Search Results (369)

While the “model minority” stereotype has been extensively studied in relation to Asian Americans, there is limited research that distinguishes these experiences by specific national origins. This paper explores the stereotypes faced by India-born scientists and engineers in the United States. They represent a significant segment of the foreign-born workforce in the U.S., accounting for one-third of this population and comprising the largest group of H-1B visa holders. Through qualitative data gathered from 40 India-born scientists and engineers employed in U.S. high-tech firms, this study examines how these individuals perceive and navigate the cultural stereotypes that shape their professional and personal lives. The paper delves into the intersections of ethnicity, nationality, and gender in shaping their experiences, challenging the characterization of Indians as “model immigrants”. Full article

American Indian communities may be at increased risk of water-related PFAS exposure. However, communicating the health risks of PFAS exposure requires attention to concepts of health literacy and aligning educational messages with the community’s understanding of health. The purpose of this study was to determine the health literacy demand of PFAS educational materials, with specific attention to their appropriateness for American Indian communities. Publicly available PFAS educational materials were evaluated using the Simple Measure of Gobbledygook (SMOG), the Patient Education Material Assessment Tool (PEMAT), and a cultural appropriateness tool. The mean reading level of the materials was above 12th grade. The PEMAT scores for the 33 print materials were 62% (understandability), 34% (actionability), and 61% (cultural appropriateness). For the videos, the scores were 62% (understandability), 53% (actionability), and 68% (cultural appropriateness). Neither the print nor the video materials met acceptable health literacy standards, meaning the materials are not well-designed for a variety of health literacy levels. There was a lack of actionable directives that should be addressed in future PFAS educational materials. This study highlights the importance of working closely with community partners to develop education materials that match the skills and preferences of the intended audience. 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

Background: Hepatitis C virus (HCV) remains a major cause of preventable liver-related mortality in the United States despite highly effective direct-acting antivirals (DAAs). Contemporary assessment of mortality trends and disparities is essential for elimination efforts. Methods: Using CDC WONDER multiple cause-of-death data (1999–2023), we identified HCV-related deaths using ICD-10 codes for acute and chronic HCV (B17.1, B18.2) and calculated age-adjusted mortality rates (AAMRs) per 100,000 (2000 US standard). Rates were stratified by sex, race/ethnicity, census region, and 2013 NCHS urban–rural classification. Joinpoint regression quantified temporal inflection points and annual percent changes (APCs). Results: Overall HCV-related AAMR increased from 1.8 (1999) to a peak of 5.0 (2014), then declined to 2.3 (2023), with a marked post-2014 decrease (APC −8.2%). Mortality was consistently higher in males than females (2023 rate ratio 2.57). In 2023, American Indian/Alaska Native individuals had the highest mortality (AAMR 8.7; rate ratio 3.48 vs. non-Hispanic White), followed by non-Hispanic Black individuals (AAMR 6.2; rate ratio 2.48). Mortality remained highest in the West and was higher in non-metropolitan than metropolitan counties (AAMR 2.8 vs. 2.3; rate ratio 1.22), with a slower post-2014 decline in non-metropolitan areas. Conclusions: Our findings indicate that while the DAA era has been associated with a substantial reduction in HCV-related mortality at the national level, this progress has not been uniform across all populations. Persistent excess mortality among Native American and non-Hispanic Black individuals may reflect inequities in the HCV care cascade, including screening, confirmatory testing, linkage to specialty care, insurance-related restrictions, and the high cost of antiviral therapy. These results highlight the need for policies and public health strategies that improve equitable and affordable access to curative HCV treatment. Full article

Background/Objectives: Racial/ethnic and regional disparities in neoplasm-related mortality remain a significant public health challenge. In this study, we aimed to evaluate long-term trends in county-level neoplasm-related mortality rates by race/ethnicity in the United States and examine associations with social determinants of health. Methods: We conducted a cross-sectional ecological study using population-based data from the Global Burden of Disease Study, including individuals residing in 50 states of the United States and the District of Columbia from 2000 to 2019. We analyzed age-standardized neoplasm-related mortality rates by ethnicity/race. Joinpoint regression analysis was used to identify significant changes in mortality trends, summarized as average annual percentage change. County-level correlations between mortality and key social determinants of health were also assessed. Results: Neoplasm-related mortality rates declined across all racial/ethnic groups from 2000 to 2019; however, disparities persisted. The age-standardized neoplasm-related mortality rates per 100,000 population decreased in all racial/ethnic subgroups. The average annual percentage change ranged from −0.94% (Hispanic and non-Hispanic American Indian or Alaska Native) to −1.90% (Black). Sex-specific analyses revealed similar trends. Southeastern states experienced slower declines than Northeastern states did. County-level smoking and poverty rates were positively correlated, whereas the primary care physician-to-population ratio, excessive alcohol consumption rate, mammography screening rate, and median household income were inversely correlated with neoplasm-related mortality rate, varying by race/ethnicity. Conclusions: Targeted, community-specific interventions are required to reduce inequities in cancer outcomes. Full article

The United States faces a worsening maternal mortality crisis that starkly contrasts with trends in other high-income nations. Maternal mortality rates (MMRs) have more than doubled over the past two decades, rising from 9.65 deaths per 100,000 live births in 1999–2002 to 23.6 in 2018–2021, with approximately 700 deaths annually. Black and American Indian/Alaska Native women experience maternal mortality rates two to three times higher than their White counterparts, reflecting persistent structural inequities rather than biological differences. This narrative review synthesizes current evidence on the underlying drivers of racial inequities in maternal mortality and evaluates evidence-based interventions and policy strategies to address these disparities. A comprehensive literature review between 2000 and 2025 was conducted using databases including PubMed, Scopus, Web of Science, and Google Scholar, focusing on studies examining clinical, social, and structural determinants of maternal health outcomes, as well as evidence-based interventions and maternal health policy. Targeted searches of policy reports and grey literature were also performed to identify relevant policy initiatives and system-level interventions. Key contributors to disparities include underlying health conditions, postpartum mental health inequities, provider shortages, and limited access to postpartum care, with pregnancy-associated breast cancer (PABC) representing a less common but clinically significant risk factor that warrants further investigation in the context of racial inequities. Structural racism and socioeconomic disparities further exacerbate inequities through differential access to care, treatment bias, and barriers to healthcare utilization. System-level challenges, including workforce shortages, maternity care deserts, and the absence of federally mandated paid maternity leave, disproportionately impact marginalized populations. Although policy initiatives such as Medicaid postpartum coverage extensions, the Maternal Health Momnibus Act, and Maternal Mortality Review Committees represent important progress, they remain insufficient without broader structural reform. Evidence-based interventions, including midwife- and doula-led care, community-based peer support, and culturally tailored mental health programs, demonstrate measurable improvements in maternal outcomes. Outcomes of this review highlight the need for a comprehensive, equity-centered approach to reducing maternal mortality disparities, emphasizing structural reform, expanded access to care, strengthened data systems, and community-driven solutions. Full article

Purpose: Purchased/Referred Care Delivery Area (PRCDA) counties are those where resident American Indian and Alaska Native (AIAN) people are eligible for Indian Health Service care. Due to concerns about racial misclassification, cancer statistics for AIAN people are often restricted to PRCDA counties. Differences in sociodemographic characteristics may exist between PRCDA and non-PRCDA counties, but have not been described; therefore, the potential selection bias associated with the restriction to PRCDA counties remains unknown. Methods: We used data from the University of California, San Francisco Health Atlas to explore ecological differences in county-level demographic, socioeconomic, healthcare access, and health outcomes data between PRCDA and non-PRCDA counties (n = 3152 counties). We tested for statistical differences in mean levels of demographics between PRCDA and non-PRCDA counties using Pooled or Welch t-tests. Results: We observed small, but statistically significant differences between PRCDA and non-PRCDA counties in county-level demographic and socioeconomic characteristics (age, poverty, utility services threat, unemployment, educational attainment, computer access, and median income), neighborhood and environment characteristics (overcrowding, severe mortgage/rent burden), healthcare access and utilization (uninsured, annual checkup, annual dental visit, mammography, binge drinking, smoking, physical inactivity, social isolation), and health outcomes (poor mental health, arthritis, poor self-rated health, high blood pressure, diabetes, high cholesterol, and obesity). Conclusions: These results indicate variability in county-level measures between PRCDA and non-PRCDA counties. While these data do not speak specifically to AIAN peoples’ experiences, they provide critical contextual information to understand how exclusion of AIAN people residing in non-PRCDA counties from cancer statistics may bias risk estimates. Full article

American Indian and Alaska Native (AI/AN) communities experienced disproportionate COVID-19 morbidity and mortality, particularly in rural areas with limited public health infrastructure. This study examined primary COVID-19 information sources among AI/AN adults in rural Michigan and evaluated how trust in these sources relates to health knowledge, attitudes, and vaccination behaviors. We conducted a prospective, randomized pre-post interventional study among 273 adults at a tribal health clinic in rural Isabella County, Michigan (2022–2024). Participants were assigned to receive a culturally tailored educational video or infographic, and surveys assessed COVID-19 knowledge, vaccine attitudes, information sources, and perceived reliability. Social media was the most frequently used information source but was rated as less reliable, whereas healthcare workers (HCWs) were considered the most trusted. Reliance on HCWs and personal relationships was associated with higher baseline vaccine knowledge and greater uptake of influenza vaccination. Both educational formats resulted in modest improvements in COVID-19 knowledge and vaccine attitudes. While no consistent differences were observed between formats overall, infographic-based education was associated with greater gains in select vaccine knowledge domains among participants who relied on trusted interpersonal or clinical information sources. These findings highlight a “usage-trust gap” in rural AI/AN health communication, where frequently used information channels are not necessarily the most trusted. Culturally tailored messaging delivered through trusted clinical and interpersonal networks may enhance the effectiveness of public health communication and support vaccine uptake in underserved communities. Full article

Background: Prostate cancer remains a major cause of cancer morbidity and mortality among men in the United States. Differences in diagnosis and survival across racial and socioeconomic groups continue to raise concern in clinical and public health research. Population-based datasets provide an opportunity to examine patterns of advanced disease and survival outcomes across diverse demographic groups. Objective: This study evaluated racial and socioeconomic disparities in cancer-specific survival among patients with metastatic prostate cancer using a national population-based dataset. Methods: A retrospective population-based study was conducted using data from the Surveillance, Epidemiology, and End Results (SEER) program. Patients diagnosed with malignant prostate cancer between 2004 and 2020 with distant stage disease were included. The final analytic sample consisted of 54,062 patients. Variables included race and ethnicity, age group, metastatic sites at diagnosis, treatment variables, and median household income. Descriptive analyses compared characteristics by cancer-specific death using chi-square tests for categorical variables and t tests for continuous variables. Survival patterns were examined using Kaplan–Meier methods and log-rank tests. Multivariable Cox proportional hazards model was used to estimate adjusted hazard ratios for factors associated with cancer-specific mortality. Results: Cancer-specific mortality differed across racial and socioeconomic groups. Higher mortality was observed among non-Hispanic Black patients (aHR = 1.15, 95% CI: 1.00 to 1.31, p = 0.046) and non-Hispanic American Indian or Alaska Native patients (aHR = 1.15, 95% CI: 1.10 to 1.20, p < 0.001) compared with non-Hispanic White patients, while Hispanic and non-Hispanic Asian or Pacific Islander patients showed lower mortality risk. Older age groups demonstrated higher mortality. Liver, lung, and brain metastases were associated with increased risk of prostate cancer death. Patients in higher income groups showed lower mortality compared with patients in lower income groups (aHR = 0.83, 95% CI: 0.80 to 0.87, p < 0.001). Conclusions: This study highlights persistent racial and socioeconomic differences in cancer-specific survival among patients with advanced prostate cancer in the United States. These findings support continued efforts to address disparities in early detection, access to care, and treatment pathways. Future research should further explore clinical and structural factors that influence survival differences across population groups. Full article

The 2021–2024 global energy crisis intensified the energy transition, with mainstream media coverage playing a pivotal role in shaping public perceptions. Guided by Burke’s and Lippmann’s theories, and supported by corpus-based critical and rhetorical discourse analyses, this interdisciplinary study aimed to analyze the role of lexical patterns and rhetorical strategies in framing the transition within a corpus of 1341 news articles retrieved from the websites of five English-language mainstream media outlets. Corpus-based analysis identified generic frames, including economic consequences, responsibility, conflict, technological, emotion, and moral duty frames. Rhetorical discourse analysis revealed specific frames, including economic opportunities, technological progress and challenges, energy security and independence, global leadership, energy partnerships, partisan divide, global disparities, corporate greenwashing, necessity, hope, and uncertainty frames, that indicated an ambivalence in the framing of the transition, thereby contributing to the polarization and manipulation of public opinion. The findings indicated a discrepancy: while British, American, and Brazilian media focused more on political divides, Indian and Chinese media emphasized energy partnerships and patriotism. Appeals to experts were less frequent, whereas appeals to emotions were often employed to shape public perceptions. The findings illustrate how lexical patterns and rhetorical strategies function as powerful framing tools within journalism, applied linguistics, and media rhetoric. Full article

American Indian and Alaska Native (AI/AN) populations experience disproportionately high kidney cancer incidence and mortality compared to other groups in the United States. Literature was reviewed to explore the factors contributing to the unequally higher kidney cancer burden in AI/AN communities and to develop recommendations to reduce these disparities. The incidence of kidney cancer has been rising over the past few decades, and this increase has been especially steep among AI/AN populations. Death rates in AI/AN populations are roughly twice those of the non-Hispanic White population. The elevated kidney cancer burden in AI/AN populations may be driven by both clinical and behavioral risk factors (obesity, diabetes, hypertension, chronic kidney disease, smoking, and environmental factors) and structural drivers of health, which can critically shape these disparities. Systemic inequalities limit AI/AN patients and community members’ access to chronic disease management, smoking cessation programs, primary and specialty care for early detection, and ultimately, treatment. AI/AN patients may have mistrust or other cultural barriers to engaging with the healthcare system and providers, while implicit bias in healthcare providers may lead to undertreatment. Therefore, key interventions and tailored programs aimed at reducing kidney cancer incidence and mortality are needed. Here we highlight some current interventions, including access to disease management and smoking cessation programs, facilitating healthcare access and quality, adopting patient navigation and culturally competent education, and developing strategies for early detection. In partnership with AI/AN communities, a combination of prevention, early detection, and healthcare system improvements is needed to close the kidney cancer gap. Full article

Mpox is a rare but potentially serious vaccine-preventable disease. The 2022 United States outbreak disproportionately impacted gay, bisexual, and other men who have sex with men, people living with HIV, and people of transgender experience. Early vaccination efforts revealed substantial racial and geographic inequities, with lower uptake among Black and Hispanic cisgender men, transgender women, and residents of rural areas. To address these challenges, Fairview’s Minnesota Immunization Networking Initiative (MINI), a 20-year-old mobile health collaborative, partnered with state and local public health agencies and community-based organizations to expand mpox vaccine access. With support from governmental outbreak response funding and stockpiled vaccine, mobile clinics were deployed in trusted community settings, including Pride events and recurring community sites. Targeted outreach, education, and coordination with local providers supported stigma reduction and second-dose series completion. Program data were collected from October 2022 through December 2024. MINI hosted 125 community-based mpox vaccination events, administered 2259 doses to individuals from 220 cities across the United States, including 195 cities in the Midwest. Pride events were key entry points for first-dose vaccination, particularly in rural areas; urban non-Pride clinics played a complementary role in facilitating second-dose completion. Program-level vaccination-to-case ratios were highest among populations experiencing disproportionate mpox burden, including Black, Hispanic, and American Indian/Alaska Native male participants, suggesting alignment of preventive resources with community need. MINI’s mobile, partnership-driven approach demonstrates the value of pairing large-scale community events with recurring clinics to address barriers to both vaccine access and series completion. These findings underscore the importance of flexible, community-centered infrastructure in advancing health equity and strengthening outbreak preparedness. Full article

There is a significant need for culturally appropriate psychological treatments for chronic pain among American Indian/Alaska Native (AI/AN) peoples. This study used Indigenous community-based participatory research methods with the Portland Area Indian Health Services—Yakama Service Unit (YSU) to gather information needed for developing culturally adapted psychological treatments for AI/AN individuals with chronic pain. This study included remote semi-structured focus groups with 16 AI/AN individuals with chronic pain to identify pain treatment preferences (Aim 1) and priorities for pain treatment outcome domains (Aim 2). Thematic analyses were conducted with Atlas.ti (version 23.2.1). Results indicated a high interest in psychological interventions and concern that referral to psychological treatment meant that pain is “not real.” Pain intensity and pain interference were identified as the most important outcome domains. To measure pain intensity, the 0 to 10 Numerical Rating Scale was most preferred. The findings support the potential utility of culturally adapted psychological treatments for chronic pain for AI/AN individuals and provided information regarding the adaptations that would be most useful. Full article

Ambient fine particulate matter (PM2.5) is associated with increased mortality at concentrations below current regulatory standards. Studies of low-level exposure often rely on large administrative cohorts whose geographic and demographic composition may influence observed associations. In a prior analysis, we observed an association between long-term PM2.5 and all-cause mortality among Native American Medicare beneficiaries living in zip codes within the lowest decile of PM2.5 exposure. The present study, a case–control analysis of 1,713,399 low-PM2.5-exposed beneficiaries enrolled in traditional Medicare during 2015–2016, evaluated whether this association could be explained by geographic context, socioeconomic position (SEP), or baseline health status. We used principal components analysis to summarize area-level SEP indicators and beneficiary-level chronic disease diagnoses. In fully adjusted pooled models, PM2.5 was more strongly associated with mortality among Native American beneficiaries (odds ratio, OR = 1.12 per ug/m³; 95% CI 1.06–1.18) than among non-Native American beneficiaries (OR = 1.01 per ug/m³; 95% CI 1.001–1.02). Sequential adjustment among Native Americans showed that state-level geographic clustering accounted for most attenuation of the PM2.5 coefficient, with additional modest attenuation after adjustment for SEP and chronic disease patterns. These findings suggest that PM2.5–mortality associations observed in low-exposure populations may partly reflect geographic composition and underlying health differences within these large cohorts. Full article

Avocado (Persea americana Mill.) is one of the most widely consumed fruit tree crops worldwide, with cultivation expanding rapidly beyond its Mesoamerican and northwest South America center of origin. In emerging secondary diversity centers such as East Africa, farmers have long propagated seedling naturalized populations that may hold valuable reservoirs of genetic diversity, yet these resources remain underexplored. To help fill this gap, this study developed the first genomic resources for avocados in Tanzania, where avocado has a long history of introduction and diversification dating to the first Arab incursions and Catholic missionary missions. Low-coverage whole-genome resequencing (lcWGS) data were obtained from 95 trees sampled in Tanzania across the low- to mid-altitude Morogoro region (n = 25) and the Southern Highlands—i.e., the Iringa (n = 20), Mbeya (n = 30) and Ruvuma (n = 20) regions. In order to guide racial assignation, sequences were merged with NCBI-available lcWGS data from 205 avocado trees, including 42 commercial varieties, with reported ancestry. Population stratification as inferred via maximum likelihood phylogenetic inference, genetic principal component analysis, and ADMIXTURE unsupervised clustering suggested that the sampled Tanzanian avocado trees were genetically closer to the West Indian race and more distant from the northwest South American Caribbean and Andean groups. Additionally, while the trees from the low- to mid-altitude region of Morogoro were almost exclusively West Indian type, some trees from the Southern Highlands aligned more closely with West Indian × Guatemalan and West Indian × Mexican hybrids. These trends were equally supported by a subset of 10,460 high-coverage (10×) SNP markers. Together these findings clarify the dynamics of avocado diversification in a secondary center in East Africa, spanning recent introductions from a single Mesoamerican race, adaptation to a wide range of locally geographic conditions, and farmer-driven selection matching local tribal preferences. Characterizing these locally adapted resources is key for identifying underrepresented yet promising provenances, developing resilient and sustainable horticultural production systems, and safeguarding the species’ global genetic heritage. Full article