Search Results (269)

Background/Objectives: Adherence to oral endocrine therapy (OET) is essential to reduce recurrence but is predominantly lower among underserved patients, leading to worse health outcomes. We aimed to depict longitudinal patterns of OET adherence using group-based trajectory modeling (GBTM) and identify predictors associated with each adherence trajectory. Methods: A single-center, retrospective study was conducted to analyze data from women 18 years or older with metastatic breast cancer who initiated with an OET and were treated from January to December 2022. Adherence was measured using a proportion of days covered (PDC > 80%) for 12 months. Binary monthly indicator of PDC was incorporated into GBTM. Four models were generated by changing the number of groups from 2 to 5, using a 2nd-order polynomial function of time. A multinomial logistic regression model was run to evaluate the predictors of non-adherence trajectories, and “adherence” was considered the reference group. Results: A total of 346 women had a (mean age of 60) years; 93% were Hispanic or of Mexican origin; 90% were taking aromatase inhibitors (AIs), with an endocrine therapy of 1.05 years. Three trajectories of adherence to GBTM were identified: a gradual decline in adherence (n = 88, 25.5%), improving suboptimal adherence (n = 106, 30.6%), and adherent (n = 152, 43.9%). Multinomial logistic regression analysis showed that significant predictors are diabetes (odds ratio (OR), 2.96; 95% confidence interval (CI), 1.57–5.57) and fewer years of therapy (OR, 2.96; 95% CI, 1.57–5.57). Suboptimal adherence among RGV patients receiving OET, with approximately 56% following a non-adherent trajectory. Conclusions: Suboptimal adherence among RGV patients receiving OET, with approximately 56% following a non-adherent trajectory. Significant predictors should be considered when designing targeted interventions. Full article

Breast cancer (BC) is the leading cancer diagnosis among women in Puerto Rico. Psychological distress is prevalent in this population, and social determinants may exacerbate this risk. This study examines whether sociodemographic characteristics, financial burden, and social support levels are associated with symptoms of anxiety and depression in Puerto Rican women with BC. A quantitative secondary analysis was conducted on a sample of 208 Hispanic women with BC, utilizing the Patient Health Questionnaire (PHQ-8) and the Generalized Anxiety Disorder (GAD-7) questionnaire. These scores were compared with sociodemographic values and Interpersonal Support Evaluation List (ISEL-12) scores, establishing statistical significance through association, parametric, and non-parametric tests, and regression models. 38.5% and 26.4% of participants showed clinically significant symptoms of depression and anxiety, respectively. Age and perceived income showed significant associations with psychological outcomes. However, regression analysis revealed perceived income as the only significant predictor for both depression and anxiety. Tangible and belonging support were significantly lower in participants with symptoms of depression, while appraisal support was significantly lower in participants with symptoms of anxiety. Findings highlight the influence of perceived financial stress on mental health and the need for psychosocial interventions tailored to the patients’ economic context. Full article

Depression and anxiety are the most prevalent mental health concerns among college students. In addition to the typical college stressors, Hispanic students may experience minority status stress associated with their membership in a socially stigmatized ethnic and cultural group. Ethnic minority status stress has been positively associated with psychological distress. Therefore, this study examined, among Hispanic college students, (a) gender differences in the associations of ethnic minority status stress and social support to depression and anxiety symptoms, (b) if social support buffered the association of minority stress with depression and anxiety symptoms, and (c) if the social support moderation effect differed by gender. The results indicated that the negative association of social support to depression symptoms was stronger for women than men and that social support buffered the association of ethnic minority status stress to depression symptoms only for women. The negative association of minority status stress to depression symptoms was statistically significant only for women who reported lower levels of social support. No gender or social support moderation effects were observed in relation to anxiety symptoms for women or men. The results highlight the importance of social support in ameliorating the potential impact of ethnic minority status stress on psychological distress among Hispanic college women. Full article

Depression is a widespread mental health condition that affects millions of women globally. In the United States (U.S.), more than half of maternal mental health-related deaths occur during the postpartum period, making it the leading cause of mortality during this time. This urban U.S. single-site quasi-experimental study aimed to evaluate the effectiveness of social support integrated into group prenatal care as an intervention for postpartum depression. The study employed a dual methodological approach, combining prospective participant recruitment with a retrospective analysis of medical records. It compared the Edinburgh Postnatal Depression Scale (EPDS) scores from group prenatal care to those from traditional individualized prenatal care, specifically focusing on Black and Hispanic women. In all, 200 postpartum women participated in the study, comprising (n = 100) group prenatal care and (n = 100) traditional individualized care. Most participants were Black (97%), with an average age of 26.8 years (SD = 5.9). At six weeks postpartum, 97% of the participants underwent depression screening, which indicated a mean EPDS score of 3.79 (SD = 4.7). Among the participants, 25% exhibited mild to moderate postpartum depression, while 3% experienced severe depression. No significant differences were observed between the models of care in terms of total scores (T = 2.0, p = 0.46) or score ranges (χ² = 5.8, p = 0.12). It is noteworthy that no severe cases of depression were identified within the group prenatal care model. Suggesting group prenatal care may still benefit Black and Hispanic women in urban areas with a history of anxiety or depression. Full article

Background: Previous research has examined the idea of the healthy immigrant effect and its potential application to pregnancy-related hypertensive disorders, particularly inracial and ethnic minority groups. The aim of this study is to examine how nativity, race, and ethnicity are related to prevalence of pregnancy-related hypertensive disorders. Methods: A retrospective cohort study was conducted using data from the PRAMS CDC dataset. These data were analyzed via Χ² comparisons of prevalence of pregnancy-related hypertensive disorders in foreign and US-born mothers, including subgroup analyses for Black and Hispanic women. Results: A sample size of 63,648 was analyzed, and revealed significant differences in the prevalence of gestational hypertension between US-born vs. foreign-born Black mothers (12.6% vs. 8.0%, Χ² (1, N = 12,046) = 36.92, p < 0.001), Hispanic mothers (9.5% vs. 7.2%, Χ² (1, N = 11,524) = 18.236, p < 0.001), and the larger sample of mothers across all reported racial and ethnic backgrounds (11.0% vs. 7.0%, Χ² (1, N = 63,648) = 163.835, p < 0.001). The results also revealed a significant difference in the prevalence of hypertension eclampsia between US-born and foreign-born Hispanic mothers (0.8% vs. 0.3%, Χ² (1, N = 11,152) = 8.480, p = 0.004). Conclusions: The study results showed evidence of significantly lower prevalence of pregnancy-related hypertensive disorders among foreign-born mothers as compared to their US-born counterparts, both in the full study sample and specifically in the subsamples of women who self-identified as Black and women who self-identified as Hispanic. These variances by nativity, race, and ethnicity provide further insight into how the healthy immigrant effect can apply to pregnancy-related hypertensive disorders, particularly for women of racial and ethnic minorities. Full article

While racial inequalities in assortative mating and fertility have been well documented, the role of neighborhoods has frequently been overlooked in explaining these disparities. In this study, I use restricted birth record data from the state of California with neighborhood-level socioeconomic and demographic data to explore the roles of neighborhoods and structural neighborhood inequality in mediating racial inequality in assortative mating and fertility in 2018 and 2019. Overall, neighborhood disadvantage, particularly disadvantage measured in a neighborhood’s mobility network, mediated a substantial proportion of the disparity in fathers’ educational attainment between White and Black or Hispanic mothers in California in 2018 and 2019. Additionally, while I observe evidence of Black and Hispanic neighborhoods having significantly greater fertility rates than White neighborhoods, this gap can be entirely explained by neighborhood disadvantage. Lastly, a significant share of the fertility gap between less-educated White and Black women is mediated by neighborhood disadvantage. This study motivates more research at the intersection of assortative mating and fertility at the neighborhood scale. Full article

Background: Ovarian cancer remains the deadliest and leading cause of gynecological cancer-associated mortality in the US. The aim of this study was to characterize the trends in the incidence of ovarian cancer between premenopausal and postmenopausal women to inform future targeted interventions. Methods: This population-based cross-sectional study analyzed data from the US Cancer Statistics (USCS) database, which covered the whole of the US population between 2001 and 2021. Joinpoint regression was used to compute the average annual percentage change (APC) with 95% confidence interval (CI) and age-standardized incidence rates per 1,000,000 population. Results: The results showed that the IR of ovarian cancer declined between 2001 and 2021. Postmenopausal women had greater decreases in the IR of ovarian cancer compared to premenopausal women who showed a small decline. When stratified by race/ethnicity, non-Hispanic American Indian/Alaska Native women aged 20–49 years experienced an increase in the IR of ovarian cancer (APC = 2.4; 95% CI 0.9 to 4.1) compared to other racial/ethnic groups which showed a decline. Joinpoint trend analyses identified one inflection point in localized ovarian cancer incidence trends among all three age groups: an initial decline from 2001 to 2011 among women 20–49 years old and 65+ years old, and from 2001 to 2012 among women 50–64 years old, followed by an upward trend thereafter to 2021. Similarly, there was one inflection point in the IR of ovarian cancer for the clear cell and endometrioid types among women aged 20–49 years old. Conclusions: The IR of ovarian cancer in the US declined significantly among postmenopausal compared to premenopausal women, for whom the IR of ovarian cancer decreased only slightly. Although encouraging, these findings show a need for continued efforts to improve early detection and prevention strategies to mitigate the burden of this deadly disease. Full article

Objective: to assess the association between attention-deficit/hyperactivity disorder (ADHD), type 1 diabetes mellitus (T1D), and cardiovascular comorbidities in adults. Methods: The Adult Self-Report Scale V1.1 (ASRS) for ADHD symptoms was electronically sent to 2069 adults with T1D. Cardiometabolic conditions, laboratory measurements, and PHQ-2/PHQ-9 depression scores were obtained from the electronic medical record. Results: In total, 292 (14.1%) individuals responded and 279 consented to medical records extraction. The average age was 47.4 years (SD: ±18.9), 64.2% were women, 95.7% were non-Hispanic white, and the mean HbA1c level was 7.7% (±1.5%). Of 273 completing ASRS, 87 med ADHD criteria (ASRS positive, 31.9%), and 42 (15.4%) had an ADHD diagnosis or medication. Women had higher scores than men. ADHD symptoms decreased with age, but remained significantly higher than the general population levels. HbA1c levels were positively associated with the ASRS scores (Spearman’s r = 0.28, p < 0.0001). ASRS positive individuals had worse glycemic control (HbA1c ≥ 8.0%, adjusted OR 2.3, 95%CI: 1.3–4.1, p < 0.0001) and higher PHQ-9 scores (10 ± 7.3 vs. 6.1 ± 6, χ²₍₁₎ = 9.2, p = 0.002) than the ASRS negative group. No associations were found between ASRS scores and cardiometabolic diseases, or other laboratory or clinical measurements. Conclusions: Many adults with T1D exhibit undiagnosed ADHD symptoms, which correlate with poorer glycemic control and depression. Further research with larger samples is needed to investigate ADHD prevalence and impacts in this group. 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

Coxiella burnetii is a significant infectious pathogen that causes Q fever. Q fever is thought to be uncommon in the US and most human cases are believed to occur in agricultural livestock workers. However, the extent of US community exposure to C. burnetii is not known with certainty. Using nationally representative 2003–2004 US National Health and Nutrition Examination Survey serologic, demographic, and occupational history data, the magnitude of US adult general population exposure to C. burnetii, excluding agricultural-sector workers, was estimated. Exposure was defined as positive serum IgG antibodies in an immunofluorescence assay (e.g., current or past infection). A total of 3.0% (95% CI: 2.0–4.4) of the US population met the criteria for C. burnetii exposure, representing some 6.2 million persons. Overall, 86.9% (95% CI: 75.5–98.4) of the seropositive persons had no lifetime history of work in the agricultural sector (5.5 million persons). This was consistently true across all US demographic groups: aged 20–59 years, 87.3%; aged 60+ years, 85.7%; men, 86.1%; women, 87.6%; non-Hispanic Whites, 82%; non-Hispanic Blacks, 95.8%; Mexican Americans, 89.4%; immigrants from Mexico, 83.5%; and other immigrants, 96.8%. As a proportion of C. burnetii infections result in acute Q fever and chronic Q fever conveys significant mortality, the community-level risks to the general public may be significant. It is recommended that a 6-year sample of the most recent NHANES stored sera be analyzed to determine the current community C. burnetii exposure rates. Also, analyzing an additional 2005–2008 stored sera sample would provide an opportunity to assess the time trends and long-term health impacts. Full article

Preterm birth (PTB; <37 weeks’ gestation) is a persistent problem in the United States that affects non-Hispanic Black women at much higher rates than White women. Several biomarkers have been associated with PTB, including vitamin D deficiency (VDD) and low levels of vitamin D-binding protein (VDBP). However, no biomarker has been found to predict PTB. To identify a predictive biomarker of PTB, gene expression differences were determined in Black women with PTB and full-term births and between women with high and low levels of plasma vitamin D and high and low VDBP levels. In this pilot study of 19 pregnant women from the Biosocial Impact on Black Births (BIBB) study, we found that 47 genes were upregulated and 16 genes were downregulated in women with PTB as compared with women who had a full-term birth, 361 genes were downregulated and 61 genes were upregulated in women with VDD as compared with those that had vitamin D sufficiency, and 44 genes were upregulated and 295 were downregulated in women with low VDBP. Several genes expressed by neutrophils were downregulated in the PTB, VDD, and low VDBP groups. These findings support the idea that vitamin D and VDBP status may be important clinical markers influencing the gene expression of genes associated with PTB. 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

Introduction: Hyperinsulinemia and insulin resistance are strong predictors of cardiometabolic diseases, which disproportionately affect individuals across gender, racial/ethnic, and socioeconomic groups. We aim to estimate and test the temporal trends in the prevalence of hyperinsulinemia and insulin resistance (IR) by sociodemographic groups among nondiabetic adults in the United States from 1999 to 2018. Methods: We used data from the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2018. We fitted linear and joinpoint logistic regression models to test the sample weighted and age-standardized time trends for linear and nonlinear trends in the prevalence of hyperinsulinemia and IR, respectively. Results: We included 17,310 nondiabetic men and nonpregnant women aged 20 years or older. The age-standardized prevalence of hyperinsulinemia increased from 28.2% in 1999–2000 to 41.4% in 2017–2018, with IR prevalence similarly rising from 24.8% in 1999–2000 to 38.4% in 2017–2018. Across the entire period examined, individuals who were male; non-Hispanic Black; Hispanic; or had a lower educational level or lower family income consistently had a higher prevalence of hyperinsulinemia and IR than other groups. We found increasing temporal trends in the prevalence of hyperinsulinemia and IR for all the sociodemographic subgroups, at least in some periods from 1999 to 2018. Conclusions: There was an increased age-standardized prevalence of hyperinsulinemia and IR among nondiabetic adults in the US across each defined sociodemographic group from 1999 to 2018. The difference in prevalence across subgroups underscores the need for designing personalized and targeted interventions to address disparities. Full article

To investigate the place-based association between BCM and air pollution in middle-aged (45–64) and older-aged women (65+) in California at the zip code level, secondary data were collected from the California Department of Public Health (CDPH) Data and Vital Statistics, CalEnviroScreen 4.0, and the American Community Survey (ACS) from the Census. Multiple linear regression was used to test the significance between air pollution and age-standardized BCM rates. The results indicate a significant association between PM_2.5 and age-standardized BCM rates for both the middle-aged and older-aged groups (β = 3.73, 95% CI [2.89, 4.58]; β = 5.33, 95% CI [2.75, 8.32], respectively). Furthermore, we found evidence of effect modification by the concentration of Hispanic women (β = −6.73, 95% CI [−9.37, −4.08]. This study provides evidence of a significant spatial association between PM_2.5 and BCM rates, which has policy implications for stricter air quality regulations and urban planning policies. Further research is needed to establish causality and the mechanism of action at the population level. Full article

Background: Clinical trials should benefit all people. Consequently, the National Cancer Institute expects cancer centers to accrue individuals to clinical trials in proportion to the cancer burden experienced by populations that live in their respective catchment areas; unfortunately, many cancer centers fail to meet this expectation. The person who gives consent for individuals in clinical trials frequently has significant contact with potential trial participants. We hypothesized that the race, ethnicity, and language of the consenter may have an important bearing on whether an individual chooses to participate in a clinical trial. Methods: We used mixed methods to investigate the impact of the socio-cultural background of the consenter on the decision of a potential research subject to participate in a clinical trial. Between 01/2018 and 02/2020, 205 women were approached in the sequential order they appeared in our breast clinic; of the 181 participants who agreed to complete the survey questionnaire, 94 (52%) were Northern European, non-Hispanic White (NE White), and 87 (48%) were Women-of-Color (WOC); this category includes participants who self-identified as Asian, Black, Hispanic/Latina, or Native American. Results: There were statistically significant differences according to the importance of the consenter’s characteristics in the decision to enroll or decline participation in the BCT. No NE White enroller (0%, n = 0) reported that consenter race was important versus 11% (n = 9) of WOC enrollers (p = 0.0009). Similarly, none of the NE White enrollers rated the consenter “looking like people in my community” as important versus 12% (n = 10) of the WOC enrollers (p = 0.0004). Conclusions: We find that consenter race and ethnicity are important for clinical trial diversity. Larger studies are needed to evaluate the generalizability of this finding. Full article