Pacific Islands Research Articles

Addressing racial and ethnic disparities in premature exits from permanent supportive housing among residents with substance use disorders

BackgroundPermanent supportive housing (PSH) is an evidence-based practice for reducing homelessness that subsidizes permanent, independent housing and provides case management—including linkages to health services. Substance use disorders (SUDs) are common contributing factors towards premature, unwanted (“negative”) PSH exits; little is known about racial/ethnic differences in negative PSH exits among residents with SUDs. Within the nation’s largest PSH program at the Department of Veterans Affairs (VA), we examined relationships among SUDs and negative PSH exits (for up to five years post-PSH move-in) across racial/ethnic subgroups.MethodsWe used VA administrative data to identify a cohort of homeless-experienced Veterans (HEVs) (n = 2,712) who were housed through VA Greater Los Angeles’ PSH program from 2016–2019. We analyzed negative PSH exits by HEVs with and without SUDs across racial/ethnic subgroups (i.e., African American/Black, Non-Hispanic White, Hispanic/Latino, and Other/Mixed [Asian, American Indian or Alaskan Native, and Native Hawaiian or Other Pacific Islander, and mixed race/ethnicity]) in controlled models and accounting for competing risk of death.ResultsIn competing risk models, HEVs with at least one SUD had 1.3 times the hazard of negative PSH exits compared to those without SUDs (95% CI: 1.00, 1.61). When stratifying by race/ethnicity, Other/Mixed race residents with at least one SUD had 6.4 times the hazard of negative PSH exits compared to their peers without SUDs (95% CI: 1.61–25.50). Hispanic/Latino residents with at least one SUD had 1.9 times the hazard compared to those without SUDs; however, this association was not statistically significant (95% CI: 0.85–4.37). African American/Black residents with at least one SUD had 1.2 times the hazard compared to those without SUDs (95% CI: 0.85–1.64), indicating no evidence of an association with negative PSH exits. Non-Hispanic White residents with at least one SUD had 1.1 times the hazard compared to those without SUDs (95% CI: 0.75–1.66), similarly indicating no evidence to suggest an association with negative PSH exits.ConclusionsThese findings suggest relationships between SUDs and negative PSH exits differ between racial/ethnic groups and suggest there may be value in culturally specific tailoring and implementation of SUD services for these subgroups.

Epidemiology of Cancer in the Fiji Islands: 2010 to 2018.

Cancer is a global public health concern with increasing incidence and mortality rates, particularly in low- and middle-income countries (LMICs) like the Pacific Island Countries and Territories (PICTs). Among the PICTs, Fiji faces a growing burden of cancer. This study aimed to analyze cancer incidence and mortality data in Fiji from 2010 to 2018 to identify trends and provide an update on the current cancer-related statistics in the Fiji Islands. The top three cancer incidence rates among women were breast, cervical, and endometrial cancer, whereas prostate, liver, and lung cancer were the most prevalent among men. Notably, the central division had higher cancer incidence rates, whereas the northern division had a disproportionately higher mortality rate. Factors contributing to these trends may include lifestyle behaviors, limited access to health care in certain regions, and low awareness. Although this study has limitations due to data quality, it emphasizes the need for targeted interventions, accurate data reporting, and improved cancer treatment delivery to reduce the burden of cancer in Fiji.

Designing the First Pregnancy Guaranteed Income Program in the United States: Qualitative Needs Assessment and Human-Centered Design to Develop the Abundant Birth Project.

Racial inequities in pregnancy outcomes persist despite investments in clinical, educational, and behavioral interventions, indicating that a new approach is needed to address the root causes of health disparities. Guaranteed income during pregnancy has the potential to narrow racial health inequities for birthing people and infants by alleviating financial stress. We describe community-driven formative research to design the first pregnancy-guaranteed income program in the United States-the Abundant Birth Project (ABP). Informed by birth equity and social determinants of health perspectives, ABP targets upstream structural factors to improve racial disparities in maternal and infant health. The research team included community researchers, community members with lived experience as Black or Pacific Islander pregnant, and parenting people in the San Francisco Bay Area. The team conducted needs assessment interviews and facilitated focus groups with participants using human-centered design methods. Needs assessment participants later served as co-designers of the ABP program and research, sharing their experiences with financial hardships and government benefits programs and providing recommendations on key program elements, including fund disbursement, eligibility, and amount. Housing affordability and the high cost of living in San Francisco emerged as significant sources of stress in pregnancy. Participants reported prohibitively low income eligibility thresholds and burdensome enrollment processes as challenges or barriers to existing social services. These insights guided the design of prototypes of ABP's program components, which were used in a design sprint to determine the final components. Based on this design process, the ABP program offered US $1000/month for 12 months to pregnant Black and Pacific Islander people, selected through a lottery called an abundance drawing. The formative design process maximized community input and shared decision-making to co-design a guaranteed income program for Black and Pacific Islander women and people. Our upstream approach and community research model can inform the development of public health and social service programs.

Trends and Disparities in Intrahepatic Cholangiocarcinoma-related Mortality in the United States from 1999 to 2020.

Intrahepatic cholangiocarcinoma (ICC) arises from the epithelial cells of the bile ducts present inside the liver parenchyma and is associated with an overall poor prognosis due to advanced disease stage at the time of diagnosis. We used the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research (CDC WONDER) database to determine ICC-related mortality patterns in the United States from 1999 till 2020. Age-adjusted mortality rates (AAMR) and crude mortality rates (CMR) were extracted from the CDC WONDER database. Annual percentage change (APC) was calculated using Joinpoint regression. Our analysis of ICC-related deaths revealed a consistent upwards trend from 1999 to 2020 in the United States (APC: 3.59, 95% CI: 3.34 to 3.83, p < 0.05). AAMR remained higher in males (1.7, 95% CI: 1.6 to 1.7) than females in (1.3, 95% CI: 1.3 to 1.3). Upon stratification by geographical distribution, we observed the highest mortality rate in the Northeast region (AAMR: 1.6, 95% CI: 1 to 2) and urban areas (1.4, 95% CI: 1.3 to 1.5). The highest ICC-related AAMR was observed in Hawaii, Rhode Island, and Washington, with mortality rates being twice as high as states at the lower end of the spectrum, including Mississippi and Arkansas. Non-Hispanic Asian or Pacific Islanders exhibited the highest AAMR (1.9, 95% CI: 1.9 to 2) as compared to other racial groups, and adults aged ≥ 85years exhibited the highest CMR (11.2, 95% CI: 10.3 to 12.1). The rise in ICC-related deaths from 1999 to 2020 is concerning, with the AAMRs observed to be the highest in males, non-Hispanic Asian or Pacific Islanders, adults aged ≥ 85years and residents of the Northeast region, urban areas, and Hawaii. Efforts must be directed towards vulnerable populations to decrease ICC-related mortality.

Trends in Prostate Cancer Incidence and Mortality Rates.

Incidence of distant stage prostate cancer is increasing in the United States. Research is needed to understand trends by social and geographic factors. To examine trends in prostate cancer incidence and mortality rates in California by stage, age, race and ethnicity, and region. This cohort study used mortality data from the California Cancer Registry and California Department of Public Health's Center for Health Statistics, and incidence data from the National Cancer Institute Surveillance, Epidemiology, and End Results program and the US Census. The dataset for these analyses was released in April 2024. Participants included males residing in California between 2004 and 2021. Analyses were conducted from April to October 2024. Stage at diagnosis, age, race and ethnicity, and region of California. The delay-adjusted incidence rates and mortality rates were calculated and age-adjusted to the 2000 US standard population. Annual percentage changes (APC) were calculated using NCI's Joinpoint Regression Program. Between 2004 and 2021, there were 387 636 prostate cancer cases (27 938 distant stage) and 58 754 prostate cancer deaths in California. In this study, 203 038 cases (52.4%) occurred among males aged 55 to 69 years, and 153 884 (39.7%) occurred among males 70 years or older. The distribution of race and ethnicity among cases was: 1031 American Indian or Alaska Native (0.3%); 31 366 Asian American, Native Hawaiian, and Pacific Islander (8.1%); 66 695 Hispanic or Latino (17.2%); 36 808 non-Hispanic Black (9.5%); 238 229 non-Hispanic White (61.5%); and 13 507 unknown or other races (3.5%). On average, the incidence of distant prostate cancer increased 6.7% (95% CI, 6.2% to 7.3%) per year between 2011 and 2021. By race and ethnicity, the APC ranged from 6.5% (95% CI, 4.2% to 13.4%) among Asian American, Native Hawaiian, and Pacific Islander males between 2011 and 2021 to 8.0% (95% CI, 6.9% to 9.5%) among Hispanic males between 2014 and 2021. In 9 of the 10 California regions, the incidence of distant prostate cancer increased by approximately 6% or more per year. Prostate cancer mortality rates declined 2.6% per year between 2004 and 2012 but plateaued between 2012 to 2021 (APC, 0.1%; 95% CI, -0.6% to 1.6%). The plateau in mortality occurred across ages, races and ethnicities, and regions. In this cohort study among California residents, the incidence of distant stage prostate cancer increased throughout the state between 2011 and 2021. Mortality rates plateaued between 2012 and 2021, ending previous decades of decline. Implementation of more effective prostate cancer screening strategies are critically needed.

Predictors of Life Satisfaction in Native Hawaiian and Pacific Islander College Students

This study examines predictors of life satisfaction in Native Hawaiian and Pacific Islander (NH/PI) college students, who form an underrepresented group in well-being research. In a sample of 128 NH/PI students from a public university in Hawaii, self-report measures of life satisfaction, affect, stress, and mood were analyzed. The results indicate that positive affect and mood are significant positive predictors for life satisfaction, while negative affect predicts lower satisfaction. By contrast with other racial/ethnic groups, perceived stress did not significantly impact life satisfaction in NH/PI students. These findings suggest that emotional well-being is a key determinant for life satisfaction in NH/PI students, and stress is not. Culturally responsive interventions that focus on positive emotions and community support can enhance well-being and academic success in this population. This study contributes to the understanding of unique cultural influences on well-being in NH/PI students and provides implications for targeted interventions.

Survival disparities among Alzheimer's disease patients in Hawaii.

Survival after an Alzheimer's disease (AD) diagnosis is vital for patients, their families, caregivers, and healthcare providers. Hawaii, known for its diverse ethnic population, exhibits significant racial health disparities. This study examined racial/ethnic and socioeconomic disparities in AD survival in Hawaii and developed machine learning models to predict overall survival using Hawaii Medicare data. Nine years of Hawaii Medicare data were utilized to gather information on AD development after age 65, following patients to capture all-cause survival or until censoring. The study examined the effects of race/ethnicity and socioeconomic status (SES) on mortality risk. Cox regression analysis was conducted on overall survival, accounting for covariates. A Survival Random Forest was employed to model survival, incorporating K years of longitudinal health profiles. The study included 9393 AD subjects. Analysis revealed that Asian Americans (AA) had a later age at AD diagnosis (p < 0.001), with an average age of 85.9, compared to 82.7 and 83.3 years for whites and Native Hawaiians and Pacific Islanders (NHPI), respectively. Low SES showed a marginal increase in hazard (Hazard Ratio [HR] = 1.36, p < 0.001). After covariate adjustment, compared to AAs with better SES, increased hazards were found for their white counterpart (HR = 1.18, p < 0.001) and groups with low SES: AA (HR = 1.28, p < 0.001), white (HR = 1.51, p < 0.001), and NHPI (HR = 1.39, p < 0.001). The predictive model had a Concordance-Index of 0.82, showing reasonable predictability. Racial/ethnic and SES disparities significantly influence AD onset and survival. Combined with longitudinal health status data, machine learning demonstrates reasonable predictability of survival.

Survival disparities among Asian, Native Hawaiian and Pacific Islander (ANHPI) patients with non-Hodgkin lymphoma (NHL) in the United States.

Non-Hodgkin lymphoma (NHL) is the seventh most common cancer among Asian, Native Hawaiian and Pacific Islanders (ANHPIs), yet the risk of death in specific ANHPI subgroups in the US is unknown. We used Surveillance, Epidemiology, and End Results data to investigate relative survival and the risk of death among NHL patients in ANHPI subgroups. Cox proportional hazards models were used to estimate hazard ratios and 95% confidence intervals (CI), comparing ANHPI subgroups to non-Hispanic White (NHW) NHL patients for all-cause death and NHL-specific death. Prognostic factors were further estimated within each ANHPI subgroup. We identified 4,513 East Asian, 4,034 Southeast Asian, 1,052 South Asian, 674 Native Hawaiian and Pacific Islander (NHPI), and 116,922 NHW patients with NHL. Compared to NHW patients, East Asian, Southeast Asian, and NHPI patients had a lower 5-year relative survival. The risk of 5-year all-cause death was 1.10-fold higher for East Asian patients (95% CI 1.04, 1.15), 1.34-fold higher for Southeast Asian patients (95% CI 1.27, 1.41), and 1.62-fold higher for NHPI patients (95% CI 1.43, 1.83) compared to NHW patients. Potential prognostic factors among ANHPI NHL patients included older age at cancer diagnosis, non-married status, advanced cancer stage, and a diagnosis of DLBCL or T-cell lymphoma. Our study revealed significant disparities in survival among ANHPI patients with NHL, particularly among East Asian, Southeast Asian, and NHPI patients. Addressing these disparities calls for the implementation of preventive strategies and interventions tailored specifically to ANHPI subgroups. Further studies are imperative to explore adverse health outcomes within these ANHPI subgroups.

Food loss in Pacific Island Countries: a scoping review of the literature

Food loss and waste pose significant challenges to global food security, economic development, and environmental sustainability. Pacific Island Countries (PICs), with limited resources, being geographically isolated, and vulnerable to climate change, face unique challenges when it comes to the issue of food loss. This scoping review aims to systematically map the literature on food loss in PICs, addressing knowledge gaps and understanding specific methodological aspects. The review utilizes the PRISMA-ScR process to identify, categorize, and synthesize relevant literature, offering a comprehensive overview of the existing evidence. Studies focusing on food loss in PICs published in English from 2011 to 2023 were included. Exclusion criteria considered studies conducted outside PICs, those lacking food loss reduction interventions, and non-peer-reviewed sources. A comprehensive literature search was conducted using the databases of JSTOR, Scopus, Science Direct and Web of Science. A total of 5,787 studies for food loss interventions were identified and out of these only 49 met the inclusion criteria. A notable increase in publications from 2011, with a significant surge in 2018 and 2019, indicate a growing interest on the topic. The review reveals a limited focus on this issue across individual PICs and underscores the need for more localized expertise in the region. The review also highlights critical inefficiencies in PIC food supply chains and the need for more studies outside the common root crop agricultural system. The scoping review identified three thematic categories addressing food loss in PICs, namely., the lack of infrastructure and need for innovative technology for post-harvest management; increased vulnerability to climate change and postharvest risks of newer convenient markets. The findings underscore the need for holistic and context-specific approaches to create resilient and sustainable food systems in the Pacific, providing valuable insights for researchers, policymakers, and practitioners involved in addressing these challenges.

Classifying Race in Out-of-Hospital Cardiac Arrest and Potential Disparities: A Retrospective Cohort Study.

Although racial disparities have been described in resuscitation, little is known about potential bias in race classification of out-of-hospital cardiac arrest (OHCA). We conducted a retrospective cohort study of adults treated by emergency medical services (EMS) for nontraumatic OHCA in King County, WA between January 1, 2018, and December 31, 2021. We assessed agreement using κ and evaluated patterns of missingness between EMS-assessed race versus comprehensive race classification from hospital and death records. Using multivariable logistic regression adjusting for Utstein data elements, we analyzed the association between race and OHCA survival across different sources. Among 5909 eligible OHCA patients, the average age was 64.0 years, 35.4% were female, and 16.1% survived to hospital discharge. Based on comprehensive race classification, 68.7% were White, 12.8% Black, 12.1% Asian, 2.5% multiracial, 2.3% Native Hawaiian/other Pacific Islander, and 1.6% American Indian/Alaska Native. EMS did not classify race in 43.7%. The κ coefficient between EMS and comprehensive race classification was 0.88 (95% CI, 0.86-0.90), though agreement varied substantially by specific race and was lowest among American Indian/Alaska Native (39.5%). Missingness in EMS records varied according to race and was greater among those classified as American Indian/Alaska Native (60.8%), Native Hawaiian/other Pacific Islander (58.8%), Asian (57.8%), or multiracial (54.1%) compared with White (40.6%) or Black (40.4%). In multivariable models using EMS-classified race, the odds ratio (OR) of survival was not significantly different for any race group compared with the White race, that is, OR. However, when using comprehensive race classification, OR of survival was significantly lower among Native Hawaiian/other Pacific Islander (OR, 0.57 [95% CI, 0.33-0.97]) and among multiracial (OR, 0.40 [95% CI, 0.20-0.75]) compared with White race. In adult OHCA, race misclassification and missingness influenced its association with survival. Efforts should continue to evaluate best practices to classify race correctly and comprehensively.

A climate change talanoa: exploring creative possibilities for a hopeful future

This article explores creative possibilities for climate action through talanoa (a form of dialogue practised in the Pacific Islands). Built on inter-subjective empathy, the dignity of persons and reciprocal justice, engaging in a talanoa creates a relational space for reflecting on the profound questions of planetary life. While a talanoa is usually produced “face-to-face”, this article demonstrates how a talanoa can also be achieved across space between a political scientist in Sweden and the Archbishop emeritus of Polynesia in Fiji. Together, we reveal the value of talanoa as a powerful medium for empowering climate change action. The content of the talanoa is critical of a scientific worldview that maintains a gap between humans and nature. Instead, emphasis is placed on relationality-as-knowledge, the importance of integrity and actively listening to the voice of nature. Values are thus taken seriously as a form of transformation and a source of hope and justice.

Who cares about caring? Gender stereotypes about communal values emerge early and predict boys' prosocial preferences.

Communal values (i.e., valuing care for and connection with others) are important to individual well-being and societal functioning yet show marked gender differences, with girls valuing communion more than boys do. We examined whether endorsement of gender stereotypes associating communal values more with girls than with boys relate to children's own communal values and interests, potentially giving rise to gender differences in preferences. We tested this relation across two studies with Canadian children between the ages of 4 and 11 years (N = 379; 92 girls, 287 boys; majority White and East Asian or Pacific Islander). We assessed children's stereotypes about communal values (Studies 1 and 2; e.g., "Who do you think cares more about always helping other people, even if it takes effort? Boys or girls?"), as well as the extent to which children themselves (a) valued communion and (b) displayed interest in communal activities (Study 2). In both studies, we found that children older than 6 consistently associated communal values with girls more than with boys. Younger children, in contrast, exhibited an ingroup bias-they associated communal values with their own gender. Study 2, which included only boys, found that endorsement of stereotypes associating communal values with girls predicted lower personal endorsement of communal values and lower interest in communal activities among boys older, but not younger, than 6. These results suggest that gender stereotypes about communal values are learned early and predict boys' disengagement from communal domains. Implications for gender differences in values and behavior are discussed. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

“You wished the ground would open and swallow you up”: Expert opinions on shame, the collective, and other cultural considerations for suicide prevention among Asian American and Pacific Islander veterans

BackgroundRates of suicide remain elevated among U.S. Veterans and have increased disproportionately among Asian American and Pacific Islander (AAPI) Veterans. Knowledge is limited regarding suicide prevention considerations for clinicians working with AAPI Veterans, yet culturally responsive strategies tend to be most effective. To address this gap, we sought to elucidate subject matter experts’ perspectives regarding suicide prevention considerations for AAPI Veterans.MethodsQualitative interviews were conducted with 14 key informants (e.g., clinicians, researchers) in 2023 to understand their experiences with, and recommendations for, preventing suicide among AAPI Veterans in the Continental U.S. Interview transcripts were analyzed through thematic analysis, with an inductive approach.ResultsKey informants discussed the heterogeneity of the AAPI population and emphasized the need to balance cultural sensitivity and cultural humility in suicide prevention with AAPI Veterans. Fear of bringing shame and dishonor upon one’s family was described as a factor which may prevent AAPI Veterans from disclosing mental health concerns and suicide risk and which may prevent them from accessing healthcare services for mental health and suicidality. Suicide risk among AAPI Veterans was viewed as being shaped by shame and the centrality of the family-collective, with family conferring both protection against and risk for suicide. Cultural norms and beliefs regarding suicide were considered pertinent to suicide among AAPI Veterans and included beliefs about perseverance in coping with distress to permittance of suicide in specific circumstances. Somatic idioms were described as a means by which AAPI Veterans may communicate distress and suicidality, with key informants discussing how this may impact treatment and outreach.ConclusionKey informant interviews provided crucial insights into cultural factors salient to conceptualizing and addressing AAPI Veterans’ risk for suicide. These findings can be utilized to inform tailored suicide prevention for this population, with emphasis on addressing mental health stigma, considering somatic idioms of distress, and considering the role of family in suicide risk and prevention.

Characterization of the Phenotypic Consequences of the Duffy-Null Genotype.

A wealth of research focused on African American populations has connected rs2814778-CC ("Duffy-null") to decreased neutrophil (neutropenia) and leukocyte counts (leukopenia). While it has been proposed that this variant is benign, prior studies have shown that the misinterpretation of Duffy-null associated neutropenia and leukopenia can lead to unnecessary bone marrow biopsies, inequities in cytotoxic and chemotherapeutic treatment courses, under-enrollment in clinical trials, and other disparities. To investigate the phenotypic correlates of Duffy-null status, we conducted a phenome-wide association study (PheWAS) across more than 1,400 clinical conditions in All of Us, the Vanderbilt University Medical Center's Biobank, and the Million Veteran Program. This reveals that Duffy-null status is only reproducibly associated with changes in white blood cell count and not with any disease outcomes. Moreover, we find that Duffy-null associated neutropenia is on average less severe than other neutropenia cases in All of Us. We also show that this genotype is present in considerable frequencies in All of Us populations that are genetically similar to African (68%) and Middle Eastern (14%) 1000Genomes/Human Genetic Diversity Panel (HGDP) reference populations as well as those who identify with more than one race (12%), as Pacific Islander (7%), and as Hispanic (5%). Further, we find that race is not an accurate predictor of Duffy-null status or associated benign neutropenia. Our research suggests that broad genetic screening of rs2814778 across all populations could provide a more robust and accurate understanding of white blood cell count and mitigate resulting health disparities.

Defensive Mechanisms of Mikania micrantha Likely Enhance Its Invasiveness as One of the World's Worst Alien Species.

Mikania micrantha Kunth is native to tropical America and has invaded tropical and subtropical Asia and numerous Pacific Islands. It forms dense thickets and reduces native species diversity and populations in its introduced range. This invasive vine also seriously impacts many agricultural crops and is listed as one of the world's 100 worst invasive alien species. Its life history characteristics, such as the production of large numbers of wind-dispersed seeds, vegetative reproduction, rapid growth, and genetic diversity all contribute to its invasiveness. In this review, we focus on how mechanisms to defend against its natural enemies boost the invasiveness of M. micrantha. It possesses potent defenses against natural enemies such as pathogenic fungi, herbivorous insects, and parasitic nematodes, and exhibits allelopathic potential against plant competitors. These defensive abilities, in concert with its formidable life history characteristics, contribute to the invasiveness of M. micrantha, potentially leading to further naturalization. Several other reviews have summarized the biology and management of the species, but ours is the first review to focus on how the defensive mechanisms of M. micrantha likely enhance its invasiveness. Relatively little is known about the array of defensive capabilities of M. micrantha; therefore, there is considerable scope for further research on its chemical defenses.

Climate change influences on the potential geographic distribution of the invasive Asian longhorned tick, Haemaphysalis longicornis

The Asian long-horned tick, Haemaphysalis longicornis Neumann, 1901, is the competent vector for severe fever with thrombocytopenia syndrome virus (SFTSV). Haemaphysalis longicornis originated mainly in eastern Asia and invaded many areas like Australia, New Zealand, and the Pacific islands, and was recently introduced to eastern parts of the USA. This species is characterized by high adaptability to a wide range of temperatures and can reproduce parthenogenically under stressful conditions. Migratory birds are important hosts of H. longicornis and are thought to be responsible for its unexpected invasion and introduction into new areas worldwide. This study predicted the historical (near current) global environmental suitability and the possible shifts in environmental suitability for H. longicornis under the ongoing climate change between 2021 and 2100. The results demonstrated that Europe is at potential of high environmental suitability for H. longicornis invasion although this species has not been recorded in any regions of Europe yet. Our model also anticipated the environmental suitability for H. longicornis in eastern parts of the USA, although the recently recorded occurrences there were not used in the model calibration. Climate change is thought to affect and increase the range of suitable environments for H. longicornis. The different maps introduced in this study may help improve understanding of the global environmental suitability for this invasive disease vector and predict the areas at high environmental suitability for possible invasion to prioritize the control programs and enhance quarantine procedures in these areas.

Mitigating bias in AI mortality predictions for minority populations: a transfer learning approach

BackgroundThe COVID-19 pandemic has highlighted the crucial role of artificial intelligence (AI) in predicting mortality and guiding healthcare decisions. However, AI models may perpetuate or exacerbate existing health disparities due to demographic biases, particularly affecting racial and ethnic minorities. The objective of this study is to investigate the demographic biases in AI models predicting COVID-19 mortality and to assess the effectiveness of transfer learning in improving model fairness across diverse demographic groups.MethodsThis retrospective cohort study used a population-based dataset of COVID-19 cases from the Centers for Disease Control and Prevention (CDC), spanning the years 2020–2024. The study analyzed AI model performance across different racial and ethnic groups and employed transfer learning techniques to improve model fairness by adapting pre-trained models to the specific demographic and clinical characteristics of the population.ResultsDecision Tree (DT) and Random Forest (RF) models consistently showed improvements in accuracy, precision, and ROC-AUC scores for Non-Hispanic Black, Hispanic/Latino, and Asian populations. The most significant precision improvement was observed in the DT model for Hispanic/Latino individuals, which increased from 0.3805 to 0.5265. The precision for Asians or Pacific Islanders in the DT model increased from 0.4727 to 0.6071, and for Non-Hispanic Blacks, it rose from 0.5492 to 0.6657. Gradient Boosting Machines (GBM) produced mixed results, showing accuracy and precision improvements for Non-Hispanic Black and Asian groups, but declines for the Hispanic/Latino and American Indian groups, with the most significant decline in precision, which dropped from 0.4612 to 0.2406 in the American Indian group. Logistic Regression (LR) demonstrated minimal changes across all metrics and groups. For the Non-Hispanic American Indian group, most models showed limited benefits, with several performance metrics either remaining stable or declining.ConclusionsThis study demonstrates the potential of AI in predicting COVID-19 mortality while also underscoring the critical need to address demographic biases. The application of transfer learning significantly improved the predictive performance of models across various racial and ethnic groups, suggesting these techniques are effective in mitigating biases and promoting fairness in AI models.

Multi-faceted examination of a deepwater seamount reveals ecological patterns among coral and sponge communities in the equatorial Pacific

Spatial changes in benthic community structure have been observed across natural gradients in deep-sea ecosystems, but these patterns remain under-sampled on seamounts. Here, we identify the spatial composition and distribution of coral and sponge taxa on four sides of a single central Pacific equatorial “model” seamount within the US EEZ surrounding the Howland and Baker unit of the Pacific Islands Heritage Marine National Monument. This seamount rises from 5,000 + m to mesophotic depths of 196 m, and is influenced by the Equatorial Undercurrent. Four remotely operated vehicle (ROV) transects were completed, one on each flank of the seamount. Shallower than ~ 250 m, the mesophotic seafloor was composed of scoured carbonate pavement with sediment accumulation only found in rocky depressions. Waters below 500 m hosted communities predominantly composed of octocorals, however, several coral taxa showed seamount flank preference (higher abundance on one or more flanks than the others) even though strong vertical (depth) zonation of corals and sponges was observed on all flanks. Euplectellidae, Plexauridae and ​​Chrysogorgia spp. corals each showed a distinct preference for flank. To help visualize the influence of current flow, oxygen, depth, and substrate type on the zonation of seamounts, we created an Alexander Von Humboldt-style infographic to illustrate the observed biodiversity patterns. Given the importance of seamounts to ocean biodiversity and productivity, this study is an early attempt at a holistic visualization of seamount biology that can advance new hypotheses about seamount ecology.

Suicidal Thoughts and Behaviors Among Health Care Trainees, Staff and Faculty at an Academic Medical Center.

Background/Objectives: Health care workers are at greater risk for death by suicide compared to the general population and are less likely to seek assistance. More information about correlates of suicidality and treatment-seeking behavior are needed to reduce risk. Methods: The American Foundation for Suicide Prevention developed an Interactive Screening Program to identify and engage at-risk staff and trainees in health care settings. The study reports on the prevalence and demographic and clinical predictors of current suicidal thoughts, behaviors and mental health treatment at a single site (n = 5898) from 2009 to 2024. Results: The study found that 18.2% of respondents reported current suicidal thoughts and behaviors. These were more common among respondents who were younger, male, and who identified as a race/ethnicity other than non-Hispanic White. Suicidal thoughts and behaviors were more likely among those with higher PHQ-8 scores (OR = 1.23, p < 0.01) and those who endorsed maladaptive coping behaviors, hopelessness, loneliness, stress and nervousness (ORs 1.36-3.04, ps < 0.01). Current mental health treatment was more likely among women, non-Hispanic White respondents compared with Asian or Pacific Islander respondents, and nurses relative to physicians. Mental health treatment was also associated with higher PHQ-8 scores, lifetime suicide attempts, difficulty controlling eating and alcohol consumption, and recent feelings of anxiety, stress and nervousness. Conclusions: Findings suggest a continued need to identify and engage health care trainees and staff who are at risk for suicide and to establish new approaches to linking these individuals to resources or interventions aimed at reducing risk. The study identified male and/or Asian/Pacific Islander-identifying health care workers who reported intense loneliness and/or hopelessness, use of non-prescription drugs and recent suicidal thoughts and/or behaviors as high-risk individuals who may require enhanced methods of outreach, identification, acceptance and accessibility of treatment.

National Trends in Racial and Ethnic Disparities in Mortality from Mechanical Complications of Cardiac Valves and Grafts (1999-2020).

Background: The volume of cardiac valve and coronary artery revascularization procedures is rising in the United States. This cross-sectional study explores ethnic disparities in mortality in cardiac surgery attributed to mechanical failures of implantable heart valves and coronary artery grafts. Methods: We used the CDC Wide-Ranging Online Data for Epidemiologic Research Multiple Causes of Death database to identify patients whose single cause of death was categorized by complications of cardiovascular prosthetic devices, implants, and grafts (ICD-10 code T82) between 1999 and 2020. The Joinpoint software (version 5.2.0, National Cancer Institute) was used to construct log-linear regression models to estimate the average annual percent changes in age-adjusted mortality (per 100,000). These patterns were compared and stratified by sex, age (0-44, 44-64, and 65 years or older), and US census regions between White, Black, Hispanic, non-Hispanic, American Indian, Alaskan Native, Asian American, and Pacific Islanders. Results: Age-adjusted mortality due to mechanical failures of cardiac implants and grafts declined across ethnicities from 2.21 (95% CI 2.16-2.27) in 1999 to 0.88 (95% CI 0.85-0.91) in 2020. Black populations (1.31 [95% CI 1.20-1.42]), both men (1.56 [95% CI 1.37-1.74]) and women (1.02 [95% CI 0.90-1.15]) experienced higher mortality in 2020 compared to all other ethnicities. This disparity was pronounced in younger groups (age 0-64), wherein age-adjusted mortality among Black populations (0.18 [95% CI 0.13-0.25]) more than doubled that of White populations (0.08 [95% CI 0.06-0.10]). Conclusions: Over the last two decades, age-adjusted mortality due to mechanical complications of cardiovascular implants has declined significantly. However, Black men and women, particularly younger patients, continue to experience higher death rates compared to other ethnicities.