Search Results (72)

Ride-pooling, as a sustainable mode of ride-hailing services, enables different riders to share a vehicle while traveling along similar routes. The COVID-19 pandemic led to the suspension of this service, but Transportation Network Companies (TNCs) such as Uber and Lyft resumed it after a significant delay following the lockdown. This raises the question of what determinants shape ride-pooling in the post-pandemic era and how they spatially influence shared ride-hailing compared to the pre-pandemic period. To address this gap, this study employs geospatial analysis and machine learning to examine the factors affecting ride-pooling trips in pre- and post-pandemic periods. Using over 66 million trip records from 2019 and 43 million from 2023, we observe a significant decline in shared trip adoption, from 16% to 2.91%. The results of an extreme gradient boosting (XGBoost) model indicate a robust capture of non-linear relationships. The SHAP analysis reveals that the percentage of the non-white population is the dominant predictor in both years, although its influence weakened post-pandemic, with a breakpoint shift from 78% to 90%, suggesting reduced sharing in mid-range minority areas. Crime density and lower car ownership consistently correlate with higher sharing rates, while dense, transit-rich areas exhibit diminished reliance on shared trips. Our findings underscore the critical need to enhance transportation integration in underserved communities. Concurrently, they highlight the importance of encouraging shared ride adoption in well-served, high-demand areas where solo ride-hailing is prevalent. We believe these results can directly inform policies that foster more equitable, cost-effective, and sustainable shared mobility systems in the post-pandemic landscape. Full article

This paper presents the development, implementation, and outcomes of the ELEVATE-US-UP (Engaging Learners through Exploration of Visionary Academic Thought and Empowerment in UnderServed and UnderPrivileged communities) teaching methodology, an equity-centered, culturally responsive pedagogical framework designed to enhance student engagement, academic performance, and science identity among underrepresented learners. This framework was piloted at Northern New Mexico College (NNMC), a Hispanic- and minority-serving rural institution. ELEVATE-US-UP reimagines science education as a dynamic, inquiry-driven, and contextually grounded process that embeds visionary scientific themes, community relevance, trauma-informed mentoring, and authentic assessment into everyday instruction. Drawing from culturally sustaining pedagogy, experiential learning, and action teaching, the methodology positions students not as passive recipients of content but as knowledge-holders and civic actors. Implemented across upper-level environmental science courses, the method produced measurable gains: class attendance rose from 67% to 93%, average final grades improved significantly, and over two-thirds of students reported a stronger science identity and a newfound confidence in their academic potential. Qualitative feedback highlighted increased perceptions of classroom inclusivity, community relevance, and instructor support. By centering on cultural context, student voice, and place-based application, the ELEVATE-US-UP framework offers a replicable and scalable model for educational transformation in underserved regions. Full article

Background: Pain is a prevalent issue among breast cancer patients and survivors, with a significant proportion receiving hydrocodone for pain management. However, the rescheduling of hydrocodone from Schedule III to Schedule II by the U.S. Drug Enforcement Administration (DEA) in October 2014 raised concerns about potential barriers to opioid access for cancer patients, particularly among vulnerable populations such as dually eligible Medicare–Medicaid beneficiaries and racial/ethnic minorities. Methods: We conducted a retrospective cohort study using Surveillance, Epidemiology, and End Results (SEER)-Medicare linked data including 52,306 early-stage breast cancer patients from 2011 to 2019. We employed multivariable logistic regression models with model specification tests to stratify the subgroups and evaluate the differential effects of the policy change by Medicaid dual eligibility and race–ethnicity, while adjusting for other patient demographics, clinical characteristics, and cancer treatments. Results: The rescheduling of hydrocodone was associated with significantly different effects on prescription opioid use across subgroups, with the most pronounced reduction in hydrocodone prescription observed among dual-eligible racial/ethnic minority patients (adjusted odds ratio [AOR] = 0.57; 95% confidence interval [CI]: 0.44–0.74; p < 0.001). Non-dual-eligible patients experienced a smaller reduction in hydrocodone use (AOR = 0.84; 95% CI: 0.78–0.90; p < 0.001). Concurrently, non-hydrocodone opioid use significantly increased among non-dual-eligible non-Hispanic White patients (AOR = 1.29; 95% CI: 1.19–1.40; p < 0.001), suggesting a substitution effect, while smaller non-significant increases were observed among other subgroups. Conclusions: Hydrocodone rescheduling led to the greatest reduction in hydrocodone use among dual-eligible racial–ethnic minority patients. The corresponding increase in non-hydrocodone opioid use was limited to non-dual-eligible non-Hispanic White patients. These findings highlight the need for opioid policies that balance misuse prevention with equitable access to pain relief, particularly among underserved populations. Full article

The National Institute on Minority Health and Health Disparities Research Framework (NIMHD-RF) provides a multidimensional structure to examine health disparities across domains and levels of influence. While influential, its current Behavioral Domain centers on observable behaviors and underrepresents key psychological factors and determinants that shape health outcomes among minoritized populations. This gap limits the framework’s capacity to account for complex factors such as internalized stigma, identity-related stress, and cultural processes that significantly contribute to mental health disparities. In this viewpoint, we propose an adaptation of the Behavioral Domain into a Psychological/Behavioral Domain to better reflect the interconnected psychological, biological, sociocultural, and environmental factors influencing health. The revised domain incorporates psychological vulnerabilities, coping strategies, and identity-based stressors across all levels of influence, from individual to societal, and acknowledges macro-level processes such as structural stigma and inequitable policies. This reframing emphasizes that behaviors are shaped by psychological experiences and systemic inequities, not merely individual choice. By explicitly integrating psychological factors and determinants, the framework becomes more robust in guiding culturally responsive, equity-driven research and interventions. This adaptation aims to enhance the framework’s utility in mental health disparities research and to support efforts to achieve health equity for historically underserved populations. Full article

Background: Understanding immune response is essential for preparing for public health crises. COVID-19 vaccination provides robust immunity against SARS-CoV-2, but immunocompromised populations may have weaker immune responses. We assessed SARS-CoV-2 spike (trimer) total IgG/IgM/IgA (total Ig) to investigate immune response to COVID-19 vaccination in people living with HIV (PLWH), considering CD4⁺ T cell count, viral load, substance use, and comorbidities. Methods: This cross-sectional study was conducted in Miami, Florida, between May 2021 and December 2021 as part of the NIH Rapid Acceleration of Diagnostics-Underserved Populations (RADx-UP) initiative (3U01DA040381-05S1) and the Miami Adult Studies on HIV (MASH) cohort (U01DA040381). Blood samples were collected and SARS-CoV-2 spike (trimer) total Ig was quantified. HIV serostatus, viral load, CD4⁺ T cell count, and COVID-19 vaccinations were abstracted from medical records. Substance use (tobacco, alcohol, and drug use [marijuana, cocaine, heroin, fentanyl, methamphetamine, amphetamine, hallucinogens, ecstasy, or misuse of prescription drugs]), and comorbidities (hypertension, diabetes, autoimmune disease, obesity, chronic kidney disease, and substance use disorders) were assessed via validated questionnaires. Drug use was confirmed via urine toxicology. Multivariable linear regression was conducted. Results: Median age (n = 1317) was 57.8 years, 49.8% were male, 50% were Black non-Hispanic, 66.2% had received ≥1 dose of a COVID-19 vaccine, and 29.6% were PLWH (71.3% virally suppressed and median CD4⁺ T cell count > 500 cells/µL). PLWH, compared to people without HIV, were more likely to have received ≥1 dose of a COVID-19 vaccine (76.2% vs. 62.0%, p < 0.001) and present with substance use (77.2% vs. 42.9%, p < 0.001) and comorbidities (72.8% vs. 48.2%, p < 0.001). Vaccinated PLWH, compared to unvaccinated PLWH, had higher CD4⁺ T cell counts (577.5 vs. 517.5, p = 0.011) and were more likely to be virally suppressed (76.4% vs. 54.8%, p < 0.001). A lower CD4⁺ T cell count (<200 vs. ≥500, β = −0.400, p = 0.033) and higher HIV viral load (≥200–<5000 vs. <200, β = −0.275, p < 0.001) were associated with lower spike (trimer) total Ig titers, indicating a diminished response to COVID-19 vaccination. Conclusions: A lower CD4⁺ T cell count and higher HIV viremia were linked to reduced SARS-CoV-2 immunogenicity in racial/ethnic minority PLWH, a population underrepresented in vaccine clinical trials. HIV care providers should target efforts to maintain viral suppression to avoid diminished responses to COVID-19 vaccination. Full article

Introduction: The COVID-19 pandemic disrupted routine childhood vaccinations schedules, posing significant challenges among underserved communities. Understanding how different sociodemographic groups in Tennessee perceive and navigate childhood vaccination barriers is critical for developing strategies to improve vaccination rates and reduce vulnerability to vaccine-preventable diseases. Methods: A cross-sectional survey was conducted to explore barriers to vaccination across diverse sociodemographic groups in Tennessee. Data were collected from caregivers/parents of children aged 18 years and younger across all 95 counties in Tennessee at community events and through partnerships with schools and other local organizations. Parental responses were analyzed to identify barriers in access, concern, and importance domains. The distribution of barriers across different sociodemographic groups such as race, income, education level, and insurance status was identified. Descriptive statistics, non-parametric tests, and log-binomial regressions were used to address the research objectives. Results: This study found that the most prominent barriers to childhood vaccination were concerns regarding vaccine safety and side effects. Significant differences in vaccine barriers were observed across racial and ethnic groups for access barriers (p < 0.001), concern barriers (p = 0.006), and importance barriers (p < 0.001). Parents with lower education levels, children without health insurance, and lower-income families faced disproportionate challenges across two of the three barrier domains studied (access and perceived importance of vaccines). Additionally, concern barriers (aPR = 0.998, p < 0.001) and importance barriers (aPR = 0.997, p < 0.001) were strongly associated with the parent-reported prevalence of up-to-date vaccination status. Conclusions: Addressing parental vaccination barriers related to concern, access, and perceived importance is crucial, particularly for underserved populations including low-income families, uninsured parents, racial/ethnic minorities, and those with limited education. A sustained, equity-focused approach integrating scientific communication, community engagement, and policy interventions is essential for increasing vaccine uptake and ensuring equitable vaccination access. Full article

Background/Objectives: The low-resource, minority and underserved populations (LRMU) that carry the highest risk of oral cancer (OC) experience many barriers to early detection and treatment, resulting in disproportionately poor outcomes. One major barrier to better outcomes is poor compliance with specialist referral for diagnosis and treatment. The goal of this prospective study was to compare specialist referral compliance for Telehealth vs. in-person visits in LRMU individuals screening positive for increased OC risk. Methods: Forty subjects who had screened positive for oral potentially malignant lesions (OPMLs) were recruited from community clinics. The subjects indicated whether they would prefer an in-person or Telehealth specialist visit. They were offered assistance with all aspects of the visit, and then tracked over 3 months for referral compliance. A novel, very low-cost, simple Telehealth platform located within the community clinic was used for the remote specialist visits. Results: In the Telehealth group, 16/24 subjects attended their first scheduled remote specialist visit; 4/24 attended rescheduled visits within 3 months, and 4/24 did not comply at all. All attendees and specialists were able to complete the remote visits in full. Of the 7/16 subjects who completed in-person visits, 3/16 attended their first scheduled visit, and 4/16 complied within 3 months; 9/16 subjects did not comply at all with specialist referral. Significantly more individuals complied with Telehealth specialist referral at 1 month (p = 0.0006) and after 3 months (p = 0.0154). Conclusions: This novel Telehealth platform may improve compliance with specialist referral in low-resource individuals with OPMLs. Full article

The coronavirus pandemic shaped challenges for marginalized groups. Specifically, lesbian, gay, bisexual, transgender, and/or queer (LGBTQ+) people experienced community-building constraints, notably in predominantly rural regions. People are also navigating digital geographies, or online social environments, in novel ways to develop virtual communities in the face of prejudice, discrimination, and potential trauma. Through a minority coping approach, the present study explored LGBTQ+ people’s experiences navigating the dynamics of digital geographies during the pandemic while residing in socially conservative, highly rural physical spaces where they may be exposed to vicarious trauma. Using qualitative semi-structured interviews, data were gathered from 43 LGBTQ+ identifying individuals between 19 and 59 years old (M/SD = 27.7/9.2) between October 2020 and January 2021. Nearly 14% identified as transgender, nonbinary, or queer individuals, 35% as bisexual individuals, and 21% as people of color including Hispanic/Latina/o. Thematic analysis of the narratives described participants’ exposures to online discrimination and stigmatization of minority groups (racial and/or sexual/gender minority groups) during the COVID-19 pandemic, institutional constraints to identity expression, utilizing social technologies to manage their identities, and negotiating digital strategies to promote social ties. Findings emphasize improving marginalized people’s experiences with digital geographies through identity affirmation and community relationship-building to offset potentially traumatic experiences. Furthermore, service providers can utilize the findings to tailor effective virtual LGBTQ+ community programming to support underserved, marginalized populations. Full article

Background: Access to healthcare is a significant challenge for rural veterans, especially those with chronic conditions; yet, research on their specific barriers remains limited. This study had three objectives: (1) to develop and validate the Rural Access to Care and Services Scale (RACSS) as a simple tool to assess access to physical, mental, and social care and services; (2) to examine whether minority veterans face greater barriers to care; and (3) to test whether RACSS scores are associated with psychosocial outcomes as theoretically expected. Methods: Data were collected from 500 rural veterans in the U.S. through a survey assessing demographic information, service-connected disability status, clinical conditions, and access to healthcare. First, the RACSS was developed and validated using Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA). Second, to assess the reliability of the RACSS, internal consistency was evaluated using Cronbach’s alpha. Finally, independent sample t-tests were conducted to explore the relationships between access to healthcare and services and participants’ minority status. Results: The scale demonstrated a one-factor structure with excellent model fit indices and high internal consistency (α = 0.89). Veterans from minoritized racial and ethnic groups reported significantly higher difficulties in accessing healthcare and services. Conclusions: The RACCS provides a reliable tool to measure access to healthcare and services among rural veterans. The findings highlight the critical need for targeted interventions to improve access to healthcare and services, especially for veterans from minoritized racial and ethnic groups. Enhancing healthcare and service delivery in rural areas is essential to reducing disparities and improving health outcomes for this underserved population. Full article

Background: Resection is considered the standard of care for patients with localized esophageal cancer who are “physiologically fit”. Patients who do not meet this standard are considered contraindicated to receive surgery. We hypothesized that among patients with non-metastatic esophageal cancer, the consideration of contraindication status would vary based on clinical and demographic factors and would vary between institutions. Methods: We identified patients with non-metastatic gastric and esophageal cancer in the National Cancer Database (NCDB) from 2004 to 2018. Patients were categorized into three groups based on surgical treatment: surgical resection (including endoscopic mucosal resection), resection contraindicated, and refusal of resection based on the coding of the “reason for no surgery” data element. Demographic, clinical, and institutional characteristics were compared between the groups using bivariate and multivariate techniques to identify factors associated with contraindicated status. A subgroup analysis of cT1N0M0 patients was also used to assess every institution in the NCDB’s observed–expected ratio for contraindication status. Results: In total, 144,591 patients with non-metastatic disease met inclusion criteria: 124,972 (86%) underwent resection, 13,793 (10%) were contraindicated for resection, and 5826 (4%) refused resection. Contraindication was associated with age, non-Hispanic Black race, socioeconomic status, Charlson–Deyo score, insurance type, institution characteristics, clinical T-stage, and clinical N-stage. There were 9459 patients who were cT1N0M0 and had no co-morbidities. In this cohort, there were more than 1000-fold differences between individual programs regarding observed–expected ratio of contraindication status when adjusting for clinical and demographic characteristics. Conclusions: Variation in the assessment of contraindication status varies dramatically between institutions. Underserved minorities, including age, race, and insurance type, are risk factors for being considered contraindicated. These findings highlight the disparities that exist regarding surgical care of non-metastatic esophageal cancer in the United States. Full article

As new artificial intelligence (AI) tools are being developed and as AI continues to revolutionize healthcare, its potential to advance health equity is increasingly recognized. The 2024 Research Centers in Minority Institutions (RCMI) Consortium National Conference session titled “Artificial Intelligence: Safely, Ethically, and Responsibly” brought together experts from diverse institutions to explore AI’s role and challenges in advancing health equity. This report summarizes presentations and discussions from the conference focused on AI’s potential and its challenges, particularly algorithmic bias, transparency, and the under-representation of minority groups in AI datasets. Key topics included AI’s predictive and generative capabilities in healthcare, ethical governance, and key national initiatives, like AIM-AHEAD. The session highlighted the critical role of RCMI institutions in fostering diverse AI/machine learning research and in developing culturally competent AI tools. Other discussions included AI’s capacity to improve patient outcomes, especially for underserved communities, and underscored the necessity for robust ethical standards, a diverse AI and scientific workforce, transparency, and inclusive data practices. The engagement of RCMI institutions is critical to ensure practices in AI development and deployment which prioritize health equity, thus paving the way for a more inclusive AI-driven healthcare system. Full article

At 63.7 million, Latinxs constitute the largest racial/ethnic minority in the United States (US). Early during the COVID-19 pandemic, Latinxs were disproportionately impacted and exhibited lower vaccine uptake. Widespread infodemics contributed to confusion, eroded trust, and fostered vaccine hesitancy among this population. This study used a convergent parallel mixed-methods approach to analyze, integrate, and interpret concurrently collected data gathered as part of the Community Engaged Alliance (CEAL) Against COVID-19 Disparities project, initiated by the National Institutes of Health (NIH) in response to the COVID-19 pandemic in the US. Target populations were three underserved Latinx communities of Miami-Dade County (MDC), Florida, during the pandemic’s peak. Qualitative findings show six themes and subthemes that integrate with quantitative survey data (N = 451). Themes included a “wait-and-see” approach to vaccine uptake; concerns about infodemics; attitudes about science, education, healthcare providers; and personal sources of information. Our findings highlight cultural significance, trusted sources, and reasons for hesitancy before vaccination decisions as corroborated by quantitative results. However, divergence was found regarding media sources. Consistent with the literature, although participants report concerns about infodemics and media bias, they still rely on media for updates, particularly with established television networks and trusted personalities. The value placed on education throughout the study (quantitative and qualitative) highlights the importance of culturally appropriate educational interventions. Moreover, the complex nature of the impact that media has on health-related information and vaccine uptake in this population underscores the need for media literacy interventions alongside health education. Full article

Background: There are high documented rates of exposure to traumatic events and mental health disorders among youths yet existing disparities in access to care for racial and ethnic minority youths and youths in rural communities. Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) is an evidence-based behavioral health therapy for children. The delivery of TF-CBT via telehealth can decrease access to care barriers. An interdisciplinary clinical team developed a training program to guide clinicians to effectively provide TF-CBT via telehealth. The goal of this study was to describe variation in implementation processes of the telehealth TF-CBT program and identify barriers and facilitators to program implementation post-training, which were utilized to develop implementation strategies for intervention sustainability. Methods: Using a mixed-methods approach, data were collected on telehealth implementation processes and facilitators and barriers to the delivery of telehealth TF-CBT. This study was guided by an adapted implementation science framework, namely the Exploration, Preparation, Implementation, Sustainment model. Interviews and surveys were completed with clinical site leaders who had participated in the telehealth TF-CBT training. Results: Throughout clinical sites, there was varied adoption and penetration of the telehealth TF-CBT program. Facilitators to implementation included leadership and site staff buy in, community needs, and training resources, while barriers included funding, available logistical resources, and child and family involvement. Conclusions: The feedback gained from this project assisted in the development of implementation strategies for increased adoption and sustainment of TF-CBT delivered via telehealth. Strategies include ongoing interactive assistance and resource support, enhanced training for stakeholders, and program adaptations, with the goal to increase access to quality mental health care for underserved populations. Full article

Health disparities in urologic oncology, particularly in prostate, bladder, kidney, and testicular cancers, significantly impact patient outcomes across different demographic groups. This narrative review aims to investigate the extent and drivers of these disparities, focusing on the influence of race, socioeconomic status, and geographic location on diagnosis, treatment, and survival outcomes. We conducted a comprehensive review of the existing literature and analyzed data from national cancer databases to identify patterns of inequity. Our findings reveal that minority populations, individuals with lower socioeconomic status, and those residing in underserved areas are less likely to receive timely and guideline-based care, leading to worse outcomes. This review underscores the urgent need for targeted interventions, including policy reforms, health system restructuring, enhanced community outreach, and increased funding for disparity-focused research, to ensure equitable access to high-quality oncologic care. Addressing these disparities is crucial for improving cancer outcomes and achieving health equity in urologic oncology. Full article

In recent years, cultural projects utilizing digital applications and immersive technologies (VR, AR, MR) have grown significantly, enhancing cultural heritage experiences. Research emphasizes the importance of usability, user experience, and accessibility, yet holistic approaches remain underexplored and many projects fail to reach their audience. This article aims to bridge this gap by presenting a complete workflow including systematic requirements analysis, design guidelines, and development solutions based on knowledge extracted from previous relevant projects. The article focuses on virtual museums covering key challenges including compatibility, accessibility, usability, navigation, interaction, computational performance and graphics quality, and provides a design schema for integrating virtual museums into such projects. Following this approach, a number of applications are presented. Their performance with respect to the aforementioned key challenges is evaluated. Users are invited to assess them, providing positive results. To assess the virtual museum’s ability to attract a broader audience beyond the usual target group, a group of underserved minorities are also invited to use and evaluate it, generating encouraging outcomes. Concluding, results show that the presented workflow succeeds in yielding high-quality applications for cultural heritage communication and attraction of wider audiences, and outlines directions for further improvements in digitized heritage applications. Full article