Air Pollution and Mortality at the Intersection of Race and Social Class

BACKGROUND

Black Americans are exposed to higher annual levels of air pollution containing fine particulate matter (particles with an aerodynamic diameter of ≤2.5 μm [PM2.5]) than White Americans and may be more susceptible to its health effects. Low-income Americans may also be more susceptible to PM2.5 pollution than high-income Americans. Because information is lacking on exposure-response curves for PM2.5 exposure and mortality among marginalized subpopulations categorized according to both race and socioeconomic position, the Environmental Protection Agency lacks important evidence to inform its regulatory rulemaking for PM2.5 standards.

METHODS

We analyzed 623 million person-years of Medicare data from 73 million persons 65 years of age or older from 2000 through 2016 to estimate associations between annual PM2.5 exposure and mortality in subpopulations defined simultaneously by racial identity (Black vs. White) and income level (Medicaid eligible vs. ineligible).

RESULTS

Lower PM2.5 exposure was associated with lower mortality in the full population, but marginalized subpopulations appeared to benefit more as PM2.5 levels decreased. For example, the hazard ratio associated with decreasing PM2.5 from 12 μg per cubic meter to 8 μg per cubic meter for the White higher-income subpopulation was 0.963 (95% confidence interval [CI], 0.955 to 0.970), whereas equivalent hazard ratios for marginalized subpopulations were lower: 0.931 (95% CI, 0.909 to 0.953) for the Black higher-income subpopulation, 0.940 (95% CI, 0.931 to 0.948) for the White low-income subpopulation, and 0.939 (95% CI, 0.921 to 0.957) for the Black low-income subpopulation.

CONCLUSIONS

Higher-income Black persons, low-income White persons, and low-income Black persons may benefit more from lower PM2.5 levels than higher-income White persons. These findings underscore the importance of considering racial identity and income together when assessing health inequities. (Funded by the National Institutes of Health and the Alfred P. Sloan Foundation.).

Sources of Tobacco Smoke Exposure and Their Associations With Serum Cotinine Levels Among US Children and Adolescents

INTRODUCTION

We assessed tobacco smoke exposure (TSE) levels based on private and public locations of TSE according to race and ethnicity among US school-aged children ages 6-11 years and adolescents ages 12-17 years.

AIMS AND METHODS

Data were from 5296 children and adolescents who participated in the National Health and Nutrition Examination Survey (NHANES) 2013-2018. Racial and ethnic groups were non-Hispanic white, black, other or multiracial, and Hispanic. NHANES assessed serum cotinine and the following TSE locations: homes and whether smokers did not smoke indoors (home thirdhand smoke [THS] exposure proxy) or smoked indoors (secondhand [SHS] and THS exposure proxy), cars, in other homes, restaurants, or any other indoor area. We used stratified weighted linear regression models by racial and ethnic groups and assessed the variance in cotinine levels explained by each location within each age group.

RESULTS

Among 6-11-year-olds, exposure to home THS only and home SHS + THS predicted higher log-cotinine among all racial and ethnic groups. Non-Hispanic white children exposed to car TSE had higher log-cotinine (β = 1.64, 95% confidence interval [CI] = 0.91% to 2.37%) compared to those unexposed. Non-Hispanic other/multiracial children exposed to restaurant TSE had higher log-cotinine (β = 1.13, 95% CI = 0.23% to 2.03%) compared to those unexposed. Among 12-17-year-olds, home SHS + THS exposure predicted higher log-cotinine among all racial and ethnic groups, except for non-Hispanic black adolescents. Car TSE predicted higher log-cotinine among all racial and ethnic groups. Non-Hispanic black adolescents with TSE in another indoor area had higher log-cotinine (β = 2.84, 95% CI = 0.85% to 4.83%) compared to those unexposed.

CONCLUSIONS

TSE location was uniquely associated with cotinine levels by race and ethnicity. Smoke-free home and car legislation are needed to reduce TSE among children and adolescents of all racial and ethnic backgrounds.

IMPLICATIONS

Racial and ethnic disparities in TSE trends have remained stable among US children and adolescents over time. This study's results indicate that TSE locations differentially contribute to biochemically measured TSE within racial and ethnic groups. Home TSE significantly contributed to cotinine levels among school-aged children 6-11 years old, and car TSE significantly contributed to cotinine levels among adolescents 12-17 years old. Racial and ethnic differences in locations of TSE were observed among each age group. Study findings provide unique insight into TSE sources, and indicate that home and car smoke-free legislation have great potential to reduce TSE among youth of all racial and ethnic backgrounds.

Racial and ethnic diversity of classic and clinical variant galactosemia in the United States

Classic and clinical variant galactosemia (CG/CVG) are allelic, autosomal recessive disorders that result from deficiency of galactose-1-P uridylyltransferase (GALT). CG/CVG has been reported globally among patients of diverse ancestries, but most large studies of outcomes have included, almost exclusively, patients categorized as White or Caucasian. As a first step to explore whether the cohorts studied are representative of the CG/CVG population at large, we sought to define the racial and ethnic makeup of CG/CVG newborns in a diverse population with essentially universal newborn screening (NBS) for galactosemia: the United States (US). First, we estimated the predicted racial and ethnic distribution of CG/CVG by combining the reported demographics of US newborns from 2016 to 2018 with predicted homozygosity or compound heterozygosity of pathogenic, or likely pathogenic, GALT alleles from the relevant ancestral groups. Incorporating some simplifying assumptions, we predicted that of US newborns diagnosed with CG/CVG, 65% should be White (non-Hispanic), 23% should be Black (non-Hispanic), 10% should be Hispanic, and 2% should be Asian (non-Hispanic). Next, we calculated the observed racial and ethnic distribution of US newborns diagnosed with CG/CVG using available de-identified data from state NBS programs from 2016 to 2018. Of the 235 newborns in this cohort, 41 were categorized as other or unknown. Of the remaining 194, 66% were White (non-Hispanic or ethnicity unknown), 16% were Black (non-Hispanic or ethnicity unknown),15% were Hispanic, and 2% were Asian (non-Hispanic or ethnicity unknown). This observed distribution was statistically indistinguishable from the predicted distribution. To the limits of our study, these data confirm the racial and ethnic diversity of newborns with CG/CVG in the US, demonstrate an approach for estimating CG/CVG racial and ethnic diversity in other populations, and raise the troubling possibility that current understanding of long-term outcomes in CG/CVG may be skewed by ascertainment bias of the cohorts studied.

Association of Social Determinants and Tumor Biology With Racial Disparity in Survival From Early-Stage, Hormone-Dependent Breast Cancer

Importance

Black women with hormone receptor-positive breast cancer experience the greatest racial disparity in survival of all breast cancer subtypes. The relative contributions of social determinants of health and tumor biology to this disparity are uncertain.

Objective

To determine the proportion of the Black-White disparity in breast cancer survival from estrogen receptor (ER)-positive, axillary node-negative breast cancer that is associated with adverse social determinants and high-risk tumor biology.

Design, Setting, and Participants

A retrospective mediation analysis of factors associated with the racial disparity in breast cancer death for cases diagnosed between 2004 and 2015 with follow-up through 2016 was carried out using the Surveillance, Epidemiology, and End Results (SEER) Oncotype registry. The study included women in the SEER-18 registry who were aged 18 years or older at diagnosis of a first primary invasive breast cancer tumor that was axillary node-negative and ER-positive, who were Black (Black), non-Hispanic White (White), and for whom the 21-gene breast recurrence score was available. Data analysis took place between March 4, 2021, and November 15, 2022.

Exposures

Census tract socioeconomic disadvantage, insurance status, tumor characteristics including the recurrence score, and treatment variables.

Main Outcomes and Measures

Death due to breast cancer.

Results

The analysis with 60 137 women (mean [IQR] age 58.1 [50-66] years) included 5648 (9.4%) Black women and 54 489 (90.6%) White women. With a median (IQR) follow-up time of 56 (32-86) months, the age-adjusted hazard ratio (HR) for breast cancer death among Black compared with White women was 1.82 (95% CI, 1.51-2.20). Neighborhood disadvantage and insurance status together mediated 19% of the disparity (mediated HR, 1.62; 95% CI, 1.31-2.00; P < .001) and tumor biological characteristics mediated 20% (mediated HR, 1.56; 95% CI, 1.28-1.90; P < .001). A fully adjusted model that included all covariates accounted for 44% of the racial disparity (mediated HR, 1.38; 95% CI, 1.11-1.71; P < .001). Neighborhood disadvantage mediated 8% of the racial difference in the probability of a high-risk recurrence score (P = .02).

Conclusions and Relevance

In this study, racial differences in social determinants of health and indicators of aggressive tumor biology including a genomic biomarker were equally associated with the survival disparity in early-stage, ER-positive breast cancer among US women. Future research should examine more comprehensive measures of socioecological disadvantage, molecular mechanisms underlying aggressive tumor biology among Black women, and the role of ancestry-related genetic variants.

Contralateral Breast Cancer Risk Among Carriers of Germline Pathogenic Variants in ATM, BRCA1, BRCA2, CHEK2, and PALB2

PURPOSE

To estimate the risk of contralateral breast cancer (CBC) among women with germline pathogenic variants (PVs) in ATM, BRCA1, BRCA2, CHEK2, and PALB2.

METHODS

The study population included 15,104 prospectively followed women within the CARRIERS study treated with ipsilateral surgery for invasive breast cancer. The risk of CBC was estimated for PV carriers in each gene compared with women without PVs in a multivariate proportional hazard regression analysis accounting for the competing risk of death and adjusting for patient and tumor characteristics. The primary analyses focused on the overall cohort and on women from the general population. Secondary analyses examined associations by race/ethnicity, age at primary breast cancer diagnosis, menopausal status, and tumor estrogen receptor (ER) status.

RESULTS

Germline BRCA1, BRCA2, and CHEK2 PV carriers with breast cancer were at significantly elevated risk (hazard ratio > 1.9) of CBC, whereas only the PALB2 PV carriers with ER-negative breast cancer had elevated risks (hazard ratio, 2.9). By contrast, ATM PV carriers did not have significantly increased CBC risks. African American PV carriers had similarly elevated risks of CBC as non-Hispanic White PV carriers. Among premenopausal women, the 10-year cumulative incidence of CBC was estimated to be 33% for BRCA1, 27% for BRCA2, and 13% for CHEK2 PV carriers with breast cancer and 35% for PALB2 PV carriers with ER-negative breast cancer. The 10-year cumulative incidence of CBC among postmenopausal PV carriers was 12% for BRCA1, 9% for BRCA2, and 4% for CHEK2.

CONCLUSION

Women diagnosed with breast cancer and known to carry germline PVs in BRCA1, BRCA2, CHEK2, or PALB2 are at substantially increased risk of CBC and may benefit from enhanced surveillance and risk reduction strategies.

Racial Disparities in Barriers to Care for Patients With Diabetic Retinopathy in a Nationwide Cohort

Purpose

To ascertain specific barriers of care among patients with diabetic retinopathy (DR) from different racial/ethnic groups.

Methods

In this cross-sectional study, we included adult participants in the National Institutes of Health All of Us Research Program with DR who answered questions in the Healthcare Access & Utilization survey and Social Determinants of Health (SDoH) survey. Logistic regression was used to study the association between barriers to care and race/ethnicity.

Results

Our cohort included 885 DR patients who answered the Healthcare Access & Utilization survey and 385 DR patients who responded to the SDoH survey. After adjusting for confounders, Hispanic individuals were more likely than non-Hispanic White individuals to report delaying getting medical care due to not being able to get child care (odds ratio [OR] = 6.57 [95% confidence interval {CI}, 1.67-27.8]). Furthermore, compared to non-Hispanic White individuals, non-Hispanic Black individuals were significantly more likely to report being treated with less respect (OR = 2.62 [95% CI, 1.15-5.80]), treated with less courtesy (OR = 2.51 [95% CI, 1.01-5.92]), and receive poorer service than other people (OR = 2.85 [95% CI, 1.25-6.34]) when they go to a doctor's office or other healthcare provider.

Conclusions

We found that Hispanic and non-Hispanic Black individuals with DR reported greater delays/barriers to care compared to non-Hispanic White individuals even after controlling for individualized socioeconomic factors.

Translational Relevance

This study highlights the importance of taking steps to promote health equity, such as increasing access to child care resources and reducing implicit bias among eye care providers, to increase access to care and prevent vision loss from DR.

Characterizing breast cancer incidence and trends among Asian American, Native Hawaiian, and non-Hispanic White women in Hawai'i, 1990-2014

PURPOSE

To characterize breast cancer (BC) incidence by age at diagnosis and BC subtype among disaggregated Asian American, Native Hawaiian, and Pacific Islander (AANHPI) women and non-Hispanic White (NHW) women in Hawai'i.

METHODS

Using 1990-2014 data from the Hawai'i tumor registry, we estimated age-adjusted incidence rates (AAIR) of BC and the annual percent change in BC incidence by age (<50 and ≥50 years) and BC subtype (hormone receptor [HR]+/human epidermal growth factor receptor 2 [HER2]-, HR+/HER2+, HR-/HER2+, triple negative BC) for Filipino American (FA), Japanese American (JA), Native Hawaiian (NH), and NHW women.

RESULTS

Among young (<50 years) women, annual BC incidence increased 2.9% (1994-2014) among JA and 1.0% (1990-2014) among NHW women. Incidence was highest among young JA women (2010-2014 AAIR 52.0 per 100,000; 95% confidence interval [CI] 45.6, 58.9). HR+/HER2- BC, the major BC subtype, was similarly highest among young JA women (AAIR 39.5; 95% CI 33.9, 45.4). Among older (≥50 years) women, annual BC incidence increased 1.6% (1990-2014) among FA and 4.2% (2006-2014) for JA women. BC incidence was highest among older NH women (AAIR 137.6, 95% CI 128.2, 147.4), who also displayed highest incidence of two subtypes: HR+/HER2- (AAIR 106.9; 95% CI 98.6, 115.5) and HR+/HER2+ (AAIR 12.1; 95% CI 9.4, 15.1).

CONCLUSION

We observed high and increasing BC incidence among JA women ages <50 years and high incidence among NH women ages ≥50 years. These results highlight racial and ethnic differences in BC incidence among disaggregated AANHPI populations in Hawai'i by age and BC subtype.

HIV mortality trends among older adults in the United States, 1999-2020

BACKGROUND

Despite the progress made in managing HIV, the mortality trends among older adults in the US remains understudied. The lack of evidence in this demographic hampers the ability to implement evidence-based interventions. Our aim is to analyze the trends in HIV-related mortality among US citizens aged 65 years and above by demographic characteristics such as age, gender, race/ethnicity, and census region.

METHODS

We abstracted national mortality data from the underlying cause of death files in the CDC WONDER database. The ICD-10 Codes- B20-B24 were used to identify HIV deaths among US older adults from 1999 to 2020. Trends in age-adjusted mortality rate (AAMR) were assessed using a five-year simple moving average and Joinpoint analysis. Results were expressed as annual percentage changes (APC), average annual percentage changes, and 95% confidence intervals (CI).

RESULTS

Between 1999 and 2020, a total of 15,694 older adults died from HIV in the US (AAMR= 1.7 per 100,000; 95% CI: 1.6 - 1.7). Overall mortality trends increased at an annual rate of 1.5% (95% CI: 1.2, 1.8) from 1999 through 2020. The trends increased among Non-Hispanic Whites, stabilized among Non-Hispanic Blacks, and decreased among Hispanics from 1999 to 2020. Further, the trends increased consistently across categories of age (65 to 74 years; 75 to 84 years), sex, and census region.

CONCLUSIONS

HIV mortality among older adults in the US has risen overall from 1999 to 2020, but with varying trends by race and ethnicity. This highlights the need for enhanced public health surveillance to better understand the scope of HIV mortality among older adults and identify high-risk demographic and regional subgroups for targeted interventions. Improving timely diagnosis, managing comorbidities, and stigma surrounding HIV among older adults are crucial to reducing HIV mortality in this population.

Inpatient outcomes comparing White and Black patients with obesity hospitalized for COVID-19 infection

OBJECTIVE

Comparisons between Black and White patients with obesity hospitalized with COVID-19 have not been fully studied. We sought to determine outcomes differences between these two groups.

METHODS

National Inpatient Sample database year 2020 was studied using multivariable regression to compare Black and White patients with obesity and COVID-19 infection. Outcomes were in-hospital mortality, length of stay, and hospital charges.

RESULTS

205,365 Black and White patients with obesity were hospitalized for COVID-19. 141,010 (68.6%) were White and 64,355 (31.3%) were Black. Black patients were younger (mean age [± standard error] 55.5 ± 0.14 vs. 62.1± 0.11; p < 0.01), more likely female (63.2% vs 50.9%; p < 0.01), and had lower mean comorbidity (Elixhauser score means [± standard error] 4.4 ± 0.02 vs. 4.6 ± 0.01; p < 0.01) than White patients. Black patients had lower odds of in-hospital mortality (adjusted Odds Ratio {aOR}=0.86 CI [0.77-0.97]; p = 0.01), longer hospital stays (adjusted Mean Difference {aMD}=0.32 days CI [0.14-0.51]; p < 0.01) and incurred higher, though non-significant hospital charges (aMD = $2,144 CI [-2270-+6560]; p = 0.34) than White patients.

CONCLUSION

During the first year of the pandemic, Black patients with obesity and COVID-19 were less likely to die during the incident hospitalization but used greater hospital resources compared to White patients.

Development of a Mobile-First Registry to Recruit Healthy Volunteers and Members of Underrepresented Communities for Alzheimer's Disease Prevention Studies

BACKGROUND

Web-based participant recruitment registries can be useful tools for accelerating enrollment into studies, but existing Alzheimer's disease (AD)-focused recruitment registries have had limited success enrolling individuals from underrepresented racial and ethnic groups. Designing these registries to meet the needs of individuals from these communities, including designing mobile-first, may facilitate improvement in the enrollment of underrepresented groups.

OBJECTIVES

Evaluate the usability of a prototype mobile-first participant recruitment registry for AD prevention studies; assess users' perceptions of and willingness to sign up for the registry.

DESIGN AND SETTING

Quantitative usability testing and an online survey; online setting.

PARTICIPANTS

We recruited 1,358 adults ages 45-75 who self-reported not having a diagnosis of mild cognitive impairment, AD, or other forms of dementia (Study 1: n=589, Study 2: n=769). Black/African American and Hispanic/Latino participants were specifically recruited, including those with lower health literacy.

METHODS AND MEASUREMENTS

Study 1 measures the prototype's usability through observed task success rates, task completion times, and responses to the System Usability Scale. Study 2 uses an online survey to collect data on perceptions of and willingness to sign up for the mobile-first registry.

RESULTS

Study 1 findings show the prototype mobile-first recruitment registry website demonstrates high usability and is equally usable for Black / African American, Hispanic/Latino, and White user groups. Survey results from Study 2 indicate that users from underrepresented communities understand the registry's purpose and content and express willingness to sign up for the registry on a mobile device.

CONCLUSIONS

Designing mobile-first participant recruitment registries based on feedback from underrepresented communities may result in more sign-ups by individuals from minoritized communities.

Examining neighbourhood-level disparities in Black, Latina/o, Asian, and White physical health, mental health, chronic conditions, and social disadvantage in California

Racial/ethnic minority individuals in the U.S. experience numerous health disparities versus Whites, often due to differences in social determinants. Yet, limited large-scale research has examined these differences at the neighbourhood level. We merged 2021 PLACES Project and 2020 American Community Survey data across 3,211 census tracts (neighbourhoods) defined as majority (>50%) Black, Latina/o, Asian or White. T-tests and hierarchical linear regressions were used to examine differences and associations between neighbourhoods on key health (general health, mental health, obesity, diabetes, cancer, coronary heart disease, chronic obstructive pulmonary disease, stroke), and social outcomes (income, unemployment, age, population density). Results indicated that minority neighbourhoods in California exhibited stark health and social disparities versus White neighbourhoods, displaying worse outcomes on nearly every social and health variable/condition examined; particularly for Black and Latina/o neighbourhoods. Moreover, regression findings revealed that, after considering income, unemployment, and population density, (1) fair/poor mental health and higher percentages of Black, Latina/o and Asian residents in neighbourhoods independently associated with greater neighbourhood fair/poor physical health, and (2) fair/poor mental health significantly associated with greater prevalence of obesity and COPD. This study thus underscores the need to address the profound health and social disparities experienced by minority neighbourhoods for more equitable neighbourhoods.

Racial and ethnic differences in severe maternal morbidity among singleton stillbirth deliveries

BACKGROUND

Despite growing evidence suggesting racial or ethnic disparities in the risk of severe maternal morbidity among live births, there is little research investigating potential differences in severe maternal morbidity risk among stillbirths across race and ethnicity.

OBJECTIVE

This study aimed to compare the risk of severe maternal morbidity by race and ethnicity among patients with singleton stillbirth pregnancies.

STUDY DESIGN

We used the California Linked Birth File database to perform a retrospective analysis of singleton stillbirth pregnancies delivered at 20 to 42 weeks' gestation between 2007 and 2011. The database contained information from fetal death certificates linked to maternal hospital discharge records. We defined severe maternal morbidity using the Centers for Disease Control and Prevention composite severe maternal morbidity indicator and compared rates of severe maternal morbidity across racial and ethnic groups. Multivariable regression analysis was used to examine how race and ethnicity were associated with severe maternal morbidity risk after accounting for the influence of patients' clinical risk factors, socioeconomic characteristics, and attributes of the delivery hospital.

RESULTS

Of the 9198 patients with singleton stillbirths, 533 (5.8%) experienced severe maternal morbidity. Non-Hispanic Black patients had a significantly higher risk of severe maternal morbidity (10.6% vs 5.2% in non-Hispanic White patients, 5.2% in Hispanic patients, and 5.1% in patients with other race or ethnicity; P<.001). The higher risk of severe maternal morbidity among non-Hispanic Black patients persisted even after adjusting for patients' clinical, socioeconomic, and hospital characteristics (adjusted odds ratio for non-Hispanic Black vs non-Hispanic White patients, 1.74; 95% confidence interval, 1.21-2.50). Further analysis separating blood-transfusion and nontransfusion severe maternal morbidity showed a higher risk of blood transfusion in non-Hispanic Black patients, which remained significant after adjusting for patients' clinical, socioeconomic, and hospital characteristics (adjusted odds ratio for non-Hispanic Black vs non-Hispanic White patients, 1.64; 95% confidence interval, 1.11-2.43). However, the higher risk of nontransfusion severe maternal morbidity in non-Hispanic Black patients was no longer significant after adjusting for patients' clinical risk factors (adjusted odds ratio for non-Hispanic Black vs non-Hispanic White patients, 1.38; 95% confidence interval, 0.83-2.30).

CONCLUSION

Severe maternal morbidity occurred in 5.8% of patients with a singleton stillbirth. Risk of severe maternal morbidity in stillbirth was higher in patients with non-Hispanic Black race, which was likely owing to a higher risk of hemorrhage, as evidenced by increased rate of blood transfusion.

Vitamin D status and prevalence of metabolic syndrome by race and Hispanic origin in US adults: findings from the 2007-2014 NHANES

BACKGROUND

Vitamin D status has been found to be inversely associated with metabolic syndrome (MetS) in some studies. Vitamin D status varies by race and ethnicity, and the association of MetS with vitamin D status in US adults and by race and Hispanic origin has not been evaluated extensively.

OBJECTIVES

We aimed to examine the associations between vitamin D status and MetS overall, and across race and Hispanic origin groups, in a nationally representative sample of US adults who participated in the NHANES from 2007 to 2014.

METHODS

The total sample included 8639 adults, ≥20 y of age. Serum vitamin D was measured using a standardized LC-tandem MS method and was categorized using data-driven tertiles. MetS was defined using measured waist circumference, triglycerides, HDL cholesterol, blood pressure, and fasting glucose. Multivariable logistic regression models were fitted [accounting for sociodemographic and lifestyle factors, dietary supplement use, and BMI (in kg/m2)] to examine the associations of serum vitamin D with MetS among adults overall, and by race and Hispanic origin.

RESULTS

Serum vitamin D in the lowest tertile (≤56 nmol/L) was significantly associated with increased odds of MetS compared with the highest tertile (>77.9 nmol/L) (fully adjusted model OR: 1.85; 95% CI: 1.51, 2.27). Inverse associations were noted for all race-Hispanic origin groups: non-Hispanic white (NHW) (OR: 2.24; 95% CI: 1.67, 3.01), non-Hispanic black (OR: 1.56; 95% CI: 1.06, 2.29), and Hispanic (OR: 1.48; 95% CI: 1.03, 2.14) adults.

CONCLUSIONS

Lower vitamin D status was significantly associated with MetS among US adults after adjusting for sociodemographic and lifestyle factors, dietary supplement use, and BMI. This finding was noted across all race and Hispanic origin groups, although the strength of the association varied, being strongest for NHW adults.

Ethnic differences in fast-food advertising exposure and body mass index among Asian American/Pacific Islander and White young adults

BACKGROUND

Fast-food advertising (FFA) is a potential contributor to obesity. Few studies have examined the relationship between FFA exposure and body mass index (BMI) among young adults. Furthermore, these studies have rarely examined ethnic differences in the relationship between FFA exposure and BMI, specifically across Asian American/Pacific Islander (AAPI) subgroups.

OBJECTIVE

This study aimed to investigate ethnic differences in the association between FFA exposure and BMI in a sample of predominantly AAPI young adults.

METHODS

Cross-sectional data were collected in 2018 from 2622 young adult college students (ages 18-25 years; 54% women) on O'ahu, Hawai'i. FFA exposure was assessed using a cued-recall measure. Multiple regression and analysis of covariance were used to analyze the data.

RESULTS

A significant association was found between higher FFA exposure and higher BMI (p < 0.05; 2-tailed) in the entire sample, adjusting for ethnicity, other demographic variables, and levels of physical activity. However, when examined by ethnic group, the association between FFA exposure and BMI was not statistically significant. A statistically significant main effect of ethnicity on BMI was found. Native Hawaiian/other Pacific Islanders (NHPI) reported the highest mean BMI [27.07 (SD ± 7.74) kg/m2] compared with the other four ethnic groups (p < 0.001). The effect of ethnicity on FFA exposure was not found to be statistically significant.

CONCLUSION

FFA exposure appears to adversely influence BMI in a population of predominantly AAPI young adults. Although we did not find ethnic differences in FFA exposure or in the association between FFA exposure and BMI, the current data make a case for similar future investigation with larger subgroup sample sizes. Regulations that curtail FFA exposure among young adults may be needed.

Drinking in Mexico by Whites and Hispanics on and off the US/Mexico border in California

This paper compares drinking patterns of Whites and Hispanics who after crossing the U.S./Mexico border drink and do not drink in Mexico. Data came from a household survey of 1,209 adults 18 to 39 years of age in California. Residence near the US/Mexico border increases the likelihood of drinking in Mexico (AOR = 4.57; 95%CI = 2.45-8.52; p < .001). Hispanics (AOR = 1.91; 95%CI = 1.26-2.90; p < .01), those who drink more frequently (AOR = 1.05; 95%CI = 1.02-1.09; p < .01) and those who drink six or more drinks in day (AOR = 1.91; 95%CI = 1.26-2.29; p < .01) are more likely than Whites and lighter drinkers to report this behavior. Crossing the U.S./Mexico border to drink is influenced by living close to the border, Hispanic ethnicity, and drinking many drinks in a day.

Silicosis mortality trends and new exposures to respirable crystalline silica - United States, 2001-2010

Silicosis is a preventable occupational lung disease caused by the inhalation of respirable crystalline silica dust and can progress to respiratory failure and death. No effective specific treatment for silicosis is available; patients are provided supportive care, and some patients may be considered for lung transplantation. Chronic silicosis can develop or progress even after occupational exposure has ceased. The number of deaths from silicosis declined from 1,065 in 1968 to 165 in 2004. Hazardous occupational exposures to silica dust have long been known to occur in a variety of industrial operations, including mining, quarrying, sandblasting, rock drilling, road construction, pottery making, stone masonry, and tunneling operations. Recently, hazardous silica exposures have been newly documented during hydraulic fracturing of gas and oil wells and during fabrication and installation of engineered stone countertops. To describe temporal trends in silicosis mortality in the United States, CDC analyzed annual multiple cause-of-death data for 2001-2010 for decedents aged ≥15 years. During 2001-2010, a total of 1,437 decedents had silicosis coded as an underlying or contributing cause of death. The annual number of silicosis deaths declined from 164 (death rate† = 0.74 per 1 million population) in 2001 to 101 (0.39 per 1 million) in 2010 (p = 0.002). Because of new operations and tasks placing workers at risk for silicosis, efforts to limit workplace exposure to crystalline silica need to be maintained.