How Education Shapes Women's Work and Family Lives Across Race and Ethnicity.

Drawing on life course and intersectional approaches, this study examines how education shapes the intertwined domains of work and family across race and ethnicity. By applying multichannel sequence analysis and cluster analysis to the National Longitudinal Survey of Youth 1979, we identify a typology of life course trajectories of work and family and test for the interactive associations of race and ethnicity with college education for different trajectory types. While our results show statistically significant and often sizable education effects across racial and ethnic groups for most of the work‒family clusters, they also suggest that the size and direction of the education effect vary widely across groups. Educational attainment plays an outsize role in shaping Black women's work‒family lives, increasing their access to steady work and partnerships, while educational attainment primarily works to increase White women's participation in part-time work. In contrast, Latina women's work‒family trajectories are less responsive to their educational attainment. In combination, the racialized role of education and persistent racial and ethnic gaps across the education distribution yield unequal patterns in work‒family strategies among Black, Latina, and White women.

Trends in Racial, Ethnic, and Gender Diversity in Orthopedic Surgery Spine Fellowships From 2007 to 2021.

STUDY DESIGN: Descriptive. OBJECTIVE: The objective of this study is to analyze trends in racial, ethnic, and gender diversity in orthopedic spine surgery fellowship trainees. SUMMARY OF BACKGROUND DATA: Orthopedic surgery has consistently been labeled as one of the least diverse fields in Medicine. Although some effort has been made to combat this in recent years at the residency level, it is uncertain whether spine fellowships have had any changes in fellow demographics. MATERIALS AND METHODS: Fellowship demographic data were collected through the Accreditation Council for Graduate Medical Education. Data collected included gender (male, female, and not reported) and race (White, Asian, Black, Hispanic, Native Hawaiians, American Indian or Alaskan Native, other, and unknown). Percentage equivalents were calculated for each group from 2007 to 2008 to 2020 to 2021. A χ 2 test for trend (Cochran-Armitage test) was done to determine whether there was a significant change in percentages of each race and gender during the study period. The results were considered statistically significant at P <0.05. RESULTS: White, Non-Hispanic males represent the largest proportion of orthopedic spine fellowship positions each year. From 2007 to 2021, there were no significant changes in the representation of any race or gender of orthopedic spine fellows. Males ranged from 81% to 95%, Whites from 28% to 66%, Asians from 9% to 28%, Blacks from 3% to 16%, and Hispanics from 0% to 10%. Native Hawaiians and American Indians remained at 0% for all years included in the study. Females and all races, excluding Whites, continue to be under-represented in orthopedic spine fellowship. CONCLUSIONS: Orthopedic spine surgery fellowship programs have not made substantial progress in diversifying its population. More attention is needed to increase diversity in residency programs through pipeline programs, increased mentorship and sponsorship, and early exposure to the field. LEVEL OF EVIDENCE: 1.

Racial/Ethnic and Gender Disparities Over the Last Decade Within Microsurgery and Craniofacial Fellowship Training.

BACKGROUND: Racial/ethnic and gender disparities persist in plastic surgery at nearly all levels of training, becoming more pronounced at each stage. Recent studies have demonstrated that the proportion of female plastic surgery residents has increased to nearly 40%, yet only 11% of full professors of plastic surgery are female. Other studies have identified severe declines in underrepresented minority plastic surgery representation between plastic surgery residents and academicians with only 1.6% of Black/African American and 4.9% of Hispanic/Latinx full professors of plastic surgery. Often, residents seek fellowship for advanced training before seeking an academic professorship. This study aims to describe the racial/ethnic and gender representation of microsurgery and craniofacial fellows. METHODS: Names and photos of graduated fellows for the past 10 years (2012-2021) were extracted from microsurgery and craniofacial fellowship Web sites. Using a 2-person evaluation method, race/ethnicity and gender were primarily determined by photographic and surname and verified, when possible, through online confirmation methods (articles, social media). Distributions were analyzed with descriptive statistics and compared with the US population. RESULTS: Among 30 microsurgery fellowships, 180 graduated fellows (52.7%) were identified, resulting in 66 female fellows (36.7%) and the following racial/ethnic distribution: 113 (62.8%) White, 49 (27.2%) Asian, 12 (6.7%) Hispanic/Latinx, and 6 (3.3%) Black/African American. Among 31 craniofacial fellowships, 136 graduated fellows (45.0%) were identified, resulting in 38 female fellows (27.9%) and the following racial/ethnic distribution: 75 (55.1%) White, 45 (33.1%) Asian, 8 (5.9%) Hispanic/Latinx, and 8 (5.9%) Black/African American. The intersection between race/ethnicity and gender revealed the most disproportionately low representation among Black women. Relative to the US population, Hispanic/Latinx (0.31-fold) and Black/African American (0.48-fold) fellows were underrepresented, White (0.90-fold) fellows were nearly equally represented, and Asian (5.42-fold) fellows are overrepresented relative to the US population. Furthermore, despite pursuing fellowships at a greater rate, Asian and Black fellows are not reaching adequate representation among academic plastic surgeons. CONCLUSION: This study demonstrates that female racial/ethnic minorities are disproportionately underrepresented among microsurgery and craniofacial fellowships. Efforts should be made to improve the recruitment of fellows of underrepresented backgrounds and thus improve the pipeline into academic careers.

Preventing COVID-19 Transmission in Education Settings.

OBJECTIVES: In fall 2020, community hubs opened in San Francisco, California, to support vulnerable groups of students in remote learning. Our objectives were to (1) describe adherence to coronavirus disease 2019 (COVID-19) mitigation policies in these urban, low-income educational settings; (2) assess associations between policy adherence and in-hub COVID-19 transmission; and (3) identify barriers to and facilitators of adherence. METHODS: We conducted a mixed-methods study from November 2020 to February 2021. We obtained COVID-19 case data from the San Francisco Department of Public Health, conducted field observations to observe adherence to COVID-19 mitigation policies, and surveyed hub leaders about barriers to and facilitators of adherence. We summarized quantitative data using descriptive statistics and qualitative data using thematic content analysis. RESULTS: A total of 1738 children were enrolled in 85 hubs (39% Hispanic, 29% Black). We observed 54 hubs (n = 1175 observations of children and 295 observations of adults). There was high community-based COVID-19 incidence (2.9-41.2 cases per 100 000 residents per day), with 36 cases in hubs and only 1 case of hub-based transmission (adult to adult). Sixty-seven percent of children and 99% of adults were masked. Fifty-five percent of children and 48% of adults were distanced ≥6 ft. Facilitators of mitigation policies included the following: for masking, reminders, adequate supplies, and "unmasking zones"; for distancing, reminders and distanced seating. CONCLUSIONS: We directly observed COVID-19 mitigation in educational settings, and we found variable adherence. However, with promotion of multiple policies, there was minimal COVID-19 transmission (despite high community incidence). We detail potential strategies for increasing adherence to COVID-19 mitigation.

A community-based, multi-level, multi-setting, multi-component intervention to reduce weight gain among low socioeconomic status Latinx children with overweight or obesity: The Stanford GOALS randomised controlled trial.

BACKGROUND: There are few long-term studies of interventions to reduce in low socioeconomic status children with overweight or obesity. The Stanford GOALS trial evaluated a 3-year, community-based, multi-level, multi-setting, multi-component (MMM) systems intervention, to reduce weight gain among low socioeconomic status, Latinx children with overweight or obesity. METHODS: We did a two-arm, parallel group, randomised, open-label, active placebo-controlled trial with masked assessment over 3 years. Families from low-income, primarily Latinx communities in Northern California, CA, USA, with 7-11-year-old children with overweight or obesity were randomly assigned to a MMM intervention or a Health Education (HE) comparison intervention. The MMM intervention included home environment changes and behavioural counselling, community after school team sports, and reports to primary health-care providers. The primary outcome was child BMI trajectory over three years. Secondary outcomes included one- and two-year changes in BMI. This trial is registered with ClinicalTrials.govNCT01642836. FINDINGS: Between July 13, 2012, and Oct 3, 2013, 241 families were recruited and randomly assigned to MMM (n=120) or HE (n=121). Children's mean age was 9·5 (SD 1·4) years, 134 (56%) were female and 107 (44%) were male, and 236 (98%) were Latinx. 238 (99%) children participated in year 1, 233 (97%) in year 2, and 227 (94%) in year 3 of follow-up assessments. In intention-to-treat analysis, over 3 years, the difference between intervention groups in BMI trajectory was not significant (mean adjusted difference -0·25 [95% CI -0·90 to 0·40] kg/m2; Cohen's d=0.10; p=0·45). Children in the MMM intervention group gained less BMI over 1 year than did children in the HE intervention group (-0·73 [-1·07 to -0·39] kg/m2, d=0.55); the same was true over 2 years (-0·63 [-1·13 to -0·14] kg/m2; d =0.33). No differential adverse events were observed. INTERPRETATION: The MMM intervention did not reduce BMI gain versus HE over 3 years but the effects over 1 and 2 years in this rigorous trial show the promise of this systems intervention approach for reducing weight gain and cardiometabolic risk factors in low socioeconomic status communities. FUNDING: US National Institutes of Health.

Development and initial validation of the Spanish form of the adjustment scales for preschool intervention (ASPI).

The purpose of the study was to develop and validate a Spanish language form of the Adjustment Scales for Preschool Intervention (ASPI) for use by early childhood teachers. A multi-step, mixed method adaptation and translation process of the English form was used to increase the cultural relevance, linguistic comparability, and metric equivalence of the measure in its Spanish language form. Exploratory and confirmatory factor analyses in a diverse sample of preschool children from low-income families (N = 4077) revealed two higher order behavioral dimensions of Overactivity and Underactivity. ASPI dimension scores across Spanish and English language forms were horizontally equated through IRT. Criterion-related validity using multilevel models was established through concurrent associations with social, emotional, behavioral, and academic readiness skills. Policy and practice applications, and future directions for the use of scale scores are discussed.

Using community priorities and misconceptions about asthma as a vessel for community-led education among Hispanics.

OBJECTIVES: In New York City, asthma prevalence is greater in Hispanics than non-Hispanics for both children (10.9% vs. 7.4%) and adults (9.0% vs. 6.3%). Disparities in asthma management among Hispanics are found to arise, in part, from a limited education about asthma. Using elements of Community Based Participatory Research (CBPR), we worked with the community to identify asthma priorities and misconceptions among Hispanics and used that information to develop a tailored asthma educational tool-the Asthma Training Modules (ATMs). METHODS: Over the past 3 years (2016, 2017, and 2018), we conducted educational asthma workshops to collect and analyze information to develop the ATMs and a summary of the ATMs in an Asthma Educational Card (AEC). We trained 6 Asthma-Community-Leaders using the ATMs, who assembled community members for teaching sessions using the AEC. Participants completed a pre-and-post asthma knowledge questionnaire. RESULTS: We identified asthma priorities and misconceptions themed on: culturally relevant resources for Hispanics, symptom and trigger recognition, and treatments. A total of 104 participants attended the teaching sessions led by Asthma-Community-Leaders and participants' mean knowledge score increased from 64% pre-teaching to 85% post-teaching, (p < 0.01). CONCLUSION: Our community-led education, which included a tailored asthma educational tool and trained Asthma-Community-Leaders, successfully improved asthma knowledge among Hispanics. Further studies are warranted to determine whether these results are reproducible among a larger cohort and what the comparative effectiveness of our intervention as compared to other education-based interventions.

Comparing Vocabulary Knowledge Conceptualizations Among Spanish-English Dual Language Learners in a New Destination State.

Purpose Despite the unprecedented growth of Spanish-English dual language learners (DLLs) in new destination states-where DLLs have not been historically served-empirical understanding of their language and literacy skills is scant. Drawing on scientific understandings of bilingual language acquisition, we compare monolingually scored and bilingually scored vocabulary knowledge of Spanish-English DLLs in a new destination state. Method Participants included second- and fourth-grade Spanish-English DLLs (N = 60) in a large urban school district in a new destination state. Students were considered DLLs if their parents indicated that Spanish was spoken at home to some extent. We utilized monolingually scored (Spanish-only and English-only) and bilingually scored (conceptual and total) conceptualizations of vocabulary knowledge. Descriptive analysis and Bonferroni-adjusted multiple comparisons were used to compare vocabulary knowledge by assessment approach (i.e., monolingual or bilingual), grade (i.e., second and fourth), and English proficiency status (i.e., limited English proficient and English proficient). Results Findings revealed that (a) DLLs, across grade levels and English proficiency status, demonstrated higher bilingual vocabulary scores compared to monolingual scores and stronger receptive vocabulary performance than expressive vocabulary performance and (b) DLLs' response patterns varied depending on the bilingual assessment approach used, with DLLs in limited English-proficient and English-proficient groups evidencing similar response patterns. Conclusions Bilingual scoring of vocabulary knowledge provides a more holistic understanding of elementary-aged DLLs' language skills. Results represent an important step toward shifting school-based assessment practices to incorporate comprehensive and equitable ways to conceptualize and measure elementary-aged Spanish-English DLLs' vocabulary knowledge.

Communication for Awareness and Action on Inequitable Impacts of COVID-19 on Latinos.

In response to coronavirus disease (COVID-19) in 2020, the national Salud America! Latino health equity program at University of Texas Health San Antonio applied its digital content curation model to create and communicate culturally relevant news, stories, and data to raise immediate awareness and generate action against the pandemic's inequitable impacts on U.S. Latinos. Digital content curation is an emerging public health communication strategy using a systematic, refined process to create tailored online and social health messages and prevent mixed messaging and information overload for an audience. Salud America! curated culturally relevant digital content to raise awareness of the pandemic's inequitable impact on Latinos and promote solutions for health equity, with a unique combination of website blog posts exploring pandemic effects on Latinos, peer-modeled stories of people responding meaningfully to the crisis, podcast episodes and Tweetchats engaging people in COVID-19 solutions for Latinos, action tools and campaigns equipping school leaders to make grassroots changes, and supplying advocates with a local data tool on health equity identification. The digital health promotion intervention produced curated content that spiked program website traffic to record highs, revealing the model's effectiveness in increasing exposure to culturally relevant and action-oriented information for a novel topic.

Sólo Se Vive Una Vez: The Implementation and Reach of an HIV Screening Campaign for Latinx Immigrants.

Latinxs in the United States are disproportionately affected by HIV and present with more advanced disease than their non-Latinx peers, due to numerous barriers to care including HIV stigma. We describe the adaptation, implementation, and reach of Sólo Se Vive Una Vez (You Only Live Once), Baltimore's first social marketing campaign promoting HIV screening among Spanish-speaking Latinxs. The 6-month campaign promoted free HIV testing by addressing HIV stigma. The campaign included a website, a social marketing campaign, community outreach events, and advertisements via radio, billboards, local partners, and buses. During the campaign, there were 9,784 unique website users, and ads were served to over 84,592 people on social media platforms. Among Latinx HIV testers at the Baltimore City Health Department, 31.6% reported having seen or heard of Sólo Se Vive Una Vez and 25.3% of Latinx HIV testers reported that the campaign influenced them to get tested.

Formative research to design a culturally-appropriate cancer clinical trial education program to increase participation of African American and Latino communities.

BACKGROUND: Addressing knowledge deficiencies about cancer clinical trials and biospecimen donation can potentially improve participation among racial and ethnic minorities. This paper describes the formative research process used to design a culturally-appropriate cancer clinical trials education program for African American and Latino communities. We characterized community member feedback and its integration into the program. METHODS: We incorporated three engagement approaches into the formative research process to iteratively develop the program: including community-based organization (CBO) leaders as research team members, conducting focus groups and cognitive interviews with community members as reviewers/consultants, and interacting with two community advisory groups. An iterative-deductive approach was used to analyze focus group data. Qualitative data from advisory groups and community members were compiled and used to finalize the program. RESULTS: Focus group themes were: 1) Community Perspectives on Overall Presentation; 2) Community Opinions and Questions on the Content of the Presentation; 3) Culturally Specific Issues to Participation in Cancer Clinical Trials; 4) Barriers to Clinical Trial Participation; and 5) Perspectives of Community Health Educators. Feedback was documented during reviews by scientific experts and community members with suggestions to ensure cultural appropriateness using peripheral, evidential, linguistic, sociocultural strategies, and constituent-involving. The final program consisted of two versions (English and Spanish) of a culturally-appropriate slide presentation with speaker notes and videos representing community member and researcher testimonials. CONCLUSIONS: Incorporating multiple community engagement approaches into formative research processes can facilitate the inclusion of multiple community perspectives and enhance the cultural-appropriateness of the programs designed to promote cancer clinical trial participation among African Americans and Latinos.

Assessment of the Medical Schools From Which Radiation Oncology Residents Graduate and Implications for Diversifying the Workforce.

PURPOSE: To identify factors predictive of a medical school graduating a high volume of future radiation oncology (RO) residents to better understand potential pathways to effectively recruit women and underrepresented minority (URM) students into RO. METHODS AND MATERIALS: Demographics for US allopathic medical schools and affiliated RO departments were collected from web resources and correlated with the percentage of graduates from each school currently enrolled in RO residency in 2019, and the probability of at least 1 female or URM student from each school pursuing RO. RESULTS: The median percentage of students per medical school who pursued RO residency was 0.37% (interquartile range, 0.16%-0.66%). A total of 79.7% of schools graduated at least 1 RO resident, whereas 51.7% graduated at least 1 female RO resident and 14.0% graduated at least 1 URM RO resident. The 30 schools graduating the highest percentage of RO residents accounted for 52.1% of current RO residents, only 4 of which were in the top quartile for URM enrollment. Medical students were significantly more likely to pursue RO when there was an affiliated RO department (0.42% vs 0.18%, P < .001) or RO residency program (0.51% vs 0.18%, P < .001), more total RO faculty (rs = 0.521, P < .001), female RO faculty (rs = 0.481, P < .001), and URM RO faculty (rs = 0.197, P < .001). The probability of at least 1 female student pursuing RO was also correlated with the number of female faculty in the affiliated RO department (rpb = 0.348, P = .001), and a similar correlation was observed between URM students and URM faculty (rpb = 0.312, P = .011). CONCLUSIONS: Most RO residents graduate from medical schools with larger affiliated RO departments but fewer URM students. To promote greater RO diversity, outreach should be considered among schools with greater URM enrollment but fewer affiliated radiation oncologists, and among female and URM students in schools that graduate many RO residents.

Prevention of alcohol consumption and transmission of human immunodeficiency virus: randomized clinical trial.

OBJECTIVE: to know the effects of a nursing intervention to reduce alcohol use and risk factors for transmission of human immunodeficiency virus (HIV). METHOD: randomized single-blinded clinical trial performed by nurses with young women. The study included 66 participants in the intervention group and 66 participants in the control group. The instruments were the Alcohol Use Disorders Identification Test, the HIV Risk Behavior Knowledge and the Condom Use Self-efficacy Scale. Analysis of variance was used. RESULTS: alcohol involvement decreased in the intervention group (F (1.119) = 50.28; p < 0.001; η2p = 0.297), while HIV knowledge (F (1.130) = 34.34; p < 0.001; η2p = 0.209) and condom use self-efficacy increased (F (1.129) = 27.20; p < 0.001; η2p = 0.174). In addition, less participants consumed alcohol in the past week compared to the control group (χ2 = 15.95; p < 0.001). CONCLUSION: the nursing intervention had positive effects, which could help young women stay away from alcohol use and the risk of sexually transmitted infections. NCT: 02405481.

Access to assistive technology (AT) information in Spanish on state and territory program websites: United States, 2018.

BACKGROUND: Compared to non-Hispanic white individuals, assistive technology (AT) utilization is lower among Hispanic individuals.1-7 In the US, Spanish is the 2nd most frequently spoken language. Greater than one-fifth of Spanish-speaking households are limited English proficiencty (LEP) households (i.e., all individuals over age 14 in the household speak English less than "very well").8 Availability of AT materials in Spanish is one factor influencing knowledge about and utilization of AT among Spanish-speakers. OBJECTIVE: To examine the availability of Spanish-language AT information on state AT program websites and to assess the relationship between availability and state demographic and linguistic characteristics. METHODS: In 2018, we evaluated 56 state and territory AT program websites for the availability of AT information in Spanish. We calculated 4 measures (US Hispanic population in the state/territory; Hispanic individuals as a proportion of state population; overall Spanish-speaking households, and Spanish-speaking, limited English proficient households) from the 2016 American Community Survey and created ranked lists for each measure. Point biserial (rpb) correlations were calculated to test associations between each measure and availability of AT information in Spanish on each program's website. RESULTS: Sixteen program websites (15 states, 1 territory) provided access to Spanish-language AT information. None of the 4 measures were strongly associated with this outcome (rpb ranged from 0.30 to 0.42). For any of the 4 measures, no more than half of states in the top 10 ranks offered online access to AT information in Spanish. CONCLUSIONS: Improving the online availability of AT information in Spanish is necessary to increase equity in AT utilization among Spanish-speaking people with disabilities.