH locus or in hyperdiploidy status. No statistically significant differences in tumor mutational burden or loss-of-heterozygosity percentage emerged between HL and NHW patients.We examined non-synonymous variations (NSV) and copy number variations at the loci of known MM driver genes and encountered no statistically significant differences in NSV, copy number, or biallelic status. We further categorized genes into pathways relevant to the pathogenesis of MM and discovered no difference in the proportions of patients harboring mutations in genes related to the MEK/ERK and NF-κB pathways, cell cycle regulation, and epigenetic modification. We were unable to the distinguish either population based on the presence of chromothripsis or in the overall preponderance of an APOBEC mutational signature. Tumor telomere length was not significantly different between the populations.An analysis of overall and progression free survival (PFS) with a median duration of follow up of 44 months revealed a trend toward poorer outcomes among the HL population that did not reach statistical significance. Median PFS was 24 months in HL patients and 35 months in the NHW population (p = 0.19). Median OS was not reached in either ethnic subgroup. In terms of overall survival, age, ISS score, overall number of driver mutations, and the presence of chromothripsis emerged with a negative impact on outcome (Figures 1a, 1b). These variables with the exception of chromothripsis retained their significant impact on progression free survival (Figure 2a, 2b).ConclusionThe correlation between Hispanic or Latin American ancestry and underlying disease biology in MM has yet to be fully elucidated. In our analysis, which was based on self-declared ancestry as opposed to admixture, no obvious differences in significant measures of genomic variation known to impact prognosis in MM emerged between HL and NHW patients. These results may help to inform the future large-scale studies to ascertain the impact of genomics, disease biology and socioeconomic factors on outcomes in this heterogeneous patient population. [Display omitted] DisclosuresWalker: Bristol Myers Squibb: Research Funding; Sanofi: Speakers Bureau. Morgan: BMS: Membership on an entity's Board of Directors or advisory committees; Jansen: Membership on an entity's Board of Directors or advisory committees; Karyopharm: Membership on an entity's Board of Directors or advisory committees; Oncopeptides: Membership on an entity's Board of Directors or advisory committees.

Homicide and the Opioid Epidemic: A Longitudinal Analysis

Recent cross-sectional research has disclosed a positive relationship between opioid-related death rates and homicide rates. The current study adds a longitudinal dimension to this research. We estimate fixed effects panel models of the temporal relationship between race-specific homicide rates and opioid-related death rates within U.S. counties and county clusters between 1999 and 2015. The results reveal a positive association between change over time in homicide and opioid-related deaths, net of multiple socioeconomic and demographic controls, in both the Non-Hispanic White and Black population. The association is stronger in the Appalachian counties, where the opioid epidemic has been particularly severe.

Molecular Biomarker Testing and Targeted Therapy Patterns in Patients with Acute Myelogenous Leukemia (AML) in Community Health Systems in the United States: A Real-World Data Analysis

Molecular Biomarker Testing and Targeted Therapy Patterns in Patients with Acute Myelogenous Leukemia (AML) in Community Health Systems in the United States: A Real-World Data Analysis

S3442 Gastric Cancer: Epidemiology and Diagnosis in the Non-Hispanic White Population at a Tertiary Medical Center

S3442 Gastric Cancer: Epidemiology and Diagnosis in the Non-Hispanic White Population at a Tertiary Medical Center

Predictors of adherence to patient reported outcomes and psychosocial needs questionnaire in a culturally diverse ambulatory oncology setting: The My Wellness Check Program.

173 Background: Electronic health record (EHR) integrated symptom monitoring using patient reported outcomes (PRO) has been associated with improved outcomes, including health-related quality of life (HRQoL), in cancer survivors. However, these improvements have been documented through reasonably high completion rates of PRO measures in predominantly non-Hispanic White patient populations using only English language assessments. This study aimed to 1) examine factors associated with the completion of PRO assessments and 2) test differences in referrals to cancer support services between PRO responders and non-responders in a cohort of cancer survivors with significant racial, ethnic, and primary language diversity. Methods: A retrospective analysis (October 2019-February 2021) was performed for patients who were assigned the My Wellness Check (MWC) program at a tertiary, comprehensive cancer center. MWC is an EHR-based PRO assessment and referral program that uses PROMIS computer adaptive tests for depression, anxiety, pain, fatigue, and physical function as well as a psychosocial needs assessment. MWC PRO questionnaire is available in English or Spanish based on patient preference. Demographic and clinical characteristics of patients were collected and incorporated in multivariable binary logistic regression model to examine factors associated with completion of the MWC PRO questionnaires. The frequency of referrals to cancer support services was compared by Chi-square test between MWC PRO responders and non-responders. Adjusted odds ratio (aOR) and 95% confidence interval (95%CI) were calculated. Results: Of the 5306 patients eligible to complete MWC PRO questionnaire, the majority were female (64.1%), White (86.9%), Hispanic (65.8%), English speaker (55.4%), and 46.0% were responders. Patients who were younger than 65 (aOR 1.39; 95%CI 1.22-1.59; p &lt; 0.0001), female (1.23; 1.09-1.41; p = 0.0019), non-Hispanic/Latino (1.43; 1.25-1.64; p &lt; 0.0001), living with partners ( = 1.28; 1.13-1.46; p = 0.0001), and receipt of active treatment (1.37; 1.18-1.58; p &lt; 0.0001) were significantly associated with MWC PRO completion. Responders were referred to cancer support services more often than non-responders (16.6% vs 5.4%, p &lt; 0.0001). Conclusions: Patient-level and clinical factors predict completion of PRO measures, and responders were more likely to have a referral to cancer support services. To optimize supportive care for ambulatory cancer patients, further research is needed to identify factors that can promote patient engagement, particularly in patients who are under-utilizers of such services.

Impact of Sociodemographic Factors on Dental Caries in Children and Availing Fluoride Treatment: A Study Based on National Survey of Children's Health (NSCH) Data 2016-2019.

IntroductionDental caries is a global health issue. It is a largely preventable, multifactorial non-communicable disease. Given the gravity of the situation, in 2014 United States Preventive Services Task Force recommended that the primary care physician apply fluoride varnish from the eruption of the first tooth till the child attains five years of age. Using 2016-2019 National Survey of Children’s Health (NSCH) cross-sectional representative data, the aim of this study was to determine if the child’s age, gender, and race are predictors of the child having decayed teeth or cavities in the past 12 months and if they had availed preventative dental services from the dentist in the past 12 months in the US and if so, did they receive fluoride treatment.MethodsThe prevalence of dental caries and dental treatment among children under each category of sociodemographic risk factors were estimated using 2016-2019 NSCH’s cross-sectional representative data on two survey questions. Then, the statistical significance of the association of the categorical risk factors with the prevalence of dental caries and the association of the categorical risk factors with the prevalence of fluoride dental treatment were tested using two-sample proportion tests and chi-square tests. Further, chi-square residual analysis was employed to better understand the nature of the association and to reveal the degree of contribution to the test statistic from each categorical combination of risk factors.ResultsPrevalence and associative risk of tooth decay in children was the highest in the 6-11 years age group across all three years under study. The 6-11 years age group had the highest prevalence and association of receiving fluoride treatment across all three years. In our study, the prevalence of dental caries in children by race varied according to the year. In 2016-2017 and 2018-2019, it was the Hispanic population with the highest prevalence of tooth decay. In 2017-2018 the highest prevalence was seen in the Non-Hispanic Black (NHB) population. Across all three years, the Hispanic population had the highest associative risk of tooth decay. The Non-Hispanic White (NHW) population had the highest prevalence and association with receiving fluoride treatment across all three years. Male children were found to have the higher prevalence and associative risk of decayed teeth across all three survey years.ConclusionDental caries is a worldwide health burden. However, it can be prevented by different precautionary measures. The results of our study revealed that certain sociodemographic factors such as age, gender, and race of the child make certain groups of the child population more at risk for the development of dental caries; most notable findings were that the male children were significantly associated to have decayed teeth and not availing dental fluoride treatment for which limited information is available in the literature. Additionally, the age groups 1-5 and 6-11 were significantly associated with the prevalence of not receiving dental treatment and the prevalence of dental caries, respectively. More active participation of pediatricians in getting trained for the application of fluoride varnish and helping getting their patients established with dental services per recommendations will help streamline preventative dental care.

Racial and Ethnic Differences in Cannabis Use Following Legalization in US States With Medical Cannabis Laws

Little is known about changes in cannabis use outcomes by race and ethnicity following the enactment of recreational cannabis laws (RCLs). To examine the association between enactment of state RCLs and changes in cannabis outcomes by race and ethnicity overall and by age groups in the US. This cross-sectional study used restricted use file data from the National Surveys of Drug Use and Health between 2008 and 2017, which were analyzed between September 2019 and March 2020. National survey data included the entire US population older than 12 years. Self-reported past-year and past-month cannabis use and, among people that used cannabis, daily past-month cannabis use and past-year Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) cannabis use disorder. Multi-level logistic regressions were fit to estimates changes in cannabis use outcomes by race and ethnicity overall and by age between respondents in states with and without enacted RCLs, controlling for trends in states with medical cannabis laws or no cannabis laws. A total of 838 600 participants were included for analysis (mean age, 43 years [range, 12-105 years]; 434 900 women [weighted percentage, 51.5%]; 511 900 participants (weighted percentage, 64.6%) identified as non-Hispanic White, 99 000 (11.9%) as non-Hispanic Black, 78 400 (15.8%) as Hispanic, and 149 200 (7.6%) as other (including either Native American, Pacific Islander, Asian, or more than 1 race or ethnicity). Compared with the period before RCL enactment, the odds of past-year cannabis use after RCL enactment increased among Hispanic (adjusted odds ratio [aOR], 1.33; 95% CI, 1.15-1.52), other (aOR, 1.31; 95% CI, 1.12-1.52), and non-Hispanic White (aOR, 1.21; 95% CI, 1.12-1.31) populations, particularly among those aged 21 years or more. Similarly, the odds of past-month cannabis use increased among Hispanic (aOR, 1.43; 95% CI, 1.22-1.69), other (aOR, 1.43; 95% CI, 1.20-1.70), and non-Hispanic White (aOR, 1.24; 95% CI, 1.13-1.35) populations after RCL enactment. No increases were found in the odds of past-year or past-month cannabis use post-RCL enactment among non-Hispanic Black individuals or among individuals aged 12 to 20 years for all race and ethnicity groups. In addition, among people who used cannabis, while no increases were found in past-month daily cannabis in any racial or ethnic group, the odds of cannabis use disorder increased post-RCL among individuals categorized as other overall (aOR, 1.45; 95% CI, 1.07-1.95), but no increases were found by age group. Changes in cannabis use by race and ethnicity that may be attributable to policy enactment and variations in recreational policy provisions should be monitored. To ensure that the enactment of recreational cannabis laws truly contributes to greater equity in outcomes and adheres to antiracist policies, monitoring unintended and intended consequences that may be attributable to recreational cannabis use and similar policies by race and ethnicity is needed.

Trends in Mortality Due to Stimulants Use in Adolescents and Young Adults

Objectives: Stimulant medications including illegal use of Methamphetamine (MA) continues to rise in adolescents and young adults. This study aims to examine mortality trends because of the stimulant overdose in this age group (15 to 34 years). Methods: Age-adjusted mortality data, including 95% confidence intervals and standard errors, were extracted using publicly available multiple causes of death files from the United States Centers for Disease Control Wide-ranging ONline Data for Epidemiologic Research (WONDER). The data was filtered using International Classification of Disease (ICD-10) codes: F15.0 (Mental and behavioral disorders because of use of other stimulants, acute intoxication), F15.1 (Mental and behavioral disorders because of use of other stimulants, harmful use), T43.6 (Psychostimulants with abuse potential). The trends analysis for 1999 to 2019 was conducted using Joinpoint regression statistical software. Results: The mortality rate has been consistently increasing in the last decade across all races and ethnicities in adolescents and young adults. Non-Hispanic White population had the highest mortality rates (7.6 per 100,000 in 2019) compared with non-Hispanic Black (3.08 per 100,000 in 2019) and Hispanic population (3.33 per 100,000 in 2019). But the annual percent change in mortality was shown to be highest in non-Hispanic Black population (34.3% between 2009 and 2019). Conclusion: The increase in overall mortality rate because of stimulants use reflects the increase of MA use in this age group. The difference in the rate of change shows worsening racial inequality. Public health policies should be implemented to include evidence-based strategies to prevent MA misuse or overdose.