American People Research Articles

Abstract 4142783: Association of Body Roundness Index and Cardiovascular Disease among US Adults

Background: Obesity is one of the major risk factors for cardiovascular disease (CVD), body roundness index (BRI) is more comprehensive in assessing fat distribution than traditional measurements. However, evidence regarding the association between BRI and the risk of CVD was limited, particularly in American people. This current study aimed to investigate the association between BRI and the risk of CVD among US adults. Hypothesis: We hypothesized that higher BRI was associated with a higher risk of CVD. Methods: A total of 21,852 participants were included in the National Health and Nutrition Examination Surveys from 6 survey cycles (2003-2004, 2005-2006, 2007-2008, 2009-2010, 2011-2012, 2013-2014, 2015-2016 and 2017-2018). Weighted multivariate logistic regression was carried out to examine the relationship between BRI and the risk of CVD. Restricted cubic spline (RCS) curves were employed to analyze nonlinear relationships. Results: Among 21,852 US adults, the mean (SD) age was 47.5 (17.3) years, 10,669 (48.8%) were female, and 1886 were diagnosed with CVD. In the weighted multi-variable logistic regression model with adjustment for demographics, lifestyle, economic status and dietary factors, higher BRI was significantly associated with a substantially higher risk of CVD. Compared with the participants in the lowest quartile of BRI, those in the highest quartile of BRI had a higher CVD, with OR and 95%CI of 2.47 (1.92-3.17). Furthermore, the RCS demonstrated a linear dose-response relationship between BRI and CVD (P non-linearity =0.29). Conclusion: This national cohort study found a higher BRI was associated with a higher risk of CVD among US adults. BRI may provide a new perspective for CVD prevention among adults.

A diverse hidradenitis suppurativa cohort: a retrospective cross-sectional study of 13,130 patients from a large US healthcare system database from 1995-2022

BackgroundMost epidemiological studies of hidradenitis suppurativa (HS) have described homogeneous patient populations. ObjectiveTo characterize demographics, modifiable health behaviors, and comorbidities of HS patients within a diverse cohort. MethodsA retrospective cross-sectional study of 13,130 HS patients within a healthcare system was conducted. ResultsA female sex bias of ∼3:1 in all racial/ethnic subgroups was observed. Black/African American (AA) patients had a lower age at HS diagnosis than White patients (37.1 years vs 39.4 years, P<0.001). A higher proportion of Black/AA females than White females with HS had BMI in the obese range (69.9% vs 56.5%; P=0.03). In contrast, fewer Black/African American males with HS had a BMI in the obese range compared to White males (51.4% vs. 61.0%; P<0.001). More Black/AA patients than White patients with HS had congestive heart failure (OR=2.10, CI=1.19-3.78; P<0.05), chronic pulmonary disease (OR=1.34; CI=1.02-1.78; P<0.05), diabetes with chronic complication (OR=1.73; CI=1.16-2.60; P<0.05), renal disease (OR=2.66; CI=1.67-4.34; P<0.05), and Charlson Comorbidity Index score ≥4 (OR=1.67; CI=1.09-2.58; P<0.05). Furthermore, male patients were more likely than female patients to have renal disease (OR=2.62; CI 1.66-4.14; P<0.05). LimitationsA single-center study. ConclusionSubgroups of HS patients had significant differences in demographics, risk factors, and comorbid conditions.

Genetic ancestry in Puerto Rican afro-descendants illustrates diverse histories of African diasporic populations.

Genetic studies of contemporary Puerto Ricans reflect a demographic history characterized by admixture between Indigenous American, African, and European peoples. While previous studies provide genetic perspectives on the general Puerto Rican population, less is known about the island's sub-populations, specifically Afro-Puerto Ricans. In this study, the genetic ancestry of Afro-Puerto Ricans is characterized and compared to other Caribbean populations. Thirty DNA samples collected among self-identified Puerto Ricans of African descent in Loíza (n = 2), Piñones (n = 13), San Juan (n = 2), Mayagüez (n = 9), and Ponce (n = 4), were genotyped at 750,000 loci on the National Geographic Genochip. We then applied unsupervised clustering and dimensionality-reduction methods to detect continental and subcontinental African and European genetic ancestry patterns. Admixture analyses reveal that on average, the largest genetic ancestry component for Afro-Puerto Ricans is African in origin, followed by European and Indigenous American genetic ancestry components. African biogeographic origins of Afro-Puerto Ricans align most closely with contemporary peoples of Lower Guinea and the Bight of Biafra, while the European genetic ancestry component is most similar to contemporary Iberian, Italian, and Basque populations. These findings contrast with the biogeographic origins of comparative Barbadian and Puerto Rican populations. Our results suggest that while there are similarities with regard to general patterns of genetic ancestry among African descendants in the Caribbean, there is previously unrecognized regional heterogeneity, including among Puerto Rican sub-populations. These results are also consistent with available historical sources, while providing depth absent from the documentary record, particularly with regard to African ancestry.

Public health resilience and recovery in Ukraine: Academic partnerships to improve population health

Abstract Background Strengthening the public health workforce is among top priorities for the transformation of Ukraine’s public health system. As part of the USAID Public Health System Recovery and Resilience Activity, an Academic Partnership Collaborative brought together three Ukrainian universities (National University Kyiv-Mohyla Academy, I. Horbachevsky Ternopil National Medical University, Sumy State University), two American universities (Temple University and Drexel University), and the All-Ukrainian Association of Public Health Specialists (UPHA) to enhance the competencies of public health graduates in Ukraine. Objectives The collaborative focuses on strengthening the Ukrainian universities’ public health curricula and the teaching and research competencies of the Ukrainian faculty, making the curricular changes in Ukraine better aligned with US and European academic standards. The university partners are collaborating with the newly established UPHA in building partnerships with peer organizations in the US (American Public Health Association) and Europe (EuPHA) and sharing advancements in public health education with the broader community of public health practitioners in Ukraine to enhance their competencies to improve population health and align with European systems of public health. Results We have established linkages among all partners via an initial meeting in Uzhhorod, Ukraine in April 2024. We anticipate results by November 2024 to include curriculum review recommendations, coaching on prioritized topics for the Ukrainian partners, faculty development plans, and the establishment of continuing professional development programs in collaboration with UPHA. Conclusions Through this partnership, selected Ukrainian universities will have an enhanced and sustainable capacity to train the public health workforce and will become leading examples for other public health programs to simulate and collaborate with beyond the project. Key messages • Ukraine’s resilience and recovery relies upon the strength of the current and future public health workforce; mechanisms for building public health training are essential to a healthy population. • A collaborative process of strategic activities among American and Ukrainian universities and professional associations can be effective in building a resilient public health system in Ukraine.

Differences in codeswitching patterns between immigrant and heritage speakers of US American Danish

This paper addresses intrasentential code-switching in US American Danish spoken by 1st generation immigrants from Denmark, who migrated to the US around 1900 as part as the transatlantic European mass emigration and their descendants (2nd and 3rd generation). The analysis is based on the Corpus of American Danish, specifically a dataset of 173 speakers producing 46 hours of speech. In this dataset, we observe significantly different patterns of intrasentential code-switching in the speech of the immigrant speakers (1st generation) and US-born heritage speakers (2nd and 3rd generation): The code-switching patterns of the heritage speakers show a preference for English lexemes that are integrated morphologically into Danish or which are part of Danish-English bilingual compounds. In contrast, the immigrant speakers prefer non-integrated English words for code-switching. This result taken per se shows that code-switching patterns show variation across generations just as other linguistic variables. Taking the result further, we have connected it to a previous study of representations of linguistic proficiency in immigrant Danish in the Americas. By this, we are able to show that the morphologically or lexically integrated code-switching of the heritage speakers correlate with features representing fluent speech, while the non-integrated code-switching of the immigrant speakers rather seems to correlate with features showing a low activation of Danish in a situation of language shift. Thus, the heritage speakers seem to have developed a way of speaking US American Danish where English word stems are an integrated part of speaking fluently and lexically varied.

Association of Adherence to a MIND-Style Diet With the Risk of Cognitive Impairment and Decline in the REGARDS Cohort.

Diet may influence the development of cognitive impairment and affect cognitive decline, but whether this relationship varies between Black American and White American people is unclear. This study examined the association of Mediterranean-Dietary Approaches to Stop Hypertension Intervention for Neurodegenerative Delay (MIND) and incident cognitive impairment and cognitive trajectories in a biracial prospective cohort study. Using data derived from the Food Frequency Questionnaire in the REasons for Geographic and Racial Differences in Stroke study, we compared MIND diet adherence with incident cognitive impairment and cognitive trajectory in Black participants and White participants. Logistic regression was used to model MIND diet score (continuous variable and using tertiles) and incident cognitive impairment after adjusting for age, sex, race, region, education, income, total energy, hypertension history, dyslipidemia, diabetes, estimated glomerular filtration rate, ischemic heart conditions, atrial fibrillation, and lifestyle factors including sedentary, obesity, and smoking. Mixed-effects models were used to examine the association between cognitive trajectory and MIND diet adherence. Dietary data to calculate the MIND diet score and cognitive data were available on 14,145 participants with a mean age of 64 years (SD 9.0 years) that was 56.7% female. Greater MIND diet adherence was associated with a decreased incidence of cognitive impairment (odds ratio [OR] 0.96, 95% CI 0.93-0.99, p = 0.02) after adjusting for all covariates. In the fully adjusted model, greater MIND diet adherence was associated with decreased risk of cognitive impairment in female participants (OR 0.92, 95% CI 0.89-0.96, p < 0.001) but not in male participants (OR 1.01, 95% CI 0.97-1.06, p = 0.64). In all models, greater MIND diet adherence was associated with decreased risk of cognitive decline. MIND diet adherence was a better predictor of cognitive decline in Black participants (β = 0.04, SE = 0.007, p < 0.001) than in White participants (β = 0.03, SE = 0.004, p < 0.001). Greater MIND diet adherence was associated with decreased risk of cognitive impairment in female participants but not male participants, with no difference between Black participants and White participants. However, MIND diet adherence was a better predictor of cognitive trajectory in Black participants than in White participants.

Evaluating Disability Rights Legislation: The Impact of the Americans with Disabilities Act on Social Equality in the United States

The Americans with Disabilities Act (ADA), enacted in 1990, set a milestone in protecting the civil rights of disabled Americans. This paper evaluates the impact of the ADA through its historical contexts, components, challenges in enforcement, and contributions of the ADA to the lives of the American people, including employment, equal access to education, public space and transportation. The ADA has successfully reduced barriers and fostered greater inclusion in society. However, its enforcement also faced many significant challenges, especially in rural areas and for small businesses due to limited economic conditions and lack of resources. Furthermore, the ADA places a significant focus on accommodating the need for physical abilities, which makes public society question whether the ADA can satisfy the needs of people with mental health and cognitive disabilities. Finally, the paper recommends regularly updating the ADA to integrate assistive technical supports. Continuous advocacy is required to enhance the position of the ADA as a legal tool for promoting equality and ensuring that all Americans can participate fully in their lives.

Racial, Ethnic, and Socioeconomic Disparities in Pediatric Aquaporin-4-Positive Neuromyelitis Optica Spectrum Disorder

BackgroundOnly 5% of aquaporin-4-positive neuromyelitis optica spectrum disorder (AQP4+ NMOSD) cases emerge during childhood. Poorer outcomes have been suggested in black/African American (AA) adults with NMOSD; however, conflicting and limited data exist for pediatric-onset NMOSD. This study evaluates racial, ethnic, and socioeconomic disparities in pediatric AQP4+ NMOSD outcomes. MethodsThirty-eight pediatric patients with AQP4+ NMOSD cared for at three pediatric tertiary care centers between 2009 and 2021 were identified. Patient addresses connected to socioeconomic measures available from the US Census. Demographic characteristics, pertinent clinical outcomes, and health care utilization in the two years following diagnosis were captured. ResultsCompared with non-Hispanic White children, Black/AA children had a significantly higher Expanded Disability Status Scale (EDSS) (2.46 vs 0.33, P = 0.003), 2.37 more hospital admissions (P = 0.002), and 28.40 additional inpatient days (P = 0.002) in the two years following their NMOSD diagnosis. Additionally, children with public insurance had higher relapse rates than those with private insurance (P = 0.046). At two years and at the most recent follow-up, a significantly higher EDSS was correlated with children living in census tracts with a lower median income, higher deprivation index, and higher proportion of population on assisted income, in poverty, and with vacant housing (all P < 0.05). ConclusionsWe identified racial, ethnic, and socioeconomic disparities in clinical outcomes and health care utilization in pediatric AQP4+ NMOSD. Further prospective and household-level data are needed to dissect the interplay of genetics, structural racism, and social determinants of health so that interventions to optimize care and outcomes for this population may be developed.

Exploring Public Emotions on Obesity During the COVID-19 Pandemic Using Sentiment Analysis and Topic Modeling: Cross-Sectional Study.

Obesity is a chronic, multifactorial, and relapsing disease, affecting people of all ages worldwide, and is directly related to multiple complications. Understanding public attitudes and perceptions toward obesity is essential for developing effective health policies, prevention strategies, and treatment approaches. This study investigated the sentiments of the general public, celebrities, and important organizations regarding obesity using social media data, specifically from Twitter (subsequently rebranded as X). The study analyzes a dataset of 53,414 tweets related to obesity posted on Twitter during the COVID-19 pandemic, from April 2019 to December 2022. Sentiment analysis was performed using the XLM-RoBERTa-base model, and topic modeling was conducted using the BERTopic library. The analysis revealed that tweets regarding obesity were predominantly negative. Spikes in Twitter activity correlated with significant political events, such as the exchange of obesity-related comments between US politicians and criticism of the United Kingdom's obesity campaign. Topic modeling identified 243 clusters representing various obesity-related topics, such as childhood obesity; the US President's obesity struggle; COVID-19 vaccinations; the UK government's obesity campaign; body shaming; racism and high obesity rates among Black American people; smoking, substance abuse, and alcohol consumption among people with obesity; environmental risk factors; and surgical treatments. Twitter serves as a valuable source for understanding obesity-related sentiments and attitudes among the public, celebrities, and influential organizations. Sentiments regarding obesity were predominantly negative. Negative portrayals of obesity by influential politicians and celebrities were shown to contribute to negative public sentiments, which can have adverse effects on public health. It is essential for public figures to be mindful of their impact on public opinion and the potential consequences of their statements.

Early Specialization and Progress of Finalist Swimmers in World Championships and Olympic Games.

Background: The main objectives of this study were to analyze the effect of early specialization in swimming and to observe the general patterns of success of two different sport specialization models [Spanish (SPA) and United States of American (USA) swimmers] participating in World Championships (WCs) and Olympic Games (OGs) between the years 2006 and 2021 of all swimming strokes and distances. Methods: Descriptive analyses and contingency tables were examined for all the variables. Explanatory models of the z scores were estimated from age depending on the events' distances and strokes. Quadratic regression models were developed to capture the behavior of the variable time with parabolic functions, and the significance of the global model and the predictor variables (age) were also evaluated. In addition, the optimal age (peak performance) as well as the curvature of the model were analyzed. These models were compared between SPA and USA swimmers. Results: The results showed that the main differences in the patterns to success between SPA and USA were the earlier participation of USA swimmers in high-level competitions, as well as the greater number of participants for all the strokes, events, genders, and competitions. Age peak performance in short distances was lower for Spanish swimmers, obtaining the opposite situation for long distances. Conclusions: Being a finalist in junior WCs did not influence success in the finals of the senior WCs and OGs. Main differences in general patterns of success between SPA and USA showed younger swimmers participating in short-distance events, backstroke, and butterfly for USA swimmers and older swimmers taking part in butterfly and short-distance events for SPA.

Black (rhetorics of) migration and laying claim to space

ABSTRACT This essay troubles the romanticized US American “nation of immigrants” narrative through its relationship to Black diasporic histories of migration. The Immigration Act of 1924 codified white ethnocentrism in US American citizenship rights, and thus represented a potential challenge to Black American citizenship claims. Here we reflect on Black American rhetorical practices as a mode of worldmaking; of laying claim to putatively white space and US American citizenship. Through this lens, Black migration and consequent transformation of space functions as a transgressive practice for a people who are perpetually positioned outside of nationality, a way of reclaiming ownership over the spoils of unwilling labor. These Black rhetorical practices echo through the diaspora, as those who built but do not own push back against the ontological negation of ethnonationalist citizenship and immigration policies dictated by white and western imperial powers, in favor of speaking themselves into belonging.

US American empire and the telos of US immigration law from 1924 to 2024

ABSTRACT Reflecting on the 100th anniversary of the 1924 Immigration Act, this brief essay suggests that the idea of “US American Empire” forms the telos of the last one hundred years of US immigration policy. Whether in the twentieth or the twenty-first centuries, or under Republican or Democratic leadership, US lawmakers have sought to restrict immigration to those who were deemed most “assimilable.” Such moves are not only about preserving or instituting a particular racial character of the United States but ensuring a particular role for the United States globally.

Lee McGuigan, Selling the American People: Advertising, Optimization, and the Origins of Adtech , Cambridge, MIT Press, 2023, 338 p.

Lee McGuigan, Selling the American People: Advertising, Optimization, and the Origins of Adtech , Cambridge, MIT Press, 2023, 338 p.

Building an evidence engine to promote more responsive government

AbstractPublic agencies require timely and reliable evidence to adapt operations and strategies quickly to effectively tackle unanticipated challenges in service to the American people. Federal agencies are generally not well equipped to take full advantage of the resources they own to effectively align with evidence needs. Guidance has been issued to fill this gap, yet federal agencies have not fully adopted the use of evidence, especially performance data, in decision‐making. Moreover, both law and academia provide little guidance on how agencies can connect the demand and supply of knowledge. This paper discusses how the Federal Acquisition Service (FAS) of the General Services Administration (GSA) has developed and sustained a framework for collecting and transforming data into reliable evidence to inform decision‐making, that is, created an evidence engine. Federal agencies can learn from the FAS approach to improve their evidence‐building activities to achieve economies of scale, reduce costs, and increase evidence‐informed responsiveness to ever‐changing needs.

Abstract A014: Racial and socioeconomic disparities in breast feeding and the impact of pregnancy-related medical conditions among a population-based sample of non-Hispanic Black and White women

Abstract Background: Breastfeeding has been associated with a reduced risk of breast cancer (BC), particularly with Triple Negative BC (TNBC). The risk of TNBC is higher among premenopausal women, Black/African American (AA) women, and poorer women. Notably there are significant disparities in breastfeeding, where non-Hispanic Black (NHB) women and poorer women are less likely to breastfeed in the United States. Studies have identified historical racial trauma, unsupportive work and hospital policies, breast milk formula advertising, and knowledge and beliefs about breast feeding as factors that contribute to breast feeding practices. However, there is a paucity of research on pregnancy related medical conditions (PMCs) that potentially impact initiation and duration of breastfeeding. The purpose of this study is to evaluate racial and socioeconomic differences in breastfeeding, and if PMCs impact breastfeeding practices in a population-based sample of non-Hispanic Black and White women. Method: Data are from the Young Women’s History and Health Study (YWHHS), a population- based case-control study of invasive BC among non-Hispanic Black (NHB) and non-Hispanic White (NHW) women aged 20-49 years residing in Metropolitan Detroit and Los Angeles County, 2010-2015. The analytic sample here includes the first pregnancy of control participants with singleton live births (n=675). Area-based control participants were sampled from the 2010 Census. Interviews assessed complete reproductive histories, including breastfeeding history (never, &amp;lt;6 months, and ≥6 months), PMCs experienced during pregnancy, self-reported race, and household financial struggles before age 13 years (to approximate childhood socioeconomic position (chSEP)). PMCs examined included: 1) premature birth, 2) diabetes or pre-diabetes related PMCs, 3) blood pressure-related PMCs, and 4) BMI ≥ 25 kg/m2 at age 18 years. Weighted percentages were evaluated with a chi-square test and considered significant at p &amp;lt; 0.05. Analyses were further stratified by race/ethnicity and chSEP. Result: NHB women were 2.4 times significantly more likely to never breastfeed than NHW women (W% =52.0 (NHB) and 21.3 (NHW), p=&amp;lt;0.0001). Similarly, women with lower compared to higher chSEP were 1.5 times significantly more likely to never breastfeed (W% = 42.7 (lower chSEP) and 28.5 (higher chSEP), p=0.003). Those with BMI ≥ 25 kg/m2 at age 18 years (p&amp;lt;0.001) alone, and with one or more PMCs (p=0.01) were also less likely to breastfeed. When stratified by race/ethnicity the pattern of breastfeeding did not differ significantly by any PMC within NHB and NHW women. When stratified by chSEP, however, BMI ≥ 25 kg/m2 at age 18 years (p = 0.004) and having one or more PMCs (p=0.03) were significantly associated with never breastfeeding among those with higher chSEP. Conclusion: NHB women and women with lower chSEP were substantially less likely to breastfeed. Additionally, BMI ≥ 25 kg/m2 at age 18 and PMCs were associated with lower frequency of breastfeeding overall and among those with higher chSEP. Citation Format: Meheret B. Gebreegziabher, Lydia R. Post, Chris C. Cho, Zhenzhen Zhang, Kelly A. Hirko, Dorothy R. Pathak, Ann S. Hamilton, Ann G. Schwartz, Ellen M. Velie. Racial and socioeconomic disparities in breast feeding and the impact of pregnancy-related medical conditions among a population-based sample of non-Hispanic Black and White women [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr A014.

California’s AB 101

In 2021, California governor Gavin Newsom signed into law AB 101, which requires that all students graduating high school by 2029–2030 must take an ethnic studies course. California is the only state in the nation with this graduation requirement. This article explores the historical and contemporary factors that pushed California to legislate and implement AB 101. We utilize a historical case study approach focusing on different student-led movements that embraced ethnic studies to combat educational inequalities. To do so, we pinpoint three historical phases in which ethnic studies became implemented throughout the state. In the first phase, influential scholars in the early and mid-twentieth century produced scholarship about historically marginalized people of color, which became foundational for the study of Black, Chicana/o, Asian American, and Indigenous people. The second phase involved students of color fighting for a culturally relevant curriculum, as demonstrated by the 1968 Third World Liberation Front, the 1968 East Los Angeles Chicano walkouts, El Plan de Santa Bárbara, and Chicanx/Latinx student hunger strikes in the 1990s. Lastly, the third phase consists of contemporary students, parents, educators, and activists successfully petitioning their local school districts to mandate ethnic studies as a high school graduation requirement. Despite these gains, far-right organizations in cities like Santa Barbara have mobilized to push back against both the ethnic studies requirement and progressive social justice groups like Just Communities Central Coast. This resistance initially derailed AB 331, an earlier ethnic studies bill that Governor Newsom vetoed based on accusations that it was “anti-Semitic.” A revised version, AB 101, was then introduced and passed. While momentous, we contend, AB 101 is still limited; reaching its full potential would require greater teacher credentialing and the expansion of ethnic studies to K–8 students.

Cultural tailoring advance care planning for an American Indian community: make your wishes about you

ABSTRACT Background Advance care planning empowers people by allowing them some control over certain healthcare decisions in the event they are unable. Yet, advance care planning rates in the American Indian and Alaska Native populations are low. Thus, we culturally tailored the Make Your Wishes About You (MY WAY), an intervention to improve advance care planning access and completion for American Indian peoples. Methods In partnership with an American Indian Tribe, the project took a community-based participatory orientation and relied on a Community Advisory Board and a Professional Advisory Board. The culturally tailoring was a 15-step process. These steps allowed us to ensure that the tailoring reflects community-specific norms and preferences, greater reliance on visual images and local idioms of expression, more appropriate attention to family roles, and inclusion of spiritual elements. Results A four-phase cultural tailoring framework emerged with each phase centering around listening, learning, and analyzing with tailoring occurring between each phase. A culturally tailored MY WAY was created, which was delivered in a manner that reflected Tribal citizenss' preferences. Materials included Tribal language, local idioms of expression, attention to family roles, and appropriate inclusion of spiritual elements. The materials were rated high on a content validity index by the advisory board members. Conclusion There is a growing interest in tailoring existing evidence-based programs with relatively little in the literature offering guidance. By sharing our efforts and experiences in culturally tailoring an advance care planning program for an American Indian Tribe, we hope that it will serve useful for future efforts in ensuring that evidence-based programming reaches those in greatest need. While this project was rooted in the core Indigenous values of community, ceremony or spirituality, language, and place it also lends itself to broader translation across different populations.

Firearm Homicide Mortality is Linked to Food Insecurity in Major US Metropolitan Cities.

Gun violence disproportionately affects metropolitan areas of the United States (US). There is limited information regarding the influence of social determinants of health, such as food insecurity (FI) on firearm homicide mortality (FHM) in major metropolitan cities in the US. We sought to examine the relationship between FI and FHM. This was a cross-sectional analysis examining the largest 51 US major metropolitan statistical areas (MSAs) using data from 2018. Demographic data, markers of social inequities, and firearm homicide data were obtained from the US Census Bureau, US Department of Education, and the Frey and Brookings Institute. Food insecurity prevalence was obtained from Feeding America. Spearman ρ and linear regression were performed. Using Spearman rho analysis, higher FI (r = 0.55, P < 0.001) was associated with FHM. Other variables associated with FHM included percent Black/African American (AA) (r = 0.77, P < 0.001), poverty rate (r = 0.53, P < 0.001), and percent of children living in single parent households (r = 0.58, P < 0.001). In linear regression analyses, FI was associated with increased FHM, with 1.3 additional FHM events for each unit increase in FI (β = 1.33, 95% CI 0.27-2.39, P = 0.02). The percent of a population that is Black/AA was also associated with FHM, with more than 4 additional cases for each 1% increase in the population (β = 4.32, 95% CI 3.26-5.38, P < 0.001). Food insecurity may influence FHM in major US metropolitan cities. Community- and hospital-based programs that target FI may help combat the gun violence epidemic and decrease gun violence.

Mother's Milk Donation to a Human Milk Bank During Bereavement: Circumstances Associated with Completing the Donation Process.

Background: Bereaved mothers describe positive experiences donating breast milk and negative experiences when not informed of opportunities to donate. Predictors of whether mothers donate milk are unknown, impairing efforts to optimize support in completing donation. Objective: To define circumstances associated with completing mother's milk (MM) donation during bereavement. Methods: A retrospective cohort study included dyads of bereaved mothers and their deceased children if a child's death occurred on-site at a quaternary care children's hospital during 2016-2020, the child had documentation of MM availability, and age at death <24 months. The primary outcome was the completion of MM donation to the milk bank. Multivariate logistic regression measured associations between clinical variables and odds of completion. Results: Of 124 deceased children with documented MM exposure, 34 mothers (28%) of 35 of those children completed MM donation, donating a mean of 13.7 liters (SD 16.8). The child's race/ethnicity documented in the medical record was White for 25 (71%), Black/African American (AA) for 1 (3%), Asian for 1 (3%), and Hispanic/Latino for 8 (23%). Referenced to mothers of White children, being a mother of an AA [OR 0.05 (95% CI: 0.01-0.43)] or Asian [0.08 (0.01-0.75)] child was associated with lower odds of donation. Referenced to mothers delivering full term (≥37 weeks'), mothers delivering <34 weeks showed higher odds [5.0 (1.5-17.5)] of donation. Conclusion: Relatively few bereaved mothers of children with indicators of MM exposure completed donation. The results suggest an opportunity to ensure bereaved mothers are uniformly informed and supported in donating.

Addressing the Impacts of Racism on American Indian and Alaska Native Child Health

The legacy of racism toward Native Americans is far-reaching. We will review the topic using the conceptual model of racism as a form of violence as it is inherent in racism, as are prejudice and power. Using the basic frameworks of racism as internalized, interpersonal, institutional, and structural, we will discuss the many types of racism affecting Native Americans today. Racism is the bedrock of generations of trauma experienced in Native communities. The generational/historical trauma of racism has led to epigenetic-level changes affecting Native American people today. We will cover the health impacts of racism and the many institutions built in racist frameworks that continue to perpetuate racism, such as family separation and child removal by child protective services, adverse policing, and disparate incarceration. These allow reflection on policies and the intentionality of racist structures. We will conclude with what can and should be done, particularly as clinicians who work within and adjacent to existing systems of oppression.