Non-white Respondents Research Articles

Association Between Social Determinants of Health, COVID-19 Stressors, and Mental Health Among New York Residents Early in the Pandemic.

The COVID-19 pandemic is a disaster event. Exposure to stressors during and after disaster events is associated with negative mental health symptoms. To inform targeted COVID-19 recovery efforts, data are needed to understand which stressors play a key role in this relationship. Cross-sectional survey data (demographics, impacts of COVID-19, social determinants of health, depression, and anxiety) were collected online from adults living in New York state between May and June 2020. Differences in the proportion of stressors (COVID-19 and social determinants) experienced by race/ethnicity were assessed using chi-square analyses. Logistic regression was used to assess which factors were associated with increased odds of depression and anxiety. A majority (n = 258, 62.2%) of the 415 respondents reported being directly impacted by the pandemic. Non-white respondents reported a significantly larger proportion of stressors compared to white respondents. Under half of respondents reported depression (n = 171, 41.2%) and anxiety (n = 164, 39.5%). Healthcare and food concerns were associated with increased odds of depression and anxiety, and economic concerns were associated with increased odds of anxiety. Findings underscore the need to respond to the COVID-19 mental health crisis by addressing social determinants of health.

Perceived discrimination, transit use, and walking behavior during the COVID-19 pandemic: Evidence from the Understanding America Study

A rise in reporting and media coverage of negative social interactions and experiences of racism in transit and other public environments suggests that perceived discrimination may have affected the travel behavior and health of people of color during the COVID-19 pandemic. In this study, to examine relationships between race, perceived discrimination, transit use, and walking behavior, we draw on data collected in 20 waves of the Understanding America Study (UAS) COVID-19 tracking survey, fielded July 2020–July 2021. Importantly, we find that transit use among minorities continued during the pandemic at higher rates, especially among Black and Hispanic respondents, despite non-White respondents reporting more frequent perceptions of discrimination. Our linear mixed-effect model results further indicate that non-White respondents were notably more likely to use transit. Examining walking behavior, we find that White and Asian respondents consistently reported more walking than Black and Hispanic respondents, even when controlling for income. Crucially, we found that in the presence of controls, while large disparities were observed in both walking and transit behavior based on race, perceived discrimination had little to no effect. While disparities in travel behavior based on race are evidently better explained by structural factors as opposed to overt, individual-level discrimination, planners, policymakers, and designers should nevertheless give greater consideration to micro- and macro-scale interventions that facilitate safe transit use and walking for racial and ethnic minorities.

The Global Psychedelic Survey: Consumer characteristics, patterns of use, and access in primarily anglophone regions around the world

ObjectivesDespite advancements in policies governing psychedelic substances globally, our understanding of real-world psychedelic use and its variations across international jurisdictions remains limited. We implemented the Global Psychedelic Survey (GPS) to capture information about psychedelic consumer characteristics, access, and usage patterns around the world. MethodsThe GPS was administered online in Spring 2023 to English-speaking adults (≥21 years) who use(d) psychedelics. We categorized survey responses into major catchment regions (Canada/US, Europe/UK, Australia/NZ, All Other). We used descriptive and bivariable statistics to characterize consumers’ socio-demographic characteristics, psychedelic access sources, and usage patterns. We examined regional differences in psychedelic use patterns using multinomial logistic regression. ResultsWe analyzed 6379 responses from 85 countries including Canada/US (n = 4434), Europe/UK (n = 771), Australia/NZ (n = 864), and Other (n = 310). Psilocybin, LSD, and MDMA were the most used psychedelics and personal growth was the most common use motive across all catchments. There were significant regional differences in psychedelic use patterns, including types of psychedelics used (e.g., less ibogaine use in Europe/UK and Australia/NZ relative to Canada/US), frequency of use (e.g., lower frequency use in Australia/NZ relative to Canada/US), motivations for use (e.g., less therapeutic use in Europe/UK and Other relative to Canada/US), and types of dosing regimens (e.g., more “micro”-dosing in Canada/US). DiscussionIn this large sample of adult psychedelic consumers from regions around the world, infrequent psychedelic use centered around life enhancement was common. Respondents indicated preference for legal access via quality-controlled sources. Jurisdictional differences in access and usage patterns likely reflect region-specific regulations and traditional practices. Further research should explore opportunities to increase representation of non-White respondents in psychedelic research via translation of studies into several languages and incorporation of culturally reflective, community-based study development.

Evaluation of a web-based, interactive guide to enhance patient-clinician electronic communication.

e13659 Background: Secure messaging (SM) enables patients to ask clinicians questions asynchronously. Benefits include enhancing patient engagement, contributing to oral chemotherapy adherence, and lowering symptom distress. However, patients are unsure how to address concerns effectively, and clinicians find it challenging to decipher patients’ needs within messages. Coupled with clinicians not having adequate time to respond to messages, breakdowns in communication are common. We developed an interactive guide to help patients with cancer craft effective secure messages. It featured an oncologist providing strategies to write messages with specificity, expressing concerns, stating needs, being direct, and included a downloadable tip sheet. Methods: Patients 18+ with a current cancer diagnosis who were enrolled in the portal at a large health center were recruited. Between October 2023 and January 2024, participants were sent a link to interact with the guide, followed by a survey. The survey included several measures: 1) Communication and Attitudinal Self-Efficacy scale for cancer (CASE-cancer); 2) Digital Behavior Change Intervention (DBCI) Engagement Scale; 3) Website User Satisfaction questionnaire (WUS); 4) Acceptability of Intervention Measure (AIM); 5) Intervention Appropriateness Measure (IAM). We used R version 4.3.2 for the descriptive analysis. The Wilcoxon rank-sum test compared groups by demographic categories. The local IRB approved this study. Results: One hundred patients participated. Median age was 64 years (range=21-86), 54% male, 83% white, 35% diagnosed with prostate cancer, 35% lung cancer, and 23% hematologic cancer. Respondents reported high levels of self-efficacy based on CASE-cancer (mean 43.3 of 48). Respondents averaged 15 minutes using the guide. 96% thought the guide’s content was presented clearly, 95% found it easy to understand, 90% enjoyed using it, 89% thought the guide was suitable, and 88% could rely on its information. Results by demographic categories found that non-white respondents (M = 43.0) were significantly more engaged than white respondents (M = 28.4), P = 0.038 , and those with a bachelor’s degree+ (M = 96.5) had higher satisfaction than those without (M = 91.6), P = 0.025. Conclusions: Patients with cancer embraced an interactive guide that provided strategies to craft secure messages. They found it engaging, satisfying, acceptable, and appropriate, with racially minoritized patients being most engaged. As SM is a widely used tool for patient-clinician communication, it is crucial to concentrate on the way messages are constructed. We found potential to improve patients’ message-writing techniques, which could result in clinicians writing more complete answers to questions. Additionally, there is the possibility to enhance underserved patients’ communication skills and make them more engaged in their care.

Safety net patients' satisfaction with oral health services by provider type and intent to return for more care.

This study examined patients' satisfaction with services provided by different oral health providers, their intent to return for additional care, and associations with patients' demographics and service characteristics. Descriptive analyses and multivariable ordinal logistic regressions were conducted using survey data from 898 patients who received care at Apple Tree Dental (ATD) in Minnesota during 2021. The questionnaire included 12 statements on patient satisfaction with the clinician's ability to explain the dental diagnosis and treatment options, to be considerate of the patient's needs and dental anxiety, and to provide technically competent services. In general, patients reported high satisfaction with dental care and a strong intent to return to ATD for future services. No significant differences in patient satisfaction were observed by provider type. Patients' intent to return was higher among non-White respondents (OR = 1.76; 95% CI = 1.06-2.92) and patients who were more satisfied with their providers' technical competence/treatment (OR = 1.47; 95% CI = 1.37-1.57). The association between intent to return and patient satisfaction with providers' information/communication was stronger for patients treated by dental hygienists. The association between intent to return and patient satisfaction with providers' technical competence/treatment was also stronger for patients who were more satisfied with providers' information/communication and understanding/acceptance, and for those treated by their desired or usual provider. The study underscores the benefits of introducing dental therapists to the oral healthcare team, showing that this can be achieved without sacrificing either the quality of patient care or patient satisfaction.

Factors that influence the formation and impact of mentorship relationships for OB/GYN residents

Background Mentorship is critical for successful careers in academic medicine. There is a gap in the literature regarding specific qualities that make effective mentorship relationships for Obstetrics and Gynecology (OB/GYN) residents. This study aimed to identify the attributes most valued by OB/GYN residents in their mentorship relationships and to explore the factors influencing their choice of mentors. Methods We conducted a cross-sectional survey among OB/GYN residents, distributed electronically November 2021-March 2022. Demographic data, mentor qualities, satisfaction with current mentorship and mentee factors were identified. The survey incorporated questions adapted from the validated Ideal Mentor Scale assessing three mentor attributes: Integrity, Guidance, and Relationship. Data analysis involved descriptive statistics, Student’s t-tests, chi-squared tests, and Fisher’s Exact tests where appropriate. Results 48 of 60 (80%) of surveyed residents responded. Among the respondents, 72.9% were female and 29.1% identified as non-white. Integrity emerged as the most valued Ideal Mentor attribute. No statistically significant gender-based differences were observed in the preferences for mentor characteristics including gender of a mentor. Non-white respondents placed greater importance on having a mentor of the same race (p<0.01). Residents interested in subspecialties expressed a stronger preference for mentors with fellowship training (p<0.01) and shared research experiences (p=0.03). Conclusions OB/GYN residents seek mentors characterized by integrity and who are active in research and professional societies aligned with their interests. The data highlight the importance of considering race and subspecialty preferences in fostering influential and equitable mentorship for all residents.

Diversity in Hand Surgery Leadership: The Impact of Mentorship and Bias.

Diversity in leadership drives innovation. However, underrepresented minorities may face barriers. The aim of this study is to understand the impact of gender and race on the experience of leaders in hand surgery. An anonymous survey was sent to leaders in hand surgery who attained the position of national society president, head of a division/department, or hand fellowship director. The survey assessed demographic information, grit, mentorship, and bias. One hundred twenty-one leaders responded for a response rate of 60.5%. Men represented 81.0% and women 19.0%. Most respondents were white (87.6%) with 7% Asian and 6% any other race. Ninety-one percent of female respondents lived in a dual career household, compared with 53.7% of male respondents (odds ratio [OR] 0.15, P = .017). Female respondents had significantly higher grit compared with male respondents (4.3 vs 4.0, P = .050). Male respondents were more likely to have a male mentor/sponsor than women (95% vs 76%, respectively, P = .001). White respondents were more likely to have a white mentor/sponsor than nonwhite respondents (91% vs 61%, respectively, P = .009). Ninety-five percent of women reported experiencing bias compared with 27% of men (P < .001). Specifically, women reported bias in salary, promotion, nomination, sponsorship, networking, and clinical resources. Nonwhite respondents were significantly more likely to experience bias in promotion (P = .006). Women and racial minorities face bias and barriers to leadership within hand surgery.

Preventive health behaviour differences across racial groups during the early stages of COVID-19.

Throughout the COVID-19 pandemic, the practice of preventative health behaviours had been used disparately across different racial groups. This study seeks to identify any differences in preventative health behaviours across racial groups, controlling for other socio-demographic factors. A US national survey study was electronically conducted from July through November 2020, to measure racial/ethnic differences in health preventive behaviours about COVID-19. We performed 2-part regression models to assess whether preventive health behaviours differed by race and ethnicity. Specifically, we employed generalized logistic regressions for investigating the predictors of the use of complementary or alternative medicine (CAM), or stay-at-home strategy, then performed ordinal logistic regression to examine the predictors of social distancing, face mask wearing, and hand hygiene strategy practice. The results show that non-White respondents were more likely to practice social distancing, mask wearing, and hand hygiene strategy to prevent COVID-19, compared to their White counterparts. Additionally, the findings indicate that individuals who experienced COVID-19-related racial abuse or depression had a higher likelihood of practicing preventive health behaviours. We found ethnicity can be a predictor of health preventive behaviours, in accordance with previous research. The causes of these disparities will require further investigation in order to be addressed.

Youth preferences for healthcare providers and healthcare interactions: a qualitative study

BackgroundPatient-physician relationships in healthcare can influence healthcare provision, patient engagement, and health outcomes. Little is known about youth preferences on types and characteristics of their healthcare providers. The aim of this study was to assess youth perspectives on preferences for and interactions with their healthcare providers.MethodsWe posed 5 open-ended questions to 1,163 MyVoice participants, a nationwide text message cohort of United States youth aged 14–24, on April 10, 2020 related to youth preferences for healthcare providers. Content analysis was used to develop a codebook. Responses were independently coded by two reviewers with discrepancies discussed to reach consensus. Descriptive statistics were calculated for demographics and frequency of codes.Results944 (81%) participants responded to at least one question. Respondents had a mean age of 18.9 years (SD: 2.8) and were a majority female (53.6%) and White (56.3%). Youth reported “kindness” or other personality traits (31%) and education (30%) as important in choosing their doctor. Patient-physician concordance was not important to many youths (44%) and among those who reported concordance as important (55%), having the same gender was the most noted (68%). Youth suggested respect, open conversation, and addressing issues directly to help alleviate uncomfortable situations, though some would simply switch providers.ConclusionPersonality and empathy are important provider characteristics valued by youth. Female respondents preferred gender concordant providers, particularly for sexual health-related issues, and non-white respondents were more likely to prefer racial concordance. Strengthening professional and interpersonal skills among youth-serving providers may improve healthcare engagement and satisfaction among youth.

Understanding Whether Representative Bureaucracy and Racial Resentment Impact Public Perceptions of the Distributive Justice of Government Programs

Within the representative bureaucracy literature, scholars argue that public perceptions of government will improve when their government looks like them. In particular, this study focuses on how the public perceives the fairness of policy outcomes, measured as distributive justice. We test this through a survey experiment that examines how perceptions of distributive justice are affected by the racial diversity of government employees. Respondents are presented with a vignette about grants allocated to small businesses, and then provided information about the racial diversity of agency employees. We further examine whether levels of racial resentment impact the relationship between diversity in government and the perceived distributive justice of policy outcomes. Racial resentment, frequently used in political science as a proxy for levels of prejudice, is included because reactions to information about race and government policy are likely to shape perceptions about the legitimacy of government action and views on representative bureaucracy. The experiment results indicate racial representation in government matters for Whites, and these effects vary by expressed levels of racial resentment. In contrast, distributive justice perceptions of non-White respondents are not changed by information on racial diversity within government agencies and do not vary by levels of racial resentment.

Factors Associated with Condom Use among Community College Students

The incidence and prevalence of sexually transmitted infections (STIs) have increased over the past decade, with half of all new diagnoses occurring in young people ages 15-24 years. Despite the risk, college students report low rates of condom use during sex. This study investigated factors associated with condom use in college students with the intent to inform health education strategies. In this cross-sectional study, a 40-item survey was administered to a random sample of classes at a community college in Central California. A total of 883 students participated. A multivariate logistic regression model identified factors associated with condom use, controlling for demographics, knowledge, and perceptions about sexually transmitted infections (STIs) and condoms.Hispanic/Latino respondents had higher rates of condom use compared to non-Hispanic/Latinos, as did non-White respondents compared to White respondents, non-females, and individuals who were not in a relationship. Regression results revealed that assertive negotiation (i.e., directly requesting to use condoms) was the most significant influencer of condom use. STI knowledge was not associated with condom use, nor was perceived seriousness or susceptibility to STIs.While traditional health promotion programs focus on knowledge and access to condoms, these results suggest that additional factors influence condom use, including the ability to directly request condom use with partners. In addition to topics such as STIs, contraception, and pregnancy, comprehensive sexual health education should also include communication and negotiation strategies between partners, through a lens that includes all sexualities and gender identities.

Is it Black and White? Testing racial framing effects of public reactions to newspaper vignettes of fatal officer-involved shootings

Abstract Objectives To investigate how race shapes public perceptions of a fatal officer-involved shooting of an armed male citizen depicted in a scenario without racial identifiers, intraracial, and interracial. Methods We distributed an online survey whereby respondents indicated justification, measured by four questions about the fatal officer-involved shooting, after being randomly assigned to three conditions that differed by the racial composition of the officer and armed male citizen. The control condition omitted racial identifiers, and two conditions depicted an interracial and intraracial deadly encounter between a White officer and a White or Black citizen. Results White and non-White respondents similarly perceived the intraracial shooting, but White respondents perceived the control condition and the interracial shooting as more justified than non-White respondents. Conclusions An identical news article of a fatal officer-involved shooting can be perceived differently when altering the race of the officer and armed male citizen.

At the nexus of grocery access and transportation: Assessing barriers and preferences for alternative approaches to enhancing food access

IntroductionMost households, especially those experiencing food insecurity, choose their preferred food retailers based on prices, rather than proximity. However, food-insecure households are often transit-dependent, further burdening vulnerable households seeking healthy, affordable groceries. This study sought to better understand the multi-faceted transportation experiences of households with varying food security levels and preferences for grocery access models designed to help overcome transportation barriers to groceries. MethodsQuestionnaires assessing household's transportation modes and preferences for accessing groceries, and their preferences for proposed grocery access models were collected through intercept and online surveys. ResultsOf the 578 survey respondents, 35% were nonwhite; 22% at risk for food insecurity; 29% without a household car. Respondents at risk for food insecurity had longer travel times (20 min or more) to the grocery store (35%) compared with food-secure respondents (14%), as did transit-dependent respondents (31%) compared to households with access to a car (13%). Most at risk for food insecurity, low education, or nonwhite respondents preferred to drive a household car to the store, whereas most food-secure, high education, or white respondents preferred to walk. Respondents indicated they would be likely or very likely to use the following general grocery access models—grocery delivery (28%), and rideshare (22%)—and neighborhood-market based models—veggie box (50%), pre-chopped produce (36%), and extra $10 SNAP (35%). Preferences for the different models varied by respondents’ demographic, transportation, and food security status. ConclusionsResults suggest unequal transportation-based access to preferred grocery stores among respondents, with longer travel times for those most vulnerable to food insecurity. Respondents’ preferences for grocery access models—which may have changed since the onset of the COVID-19 pandemic—provide insight for designing a multi-faceted policy approach to transportation barriers to grocery access.

What does environmental justice look like in Vermont? Centering perspectives from the margins

Until 2022, Vermont was one of the few US states that did not have an Environmental Justice (EJ) policy. In 2016, the Vermont Department of Environmental Conservation (DEC) initiated a process to create an EJ policy based on an agreement with the US Environmental Protection Agency (EPA). A coalition of academics, non-profit organization leaders, legal experts, and community-based partners formed in response to the DEC’s initial approach because it lacked a robust process to center the voices of the most vulnerable Vermonters. The coalition developed a mixed-method, community-based approach to ask, “What does EJ look like in Vermont?” This article reports the door-to-door survey portion of that broader research effort. The survey of 569 Vermont residents purposively sampled sites of likely environmental harm and health concerns and sites with existing relationships with activists and community organizations engaged in ongoing EJ struggles. The survey results use logistic regression to show that non-white respondents in the sites sampled were significantly more likely to be renters, to report exposures to mold, to have trouble paying for food and electricity, to lack access to public transportation, were less likely to own a vehicle, to have a primary care doctor, and reported higher rates of Lyme disease than white respondents. Our findings contribute to EJ theory regarding the co-productive relationship between environmental privilege and environmental harms within the context of persistent characterizations of Vermont as an environmental leader with abundant environmental benefits.

Attitudes and beliefs about Vermont’s 2021 buprenorphine decriminalization law among residents who use illicit opioids

BackgroundIn July 2021, Vermont removed all criminal penalties for possessing 224mg or less of buprenorphine. MethodsVermont residents (N=474) who used illicit opioid drugs or received treatment for opioid use disorder in the past 90 days were recruited for a mixed-methods survey on the health and criminal legal effects of decriminalization. Topics assessed included: motivations for using non-prescribed buprenorphine, awareness of and support for decriminalization, and criminal legal system experiences involving buprenorphine. We examined the frequencies of quantitative measures and qualitatively summarized themes from free-response questions. ResultsThree-quarters of respondents (76%) reported lifetime use of non-prescribed buprenorphine. 80% supported decriminalization, but only 28% were aware buprenorphine was decriminalized in Vermont. Respondents described using non-prescribed buprenorphine to alleviate withdrawal symptoms and avoid use of other illicit drugs. 18% had been arrested while in buprenorphine, with non-White respondents significantly more likely to report such arrests (15% v 33%, p<0.001). ConclusionDecriminalization of buprenorphine may reduce unnecessary criminal legal system involvement, but its health impact was limited by low awareness at the time of our study.

645-P: Experiences of Managing Comorbid Obstructive Sleep Apnea and Type 2 Diabetes among Veterans

Obstructive sleep apnea (OSA) is highly prevalent in patients with type 2 diabetes (T2DM), more so in veterans compared to non-veterans. Positive airway pressure (PAP) is the recommended first-line treatment for OSA. However, adherence to both PAP and to diabetes management regimens can be challenging to older adults. This study describes older veterans’ experiences managing comorbid OSA and T2DM, and the types of support they receive from family and friends. Methods: We conducted a postal survey of 900 randomly selected veterans (aged ≥50 years with medical diagnoses of OSA and T2DM) from one VA healthcare system. Questions included the Diabetes Patient Behavior Checklist and perceived benefits of and assistance with PAP use. Results: Of the 145 respondents (97% men, 51% White, 21% Black, mean age 72 years), 43% received help for diabetes from family or a friend, including preparing healthy food (91%), providing encouragement for diabetes self-care (89%), and eating at the same time (89%). Almost two thirds of the respondents were current PAP users. Among the respondents, 27% received help using PAP from a household member, including putting on the mask (68%), filling the water reservoir (59%), and cleaning the device (59%). Current PAP users had significantly lower levels of hemoglobin A1c than nonusers (6.7 ± 1.1 vs. 7.3± 1.6 %, respectively, p=0.008). Current PAP users also reported significantly higher perceived benefits of PAP use on improving sleep quality, sleep apnea, diabetes, and general health than nonusers. Married or non-White respondents thought it would be more helpful for a family member or friend to receive education on treatment of both OSA and T2DM. Conclusion: Future studies should investigate feasible strategies for addressing adherence to PAP use as part of diabetes self-management to improve glycemic control and overall health outcomes among patients with T2DM and comorbid OSA. Family support and social/demographic factors should be considered. Disclosure Y.Song: None. S.E.Choi: None. A.Papazyan: None. P.M.Macey: None. C.Alessi: None. C.H.Fung: None. J.Martin: None. Funding National Institutes of Health (K23AG055668); University of California, Los Angeles Clinical and Translational Science Institute School of Nursing

652-P: Understanding the Impact of Insulin Affordability Challenges across Demographic Groups and on Mental Well-Being in the U.S.

Over 30% of people with diabetes (PWD) in the United States require insulin to manage their diabetes, and the rising cost of insulin over the past two decades has put a large financial burden on many of these PWD. This study aimed to understand differences in insulin affordability challenges across demographic groups and their association with mental well-being. In 2022, 2,794 insulin-using adult PWD in the U.S. responded to three online questionnaires in which they reported challenges affording their insulin in the past 6 months and the mental health burden of their diabetes. Respondents also answered the 5-item WHO-5 Well-being Index. Results were analyzed across demographic groups (58% type 1, 66% female, 85% white). The prevalence of insulin affordability challenges was highest among Black/African American PWD (20%) compared to Hispanic/Latinx (12%) and white PWD (11%). Among those who had challenges affording insulin, non-white respondents were more likely to experience these challenges “all of the time” compared to white respondents (39% vs. 23%, p=.015). PWD who struggled to afford their insulin were more likely to have a poor well-being score as measured by the WHO-5 compared to those who did not (p&amp;lt;.001). They were also more likely to agree that diabetes management takes too much effort (p&amp;lt;.01) and that they felt overwhelmed by their diabetes (p&amp;lt;.001), unmotivated to manage their diabetes (p&amp;lt;.001), and burned out by their diabetes (p&amp;lt;.001). PWD who struggle to afford their insulin have a higher prevalence of poor well-being and mental burden from their diabetes. These issues may disproportionately affect certain racial minority groups, among whom insulin affordability challenges are higher in prevalence and frequency. As new legislation capping insulin out-of-pocket costs come into effect this year, it will be important to understand how they impact inequalities in access to medical needs and quality of life for PWD. Disclosure E.Xu: Employee; dQ&amp;A. A.Zeng: Employee; dQ&amp;A. T.Bell: Employee; dQ&amp;A. T.L.Bristow: Employee; dQ&amp;A.

Patient Attitudes on Collection of Sexual Orientation and Gender Identity Data in a Women's Health Clinic with an Embedded Transgender Medicine Program.

Purpose: We examined patient attitudes about the collection of sexual orientation and gender identity (SOGI) data in a mixed sample of sexual and gender minority (SGM) and cisgender heterosexual people. Methods: SOGI questions and an evaluation questionnaire were administered to a convenience sample of patients presenting at an academic women's health clinic with an embedded transgender medicine program. Clinic census is ∼10,000 patients, which includes some 1000 cisgender males and 800 transgender patients. Bivariate and multivariate analyses were performed. Our methods expand on prior study in this area through implementing an analysis which divides the sample into three groups; cisgender heterosexual, cisgender sexual minority, and transgender respondents, and includes an intersectional approach to the analysis by income and age range, race/ethnicity, and presence of a non-English language spoken at home. Results: Some 231 respondents participated out of 291 approached, including 149 cisgender heterosexual respondents, 26 cisgender sexual minority respondents, and 56 transgender people of any sexuality. Scores were high regarding ease and accuracy of the SOGI questionnaire, and willingness to answer SOGI questions. Among those identifying as cisgender/heterosexual, non-White respondents had an odds ratio of 5.48 of being offended by sexual behavior questions compared with White respondents. Respondents overwhelmingly preferred to complete questionnaires through confidential electronic or pen-and-paper means. Conclusion: Patients were overwhelmingly willing to complete SOGI data questionnaires in a clinic setting, and preferred to do so using confidential means rather than by live interview by staff or providers.

The moderating role of neighborhood disadvantage on the link between functional limitations and self-rated health.

Self-rated health is an important health outcome and determinant of health. Improvements to our understanding on self-rated health could help design plans and strategies to improve self-rated health and achieve other preferred health outcomes. This study examined whether the link between functional limitations and self-rated health varies by neighborhood socioeconomic status. This study used the Midlife in the United States study linked with the Social Deprivation Index developed by the Robert Graham Center. Our sample consist of noninstitutionalized middle to older adults in the United States (n = 6,085). Based on stepwise multiple regression models, we computed adjusted odds ratios to examine the relationships between neighborhood socioeconomic status, functional limitations, and self-rated health. Respondents in the socioeconomically disadvantaged neighborhoods were older, had higher percentage of females, non-White respondents, lower educational attainment, lower perceived neighborhood quality, and worse health status with greater number of functional limitations than those in socioeconomically advantaged neighborhoods. Results showed a significant interaction was found where neighborhood-level discrepancies in self-rated health was biggest among individuals with highest number of functional limitations (B = -0.28, 95% CI[0.53, -0.04], p = 0.025). Specifically, individuals with the highest number of functional limitations from the disadvantaged neighborhoods had higher self-rated health compared to those from advantaged neighborhoods. Our study findings highlight that neighborhood discrepancy in self-rated health is underestimated particularly among those with severe functional limitations. Moreover, when interpreting self-rated health status, values should not be taken face value, and should be considered together with the environmental conditions of where one resides.

Factors Related to Differential Treatment and Practice Limitations Amongst Urologists: A Report of American Urological Association 2021 Census Data

To assess rates of urologist-reported differential treatment in practice and practice limitations based on characteristics of urologists' identity. The 2021 AUA Census samples were linked with the United States (US) practicing urologist population file and assigned proper sample weighting to adjust for non-response bias. Responses to 2 questions of the Census related to (1) (negative) differential treatment experienced in practice and (2) limitations in patients/diagnoses seen in practice due to different aspects of respondent's identity were evaluated. Responses were stratified based on self-reported gender (female vs male) and race (White vs non-White); results were compared using a chi-squared test. A total of 1742 urologists, representing 13,790 practicing US urologists through post-stratified weighting, responded to the Census. Overall, amongst those who answered the relevant questions, 16.3% reported having experienced differential treatment in practice due to their identity and 6.1% reported being limited in patients/diagnoses seen in practice due to their identity. Women were more likely than men to have experienced differential treatment (75.0% vs10.2%, P<.001) and to be limited in patients/diagnoses seen in practice (27.0% vs3.7%, P<.001). Similarly, non-White respondents were more likely than White urologists to both have experienced differential treatment (30.4% vs14.1%, P<.001) and to be limited in patients/diagnoses seen in practice (12.8% vs5.0%, P<.001). Female and non-White urologists are more likely to experience differential treatment in their practice and limitations in the scope of their practice. Further studies are needed to characterize these experiences and explore the etiologies of these differences.