non-Latinx White Research Articles

Journal-related Activities and Other Special Activities at the 2021 American Society of Anesthesiologists Meeting

Journal-related Activities and Other Special Activities at the 2021 American Society of Anesthesiologists Meeting

¡No me duele cuando me deprimo!: An Examination of Ethnic Differences in Depression Symptoms Among Latinx and Non-Latinx Primary Care Patients

The research on ethnic differences in prevalence rates of depression is mixed. Additionally, culture has been hypothesized to impact symptom manifestation. The purpose of this study was to examine prevalence rates of depression among Spanish-speaking Latinx and non-Latinx White (NLW) primary care patients and explore ethnic differences in how depression symptoms manifest. Participants were 240 primary care patients who completed a demographic questionnaire and the Beck Depression-Inventory-2 (BDI-II). Latinx primary care patients had lower prevalence rates of depressive symptoms and less severe depressive symptoms than NLW primary care patients. Holding total BDI-II score constant, Latinxs also endorse pessimism, past failures, feelings of being punished, agitation, and problems with sleeping less than their NLW counterparts. This study adds support to research that indicates that Latinxs have lower rates of depression than NLWs and suggests that Latinxs are not more likely to endorse somatic complaints.

Health Locus of Control and Neurocognitive Function in Latinx and Non-Latinx White People Living With HIV: A Cross-sectional Study.

Research suggests that health locus of control (HLOC) is related to important health and neurocognitive outcomes in people living with HIV. However, the role of ethnicity in these relationships remains poorly understood. This study explored the role of HLOC on neurocognition in a diverse sample of 134 people living with HIV (Latinx: n = 96; non-Latinx White: n = 38) who completed comprehensive neurocognitive evaluations and the Multidimensional HLOC Scale-Form C. Results indicate no ethnocultural differences in HLOC beliefs (ps > .05). External HLOC (i.e., chance and powerful others) related to worse neurocognition in the Latinx group and contributed to significant variance in global neurocognition and learning, memory, and verbal fluency, underscoring the role of external HLOC beliefs on neurocognition, particularly for Latinx individuals. Additional research is needed to better characterize the mechanistic relationship between HLOC beliefs and neurocognitive function and to further explore this relationship among other underrepresented populations also disproportionately affected by HIV.

P69 Adapting a Nutrition Education Program Targeting School-Age Children from In-Person to Virtual During COVID-19

<h3>Background</h3> School-based nutrition education and gardening programs are found to positively affect nutrition knowledge and healthy eating behaviors in children. Due to the limit on in-person learning during the COVID-19 pandemic, innovative technology approaches for continued nutrition and garden education efforts was imperative. <h3>Objective</h3> Therefore, the purpose of this research study was to examine the effect of a virtual nutrition education and gardening program on the identification, intake and likability of fruits and vegetables. Study Design, Setting, <h3>Participants</h3> This was a quasi-experimental study. A total of 14 students (7 Latinx and 7 Non-Latinx White) ages 7-12 years old participated in an all virtual, 6-week summer nutrition education and gardening course. <h3>Measurable Outcomes/Analysis</h3> At baseline and at the end of the 6-week class, participants completed questionnaires to measure their food identification, intake and likeability. Paired samples <i>t</i> tests were run to examine differences in their pre- and pos<i>t</i> test scores. <h3>Results</h3> Students improved their overall test scores from the pre- to pos<i>t</i> test by 7% (<i>P</i> = 0.04). There was no difference in scores for Latinx and Non-Latinx students. On a 0-1 scale, identification (0.06), intake (0.05) and likability (0.10) scores each increased from pre- to pos<i>t</i> test although not significantly. <h3>Conclusion</h3> COVID-19, has limited the ability for children to be exposed to in-person nutrition education programs they may receive in schools. An effective use of technology to disseminate nutrition and gardening education to school-aged children can lead to positive nutrition outcomes.

Collectivism is associated with enhanced neural response to socially salient errors among adolescents.

The perceived salience of errors can be influenced by individual-level motivational factors. Specifically, those who endorse a high degree of collectivism, a cultural value that emphasizes prioritization of interpersonal relationships, may find errors occurring in a social context to be more aversive than individuals who endorse collectivism to a lesser degree, resulting in upregulation of a neural correlate of error-monitoring, the error-related negativity (ERN). This study aimed to identify cultural variation in neural response to errors occurring in a social context in a sample of diverse adolescents. It was predicted that greater collectivism would be associated with enhanced neural response to errors occurring as part of a team. Participants were 95 Latinx (n = 35), Asian American (n = 20) and non-Latinx White (n = 40) adolescents (ages 13–17) who completed a go/no-go task while continuous electroencephalogram was recorded. The task included social (team) and non-social (individual) conditions. ERN was quantified using mean amplitude measures. Regression models demonstrated that collectivism modulated neural response to errors occurring in a social context, an effect that was most robust for Latinx adolescents. Understanding cultural variation in neural sensitivity to social context could inform understanding of both normative and maladaptive processes associated with self-regulation.

Racial/Ethnic Differences in Knowledge, Attitudes, and Beliefs About COVID-19 Among Adults in the United States.

Background: Knowledge, attitudes, and beliefs are cognitive outcomes that serve as key determinants of engaging in health behaviors, likely including vaccination and other mitigation behaviors against coronavirus disease 2019 (COVID-19). Studies have begun examining people's knowledge, attitudes, and beliefs about COVID-19, but little is known about how these cognitive outcomes differ across racial/ethnic groups.Methods: An online survey was conducted with a convenience sample of adults ages 18 and older in the United States (n = 2,006) in May 2020, about 2 months after COVID-19 was declared a pandemic. Multivariable regression models were used to examine differences in knowledge, attitudes, and beliefs about COVID-19 across racial/ethnic groups (non-Latinx white, non-Latinx black, non-Latinx of another race, or Latinx).Results: Knowledge tended to be lower among non-Latinx blacks and Latinx participants compared to non-Latinx whites. For example, fewer non-Latinx blacks responded correctly that COVID-19 is not caused by the same virus that causes influenza (adjusted OR = 0.66, 95% CI: 0.49–0.90), and Latinx participants were less likely to respond correctly that people with COVID-19 do not always show symptoms of being sick (adjusted OR = 0.63, 95% CI: 0.45–0.87). For beliefs and attitudes, non-Latinx blacks (β = −0.09) and non-Latinx participants of another race (β = −0.05) reported lower perceived likelihood of getting COVID-19 in the future compared to non-Latinx whites, while Latinx participants reported greater perceived stigma of COVID-19 (β = 0.08) (all p < 0.05).Conclusions: Several differences in cognitive outcomes about COVID-19 exist across racial/ethnic groups, including gaps in knowledge and varied beliefs and attitudes. Results identify modifiable targets for public health programs promoting vaccination and other mitigation behaviors against COVID-19.

613 Variation in Sleep Beliefs and Behaviors Among Caregiver-Child Dyads Participating in a Sleep Extension Intervention

Abstract Introduction Given the high prevalence and poor outcomes of insufficient child sleep, effective interventions for the pediatric primary care setting are needed. Collecting family perspectives on intervention strategies is critical to understand and enhance outcomes, particularly among children who do not experience improvements. This study examined variation in qualitative family sleep beliefs and behaviors by quantitative child sleep outcomes of a sleep extension intervention. Methods A total of 24 caregiver-child dyads (child age 9–12 years, M age 11.3 (SD:1.0) years; 46% male; 50% non-Latinx White; 29% Black) participated in a mobile health sleep extension intervention, between March-December 2019, and completed post-intervention semi-structured telephone interviews to solicit intervention perceptions. The intervention used a 25 factorial design consisting of sleep duration goals and weekly performance feedback, with random assignment to sleep health promotion messaging and financial incentive conditions. Sleep duration was assessed via Fitbit Flex 2 devices during 2-week baseline and 7-week intervention periods. We developed a codebook using a grounded theory approach and conducted coding in NVivo. We compared preliminary qualitative themes among children who showed a &amp;gt;=30-minute improvement in sleep duration (‘responders’) versus those who did not (‘non-responders’). Results Of the 24 dyads, 38% (N=9 dyads) were classified as non-responders. Preliminary qualitative themes included: family beliefs about sleep and electronics usage; the study impact on sleep behaviors; and an enhanced awareness of child sleep. Intervention responder and non-responder dyads similarly described family restrictions on evening electronics usage (e.g., electronic parental controls; physical removal of devices) to benefit child sleep. However, more children classified as intervention responders described the benefits of these restrictions and expressed beliefs about the negative impacts of electronics on sleep. Whereas caregivers of both responders and non-responders described efforts to remind their child to go to bed earlier during the intervention, caregivers in the responder group described being more focused on and active in child sleep extension strategies. These included setting bedtime reminders and adjusting family activities to ensure an extended sleep schedule. Conclusion Addressing caregiver-child beliefs about sleep behaviors and engagement in sleep extension strategies could augment sleep extension intervention outcomes in future research. Support (if any) K01HL123612 (JAM), CHOP (JAM), K23HD094905 (AAW)

Trajectories of Opioid Use Following First Opioid Prescription in Opioid-Naive Youths and Young Adults

Although prescription opioids are the most common way adolescents and young adults initiate opioid use, many studies examine population-level risks following the first opioid prescription. There is currently a lack of understanding regarding how patterns of opioid prescribing following the first opioid exposure may be associated with long-term risks. To identify distinct patterns of opioid prescribing following the first prescription using group-based trajectory modeling and examine the patient-, clinician-, and prescription-level factors that may be associated with trajectory membership during the first year. This cohort study examined Pennsylvania Medicaid enrollees' claims data from 2010 through 2016. Participants were aged 10 to 21 years at time of first opioid prescription. Data analysis was performed in March 2020. This study used group-based trajectory modeling and defined trajectory status by opioid fill. Among the 189 477 youths who received an initial opioid prescription, 107 562 were female (56.8%), 81 915 were non-Latinx White (59.6%), and the median age was 16.9 (interquartile range [IQR], 14.6-18.8) years. During the subsequent year, 47 477 (25.1%) received at least one additional prescription. Among the models considered, the 2-group trajectory model had the best fit. Of those in the high-risk trajectory, 65.3% (n = 901) filled opioid prescriptions at month 12, in contrast to 13.1% (n = 6031) in the low-risk trajectory. Median age among the high-risk trajectory was 19.0 years (IQR, 17.1-20.0 years) compared with the low-risk trajectory (17.8 years [IQR, 15.8-19.4 years]). The high-risk trajectory received more potent prescriptions compared with the low-risk trajectory (median dosage of the index month for high-risk trajectory group: 10.0 MME/d [IQR, 5.0-21.2 MME/d] vs the low-risk trajectory group: 4.7 MME/d [IQR, 2.5-7.8 MME/d]; P < .001). The trajectories showed persistent differences with more youths in the high-risk trajectory going on to receive a diagnosis of opioid use disorder (30.0%; n = 412) compared with the low-risk group (10.1%; n = 4638) (P < .001). This study's results identified 2 trajectories associated with elevated risk for persistent opioid receipt within 12 months following first opioid prescription. The high-risk trajectory was characterized by older age at time of first prescription, and longer and more potent first prescriptions. These findings suggest even short and low-dose opioid prescriptions can be associated with risks of persistent use for youths.

Sleep Problems, Cumulative Risks, and Psychological Functioning in Early Childhood.

Sleep problems and cumulative risk factors (e.g., caregiver depression, socioeconomic disadvantage) have independently been linked to adverse child development, but few studies have examined the interplay of these factors. We examined whether cumulative risk exposure moderated the link between sleep problems, including insomnia and poor sleep health, and child psychological outcomes. 205 caregiver-child dyads (child Mage = 3.3 years; 53.7% girls; 62.9% Black, 22.4% non-Latinx White, and 4.4% Latinx; 85.4% maternal caregiver reporter) completed child sleep, family sociodemographic, and child psychological functioning (internalizing, externalizing, and executive functioning) questionnaires. Indexes of cumulative risk exposure, insomnia symptoms, and poor sleep health were created. Ninety percent of children had ≥1 cumulative risks, 62.9% had ≥1 insomnia symptom, and 84.5% had ≥1 poor sleep health behavior. Increased insomnia symptoms were significantly associated with increased child internalizing, externalizing, and global executive functioning impairments controlling for child age, race/ethnicity, and sex. Poor sleep health behaviors were associated with internalizing concerns. Cumulative risk exposure was not associated with outcomes but moderated the association between insomnia symptoms and all psychological outcomes, such that children with higher cumulative risk exposure and insomnia symptoms had the greatest impairments. Children with the poorest sleep health behaviors and highest cumulative risks had the greatest internalizing concerns. Insomnia symptoms in particular are associated with poor child outcomes, which are exacerbated when accompanied by greater cumulative risk exposure. Clinicians should assess sleep when treating early psychological concerns, especially within the context of increased cumulative risks.

Engagement in Care and Housing Instability Influence HIV Screening Among Transgender Individuals in South Florida.

Purpose: HIV screening is a critical step in the HIV care continuum to lowering incidence and achieving viral load suppression among at-risk populations. Few studies assess factors associated with HIV screening among transgender individuals living in the southeast region of the United States. This study was conducted to determine factors that influence HIV screening among transgender individuals in South Florida. Methods: During Fall 2016, 68 participants were recruited to complete a questionnaire as part of a pilot pre-exposure prophylaxis study. Correlations were examined between sociodemographic factors, HIV risk, and access to and engagement in care. Significant correlations were entered into one logistic regression model to estimate predictors of HIV screening and knowledge of HIV status. Results: Almost half (48.5%) of the respondents were Latinx, 38.2% Black, 10.3% non-Latinx White, and 3% other. Seventy-eight percent reported access and routine engagement in care within the past year, 25% had not screened for HIV in the past year, and of those who knew their status, 16.7% reported living with HIV. Regression analysis revealed that participants with routine engagement in care were twice as likely to screen for HIV (p=0.02). Unstable housing was associated with no HIV screening in the past year (p=0.05). Conclusion: Stable housing is linked to engagement in routine care that can increase the likelihood of an at-risk transgender individual screening for HIV. Further research is needed to develop interventions to improve engagement in care among transgender individuals who do not have adequate housing or access to care.

Maximizing Black applicant matriculation in U.S. PA programs: associations between the number of submitted applications and likelihood of matriculation

BackgroundPhysician Assistants (PA) are important members of the medical team, and increasing diversity in healthcare professionals has been consistently associated with improved health outcomes for underrepresented minority patients. In this study of a national cohort of PA program applicants, we investigated whether the number of programs a student applied to (Application Number, AN) was significantly associated with increased likelihood of matriculation into a PA program.MethodsWe examined all applications (n = 27,282) to the 2017–2018 admissions cycle of the Central Application Service for Physician Assistants, which is utilized by over 90% of accredited PA programs in the US. As we a priori hypothesized that associations would be non-linear, we used natural cubic splines to estimate the associations between matriculation and AN, controlling for multiple metrics of academic achievement, experience, and applicant demographics. We subsequently used segmented regression analyses (modified poisson regression with robust error variance) to investigate log-linear associations above and below inflection points identified in the spline analyses. Additionally, we explored for effect modification by race/ethnicity.ResultsThe strongest associations were observed between application number 2–7, and a threshold effect was observed at > 16 applications, beyond which there was no significant, incremental benefit in matriculation likelihood. Associations differed by race, particularly for application number 2–7, wherein the incremental benefit from each additional application was highest for Black applicants (Likelihood Ratio [LR]: 1.243, 95% CI: 1.136 to 1.360) vs non-Latinx White (LR: 1.098, 95% CI: 1.072 to 1.125), with no additional, incremental benefit beyond 7 program applications. For all other races, significant increased likelihoods of matriculation were observed until 16 program applications.ConclusionsThese findings can help guide pre-PA advisors and PA programs, providing recommended thresholds to applicants on the most cost effective ways to increase their likelihood of admissions, and the PA profession as a whole by providing actionable information that can potentially increase Race/Ethnic diversity in the PA profession and, by extension, medical teams.

Assessing the Validity of Self-rated Health Across Ethnic Groups: Implications for Health Disparities Research.

This study examines the association between morbidity (i.e., chronic health conditions) and self-rated health (SRH) with the aim of testing the within-group and across-group validity of SRH across nine ethnic groups: non-Latinx White, Mexican, Puerto Rican, Cuban, African American, Afro-Caribbean, Chinese, Filipino, and Vietnamese Americans. In addition, we assess whether acculturation (i.e., nativity, years of US residency, language of interview) and health-related factors (e.g., mental disorder) account for ethnic distinctions in SRH. Data are from the National Survey of American Life (NSAL) and the National Latino and Asian American Study (NLAAS) (N = 8338). Weighted proportions and means for SRH and chronic conditions are reported. Ordered logistic regression analysis is used to determine ethnic group patterns in SRH. Despite evidence of within-group validity of SRH for each ethnic group, our results seriously challenge the across-group validity of SRH. For example, Chinese and Vietnamese respondents report lower SRH despite having fewer chronic conditions relative to non-Latinx Whites. Moreover, Mexican Americans report fewer chronic health problems but lower SRH compared to non-Latinx Whites. Acculturation factors (e.g., language of interview) partially explain the Mexican-White difference in SRH. Among Chinese Americans, completing an interview in English is associated with higher SRH relative to those who completed an interview in Chinese. These findings have implications for health disparities research that uses SRH as the dependent measure. Studies that compare the health profiles of diverse ethnic groups should use the SRH measure with caution, as SRH does not align with ethnic patterns of morbidity.

237 Do latinas undergo general anesthesia for unscheduled cesarean delivery more than other women?

Misconceptions regarding Latinas and pain management in labor, compounded by language barriers, may lead to disparities in pain control and potential maternal adverse outcomes if general endotracheal anesthesia (GETA) is required for emergent cesarean delivery (CD). Thus, we explored whether Latinx ethnicity was associated with higher use of GETA compared to Non-Latinx Black (NLB) and Non-Latinx White (NLW) women undergoing unscheduled CD. Secondary analysis of a multicenter prospective cohort of women undergoing CD from the MFMU Cesarean Registry (1999-2002). In this analysis, we included women who identified as Latinx, NLB or NLW and had an unscheduled CD after labor with a liveborn singleton. The primary outcome was GETA. Outcomes were compared across groups. Multivariable logistic regression estimated adjusted odds ratios (95% CI) for the study outcomes with Latinx as referent group. Outcomes were also compared across race/ethnicity in the subgroup of women with GETA. A total of 19,623 women were analyzed: Latinx (27.7%), NLB (34.3%), and NLW (37.9%). Latinx women were more likely to present in spontaneous labor and have lower BMI compared to NLB and NLW women (p<0.001). Latinas had the lowest rates of GETA in bivariable analysis; however, after adjustment for confounders the odds of GETA were not different for NLB or NLW women compared to Latinx (Table 1). The indications for GETA were also similar. For women that underwent GETA, Latinas had higher odds of uterine atony compared to NLB but not NLW (Table 2). There was no significant association between Latinx ethnicity and composite neonatal outcome (Table 2). GETA for unscheduled CD is not more common among Latinas compared to NLB or NLW. Among women who have GETA, Latinas experience more uterine atony compared to NLB women, but have similar neonatal outcomes as NLB and NLW women. This increased risk of uterine atony in Latinas undergoing GETA for CD warrants confirmation in order to provide adequate surgical counseling and management.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

234 Adverse maternal and neonatal outcomes in latinas compared to Non-Latinx black and Non-Latinx white women

The Latinx population is partly comprised of recent immigrants, many of whom do not qualify for governmental insurance. This plus language and cultural differences may limit prenatal care, increasing the potential for adverse perinatal outcomes. We assessed if Latinas had higher rates of cesarean delivery (CD) and adverse perinatal outcomes compared to Non-Latinx Black (NLB) and Non-Latinx White (NLW) women. Secondary analysis of an observational study of all women delivering at a single center in 2013, which evaluated the association between human papillomavirus and adverse perinatal outcomes. In this analysis, we included women with single gestations who self-identified as Latinx, NLB, or NLW. The primary outcome was CD. Secondary outcomes included maternal and neonatal morbidity. Multivariable logistic regression models calculated adjusted odds ratios (95% CIs) for the outcomes using Latinx as referent group. A total of 2,166 women were analyzed: Latinx (20%), NLW (27%) and NLB (53%). Latinas were more likely to be parous and have a prior vaginal delivery (Table 1). While Latinas had the lowest rates of CD compared to NLB and NLW women (p=0.001), the association was not significant after adjusting for confounders (Table 2). Latinas, did, however have the lowest primary CD rates with NLW and NLB women having nearly two times the odds of primary CD (Table 2). Compared to Latinas, NLW women were 60% less likely to have composite maternal morbidity, and both NLB and NLW women were less likely (38-65%) to have postpartum hemorrhage (PPH). NLB and NLW women were twice as likely to experience preterm birth (PTB) or composite neonatal morbidity compared to Latinas (Table 2). Compared to NLB and NLW women, Latinas were most likely to have PPH and least likely to have a PTB, primary CD or neonatal morbidity. There was no difference in overall CD among Latinx versus NLB and NLW women. Latinas experience PPH in a disproportionate manner warranting further exploration to determine whether it is driven by provider bias or labor management.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Parenting & Children’s Psychological Adjustment During the COVID-19 Pandemic

Empirical data on the impact of the COVID-19 pandemic on families with school-aged children is limited. We used a cross-sectional, descriptive design to examine pandemic-related family impacts and whether impacts varied based on demographics. We also examined whether parenting behaviors in response to the virus and parent–child interactions were related to pandemic impacts and children’s psychological adjustment. We surveyed 595 United States parents (69.2% non-Latinx White, 12.1% Black/African American) using Amazon Mechanical Turk in May 2020. Results revealed that families experienced negative and positive impacts related to the pandemic. Independent samples t-tests and one-way ANOVAs indicated that parents of color, parents with lower income, and parents of elementary school children reported more negative impacts. Correlational analyses revealed parents who encouraged hygienic behaviors and promoted social connection reported their children engaged in more virus safety behaviors and experienced less impairment. Parents who limited access to COVID-19 information reported their children demonstrated more fear, impairment, and safety behaviors. Positive parenting was inversely related to negative pandemic impacts, whereas inconsistent discipline was positively related to negative pandemic impacts and to children’s fear and impairment related to COVID-19. Recommendations for how practitioners and school personnel can support parents during the pandemic are provided. IMPACT STATEMENT This study contributes to our growing understanding of demographic trends in parents’ COVID-19 responses and also identifies parenting behaviors associated with children’s adjustment to the pandemic. Our findings highlight the need for interventions to teach parents how to talk to their children about the virus and help their child cope with the pandemic. Interventions should also focus on helping parents learn and utilize positive and consistent parenting strategies. Schools should consider developing focused supports for families of color, of lower income, and with elementary school-aged children to help reduce burden associated with adverse impacts of the pandemic, such as children’s transition to online learning from home

Cultural Values Influence Relations Between Parent Emotion Socialization and Adolescents' Neural Responses to Peer Rejection.

Adolescents' responses to negative social experiences can be influenced by parenting behaviors. This includes how parents react to their child's expression of emotions, an aspect of parenting referred to as emotion socialization. Emotion socialization may intersect with cultural values, particularly collectivism, a socially-relevant attitude that emphasizes the importance of interpersonal relationships. Examination of a neural measure called the feedback-related negativity (FRN), thought to reflect the degree to which feedback is experienced as aversive, could help elucidate neural contributions to and consequences of the role of collectivism in such family dynamics. Thus, this study examined whether adolescents' endorsement of collectivism moderated the association of parents' dismissive emotion socialization responses (called override responses) and FRN following peer rejection. A community sample of 83 Latinx (n = 32), Asian American (n = 20), and non-Latinx White (n = 31) adolescents ages 13-17 completed a computerized peer feedback task while continuous electroencephalogram was recorded. Their parents completed a battery of self-report questionnaires. Regression analyses demonstrated that adolescents' endorsement of collectivism moderated the association of override responses and FRN following peer rejection, such that FRN was enhanced as override responses increased for adolescents endorsing low and moderate levels of collectivism. Results suggest that there is cultural variation in the association of the emotion socialization strategy of override and adolescents' neural responses to socially-salient events. Findings have implications for parenting interventions designed to enhance adolescents' emotion regulation abilities.

A-06 Current Norms May Overestimate Rates of Neurocognitive Impairment among American Indian and Alaskan Native Adults.

Abstract Objective Currently available normative data subsume American Indian and Alaskan Native (AI/AN) populations within the non-Latinx white (NLW) ethnoracial group. The classification accuracy of such norms among AI/AN remains unknown. This cross-sectional study aims to identify whether disparities exist in the rates of neurocognitive impairment (NCI) between AI/AN and NLW adults. &amp;lt; br&amp;gt;&amp;lt;br &amp;gt; Method Two hundred community-dwelling adults (50&amp;#37; NLW; 50&amp;#37; Male; M Age = 42 ± 14 years; M Education = 13 ± 3 years) completed comprehensive neurocognitive, quality of education (Wide Range Achievement Test- 4 [WRAT-4]), neuromedical, urine toxicology, and psychiatric/substance use evaluations. Average T-scores were calculated using widely used demographically corrected (age, gender, education) NLW norms to identify NCI (&amp;gt; 1 SD; e.g., Heaton et al., 2004; Heaton &amp; Marcotte, 2000). A comorbid condition propensity score (CCPS) identified the probability to which comorbid conditions (e.g., Heaton et al., 2010) informed ethnoracial identity. &amp;lt;br&amp;gt;&amp;lt;br &amp;gt; Results After adjusting for WRAT-4 and CCPS, the results of a logistic regression analysis demonstrated a significant ethnoracial disparity in risk for NCI (X2(3) = 13.88, p&amp;lt;.01, R2 = .07), such that the AI/AN group was at 2.52 times higher odds (32.3&amp;#37; vs. 16.0, CI: 1.15–5.46, p = .01, Cohen’s d = .51) for NCI in comparison to the NLW group. &amp;lt;br&amp;gt;&amp;lt;br &amp;gt; Conclusions Published norms for NLW adults may overestimate impairment in AI/AN adults. Thus, population-specific normative data are needed to clarify the classification accuracy of neurocognitive impairment and possible disparities in neurocognitive disorders (e.g., HIV-associated neurocognitive disorders) among AI/AN adults. Future work should replicate these findings among other diverse populations (e.g., Caribbean, Middle Eastern) lacking population-specific normative data.876199.

Social inequalities contribute to racial/ethnic disparities in depressive symptomology among men who have sex with men.

Racial/ethnic minorities experience disproportionate rates of depressive symptoms in the United States. The magnitude that underlying factors-such as social inequalities-contribute to these symptoms is unknown. We sought to identify exposures that explain racial/ethnic differences in clinically significant depressive symptomology among men who have sex with men (MSM). Data from the Multicenter AIDS Cohort Study (MACS), a prospective cohort study, were used to examine clinically significant symptoms of depression (Center for Epidemiologic Studies Depression Scale score ≥ 20) among non-Latinx White, non-Latinx Black, and Latinx MSM. We included 44,823 person-visits by 1729 MSM seen in the study sites of Baltimore/Washington, DC; Chicago; Pittsburgh/Columbus; and Los Angeles from 2000 to 2017. Regression models estimated the percentage of depressive symptom risk explained by social, treatment, and health-related variables related to race/ethnicity. Machine-learning methods were used to predict the impact of mitigating differences in determinants of depressive symptoms by race/ethnicity. At the most recent non-missing MACS visit, 16% of non-Latinx White MSM reported clinically significant depressive symptoms, compared to 22% of non-Latinx Black and 25% of Latinx men. We found that income and social-environmental stress were the largest contributors to racial/ethnic disparities in risk for depressive symptoms. Similarly, setting the prevalence of these two exposures to be equal across racial/ethnic groups was estimated to be most effective at reducing levels of clinically significant depressive symptoms. Results suggested that reducing socioeconomic inequalities and stressful experiences may be effective public health targets to decrease racial/ethnic disparities in depressive symptoms among MSM.

Disparities in Electronically Monitored Antiretroviral Adherence and Differential Adherence Predictors in Latinx and Non-Latinx White Persons Living with HIV.

Antiretroviral therapy (ART) adherence is vital for optimal HIV treatment. However, there is limited ART adherence research on the US Latinx population, who are at increased risk for HIV infection and worse HIV health outcomes. This study examined electronically measured ART adherence (Medication Event Monitoring System) and its association with demographic, clinical, neurocognitive, and sociocultural variables in Latinx and non-Latinx white (NLW) persons living with HIV [PLWH (N = 128)]. Latinx participants demonstrated worse adherence than NLW participants (p = 0.04). Linear regressions revealed different predictors of adherence. Among Latinx participants, recent cocaine use, stress, and, unexpectedly, higher US acculturation predicted worse adherence (ps < 0.05). Among NLW participants, recent cocaine use predicted worse adherence (p < 0.05). Intergroup comparisons within the Latinx group were not conducted due to subsample size. Thus, ethnicity, sociocultural variables, and cocaine use are important considerations for ART adherence, and poor ART adherence may be one pathway explaining worse outcomes in Latinx PLWH. Culturally tailored adherence interventions incorporating substance use treatment, acculturation, and stress management are warranted to improve health outcomes.

0952 Parent-Child Perceptions About Healthy Sleep Promotion in a Mobile Health Sleep Extension Intervention

Abstract Introduction Over half of school-aged children sleep insufficiently and sleep promoting interventions are urgently needed. To effectively promote pediatric sleep health, it is critical to obtain feedback from youth and their families about acceptable intervention strategies. This qualitative study examined perceptions about healthy sleep promotion in parent-child dyads participating in a mobile health sleep extension intervention. Methods A total of 26 parent-child dyads (child mean age 11 years, SD = 0.67; 46% non-Latinx White; 19% Black) participated in a mobile intervention to extend child sleep duration over 11 weeks (2-week baseline; 7-week intervention; 2-week follow-up). Participants wore a FitBit during the study, were provided with a sleep duration goal, and received general sleep health-promoting electronic messages using the University of Pennsylvania’s Way to Health platform. Following the intervention, parents and their children separately completed a semi-structured telephone interview to capture perceptions of the intervention strategies. Three coders developed a codebook using an inductive approach to identify emergent themes and conducted coding in NVivo. Results Emergent themes fell into domains of intervention acceptability/feasibility and barriers. Mobile messaging about the child’s sleep duration goal was well-received, although child participants in particular desired more personalized messaging, with sleep promotion targeted to their specific sleep habits. Parents and children both discussed ancillary benefits to intervention participation, including an enhanced focus on sleep. Barriers to sleep extension during the intervention and maintenance of any gains post-intervention were related to: competing child academic, social, and extracurricular demands; family factors (work schedules; family rules and norms); and the challenges of limiting ubiquitous electronic devices. Conclusion Despite high parent-child acceptability of a mobile child sleep extension intervention, individual and contextual barriers may limit long-term adherence. Tailoring healthy sleep messages to target these factors could improve sustained benefits to child sleep. Support Sleep Research Society Foundation and K23HD094905 (AAW); NIH/NCATS UL1TR001878 (JAM and DFD) and K01HL123612 (JAM).