Suchergebnisse

Objectives: The purpose of this study was to determine if central anthropometric vari­ables that best estimate blood pressure risks in European Americans also best estimate blood pressure risks in African Americans.Design: The participants were 357 nor­motensive African and European American volunteers with a mean age of 32.6 ± 12.4 years. Participants were evaluated for central adiposity with dual energy X-ray ab­sorptiometry, abdomen and thigh skinfolds, waist and hip circumferences, waist/hip ratio, waist/height ratio, body mass index, and systolic and diastolic blood pressures. Descriptive statistics, partial correlations, ANOVA and stepwise regressions were used to analyze the data.Results: Central adiposity anthropometric indices made different contributions to blood pressure in African and European American men and women. When weight was held constant, waist circumference shared stronger partial relationships with blood pressure in African Americans (r = .30 to .47) than in European Americans (r = .11 to .32). Waist circumference in com­bination with other indices was a predictor of systolic and diastolic blood pressures in European American men (P<.05) but only a predictor for diastolic blood pressure in African American men and women (P<.01). Hip circumference was the only predic­tor for systolic blood pressure (P<.01) in African American men and women.Conclusions: Further research on the rela­tive contributions of central anthropometric indices to blood pressure in African and European Americans is warranted. A better understanding of this relationship may help reduce hypertensive morbidity and mortali­ty disparities between African and European Americans. Ethn Dis. 2020;30(2):349-356; doi:10.18865/ed.30.2.349

Minority research and training (MRT) programs utilize interventions aimed at increasing student persistence toward the completion of undergraduate degrees and continuation into doctoral degrees. Numerous studies identify these support interventions as essential components for positive outcomes among underrepresented students, including research experiences, social integration, mentorship, and financial support. Many of these previous studies utilize quantitative design involving current program participants or program alumni who continued into graduate programs. This pilot study employed a multiple case study with a narrative approach involving partici­pants of an MRT program who completed a BSc degree but did not subsequently ma­triculate into a doctoral program. The cross-case analysis identified perceived barriers deterring continuation into doctoral degree programs among former MRT participants. Results from this study add student voice to the current literature and provide recom­mendations to better serve underrepresent­ed students in the STEM disciplines. Ethn Dis. 2020;30(2):313-320; doi:10.18865/ ed.30.2.313

The health of African Americans has been largely described in terms of deficits, disease and death. Little attention has been histori­cally given to the fact that African Americans as a population show the sustained ability to survive an evolving array of social, eco­nomic and environmental adversities that date back to more than a century before the founding of the United States. While these inequities have indeed taken (and continue to take) a devastating toll, there is also wide heterogeneity in outcomes, suggesting the existence of substantial individual and col­lective resilience among African Americans.This Perspective aims to stimulate discus­sion and research that explores resilience in a population in which "overcoming" and "bouncing back" from adversities (ranging from minor incidents to legally ordained, chronic and horrific oppression) has been a requirement for survival. Rigorous scientific exploration of Black resilience may yield important insights into the phenomenon of human resilience that transcend race. Ethn Dis. 2020;30(2):365-368; doi:10.18865/ ed.30.2.365

Objective: To examine incidence and survival of testicular cancer in New Mexico, overall and separately for border and non-border counties.Methods: Incidence and 5-year survival rates for testicular cancer were obtained from the SEER18 database using the SEER*Stat program following established NCI protocols. Incidence data were com­pared using Student's t-test. Age-adjusted 5-year survival and Kaplan-Meier method were used to estimate survival. Log-rank tests were used to compare survival for New Mexico to the remaining17 geographi­cal areas of the SEER 18 and for the New Mexico border counties to the New Mexico non-border counties. Odds ratios were used to compare testicular stage at diagnosis. Cox proportional hazards regression was performed to account for race/ethnicity, and border status.Results: From 2000-2015, New Mexico had a testicular cancer incidence rate of 6.3 per 100,000 people, significantly higher than SEER18 (P<.001). The 5-year survival rate in New Mexico did not differ signifi­cantly from the SEER18 (P=.3). Border His­panics had a lower survival rate than border non-Hispanic populations (P=.03). From 2000-2018, New Mexico had a significantly higher proportion of distant cancers than the SEER18 (OR: 1.29, 95% CI: 1.08 to 1.53, P=.005).Conclusions: The higher incidence of testicular cancer in New Mexico does not appear to have a clear explanation based on the current understanding of risk factors; however, the increased incidence in New Mexico does not appear to be associated with increased mortality. The higher propor­tion of advanced testicular cancers in New Mexico may represent a delay in diagnosis. The increased mortality rate seen in Hispan­ic border populations may be due in part to barriers to care.Ethn Dis. 2020;30(2):357- 364; doi:10.18865/ed.30.2.357

Objective: This study investigated whether HIV testing attitudes, HIV conspiracy beliefs, and reported sexual partner disclosure of HIV/STI status related to one-month self-report HIV testing outcomes following a brief intervention among Black women aged 18-25 years residing in rural Mississippi.Participants: Black women (N=119; Mage=19.90, SD=1.81) recruited in rural Mississippi completed an online assessment before a brief HIV prevention intervention and a one month follow-up assessment dur­ing January to November 2016.Main Outcome Measures: Self-reported HIV testing 30-days following the interven­tion, partner HIV/STI status disclosure, beliefs in HIV conspiracy theory, and HIV testing attitudes in pre- and post-interven­tion assessments. Bivariate and multivariate analyses tested associations with HIV testing behaviors following the intervention.Results: Moderated moderation was used to examine whether HIV conspiracy beliefs and partner disclosure status both moder­ated the relationship between pre-interven­tion attitudes toward HIV testing and HIV testing at 1-month follow-up. It was found that both HIV conspiracy beliefs and partner disclosure moderated the relationship between attitudes and HIV testing at one-month follow-up. When partner disclosure was low, women with more negative at­titudes toward testing and higher conspiracy beliefs were less likely to get tested than those with negative attitudes and lower conspiracy beliefs; conspiracy beliefs did not relate to testing outcomes when testing attitudes were positive.Conclusion: Findings suggest that interven­tions may benefit from accounting for con­spiracy beliefs and the dyadic status disclo­sure when encouraging young rural women to test for HIV.Ethn Dis. 2020;30(2):251- 260; doi:10.18865/ed.30.2.251

Objective: Black female youth have been disproportionately burdened by the HIV epidemic. Emerging literature suggests that individual and social-structural factors may uniquely increase HIV risk within this popu­lation during key developmental periods, namely adolescence (ages 10-17 years) and emerging adulthood (ages 18-25 years). Few studies, however, have compared drivers of risk within and between these key develop­mental periods. Therefore, we conducted a systematic review of recent literature to characterize and identify important gaps in our understanding of the individual, psycho­social, and social-structural determinants of HIV risk among Black adolescent girls and emerging adult women.Design: Using a replicable strategy, we searched electronic databases for articles and abstracts published between October 1, 2017 and September 30, 2019 in which the primary focus was on HIV prevention among Black adolescent girls and emerging adults in the United States.Results: In total, 21 studies met the inclu­sion criteria. Most of the studies on Black adolescent girls assessed family functioning, parental monitoring, and parent-adolescent communication as determinants of HIV-related behaviors. However, equivalent studies were lacking for Black emerging adult women. Moreover, few studies as­sessed neighborhood characteristics, social networks, or other community-level factors as determinants of HIV-related behaviors, which are known drivers of HIV disparities.Conclusions: Our findings highlighted several gaps in the literature, including failure to recognize the ethnic and cultural differences among Black women that may contribute to behavioral differences within this population and insufficient acknowledg­ment of the role of HIV protective factors (eg, resilience and community assets). Implications and future directions are discussed. Ethn Dis. 2020;30(2):277-286; doi:10.18865/ed.30.2.277

Every cell has a genetic sex that is deter­mined at the time of fertilization. However, the natal sex of cells may not match the hormonal environment in which they reside in transgender individuals. This discordance provides a unique opportunity to study the short- and long-term effects across a range of cellular functions, health conditions, physi­ologic processes and psychosocial outcomes to the benefit of transgender and cisgender communities. While there is a growing body of knowledge as the literature on sex differences in virtually every organ system accumulates, there remains a paucity of data on the effect of cross hormonal therapy on cellular function in transgender individuals. Beyond cellular function, the effect of cross hormonal therapy on neuroanatomy, the interpretation of neuropsychological assess­ments or even the effect of daily stressors of stigma and discrimination on long-term neurocognitive function remain unclear.In 2011 the Institute of Medicine indicated that transgender adults were an understud­ied population and in critical need of more biomedical and population health research, yet the experience of stigma, discrimination, microaggressions, limited access to culturally competent care continue to make this an un­fulfilled mandate. In addition to using a life course perspective, it is essential to identify research gaps and formulate a responsive research agenda while maintaining scientific rigor and respectful involvement of the popu­lation under study. None of this, however, will enhance the participation of transgender communities in biomedical research until the transgender and biomedical research com­munities can engage in open, respectful and bidirectional dialogue.From respectful, sensitive and appropriate health care to culturally competent research engagement from study inception to data dissemination, transgender communities can make an important and valuable contribu­tion to biomedical research. Inclusion of their voices at all levels, including investigators from transgender communities, are essential to advance this much overdue scientific agenda. Transgender, cisgender and the biomedical research communities will all benefit from a more inclusive and expansive research agenda.Ethn Dis. 2020;30(2):247- 250; doi:10.18865/ed.30.2.247

Objective: The increased life expectancy of people living with HIV has brought about an increase in serodiscordant couples, in which there is risk of HIV transmission. Therefore, interventions that promote sexual health and reduce risk are critical to develop for these couples. Given the disproportionate burden of HIV among populations of color, it is also critical that these interventions are culturally congruent. The EBAN intervention for African American serodiscordant couples recognizes the centrality of culture in shap­ing sexual behaviors and helps couples develop intimacy and positive prevention behaviors. The analytic objective of our study was to examine the knowledge and awareness gained by participants in the intervention.Participants: Participants (n=17) who com­pleted at least half of the eight intervention sessions.Methods: Brief post-implementation semi-structured interviews were conducted be­tween January 1, 2016 and December 31, 2016. Team-based, targeted content analysis focused on knowledge and awareness gains.Results: Participants described learning about sexual health, expanded sexual options, and sexual communication. The "EBAN café," a component that gives couples a menu of options for safer sex behaviors, was particularly popular. Partici­pants also noted the value of learning how to communicate with one another about their sexual health-related concerns and preferences. They appreciated the "cultural stuff" that was infused throughout the ses­sions, including the emphasis on learning from one another as couples.Conclusions: Couples at risk for HIV trans­mission benefit from strengthening skills and knowledge related to healthy sexual­ity. A behavioral intervention that aligns with cultural values and imparts culturally congruent sexual health information appeals to couples who seek ways to enhance their intimacy and sexual options while also re­ducing risk. Ethn Dis. 2020;30(2):269-276; doi:10.18865/ed.30.2.269

Objectives: The metabolic syndrome (MetS) refers to a cluster of interrelated physiological characteristics that are associ­ated with an increased risk of cardiovascular disease and diabetes. While the clinical usefulness of the MetS has been the subject of controversy for years, increasingly sophis­ticated methods are being used to measure the concept.Participants: Study of community health center patients who were not diabetic; study group was evenly divided between Black and White adults.Methods: Structural equation modeling of MetS incorporating the effects of race/eth­nicity, racial discrimination, socioeconomic position (SEP), and selected mediating variables.Main Outcome Measure: Latent MetS score and MetS status based on the five-point scale developed by the National Cholesterol Education Panel (NCEP).Results: The largest influences on latent MetS scores were SEP (negative relationship) and male gender (higher scores for men). Two mediating variables, physical activ­ity and stress-related eating, had smaller impacts. Self-reported racial discrimination was associated with cynical hostility but did not influence the MetS level among non­diabetics. Despite higher NCEP scores and MetS prevalence rates for Blacks compared with Whites, race did not have direct effect on MetS levels when adjusted for the other characteristics in our model.Conclusions: Neither race nor self-reported racial discrimination had direct effects on MetS level in our structural model. The large effects of socioeconomic position and male gender were not mediated by the other variables in the model.Ethn Dis. 2020;30(2):331-338; doi:10.18865/ ed.30.2.331

Latinos represent a critical resource of talent that could be cultivated to expand the HIV research workforce. However, their rapid growth, as the largest and fastest growing ethnic minority group in the US population, has yet to translate into a significant increase in Latino health academic researchers. Historically, strategies to build a diverse research workforce have grouped together individuals from underrepresented minority populations obscuring significance between and within group differences. This limits ap­proaches that are responsive to the diversity of needs and experiences of emerging investigators from underrepresented groups.In this article, we discuss challenges associ­ated with heterogeneity of Latinos and bar­riers that impede research independence/ career success in the context of a review of Latino-investigator targeted mentorship approaches on the behavioral-social science of HIV infection. Mentorship workforce strategies could benefit from a personal­ized framework emphasizing individualized and tailored approaches to address the limitations and gaps in knowledge regard­ing Latino research development. This perspective encourages increased emphasis on organizational and structural processes to aid in overcoming institutional-level barriers that impede research and career develop­ment. Recommendations are proposed for features and components of effective mentorship programs that will lead to robust outcomes for strengthening the Latino research workforce in the HIV research field and elsewhere.Ethn Dis. 2020;30(2):305- 312; doi:10.18865/ed.30.2.305.

Introduction: The current hypercompeti­tive extramural funding environment in the United States emphasizes the critical need for effective research training programs that focus not only on grantsmanship, but on skill development across the full range of research activities, culminating in writing re­search results for publication. Using Writing Accountability Groups (WAG), the National Heart, Lung, and Blood Institute (NHLBI) funded Obesity Health Disparities (OHD) PRIDE is one of the few research training and mentoring programs that places an equal focus on scientific writing and grant writing. This article reports on the utility of WAGs for OHD PRIDE mentees.Method: Participants included 14 of 26 individuals who were fellows in the OHD PRIDE research training and mentoring program. A typical WAG has between four and eight members who meet for one hour each week over a 10-week period and com­mit a priori to attend at least 70% of the sessions. Summary statistics were produced to characterize number of peer-reviewed publications, grants, years in academic rank, and category of current academic rank, bar­riers to frequency of writing, and duration of writing. Results from pre- and post-WAG surveys were compared to determine the overall impact of the WAG. The study period discussed in this article took place between January and December 2017 and included data from three 10-week cycles beginning in February, May, and September.Results: Fifty-three percent of OHD PRIDE participants successfully completed at least one 10-week WAG cycle. The WAGs did not have a statistically significant impact on either the frequency of writing or the dura­tion of writing. However, the majority of the participants who successfully completed at least one WAG cycle reported that they either maintained or increased their fre­quency or duration of writing.Conclusion: By providing a structured approach to developing and/or enhancing a practice of consistent writing, time man­agement skills, and collaborative relation­ships, the WAG has promise for enhancing scientific writing skills for many trainees and early-career faculty. Longer term follow-up is needed to more fully assess the potential impact of WAGs. Ethn Dis. 2020;30(2):295- 304; doi:10.18865/ed.30.2.295

Introduction: Mentorship is crucial for academic success. And yet, there are few mentoring programs that address the needs of underrepresented, racially/ethnically diverse junior faculty conducting health-related research in the United States.Methods: To expand mentoring capacity for these racially/ethnically diverse faculty, we developed a Peer Mentor Develop­ment Program (PMDP) to prepare near-peers, who have similar characteristics and personal experiences, to provide support to participants in an NIH-PRIDE funded Insti­tute. The PMDP program is designed based on the 8-year experience of the Mentor Development Program of the NYU-Health and Hospitals Clinical Translational Science Institute. Annually, up to six alumni are selected into the PMDP, participate in the 12-hour program over 4 days, are paired with 1 to 3 scholar participants to mentor and join monthly PMDP conference calls during the ensuing year.Results: We describe the program, partici­pant experience and lessons learned from our first 18 peer mentors in three PMDP cohorts. Additionally, all 18 peer mentors completed a post-evaluation survey to as­sess the program. Overall, peers agreed that participating in the PMDP enhanced most of the specific skills targeted. Participants rated 53%-86% of skills as "more than be­fore" participating in PMDP, demonstrating the appreciation and impact of the program.Conclusions: The PMDP may be a model for higher education and academic medi­cine programs committed to mentoring and retaining racially/ethnically diverse faculty and ultimately contributing to reducing entrenched health disparities between majority and minority populations.Ethn Dis. 2020;30(2):321-330; doi:10.18865/ ed.30.2.321

Ethn Dis. 2020;30(2):241-246; doi:10.18865/ed.30.2.241

Objectives: African Americans face chal­lenges in accessing services for sexually transmitted infections (STIs). From 2012- 2016, the EBAN II intervention was funded by the NIH to test the effectiveness of implementing a culturally congruent, evidence-based HIV/AIDS prevention program in Los Angeles and Oakland, California. This study examined the impact of personal characteristics and experiences of discrimination on the likelihood of being tested for STIs.Method: Participants (N=91) completed a baseline survey. Descriptive statistics were used to test for differences between those who did and did not obtain STI testing. Factors included HIV serostatus, sociodemo­graphic variables, STI history, the presence of outside partners, and discrimination ex­periences. Multiple logistic regressions were conducted for men and women separately.Results: Participants with no recent experi­ences of discrimination were more than 3 (3.4) times more likely to obtain a baseline STI test than those who reported discrimina­tion experiences. HIV-positive women with no recent experiences of discrimination were 11 times more likely than those with reports of recent discrimination to obtain STI tests.Conclusions: It is often women who are the gatekeepers for health seeking in families and the same may be for these couples. Ex­periences of discrimination may impede STI testing, and heighten several health risks, particularly among HIV-positive African American women in HIV-serodiscordant relationships. Addressing the impact of dis­crimination experiences may be important for STI prevention and treatment efforts in interventions promoting health care utilization. Ethn Dis. 2020;30(2):261-268; doi:10.18865/ed.30.2.261

Background and Purpose: Blacks have a higher burden of post-stroke disability. Factors associated with racial differences in long-term post-stroke disability are not well-understood. Our aim was to assess the long-term racial differences in risk factors associated with stroke recovery.Methods: We examined Health and Retire­ment Study (HRS) longitudinal interview data collected from adults living with stroke who were aged >50 years during 2000- 2014. Analysis of 1,002 first-time, non- Hispanic, Black (210) or White (792) stroke survivors with data on activities of daily liv­ing (ADL), fine motor skills (FMS) and gross motor skills (GMS) was conducted. Ordinal regression analysis was used to assess the impact of sex, race, household residents, household income, comorbidities, and the time since having a stroke on functional outcomes.Results: Black stroke survivors were young­er compared with Whites (69 ± 10.4 vs 75 ± 11.9). The majority (~65%) of Black stroke survivors were female compared with about 54% White female stroke survivors (P=.007). Black stroke survivors had more household residents (P<.001) and comor­bidities (P<.001). Aging, being female, being Black and a longer time since stroke were associated with a higher odds of hav­ing increased difficulty in ADL, FMS and/or GMS. Comorbidities were associated with increased difficulty with GMS. Black race increased the impact of comorbidities on ADL and FMS in comparison with Whites.Conclusion: Our data suggest that the effects of aging, sex and unique factors associated with race should be taken into consideration for future studies of post-stroke recovery and therapy.Ethn Dis. 2020;30(2):339-348; doi:10.18865/ ed.30.2.339