More than Tuskegee: understanding mistrust about research participation

Increasing Representation of Historically Marginalized Populations in Allergy, Asthma, and Immunologic Research Studies: Challenges and Opportunities

A growing body of epidemiological data indicates that the prevalence and public health burden of asthma and other common allergic conditions (eg, atopic dermatitis, food allergy, allergic rhinitis, and drug allergy) is greatest among certain historically marginalized populations. However, these historically marginalized populations are often under-represented in research aiming to better understand, treat, and prevent these chronic conditions, raising concerns about the generalizability of the resulting study findings to those who are most affected. In a country as heterogeneous as the United States, with respect to race and ethnicity, socioeconomic status, culture, geography, and behavior, researchers aiming to characterize the burden of allergic disease, evaluate treatments, and/or better understand its mechanisms must pay particular attention to whether their samples are sufficiently diverse and representative in order to maximize the validity-and scientific utility-of the resulting data. Therefore, the goal of this clinical commentary is to highlight the need for improved, more thoughtful representation of the full diversity of affected populations in allergy/immunology research and share best practices for study design, recruitment, retention, and data analysis, so that both the research process and products can have maximal public health impact.

The Impact of Race/Ethnicity on the Outcomes of Burn Patients: A Systematic Review of the Literature

Racial and ethnic disparities are endemic to the United States and are only beginning to attract the attention of researchers. With an increasingly diverse population, focused and tailored medicine to provide more equitable care is needed. For surgical trauma populations, this topic is a small but expanding field and still rarely mentioned in burn medicine. Disparities in prevention, treatment, and recovery outcomes between different racial and ethnic minorities who are burned are rarely discussed. The purpose of this study is to determine the current status of identified disparities of care in the burn population literature and areas of future research. A systematic review was conducted of literature utilizing PubMed for articles published between 2000 and 2020. Searches were used to identify articles that crossed the burn term (burn patient OR burn recovery OR burn survivor OR burn care) and a race/ethnicity and insurance status-related term (race/ethnicity OR African-American OR Black OR Asian OR Hispanic OR Latino OR Native American OR Indigenous OR Mixed race OR 2 or more races OR socioeconomic status OR insurance status). Inclusion criteria were English studies in the United States that discussed disparities in burn injury outcomes or risk factors associated with race/ethnicity. One thousand one hundred and sixty-nine papers were populated, 55 were reviewed, and 36 articles met inclusion criteria. Most studies showed minorities had poorer inpatient and outpatient outcomes. While this is a concerning trend, there is a paucity of literature in this field and more research is needed to create culturally tailored medical care and address the needs of disadvantaged burn survivors.

Benefits of mHealth Co-design for African American and Hispanic Adults: Multi-Method Participatory Research for a Health Information App

Background

Participatory research methodologies can provide insight into the use of mobile health (mHealth) apps, cultural preferences and needs, and health literacy issues for racial and ethnic groups, such as African Americans and Hispanics who experience health disparities.

Objective

This methodological paper aims to describe a 1-year multi-method participatory research process that directly engaged English-speaking African American and bilingual or Spanish-speaking Hispanic adults in designing a prevention-focused, personalized mHealth, information-seeking smartphone app. We report design team participants’ experiences with the methods to show why our approach is valuable in producing apps that are more aligned with their needs.

Methods

Three design sessions were conducted to inform the iteration of a prevention-focused, personalized mHealth, information-seeking app. The research team led sessions with 2 community member design teams. Design team participants described their goals, motives, and interests regarding prevention information using different approaches, such as collage and card sorting (design session 1), interaction with the app prototype (design session 2), and rating of cultural appropriateness strategies (design session 3).

Results

Each design team had 5 to 6 participants: 2 to 3 male participants and 3 female participants aged between 30 and 76 years. Design team participants shared their likes and dislikes about the sessions and the overall experience of the design sessions. Both African American and Hispanic teams reported positive participation experience. The primary reasons included the opportunity for their views to be heard, collectively working together in the design process, having their apprehension about mHealth reduced, and an opportunity to increase their knowledge of how they could manage their health through mHealth. The feedback from each session informed the following design sessions and a community-engaged process. In addition, the specific findings for each design session informed the design of the app for both communities.

Conclusions

This multi-method participatory research process revealed 4 key lessons learned and recommendations for future research in mHealth app design for African Americans and Hispanics. Lesson 1—community partnerships are key because they provide the chain of trust that helps African American and Hispanic participants feel comfortable participating in app research. Lesson 2—community-based participatory research principles continue to yield promising results to engage these populations in mHealth research. Lesson 3—interactive design sessions uncover participants’ needs and development opportunities for mHealth tools. Lesson 4—multiple design sessions with different methods provide an in-depth understanding of participants’ mHealth preferences and needs. Future developers should consider these methods and lessons to ensure health apps in the marketplace contribute to eliminating health disparities and achieving health equity.

Medical education for African American communities in the rural South: A focus group approach to identify fundamental considerations

PURPOSE

We sought to understand concerns fundamental to planning medical education specific to rural southern African Americans who are virtually nonexistent in American medical schools.

METHODS

A diverse multidisciplinary research team conducted this qualitative study with 3 focus groups, including 17 rural medical educators recruited nationwide, 10 African American alumni of a rural medical education pipeline in Alabama, and 5 community and institutional associates of this pipeline. Analysis of recorded transcripts generated themes fitting an ecological model suggesting concerns and intervention foci at individual, community, and institutional levels.

FINDINGS

Three major themes operating at all ecological levels were: (1) How "rural minority student" is defined, with "rural" often supplanting race to indicate minority status; (2) Multiple factors relate to rural racial minority student recruitment and success, including personal relationships with peers, mentors, and role models and supportive institutional policies and culturally competent faculty; and (3) Challenges to recruitment and retention of rural minority students, especially financial concerns and preparation for medical education.

CONCLUSIONS

Our findings suggest that individuals, communities, and institutions provide intervention points for planning medical education specific to southern rural African Americans. These spheres of influence project a need for partnership among communities and rural medical educators to affect broad programmatic and policy changes that address the dire shortage of rural African American health professionals to help ameliorate health inequities experienced in their home communities. It is likely that linear thinking and programming will be replaced by integrated, intertwined conceptualizations to reach this goal.

Inequality in science and the case for a new agenda

The history of the scientific enterprise demonstrates that it has supported gender, identity, and racial inequity. Further, its institutions have allowed discrimination, harassment, and personal harm of racialized persons and women. This has resulted in a suboptimal and demographically narrow research and innovation system, a concomitant limited lens on research agendas, and less effective knowledge translation between science and society. We argue that, to reverse this situation, the scientific community must reexamine its values and then collectively embark upon a moonshot-level new agenda for equity. This new agenda should be based upon the foundational value that scientific research and technological innovation should be prefaced upon progress toward a better world for all of society and that the process of how we conduct research is just as important as the results of research. Such an agenda will attract individuals who have been historically excluded from participation in science, but we will need to engage in substantial work to overcome the longstanding obstacles to their full participation. We highlight the need to implement this new agenda via a coordinated systems approach, recognizing the mutually reinforcing feedback dynamics among all science system components and aligning our equity efforts across them.

Mental health needs in a large urban school district: Findings from a web-based survey

OBJECTIVE

To explore the mental health needs of students, and the professional development and support needs of teachers and school health professionals, as a way to foster community engagement and help set priorities for a comprehensive school mental health system in the Detroit Public Schools Community District (DPSCD).

SETTING

The study team surveyed all DPSCD staff in June 2019 and all students in grades 8-12 between October and December 2019.

STUDY DESIGN

A descriptive study based on anonymous, web-based surveys focused on student trauma exposure and mental health symptoms, student mental health resource utilization, staff burnout, and professional development needs.

DATA COLLECTION

All students (grades 8-12) and district staff were eligible to participate; the student survey was made available in six languages. Parents/guardians could opt children out; schools could exclude children unable to complete the survey independently. Student surveys were administered in school; staff surveys were sent via email.

PRINCIPAL FINDINGS

Thirty-four percent of DPSCD students reported moderate/severe depression symptoms; 22% had seriously considered suicide in the past year. Rates exceed national averages; 37% of students with severe depression and 34% of those with suicidal ideation had not accessed mental health supports. Staff indicated high levels of burnout and substantial interest in learning about self-care strategies or coping with vicarious trauma. Over 75% of teachers and school mental health professionals expressed interest in learning about best practices for supporting students impacted by trauma or mental illness.

CONCLUSIONS

A large number of DPSCD students are experiencing symptoms of depression and anxiety, and many students who need care are not accessing it. Addressing the mental health needs of students is a high priority for staff, but they need more training and support, as well as support for their own vicarious trauma and high levels of burnout.

Targeted Strategies for Recruitment and Engagement of Latinx Immigrants in Longitudinal Biobehavioral Research

Introduction: Racial/ethnic minority communities are underrepresented in research. Medical mistrust and mistreatment, discrimination, and a lack of diverse research workforce may influence recruitment and engagement. Engaging Latinx immigrants for research presents unique recruitment challenges, especially for biobehavioral research which is not well explored. The purpose of this paper is to examine the effect of targeted strategies for recruiting young adult, Latinx immigrants. Methods: Recruitment occurred from 2018 to 2019 in an ongoing, longitudinal, community-engaged research study examining risk and resilience factors for health outcomes in Latinx immigrants. Strategies included active recruitment (e.g., community-based events and public events) and passive recruitment (e.g., word-of-mouth and radio and flyer advertisements). Logistic regression analysis was conducted to examine the influence of type of recruitment on participant enrollment. Results: The study enrolled 391 participants of 701 interested individuals (55%). Greater odds of enrollment were among participants recruited through radio and flyer advertisements (adjusted odds ratio [AOR]=2.90, 95%CI [1.59, 5.27], p=.001), word-of-mouth (AOR=2.50, 95% CI [1.55, 4.03], p<.000), or community-based organization events (AOR=1.68, 95% CI [1.19, 2.38], p=.003). Conclusions: Passive recruitment strategies through trusted sources increased the odds of enrollment of Latinx immigrants in biobehavioral research. Future recruitment efforts should leverage trusted sources to disseminate recruitment materials addressing barriers to recruiting Latinx participants for research.

A culturally grounded autism parent training program with Black parents

LAY ABSTRACT

Parent training programs have been well-studied in Autism Spectrum Disorders and shown to increase a parent's feeling of empowerment, advocacy skills, and treatment enrollment for their child. The majority of parent training interventions have been developed without considering the unique needs of under-represented communities, such as the Black community. Black children with autism are not only misdiagnosed or not diagnosed at all, but are not accessing services equally compared to their White peers. There is an urgent need for culturally adapted interventions in order to decrease the disparity gap. The Color of Autism Foundation developed and ran a parent training program for Black parents of children with autism. The program was grounded in two key features: (1) creating a circle of support for parents to connect and heal from ongoing and historical racial trauma and (2) using parents of Black children with autism as the main facilitators. We believe this increased parent's ability to engage in the educational aspects of the training. Overall, parents reported high levels of satisfaction with the training were highly engaged (attended an average of five of six sessions) and reported high levels of empowerment. Parents also reported continued mistrust in the medical and research community and a need for more Black providers. Further work should examine the relationship of the parent and provider in autism treatment and study the impact of circles of healing for Black families.

Addressing Black men's oral health through community engaged research and workforce recruitment

BACKGROUND

Racism negatively affects the life experiences and subsequent health of Black men, including oral disease prevalence and outcomes. Few examples in the literature discuss how racism may affect successful, unsuccessful, and non-attempts to address Black men's oral health.

AIMS

This commentary describes anti-racism approaches to address Black men's oral health through community-based participatory research, oral health promotion, and workforce recruitment.

MATERIALS AND METHODS

Stakeholders from two organizations and one dental school share their experiences and key insights on how to strengthen efforts while minimizing the influence of racism on Black men's participation.

RESULTS

Common insights identified were a need to engage a diverse range of Black men within varying social and economic contexts, race and gender concordance among program leaders and participants, and the value of partnership to reach Black men in places where they feel comfortable and supported.

DISCUSSION AND CONCLUSION

These examples stress the imperative of addressing racism among Black men in the development and improvement of targeted oral health interventions. They also emphasize the value of commitment from institutional leadership, relationship building with Black men, and the empowerment of Black men to lead program development and implementation efforts.

Recruiting African American parents of school-aged children in a physical activity study: Lessons learned

OBJECTIVES

To describe the recruitment strategies and lessons learned when enrolling African American parents/caregivers of school-aged children (ages 6-12 years) in an online survey of physical activity. With physical activity serving as a modifiable behavioral risk factor for several chronic diseases (obesity and cardiovascular diseases), little is understood regarding the influences on African Americans' physical activity participation to develop culturally appropriate physical activity interventions. Gaining a better understanding of physical activity influences is possible through research, yet recruiting and enrolling African Americans in health research is a challenge.

METHODS

Over a three-month period, a multidimensional approach (distribution of flyers, community partnerships, network sampling, African American researcher, effective communication, and data collection procedures) was used for study recruitment.

RESULTS

We exceeded our recruitment goal of 105 participants. A total of 127 African American parent/caregivers of school-aged children enrolled, which included both females/mothers (n = 87, 69%) and males/fathers (n = 40, 31%). Network sampling was the single most effective recruitment strategy for reaching this population. Lessons learned in this study includes considering participant burden and their comfort with technology, as well as gaining community trust.

DISCUSSION

Lessons learned in recruiting African American parents provides a guide for future research. Efforts are needed to further increase the representation of African American males in health research.

Enrollment of Non-White Participants and Reporting of Race and Ethnicity in Phase III Trials of Multiple Sclerosis DMTs: A Systematic Review

BACKGROUND AND OBJECTIVES

Black and Hispanic people with multiple sclerosis (MS) (pMS) have been found to have different disease courses or worse outcomes associated with MS compared to White pMS. They are also more likely to be negatively affected by social determinants of health, further worsening disparities in outcomes. As these disparities may affect treatment response, non-White pMS must be included in trials for greater generalizability of research and therefore more inclusive treatment plans. In this study, we aimed to evaluate how representation of non-White groups in phase III trials of approved disease-modifying therapies (DMTs) has evolved over time and how race and ethnicity are reported in medical journals and on manufacturer websites.

METHODS

We conducted a systematic review of the PubMed database from 1995 to June 2020 to identify manufacturer-sponsored phase III trials for Food and Drug Administration-approved MS DMTs. We explored how race and ethnicity were reported in trial publications. Using studies where information was available, we analyzed the representation of non-White pMS over time and compared to multinational census data. We reviewed patient- and health care provider (HCP)-facing websites of available DMTs to assess the dissemination of information on racial and ethnic representation in trials.

RESULTS

A total of 44 phase III trial publications were reviewed, representing 45 trials, among which 17 (37.8%) did not report race or ethnicity, 14 (31.1%) reported race and ethnicity as proportion of White participants only, and 14 (31.1%) reported 2 or more races/ethnicities. When compared to multinational census data, non-White pMS were significantly underrepresented in MS trials. Due to lack of data, trends in representation of other races and ethnicities could not be assessed. No patient- or HCP-facing DMT websites reported data on race and ethnicity in pivotal trials. Study results are available on our study dashboard.

CONCLUSION

Race and ethnicity are underreported in MS DMT trial publications and race and ethnic representation are omitted from manufacturer websites. When available, data show that non-White pMS are significantly underrepresented in MS trials. The availability of this information is crucial for patients, together with their HCPs, to make informed decisions about their care.

The evolving story of apolipoprotein L1 nephropathy: the end of the beginning

Genetic coding variants in APOL1, which encodes apolipoprotein L1 (APOL1), were identified in 2010 and are relatively common among individuals of sub-Saharan African ancestry. Approximately 13% of African Americans carry two APOL1 risk alleles. These variants, termed G1 and G2, are a frequent cause of kidney disease — termed APOL1 nephropathy — that typically manifests as focal segmental glomerulosclerosis and the clinical syndrome of hypertension and arterionephrosclerosis. Cell culture studies suggest that APOL1 variants cause cell dysfunction through several processes, including alterations in cation channel activity, inflammasome activation, increased endoplasmic reticulum stress, activation of protein kinase R, mitochondrial dysfunction and disruption of APOL1 ubiquitinylation. Risk of APOL1 nephropathy is mostly confined to individuals with two APOL1 risk variants. However, only a minority of individuals with two APOL1 risk alleles develop kidney disease, suggesting the need for a ‘second hit’. The best recognized factor responsible for this ‘second hit’ is a chronic viral infection, particularly HIV-1, resulting in interferon-mediated activation of the APOL1 promoter, although most individuals with APOL1 nephropathy do not have an obvious cofactor. Current therapies for APOL1 nephropathies are not adequate to halt progression of chronic kidney disease, and new targeted molecular therapies are in clinical trials.

This Review summarizes current understanding of the role of APOL1 variants in kidney disease. The authors discuss the genetics, protein structure and biological functions of APOL1 variants and provide an overview of promising therapeutic strategies.

In contrast to other APOL family members, which are primarily intracellular, APOL1 contains a unique secretory signal peptide, resulting in its secretion into plasma.

APOL1 renal risk alleles provide protection from African human trypanosomiasis but are a risk factor for progressive kidney disease in those carrying two risk alleles.

APOL1 risk allele frequency is ~35% in the African American population in the United States, with ~13% of individuals having two risk alleles; the highest allele frequencies are found in West African populations and their descendants.

Cell and mouse models implicate endolysosomal and mitochondrial dysfunction, altered ion channel activity, altered autophagy, and activation of protein kinase R in the pathogenesis of APOL1-associated kidney disease; however, the relevance of these injury pathways to human disease has not been resolved.

APOL1 kidney disease tends to be progressive, and current standard therapies are generally ineffective; targeted therapeutic strategies hold the most promise.

Community Engagement in Cutaneous Leishmaniasis Research in Brazil, Ethiopia, and Sri Lanka: A Decolonial Approach for Global Health

Cutaneous leishmaniasis (CL) is a parasitic skin disease endemic in at least 88 countries where it presents an urgent, albeit often “neglected” public health problem. In this paper, we discuss our model of decolonial community engagement in the ECLIPSE global health research program, which aims to improve physical and mental health outcomes for people with CL. The ECLIPSE program has four interlinked phases and underpinning each of these phases is sustained and robust community engagement and involvement that guides and informs all activities in ECLIPSE. Our decolonial approach implies that the model for community engagement will be different in Brazil, Ethiopia and Sri Lanka. Indeed, we adopt a critical anthropological approach to engaging with community members and it is precisely this approach we evaluate in this paper. The data and material we draw on were collected through qualitative research methods during community engagement activities. We established 13 Community Advisory Groups (CAGs): in Brazil (n = 4), Ethiopia (n = 6), and Sri Lanka (n = 3). We identified four overarching themes during a thematic analysis of the data set: (1) Establishing community advisory groups, (2) CAG membership and community representation, (3) Culturally appropriate and context-bespoke engagement, and (4) Relationships between researchers and community members. During our first period of ECLIPSE community engagement, we have debunked myths (for instance about communities being “disempowered”), critiqued our own practices (changing approaches in bringing together CAG members) and celebrated successes (notably fruitful online engagement during a challenging COVID-19 pandemic context). Our evaluation revealed a gap between the exemplary community engagement frameworks available in the literature and the messy, everyday reality of working in communities. In the ECLIPSE program, we have translated ideal(istic) principles espoused by such community engagement guidance into the practical realities of “doing engagement” in low-resourced communities. Our community engagement was underpinned by such ideal principles, but adapted to local sociocultural contexts, working within certain funding and regulatory constraints imposed on researchers. We conclude with a set of lessons learned and recommendations for the conduct of decolonial community engagement in global health research.

Passive Data Use for Ethical Digital Public Health Surveillance in a Postpandemic World

There is a fundamental need to establish the most ethical and effective way of tracking disease in the postpandemic era. The ubiquity of mobile phones is generating large amounts of passive data (collected without active user participation) that can be used as a tool for tracking disease. Although discussions of pragmatism or economic issues tend to guide public health decisions, ethical issues are the foremost public concern. Thus, officials must look to history and current moral frameworks to avoid past mistakes and ethical pitfalls. Past pandemics demonstrate that the aftermath is the most effective time to make health policy decisions. However, an ethical discussion of passive data use for digital public health surveillance has yet to be attempted, and little has been done to determine the best method to do so. Therefore, we aim to highlight four potential areas of ethical opportunity and challenge: (1) informed consent, (2) privacy, (3) equity, and (4) ownership.

"People Think It's Easy Because I Smile, But It's Not Easy": The Lived Experiences of Six African American Single Mothers

Grounded in Resilience Theory (Masten et al., 1990; Walsh, 1996; Walsh, 2002; Walsh, 2003) with a specific focus on parental resilience (Gavidia-Payne et al., 2015), this qualitative phenomenological study explored the lived experiences of low-income Female adult single parent (FASP) families. Each family had at least one adolescent aged 11 through 21 enrolled in special education classes and engaging in risk behaviors. Two central research questions were addressed. The first focused on the lived experiences of FASP and the second focused on their perspectives on how schools can enhance their support. Data were collected through face-to-face, in-depth, semi-structured interviews. Three major themes emerged: Life adjustment, The child is the priority, and Perseverance revealing their experience to be one of resilience. Participants also shared and provided insight on their perspectives regarding how schools can better support families. Findings revealed limited parent-school collaboration and highlight the need for further research with this population in the context of resilience. Suggestions for schools and communities working with such families are discussed.

Current status of inclusion of black participants in neuropsychological studies: A scoping review and call to action

In recognition that insufficient diversity in research impedes the generalizability of findings and negatively impacts clinical outcomes, the 1993 National Institutes of Health (NIH) Revitalization Act required NIH-funded clinical trials to include and assess outcomes for women and minority participants. Since that time, the American Psychological Association (APA) and the American Academy of Clinical Neuropsychology (AACN) have also acknowledged the reporting of this information as an essential element of research, and they have established similar aspirational goals. Nevertheless, Black communities remain disproportionately underrepresented in neuropsychology research. The objective of this study was to investigate current levels of inclusion and reporting of Black research participation in neuropsychological studies.

Publications from high impact neuropsychology journals between 2019-2020 were selected via established methodologies. Studies were analyzed to determine the rates of demographic inclusion and reporting of minority, particularly Black, participants.

A total of 1,764 articles were reviewed across seven neuropsychology journals. Of the 653 studies not excluded for other reasons, 43% neglected to include sufficient information about participants' race/ethnicity. Of the subset of eligible studies that did include racial/ethnic demographic information (n = 349), only 61% included any Black participants at all. Only 34.1% of them included enough Black participants equal to or greater than the proportion of Black individuals within the United States.

Setting a standard of routinely reporting and analytically reflecting on demographic information is necessary to make valid inferences regarding disease sequelae, treatment, and public health strategies. The authors offer specific recommendations to improve the inclusion and reporting of Black research participation, ensure compliance with established policies, and improve the quality of neuropsychological research.

Exploring the Readiness of African-American Churches to Engage in a Community-Engaged Blood Pressure Reduction Research Study: Lessons Learned from the Church Challenge

Introduction

The Transtheoretical Model (TTM) has been used to assess individual readiness for health behavior change. We describe our use of the TTM to assess organizational readiness of African-American churches to participate in the Church Challenge (CC) in Flint, Michigan; the processes of change that moved churches toward readiness for change; and lessons learned.

Methods

The CC was a faith-based, multilevel intervention to reduce chronic disease risk. A community-based participatory approach was used to engage and recruit churches. We used the TTM to capture church readiness for change and track church progress through the five stages.

Results

We engaged with 70 churches: 35 remained in Stage 1 (precontemplation), 10 remained in Stage 2 (contemplation), 3 remained in Stage 3 (preparation), 5 made it to Stage 4 (action), and 17 finished within Stage 5 (maintenance). Churches engaged in several processes of change as they moved through the various stages of change.

Lessons Learned

Utilizing processes of change, establishing rapport, and having previous participants share success stories helped move churches from stage-to-stage. However, certain barriers prevented progression, such as burnout/trauma from the Flint Water Crisis and scheduling conflicts.

Discussion

Faith-based organizational readiness greatly impacted participation in the CC. Researchers should utilize established social capital, build rapport, and remain flexible when working with African-American churches.

Conclusion

Although traditionally used at the individual level, the TTM works well at the organizational level to assess and monitor church readiness to participate in community-engaged research and health programming to improve health in an African-American faith community.

Perceptions of HIV Research Participation Among Gay, Bisexual, and Other Men who Have Sex with Men and Transgender and Nonbinary Adults: Results From a Midwest Pride Event

Human immunodeficiency virus (HIV) continues to disproportionately affect gay, bisexual, and other men who have sex with men (GBM) and transgender and nonbinary (trans/NB) individuals. This study investigated attitudes toward participation in HIV survey research, guided by Emanuel's framework for ethical clinical research (e.g., risk-benefit ratio, fair participant selection, respect for participants, social value, and collaborative partnership). GBM (n = 294) and trans/NB (n = 86) persons recruited at a Pride event in Milwaukee completed a survey assessing risks and benefits of participation in, and comfort responding to, sexual health surveys. Participants reported few ethical concerns (e.g., privacy and confidentiality), with notable differences by race, sexual orientation and gender identity, and prior research experiences. Implications for HIV research with GBM and trans/NB individuals are discussed.

The Relationship Between Attitudes about Research and Health Literacy among African American and White (Non-Hispanic) Community Dwelling Older Adults

BACKGROUND

Ethnic minority representation lacks in research. Understanding factors that promote minorities in research helps address this participation gap. Minorities often face representation disparities, including health education, socioeconomic status, and race. Compared to other races in the USA, over 50% of African Americans (AA) over age 65 face obstacles towards achieving basic health literacy skills. This study aims to investigate differences in beliefs regarding research and health literacy between White and AA participants.

METHODS

This cross-sectional study compared 46 AA vs. 60 White healthy older adults (n = 106; age = 73.97 ± 10.6 years). Participants were assessed once with the Participant Attitudes and Beliefs towards Research Questionnaire (PABRQ) and two validated health literacy measures, the Rapid Estimate of Adult Literacy in Medicine (REALM) and the Short Test of Functional Health Literacy for Adults (S-TOFHLA).

RESULTS

Controlling for age, sex, and education, AA performed significantly worse on REALM. Compared to White participants, AA more likely believed that researchers were motivated to perform studies to increase their general knowledge. Participants with lower health literacy scores more likely believed that scientists were motivated to conduct research to minimize treatment expenses. About 83-85% of participants reported not being familiar with the informed consent process, 90-95% had positive attitudes towards research involvement, and 38-52% believed researchers performed to promote their own careers.

CONCLUSION

This work helps link older adults' beliefs towards research, health literacy, and their participation in research. Future research is needed to remove barriers to participation in research for underserved, older adults.

Advancing Inclusive Research: Establishing Collaborative Strategies to Improve Diversity in Clinical Trials

Well-characterized disparities in clinical research have disproportionately affected patients of color, particularly in underserved communities. To tackle these barriers, Genentech formed the External Council for Advancing Inclusive Research, a 14-person committee dedicated to developing strategies to increase clinical research participation. To help improve the recruitment and retention of patients of color, this article chronicles our efforts to tangibly address the clinical research barriers at the system, study, and patient levels over the last four years. These efforts are one of the initial steps to fully realize the promise of personalized health care and provide increased patient benefit at less cost to society. Instead of simply acknowledging the problem, here we illuminate the collaborative and multilevel strategies that have been effective in delivering meaningful progress for patients.

What Do Placebo and Nocebo Effects Have to Do With Health Equity? The Hidden Toll of Nocebo Effects on Racial and Ethnic Minority Patients in Clinical Care

A placebo effect is a positive clinical response to non-specific elements of treatment with a sham or inert replica of a drug, device, or surgical intervention. There is considerable evidence that placebo effects are driven by expectation of benefit from the intervention. Expectation is shaped by a patient's past experience, observations of the experience of others, and written, verbal, or non-verbal information communicated during treatment. Not surprisingly, expectation in the clinical setting is strongly influenced by the attitude, affect, and communication style of the healthcare provider. While positive expectations can produce beneficial effects, negative information and experiences can lead to negative expectations, and consequently negative or nocebo effects. Key components identified and studied in the placebo and nocebo literature intersect with factors identified as barriers to quality care in the clinical setting for Black patients and other patients of color, including poor patient-clinician communication, medical mistrust, and perceived discrimination. Thus, in the context of discrimination and bias, the absence of placebo and presence of nocebo-generating influences in clinical settings could potentially reinforce racial and ethnic inequities in clinical outcomes and care. Healthcare inequities have consequences that ripple through the medical system, strengthening adverse short- and long-term outcomes. Here, we examine the potential for the presence of nocebo effects and absence of placebo effects to play a role in contributing to negative outcomes related to unequal treatment in the clinical encounter.

Sharing research results with Latina breast cancer survivors who participated in a community-engaged behavioral RCT study: a descriptive cross-sectional survey study

BACKGROUND

An often heard and justifiable concern of ethnic minorities is related to researchers' lack of attention to sharing the results of a study with participants after the study has concluded. Few studies have examined the effects of returning overall study results on participants' attitudes, especially among populations underrepresented in research. Among Latina research participants, providing a summary of study results could enhance participation in research. We assess Latina breast cancer survivors' reactions to receiving study results and their attitudes about participating in future studies.

METHODS

For this cross-sectional survey study, all women who had participated in two behavioral randomized controlled trials (RCTs) were mailed a letter summarizing the study results (using written and graphic formats) and a questionnaire assessing problems and understanding the results, importance of sharing results, willingness to participate in future studies, and format preferences for receiving the results. A postage-paid envelope for returning the completed questionnaire was included. Logistic regression examined the associations of age, education, and rural/urban residence on format preferences and willingness to participate. The survey sample consisted of 304 low-income, predominantly Spanish-speaking Latina breast cancer survivors (151 from urban and 153 from rural communities) who had participated in two RCTs testing a stress management program designed for Latina breast cancer survivors.

RESULTS

Ninety-two women returned the questionnaires (30.3%). Most of the women (91.1%) indicated that they had no trouble understanding the results of the study, and 97% agreed that it is very/extremely important for researchers to share the study result with the participants. The majority (60.2%) reported that receiving the results increased their willingness to participate in future studies. About half (51.7%) did not have a format preference, 37.4% preferred written summaries, and 10.9% preferred graphs.

CONCLUSIONS

This study is an important first step to understanding the impact of returning study results among a population that is underrepresented in research. Returning the results of studies and understanding the impact of doing so is consistent with maintaining community involvement in all phases of research. The findings suggest that sharing aggregate research results in simple language yields few problems in participants' understanding of the results and is viewed as important by participants.

TRIAL REGISTRATION

ClinicalTrials.gov NCT02931552 Date registered: October 13, 2016 and NCT01383174 Date registered: June 28, 2011.

Responding to healthcare distrust among underserved communities: Phase II

OBJECTIVE

Medical distrust is both a psychosocial construct and an underappreciated individual social determinant of health with the potential to affect oncology care and clinical trial participation. A community-based participatory research effort, called the Forward Movement Project (FMP), identified multilevel factors affecting trust for healthcare and research in an underserved urban community. In FMP Phase II, we implemented a community-responsive approach to provide lay-oriented education and address misinformation, with the goal of beginning to remediate distrust for healthcare systems and biomedical research.

METHODS

Community residents (N = 154 adults, 64% male, M = 61.5 years old, 53% annual income <$10,000, 83% African American/Black) engaged in participant-driven dialogues with oncology clinicians/clinical researchers and support services professionals. A program evaluation focused on trust for healthcare and biomedical research.

RESULTS

Participants reported positive evaluations of both the program and the cancer center clinicians and staff, who were rated as trustworthy (80% strong agreement). However, trust for healthcare systems ("Strongly agree" = 58%) and medical researchers ("Strongly agree" = 50%) following the program was moderate. Over half of the sample (52%) strongly agreed they would participate in a clinical trial compared to before joining this study.

CONCLUSION

Findings supported the user-generated program approach. The FMP is an example of a model for true community engaged research and has implications for rebuilding trust in healthcare and research.

Representation of Race and Ethnicity in Counseling and Counseling Psychology Journals

Literature reviews have concluded that People of Color are underrepresented in psychological literature; however, the fields of counseling and counseling psychology have taken a clear affirmative stance with respect to human diversity. This study sought to evaluate the representation of People of Color in four key journals across the 2000–2019 timespan: The Counseling Psychologist, Journal of Counseling Psychology, Journal of Counseling & Development, and Counselling Psychology Quarterly. Journal articles were coded for variables including focus on racial/ethnic minority (REM) groups and article content topics. Results indicated that 26.3% of the articles were coded as REM-focused (3.8% focused on African Americans, 4.1% on Asian Americans, 3.1% on Latinxs, and 0.7% on Native Americans). The need for additional research is especially notable in the case of Latinxs (the least represented REM group relative to United States Census estimates) and for several multicultural topics that remain underrepresented in the literature.

Recruitment of Older African Americans in Alzheimer's Disease Clinical Trials Using a Community Education Approach

Alzheimer's disease and related dementias (ADRD) is two times more prevalent among compared to non-Hispanic Whites. Despite the higher prevalence of ADRD among older African Americans, recent estimates suggest research enrollment by those who identify as African American remains limited. The purpose of the study is to 1) explore how a culturally tailored community education program impacts clinical trial interest and enrollment in ADRD research studies and to 2) identify how applicable the African American community perceived the culturally tailored curriculum. Using a community-engaged research approach, we collaborated with predominately African American serving community-based organizations to support content development and delivery of Aging with Grace (AWG), a culturally tailored ADRD educational curriculum. A total of five AWG presentations were given to 66 attendees. Most attendees (67%) expressed interest in participating in clinical trials after attending AWG. Enrollment increased within an observational study (84%) and lifestyle prevention clinical trials (52%) from 2018 to 2019. Attendees (32%) also perceived an increase in ADRD knowledge from attending AWG and 89.1% believed more African Americans should participate in research. Our work demonstrates the effectiveness of a culturally tailored community education program to enhance knowledge, clinical trial interest, and recruitment into observational studies and lifestyle ADRD clinical trials among older African Americans. Education programs developed in partnership with the community can serve as bridge to research participation for underrepresented minorities in clinical research. Future studies should assess long-term retention of knowledge and research readiness.

Racial differences in the dermatological manifestations of tuberous sclerosis complex and the potential effects on diagnosis and care

Background

Tuberous sclerosis complex (TSC) is an autosomal dominant neurocutaneous disorder of non-malignant tumor growths throughout major organ systems and neurological, neuropsychiatric, renal, and pulmonary co-morbidities. Skin manifestations are readily visible, often develop early in life, and are major features that contribute to TSC diagnosis. Medical photographs of such manifestations are commonly shown as examples from White individuals creating a potential barrier to accurately identifying these features in darker skinned individuals.

Objectives

The aim of this report is to raise awareness of dermatological manifestations associated with TSC, compare their appearance by race, and consider how recognition of these features could impact diagnosis and treatment of TSC.

Design and Methods

We conducted a retrospective chart review at the TSC Center of Excellence (TSCOE) at the Kennedy Krieger Institute, which included all patients in the center from 2009 (inception) through the end of the calendar year 2015 and analyzed data from the TSC Alliance Natural History Database (NHD).

Results

Among TSCOE patients, 50% of Black patients were diagnosed before the age of 1 year, compared with 70% of White patients. NHD data corroborated this trend showing a significant difference with only 38% of Blacks as compared with 50% of Whites were diagnosed at age ⩽1 year. A significant difference was observed where White participants had higher odds of having received genetic testing in both data sets. While no differences in the total number of TSC features was observed in either data set, shagreen patches and cephalic fibrous plaques were more frequently recorded in the NHD for Black individuals.

Conclusion

We highlight a disparity in the representation of Black participants within the NHD, TSCOE, and TSC trials, in addition to differences in utilization of molecular testing and topical mechanistic target of rapamycin (mTOR) inhibitor therapy between Black and White individuals. We show a trend toward later diagnosis age in Black individuals. These differences between races warrant further study across additional clinical sites and other minority groups.

Exercising empathy: Pharmacists possess skills to increase coronavirus vaccine confidence

The coronavirus disease 2019 (COVID-19) vaccines are the essential public health intervention to confer immunity against severe acute respiratory syndrome coronavirus 2, while decreasing the risks of severe COVID-19 disease, hospitalizations, and death associated with natural infection. Public health experts agree that the public health interventions of social distancing and face coverings will only be able to successfully curtail the COVID-19 pandemic in the United States when combined with the highly effective COVID-19 vaccines. The risk for severe COVID-19 is higher in Americans with highly prevalent metabolic and cardiovascular chronic conditions as well as vulnerable demographics, such as minorities and pregnant women. Unfortunately, experience with past unethical health practices can influence current vaccine confidence in people of color and women of childbearing age. Pharmacists are well-positioned in myriad health care settings across the nation to listen to these concerns and have the conversations necessary to increase vaccine confidence. Similar to effective roles that pharmacists have had in other health prevention efforts such as smoking cessation, pharmacists possess the motivational interviewing skills to guide patients from the "precontemplation" to the "action" stages of health behavior change. This nonjudgmental, mutual understanding will help identify the individual factors influencing vaccine decision-making and bring us closer to achieving "community immunity."

Concordance between Self-Reported Drug Use and Urinalysis in a Sample of Black American Women

BACKGROUND

Obtaining accurate drug use data is important in the field of substance use research. Urinalysis, considered gold standard, can be costly or infeasible, whereas self-report is quick and easy, but susceptible to imperfect recall or misrepresentation. It is important to determine the concordance between self-report and urinalysis, and better understand the contexts and participant characteristics that influence self-report accuracy. The current study aims to assess this concordance for marijuana and cocaine in a sample of Black American women, some with criminal justice exposure, and to investigate predictors of non-concordance.

METHODS

In this longitudinal study, a sample of Black American women were recruited from community, prison, and probation settings. Self-report drug use and urine drug screens were obtained at 6-, 12-, and 18-month follow-ups, allowing for the calculation of concordance. Generalized linear mixed models were used to assess participant characteristics that predicted non-concordance (both false positives and false negatives).

RESULTS

In general, there was agreement between self-report and urinalysis results for both marijuana and cocaine. Baseline drug use status was the most consistent predictor of non-concordance. Individuals recruited while on probation were more likely to have false negative results and less likely to have false positive results. Additionally, concordance rates for marijuana increased over the follow-up period.

CONCLUSIONS

Self-reported marijuana and cocaine use are accurate measures of actual drug consumption in a sample of Black American women with a variety of criminal justice interactions.

An Elicitation Study to Understand Black, Hispanic, and Male Older Adults' Willingness to Participate in Alzheimer's Disease-Focused Research Registries

BACKGROUND

There is a lack of racial, ethnic, and sex diversity in recruitment research registries and Alzheimer's disease (AD) research studies and trials. Theory-based recruitment messages may provide an opportunity to increase study participant diversity in AD research studies and trials.

OBJECTIVE

To identify behavioral, normative, and control beliefs that are associated with joining an AD-focused recruitment registry among historically underrepresented groups.

METHOD

Using a Reasoned Action Approach, we conducted 60 semi-structured phone interviews in 2020 among White, Black, and Hispanic adults ages 49-79 years in Philadelphia, PA. Underlying beliefs were elicited for the target behavior of "signing up to be on a registry for brain health research studies in the next month." Percentages based on counts are reported for the overall sample and by race and ethnicity and sex.

RESULTS

Participants were most concerned that if they were to sign up for a registry, they would be asked to participate in experimental studies. Advancing science to help others was a commonly reported positive belief about signing up. Participants' children and friends/neighbors were important from a normative perspective. Barriers to enrollment focused on logistical concerns and inconvenient sign-up processes, including using a computer. Results show generally few racial and ethnic or sex group differences.

CONCLUSION

The elicited beliefs from underrepresented groups offer a basis for understanding the behavior of signing up for research registries. However, there were few differences between the groups. Implications for outreach and recruitment are discussed.

Association Between Motor Task Performance and Hippocampal Atrophy Across Cognitively Unimpaired, Amnestic Mild Cognitive Impairment, and Alzheimer's Disease Individuals

Hippocampal atrophy is a widely used biomarker for Alzheimer's disease (AD), but the cost, time, and contraindications associated with magnetic resonance imaging (MRI) limit its use. Recent work has shown that a low-cost upper extremity motor task has potential in identifying AD risk. Fifty-four older adults (15 cognitively unimpaired, 24 amnestic mild cognitive impairment, and 15 AD) completed six motor task trials and a structural MRI. Several measures of motor task performance significantly predicted bilateral hippocampal volume, controlling for age, sex, education, and memory. Thus, this motor task may be an affordable, non-invasive screen for AD risk and progression.

Recruitment strategies and lessons learned from a large genetic study of African Americans

Genetic studies must enroll large numbers of participants to obtain adequate statistical power. Data are needed on how researchers can best use limited financial and practical resources to achieve these targets, especially in under-represented populations. This paper provides a retrospective analysis of the recruitment strategies for a large glaucoma genetics study in African Americans. The Primary Open-Angle African American Glaucoma Genetics study enrolled 10,192 African American subjects from the Philadelphia region. Major recruitment approaches included clinic enrollment from University of Pennsylvania (UPenn) sites, clinic enrollment from external sites, sampling of Penn Medicine Biobank (PMBB), and community outreach. We calculated the enrollment yield, cost per subject, and seasonal trends of these approaches. The majority (65%) of subject were enrolled from UPenn sites with an average cost of $133/subject. Over time, monthly case enrollment declined as the pool of eligible subjects was depleted. Expanding to external sites boosted case numbers ($129/subject) and the biobank provided additional controls at low cost ($5/subject), in large part due to the generosity of PMBB providing samples free of cost. Community outreach was costly with low return on enrollment ($978/subject for 220 subjects). Summer months (Jun-Aug) produced the highest recruitment yields (p<0.001). Genetic studies will benefit from a multi-pronged and culturally sensitive recruitment approach. In our experience, the biobank was most cost-effective for control enrollment, while recruitment from clinics (including expansion to new sites) was necessary to recruit fully phenotyped cases.

Reducing mental health disparities among racially and ethnically diverse populations: A review of couple and family intervention research methods (2010-2019)

Racially and ethnically diverse and globally underserved populations continue to experience mental health disparities. The goal of this review was to examine the extent to which diverse populations were included in couple and family intervention research over the past decade and whether these studies were conducted with attention to issues of diversity. We performed a review of 271 articles reviewed in the current special issue on the efficacy and effectiveness of couple and family interventions across 11 mental health topics. Overall, only 68 of the 271 (25%) articles included predominately racial/ethnic minority samples or globally underserved populations. Among articles (n = 60) describing US-based research with racial/ethnic minority samples, there was a pattern of inattention to methodological considerations relevant to diverse populations. Although some progress was noted, more research is necessary. Specifically, we call for research that advances social justice by using critically conscious methods to promote mental health equity.

Inclusion of Older Adults Who Experience Homelessness in Laboratory-Based Audiology Research: a Feasibility Study

OBJECTIVES

The objective of this study was to recruit older adults who experience homelessness into a feasibility study on laboratory-based audiology research.

DESIGN

Using best practices for recruiting individuals who experience homelessness into research, we aimed to recruit 25 participants over the course of six months. The protocol included hearing health history and hearing test. Individuals were also referred to services if needed and requested.

RESULTS

Among the 11 study participants recruited, almost half of the individuals did not meet the inclusion criteria due to severe hearing loss, neurological disorders, and difficulty staying alert.

CONCLUSIONS

We identified a few barriers to including older adults who experience homelessness in laboratory-based audiology research and discussed potential strategies. Our findings provide lessons for future audiology research on including a population of individuals who may be vulnerable to health disparity and often omitted from research.

Barriers and facilitators to qualitative data sharing in the United States: A survey of qualitative researchers

Qualitative health data are rarely shared in the United States (U.S.). This is unfortunate because gathering qualitative data is labor and time-intensive, and data sharing enables secondary research, training, and transparency. A new U.S. federal policy mandates data sharing by 2023, and is agnostic to data type. We surveyed U.S. qualitative researchers (N = 425) on the barriers and facilitators of sharing qualitative health or sensitive research data. Most researchers (96%) have never shared qualitative data in a repository. Primary concerns were lack of participant permission to share data, data sensitivity, and breaching trust. Researcher willingness to share would increase if participants agreed and if sharing increased the societal impact of their research. Key resources to increase willingness to share were funding, guidance, and de-identification assistance. Public health and biomedical researchers were most willing to share. Qualitative researchers need to prepare for this new reality as sharing qualitative data requires unique considerations.

Genetic Risk Factors for Alzheimer's Disease in Racial/Ethnic Minority Populations in the U.S.: A Scoping Review

Objectives: As the United States (U.S.) population rapidly ages, the incidence of Alzheimer's Disease and Related Dementias (ADRDs) is rising, with racial/ethnic minorities affected at disproportionate rates. Much research has been undertaken to test, sequence, and analyze genetic risk factors for ADRDs in Caucasian populations, but comparatively little has been done with racial/ethnic minority populations. We conducted a scoping review to examine the nature and extent of the research that has been published about the genetic factors of ADRDs among racial/ethnic minorities in the U.S. Design: Using an established scoping review methodological framework, we searched electronic databases for articles describing peer-reviewed empirical studies or Genome-Wide Association Studies that had been published 2005-2018 and focused on ADRD-related genes or genetic factors among underrepresented racial/ethnic minority population in the U.S. Results: Sixty-six articles met the inclusion criteria for full text review. Well-established ADRD genetic risk factors for Caucasian populations including APOE, APP, PSEN1, and PSEN2 have not been studied to the same degree in minority U.S. populations. Compared to the amount of research that has been conducted with Caucasian populations in the U.S., racial/ethnic minority communities are underrepresented. Conclusion: Given the projected growth of the aging population and incidence of ADRDs, particularly among racial/ethnic minorities, increased focus on this important segment of the population is warranted. Our review can aid researchers in developing fundamental research questions to determine the role that ADRD risk genes play in the heavier burden of ADRDs in racial/ethnic minority populations.

Race, ethnicity, and gender reporting in North American clinical trials for BCG-unresponsive non-muscle invasive bladder cancer

INTRODUCTION

The National Institutes of Health (NIH) Revitalization Act of 1993 established guidelines for the inclusion of racial/ethnic minorities and women in clinical research. However, the reporting rate of such patient demographic data in clinical trials for BCG-unresponsive non-muscle invasive bladder cancer is not well characterized.

METHODS

We identified published clinical trials of all phases (I -III) for BCG-unresponsive non-muscle invasive bladder cancer conducted in the US and/or Canada. We calculated the proportion of studies reporting patient gender and race/ethnicity, tabulating these data when present. We compared reported trial participant race, ethnicity and gender with the number of new bladder cancer cases and deaths using the Centers for Disease Control and Prevention (CDC) and National Cancer Institute (NCI) U.S. Cancer Statistics data from 2013 -2017.

RESULTS

We identified 27 trials published from 1998 -2021 enrolling a total of 1673 patients. While all trials included data on patient gender (22% women overall), only 40.7% included any data on patient race/ethnicity. Among those that did, trial participants were reported as white (94%), Black (2.1%), Hispanic (0.6%), Asian (0.9%), and Other (2.3%). Racial/ethnic minorities were underrepresented in clinical trials relative to their proportion of new bladder cancer cases and deaths.

CONCLUSION

Most clinical trials that have been conducted for BCG-unresponsive non-muscle invasive bladder cancer do not report data on patient race or ethnicity despite NIH guidelines advocating for inclusion of such data. Racial/ethnic minorities remain underrepresented in these trials relative to the burden of bladder cancer prevalence and mortality faced by these groups.

Real-World Evidence for Equality

As stakeholders in the transformative medical research ecosystem, real-world evidence researchers must conduct observational research with an awareness of racism. Advancements in understanding of the impact of racism on health outcomes, the abundance of health care data, and innovations in health information technology provide tools that create opportunities to conduct more focused research that illustrates how racism in health care deters the advancement of equity.

COVID-19 Disparities and Vaccine Hesitancy in Black Americans: What Ethical Lessons Can Be Learned?

OBJECTIVE

This state of the art review focuses on bioethical questions and considerations from research findings and methodological issues, including design and recruitment of participants, in studies related to COVID-19 vaccine hesitation in Black individuals. Ethical concerns identified were applied to otolaryngology with recommendations for improving health inequities within subspecialties.

DATA SOURCES

An internet search through PubMed, CINAHL, and socINDEX was conducted to identify articles on COVID-19 vaccine hesitation among the Black population between 2020 and 2021.

REVIEW METHODS

A systematic review approach was taken to search and analyze the research on this topic, which was coupled with expert analysis in identifying and classifying vital ethical considerations.

CONCLUSIONS

The most common COVID-19 vaccine hesitation factors were related to the development of the vaccine, mistrust toward government agencies, and misconceptions about safety and side effects. These findings raised bioethical concerns around mistrust of information, low health literacy, insufficient numbers of Black participants in medical research, and the unique positions of health professionals as trusted sources. These bioethical considerations can be applied in otolaryngology and other health-related areas to aid the public in making informed medical decisions regarding treatments, which may reduce health inequalities among Black Americans and other racial and ethnic minority groups.

IMPLICATIONS FOR PRACTICE

Addressing ethical questions by decreasing mistrust, tailoring information for specific populations, increasing minority representation in research, and using health professionals as primary sources for communicating health information and recommendations may improve relationships with Black communities and increase acceptance of new knowledge and therapies such as COVID-19 vaccination.

Knowledge into the Practice against COVID-19: A Cross-Sectional Study from Ghana

The COVID-19 pandemic has affected populations globally, including Ghana. Knowledge of the COVID-19 disease, and the application of preventive public health interventions are pivotal to its control. Besides a lockdown, measures taken against the spread of the virus include the wearing of face masks, social distancing, regular hand washing with soap and, more recently, vaccination against the virus. In order to establish a possible link between the knowledge of the disease and compliance with preventive measures, including vaccination, a cross-sectional study employing an interview-structured questionnaire was conducted in six regions of Ghana (n = 1560). An adequate level of knowledge of COVID-19 (69.9%) was reported. The linear multiple regression analysis further explicated the differences in the knowledge of COVID-19 among the respondents by their knowledge of cholera and influenza (adjusted R-Square = 0.643). Despite this profound knowledge of the illness, two thirds of the respondents were unwilling to follow basic preventive measures and only 35.3% were willing to be vaccinated. Amazingly, neither knowledge of COVID-19 nor the socio-demographic characteristics had any meaningful influence on the practice of preventive measures. Personal attitude leading to efficient public compliance with preventive measures, therefore, is a critical issue demanding special attention and effective interventions by the government and locals with authority to curb the spread of the pandemic which surpasses the traditional channels of public health communication. This includes a roll-out of persuasion, possibly including public figures and influencers, and in any case, a balanced and open discussion addressing the acceptance of the COVID-19 vaccine in order to avoid new variants and comparable problems currently facing many countries of Western Europe. Indeed, a profound hesitancy against vaccination may turn African countries such as Ghana for many years into hotspots of new viral variants.

Stakeholder Perspectives on Returning Nonactionable Apolipoprotein L1 (APOL1) Genetic Results to African American Research Participants

The ethics of returning nonactionable genetic research results to individuals are unclear. Apolipoprotein L1 (APOL1) genetic variants are nonactionable, predominantly found in people of West African ancestry, and contribute to kidney disease disparities. To inform ethical research practice, we interviewed researchers, clinicians, and African American community members (n  =  76) about the potential risks and benefits of returning APOL1 research results. Stakeholders strongly supported returning APOL1 results. Benefits include reciprocity for participants, community education and rebuilding trust in research, and expectation of future actionability. Risks include analytic validity, misunderstanding, psychological burdens, stigma and discrimination, and questionable resource tradeoffs.

Conclusions: APOL1 results should be offered to participants. Responsibly fulfilling this offer requires careful identification of best communication practices, broader education about the topic, and ongoing community engagement.

SToRytelliing to Improve Disease outcomes in Gout (STRIDE-GO) in African American veterans with gout: a trial study protocol

Objective

Medication adherence in gout is suboptimal, and the lack of effective interventions to address it presents a huge challenge. Medication adherence and gout outcomes are worse in racial/ethnic minorities. The objective of this paper was to provide the details of the study protocol for randomized, controlled trial (RCT) in African Americans (AAs) with gout that will test the effectiveness of a culturally appropriate gout storytelling intervention.

Methods

The SToRytelliing to Improve Disease outcomes in Gout (STRIDE-GO) study will be a 12-month, multicenter, open-label RCT that will assess the effect of a culturally appropriate gout storytelling in at least 300 AA veterans with gout. Participants will be randomized to gout-storytelling intervention vs. a stress reduction video in a 1:1 ratio. The primary outcome is urate-lowering therapy (ULT) adherence measured with MEMSCap™, an electronic monitoring system (efficacy, 6 months; sustenance of efficacy, 12 months). Secondary outcomes include gout flares, serum urate (SU), gout-specific health-related quality of life [HRQOL], self-reported ULT adherence, patient satisfaction with treatment, and patient understanding of the intervention. AA veterans with gout who met the 1977 Preliminary American College of Rheumatology (ACR) classification criteria for gout, currently prescribed an oral ULT medication (allopurinol or febuxostat) for at least 6 months, and not using a pillbox to redistribute their medications, will be invited to an in-person study visit. After the study coordinators obtain informed consent, and ensure that participants meet the inclusion criteria, the eligible participants will be provided with their current ULT in a MEMSCap™ bottle for the 1-month run-in period and asked to return to the clinic in 1 month. ULT adherence with MEMSCap™ will be recorded at a 1-month return visit. Interested participants will complete the baseline assessments, randomized using the computerized system to either gout-storytelling intervention or a stress reduction intervention video arm and watch the respective video in-clinic. Patients will be interviewed on the phone at 2 and 4 months regarding the viewing of the videos at home at each time. Participants will be assessed in-clinic at 3, 6, 9, and 12 months; MEMSCap™ data and patient surveys will be captured at each visit. For any missed visit, assessments will be completed on the phone and MEMSCap™ data captured at the next in-clinic visit.

Discussion

The study will assess the efficacy of a behavioral intervention to improve ULT adherence in minority populations with gout.

Trial registration

ClinicalTrials.gov NCT 02741700. Registered on 14 September 2018

Supplementary Information

The online version contains supplementary material available at 10.1186/s13063-021-05847-9.

Factors influencing intent to receive COVID-19 vaccination among Black and White adults in the southeastern United States, October - December 2020

Vaccination intent is foundational for effective COVID-19 vaccine campaigns. To understand factors and attitudes influencing COVID-19 vaccination intent in Black and White adults in the US south, we conducted a mixed-methods cross-sectional survey of 4512 adults enrolled in the Southern Community Cohort Study (SCCS), an ongoing study of racial and economic health disparities. Vaccination intent was measured as "If a vaccine to prevent COVID-19 became available to you, how likely are you to choose to get the COVID-19 vaccination?" with options of "very unlikely," "somewhat unlikely," "neither unlikely nor likely," "somewhat likely," and "very likely." Reasons for intent, socio-demographic factors, preventive behaviors, and other factors were collected. 46% of participants had uncertain or low intent. Lower intent was associated with female gender, younger age, Black race, more spiritual/religious, lower perceived COVID-19 susceptibility, living in a greater deprivation area, lower reading ability, and lack of confidence in childhood vaccine safety or COVID-19 vaccine effectiveness or safety (p < .05 for all). Most factors were present in all racial/gender groups. Contextual influences, vaccine/vaccination specific issues, and personal/group influences were identified as reasons for low intent. Reasons for higher intent included preventing serious illness, life returning to normal, and recommendation of trusted messengers. Hesitancy was complex, suggesting tailored interventions may be required to address low intent.

Perceptions, Beliefs, and Experiences of Asians and Micronesian Islanders on Family Health History Genetic Cancer Screening Community Outreach

Cancer carries stigma, taboos, and shame including, for diverse communities, who can have difficulty understanding and communicating about family health history genetic cancer screening (GCS). The Oregon Health Authority ScreenWise Program reached out to our academic-community research team to explore Asians and Micronesian Islanders (MI) perceptions on public health education outreach on GCS due to having previously only worked with the Latinx community. The purpose of the qualitative description pilot study was to elicit perceptions, beliefs, experiences, and recommendations from Asian and MI community leaders and community members regarding family health history GCS outreach in communities. Twenty Asians (Chinese and Vietnamese) and Micronesian Islanders (Chuukese and Marshallese) were recruited from the US Pacific Northwest. Nineteen participants are immigrants with an average 21.4 and 18.5 years having lived in the USA, respectively. Individual in-depth interviews were conducted using a semi-structured, open-ended interview guide and analyzed using conventional content analysis. Three main transcultural themes were identified: (1) degree of knowing and understanding cancer screening versus family health history GCS, (2) needing culturally relevant outreach messaging on family health history GCS, and (3) communication and decision-making regarding discussing with family and health care providers about cancer screening and GCS. Culturally relevant messaging rather than generic messaging is needed for inclusive outreach. Healthcare providers are encouraged to assess a client's family health history routinely because Asian and MI clients may not understand the information requested, may be hesitant to offer, or unable to provide information about their personal or family history of cancer.

Towards a more inclusive and equitable developmental cognitive neuroscience

Brain and cognitive development is a burgeoning area of scientific inquiry, with tremendous potential to better the lives of children. Large scale longitudinal neuroimaging studies offer opportunities for significant scientific advances in our understanding of developing brain structure and function. The proposed manuscript will focus on the scientific potential of the HEALthy Brain and Cognitive Development (HBCD) Study, highlighting what questions these data can and what they cannot answer about child development. Specifically, we caution against the misuse of these data for advancing de-contextualized and scientifically questionable narratives about the development of children from marginalized communities. We will focus on building and organizing a framework for interpreting HBCD data through the lens of sampling, cultural context, measurement, and developmental science theory. Our goal is to thoughtfully offer the scientific community opportunities to use the large scale and collaborative nature of HBCD to collectively revise practices in developmental science that to-date have not carefully considered their own role in perpetuating narratives that support systemic injustice.

Racial and Ethnic Disparities in the Research and Care of Hereditary Angioedema Patients in the United States

BACKGROUND

Hereditary angioedema (HAE) affects all races and both sexes equally. Minority patients are underrepresented in clinical trials and may be at risk for additional disease burden.

OBJECTIVES

To examine racial and ethnic disparities in the research and care of patients with HAE.

METHODS

We conducted a retrospective population-based study using TriNetX Diamond Network. International Classification of Diseases, 10th Revision, Current Procedural Terminology, and RxNorm codes identified patients with HAE. The proportions of White, Black, and Hispanic patients with HAE were contrasted with racial and ethnic distributions of patients with HAE in clinical trials. Lifetime prevalence of mental health disorders and HAE treatments was contrasted among different racial and ethnic groups.

RESULTS

A population-based search identified 2122 patients with HAE. The prevalence of HAE among Black patients (1.64/100,000 patients) mirrored that of White patients (1.47/100,000 patients), whereas there was a lower HAE prevalence among Hispanic patients (0.80/100,000 patients). The demographics of the 1274 patients with HAE included in phase 2/3 clinical trials differed significantly from population-based data with overrepresentation of White patients (89.9% vs 77.9%) and underrepresentation of Black patients (3.8% vs 13.6%) and Hispanic patients (1.3% vs 8.1%). Across the different racial and ethnic groups of patients with HAE, the prevalence of mental health disorders was comparatively higher than among patients without HAE. Whereas depression was equally prevalent across the different HAE racial and ethnic groups, anxiety was more prevalent among White patients.

CONCLUSIONS

Clinical trials for Food and Drug Administration-approved HAE medications underrepresent minority patients. Hereditary angioedema remains underdiagnosed in Hispanic patients. Other than a lower prevalence of anxiety disorders among Black patients relative to White patients, the mental health impact of HAE is equally distributed across the different racial and ethnic groups.

Socioeconomic disparities and neuroplasticity: Moving toward adaptation, intersectionality, and inclusion

Childhood socioeconomic status (SES) has far-reaching linkages with children's cognitive and socioemotional development, academic achievement, health, and brain structure and function. Rather than focusing on understandings about the neuroscience of socioeconomic inequality that have recently been reviewed elsewhere, the present article reviews several new directions in the field, beginning first with a consideration of the deficit versus adaptation framework. Although scientists largely agree that socioeconomic disparities in brain development are experience-dependent phenomena rooted in neuroplasticity, historically, such differences have been framed as deficits, which may benefit from intervention. However, emerging research suggests that some developmental differences among children experiencing adversity may alternatively be considered context-appropriate adaptations to the individual's environment. We next discuss how socioeconomic circumstances are inextricably intertwined with race, and consider how measurement of racism and discrimination must be part of a full understanding of the neuroscience of socioeconomic inequality. We argue that scientists must consciously recruit racially and socioeconomically diverse samples-and include measures of SES, race, and discrimination in analyses-to promote a more complete understanding of the neuroplasticity specifically, and psychological science more broadly. We discuss the extent to which researcher and editor positionality have contributed to these problems historically, and conclude by considering paths forward. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Barriers and Facilitators to Participation in Long-Acting Injectable PrEP Research Trials for MSM, Transgender Women, and Gender-Nonconforming People of Color

We collected 216 responses from sexually active MSM, transgender women, and gender-nonconforming (GNC) people of color through a web-based survey to understand the facilitators and barriers to research participation in a hypothetical LAI PrEP trial. In adjusted models, these items were found to be significantly associated with research participation likelihood: ever participated in HIV research study; comfort with taking daily pill; comfort with providing urine sample; and concerns over potential side effects of shot. Asian participants were more concerned about others knowing they were being recruited than were Black and Latinx respondents F(2, 216) = 3.98; p < .05. Asian respondents were also less comfortable with being recruited at organizations serving communities of color than Black and Latinx respondents, F(2, 216) = 5.10; p < .05. Cisgender respondents were more comfortable with being recruited by a friend or colleague than were transgender/GNC respondents, F(1, 215) = 4.8; p < .05.

Pervasive structural racism in environmental epidemiology

BACKGROUND

Epistemological biases in environmental epidemiology prevent the full understanding of how racism's societal impacts directly influence health outcomes. With the ability to focus on "place" and the totality of environmental exposures, environmental epidemiologists have an important opportunity to advance the field by proactively investigating the structural racist forces that drive disparities in health.

OBJECTIVE

This commentary illustrates how environmental epidemiology has ignored racism for too long. Some examples from environmental health and male infertility are used to illustrate how failing to address racism neglects the health of entire populations.

DISCUSSION

While research on environmental justice has attended to the structural sources of environmental racism, this work has not been fully integrated into the mainstream of environmental epidemiology. Epidemiology's dominant paradigm that reduces race to a mere data point avoids the social dimensions of health and thus fails to improve population health for all. Failing to include populations who are Black, Indigenous, and people of color (BIPOC) in health research means researchers actually know very little about the effect of environmental contaminants on a range of population health outcomes. This commentary offers different practical solutions, such as naming racism in research, including BIPOC in leadership positions, mandating requirements for discussing "race", conducting far more holistic analyses, increasing community participation in research, and improving racism training, to address the myriad of ways in which structural racism permeates environmental epidemiology questions, methods, results and impacts.