A Systems Approach to Achieve Equity in Healthcare Research

Healthcare in the United States is inequitable. The consequence of inequity is that the burden of serious chronic disease, such as diabetes, falls disproportionately on populations experiencing health disparities, predominantly Black, Indigenous, and people of color. [1] The reasons for the inequity include the negative impact of the social determinants of health of individuals and families from these communities, being underrepresented as participants in clinical research, having limited access to technologies that support self-care, and a lack of researchers and clinicians from these same populations. [2] To achieve equity and fairness, there is a need for a paradigm shift in healthcare research and innovation based on improving access, trust, and self-efficacy [3] to convert new knowledge into positive health outcomes.

We Are Family: Effects of a Relationship-Strengthening Prevention Intervention on Parenting Behaviors Among Black and Latino Adolescent Couples

Relationship strain or dissolution between new parents can affect the co-parenting relationship and parenting engagement. The purpose of this study was to evaluate the effect of a relationship-strengthening intervention on parenting behaviors among adolescent couples. Data from a pilot randomized control trial conducted with predominantly Black and Latino couples were analyzed using repeated measures analysis of variance. Observed intervention * time effects and intervention * time * gender effects were not statistically significant, but had small to moderate effect sizes. Intervention couples demonstrated increased parenting sense of competence compared to control couples. Gender differences in intervention effects were observed for both parenting experiences and parenting engagement. Given the pilot nature of the study, these findings provide preliminary evidence of the effectiveness of this couple-based intervention for improving parenting outcomes. Future research should assess the intervention in a larger sample and leverage technology-based approaches as methods for content delivery.

Air pollution is linked to higher cancer rates among black or impoverished communities in Louisiana

Despite longstanding concerns about environmental injustice in Louisiana’s industrialized communities, including the area known as Cancer Alley, there is a lack of environmental health research in this state. This research gap has direct consequences for residents of industrialized neighborhoods because state regulators have cited a lack of evidence for adverse health outcomes when making industrial permitting decisions. We investigated how cancer incidence relates to cancer risk from toxic air pollution, race, poverty, and occupation across Louisiana census tracts, while controlling for parish-level smoking and obesity rates, using linear regression and Akaike information criterion model selection. We used the most recent cancer data from the Louisiana Tumor Registry (2008–2017), estimates of race, poverty, and occupation from the US Census Bureau’s American Community Survey (2011–2015), and estimated cancer risk due to point sources from the US Environmental Protection Agency’s 2005 National Air Toxics Assessment (accounting for cancer latency). Because race and poverty were strongly correlated (r = 0.69, P < 0.0001), we included them in separate, analogous models. Results indicated that higher estimated cancer risk from air toxics was associated with higher cancer incidence through an interaction with poverty or race. Further analysis revealed that the tracts with the highest (i.e. top quartile) proportions of impoverished residents (or Black residents) were driving the association between toxic air pollution and cancer incidence. These findings may be explained by well-established disparities that result in greater exposure/susceptibility to air toxics in Black or impoverished neighborhoods. Regardless, our analysis provides evidence of a statewide link between cancer rates and carcinogenic air pollution in marginalized communities and suggests that toxic air pollution is a contributing factor to Louisiana’s cancer burden. These findings are consistent with the firsthand knowledge of Louisiana residents from predominantly Black, impoverished, and industrialized neighborhoods who have long maintained that their communities are overburdened with cancer.

Analysis of COVID-19 Case Demographics in Gary, Indiana

Background and Hypothesis It has been reported in several recent studies that health disparities associated with COVID-19 infection r are prevalent in Black and impoverished populations. The contribution of multiple causes to these disparities is still not completely elucidated. Gary, Indiana has a large Black population (80%), high number of residents living below the poverty line (34%), and high unemployment rate (20%). We hypothesized that Black individuals in Gary have a higher rate of positive cases, hospitalizations, and deaths than non-Black individuals. Also, we hypothesized that (median household income measured by the zip code) is negatively correlated with COVID-19 positive cases, hospitalizations, and deaths. Methods In collaboration with the Gary Health Department, we analyzed data on all positive cases in the city from 06/16/2020 through 06/07/2021(totally 5149 cases). We compared this data to the data from 03/16/2020 through 06/16/2020 (totally 724 cases) that we analyzed previously. Data was de-identified and included age, race, ethnicity, and zip code. The data was analyzed using Pearson's chi-square test and regression analysis. Results When compared to the non-Black population in Gary age and population-adjusted rates of hospitalizations and deaths in the Black population are 3-fold (p<9.385E-11) and 2-fold (p<0.0171) higher, respectively. Surprisingly, the non-Black population had a higher infection rate than the Black population (p<2.69E-09). Median household income of a zip code is negatively correlated with COVID-19 hospitalizations in that zip code (R2=0.6345, p=0.03), but is does not affect the .rates of infections and deaths. Conclusion Our data show that in Gary, there is a clear health disparity of both income and race, specifically in the context of COVID-19. IUSMNW and Gary health officials can collaborate and utilize this data to reallocate resources to the highly populated, low income, and predominantly Black neighborhoods.

Retrospective Analysis of COVID-19 Pandemic Impact on Breast Cancer Screening Rates in Northwest Indiana

Background: Few changes to healthcare delivery during the COVID-19 pandemic altered pre-pandemic diagnostic testing as much as those made to cancer screening. Several studies show that screening volumes decreased by as much as 80% across multiple modalities and cancer types in the spring of 2020. These studies examined large hospital systems in the American East and West, but communities with predominantly Black populations like Gary, Indiana, have been absent from this research. Methods: Our study captures how the COVID-19 pandemic affected access to diagnostic screening for cancerous and precancerous breast lesions through mammography using patient-level data. “Hospital A” provided data from 17,973 mammography encounters that occurred between March 2019 and June 2021. Screening volumes from the eight-week period from March 23rd and May 17th in 2020, the period elective procedures were suspended, was compared to three other distinct periods: the previous 8-week period, the next 8-week period, and the same 8-week period from 2019. Results: From the 17,973 encounters, the average patient age was 61.7 (SD 11.4) years, 61.0% of patients paid with Medicare or Medicaid, and 66.0% of patients identified as Black. Despite performing a weekly average of 190 (12.3) mammograms during the 2019 baseline period and 158 (16.1) mammograms in the eight weeks preceding the COVID-19 pandemic, the weekly average fell to 13 (22.4) mammograms during the study period with zero occurring in a four-week stretch. Fortunately, volume returned sharply to near pre-pandemic levels in the eight weeks following the study period with 139 (18.9) average weekly mammograms. Conclusion: Despite a 93% year-over-year decrease in mammography during the height of the pandemic, volume returned in the summer of 2020. Concerning, however, is that average monthly volume (582 (88.5) mammograms) in the first six months of 2021 remains 22.1% lower than 2019 numbers (747 (66.7) mammograms).

Corporate Colonization of Blackness – The Representation of Blackness in the National Basketball Association from 1984 to 2005

In light of current social justice dynamics, this article examines marketing strategies employed by the NBA (and associated companies) to sell predominantly Black athletes to a chiefly White audience. Through historical contextualization and critical analysis, the NBA’s development from a non-profitable and scorned circus to a multi-faceted and multi-billion-dollar global attraction is explored. From the earliest league structures until the 1980s, a dichotomy between Black and White players (and the values/stigma they embodied) dominated the sport of Basketball. This however changed with the rise of Michael Jordan to fame. Jordan became the first basketball player who transcended these racial lines in terms of associated values and/or stigmas. Simultaneously, His Airness’ rise to global fame let the NBA’s popularity soared into astronomical spheres. A shiny Black Superhero was born, yet his public image is predominantly inspired by corporate considerations – a case of corporate colonization of Black bodies. Black players’ transgressions and the NBA’s reactions to those – as happened in the Malice in the Palace (2005) incident – highlight the conflicting lines along which the NBA constructs and presents its players with a clear tendency towards corporate colonization, a concept which will be outlined in the paper. Through critical historical reading of past corporate efforts, this article re- and deconstructs the strategic illustration of Black athletes.

Qualitative Evaluation Informs Understanding of Motor Cognition and Therapies in Older Adults with Mild Cognitive Impairment

Background: 10%to 20%of Americans aged 65 and older have mild cognitive impairment (MCI) with 10%progressing to Alzheimer’s disease (AD) each year. Underserved groups, including African Americans (AAs), are among the most vulnerable to MCI and AD. Although evidence continues to amass, the benefits of exercise and movement for AD is still understudied in AD. Objective: Understanding the attitudes, perceptions, and beliefs about motor-cognitive integration and examining the physical activity of a sample of predominantly Black women community members with self-reported memory problems will allow improved recruitment and refinement of multimodal interventions designed to improve motor-cognitive and cognitive function. Methods: We conducted focus groups with older adults who reported subjective memory complaints (n = 15; Black: n = 12, White: n = 3, mean age 71.7±5.8). Results: Findings from thematic analysis showed most participants knew of benefits of exercise. However, most participants reported not getting adequate exercise due to factors such as pain, increased responsibilities, and fears of injury. Despite barriers, participants expressed enthusiasm for multimodal interventions designed to target body and brain health and provided several suggestions to improve or enhance the proposed interventions. Conclusion: Results provide useful insights regarding improving participation among historically under-represented groups in clinical movement-based research. Participants’ discussion focused primarily on the way motor-cognitive integration prevents falls, maintains memory, and provides a social benefit. The reported perceived benefits and limitations of exercise, as this population understands it, can help researchers and physicians better engage the community for lifestyle changes that will support greater motor-cognitive health.

An Important Genotype for Sustainable Extensive Goat Production Systems of Turkey: The Gökçeada Goat

In this study, it was aimed to report some traits of Gökçeada goats, which raised under the natural conditions of Gökçeada, with respect to their protection within the scope of genetic resources. In this respect the information obtained from the goats supplied from the Island and reared in a semi-intensive system at Çanakkale Onsekiz Mart University and also the information obtained from the literature were collected and the biological and zootechnical identifications of the Gökçeada goat were performed. Gökçeada goats, which are predominantly black, have yellow or red blazes on both sides of their heads including their eyes. It was seen that Gökçeada goats had similar body measurements and lower live weights as compared to those of the same species on the mainland. The birth weight and the mature live weight of Gökçeada goats were found as 2.55 kg and 38 kg, respectively, whereas their mean kid yield per goat at birth was determined as 1.6 to 1.8 kids. Individuals with a milk yield of 591 kg were striking in the Gökçeada genotype, in which the mean lactation length and the mean lactation milk yield were determined as 251 to 259 days and 227 to 245 kg, respectively. Its milk fat (4.92-5.75%) and milk protein (3.29%) resembled those of our other native breeds. It is necessary to reveal, with more elaborate studies, the potential for Gökçeada goat cheese that is greatly demanded on the Island. It was determined that the Gökçeada kids, which were considered as dairy kids, had some small but nonfat carcass and that their meat was soft and of a light color and had a slight smell. One should be careful about the adaptation of the Gökçeada genotype, which successfully maintains itself under the island conditions and which is the source of income for producers, to intensive and extensive goat production systems.