Minority Representation Research Articles

Babasaheb Dr. Ambedkar and His Role in Nation-building for Modern India

Dr. Bhimrao Ramji (Babasaheb) Ambedkar is seen in many lights, such as the champion of the Dalit cause, a traditional reformer, an anthropologist, a political leader, a constitutionalist, a historian, and many more. However, his intellectual acumen cannot be condensed into a few terms; because all his strides in life were in itself an igneous testament of time. Babasaheb Dr. Ambedkar’s ideal revolved around the notion of providing social justice to the “the last, the lost and the least”, since he supposed that there could be no successful nation lest every individual within it were equal. Being a politician from the marginalised sect, he was also most critical of the mainstream political discourses due to the lack of minority representations at the higher levels. His ideas and philosophies are still ignored by the academic sphere, citing them as too polemic. But upon further detailed research, his life can be divided into eight folds which have invoked myriad approaches toward nation-building. Babasaheb Dr. Ambedkar’s work shaped the contours of modern India which offers this collection of vantage points for continual reflection on concerns of social justice and its relation to other values. This is predominantly pertinent or might be indispensable, in contemporary times, not only in India but also across the world.

Addressing Disparities and Inequalities in Healthcare: Disproportionate Representation of Minorities in COVID-19 Deaths as a Health and Social Injustice

Social inequalities exist around the world limiting a group's social, health, and economic advancement. These unfavorable conditions inhibit people from having access to essential resources such as healthcare, housing, education, employment, and transportation. Consequently, inequalities in accessing indispensable social goods generally affects diets and overall health and wellness of individuals negatively. Unfortunately, this systemic problem tends to inflict greater harm to lower-income groups disproportionately. These limitations usually result in poorer health and higher rates of health problems. Historically, existing inequalities in society are manifested in moments of crisis, and the COVID-19 pandemic (2019-2021) revealed overwhelming manifestation of this fact. The mortality rates for African Americans are more than triple the rates for whites after correcting for age, and the rates for Hispanic/Latinos are almost double the rates for non-Hispanic whites. According to the CDC’s racial demographic information on COVID-19 cases and deaths, almost 23% of reported COVID-19 deaths in the U.S. are African Americans, even though blacks make up approximately only 13% of the U.S. population. This glaring revelation of the health inequities that exist in our society must be addressed. This paper examines the documented cases of significant health inequities in the U.S. including the underlying social determinants and implications that make minority groups vulnerable, contributing to their higher risk of morbidity and mortalities, and argued that healthcare is a fundamental human rights issue as stated in a 2017 WHO press release. This author contends that health inequity due to social inequity is unsustainable, and a detriment to sustainable development and provide recommendations to address the health inequities.

Current challenges faced by transgender and gender-diverse patients and providers in anesthesiology.

Current challenges faced by transgender and gender-diverse patients and providers in anesthesiology.

Safety, Feasibility, and Efficacy of Upfront Daratumumab-Based Therapy in Blacks with Dysproteinemia

Background: Black patients (pts) with dysproteinemia are underrepresented in clinical trials included in new drug applications and biological license application submissions. Even after approval, access to novel therapies remains a challenge. Daratumumab (dara) is an anti-CD38 monoclonal antibody, which has revolutionized the care of patients with both multiple myeloma (MM) and light chain (AL) amyloidosis. The underrepresentation of black pts in clinical trials of dara in newly diagnosed patients with dysproteinemia raises concerns regarding the safety, tolerability and efficacy of dara in this population. We report the results from a cohort of pts treated with dara in the management of newly diagnosed MM (NDMM) and AL amyloidosis. Methods: The Cancer and Aging Resilience Evaluation in Hematologic Malignancies (CARE-Heme) registry is an ongoing prospective registry enrolling pts ≥50 years of age with a diagnosis of hematologic malignancy undergoing treatment at a single institution. For this analysis, we included pts with NDMM and AL amyloidosis treated with dara-based combination therapy between January 2020 and January 2022. We obtained baseline disease- and patient-related characteristics. Toxicity was evaluated by chart review up to the first 6 cycles and adverse events (AEs) were graded using Common Terminology Criteria for Adverse Events (CTCAE v5.0). For patients receiving >1 cycle, response assessment was ascertained using International Myeloma Working Group (IMWG) uniform response criteria. All patients were followed until progression, death or last follow up and progression-free survival (PFS) and overall survival (OS) were measured using Kaplan Meier methods. Health-related quality of life (HRQoL) was measured using Patient-Reported Outcomes Measurement Information System (PROMIS) global 10 and quantified using physical health (PH) and mental health (MH) t-scores at baseline and 3 month follow up. Variables were compared in each race by using independent and paired sample t-tests as appropriate. Results: Over the study period, 36 black pts (NDMM=32; AL=4) and 50 white pts (NDMM=44; AL=6) received upfront dara-based combination therapy. There were no differences in age or sex, IGH translocations, but there was a higher incidence of cytogenetic high-risk disease among the black pts in our cohort (p=0.02). Black pts presented with more advanced disease at the time of presentation - hypercalcemia 33% vs. 14%, p=0.04; renal dysfunction 56% vs. 28%, p=0.01; anemia 67% vs. 38%, p=0.01). Incidence of bone disease was similar between the groups (p=0.69) (Table 1) Among blacks, the most utilized regimen was DaraVRd (56%), DaraRd (17%), DaraKRd (11%) and DaraVCd (11%). While for the white pts, it was DaraVRd (52%), DaraRd (12%), DaraKRd (8%) and DaraVCd (22%). Blacks had a similar incidence of ≥grade 3 non-hematologic AEs (p=0.21), with fatigue, diarrhea and leg edema being the most common. There is a trend towards higher ≥grade 3 hematologic AEs which did not reach statistical significance (p=0.05). After 6 cycles of therapy, overall response rate was comparable (100% vs. 94%, p=0.81) among the two groups (≥VGPR 47% vs. 62%, p=0.36). With 18 month median follow up, there was no difference in median PFS and OS, both not reached (Figure 1). Complete quality of life (QoL) t-scores were available at baseline for 55 pts (20 blacks and 35 whites). The baseline PH and MH related QoL scores were comparable between whites and blacks (p= 0.51; p=0.58, respectively). From baseline to 3 months follow up, PH t-scores improved in both whites as well as blacks although the difference was not statistically significant. Meanwhile, MH t-scores remained largely unchanged from baseline to follow up in both groups. Conclusions: We report the largest cohort to date of black pts with dysproteinemia systematically treated with frontline dara. Our data shows the feasibility of this strategy in a single institution setting with comparable safety, efficacy and HRQoL with the use of upfront dara-based combinations in black and white pts. Our data supports comparable clinical outcomes among black pts when treated with novel therapeutic combinations despite a higher proportion of high risk cytogenetic abnormalities in our cohort without an increase in AEs. Minority representation in cancer clinical trials as well as access to approved novel therapies can significantly help mitigate disparities in outcomes. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Abstract 12263: Lack of Diversity in Aortic Stenosis Progression Cohorts: A Systematic Review

Introduction: Aortic stenosis (AS) is characterized by highly variable progression rates. Differential rates of AS progression have been proposed to explain apparent disparities in the treatment of severe AS. However, the evidence supporting this claim is uncertain. Methods: We conducted a systematic review of MEDLINE and EMBASE from 1989 to 2022 to identify prospective cohort studies of AS hemodynamic progression. We evaluated the pooled patient demographics, AS severity, baseline and mean annual changes in echocardiographic markers, and prognostic factors. Results: We identified 32 prospective cohort studies. Overall, 11,432 patients were followed for 27 +/- 15 months on average. The average age was 67 +/- 8 years. The average percent female was 36 +/- 14%. Race was reported in only 4 (13%) cohorts; the average proportion of white patients was 93.9 +/- 6.1%. The average baseline hemodynamic severity was consistent with aortic sclerosis, mild AS, moderate AS, and severe AS in 3 (9.4%), 8 (25.0%), 19 (59.3%), and 2 (6.3%) studies, respectively. Overall, average baseline and annual changes in echocardiographic values were: peak aortic jet velocity (Vmax) 3.21 +/- 0.61 m/s (0.20 +/- 0.09 m/s/yr); aortic valve area (AVA) 1.23 +/- 0.31 cm2 (-0.09 +/- 0.05 cm2/yr); and mean aortic valve gradient (MG) 26.2 +/- 7.6 mmHg (3.9 +/- 1.6 mmHg/yr). Age, sex, coronary artery disease, hypertension, diabetes, hyperlipidemia, and smoking were not associated with AS progression in >75% cohorts. Baseline Vmax and MG were associated with greater AS progression in 6 cohorts (75%). Baseline aortic valve calcification (AVC) and AVA were consistently associated with greater AS progression in 9 cohorts (100%). One cohort found that women have a greater ΔMG for a given level of AVC. A univariate analysis of race in one cohort showed that African American ethnicity was associated with lower risk of progression from normal aortic valves to incident AS. Conclusion: There is limited representation of women and ethnic minorities in prospective AS progression cohorts. Active recruitment of diverse populations in these cohorts is needed. The available clinical evidence provides limited support for claims of differential progression as the cause of racial disparities in AS treatment.

A Magyarország területén élő nemzetiségek politikai képviselete a nemzeti önkormányzati választásokon és az országgyűlési választásokon való részvétel tükrében

The political representation of minorities within a nation-state is a task that has always posed a great challenge to countries with substantial ethnic minorities, since both the hardships of establishing an adequate legislative environment, both the sensitivity of the subject make it exceedingly difficult for the legislator to develop a sufficient system. The issue of the proper representation of those 13 recognised minorities that are considered constituent components ofthe state were part of Hungary’s political history since the regime change, and for a rather long period of time it seemed that the adequate solution for their political representation was the local governmental system of ethnic minorities. Since 2011 however, the electoral system makes it possible for ethnic minorities to be represented within the Hungarian Parliament as well, which raises the question of whether this will shift the attention of the affected minority groups from the local self-governments towards the parliamentary representation. In this paper, after reviewing the changes within the legislative environment and – in close connection with that – the problems surrounding the issue of political representation of ethnic minorities, I will attempt to answer this emerging question through a brief analyses based on the turnout-data regarding the 2014 and the 2019 elections local governmental elections.

Roads Diverged: Developmental Trajectories of Irritability From Toddlerhood Through Adolescence

Irritability is a dimensional trait that manifests from early life and is a robust transdiagnostic risk factor for psychopathology and impairment. A large, national dataset was leveraged to identify and broadly characterize trajectories from toddlerhood through adolescence, which is crucial for timely, targeted interventions. Data on irritability and a broad array of potential factors affecting irritability development from 4,462 children assessed longitudinally at ages 3, 5, 9, and 15 were included. Latent class growth models identified groups of children based on their nonlinear irritability trajectories from toddlerhood to adolescence. LASSO regression then identified key characteristics differentiating trajectory groups. Five distinct irritability trajectories were identified, two of which were stable, maintaining medium or high irritability from age 3 to 15. Three trajectories showed undulating change over development, with an inflection point at the transition to adolescence (age 9): Most children had consistently low irritability. Two smaller groups started with high irritability at age 3 but diverged, sharply decreasing or increasing until a turning point at age 9. Developmental patterning of harsh/neglectful parenting and child internalizing symptoms most strongly differentiated trajectory groups. Sociodemographic characteristics, attachment style, neighborhood support, cognitive functioning, and genetic variation also differentiated trajectories. The results demonstrated the importance of the transition to adolescence as a critical inflection point for youths with fluctuating irritability trajectories. Identifying these patterns and multiple malleable factors associated with stably high or rising trajectories is an important step toward targeted interventions for the most vulnerable subgroups. We worked to ensure sex and gender balance in the recruitment of human participants. We worked to ensure race, ethnic, and/or other types of diversity in the recruitment of human participants. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented racial and/or ethnic groups in science. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented sexual and/or gender groups in science. One or more of the authors of this paper self-identifies as living with a disability. One or more of the authors of this paper received support from a program designed to increase minority representation in science. We actively worked to promote sex and gender balance in our author group. We actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our author group.

Crossing the Threshold: Organizational and Community Correlates of Female and Minority Representation Among U.S. Law Enforcement Agencies

The current research explores relationships between female and minority officer representation and elements of organizational structure, practices, and context (internal and external). These relationships are viewed through the lenses of representative bureaucracy and structural contingency theory. Employing LEMAS (2016) survey and ACS (2011–2015) data, a series of OLS regression models explored these relationships. Findings suggest diversity breeds diversity in law enforcement agencies. Organizational structure continues to influence female and minority officers throughout their careers. Structural elements of both complexity and control were related to officer representation at all three career points, as were organizational practices. Finally, relationships related to internal context demonstrated greater consistency than external, although external context was related to overall representation. Relationships between structure, practices, and context varied for females and minorities, suggesting a greater need for unique recruitment and retention strategies for these officers.

Gender, Racial, and Socioeconomic Determinants of Choosing a Surgical Career

• Surgical specialties continue to struggle with achieving proportionate representation of minorities. • Those from racial/ethnic minorities and lower socioeconomic status backgrounds are more likely to choose non-surgical careers. • Multiple potential solutions exist, including more loan relief programs for surgical specialties, increasing exposure in pre-clinical education, funded research programs, and improving accessibility to mentorship. Surgical specialties continues to struggle with achieving proportionate representation of women, racial and ethnic minorities, and LGBTQ individuals at all levels of training and academic positions. This study aimed to analyze how socioeconomic determinants and demographic variables including gender and race/ethnicity affect choice of specialty. A 25-question survey was distributed via Qualtrics to residents at a single institution between September 2021 and February 2022. This study was performed at a single-institution, at an academic university center. All resident physicians at the institution, ranging from post-graduate year 1 to post-graduate year 9, were invited to participate in the survey. All specialties were invited to participate. A total of 294 responses (86 in surgical fields, 204 in medical fields) were collected, with an overall response rate of 47%. The average amount of reported student debt was USD 183,000. Underrepresented in medicine (UIM) students chose significantly shorter residencies (p=0.046), had significantly lower average household incomes and grew up in poorer communities (p<0.001), were more likely to have an urban upbringing (p<0.001), and were more likely to have parents without graduate education (p=0.016). Average household income growing up was higher for those from surgical specialties than those from medical specialties (USD 167,000, 144,000, p=0.051). In a multiple logistic regression , race (p=0.041) and ethnicity (p=0.046) were the most significant unique predictors of choosing a medical residency over a surgical residency. Female gender (p=0.014), being the sole source of income (p=0.018), and lower parent/guardian educational status were factors predictive of not pursuing a top 10 paying residency. Understanding the socioeconomic influences in specialty choice provides important insight to guide future programs and policies focused on alleviating barriers that dissuade qualified and diverse applicants from pursuing surgical careers.

Gender and Racial Representation Trends Among Internal Medicine Department Chairs from 2010–2020

BackgroundQuality medical education, reduction in health disparities, and healthcare research that includes all members of society are enhanced by diversity in departments of internal medicine (IM). Research on increasing diversity within the academic medicine student body or faculty notes the important role of leadership. Yet, there is a scarcity in research into diversity in leadership.ObjectiveThe purpose of this study is to go beyond aggregate numbers and answer the question: What is the level of parity representation, by gender and race, at department chair positions in academic IM departments?DesignA cross-sectional analysis of race/ethnicity and gender in IM medical school departments from 2010 to 2020 was conducted using data from the American Association of Medical College’s (AAMC) Faculty Roster. The proportion of IM department chairs to IM faculty by race/ethnicity for each year (2010–2020) was used to calculate the Leadership Parity Index (LPI) in this study. LPI by gender and by gender and race/ethnicity were also calculated for each year.ResultsIn aggregate numbers, Black or African American and Hispanic, Latino, or of Spanish Origin faculty remain under-represented in academic IM each making up, on average, approximately 4% of the total IM faculty. The LPI calculations revealed that faculty who identified as White were consistently over-represented as department chairs while Asian faculty were consistently under-represented in leadership and ranked lowest in leadership parity among the ethnic groups studied. The leadership parity index also showed that women faculty across all races were under-represented.ConclusionWomen and Asian faculty encounter a ceiling effect that may be at play in IM departments. While significant progress still needs to be made in the representation of under-represented minorities, the findings of this study show that aggregate data does not provide a true picture of equity and parity in Internal Medicine faculties.

Diversity and transparency in gynecologic oncology clinical trials.

Clinical trials advance the standard of care for patients. Patients enrolled in trials should represent the population who would benefit from the intervention in clinical practice. The aim of this study was to assess whether clinical trials enrolling patients with gynecologic cancers report racial and ethnic participant composition and to examine the level of diversity in clinical trials. Using ClinicalTrials.gov, we identified clinical trials enrolling patients with ovarian, uterine/endometrial, cervical, vaginal, and vulvar cancers from 1988 to 2019. Race and ethnicity data were extracted from participant demographics. Descriptive statistics on race, ethnicity, cancer type, location, study status, and sponsor type were calculated. Among trials which reported race and/or ethnicity, sub-analyses were performed on composition of race and ethnicity by funding source, location, and completed study status. A total of 1,882 trials met inclusion criteria; only 179 trials (9.5%) reported race information. Of these, the racial distribution of enrollees was 66.9% White, 8.6% Asian, 8.5% Black/African American, 0.4% Indian/Alaskan Native, 0.1% Native Hawaiian/Pacific Islander, 1.0% more than one race, and 14.5% unknown. Only 100 (5.3%) trials reported ethnicity. Except for trials enrolling patients with cervical cancer which enrolled 65.2% White and 62.1% Non-Hispanic/Latino/a patients, enrollees in trials for other gynecologic cancers were over 80% White and 88% Non-Hispanic/Latino/a. Industry funded trials enrolled higher proportions of White (68.4%) participants than non-industry funded trials (57.5%). Domestic trials report race (11.5%) and ethnicity (7.6%) at higher rates than international trials (6.9% and 2.3%, respectively). Reporting of race (1.7% vs. 13.9%) and ethnicity (1.7% vs. 11.1%) has increased over time for patients enrolled in 2000 vs. 2018. Less than 10% of trials enrolling patients with gynecologic malignancies report racial/ethnic participant composition on ClinicalTrials.gov. Accurate reporting of participant race/ethnicity is imperative to ensuring minority representation in clinical trials.

A Comprehensive Analysis of Institutional and Nationwide Datasets Identifies Key Parameters that Influence Racial Minority Enrollment onto Clinical Trials

<h3>Purpose/Objective(s)</h3> Minority accrual to clinical cancer treatment trials remains consistently low across the United States. We hypothesize that specific aspects of clinical cancer trials associate favorably with minority accrual, and may guide future clinical trial design. <h3>Materials/Methods</h3> We identified cancer treatment trials with a minimum of 10 patients at a multi-institutional NCI designated cancer center from 2010-2022. We also analyzed the National Cancer Database (NCDB) from 2004 to 2018 to assess co-variables that influence minority accrual across the United States. Racial minorities were defined as any non-white individual for both our institutional and NCDB cohorts. Our study endpoint was the probability of enrolling a minority patient on a clinical cancer treatment trial. Separate univariable and multivariable logistic regression were used to determine whether co-variables from either our institutional dataset or the NCDB associated with the study endpoint. P-values of less than 0.05 were considered statistically significant. All analysis was performed in R (R Foundation for Statistical Computing, version 4.0.2). <h3>Results</h3> We identified a total of 352 cancer treatment trials from our multi-institutional cohort. These trials enrolled a total of 7,981 patients, and a total of 969 minorities (12%). Clinical trials treating breast and genitourinary malignancies had a favorable association with accruing a minority patient when compared to other solid tumors (OR 1.32 95% CI 1.04-1.66 and OR 1.33, 95% CI 1.02-1.71). Phase II clinical trials had a less favorable association with accruing a minority patient (OR 0.75, 95% CI 0.62 – 0.91) when compared to early phase trials (pilot + phase I + phase I/II). Analysis of the NCDB identified 19,139 minorities enrolled on institutional or double-blinded clinical trials. Minorities enrolled on clinical trials were more likely to be female versus male (OR 1.22, 95% CI 1.09-1.37), un-insured versus private insurance or Medicare (OR 2.22, 95% CI 1.67 – 2.94 and OR 1.96, 95% CI 1.43 – 2.63), live within 30 miles of their hospital (OR 2.33, 95% CI 2.08 – 2.63), receive treatment at academic versus community facilities (OR 1.75, 95% CI 1.52-2.04), and be treated with surgery (OR 1.59, 95% CI 1.41 – 1.79). Minority patients enrolled on clinical trials were more likely to have breast and genitourinary cancers (OR 1.54, 95% CI 1.31 – 1.81 and OR 1.35, 95% CI 1.14 – 1.61). <h3>Conclusion</h3> Twelve percent of patients that enrolled on clinical trials in our institutional cohort were minorities, which is comparable to current minority representation in NCI trials. Our analysis found that minority patients enrolled on early phase clinical trials, breast and genitourinary treatment trials, tended to be female, un-insured, live within 30 miles of a facility, and receive surgical treatment. This analysis demonstrates that minority patients favorably associate with specific aspects of cancer treatment trials that should be addressed in future clinical trial design.

Racial Disparities in Clinical Outcomes on Investigator-Initiated Breast Cancer Clinical Trials at an Urban Medical Center

BackgroundBlack women are 40% more likely to die of breast cancer compared to White women. Inadequate representation of Black patients in clinical trials may contribute to health care inequity. We aimed to assess breast cancer clinical outcomes in Non-Hispanic Black (Black) versus Non-Hispanic White (White) women with metastatic breast cancer (MBC) enrolled on investigator-initiated clinical trials at Winship Cancer Institute at Emory University, given the significant number of patients from underrepresented minority groups seen at Winship. Materials and MethodsBlack and White women with MBC on investigator-initiated trials at Emory between 2009 and 2019 were retrospectively evaluated. Univariate analyses and multiple logistic regression models were used to assess clinical response and treatment toxicities. Differences in overall survival between groups was assessed using quantile analysis. ResultsSixty-two women with MBC were included (66% White vs. 34% Black). Black patients had less clinical benefit from the trial therapy as only 57% had partial response or stable disease as best response compared to 78% of White women (P = .09). Quantile analysis showed significant difference in mean survival between Whites and Blacks by the end of follow up (64 vs. 38 months). There were no significant differences in toxicities between groups. ConclusionParticipation rates of Black women with MBC on investigator-initiated clinical trials at an urban cancer center were higher compared to key national trials. Black women had worse treatment response and survival. These results reinforce the need for assessment of tumor differences by ancestry and continued improvement in minority representation on clinical trials.

Surviving Racism and Sexism in Academia: Sharing Experiences, Insights, and Perspectives

Surviving Racism and Sexism in Academia: Sharing Experiences, Insights, and Perspectives

An investigation of the impact of Black male and female actors on US movies’ box-office across countries

Globalization has resulted in an environment in which foreign markets constitute a large portion of new product sales. This is particularly the case in the movie industry. The movie industry is also pressured to increase the representation of ethnic minorities, especially in casting choices. We investigate how Black (1) male and (2) female actors affect the country-level international box-office of 788 US movies released in 2012–2019. The results show that Black male (female) actors increase (decrease) a movie’s box-office in a given country. Extending developments in the literature on intergroup contact, we examine how these effects are moderated by (a) actors’ star power, (b) the number of releases prior to release in the country, (c) the time-lag between worldwide release and release in the country, and (d) whether the country is emerging (vs. developed).

The mental health experiences of ethnic minorities in the UK during the Coronavirus pandemic: A qualitative exploration.

BackgroundWorldwide, the Coronavirus pandemic has had a major impact on people's health, lives, and livelihoods. However, this impact has not been felt equally across various population groups. People from ethnic minority backgrounds in the UK have been more adversely affected by the pandemic, especially in terms of their physical health. Their mental health, on the other hand, has received less attention. This study aimed to explore the mental health experiences of UK adults from ethnic minorities during the Coronavirus pandemic. This work forms part of our wider long-term UK population study “Mental Health in the Pandemic.”MethodsWe conducted an exploratory qualitative study with people from ethnic minority communities across the UK. A series of in-depth interviews were conducted with 15 women, 14 men and 1 non-binary person from ethnic minority backgrounds, aged between 18 and 65 years old (mean age = 40). We utilized purposefully selected maximum variation sampling in order to capture as wide a variety of views, perceptions and experiences as possible. Inclusion criteria: adults (18+) from ethnic minorities across the UK; able to provide full consent to participate; able to participate in a video- or phone-call interview. All interviews took place via MS Teams or Zoom. The gathered data were transcribed verbatim and underwent thematic analysis following Braun and Clarke carried out using NVivo 12 software.ResultsThe qualitative data analysis yielded seven overarching themes: (1) pandemic-specific mental health and wellbeing experiences; (2) issues relating to the media; (3) coping mechanisms; (4) worries around and attitudes toward vaccination; (5) suggestions for support in moving forward; (6) best and worst experiences during pandemic and lockdowns; (7) biggest areas of change in personal life. Generally, participants' mental health experiences varied with some not being affected by the pandemic in a way related to their ethnicity, some sharing positive experiences and coping strategies (exercising more, spending more time with family, community cohesion), and some expressing negative experiences (eating or drinking more, feeling more isolated, or even racism and abuse, especially toward Asian communities). Concerns were raised around trust issues in relation to the media, the inadequate representation of ethnic minorities, and the spread of fake news especially on social media. Attitudes toward vaccinations varied too, with some people more willing to have the vaccine than others.ConclusionThis study's findings highlight the diversity in the pandemic mental health experiences of ethnic minorities in the UK and has implications for policy, practice and further research. To enable moving forward beyond the pandemic, our study surfaced the need for culturally appropriate mental health support, financial support (as a key mental health determinant), accurate media representation, and clear communication messaging from the Governments of the UK.

S271 Representation of Racial Minorities in the United States Colonoscopy Surveillance Interval Guidelines

Introduction: Clinical guidelines should ideally be formulated from data representative of the population they are applicable to. However, historically many studies have had disproportionately high rates of white patient enrollment, which could lead to inequities in care for racial minorities. In this study, we examined the degree to which racial minorities were represented in the US colonoscopy surveillance guidelines. Methods: We reviewed US guidelines between 1997 and 2020 and identified all studies cited by recommendations for surveillance after a baseline colonoscopy with no polyps, adenomas, sessile serrated polyps (SSPs), and hyperplastic polyps (HPs). Each study within a meta-analysis was analyzed separately. We compared the proportion of studies reporting race to the proportion which reported sex and family history of colorectal cancer (CRC). Among studies reporting race, we calculated both the median percentage of minorities and the aggregate racial distribution of patients. Statistical testing was performed via Fisher’s exact test, and Bonferroni correction was applied for multiple comparisons. Results: We reviewed a total of 77 studies, of which 35 were from the US (Table). 18 studies (23%) reported race, compared to 73 studies (95%) which reported sex and 34 (44%) which reported family history of CRC (p < 0.001 and p = 0.006 respectively). All studies which reported race were US-based studies, thus 51% of US-based studies reported race. Among studies that reported race, the median number of minorities was 15% of the study population, ranging from a low of 12% for studies on adenomas and HPs to 30% for studies on SSPs. In aggregate, non-white patients comprised 43% of the study population for normal colonoscopies but only 9% for adenomas, 22% of for SSPs, and 15% for HPs (p < 0.001 for all pairwise comparisons). Conclusion: Most studies on colonoscopy surveillance intervals, including approximately half of US-based studies, do not report the race of study participants. Among the studies that report racial data, minority patients are underrepresented in studies of adenoma, SSP, and HP surveillance intervals compared to the US population. Underrepresentation may lead to differences in outcomes being missed, thus future research should strive to include more data from these underrepresented groups. Table 1. - Reporting of Race and Racial Distribution of Patients among Studies of Colonoscopy Surveillance Intervals Abbreviations: CRC, colorectal cancer All studies(N=77) Normal colonoscopy(N=18) Adenomas(N=54) Sessile serrated polyps(N=7) Hyperplastic polyps(N=5) Number of studies which reported: Sex, n (%) 73 (95) 16 (89) 51 (94) 7 (100) 5 (100) Family history of CRC, n (%) 34 (44) 8 (44) 24 (44) 3 (43) 3 (60) Race, n (%) 18 (23) 3 (17) 12 (22) 2 (29) 2 (40) Percentage of minority patients, median (range)* 15 (4-43) 24 (15-43) 12 (4-36) 30 (16-43) 12 (10-15) Number of patients:* White, n (%) 752,876 (58) 710,149 (57) 26,672 (91) 3,053 (78) 13,341 (85) Black, n (%) 80,528 (6) 77,510 (6) 1,020 (4) 561 (14) 1,437 (9) Asian, n (%) 155,966 (12) 155,079 (12) 295 (1) 217 (6) 375 (2) Hispanic, n (%) 144,783 (11) 144,093 (12) 309 (1) 59 (2) 322 (2) Other, n (%) 167,082 (13) 165,955 (13) 954 (3) 19 (1) 154 (1) *Among studies which reported race.

Psilocybin use patterns and perception of risk among a cohort of Black individuals with Opioid Use Disorder.

There is growing evidence that psilocybin, a serotonergic psychedelic substance, may be useful in the treatment of substance use disorders. However, there is a lack of data on the beliefs and attitudes towards psilocybin amongst Black individuals diagnosed with Opioid Use Disorder (OUD). This study characterized psilocybin use patterns and perception of risk amongst a cohort of Black individuals diagnosed with OUD. Using a convenience sampling approach, patients were recruited from an urban methadone treatment program and paid five dollars to complete an anonymous phone-based survey. Twenty-eight patients participated (mean age 53.8; N = 28; 35.7% female). Most (N = 23; 82.1%) had "heard of" psilocybin mushrooms before taking the survey, but only five (N = 5; 17.8%) had ever used them. More than 80% perceived a risk or were "unsure" of the risk for sixteen of the seventeen items queried about psilocybin. Approximately half (N = 15; 53.6%) were willing to try therapy incorporating psilocybin and half (N = 14; 50%) said they would be more likely to try if it were FDA approved for OUD. Most (N = 18; 64.3%) preferred to stay on methadone treatment alone, 32.1% (N = 9) wanted to try treatment with both psilocybin and methadone, and only one participant opted for psilocybin treatment without methadone. Many Black individuals with Opioid Use Disorder perceive psilocybin as dangerous and may be hesitant to try psilocybin treatment. Culturally informed treatment models, educational interventions and community outreach programs should be developed to increase racial/ethnic minority representation in psilocybin research and treatment.

A representative-represented matrix: exploring the symbolic effect of minority representation

ABSTRACT This study explores how symbolic representation varies by citizens’ demographic identities and bureaucracies’ demographic composition. First, it presents a representative-represented matrix to provide a conceptual framework from the citizens’ perspective. Then, this is followed by the application to the area of policing in the experimental setting. Citizen perceptions are explored in terms of minority bureaucrats’ representative role and the potential benefits of a representative bureaucracy. The empirical evidence demonstrates that the symbolic effect of minority representation varies and may not accomplish expected outcomes for all minorities. The symbolic representation may be manifested for women and minorities but limited for White men.

Who's on first? People asymmetrically attend to higher-ranked (vs. lower-ranked) competitors

Rankings, hierarchies, and competitions are an integral part of peoples' personal and professional lives and knowing one's standing vis-à-vis others helps employees decide how to outdo higher-ranked colleagues and how to refrain from being outdone by lower-ranked others. But whom do people attend to when considering these rankings? In seven studies (and five supplementary studies; N = 4496) we document a robust asymmetry in attention to higher-ranked versus lower-ranked competitors. First, using unobtrusive measures, we show that people attend more to and exhibit better memory for their higher-ranked (vs. lower-ranked) peers. Second, we demonstrate that this asymmetry is reduced when attention is shifted to lower-ranked competitors, and is moderated by participants' own standing. Finally, we find that asymmetrically attending to higher-ranked others leads people to overestimate minority representation in rankings and to make suboptimal financial decisions. We discuss implications for social comparison theory, workplace rankings, and the psychology of competition.