Search Results (126)

Introduction: Racial and ethnic disparities in end-of-life (EOL) cancer care persist, leading to lower rates of advance care planning (ACP), reduced access to palliative care, and poorer patient outcomes for minority populations. While previous research has documented these inequities, less is known about the specific interventions developed to address them, necessitating a comprehensive review of existing strategies aimed at improving EOL care for racial and ethnic populations. The objective of this scoping review is to examine the extent and characteristics of interventions and their outcomes designed to address racial and ethnic disparities in EOL cancer care in the United States. Methods: A comprehensive search of EOL cancer care interventions for minority populations was conducted in Ovid MEDLINE, CINAHL with Full Text (EBSCOhost), and Scopus (Elsevier) in September 2024. Two independent reviewers screened titles, abstracts, and full texts following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines, with inclusion limited to studies conducted in the US and published in English. Results: Of 3104 screened studies, 10 met the inclusion criteria. Participants enrolled were only from Latino (n = 6 studies) or Black (n = 4 studies) populations. We identified four types of interventions, including communication skills for patients, caregivers, researchers, and clinicians (n = 2), education programs for patients (n = 1), navigation and support programs for patients and caregivers (n = 3), and training programs for health workers and community leaders (n = 4). The most effective interventions were those that addressed linguistic barriers, integrated cultural values, and involved trusted community figures. Faith-based models were particularly successful among African American patients, while bilingual navigation and family-centered ACP interventions had the greatest impact in Latino populations. Conclusions: This review highlights (1) the importance of culturally tailored interventions for specific minority populations and (2) the limited number of such interventions, which primarily target only the largest minority groups. 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

Environmental justice research in the United States (US) documents greater air pollution exposures for Hispanic/Latino vs. non-Hispanic White groups. EJ research has not focused on the intersection of race/ethnicity and older age nor short-term fine particulate matter (PM_2.5) exposures. We address these knowledge gaps by studying US metropolitan area census tracts within 100 km of the US–Mexico border, a region with serious air quality issues. We use US Census American Community Survey data to construct sociodemographic variables and Environmental Protection Agency Downscaler data to construct long-term and short-term measures of PM_2.5 exposure. Using multivariable generalized estimating equations, we test for differences in PM_2.5 exposures between census tracts with higher vs. lower proportions of older Hispanic/Latino residents and older non-Hispanic White residents. The results indicate that as the proportion of the Hispanic/Latino population ≥ 65 years of age increases, long-term and short-term PM_2.5 exposures significantly increase. In contrast, as the proportion of the non-Hispanic White population ≥ 65 years of age increases, changes in long-term and short-term PM_2.5 exposures are statistically non-significant. These findings illuminate how race/ethnicity and older age intersect in shaping PM_2.5 exposure disparities and may inform efforts to mitigate air pollution exposures for overburdened people along the US–Mexico border. Full article

Research on sleep disorders among migrant populations is limited, particularly in the context of south–south Latinos migrating to other Latin American countries. Objective: This study aims to analyze the effect that the acculturation process may play on the presence of the subjective assessment of insomnia symptoms in South American migrants in Chile. Methods: Under a cross-sectional design, 1844 South American migrants from Colombia, Venezuela and Peru, currently residing in Chile, were evaluated. Of these, 50% were women with an average age of 35 years. Data were collected using the Insomnia Severity Index (ISI), the EBEA scale for acculturation stress, a scale based on Berry’s acculturation strategies, and the anxiety subscale of the DASS-21. Mediation models were employed to assess anxiety as a mediating variable between both acculturation stress and acculturation orientations as well as insomnia symptoms. Results: A home-country-focused orientation was inversely related to insomnia symptoms, whereas a host-country-focused orientation showed a direct association. Anxiety did not mediate either of these relationships. However, acculturation stress was directly associated with the emergence of insomnia symptoms; in this relationship, anxiety partially mediated the negative effect of stress on sleep. Conclusions: There is a complex and dynamic interplay between the acculturation process, insomnia, and anxiety within south-to-south migration in Latin countries. Understanding these relationships could promote culturally sensitive interventions to mitigate the adverse effects of migration-related stressors on sleep health and the overall well-being of Latino migrants. Full article

This study investigates how the ability to recognize static facial emotional expressions changes over time, specifically through three developmental stages: childhood, preadolescence, and adolescence. A total of 301 Italian participants were involved and divided into three age groups: children (7–10 years), pre-adolescents (11–13 years), and adolescents (14–19 years). Participants completed an online emotional decoding task using images from the Child Affective Facial Expression (CAFE) database, depicting anger, disgust, fear, happiness, sadness, surprise, and neutrality, conveyed by children of different ethnicities (African American, Caucasian/European American, Latino, and Asian). Results indicated that female participants generally exhibited a higher emotion recognition accuracy than male participants. Among the emotions, happiness, surprise, and anger were the most accurately recognized, while fear was the least recognized. Adolescents demonstrated a better recognition of disgust compared to children, while pre-adolescents more poorly recognized neutrality compared to children and adolescents. Additionally, this study found that female facial expressions of disgust, sadness, and fear were more accurately recognized than male expressions, whereas male expressions of surprise and neutrality were better recognized than female expressions. Regarding the ethnicity of facial expressions, results revealed that ethnicity can be better or more poorly recognized depending on the emotion investigated, therefore presenting very heterogeneous models. Full article

Political socialization in the United States is circuitous and influenced by numerous outside sources, including parents, teachers, and peers. Moreover, civic organizations and political parties often work directly to recruit and mobilize citizens into politics. However, many foreign-born immigrants are denied these opportunities to acquire socialization. Immigrants are also often further overlooked or ignored by the civic and political organizations that incorporate most native-born Americans into politics. While a range of previous scholarship has sought to demonstrate and explain these disparities, few studies have examined alternative routes to political socialization or reconsidered the paradigm of incremental socialization as it applies to foreign-born populations. We argue that immigrants may instead become involved in the U.S. political system through religious conversion—a pivotal event in their lives. Using surveys of the two predominant U.S. immigrant groups, Asian Americans and Latinos, we show that religious conversion can catalyze the socialization process. Among both groups, religious conversion in the U.S. is associated with increased rates of political participation. These results suggest that immigrant socialization may follow different pathways than those of native-born populations, and that scholars should take into greater consideration the role of critical life events when modelling political socialization among foreign-born populations. Full article

Latinos/as are the largest ethnic group in the U.S. and are a continuous source of population growth. Therefore, their health and quality of life are important public health concerns. Acculturation is an important determinant of health for Latinos/as. However, few studies examine models identifying determinants of acculturation along with its relationship to other social and health behaviors. The current study uses social network data from a sample of crowdsourced recruited Latinos/as (N = 300) to examine a structural model between network acculturation, psychological acculturation, social capital, help-seeking, and quality of life (QoL). The model posits several paths through which social networks (i.e., network acculturation) relate to acculturation and other model variables. Directly, network acculturation was found to be significantly related to Latino/a enculturation (−0.83, p = 0.002) and White American Acculturation (0.47, p = 0.003). Latino/a enculturation was related to help-seeking (0.21, p = 0.029) and social capital (0.36, p < 0.001), while White American acculturation was only related to social capital (0.35, p = 0.003). Social capital demonstrated a robust relationship with help-seeking (0.48, p = 0.004) and QoL (0.96, p = 0.003). The findings suggest that determinants of acculturation (i.e., network acculturation) are meaningful contributors to psychological acculturation and other variables relating to Latino/as’ QoL. Full article

Background: Marginalized low-income racial and ethnic minority residents of public housing represent an intersectional population with multiple health needs and low healthcare utilization. Telehealth has been proposed as a solution to address healthcare access disparities, yet the role of telehealth attitudes, including perceived benefits and self-efficacy, in influencing telehealth use of this population remains unknown. Objective: This study investigates whether two domains of telehealth attitudes, namely self-efficacy and perceived benefits (expectancy), mediate the relationship between demographic, health, and social determinants of telehealth use among low-income racial and ethnic minority residents of public housing in Los Angeles. Methods: This cross-sectional study analyzed data collected from low-income racial and ethnic minority residents of public housing in Los Angeles. Measures included demographic factors (age and gender), social determinants of health (e.g., education, language, and primacy care provider), health (chronic illnesses and physical mobility), telehealth attitudes (perceived benefits and self-efficacy), and telehealth use frequency. Mediation analysis was conducted to test whether telehealth attitudes explained the association between demographic, social, and health determinants of telehealth use. Results: The findings revealed that neither of the two domains of telehealth attitudes, including perceived benefits and self-efficacy, were significantly associated with telehealth use. As such, these attitude domains did not operate as mediators of the relationship between demographic, health, and social determinants of telehealth use. Conclusion: The study results suggest that structural barriers, rather than individual attitudes, primarily drive telehealth use disparities among this intersectional population. Interventions aimed at increasing telehealth adoption should prioritize addressing systemic inequities rather than focusing solely on changing individual attitudes. These findings underscore the importance of structural solutions to promote equitable telehealth access in marginalized communities. Full article

Background/Objectives: This study examines the factors associated with U.S. adolescents’ obesity and overweight status. Methods: Using a multivariable logistic regression, we analyzed the data from the 2021 Youth Risk Behavior Surveillance System (YRBSS), comprising 17,232 students. Results: The odds of being obese or overweight were significantly higher (p ≤ 0.05) for the participants who perceived themselves as slightly overweight (AOR, 13.31; 95% CI [11.83, 14.97]) or very overweight (AOR, 39.29; 95% CI [30.12, 51.25]) compared to those who perceived their weight as about right. The participants with significantly higher odds included those aged 14 years (AOR, 2.53) compared to those aged 13 years or younger; male students (AOR, 1.63) compared to female students; and American Indian/Alaska Native and Native Hawaiian/Other Pacific Islander students (AOR, 2.11), Black or African American students (AOR, 2.63), Hispanic/Latino students (AOR, 1.54), and students of multiple races (AOR, 1.56), compared to White students. The odds were also significantly higher for the participants who did not eat breakfast on all seven days of a week (AOR, 1.21) and for the students who did not report their mental health status (AOR, 2.07) compared to those who reported their mental health as mostly or always not good. Conclusions: These findings suggest schools are uniquely positioned to implement strategies for healthier behaviors designed and implemented with a focus on health equity. Full article

Background/Objectives: Although the extant literature has recognized the importance of neighborhood contexts for adolescent alcohol and tobacco use, less is known about the effects of exposure to neighborhood violence on the prevalence and timing of initiation across gender and race/ethnic groups. Methods: This secondary analysis of administrative and survey data from a natural experiment in Denver examines the influence of neighborhood contexts on the health and well-being of 1100 Latino/a and African American adolescents. Cox Proportional Hazard models were used to (1) estimate the effects of exposure to neighborhood violence on the prevalence and timing of adolescent alcohol and tobacco use initiation; (2) examine gender and race/ethnic variations in alcohol and tobacco use initiation after controlling for adolescent, caregiver, household, and other neighborhood characteristics; and (3) test for threshold effects. Results: Prevalence rates among all adolescents were 12.9% for alcohol use initiation and 13.7% for tobacco use initiation but were 14.6% and 17.3%, respectively, among adolescents exposed to higher levels of neighborhood violence. The average age of initiation was 16.1 and 15.6 years for alcohol and tobacco use, respectively, but 2–8 months earlier for adolescents exposed to higher levels of neighborhood violence. Heightened exposure to neighborhood violence increased the hazards of alcohol use initiation by 32% for all adolescents and 38% for adolescent males. The hazards of tobacco use initiation were 1.3 to 1.5 times higher for male, Latino/a, and African American adolescents. Exposure to neighborhood violence suggests threshold effects of diminishing returns on adolescent tobacco use initiation. Conclusions: Findings underscore the need to examine gender and race/ethnic group differences in adolescent alcohol and tobacco initiation, the multiple pathways to such use, and interventions aimed at reducing neighborhood violence. Full article

Background: Chordoma is a rare bone cancer with limited treatment options. Clinical trials are crucial for developing effective therapies, but their success depends on including diverse patient populations. The objective of this study was to systematically evaluate the reporting of racial, ethnic, and socioeconomic diversity in United States clinical trials exploring treatment for chordoma. Methods: A literature search was conducted through PubMed/Medline, Cochrane, Epistemonikos, and ClinicalTrials.gov databases for published US chordoma trials up until 19 August 2024. The data collected included trial characteristics and racial and ethnic data, as well as socioeconomic indicators when available. Methodological Index for Non-Randomized Studies (MINORS) and Revised Cochrane Risk-of-Bias Tool for Randomized Trials (RoB2) analyses were adopted to assess the methodological quality. The N-1 Chi-squared (χ²) test was implemented to compare the reported racial and ethnic data with the most recent US Census Bureau data. Results: Five trials involving 111 patients (median age: 63 years; 34% female) were included. Four studies (80%) were single-arm non-randomized studies with one study (25%) having a high methodological quality and three (75%) having a moderate quality based on the MINORS analysis. Most patients (91%, n = 82) were White/Caucasian, representing a proportion which was significantly higher than the reported 75% in the US population (p = 0.0005). Black/African American patients (2%, n = 2) were significantly underrepresented compared to the 14% in the US population (p = 0.0015). Regarding ethnicity, Hispanic/Latino patients (7%, n = 6) were significantly underrepresented compared to the 20% in the US population (p = 0.0021). No measures of socioeconomic status were reported. Conclusions: This systematic review highlighted the need for improved racial and ethnic diversity in chordoma trials and the better reporting of socioeconomic data. The underrepresentation of minority groups may obscure potential disparities in disease incidence, treatment access, and clinical outcomes. Full article

The relationship between race and labour has been analyzed from different theoretical perspectives. Some have focused on the connection between race and the extraction of surplus from people of colour, Black people in particular Others have integrated race within the context of capitalism as a world system or have focused on race as a category of exploitation that defines both feudalism and capitalism that is essential for the survival of capitalism. This paper argues that, to understand the relation between race and labour, race must be understood as legal status. Race is a set of legal rights given to or withheld from workers because of loosely defined and arbitrarily selected physical characteristics. By assigning different rights to workers based on race, their labour is racialized, and race becomes an important element to the functioning of capitalism because it defines the value of labour. As legal status, race is defined and enforced by the state. In addition, this paper analyses the development of US naturalization and immigration law from 1790 to 1964, selected as an example of the process of racialization of labour. Specifically, it discusses the process of racialization of labour by connecting it to the concept of Westphalian sovereignty and the differentiation between natural and political rights. It concludes that, between 1790 and 1965, race supported the development and stability of US capitalism through the development of three distinct highly racialized labour markets: the Northeast, mostly defined by the racialization of European workers along a scale of whiteness; the West, determined by the racialization of Asian and, later, Latino workers; and the South, characterized by the racialization of African Americans and selected southern European workers, Italians in particular, and, later, Latino workers. These three markets operated in symbiosis with each other and featured different forms of racialization of labour, as defined by different forms of enforcement of race as legal status, ranging from the Chinese Exclusion Act of 1882 on the West Coast to the Jim Crow System that emerged in the southern states after the Compromise of 1877 and the Immigration Act of 1924 that dramatically limited immigration from southern and Eastern Europe. Full article

Family conflict has been demonstrated as a risk factor impacting children’s mental health and behaviors; however, the mechanisms underlying these connections are unclear. Focusing on 1622 children from low-income families (51.4% boys, 38.3% White, 35.5% Hispanic/Latino, 22.1% African American, 4.1% other), the current study examines the role that maternal depression and parenting behaviors play in the associations between family conflict in early childhood and children’s internalizing and externalizing behaviors in early adolescence. Family conflict was positively associated with maternal depression at age 3 and detached parenting at age 5; however, maternal depression was linked to increased child internalizing and externalizing behaviors, and detached parenting was associated with decreased behavioral outcomes. Maternal depression at age 3 and intrusive parenting at age 5 successively mediated the association between family conflict and child externalizing. Multi-group analysis indicated different indirect paths of parenting behaviors in boys and girls. Specifically, in boys, the indirect effect of detached parenting on the links between family conflict and externalizing and internalizing behaviors was sustained. In girls, maternal depression and intrusive parenting sequentially explained the link between family conflict and externalizing behaviors. The findings highlighted the importance of addressing family well-being and parenting support, especially for children from low-income families. Full article

Background: Rare movement disorders often have a genetic etiology. New technological advances have increased the odds of achieving genetic diagnoses: next-generation sequencing (NGS) (whole-exome sequencing—WES; whole-genome sequencing—WGS) and long-read sequencing (LRS). In 2017, we launched a WES program for patients with rare movement disorders of suspected genetic etiology. We aim to describe the accumulated experience of a modern movement disorder genetic clinic, highlighting how different available genetic tests might be prioritized according to the clinical phenotype and pattern of inheritance. Methods: Participants were studied through WES analysis. Descriptive statistics, including the mean, standard deviation, counts, and percentages, were used to summarize demographic and clinical characteristics in all subjects and with each type of result [pathogenic or likely pathogenic, variants of uncertain significance (VUS), negative]. Results: We studied 88 patients (93.2% Caucasian, 5.72% African American, and 1.08% Hispanic or Latino). After excluding six family members from four index participants, the diagnostic yield of WES reached 27% (22/82 probands). The age at onset was significantly lower in patients with pathogenic/likely pathogenic variants. The most common clinical phenotypes were ataxia and parkinsonism. Dystonia, ataxia, leukoencephalopathy, and parkinsonism were associated with most genetic diagnoses. Conclusions: We propose a comprehensive protocol with decision tree testing for WGS and LRS, a return of results, and a re-analysis of inconclusive genetic data to increase the diagnostic yield of patients with rare neurogenetic disorders. Full article

Background: Cardiometabolic disease (CMD) disproportionately affects African American/Black (AA) and Latino communities. CMD disparities are exacerbated by their underrepresentation in clinical trials for CMD treatments including nutritional interventions. The study aimed to (1) form a precision nutrition community consultant panel (PNCCP) representative of Latino and AA communities in Los Angeles to identify barriers and facilitators to recruitment and retention of diverse communities into nutrition clinical trials and (2) develop culturally informed strategies to improve trial diversity. Methods: A deliberative community engagement approach was used to form a PNCCP for the Nutrition for Precision Health (NPH) trial, part of the of the All of Us research initiative. The PNCCP included individuals that provide services for Latino and AA communities who met during 11 virtual sessions over 1 year. Discussion topics included enhancing recruitment and cultural acceptance of the NPH trial. We summarized CCP recommendations by theme using an inductive qualitative approach. Results: The PNCCP included 17 adults (35% AA, 47% Latino). Four thematic recommendations emerged: reducing structural barriers to recruitment, the need for recruitment materials to be culturally tailored and participant-centered, community-engaged trial recruitment, and making nutrition trial procedures inclusive and acceptable. We outlined the study response to feedback, including the constraints that limited implementation of suggestions. Conclusion: This study centers community voices regarding the recruitment and retention of AA and Latino communities into a nutrition clinical trial. It highlights the importance of community engagement early on in protocol development and maintaining flexibility to enhance inclusion of diverse communities in nutrition clinical trials. Full article