Something You Can See, Hear, and Feel: A Descriptive, Exploratory Mixed-Methods Analysis of Youths’ Articulations About Racism

This descriptive, exploratory, sequential mixed-methods study investigated youths’ articulations about racism via an open-ended survey question, and the extent to which these articulations differed based on youths’ demographic characteristics. This study included 384 youth who identified as African American ( n = 98), Latinx/o/Hispanic ( n = 74), Asian/Pacific Islander ( n = 52), Multiracial ( n = 38), Native American ( n = 20), and White ( n = 100). Youth were between 14 and 18 years of age ( Mage = 16.66, SD = 1.28) and were primarily cisgender girls (51.3%) followed by cisgender boys (44.5%) and transgender (4.2%) youth. Thematic analysis was used to analyze youths’ responses, finding that youth displayed an analysis of intrapersonal/interpersonal racism, structural racism, and color-evasive ideology. Cross-tabulation analysis revealed that youth from lower socioeconomic statues (SES) were more likely than higher SES youth to describe racism as an intrapersonal/interpersonal phenomenon, and girls and transgender youth were more likely than boys to express a structural analysis of racism. Study findings suggest that youths’ beliefs about racism are multidimensional and primarily characterize racism as an intrapersonal/interpersonal phenomenon. Results may be used to inform the development of youth programs that aim to discuss racism in critical ways.

Incidence rates of systemic lupus erythematosus in the USA: estimates from a meta-analysis of the Centers for Disease Control and Prevention national lupus registries

ObjectiveTo estimate the annual incidence rate of SLE in the USA.MethodsA meta-analysis used sex/race/ethnicity-specific data spanning 2002–2009 from the Centers for Disease Control and Prevention network of four population-based state registries to estimate the incidence rates. SLE was defined as fulfilling the 1997 revised American College of Rheumatology classification criteria. Given heterogeneity across sites, a random effects model was employed. Applying sex/race/ethnicity-stratified rates, including data from the Indian Health Service registry, to the 2018 US Census population generated estimates of newly diagnosed SLE cases.ResultsThe pooled incidence rate per 100 000 person-years was 5.1 (95% CI 4.6 to 5.6), higher in females than in males (8.7 vs 1.2), and highest among black females (15.9), followed by Asian/Pacific Islander (7.6), Hispanic (6.8) and white (5.7) females. Male incidence was highest in black males (2.4), followed by Hispanic (0.9), white (0.8) and Asian/Pacific Islander (0.4) males. The American Indian/Alaska Native population had the second highest race-specific SLE estimates for females (10.4 per 100 000) and highest for males (3.8 per 100 000). In 2018, an estimated 14 263 persons (95% CI 11 563 to 17 735) were newly diagnosed with SLE in the USA.ConclusionsA network of population-based SLE registries provided estimates of SLE incidence rates and numbers diagnosed in the USA.

Healthcare workers benefit from second dose of COVID-19 mRNA vaccine: Effects of partial and full vaccination on sick leave duration and symptoms

Importance: In addition to morbidity and mortality of individuals, COVID-19 can affect staffing among organizations. It is important to determine whether vaccination can mitigate this burden. Objective: This study examined the association between COVID-19 vaccination status and time until return to work among 952 healthcare workers (HCW) who tested positive for COVID-19. Design: Data were collected prospectively between December 2020 and July 2021. HCW who tested positive for COVID-19 completed an initial interview and were followed until they returned to work. Setting: An academic campus in Southern California consisting of two large hospitals and multiple outpatient clinics and other facilities. Participants: Clinical and nonclinical HCW who tested positive for COVID-19 during the study period (N=952, mean age=39.2 years, 69% female, 45% Hispanic, 14% white, 14% Asian/Pacific Islander, 5% African American, and 21% other race/ethnicity). Exposure: COVID-19 vaccination status (unvaccinated, partially vaccinated, or fully vaccinated) Main Outcome Measures: Days until return to work, presenting symptom Results: Return-to-work time for fully vaccinated HCWs (mean=10.9 days) was significantly shorter than that of partially vaccinated HCWs (15.5 days), which in turn was significantly shorter than that of unvaccinated HCWs (18.0 days). Fully vaccinated HCWs also showed milder symptom profiles compared to partially vaccinated and unvaccinated HCWs. Conclusions and Relevance: COVID-19 vaccination has the potential to prevent long absences from work and the adverse financial, staffing, and managerial consequences of these long absences.

Are Pivotal Trials for Drugs Approved for Leukemia, Myelodysplastic Syndromes, and Multiple Myeloma Representative of the Population Demographics Affected By These Diseases?

Background: There are significant disparities in cancer care and outcomes. Many new drugs have been recently approved for hematologic malignancies through randomized clinical trials (RCTs). Equitable population participation in RCTs is important to ensure proper representation of the populations suffering from the malignancies being targeted. It is uncertain whether patients enrolled in clinical trials represent the demographics of a given malignancy. In this study, we evaluate the extent to which trials match disease burden and how trial methods and results differ across racial/ethnicity/minority disparities in participation of clinical trials. Methods: We performed a retrospective review of RCTs published from 2017 to May 2021 that led to Food and Drug Administration (FDA) approval of hematological malignancy drugs (Leukemias, Multiple Myeloma (MM), Myelodysplastic Syndrome (MDS), and Myeloproliferative Neoplasm (MPN)). We excluded drugs approved for Amyloidosis, pediatric studies, Blastic Plasmacytoid Dendritic Cell Neoplasm, and Erdheim-Chester Disease (Non-Langerhans Histiocytosis). The drugs investigated were selected using FDA Databases, 'Oncology (Cancer) / Hematologic Malignancies Approval Notifications' and 'Novel Drug Approvals'. A Pubmed search was conducted using the drug name and/or clinical trial number as key terms to identify manuscripts related to the approved drugs. The manuscripts were verified with respective FDA drug approval announcement to ensure that this was the appropriate study. 34 drugs were found using the inclusion/exclusion criteria, only 12 drugs had primary manuscripts with demographics including race. Data was then extracted from NIH Surveillance, Epidemiology, and End Results Program (SEER) for prevalence on 1/2018 by race for acute myeloid leukemia (AML), acute lymphoblastic leukemia (ALL), MM, chronic myeloid leukemia (CML), and MDS that the 12 drugs were approved for. SEER data is collected over 13 US locations. Results: The study characteristics for the 12 drugs and demographics are found in Table 1. These included 4 drugs approved for MM, 3 for AML, 2 for ALL, and one each for CML, MDS, and hairy cell leukemia with a total of 3839 patients. The study with the largest sample included 176 sites in 14 countries, and the smallest 15 sites in 2 countries. MM studies enrolled 1757 patients, with 123 (7%) Asian/Pacific Islander patients, 50 (2.8%) Black/African American, 1452 (82.6%) Whites (including Hispanics), 1(<0.1%) Native American patient, and 131 (7.4%) did not report. AML studies enrolled 812, with 112 (13.8) were Asian/Pacific Islander, 35 (4.3%) Black/African American, 616 (75.9%) Whites (including Hispanics), and 49 (6.0%) did not report. ALL studies enrolled 623, with 62 (10%) Asian/Pacific Islander, 11(1.8%) Black/African American, 495 (79.5%) Whites (including Hispanics), and 55 (8.8%) did not report. The one MDS study enrolled 80, with 0 Asian/Pacific Islander, 2 (2.5%) Black/African American, 74 (92.5%) Whites (including Hispanics), and 4 (5.0%) did not report. The one CML study enrolled 487, with 60 (12.32%) Asian/Pacific Islander, 20 (4.11%) Black/African American, 377 (77.41%) Whites (including Hispanics), and 30 (6.16%) did not report. The one hairy cell leukemia enrolled 80: with 1 (1.3%) Asian/Pacific Islander, 1 (1.3%) Black/African American, 70 (87.5%) Whites (including Hispanics), and 8 (10%) did not report. Two studies reported ethnicity, Hispanics and Non-Hispanics. Sex was not differentiated by race in the studies. All but one study showed sex overall, with 1648 Women and 2148 Men across the 12 studies. Figure 1. shows in all diseases that Black/African-Americans are underrepresented. African Americans had an 86.5% (MM), 68.% (AML), 75.8% (ALL), and 64.2% (CML) percent lower representation compared to SEER demographics. In contrast, Asian/Pacific Islanders had a percent increase from the SEER population by 58.6% (MM), 75.3% (AML), 52.1% (ALL), and 68.3% (CML). There were significant differences in all racial categories for the four disease with the exception of Native American representation in AML and CML, and White representation in ALL and CML when compared using Z-statistics. Conclusion: The misrepresentation of minorities in pivotal clinical trials may lead to results that may not fully translate to such populations. These disparities in enrollment should be corrected in future studies. Figure 1 Figure 1. Disclosures Cortes: Novartis: Consultancy, Research Funding; Sun Pharma: Consultancy, Research Funding; Bristol Myers Squibb, Daiichi Sankyo, Jazz Pharmaceuticals, Astellas, Novartis, Pfizer, Takeda, BioPath Holdings, Incyte: Consultancy, Research Funding; Bio-Path Holdings, Inc.: Consultancy, Membership on an entity's Board of Directors or advisory committees; Takeda: Consultancy, Research Funding; Pfizer: Consultancy, Research Funding.

Head and Neck Cancer among American Indian and Alaska Native Populations in California, 2009–2018

The purpose of this study was to determine the incidence of HPV-positive (HPV+) and HPV-negative (HPV-) head and neck cancer (HNC) in the American Indian/Alaska Native (AI/AN) population in California to assess whether incidence is higher among AI/ANs compared to other ethnicities. We analyzed data from the California Cancer Registry, which contains data reported to the Cancer Surveillance Section of the Department of Public Health. A total of 51,289 HNC patients were identified for the years 2009–2018. Outcomes of interest included sex, stage at presentation, 5-year survival rate, tobacco use, and HPV status. AI/AN and White patients had the highest burden of late stage HNC (AI/AN 6.3:100,000; 95% CI 5.3–7.4, White 5.8:100,000; 95% CI 5.7–5.9) compared to all ethnicities or races (Black: 5.2; 95% CI 4.9–5.5; Asian/Pacific Islander: 3.2; 95% CI 3–3.3; and Hispanic: 3.1; 95% CI 3–3.2 per 100,000). Additionally, AI/AN and White patients had the highest burden of HPV+ lip, oral cavity, and pharynx HNC (AI/AN 0.9:100,000; 95% CI 0.6–1.4, White 1.1:100,000; 95% CI 1–1.1) compared to all ethnicities or races (Black: 0.8:100,000; 95% CI 0.7–0.9; Asian/Pacific Islander: 0.4; 95% CI 0.4–0.5; and Hispanic: 0.6; 95% CI 0.5–0.6). AI/ANs had a decreased 5-year survival rate compared to White patients (AI/AN 59.9%; 95% CI 51.9–67.0% and White 67.7%; 95% CI 67.00–68.50%) and a higher incidence of HNC in former and current tobacco users. These findings underscore the disparities that exist in HNC for California AI/AN populations. Future studies should aim to elucidate why the unequal burden of HNC outcomes exists, how to address increased tobacco usage, and HPV vaccination patterns to create culturally and community-based interventions.

Prenatal Exposure to Acetaminophen and Childhood Asthmatic Symptoms in a Population-Based Cohort in Los Angeles, California

Acetaminophen is the most common over-the-counter pain and fever medication used by pregnant women. While European studies suggest acetaminophen exposure in pregnancy could affect childhood asthma development, findings are less consistent in other populations. We evaluated whether maternal prenatal acetaminophen use is associated with childhood asthmatic symptoms (asthma diagnosis, wheeze, dry cough) in a Los Angeles cohort of 1201 singleton births. We estimated risk ratio (RR) and 95% confidence interval (CI) for childhood asthmatic outcomes according to prenatal acetaminophen exposure. Effect modification by maternal race/ethnicity and psychosocial stress during pregnancy was evaluated. The risks for asthma diagnosis (RR = 1.39, 95% CI 0.96, 2.00), wheezing (RR = 1.25, 95% CI 1.01, 1.54) and dry cough (RR =1.35, 95% CI 1.06, 1.73) were higher in children born to mothers who ever used acetaminophen during pregnancy compared with non-users. Black/African American and Asian/Pacific Islander children showed a greater than two-fold risk for asthma diagnosis and wheezing associated with the exposure. High maternal psychosocial stress also modified the exposure-outcome relationships. Acetaminophen exposure during pregnancy was associated with childhood asthmatic symptoms among vulnerable subgroups in this cohort. A larger study that assessed prenatal acetaminophen exposure with other social/environmental stressors and clinically confirmed outcomes is needed.

Motivation and Sense of Belonging in the Large Enrollment Introductory General and Organic Chemistry Remote Courses

The rapid shift from face-to-face to remote instruction in 2020 has resulted in recalibration of lecture and laboratory pedagogy. This research analyzed the impact of remote learning on student motivation and sense of belonging in large enrollment chemistry courses. Student responses were parsed according to specific demographics including gender, academic standing, first-generation status, and ethnicity. Research objectives included the analysis of how remote learning impacted specific demographics to develop guidelines for best practices moving forward for hybrid or online courses. Our findings show that second year students (sophomores) were the most impacted of the academic standing cohorts. Sophomores reported a statistically greater change in motivation after the start of the semester and statistically lower satisfaction with their performance on assignments. Females reported statistically lower motivation and a statistically lower sense of belonging in the course and science, technology, engineering, and mathematics (STEM) fields. Black/African students reported a statistically lower motivation for remote learning than Asian/Pacific Islander and White/Caucasian students. Finally, both White/Caucasian and Black/African students reported a statistically lower sense of belonging in the course and in STEM fields than Asian/Pacific islander students. Finally, statistical differences were not observed based upon first-generation status. The research indicates that students were differentially impacted by the shift to remote learning. From these findings, a stronger understanding of how specific demographics are differentially impacted by remote learning in STEM courses is provided, granting greater insight into best practices moving forward.