Search Results (357)

Introduction: Racially and ethnically diverse women experience sub-optimal outcomes on both the HIV treatment and prevention cascade when compared to their white counterparts due to factors including racism, sexism, and xenophobia. While PrEP is a promising biomedical tool that can narrow this gap, similar trends are observed in PrEP utilization among culturally diverse women. We sought to explore the differences in diverse women’s preferences, challenges, and facilitators of PrEP uptake. Methods: From January 2022 to July 2023, thirty-one diverse women who could benefit from PrEP in Miami, FL, completed qualitative interviews with trained research staff to discuss their willingness, perceptions, and access to PrEP. Women also completed a demographic survey via Research Electronic Data Capture (REDCap). Semi-structured interviews were analyzed via NVivo using a hybrid inductive–deductive thematic analysis approach. Results: The majority of participants were Black (81%) and ethnically diverse (41.9% African American, 25.8% Hispanic/Latina, 16.1% Afro-Caribbean Black (non-Haitian) and 16.1% Haitian/Haitian American). Qualitative coding revealed numerous themes common across ethnic groups on (a) HIV transmission risk, reasons for prevention, and protective factors, (b) PrEP awareness, acceptability and willingness, (c) access to healthcare, and (d) relationships. Conclusions: To develop culturally sound interventions to increase PrEP uptake among women most impacted by HIV, an understanding of their perspectives and experiences is needed, as well as interventions/strategies informed by their insights. Full article

This study examined whether racial and ethnic friendship diversity predicted adolescents’ civic action and commitment to social change, and the pathways leading to these outcomes. Using 2 years of data from a large, diverse sample of high school students (N = 3322; 47% female; Mage at T1 = 17.53; 11% Black/African American, 16% East/Southeast Asian, 36% Latiné, 24% White, 12% Multiracial/Biracial), findings revealed that friendship diversity at T1 (11th grade) predicted higher civic action and commitment 1 year later at T2 (12th grade). Across two mediation models, these associations operated indirectly through greater awareness of inequality and more positive beliefs about the value of diversity. Direct effects were nonsignificant once mediators were included. Multigroup tests showed similar pathways across racial/ethnic groups. Findings highlight friendship diversity as a developmental context that predicted greater awareness of inequality and valuing of diversity, which in turn was associated with civic action and commitment to social change. Results underscore the importance of racially and ethnically diverse friendship networks and awareness of inequality and valuing diversity as pathways to promote adolescents’ civic action and commitment social change. Full article

Background/Objectives: School-age athletes occupy a paradoxical position in the adolescent opioid crisis, combining health-oriented activity with elevated risk of sports-related injury and prescription opioid exposure. In response to the opioid epidemic, states enacted opioid prescribing limit laws (OPLLs) beginning in 2016–2017, yet whether these supply-side policies reached high-risk youth subgroups remains unclear. This study evaluated national temporal trends in prescription opioid misuse among U.S. high school students during the period of OPLL implementation and examined differences across athletic participation, concussion history, sex, grade, race/ethnicity, and substance-use profiles. Methods: Using four biennial waves of the Youth Risk Behavior Surveillance System with a consistent prescription pain-medicine measure (2017, 2019, 2021, and 2023; total N = 44,501), we conducted survey-weighted multivariable logistic regression models producing adjusted odds ratios (aORs) for lifetime prescription opioid misuse, controlling for survey year, sports participation, sex, grade, race/ethnicity, alcohol use, and other illicit drug use. Interaction and stratified models examined differences associated with sports participation, concussion history, demographic characteristics, and substance use. Results: Weighted prescription opioid misuse declined from 13.9% in 2017 to 12.0% in 2023, with a significant unadjusted linear decline per two-year survey wave (OR = 0.936; 95% CI: 0.879–0.997; p = 0.040). This overall trend was attenuated after adjustment (aOR = 0.967; 95% CI: 0.914–1.024; p = 0.248). Temporal patterns differed significantly across race/ethnicity, sex, grade, and selected substance-use groups. White and male students demonstrated significant adjusted linear declines, whereas Hispanic/Latino and female students remained flat. Black/African American students showed significant year-to-year variation, with elevated adjusted odds in 2019 and 2021 relative to 2017. Concussion history was independently associated with misuse among athletes (aOR = 1.645; 95% CI: 1.417–1.909; p < 0.001), with significant associations observed among White, Asian, Black/African American, and Hispanic/Latino athletes. The pooled concussion-by-race/ethnicity interaction, however, was not significant (p = 0.295). Conclusions: Although prescription opioid misuse declined descriptively between 2017 and 2023, adjusted analyses did not identify a significant overall national temporal change. Since subgroup patterns diverged, prevention planning and surveillance should be disaggregated by race/ethnicity and sex rather than guided by national totals, and groups whose misuse did not decline may require strategies extending beyond clinical prescribing controls. Full article

This paper argues for the necessity of psychoanalysis in the North American field of spiritual care. More specifically, the essay argues that at a time of social unrest, despair, and authoritarian rule, the work of interiority that psychoanalysis and African religious cosmologies emphasize is especially suited to the current moment in U.S. history. An integrative sampling of black psychoanalytic thinkers and black religious scholars will be highlighted as possible examples of interdisciplinary praxis for the work of spiritual care in a world where freedom and democracy are in peril. As the voices of many black and brown scholars in this area have been overlooked, disregarded, or ghettoized as only being relevant to ethnic minority populations, this essay reflects on how the symmetry between psychoanalytic thought and African spirituality and cosmology can function as a formidable psychospiritual framework for spiritual care in the 21st-century authoritarian state. Full article

Background/Objectives: Multiple myeloma (MM) disproportionately affects older adults and racial/ethnic minorities, many of whom face socioeconomic barriers to care. Immunomodulators (IMiDs) are central to MM therapy, but their benefit relies on timely initiation and sustained adherence. In safety-net settings, barriers such as insurance approvals, Patient Medication Assistance Program (PMAP) enrollment, and Risk Evaluation and Mitigation Strategy (REMS) requirements may influence adherence. This study evaluated IMiD adherence during the first two years of therapy among socioeconomically vulnerable MM patients in a large safety-net hospital, with attention to PMAP enrollment and treatment delays. Methods: We conducted a retrospective cohort study of adults (≥18 years) with newly diagnosed MM between October 2010 and January 2022 who initiated lenalidomide or pomalidomide at a safety-net hospital. Adherence was measured using the proportion of days covered (PDC). Delays in initiation were defined as ≥1 month from diagnosis to first IMiD prescription fill. This threshold was selected a priori based on the REMS-mandated 28-day prescription supply limit for lenalidomide and pomalidomide, which establishes a natural monthly treatment cycle; a delay exceeding one full 28-day cycle before therapy initiation is operationally meaningful within the REMS framework. Results: Eighty patients met criteria (mean age 55.1 years; 56.3% Hispanic/Latino; 31.3% African American). Most were unemployed (63.8%), 42.5% uninsured, and 57.5% enrolled in PMAP. Only 12.5% achieved PDC ≥ 80%. Median PDC was higher among PMAP enrollees (0.40 vs. 0.31; p = 0.0293) and transplant-ineligible patients (0.46 vs. 0.27; p = 0.0218). Delays ≥ 1 month occurred in 65% of patients. Conclusions: Adherence to IMiDs was suboptimal in this younger safety-net cohort. Although PMAP improved adherence, program delays may reduce early treatment benefits, underscoring the need for streamlined access and targeted interventions to address both patient- and system-level barriers. Full article

Introduction: Diabetic foot ulcers (DFUs) are a debilitating complication of diabetes, and management by multidisciplinary foot teams has been shown to reduce serious sequelae, such as amputations. There are stark racial and ethnic disparities in morbidity and mortality from DFUs, and multidisciplinary care has been shown to reduce lower extremity amputations, length of hospital stays and readmissions. This is a review of the impact of multidisciplinary care on DFUs, particularly regarding social determinants of health, with an illustrative case. Case Presentation: This is a case of a 32-year-old African American male with Type 1 Diabetes, a history of poor glycemic control, attention deficit hyperactivity disorder, tobacco and marijuana use disorder, and multiple social and structural barriers to care. He presented with bilateral Wagner grade 3 DFUs with osteomyelitis to the emergency department, requiring hospitalization. Upon discharge, he was referred to a multidisciplinary diabetes clinic and received coordinated support from endocrinology, podiatry, vascular surgery, infectious disease, pedorthics, and behavioral health. Comprehensive evaluation, intensive wound care with adjuvant hyperbaric oxygen therapy, offloading, blood glucose management and medical source control of infection were established for his treatment plan. At the three-month follow-up, the patient’s wound beds had significantly improved, and his Hemoglobin A1c declined from 12.6% to 9.3%. The right plantar wound completely epithelialized, and the left foot wound showed 90% contracture. Review and Discussion: This case highlights the importance of integrated, multidisciplinary care for DFUs, particularly in addressing both the clinical and social drivers of complications from diabetes. Full article

Wearable fitness trackers are increasingly popular for monitoring health-related metrics, yet their ownership patterns across socioeconomic, demographic, and gender-diverse populations remain underexplored at a population level. This study utilized data from the NIH All of Us Research Program to investigate how area-level socioeconomic status, race, and gender identity influence wearable device ownership. Methods. Data were analyzed from 633,547 participants from the All of Us Dataset. Fitbit ownership was modeled with four binary logistic regression models: a demographics-only model, a ZIP3-level socioeconomic indicators model, and a combined model incorporating four demographic × median household income interactions (race, gender, age, and Hispanic/Latino ethnicity), and an intersectional model adding a race x gender interaction. Continuous socioeconomic predictors were rescaled for interpretability (median income per USD 10,000; area-level fractions per 10 percentage points). Socioeconomic-adjusted models were restricted to 606,414 participants with available ZIP3-linked data. Fitbit ownership was defined as having a Fitbit record in the database. Results. Fitbit ownership was observed in 8.34% of the study population. Logistic regression analyses revealed significant demographic disparities: female participants and gender-diverse identities had significantly higher odds of ownership than males (OR = 1.25–2.2). Black or African American (OR = 0.38) and NHPI/MENA (OR = 0.82) participants had lower odds compared to White participants, while Asian (OR = 1.13), more than one race (OR = 1.25), and Hispanic or Latino (OR = 1.25) participants had higher odds. Each USD 10,000 increase in ZIP3 median household income was associated with 12.5% lower odds of ownership overall (OR = 0.875), but this gradient varied significantly by race. For Black or African American participants, the relationship reversed direction (OR = 1.08 per $10,000). A race x gender interaction further showed that female ownership was not uniform across race, being the largest among Black or African American participants (OR = 2.27) and reversed among Asian participants (OR = 0.87). ZIP3 socioeconomic data were structurally unavailable for all American Indian or Alaska Native participants due to the All of Us program’s small-population ZIP3 aggregation policy, precluding their inclusion in socioeconomic-adjusted models. Conclusions. This analysis demonstrates significant gender, racial, and socioeconomic disparities in wearable fitness tracker ownership, showing significantly higher device usage among females and gender-diverse individuals, but lower usage among certain racial groups and a seemingly contradictory negative ownership rates among higher socioeconomic levels. Ownership patterns nonetheless appear more equitable than in consumer cohorts, likely reflecting the device-provision programs undertaken by the NIH. Full article

West African cuisine is among the world’s most complex and historically significant culinary traditions, shaped by diverse ecosystems, centuries of trans-regional trade, and the cultural heritage of more than three hundred distinct ethnic groups spanning the Atlantic coast and the Sahel. West African cuisine has undergone a significant cultural and culinary transformation in the American food landscape, moving from relative obscurity to mainstream visibility. This entry examines the rise of West African cuisine in the United States, with particular attention to jollof as a cultural symbol of identity, diaspora, and culinary diplomacy. Drawing on academic scholarship, food journalism, and primary cultural sources, the entry traces the historical roots of West African foodways through the transatlantic slave trade and their enduring influence on American culinary traditions. It further explores how contemporary chefs, restaurateurs, and food writers of West African descent, including Eric Adjepong, Pierre Thiam, and Kwame Onwuachi, have elevated the cuisine within American fine dining and popular culture. The entry also addresses the role of social media, particularly the viral “Jollof Wars,” in amplifying West African culinary culture globally, culminating in UNESCO’s recognition of Senegalese jollof rice as an element of intangible cultural heritage. Questions of structural barriers, authenticity, and representation are critically examined. The entry argues that while West African cuisine is experiencing unprecedented visibility in America, its mainstream acceptance remains mediated by cultural filters that risk diluting its complexity and richness. Ultimately, this entry positions West African cuisine not merely as a culinary trend but as a living expression of diasporic identity, cultural resilience, and global influence. Full article

Experiences of discrimination and/or microaggressions may negatively affect mental health among university students. We assessed the association between experiences of discrimination, microaggressions, and combined exposure on poor behavioral health (PBH) among university students in Spring 2023 (N = 45,386) using cross-sectional data from the American College Health Association’s National College Health Assessment III. PBH (an index of severe psychological distress and substance use risk) was reported by 42.9% of students. More than half of sexual and gender minority (SGM) youth reported PBH, and had a high prevalence of discrimination and microaggressions. Among racial/ethnic groups, Black/African American students had the highest prevalence of experiences of discrimination and microaggressions. Minoritized groups who experienced discrimination or microaggressions consistently reported a higher prevalence of PBH compared to their counterparts not reporting these experiences; the opposite pattern was observed among cisgender, heterosexual, and White participants. In the logistic regression models, experiences of both discrimination and microaggressions were associated with an over 2-fold increase in odds of PBH, controlling for demographic variables, compared to those experiencing neither. Interaction effects revealed that experiences of microaggressions did not consistently and differentially predict PBH across subgroups of minority youth. Efforts to increase resilience on university campuses may improve behavioral health. Full article

Background/Objectives: Osteoporosis-related fragility fractures are sentinel events that should trigger timely secondary prevention, yet post-fracture care remains inconsistent. Leveraging the NIH All of Us Research Program, we quantified initiation of osteoporosis pharmacotherapy after fragility fracture and explored associations by age, sex at birth, race, and ethnicity. Methods: Retrospective cohort study using All of Us Controlled Tier data (v8) included adults aged 45 to 100 years with an index fragility fracture using prespecified OMOP concept sets intended to capture fractures commonly associated with osteoporosis. A new-user design excluded participants with any osteoporosis pharmacotherapy in the 365 days before fracture; participants required at least 180 days of follow-up. The primary outcome was initiation of osteoporosis pharmacotherapy (bisphosphonates, denosumab, or anabolic agents) within 180 days. Secondary outcomes were completion of dual-energy x-ray absorptiometry (DXA) and bone-health laboratory testing within 180 days. Multivariable logistic regression estimated adjusted odds ratios (OR) for each outcome by age at fracture, sex at birth, race, and ethnicity. Results: Among 1492 eligible participants, 87 initiated pharmacotherapy within 180 days (5.83%). After adjustment, older age was associated with higher odds of initiation (OR 1.04 per year; 95% CI 1.02 to 1.05). Male participants had markedly lower odds of pharmacotherapy initiation (OR 0.20; 95% CI 0.11 to 0.37) and DXA screening (OR 0.22; 95% CI 0.15 to 0.32) compared with female participants. In exploratory adjusted models, we did not detect an independent association between race and pharmacotherapy initiation (White vs. Black/African American OR 1.01; 95% CI 0.49 to 2.09), while White participants had higher odds of DXA screening than Black/African American participants (OR 1.79; 95% CI 1.02 to 3.28). Conclusions: In this diverse national EHR-based cohort, initiation of osteoporosis pharmacotherapy after fracture was uncommon, highlighting a substantial secondary prevention gap. In exploratory adjusted models, male sex was associated with lower odds of pharmacotherapy initiation and DXA receipt, while White participants had higher odds of DXA receipt than Black participants. System-level post-fracture pathways, including fracture liaison services and EHR-based prompts, may improve equitable identification and treatment of osteoporosis for All of Us participants and their communities. Full article

Background/Objectives: Binge eating behavior has been deemed a significant factor associated with adolescent obesity. Understanding the underlying factors contributing to binge eating is critical, particularly among youth at risk of obesity. Hispanic and African American/Black children and adolescents experience disproportionately higher rates of obesity compared to their White peers. This study investigated the associations among anxiety, sleep quality, and binge eating among 315 Hispanic and African American/Black boys and girls, while controlling for demographic and adiposity covariates. Methods: Participants completed self-report surveys and underwent objective assessments of height, weight, and body fat percentage. Results: Descriptive analyses indicated a mean age of 10.71 years for boys and 10.92 years for girls. Most participants (71.9%) were classified as overweight or obese, and 94.1% were U.S.-born. Hierarchical regression analyses showed that both anxiety (β = 0.24, p < 0.001) and sleep quality (β = 0.23, p < 0.001) were significantly linked with higher levels of reported binge eating, after controlling for age, ethnicity, gender, and body fat percentage. The full model accounted for 15.4% of the variance in binge eating. Conclusions: These findings highlight the importance of targeting anxiety and sleep quality in interventions aimed at reducing binge eating among Hispanic and African American/Black early adolescents. Full article

Background: Out-of-hospital cardiac arrest is a major cause of mortality, and survival depends heavily on rapid defibrillation. Automated external defibrillators (AEDs) can significantly improve outcomes when used before emergency medical services (EMS) arrive, yet access to and use of these devices remain uneven across communities. This study investigates racial and geographic disparities in AED use during EMS encounters in the United States, evaluating differences across racial groups, geographic settings, cardiac arrest status, and patient acuity, irrespective of whether a bystander or EMS personnel applied the device. Methods: This descriptive study used aggregated data from the National Emergency Medical Services Information System (NEMSIS) Public Release Data Cube to compare AED use across racial, geographic, cardiac arrest, and acuity categories. AED use was defined as any documented application during the EMS encounter. Results: The dataset included 106,246 EMS encounters across six racial and ethnic groups. AEDs were applied in 16,688 encounters (15.7%), with substantial variation across demographic and geographic categories. Asian, American Indian or Alaska Native, and Black or African American patients had the highest rates of AED use, while White patients had the lowest rate despite representing the largest share of encounters. Urban areas accounted for most AED deployments, whereas suburban and frontier regions showed markedly lower use, while rural AED use was similar to urban rates. AED application was strongly associated with cardiac arrest and high patient acuity, yet racial differences persisted even within these clinically severe categories. Conclusions: AED use generally aligns with clinical indicators such as cardiac arrest and critical acuity, but meaningful racial and geographic differences were observed, reflecting descriptive patterns rather than confirmed disparities. These patterns should be interpreted cautiously, as the aggregated nature of the dataset limits the ability to determine whether differences reflect inequities, incident characteristics, or EMS system factors. These findings highlight the need for targeted strategies to expand AED access, improve device placement, and strengthen community readiness in underserved areas. Integrating AED availability into broader EMS planning and community outreach may help reduce inequities and create conditions that support improved survival outcomes. Further research using individual-level data and geospatial methods is needed to clarify the drivers of these observed differences and inform equitable prehospital care policies. Full article

Glioblastoma multiforme (GBM) is the most aggressive primary brain tumor, with well-documented incidence disparities across ethnic populations: highest in Europeans and lowest in East Asians and Africans. Still, the genetic basis of these differences remains poorly understood. This study assessed whether population-level differences in GBM risk allele frequencies correlate with ethnic disparities in prevalence. We analyzed 673 genome-wide significant GBM candidate loci across five ethnic superpopulations and 26 subpopulations using phased genotype data from the 1000 Genomes Project Phase 3. Population genetic structure was characterized using allele frequencies, heterozygosity, Wright’s fixation index, analysis of molecular variance (AMOVA), Nei’s genetic distances, and principal coordinate analysis. Risk allele enrichment was visualized via hypergeometric heatmaps, and polygenic risk scores were compared using Kruskal–Wallis and Dunn’s tests. Significant interpopulation differentiation was detected across all superpopulation pairs (p < 0.001). European populations had the highest polygenic risk scores, followed by South Asian and Admixed American populations, while East Asians had the lowest. Allele frequencies at key loci, including rs634537 (CDKN2B-AS1) and rs55705857 (CCDC26), differed up to tenfold. Finnish populations showed an elevated risk consistent with founder effects. Population genetic structure at GBM risk loci correlates with ethnic incidence disparities, underscoring the need for ancestry-specific approaches in risk modeling and trans-ancestry studies. Full article

While a conserved core microbiome is shared across healthy individuals, significant interindividual taxonomic variation exists; however, the specific influence of genetic ancestry on supragingival plaque structure in eubiosis remains unclear. This systematic review analyzed evidence regarding taxonomic variations in supragingival plaque associated with ethnicity in systemically healthy populations. A search was conducted in PubMed, Scopus, ScienceDirect, and Scielo following PRISMA 2020 guidelines, covering literature up to October 2025. Cross-sectional studies using genomic sequencing or metagenomics were included, with quality assessed via the GRADE system. Six studies met eligibility criteria. Results identified a universal core microbiome structurally dominated by Corynebacterium spp. and Streptococcus spp. However, distinct ethnic-specific taxonomic signatures emerged, such as the enrichment of Fusobacterium spp. in African Americans and Corynebacterium spp. in Caucasians, alongside the exclusive presence of Sneathia spp. in Burmese individuals. Although a basal microbial architecture necessary for homeostasis exists, ethnicity acts as a biological filter defining distinctive bacterial profiles and differential susceptibilities. These findings suggest that while the core microbiome is conserved, the composition of peripheral species in the dental plaque hedgehog structure varies according to ancestry. This supports a transition from standardized dental care to personalized medicine oriented towards the patient’s biological heritage. Full article

For historically marginalized groups and residents of low-resource rural communities, contact tracing is a critical tool for controlling the spread of communicable diseases. To improve its effectiveness, more research on identifying factors that influence an individual’s willingness to comply with contact tracers is needed. Therefore, we examined the association of race/ethnicity, contextual factors, and willingness to engage in contact tracing during the COVID-19 pandemic. The sample included 337 adults (56% Black/African American and 66% female). Approximately 80% of the participants indicated they would disclose the names of contacts. The results from the multivariate logistic regression analyses indicated lack of access to COVID-19 testing sites (aOR = 2.20; 95% CI = 1.08–4.48) and trust in health care providers (aOR = 7.57; 95% CI = 3.82–14.88) were significantly associated with willingness to share information with contact tracers. Race did not moderate the relationship between trust and engaging with contact tracers. The results suggest contact tracing is a viable strategy for mitigating disease transmission in rural communities, particularly when trust in health care providers is high and access to testing is limited, regardless of race. Public health officials should invest in maintaining contact tracing teams that include medical providers and prioritize building trusting relationships with all community members. Full article