Comparative predictors for cervical cancer screening in Southeast Michigan for Middle Eastern-North African (MENA), White and African American/black women.

The cervical cancer screening behaviors of Arab American women are not adequately understood, in part because Middle Eastern North African (MENA) descent is not a US Census category. Others have shown decreased cervical cancer screening in this race of women. Our primary aim is to evaluate the predictors of cervical cancer screening among MENA, White and Black women of southeast Michigan. A community-wide health survey reached MENA, White and Black populations asking self-report questions about health behaviors, attitudes, and medical history. Cervical cancer screening was considered up-to-date if it was reported to have occurred within the past three years. Survey responses were limited to women 30-65 years old and were analyzed with inferential and logistic regression models to determine risk factors for cervical cancer screening. Overall, 78% reported cervical cancer screening within the past three years. MENA women screened less often if time in the US was less than ten years (aOR 0.24 (0.05, 0.76)) compared to more than ten years and if single (aOR 0.27 (0.07, 0.97)) compared to married. Religion was not associated with screening in any study population. Those of all races without insurance screened significantly less often than those with insurance. The barriers to cervical cancer screening among MENA women are not associated with religion but instead with lack of insurance and length of time residing in the US.

The impact of the COVID-19 pandemic on medical conditions and medication adherence in people with chronic diseases.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has drastically disrupted primary health care and pharmacy services, posing a challenge in people with chronic diseases who receive routine care. Currently, there exists limited literature on the indirect impact of the pandemic on chronic disease management, particularly related to accessibility to medications and health care resources. OBJECTIVES: To determine the prevalence of medical- and medication-related problems reported by people with chronic diseases during the pandemic. The secondary objective was to identify the barriers and contributing factors related to these medical- and medication-related problems. METHODS: The anonymous and voluntary, Web-based survey was filled out by interested adult respondents with chronic disease(s) across Michigan between September 1, 2020, and January 1, 2021. The primary outcome included self-reported medical- and medication-related problems during the pandemic. Secondary outcomes included potential risk factors for medical- and medication-related problems. Descriptive statistics was used to describe respondents' demographics, chronic disease characteristics, medication adherence, medical- and medication-related problems, and COVID-19-related factors. The multivariable Firth logistic regression was used to analyze correlations between potential risk factors associated with medical- and medication-related problems. RESULTS: A total of 1103 respondents completed the survey and were included in the analysis. Approximately, 51% of respondents reported a medication-related problem with 19.6% reported problems obtaining medication(s) and 31.7% reported forgetting or not taking their medication(s). The top reason for problems obtaining medication(s) was doctor's office being closed for in-person visit(s). In addition, of all responses, more than half reported worsening symptoms of their chronic disease(s) during the pandemic especially with psychiatric disorders (79.5%) and inflammatory bowel disease (60%). Respondents with a significantly higher risk of medication-related problems included those who were younger, were female, and had psychiatric disorder(s), diabetes, arthritis, or lupus, and respondents with a significantly higher risk of medical-related problems included those with multiple chronic diseases, psychiatric disorder(s), and heart failure. CONCLUSION: Understanding the consequences of the pandemic, such as medical- and medication-related problems, in this population is critical to improving health care accessibility and resources through potential outpatient pharmacy services during this and future pandemics.

Mental health outcomes among Arab refugees, immigrants, and U.S. born Arab Americans in Southeast Michigan: a cross-sectional study.

BACKGROUND: Arab refugees and immigrants living in the United States may be exposed to political, economic, social, and environmental stressors that may affect their mental health. Yet, little is known regarding mental health outcomes among Arab Americans. The purpose of this study was to measure depression and anxiety levels among Arabs in Southeast Michigan and determine whether these levels differ by resident status: refugee, immigrant, or U.S. born. METHODS: We conducted a cross-sectional study in a convenience sample of 275 adults who self-identify as Arab living in Southeast Michigan. Participants were recruited from a non-profit health and social services organization between August-November 2015. Data were collected via self-administered questionnaires, using standardized instruments to assess depression and anxiety symptoms. RESULTS: All three resident groups exhibited high mean levels of depression and anxiety. Refugees reported higher levels of depression and anxiety than either immigrants or U.S. born Arab Americans. After adjustment for sociodemographics, differences between U.S. born Arab Americans and refugees were statistically significant for depression (b = 2.84; 95% CI: 0.21, 5.47), but not for anxiety. Refugees had significantly higher depression scores (b = 3.18, 95% CI: 1.52, 4.84) and anxiety scores (b = 1.31, 95% CI: 0.11, 2.50) than immigrants. Those reporting political violence and religious persecution as reasons for immigration had the highest levels of depression and anxiety. CONCLUSIONS: This convenience sample of Arab Americans reported high levels of depression and anxiety symptoms. Refugees appear to have poorer mental health outcomes than either immigrants or U.S.-born Arab Americans.

Efficacy of spent black tea for the removal of nitrobenzene from aqueous media.

Nitrobenzene (NB) is a kind of persistent organic pollutant. A ubiquitous and cost-effective substance spent black tea (SBT) was investigated for the removal of nitrobenzene from aqueous media. The maximum uptake potential of dried biomass (SBT) for NB was found to be 14.86 mg per gram (qmax) in a batch experimental set-up. Equilibration time for NB sorption was about 50 min, and optimal removal efficiency was achieved at a dosage of 2 g/L with an initial concentration of 100 mg/L of NB. Findings revealed that NB uptake increased with an increase in the temperature from 273 K to 353 K. Sorption was also found to be pH sensitive, sorption improved as the pH value changes from alkaline to acidic (from 10 to 2). Different isotherm (Langmuir, Freundlich, Temkin and Dubinin Radushkevich) and kinetic models (pseudo-1st order, pseudo-2nd order and Elovich models) were applied to experimental results; the sorption mechanism was well described by the Freundlich and pseudo-2nd order models. Moreover, Scanning electron micrographs, ATR-FTIR spectra and the results of elemental analysis also supported the efficacy of SBT as an efficient bio-sorbent for the elimination of NB from water.

Cervical cancer screening and vaccination acceptability and attitudes among Arab American women in Southeastern Michigan: a qualitative study.

Among Arab-American women in Michigan, rates of cervical cancer screening are lower than those in non-Hispanic White and Black women in the state. A deep understanding of the Arab community's perspective on cervical cancer screening is needed to address the disparity in rates across populations in Michigan. Arab and Chaldean women across Michigan were invited to participate in Zoom-based focus groups to understand the attitudes, acceptability, and barriers of cervical cancer screening among this population. Four focus groups with a total of 19 women aged 30 to 61 were conducted. The focus groups were conducted in English, Arabic, or both languages. The guided discussion was focused on knowledge of cervical cancer and Human papillomavirus (HPV) and its transmission, attitudes towards HPV vaccination, and attitudes towards cervical cancer screening. HPV self-sampling as an alternative to traditional provider-based screening was specifically discussed as this has been proposed as a way to increase screening in hard-to-reach populations. The conversations revealed insights related to barriers at the individual and community levels for screening and vaccination, attitudes towards preventive health care including screening, a need for accessible women's health literature, and health education. The women also discussed vaccine hesitancy related to HPV and COVID-19, suggesting a need for targeted community interventions.

Fear of Deportation and Associations with Mental Health Among Michigan Residents of Middle Eastern & North African Descent.

Anti-immigrant rhetoric and immigration policy enforcement in the United States over the last 2 decades has increased attention to fear of deportation as a determinant of poor health. We describe its association with mental health outcomes among Middle East and North African (MENA) residents of Michigan. Using a convenience sample of MENA residents in Michigan (n = 397), we conducted bivariate and multiple variable regression to describe the prevalence of deportation worry and examine the relationship between deportation worry and depressive symptoms (PHQ-4 scores). We found that 33% of our sample worried a loved one will be deported. Deportation worry was associated with worse mental health (p < 0.01). Immigration policies are health policies and deportation worry impacts mental and behavioral health.

Risk and Protective Factors for Cost-Related Nonadherence Among Middle East and North African (MENA) Adults.

OBJECTIVE: Cost-related nonadherence to health maintenance behaviors is common in the general population, yet we know little about these behaviors in Middle East and North African (MENA) Americans. We examined cost-related nonadherence (CRN) in the MENA community in SE Michigan to determine demographic predictors, and risk and protective factors. DESIGN SETTING AND PARTICIPANTS: We used data from a cross-sectional convenience sample of MENA adults (N=398) conducted May-September 2019 to identify relevant demographic predictors, as well as the association between individual health, social, and clinical factors and the likelihood of reporting CRN. METHODS AND MEASURES: CRN was defined by whether respondents reported any of the following: that they took less medicine, skipped doses, or delayed getting a prescription filled. Other factors included patient/provider communication and racial concordance, mental health distress, food insecurity and insurance status. We used multivariable logistic regression models to determine association of these health and social factors with CRN. RESULTS: Those with highest incomes were least likely to report CRN. Participants with private insurance and with no coverage were more likely to report CRN compared with those with Medicaid coverage. Risk factors for CRN included food insecurity and mental health distress, though strong patient/provider communication was protective of CRN. DISCUSSION: The risk factors for CRN in the MENA community align with risk factors in the general population. As provider communication is protective of CRN, interventions focused on improving patient/provider communication may serve as a way to protect against financially motivated medication nonadherence.

HPV vaccination initiation among white, black and Middle East North African (MENA) males.

Objectives: US males initiate HPV vaccination at older ages than females and currently have low population coverage. We aim to describe the prevalence and predictors of HPV vaccination initiation among males of White, Black, and Middle-Eastern/North-African (MENA) descent in southeast Michigan. Methods: We conducted three community-based surveys in 2019 that provided primary data via self report. Using population weights and multivariate modeling, we measured the prevalence and predictors of HPV vaccine initiation in each race/ethnicity of men (age 18-34 years) analyzed. Results: The vaccine initiation rates were 44.5 % (95 % CI: 44.4, 44.6) for White men, 46.2 % (46.0, 46.4) for Black men, and 23.2 % (22.8, 23.6) for MENA men, (p < 0.001). Being a student, compared to unemployed or disabled, was significantly associated with HPV vaccine initiation across all three races/ethnicities. Married men of any race/ethnicity were unlikely to be vaccinated. MENA men born in the US and having some college education were also more likely to initiate HPV vaccination. Conclusions: White, Black, and MENA men are not vaccinated in accord with Healthy (Healthy People 2030, 2022) goals. Each race/ethnicity has different predictors of vaccination.

Concordant physician-patient characteristics lose importance for Arab American women and their healthcare- cross-sectional study.

Background: Arab American women have preferred women physicians of their own culture in the past. The primary aim of this study is to determine the current influence of religion/culture among MENA women and their preferences for physicians of same sex, culture, and religion on the avoidance and uncomfortableness of routine and women's health exams. Methods: A cross sectional community survey including religiosity and the importance of physician matched sex, culture, and religion was completed. Outcome measures were avoidance of a routine physical exam, or a women's health exam because of religious/cultural issues; and the uncomfortableness of the women's health exam. Linear regression modeling was used to evaluate the association between outcomes and potential predictors, with significance assessed using a bootstrap method. Findings: The responses of 97 MENA women 30-65 years old showed that MENA women agreed that they would avoid routine health exams because of religious/cultural issues if their physician was of the same religion or culture as they were (p < 0.001, p < 0.05, respectively) or they had less education (p < 0.05). MENA women also avoided women's health exams due to religious/cultural issues if her physician was of the same religion as she (p < 0.01). Interpretation: MENA women 30-65 years old may no longer be bound to a female physician of their same religion/culture for their health exams.

A Qualitative Study of Arab-American Perspectives on Intimate Partner Violence in Dearborn, Michigan.

Few studies explore how intimate partner violence (IPV) affects Arab Americans. Through focus groups with stakeholders from an Arab-centered health organization and semistructured interviews with Arab-American female clients (18-65 years), we explore how IPV affects Arab-American women and factors that impede and facilitate their access to support services. We find that IPV is a critical concern among Arab Americans and that generational status, educational attainment, and support from family, friends, or religious leaders were perceived to influence access to IPV support services. This study has implications for developing culturally sensitive IPV interventions for Arab-American women.

A Snapshot of Social Risk Factors and Associations with Health Outcomes in a Community Sample of Middle Eastern and North African (MENA) People in the U.S.

Social factors (e.g. housing, food security, etc.) contribute significantly to health. The purpose of this study is to describe social risk and social exclusion factors in one of the largest Middle Eastern and North African (MENA) populations in the U.S. and their association with health outcomes. We conducted a cross-sectional study with a community convenience sample of 412 adults who self-identify as MENA. Weighted, adjusted linear regression models were used to examine relationships of interest. Prevalent social risks included transportation barriers to healthcare (33%), food insecurity (33%), and financial strain (25%). In adjusted models, perception of being treated unfairly (Estimate (SE) 0.08 (0.04), p < 0.05) and fear of deportation (0.26 (0.06), p < 0.001) were associated with more social risk factors. More social risk factors were associated with worse self-reported health (0.09 (0.03), p < 0.01), more chronic conditions (0.11 (0.03), p < 0.004), and more mental health symptoms (0.34 (0.14) p < 0.01).Social risk is high among those perceiving unfairness and fear deportation. Those with more social risk factors reported worse health. These findings have implications for social needs screening and referral models that can best serve U.S. MENA sub-populations.

Ligneous conjunctivitis exacerbated by Pseudomonas aeruginosa - Diagnostic and therapeutic approach.

Ligneous conjunctivitis is a rare disease in which pseudomembranes develop on the mucosal surfaces of the eye. Only a handful of cases have been reported in the past 100 years. Although plasminogen deficiency is largely implicated in the pathogenesis of this condition, infectious agents are also thought to play a role in worsening the disease. Treatment is usually challenging. We present a case of 3-year-old female in whom a multidrug-resistant Pseudomonas aeruginosa was isolated from the culture of the pseudomembranes. To the best of our knowledge, this is the first time P. aeruginosa has been implicated as an exacerbation factor. Furthermore, we have given merit to the triple regimen of corticosteroids, heparin, and cyclosporine as being effective. We also added antibiotics to target the infectious organism.

Cancer risk perception and physician communication behaviors on cervical cancer and colorectal cancer screening.

Background: Women 50-65 years of age have the lowest cervical and colorectal cancer (CRC) screening rates among ages recommended for screening. The primary aim of this work is to determine how cancer risk perceptions and provider communication behaviors, in addition to known demographic factors, influence the uptake of both cervical and CRC screening or a single screen among women in southeast Michigan. Methods: Fourteen health services and communication behavior questions were adapted from the Health Information National Trends Survey (HINTS) and administered to a multiethnic sample of adults in southeast Michigan. The outcome variable was self-reported up-to-date cervical cancer and/or CRC screening as defined by the United States Preventive Services Task Force (USPSTF). Demographic and cancer risk/communication behavior responses of the four screening populations (both tests, one test, no tests) were analyzed with multinomial regression for all comparisons. Results: Of the 394 respondents, 54% were up to date for both cervical and CRC screening, 21% were up to date with only cervical cancer screening and 12% were up to date for only CRC screening. Of the 14 risk perception and communication behavior questions, only 'Did your primary care physician (PCP) involve you in the decisions about your health care as much as you wanted?' was significantly associated with women having both screens compared to only cervical cancer screening (aOR 1.67; 95% CI: 1.08, 2.57). The multivariate model showed age, and Middle East and North African (MENA) ethnicity and Black race, in addition to PCP-patient dyad decision-making to be associated with the cancer screenings women completed. Conclusions: Optimizing PCP-patient decision-making in health care may increase opportunities for both cervical cancer and CRC screening either in the office or by self-sampling. Understanding the effects of age and the different interventional strategies needed for MENA women compared to Black women will inform future intervention trials aimed to increase both cancer screenings. Funding: This work was supported by NIH through the Michigan Institute for Clinical and Health Research UL1TR002240 and by NCI through The University of Michigan Rogel Cancer Center P30CA046592-29-S4 grants.

Lab-scale continuous flow studies for comparative biosorption of cadmium (II) on untreated and xanthated Ficus religiosa biomass.

The present studies report the use of an ecofriendly biomass Ficus religiosa in untreated (UFR) and xanthate treated (XFR) forms for the Cd (II) ions removal in a fixed bed column. FTIR, SEM-EDS, BET surface area, and elemental analysis (CHNS) techniques were used to characterize the biosorbents. The acquired data supported FTIR findings regarding the nature of functional groups present in the materials. Packed bed continuous flow studies explored the effects of various parameters such as Cd (II) ion concentration (100 mg/L-300 mg/L), bed heights (5 cm-30 cm), pH (3-5), at a constant linear flow rate (~1.13 cm/min). The obtained S-shaped breakthrough curves indicated the efficiency of the packed bed for the Cd (II) removal. Breakthrough time and exhaust times increased (67.5 min-390 min and 292.5 min-1852.5 min) (97.5 min-442.5 min and 345 min-1920 min) for unmodified and modified respectively with bed heights. The BDST, Thomas, and Yoon-Nelson models were used to evaluate the experimental results. The Yoon-Nelson model describes the breakthrough data more efficiently compared to other models. Under similar conditions, the modified material exhibited 400% increased capacity (55.20 mg/g) than that of unmodified material (13.33 mg/g). Thus, xanthate modification significantly enhanced the capacity for Cd (II) ions from aqueous solutions. PRACTITIONER POINTS: Xanthate modification of Ficus religiosa is an environmentally friendly process. Modified and unmodified materials were utilized for Cd (II) removal in fixed bed column process which is industrially viable process. Low inlet Cd (II) concentration at pH 5 and higher bed height favored the continuous flow process at fixed flow rate. Modification caused an increase of about 400% in the capacity of material.

Effect of substrate ratios on the simultaneous carbon, nitrogen, sulfur and phosphorous conversions in microbial fuel cells.

The columbic efficiency, removal efficiency and voltage production of seven different combinations of carbon (acetic acid, albumin and sucrose) with nutrients (C:N, C:P, C:S, C:N:S, C:P:S, C:N:P and C: N:S:P) were investigated at three different ratios (20:1, 15:1 and 10:1). The effects of various pH values were also explored for these combinations of carbon, and sulfur compounds (pH 6-8). The highest columbic efficiency (75.8%), COD removal efficiency (86%) and voltage (667 mV) were recorded when the acetic acid was used in the MFC and the lowest columbic efficiency (12.8%), removal efficiency (37.6%) and voltage (145 mV) were observed in case of albumin. A marked increase in columbic efficiency, removal efficiency and voltage production were seen with the rise in the pH value from 6 to 8. The lowest columbic efficiency, removal efficiency and voltage production were seen at pH 6 and highest at pH 8. At each investigated pH, the highest removal efficiency, columbic efficiency, and voltage were found at substrate ratio of 20:1 while lower at 10:1. At all pH values, the carbon to nutrient ratios seemed to have followed a similar trend i.e., the COD removal efficiency, columbic efficiency and voltage generation was found in the order C:N > C:N:S > C:N:S:P > C:N:P > C:S > C:P:S > C:P. In all cases, nitrogen showed a higher removal as compared to phosphorous and sulfur.

Building Youth Capacity to Address Environmental Health and Justice Concerns in Dearborn, Michigan.

BACKGROUND: Environmental Health Research-to-Action (EHRA) is a community-academic partnership focused on building skills and intergenerational knowledge in environmental health, community science, and policy advocacy to address cumulative exposures in Dearborn, Michigan and nearby communities, primarily through a youth academy. OBJECTIVES: This article outlines our EHRA Youth Academy curriculum with sample recruitment materials, and we describe its beginnings, steering committee (SC), learning objectives, design, implementation, and recommendations from ongoing program evaluation and reflections of the SC. METHODS: In 2018 and 2019, we piloted the EHRA Academy with a total of forty-five fellows (16-18 years old), primarily Arab youth living in or near frontline communities. Fellows participated in a 2-week academy of interactive sessions, including a tour of local industry, participatory mapping, practice using handheld monitors to measure air pollution, and a policy advocacy 101 training. Applying lessons in accessing secondary data and environmental health literacy, fellows then created scientifically-informed materials including infographics and oral presentations for varied audiences. They completed a pre-survey, brief daily surveys, and a post-survey, and reported increased likelihood of advocacy behaviors and knowledge related to all content areas. CONCLUSIONS: In Southeast Dearborn, Michigan, threats to environmental health are constant, and intergenerational community mobilization remains necessary to reduce their adverse effects. Grounded in the principles of community-based participatory research (CBPR) and using high-impact active learning strategies, the EHRA Academy may provide one effective model for centering youth to build community capacity towards environmental justice (EJ).

The Association of Unfairness with Mental and Physical Health in a Multiethnic Sample of Adults: Cross-sectional Study.

BACKGROUND: Two psychosocial constructs that have shown consistent associations with negative health outcomes are discrimination and perceived unfairness. OBJECTIVE: The current analyses report the effects of discrimination and unfairness on medical, psychological, and behavioral outcomes from a recent cross-sectional survey conducted in a multiethnic sample of adults in Michigan. METHODS: A cross-section survey was collected using multiple approaches: community settings, telephone-listed sample, and online panel. Unfairness was assessed with a single-item previously used in the Whitehall study, and everyday discrimination was assessed with the Williams 9-item scale. Outcomes included mental health symptoms, past-month cigarette use, past-month alcohol use, past-month marijuana use, lifetime pain medication use, and self-reported medical history. RESULTS: A total of 2238 usable surveys were collected. In bivariate analyses, higher unfairness values were significantly associated with lower educational attainment, lower age, lower household income, and being unmarried. The highest unfairness values were observed for African American and multiracial respondents followed by Middle Eastern or North African participants. Unfairness was significantly related to worse mental health functioning, net adjustment for sociodemographic variables, and everyday discrimination. Unfairness was also related to self-reported history of depression and high blood pressure although, after including everyday discrimination in the model, only the association with depression remained significant. Unfairness was significantly related to 30-day marijuana use, 30-day cigarette use, and lifetime opiate use. CONCLUSIONS: Our findings of a generally harmful effect of perceived unfairness on health are consistent with prior studies. Perceived unfairness may be one of the psychological pathways through which discrimination negatively impacts health. Future studies examining the relationships we observed using longitudinal data and including more objective measures of behavior and health status are needed to confirm and extend our findings.

Development of an Ethnic Identity Measure for Americans of Middle Eastern and North African Descent: Initial Psychometric Properties, Sociodemographic, and Health Correlates.

BACKGROUND: Southeast Michigan is home to the second largest Middle Eastern and North African (MENA) US population. There is increasing interest in understanding correlates of psychosocial outcomes and health behaviors in this growing population. One potentially important health correlate is ethnic identity (EI). This paper reports the development, validity, and initial correlates of a new measure of MENA identity named the MENA-IM. METHODS: We used convenience sampling at locations frequented by individuals of MENA descent in southeast Michigan. We also measured EI centrality, religiosity, cultural mistrust, substance use, and health status to assess convergent and divergent validity. Exloratory and Confirmatory Factor Analysis identified three subscales, which were valid for both Arab and Chaldean respondents and were named (1) MENA cultural affiliation, (2) MENA media use, and (3) multicultural affiliation. We also created and tested a 20-item, single-factor version. RESULTS: We obtained data from 378 adults, 73% of whom identified as Arab and 27% as Chaldean. MENA-IM scores were higher among older, lower-educated, lower-income, non-US born, and Arabic-speaking respondents. Arab respondents reported significantly higher scores than Chaldeans. MENA-IM scores were positively associated with EI centrality and religiosity. Higher MENA-IM scores were found among those not reporting use of marijuana, alcohol, and opiates. Higher MENA-IM scores were also found among those without a self-reported history of heart disease and among those with better mental health status. DISCUSSION: The MENA-IM has strong psychometric properties and demonstrated initial evidence of convergent and discriminant validity. In general, values on the measure were associated with better psychosocial and health status. How the measure performs with MENA populations outside of Michigan and how it may relate to other health outcomes merit investigation.

Factors Associated With Racial/Ethnic Group-Based Medical Mistrust and Perspectives on COVID-19 Vaccine Trial Participation and Vaccine Uptake in the US.

Importance: The impact of COVID-19 in the US has been far-reaching and devastating, especially in Black populations. Vaccination is a critical part of controlling community spread, but vaccine acceptance has varied, with some research reporting that Black individuals in the US are less willing to be vaccinated than other racial/ethnic groups. Medical mistrust informed by experiences of racism may be associated with this lower willingness. Objective: To examine the association between race/ethnicity and rejection of COVID-19 vaccine trial participation and vaccine uptake and to investigate whether racial/ethnic group-based medical mistrust is a potential mediator of this association. Design, Setting, and Participants: This cross-sectional survey study was conducted from June to December 2020 using a convenience sample of 1835 adults aged 18 years or older residing in Michigan. Participants were recruited through community-based organizations and hospital-academic networks. Main Outcomes and Measures: Separate items assessed whether respondents, if asked, would agree to participate in a research study to test a COVID-19 vaccine or to receive a COVID-19 vaccine. Participants also completed the suspicion subscale of the Group-Based Medical Mistrust Scale. Results: Of the 1835 participants, 1455 (79%) were women, 361 (20%) men, and 19 (1%) other gender. The mean (SD) age was 49.4 (17.9) years, and 394 participants (21%) identified as Black individuals. Overall, 1376 participants (75%) reported low willingness to participate in vaccine trials, and 945 (52%) reported low willingness to be vaccinated. Black participants reported the highest medical mistrust scores (mean [SD], 2.35 [0.96]) compared with other racial/ethnic groups (mean [SD] for the total sample, 1.83 [0.91]). Analysis of path models revealed significantly greater vaccine trial and vaccine uptake rejection among Black participants (vaccine trial: B [SE], 0.51 [0.08]; vaccine uptake: B [SE], 0.51 [0.08]; both P < .001) compared with the overall mean rejection. The association was partially mediated by medical mistrust among Black participants (vaccine trial: B [SE], 0.04 [0.01]; P = .003; vaccine uptake: B [SE], 0.07 [0.02]; P < .001) and White participants (vaccine trial: B [SE], -0.06 [0.02]; P = .001; vaccine uptake: B [SE], -0.10 [0.02]; P < .001). Conclusions and Relevance: In this survey study of US adults, racial/ethnic group-based medical mistrust partially mediated the association between individuals identifying as Black and low rates of acceptance of COVID-19 vaccine trial participation and actual vaccination. The findings suggest that partnerships between health care and other sectors to build trust and promote vaccination may benefit from socially and culturally responsive strategies that acknowledge and address racial/ethnic health care disparities and historical and contemporary experiences of racism.

Mu-Beta event-related (de)synchronization and EEG classification of left-right foot dorsiflexion kinaesthetic motor imagery for BCI.

The left and right foot representation area is located within the interhemispheric fissure of the sensorimotor cortex and share spatial proximity. This makes it difficult to visualize the cortical lateralization of event-related (de)synchronization (ERD/ERS) during left and right foot motor imageries. The aim of this study is to investigate the possibility of using ERD/ERS in the mu, low beta, and high beta bandwidth, during left and right foot dorsiflexion kinaesthetic motor imageries (KMI), as unilateral control commands for a brain-computer interface (BCI). EEG was recorded from nine healthy participants during cue-based left-right foot dorsiflexion KMI tasks. The features were analysed for common average and bipolar references. With each reference, mu and beta band-power features were analysed using time-frequency (TF) maps, scalp topographies, and average time course for ERD/ERS. The cortical lateralization of ERD/ERS, during left and right foot KMI, was confirmed. Statistically significant features were classified using LDA, SVM, and KNN model, and evaluated using the area under ROC curves. An increase in high beta power following the end of KMI for both tasks was recorded, from right and left hemispheres, respectively, at the vertex. The single trial analysis and classification models resulted in high discrimination accuracies, i.e. maximum 83.4% for beta ERS, 79.1% for beta ERD, and 74.0% for mu ERD. With each model the features performed above the statistical chance level of 2-class discrimination for a BCI. Our findings indicate these features can evoke left-right differences in single EEG trials. This suggests that any BCI employing unilateral foot KMI can attain classification accuracy suitable for practical implementation. Given results stipulate the novel utilization of mu and beta as independent control features for discrimination of bilateral foot KMI in a BCI.