Inequities in Chlamydia trachomatis Screening Between Black and White Adolescents in a Large Pediatric Primary Care Network, 2015–2019

Objectives. To identify associations between patient race and annual chlamydia screening among adolescent females. Methods. We performed a retrospective cohort study of females aged 15 to 19 years in a 31-clinic pediatric primary care network in Pennsylvania and New Jersey from 2015 through 2019. Using mixed-effect logistic regressions, we estimated associations between annual chlamydia screening and patient (race/ethnicity, age, previous chlamydia screening and infection, insurance type) and clinic (size, setting) characteristics. We decomposed potential effects of clinician’s implicit racial bias and screening, using covariates measuring the proportion of Black patients in each clinician’s practice. Results. There were 68 935 well visits among 37 817 females, who were 28.8% Black and 25.8% Medicaid insured. The mean annual chlamydia screening rate was 11.1%. Black females had higher odds of screening (adjusted odds ratio [AOR] = 1.67; 95% confidence interval [CI] = 1.51, 1.84) than did White females. In the clinician characteristics model, individual clinicians were more likely to screen their Black versus non-Black patients (AOR = 1.88; 95% CI = 1.65, 2.15). Conclusions. Racial bias may affect screening practices and should be addressed in future interventions, given the critical need to increase population-level chlamydia screening.(Am J Public Health. 2022;112(1):135–143. https://doi.org/10.2105/AJPH.2021.306498 )

Racial Disparity in Immediate Breast Reconstruction; a Gap That is not Closing

Background: Immediate breast reconstruction (IBR) is offered as part of the standard-of-care to females undergoing mastectomy. Racial disparity in IBR has been previously reported with a longstanding call for its elimination, though unknown if this goal is achieved. The aim of this study was to examine the current association between race and IBR and to investigate whether racial disparity is diminishing. Methods: Data was extracted from the National Cancer Database (NCDB) from 2004 to 2016. All variables in the database were controlled so that the comparison would be made solely between Black and White females. We also analyzed the trend in racial disparity to see if there has been a change from 2004 to 2016 after several calls for healthcare equality. Results: After propensity score matching, 69,084 White females were compared to 69,084 Black females. There was a statistically significant difference between the rate of IBR and race (23,386 [33.9%] in White females vs 20,850 [30.2%] in Black females, P-value < .001). Despite a twofold increase in the rate of IBR in both White and Black females, a persistent gap of about 4% was observed over the study period, which translates to more than 2,500 Black females not receiving IBR. Conclusions: Using the NCDB database, a racial disparity was identified for IBR between White and Black females from 2004 and 2016. Unfortunately, the gap between the groups remained constant over this 13-year period.

Challenges in Resource Utilization for Caregivers of Persons With Dementia: A qualitative Study

This study highlights primary caregivers’ experiences with health department policies designed to support people with cognitive impairment/Alzheimer’s Disease and Related Dementias (ADRD). Caregivers were defined as individuals aged 45-85 that provide at least 10 hours of unpaid care. Five, 90-minute focus groups were conducted virtually with 24 caregivers of individuals with cognitive impairment/ADRD. Transcripts were analyzed thematically. Caregivers were primarily Black females (75%) with at least a high school education (42%). Care recipients were likely to be community-dwelling parents (71%), with moderate or advanced (79%) dementia. Caregivers described challenges with accessing resources intended for care recipients, especially as cognitive impairment worsened. Caregivers reported providing care 24/7 as traumatizing. Home-based personal aides and companionship services did not reduce this burden. COVID-19 impacted caregivers and care recipient’s access to resources increasing burden. Policies need to be flexible for ever-changing needs of individuals with ADRD and support the overall well-being of the caregivers.

Applying Intersectionality Framework to Explore the Development of Frailty in Older Adults

Background Frailty is a state of compromised homeostasis reserve that makes older adults susceptible to adverse health outcomes. Frailty is highly prevalent among women, racial and ethnic minorities. We aimed to investigate the combined influence of gender, race, and ethnicity on the development of frailty in older adults without frailty at baseline using the intersectionality framework. Methods The data came from the Health and Retirement Study, a nationally representative US older adults of 65 years and older (2006-2012). Logistic regressions were used to examine the relationships. Results 18.7% of older adults without frailty at baseline developed frailty after a 4-year follow-up. Females were likely to develop frailty than males (aOR 1.66, 95% CI 1.32-2.09, p &lt; 0.0001). In comparison to Non- Hispanic Whites, Non-Hispanic Blacks (aOR 2.66, 95% CI 1.89, 3.74, p &lt; &lt;.0001) and Hispanics or others (aOR 1.73, 95% 1.16, 2.58, p &lt; .0068) had the greater likelihood of developing frailty, after adjusting for age and clinical morbidities, such as lung disease and cardiometabolic diseases. The intersectionality approach showed that both Non-Hispanic Black females (aOR 1.82, 95% CI 1.12-2.99, p = 0.0185) and males (aOR 3.30, 95% CI 1.85-5.91, p &lt; .0001) had the highest likelihood of developing frailty than Non-Hispanic Whites at 4-year post-baseline, adjusting for age and chronic clinical conditions. Conclusion Our findings highlight the importance of taking the intersectionality approach to examining the frailty risk in later life, which will help in providing precision-based care.

Race-Related Differences Between and Within Sex to Experimental Thermal Pain in Middle and Older Adulthood: An Exploratory Pilot Analysis

This brief report details a pilot analysis conducted to explore racial differences in pain sensitivity and unpleasantness between cognitively healthy Black and White adults, stratified by sex. A total of 24 cognitively healthy adults (12 Black and 12 White) from two completed studies were matched by age and sex, and divided into two groups based on race. Stratified analyses by sex demonstrated that Black females reported experiencing pain intensity ratings of all three intensity sensations at lower temperatures than White females. These findings will inform future research studies to determine if these results hold true in a fully-powered sample and should include mixed methodologies, incorporating neuroimaging data to further assess this phenomenon. Improving pain assessment and management across racial/ethnic groups will help healthcare providers such as nurses and physicians to ensure optimal quality of life for all.

Black Girls And Referrals: Racial and Gender Disparities in Referral to Substance Use Disorder Screening in The Juvenile Justice System

Background: Justice-involved children (JIC) have a high risk for illicit substance use (SU) and substance use disorders (SUD). Females are particularly vulnerable. It is critical that JIC who report current SU are referred for SUD screening to be provided with potentially life-saving treatment services. Florida law and Florida Department of Juvenile Justice (FLDJJ) policy mandate that JIC who report current SU be referred for SUD screening. Evidence suggests a racial referral gap among JIC who require SUD screening, and research on intersectionality suggests that these disparities may be exacerbated for minority females. Therefore, we hypothesize that Black and Latinx females will be less likely to be referred for SUD screening than White children despite reporting current substance use to FLDJJ. Methods: Multivariate logistic regression was employed to analyze cross-sectional data from FLDJJ on 35,884 JIC who reported SU in the past six months. The main and interaction effects of race and gender on the likelihood of referral for SUD screening were tested. The control variables included substance type, age, household income, current SU problems, history of mental health problems, number of misdemeanors, and risk to recidivate. Results: There were no significant differences in the likelihood of being referred for SUD screening between White females and White males. However, Black females (AOR= 0.48), Latinx females (AOR= 0.77), and Black males (AOR= 0.76) were significantly less likely to be referred than White males. Black females were half as likely to be referred as White males and females. Conclusion: This study finds evidence that Black females in the juvenile justice system are significantly underserved. The justice community must leverage these findings to implement protocols that ensure equal services for all children and eliminate gender and racial disparities in SUD screening.

Bridging Black Male and Female Standpoints through Autoethnographic Cultural Symbiosis in Gloria Naylor’s The Men of Brewster Place

The present paper argues that Gloria Naylor in The Men of Brewster Place (1998) spectacularly recreates, from a black female’s viewpoint, a solemn literary leeway for African American men’s narratives, and recommends an obligatory shufti to their hidden lives as to how the apparatuses of dominion objectify, suppress and marginalize African American men as well. These men have also been victimized, marginalized and objectified on the basis of their race, class and sexuality by the stereotypical mainstream power structure just like their female counterparts. Furthermore, the paper endeavours to scrutinize how it is unworkable to accomplish a genuine Black Feminist Standpoint without essentially appreciating Black Men’s Standpoint. Black men, who although are suppressors when it comes to their relationship with black females, simultaneously are also being suppressed beneath the tutelage of the mainstream hegemonistic-cum-stereotypical power system. As a sequel to Naylor’s first novel, The Women of Brewster Place (Naylor, 1983), The Men of Brewster Place attempts to autoethnographically lend some voice to her male characters, who complemented her female characters in the first novel.

Abstract P246: Relationship Between Urinary Sodium/potassium Ratio And Systolic Blood Pressure In Salt Sensitive Subjects In The Dash-sodium Trial

Excessive salt intake is associated with hypertension and cardiovascular morbidity. However, identifying those at risk of salt sensitive hypertension (SSH) remains a challenge due to its unequal distribution among populations and inaccurate assessment of dietary sodium (Na) and potassium (K) intake. The objective of this study was to compare indices of dietary Na intake in relation to systolic blood pressure (SBP) in salt sensitive (SS) and salt resistant (SR) subjects from the Dietary Approaches to Stop Hypertension (DASH)-Sodium trial. We hypothesized that when compared to urinary Na or K independently, Na/K ratio is a better predictor of SSH when defined as a 5-10 mmHg change in SBP from low to high dietary Na. Among 404 Black and White subjects, baseline classifications included 177 SS and 227 SR. After diet randomization, on the control 107 were SS and 92 SR and on the DASH 70 were SS and 135 SR. Descriptive statistics, bivariate analysis, followed by linear regression models for baseline and multilevel mixed-effects models after intervention were used to assess the relationship between SBP and dietary Na (as measured by urinary Na/K ratio or Na and K independently) using SS as a categorical factor. SBP was consistently associated with SS, Na/K ratio, and age in all models . At baseline, SBP was significantly higher in SS and SR subjects of the same race and sex, after controlling for age and urinary Na/K ratio and was highest for White females, SS:142.3 (138.8, 145.7) vs. SR:133.2 (130.7, 135.7), and for Black males, SS:137.0 (133.8, 140.1) vs. SR: 129.6 (127.0, 132.3). On average, SBP increased 1.02 (0.065, 1.98) mmHg with each unit increase in Na/K ratio and 3.30 (2.41, 4.19) mmHg with each 10-year increase in age. After randomization and exposure to increasing levels of sodium, SBP increased in SS subjects on the control diet:125.3 (123.2, 127.3) to 136.8 (134.8, 138.9), an effect that was greater in White vs Black females and in Black vs White males. SBP increased in SS subjects on the DASH diet: 121.4 (118.8, 124.0) to 131.2 (128.7, 133.7), but there were no differences by race and sex. These results suggest that a 5-10 mmHg change in SBP in subjects on a typical American diet and Na/K ratio are good predictors of SSH and that the DASH diet may help to reduce race and sex disparities.

The Intersection Between Sex and Race in Understanding Substance Co-Use Patterns in Adolescents From the Fragile Families Study

The current study examined the prevalence of alcohol, cigarette, and cannabis co-use among a longitudinal cohort of youth predominately born to single-parent families. Data were drawn from wave six of the Fragile Families and Child Wellbeing Study ( N = 2976; M age = 15.6; 49% female; 53% non-Hispanic Black, 27% Hispanic, 20% White). Adolescents’ reports of their past 30-day use of alcohol, cigarettes, and cannabis were used to construct eight mutually exclusive use groups. Multinomial logistic regressions adjusting for sociodemographic factors revealed that Black adolescents were at lower relative risk of using Alcohol Only compared to White adolescents. Black males were at greater relative risk of using Cannabis Only than both White males and Black females. Finally, Hispanic males were at a marginally increased relative risk of co-using Alcohol and Cannabis compared to White males. Prevention efforts targeting Black and Hispanic males’ use of cannabis (both alone and in combination with alcohol) may be beneficial.