non-Hispanic White Women Research Articles

Racialized Economic Segregation, Treatment and Outcomes in Women with Triple-Negative Breast Cancer.

We previously demonstrated differences in treatment and mortality between non-Hispanic Black (NHB) and non-Hispanic White (NHW) women with triple-negative breast cancer (TNBC). The impact of residential segregation on TNBC treatment and outcomes remains unknown. We identified NHB and NHW women with TNBC diagnosed from 2010-2015 and followed through 2016, using the Surveillance, Epidemiology, and End Results dataset. County-level racialized economic segregation was measured using the Index of Concentration at the Extremes. Multilevel Cox regression and multilevel logistic regression accounting for county-level clustering were used to calculate hazard ratios (HRs) and odds ratios (ORs). Of 25217 patients, 25.6% were NHB. Compared with patients in counties with the highest concentration of high-income NHW residents (most privileged), patients in counties with the highest concentration of low-income NHB residents (most deprived) had significantly higher risks of breast cancer-specific mortality (HR=1.14, 95% CI 1.01-1.30; Ptrend=0.12), overall mortality (HR=1.15, 95% CI 1.02-1.29; Ptrend=0.06), and late-stage diagnosis (OR=1.15, 95% CI 1.01-1.32; Ptrend=0.03). Overall, 28.2%, 24.5%, and 18.3% of excess risks of breast cancer mortality, overall mortality, and late-stage diagnosis in NHB (vs NHW) patients were explained by residential segregation. There was no significant association between residential segregation and treatment. Living in the most deprived vs privileged neighborhoods was associated with lower likelihoods of early detection and survival of TNBC, contributing to TNBC outcome disparities between NHBs and NHWs. This highlights the importance of breast cancer screening for neighborhoods with predominantly low-income NHB residents and elucidating the pathways linking segregation to TNBC prognosis.

Variation in the Use of Guideline-Based Care by Prenatal Site: Decomposing the Disparity in Preterm Birth for Non-Hispanic Black Women.

Variation in the Use of Guideline-Based Care by Prenatal Site: Decomposing the Disparity in Preterm Birth for Non-Hispanic Black Women.

Differences in plasma metabolome between non-Hispanic White and non-Hispanic Black women

BackgroundTo understand potential racial differences in disease susceptibility and develop targeted prevention strategies, it is essential to establish biological differences between racial groups in healthy individuals. However, knowledge about how race impacts metabolites is limited. We therefore performed a cross-sectional study using comprehensive metabolomics analysis to investigate racial differences in metabolites among 506 non-Hispanic White (NHW) women and 163 non-Hispanic Black (NHB) women.MethodsWe performed untargeted plasma metabolomic profiling using Metabolon’s platform (Durham, NC®) and identified 1074 metabolites in 9 super-pathways. We used multivariable linear regression models, adjusted for confounders, to identify associations between race and metabolites. We applied a Bonferroni correction (p-value < 10–5) to account for multiple testing.ResultsWe identified 26 metabolites that differed significantly between NHW and NHB women. Seven, 10, 17, and 23 metabolites showed absolute percentage differences ≥ 50, ≥ 40%, ≥ 30%, and ≥ 20%, respectively. Xenobiotics (n = 5) and amino acids (n = 2) exhibited the largest absolute percentage differences (≥ 50%) between NHB and NHW women. In the xenobiotics super-pathway, NHB women had higher thymol sulfate, 2-naphthol sulfate, and 2-hydroxyfluorene sulfate, derived from the exposure to polycyclic aromatic hydrocarbons, while NHW women had higher xanthine metabolites. In the amino acid super-pathway, lysine and tryptophan metabolites were lower in NHB women.ConclusionsWe report differences in several metabolites between NHW and NHB women. These findings require validation in a different study and could provide insight into investigating how racial differences in metabolites may impact disease burden across diverse populations.

Evaluating Racial and Ethnic Differences in Use of Elective Labor Induction for Low-Risk Births : A Retrospective Cohort Study.

The study sought to identify differences in use of elective induction of labor (IOL) post-ARRIVE trial, by race and ethnicity, and contributions of multilevel contextual factors to induction use. Racial disparities in birth outcomes have been attributed to community and provider (ie, multilevel contextual) factors. The varied use of elective induction, a common obstetric procedure, can provide insights on how racial biases are evidenced in care delivery. A retrospective cohort study, 2018 from 2020, utilized health record data from a multi-hospital regional health system to identify the sample of term, singleton gestations without maternal or fetal indications for induction. Multivariate logistic regression was used to test associations between race/ethnicity and odds of labor induction. Labor induction occurred in 26.8% of 10 473 births. Use varied by reported race or ethnicity; non-Hispanic-White (31.1%), -Asian (22.2%), -Black or African American (22.1%), and -all other races (24.1%) and Hispanic (19.3%). Hispanic women had significantly fewer labor inductions compared to non-Hispanic White women (odds ratio [OR]: 0.62, 95% confidence interval [CI]: 0.55-0.70, P < .001). Physician care was associated with higher use compared to midwifery care (OR: 1.48, 95% CI: 1.33-1.65, P < .001); hospital geographic location and older maternal age were associated with higher induction use. Hispanic women had significantly higher rate of cesarean birth after IOL. Provider type, hospital geographic location, and maternal age predicted differences in elective IOL use between racial and ethnic groups. Future research should focus on additional contextual factors affecting use of elective induction and resultant mode of birth, particularly between racial and ethnic groups.

Peripheral and Central Hemodynamic Responses to Rhythmic Handgrip Exercise in Young, Healthy Black Women.

Non-Hispanic Black (NHB) women in the United States exhibit higher prevalence and mortality rates from cardiovascular diseases compared to non-Hispanic White (NHW) women. Previous studies in NHB men have demonstrated impaired vascular function at rest and during exercise; however, to date, no studies have investigated the hyperemic responses during exercise in NHB women. Therefore, we tested the hypothesis that, compared with NHW women, NHB women would present an attenuated increase in forearm blood flow (FBF) and forearm vascular conductance (FVC) during steady-state rhythmic handgrip exercise. FBF (duplex Doppler ultrasound) and central hemodynamics including mean arterial pressure (MAP; finger photoplethysmography) were measured in healthy young NHW (n = 16) and NHB (n = 14) women during rhythmic handgrip exercise performed at 15%, 30% and 45% of maximal voluntary contraction (MVC). FVC (calculated as FBF/MAP), FBF, and MAP were not different between groups at rest (FVC: 52 ± 13 ml/min/100 mmHg in NHW women vs. 56 ± 14 ml/min/100 mmHg in NHB women; P = 0.43). There was an intensity-dependent increase in FBF and FVC during exercise in both groups, but there was no difference between the groups (e.g., FVC at 45% MVC; NHW: 304 ± 55 ml/min/100 mmHg, NHB: 351 ± 121 ml/min/100 mmHg, interaction P = 0.257). MAP responses during exercise were also not different between groups (e.g., ΔMAP at 45% MVC; NHW: 7 ± 6 mmHg, NHB:8 ± 6 mmHg, P = 0.553). Additionally, all central hemodynamics during exercise, and flow-mediated dilation were comparable between the groups. Collectively, these findings indicate that the hyperemic responses to rhythmic handgrip exercise are not different between young, healthy NHB and NHW women.

Prenatal Dental Visits, Perceived Benefits of Oral Health, and Preterm Birth Outcome, 2009-2021.

Previous studies have demonstrated a significant association between maternal oral health and pregnancy complications, including preterm birth (<37 wk). However, research on the impact of dental care utilization during pregnancy on these outcomes has produced both positive and negative results. The current study investigated the association between preterm birth and dental care utilization, focusing on dental visits for cleaning during pregnancy as well as the perceived benefits of oral health during pregnancy. This secondary data analysis cross-sectional study used data from the Pregnancy Risk Assessment Monitoring System in the United States from 2009 to 2021. Descriptive and multivariate logistic regression analyses were performed to examine the association between dental variables and preterm birth. The study included 399,847 women with a recent single live birth, representing 21,218,114 women across 48 states and New York City. After adjusting for factors such as race and ethnicity, age, marital status, medical insurance type, education level, adequacy of prenatal care, and other medical variables associated with preterm birth, women who had dental visits for cleaning during pregnancy had a lower odds of preterm birth (adjusted odds ratio [aOR] = 0.90, 95% confidence interval [CI] [0.86, 0.93], P < 0.001) compared with those who did not. A significant association between prenatal dental cleaning and reduced preterm birth was observed only among women who perceived the benefits of oral health during pregnancy (aOR = 0.93, 95% CI [0.88, 0.97], P = 0.002) and among non-Hispanic White women (aOR = 0.88, 95% CI [0.83, 0.93], P < 0.001). This study revealed an inverse relationship between dental cleaning visits during pregnancy and preterm birth outcomes, notably among women who recognized the benefits of oral health and among non-Hispanic White women. The results emphasize the significance of dental visits and the perception of oral health benefits during pregnancy. The study demonstrated an inverse association between dental visits for cleaning during pregnancy and preterm birth outcomes, with this relationship being significant among women who perceived the benefits of oral health during pregnancy and among non-Hispanic White women. These findings suggest that both the dental visits and the perception of oral health benefits may be important factors linked to preterm birth outcomes, with potential racial and ethnic variations. Policy makers and clinicians could integrate oral health care and prenatal oral health education into prenatal care as essential components of primary health care to improve both oral and overall health outcomes for women.

Evaluating personal care product use by Environmental Working Group hazard scores in relation to consumers' sociodemographic characteristics, purchasing behaviors, and product safety perceptions.

Personal care products (PCPs) are a source of environmental chemical exposures. Little research has examined the specific PCPs people use, the environmental hazards posed by those PCPs, and factors informing PCP selection. To examine chemical hazards of the specific products used in relation to sociodemographic factors, purchasing behaviors, and perceptions about PCP safety. In a cross-sectional, university-based sample (NJ, USA, N = 593), participants reported on sociodemographics, PCP purchasing behaviors and perceptions, and PCP use in the last 24-48 h (including brand and product name). Those PCPs were linked to product hazard scores (1=least hazardous, 10=most hazardous) in the Environmental Working Group's Skin Deep® database. For each participant, we calculated average hazard scores across all PCPs used and by category (e.g., haircare, skincare) and evaluated use of PCPs with high hazard scores (7-10). We fitted adjusted regression models examining associations of sociodemographic factors and participants' perceptions and purchasing behaviors with product hazard scores. Of 9349 unique PCPs used by participants, 68% matched to Skin Deep®. Average hazard scores varied by participant characteristics (e.g., age) for perfumes/colognes, beauty, and skin care products. The relative risk (RR) of recent use of a hair product with a high hazard score was twice as high in non-Hispanic Black women compared to non-Hispanic White women (RR:1.99; 95%CI:1.37, 2.89). Frequent use of healthy product apps (β = -0.49, 95%CI:-0.77, -0.21), reading product ingredient labels (β = -0.26; 95%CI:-0.82, -0.30), and seeking eco-friendly products (β = -0.17; 95%CI:-0.36, -0.01) were associated with use of skin care products with lower hazard scores. Results for hair and beauty products were similar. Concerns about PCP health impacts and regulation were associated with using products with lower hazard scores. Personal care products (PCPs) can contain numerous endocrine disrupting and carcinogenic chemicals. In a U.S. university-based sample, we linked the PCPs used by participants in the last 24-48 h to hazard scores in the Skin Deep® database. Average hazard scores of the PCPs used by participants varied by sociodemographic factors. Participant behaviors (e.g., use of healthy product apps) and perceptions of PCP safety and regulation were associated with the average hazard scores of the PCPs they used. Our findings suggest that education and tools to inform PCP choice may help consumers choose safer products and potentially, reduce chemical exposures.

Psychological resilience and cognitive functioning in Black and White men and women.

Psychological resilience is associated with better physical and mental health, but little is known about its role in cognitive health from an intersectional perspective. This study aimed to assess the relationship between psychological resilience and cognitive function across subgroups of older non-Hispanic Black and White men and women while taking stress exposure into account. 453 participants (Black men=87; Black women=147; White men=98; White women=121) from the Michigan Cognitive Aging Project completed the Brief Resilience Scale and a neuropsychological battery. ANOVAs were used to assess differences in psychological resilience across the intersection of gender and race. Linear regressions assessed relationships between psychological resilience and global cognition, controlling for sociodemographics and discrimination. Interaction terms and stratified regressions characterized these relationships across intersectional groups. Level of psychological resilience did not differ across intersectional groups despite differences in stress exposure. Higher resilience was associated with better global cognition in the whole sample (β= 0.12, p=.002), but this association was found only among Black men (β=0.40, p<.001). Levels of resilience did not differ between Black and White older adults, despite disproportionate stress exposure among Black older adults. Links between psychological resilience and cognition may depend on stressors and resources that are differentially patterned across intersectional groups. Psychological resilience may be particularly important for cognitive health among Black men, who are frequently underrepresented in cognitive aging research.

Disparities in Postmastectomy Breast Reconstruction Among American Indian and Alaska Native Women: A Systematic Literature Review and Meta-analysis.

Disparities in healthcare access and outcomes are well documented among racial and ethnic minority groups in the USA, with American Indian/Alaska Native (AI/AN) women experiencing significant barriers to postmastectomy breast reconstruction. This systematic review and meta-analysis of 11 studies highlights these disparities, revealing that AI/AN women are significantly less likely to undergo reconstruction compared with non-Hispanic white women (pooled OR 0.47, 95% CI 0.34-0.66). Contributing factors include geographic isolation, socioeconomic barriers, limited access to reconstructive surgeons, and cultural influences shaped by historical trauma and systemic inequities. Geographic and financial challenges are compounded by inadequate healthcare infrastructure and low rates of culturally sensitive outreach. Addressing these disparities requires targeted interventions such as enhanced healthcare access in rural areas, policy reforms to improve insurance coverage, and culturally tailored patient education initiatives.

Building evidence for indoor tanning as a behavioral addiction: concerns, problems, and change perceptions are associated with addictive symptoms

BackgroundRates of ultraviolet radiation (UVR)-emitting tanning bed use have declined in the United States over the past decade. However, many young adults continue to indoor tan at rates that put them at risk for melanoma. There is evidence that UVR may impact addiction pathways and some people who use tanning beds experience urges to tan and diminished control over tanning which may be evidence of a behavioral addiction. However, studies have not adequately explored whether excessive tanning continues despite concerns and problems that would be expected with behavioral addiction. This represents an important gap since behavioral persistence in the face of such negative experiences is a hallmark of behavioral addiction. Further, there is a dearth of research exploring change perceptions of excessive tanners.MethodsWe administered a cross-sectional online survey to women between 18 and 34 years old who reported frequent indoor tanning (at least 10 times) in the past 12 months. Participants completed the 7-item Behavioral Addiction Indoor Tanning Screener (BAITS). T- and chi-square tests were used to compare the association of theoretically informed correlates from conceptual models of behavioral addiction (e.g., concerns and problems) and tanning change/quit perceptions with results from the BAITS (i.e., a positive or negative screen for tanning addiction symptoms).ResultsParticipants were 280 non-Hispanic White women (mean age = 27.5 years (SD = 4.3)) from across the United States (mean number of past 12-month indoor tanning sessions = 40.1 (SD = 42.5)). Frequent indoor tanners with a positive BAITS score had higher mean scores for negative affect, greater worry about getting skin cancer, and more tanning-related problems compared to those with a negative score. A positive BAITS score was also associated with more perceived barriers to quitting tanning, increased interest in getting help to reduce tanning, and a higher number of quit attempts.ConclusionsOur findings provide unique evidence for tanning as a behavioral addiction by demonstrating an association between tanning behavioral addiction symptoms with skin cancer concerns, tanning-related problems, and unsuccessful attempts to change. These findings have implications for the design of interventions and support the need for additional research to support the conceptualization of indoor tanning as a behavioral addiction.

Gender and ethnic disparities in hepatocellular carcinoma: Trends in incidence rates across U.S. populations from 2000 to 2021.

524 Background: Hepatocellular carcinoma (HCC) is a primary malignancy of the liver strongly associated with liver cirrhosis and the etiologies producing cirrhosis. As such, racial and ethnic factors might affect incidence rates of HCC resulting in disparities. While disparities have been reported, the effect of gender within certain populations, particularly Hispanic and non-Hispanic White ancestry, have not been fully explored. This study looks at the changing incidence rates of HCC in the US amongst different populations with a particular focus on the impact of gender on incidence. Methods: Incidence rates of HCC between 2000 and 2021 among different sexes within racial and ethnic groups in the United States were analyzed utilizing delay-adjusted data from the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) program. Annual percent change (APC) was calculated by using Joinpoint Regression software. Results: Overall, HCC incidence rates since 2014 to 2021 show a slight decrease (APC, -0.06). While Hispanic men HCC incidence rates declined from 2012 to 2021 (APC, -0.44), Hispanic women incidence have had a steady increase since 2000 (APC, +2.52). Non-Hispanic Black men (APC, -3.07) rates vastly declined from 2015 to 2021 while non-Hispanic black women interestingly experienced a slight decrease in incidence from 2013 to 2021 (APC, -0.34). Non-Hispanic White men experienced stagnant rates of HCC since 2014 (APC, -0.05) while non-hispanic white women (APC, +3.59) showed increasing trends in HCC incidence since 2003. For comparison, non-Hispanic Asian/Pacific Islander men (APC, -2.19) and women (APC, -2.36), which both experienced a decline since 2007. This analysis was repeated without significant change. Further corroborations are necessary to validate these findings. Conclusions: These findings show that while the incidence rates of HCC overall have decreased, this benefit appears to be largely driven in male populations. In contrast, in women, and particularly Hispanic and Non-Hispanic White women, incidence rates have been increasing. This phenomenon likely reflects the changes in etiologies of cirrhosis and HCC. Surveillance strategies and screening might need to be optimized to reflect these trends.

Cervical cancer incidence and trends among women aged 15-29 years by county-level economic status and rurality - United States, 2007-2020.

Cervical cancer incidence and trends among women aged 15-29 years by county-level economic status and rurality - United States, 2007-2020.

Time trend analysis of osteoporosis prevalence among adults 50 years of age and older in the USA, 2005–2018

SummaryUsing data from NHANES for years 2005–2018, we examined temporal trends in osteoporosis prevalence and the proportion of undiagnosed osteoporosis in the United States of America. Our results suggested statistically significant increases in osteoporosis prevalence across several demographic groups. These findings carry profound implications for public health, given increased life expectancy and burden of chronic diseases.IntroductionThis is the first study to assess osteoporosis prevalence trends over time and the proportion of undiagnosed osteoporosis across gender, ethnicity/race, and age groups.MethodsObservational time trend analyses were conducted using the 2005–2006, 2007–2008, 2009–2010, 2013–2014, and 2017–2018 National Health and Nutrition Examination Survey (NHANES) datasets, along with a descriptive analysis using the 2017–2018 NHANES dataset to capture the proportion of undiagnosed osteoporosis.ResultsThe findings showed a statistically significant increase in osteoporosis prevalence among women, non-Hispanic Whites, and all age groups (except for individuals 80 years of age and older) during the study period. A subsequent analysis examining individuals by both gender and ethnicity/race demonstrated a statistically significant increase among Other Hispanic men and non-Hispanic White women. Additional descriptive analyses found that 69.12% of individuals with osteoporosis went undiagnosed. Specifically, 86.88% of men and 84.77% of individuals 50–59 years of age with osteoporosis went undiagnosed, representing the two highest groups.Discussion and conclusionThe substantial and increasing prevalence among certain groups and sub-groups, along with the lack of diagnostic capture of osteoporosis, highlights existing gaps in public health efforts and care delivery infrastructure. This paper highlights high-risk groups and sub-groups that may benefit most from accelerated initiatives to reduce the burden of illness associated with osteoporosis.

Racial discrimination among women seeking breast cancer care

Discrimination can contribute to worse health outcomes, but its prevalence in breast cancer is not well studied. We aimed to understand how women with stage I-III breast cancer faced discrimination in health care and everyday settings through the Everyday Discrimination Scale, cross-sectional survey. 296 women, 178 (60%) Non-Hispanic White (NHW), 76 (26%) Non-Hispanic Black (NHB), and 42 (14%) Hispanic participated. NHB women reported significantly more discrimination in everyday life compared to NHW women (score 20.1 vs 16.1, p < 0.001) and Hispanic women (score 20.1 vs 16.0, p < 0.001). In the health care setting, NHB had statistically more frequent reports of being ignored (23.7% vs. 5.6%), treated with less respect (21.1% vs. 7.3%), and treated with less courtesy (18.7% vs. 6.2%; all P = < 0.001) when compared to NHW women. NHB women experience a higher degree of discrimination both inside and outside of health care. Further research to understand discrimination on breast cancer outcomes is warranted.

A registry-based approach for estimating county-level race disparities in breast cancer mortality: an analysis in Georgia.

Despite similar incidence rates, nationwide breast cancer mortality is 40% higher among non-Hispanic Black (NHB) than non-Hispanic White (NHW) women. The racial disparity persists even among women with early-stage disease, prognostically favorable subtypes, and indicators of high socioeconomic status and is not evenly distributed throughout the US. Understanding geographic differences may provide additional insight into the drivers of the disparity. However, current data are geographically limited, based primarily on death certificate information, do not incorporate incidence, and often do not provide estimates or account for areas with small populations or sparse case data. Using a Bayesian framework, we estimated the local racial disparity in 5-year mortality for non-metastatic breast cancer diagnosed during 2005-2013 across counties in Georgia, a racially and geographically diverse state. Overall, during the study period, 5-year breast cancer mortality was 43% higher among NHB than NHW women. The racial disparity varied across Georgia with more pronounced disparity observed in the central and southeast and less pronounced disparity in the southwest. Rurality increased and the proportion of owner-occupied housing decreased the magnitude of the disparity, but only after accounting for other area-level covariates. This approach can help guide decisions and resource allocation at the local level.

Barriers impacting breast cancer screening during the COVID-19 pandemic among Hispanic women in New Jersey

AbstractHispanic women in the United States have been identified as an ethnic group experiencing disproportionately higher mortality rates of breast cancer. These higher rates have been linked to contextual factors that delay breast cancer screening utilization. The COVID-19 pandemic posed a significant disruption to obtaining breast cancer screening affecting utilization of these services especially among minorities. Our cross-sectional study utilized the socio-ecological model (SEM) as a framework to identify barriers influencing delayed utilization using a comprehensive self-administered survey, which was completed among 155 Hispanic and 147 non-Hispanic White women, aged 50 and older, and who resided in the state of New Jersey during the COVID-19 pandemic. Cancer screening attitudes and the extent in which numerous barriers affected utilization of breast cancer screening services during the pandemic were assessed using logistic regression and factor analysis. The analysis confirmed barriers that included low socio-economic status, lack of health insurance, low education attainment, unemployment, limited access to health care services, cancer fatalism, fear of acquiring COVID-19, and linguistic barriers. The findings of this study validate the recommendation of using multi-pronged interventions based on the SEM framework to address both individual and systemic barriers to screening. Breast cancer screening education, resources to access health services and health insurance options may be applied to these vulnerable populations to reduce barriers and facilitate yearly breast cancer screening.

Hair Straightener Use in Relation to Prevalent and Incident Fibroids in the Sister Study with a Focus on Black Women.

Uterine fibroids disproportionately affect Black women, and exposure to chemicals from hair relaxers or straighteners ("straighteners") may contribute to fibroid development. We examined the association between straightener use and prevalent young-onset uterine fibroids (diagnosed before age 36 y), as well as incident fibroids (diagnosed age 36-60 y), with a focus on Black women. We also examined differences in associations across birth cohorts as proxies for formulation changes. Data from 4,162 Black women in the Sister Study, a prospective cohort of women 35-74 y of age (enrolled 2003-2009), were analyzed. We used logistic regression to estimate odds ratios (ORs) for the association of straightener use at 10-13 y of age and self-reported young-onset fibroids. We used Cox regression to assess hazard ratios (HRs) for straightener use (age 10-13 y and in 12 months before enrollment) and incident fibroids among 779 premenopausal Black women. Similar analyses were conducted in 40,782 non-Hispanic White women. Over 70% of Black women used straighteners. In comparison with no use, any [; 95% confidence interval (CI): 0.96, 1.36] and frequent use (; 95% CI: 0.99, 1.42) of straighteners at 10-13 y of age were associated with young-onset fibroids. This association was most apparent among those born between 1928 and 1945 (; 95% CI: 1.15, 2.74) and 1965-1974 (; 95% CI: 0.82, 3.29). Fibroid incidence from 36 to 60 y of age was modestly associated with use of straighteners at 10-13 y of age [hazard ratio ; 95% CI: 0.81, 1.63] and in the 12 months prior to enrollment (; 95% CI: 0.88, 2.00). Among non-Hispanic White women, straightener use at 10-13 y of age was similarly associated with young-onset fibroids (; 95% CI: 1.03, 1.47) despite lower use () of straighteners. Sensitivity analyses indicated a potential for bias due to fibroid misclassification, with an overestimation of the effect likely if nulliparous women or women from households with lower education reported their fibroid status less accurately. Hair straightener use may be positively associated with fibroid risk. https://doi.org/10.1289/EHP14493.

Community-Based Participatory Research to Address the Disproportionate Burden of Breast Cancer in Black Women.

Black/African American women with breast cancer have disproportionately higher mortality rates and report experiencing a lower quality of life during survivorship compared to non-Hispanic white women. Despite support for the integration of peer navigation in cancer care and survivorship to address these inequities, Black/African American women often have limited access to culturally tailored peer navigation programs. We aimed to investigate the unique needs and strengths of Black/African American women with breast cancer and survivors to inform the development of a culturally tailored peer navigation program for Black/African American women. We developed a community-university partnership based on best practices of community-based participatory research. The partnership conducted storytelling sessions with Black/African American survivors of breast cancer and their caregivers and key informant interviews with community partners and applied thematic analysis. A total of 14 survivors and 4 caretakers took part in storytelling sessions and 6 community partners took part in key informant interviews. Themes from the storytelling sessions included spirituality, social support, information seeking, and relationship with care team. These themes were then incorporated into developing the theoretical basis, structure, and content of the BLACC peer navigation program. The key informant interviews were instrumental in building new partnerships to support the implementation of the peer navigation program. The community-university partnership successfully identified the unique needs and strengths of Black/African American women who either had breast cancer or were survivors of breast cancer, identified valuable resources, and secured buy-in from community leaders to develop a comprehensive peer navigation program.

OLDER AGE PREDICTS POSITIVITY IN HOSPICE FAMILY CAREGIVER AUDIO DIARIES: IMPLICATIONS FOR ASSESSMENT INNOVATION

Abstract The likelihood of becoming a caregiver of someone with a serious illness increases with age, and those 55 years of age and older are more likely to be end-of-life caregivers of family and friends. Older adults may also use more emotional coping skills, which can have a protective effect depending on perceived stress and gender. We asked in-home hospice family caregivers of cancer patients (n=58) to record daily, open-ended audio diaries about their experiences. We examined whether age and gender predicted the amount of affect-related content and overall emotional tone (positivity/negativity). Caregivers recorded audio diaries up to 5 minutes via an IVR system (n=984 entries). We transcribed diaries and used LIWC software to quantify the proportion of affect-related content and positive/negative tone, and mixed-effects regression modeling to analyze the effects of age and gender on these indicators. Our sample (M age=60.72, SD=13.12, range=30-86) was mostly white (84.5%) non-Hispanic (86.2%) women (74.1%) caring for their spouse (44.8%). Age predicted positivity, with each additional year of age predicting a slight increase (β=0.426, p=0.028). Age did not predict affect (β=0.032, p=0.251). Gender did not predict tone (β=2.622, p=0.619), but trended towards predicting less affect expression in men (β= -1.482, p=0.062). Hospice family caregiving is challenging and often isolating, affording few opportunities for processing experiences. Our findings suggest an interplay of age and gender in caregiver self-expression. Understanding how caregivers’ self-expression aligns with underlying coping and unmet needs is important for developing audio diaries as a low-cost assessment of coping and well-being.

SEX/GENDER DIFFERENCES IN DIAGNOSIS OF PAIN AMONG OLDER MEDICARE BENEFICIARIES

Abstract Pain is often underdiagnosed among women, especially Black women, but the extent of underdiagnosis is unknown. Cognitive status can also complicate pain reporting and diagnosis. Our objective was to assess the odds of having a pain diagnosis, by sex/gender, while considering race/ethnicity and cognitive status. We used data from the 2018 Health and Retirement Study linked to Medicare claims. We included individuals with complete 2018 Part A and B enrollment and complete information on covariates, excluding those with HMO. Our outcome combined self-reported frequent pain and diagnosis of chronic pain: no pain, self-report only, and diagnosed (both diagnosed only and diagnosed + self-report). Our exposure was sex/gender. We used multinomial logistic regression models to assess the odds of pain diagnosis, by sex/gender, controlling for age, education, race/ethnicity, rurality, cognitive status, and Elixhauser comorbidity index. Among our participants (n=3,523), 12.0% had no pain, 4.6% had undiagnosed pain, and 83.4% had diagnosed pain. Compared to men, women had higher odds of diagnosed pain. The interaction between gender and race/ethnicity was significant (p=0.02). When stratified by sex/gender, non-Hispanic (NH) Black women had lower odds of diagnosed pain, compared to NH White women. Compared to NH Black and Hispanic men, NH White men had lower odds of any type of pain (both diagnosed and self-reported). The main effect of cognitive status and interaction with gender was not significant. Contrary to our hypothesis, women had higher odds of diagnosed pain than men. Within racial/ethnic group differences exist in men and women and warrant future studies.