Non-white Participants Research Articles

NCI’s national treatment trial networks: Experience and adaptations during COVID-19.

1562 Background: The National Cancer Institute supports several national trial networks which responded rapidly to the COVID-19 pandemic to overcome operational barriers to clinical cancer research. The National Clinical Trials Network (NCTN) focuses on late phase treatment trials, while the Experimental Therapeutics Clinical Trials Network (ETCTN) conducts early phase treatment trials. We report findings on the experience and adaptations of these networks during COVID-19. Methods: Using 2019 and 2020 accrual data, we analyzed changes in accrual levels and demographics. We also evaluated changes in trial activation numbers and timelines. In July 2020, we surveyed 255 investigators from academic and community sites to assess changes in research practices and get feedback on modified processes implemented by NCI to address trial conduct during the pandemic. Results: Accrual across the NCTN and ETCTN fell significantly in mid-March 2020, dropping from a weekly average of 307 patients in February to 169 the week of March 23-29. Accrual began to recover in June and July but did not return to pre-pandemic levels until September. Accrual in November and December 2020 followed the patterns seen in 2019, with short-term drops around major holidays. Non-White participants were enrolled to NCTN and ETCTN trials at similar monthly rates throughout 2019 and 2020, with slightly higher overall enrollment in 2020 (23.7% vs. 22.7%). New trials continued to be developed and activated throughout 2020. Between 2017 and 2019, an average of 71 trials were activated per year (NCTN = 46, ETCTN = 25), compared to 84 activated in 2020 (NCTN = 58, ETCTN = 26). The average time to trial activation was similar or slightly longer in 2020 compared to 2019. The investigator survey yielded 111 responses (43.5% response rate). 43% of respondents’ sites paused enrollment to phase 1 trials during the pandemic, compared to 18% for phase 3 trials. Many sites temporarily stopped opening new trials and processing specimens. Sites were more likely to keep enrolling to trials offering clear potential benefit and pause complex trials that required more patient contact. Respondents attributed some of the decline in accrual to a reduction in overall patient volume, increased patient concerns, and reduced research staff on site. Respondents were asked to rate the usefulness of modified trial processes NCI put in place during the pandemic. Telehealth was rated most useful (avg. 4.6/5), followed by shipping oral IND agents to enrolled patients (4.5/5), remote informed consent (4.2/5), coordinating care with local providers (3.9/5), and remote auditing (3.7/5). Conclusions: The cancer trials community has an opportunity to learn from working through the challenges of COVID-19. NCI will seek to continue and expand on modifications to clinical trial processes that have the potential to improve operational efficiency, reduce cost, and help bring trials to more patients.

Symptom dimensions of major depression in a large community-based cohort.

Our understanding of major depression is complicated by substantial heterogeneity in disease presentation, which can be disentangled by data-driven analyses of depressive symptom dimensions. We aimed to determine the clinical portrait of such symptom dimensions among individuals in the community. This cross-sectional study consisted of 25 261 self-reported White UK Biobank participants with major depression. Nine questions from the UK Biobank Mental Health Questionnaire encompassing depressive symptoms were decomposed into underlying factors or 'symptom dimensions' via factor analysis, which were then tested for association with psychiatric diagnoses and polygenic risk scores for major depressive disorder (MDD), bipolar disorder and schizophrenia. Replication was performed among 655 self-reported non-White participants, across sexes, and among 7190 individuals with an ICD-10 code for MDD from linked inpatient or primary care records. Four broad symptom dimensions were identified, encompassing negative cognition, functional impairment, insomnia and atypical symptoms. These dimensions replicated across ancestries, sexes and individuals with inpatient or primary care MDD diagnoses, and were also consistent among 43 090 self-reported White participants with undiagnosed self-reported depression. Every dimension was associated with increased risk of nearly every psychiatric diagnosis and polygenic risk score. However, while certain psychiatric diagnoses were disproportionately associated with specific symptom dimensions, the three polygenic risk scores did not show the same specificity of associations. An analysis of questionnaire data from a large community-based cohort reveals four replicable symptom dimensions of depression with distinct clinical, but not genetic, correlates.

Knowledge about Benefits of Kidney Transplantation: A Survey of Dialysis Patients

Knowledge about benefits of kidney transplantation (KT) is an important determinant of the patients' decision to pursue KT. We investigated factors associated with End Stage Renal Disease (ESRD) patients' knowledge about KT benefits. We randomly invited 1,400 dialysis patients to complete a survey about benefits of KT. Using multivariate analysis, we calculated odds ratios for the probability of choosing the correct responses. Of 673 participants, 17.6% agreed with benefit of KT for older patients, 36.5% agreed with benefit of KT for diabetic patients, and 31.5% agreed with benefit of pre-emptive KT. Non-white (OR: 0.68) and older (OR: 0.65) participants were less likely to agree with the survival benefit of KT. Older participants were less likely to agree with benefit of KT for older (OR: 0.64), and diabetic patients (OR: 0.54). Participants with less than high school education were less likely to agree with benefit of pre-emptive KT (OR: 0.58). Participants with a previous KT were more likely to agree with benefit of KT for older (OR: 2.32), and diabetic patients (OR: 2.50), and with the benefit of pre-emptive KT (OR: 2.34). Participants who had received 3 or more modes of education about KT were more likely to agree with benefit of KT for diabetic patients (OR: 2.04), and with benefit of pre-emptive KT (OR:1.67). Dialysis patients have limited knowledge about benefits of KT. Previous KT, exposure to 3 or more modes of KT education, and education attainment are significant contributors to knowledge about KT benefits.

Attitudes toward deprescribing among adults with heart failure with preserved ejection fraction.

Attitudes toward deprescribing could vary among subpopulations. We sought to understand patient attitudes toward deprescribing among patients with heart failure with preserved ejection fraction (HFpEF). Retrospective cohort study. Academic medical center in New York City. Consecutive patients with HFpEF seen in July 2018-December 2019 at a program dedicated to providing care to older adults with HFpEF. We assessed the prevalence of vulnerabilities outlined in the domain management approach for caring for patients with heart failure and examined data on patient attitudes toward having their medicines deprescribed via the revised Patient Attitudes Toward Deprescribing (rPATD). Among 134 patients with HFpEF, median age was 75 (interquartile range 69-82), 60.4% were women, and 35.8% were nonwhite. Almost all patients had polypharmacy (94.0%) and 56.0% had hyperpolypharmacy; multimorbidity (80.6%) and frailty (78.7%) were also common. Overall, 90.3% reported that they would be willing to have one or more of their medicines deprescribed if told it was possible by their doctors; and 26.9% reported that they would like to try stopping one of their medicines to see how they feel without it. Notably, 91.8% of patients reported that they would like to be involved in decisions about their medicines. In bivariate logistic regression, nonwhite participants were less likely to want to try stopping one of their medicines to see how they feel without it (odds ratio 0.25, 95% confidence interval [0.09-0.62], p=0.005). Patients with HFpEF contend with many vulnerabilities that could prompt consideration for deprescribing. Most patients with HFpEF were amenable to deprescribing. Race may be an important factor that impacts patient attitudes toward deprescribing.

Tertiary education expansion and access for disadvantaged women in Brazil and Mexico

This paper seeks to identify if women from vulnerable, socioeconomic and ethnic/racially, backgrounds have been benefited from this process through the Maximally Maintained Hypothesis developed by Raftery and Hout (1993), in which vulnerable or less advantageous groups can access education only after the demand of the most advantaged group has been met. Using data from the National Household Surveys from Brazil (PNAD) and Mexico (ENIGH) both countries were studied for the 2004 and 2014 periods in order to observe the changes occurring through time, with a focus on the women population. As a result, this study found two different dynamics of inclusion: while in Brazil higher socioeconomic inclusion has been attained, there is a persistent stratification by race in tertiary education with an underrepresentation of non-white participants. On the other hand, Mexico has advanced in terms of including the population that describes itself as indigenous or understands an indigenous language, nonetheless underrepresentation from those that speak an indigenous language persist and socioeconomic stratification remains a factor of exclusion.

Racial/Ethnic Disparities in Ophthalmology Clinical Trials Resulting in US Food and Drug Administration Drug Approvals From 2000 to 2020

Diverse, representative enrollment in pivotal clinical trials is vital to sufficiently power subgroup analyses and ensure equity and validity of trial results. To evaluate the racial/ethnic representation, trends, and disparities in clinical trials leading to US Food and Drug Administration (FDA) ophthalmology drug approvals from 2000 to 2020. This cohort study used data from participants in clinical trials of drugs for neovascular age-related macular degeneration (AMD), open-angle glaucoma (OAG), and expanded indications for diabetic retinopathy (DR) from January 1, 2000, to December 31, 2020. Trial data were sourced from FDA reviews, ClinicalTrials.gov, and relevant linked studies. National expected racial/ethnic proportions were sourced from public National Eye Institute prevalence data as well as published rates scaled using US Census Bureau data. The primary outcome measures were the distribution of and change over time in the racial/ethnic proportion of participants in clinical trials leading to FDA approval of drugs for AMD, OAG, and DR. During the 20-year period, 31 clinical trials were identified for 13 medications with 18 410 participants. The distribution of trial participants was different from the expected trial distribution for most approvals with regard to race/ethnicity (12 drugs) and sex (10 drugs). Compared with the first decade (2000-2010), trials conducted in the second decade (2011-2020) showed increases in enrollment of Asian (odds ratio [OR], 2.30; 95% CI, 1.97-2.68; P < .001) and Hispanic or Latinx participants (OR, 1.74; 95% CI, 1.49-2.03; P < .001) for AMD, Asian participants (OR, 2.21; 95% CI, 1.46-3.42; P < .001) for DR, and Black (OR, 1.60; 95% CI, 1.43-1.78; P < .001) and Hispanic or Latinx participants (OR, 10.31; 95% CI, 8.05-13.35; P < .001) for OAG. There was a decrease in Black participants in DR trials (OR, 0.58; 95% CI, 0.42-0.79; P < .001). Based on these trends, the enrollment incidence ratio is expected to worsen by 2050, with overrepresentation of white participants vs underrepresentation of Black and Hispanic or Latinx participants in trials of drugs for AMD (1.08 vs 0.04 vs 0.77), DR (1.83 vs 0.87 vs 0.59), and OAG (1.62 vs 0.90 vs 0.37). In this cohort study, Black, Hispanic or Latinx, and other non-White participants were underrepresented in clinical trials leading to FDA ophthalmology drug approvals compared with the expected disease burden and racial/ethnic distribution in the US. Although there was meaningful improvement from 2000 to 2020, further efforts to increase minority enrollment in clinical trials seem to be warranted.

Examining Weight Bias and Loss-of-Control Eating among Individuals Seeking Bariatric Surgery.

Externalized weight bias (EWB), directed towards others, and internalized weight bias (IWB), directed towards the self, are thought to exacerbate obesity and disordered eating and may be important factors to assess and understand among individuals seeking bariatric surgery. This study examined clinical correlates (pre-surgical BMI, depressive symptoms, weight self-efficacy, and shape/weight overvaluation) of both EWB and IWB among individuals presenting for bariatric surgery with and without regular loss-of-control eating (LOC eating). A total of 316 adults presenting for bariatric surgery completed established self-report measures to assess EWB, IWB, depressive symptoms, weight self-efficacy, and core symptoms of disordered eating including LOC eating and overvaluation of shape/weight. IWB and EWB were not associated with pre-surgical BMI, age, or sex, but were both significantly higher among White than non-White participants. Adjusting for race, IWB and EWB were significantly associated with greater eating disorder psychopathology and depressive symptoms and with less weight-related self-efficacy. Participants who endorsed regular LOC eating (53.5% of the sample) endorsed significantly lower weight self-efficacy and higher IWB, EWB, depressive symptoms, and overvaluation of shape/weight. Findings suggest that regular LOC eating is common among individuals seeking bariatric surgery and associated with a range of heightened eating disorder and psychosocial concerns including both IWB and EWB. Future research exploring the longitudinal significance of the relationship between these two forms of weight bias and LOC eating is indicated.

Race reporting and diversity in US food and drug administration (FDA) registration trials for prostate cancer; 2006\u20132020

BackgroundThere is significant racial disparity in prostate cancer (PCa) in terms of incidence, treatment, and outcomes. Racial diversity and compliance with FDA race reporting guidelines in PCa drug registration trials are unknown. We analyzed racial diversity and race reporting in drug licensing trials for PCa.MethodsNew drug authorizations for PCa from 2006 to 2020 were identified. The corresponding licensing trial publications were analyzed to check compliance with current FDA recommendations for race reporting. If race was unreported, the clinical trial report was analyzed to determine participant recruitment by race and lead the recruiting country.ResultsDuring the study period, 17 new drug registrations for the management of PCa involving ten unique drugs were identified. In total, 18,455 participants were included in FDA registration trials, of which 76.3% were white or Caucasian, 7.9% Asian, 2.9% Black or African American, 0.5% American Indian or Alaskan Native, 0.1% Native Hawaiian or other Pacific Islander, 1.8% other or multiple races and 10.5% unknown. 53% of trials reported race in the licensing publication, however of this only 55% met current FDA recommendations. When the race was unreported in the licensing publication, 88% of studies had further information in the clinical study report.ConclusionWe found a significant under-representation of non-white participants in FDA drug registration trials for PCa. Race reporting in licensing publication is inconsistent and both FDA and International Committee of Medical Journal Editors guidelines are not being universally followed. Given the disproportionality of the disease burden of PCa, recruitment of Black and other minority participants to trials should be a research priority.

The relationship between traffic-related air pollution exposures and allostatic load score among youth with type 1 diabetes in the SEARCH cohort

ObjectiveWe investigated the effects of chronic exposures to particulate and traffic-related air pollution on allostatic load (AL) score, a marker of cumulative biological risk, among youth with type 1 diabetes. Research design and methodsParticipants were drawn from five clinical sites of the SEARCH for Diabetes in Youth (SEARCH) study (n = 2338). Baseline questionnaires, anthropometric measures, and a fasting blood test were taken at a clinic visit between 2001 and 2005. AL was operationalized using 10 biomarkers reflecting cardiovascular, metabolic, and inflammatory risk. Annual residential exposures to PM2.5 and proximity to heavily-trafficked major roadways were estimated for each participant. Poisson regression models adjusted for sociodemographic and lifestyle factors were conducted for each exposure. ResultsNo significant associations were observed between exposures to PM2.5 or proximity to traffic and AL score, however analyses were suggestive of effect modification by race for residential distance to heavily-trafficked major roadways (p = 0.02). In stratified analyses, residing <100, 100-<200 and 200-<400 m compared to 400 m or more from heavily-trafficked major roadways was associated with 11%, 26% and 14% increases in AL score, respectively (95% CIs: -4, 29; 9, 45; −1, 30) for non-white participants compared to 6%, −2%, and −2% changes (95% CIs: -2, 15; −10, 7; −8, 6) for white participants. ConclusionsAmong this population of youth with type 1 diabetes, we did not observe consistent relationships between chronic exposures to particulate and traffic-related air pollution and changes in AL score, however associations for traffic-related pollution exposures may differ by race/ethnicity and warrant further examination.

Prediagnostic Antibody Responses to Fusobacterium nucleatum Proteins Are Not Associated with Risk of Colorectal Cancer in a Large U.S. Consortium

Abstract Background: The association between prediagnostic antibody responses to Fusobacterium nucleatum (F. nucleatum) and subsequent risk of colorectal cancer is not established. Methods: We conducted a nested case–control study of 8,126 participants in a consortium of 10 prospective cohorts in the United States. Results: Higher seroprevalence of any F. nucleatum antibody was observed among non-White participants (51.1%) compared with White participants (31.2%). We did not find any statistically significant association between seropositivity to any of the eight F. nucleatum proteins and colorectal cancer risk. Conclusions: Prediagnostic antibody responses to F. nucleatum proteins were not associated with the risk of colorectal cancer. Impact: Future studies may consider a more specific detection of the immunoglobulin isotypes or focus on examining F. nucleatum in stool or tissue samples.

Race and satisfaction with pain management among patients with HIV receiving long-term opioid therapy

IntroductionManagement of chronic pain is an essential aspect of HIV primary care. Previous literature in the general population has elucidated racial disparities in the evaluation and treatment of pain. This study examined racial/ethnic differences in patient satisfaction and barriers to pain management among a cohort of PWH receiving LTOT. Materials and methodsPatient-reported survey and EMR data were compared between non-white (n = 135; 81.3 %) and white (n = 31; 18.7 %) patients in a cohort of 166 PWH receiving LTOT in two clinics in Atlanta and Boston. Quantile and linear regression were used to evaluate the association between race and pain management outcomes: 1) satisfaction with pain management (0–10) and 2) patient-related barriers to pain management, including patient perceptions of pain medications, fatalism, and communication about pain. Models were adjusted for sex, age, clinical site, and baseline general health. ResultsNon-white participants were noted to receive chronic opioids for a shorter mean duration of time than white participants (6.0 versus 11.0 years, p < 0.001) and lower mean morphine equivalent daily dose (MEDD) than white participants (28.1 versus 66.9 mg, p < 0.001). In adjusted analyses, there was no significant difference in satisfaction with pain management among non-white and white participants (p = 0.101). There was no significant difference in barriers to pain management in unadjusted (p = 0.335) nor adjusted models (p = 0.397). ConclusionWhile non-white PWH were noted to have received lower doses of chronic opioids and for shorter duration than white PWH, satisfaction with pain management was similar. Patient-related barriers to pain management were similar among non-white and white PWH.

Randomized Controlled Trial of Treatments for Loss-of-Control Eating Following Bariatric Surgery.

Loss-of-control (LOC) eating postoperatively is a consistent predictor of suboptimal longer-term bariatric surgery outcomes. This randomized controlled trial examined the effectiveness of two guided self-help treatments (cognitive behavioral therapy [gshCBT] and behavioral weight loss [gshBWL]) compared with a control (CON) for reducing LOC eating and weight. A total of 140 patients with recurrent LOC eating approximately 6 months after bariatric surgery were randomly assigned (5:5:2 ratio) to one of three conditions: gshCBT (n = 56), gshBWL (n = 60), or CON (n = 24). Three-month treatments were delivered by trained allied health clinicians to increase generalizability to bariatric surgery settings. Independent assessments were performed by doctoral research-clinicians using established interviews/measures; posttreatment outcomes were obtained for 89% of patients. Mixed models revealed significant improvements for LOC eating frequency and weight loss but no significant differences between treatments; race neither predicted (main effect) nor moderated (interaction effect) treatment outcomes. Intent-to-treat categorical analyses of abstinence from LOC eating (30% for gshCBT, 27% for gshBWL, 38% for CON) and proportion attaining 5% weight loss (20%, 22%, 17%) revealed no significant differences between treatments; non-White participants had a higher proportion achieving LOC eating abstinence but a lower proportion attaining 5% weight loss compared with White participants. In this 12-week randomized controlled trial following bariatric surgery, significant LOC eating reductions and weight loss did not differ significantly between treatments. Race was associated with posttreatment categorical outcomes.

Single-dose Oxford–AstraZeneca COVID-19 vaccine followed by a 12-week booster

Single-dose Oxford–AstraZeneca COVID-19 vaccine followed by a 12-week booster

Prevalence and cardiometabolic correlates of ketohexokinase gene variants among UK Biobank participants.

Essential fructosuria (EF) is a benign, asymptomatic, autosomal recessive condition caused by loss-of-function variants in the ketohexokinase gene and characterized by intermittent appearance of fructose in the urine. Despite a basic understanding of the genetic and molecular basis of EF, relatively little is known about the long-term clinical consequences of ketohexokinase gene variants. We examined the frequency of ketohexokinase variants in the UK Biobank sample and compared the cardiometabolic profiles of groups of individuals with and without these variants alone or in combination. Study cohorts consisted of groups of participants defined based on the presence of one or more of the five ketohexokinase gene variants tested for in the Affymetrix assays used by the UK Biobank. The rs2304681:G>A (p.Val49Ile) variant was present on more than one-third (36.8%) of chromosomes; other variant alleles were rare (<1%). No participants with the compound heterozygous genotype present in subjects exhibiting the EF phenotype in the literature (Gly40Arg/Ala43Thr) were identified. The rs2304681:G>A (p.Val49Ile), rs41288797 (p.Val188Met), and rs114353144 (p.Val264Ile) variants were more common in white versus non-white participants. Otherwise, few statistically or clinically significant differences were observed after adjustment for multiple comparisons. These findings reinforce the current understanding of EF as a rare, benign, autosomal recessive condition.

Evaluating performance of covariate-constrained randomization (CCR) techniques under misspecification of cluster-level variables in cluster-randomized trials

Covariate constrained randomization (CCR) is a method of controlling imbalance in important baseline covariates in cluster-randomized trials (CRT). We use simulated CRTs to investigate the performance (control of imbalance) of CCR relative to simple randomization (SR) under conditions of misspecification of the cluster-level variable used in the CCR algorithm.We use data from a Patient-Centered Outcomes Research Institute (PCORI)-funded CRT evaluating the Mothers and Babies (MB) intervention (AD-1507-31,473). CCR methodology was used in the MB study to control imbalance in, among other baseline variables, the percent minority (i.e., non-White) participants at each study site. Simulation schemes explored variation in degree of misspecification in the baseline covariate of interest, and include correct report, observed misspecification, and a range of simulated misspecification for intervals within and beyond that observed in the MB study. We also consider three within-site sample size scenarios: that observed in the MB study, small (mean 10) and large (mean 50). Simulations at every level of baseline covariate misspecification suggest that use of the CCR strategy provides between-arm imbalance that is simultaneously lower and less variable, on average, than that produced from the SR strategy. We find that the gains to using CCR over SR are nearly twice as high with accurate reporting (Δ = −5.33) compared to the observed study-level misspecification (Δ = −3.03). Although CCR still outperforms SR as the level of misspecification increases, the gains to using CCR over SR decrease; thus, every effort should still be made to obtain high-quality baseline data.

Socio-cultural correlates of self-reported experiences of discrimination related to COVID-19 in a culturally diverse sample of Canadian adults

Minorities and marginalized groups have increasingly become the target of discriminatory actions related to the COVID-19 pandemic. Detailed information about the manifestation of COVID-related discrimination is required to develop preventive actions that are not stigmatizing for such groups. The present study investigates experiences of perceived discrimination related to COVID-19 and its socio-cultural correlates in a culturally diverse sample of adults in Quebec (Canada). An online survey was completed by 3273 Quebec residents (49 % 18−39 years old; 57 % female; 49 % White). We used multivariate binomial logistic regression models to assess prevalence of COVID-related discrimination and to investigate socio-cultural correlates of reasons and contexts of discrimination. COVID-related discrimination was reported by 16.58 % of participants. Non-white participants, health-care workers and younger participants were more likely to experience discrimination than White, unemployed and older participants, respectively. Discrimination was reported primarily in association with participants’ ethno-cultural group, age, occupation and physical health and in the context of public spaces. Participants of East-Asian descent and essential workers were more likely to report discrimination because of their ethnicity and occupation, respectively. Although young people experienced discrimination across more contexts, older participants were primarily discriminated in the context of grocery stores and because of their age. Our findings indicate that health communication actions informed by a social pedagogy approach should target public beliefs related to the association of COVID-19 with ethnicity, age and occupation, to minimize pandemic-related discrimination. Visible minorities, health-care workers and seniors should be protected and supported, especially in public spaces.

Patient Perceptions on Barriers and Facilitators to Accessing Low-acuity Surgery During COVID-19 Pandemic

BackgroundThe onset of the COVID-19 pandemic led to the postponement of low-acuity surgical procedures in an effort to conserve resources and ensure patient safety. This study aimed to characterize patient-reported concerns about undergoing surgical procedures during the pandemic. MethodsWe administered a cross-sectional survey to patients who had their general and plastic surgical procedures postponed at the onset of the pandemic, asking about barriers to accessing surgical care. Questions addressed dependent care, transportation, employment and insurance status, as well as perceptions of and concerns about COVID-19. Mixed methods and inductive thematic analyses were conducted. ResultsOne hundred thirty-five patients were interviewed. We identified the following patient concerns: contracting COVID-19 in the hospital (46%), being alone during hospitalization (40%), facing financial stressors (29%), organizing transportation (28%), experiencing changes to health insurance coverage (25%), and arranging care for dependents (18%). Nonwhite participants were 5 and 2.5 times more likely to have concerns about childcare and transportation, respectively. Perceptions of decreased hospital safety and the consequences of possible COVID-19 infection led to delay in rescheduling. Education about safety measures and communication about scheduling partially mitigated concerns about COVID-19. However, uncertainty about timeline for rescheduling and resolution of the pandemic contributed to ongoing concerns. ConclusionsProviding effective surgical care during this unprecedented time requires both awareness of societal shifts impacting surgical patients and system-level change to address new barriers to care. Eliciting patients’ perspectives, adapting processes to address potential barriers, and effectively educating patients about institutional measures to minimize in-hospital transmission of COVID-19 should be integrated into surgical care.

863 COVID-19-related perinatal stress associated with increased depression risk

The COVID-19 pandemic has been associated with increased distress among pregnant and recently delivered parents. We examined whether COVID-19-related stress was associated with depressive risk among individuals who were pregnant or within 6 months of delivery. A web-based survey was distributed to all patients who were pregnant or within 6 months of delivery at a health system in the Chicagoland area. The survey included the Edinburgh Perinatal Depression Survey (EPDS), Likert scales 0-10 evaluating COVID-related financial, social, and general stress, and collected race/ethnicity, insurance, and pregnancy status. Participants scoring ≥10 on the EPDS were considered to have clinically significant depressive symptomology. Multivariate logistic regression examined the relationship between COVID-related stress and EPDS scores. Of the 4,160 patients receiving the survey, 372 (9%) were consented and completed the survey. 137 (37%) of respondents were pregnant, 77% were white, and 93% were privately insured (Table 1). Respondents reported moderate general distress (6.15±2.4), financial stress (5.37±2.7), and social disruption (6.13±2.7) due to the COVID-19 pandemic. Non-white (39% versus 29%, p=0.07) and Medicaid-enrolled (44% versus 30%, p=0.12) participants were more likely to report depressive symptomology. Adjusting for race, insurance, and pregnancy status, those reporting higher general COVID-related stress were 1.6 (95%CI 1.39,1.80) times more likely to score ≥10 on the EPDS. Financial (aOR=1.25, 95%CI 1.14,1.37) and social distress (aOR=1.25, 95%CI 1.13,1.37) were also significantly associated with elevated risk for depressive symptomology. COVID-related distress is associated with depressive symptomology among perinatal patients. During this time of heightened financial, social, and health stressors, patients should be screened for depression and linked to care. Future studies should examine whether COVID-related depressive symptomology is associated with adverse perinatal outcomes.

Racial Differences in Co-Offending: Correlations With Concurrent Juvenile Police Contacts and Predictions of Future Adult Police Contacts

The purpose of this study was to determine whether the relationship between co-offending and offense seriousness varied by race and whether similarities in age (juvenile, adult) and race (white, non-white) augmented the frequency and severity of future offending in co-offending males. Analyzing 15,059 incidents of police contact involving male juvenile participants from the Second Philadelphia Birth Cohort (PBC II) and the records of 7,420 male participants from the PBC II, a stronger co-offending–offense seriousness relationship was noted in the juvenile police contacts of non-white participants, whereas similarity between co-offenders led to increased adult police contacts in non-white but not white participants. These results suggest that juvenile co-offending may operate along social learning lines in non-white, if not white, youth.

Understanding aggression and microaggressions by and against people of colour

AbstractEfforts to understand racial microaggressions have focused on the impact on targets, but few studies have examined the motivations and characteristics of offenders, and none has examined microaggressions committed by members of racialized groups. The purpose of this study is to determine if racial microaggressions should be conceptualized as a form of aggression when committed by racialized individuals by examining the relationship between propensity to commit microaggressions and aggressive tendencies to help inform interventions. This nationwide survey recruited 356 Asian, Black and Hispanic American adults. Participants completed measures of likelihood of committing anti-Black microaggressions, aggression, negative affect, and ethnic identity. There was a significant negative correlation between ratings by diversity experts of microaggressive interactions being racist and participants’ likelihood of engaging in those same interactions. For each ethnoracial group, likelihood of committing anti-Black microaggressions was significantly positively correlated with all measures of aggression examined. The correlation between microaggressions and aggression was strongest for non-White Hispanic participants and weakest among Asian participants. A linear regression showed that aggression uniquely predicted microaggression likelihood, after controlling for respective co-variates within groups. Among non-White Hispanic participants, there was a significant positive correlation between negative affect and propensity to commit microaggressions, but this association disappeared in the regression analysis after accounting for aggression. A positive ethnic identity was not correlated with microaggression likelihood among Black participants. Findings indicate that microaggressions represent aggression on the part of offenders and constitute a form of behaviour that is generally socially unacceptable. Implications and cognitive behavioural treatment approaches are discussed.Key learning aims(1)People of colour generally recognize that racial microaggressions are unacceptable.(2)People of colour may commit microaggressions against other people of colour.(3)Anti-Black microaggressions are correlated to aggression in perpetrators.(4)Microaggressions are not solely attributable to negative affect or low ethnic identity.(5)Therapists should address microaggressions, even when committed by people of colour.