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Stradford J, Heyworth NC, Jackson M, Norman M, Banks SJ, Sundermann EE, Thames AD. Increasing research study engagement in minoritized populations: An example from the Black Women Inflammation and Tau Study. Alzheimers Dement 2024. [PMID: 39140387 DOI: 10.1002/alz.14177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2024] [Revised: 07/12/2024] [Accepted: 07/16/2024] [Indexed: 08/15/2024]
Abstract
Black women are sorely underrepresented in studies of Alzheimer's disease and related dementias (ADRD) despite higher rates of ADRD diagnoses than in non-Hispanic White women. There are many reasons for underrepresentation, including medical mistrust, limited access to clinical studies, and restrictive study inclusion criteria. These pervasive barriers to research participation are often not considered during study development and, if eventually thought of tend to be after the fact. Community-engaged research (CER) approaches are an effective method for reducing participation barriers. This article describes how CER approaches were used to develop the Black Women Inflammation and Tau Study (BWITS), a prospective study to identify biopsychosocial risk factors for ADRD in Black women. Guidelines discussed here for future ADRD research in diverse populations are informed by Community-Based Participatory Research (CBPR), the National Institute on Minority Health and Health Disparities (NIMHD), and the Patient-Centered Outcomes Research Institute (PCORI). HIGHLIGHTS: Understand the historical tragedies related to medical practices and research designs that may contribute to the underrepresentation of Black Americans in research studies today. Highlight community-engaged research approaches that effectively reduce participation barriers in minoritized groups. Review Community-Based Participatory Research, National Institute of Minority Health and Health Disparities, and the Patient-Centered Outcomes Research Institute guidelines for conducting research with minoritized communities. Describe using the three frameworks to inform the study development protocol for the Black Women Inflammation and Tau Study. Conclude by offering study design considerations that we hope can be a helpful starting point for others conducting research with minoritized communities.
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Affiliation(s)
- Joy Stradford
- SDSU/UCSD Joint Doctoral Program in Clinical Psychology, San Diego, California, USA
- Department of Psychiatry, University of California, San Diego, La Jolla, California, USA
| | - Nadine C Heyworth
- Department of Neurosciences, University of California, San Diego, La Jolla, California, USA
| | - Michelle Jackson
- Department of Neurosciences, University of California, San Diego, La Jolla, California, USA
| | - Marc Norman
- Department of Psychiatry, University of California, San Diego, La Jolla, California, USA
| | - Sarah J Banks
- Department of Neurosciences, University of California, San Diego, La Jolla, California, USA
- Department of Psychiatry, University of California, San Diego, La Jolla, California, USA
| | - Erin E Sundermann
- Department of Psychiatry, University of California, San Diego, La Jolla, California, USA
| | - April D Thames
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, California, USA
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Lloyd SL, Foy CG, Caban-Holt A, Gwathmey T, Williams KL, Starks TD, Mathews A, Vines AI, Richmond A, Byrd GS. Assessing the Role of Trust in Public Health Agencies and COVID-19 Vaccination Status Among a Community Sample of African Americans in North Carolina. J Racial Ethn Health Disparities 2024; 11:1730-1740. [PMID: 37273163 PMCID: PMC10241131 DOI: 10.1007/s40615-023-01646-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 05/11/2023] [Accepted: 05/15/2023] [Indexed: 06/06/2023]
Abstract
BACKGROUND Mistrust of the government and medical establishments are prominent reasons for vaccine hesitancy among African Americans (AAs). As COVID-19 research evolves in real time with some uncertainties remaining, AA communities may be less trusting of public health agencies. The purpose of these analyses was to assess the association between trust in public health agencies that recommend the COVID-19 vaccination and COVID-19 vaccination status among AAs in North Carolina. METHODS A 75-item cross-sectional survey, the Triad Pastors Network COVID-19 and COVID-19 Vaccination survey, was developed and administered to African Americans in North Carolina. Multivariable logistic regression was used to examine the association between levels of trust in public health agencies who recommend the COVID-19 vaccine and COVID-19 vaccination status among AAs. RESULTS Of the 1157 AAs included in these analyses, approximately 14% of AAs had not received the COVID-19 vaccine. These findings indicated that lower levels of trust in public health agencies significantly decreased the odds of getting the COVID-19 vaccination compared to those with higher levels of trust among AAs. The most trusted source for information on COVID-19 included federal agencies among all respondents. Among the vaccinated, primary care physicians were another trusted source of information. Pastors were another trusted source for those willing to be vaccinated. CONCLUSIONS Despite the majority of the respondents in this sample receiving the COVID-19 vaccine, subgroups of AAs remain unvaccinated. Federal agencies have a high level of trust among AA adults; however, innovative approaches are needed to reach AAs who remain unvaccinated.
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Affiliation(s)
- Shawnta L Lloyd
- Maya Angelou Center for Health Equity, Wake Forest University School of Medicine, 525 Vine Street, Suite # 150, Winston Salem, NC, 27102, USA.
| | - Capri G Foy
- Maya Angelou Center for Health Equity, Wake Forest University School of Medicine, 525 Vine Street, Suite # 150, Winston Salem, NC, 27102, USA
| | - Allison Caban-Holt
- Maya Angelou Center for Health Equity, Wake Forest University School of Medicine, 525 Vine Street, Suite # 150, Winston Salem, NC, 27102, USA
| | - TanYa Gwathmey
- Maya Angelou Center for Health Equity, Wake Forest University School of Medicine, 525 Vine Street, Suite # 150, Winston Salem, NC, 27102, USA
| | - Kelvin Lamonte Williams
- Maya Angelou Center for Health Equity, Wake Forest University School of Medicine, 525 Vine Street, Suite # 150, Winston Salem, NC, 27102, USA
| | - Takiyah D Starks
- Maya Angelou Center for Health Equity, Wake Forest University School of Medicine, 525 Vine Street, Suite # 150, Winston Salem, NC, 27102, USA
| | - Allison Mathews
- COMPASS Initiative® Faith Coordinating Center, Wake Forest University School of Divinity, Winston Salem, NC, 27109, USA
| | - Anissa I Vines
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Alan Richmond
- Community-Campus Partnerships for Health, Raleigh, NC, 27605, USA
| | - Goldie S Byrd
- Maya Angelou Center for Health Equity, Wake Forest University School of Medicine, 525 Vine Street, Suite # 150, Winston Salem, NC, 27102, USA
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Langbaum JB, Maloney E, Hennessy M, Harkins K, Karlawish J, Nosheny RL, Bleakley A. How intention to join an Alzheimer's participant recruitment registry differs by race, ethnicity, sex, and family history: Results from a national survey of US adults. Alzheimers Dement 2023; 19:5399-5406. [PMID: 37204220 PMCID: PMC10657330 DOI: 10.1002/alz.13126] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 03/30/2023] [Accepted: 04/14/2023] [Indexed: 05/20/2023]
Abstract
INTRODUCTION Alzheimer's-focused participant recruitment registries are tools for accelerating enrollment into studies, however, registry members are primarily White women. METHODS We conducted a national online survey of 1501 adults ages 50-80, oversampling for Black and Hispanic/Latino respondents, assessing intention to join a generic "brain health" registry and to join a registry that required specific tasks. RESULTS Intention to join a registry was low (M 3.48, SD 1.77), and lower than intention to join a registry requiring specific tasks. Intention was greatest for registries requiring completing surveys (M 4.70, SD 1.77). Differences in intention were primarily between White women and Black women; differences between other groups were limited to specific tasks required. DISCUSSION The results indicate uncertainty about what a registry is, its purpose, and/or the concept of "brain health." Using the Reasoned Action Approach (RAA) to develop evidence-based outreach messages describing a registry and required tasks may increase diversity.
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Affiliation(s)
- Jessica B Langbaum
- Alzheimer's Prevention Initiative Department, Banner Alzheimer's Institute, Phoenix, Arizona, USA
| | - Erin Maloney
- Department of Communication, University of Delaware, Newark, Delaware, USA
| | - Michael Hennessy
- Department of Communication, University of Delaware, Newark, Delaware, USA
| | - Kristin Harkins
- Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jason Karlawish
- Departments of Medicine, Medical Ethics and Health Policy, and Neurology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Rachel L Nosheny
- Departments of Psychiatry and Behavioral Sciences, Radiology and Biomedical Engineering, University of California, San Francisco, California, USA
- Northern California Institute for Research and Education (NCIRE), Department of Veterans Affairs Medical Center, San Francisco, California, USA
| | - Amy Bleakley
- Department of Communication, University of Delaware, Newark, Delaware, USA
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Byfield G, Starks TD, Luther R, Edwards CL, Lloyd SL, Caban-Holt A, Deon Adams L, Vance JM, Cuccaro M, Haines JL, Reitz C, Pericak-Vance MA, Byrd GS. Leveraging African American family connectors for Alzheimer's disease genomic studies. Alzheimers Dement 2023; 19:5437-5446. [PMID: 37212603 PMCID: PMC10663385 DOI: 10.1002/alz.13106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 03/22/2023] [Accepted: 03/23/2023] [Indexed: 05/23/2023]
Abstract
INTRODUCTION The underrepresentation of African Americans (AAs) in Alzheimer's disease (AD) research may limit potential benefits from translational applications. This article describes an approach to recruit AA families into an AD genomic study and characteristics of seeds (family connectors) used to overcome recruitment barriers of AA families into AD research. METHODS A four-step outreach and snowball sampling approach relying on family connectors was used to recruit AA families. Descriptive statistics of a profile survey were gathered to understand the demographic and health characteristics of family connectors. RESULTS Twenty-five AA families (117 participants) were enrolled in the study via family connectors. Most family connectors self-identified as female (88%), were 60 years of age or older (76%), and attained post-secondary education (77%). DISCUSSION Community-engaged strategies were essential to recruit AA families. Relationships between study coordinators and family connectors build trust early in the research process among AA families. HIGHLIGHTS Community events were most effective for recruiting African American families. Family connectors were primarily female, in good health, and highly educated. Systematic efforts by researchers are necessary to "sell" a study to participants.
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Affiliation(s)
- Grace Byfield
- Department of Genetics, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, 27514, USA
| | - Takiyah D. Starks
- Maya Angelou Center for Health Equity, Wake Forest School of Medicine, Winston Salem, North Carolina, 27101, USA
| | | | - Christopher L. Edwards
- College of Arts, Social Sciences and Humanities, North Carolina Central University, Durham, North Carolina, 27707, USA
| | - Shawnta L. Lloyd
- Maya Angelou Center for Health Equity, Wake Forest School of Medicine, Winston Salem, North Carolina, 27101, USA
| | - Allison Caban-Holt
- Maya Angelou Center for Health Equity, Wake Forest School of Medicine, Winston Salem, North Carolina, 27101, USA
| | - Larry Deon Adams
- John P. Hussman Institute for Human Genomics, University of Miami Miller School of Medicine, Miami, Florida, 33136, USA
| | - Jeffery M. Vance
- John P. Hussman Institute for Human Genomics, University of Miami Miller School of Medicine, Miami, Florida, 33136, USA
- Dr. John T. Macdonald Foundation Department of Human Genetics, University of Miami Miller School of Medicine, Miami, FL, 33136, USA
| | - Michael Cuccaro
- John P. Hussman Institute for Human Genomics, University of Miami Miller School of Medicine, Miami, Florida, 33136, USA
- Dr. John T. Macdonald Foundation Department of Human Genetics, University of Miami Miller School of Medicine, Miami, FL, 33136, USA
- Department of Psychology & Behavioral Sciences, University of Miami Miller School of Medicine, Miami, Florida, 33136, USA
| | - Jonathan L. Haines
- Cleveland Institute for Computational Biology and Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, Ohio, 44106, USA
| | - Christiane Reitz
- Gertrude H. Sergievsky Center and the Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Columbia University, New York, New York, 10032, USA
| | - Margaret A. Pericak-Vance
- John P. Hussman Institute for Human Genomics, University of Miami Miller School of Medicine, Miami, Florida, 33136, USA
- Dr. John T. Macdonald Foundation Department of Human Genetics, University of Miami Miller School of Medicine, Miami, FL, 33136, USA
| | - Goldie S. Byrd
- Maya Angelou Center for Health Equity, Wake Forest School of Medicine, Winston Salem, North Carolina, 27101, USA
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Savold J, Cole M, Thorpe RJ. Barriers and solutions to Alzheimer's disease clinical trial participation for Black Americans. ALZHEIMER'S & DEMENTIA (NEW YORK, N. Y.) 2023; 9:e12402. [PMID: 37408664 PMCID: PMC10318422 DOI: 10.1002/trc2.12402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 04/10/2023] [Accepted: 05/16/2023] [Indexed: 07/07/2023]
Abstract
Introduction Black Americans are disproportionately burdened by Alzheimer's disease (AD) relative to other racial groups in the United States and continue to be underrepresented in AD clinical trials. This review explores the primary barriers for participation in clinical trials among Black Americans and provides literature-based recommendations to improve the inclusion of Black Americans in AD clinical trials. Methods We searched electronic databases and gray literature for articles published in the United States through January 1, 2023, ultimately identifying 26 key articles for inclusion. Results Barriers to participation in clinical trials for Black Americans are rooted in social determinants of health, including access to quality education and information, access to health care, economic stability, built environment, and community context. Best practices to improve the inclusion of Black Americans in clinical trials require pharmaceutical companies to adopt a multifaceted approach, investing in innovative strategies for site selection, development of local partnerships, outreach, and education. Discussion While multisectoral action must occur to effectively address the disproportionate burden of AD on Black Americans, the pharmaceutical industry has an important part to play in this space due to their central role in product development and clinical trials.
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Affiliation(s)
- Jordan Savold
- Johns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | - Michele Cole
- Global Market Access, Neuroscience Therapeutic AreaJohnson & JohnsonRaritanNew JerseyUSA
| | - Roland J. Thorpe
- Johns Hopkins Alzheimer's Disease Resource Center for Minority Aging ResearchBaltimoreMarylandUSA
- Johns Hopkins Center for Health Disparities SolutionsBaltimoreMarylandUSA
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6
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Eliacin J, Hathaway E, Wang S, O'Connor C, Saykin AJ, Cameron KA. Factors influencing the participation of Black and White Americans in Alzheimer's disease biomarker research. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2022; 14:e12384. [PMID: 36505397 PMCID: PMC9728547 DOI: 10.1002/dad2.12384] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 11/04/2022] [Accepted: 11/10/2022] [Indexed: 12/12/2022]
Abstract
Introduction Alzheimer's disease (AD) is a public health priority. AD biomarkers may vary based on race, but the recruitment of diverse participants has been challenging. Methods Three groups of Black and White participants with and without prior research advocacy or participation were interviewed individually or in focus groups to better understand perspectives related to AD biomarker research participation. A rapid qualitative data analytic approach was used to analyze the data. Results Identified barriers to AD biomarker research participation included hesitancy due to fear, distrust of research and researchers, lack of relevant knowledge, and lack of research test results disclosure. Drivers for engagement in biomarker research procedures included knowledge about research, AD, and related clinical procedures, perceived benefits of participation, and outreach from trusted sources. Discussion Participants' comments related to the need for diversity in research and desire for results disclosure suggest opportunities to engage Black individuals. Highlights Black Americans experience more salient barriers to Alzheimer's disease (AD) biomarker research participation.Concerns about research diversity influence research participation decisions.Research test disclosure may affect research participation and retention.
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Affiliation(s)
- Johanne Eliacin
- VA HSR&D Center for Health Information and CommunicationRichard L. Roudebush VA Medical CenterIndianapolisIndianaUSA,Regenstrief InstituteIndianapolisIndianaUSA,National Center for PTSDBoston VA Healthcare SystemBostonMassachusettsUSA,Indiana Alzheimer's Disease Research CenterIndiana University School of MedicineIndianapolisIndianaUSA
| | - Elizabeth Hathaway
- Department of PsychiatryIndiana University School of MedicineIndianapolisIndianaUSA
| | - Sophia Wang
- Indiana Alzheimer's Disease Research CenterIndiana University School of MedicineIndianapolisIndianaUSA,Department of PsychiatryIndiana University School of MedicineIndianapolisIndianaUSA
| | - Caitlin O'Connor
- VA HSR&D Center for Health Information and CommunicationRichard L. Roudebush VA Medical CenterIndianapolisIndianaUSA
| | - Andrew J. Saykin
- Indiana Alzheimer's Disease Research CenterIndiana University School of MedicineIndianapolisIndianaUSA,Center for NeuroimagingDepartment of Radiology and Imaging SciencesIndiana University School of MedicineIndianapolisIndianaUSA,Department of Medical and Molecular GeneticsIndiana University School of MedicineIndianapolisIndianaUSA
| | - Kenzie A. Cameron
- Department of MedicineDivision of General Internal MedicineFeinberg School of MedicineNorthwestern UniversityChicagoIllinoisUSA
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Lennon JC, Aita SL, Del Bene VA, Rhoads T, Resch ZJ, Eloi JM, Walker KA. Black and White individuals differ in dementia prevalence, risk factors, and symptomatic presentation. Alzheimers Dement 2022; 18:1461-1471. [PMID: 34854531 PMCID: PMC9160212 DOI: 10.1002/alz.12509] [Citation(s) in RCA: 65] [Impact Index Per Article: 32.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 09/23/2021] [Accepted: 09/28/2021] [Indexed: 01/25/2023]
Abstract
INTRODUCTION Although dementia prevalence differs by race, it remains unclear whether cognition and neuropsychiatric symptom severity differ between Black and White individuals with dementia. METHODS Using National Alzheimer's Coordinating Center (NACC) data, we evaluated dementia prevalence in non-Hispanic Black and White participants and compared their clinicodemographic characteristics. We examined race differences in cognition, neuropsychiatric symptoms, and functional abilities in participants with dementia using multivariable linear and logistic regression models. RESULTS We included 5,700 Black and 31,225 White participants across 39 Alzheimer's Disease Research Centers. Of these, 1,528 (27%) Black and 11,267 (36%) White participants had dementia diagnoses. Despite having lower dementia prevalence, risk factors were more prevalent among Black participants. Black participants with dementia showed greater cognitive deficits, neuropsychiatric symptoms/severity, and functional dependence. DISCUSSION Despite lower dementia prevalence, Black participants with dementia had more dementia risk factors, as well as greater cognitive impairment and neuropsychiatric symptom severity than White participants.
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Affiliation(s)
- Jack C. Lennon
- Department of Psychology, Adler University, Chicago, IL 60602, USA
| | - Stephen L. Aita
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, NH 03755, USA
| | - Victor A. Del Bene
- Department of Neurology, University of Alabama at Birmingham School of Medicine, Birmingham, AL 35233, USA
| | - Tasha Rhoads
- Department of Psychology, Rosalind Franklin University of Medicine & Science, North Chicago, IL 60064, USA
| | - Zachary J. Resch
- Department of Psychology, Rosalind Franklin University of Medicine & Science, North Chicago, IL 60064, USA
| | - Janelle M. Eloi
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, NH 03755, USA
| | - Keenan A. Walker
- Laboratory of Behavioral Neuroscience, Intramural Research Program, National Institute on Aging, Baltimore, MD 21224, USA,Corresponding author: Keenan Walker, Ph.D., BRC BG RM 04B311, 251 Bayview BLVD., Baltimore, MD 21224, , Office Phone: 667-205-2657
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Parker LJ, Gaugler JE, Gitlin LN. Use of Critical Race Theory to Inform the Recruitment of Black/African American Alzheimer's Disease Caregivers into Community-Based Research. THE GERONTOLOGIST 2022; 62:742-750. [PMID: 34999789 PMCID: PMC9154262 DOI: 10.1093/geront/gnac001] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Indexed: 01/09/2023] Open
Abstract
Nearly 30 years after the 1993 National Institute of Health (NIH) Revitalization Act, which required the inclusion of women and racial/ethnic minority groups into government-funded clinical trials, minority groups remain underrepresented in research, and disparities in health outcomes and longevity remain. These problematic trends are particularly evident when considering Black and community-based research in Alzheimer's disease and related dementia (ADRD). Deeply rooted historical race-based mistreatment in research and in the health care system at large along with ineffective recruitment approaches persists as barriers to the low participation of Black participants in dementia care studies. In this article, we explore Critical Race Theory, its tenets, and applicability to inform national strategies to encourage participation of Black participants in ADRD research. We describe how Critical Race Theory constructs (e.g., race consciousness, storytelling, and praxis) can be used to inform recruitment strategies of Black caregivers for people living with dementia into community-based research. We provide a case example that draws upon our NIH-funded Adult Day Service Plus randomized trial and its engagement of Black caregivers into a community-based biomarker research arm of the main trial. Although the contribution of this article is primarily theoretical, in the spirit of Critical Race Theory it is also a call for action to transform dementia care research by offering a conceptual tool to assure inclusivity of Black participants, who are disproportionately affected by dementia when compared to other racial groups.
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Affiliation(s)
- Lauren J Parker
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Joseph E Gaugler
- School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Laura N Gitlin
- College of Nursing and Health Professions, Drexel University, Philadelphia, Pennsylvania, USA
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Gilmore-Bykovskyi A, Croff R, Glover CM, Jackson JD, Resendez J, Perez A, Zuelsdorff M, Green-Harris G, Manly JJ. Traversing the Aging Research and Health Equity Divide: Toward Intersectional Frameworks of Research Justice and Participation. THE GERONTOLOGIST 2022; 62:711-720. [PMID: 34324633 PMCID: PMC9154232 DOI: 10.1093/geront/gnab107] [Citation(s) in RCA: 50] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Indexed: 11/14/2022] Open
Abstract
Meaningful reductions in racial and ethnic inequities in chronic diseases of aging remain unlikely without major advancements in the inclusion of minoritized populations in aging research. While sparse, studies investigating research participation disparities have predominantly focused on individual-level factors and behavioral change, overlooking the influence of study design, structural factors, and social determinants of health on participation. This is also reflected in conventional practices that consistently fail to address established participation barriers, such as study requirements that impose financial, transportation, linguistic, and/or logistical barriers that disproportionately burden participants belonging to minoritized populations. These shortcomings not only risk exacerbating distrust toward research and researchers, but also introduce significant selection biases, diminishing our ability to detect differential mechanisms of risk, resilience, and response to interventions across subpopulations. This forum article examines the intersecting factors that drive both health inequities in aging and disparate participation in aging research among minoritized populations. Using an intersectional, social justice, and emancipatory lens, we characterize the role of social determinants, historical contexts, and contemporaneous structures in shaping research accessibility and inclusion. We also introduce frameworks to accelerate transformative theoretical approaches to fostering equitable inclusion of minoritized populations in aging research.
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Affiliation(s)
- Andrea Gilmore-Bykovskyi
- University of Wisconsin-Madison Center for Health Disparities Research, Madison, WI, USA
- University of Wisconsin–Madison School of Nursing, Madison, WI, USA
| | - Raina Croff
- NIA Layton Aging and Alzheimer’s Disease Center, Oregon Health & Science University, Portland, Oregon, USA
| | - Crystal M Glover
- Division of Behavioral Sciences, Rush Medical College, Chicago, Illinois, USA
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, Illinois, USA
| | - Jonathan D Jackson
- Community Access, Recruitment, & Engagement (CARE) Research Center, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Jason Resendez
- UsAgainstAlzheimer’s, Washington, District of Columbia, USA
| | - Adriana Perez
- University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA
| | - Megan Zuelsdorff
- University of Wisconsin-Madison Center for Health Disparities Research, Madison, WI, USA
| | | | - Jennifer J Manly
- Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York City, New York, USA
- Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Columbia University, New York City, New York, USA
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Bazargan M, Bazargan-Hejazi S. Disparities in Palliative and Hospice Care and Completion of Advance Care Planning and Directives Among Non-Hispanic Blacks: A Scoping Review of Recent Literature. Am J Hosp Palliat Care 2021; 38:688-718. [PMID: 33287561 PMCID: PMC8083078 DOI: 10.1177/1049909120966585] [Citation(s) in RCA: 69] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES Published research in disparities in advance care planning, palliative, and end-of-life care is limited. However, available data points to significant barriers to palliative and end-of-life care among minority adults. The main objective of this scoping review was to summarize the current published research and literature on disparities in palliative and hospice care and completion of advance care planning and directives among non-Hispanc Blacks. METHODS The scoping review method was used because currently published research in disparities in palliative and hospice cares as well as advance care planning are limited. Nine electronic databases and websites were searched to identify English-language peer-reviewed publications published within last 20 years. A total of 147 studies that addressed palliative care, hospice care, and advance care planning and included non-Hispanic Blacks were incorporated in this study. The literature review include manuscripts that discuss the intersection of social determinants of health and end-of-life care for non-Hispanic Blacks. We examined the potential role and impact of several factors, including knowledge regarding palliative and hospice care; healthcare literacy; communication with providers and family; perceived or experienced discrimination with healthcare systems; mistrust in healthcare providers; health care coverage, religious-related activities and beliefs on palliative and hospice care utilization and completion of advance directives among non-Hispanic Blacks. DISCUSSION Cross-sectional and longitudinal national surveys, as well as local community- and clinic-based data, unequivocally point to major disparities in palliative and hospice care in the United States. Results suggest that national and community-based, multi-faceted, multi-disciplinary, theoretical-based, resourceful, culturally-sensitive interventions are urgently needed. A number of practical investigational interventions are offered. Additionally, we identify several research questions which need to be addressed in future research.
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Affiliation(s)
- Mohsen Bazargan
- Department of Family Medicine, Charles R. Drew University of Medicine and Science (CDU), Los Angeles, CA, USA
- Department of Family Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Shahrzad Bazargan-Hejazi
- Department of Psychiatry, Charles R. Drew University of Medicine and Science (CDU), Los Angeles, CA, USA
- Department of Psychiatry, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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Sinha N, Berg CN, Yassa MA, Gluck MA. Increased dynamic flexibility in the medial temporal lobe network following an exercise intervention mediates generalization of prior learning. Neurobiol Learn Mem 2021; 177:107340. [PMID: 33186745 PMCID: PMC7861122 DOI: 10.1016/j.nlm.2020.107340] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 07/29/2020] [Accepted: 11/01/2020] [Indexed: 11/28/2022]
Abstract
Recent work has conceptualized the brain as a network comprised of groups of sub-networks or modules. "Flexibility" of brain network(s) indexes the dynamic reconfiguration of comprising modules. Using novel techniques from dynamic network neuroscience applied to high-resolution resting-state functional magnetic resonance imaging (fMRI), the present study investigated the effects of an aerobic exercise intervention on the dynamic rearrangement of modular community structure-a measure of neural flexibility-within the medial temporal lobe (MTL) network. The MTL is one of the earliest brain regions impacted by Alzheimer's disease. It is also a major site of neuroplasticity that is sensitive to the effects of exercise. In a two-group non-randomized, repeated measures and matched control design with 34 healthy older adults, we observed an exercise-related increase in flexibility within the MTL network. Furthermore, MTL network flexibility mediated the beneficial effect aerobic exercise had on mnemonic flexibility, as measured by the ability to generalize past learning to novel task demands. Our results suggest that exercise exerts a rehabilitative and protective effect on MTL function, resulting in dynamically evolving networks of regions that interact in complex communication patterns. These reconfigurations may underlie exercise-induced improvements on cognitive measures of generalization, which are sensitive to subtle changes in the MTL.
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Affiliation(s)
- Neha Sinha
- Center for Molecular and Behavioral Neuroscience, Rutgers University-Newark, NJ, USA.
| | - Chelsie N Berg
- Center for Molecular and Behavioral Neuroscience, Rutgers University-Newark, NJ, USA.
| | - Michael A Yassa
- Center for the Neurobiology of Learning and Memory, Department of Neurobiology and Behavior, University of California, Irvine, CA, USA.
| | - Mark A Gluck
- Center for Molecular and Behavioral Neuroscience, Rutgers University-Newark, NJ, USA.
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12
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Denny A, Streitz M, Stock K, Balls-Berry JE, Barnes LL, Byrd GS, Croff R, Gao S, Glover CM, Hendrie HC, Hu WT, Manly JJ, Moulder KL, Stark S, Thomas SB, Whitmer R, Wong R, Morris JC, Lingler JH. Perspective on the "African American participation in Alzheimer disease research: Effective strategies" workshop, 2018. Alzheimers Dement 2020; 16:1734-1744. [PMID: 33034414 PMCID: PMC7887120 DOI: 10.1002/alz.12160] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 06/24/2020] [Accepted: 07/07/2020] [Indexed: 12/23/2022]
Abstract
The Washington University School of Medicine Knight Alzheimer Disease Research Center's "African American Participation in Alzheimer Disease Research: Effective Strategies" Workshop convened to address a major limitation of the ongoing scientific progress regarding Alzheimer's disease and related dementias (ADRD): participants in most ADRD research programs overwhelmingly have been limited to non-Hispanic white persons, thus precluding knowledge as to how ADRD may be represented in non-white individuals. Factors that may contribute to successful recruitment and retention of African Americans into ADRD research were discussed and organized into actionable next steps as described within this report.
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Affiliation(s)
- Andrea Denny
- Knight Alzheimer Disease Research Center, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Marissa Streitz
- Knight Alzheimer Disease Research Center, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Kristin Stock
- Washington University in Saint Louis, Saint Louis, Missouri, USA
| | - Joyce E Balls-Berry
- Knight Alzheimer Disease Research Center, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Lisa L Barnes
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, Illinois, USA
| | - Goldie S Byrd
- Maya Angelou Center for Health Equity, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Raina Croff
- Layton Aging & Alzheimer's Disease Center, Department of Neurology, Oregon Health and Science University, Portland, Oregon, USA
| | - Sujuan Gao
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Crystal M Glover
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, Illinois, USA
| | - Hugh C Hendrie
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | | | - Jennifer J Manly
- Department of Neurology, Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University Medical Center, New York, New York, USA
| | - Krista L Moulder
- Knight Alzheimer Disease Research Center, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Susan Stark
- Department of Occupational Therapy, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Stephen B Thomas
- Maryland Center for Health Equity, University of Maryland College Park, College Park, Maryland, USA
| | - Rachel Whitmer
- Alzheimer's Disease Research Center, UC Davis School of Medicine, Sacramento, California, USA
| | - Roger Wong
- Public Health Sciences Brown School, Washington University in Saint Louis, Saint Louis, Missouri, USA
| | - John C Morris
- Knight Alzheimer Disease Research Center, Harvey A & Dorismae Hacker Friedman Distinguished Professor of Neurology, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Jennifer H Lingler
- School of Nursing and Alzheimer's Disease Research Center, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
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13
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Shah-Williams E, Levy KD, Zang Y, Holmes AM, Stoughton C, Dexter P, Skaar TC. Enrollment of Diverse Populations in the INGENIOUS Pharmacogenetics Clinical Trial. Front Genet 2020; 11:571. [PMID: 32670350 PMCID: PMC7330082 DOI: 10.3389/fgene.2020.00571] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 05/11/2020] [Indexed: 12/15/2022] Open
Abstract
Recruitment of diverse populations and subjects living in Medically Underserved Areas and Populations (MUA/P's) into clinical trials is a considerable challenge. Likewise, representation of African-Americans in pharmacogenetic trials is often inadequate, but critical for identifying genetic variation within and between populations. To identify enrollment patterns and variables that predict enrollment in a diverse underserved population, we analyzed data from the INGENIOUS (Indiana GENomics Implementation and Opportunity for the UnderServed), pharmacogenomics implementation clinical trial conducted at a community hospital for underserved subjects (Safety net hospital), and a statewide healthcare system (Academic hospital). We used a logistic regression model to identify patient variables that predicted successful enrollment after subjects were contacted and evaluated the reasons that clinical trial eligible subjects refused enrollment. In both healthcare systems, African-Americans were less likely to refuse the study than non-Hispanic Whites (Safety net, OR = 0.68, and p < 0.002; Academic hospital, OR = 0.64, and p < 0.001). At the Safety net hospital, other minorities were more likely to refuse the study than non-Hispanic Whites (OR = 1.58, p < 0.04). The odds of refusing the study once contacted increased with patient age (Safety net hospital, OR = 1.02, p < 0.001, Academic hospital, OR = 1.02, and p < 0.001). At the Academic hospital, females were less likely to refuse the study than males (OR = 0.81, p = 0.01) and those not living in MUA/P's were less likely to refuse the study than those living in MUA/P's (OR = 0.81, p = 0.007). The most frequent barriers to enrollment included not being interested, being too busy, transportation, and illness. A lack of trust was reported less frequently. In conclusion, African-Americans can be readily recruited to pharmacogenetic clinical trials once contact has been successfully initiated. However, health care initiatives and increased recruitment efforts of subjects living in MUA/Ps are needed. Enrollment could be further enhanced by improving research awareness and knowledge of clinical trials, reducing time needed for participation, and compensating for travel.
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Affiliation(s)
- Ebony Shah-Williams
- Department of Medical and Molecular Genetics, Indiana University, Indianapolis, IN, United States
| | - Kenneth D. Levy
- Department of Medicine, Indiana University, Indianapolis, IN, United States
| | - Yong Zang
- Department of Biostatistics, Indiana University, Indianapolis, IN, United States
| | - Ann M. Holmes
- Department of Health Policy and Management, Fairbanks School of Public Health, Indiana University–Purdue University Indianapolis, Indianapolis, IN, United States
| | - Christa Stoughton
- Department of Urology, Indiana University Hospital, Indianapolis, IN, United States
| | - Paul Dexter
- Department of Medicine, Indiana University, Indianapolis, IN, United States
- Regenstrief Institute for Health Care, Indianapolis, IN, United States
| | - Todd C. Skaar
- Department of Medicine, Indiana University, Indianapolis, IN, United States
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14
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Bardach SH, Parsons K, Gibson A, Jicha GA. "From Victimhood to Warriors": Super-researchers' Insights Into Alzheimer's Disease Clinical Trial Participation Motivations. THE GERONTOLOGIST 2020; 60:693-703. [PMID: 31322657 DOI: 10.1093/geront/gnz096] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Recruitment and retention of research participant serve as a significant challenge in the search for ways to slow or prevent Alzheimer's disease. While barriers to participation are well documented, less is known about motivations for Alzheimer's disease clinical research participation. The purpose of this study was to explore what motivates individuals-who ultimately develop an ongoing connection to research and frequently participate-to engage and stay involved in Alzheimer's disease research. RESEARCH DESIGN AND METHODS Individuals who had participated in multiple Alzheimer's disease-related clinical trials, or their study partners, were interviewed about their decisions to engage and remain in research. FINDINGS Interviews were completed with 33 individuals, 28 research participants, and 5 study partners. All interviews were audio-recorded and transcribed verbatim for analysis. Respondents indicated learning about research opportunities through the media, community events, doctors, and other research participants. While many were initially motivated by a family history or knowing someone with Alzheimer's disease, others had no personal exposure. Individuals in prevention studies were generally proactive and viewed research as a constructive way to address memory concerns. While several individuals acknowledged personal benefits of research participation, most indicated an understanding of the importance of research and being motivated to help others in the future, frequently referencing a sense of social responsibility or moral obligation to help. Positive relationships with personnel at the site encouraged continued involvement. DISCUSSION AND IMPLICATIONS These findings suggest that efforts to identify research participants should highlight the value of research and help illuminate how participation may contribute to well-being of future generations.
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Affiliation(s)
- Shoshana H Bardach
- Sanders-Brown Center on Aging, University of Kentucky, Lexington.,College of Public Health, University of Kentucky, Lexington
| | - Kelly Parsons
- Sanders-Brown Center on Aging, University of Kentucky, Lexington
| | - Allison Gibson
- College of Social Work, University of Kentucky, Lexington
| | - Gregory A Jicha
- Sanders-Brown Center on Aging, University of Kentucky, Lexington.,College of Medicine, University of Kentucky, Lexington
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15
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Gilmore-Bykovskyi AL, Jin Y, Gleason C, Flowers-Benton S, Block LM, Dilworth-Anderson P, Barnes LL, Shah MN, Zuelsdorff M. Recruitment and retention of underrepresented populations in Alzheimer's disease research: A systematic review. ALZHEIMER'S & DEMENTIA (NEW YORK, N. Y.) 2019; 5:751-770. [PMID: 31921966 PMCID: PMC6944728 DOI: 10.1016/j.trci.2019.09.018] [Citation(s) in RCA: 145] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
INTRODUCTION Alzheimer's disease and related dementias (ADRD) disproportionately impact racial and ethnic minority and socioeconomically disadvantaged adults. Yet, these populations are significantly underrepresented in research. METHODS We systematically reviewed the literature for published reports describing recruitment and retention of individuals from underrepresented backgrounds in ADRD research or underrepresented participants' perspectives regarding ADRD research participation. Relevant evidence was synthesized and evaluated for quality. RESULTS We identified 22 eligible studies. Seven studies focused on recruitment/retention approaches, all of which included multifaceted efforts and at least one community outreach component. There was considerable heterogeneity in approaches used, specific activities and strategies, outcome measurement, and conclusions regarding effectiveness. Despite limited use of prospective evaluation strategies, most authors reported improvements in diverse representation in ADRD cohorts. Studies evaluating participant views focused largely on predetermined explanations of participation including attitudes, barriers/facilitators, education, trust, and religiosity. Across all studies, the strength of evidence was low. DISCUSSION Overall, the quantity and quality of available evidence to inform best practices in recruitment, retention, and inclusion of underrepresented populations in ADRD research are low. Further efforts to systematically evaluate the success of existing and emergent approaches will require improved methodological standards and uniform measures for evaluating recruitment, participation, and inclusivity.
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Affiliation(s)
- Andrea L. Gilmore-Bykovskyi
- Division of Geriatrics, Department of Medicine, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA
- University of Wisconsin-Madison School of Nursing, Madison, WI, USA
- William S. Middleton Memorial Veterans Hospital, Geriatric Research Education and Clinical Center, Madison, WI, USA
| | - Yuanyuan Jin
- University of Wisconsin-Madison School of Nursing, Madison, WI, USA
| | - Carey Gleason
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA
| | - Susan Flowers-Benton
- Department of Family Medicine and Community Health, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA
| | - Laura M. Block
- University of Wisconsin-Madison School of Nursing, Madison, WI, USA
| | - Peggye Dilworth-Anderson
- Gillings School of Global Public Health, University of North Carolina Chapel Hill, Chapel Hill, NC, USA
| | - Lisa L. Barnes
- Department of Neurological Sciences, Rush Alzheimer's Disease Center, Rush University, Chicago, IL, USA
| | - Manish N. Shah
- Division of Geriatrics, Department of Medicine, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA
- Department of Emergency Medicine, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA
| | - Megan Zuelsdorff
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA
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