Urban Minority Research Articles

Research Attitudes and Interest Among Elderly Latinxs: The Impact of a Collaborative Video and Community Peers.

Latinx elders are underrepresented in dementia research. In a previous study we assessed research attitudes in urban minority elders and found a significant minority expressed neutral to negative attitudes relating to trust, safety, and personal responsibility to help research. To assess the impact of a composite intervention on attitudes toward research and research participation among elderly Latinx. The intervention was a collaboratively produced research participation video shown during presentations with our elderly community advisory board (CAB) as co-presenters. The video was created by the ADRC and CAB. All senior center attendees were eligible to participate. Afterwards, the Research Attitudes Questionnaire (RAQ) and a brief questionnaire on the impact of the video were administered. Using Wilcoxon Rank Sum Tests, Chi Square, and OLS regressions, RAQ responses were compared to those from a historical cohort from similar centers. 74 in the "Historical Cohort 1" and 104 in "Intervention Cohort 2" were included. RAQ total score was higher in Cohort 2 than Cohort 1 (28.5 versus 26.1, p < 0.05) after controlling for age, education, and country of origin. In response to the question "Has the video influenced your willingness and interest to participate in research", 88.7%of the participants in Cohort 2 reported being "more" or "much more" interested in research. Tailoring community research recruitment programs to include relatable peers using novel recruitment techniques may have positive implications for improving enrollment of diverse elderly individuals in research.

Abstract 2553: Using a “train-the-trainer” approach with urban and rural minority community health workers to implement the cancer-Community Awareness Access Research and Education (c-CARE) Project

Abstract Introduction: Community health workers (CHW) are often a key component to effective implementation of health promotion interventions; training on intervention delivery and self-efficacy enhances CHW effectiveness. The cancer-Community Awareness Access Research and Education (c-CARE) project utilized a train-the-trainer approach to equip CHWs to teach the four-week c-CARE lung cancer module. Project objectives included providing and facilitating: 1) education on risks of lung cancer, 2) low-dose CT (LCDT) screening for eligible participants, 3) smoking cessation, and 4) training CHWs to deliver the educational intervention and thus promote sustainability. Methods: Lay CHWs (n=63, 54 urban, 9 rural, 92% female, 56% having ≥Bachelors degree, 79% healthcare providers) were selected from 16 historically African American (AA) churches (n = 9 urban, 3 rural), Federally-Qualified Health centers (n=3) and one community center, all in Georgia or South Carolina. CHW inclusion criteria included pastor recommendation from the churches' healthcare ministry (primarily nurses and other allied health professionals) or community clinic workers who were public health practitioners, nurses, and paraprofessionals. CHWs participated in a 2-day implementation training. Training topics included: their role as a c-CARE facilitator, knowledge of cancer risk factors and lung cancer screening, and using the c-CARE materials to teach the sessions. Pre and post surveys assessed knowledge, satisfaction with the training, and self-efficacy regarding teaching the content. Responses were summarized; all significance tests were two-tailed using a significance level of 0.05. Result: Improvement in each of the six items was strongly significant (p &amp;lt; 0.001), with a mean improvement of at least 2 points on the 0-10 scale in: 1) understanding of their roles as c-CARE facilitators, 2) knowledge of cancer risk factors, 3) knowledge of lung cancer screening, 4) confidence in conducting a c-CARE group, 5) confidence in their abilities to implement a policy change, and 6) confidence in using c-CARE materials to teach participants. Participants also reported satisfaction with the c-CARE training they received. There were no significant differences between urban and rural CHW participants. CHWs conducted 64 sessions for 586 participants as a part of the c-CARE project. Discussion: Use of lay CHWs to deliver culturally competent cancer education and screening navigation was an important component of the c-CARE project. Increases in knowledge regarding cancer risk factors, screening requirements, and self-efficacy in leading the sessions were reported by the CHWs. Use of local lay CHWs ensures sustainability, positively affecting community knowledge, attitude and beliefs regarding lung cancer, prevention, and screening behaviors. Citation Format: Marlo M. Vernon, Ghadeer Albashir, Samantha J. Sojourner, Justin X. Moore, Stephen W. Looney, Martha S. Tingen. Using a “train-the-trainer” approach with urban and rural minority community health workers to implement the cancer-Community Awareness Access Research and Education (c-CARE) Project [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr 2553.

Trajectories of adiposity indicators and association with asthma and lung function in urban minority children

A relationship between adiposity and asthma has been described in some cohort studies, but little is known about trajectories of adiposity throughout early childhood among children at high risk for developing asthma in urban United States cities. Moreover, early life trajectories of adipokines that have metabolic and immunologic properties have not been comprehensively investigated. Our objective was to characterize trajectories of adiposity in a longitudinal birth cohort of predominately Black and Latinx children (n= 418) using several different repeated measures including body mass index (BMI) z score, bioimpedance analysis, leptin, and adiponectin in the first 10 years of life. In a longitudinal birth cohort of predominately Black and Latinx children, we used repeated annual measures of BMI, bioimpedance analysis (ie, percentage of body fat), leptin, and adiponectin to create trajectories across the first 10 years of life. Across those trajectories, we compared asthma diagnosis and multiple lung function outcomes, including spirometry, impulse oscillometry, and methacholine response. Three trajectories were observed for BMI z score, bioimpedance analysis, and leptin and 2 for adiponectin. There was no association between trajectories of BMI, percentage of body fat, leptin, or adipokine and asthma diagnosis or lung function (P> .05). Trajectories of adiposity were not associated with asthma or lung function in children at high risk for developing asthma. Risk factors related to geography as well as social and demographic factors unique to specific populations could explain the lack of association and should be considered in obesity and asthma studies.

Maternal pre-pregnancy weight and early life lower respiratory tract infections in a low-income urban minority birth cohort

The prevalence of maternal obesity has increased dramatically with adverse consequences on infant health. Prior studies have reported associations between maternal obesity and childhood wheeze, asthma as well as lower respiratory tract infections (LRTI). However, studies examining the association of obesity with early-life LRTIs in low-income urban minority populations are still lacking. This is a critical gap because both obesity and infant respiratory morbidity are more prevalent and severe in these communities. We examined mother‐child dyads from the Boston Birth Cohort (BBC) to define the longitudinal association of maternal pre‐pregnancy BMI and LRTI in infancy, defined as the presence of bronchiolitis, bronchitis, or pneumonia during the first year of life (< 12 months of age). A total of 2,790 mother‐child dyads were included in our analyses. Infants born to pre-pregnancy obese mothers (n = 688, 25%) had 1.43 increased odds (adjOR = 1.43, 95% CI 1.08–1.88, p = 0.012) of developing LRTI during the first year of life when compared with newborns born to normal-weight mothers after adjusting by relevant LRTI risk factors. Notably, infants born to overweight mothers (n = 808, 29%) followed a similar trend (adjOR = 1.31, 95% CI 1.00–1.72, p = 0.048). Our study demonstrated that maternal pre-pregnancy obesity is an independent risk factor for the development of LRTI during infancy in a low-income urban minority birth cohort.

The Urban Youth Trauma Center: A Trauma-Informed Continuum for Addressing Community Violence Among Youth.

Contemporary community violence has escalated into a national public health crisis with urban youth, particularly ethnic minorities, suffering disproportionate negative impacts. The Urban Youth Trauma Center (UYTC) promotes a trauma-informed continuum of prevention-to-intervention services that combines community-based and clinic-based manualized protocols designed to reduce and prevent community violence for youth and families. Based on a socio-ecological model, UYTC has the main goals of addressing community violence and related traumatic stress as well as co-occurring conditions of substance abuse and disruptive behavior problems in urban youth by: (1) raising public awareness; (2) disseminating specialized trauma-informed training; and (3) mobilizing service system coalitions. UYTC employs this evidence-based yet flexible structure for disseminating, implementing, and evaluating trauma-informed training as a means of contributing to the reduction and prevention of community violence for low-income urban minority youth and families who bear the biggest burden of this current crisis.

Asthma and Physical Activity in Urban Children.

Asthma and obesity disproportionately affect urban minority children. Avoidance of physical activity contributes to obesity, and urban children with asthma are at risk for lower levels of physical activity. We examined associations between lung function and moderate to vigorous physical activity (MVPA) and moderators of this association in a diverse sample of children with asthma. Urban children (N = 142) ages 7-9 with persistent asthma and their caregivers completed a study of asthma and physical activity. Longitudinal mixed effects models examining daily-level asthma and physical activity evaluated the association between asthma and MVPA, and the moderating effect of weight, and cultural/contextual factors on this association. Average daily MVPA was below recommended guidelines. Differences in MVPA were found by racial/ethnic group (p = .04) and weight (p = .001). Poorer asthma status was associated with lower MVPA in Latino and Black participants (p's < .05), and in normal weight youth (p = .01). Body mass index (BMI) moderated the association between asthma and MVPA. Those with lower BMI had more optimal asthma status and higher MVPA levels, whereas associations attenuated for participants with higher BMI (p = .04). Caregivers' perceptions of neighborhood safety and fear of asthma were marginally associated with children's symptoms and MVPA: as perceptions of safety decreased and fear increased, associations between asthma and MVPA weakened (p's = .09 and .07, respectively). Suboptimal asthma status is associated with less MVPA in urban children. Weight status and cultural/contextual factors play a role in the association and are worthy targets for future research and intervention.

Psychosocial stress, sleep quality and interest in mind-body integrative health sleep intervention among urban adolescents in the school-based health setting

BackgroundMind-body integrative health (MBIH) interventions to improve adolescent sleep are lacking. The study characterized sleep quality and bedtime-related psychosocial stressors among urban minority adolescents, explored associations between demographics factors, stressors and sleep quality, and gauged interest in a MBIH sleep intervention. Materials and methods167 school-based health center (SBHC) patients (mean age = 16.3; 64 % female; 68 % Latino) participated in a needs assessment as part of a quality improvement project. They reported bedtime-related psychosocial stressors using items from the Adolescent Sleep Hygiene Scale (ASHS), sleep quality using the Pittsburgh Sleep Quality Index (PSQI), and interest in a MBIH-based sleep intervention. Chi-square and logistic regression examined associations between demographics, stressors, sleep quality, and interest in the intervention. Results67 % had poor sleep quality. Females, compared to males, had 2.23 higher odds (95 % Confidence Interval [CI]: 1.12, 4.42) of having poor sleep quality. Nearly 80 % experienced bedtime-related stressors (25 % experienced one stressor, 17 % two stressors and 37 % three or more stressors); relative to those reporting no stressors, those reporting 3+ stressors had 3.15 higher odds (95 % CI: 1.27, 7.84) of having poor sleep quality. Most (77 %) reported they would participate in an SBHC-based intervention that utilized MBIH modalities preferring both one-on-one and group sessions. ConclusionsUrban, predominantly Hispanic and Black, SBHC adolescent patients have poor sleep quality and report bedtime-related psychosocial stressors. Their interest in MBIH interventions to address sleep problems represents a unique opportunity for practitioners and complementary therapists to offer MBIH interventions to a population at high-risk for poor sleep quality.

Urbanizing Minority Minzu in the PRC: Insights from the Literature on Settler Colonialism

This article provides a synthesis and critical review of the literature on urban minority minzu 民族 in the People’s Republic of China (PRC). The vast majority of the Chinese-language literature on minorities in cities adopts a state-centric view through the lens of stability and integration, focusing on how minorities can adapt to urban life for the purpose of creating a “harmonized” society. This statist narrative not only denies the subjectivity of minorities in the city but also constrains the understandings of the dynamics of urban indigeneity. In this article, we draw on the literature of urban Indigenous peoples in settler colonial contexts to suggest new ways of examining the urban experience of minority minzu in the PRC. We suggest that this literature provides useful insights that help center the subjectivities and agency of Indigenous people in the PRC’s cities. Literature on urban minorities in the PRC can be expanded by engaging with the Indigenous urbanization literature to include coverage of three topics: representation (how minority people are shown as belonging to the city), mobilization (the use of urban space by minority people to pursue social, cultural, and political projects), and mobility (movement and interconnectedness between rural homelands and the city).

A Pharmacist and Health Coach-Delivered Mobile Health Intervention for Type 2 Diabetes: Protocol for a Randomized Controlled Crossover Study.

BackgroundAggressive management of blood glucose, blood pressure, and cholesterol through medication and lifestyle adherence is necessary to minimize the adverse health outcomes of type 2 diabetes. However, numerous psychosocial and environmental barriers to adherence prevent low-income, urban, and ethnic minority populations from achieving their management goals, resulting in diabetes complications. Health coaches working with clinical pharmacists represent a promising strategy for addressing common diabetes management barriers. Mobile health (mHealth) tools may further enhance their ability to support vulnerable minority populations in diabetes management.ObjectiveThe aim of this study is to evaluate the impact of an mHealth clinical pharmacist and health coach–delivered intervention on hemoglobin A1c (HbA1c, primary outcome), blood pressure, and low-density lipoprotein (secondary outcomes) in African-Americans and Latinos with poorly controlled type 2 diabetes.MethodsA 2-year, randomized controlled crossover study will evaluate the effectiveness of an mHealth diabetes intervention delivered by a health coach and clinical pharmacist team compared with usual care. All patients will receive 1 year of team intervention, including lifestyle and medication support delivered in the home with videoconferencing and text messages. All patients will also receive 1 year of usual care without team intervention and no home visits. The order of the conditions received will be randomized. Our recruitment goal is 220 urban African-American or Latino adults with uncontrolled type 2 diabetes (HbA1c ≥8%) receiving care from a largely minority-serving, urban academic medical center. The intervention includes the following: health coaches supporting patients through home visits, phone calls, and text messaging and clinical pharmacists supporting patients through videoconferences facilitated by health coaches. Data collection includes physiologic (HbA1c, blood pressure, weight, and lipid profile) and survey measures (medication adherence, diabetes-related behaviors, and quality of life). Data collection during the second year of study will determine the maintenance of any physiological improvement among participants receiving the intervention during the first year.ResultsParticipant enrollment began in March 2017. We have recruited 221 patients. Intervention delivery and data collection will continue until November 2021. The results are expected to be published by May 2022.ConclusionsThis is among the first trials to incorporate health coaches, clinical pharmacists, and mHealth technologies to increase access to diabetes support among urban African-Americans and Latinos to achieve therapeutic goals.International Registered Report Identifier (IRRID)DERR1-10.2196/17170

Mental Health of High-Risk Urban Youth: The Housing Subsidies Paradox.

Housing subsidies, including public housing and Section 8 vouchers, are key components of the social safety net, intended to promote family and child welfare. Studies evaluating the impact of housing subsidies on child and adolescent mental health, however, are generally inconclusive. This may reflect variation in the influence by type of subsidies to income, improved physical environment, increased access to resources, and improved perception of neighborhood safety. Further, most prior research focused on housing subsidies failed to simultaneously formally assess child psychopathology. In the present study, we examine, among adolescents (ages 9-17) from a low-income, urban minority area, the association of housing with psychiatric symptoms and disorders, as well as with their social functioning. The data were obtained from the Stress & Justice Study (S&J) baseline survey, an investigation designed to examine impact of parental criminal justice system involvement (CJSI) on their children's mental health. Housing type during the past year was categorized from parental report as public housing, section 8, both, or neither. Child mental health was assessed with the Diagnostic Interview Schedule for Children (DISC). Additionally, family resources and physical quality of the housing environment by housing type was assessed, and we tested whether these dimensions mediated associations of housing type with the adolescent's current mental health outcomes. We found that while internalizing and externalizing disorders and impairment were attenuated by individual characteristics (e.g., SES, CJSI), internalizing and externalizing symptom counts were significantly more prevalent among children in subsidized housing, compared to those in non-subsidized housing, after controlling for individual characteristics. These findings have the potential to inform whether, and through which mechanisms, housing subsidies are associated with adolescent mental health.

Psychosocial Moderators and Outcomes of a Randomized Effectiveness Trial for Child Asthma.

Psychosocial factors play a role in child asthma morbidity and disparities, but their impact on asthma intervention effectiveness is less understood. This study examined how child, parent, and family psychosocial factors moderated asthma response to, and changed in response to, 2 community asthma interventions among urban minority youth. Asthma Action at Erie was a randomized comparative effectiveness trial examining a community health worker (CHW) home intervention versus certified asthma educator (AE-C) services for children aged 5-16 with uncontrolled asthma (N = 223; mean age = 9.37, SD = 3.02; 85.2% Hispanic). Asthma control was assessed via the Asthma Control Test (ACT)/childhood ACT and activity limitation. Baseline child/parent depression and posttraumatic stress disorder (PTSD) symptoms, family chaos, and social support were examined as treatment moderators. We also tested intervention effects on psychosocial outcomes. For parents with higher baseline depression symptoms, youth in the CHW group had greater ACT improvement by 24 months (7.49 points) versus AE-C (4.76 points) and 51% reduction in days of limitation by 6 months versus AE-C (ß = -0.118; p = .0145). For higher parent PTSD symptoms, youth in CHW had 68% fewer days of limitation at 24 months versus AE-C (ß = -0.091; p = .0102). Psychosocial outcomes did not vary by group, but parent depression, parent and child PTSD symptoms, and social support improved for all. CHW intervention was associated with improved asthma control among families with higher parent strain. Findings have implications for utilizing tailored CHW home interventions to optimize asthma outcomes in at-risk families.

Disparities in Health Care Access and Utilization at the Intersections of Urbanicity and Sexual Identity in California.

Purpose: The aim was to examine differences in health care access at the intersections of urbanicity and sexual identity in California. Methods: We used the 2014-2017 Adult California Health Interview Survey paired with the sexual orientation special use research file to create dummy groups representing each dimension of urbanicity and sexual identity to compare access to health care outcomes. We calculated unadjusted proportions and estimated adjusted odds ratios of each dimension relative to urban heterosexual people using logistic regressions. Results: Relative to urban heterosexual people, urban gay/lesbian people had 1.651 odds of using the emergency room (ER). Urban bisexual people had 1.429 odds of being uninsured, 1.575 odds of delaying prescriptions, and 1.907 odds of using the ER. Rural bisexual people experienced similar access barriers having 1.904 odds of uninsurance and 2.571 odds of using the ER. Conclusions: Our study findings demonstrated disparate access to health care across sexual orientation and rurality. The findings are consistent with literature that suggests urban and rural sexual minority people experience health care differently and demonstrate that bisexual people experience health care differently than gay/lesbian people. These findings warrant further study to examine how social identities, such as race/ethnicity, interact with sexual orientation to determine health care access. Furthermore, these findings demonstrate the need to emphasize the health care access needs of sexual minority people in both rural and urban areas to eliminate health care access disparities.

Prenatal and Perinatal Risk Factors for Lower Respiratory Tract Infections in Inner-city Minority Infants

Children born in urban minority populations are at higher risk of respiratory morbidity, including lower respiratory tract infections (LRTI) and the ongoing COVID-19 pandemic. There is a critical need to identify risk and protective factors for LRTI in this vulnerable population.

The role of asylum in processes of urban gentrification

This article analyses the relationship between the accommodation of Dispersed asylum seekers and urban gentrification in the UK. We argue that alongside other racialised and classed minorities, asylum seekers are vulnerable to spatial strategies associated with gentrification such as neighbourhood ‘dumping’, containment and ‘territorial stigmatisation’, the highly coercive quality of the UK government’s Dispersal Scheme means that any relationship between asylum and gentrification must be treated as deliberate, the result of the multiscalar interests which have a stake both in Dispersal and urban ‘development’. Drawing on empirical research conducted in Glasgow, the recipient of the largest asylum seeking population annually in the UK, we find that asylum accommodation processes and gentrification have developed a symbiotic dynamic, whereby the ‘failure’ of mid twentieth-century urban ‘regeneration’ provided means and motive for Dispersal, and Dispersal provided sufficient resources to fuel further rounds of urban ‘regeneration’. We also find that recent changes to the Dispersal contract, from a dynamic in which resources were associated with housing availability, to one in which they are associated with maximum housing capacity, have created conditions for alternative forms of gentrification, in which strategies such as rent gap suppression are seen as having potential to yield more capital than infrastructural development. Finally, we argue that the respective spatial politics of both Dispersal and gentrification must be understood as mutually-interested, coercive technologies, which work together to contain and exploit racialised and bordered urban minorities. We call for urgent further research into how the asylum border is embedded in contemporary urban spatial economies.

Small-Groups Versus Full-Class Exergaming on Urban Minority Adolescents' Physical Activity, Enjoyment, and Self-Efficacy.

The effects of school-based exergaming interventions on adolescents' physical activity (PA) and psychosocial outcomes have been mixed. Researchers speculate this may be attributed to design issues. Therefore, this study examined differences in urban minority adolescents' PA, enjoyment, and self-efficacy during small-groups and full-class exergaming. Forty-seven urban minority adolescents (83% black; X¯age=11.8+1.3 y) completed two 15-minute exergaming sessions on the Xbox One Kinect Just Dance: (1)small groups (n = 3-4) and (2)full class (n = 23-24). Participants' time in sedentary behavior, light PA, and moderate to vigorous PA and steps were retrieved from ActiGraph GT3X+ accelerometers with enjoyment and self-efficacy assessed using validated surveys. Participants spent significantly more time in sedentary behavior (5.9 [5.2] min vs 3.5 [2.7] min, respectively: P < .001, d = 0.57) and less time in moderate-to-vigorous PA (2.1 [2.8] min vs 5.5 [2.2]min, respectively: P < .001, d = 0.85) during the full-class versus the small-groups session. Moreover, small-groups exergaming resulted in significantly higher steps than the full-class exergaming (504.2 [132.1] vs 387.8 [122.1], respectively: P = .01, d = 0.50) and significantly greater enjoyment (3.5 [1.1] vs 3.2 [1.0], respectively: P = .02, d = 0.37). There were no significant differences between sessions for time in light PA and self-efficacy. Small-groups exergaming appears ideal for promoting enjoyable PA at higher intensities and lower sedentary time in underserved minority adolescents.

Increasing HIV/AIDS knowledge among urban ethnic minority youth: Findings from a community-based prevention intervention program

HIV (Human Immunodeficiency Virus)/AIDs (Acquired immunodeficiency syndrome) prevention and research are imperative. Prevention-intervention programming is minimal in low-income communities of color. Additional research is needed that uncovers points of support and prevention to increase HIV knowledge and awareness and limit new HIV infections among adolescents of color. This study presents preliminary findings from a community-based HIV/AIDS, substance abuse, and viral hepatitis (VH) prevention education intervention for ethnic minority youth in a northeastern urban community. We evaluated HIV/AIDS knowledge and factors associated with knowledge. Participants (N = 599) completed a baseline survey followed by an exit survey measuring HIV/AIDS knowledge. Exit survey findings indicated that there was an increase in HIV/AIDs knowledge. Multivariate regression analyses showed that change scores in VH knowledge accuracy, sexual negotiation skills, risk perception, and ethnic identity were positively associated with change in HIV/AIDs knowledge score. The development and implementation of HIV/AIDS knowledge interventions can be crucial in alleviating new infections in the U.S.

Etiological Analysis of Reactive Gastropathy in an Urban Population

Background: Reactive gastropathy (RG) is an adaptive response to assaults of the gastric mucosa. Demographic information regarding RG as well as the coincidence of RG and gastrointestinal cancer are poorly characterized entities. Objective: Herein, we aim to investigate relationships of RG to both modifiable and nonmodifiable risk factors, as well as conduct a stratified analysis by race in an ethnically diverse, urban population. Methods: In this retrospective study, we queried an urban hospital inpatient pathology database searching for patients with surgical gastric biopsies positive for RG between March 25, 2015, and March 25, 2016. Of the 728 patients with a final diagnosis of RG, 292 were selected based on strict inclusion and exclusion criteria. We explored risk factors and conducted a stratified analysis for associations based on patient demographics. Results: In this urban minority population, nonsteroidal anti-inflammatory drugs (NSAIDs) were the most common medication associated with RG (Fig. 1), as well as the most common cause of RG, followed by chronic bile reflux. In addition, significant differences in demographics and gastropathic characteristics associated with RG, stratified by ethnicity, were found (Fig. 2). Notably, Hispanics, African Americans, and Caucasians had the highest rate of concomitant RG and diabetes, hypertension, and tobacco/alcohol use, respectively. Conclusion: Our study indicated that NSAID usage is the most common cause of RG, followed by bile reflux-mediated mucosal injury, in an ethnically diverse urban US-based population. Of note, few patients had intestinal metaplasia, suggesting it to be a slow or negligent sequela of RG.

Perceptions of the Osteopathic Profession in New York City's Korean Communities

Objective: The purpose of this study was to assess knowledge of and barriers to osteopathic medicine in Korean communities in New York City.&#x0D; Design: A cross-sectional study was designed in which a culturally appropriate survey in Korean and English versions was administered anonymously to measure community perceptions and knowledge of osteopathic medicine.&#x0D; Setting: Data collection occurred in the municipal delineations for the Bayside neighborhood within the New York, New York borough of Queens.&#x0D; Participants: Community members were selected using convenience sampling from high-density areas to participate. The survey included demographics, education level, health care habits and knowledge of the osteopathic profession.&#x0D; Results: 105 surveys were conducted with 47 males and 58 females, with an average age = 66. Only 14% (n=15) indicated knowledge about osteopathic manipulative medicine (OMM) and 9% (n=9) indicated knowledge of osteopathic physicians (DOs), with the primary language spoken at home (Korean) as the sole statistically significant factor in recognition of OMM and DOs among the study variables.&#x0D; Conclusion: Compared to research on the general U.S. population, a general lack of knowledge of osteopathic medicine exists within New York City's Korean community. Although this difference may be ascribed to linguistics and ethnosociological factors, greater outreach and education is needed in urban minority communities to make immigrants aware of all health care resources available during the current shortage of primary care physicians in the U.S.

Prenatal exposure to mercury and precocious puberty: a prospective birth cohort study

Abstract STUDY QUESTION Is in utero exposure to mercury associated with the risk of precocious puberty? SUMMARY ANSWER Prenatal exposure to high levels of mercury was associated with increased risk of precocious puberty, which was strengthened by concomitant maternal cardiometabolic conditions and adverse birth outcomes. WHAT IS KNOWN ALREADY The developing fetus is sensitive to mercury, a well-known endocrine disruptor which impacts the endocrine and reproductive system. STUDY DESIGN, SIZE, DURATION This study included 1512 mother–child pairs from the Boston Birth Cohort, a longitudinal cohort which recruited at birth and followed prospectively up to 21 years of age. PARTICIPANTS/MATERIALS, SETTING, METHODS Mother–child pairs, from a predominantly urban minority population, were enrolled from 2002 to 2013. Prenatal exposure was assessed by maternal mercury concentration in red blood cells (RBCs) collected at 1–3 days after delivery. Precocious puberty was defined based on International Classification of Disease codes. Cox proportional hazards models were applied to the association between maternal mercury concentrations and the risk of precocious puberty. MAIN RESULTS AND THE ROLE OF CHANCE The median (interquartile range) of maternal mercury concentrations among children with and without precocious puberty were 3.4 (1.9–4.6) µg/l and 2.0 (1.0–3.7) µg/l, respectively. Compared to those in the lowest tertile for mercury, the highest tertile was associated with increased risk of precocious puberty, with an adjusted hazard ratio (HR) of 2.41, 95% CI: 1.16–5.03. In addition, concomitant maternal cardiometabolic conditions and adverse birth outcomes strengthened the effects of mercury on the risk of precocious puberty. The highest risk of precocious puberty was observed among children who had adverse birth outcomes and whose mothers had high RBC-mercury concentrations along with cardiometabolic conditions, with an HR of 4.76 (95% CI: 1.66–13.60) compared to children with favorable profiles of all three risk factors. LIMITATIONS, REASONS FOR CAUTION Precocious puberty was defined based on medical records, not on a direct assessment, which may have led to underdiagnosis and the inability to make a subclassification. The study included a predominately urban, low-income, minority population and as such our findings may not be widely generalizable. WIDER IMPLICATIONS OF THE FINDINGS Prenatal Hg exposure was associated with an increased risk of precocious puberty. This risk was strengthened by concomitant maternal cardiometabolic conditions during pregnancy and adverse birth outcomes. STUDY FUNDING/COMPETING INTEREST(S) This study was funded by the NIH/National Institute of Environmental Health Sciences, NIH/Eunice Kennedy Shriver National Institute of Child Health and Human Development and the Health Resources and Services Administration of the U.S. Department of Health and Human Services. The authors declare no conflicts of interest. TRIAL REGISTRATION NUMBER N/A.

Social Determinants of Pharmacy Deserts in Los Angeles County

As medications are commonly used to prevent and mitigate chronic diseases and their associated complications and outcomes, limited geographic access to medications in communities that are already plagued with health inequity is a growing concern. This is especially important because low-income urban minority communities often have high prevalence and incidence of cardiometabolic and respiratory chronic conditions. Community pharmacy deserts have been established in Chicago, New York, and other locales. In part because the definition was originally adapted from the concept of food deserts, existing studies have either utilized the distance of 1 mile or greater to the nearest community pharmacy solely, or used distance along with the same predefined social indicator thresholds that define food deserts (i.e., income and vehicle ownership), to define and identify areas as pharmacy deserts. No full analysis has been conducted of the social determinants that define and characterize medication shortage areas within a given locale, even though medication and food are usually accessed independently. Therefore, to address this gap in the literature, this study was designed to identify all potential “pharmacy deserts” in Los Angeles County based on distance alone and then characterize them by their social determinants of health (SDOH) indicators. Geographic pharmacy deserts were identified as census tracts where the nearest community pharmacy was 1 mile or more away from a tract centroid. K-means clustering was applied to group pharmacy deserts based on their composition of social determinants of health indicators. Twenty-five percent (571/2323) of LA County census tracts were pharmacy deserts and 75% (1752/2323) were pharmacy non-deserts. Within the desert areas, two statistically distinct groups of pharmacy deserts (type one and type two) emerged from the analysis. In comparison to type two pharmacy deserts, type one pharmacy deserts were characterized by a denser population, had more renters, more residents that speak English as a second language, less vehicle ownership, more residents living under the federal poverty level, more Black and Hispanic residents, more areas with higher crime against property and people, and less health professionals to serve the area. Residing in type one desert areas, potentially compounds the geographic shortage of pharmacies and pharmacy services. As such, residents in Los Angeles County pharmacy deserts might benefit greatly from equitable, innovative, community-based interventions that increase access to medications, pharmacy services, and pharmacists.