Search Results (223)

Background: Asian American children and adolescents are underrepresented in physical activity research, and available evidence relies largely on self- or caregiver-reported measures. This study evaluated accelerometer-measured physical activity levels among Asian American children and adolescents, benchmarked against a national reference and explored differences by nativity and sex. Methods: We analyzed National Health and Nutrition Examination Survey (NHANES) 2011–2014 data from non-Hispanic Asian children and adolescents aged 6–17 years who provided valid wrist-worn ActiGraph accelerometer data. Nativity was classified as U.S.-born or non-U.S.-born. Physical activity was summarized using the Monitor-Independent Movement Summary (MIMS) units and sex- and age-specific MIMS percentiles using U.S. reference values. Survey-weighted linear regression models examined associations between nativity and MIMS percentile, adjusting for age group, sex, and family income. A sex-by-nativity interaction was tested. Results: Among 410 participants, the mean MIMS percentile was 36.7 (95% CI: 33.8–39.6), significantly below the national median. Overall MIMS percentiles did not differ by nativity. A sex-by-nativity interaction was observed but did not reach a statistical significance (p = 0.06). Descriptively, non-U.S.-born males tended to have higher MIMS percentiles than U.S.-born males (difference = 8.2; p = 0.16), whereas non-U.S.-born females tended to have lower MIMS percentiles than U.S.-born females (difference = −4.6; p = 0.19). Conclusions: Accelerometer-measured PA in Asian American children and adolescents was below the national reference. Nativity- and sex-related patterns were exploratory and warrant confirmation in larger samples. Full article

Background/Objective: The Behavioral and Mental Wellness in Indigenous Communities (BMWIC) education program was created to address mental health (MH) resource gaps in the Fort Belknap Community (FBC). Designed to enhance MH literacy, task-shifting capacity, and MH care coordination skills, the FBC partnered with Johns Hopkins School of Nursing (JHSON) to co-develop a culturally aligned MH training program. This protocol outlines the development of the BMWIC curriculum. Methods: Steps 1–5 of the 6-step Collaborative Participatory Adaptation Model (CPAM) guided the development of the BMWIC, including collaboration, review of evidence-based models, cultural adaptation of materials, and the creation of a robust evaluation plan to be conducted. Four courses were ultimately developed on: historical trauma, culturally informed MH screening and care, risk and protective factors and health-related Tribal, state and federal legal jurisdiction in American Indian and Alaska Native (AI/AN) communities. Discussion: The BMWIC development process serves as a prime example of translating community priorities into an educational intervention through a combination of best practices in health science education with Indigenous ways of knowing (IWK). Targeted training and task shifting, such as through the BMWIC, may have the potential to expand MH-related knowledge and strengthen the capacity of community health systems to identify psychological and behavioral concerns early, coordinate care more effectively, and improve access to MH care and resources at the community level. Conclusions: This protocol may be useful for academic-community partnerships creating culturally informed educational programs across disciplines and specialties in service to Indigenous communities. The next steps will involve piloting and evaluating the curriculum and collaborating with healthcare organizations to determine sustainable pathways for scaling the BMWIC where it is most needed. Full article

The Asian tiger mosquito (Aedes albopictus) is an invasive species that has become widespread throughout the Americas. It is a vector for several arboviruses, making it an increasing threat to human health as its range expands. To characterize population genetic structure and gain insight into the origin and spread of this invasive mosquito, we genotyped 959 individuals using ~20k SNPs. We included 50 localities across the Americas, and previously genotyped mosquitoes from 28 localities in Asia and 14 in Europe. Our analyses revealed that populations in North America were distinct from populations in South America, and this relationship was consistently supported across analyses. Most North American mosquitoes shared a common origin with those from Japan and Southern Europe (e.g., Italy, Spain), with the exception of individuals from California, which clustered with more southern areas of East Asia (China and Vietnam), as well as Greece. Brazilian and Argentinian populations were distinct from all other sampled locations, including those in the native range, but were most closely related to mosquitoes from more tropical locations in South and Southeast Asia. By revealing the likely sources of invasions in the Americas, our findings have important implications for understanding invasion dynamics of this species. Full article

The freshwater crustaceans Macrobrachium borellii and Palaemon argentinus are key components of benthic communities and are widely distributed throughout South American freshwater ecosystems. As native species, they inhabit environments frequently impacted by pollutants from agricultural activity. Due to their marked sensitivity to these chemical stressors, both species have been proposed as valuable bioindicators for monitoring freshwater pollution. The aim of this study was to synthesize available information regarding the effects of several pesticide classes on standard ecotoxicological endpoints. Specifically, the review examines lethal concentration values (e.g., LC₅₀) and sublethal effects including metabolic disorders, histopathological alterations, and behavioral changes used as biomarkers. These biological responses were evaluated across different life stages, including embryos, larvae, and adults. Reports to date show that both species are highly sensitive to pesticides with different mechanisms of toxicity. Such biological responses are significantly influenced by concentration, exposure time, and developmental stage. The information collected on the biological and ecological characteristics of M. borellii and P. argentinus supports their suitability for ecotoxicological research and underscores their role as reliable indicator organisms for assessing the health of South American aquatic ecosystems. 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

Background: Traumatic brain injury (TBI) and substance use disorder (SUD) frequently co-occur due to shared risk factors and a potentially bidirectional relationship. However, epidemiological patterns in rural populations remain understudied despite known disparities in access and outcomes. This study aimed to characterize the relationship between TBI and SUD in a rural Southwestern population, including demographic and clinical patterns of diagnostic sequencing. Methods: A retrospective observational study was conducted using electronic health records and trauma registry data (2022–2023) from a rural trauma center. Cohort one included 24,389 emergency department encounters with ICD-10 codes for TBI or SUD. Cohort two included 248 trauma registry patients with TBI and SUD diagnoses. Descriptive statistics and multinomial logistic regression models were used to evaluate diagnostic patterns and associated demographic factors. Results: Males were more likely to have co-occurring TBI and SUD (Relative Risk Ratio [RRR] = 1.35), while increasing age was associated with TBI-only diagnoses. Among patients with multiple visits and diagnoses, 16% had co-diagnoses, while 9% had sequential diagnoses. American Indian/Alaska Native patients had higher co-diagnosis risk compared to White patients (RRR = 2.21, p < 0.001). Higher blood alcohol concentration was associated with lower Glasgow Coma Scale scores (r = −0.15, p = 0.022), indicating greater severity. Conclusions: TBI and SUD frequently co-occur in rural populations, with notable disparities by sex and race/ethnicity. Emergency Departments are critical points of care for interventions such as screening for both substance use and head injury when either is suspected, and employing culturally responsive education and referral pathways upon discharge. Full article

Significant gaps exist in survivorship services across the cancer care continuum for Indigenous Peoples in the United States. Despite overcoming overwhelming cancer burden and high mortality risk, Indigenous cancer survivors report lower quality of life compared to non-Indigenous cancer survivors. Using an Indigenous social determinants of health framework, this article shares reflective commentaries from four Indigenous (Haudenosaunee) cancer care professionals who provide insights into the need for traditional Indigenous land-based healing practices among Indigenous cancer survivors, their families, and caregivers. Results suggest that (1) traditional Indigenous healing practices, (2) Indigenous patient navigation services, (3) communities of care, and (4) Indigenous lands and social determinants of health are important factors to support the health and wellbeing of Indigenous cancer survivors. Land-based healing for Indigenous cancer survivors requires further research for future implementation. Full article

Background. Understanding the perspectives of Indigenous older adults about aging and dementia in different Indigenous communities can inform the provision of culturally grounded services and advance equity. However, the experiences and perspectives of Southwestern Pueblo communities are under-researched. Methods. Approved by the Zuni Tribal Government and IRB, this community-engaged, qualitative research explored Zuni older adults’ perceptions, experiences, and support needs. Two co-authors who are community members co-led four focus groups and transcribed them. Results. Twenty participants in four focus groups shared holistic perceptions of dementia. Whereas they often described dementia as a part of aging, they also expressed a strong desire for specialized dementia care and information. They expressed a strong commitment to caregiving as a cultural value, along with challenges and the need for resources to support caregiving as part of specialized dementia healthcare. The challenges experienced by community members were exacerbated by the devastating impact of the COVID-19 pandemic, including the loss of loved ones, long-term COVID-19, disruption of gatherings, loneliness and social isolation. Conclusions. The need for culturally grounded services is inseparable from Zuni participants’ requests for specialized dementia services (including prevention, screening, and caregiving). As the first study to report on the impact of the COVID-19 pandemic on Zuni aging, it highlights the importance of re-building social services and gatherings in planning of service provision. 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

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