Racial-ethnic Differences Research Articles

Identifying Culturally Relevant School Support Profiles and Links to Academic Functioning in Adolescents.

There is limited knowledge about patterns of adolescents' experiences of general teacher support and support for critical consciousness and cultural competence development in school settings, which are key experiences proposed to promote academic functioning. Furthermore, less is known about potential developmental and ethnic-racial differences in these patterns. Using a person-centered approach, this study examined culturally relevant school support profiles in a sample of sixth and ninth grade students (N = 717; 49.9% girls) from the U.S. Southwest. Participants were aged 10 to 18 years (M = 13.73; SD = 1.54) and were ethnoracially diverse (31.8% Hispanic/Latinx, 31.5% Multiethnic, 25.7% White, 7.3% Black or African American, 1.4% Asian American or Pacific Islander, 1.4% American Indian or Alaska Native, and 1% Arab, Middle Eastern, or North African). Four culturally relevant school support profiles were identified: (1) low general, devoid cultural & critical support; (2) moderate general, moderate cultural, & devoid critical support; (3) high general, moderate cultural & critical support; and (4) high general, cultural, & critical support. Youth in the high general, cultural, & critical support profile had higher concurrent emotional and behavioral engagement. No significant differences were found between early (6th grade) and middle adolescent (9th grade) youth, pointing to the relevance and associations of the identified profiles across development. One significant difference emerged when comparing White and ethnoracially minoritized youth; among White youth, those in the high general, cultural, & critical support and high general, moderate cultural & critical support profiles had higher academic expectations than those in the low general, devoid cultural & critical support profile. The discussion focuses on characterizing heterogeneous and culturally relevant school support profiles, the associations between these profiles and indicators of academic functioning for ethnoracially diverse youth to advance developmental theory and the importance of promoting culturally relevant school support practices to foster developmental competencies among youth.

6578 National Trends in Vitamin D Deficiency and Racial-Ethnic Differences Among US Women With Low Bone Mineral Density

Abstract Disclosure: A. Atri: None. C. Anastasopoulou: None. Introduction: Vitamin D (Vit D) plays a critical role in maintaining bone mineralization and its deficiency adversely impacts bone health. Contemporary trends of Vit D deficiency (VDD) and racial-ethnic differences in these trends among US women with low bone mineral density (BMD) are not well elucidated. Methods: We used data from the National Health and Nutrition Examination Survey (NHANES) for the years 2009-10, 2013–14 and 2017–18 to include U.S. women ≥ 50 years with femoral neck T score ≤ -1. Osteoporosis was defined by a T-score ≤ -2.5. BMD assessment in NHANES was not completed in 2011–12 and 2015–16, and therefore not included in the analysis. Femoral neck BMD was measured by dual energy x-ray absorptiometry (DEXA) on Hologic Discovery Model A Densitometers (Hologic, Inc., Bedford, Massachusetts). VDD was defined as serum 25(OH)D <30 nmol/L. Participants with missing data on race-ethnicity, BMD and Vit D data were excluded. Independent samples median test was used for comparing medians. The Cochran-Armitage test was utilized for trend analysis. Results: Overall, in women with low BMD, from 2009-10 to 2017-18, prevalence of osteoporosis increased from 13.7% to 16.9% while VDD decreased significantly from 5.6% to 2.3% (p trend = 0.001). When stratified by race-ethnicity, the prevalence of osteoporosis increased in Whites (14.1% to 17.6%, p trend = 0.001), Hispanics (12.6% to 13.7%, p trend = 0.001) and Other race-ethnicity (Asian/Mixed) (14.1% to 21.4%, p trend = 0.001), but a modest decrease was noted among the Black population (7.3% to 6.8%, p trend = 0.001). VDD was disproportionately high among Blacks (In 2009-10: 28.1% vs 4.2% in Whites, 5.4% in Hispanics and 10.7% among Others). However, significantly improving trends in VDD were observed among all the groups, regardless of race/ethnicity, to 12.5% prevalence among Blacks, 1.3% in Whites, 4.9% in Hispanics and 1.1% in the Other race ethnicity group (p trend = 0.001). Discussion In this contemporary analysis, rates of VDD have decreased from nearly 1 in 20 to 1 in 50 women with low BMD in the US. Highest prevalence of VDD was noted among Blacks, seen in nearly 1 in 3 Black women in 2009-10, with improvement to 1 in 8, in 2017-18. Similar favorable trends of decline in VDD were observed across all other racial-ethnic groups as well. Despite the overall improvement in VDD, prevalence of osteoporosis declined only among Black women, suggesting the potential role of other protective factors against osteoporosis among them. Nevertheless, VDD continues to remain prevalent in this high-risk group, emphasizing the need for public health interventions to bridge this gap. Presentation: 6/2/2024

Increasing Prevalence of Diagnosed Gestational Diabetes in South Carolina: 2015-2021.

Objective: To examine trends with a focus on racial and ethnic disparities in reported gestational diabetes mellitus (GDM) and related outcomes (macrosomia, large for gestational age infants) before and during the COVID-19 pandemic in South Carolina (SC). Methods: A retrospective cohort study of pregnancies resulting in livebirths from 2015 through 2021 was conducted in SC. Statewide maternal hospital and emergency department discharge codes were linked to birth certificate data. GDM was defined by ICD-9-CM (i.e., 648.01-648.02, 648.81-648.82) or ICD-10-CM codes (i.e., O24.4, O24.1, O24.9), or indication of GDM on the birth certificate without evidence of diabetes outside pregnancy (ICD-9-CM: 250.xx; ICD-10-CM: E10, E11, O24.0, O24.1, O24.3). Results: Our study included 194,777 non-Hispanic White (White), 108,165 non-Hispanic Black (Black), 25,556 Hispanic, and 16,344 other race-ethnic group pregnancies. The relative risk for GDM associated with a 1-year increase was 1.01 (95% confidence interval [CI]: 1.01-1.02) before the pandemic and 1.12 (1.09-1.14) during the pandemic. While there were race-ethnic differences in the prevalence of GDM, increasing trends were similar across all race-ethnic groups before and during the pandemic. From quarter 1, 2020, to quarter 4, 2021, the prevalence of reported GDM increased from 8.92% to 10.85% in White, from 8.04% to 9.78% in Black, from 11.2% to 13.65% in Hispanic, and from 13.3% to 16.16% in other race-ethnic women. Conclusion: An increasing prevalence of diagnosed GDM was reported during the COVID-19 pandemic. Future studies are needed to understand the mechanisms underlying increasing trends, to develop interventions, and to determine whether the increasing trend continues in subsequent years.

Racial-ethnic differences in the associations between functional disabilities and subsequent depression among community-dwelling midlife and older adults in the US

BackgroundThe intersection of race/ethnicity with disability is a critical dimension of mental health outcomes in later ages that remains under-investigated. ObjectiveWe examined the role of race-ethnicity in moderating the associations between functional disabilities and subsequent depression among Americans 51 and older and stratified into the two age-groups of midlife (51-64) and older adults (≥65). MethodsUsing a nationally representative sample of community-dwelling Americans (≥51; n=7,475) in the 2016-2018 Health and Retirement Study, we conducted bivariate and multivariable regression analyses. Racial-ethnic groups included non-Hispanic (NH) Black, Hispanic, and NH White and a binary (0/1) outcome defined subsequent depression in 2018. The total number of difficulties on the Nagi, Lawton, and Katz disability scales represented baseline (2016) functional disabilities with a secondary four-level (no/mild/severe with assistance/severe without assistance) disability indicator incorporated to examine the role of assistance with daily living. ResultsAcross age-groups, subsequent depression was significantly more prevalent among NH Whites with functional disabilities compared to counterparts reporting no disabilities. Compared to NH Black and Hispanic counterparts, midlife NH Whites were three times more likely to report subsequent depression with each unit increase in the functional disability score, after adjusting for covariates. However, we observed no such racial-ethnic differences among older adults. Among the 51+ severe with no assistance group, adjusted odds of subsequent depression among NH Whites was 2.5 times higher than minority counterparts. ConclusionHealth programs and environmental adaptations supporting functional care needs in later ages could be beneficial for improving mental health of adults with disabilities.

Racial-Ethnic Comparison of Treatment for Papillary Thyroid Cancer in the Military Health System.

We aimed to compare Asian or Pacific Islander, Black, Hispanic, and non-Hispanic White patients in treatment for papillary thyroid cancer (PTC) in the equal access Military Health System to better understand racial-ethnic cancer health disparities observed in the United States. We used the MilCanEpi database to identify a cohort of men and women aged 18 or older who were diagnosed with PTC between 1998 and 2014. Low- or high-risk status was assigned using tumor size and lymph node involvement. Treatment with surgery (e.g., thyroidectomy) overall and treatment by risk status [active surveillance (low-risk) or adjuvant radioactive iodine (RAI) (high-risk)] was compared between racial-ethnic groups using multivariable logistic regression and expressed as adjusted odds ratios (AOR) with 95% confidence intervals (CIs). The study included 598 Asian, 553 Black, 340 Hispanic, and 2958 non-Hispanic White patients with PTC. Asian (AOR = 1.21, 95% CI 0.98, 1.49), Black (AOR = 1.07, 95% CI 0.87, 1.32), and Hispanic (AOR = 0.92, 95% CI 0.71, 1.19) patients were as likely as White patients to receive surgery. By risk status, there were no significant racial-ethnic differences in receipt of active surveillance or thyroidectomy for low-risk PTC or in thyroidectomy or total thyroidectomy with adjuvant RAI for high-risk PTC. In the Military Health System, where patients have equal access to care, there were no overall racial-ethnic differences in surgical treatment for PTC. As American Thyroid Association guidelines evolve to include more conservative treatment, further research is warranted to understand potential disparities in active surveillance and surgical management in U.S. healthcare settings.

Cultural Socialization and Civic Engagement Among Racially Diverse Students of Color: Examining Ethnic-Racial Identity Components as Mediators and Neighborhood Racial Composition as a Moderator

Understanding the factors that promote civic engagement among emerging adult college students is crucial, especially considering its association with positive youth development. The current study examined ethnic-racial identity (ERI) exploration, resolution, and affirmation as mediators of the relation between cultural socialization and civic engagement. Additionally, the extent to which students were raised in predominantly minoritized neighborhoods (i.e., predominantly minoritized neighborhood racial composition; PMNRC) was included as a moderator of the associations between cultural socialization and ERI components. Last, we tested whether findings varied based on students’ ethnic-racial backgrounds (i.e., differences in the model for Asian, African American, Latinx, and Multiracial students of color; N = 1036). Results indicated that there was a significant mediation path, such that cultural socialization predicted greater ERI exploration and, in turn, greater civic engagement. Cultural socialization was also positively associated with greater ERI resolution and affirmation. The racial composition of the neighborhoods that individuals were raised in was not significantly associated with any ERI component; however, PMNRC moderated the relation between cultural socialization and ERI affirmation. Specifically, cultural socialization predicted more ERI affirmation at higher levels of PMNRC, but this relation was not significant at low levels of PMNRC. There were no significant ethnic-racial differences in relations we tested in the model. These findings highlight the importance of cultural processes in civic engagement among diverse emerging adults.

Parent perceptions of school relationships: Considerations of racial-ethnic differences and youth's peer victimization.

Literature has highlighted that social relationships at school are essential to school success, yet few studies have examined this construct from parents' perspectives. Even less research has explored perceptions of social relationships in the school among parents whose children are bullying victims and potential racial-ethnic differences in the perceptions. Using self-report data from 3,261 parents of middle and high school youth, this study used multilevel analyses in which parents were nested in their child's schools and examined parent perceptions of school relationships (including Child-School Connectedness, Parent-School Connectedness, School Outreach and Involvement, and Culture of Inclusiveness and Equity) in the context of youth victimization and whether these perceptions varied by the parent's racial-ethnic background. Results showed that compared with parents whose child was not a bullying victim (63.5%), those whose child was victimized (36.5%) had poorer perceptions of school relationships and that this difference was more pronounced in some racial-ethnic groups (e.g., Asian and Black) than in others (e.g., White, bi- or multiracial). These findings underscore the importance of addressing ethnic heterogeneity in how parents evaluate school-based social relationships in the context of peer bullying to effectively engage racial-ethnic minoritized parents of victimized youth in culturally responsive school bullying interventions. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Risk management or racial Bias? The disparate use of restraints in the Emergency Department of an Urban Safety-Net Hospital

ObjectivesLimited data exist on racial-ethnic differences in the application of restraints for patients visitng the emergency department (ED). This study examines whether there is an association between race and patient ED visit type with the application of four-point mechanical restraints in a high acuity safety-net urban academic hospital. MethodsThe study retrospectively reviewed 198,610 visits to the ED at Boston Medical Center made by patients between 18 and 89 years old between May 1, 2014 and May 1, 2019. ED visit type was categorized based on primary billing code for the visit as either medical or behavioral; behavioral visits were further categorized into 5 groups based on corresponding primary psychiatric billing code category. The relationships between race/ethnicity and four-point mechanical restraints were analyzed using binary logistic regression models in SPSS. Results1.4% of unique visits involved the use of four-point mechanical restraints. Patients with a behavioral visit were significantly over 16 times more likely to be restrained than those with a medical visit. Black patients were significantly more likely to be restrained than white patients for behavioral visits but less likely for medical visits. Black and Hispanic patients were also significantly more likely to be restrained for a behavioral visit regardless of psychiatric diagnosis. Asian patients were less likely to be restrained regardless of ED visit type. ConclusionsSignificant racial differences in restraints for White patients with medical visits and Black and Hispanic patients with behavioral visits prompts further investigation on the role of clinician bias when managing acute patients.

Supplemental Material for Parent Perceptions of School Relationships: Considerations of Racial–Ethnic Differences and Youth’s Peer Victimization

Supplemental Material for Parent Perceptions of School Relationships: Considerations of Racial–Ethnic Differences and Youth’s Peer Victimization

Racial-Ethnic Disparities in Quality of Care Among Medicaid Beneficiaries With Schizophrenia.

The authors sought to update and expand the evidence on the quality of health care and disparities in care among Medicaid beneficiaries with schizophrenia. Adult beneficiaries of New York State Medicaid with schizophrenia receiving care during 2016-2019 were identified. Composite quality scores were derived from item response theory models by using evidence-based indicators of the quality of mental and general medical health care. Risk-adjusted racial-ethnic differences in quality were estimated and summarized as percentiles relative to White beneficiaries' mean quality scores. The study included 71,013 beneficiaries; 42.8% were Black, 22.9% Latinx, 27.4% White, and 6.9% other race-ethnicity. Overall, 68.8% had a mental health follow-up within 30 days of discharge, and 90.2% had no preventable hospitalizations for chronic obstructive pulmonary disease or asthma. Among beneficiaries receiving antipsychotic medications, medication adherence was adequate for 43.7%. Fourteen indicators for mental and general medical health care quality yielded three composites: two for mental health care (pharmacological and ambulatory) and one for acute mental and general medical health care. Mean quality of pharmacological mental health care for Black and Latinx beneficiaries was lower than for White beneficiaries (39th and 44th percentile, respectively). For Black beneficiaries, mean quality of ambulatory mental health care was also lower (46th percentile). In New York City, Black beneficiaries received lower-quality care in all domains. The only meaningful group difference in the quality of acute mental and general medical health care indicated higher-quality care for individuals with other race-ethnicity. Disparities in the quality of Medicaid-financed health care persist, particularly for Black beneficiaries. Regional differences merit further attention.

Race-ethnicity, age, and heart failure in ischemic stroke

ObjectivesRace-ethnic disparities contribute to cardiovascular morbidity. Heart failure (HF) is highly prevalent in acute ischemic stroke (AIS) and associated with worse outcomes. We hypothesized race-ethnic differences exist in the prevalence of HF among patients with AIS, particularly in younger patients, and in a manner not fully explained by cardiovascular profiles. MethodsPatients with AIS in the National Inpatient Sample (2016–2019) were categorized as young (<50 years), middle (50–64) and older (≥65) age. Interaction between age and race-ethnicity on the presence of comorbid HF was examined, adjusting for vascular risk factors. Effect modification on in-hospital mortality and prolonged hospitalization across race-ethnic groups and age was also examined. ResultsOf 398,470 AIS patients, 16.2 % had HF. HF patients were older (73.7 vs. 69.5 years, P < 0.001), had a lower proportion of White, Hispanic and Asian/PI individuals but a larger proportion of patients of Black race (21.0 vs. 16.4 %, P < 0.001). Race-ethnicity modified the relationship between HF and age (Pinteraction < 0.001). Stroke patients of Black race had the greatest odds of having HF across all age groups, however differences between Black and White patients were most pronounced in young adults (OR: 2.08, 95 % CI: 1.91–2.27) after adjusting for vascular risk factors. Among patients with HF, Black race was associated with reduced risk of in-hospital mortality but greater likelihood of prolonged hospitalization at middle and older age. ConclusionHF is highly prevalent in stroke patients of Black race, particularly in younger cohorts, and in a manner not fully explained by cardiovascular profiles.

Racial-Ethnic Gaps in Pandemic-Related Economic Hardship: Age Differences Among Older Adults.

Racial-ethnic disparities in experiences of economic hardship during the pandemic are well documented in the population overall and among older adults. Existing research shows that this economic hardship was much less common at older than younger ages. Little is known about the intersection of racial-ethnic and age disparities in pandemic-related hardship in later life. This research report investigated racial-ethnic gaps in economic hardship by age group among older adults. Data were from the 2018 and 2020 U.S. Health and Retirement Study (HRS) including the 2020 coronavirus disease 2019 module. We estimated Heckman-corrected linear probability models to examine differences in experiences of pandemic-related economic hardship in the 2020 HRS by race-ethnicity (non-Hispanic White, non-Hispanic Black, U.S.-born Hispanic, foreign-born Hispanic) across age groups (55-64, 65-74, 75+). In the multivariable analysis, we controlled for sociodemographic characteristics, participation in social programs, pre-existing health conditions and behaviors, and economic resources from the 2018 HRS. Experiences of economic hardship declined with age within each racial-ethnic group. Racial-ethnic gaps in hardship remained at older ages without any controls. However, when all controls were added, racial-ethnic gaps in economic hardship were eliminated for those ages 75+. Individual characteristics prior to the pandemic explained racial-ethnic differences in hardship for the oldest adults (75+) but did not explain gaps for those ages 55-74. Results point to structural factors generating new racial-ethnic gaps in pandemic-related economic hardship among those approaching retirement (ages 55-74) that did not affect the oldest adults (ages 75+).

Forensic Assessments of Racial-Ethnic Differences in Genuine and Malingered Psychotic Presentations.

Competent forensic practice has required continued training and professional practice in differentiating between genuine and malingered presentations, especially within the spectrum of psychotic disorders. Historically, practitioners valued racial, ethnic, and cultural differences but often considered them as peripheral matters. In contemporary forensic practice, however, language and culture play preponderant roles. This commentary is focused on core features of malingering via a cultural lens. Three core, race-informed principles, such as biases against the African American Language, are highlighted and discussed. Related subjects for forensic practice include relevant clinical constructs such as malingering bias and "imposed etics," specifically, the imposition of mainstream values and discounting of cultural differences.

Racial-ethnic differences in liver transplant waitlist outcomes in patients with hepatocellular carcinoma before and after recent changes to allocation policy.

In May 2019, liver transplant (LT) allocation policy changed to limit MELD exception points for hepatocellular carcinoma (HCC) to median MELD at transplant minus three (MMaT-3). We evaluated this policy's impact on waitlist outcomes for HCC candidates, by race and ethnicity, hypothesizing that the introduction of the MMaT-3 reduced inequities in waitlist outcomes. Retrospective cohort study of the Scientific Registry for Transplant Recipients, including all adult LT candidates (N=10751) who received HCC exception points from May 17, 2017 to May 18, 2019 (pre-policy; N=6627) to May 19, 2019 to March 1, 2021 (post-policy; N=4124). We compared incidence of LT and waitlist removal for death or becoming too sick pre- and post-policy for non-Hispanic White, non-Hispanic Black, Hispanic/Latinx, and Asian patients using competing risk regression adjusted for candidate characteristics. One-year cumulative incidence of LT decreased significantly pre-/post-policy among White (77.4%vs. 64.5%; p<.01) and Black (76.2%vs. 63.1%; p<.01) candidates only, while a 1-year incidence of death/non-LT waitlist removal decreased significantly only among Hispanics (13.4%vs. 7.5%; p<.01). After covariate adjustment, the effect of the policy change was a significantly decreased incidence of LT for White (SHR:.63 compared to pre-policy; p<.001), Black (SHR:.62; p<.001), and Asian (SHR:.68; p=.002), but no change for Hispanic patients. Only Hispanic patients had a significant decrease in death/waitlist removal after the policy change (SHR: .69; p=.04). Compared to White patients in the pre-policy era, Hispanic (SHR: .88, p<.007) and Asian candidates (SHR: .72; p<.001) had lower unadjusted incidence of LT. This disparity was mitigated in the post-policy era where Hispanic patients had higher likelihood of LT than Whites (SHR: 1.22; p=.002). For the outcome of death/non-LT waitlist removal, the only significant difference was a 42% lower incidence of waitlist removal for Asian compared to White patients in the post-policy era (SHR: .58; p=.03). Among LT recipients with HCC, racial/ethnic subpopulations were differentially affected by the MMAT-3 policy, resulting in a post-policy reduction of some of the previous disparities.

Determinants of urinary dialkyl phosphate metabolites in midlife women: the Study of Women's Health Across the Nation Multi-Pollutant Study (SWAN-MPS).

Biomonitoring data and determinants of urinary dialkylphosphate (DAP) metabolites, markers of organophosphate pesticides, in racially diverse, non-occupationally exposed populations are scarce. This study evaluated urinary concentrations and potential determinants of DAP metabolites of organophosphate pesticides in a multi-site, multi-racial/ethnic cohort of women aged 45-56 years, the Study of Women's Health Across the Nation Multi-Pollutant Study (SWAN-MPS). We analyzed 963 urine samples collected in 1999-2000, the baseline of SWAN-MPS for longitudinal studies, and quantified DAP metabolites, including dimethyl alkylphosphates (DMAPs): dimethylphosphate (DMP), dimethylthiophosphate (DMTP), dimethyldithiophosphate (DMDTP); and diethyl alkylphosphates (DEAPs): diethylphosphate (DEP), diethylthiophosphate (DETP), diethyldithiophosphate (DEDTP), using gas chromatography and triple quadrupole mass spectroscopy. Adjusted least squared geometric means (LSGMs) and 95% confidence intervals (CIs) were computed to compare DAP concentrations by socio-demographic, behavioral and dietary factors. The geometric means (geometric standard deviations) of total DAPs, DMAPs, and DEAPs were 141 (2.63) nmol/L, 102 (2.99) nmol/L, and 26.8 (2.46) nmol/L, respectively. Body mass index (BMI) was inversely associated with DMAPs and DEAPs: LSGM (95% CI) = 68.8 (55.7-84.9) and 21.0 (17.7-25.0) nmol/L for women with obesity vs. 102 (84.7-123) and 30.1 (25.7-35.1) nmol/L for women with normal/underweight, respectively. Fruit consumption was positively (74.9 (62.1-90.2) for less than 5-6 servings/week vs. 105 (84.8-130) nmol/L for 1 serving/day and more) whereas meat consumption was inversely associated with DMAPs (110 (95.0-128) for seldom vs. 82.3 (59.5-114) nmol/L for often consumption). Fresh apple consumption appears to be attributed to the DMAP differences. Alcohol consumption was positively associated with DEAPs (27.5 (23.1-32.7) for 2 drinks/week and more vs. 23.0 (20.0-26.6) nmol/L for less than 1 drink/month). Black women had higher concentrations of DEAPs compared with White women (27.3 (21.2-35.2) vs. 23.2 (20.2-26.7) nmol/L). Organophosphate pesticides (OPs) are synthetic chemicals and currently the most widely used type of insecticides. We examined multi-site, multi-ethnic cohort of midlife women in the U.S. that offers a unique opportunity to evaluate major determinants of OP exposure. We improved OP metabolite detection rates and obtained accurate concentrations using an improved analytical technique. Our findings suggest that consumptions of fruit, meat and alcohol are important determinants of OP exposure for midlife women. Higher concentrations of diethyl OP metabolites in Black women compared to White women, even after accounting for dietary intake, suggests additional, but unknown racial-ethnic differences that affect exposure.

Collaborative Care for Depression and Anxiety: Racial-Ethnic Differences in Treatment Engagement and Outcomes.

This study aimed to examine racial-ethnic differences in engagement with and clinical outcomes of a collaborative care model (CoCM) implemented in primary care outpatient clinics in an urban academic medical center. Adult patients (N=4,911) who screened positive for symptoms of depression, anxiety, or both on the Patient Health Questionnaire-9 or the Generalized Anxiety Disorder-7 scale and who identified as non-Hispanic Black, Hispanic, or non-Hispanic White were offered participation in a CoCM implementation. The primary outcome was treatment engagement, defined as receipt of any follow-up visit, minimally adequate 4-week follow-up (at least one visit), and minimally adequate 16-week follow-up (at least three visits) after initial assessment. Secondary outcomes were response and remission of depression or anxiety. After adjustment of analyses for sociodemographic covariates, Black and Hispanic participants were significantly less likely than White participants to have received any or minimally adequate follow-up. Black and Hispanic participants who received any or minimally adequate 16-week follow-up were more likely than White participants to demonstrate depression symptom response and remission of anxiety symptoms. This CoCM implementation appears to have been effective in treating depression and anxiety among Black and Hispanic patients. However, significant disparities in receipt of follow-up care were observed. Efforts must be made to improve the retention of patients from racial-ethnic minority groups in collaborative care.

Racial-Ethnic disparities in stroke prevalence among patients with heart failure

Racial-ethnic disparities exist in the prevalence and outcomes of heart failure (HF) and are presumed to be related to differences in cardiovascular risk factor burden and control. There is little data on stroke disparities among patients with HF or the factors responsible. We hypothesized disparities in stroke prevalence exist among patients with HF in a manner not fully explained by burden of cardiovascular disease. We analyzed data from the National Health and Nutrition Examination Survey (1999–2014). Cardiovascular profiles were compared by race/ethnicity. Using survey-weighted models, effect modification of the relationship between HF and stroke by race/ethnicity was examined adjusting for cardiovascular profiles. Of 40,437 participants, 2.5 % had HF. The HF cohort had a greater proportion of White and Black participants (77 % vs 74 % and 15 % vs 12 %, respectively) and fewer participants of Hispanic ethnicity (8 % vs 14 %). Stroke was 8 times more prevalent in HF (19.6 % vs 2.3 %, <0.001). Among individuals with HF, race-ethnic differences were identified in the prevalence and mean values of vascular risk factors but were largely driven by higher rates in Black participants. There was significant interaction between HF and race/ethnicity; HF increased the odds of stroke over 7-fold in participants of Hispanic ethnicity (aOR: 7.84; 95 % CI: 4.11–15.0) but to a lesser extent in Black and White participants (Black aOR: 2.49; 95 % CI: 1.72–3.60; White aOR: 3.36; 95 % CI: 2.57–4.40). People of Hispanic ethnicity with HF have a disproportionately higher risk of stroke in a manner not fully explained by differences in vascular risk profiles.

27 Racial-Ethnic Differences in Antipsychotic Initiation Among Youth with Diagnosed ADHD, Depression, or Conduct Disorder

OBJECTIVES/GOALS: This study examined racial-ethnic differences in antipsychotic initiation within psychiatric diagnostic groups. This is a follow-up to our prior work, which reported that, overall, youth from minority backgrounds had 30-65% lower odds of initiating antipsychotics compared to White youth. METHODS/STUDY POPULATION: This study used 2009-2021 data from Optum’s® Clinformatics® Data Mart, a database containing longitudinal patient information from nationwide commercial insurance claims. We created three separate samples of antipsychotic users and matched non-user controls between the ages of 6-17 years old. These groups contained individuals with clinically diagnosed ADHD, conduct disorder, and depressive disorder, respectively. We used conditional logistic regression to estimate the odds of antipsychotic initiation based on race-ethnicity within each diagnostic group. RESULTS/ANTICIPATED RESULTS: There were no racial-ethnic differences in the odds of antipsychotic initiation among youth diagnosed with ADHD. Among youth with depression diagnoses, Asian youth had 19% lower odds of initiating antipsychotics and Hispanic youth had 11% lower odds compared with White youth. Similar results were observed for conduct disorders, with Asian and Black youth having approximately 10% lower odds of initiating antipsychotic treatment and Hispanic youth having 18% lower odds relative to White youth. DISCUSSION/SIGNIFICANCE: Previously observed lower rates of antipsychotic initiation among racial-ethnic minority groups may be at least partially due to factors leading to disparities in diagnosis. Further research is needed to evaluate factors that may lead to differential antipsychotic use, as the disparities may occur upstream of receiving clinical diagnoses.

Intimate Partner Violence, Loss of Control, and Adolescent Perception of Birth.

This secondary analysis used cross-sectional baseline data from a previous longitudinal study exploring the mental health of 303 postpartum adolescents to examine associations and predictors reflecting the perception of the birth experience among three race-ethnic groups. Analysis of two key variables, partner violence and loss of control (LOC) during labor, revealed no association. Race-ethnic differences were noted for demographic variables (marital status, birth mode, and stress level) and perception of the birth experience. Black ethnicity, multiparity, LOC, and vaginal birth were found to predict a negative perception of the birth experience. Health-care provider awareness of risk factors can guide perinatal assessments and supportive and educational interventions to promote a positive perception of birth.

What motivates bridge building across pernicious group divides? The effects of regulatory motives, framing, and fit on increasing constructive engagement across political and racial divisions

IntroductionToday, the U.S. and countless other democracies have found themselves dangerously divided across political and racial-ethnic differences. Under these conditions, more extreme actors often wield disproportionate influence, with moderate citizens tending to disengage politically, sparking a vicious cycle.MethodsSix studies (N = 2,179) were conducted to investigate ways to mobilize citizens to engage in bridge-building activities fostering intergroup tolerance and compassion. Derived from basic regulatory theories of motivation, we tested the effects of stronger prevention (mitigating negative outcomes) vs. promotion (seeking ideal outcomes) and assessment (evaluating the best way to proceed) vs. locomotion (just “getting it done”) motivational orientations and the fit vs. non-fit framing effects of how the activities were presented on differences in engagement with political and racial bridge-building activities across political, racial, and gender groups in the U.S. We hypothesized that individuals with stronger levels of each of the four motivational mindsets would be more likely to express willingness to engage in bridging activities when they were framed in ways consistent (fitting) vs. inconsistent (non-fitting) with their more chronic orientations.Results and discussionFindings supported our hypotheses with some qualifiers and revealed important political, racial, and gender group differences on motivation and bridge-building for different types of engagement activities.