Factors Associated with Opting Out of an Unrelated Hematopoietic Stem Cell Donor Registry: Differences and Similarities across Five Key Groups of Young Race/Ethnically Diverse Potential Donors in the United States.

Young adults from underserved racial/ethnic groups are critically needed as unrelated hematopoietic stem cell (HSC) donors, yet they are more likely than other groups to opt out of donation after having matched a patient. Understanding which factors are most strongly associated with opting out among young underserved racial/ ethnic registered donors compared with their White counterparts will provide the basis for specific interventions to improve donor retention. We sought to determine the key, modifiable psychosocial, registry-related, and donation-related characteristics that are uniquely associated with opting out across 5 key racial/ethnic groups of young HSC donor registry members who had been contacted as a potential match for a patient. This study examines data from a large cross-sectional survey of young (age 18 to 30) registry members shortly after they preliminarily matched a patient (CT-stage) and continued toward or opted out of donation (CT-C and CT-NI), stratified by racial/ethnic group and sex. We assessed psychosocial, registry-related, and donation-related characteristics for all participants. We used chi-squared and F tests to assess differences between racial/ethnic groups. A separate logistic regression analysis for each racial/ethnic group was conducted to quantify adjusted associations between each variable and opting out. Then, we compared these associations across the racial/ethnic groups by evaluating the interaction effect between each variable and racial/ethnic group, with the same outcome (CT-C versus CT-NI) in question. Nine hundred thirty-five participants were surveyed, including 284 White, 165 Hispanic, 191 Black, 192 Asian/Pacific Islander, and 103 Multiracial/multiethnic participants. There were significant differences across racial/ethnic groups in values/goals, religious objections to donation, HSC-related medical mistrust, and parental involvement in donation decisions. Adjusted logistic regression subgroup analyses indicated that ambivalence was strongly associated with opting out across all racial/ethnic groups. Greater focus on intrinsic life goals (e.g., raising a family, becoming a community leader, influencing social values) was associated with opting out in the Multiracial/multiethnic, Hispanic, and Asian/Pacific Islander groups. Healthcare mistrust and insufficient registry contact was a significant factor for Hispanic participants. Protective factors against opting out included remembering joining the registry (Black participants), and parental support for donation decision (Asian/Pacific Islander participants). The performance of each logistic regression model was strong, with area-under-the curve ≥.88, CT-stage outcome classification accuracy ≥89%, and good fit between expected and observed opt-out probabilities. In the analysis across different racial/ethnic groups, the only significant interaction was race/ethnicity by whether more contact with the registry would have changed the decision at CT-stage; this variable was significant only for the Hispanic group. In the within-group analysis for Hispanic participants, the "more registry contact" variable was strongly associated with opting out (odds ratio 5.8, P = .03). Consistent with a growing body of HSC donor research, ambivalence was a key factor associated with opting-out for all racial/ethnic groups. Other key variables were differentially associated with opting-out depending on racial/ethnic group. Our study highlights key variables that registries should focus on as they develop targeted and tailored strategies to enhance commitment and reduce attrition of potential donors.

Gender Equitable Attitudes Among Adolescents: A Validation Study and Associations with Sexual Health Behaviors.

Gender inequitable attitudes are associated with violence perpetration and poor sexual health. There is limited diversity in U.S. samples used to validate gender attitudes measurements. This study assessed a 13-item gender equitable attitudes scale's validity among a sample of predominantly Black adolescent boys (n = 866; mean age = 15.5, range = 13-19 years) and examined associations with sexual health behaviors. Exploratory and confirmatory factor analyses tested construct validity. Logistic mixed-effects models were used to explore associations between gender equitable attitudes, adolescent relationship abuse, pornography use, and condom use behaviors; linear mixed-effects models explored associations between gender equitable attitudes and condom negotiation self-efficacy. By pooling data from two other gender transformative programs, Sisterhood 2.0 (n = 246, 13-19-year-old females (mean age = 15.2), 73.6% Black/African American) and Coaching Boys into Men Middle School (n = 958, 11-14-year-old males-6th grade: 10.4%, 7th grade: 36.5%, 8th grade: 53.1-56.6% white), measurement invariance was assessed across Black (n = 400) and white (n = 298) race and male (n = 429) and female (n = 246) gender. A three-factor 11-item scale showed construct validity among a sample of Black adolescent boys, weak factorial invariance across Black and white race, and configural invariance across male and female gender. Gender equitable attitudes were associated with less adolescent relationship abuse, higher condom negotiation self-efficacy, and less pornography use. These findings demonstrate some variability in measurements of gender equitable attitudes by race and gender. Targeting harmful gender norms may help prevent adolescent relationship abuse and improve sexual health behaviors.