Ending "domestic helicopter research".

"Helicopter research" refers to a practice where researchers from wealthier countries conduct studies in lower-income countries with little involvement of local researchers or community members. This practice also occurs domestically. In this Commentary, we outline strategies to curb domestic helicopter research and to foster equity-centered collaborations.

Social and Demographic Influences of Trust in Cancer Information Among Brooklyn, New York Residents.

Little is known regarding the patterns of trust sources for cancer information among diverse populations in the US, which is particularly poignant during the current era of misinformation. Our objective to assess trust from different sources among a sample of Brooklyn, New York residents. Using data from the NCI funded Brooklyn Cancer Health Impact Program, we examined HINTS validated questions examining trust in cancer information across 9 sources. Logistic regression models were used to examine associations with cancer information trust sources. For trust in government health agencies, participants who had less than a college degree were almost 30% less likely to report high levels of trust (aOR: 0.71; 95% CI: 0.52-0.98), participants who reported a household income under $50,000 were 35% less likely report high levels of trust (aOR: 0.65; 95% CI: 0.47-0.89). Participants whose primary language was Spanish were significantly less likely to trust government (aOR: 0.45; 95% CI: 0.29-0.70), newspapers and magazines (aOR: 0.54; 95% CI, 0.34-0.84), and charitable organizations (aOR: 0.48; 95% CI, 0.31-0.75) compared to participants whose primary was English. New York is the most populous city in the US, a city of immigrants, and it is important for healthcare and public health professionals to explore how they can utilize media to provide accurate scientific evidence to combat cancer misinformation.

The Influence of the COVID 19 Pandemic on Food Insecurity Among Cancer Survivors Across New York State.

People surviving cancer represent a particularly vulnerable population who are at a higher risk for food insecurity (FI) due to the adverse short- and long-term effects of cancer treatment. This analysis examines the influence of the COVID-19 pandemic on the prevalence of FI among cancer survivors across New York State (NYS). Data from the 2019 and 2021 NYS Behavioral Risk Factor Surveillance System (BRFSS) were used to estimate the prevalence of FI. Multivariable logistic regression was used to explore socioeconomic determinants of FI. Among cancer survivors, FI varied geographically with a higher prevalence in New York City compared to the rest of the state (ROS) prior to (25.3% vs. 13.8%; p = .0025) and during the pandemic (27.35% vs. 18.52%; p = 0.0206). In the adjusted logistic regression model, pre-pandemic FI was associated with non-White race (OR 2.30 [CI 1.16-4.56]), household income <$15,000 (OR 22.67 [CI 6.39-80.43]) or $15,000 to less than <$25,000 (OR 22.99 [CI 6.85-77.12]), and more co-morbidities (OR 1.39 [CI 1.09-1.77]). During the pandemic, the association of FI with non-White race (OR 1.76 [CI 0.98-3.16]) was attenuated but remained significant for low household income and more co-morbidities. FI was newly associated with being out of work for less than one year (OR 6.36 [CI 1.80-22.54] and having one (OR 4.42 [CI 1.77-11.07]) or two or more children in the household (OR 4.54 [CI 1.78-11.63]). Our findings highlight geographic inequities and key determinants of FI among cancer survivors that are amendable to correction by public health and social policies, for which several were momentarily implemented during the pandemic.

Understanding cognitive and emotional illness representations of South Asian head and neck cancer survivors: a qualitative study.

OBJECTIVES: Head and neck cancer (HNC) constitutes a substantial portion of the cancer burden worldwide, with over 550,000 new cases and over 300,000 deaths annually, with disproportionately high mortality rates in the developing countries. The large majority of HNCs are caused by tobacco use, and synergistic effects of tobacco and alcohol use. Using the Common-Sense Model (CSM) as a framework, this qualitative study sought to understand South Asian HNC survivors' cognitive and emotional representations of their cancer; and to assess if these representations differ by smokeless tobacco (SLT) vs. smoked tobacco use. DESIGN: In-depth semi-structured interviews, conducted with South Asian HNC survivors (N = 15, 80% participants were immigrants, while 20% came to the United States for treatment) to identify key themes and issues related to HNC experience and SLT vs. smoked tobacco use. RESULTS: The results of the study provide a deeper understanding of South Asian HNC survivor experiences with receiving a HNC diagnosis, delays in seeking treatment and related medical care, disagreement regarding smoked tobacco/SLT history as potential causes of cancer, strategies to cure the cancer or prevent recurrence, enduring physical and psycho-social consequences of treatment, and emotional impact of the cancer experience. Three key implications emerged: (a) the utility of narratives as a method of eliciting HNC survivor experience to understand patient experiences and concerns; (b) the potential for public health practitioners to harness patients' voices and the power of storytelling for developing campaigns about public awareness of SLT use, providing information and support to SLT users, and encouraging SLT quitting resources; and (c) the importance of providing clear, personalized and culturally sensitive education regarding the risks of SLT use. CONCLUSIONS: This study underscores the significance of offering tailored tobacco cessation services to South Asian HNC survivors, and to help inform supportive models of care for others.

Disparities in Awareness of Hepatitis C Virus Among US Adults: An Analysis of the 2019 Health Information National Trends Survey.

BACKGROUND: The U.S. Preventive Services Task Force updated hepatitis C virus (HCV) screening 2020 guidelines to target adults aged 18 to 79 years: a major shift from the prior focus on high-risk populations ("baby boomers" aged ≥55 years as of 2019). To inform efforts to maximize HCV screening coverage, our objective was to identify demographic groups reporting a lack of HCV awareness, particularly by race/ethnicity and age, and sources of health information. METHODS: We used nationally representative data of adults (≥18 years) included in the 2019 Health Information National Trends Survey (n = 5438). Awareness of HCV was defined using the following question: "Have you ever heard of the hepatitis C virus (also known as Hep C or HCV)?" We estimated frequencies by demographic groups and computed risk differences (RDs) with 95% confidence intervals (CIs) to compare lack of HCV awareness by age (<55 and ≥55 years) and race/ethnicity. RESULTS: Overall, 17% of adults never heard of HCV. Younger adults (<55 years; 21%) were more likely to have never heard of HCV compared with older adults (≥55 years; 12%; χ2P < 0.001). This observation was consistent across most demographic characteristics including, racial/ethnic categories, and residing in the Southern United States. More than one-third of adults with low English fluency had a lack of HCV awareness in both age groups (χ2P = 0.537). Non-Hispanic (NH) Asian (RD, 25%; 95% CI, 6.9%-43.3%) and Hispanic (RD, 10%; 95% CI, 0.01%-19.6%) adults younger than 55 years were significantly more likely to have never heard of HCV compared with their NH White counterparts after adjustment for sex, educational level, household income, English fluency, and having a regular provider. Adults younger than 55 years with a lack of HCV awareness commonly obtained their health information from the Internet across most sociodemographic characteristics. CONCLUSIONS: Hispanic and NH Asian young adults should be targeted for public health messaging regarding HCV screening, potentially through social media campaigns.

Thinking with two brains: Student perspectives on the presentation of race in pre-clinical medical education.

CONTEXT: There is growing concern that during their education medical students come to believe that 'race' is a biological construct and that differential treatment of patients based on 'race' is clinically beneficial. How 'race' is presented to medical students may influence both their implicit biases and future clinical practices, potentially widening racial disparities in care. METHODS: We conducted in-depth interviews with twenty-two pre-clinical mostly non-White medical students attending a public medical school in a major metropolitan area in the northeastern United States. Interview content focused on how medical students experience the presentation of race in medical education, use race in their learning experiences, and envision using race as physicians in future clinical encounters. Transcripts were analysed using the framework method and emergent themes were identified. RESULTS: Participants described being most aware of the presentation of race in board-style questions and least aware of the presentation of race during lectures. They described being aware of race in problem-based learning (PBL) modules if the case revolved around a likely race-disease association. They identified imprecision in how race was presented during lectures and insufficient explanations of causes of racial disparities in health. Participants described feeling ill-prepared to obtain racial self-identification and receiving mixed messages around the utility of race in diagnosing a patient. Participants reported experiences of cognitive dissonance around the presentation of race in board-style questions and lectures. CONCLUSIONS: Critical evaluation of the presentation of and instruction around 'race' is needed to address whether it is presented as a biological vs. social construct, the level of precision of racial categorisation in curricular content, and the causes of and mechanisms behind race-disease associations. This has the potential to minimise false beliefs about race as a biological construct and the resultant negative impacts on clinical care. Future research could evaluate whether problem-based or experiential (OSCE) learning, in contrast to board-style questions and didactic lectures, are the most effective way to educate students around race in health and illness. Additionally, future research can investigate if the mission (ie social) and composition (Predominantly White Institution or Historically Black College/University) of the faculty impacts student experiences of the presentation of race.

Relationship between area mortgage foreclosures, homeownership, and cardiovascular disease risk factors: The Hispanic Community Health Study/Study of Latinos.

BACKGROUND: The risk of mortgage foreclosure disproportionately burdens Hispanic/Latino populations perpetuating racial disparities in health. In this study, we examined the relationship between area-level mortgage foreclosure risk, homeownership, and the prevalence of cardiovascular disease risk factors among participants of the Hispanic Community Health Study/Study of Latinos (HCHS/SOL). METHODS: HCHS/SOL participants were age 18-74 years when recruited from four U.S. metropolitan areas. Mortgage foreclosure risk was obtained from the U.S. Department of Housing and Urban Development. Homeownership, sociodemographic factors, and cardiovascular disease risk factors were measured at baseline interview between 2008 and 2011. There were 13,856 individuals contributing to the analysis (median age 39 years old, 53% female). RESULTS: Renters in high foreclosure risk areas had a higher prevalence of hypertension and hypercholesterolemia but no association with smoking status compared to renters in low foreclosure risk areas. Renters were more likely to smoke cigarettes than homeowners. CONCLUSION: Among US Hispanic/Latinos in urban cities, area foreclosure and homeownership have implications for risk of cardiovascular disease.

New onset of asthma and job status change among world trade center responders and workers.

BACKGROUND: Despite the high rates, the consequences of new onset asthma among the World Trade Center (WTC) responders in terms of the change in job status have not been studied. METHODS: This study consists of a cohort of 8132 WTC responders out of the total 25 787 responders who held a full-time job at the baseline visit, and participated in at least one follow-up visit. RESULTS: Overall, 34% of the study cohort changed their job status from full-time at a follow-up visit. Multivariable models showed that asthmatics were respectively 27% and 47% more likely to have any job status change and get retired, and twice as likely to become disabled as compared to non-asthmatics. CONCLUSIONS: With asthma incidence from WTC exposure, negative job status change should be considered as a potential long-term consequence of WTC exposure.

Racial disparities in esophageal cancer survival after surgery.

OBJECTIVES: Esophageal cancer (EC) black patients have higher mortality rates than Whites. The lower rate of surgery in Blacks may explain the survival difference. We explored the Surveillance Epidemiology and End Results database to determine the impact of surgery on mortality in Blacks and Whites EC. METHODS: All cases of pathologically proven local and locoregional adenocarcinoma and squamous cell carcinoma of the esophagus from 1973 to 2011 were identified (13,678 White, 2,894 Black patients). Cervical esophageal cancer was excluded. Age, sex, diagnosis year, stage, cancer-directed surgery, radiation, and vital status were analyzed according to self-reported race. RESULTS: Blacks had higher 1-year mortality, adjusted for age, sex, stage, year of diagnosis, histology, and therapy [adjusted hazard ratio (HRadj ): 1.24 (95% CI 1.16-1.32)]. Undergoing surgery was an independent predictor of improved survival overall (HRadj 0.30, 95% CI 0.27-0.33). Black patients treated surgically experienced significantly lower survival than Whites, but the difference was not observed in those who did not undergo surgery. CONCLUSIONS: Although surgery appears to reduce mortality overall, early survival is worse for Blacks. Investigation into racial disparities in health care access and delivery, and to skilled esophageal surgeons is warranted to improve survival for all patients, particularly Blacks. J. Surg. Oncol. 2016;113:659-664. © 2016 Wiley Periodicals, Inc.

Associations of neighborhood concentrated poverty, neighborhood racial/ethnic composition, and indoor allergen exposures: a cross-sectional analysis of los angeles households, 2006-2008.

Although racial/ethnic, socioeconomic, and neighborhood factors have been linked to asthma, and the association between indoor allergens and asthma is well documented, few studies have examined the relationship between these factors and indoor allergens. We examined the frequency of reported indoor allergens and differences by racial/ethnic, socioeconomic, and neighborhood characteristics among a diverse sample of Los Angeles households. Multilevel logistic regression models were used to analyze the data from 723 households from wave 2 of the Los Angeles Family and Neighborhood Survey. The reported presence of rats, mice, cockroaches, mold, pets, and tobacco smoke were the primary outcomes of interest. Hispanic and Asian households had a nearly threefold increase in the odds of reporting cockroaches compared to non-Hispanic Whites (OR, 2.85; 95 % CI 1.38-5.88 and OR, 2.62; 95 % CI 1.02-6.73, respectively) even after adjusting for socioeconomic factors. Primary caregivers who had obtained a high school degree were significantly less likely to report the presence of mice and cockroaches compared to primary caregivers with less than a high school degree (OR, 0.19; 95 % CI 0.08-0.46 and OR, 0.39; 95 % CI 0.23-0.68, respectively). Primary caregivers with more than a high school degree were also less likely to report the presence of rats, mice, and cockroaches within their households, compared to those with less than a high school degree. Compared to renters, home owners were less likely to report the presence of mice, cockroaches, and mold within their households. At the neighborhood level, households located within neighborhoods of high concentrated poverty (where the average poverty rate is at least 50 %) were more likely to report the presence of mice and cockroaches compared to households in low concentrated poverty neighborhoods (average poverty rate is 10 % or less), after adjusting for individual race/ethnicity and socioeconomic characteristics. Our study found evidence in support of neighborhood-level racial/ethnic and socioeconomic influences on indoor allergen exposure, above and beyond individual factors. Future studies should continue to explore individual and neighborhood-level racial/ethnic and socioeconomic differences in household allergen exposures across diverse contexts.

Heterogeneity of breast cancer clinical characteristics and outcome in US black women--effect of place of birth.

Breast cancer mortality in black women is disproportionately high; reasons for this phenomenon are still unclear. In addition to socioeconomic factors, the biology of the tumor may play a role. We analyzed 1,097 incident invasive breast cancer cases diagnosed between 2000 and 2010 in black US women from Long Island and Brooklyn. Thirty-five percent of women had an estrogen receptor (ER) negative tumor, 46% a progesterone receptor (PR) negative tumor. ER, PR negative tumors were diagnosed at an earlier age (55.8 versus 55.3 years), at a later stage (p = 0.06), were larger in size (p = 0.04), and more frequently treated with neo-adjuvant chemotherapy (p = 0.06) than ER, PR positive tumors. Determinants of shorter survival were: ER, PR negativity (HR: 2.2, 95% CI: 1.4-3.4), age, and stage at diagnosis (HR: 2.0; 95% CI: 1.5-2.7). ER, PR negative breast cancer born outside of the US experienced a significantly worse survival than ER, PR negative women who were born in the US. ER, PR negative tumors in black women born outside the US, mainly in the Caribbean, are biologically more aggressive than the same size and age-matched tumors in black women born in the US. Our study suggests that environmental exposures in the country of origin may impact on host cancer interactions and cancer outcome.

COVID-19-Associated Food Insecurity and Mental Health Symptoms Among Latinx Adults in the United States.

Introduction: U.S. Latinx adults were disproportionately burdened by COVID-19 infection, as well as food insecurity compared to their non- Hispanic white adults. It is less clear if within-group variations among U.S. Latinx adults exist in food insecurity and mental health outcomes. Methods: We conducted a secondary data analysis of repeated cross-sectional survey waves from the Understanding America Study (UAS) study (N = 182,865). We computed multivariable generalized linear regression models to examine associations between food insecurity, demographic characteristics, and depressive symptoms. Results: Participants with a history of food insecurity had a higher prevalence of depressive symptoms compared to those without a history of food insecurity (21.1% compared to 5.23%, p < .0001). Mexican participants reported a significantly higher prevalence of depression compared to Latino participants of Puerto Rican, Central American, or another Latino ethnicity (8.94% compared to 2.84%, 1.76%, and 2.91%, respectively, p < .0001). Associations of self-reported food insecurity among men and women varied by asthma status. Conclusions: Our study demonstrates that participants with a history of food insecurity had a higher prevalence of depressive symptoms compared to those without a history of food insecurity. Our findings also illuminate the importance of disaggregating U.S. Latinx adults when examining associations between food insecurity and mental health.

Racial and ethnic disparities in knowledge, attitudes, and invitation to participate in clinical trials among cancer survivors in the United States: An analysis of the 2020 U.S. HINTS.

Background: Despite the use of clinical trials to provide gold-standard evidence of cancer treatment and intervention effectiveness, racial/ethnic minorities are frequently underrepresented participants. Our objective was to evaluate racial/ethnic differences in knowledge and attitudes towards clinical trials among U.S. cancer survivors. Methods: We leveraged the 2020 Health Informational National Trends Survey (HINTS) data (February-June 2020), which is a weighted, nationally representative survey of 3865 adults (≥18 years), including cancer survivors. We descriptively evaluated cancer survivor's (n = 553) knowledge of clinical trials, and trusted sources of information regarding clinical trials. Using Poisson regression, we estimated predictors of self-reported knowledge of clinical trials. Results: Among cancer survivors, 82 % were NH-White and 60 % self-reported to at least have some knowledge about clinical trials. When asked about factors that would influence their decision to participate in clinical trials, participants across racial groups frequently chose "I would want to get better" and "If the standard care was not covered by my insurance." NH-White (76 %), NH-Black (78 %), and Hispanic/Latinx (77 %) cancer survivors reported their trusted source of information about clinical trials was their health care provider; NH-Asian cancer survivors reported their health care provider (51 %) as well as government health agencies (30 %) as trusted sources. Cancer survivors with only a high school degree were less likely to have any knowledge of clinical trials compared to those with a Baccalaureate degree or more (aPR:0.61;95 % CI:0.45-0.83). Conclusion: Health care providers are a trusted source of clinical trial information.

Racial and Ethnic Inequities in Cancer Care Continuity During the COVID-19 Pandemic Among Those With SARS-CoV-2.

Importance: Racially and ethnically minoritized US adults were disproportionately impacted by the COVID-19 pandemic and experience poorer cancer outcomes, including inequities in cancer treatment delivery. Objective: To evaluate racial and ethnic disparities in cancer treatment delays and discontinuations (TDDs) among patients with cancer and SARS-CoV-2 during different waves of the COVID-19 pandemic in the United States. Design, Setting, and Participants: This cross-sectional study used data from the American Society of Clinical Oncology Survey on COVID-19 in Oncology Registry (data collected from April 2020 to September 2022), including patients with cancer also diagnosed with SARS-CoV-2 during their care at 69 US practices. Racial and ethnic differences were examined during 5 different waves of the COVID-19 pandemic in the United States based on case surge (before July 2020, July to November 2020, December 2020 to March 2021, April 2021 to February 2022, and March to September 2022). Exposures: Race and ethnicity. Main Outcomes and Measures: TDD was defined as any cancer treatment postponed more than 2 weeks or cancelled with no plans to reschedule. To evaluate TDD associations with race and ethnicity, adjusted prevalence ratios (aPRs) were estimated using multivariable Poisson regression, accounting for nonindependence of patients within clinics, adjusting for age, sex, body mass index, comorbidities, cancer type, cancer extent, and SARS-CoV-2 severity (severe defined as death, hospitalization, intensive care unit admission, or mechanical ventilation). Results: A total of 4054 patients with cancer and SARS-CoV-2 were included (143 [3.5%] American Indian or Alaska Native, 176 [4.3%] Asian, 517 [12.8%] Black or African American, 469 [11.6%] Hispanic or Latinx, and 2747 [67.8%] White; 2403 [59.3%] female; 1419 [35.1%] aged 50-64 years; 1928 [47.7%] aged ≥65 years). The analysis focused on patients scheduled (at SARS-CoV-2 diagnosis) to receive drug-based therapy (3682 [90.8%]), radiation therapy (382 [9.4%]), surgery (218 [5.4%]), or transplant (30 [0.7%]), of whom 1853 (45.7%) experienced TDD. Throughout the pandemic, differences in racial and ethnic inequities based on case surge with overall TDD decreased over time. In multivariable analyses, non-Hispanic Black (third wave: aPR, 1.56; 95% CI, 1.31-1.85) and Hispanic or Latinx (third wave: aPR, 1.35; 95% CI, 1.13-1.62) patients with cancer were more likely to experience TDD compared with non-Hispanic White patients during the first year of the pandemic. By 2022, non-Hispanic Asian patients (aPR, 1.51; 95% CI, 1.08-2.12) were more likely to experience TDD compared with non-Hispanic White patients, and non-Hispanic American Indian or Alaska Native patients were less likely (aPR, 0.37; 95% CI, 0.16-0.89). Conclusions and Relevance: In this cross-sectional study of patients with cancer and SARS-CoV-2, racial and ethnic inequities existed in TDD throughout the pandemic; however, the disproportionate burden among racially and ethnically minoritized patients with cancer varied across SARS-CoV-2 waves. These inequities may lead to downstream adverse impacts on cancer mortality among minoritized adults in the United States.

Neighborhoods and Cardiovascular Health: A Scientific Statement From the American Heart Association.

The neighborhoods where individuals reside shape environmental exposures, access to resources, and opportunities. The inequitable distribution of resources and opportunities across neighborhoods perpetuates and exacerbates cardiovascular health inequities. Thus, interventions that address the neighborhood environment could reduce the inequitable burden of cardiovascular disease in disenfranchised populations. The objective of this scientific statement is to provide a roadmap illustrating how current knowledge regarding the effects of neighborhoods on cardiovascular disease can be used to develop and implement effective interventions to improve cardiovascular health at the population, health system, community, and individual levels. PubMed/Medline, CINAHL, Cochrane Library reviews, and ClinicalTrials.gov were used to identify observational studies and interventions examining or targeting neighborhood conditions in relation to cardiovascular health. The scientific statement summarizes how neighborhoods have been incorporated into the actions of health care systems, interventions in community settings, and policies and interventions that involve modifying the neighborhood environment. This scientific statement presents promising findings that can be expanded and implemented more broadly and identifies methodological challenges in designing studies to evaluate important neighborhood-related policies and interventions. Last, this scientific statement offers recommendations for areas that merit further research to promote a deeper understanding of the contributions of neighborhoods to cardiovascular health and health inequities and to stimulate the development of more effective interventions.

Demographic and Social Patterns of the Mean Values of Inflammatory Markers in U.S. Adults: A 2009-2016 NHANES Analysis.

Several studies have reported on the negative implications of elevated neutrophil-to-lymphocyte ratio (NLR) and elevated platelet-to-lymphocyte ratio (PLR) levels associated with outcomes in many surgical and medical conditions, including cancer. In order to use the inflammatory markers NLR and PLR as prognostic factors in disease, a normal value in disease-free individuals must be identified first. This study aims (1) to establish mean values of various inflammatory markers using a healthy and nationally representative U.S. adult population and (2) to explore heterogeneity in the mean values by sociodemographic and behavioral risk factors to better specify cutoff points accordingly. The National Health and Nutrition Examination Survey (NHANES) of aggregated cross-sectional data collected from 2009 to 2016 was analyzed; data extracted included markers of systemic inflammation and demographic variables. We excluded participants who were under 20 years old or had a history of an inflammatory disease such as arthritis or gout. Adjusted linear regression models were used to examine the associations between demographic/behavioral characteristics and neutrophil counts, platelet counts, lymphocyte counts, as well as NLR and PLR values. The national weighted average NLR value is 2.16 and the national weighted average PLR value is 121.31. The national weighted average PLR value for non-Hispanic Whites is 123.12 (121.13-125.11), for non-Hispanic Blacks it is 119.77 (117.49-122.06), for Hispanic people it is 116.33 (114.69-117.97), and for participants of other races it is 119.84 (116.88-122.81). Non-Hispanic Blacks and Blacks have significantly lower mean NLR values (1.78, 95% CI 1.74-1.83 and 2.10, 95% CI 2.04-2.16, respectively) as compared with that of non-Hispanic Whites (2.27, 95% CI 2.22-2.30, p < 0.0001). Subjects who reported a non-smoking history had significantly lower NLR values than subjects who reported any smoking history and higher PLR values than current smokers. This study provides preliminary data for demographic and behavioral effects on markers of inflammation, i.e., NLR and PLR, that have been associated with several chronic disease outcomes, suggesting that different cutoff points should be set according to social factors.

Experiences of race- and gender-based discrimination among Black female physicians.

INTRODUCTION: Recently, in the United States, there has been a strong effort to increase representation of members of social groups underrepresented in medicine (URiM). Experiences of discrimination among URiM group members, including women and people of color, have negative effects on their health and well-being and drive further underrepresentation. Here we report results of a qualitative research study designed to characterize Black female physicians' experiences of discrimination related to their identities both as women and people of color, in medical education and the practice of medicine. METHODS: A trained interviewer conducted semi-structured qualitative, in-depth interviews with twenty Black, cis-gender, female physicians working in various fields of medicine. Broadly framed within intersectionality theory and analyzed using a pragmatic analytic approach, all interviews were transcribed, read, coded, and analyzed identifying key emergent themes. RESULTS: Two broad and overlapping themes emerged: (1) experiencing and managing micro/macroaggressions and biases in the workplace; and (2) strategies to overcome experiences of intersectional discrimination. Each theme contained several subthemes, such as "presumed incompetence", "isolation and exclusion", "managing burdensome expectations", "building support systems", "speaking up", and "resilience". Participants described both intersectional and independent forms of discrimination and a range of sources of discrimination, including patients, peers, and colleagues, in their careers as trainees and professionals. Most described minimal and largely ineffective efforts to prevent or mitigate the impact of discrimination at any level of their educational and professional contexts. DISCUSSION: Black female physicians report experiencing damaging discrimination with few effective intervention efforts in tAheir medical training and workplaces. There is need for more research and evaluation of interventions to reduce discrimination at all levels of education and training.

Mental Health Symptoms during the COVID-19 Pandemic among Cancer Survivors Who Endorse Cannabis: Results from the COVID-19 Cannabis Health Study.

Our objective was to examine the prevalence of mental health symptoms and the behavioral impact of the COVID-19 pandemic on cancer survivors who endorse cannabis. Participants included 158 adults (≥18 years) who self-reported medicinal cannabis use and responded to our internet-based questionnaire (21 March 2020−24 March 2021). Data included 79 cancer survivors and 79 age-matched adults without a history of cancer. Descriptive statistics were used to compare demographics, the prevalence of generalized anxiety (GAD-7), depression (CES-D-10), and changes in behavior during the COVID-19 pandemic by cancer survivorship status. Overall, 60.8% and 48.1% of cancer survivors self-reported the use of cannabis to manage their anxiety and depression, respectively. Probable clinical depression (CES-D-10 score ≥ 10) and anxiety (GAD-7 score ≥ 10) were identified in 50.7% and 38.9% of cancer survivors, respectively. Cancer survivors were more likely to report that their anxiety symptoms made it very or extremely difficult to work, take care of home, or get along with others than their counterparts. Cancer survivors with anxiety and/or depression were more likely to fear giving COVID-19 to someone else (47.5% vs. 23.1%, p = 0.023) and to fear being diagnosed with COVID-19 (77.5% vs. 38.5%, p < 0.001) compared to cancer survivors without anxiety and depression symptoms. Further research is recommended to evaluate the use of cannabis as palliative care to improve mental health among cancer survivors.

Financial hardship and mental health among cancer survivors during the COVID-19 pandemic: An analysis of the US COVID-19 Household Impact Survey.

Purpose: Our objective was to (1) identify associated characteristics of financial hardship (FH), and (2) evaluate associations of FH with mental health symptoms among cancer survivors during the COVID-19 pandemic. Methods: Using data from the nationally representative COVID-19 Impact Survey, we defined cancer survivors as those with a self-reported diagnosis of cancer (n = 854,7.6%). We defined FH using the following question: "Based on your current financial situation, how would you pay for an unexpected $400 expense?" Multivariable Poisson regression was used to estimate adjusted prevalence ratios (aPR) with 95% confidence intervals (95%CI) to identify associated characteristics of FH and associations of FH with mental health symptoms among cancer survivors overall and by age (18-59 years/60+ years). Results: Forty-one percent of cancer survivors reported FH, with 58% in 18-59 and 33% in 60+ year old respondents. Compared to cancer survivors aged 60+ years, those aged 30-44 (aPR:1.74,95% CI:1.35-2.24), and 45-59 years (aPR:1.60,95% CI:1.27-1.99) were more likely to report FH. Compared to non-Hispanic(NH)-White cancer survivors, NH-Black cancer survivors had a 56% higher prevalence of FH (aPR:1.56; 95% CI: 1.23-1.97). Among 60+ years aged cancer survivors, NH-Black (aPR:1.80; 95% CI: 1.32-2.45) and NH-Asian cancer survivors (aPR:10.70,95% CI:5.6-20.7) were more likely to experience FH compared to their NH-White counterparts. FH was associated with feeling anxious (aPR:1.51,95% CI:1.11-2.05), depressed (aPR:1.66,95% CI:1.25-2.22), and hopeless (aPR:1.84,95% CI:1.38-2.44). Conclusion: Minoritized communities, younger adults, and cancer survivors with low socioeconomic status had a higher burden of FH, which was associated with feelings of anxiety, depression, and hopelessness.

Food Insecurity Disparities and Mental Health Impacts Among Cancer Survivors During the COVID-19 Pandemic.

Introduction: Food insecurity can negatively impact adherence and receipt of high-quality cancer care. The purpose of the study was to (1) compare the prevalence of COVID-19-associated food insecurity by cancer history and (2) examine determinants associated with COVID-19-related food insecurity among cancer survivors. Methods: We used nationally representative data from the 2020 COVID-19 Household Impact Survey (n=10,760). Our primary exposure was participants' self-report of a cancer diagnosis (n=854, 7.1%). Primary outcomes of food insecurity were categorized by the following questions: "We worried our food would run out before we got money to buy more" or "The food that we bought just didn't last, and we didn't have money to get more"; respondents were categorized as food insecure if they chose often true or sometimes true. Multivariable Poisson regression was used to identify demographic determinants of food insecurity among cancer survivors. Results: Thirty-two percent of cancer survivors were food insecure. Cancer survivors 30-44 years of age and those ≥60 years of age were more likely to report being food insecure compared to respondents without a history of cancer, respectively (30-44 years, 59.9% vs. 41.2% p=0.01, ≥60 years 27.2% vs. 20.2%, p=0.01). Cancer survivors without a high school diploma were more likely to report food insecurity compared to adults with no history of cancer (87.0% vs. 64.1%, p=0.001). In multivariable models, uninsured cancer survivors (adjusted prevalence ratio [aPR] aPR: 2.39, 95% CI: 1.46-3.92) and those on Medicaid (aPR: 2.10, 95% CI: 1.40-3.17) were also more likely to report being food insecure. Conclusion: Food insecurity during the COVID-19 pandemic is vast, but disparities persist. Among cancer survivors, differences in food insecurity were observed by age and socio economic status. Cancer survivors experiencing food insecurity more frequently reported mental health symptoms of depression, loneliness, and hopelessness compared to those who were food secure.