Race and Ethnicity in Otolaryngology Academic Publications.

OBJECTIVE: Within otolaryngology, race is commonly included as a study covariate; however, its value in clinical practice is unclear. This study sought to explore how race and ethnicity have been used and applied over time in otolaryngology publications. DATA SOURCES: PubMed database. REVIEW METHODS: A systematic review was done to identify original otolaryngology studies between January 1, 1946, and June 25, 2020, with the following search terms: "otolaryngology" AND "race" OR "ethnicity." RESULTS: Of the 1984 yielded studies, 932 were included in the final analysis. Only 2 studies (0.2%) defined race, and 172 (18.5%) gave participants the opportunity to self-identify race. Less than half (n = 322, 43.8%) of studies controlled for confounders. One hundred studies (10.7%) linked race to genetic factors. An overall 564 (60.5%) made conclusions about race, and 232 (24.9%) mentioned that race is relevant for clinical decision making. The majority of studies had first and senior authors from high-income countries (93.9% and 93.8%, respectively). Over time, there was a significant increase in publications that controlled for confounders, the number of race categories used, and studies that highlighted disparities. CONCLUSION: Race and ethnicity are often poorly defined in otolaryngology publications. Furthermore, publications do not always control for confounding variables or allow participants to self-identify race. On the basis of our findings, we suggest 7 foundational principles that can be used to promote equitable research in otolaryngology publications. Future efforts should focus on incorporating research guidelines for race and ethnicity into journal publication standards.

Electronic screen technology use and connection to nature in Canadian adolescents: a mixed methods study.

OBJECTIVES: Declines in exposure to nature may deprive young people of experiences that are positive for their mental health. One factor that may interfere with connections to nature is use of electronic screen technologies. The objectives of this study are to (1) document variations in the perceived importance of connections to nature nationally among adolescents; (2) explore relationships between these connections and the use of electronic screens, both epidemiologically and qualitatively; and (3) integrate core findings from both strands in order to provide evidence-based recommendations for health promotion. METHODS: The study involved a mixed methods design. Strand 1 involved a qualitative study of 74 Canadians (ages 10-18, years 2016-2018) with data collected through focus groups and interviews. Strand 2 involved a cross-sectional observational analysis of a national survey of 23,920 Canadians (ages 11-15, years 2013-2014). Findings from both strands were integrated through an established protocol. RESULTS: Increased use of electronic screen technology was consistently associated with lower perceived importance of connections to nature. Barriers to connecting to nature included choices that young people are making, the addictive properties of technology, and beliefs that being indoors is more comfortable and safer than being outdoors. When young people disconnected, their appreciation of being outdoors increased. INTERPRETATION: This novel study showed, quantitatively, that the time young people spend with electronic screens displaces time that they spend engaging in outdoor activities. Deeper reasons why such associations occur emerged in the qualitative strand. Temporary disconnection from screens may lead to renewed opportunities for outdoor exposures.