Urban Minority Research Articles

Colorectal Cancer Screening in African American HOPE VI Public Housing Residents.

This study explores whether colorectal cancer screening outreach via home visits and follow-up calls is effective among public housing African American residents. It reports on the proportion of returned Fecal Immunochemical Test kits, on the characteristics of study participants, and on their primary reasons for returning the kit. By conducting home visits and follow-up calls, our colorectal cancer-screening outreach resulted in a higher Fecal Immunochemical Test kit return rate than anticipated. Findings suggest that a more personalized outreach approach can yield higher colorectal cancer-screening rates among urban minority populations, which are at higher risk to be diagnosed with late-stage colorectal cancer.

Fall Risk Reduction Program Paired with a Transportation Program in an Underserved, Urban Minority Community: A Qualitative Evaluation.

This study sought to evaluate A Matter of Balance/Volunteer Lay Leaders (AMOB/VLL) fall prevention curriculum in combination with a “door-through-door” program: Coordinated Older-Adult Senior Transportation Services (COASTS) for older adults living in an urban, underserved community. AMOB/VLL participants were offered eight 2-hour classes as part of the training program. Focus groups were conducted with older adult participants, COASTS mobility facilitators, and AMOB/VLL master trainers. A thematic analysis was conducted, and primary themes relating to curriculum content, cultural relevancy, and outcomes were examined. Older adults and facilitators felt the course was rewarding and led to improvements in mobility and confidence. Master trainers were more critical and recommended simplifying content, with tailored guidance for specific populations. They also recommended increased emphasis on balance and physical activity. Although participants and MoFas felt combining AMOB/VLL and COASTS was rewarding and improved participant mobility, master trainers and participants suggested minor modifications to increase program benefits for urban, underserved communities.

Promoting Health-related Quality of Life in Minority Youth through Environmental Education and Nature Contact

Few studies have examined the relationship between environmental sustainability education and health outcomes in youth. The purpose of this study was to examine health-related quality of life over a 13-week time period in a sample of urban minority youth who participated in an environmental education program with a nature contact component. Health-related quality of life (HRQoL) was measured using a survey comprising five items (physical activity, emotional functioning, school functioning, family support, and social functioning). The overall HRQoL score was determined as the sum of the scores on the five items, with higher scores indicating better HRQoL. A pre-test/post-test within-subjects study design was used to evaluate changes in HRQoL. A total of 53 students (ages 10 to 14 years) participated in the environmental education intervention; 46 (87%) of those students completed HRQoL questionnaires before and after the program. There were statistically significant improvements in overall HRQoL scores and in the family support HRQoL domain scores. Engaging in the natural environment through environmental education may promote HRQoL in youth. Larger, prospective studies are warranted to further investigate these initial findings.

Characteristics of the Provider-Patient Encounter Associated With Awareness of and Willingness to Take PrEP Among Young Minority Urban Males in Baltimore City.

We aimed to identify provider encounter characteristics associated with awareness of and willingness to take PrEP among young urban minority males at higher risk for HIV acquisition. The 74 individuals included in this analysis from a cross-sectional survey of males aged 15-24 being seen at a Baltimore city clinic were those who identified as a man who had sex with men (MSM), reported injection drug use, were in a serodiscordant relationship, had a sexually transmitted infection (STI) in the past 6 months, or reported condomless sex with a partner with unknown HIV status. Topics of provider-initiated conversations associated with willingness to take PrEP included one's sexual behavior (OR 7.35, 95% CI [2.23, 24.26]), whether one had been hurt by a partner (OR 4.71, 95% CI [1.40, 15.87]), and risk reduction (OR 6.91, 95% CI [2.10, 22.81]). This study may yield new targets for provider-level interventions for increasing PrEP uptake.

Do Urban Minority Parents and Children Agree on Asthma Symptoms with Exercise, Worries, and Confidence in Disease Management?

ObjectiveProviders commonly rely on parent reports of a child's asthma symptoms; however, children as young as 7 years can report on their own health. Our study compared parent and child reports of asthma symptoms with exercise, worries about developing an asthma attack, and confidence in disease management. MethodsWe recruited children ages 7 to 10 years with asthma from 4 Bronx, NY, schools, as well as their parents. The parents and children completed interview surveys with parallel questions regarding perceived asthma symptoms, asthma-related worries, and confidence in disease management. We used McNemar tests for paired data to compare parent and child responses. ResultsWe analyzed data for 105 parent-child pairs. Mean child age was 8.5 years (standard deviation, 0.99); 53% were male, and 82% were Hispanic. Children were more likely than their parents to report ever having an exercise-induced asthma attack (85% vs 48%; P < .001) and that they “worry a lot” about developing an asthma attack during exercise (63% vs 45%; P = .01). Children felt more confident about using an inhaler correctly (76% of the children were “very sure” vs 60% of the parents; P = .009) and were more likely to report having an inhaler available in case of an attack (38% of the children were “very sure” vs 20% of the parents; P = .003). ConclusionsIn this school-based sample of urban children with asthma, we found disagreement between parent and child reports of symptoms with exercise, worry about developing an attack, and confidence in medication use. These findings suggest that including child reports during history taking could help providers identify children in need of enhanced asthma management.

Carotenoids, fatty acids and disease burden in obese minority adolescents with asthma

Paediatric obesity-related asthma causes high disease burden, is associated with metabolic abnormalities, has few therapeutic options, and disproportionately affects urban minority children. Although poor diet quality is linked to asthma, the association of nutritional status with disease burden among children with obesity-related asthma is not well understood. To quantify nutritional status, defined as concentrations of serum carotenoids and n-3 fatty acids, and its association with pulmonary function and metabolic markers among obese asthmatic children. We quantified serum carotenoids and fatty acids in a study cohort of 158 urban minority adolescents including 39 obese asthmatics, 39 healthy weight asthmatics, 38 obese controls and 42 healthy weight controls and compared between the groups. We correlated carotenoid and fatty acid levels with pulmonary function indices and with insulin resistance and dyslipidemia. Mean total carotenoids were lowest in obese asthmatic children (0.41μg/mL), lower than healthy weight asthmatics (0.52μg/mL, P<0.05) and healthy weight controls (0.60μg/mL, P<0.001). n-6/n-3 polyunsaturated fatty acid (PUFA) ratio also differed between the groups (P<0.05). Total carotenoids positively correlated with per cent-predicted FEV1 and inversely correlated with insulin resistance among obese asthmatics only. n-6/n-3 PUFA ratio inversely correlated with per cent-predicted FEV1 in obese asthmatics. Our findings suggest that carotenoids, which are lowest in obese asthmatic children, may have protective effects on metabolic health and pulmonary function among obese asthmatic children. Similarly, n-3 PUFA appear to be protective for pulmonary function.

The Role of Familial Incarceration and Ethnic Identity in Suicidal Ideation and Suicide Attempt: Findings from a Longitudinal Study of Latinx Young Adults in California.

Suicide is a leading cause of death among young adults; however, contextual risks and cultural factors are rarely studied in the context of ethnic minority suicidal ideation (SI) and suicidal attempt (SA). This study assessed the association between familial incarceration and suicide behaviors and examined ethnic identity as a potential moderator. Data from a longitudinal study of health among Hispanics (n=1,094) in California were used to test associations between familial incarceration, ethnic identity, and SA and SI, adjusting for demographic factors and covariates. Approximately 18% and 8% of respondents reported SI and SA, respectively. Compared to no incarceration, or the incarceration of a relative, parental incarceration was associated with higher odds (AOR: 2.09, 95% CI: 1.23-3.34) of SI whereas higher affective ethnic identity reduced the odds (AOR: 0.52, 95% CI: 0.31-0.89) of SA. Ethnic identity moderated the association between parental incarceration and SI (AOR: 0.33, 95% CI: 0.13-0.79). Incarceration of a family member can set the stage for exclusion from critical institutions and can have long-term consequences for adult mental health. Promoting a positive ethnic identity may be a promising prevention strategy that could bolster resilience among at-risk, urban minority youth.

Asthma and academic performance in urban children

BackgroundUrban minority children experience high levels of asthma morbidity. Poor school performance can be an indicator that asthma is in poor control. Little attention has been paid to examining real-time links between asthma and academic performance, particularly in high-risk groups. ObjectiveExamine 1) academic performance across a range of indicators in a group of urban children with asthma and urban children without chronic illness and ethnic differences in these associations, and 2) associations between asthma and academic performance in the group of urban children with asthma and ethnic differences in these associations. MethodsTwo hundred sixteen black/African American (33%), Latino (46%), and non-Latino white (21%) urban children, ages 7 to 9 years completed a clinic- and home-based protocol that assessed asthma and allergy status, objective measurements of lung function, and academic functioning. ResultsAnalyses revealed that children with asthma experienced a higher number of school absences when compared with healthy controls. Greater disparities in academic outcomes emerged when examining ethnic differences within the groups of children with and without asthma. Poor academic outcomes were observed in Latino children with asthma. Furthermore, a strong correspondence of poor asthma outcomes and decrements in academic performance were seen in the full sample, and these associations emerged across ethnic groups. ConclusionAsthma activity contributes to poorer academic outcomes across a range of indicators, and urban minority children with asthma, particularly Latino children, may be at heightened risk for poorer academic performance. School management guidelines for asthma need to be consistently implemented and tailored for school staff, caregivers, and students with asthma to address challenges of managing asthma within the urban school setting.

Abstract P397: Neighborhood Environment Perceptions Associate With Depression Levels and Cardiometabolic Risk: Data From the Washington, DC Cardiovascular Health and Needs Assessment

Background: Little is understood about associations between perceived neighborhood characteristics and depression, a known cardiovascular (CV) disease risk factor, in diverse populations. We examined the relationship between neighborhood environment perception (NEP), depression, and CV disease markers within an urban, predominantly African-American (AA) cohort. Methods: We conducted the DC CV Health and Needs Assessment, a health evaluation among adults (n=100) in resource-limited DC communities. We measured overall NEP and factor analysis identified three NEP sub-scores: 1) neighborhood violence; 2) physical environment; and 3) social cohesion (higher score=more favorable NEP). Depression was defined by the revised Center for Epidemiologic Studies Depression Scale (CESD-R, higher score=higher depression likelihood). We leveraged linear regression modeling to examine NEP and depression associations adjusting for race, income, Framingham risk score, and neighborhood deprivation index (NDI). A population subset (n=42) provided blood samples which were tested for levels of IL-1β, IL-18, and CRP by ELISA (Mesoscale Diagnostics, USA). Results: Participants (n= 100; mean age = 59; 99% AA) had a mean CESD-R score=5.8 (SD=8.9) and mean NEP score=56.1 (SD=12.6). In fully adjusted models, more favorable NEP, specifically physical environment and social cohesion, was associated with significantly lower CESD-R scores (Figure). Higher CESD-R scores were positively associated with increasing IL-1β (β= 20.3 p&lt;.01) and IL-18 (β=0.006 p&lt;.01). Conclusions: More favorable perceptions of one’s neighborhood are related to lower depression symptoms in a predominantly AA cohort from Washington, DC resource-limited communities. Additionally, increasing CESD-R score was related to higher pro-inflammatory markers. These results suggest that improving individuals’ neighborhood perceptions may be beneficial in improving the psychological well-being and, ultimately, CV health of urban minority residents.

Social Influences on Drinking Trajectories From Adolescence to Young Adulthood in an Urban Minority Sample

Research on the heterogeneity in drinking patterns of urban minorities within a socioecological framework is rare. The purpose of this study was to explore multiple, distinct patterns of drinking from adolescence to young adulthood in a sample of urban minority youth and to examine the influence of neighborhood, family, and peers on these trajectories. Data are from a longitudinal study of 584 (56% male) primarily Black (87%) youth who were first sampled in childhood based on their residence in low-income neighborhoods in Baltimore City and followed up annually through age 26. Data were analyzed using group-based trajectory modeling and multinomial logistic regression. Modeling revealed six trajectories from ages 14 to 26: abstainer, experimenter, adult increasing, young adult increasing, adolescent limited, and adolescent increasing. Neighborhood disadvantage was a risk factor for drinking regardless of the timing of onset. Perceptions of availability, peer drinking, and parental approval for drinking were risk factors for underage drinking trajectories, whereas parental supervision was a significant protective factor. Positive social activities in neighborhoods was protective against increased drinking, whereas a decline in perceptions of peer drinking was associated with adolescent-limited drinking. Our findings uniquely highlight the importance of developing interventions involving parents for urban minority youth for whom family is particularly relevant in deterring underage drinking. Perhaps most importantly, our data suggest that interventions that support positive social activities in disadvantaged neighborhoods are protective against adolescent drinking and altering perceptions of peer drinking may reduce adolescent drinking among low-income, urban minority youth.

The CITIES Project: Understanding the Health of Underrepresented Populations in Ohio.

Ohio, the catchment area of The Ohio State University Comprehensive Cancer Center (OSUCCC), includes diverse populations with different cancer profiles. As part of the National Cancer Institute (NCI)-funded initiative to conduct population health assessments in cancer center catchment areas, the OSUCCC surveyed residents, focusing on factors contributing to cancer disparities in Ohio populations. Two sampling strategies were used: (i) probability sampling of mailing lists and (ii) convenience sampling at community events, coupled with phone/in-person/web surveys. Survey items were chosen along multilevel framework constructs, used in concert with other funded NCI-Designated Cancer Centers. Multivariable logistic regression models investigated predictors associated with health behaviors, cancer beliefs, knowledge, and screening. The sample of 1,005 respondents were white (46.6%), African American (24.7%), Hispanic (13.7%), Somali (7.6%), and Asian (7.5%). A total of 216 respondents were Appalachian. Variations in cancer attitudes, knowledge, and behaviors were noted by racial/ethnic and geographic group. Multivariable models identified individuals with less financial security as less likely to exercise or be within guidelines for screening, but more likely to smoke and have a poor diet. At the community-level, measures of poverty were highest in Appalachia, whereas children in female-headed households were greater in urban minority areas. This population health assessment reinforced the diversity of the OSUCCC catchment area. These populations are ripe for implementation science strategies, focusing in communities and clinics that serve vulnerable populations. Understanding attitudes, knowledge, and behaviors of this population can assist tailoring outreach and research strategies to lessen the cancer burden.

Urban Minority Community Safety and its Impact on Physical Activity: The Center for Promoting Health and Health Equity-Racial and Ethnic Approaches to Community Health (CPHHE-REACH) Initiative

Background/PurposeDaily physical activity is known to improve personal health and well-being and can often be influenced by one's living environment. A qualitative secondary data analysis of a focus group study, performed by the Creighton University Center for Promoting Health and Health Equity (CPHHE) – Racial and Ethnic Approaches to Community Health (REACH), assesses behavioral changes in individuals who participated in newly established physical activities in faith-based organizations, local residential towers, and the local community health center. MethodApplying thematic analysis within the Health Belief Model framework, the investigators further investigated the relationships between its constructs and levels of physical activity in urban minority neighborhoods. ResultsResults indicated that residents who perceived their neighborhoods as unsafe had a negative attitude toward physical activity. In contrast, building social relationships and camaraderie that enhanced social cohesion were major themes that increased participants' self-efficacy, resulting in positive changes in health behavior. ConclusionCommunity partnerships had a positive impact on motivating individuals to live healthier lifestyles. An interesting concept was that of community efficacy, which reflects the community's confidence in its ability to generate behavioral changes in individuals.

Trends in Epidemiology: Analysis of Risk Factors and Outcomes of Infective Endocarditis: A Retrospective Study (2009-2015).

BackgroundDespite advanced diagnosis and treatment, infective endocarditis (IE) is a potentially life-threatening condition. Although recent studies have provided evidence of changing trends in IE epidemiology, few studies examine patterns within urban minority populations. Here we present the epidemiology, risk factors, and outcomes of IE among an underserved African American population in Brooklyn, New York, compared to the general population.MethodsThis is a retrospective study which included 67 patients with IE diagnosed at The Brooklyn Hospital Center from 2009 to 2015. Patients were selected according to the modified Duke Criteria for definite IE. Various epidemiological parameters were examined via chi-square and Fisher’s exact test using SPSS 24 software (IBM Corp., Armonk, NY).ResultsThe mean age of the 67 patients was 63 years and 46.3% of the patients were men. The majority of patients (70.1%) were African American while Hispanics and Caucasians were 17.9% and 7.5%, respectively. Healthcare-associated IE (58.2%, n=39) outnumbered community-acquired IE (41.8%, n=28). The sites of vegetation were the mitral valve (62.7%, n=42), tricuspid valve (22.4%, n=15), aortic valve (11.9%, n=8), and intravenous catheter (3%, n=2). In valves, 13.4% of the cases were found in prosthetic valves while the majority occurred in native valves. The most common pathogens of IE were the Staphylococcus (50.8%, n=34) species, followed by Streptococcus species (32.8%, n=22). Overall, the in-hospital mortality was 38.8% (n=26) with higher mortality observed for healthcare-associated IE than community-acquired IE (P = .049). Embolic complications were associated with significant mortality (P < .001).ConclusionOur study demonstrated that the common causative pathogens for IE among African Americans trends towards Staphylococcus species followed by Streptococcus species, similar to the contemporary epidemiology of IE. Healthcare-associated IE outnumbered community-acquired IE and was associated with higher mortality. Embolic complications were significantly associated with high mortality. Therefore, efforts made to control healthcare-associated infections are expected to decrease the trend of IE.

BRIGHTEN Heart intervention for depression in minority older adults: Randomized controlled trial.

Assess the effectiveness of an interdisciplinary geriatric team intervention in decreasing symptoms of depression among urban minority older adults in primary care. Secondary outcomes included cardiometabolic syndrome and trauma. 250 African American and Hispanic older adults with PHQ-9 scores ≥ 8 and BMI ≥ 25 were recruited from 6 underserved urban primary care clinics. Intervention arm participants received the BRIGHTEN Heart team intervention plus membership in Generations, an older adult educational activity program; comparison participants received only Generations. Both arms demonstrated clinically significant improvements in PHQ-9 scores at 6 months (-5 points, intervention and comparison) and 12 months (-7 points intervention, -6.5 points comparison); there was no significant difference in change scores between groups on depression or cardiometabolic syndrome at 6 months; there was a small difference in depression trajectory at 12 months (p < .001). More participants in the treatment group (70.7%) had greater than 50% reduction in PHQ-9 scores than the comparison group (56.3%; p = .036). For those with higher PTSD symptoms (PCL-C6), improvement in depression was significantly better in the intervention arm than the comparison arm, regardless of baseline PHQ-9 (p = .001). In mixed models, those with higher PTSD symptoms (β = -0.012, p = < 0.001) in the intervention arm showed greater depression improvement than those with lower PTSD symptoms (β = -0.004, p = .001). The BRIGHTEN Heart intervention may be effective in reducing depression for urban minority older adults. Further research on team care interventions and screening for PTSD symptoms in primary care is warranted. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

A Web-Based Interactive Tool to Reduce Childhood Obesity Risk in Urban Minority Youth: Usability Testing Study.

BackgroundChildhood obesity is a serious public health issue among minority youth in the United States. Technology-enhanced approaches can be effective for promoting healthy behavior change.ObjectiveThe purpose of this study was to test the usability of prototypes of a Web-based interactive tool promoting healthy dietary behaviors to reduce childhood obesity risk in urban minority youth. The Web-based tool comprised a manga-style comic with interactive features (eg, sound effects, clickable pop-ups), tailored messaging, and goal setting, and was optimized for use on tablet devices.MethodsLatino and black/African American children ages 9 to 13 years were recruited to participate in two rounds of usability testing. A modified think-aloud method was utilized. Self-reported surveys and field notes were collected. Audio recordings and field notes from usability testing sessions were systematically reviewed by extracting and coding user feedback as either positive comments or usability or negative issues. The quantitative data from self-reported questionnaires were analyzed using descriptive statistics.ResultsTwelve children (four female; eight black/African American) with a mean age of 10.92 (SD 1.16) years participated. Testing highlighted overall positive experiences with the Web-based interactive tool, especially related to storyline, sound effects, and color schemes. Specific usability issues were classified into six themes: appearance, content, special effects, storyline, terminology, and navigation. Changes to the Web-based tool after round 1 included adding a navigation guide, making clickable icons more visible, improving graphic designs, and fixing programming errors. In round 2 of testing (after modifications to the Web-based tool were incorporated), many of the usability issues that were identified in round 1 did not emerge.ConclusionsResults of testing will inform further development and finalization of the tool, which will be tested using a two-group pilot randomized study, with the goal of reducing childhood obesity risk in minority, low-income youth.

Mindfulness as a Construct in Urban Dwelling Minority Fifth Graders: Psychometric Properties of the Child and Adolescent Mindfulness Measure (CAMM)

ABSTRACTThe operationalization and conceptualization of mindfulness into Westernized societies have shown certain challenges. Additional attention is needed to demonstrate the ways in which mindfulness is measured in youth and adolescents. This article explored the Child and Adolescent Mindfulness Measure as a reliable and valid measure for youth in a convenience sample of fifth graders who are predominantly minority and living in an urban environment (n = 248). Results from an exploratory factor analysis show that construct validity was established with all 10 items loading on two factors. Unlike the original validation and many subsequent studies that were unidimensional, this study revealed two factors present in this sample: avoidance of feelings and present moment non-judgmental awareness. The model explained 50.37% of the total variance in the examination of mindfulness. The two factors also demonstrated acceptable divergent validity with measures of anxiety (factor 1: r = −0.45; factor 2: r = −0.67) and involuntary responses to stress (factor 1: r = −0.55; factor 2: r = −0.71). Discussion as to why two factors were found in our study, unlike many previous studies, is offered with suggestions for future research outlined.

Qualitative Investigation of FIT Colorectal Cancer Screening Uptake in an Uninsured Urban Minority Population

Introduction: Colorectal cancer (CRC) is the 2nd leading cause of cancer death in the USA. Screening and prevention of CRC with stool testing and colonoscopy is cost effective and greatly reduces the risk for CRC and death. Fecal immunochemical testing (FIT) has been shown to be more accurate than guaiac testing for CRC and advanced adenoma detection. Our post-intervention analysis aims to identify barriers to FIT in patients who were provided with free FIT as part of a comprehensive cancer screening program. Methods: Validated standardized surveys were mailed to 100 patients who ‘returned' FIT kits and 100 patients who ‘refused to return' FIT kits (Image 1). Patients received a $5 gift card if they completed the questionnaire. Postage-paid return envelopes were included. Patients had two months to return the completed questionnaires. Results: A total of 17 ‘returned' questionnaires and 8 of ‘refused' questionnaires were completed. Of the 17 ‘returned' questionnaires, 13 were female and 4 were male. 8 of the ‘returned' respondents were African American, while 3 were Caucasian, 4 were Hispanic and 2 were Asian. Further demographics are shown in Image 2.2763_A Figure 1. Mailed Surveys2763_B Figure 2. Study DemographicsConclusion: We report low response rates for both questionnaires. This suggests that identifying barriers to FIT/colonoscopy screening remains challenging in an uninsured urban minority population. African American females with income <$10,000 were the predominant respondents from the ‘returned' cohort, which may indicate better screening uptake among this subpopulation. Six (35%) of ‘returned' respondents reported previous FIT, while none of the ‘refused' cohort had previous FIT. This may represent an unfamiliarity factor among ‘refused' respondents. Among the ‘returned' respondents, some of the identified reasons that influenced use of the FIT kit included lack of insurance, family history of colon polyps, interest in preventative screening and physician recommendation during an encounter for screening mammogram. ‘Difficult instructions' was listed as a reason for not using the FIT kit by 12.5% of the ‘refused' respondents while others from this cohort reported not receiving the kit or not having time to perform the testing. Although eliciting information regarding barriers to FIT kit use remains challenging, more study into this area is warranted to increase CRC screening rates.

HCV Co-Infection in Patients With HBV Infection in Urban Minority Population in a U.S. Major City - A Closer Look

Introduction: Hepatitis B Virus (HBV) and Hepatitis C virus (HCV) infections are major global health problems causing life threatening liver infections.The Model of End-stage Liver Disease (MELD) score used to predict mortality risk and the severity of chronic liver diseases. Many studies have shown dually infected patients to be at higher risk of more severe liver cirrhosis. However, few studies are conducted in U.S. major city involving urban minority population. Methods: Retrospective observational study- all patients with chronic HBV infection. Patients were divided into 2 groups: Group A- HBV infection; Group B- Coinfection with HBV and HCV. Demographics, epidemiology and disease severity were compared. Results: Total patients with chronic HBV infection were n=273, of which 151(55.3%) had HBV monoinfection (Group A) and 122 (44.7%) had co-infection with HCV (group B). Patients >40 years were higher in group B (92%) compared to group A (77%). Majority of the patients were males in both groups (55% and 66% respectively) and of African American ethnicity (88% and 74% respectively). Prevalence of smoking, alcohol and IV drug use (IVDU) was higher in Group B (76%, 80% and 49% respectively) compared to Group A (45%, 56% and 41% respectively). HBV immunization rates were low in both groups, group A (6.6%) and group B (1.6%). Majority of the patients were treatment naïve in both groups with Group A (92%) greater than Group B (78%). Group B had higher incidence of hepatic encephalopathy (15%) and ascites (18%) compared to group A (12% and 9% respectively). MELD scores distribution was similar in both groups for MELD 30, there were increased patients in Group B (18%) compared to group A (5%). Conclusion: A high number of patients with chronic HBV had co-infection with HCV, majority of them being males, over 40 years of age, and African American ethnicity. The incidence of smoking and alcohol use although higher in group B, IVDU was comparable similar in both groups.Both groups had comparable disease severity with moderately higher rates of hepatic encephalopathy and ascites among patients with co-infection. Patients with co-infection had a greater 3- month mortality prediction compared to mono-infection group.Overall this study throws light on the very low HBV immunization rates in the urban minority population and the high rate of co-infection, resulting in increased disease burden and mortality risk as considered by the measured MELD scores in this population.

Impact of Obesity on Asthma Morbidity During a Hospitalization.

Asthma and obesity are 2 common pediatric problems. Obesity is a known risk factor for asthma, and obese children with asthma have higher disease burden. However, little is known on how obesity in urban minority children, mainly Hispanic and African American children, impacts morbidity during pediatric asthma hospitalizations. A retrospective chart review was conducted on children and adolescents age 2 to 18 years hospitalized at the Children's Hospital at Montefiore for an acute asthma exacerbation. We elucidated the association of overweight or obese status with severity of the exacerbation, quantified by length of stay (LOS) and need for intensive care management. Multivariate analysis was conducted to identify independent predictors of LOS. A total of 975 children met the inclusion criteria, of whom 55% were normal weight and 45% were overweight or obese. Sixty percent were Hispanic, and 37% were African American. The overall average LOS was 2.57 days (range: 0.67-12.92). Overweight or obese status was associated with a higher asthma severity at baseline (P = .021). Overweight or obese children had a longer average LOS compared with normal weight children (2.75 vs 2.39 days; P < .01) with more PICU stays (P = .006), even after adjustment for higher baseline asthma severity. The severity of the exacerbation did not differ by ethnicity. Obesity in children hospitalized for asthma is associated with more severe asthma exacerbations, longer LOS, and increased use of PICU level care, independent of their higher baseline disease severity and ethnicity.

Beliefs About the End of AIDS, Concerns About PrEP Functionality, and Perceptions of HIV Risk as Drivers of PrEP Use in Urban Sexual Minority Men: The P18 Cohort Study.

Using cross-sectional data from an ongoing cohort study of young gay, bisexual, and other men who have sex with men (N=492), we examined the extent to which cognitive factors such as beliefs about the end of AIDS, concerns about the manner in which PrEP works, and perceptions about risk of contracting HIV, are related to PrEP uptake and use. While almost all participants indicted awareness of PrEP, a mere 14% had ever used PrEP. Those with lower concerns about the side effects of PrEP and greater belief that treatment and PrEP would eliminate AIDS were also more likely to have ever used PrEP. Our findings support the ongoing challenges of PrEP uptake as means of curtailing HIV in young sexual minority men, and suggest that beyond the structural factors, consideration must be given to further educating the population as a means of adjusting potentially faulty beliefs, concerns, and perceptions which may influence PrEP utilization.