Reduction in Standard Cancer Screening in 2020 throughout the U.S.

Cancer screening is an important way to reduce the burden of cancer. The COVID-19 pandemic created delays in screening with the potential to increase cancer disparities in the United States (U.S.). Data from the 2014–2020 Behavioral Risk Factor Surveillance System (BRFSS) survey were analyzed to estimate the percentages of adults who reported cancer screening in the last 12 months consistent with the U.S. Preventive Services Task Force (USPSTF) recommendation for cervical (ages 21–65), breast (ages 50–74), and colorectal cancer (ages 50–75) prior to the pandemic. Cancer screening percentages for 2020 (April–December excluding January–March) were compared to screening percentages for 2014–2019 to begin to look at the impact of the COVID-19 pandemic. Screening percentages for 2020 were decreased from those for 2014–2019 including several underserved racial groups. Decreases in mammography and colonoscopy or sigmoidoscopy were higher among American Indian/Alaskan Natives, Hispanics, and multiracial participants, but decreases in pap test were also highest among Hispanics, Whites, Asians, and African-Americans/Blacks. Decreases in mammograms among women ages 40–49 were also seen. As the 2020 comparison is conservative, the 2021 decreases in cancer screening are expected to be much greater and are likely to increase cancer disparities substantially.

Racial differences in institutional trust and COVID-19 vaccine hesitancy and refusal

Background Previous research has indicated that demographic differences affect COVID-19 vaccination rates. Trust, in both the vaccine itself and institutional trust, is one possible factor. The present study examines racial differences in institutional trust and vaccine status among a nationally representative sample of adults in the United States. Methods Data for the current study was collected as part of Wave 8 Omnibus 2000 survey conducted by RAND ALP and consisted of 2080 participants. Responses were collected through the online RAND ALP survey in March 2021. Results Trust in the scientific community was the strongest predictor for already receiving at least one dose of the COVID-19 vaccine at the time of study. Asians had a significantly higher trust in the scientific community compared to all other groups. Results also showed a significant difference in level of trust of the government’s response to the COVID-19 pandemic with Indian/Alaskan Natives reporting lower trust compared to Whites, Blacks and Asians. Asians also had a significantly higher level of trust when compared to those who identified as racial Other. Those who identify as American Indian/Alaskan Natives had the lowest levels of institutional trust. Trust in the government’s response was not indicative of vaccination within the sample. Conclusions Strategies to increase trust of the scientific community can be employed to address vaccine hesitancy through community-based initiatives and building of partnerships between the scientific community and local community stakeholders.

Technology-based interventions in substance use treatment to promote health equity among African Americans/Blacks, Hispanics/Latinx, and American Indians/Alaskan Natives: a scoping review protocol (Preprint)

BACKGROUND Technology-based interventions (TBIs) (i.e., web-based and mobile interventions) have the potential to promote health equity in substance use disorder treatment (SUTx) for underrepresented groups (i.e., African Americans/Blacks, Hispanics/Latinx, and American Indians/Alaskan Natives) by removing barriers and increasing access to culturally relevant, effective treatments. However, technologies (emergent and more long-standing) may have unintended consequences that could perpetuate healthcare disparities among underrepresented groups. Healthcare research, and SUTx research specifically, is infrequently conducted with these groups as a main focus. Therefore, an improved understanding of the literature at the intersection of SUTx, TBIs, and underrepresented groups is warranted to avoid exacerbating inequities and to promote health equity. OBJECTIVE To explore peer-reviewed literature (January 2000-March 2021) that includes underrepresented groups in SUTx research using TBIs. We further seek to explore whether this subset of research is race/ethnicity conscious (i.e., does the research consider underrepresented groups (beyond their inclusion as study participants) in introduction, methods, results, and/or discussion). METHODS Five electronic databases (MEDLINE, Scopus, Cochrane Library, CINAHL, and PsychInfo) will be searched to identify SUTx research using TBIs, and studies will be screened for eligibility at the title/abstract and full-text levels. Studies will be included if their sample includes underrepresented groups at 50% or more when combined. RESULTS This project is currently in the data extraction phase with an anticipated completion date of March 2022. CONCLUSIONS Research is needed to increase our understanding of the range and nature of TBIs being used in SUTx research studies with underrepresented groups. The planned scoping review will highlight research at this intersection to promote health equity.

Racial Disparities and Sex Differences in Early- and Late-Onset Colorectal Cancer Incidence, 2001–2018

BackgroundColorectal cancer (CRC) incidence rates have increased in younger individuals worldwide. We examined the most recent early- and late-onset CRC rates for the US.MethodsAge-standardized incidence rates (ASIR, per 100,000) of CRC were calculated using the US Cancer Statistics Database’s high-quality population-based cancer registry data from the entire US population. Results were cross-classified by age (20-49 [early-onset] and 50-74 years [late-onset]), race/ethnicity (non-Hispanic White, non-Hispanic Black, Hispanic, American Indian/Alaskan Native, Asian/Pacific Islander), sex, anatomic location (proximal, distal, rectal), and histology (adenocarcinoma, neuroendocrine).ResultsDuring 2001 through 2018, early-onset CRC rates significantly increased among American Indians/Alaskan Natives, Hispanics, and Whites. Compared to Whites, early-onset CRC rates are now 21% higher in American Indians/Alaskan Natives and 6% higher in Blacks. Rates of early-onset colorectal neuroendocrine tumors have increased in Whites, Blacks, and Hispanics; early-onset colorectal neuroendocrine tumor rates are 2-times higher in Blacks compared to Whites. Late-onset colorectal adenocarcinoma rates are decreasing, while late-onset colorectal neuroendocrine tumor rates are increasing, in all racial/ethnic groups. Late-onset CRC rates remain 29% higher in Blacks and 15% higher in American Indians/Alaskan Natives compared to Whites. Overall, CRC incidence was higher in men than women, but incidence of early-onset distal colon cancer was higher in women.ConclusionsThe early-onset CRC disparity between Blacks and Whites has decreased, due to increasing rates in Whites—rates in Blacks have remained stable. However, rates of colorectal neuroendocrine tumors are increasing in Blacks. Blacks and American Indians/Alaskan Natives have the highest rates of both early- and late-onset CRC.ImpactOngoing prevention efforts must ensure access to and uptake of CRC screening for Blacks and American Indians/Alaskan Natives.

Expanding Understanding of Racial-Ethnic Differences in ADHD Prevalence Rates among Children to Include Asians and Alaskan Natives/American Indians

Background Prior studies show that ADHD prevalence rates vary by race-ethnicity, but these studies do not include a full range of racial-ethnic minority groups. Objective This study aimed to understand differences in ADHD prevalence among children across a wider range of racial-ethnic groups, overall and stratified by biological sex. Method Data on children aged 5 to 17 from the 2004 to 2018 National Health Interview Survey Sample Child Files were used in analyses ( N = 120,129). Results Compared to Non-Hispanic White children, ADHD prevalence was lower among Hispanic and Non-Hispanic Asian children. This difference was present for both males and females. Across all racial-ethnic groups, males had higher ADHD prevalence than females. Conclusion Results from this study provide further evidence that racial-ethnic disparities in ADHD prevalence rates persist across sex and provide initial evidence of substantially lower ADHD prevalence among Non-Hispanic Asians. Implications, limitations, and future research directions derived from the results are discussed.

An Expression of Self-Determination: Incorporating Alaska Native Knowledge into Community-Driven Energy Sovereignty

Traditional ecological knowledge (TEK) systems continue to demonstrate that they play a significant role in developing working relationships between Indigenous communities and the world. By narrowing TEK’s application to ecologically distinct regions, we begin to understand that Indigenous peoples’ local knowledge of a place is experienced and observed over time, and how the incorporation of these knowledge systems can strengthen community initiatives. The study of Alaskan Native knowledge (ANK) that is the focus of this article is specific to cultural regions of Alaska and to areas where certain communities live. To better understand the importance of this “Local ANK,” the author explored its incorporation during a timber harvest in Fort Yukon, Alaska and completed first-person interviews with project personnel of the wood-to-energy project. Local ANK is paramount in the planning and implementation of industrial projects that move Alaskan Natives towards self-determination.

Assessment of Diversity Outcomes in American Medical School Admissions: Applying the Grutter Legitimacy Principles

In the last 30 years, except for female participation, the enrollment of Latinx, African Americans, Native Americans, Alaskan natives, and disadvantaged students in medical school has been constant; however, increasing enrollment of these minority populations is feasible, if admissions committees make two changes in approach. First, the traditional belief that matriculation merit is a linear function of past academic performance must be rejected. Second, once the threshold needed to complete medical school in four years and to pass licensing examinations at the first attempt has been met, all candidates are equally qualified, and matriculation decisions must be based, in part, on societal interests. In Grutter vs. Bollinger, the United States Supreme Court determined that graduate admission committees can and should consider societal interests. Each admission decision represents a substantial government investment in each student, as the Medicare Act directly subsidizes much of the cost of medical education. As Grutter explained, there is a societal interest in the public having confidence in, and access to, the medical school training that will prepare tomorrow’s medical, professional, and political leaders. Our analysis suggests that medical school admissions are biased towards academic achievement in matriculants, beyond acceptable thresholds for graduation and licensure. We believe medical schools must shift their admissions strategies and consider noncognitive factors in all candidates as determinative once minimum acceptable academic standards have been met.

Comparing the Workplace Discrimination Experiences of Older and Younger Workers With Multiple Sclerosis Under the Americans With Disabilities Act Amendments Act

BackgroundIn this study, investigators examined the employment discrimination experiences of older workers (55 and over) with multiple sclerosis (MS) in comparison to younger adult workers with MS.ObjectiveTo examine age as a differential indicator of demographic characteristics of the Charging Parties, the discrimination issues alleged to occur, and the legal outcome of allegation investigations.MethodsThe study utilized data from the Integrated Mission System of the U.S. Equal Employment Opportunity Commission (EEOC).ResultsFindings indicate that allegations filed by older Charging Parties with MS were more likely to come from Whites and Native Americans/Alaskan Natives. Allegations filed by older Charging Parties were less likely to come from African Americans. Allegations filed by older workers were less likely to involve reasonable accommodations and more likely to involve issues related to demotion. No significant differences were observed related to the types of case resolutions between the two groups.ConclusionsResults suggest that many of the workplace discrimination experiences of people with MS are common across age groups, indicating that the very presence of MS is likely the most salient factor in the discrimination experiences of Americans with MS. Implications for policy and practice are discussed.