Search Results (232)

Approximately 10% of the US Black diaspora were born either in Latin America and the Caribbean (LAC) or Sub-Saharan Africa (SSA), projected to account for a third of the Black US diaspora by 2060. Yet, details on foreign-born Black women’s labor and delivery (L&D) characteristics, such as the type of birth attendant, remain scarce. We used the National Center for Health Statistics 2016 to 2020 Natality data (n = 2,041,880). The associations between detailed maternal nativity (DMN) and the type of attendant at birth (i.e., physician, certified nurse-midwife (CNM), certified professional midwife (CPM)) among US-born, LAC-born, and SSA-born Black women were examined using multivariate multinomial regression. The study revealed that LAC-born women were more likely to have a CNM during birth than US-born Black women, but Haitian-born and Jamaican-born women had lower odds of having a certified professional midwife (CPM) at birth. When compared to US-born Black women, Cameroonian-born women had decreased odds of having either a CNM or CPM during birth. Findings suggest that DMN could be an indicator of cultural preferences in maternity care. There is a need for further investigation beyond DMN and comprehensive data collection methods for future research to understand the specific needs and preferences of different ethnocultural groups to improve maternity care and prevent adverse maternal health outcomes. Full article

While genetic mechanisms in neurodevelopmental disorders are well studied, the mechanisms of environmental factors such as prenatal stress are less understood. Our lab previously characterized miRNA changes associated with stress during pregnancy in mouse brains and in maternal blood from mothers of children with ASD and indicated that prenatal stress can be linked to epigenetic markers. These miRNAs could be used as discovery biomarkers for stress exposure, as well as predictors of neurodevelopmental outcomes. In this pilot study, we gathered saliva samples and stress survey questionnaires from 83 pregnant African American women (ages 18–40) at the time of their ultrasound performed at 20 weeks. miRNA analysis was performed on the 10 highest- and 10 lowest-stress subjects. Out of 6631 miRNAs examined, 34 had significant differential expression, with 5 being upregulated and 29 downregulated in the high-stress group. Predicted targets of differentially expressed miRNAs revealed significant enrichment in neurodevelopmental pathways, including forebrain development, sensory system development, and neuronal growth regulation. This may suggest the potential developmental salience of these miRNA profiles. Future research will examine the neurodevelopmental outcomes of these pregnancies to determine the predictive potential of these miRNAs. This may help identify individuals at greatest risk after stress exposure during pregnancy. Full article

Intersectionality, especially with a race–class–gender focus, has been used to study many facets of women’s experiences. However, this framework has been underutilized in the study of breastfeeding prevalence. Our study is the first of its kind to use intersectionality to illuminate breastfeeding network prevalence disparities with empirical data. We use insights from this theory to examine breastfeeding patterns reported by women living on the Mississippi Gulf Coast. Mississippi makes an excellent site for such an examination, given its history of racial discrimination, entrenched poverty, and strikingly low rates of breastfeeding, particularly for African American women. We identify a series of factors that influence racial disparities in lactation network prevalence, that is, breastfeeding among friends and family of the women we surveyed. Our investigation relies on survey data drawn from a random sample of adult women who are representative of the Mississippi Gulf Coast population supplemented by a non-random oversample of African American women in this predominantly rural tri-county area. Results from the first wave of the CDC-funded 2019 Mississippi REACH Social Climate Survey reveal that Black-White differentials in breastfeeding network prevalence are significantly reduced for African American women who report (1) higher income levels and (2) more robust community support for breastfeeding. We conclude that breastfeeding is subject to two key structural factors: economic standing and community context. An appreciation of these intersecting influences on breastfeeding and long-term efforts to alter them could bring about greater breastfeeding parity among African American and White women in Mississippi and perhaps elsewhere. We end by identifying the practical implications of our findings and promising directions for future research. Full article

Background and Objectives: Growing evidence suggests a strong relationship between hypertension and cancer, which can increase the risk of poor prognosis. However, data regarding mortality related to cancer and hypertension are limited. Our study aims to analyze the mortality trends related to cancer and hypertension in the United States from 1999 to 2023. Materials and Methods: A retrospective observational analysis was conducted using mortality data for the adult U.S. population from 1999 to 2023, retrieved from the CDC WONDER database using death certificates. Age-adjusted mortality rates (AAMRs) were calculated, and annual percentage changes (APCs) were analyzed using JoinPoint Regression. Results: From 1999 to 2023, a total of 1,406,107 deaths related to cancer and hypertension were recorded in the United States. The AAMR increased from 12.59 in 1999 to 35.49 in 2023. Males had a higher mortality rate compared to women throughout the study period (AAMR; 30.3 vs. 20.4). Non-Hispanic (NH) Black Americans, or African Americans had the highest mortality rates, followed by NH white, Hispanic or Latino groups, and other NH groups. The highest AAMR was observed in the South, followed by the Midwest, the Northeast, and the West. Rural areas had higher mortality rates compared to urban areas. Conclusions: Cancer- and hypertension-related mortality rates have consistently increased in the United States from 1999 to 2023, particularly affecting males, NH Black Americans, the southern region, and rural areas. The trends highlight the need for targeted prevention, including early screening, lifestyle changes, and treatment adherence. Full article

Workplace inequities disproportionately affect African American professionals, with 41% reporting discrimination in hiring, salary negotiations, and promotions due to their racial or ethnic identity. These challenges are further accentuated by gender disparities, as 48% of Black men and 36% of Black women acknowledge experiencing workplace discrimination. Comparatively, smaller proportions of Asian (25%), Hispanic (20%), and White (8%) employees report similar treatment, underscoring the systemic barriers that shape the professional trajectories of marginalized workers in the United States. Addressing these pervasive inequities necessitates a transformative framework rooted in allyship, particularly among White male leaders who occupy positions of significant power and influence. Allyship, a dynamic and relational process, requires intentional advocacy, empathy, and accountability to dismantle exclusionary practices and foster inclusion. This research employs human geography as a metaphor to explore the challenges faced by minority employees in navigating workplaces that often resemble hostile terrains characterized by bias, limited representation, and a lack of psychological safety. The climb to senior leadership for minorities parallels traversing rugged landscapes, requiring resilience and access to critical pathways such as mentorship, sponsorship, and equitable opportunities. As inclusive planners, White male allies can address these systemic barriers by leveraging their privilege to create equitable and supportive environments. Aligning allyship with principles of human geography highlights its potential to address workplace inequities and contributes to broader societal cohesion. This study underscores a pivotal lacuna in the discourse on organizational equity: the insufficient exploration of allyship as a transformative paradigm, particularly when championed by White male leaders who occupy positions of substantial authority and influence. Full article

Purpose: Adjuvant endocrine therapy (AET) significantly diminishes recurrence and mortality risks in hormone receptor-positive breast cancer (BCa) patients. Nonetheless, suboptimal adherence and premature discontinuation during the initial year of treatment undermine these positive outcomes. This study aims to understand the potential diverse factors associated with perceived barriers to AET compliance at the onset of medication. Methods: We assessed perceived barriers to AET using the ASK-20 instrument for BCa patients initiating AET within 3 months. Our survey also included demographic variables (e.g., musculoskeletal symptoms) and clinical traits (e.g., medication type). Stepwise regression analyses were employed to elucidate the links between multilevel factors and perceived barriers to AET adherence. Results: In our cohort of 272 women, the mean ASK-12 score was 38.2 +/− 9.2 (range 20–100). In the multivariable regression model, greater perceived barriers to adhering to AET were found to be associated with African American ethnicity (Β  =  2.47; 0.53–4.21; p  <  0.05), lower self-efficacy in medication management (Β  =  −0.80; −1.03–−0.58; p  <  0.001), higher psychological distress (Β  =  2.79; 0.61–4.97; p  <  0.05), increased reported distress related to musculoskeletal side effects (Β  =  0.64; 0.31–0.97; p  <  0.001), weight gain symptoms (Β  =  0.61; 0.18–1.03; p  <  0.05), less family support (Β  =  −0.38; −0.53–−0.13; p  <  0.05), and higher levels of concern pertaining to AET (Β  =  0.64; 0.41–0.87; p  <  0.001). Conclusions: Modifiable factors are associated with women’s perceived barriers to AET at the onset of treatment. Proactively addressing patient concerns about AET, improving self-regulatory skills for medication management and family support, and enhancing symptom management strategies, along with addressing distress at the onset of treatment, hold promise for mitigating barriers to AET. Furthermore, recognizing the distinctive challenges faced by African American subgroups is crucial, necessitating culturally tailored interventions to reduce potential disparities and ensure equitable access and adherence to AET. Continued research and tailored interventions are important for optimizing outcomes and reducing the impact of modifiable barriers on AET adherence. Full article

Background: Racial discrimination experiences are associated with the activation of stress biology pathways and signs of accelerated biological aging, including alterations in DNA methylation (DNAm). Coping strategies may mitigate stress from racial discrimination and protect against long-term adverse health outcomes. Methods: We conducted a secondary analysis of data from the Intergenerational Impact of Genetic and Psychological Factors on Blood Pressure cohort, an all-African-American sample, to test the hypothesis that social support can protect against accelerated biological aging associated with experiences of racial discrimination. We measured biological aging from saliva DNAm using six epigenetic clocks. Clock values were residualized on participant age and the estimated proportion of epithelial cells contributing to the DNA sample and standardized to M = 0, SD = 1 within the analysis sample. The primary analysis was focused on the second-generation PhenoAge and GrimAge clocks and the third-generation DunedinPACE “speedometer,” which previous studies have linked with racial discrimination. Results: In our sample (n = 234; mean age = 31.9 years; SD = 5.80), we found evidence consistent with our hypothesis in the case of the PhenoAge clock, but not the other clocks. Among mothers who did not seek social support, experiences of racial discrimination were associated with an older PhenoAge (b = 0.26, 95% CI = 0.02–0.50, p = 0.03). However, social-support seeking mitigated this risk; at the highest levels of social support, no adverse consequences of discrimination were observed (interaction b = −0.01, 95% CI = −0.02–−0.00, p = 0.03). Conclusions: The replication of results is needed. Future research should also investigate additional adaptive and maladaptive coping strategies utilized by African American women and mothers to identify protective measures that influence health outcomes. Full article

Objective: Psychological resilience, defined as one’s self-reported ability to bounce back from stress, is understudied in young African American women (YAAW). Guided by community feedback, this study examined the associations between resilience and the following three constructs from Staudinger’s 2015 resilience and aging model: perceived stress, non-psychological resources, and psychological resources. We aimed to identify cultural resources that can enhance resilience in the face of unique stressors. Methods: A cross-sectional survey was administered to 512 self-identified YAAW aged 18–35 years. Resilience was measured by the Brief Resilience Scale, ranging from one to five, with higher scores indicating greater resilience. We employed linear regression to examine the relationships among stressors, resources, and resilience, and then used elastic net (EN) regularization to identify the resources most strongly associated with resilience after adjusting for age and stressors. Data were analyzed using SAS version 9.4. Results: YAAW with higher resilience experienced fewer stressors and reported greater access to both non-psychological and psychological resources. In the adjusted EN model, perceived stress (β = −0.16), internalized racism (β = −0.06), and adverse childhood experiences (β = −0.03) demonstrated the strongest associations with lower resilience. Conversely, improvisational skills (β = 0.23), (emotional stability or the absence of) neurotic personality traits, β = −0.22), presence of conscientious personality traits (β = 0.08), and not expressing anger to cope with discrimination (β = −0.04) had the strongest associations with higher resilience. Notably, high improvisation skills and low levels of neuroticism were identified as key resilience resources. Conclusion: Stress reduction techniques that focus on addressing racial trauma and highlight the health-promoting aspects of AA cultural identity, such as improvisation, may play an important role in fostering resilience among YAAW. Further research is needed to validate these findings and to help inform the development of effective intervention strategies in this group. Full article

Background and Introduction: Race-based social rejection has been found to predict post-traumatic stress and depression symptoms, consistent with previous studies that have shown the negative mental health effects of racism, as well as social rejection in general. While racial identity has been noted as a protective factor among African Americans, the role it plays in the context of race-based social rejection is less clear. Methods: This study examines the relationships among self-reported race-based social rejection, hypothesized protective factors, and negative psychological outcomes among a sample of 230 low-income, urban African American men and women. Results: Multiple regression analyses revealed that racial identity did not moderate the race-based social rejection–depression relationship. However, it exacerbated post-traumatic stress symptoms in the face of race-based social rejection. Discussion: These results suggest that when one perceives such rejection, identifying strongly with one’s group may amplify post-traumatic stress by triggering collective instances of racial trauma. Conclusions: The role of racial identity highlights the unique nature of racial trauma, involving the interplay of individual and social facets, particularly among those who highly identify with their racial group, and call for collective and creative solutions. Full article

Health disparities have been associated with diet quality inequalities. Study objectives were to determine if race and/or income were associated with the diet quality of White and African American urban women and to compare core food and beverage categories consumed at eating occasions by diet quality within race and income groups. Two 24 h dietary recalls were collected on 1219 women interviewed in the Healthy Aging in Neighborhoods of Diversity across the Life Span study, 2013–2017. Healthy Eating Index (HEI)-2010 scores were calculated. Linear regression Model 1 included race, marital status, and age. Model 2 included Model 1 variables plus income, education, literacy, employment, enough money for food, and food security. Core food categories and most frequently consumed items were identified at five eating occasions within the first and third tertile HEI-2010. Diet quality was associated with age, education, literacy, and employment. More fruit and vegetable categories at meals and snacks, and more water as a top beverage, were observed for women whose diets were in the third HEI-2010 tertile. The majority of foods reported by women in the first HEI-2010 tertile would be considered ultra-processed. The health benefits of consuming more minimally processed foods and unsweetened beverages may reduce health disparity gaps. Full article

Background: Cervical cancer (CC) rates have declined nationally but rates remain high in Black women with most cases occurring among unscreened and under-screened women. This paper describes the adaptation, acceptability, and useability of an education intervention, “Health is Wealth: A Cervical Health Intervention”, to promote cervical screening and reduce perceived barriers to CC screening among two subgroups of Black women: African American (AA) and sub-Saharan African immigrant (SAI) women. Methods: In this paper, we describe the process of adapting the Health is Wealth intervention using the Barrera and Castro adaptation framework. The iterative adaptation process included formative focus groups (n = 30 participants) to gather information, expert feedback (n = 4), and usability testing (n = 7). Results: The systematic process resulted in the modification of educational intervention components. Several aspects of the intervention were modified, and core elements of the original intervention were preserved. The usability testing findings suggest the intervention would support the objective of promoting cervical cancer screening uptake among AA and SAI women. Conclusions: Adaptation of an evidence-based intervention is necessary to ensure contextually and culturally appropriateness for target populations, particularly for minoritized populations. We demonstrated that an evidence-based intervention for Pap screening can be adapted for HPV-self-sampling promotion with target community input. Full article

Background/Objectives: Limited evidence is available regarding insulin total daily dose (TDD), or the factors associated with TDD, among adults with type 2 diabetes (T2D) using multiple daily injections of insulin (MDI). Our aim was to determine the percentage of adults in the United States (US) with T2D who are prescribed MDI, their prescribed insulin TDD, and potential factors associated with TDD. Methods: This retrospective cohort study used deidentified data from the US IQVIA ambulatory electronic medical record database to study adults (≥18 years) with T2D initiating MDI (≥3 daily basal-plus-prandial insulin injections) from 1 January 2017 to 1 July 2022. The TDD was calculated from first evidence of MDI (index date). We used a generalized linear model regression analysis to model the relationship between TDD and clinically relevant factors associated with TDD. Results: During the study period, of 3,339,663 adults with T2D, 451,769 (13.5%) had ≥1 basal insulin prescriptions, 206,000 (6.2%) had both basal and prandial insulin prescriptions, and 41,215 (1.2%) were prescribed MDI (mean age, 58 years; 52% women; 62% White/Caucasian, 14% African American; mean body mass index [BMI], 34 kg/m²). Mean TDD was 96 units (1.0 units/kg/day); median TDD was 80 units (interquartile range, 54–124). In the regression analysis (model R², 0.14), factors predicting lower TDD included female sex, African American race, and prior 6-month (pre-index) prescriptions of sulfonylurea, metformin, or 2–3 noninsulin glucose-lowering medications. Predictors of greater TDD included increasing BMI, age 30–64 years, and pre-index SGLT2 inhibitor or GLP-1 RA prescription. Conclusions: Among US adults with T2D, 1.2% were prescribed MDI, with a wide range of TDD and median TDD of 80 units. Further research in other populations and using other data sources is warranted to explore prescribed insulin TDD for T2D and to examine other potentially relevant predictors of TDD. Full article

African American women living in public housing carry a heavy burden of cardiovascular disease. Eating a heart-healthy diet is crucial to achieving optimal heart health, yet this health disparity population encounters major barriers to healthy eating. This study explored their perceptions of healthy eating and cardiovascular disease. Participants were recruited from public housing in a mid-sized city. Six 2-h focus groups with 32 women were conducted. Focus groups were analyzed using deductive coding. The major focus group findings focused on a limited access to affordable healthy foods. Participants also discussed the use of cost control measures to maximize household food budgets to access healthy foods and the ability to eat healthily. Our findings indicate that food insecurity persists for the populations most at-risk for cardiovascular disease. Plant-based diets may offer a culturally sensitive, innovative, and sustainable approach to reducing heart health risks, alleviating food insecurity, and promoting optimal health outcomes. Full article

Background: Environmental exposures to heavy metals/metalloids such as arsenic, cadmium, and mercury have been implicated in adverse cardiovascular health outcomes. Using data from the All of Us research program, we investigated the associations between these metals/metalloids and six cardiovascular-related biomarkers: systolic blood pressure (SBP), HDL cholesterol, LDL cholesterol, C-reactive protein (CRP), total cholesterol, and triglycerides. Methods: This study explored the relationship between outcome cardiovascular variables (SBP, CRP, LDL, HDL, triglycerides, and total cholesterol) and predictor metal/metalloid variables (cadmium, mercury, and arsenic) among 136 participants (53.4 percent women). We initially conducted linear regression to determine the association between variables of interest. Bayesian Kernel Machine Regression (BKMR) analysis was subsequently performed to capture potential non-linear relationships, as well as interactions among metal/metalloid exposures. In the BKMR analysis, posterior inclusion probabilities (PIPs) quantified the contribution of each metal/metalloid to the outcomes, with higher PIP values indicating a greater likelihood of a specific exposure being a key predictor for a given cardiovascular biomarker. Within the BKMR framework, univariate, bivariate, and overall exposure–response analyses provided insights into the individual and combined effects of metal/metalloid exposures. These analyses identified the factors with the strongest associations and highlighted interactions between exposures. Results: In this study, the average age of male participants was 58.2 years, while female participants had an average age of 55.6 years. The study population included 104 individuals identifying as White (mean age: 57.5 years), 10 as Black or African American (mean age: 63.2 years), 7 as Hispanic (mean age: 48.2), 3 as Asian (mean age: 49.7 years), and 12 as Other race (mean age: 48.8 years). In our study, men exhibited higher levels of SBP, triglycerides, mercury, and arsenic, while women had higher levels of CRP, LDL cholesterol, HDL cholesterol, total cholesterol, and cadmium. Black people exhibited higher levels and greater variability in markers of cardiovascular risk and inflammation (e.g., blood pressure and CRP), Asians consistently showed the lowest levels across most biomarkers, while White people, Hispanics, and the “Other” group demonstrated moderate levels with some variability. In linear regression, we identified significant positive associations between mercury and HDL cholesterol, arsenic and triglycerides, and arsenic and total cholesterol. In BKMR analysis, PIP results revealed that mercury had the highest predictive contribution for SBP, HDL cholesterol, and triglycerides; cadmium for CRP; and arsenic for LDL and total cholesterol. Univariate and bivariate exposure–response analyses in BKMR demonstrated non-linear exposure–response patterns, including U-shaped and inverted U-shaped patterns for cadmium, particularly CRP and total cholesterol. Traditional linear regression techniques would have missed these patterns. Conclusion: Our study results highlight the influence of environmental metal/metalloid exposures on cardiovascular biomarkers, providing evidence of non-linear and interactive effects that warrant further investigation to understand their role in cardiovascular disease risk better. Full article

Background/Objectives: Alzheimer’s disease (AD) and related dementias (ADRD) disproportionately impact racial and ethnic minorities. Contributing biological factors that explain this disparity have been elusive. Moreover, non-invasive biomarkers for early detection of AD are needed. Endothelin-1 (ET-1), a vasoconstrictive factor linked to cerebral vascular disease pathology and neuronal injury, could provide insights to better understand racial disparities in AD. As a potent vasoconstrictive peptide that regulates contractions in smooth muscle, endothelial cells, and pericytes, ET-1 may result in cerebral vascular constriction, leading to cerebral hypoperfusion; over time, this may result in neuronal injury, contributing to the pathology of AD. The role of the ET-1 system as a driver of ethnic disparities in AD requires further investigation. In the United States (U.S.), ET-1 dysregulation in Hispanic/Latinx (H/L) ethnic populations has largely been unexplored. Genetics linking ET-1 dysregulation and racial disparities in AD also require further investigation. In this study, we examined the role of the ET-1 protein in human plasma as a potential biomarker with predictive value for correlating with the development of AD by age, race, and sex. Methods: We examined ET-1 protein levels using quantitative mass spectrometry in AA and NHW patients with AD, along with controls. Results: A partial correlation between age at draw and ET-1, stratified by race and sex, while controlling for AD status, was significant for female AAs (r = 0.385, p = 0.016). When the data were not stratified but controlled for AD status, the partial correlation between age at draw and ET-1 was not significant (r = 0.108, p = 0.259). Conclusions: Based on the small number of plasma specimens and no plasma specimens from H/L individuals with AD, we conclude that ET-1 was clearly not a significant factor in predicting AD in this study and will require a larger scale study for validation. Full article