Discrimination in Medical Settings across Populations: Evidence from the All of Us Research Program.

INTRODUCTION: Discrimination in medical settings (DMS) contributes to health care disparities in the United States, but few studies have determined the extent of DMS in a large national sample and across different populations. This study estimated the national prevalence of DMS and described demographic and health-related characteristics associated with experiencing DMS in seven different situations. METHODS: Survey data from 41,875 adults participating in the All of Us Research Program collected in 2021-2022 and logistic regression were used to examine the association between sociodemographic and health-related characteristics and self-reported DMS among adults engaged with a health care provider within the past 12 months. Statistical analysis was performed in 2023-2024. RESULTS: About 36.89% of adults reported having experienced at least one DMS situation. Adults with relative social and medical disadvantages had higher prevalence of experiencing DMS. Compared to their counterparts, respondents with higher odds of experiencing DMS in at least one situation identified as female, non-Hispanic Black, having at least some college, living in the South, renter, having other living arrangement, being publicly insured, not having a usual source of care, having multiple chronic conditions, having any disability, and reporting fair or poor health, p<0.05. CONCLUSIONS: The findings indicate a high prevalence of DMS, particularly among some population groups. Characterizing DMS may be a valuable tool for identifying populations at risk within the health care system and optimizing the overall patient care experience. Implementing relevant policies remains an essential strategy for mitigating the prevalence of DMS and reducing health care disparities.

Breaking Academic Silos: Pedagogical Recommendations for Equitable Obesity Prevention Training and Research During an Age of Nutrition Polarization.

Introduction: Obesity is a preventable chronic condition and a risk factor for poor health and early mortality. Weight stigma and weight-neutral medicine are popular topics in social media that are often at odds with current medical guidelines on obesity treatment and prevention. This conflict may erode the public's trust in science, impede research progress on preventing obesity in marginalized groups, and uphold the ongoing and historical lack of diversity among nutrition trainees. Methods: The authors conducted a series of student-led dialogue sessions with nutrition graduate students in Boston, Massachusetts, from March to May 2023 to understand perceptions of obesity research, health equity, and racism and discrimination. This article summarizes the lessons learned and provides pedagogical recommendations for jointly addressing obesity at the population level and the recruitment, training, and retention of diverse scholars, clinicians, and public health practitioners. Results: Dialogue sessions revealed that students perceive a disproportionate focus on the harms of obesity as a chronic disease, highlighting that inadequate attention is given to weight stigma and discrimination. Some participants believed that weight-based discrimination is equally detrimental to individual health and wellbeing as having obesity. Discussions also emphasized the need to pinpoint the multidimensional and cultural manifestations of weight stigma, which necessitates collaboration across social sectors and academic disciplines. Students recognized the urgent need to apply an equity lens to obesity research and teaching but felt limited in their access to experts within nutrition science who specialize in racism, discrimination, eating disorders, and weight stigma. Conclusions: This study identified concrete opportunities for urgently needed new training and research in population-level obesity prevention, emphasizing antiracism, harm reduction, and elimination of stigma and bias across multiple levels of science and society. Overall, the decision to use the BMI within pedagogy and training must be explicitly stated-research, population surveillance, decision-making, or treatment pedagogy and training-while acknowledging its strengths and limitations across diverse settings. Finally, the social determinants of obesity should incorporate not only weight stigma but also racism and multiple forms of discrimination.

Education, Income, Wealth, and Discrimination in Black-White Allostatic Load Disparities.

INTRODUCTION: Allostatic load (AL) is a significant marker of aging, associated with disease and mortality. Research has elucidated the impact of education and income on AL. However, the roles of wealth and discrimination in contributing to AL and shaping AL disparities remain underexplored. This study aimed to investigate the association between wealth and AL, while also examining the independent contributions of education, income, wealth, and everyday discrimination in shaping AL disparities. METHODS: Using 2016 data from the nationally representative Health and Retirement Study (N=3,866), this study employed multilinear regression analysis to quantify the association between education and income, wealth (calculated as assets minus debts), and everyday discrimination with AL. Oaxaca-Blinder decomposition analysis was conducted to determine the proportion of AL disparities between Black and White participants attributed to education and income, wealth, and everyday discrimination. Analyses were performed in 2023. RESULTS: Having a college degree or more (b = -0.32; 95% CI: -0.46, -0.17), higher income (b = -0.06; 95% CI: -0.11, -0.01), and greater wealth (b = -0.11; 95% CI: -0.16, -0.07) were linked to reduced AL. Conversely, increased experiences of everyday discrimination were associated with heightened AL (b = 0.07; 95% CI: 0.01, 0.16). Collectively, differences in possessing a college degree or more, wealth, and exposure to discrimination accounted for about 18% of the observed Black-White AL disparities. CONCLUSIONS: Education, income, wealth, and experiences of discrimination may independently contribute to AL and partially explain Black-White disparities in AL. There is a need to elucidate the underlying mechanisms governing these relationships, particularly wealth, and extend the research to additional social determinants of racial health disparities.

A novel approach to model cumulative stress: Area under the s-factor curve.

OBJECTIVE: Using a large longitudinal sample of adults from the Midlife in the United States (MIDUS) study, the present study extended a recently developed hierarchical model to determine how best to model the accumulation of stressors, and to determine whether the rate of change in stressors or traditional composite scores of stressors are stronger predictors of health outcomes. METHOD: We used factor analysis to estimate a stress-factor score and then, to operationalize the accumulation of stressors we examined five approaches to aggregating information about repeated exposures to multiple stressors. The predictive validity of these approaches was then assessed in relation to different health outcomes. RESULTS: The prediction of chronic conditions, body mass index, difficulty with activities of daily living, executive function, and episodic memory later in life was strongest when the accumulation of stressors was modeled using total area under the curve (AUC) of estimated factor scores, compared to composite scores that have traditionally been used in studies of cumulative stress, as well as linear rates of change. CONCLUSIONS: Like endogenous, biological markers of stress reactivity, AUC for individual trajectories of self-reported stressors shows promise as a data reduction technique to model the accumulation of stressors in longitudinal studies. Overall, our results indicate that considering different quantitative models is critical to understanding the sequelae and predictive power of psychosocial stressors from midlife to late adulthood.

Love after lockup: examining the role of marriage, social status, and financial stress among formerly incarcerated individuals.

BACKGROUND: Upon reintegration into society, formerly incarcerated individuals (FIIs) experience chronic financial stress due to prolonged unemployment, strained social relationships, and financial obligations. This study examined whether marriage and perceived social status can mitigate financial stress, which is deleterious to the well-being of FIIs. We also assessed whether sociodemographic factors influenced financial stress across marital status. We used cross-sectional data from 588 FIIs, collected in the 2023 Survey of Racism and Public Health. The financial stress outcome (Cronbach's [Formula: see text] = 0.86) comprised of five constructs: psychological distress, financial anxiety, job insecurity, life satisfaction, and financial well-being. Independent variables included marital and social status, age, race/ethnicity, gender identity, educational attainment, employment status, and number of dependents. Multivariable models tested whether financial stress levels differed by marital and perceived social status (individual and interaction effects). Stratified multivariable models assessed whether social status and sociodemographic associations varied by marital status. RESULTS: We found that being married/living with a partner (M/LWP, b = -5.2) or having higher social status (b = -2.4) were protective against financial stress. Additionally, the social status effect was more protective among divorced, separated, or widowed participants (b = -2.5) compared to never married (NM, b = -2.2) and M/LWP (b = -1.7) participants. Lower financial stress correlated with Black race and older age, with the age effect being more pronounced among M/LWP participants (b = -9.7) compared to NM participants (b = -7.3). Higher financial stress was associated with woman gender identity (overall sample b = 2.9, NM sample b = 5.1), higher education (M/LWP sample b = 4.4), and having two or more dependents (overall sample b = 2.3, M/LWP sample b = 3.4). CONCLUSIONS: We provide novel insights into the interrelationship between marriage, perceived social status, and financial stress among FIIs. Our findings indicate the need for policies and programs which may target the family unit, and not only the individual, to help alleviate the financial burden of FIIs. Finally, programs that offer legal aid to assist in expungement or sealing of criminal records or those offering opportunities for community volunteer work in exchange for vouchers specific to legal debt among FIIs could serve to reduce financial stress and improve social standing.

The cost of doubt: assessing the association between attributional ambiguity and mental health.

OBJECTIVE: To quantify the association between attributional ambiguity-the uncertainty of whether an experience is discrimination-and mental health. METHODS: Using a nationally representative sample of U.S. adults recruited through an online survey by Ipsos (April 23 and May 3, 2021), attributional ambiguity was quantified by asking participants if they experienced anything in the past 6 months that they were unsure was discrimination. The survey also assessed the degree to which these experiences caused participants to feel bothered and to ruminate on them. Multiple linear regression models were used to analyze associations between attributional ambiguity and depressive symptoms and mental health status. RESULTS: Black and Hispanic participants reported higher rates of attributional ambiguity than White participants. Experiencing attributional ambiguity was associated with higher levels of depressive symptoms and poorer self-reported mental health status. Among those who reported attributional ambiguity, increases in bother and rumination scores were positively associated with depressive symptoms. CONCLUSION: Attributional ambiguity is an important yet overlooked social determinant of mental health. More research is needed to fully understand the impact of this stressor on population health, particularly among minoritized populations.

The Influence of Contested Racial Identity and Perceived Everyday Discrimination Exposure on Body Mass Index in US Adults.

Contested racial identity-the discrepancy between one's self-identified race and socially assigned race-is a social determinant of health and may contribute to overweight and obesity. Obesity is associated with a host of short- and long-term health conditions, including cardiovascular disease, a leading cause of death. Individuals racialized as Black, Hispanic, and Latino are at the greatest risk of obesity. Previous research indicates that experiencing interpersonal discrimination is associated with higher body mass index (BMI) in adults, and individuals with a contested racial identity are disproportionately exposed to interpersonal discrimination. However, the association between BMI and contested racial identity is unknown. This cross-sectional study measured the relationship between contested racial identity and perceived everyday discrimination on BMI in a nationally representative sample of US adults. Contested racial identity was measured with a binary variable indicating agreement between participants' self-identified race and socially assigned race. Weighted unadjusted and adjusted multiple linear regression models quantified the associations between BMI and contested racial identity with and without the mean discrimination score. Covariates included nativity status, income, education, racial identity salience, gender, and age. Among 1689 participants, 18.3% had a contested racial identity. Contested identity was associated with significantly higher BMI (ß = 1.01, 95% CI = 0.06, 1.92), but the relationship was attenuated when adjusting for interpersonal discrimination, suggesting that individuals with contested identity may face a greater risk of obesity due to their disproportionately high exposure to interpersonal racial discrimination. Further research is needed to elucidate the impact of racism on BMI and obesity risk.

Parental education and epigenetic aging in middle-aged and older adults in the United States: A life course perspective.

Epigenetic aging is one plausible mechanism by which socioeconomic status (SES) contributes to disparities in morbidity and mortality. Although the association between SES and epigenetic aging is well documented, the role of parental education into adulthood remains understudied. We examined (1) if parental education was independently associated with epigenetic aging, (2) whether upward educational mobility buffered this association, and (3) if the benefit of parental education was differentiated by race/ethnicity. Secondary data analysis of a subsample (n = 3875) of Non-Hispanic [NH] Black, Hispanic, NH White, and NH other race participants from the Venous Blood Study within Health and Retirement Study were examined. Thirteen clocks based on DNA methylation of cytosine-phosphate-guanine sites were used to calculate epigenetic aging. Participants' education (personal) and their report of their respective parent's education (parental; mother's and/or father's) were included as independent variables; several potential confounders were also included. Direct associations and interactions between parental and personal education were estimated via survey-weighted generalized linear models; marginal means for epigenetic aging were estimated and contrasts were made between the education subcategories. Analyses were also stratified by race/ethnicity. Our results showed that higher parental education was independently associated with slower epigenetic aging among four clocks, whereas higher personal education magnified this association among four different epigenetic clocks. Participants with the lowest parental and personal education had higher marginal means (i.e., accelerated aging) compared to participants with the highest parental and personal education, and there was little evidence of upward mobility. These associations were more frequently observed among NH White participants, whereas fewer were observed for Hispanic and NH Black participants. Overall, our findings support that early-life circumstances may be biologically embedded through epigenetic aging, which may also limit the biological benefits associated with one's own education.

Association of Racial Discrimination With Adiposity in Children and Adolescents.

Importance: Childhood obesity is a major public health issue and is disproportionately prevalent among children from minority racial and ethnic groups. Personally mediated racism (commonly referred to as racial discrimination) is a known stressor that has been linked to higher body mass index (BMI; calculated as weight in kilograms divided by height in meters squared) in adults, but little is known about the association of racial discrimination and childhood and adolescent adiposity. Objective: To assess the prospective association between self-reported experiences of racial discrimination and adiposity (BMI and waist circumference) in a large sample of children and adolescents in the Adolescent Brain Cognitive Development (ABCD) study. Design, Setting, and Participants: This cohort study used complete data from the ABCD study (2017 to 2019), involving a total of 6463 participants. The ABCD study recruited a diverse sample of youths from across the US, with rural, urban, and mountain regions. Data were analyzed from January 12 to May 17, 2023. Exposure: The child-reported Perceived Discrimination Scale was used to quantify racial discrimination, reflecting participants' perceptions of being treated unfairly by others or unaccepted by society based on their race or ethnicity. Main Outcomes and Measures: Weight, height, and waist circumference were measured by trained research assistants. BMI z scores were computed by applying the US Centers for Disease Control and Prevention's age and sex-specific reference standards for children and adolescents. Waist circumference (inches) was quantified as the mean of 3 consecutive measures. Measurements were taken from time 1 (ie, 2017 to 2019) and time 2 (ie, 2018 to 2020). Results: Of the 6463 respondents with complete data, 3090 (47.8%) were female, and the mean (SD) age was 9.95 (0.62) years. Greater racial discrimination exposure at time 1 was associated with higher BMI z score in both unadjusted (ß, 0.05; 95% CI, 0.02-0.08) and adjusted regression models (ß, 0.04; 95% CI, 0.01-0.08). Discrimination at time 1 was associated with higher waist circumference in unadjusted (ß, 0.35; 95% CI, 0.15-0.54) and adjusted (ß, 0.24; 95% CI, 0.04-0.44) models. Conclusions and Relevance: In this cohort study of children and adolescents, racial discrimination was positively associated with adiposity, quantified by BMI z score and waist circumference. Interventions to reduce exposure to racial discrimination in early life may help reduce the risk of excess weight gain across throughout life.

Use of Bland-Altman Analysis to Examine the Racial and Ethnic Representativeness of Study Populations in Community-Based Pediatric Health Research.

Importance: Children from marginalized racial and ethnic groups are underrepresented in health research. To improve external validity and routinize race and ethnicity reporting, a specific and standardized methodology for quantifying representativeness of participant populations is needed. Objective: To develop a standardized method for quantifying the racial and ethnic representativeness of study samples. Design, Setting, and Participants: In this cross-sectional study, data from 7 US community-based health studies (conducted between 2003 and 2017) were retrospectively pooled to assess the school-level representativeness of enrolled samples by race and ethnicity. The sampling frame for the study was constructed using the National Center of Education Statistics Common Core of Data, which provides year-specific racial and ethnic counts by grade. Representativeness was quantified by aggregating children's data at the school level, reported individually for Asian, Black, Hispanic or Latino, Native Hawaiian or other Pacific Islander, White, or multiple races. In this analysis, the Asian and Native Hawaiian or other Pacific Islander subgroups were combined. Data were analyzed from April 1 to June 15, 2022. Exposure: Community-based nutritional health studies conducted with children in grades 1 to 8. Main Outcomes and Measures: Visual comparisons of percentage expected and percentage observed of the pooled sample by race and ethnicity were performed using scatterplots and Bland-Altman plots. Spearman rank-order correlation was used to assess associations. Results: This study included 104 study schools (N = 5807 children) located in California, Kentucky, Massachusetts, Mississippi, and South Carolina. Bland-Altman analysis revealed notable patterns and variability in the representativeness of racial and ethnic groups. Differences in the overall representativeness of Asian or Native Hawaiian or other Pacific Islander children (0.45 percentage points [95% CI, -7.76 to 8.66]), Black children (0.12 percentage points [95% CI, -15.73 to 15.96]), and White children (-0.72 percentage points [95% CI, -23.60 to 22.16]) were negligible, but measures of spread suggested that target population demographics affected representativeness differently across groups. Conclusions and Relevance: The results of this cross-sectional study suggest that replicating, testing, and scaling the proposed method for quantifying racial and ethnic representativeness, which uses measures of spread, could improve the transparency of race and ethnicity reporting during publication and lead to a more externally valid health evidence base. During implementation, investigators should adopt community-based research methods and allocate appropriate resources during recruitment, including a priori assessment of population demographics, as these conditions may affect racial and ethnic study enrollment differently. Prioritizing these methodological decisions could alleviate rising inequities.

Perceived intrinsic, social, and environmental barriers for weight management in older Hispanic/Latino adults with obesity.

Background: The burden of obesity and chronic disease is increasing in the older US Hispanic/Latino adult population. There is limited evidence on successful weight management strategies as perceived by this population. Assessing barriers and opportunities for weight management using mixed methods is a robust approach to collect in-depth information that can be applied to the development of well-tailored weight management interventions for this population. Objective: The objective of this study was to assess perceived individual, interpersonal, and environmental factors that influence weight management in older Hispanic/Latino adults. Methods: This community-based cross-sectional study included 23 Hispanic/Latino older (>50y) adults with obesity (BMI >30 kg/m2). Perceived barriers and opportunities for weight management were assessed through validated questionnaires and focus groups. Prospectively registered on ClinicalTrials.gov (NCT03978416) on 7 June 2019. Results: In this demographically heterogeneous population, language acculturation was generally low, and the frequency of poor dietary behaviors was high. Participants linked financial strain to lower diet quality, as well as anxiety to uncontrolled eating and food cravings. Social support and trust in healthcare professionals were perceived as priorities for healthy eating. Structural and environmental barriers such as affordability and availability of culturally preferred foods were also identified as influences on food choices and eating behavior. Conclusions: This study revealed opportunities for culturally tailored weight management interventions in older Hispanic/Latino adults with obesity. Clinical Trial Registry Number: NCT03978416 (ClinicalTrials.gov).

Genetic Liability, Exposure Severity, and Post-Traumatic Stress Disorder Predict Cognitive Impairment in World Trade Center Responders.

BACKGROUND: There is a high incidence of cognitive impairment among World Trade Center (WTC) responders, comorbid with post-traumatic stress disorder (PTSD). Yet, it remains unknown whether genetic liability for Alzheimer's disease, PTSD, educational attainment, or for a combination of these phenotypes, is associated with cognitive impairment in this high-risk population. Similarly, whether the effects of genetic liability are comparable to PTSD and indicators of exposure severity remains unknown. OBJECTIVE: In a study of 3,997 WTC responders, polygenic scores for Alzheimer's disease, PTSD, and educational attainment were used to test whether genome-wide risk for one or more of these phenotypes is associated with cognitive impairment, controlling for population stratification, while simultaneously estimating the effects of demographic factors and indicators of 9/11 exposure severity, including symptoms of PTSD. RESULTS: Polygenic scores for Alzheimer's disease and educational attainment were significantly associated with an increase and decrease, respectively, in the hazard rate of mild cognitive impairment. The polygenic score for Alzheimer's disease was marginally associated with an increase in the hazard rate of severe cognitive impairment, but only age, exposure severity, and symptoms of PTSD were statistically significant predictors. CONCLUSION: These results add to the emerging evidence that many WTC responders are suffering from mild cognitive impairments that resemble symptoms of Alzheimer's disease, as genetic liability for Alzheimer's disease predicted incidence of mild cognitive impairment. However, compared to polygenic scores, effect sizes were larger for PTSD and the type of work that responders completed during rescue and recovery efforts.

Discrimination Exposure and Polygenic Risk for Obesity in Adulthood: Testing Gene-Environment Correlations and Interactions.

INTRODUCTION: Exposure to discrimination has emerged as a risk factor for obesity. It remains unclear, however, whether the genotype of the individual can modulate the sensitivity or response to discrimination exposure (gene × environment interaction) or increase the likelihood of experiencing discrimination (gene-environment correlation). METHODS: This was an observational study of 4,102 white/European Americans in the Health and Retirement Study with self-reported, biological assessments, and genotyped data from 2006 to 2014. Discrimination was operationalized using the average of nine Everyday Discrimination Scale items. Polygenic risk scores (PRSs) for body mass index (BMI) and waist circumference (WC) were calculated using the weighted sum of risk alleles based on studies conducted by the Genetic Investigation of Anthropometric Traits (GIANT) consortium. RESULTS: We found that greater PRS-BMI was significantly associated with more reports of discrimination (ß = 0.04 ± 0.02; p = 0.037). Further analysis showed that measured BMI partially mediated the association between PRS-BMI and discrimination. There was no evidence that the association between discrimination and BMI, or the association between discrimination and WC, differed by PRS-BMI or PRS-WC, respectively. CONCLUSION: Our findings suggest that individuals with genetic liability for obesity may experience greater discrimination in their lifetime, consistent with a gene-environment correlation hypothesis. There was no evidence of a gene-environment interaction. More genome-wide association studies in diverse populations are needed to improve generalizability of study findings. In the meantime, prevention and clinical intervention efforts that seek to reduce exposure to all forms of discrimination may help reduce obesity at the population level.

Intersectional vulnerability in the relationship between discrimination and inflammatory gene expression.

Addressing social disparities in health and well-being requires understanding how the effects of discrimination become biologically embedded, and how embedding processes might vary across different demographic contexts. Emerging research suggests that a threat-related gene expression response may contribute to social disparities in health. We tested a contextual vulnerability model of discrimination embedding using an empirical intersectionality (interaction discovery) analysis of pro-inflammatory gene expression in a national sample of non-institutionalized, English-speaking adults with RNA biomarker data (n = 543). At the time of data collection, the average age of participants was 55 years (SD = 13.26) and approximately half identified as female (50.46%). Most participants identified as White (∼73%) and had some college experience (∼60%). Results showed significant variation in the strength of association between daily discrimination and inflammatory gene expression by race and sex (b = -0.022; 95% CI:-0.038,-0.005, p = .009) with the estimated marginal association larger for racially-minoritized males (b = 0.007; 95% CI:-0.003,0.017, p = .163), compared to White males (b = -0.006; 95% CI:-0.013,0.001, p = .076). This study indicates that the link between daily discrimination and inflammatory gene expression may vary by sociodemographic characteristics. To improve initiatives and policies aimed at ameliorating disparities within populations, greater attention is needed to understand how interlocking systems of inequalities contribute to physiological health.

The Relationship Between Subjective Social Status, Mental Health Disparities, and the Mediating Role of Discrimination Among Latinx Populations.

OBJECTIVES: Subjec tive social status (SSS) has consistently been linked to health outcomes among Latinx populations, but less is known about how discrimination explains the relationship between SSS and health disparities. While SSS, an individual's perception of her socioeconomic standing, is a robust predictor of health disparities in many societies, discriminatory experiences may impact the relationship between SSS and mental health and health outcomes. Subjective social status can negatively contribute to health disparities through several pathways including the stigma associated with lower social status and poverty. Experiencing discrimination can contribute to feelings of marginalization and therefore decrease individuals' perception of their social status. This study tested discrimination as a mediator of SSS and health disparities among Latinx populations. DESIGN: Using the National Latino and Asian American Study (NLAAS), we identified 2554 Latinx participants to be included in the sample. Participants reported ratings of mental and physical health and exposure to everyday discrimination. Mediation models were used to analyze everyday discrimination as a mediator of SSS and health outcomes. RESULTS: The present results support that SSS is directly associated with ratings of mental and physical health in Latinx individuals. Discrimination was also found to mediate the relationship between SSS and health outcomes. CONCLUSIONS: These findings have practice implications for health disparities among Latinx populations. In particular, discrimination may be a major contributing factor to the role of SSS on health outcomes.

Length of Residency in the United States and Obesity Across Race/Ethnicity.

We examined whether the association between length of US residency (LUSR) and obesity is dependent on race/ethnicity and sex, among foreign-born individuals. Adult's body mass index (N = 151,756) were analyzed using the 2013-2017 National Health Interview Surveys. Among foreign-born adults living in the US < 5 years, non-Hispanic Blacks and Hispanics had the highest obesity prevalence compared to non-Hispanic Whites and Asians. Blacks and Hispanics also had the highest incremental percentage point increase in obesity (13%) between < 5 years and ≥ 15 years LUSR. Foreign-born black men had the lowest obesity prevalence among men in the US < 5 years (5.3%) but had the sharpest percentage point increase in obesity among men in the US ≥ 15 years (21%). Foreign-born black women in the US < 5 years had a 30.1% obesity prevalence. Obesity prevention interventions should account for differences in LSUR among foreign-born individuals.

Socially Assigned Race and the Health of Racialized Women and Their Infants.

Introduction: While historically most public health research has relied upon self-identified race as a proxy for experiencing racism, a growing literature recognizes that socially assigned race may more closely align with racialized lived experiences that influence health outcomes. We aim to understand how women's health behaviors, health outcomes, and infant health outcomes differ for women socially assigned as nonwhite when compared with women socially assigned as white in Massachusetts. Methods: Using data from the Massachusetts Pregnancy Risk Assessment Monitoring System (PRAMS) Reactions to Race module, we documented the associations between socially assigned race (white vs. nonwhite) and women's health behaviors (e.g., initiation of prenatal care, breastfeeding), women's health outcomes (e.g., gestational diabetes, depression before pregnancy), and infant health outcomes (e.g., preterm birth, low birth weight [LBW]). Multivariable models adjusted for age, marital status, education level, nativity, receipt of Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) assistance during pregnancy, infant sex, plurality, and gestational age. Additional models adjusted for treatment by race, how often one thinks about race, and nativity. Results: Women socially assigned as nonwhite had higher odds of breastfeeding (adjusted odds ratio [AOR]: 1.86, 95% confidence interval [CI]: 1.54 to 2.25), lower odds of consuming alcohol (AOR: 0.27, 95% CI: 0.24 to 0.31), and lower odds of smoking (AOR: 0.30, 95% CI: 0.24 to 0.38) compared with those socially assigned as white. However, women socially assigned as nonwhite had higher odds of reporting gestational diabetes (AOR: 1.97, 95% CI: 1.49 to 2.61). Mothers socially assigned as nonwhite also had higher odds of giving birth to an LBW (AOR: 1.66, 95% CI: 1.29 to 2.14) and small-for-gestational age (AOR: 1.46, 95% CI: 1.19 to 1.80) infant compared with women socially assigned as white. Discussion: In comparison with women socially assigned as white, we observed poorer health outcomes for women who were socially assigned nonwhite despite engaging in more beneficial pregnancy-related health behaviors. Socially assigned race can provide an important context for women's experiences that can influence their health and the health of their infants.

Medical mistrust, discrimination, and COVID-19 vaccine behaviors among a national sample U.S. adults.

Background: COVID-19 vaccine uptake has been suboptimal and disparities in uptake have exacerbated health inequities. It has been postulated that mistrust in the healthcare system and experiences of discrimination or unfair treatment in other settings may be barriers to uptake of the COVID-19 vaccine, although few studies to date have investigated medical mistrust and perceived discrimination together. Method: We conducted a cross-sectional online survey between April 23-May 3, 2021, among a national sample of U.S. adults ages 18 years and older. We assessed receipt of and intention to be vaccinated for COVID-19 and associations with the validated Medical Mistrust Index and Everyday Discrimination Scale. Results: 1449 individuals responded, of whom 70.2% either had ≥1 dose of COVID-19 vaccine or reported that they were 'very' or 'somewhat' likely to be vaccinated in the future. In bivariate analyses, vaccination status was significantly associated with age, race/ethnicity, education, income, employment, marital status, health insurance, and political party affiliation. In multivariable analyses comparing those who had ≥1 vaccine dose or were likely to get vaccinated in the future with those who had not had any vaccine doses or did not intend to be vaccinated, each additional point in the Medical Mistrust Index was independently associated with a 16% decrease in the odds of vaccination (adjusted odds ratio = 0.84; 95% confidence interval = 0.81, 0.86). Discriminatory experiences were not associated with vaccination behavior or intention in bivariate or multivariable analyses. Conclusions: Medical mistrust is significantly associated with vaccination status and intentions. Increasing uptake of COVID-19 vaccines will likely require substantive efforts on the part of public health and healthcare officials to build trust with those who are not yet fully vaccinated. We recommend that these efforts focus on building the 'trustworthiness' of these entities, an approach that will require a paradigm shift away from a focus on correcting individual beliefs and knowledge, to acknowledging and addressing the root causes underlying mistrust.

Examining the relationship between household wealth and colorectal cancer screening behaviors among U.S. men aged 45-75.

Colorectal cancer (CRC) is the third leading cause of cancer-related death among men in the United States (U.S.), particularly among men aged 45 years and older. Early-detection screening remains a key method of decreasing CRC-related deaths, yet socioeconomic barriers exist to planning and completing CRC screening. While accumulating evidence shows income disparities in CRC screening prevalence, a dearth of research has investigated wealth disparities. This study aimed to determine whether household wealth was associated with CRC screening uptake and future screening intent. In February 2022, we sent an online survey to potential participants; U.S. men aged 45-75 years were eligible to participate. We examined four CRC screening behaviors as outcomes: ever completing a stool-based or exam-based screening test, current screening status, and future screening intent. Household net wealth, determined by self-reported household wealth and debt, was the primary predictor. We used logistic regression to estimate odds ratios (ORs) and their 95% confidence interval (CI). Of the study participants (N = 499), most self-identified as Non-Hispanic White, were aged 50-64 years, and had previously completed a CRC screening test. Results revealed that, among men aged 45-49 years, higher net wealth decreased the odds of ever completing a stool- or exam-based test (OR = 0.58, 95% CI: 0.33, 0.98; OR = 0.55, 95% CI: 0.31, 0.94, respectively). By contrast, among men aged 50-75 years, higher net wealth increased the odds of being current with CRC screening (OR = 1.40, 95% CI: 1.03, 1.92). Net wealth was unassociated with CRC screening intent. These findings suggest that household net wealth, rather than income, is an important socioeconomic factor to consider in relation to uptake of CRC early-detection screening. The financial and social cognitive mechanisms linking household wealth to CRC screening behaviors merit future research and intervention.

The weight of childhood adversity: evidence that childhood adversity moderates the impact of genetic risk on waist circumference in adulthood.

OBJECTIVE: The present study tested the interactive effects of childhood adversity and polygenic risk scores for waist circumference (PRS-WC) on waist circumference (WC). Consistent with a diathesis-stress model, we hypothesize that the relationship between PRS-WC and WC will be magnified by increasing levels of childhood adversity. METHODS: Observational study of 7976 adults (6347 European Americans and 1629 African Americans) in the Health and Retirement Study with genotyped data. PRS-WC were calculated by the HRS administrative core using the weighted sum of risk alleles based on a genome-wide association study conducted by the Genetic Investigation of Anthropometric Traits (GIANT) consortium. Childhood adversity was operationalized using a sum score of three traumatic events that occurred before the age of 18 years. RESULTS: There was a statistically significant interaction between PRS-WC and childhood adversity for European Americans, whereby the magnitude of PRS-WC predicting WC increased as the number of adverse events increased. CONCLUSIONS: This study supports the idea of the interactive effects of genetic risks and childhood adversity on obesity. More epidemiological studies, particularly with understudied populations, are needed to better understand the roles that genetics and childhood adversity play on the development and progression of obesity.