More than Tuskegee: understanding mistrust about research participation

Exploring relationships among smoking cessation app use, smoking behavioral outcomes, and pharmacotherapy utilization among individuals who smoke cigarettes

INTRODUCTION

Most individuals who smoke cigarettes are interested in quitting, but many are unable to quit. Fewer than one-third of individuals who smoke cigarettes attempt to quit using FDA-approved cessation methods, such as nicotine replacement therapy (NRT) and prescription medications. Smoking cessation apps (SCAs) provide individuals with personalized quit plans, information about smoking cessation treatments, craving management strategies, and other features. However, their relationship to NRT/prescription medication utilization and quit attempts is understudied.

METHODS

We conducted a longitudinal secondary data analysis using a subset of adults who smoked at least 100 cigarettes in their lifetime, currently smoked every day or some days, and planned to quit within a year. This subset was drawn from the Population Assessment of Tobacco and Health (PATH) Study, a nationally representative cohort study. We utilized Generalizing Estimating Equation models to examine the longitudinal associations between SCA use initiation and the following outcomes across 2014-2019: NRT, prescription medications, and quit attempts.

RESULTS

SCA use initiation was associated with greater odds of prescription medication utilization (AOR = 2.43, 95 % CI: 1.63, 3.64; p < 0.05). Likewise, SCA use initiation was associated with greater odds of making a quit attempt (AOR = 1.38, 95 % CI: 1.09, 1.76; p < 0.01), but not NRT utilization.

CONCLUSION

Among adults who regularly smoked cigarettes and had plans to quit, SCA use initiation was associated with prescription medication utilization and quit attempts but not NRT utilization. SCAs may have utility as a population-level intervention but specific features needed to be studied further.

ABBREVIATIONS

SCA, Smoking Cessation App; NRT, Nicotine Replacement Therapy.

Understanding Inclusion and Participation of People From Black African Diaspora Communities in Health and Care Research: A Realist Review

BACKGROUND

People from Black African Diaspora Communities (BAFDC) experience poorer health outcomes and are persistently under-represented in health and care research. There is limited understanding about how to support their greater inclusion and participation.

OBJECTIVES

Explore secondary data providing insights for the co-development of a realist theory of inclusion and participation for people from BAFDC in health and care research in the United Kingdom. Drawing on these theories, co-produce a realist review with a diverse range of people from BAFDC.

METHODS

A realist approach underpinned the study. Pawson's five steps to a realist approach were taken to shape the review, identify relevant sources, extract the data and then analyse and synthesise to inform an overarching programme theory. Initial programme theories (IPTs) were developed through context (C), mechanism (M), outcome (O) configurations (CMOCs).

MAIN RESULTS

The review identified 43 relevant documents. Synthesis of evidence from the documents resulted in 8 IPTs and 17 CMOCs helping to understand and explain the inclusion and participation of people from BAFDC. Four key thematic clusters emerged: (1) Health and care research as a White space, (2) Trust deficit: the expansiveness of broken trust, (3) Implicit and complicit bias and (4) Processes that affect inclusion and participation. Findings were underpinned by five existing mid-range theories (MRTs) around central concepts of candidacy, social dominance, networks, narratives and racism that guided analysis and synthesis, supporting conceptualisation of CMOCs. An overarching programme theory was developed.

CONCLUSION

The review identifies how the influence of perspectives, attitudes and beliefs held by individuals or groups about people from BAFDC operates in health and care research, resulting in exclusion, lack of trust and deficit thinking. The findings should be used to inform interventions aimed at increasing inclusion and participation of people from BAFDC.

PATIENT OR PUBLIC CONTRIBUTION

The co-production group comprised a diverse range of individuals from within the health and care research system with different lived experiences of being Black. They contributed to the entire review process, including the development of initial programme theories and retroductive thinking and interpretation of the evidence.

CLINICAL TRIAL REGISTRATION

Not applicable.

Ethno-racial differences in the frequency of cancer reported from family pedigrees in the prenatal genetic counseling setting

This study analyzed whether differences in cancer reporting exist between different ethno-racial groups in pedigrees from a prenatal genetic counseling setting. Data were collected from 446 charts at University of California, Irvine from January 1, 2015 to August 31, 2020. A total of 795 pedigrees meeting inclusion criteria were analyzed from four ethno-racial groups: White, Hispanic/Latinx, Asian, and African American/Black. The total number of first- and second-degree relatives affected with cancer was analyzed using contingency tables, nonparametric tests, and Poisson regression. Cancer reporting in first- and second-degree relatives was highest among the White group and lower in the Latinx, Asian, and Black groups. Ethno-racial group, presence or absence of the prospective father, and medical interpreter use were significant factors in predicting the number of relatives reported to have cancer in a Poisson regression model. Controlling for the total number of relatives in the pedigree, cancer reporting rates for the Latinx, Black, and Asian groups were 36.3%, 50.2%, and 65.5%, respectively, of that in the White pedigrees. Cancer reporting rates observed in Asian pedigrees (in comparison to White pedigrees) were similar to the rates reported by the Centers for Disease Control and Prevention, but reporting in the Latinx and Black pedigrees was less than would be expected based on population incidence. This suggests that cancer histories in some people of color (POC) may be truncated. Healthcare professionals should recognize that certain patient populations may have limited knowledge of their family cancer history, or that such information may not be disclosed due to nuances of cultural differences or possible provider bias. In order to provide appropriate risk assessment, interventions addressing structural barriers should be undertaken in prenatal clinics to reduce existing health disparities and improve health outcomes in POC, since this may be the only opportunity to obtain a comprehensive family health history.

Integrating public preferences to overcome racial disparities in research: findings from a US survey on enhancing trust in research data-sharing practices

Objectives

Data-sharing policies are rapidly evolving toward increased data sharing. However, participants' perspectives are not well understood and could have an adverse impact on participation in research. We evaluated participants' preferences for sharing specific types of data with specific groups, and strategies to enhance trust in data-sharing practices.

Materials and Methods

In March 2023, we conducted a nationally representative online survey with 610 US adults and used logistic regression models to assess sociodemographic differences in their willingness to share different types of data.

Results

Our findings highlight notable racial disparities in willingness to share research data with external entities, especially health policy and public health organizations. Black participants were significantly less likely to share most health data with public health organizations, including mental health (odds ratio [OR]: 0.543, 95% CI, 0.323-0.895) and sexual health/fertility information (OR: 0.404, 95% CI, 0.228-0.691), compared to White participants. Moreover, 63% of participants expressed that their trust in researchers would improve if given control over the data recipients.

Discussion

Participants exhibit reluctance to share specific types of personal research data, emphasizing strong preferences regarding external data access. This highlights the need for a critical reassessment of current data-sharing policies to align with participant concerns.

Conclusion

It is imperative for data-sharing policies to integrate diverse patient viewpoints to mitigate risk of distrust and a potential unintended consequence of lower participation among racial and ethnic minority participants in research.

The Roles of Acculturation and Pre-migration Experiences in Influencing the Confidence of Vietnamese Parents in Vaccine Use Among Adolescents

Vaccine confidence is a critical antecedent of vaccine uptake. Little research has examined vaccine confidence among Asian communities, particularly the associations with acculturation and pre-migration experiences. We explored this issue among U.S. Vietnamese parents. Our study uses an explanatory sequential mixed-methods design to investigate the influence of American acculturation, Vietnamese acculturation, and pre-migration experiences on U.S. Vietnamese parents' vaccine confidence for their adolescents. A cross-sectional web-based survey (n = 408) was followed by semi-structured interviews (n = 32). Quantitative analysis showed that many participants reported high or complete trust in scientists involved in vaccine development (61%), federal agencies responsible for vaccine safety monitoring and licensure (53%), the CDC (62%), and the FDA (58%). High or complete trust in scientists was associated with a higher Vietnamese acculturation score [aRR = 1.20 (1.03-1.40)], while trust in federal government agencies was associated with English medical proficiency [aRR = 1.42 (1.15-1.76)]. Qualitative findings provided deeper insights, with many parents expressing trust in vaccine efficacy, safety, and the rigorous development and approval process. Pre-migration experiences in Vietnam had mixed influences on vaccine confidence. Some participants cited positive experiences with the national immunization program, while others were influenced by negative vaccine-related injury stories. Newer immigrants reported limited familiarity with U.S. health authorities. Language preferences (Vietnamese versus English) for vaccine information varied. Our study highlights the complex interplay of acculturation, cultural identity, language, and historical experiences in shaping vaccine confidence among U.S. Vietnamese parents and emphasizes the need to take these factors into account with tailored public health strategies.

Beyond the Guinea Pig Myth: Understanding Complex Attitudes Toward Clinical Trials Participation in a Community Clinic

The urgency to enhance cancer clinical trial enrollment among racial and ethnic minority patients is underscored by the rise in novel therapies. This study examines referral mechanisms from a community-based oncology care clinic to an academic medical center, evaluates the clinical trial knowledge of minority groups, and explores perceptions and attitudes toward trials. Using a sequential explanatory mixed methods research design, the Clinical Trial Knowledge Survey was administered to patients seen at the Hem/Onc clinic in a community medical center. Descriptive statistics were calculated, and multivariate analysis was used to examine associations between variables using STATA 18. Qualitative data from 11 semistructured interviews were analyzed by two independent investigators using NVivo 14. Themes were identified through a combination of deductive and inductive approaches. Of the 502 mailers sent, 98 individuals responded (response rate of 9.56%). The average age of participants was 54 years, predominantly single and African American. The majority of the respondents (62%) agreed that patient participation is crucial for generating new and effective treatments. Then, 65% believed that clinical trials are typically conducted on drugs presumed to be effective. However, 32.99% of the respondents perceived participation in clinical trials as a frightening experience. Three qualitative themes emerged: (i) While clinical trial awareness was limited, willingness to participate was strongly endorsed. (ii) Potential participants obtain knowledge about clinical trials from multiple sources, impacting their attitudes toward clinical trials. (iii) There is a need to tailor educational strategies to increase awareness of and participation in clinical trials. The findings emphasize the critical role of awareness and tailored, culturally congruent educational strategies that are crucial to bridge the knowledge gap, alleviate hesitations, and enhance cancer clinical trial participation rates among racial and ethnic minorities.

Embodiment of structural racism and multiple sclerosis risk and outcomes in the USA

Disparities in the incidence, prevalence and outcomes of multiple sclerosis (MS) exist in the USA, often to the detriment of Black and Hispanic people. Despite the common misconception that MS is a disease of white people, the incidence is highest in Black people. Disability accumulates faster and at younger ages in Black and Hispanic people with MS than in their white counterparts, and MS-related mortality in early and mid-adulthood is highest in Black people. These differences are often erroneously interpreted as evidence of innate racial or ethnic variations. In this Perspective, we demonstrate how race and ethnicity - social constructs with a limited biological basis that are often assigned by systems of power - can influence biology through lived experiences, a phenomenon termed 'embodiment'. We review how downstream consequences of structural racism can lead to biological outcomes strongly associated with MS susceptibility, such as imbalanced immune system development, dysregulated immune responses to the Epstein-Barr virus and childhood obesity. We also consider how inequitable health-care access and quality, combined with the younger age of onset and higher comorbidity burdens, might explain racial and ethnic disparities in MS prognosis. Our proposed conceptual model offers a roadmap for generating knowledge and implementing interventions to narrow racial and ethnic disparities in MS susceptibility and outcomes.

Gender and race in neurotrauma: part 2-underrepresentation in clinical trial enrollment and impact on clinical outcomes

The underrepresentation of women and racial minorities in clinical trials populations remains a persistent challenge across many medical specialties, including Neurosurgery. A diverse research cohort brings varied perspectives and experiences, which can lead to more innovative solutions to medical problems, generalizable findings, and the foundations to provide culturally competent care to the populations most affected by the condition at hand. The importance of representative Neurotrauma trial populations cannot be overstated, as results are essential to inform decision making and gender and race have both been shown to significantly influence patient outcomes, as seen in the traumatic brain injury and spinal cord injury populations. Although the path towards gender and racial parity in clinical trial participants has been slow, numerous actions have been taken, including the FDA Safety and Innovation Act (2012) and Omnibus Reform Act (2022) on a systemic level. In this paper, we aimed to explore the barriers to and implications of inadequate representation in neurotrauma trials to outline a roadmap towards more diverse trial inclusion and retention. Key strategies moving forward include recruiting a diverse research team, developing flexible study protocols that support the varying needs of individuals of different backgrounds, establishing methods of data analysis that control for social and demographic factors instead of excluding individuals from participating, introducing patient navigators, reflecting on systemically engrained biases, implementing mandatory reporting of gender and race data, establishing and analyzing policies that keep researchers accountable towards goals of inclusive recruitment, and identifying and addressing unique barriers that individuals at the intersection of gender and racial minority status face.

Vaccine hesitancy among racially diverse parents in Canada: The important role of health literacy, conspiracy beliefs and racial discrimination

Parental vaccine hesitancy is a global public health issue that leads to lower immunization coverage among children. While vaccine mistrust is increased among racialized adults, whether parental vaccine hesitancy differs by ethnicity in the era of COVID-19 is unknown. Addressing these gaps in the literature, this study explores the factors influencing vaccine hesitancy among a racially diverse and representative sample of Canadian parents of children aged 0 to 12, comparing perspectives across different racial groups. An online survey was administered to a nationally representative sample of Arab, Asian, Black, Indigenous, White, and Mixed-race parents from October to November 2023. Data were collected on demographics, COVID-19 vaccine hesitancy, experience of major racial discrimination, conspiracy beliefs and health literacy. A total of 2528 parents (57.52 % women, 42.29 % men, and 0.20 % identified as non-binary gender) completed the survey. Significant mean differences in vaccine hesitancy were observed among racialized groups, F(7, 2520) = 3.89, p < .001, with Arab parents (M = 23.73, SD = 7.46) reporting higher hesitancy than White parents (M = 21.28, SD = 8.59). Younger participants (14-24 years) showed greater hesitancy (M = 23.98, SD = 8.22) than those aged 55+ (M = 20.26, SD = 7.83), F(4, 2523) = 2.84, p = .023. Regression analyses indicated that conspiracy beliefs (β = 0.48, p < .001) and racial discrimination (β = 0.09, p = .012) are key predictors of vaccine hesitancy. A significant interaction between conspiracy beliefs and discrimination was found among racialized groups (β = 0.24, p < .001). Based on these results, addressing vaccine hesitancy requires nuanced, participatory approaches that foster trust, counter misinformation, and acknowledge systemic racial inequities. As, health literacy, conspiracy beliefs, and racial discrimination significantly shape parental decisions, future policies must integrate culturally and racially tailored strategies to promote vaccination, ensuring that every child in Canada is protected.

"They Don't Respect Black Women": Narrating a Young Black Woman's Harrowing Birthing Experience

Black women tend to feel underserved due to the lack of culturally competent care and support from healthcare systems. In particular, the combination effects of racial discrimination, inadequate prenatal care, and pregnancy complications contribute to the increased risks of stress and trauma among Black pregnant women. Though the literature has documented the challenges that Black women face in the healthcare system, in-depth narratives of birthing experiences may provide a better understanding of these issues. In this paper, we used a qualitative approach to describe the case study of a 30-year-old Black American woman who had a harrowing birthing experience. We conducted an individual interview with the participant upon her request. Six key themes were derived from her narrative that summarized her birthing experience: healthcare provider miscommunication, lack of control, trauma experience, interpersonal racism, systemic racism, and internalized racism. The participant had a birthing experience that she felt "could not go untold." The discomfort and disrespect she experienced appear not to be uncommon in a considerable number of Black women of reproductive age. There is a need for healthcare providers to be trained to provide culturally appropriate care to Black women. In addition, healthcare providers need to treat Black women absent of prior stereotypes or biases to contribute to more effective care. Employing such treatment may improve Black women's reproductive health-seeking behavior as well as maternal and child health.

Disseminating Community-Engaged Research Involving People Experiencing Homelessness and Diabetes Using Participatory Theater

People experiencing homelessness balance competing priorities resulting in reduced capacity to meet the care demands of chronic conditions, including Type 2 Diabetes Mellitus (T2DM). Arts-based performances present an avenue to expose others to these challenges. This article describes the process of incorporating qualitative research findings in a community-based participatory theater production to expose audiences to the day-to-day realities of living with T2DM while simultaneously experiencing homelessness. We conducted five focus groups and two individual interviews with people living with T2DM who had experienced homelessness with guidance from a community-engaged research team. We then collaborated with a local theater company to present common themes from these focus groups in a co-created play about the experience of managing T2DM while being homeless. We performed a staged reading of the play and assessed audience members' perceived stigma through a pre- and post-survey to determine if audience engagement within our theatrical production could reduce stigma toward individuals living with diabetes and/or people experiencing homelessness. This theatrical production is titled "Life Heist: Stealing Hope While Surviving Diabetes and Homelessness." Our work illustrates the feasibility and effectiveness of using participatory theater to disseminate qualitative research findings.

Living with osteoarthritis pain during COVID-19: perspectives of Black and White Canadians

OBJECTIVE

This study examines the lived experience and daily impact of hip and knee osteoarthritis pain in Black and White Canadians in the context of the COVID-19 pandemic.

METHODS

An interpretative description approach was used. Recruitment was tailored to engage a diverse sample. During semi-structured, one-on-one interviews, participants reflected on their pain, its impact, and strategies for its management. A constant comparative approach was used. Standardized questionnaires collected gender, race, and OA severity to describe the sample.

RESULTS

Thirty participants (15 Black, 15 White) with moderate knee and hip symptoms participated. OA pain was experienced on two continua. A continuum of control ranged from OA pain versus the participant controlling decisions to participate in daily activities. A continuum of certainty ranged from doubting versus feeling confident in the ability to manage OA pain. These continua intersected, creating quadrants. Pain controlling decisions and uncertainty led to a quadrant of feeling worn out. Pain controlling decisions and certainty resulted in a quadrant of unmet expectations. The participant controlling decisions combined with uncertainty was experienced as coping. The participant controlling decisions combined with certainty in managing OA pain created overcoming. Contextual factors that influenced these continua included COVID-19 restrictions, housing, employment, interactions with healthcare providers, and health literacy.

CONCLUSION

Participants' experiences of OA pain were linked to the sense of control in daily decisions and certainty in managing OA pain, reflecting concepts of locus of control and self-efficacy. Sociocultural factors, life experiences, and issues such as employment, housing, COVID-19 restrictions, and health literacy shaped these experiences.

Using hair biomarkers to examine social-emotional resilience in adolescence: A feasibility study

Background

The SKY Schools Program combines breath-based techniques and a social-emotional learning curriculum. We examined its effects on objective physiological biomarkers, including hair cortisol (HCC, chronic stress measure) and hair oxytocin (HOC, social affiliation measure), as well as behavioral (youth risk behaviors) and mental health outcomes (anxiety, depression).

Methods

The SKY Schools program was adapted for post-pandemic restrictions (i.e., staff shortages, no lessons requiring writing, limited weekly follow-ups) and implemented among 7th grade students (daily in-person 40-min sessions for three weeks during physical education classes). Longitudinal assessments were obtained at baseline (T1, February 2022, N = 21), post-intervention (T2, June 2022, N = 20), and follow-up (T3, December 2022, N = 18).

Results

Most of our sample was male (67 %), Hispanic (62 %), and lived in low-income (<$100K) households (75 %). Students reported fewer poor mental health days at follow-up (Friedman test p < 0.01). Log-normal (Ln)-HCC (p < 0.01) were higher post-intervention vs. baseline (median 1.81 (IQR 1.63-2.46) vs. 1.60 (0.91-1.85)) and lower at follow-up (1.23; IQR: 0.64-1.50), with HCC in more students moving into the adaptive range (25th-75th percentile). Ln-HOC (p = 0.04) were higher post-intervention vs. baseline (1.78 (1.54-2.26) vs. 1.50 (0.81-1.70)).

Conclusions

This study uniquely evaluated the impact of the SKY intervention on hair cortisol (HCC) and hair oxytocin concentrations (HOC), which are objective, physiological measures of chronic stress and social affiliation. Results suggest that SKY may improve social affiliation and possibly HPA-axis regulation.

COVID-19 Vaccine Uptake Rates and Associated Factors in Racially Diverse Parents in Canada: The Threat From Conspiracy Beliefs and Racial Discrimination

Although vaccination is a well-recognized illness prevention strategy in medicine, vaccine uptake remains inconsistent in racialized and Indigenous communities in North America. Given that vaccination decisions in children are largely mediated by their parents' beliefs and values, this study aimed to examine vaccination rates and associated factors among parents of children aged 0-12 years from various racial groups in Canada. A cross-sectional study was conducted in 2023, involving a nationally representative sample of 2528 parents of children aged 0-12 years across Canada (57.52% women). Vaccine uptake prevalence rate was 86.39% among the participants. We observed significant differences in vaccination prevalence for racialized parents, χ2 (6) = 32.65, p < 0.001. Overall, Asian parents had the highest vaccine uptake (95.49%), compared to Arab (89.29%), White (85.59%), Other (84.33%), Black (84.33%) and Indigenous (83.13%) parents. Lowest COVID-19 vaccination rates were found for mixed racial group parents (77.01%). Conspiracy beliefs (β = -0.19, p < 0.001) and everyday experiences of racial discrimination (White vs. Racialized groups, β = -0.09, p = 0.037) were negatively associated with vaccine uptake. This study offers a novel regard on parent beliefs and behaviors regarding vaccination, disaggregated by various racial groups. While vaccination remains a cornerstone of public health, our findings reveal disparities that extend beyond access, reflecting deeper societal influences. Variations in uptake across racial groups, shaped by trust and lived experiences, underscore the need for inclusive strategies that foster confidence and engagement in immunization efforts.

Acceptability of Stool-Based DNA Colorectal Cancer Screening among Black/African-American Patients Served by Federally Qualified Health Centers

Colorectal cancer (CRC) has an increased burden among Black/African-American populations. Following the COVID-19 pandemic, home-based CRC screening options are being used more frequently. We conducted focus groups to understand the acceptability of stool-based DNA testing for CRC screening in this population. Ten focus groups about the acceptability of various CRC screening modalities were held with Black/African-American participants at two federally qualified health centers (FQHCs) in Milwaukee, Wisconsin. Participants were separated into focus groups based on age and gender. Thematic analysis was carried out using NVivo. Across the groups, there were a total of 79 participants, of which 40.5% were aged 40-50 years ("younger participants"), 59.5% aged > 50 years ("older participants"), 53.2% male, and 46.8% female. Overall, knowledge was low regarding perceived risk of CRC. There was limited awareness of CRC screening options among younger patients and widespread lack of knowledge about stool-based DNA testing. Most respondents preferred colonoscopy as their first-choice screening test but were open to other screening tests. Stool-based DNA tests were more preferred among younger participants but was felt to be acceptable across all groups. Given the low awareness/knowledge of screening modalities identified in our study, educational interventions and shared decision making by primary care providers are needed.

Treatment Decision-Making in West African Women With Breast Cancer: A Critical Ethnography

OBJECTIVES

This study aimed to understand and characterize how culture affected behavior and decision-making about treatment and care in West African women with breast cancer living in the United Kingdom.

METHODS

A critical ethnographic design was used with a sample consisting of 32 West African women, 27 supporters, and 18 health care professionals. Data were collected through 263 hours of participant observation and 98 informal and 10 formal interviews in a London cancer unit. Study materials and approach were informed by patient and public involvement group recommendations. Data were analyzed using an adapted Carspecken critical ethnographic approach.

RESULTS

Three main themes were developed from the data: cultural knowledge, beliefs, and values; otherness; and cultural curiosity. West African women described a range of meanings and beliefs about their breast cancer diagnoses and treatments. They felt "Other" from, and were seen as "Other" by, their communities and health care teams. The clinical team exhibited varying levels of cultural curiosity, which evolved over time.

CONCLUSION

Cultural beliefs concerning cancer and its treatment were so strong that they led to some women refusing, delaying, or interrupting treatment. Nurses must seek to understand and value the perspectives and beliefs of people from unfamiliar cultures and consider how services might be made more flexible to meet their specific needs.

IMPLICATIONS FOR NURSING PRACTICE

By being culturally curious and gaining understanding about how a woman's culture affects decisions about treatment and care, health care professionals began to understand that patients are more able to accept optimum treatment if adjustments are made to the service.

Using Social Media to Engage and Enroll Underrepresented Populations: Longitudinal Digital Health Research

BACKGROUND

Emerging digital health research poses roadblocks to the inclusion of historically marginalized populations in research. Exclusion of underresourced communities in digital health research is a result of multiple factors (eg, limited technology access, decreased digital literacy, language barriers, and historical mistrust of research and research institutions). Alternative methods of access and engagement may aid in achieving long-term sustainability of diversified participation in digital health research, ensuring that developed technologies and research outcomes are effective and equitable.

OBJECTIVE

This study aims to (1) characterize socioeconomic and demographic differences in individuals who enrolled and engaged with different remote, digital, and traditional recruitment methods in a digital health pregnancy study and (2) determine whether social media outreach is an efficient way of recruiting and retaining specific underrepresented populations (URPs) in digital health research.

METHODS

The Better Understanding the Metamorphosis of Pregnancy (BUMP) study was used as a case example. This is a prospective, observational, cohort study using digital health technology to increase understanding of pregnancy among 524 women, aged 18-40 years, in the United States. The study used different recruitment strategies: patient portal for genetic testing results, paid/unpaid social media ads, and a community health organization providing care to pregnant women (Moses/Weitzman Health System).

RESULTS

Social media as a recruitment tool to engage URPs in a digital health study was overall effective, with a 23.6% (140/594) enrollment rate of those completing study interest forms across 25 weeks. Community-based partnerships were less successful, however, resulting in 53.3% (57/107) engagement with recruitment material and only 8.8% (5/57) ultimately enrolling in the study. Paid social media ads provided access to and enrollment of a diverse potential participant pool of race- or ethnicity-based URPs in comparison to other digital recruitment channels. Of those that engaged with study materials, paid recruitment had the highest percentage of non-White (non-Hispanic) respondents (85/321, 26.5%), in comparison to unpaid ads (Facebook and Reddit; 37/167, 22.2%). Of the enrolled participants, paid ads also had the highest percentage of non-White (non-Hispanic) participants (14/70, 20%), compared to unpaid ads (8/52, 15.4%) and genetic testing service subscribers (72/384, 18.8%). Recruitment completed via paid ads (Instagram) had the highest study retention rate (52/70, 74.3%) across outreach methods, whereas recruitment via community-based partnerships had the lowest (2/5, 40%). Retention of non-White (non-Hispanic) participants was low across recruitment methods: paid (8/52, 15.4%), unpaid (3/35, 14.3%), and genetic testing service subscribers (50/281, 17.8%).

CONCLUSIONS

Social media recruitment (paid/unpaid) provides access to URPs and facilitates sustained retention similar to other methods, but with varying strengths and weaknesses. URPs showed lower retention rates than their White counterparts across outreach methods. Community-based recruitment showed lower engagement, enrollment, and retention. These findings highlight social media's potential for URP engagement and enrollment, illuminate potential roadblocks of traditional methods, and underscore the need for tailored research to improve URP enrollment and retention.

Decentralized Biobanking Apps for Patient Tracking of Biospecimen Research: Real-World Usability and Feasibility Study

BACKGROUND

Biobank privacy policies strip patient identifiers from donated specimens, undermining transparency, utility, and value for patients, scientists, and society. We are advancing decentralized biobanking apps that reconnect patients with biospecimens and facilitate engagement through a privacy-preserving nonfungible token (NFT) digital twin framework. The decentralized biobanking platform was first piloted for breast cancer biobank members.

OBJECTIVE

This study aimed to demonstrate the technical feasibility of (1) patient-friendly biobanking apps, (2) integration with institutional biobanks, and (3) establishing the foundation of an NFT digital twin framework for decentralized biobanking.

METHODS

We designed, developed, and deployed a decentralized biobanking mobile app for a feasibility pilot from 2021 to 2023 in the setting of a breast cancer biobank at a National Cancer Institute comprehensive cancer center. The Flutter app was integrated with the biobank's laboratory information management systems via an institutional review board-approved mechanism leveraging authorized, secure devices and anonymous ID codes and complemented with a nontransferable ERC-721 NFT representing the soul-bound connection between an individual and their specimens. Biowallet NFTs were held within a custodial wallet, whereas the user experiences simulated token-gated access to personalized feedback about collection and use of individual and collective deidentified specimens. Quantified app user journeys and NFT deployment data demonstrate technical feasibility complemented with design workshop feedback.

RESULTS

The decentralized biobanking app incorporated key features: "biobank" (learn about biobanking), "biowallet" (track personal biospecimens), "labs" (follow research), and "profile" (share data and preferences). In total, 405 pilot participants downloaded the app, including 361 (89.1%) biobank members. A total of 4 central user journeys were captured. First, all app users were oriented to the ≥60,000-biospecimen collection, and 37.8% (153/405) completed research profiles, collectively enhancing annotations for 760 unused specimens. NFTs were minted for 94.6% (140/148) of app users with specimens at an average cost of US $4.51 (SD US $2.54; range US $1.84-$11.23) per token, projected to US $17,769.40 (SD US $159.52; range US $7265.62-$44,229.27) for the biobank population. In total, 89.3% (125/140) of the users successfully claimed NFTs during the pilot, thereby tracking 1812 personal specimens, including 202 (11.2%) distributed under 42 unique research protocols. Participants embraced the opportunity for direct feedback, community engagement, and potential health benefits, although user onboarding requires further refinement.

CONCLUSIONS

Decentralized biobanking apps demonstrate technical feasibility for empowering patients to track donated biospecimens via integration with institutional biobank infrastructure. Our pilot reveals potential to accelerate biomedical research through patient engagement; however, further development is needed to optimize the accessibility, efficiency, and scalability of platform design and blockchain elements, as well as a robust incentive and governance structure for decentralized biobanking.

Amplifying Lived Expertise on "Food Is Medicine" in the Mississippi Delta's Legacy of Racism

For generations, Mississippi Delta residents have been subjected to food inequity and resource deprivation from centuries of racism. The Food Is Medicine (FIM) movement is gaining salience as one solution to address diet-related health conditions in partnership with health care providers, medical systems, and local agriculture groups. The Delta GREENS (Growing a Resilient, Enriching, Equitable, Nourishing food System) FIM research study conducted focus groups in July and August 2023 to center the perspectives and lived expertise of residents in the Mississippi Delta receiving health care services from the Delta Health Centers. This analytic essay provides context of the past and present food and farming infrastructure in the Mississippi Delta from the residents of these communities. The goal is to inform equitable and sustainable FIM interventions in the rural South and elsewhere in the country among historically marginalized populations. (Am J Public Health. 2025;115(4):528-535. https://doi.org/10.2105/AJPH.2024.307937).

Trust in scientists and their role in society across 68 countries

Science is crucial for evidence-based decision-making. Public trust in scientists can help decision makers act on the basis of the best available evidence, especially during crises. However, in recent years the epistemic authority of science has been challenged, causing concerns about low public trust in scientists. We interrogated these concerns with a preregistered 68-country survey of 71,922 respondents and found that in most countries, most people trust scientists and agree that scientists should engage more in society and policymaking. We found variations between and within countries, which we explain with individual- and country-level variables, including political orientation. While there is no widespread lack of trust in scientists, we cannot discount the concern that lack of trust in scientists by even a small minority may affect considerations of scientific evidence in policymaking. These findings have implications for scientists and policymakers seeking to maintain and increase trust in scientists.

Racial and Ethnic Disparities Among Patients Enrolled in Breast Reconstruction-Related Clinical Trials

INTRODUCTION

Breast reconstruction clinical trials that reflect the racial and ethnic makeup of breast cancer disease burden are fundamental in improving breast reconstruction accessibility and outcomes. We aim to evaluate race and ethnicity reporting in breast reconstruction-related clinical trials (BRRCTs) and determine whether reported race and ethnicity of enrollees aligns with their breast cancer incidence rates in the general US population.

METHODS

All completed, US-based BRRCTs were retrospectively reviewed via ClinicalTrials.gov in February 2024. Age, race, ethnicity, and BRRCT funding source were recorded. BRRCT enrollment rates of racial and ethnic groups were compared to their expected representation rates, calculated using breast cancer incidence rate. Descriptive statistics and univariate analyses were performed.

RESULTS

Twenty-five studies representing 2603 patients were included. The mean age of enrollees was 49.4 ± 2.2 years. Seven (28%) reported enrollees' race, and 5 (20%) reported both race and ethnicity. Most enrollees were White (90.8%), followed by Black (3.5%), Asian (1.5%), and American Indian/Alaska Native (AI/AN) (0.1%). Fewer enrollees identified as Hispanic/Latino than non-Hispanic/Latino (7.6% vs 91.5%, P < 0.01). Observed enrollment rates of minority groups were lower than their respective expected representation rates (Black: 3.5% vs 24.9%, P < 0.01; Asian: 1.5% vs 23.9%, P < 0.01; AI/AN: 0.1% vs 24.9%, P < 0.01; Hispanic/Latino: 7.6% vs 45.2%, P < 0.01). Conversely, White enrollees were overrepresented when compared to the group's overall breast cancer burden (90.8% vs 26.4%; P < 0.01).

CONCLUSIONS

Over 70% of BRRCTs did not report the race or ethnicity of enrollees. When reported, racial and ethnic minorities were significantly underrepresented in BRRCTs. More diligent reporting and proactive initiatives to increase recruitment of minority groups in clinical trials are needed to strengthen the validity of BRRCTs.

Racial, Ethnic, Sex, and Geographical Diversity in Myositis Clinical Trials

OBJECTIVE

The number of randomized clinical trials (RCTs) with patients with idiopathic inflammatory myopathies (IIMs) has grown exponentially over the last decade. Race, ethnicity, and sex reporting and representation of participants as well as the geographic distribution of enrolling sites in IIM RCTs are unknown. This information can provide critical insights into the current state of enrollment practices and generalizability in IIM RCTs.

METHODS

A systematic literature review assessed IIM RCTs published between 2010 to 2023. Sex and gender reporting was analyzed per Sex and Gender Equity in Research guidelines. Appropriate reporting of race and ethnicity was defined as reporting them for all trial participants. Countries were categorized based on the Human Development Index. US enrollment sites were grouped using the National Center for Health Statistics Urban-Rural Classification Scheme and medically underserved areas (MUAs).

RESULTS

Of the 19 RCTs included, race was appropriately reported in 58%. Black, Asian, and Hispanic or Latino participants represented 3%, 7%, and 2% of the enrollees, respectively. Ethnicity was only reported in 26% of RCTs, and 16% conflated race and ethnicity. Temporal trends showed encouraging results for race and ethnicity representation. Most trials (90%) had greater than 45% women participants. Geographic regions of sites included North America, Europe, Asia, and Australasia, with no sites in South America or Africa. The majority of US sites were located in large metropolitan areas, whereas none were in nonmetropolitan areas, and only 31% in MUAs.

CONCLUSION

Racial, ethnic, and geographic representation in IIM RCTs remains a critical issue. Inadequate reporting of race and ethnicity and limited sociodemographic and geographic representation of participants raise concerns about the generalizability of findings of IIM RCTs.

Medical Mistrust: A Concept Analysis

Background: The term "medical mistrust" has increased in literary usage within the last ten years, but the term has not yet been fully conceptualized. This article analyzes the usage of the term "medical mistrust" in the extant literature in order to articulate its antecedents, attributes, and consequences. The aim of this article is to provide a preliminary conceptual definition and conceptual figure for medical mistrust. Methods: Walker and Avant's method of conceptual analysis was used to extract concept attributes, antecedents, and consequences and define empirical referents. The databases PubMed, CINAHL, Scopus, and PSYCinfo and the Google search engine were used. Results: Medical mistrust is a social determinant of health fueled by a fear of harm and exploitation and is experienced at both the interpersonal, intergenerational, and institutional levels, reinforced by structural racism and systemic inequalities. Medical mistrust is antedated by historical trauma, socioeconomic disparities, medical gaslighting, traumatic medical experiences, maladaptive health beliefs and behaviors, and individual minority identities and is transmitted intergenerationally and culturally. The consequences of medical mistrust include the underutilization of health services, delays in diagnosis and care, poor treatment adherence, poor health outcomes, negative psychological effects, and an increase in the uptake of medical misinformation and maladaptive health behaviors. Conclusions: The findings of this concept analysis have important implications for healthcare providers, healthcare systems, and researchers, as well as healthcare policy makers.

Engaging Minoritized Communities in Clinical Trials Through Social Media: Recommendations from Community-Based Participatory Research

The current study aims to understand what Black and Latino community members know about clinical trials and develop effective messaging to generate interest, improve access, and encourage participation among minoritized populations through social media. Employing community-based participatory research, we formed a community research advisory team and conducted focus group interviews with Black and Latino community members about elements of social media messages that might reduce hesitancy about and increase engagement in clinical trials. From the interview transcripts, we extracted seven key themes: transparency, familiarity, altruism, adaptability, flexibility, recognition, and safety. We suggest leveraging these themes as strategies to craft targeted recruitment messages addressing barriers to participation in clinical trials among Black and Latino community members.

Barriers and facilitators for engaging underrepresented ethnic minority populations in healthcare research: an umbrella review

BACKGROUND

Research highlights that participation of ethnic minority individuals in research is low when compared to white counterparts. This poses challenges for healthcare planning and delivery, as lack of representativeness in research means that findings are generalised across all ethnic groups, and do not provide stakeholders with a full picture of how minority populations are affected. This contributes to health inequalities as these populations may then be underserved and not get the best possible management if differences due to ethnicity were to exist. This study synthesises the barriers to engaging minority individuals in research to understand, and enablers to better engagement of different minority communities in healthcare research.

METHODS

Five databases were searched (MEDLINE, CINAHL, PsycINFO and Web of Science and EMBASE) up to 29th April 2024, resulting in 897 articles, of which 11 met the inclusion criteria. Data were extracted from reviews and synthesised using qualitative meta-aggregation techniques. The socio-ecological framework was applied to synthesise the main outcomes. A protocol for this review was registered on PROSPERO (CRD42024532686).

RESULTS

The main barriers for research participation included: mistrust of healthcare professionals, research and researchers; socioeconomic and logistical challenges; language and cultural barriers; lack of awareness; external influences and perceived bias. Facilitators to support better research participation included: Community engagement and personalised approaches; culturally sensitive research strategies; linguistically appropriate study materials and study advertising; education workshops.

CONCLUSIONS

To enable wider participation, it is important to understand not only the barriers but also to employ culturally appropriate facilitators, engaging with patient and public involvement (PPI) groups that communities trust, offer cultural training for researchers, and adopt a more collaborative and transparent way of working. This overview highlights the work that needs to be done on an intrapersonal, interpersonal, community and policy level to make research accessible and inclusive for ethnic minority groups.

Bias recognition and mitigation strategies in artificial intelligence healthcare applications

Artificial intelligence (AI) is delivering value across all aspects of clinical practice. However, bias may exacerbate healthcare disparities. This review examines the origins of bias in healthcare AI, strategies for mitigation, and responsibilities of relevant stakeholders towards achieving fair and equitable use. We highlight the importance of systematically identifying bias and engaging relevant mitigation activities throughout the AI model lifecycle, from model conception through to deployment and longitudinal surveillance.

Building a Decentralized Biobanking App for Research Transparency and Patient Engagement: Participatory Design Study

BACKGROUND

Patient-derived biospecimens are invaluable tools in biomedical research. Currently, there are no mechanisms for patients to follow along and learn about the uses of their donated samples. Incorporating patients as stakeholders and meaningfully engaging them in biomedical research first requires transparency of research activities.

OBJECTIVE

In this paper, we describe the use of participatory design methods to build a decentralized biobanking "de-bi" mobile app where patients could learn about biobanking, track their specimens, and engage with ongoing research via patient-friendly interfaces overlaying institutional biobank databases, initially developed for a breast cancer use case.

METHODS

This research occurred in 2 phases. In phase 1, we designed app screens from which patients could learn about ongoing research involving their samples. We embedded these screens in a survey (n=94) to gauge patients' interests regarding types of feedback and engagement opportunities; survey responses were probed during 6 comprehensive follow-up interviews. We then held an immersive participatory design workshop where participants (approximately 50) provided general feedback about our approach, with an embedded codesign workshop where a subset (n=15) provided targeted feedback on screen designs. For phase 2, we refined user interfaces and developed a functional app prototype in consultation with institutional stakeholders to ensure regulatory compliance, workflow compatibility, and composability with local data architectures. We presented the app at a second workshop, where participants (n=25, across 9 groups) shared thoughts on the app's usability and design. In this phase, we conducted cognitive walkthroughs (n=13) to gain in-depth feedback on in-app task navigation.

RESULTS

Most of the survey participants (61/81, 75%) were interested in learning the outcomes of research on their specimens, and 49% (41/83) were interested in connecting with others with the same diagnosis. Participants (47/60, 78%) expressed strong interest in receiving patient-friendly summaries of scientific information from scientists using their biospecimens. The first design workshop identified confusion in terminology and data presentation (eg, 9/15, 60% of co-designers were unclear on the biospecimens "in use"), though many appreciated the ability to view their personal biospecimens (7/15, 47%), and most were excited about connecting with others (12/15, 80%). In the second workshop, all groups found the app's information valuable. Moreover, 44% (5/9) noted they did not like the onboarding process, which was echoed in cognitive walkthroughs. Walkthroughs further confirmed interest in biospecimen tracking, and 23% (3/13) had confusion about not finding any of their biospecimens in the app. These findings guided refinements in onboarding, design, and user experience.

CONCLUSIONS

Designing a patient-facing app that displays information about biobanked specimens can facilitate greater transparency and engagement in biomedical research. Co-designing the app with patient stakeholders confirmed interest in learning about biospecimens and related research, improved presentation of data, and ensured usability of the app in preparation for a pilot study.

Principles and practices of returning individual research results to participants in large studies of pregnancy and childhood

Investigators conducting human subject research have typically conveyed only clinically actionable results back to individual participants. Shifting scientific culture around viewing participants as partners in research, however, is prompting investigators to consider returning as much data or results as the participant would like, even if they are not clearly actionable. Expanding return of individual results may add value for individual participants and their communities, refine future research questions and methods, build trust, and enhance retention of participants. Yet, gaps remain in understanding the implications of these changes for groups of "vulnerable" participants, including pregnant and pediatric participants. Here we present the findings of a National Institutes of Health workshop on returning individual research results, particularly as applicable to pregnant and pediatric participants. Research participants who were panelists at the workshop agreed that they desired to receive their results. Workshop findings and current literature indicate that participants have differing preferences for what results they receive. One way to address the limits of current practice is to develop flexible digital platforms that convey individual results along with researchers' availability to answer questions, and to provide as much information as possible about actionable steps for controlling environmental exposures associated with disease risk.

Invited commentary: improving spatial exposure data for everyone-life-course social context and ascertaining residential history

Measuring age-specific, contextual exposures is crucial for life-course epidemiology research. Longitudinal residential data offer a "golden ticket" to cumulative exposure metrics and can enhance our understanding of health disparities. Residential history can be linked to myriad spatiotemporal databases to characterize environmental, socioeconomic, and policy contexts that a person has experienced throughout life. However, obtaining accurate residential history is challenging in the United States due to the limitations of administrative registries and self-reports. In a recent article, Xu et al (Am J Epidemiol. 2024;193(2):348-359) detailed an approach to linking residential history sourced from LexisNexis Accurint to a Wisconsin-based research cohort, offering insights into challenges with collection of residential history data. Researchers must analyze the magnitude of selection and misclassification biases inherent to ascertaining residential history from cohort data. A life-course framework can provide insights into why the frequency and distance of moves is patterned by age, birth cohort, racial/ethnic identity, socioeconomic status, and urbanicity. Historical and contemporary migration patterns of marginalized people seeking economic and political opportunities must guide interpretations of residential history data. In this commentary, we outline methodological priorities for use of residential history in health disparities research, including contextualizing residential history data with determinants of residential moves, triangulating spatial exposure assessment methods, and transparently quantifying measurement error.

Increasing African American representation in plastic surgery

Plastic surgery is a specialty crucial for addressing the needs of diverse patient, yet it faces significant underrepresentation of African Americans, especially in academic leadership. This imbalance persists throughout medical education, training, and professional advancement. Dr. Arthur L. Garnes, the first board-certified African American plastic surgeon, overcame profound challenges, inspiring subsequent generations. Notable figures like Dr. Camille Cash and Dr. Steven Williams further exemplify resilience in the face of barriers. Mentorship emerges as pivotal, fostering diversity and inclusion within plastic surgery. Initiatives promoting mentorship, financial support, and recruitment are essential to rectifying disparities, ensuring equitable representation, and improving access to care for minority patients.

Therapeutic Clinical Trial Eligibility and Enrollment among Women with Breast Cancer: Implications for Understanding Trial Disparities

INTRODUCTION

Therapeutic clinical trials frequently lack diverse representation, hindering generalizability and exacerbating preexisting disparities in clinical outcomes. This study explored associations between breast cancer patient demographics, clinical trial eligibility, and enrollment in a National Cancer Institute (NCI)-designated cancer center.

PATIENTS AND METHODS

This prospective cohort study included patients with breast cancer screened for therapeutic clinical trials from July 2020 to January 2024. Eligibility was determined by the provider and study coordinator. Patient characteristics were abstracted from the electronic medical record. Rurality and neighborhood disadvantage were mapped by address using rural-urban commuting area codes and area deprivation index (ADI), respectively. Likelihood of eligibility and enrollment by race, rurality, and neighborhood disadvantage were evaluated using risk ratios (RR) and 95% confidence intervals (CIs) from modified Poisson regression models.

RESULTS

Of 343 patients screened for therapeutic trials, the mean age was 56 years (SD 13), 33% were Black/other race, 22% lived in highly disadvantaged areas, and 16% in rural areas. Most patients were screened for one trial (87%). Overall, 54% of patients were eligible for trials, and of those, 58% enrolled. Similar likelihoods of eligibility and enrollment were seen by race and rurality. Though not significant, patients living in highly disadvantaged areas trended toward higher likelihood of enrollment (RR 1.24, 95% CI 0.99-1.55).

CONCLUSIONS

Over half of trial-eligible patients, even across race, rurality, or neighborhood disadvantage, enrolled, surpassing the national average. In contrast to national trends, there was higher enrollment among patients of higher ADI.

The Importance of Including Underserved Populations in Research

This paper provides an overview of the ethical considerations surrounding the inclusion of underserved populations in later-phase clinical trials. Underserved populations, defined here as those with restricted access to or limited benefits from healthcare, often face systemic, logistical, and social barriers that limit their participation in research. This results in a lack of representation that undermines fairness in research and also hampers the development of effective inclusive healthcare practices. This paper argues that including underserved populations in research is crucial for promoting justice, increasing the generalizability of research findings, and building trust in medical institutions. It differentiates underserved populations from other populations of interest, including vulnerable, minority, and underrepresented groups. It then explores barriers to research participation and targeted solutions for four underserved populations: rural residents, racial and ethnic minorities, low-income individuals, and older adults. Strategies for improving participation include expanding trial sites to accessible locations, lowering financial and logistical barriers, broadening eligibility criteria, and fostering culturally tailored outreach and engagement. While some interventions may apply broadly across groups, effective solutions will often require intersectional and context-specific strategies tailored to each population's unique needs as well as coordinated efforts from multiple stakeholders. While these interventions alone cannot resolve healthcare inequities - as underrepresentation of underserved populations in research is just one contributing factor - their widespread implementation would represent meaningful steps toward advancing health equity.

Parental Perceptions of Early Childhood In-Home Research with Monitoring: A Qualitative Study

OBJECTIVE

To explore perceptions, concerns, and enthusiasm from a diverse group of parents regarding early childhood research that involves home monitoring technologies for collecting environmental exposure data.

STUDY DESIGN

A diverse group of new and expecting parents participated in semi-structured interviews. A single interviewer conducted all sessions and introduced a hypothetical longitudinal early childhood research study, which included the following novel home monitoring approaches: (1) wearable devices, (2) audio monitoring, and (3) environmental sampling. Interviews were audio-recorded, transcribed, and coded. Qualitative description guided the study, and a constant comparative approach was used to identify themes from transcripts.

RESULTS

Twenty-four interviews were completed. Emerging themes included the following: (1) Ready and Willing to Participate; (2) Helping Others, Helping Ourselves: Motivation for Participation; (3) Trust and Transparency: Understanding the "What?" and the "Why?;" (4) Data Privacy and Security: "What If It Gets into the Wrong Hands?;" and (5) It's a Lot to Juggle: Logistical Realities. Perceptions were similar across racial, ethnic, and socioeconomic groups. Perceptions were positive, and participants desired additional information about study feasibility and purpose. Many had concerns related to wearable device safety and data privacy; a trusting relationship with the research team was a priority.

CONCLUSION

Participants had positive sentiments regarding longitudinal observational studies involving pregnancy and infancy yet expressed concerns about safety, privacy, feasibility, and transparency. These findings can inform future early childhood research study design to ensure protocols are transparent, inclusive, and appealing to parents.

Investigator racial diversity and clinical trial participation

We investigate whether increased racial diversity of clinical trial principal investigators could increase the enrollment of Black patients, which currently lags population and disease-burden. We conducted a survey experiment in which respondents were shown a photo of a current NIH investigator in which race (Black/White) was randomized. Sex was also randomized as a relevant benchmark. Black respondents reported 0.35 standard deviation units higher interest in participating in a clinical study led by a race concordant investigator (a 12.6% increase). Sex concordance had no effect. Further analyses indicate that perceived trustworthiness and attractiveness are the most important factors explaining these results.

Advancing Health Equity in the Cardiovascular Device Life Cycle

Despite advancements in diagnostics and therapeutics for cardiovascular disease, significant health disparities persist among patients from historically marginalized racial and ethnic groups, women, individuals who are socioeconomically under-resourced or underinsured, and those living in rural communities. While transcatheter interventions have revolutionized the treatment landscape in cardiology, populations bearing the greatest burden of disease continue to face inequitable access and poorer outcomes. A notable gap in the literature concerns the role of modern approaches to cardiovascular device innovation in shaping and perpetuating health disparities. Health equity has been declared one of the top strategic initiatives for 2022 to 2025 by the Food and Drug Administration Center for Devices and Radiological Health, underscoring the need for greater attention, dialogue, and targeted interventions in this space. This narrative review uses the cardiovascular device life cycle as a conceptual framework to enhance understanding and guide future efforts to mitigate disparities in the field of interventional cardiology. Drawing on illustrative examples from interventional cardiology, we examine current practices in cardiovascular device regulation and approval, clinical trial evaluation, adoption patterns, and postprocedural outcomes with the aim of uncovering potential mechanisms of disparities and identifying opportunities for targeted interventions.

Postpartum Patient Perspectives on the US Medicaid Waiting Period for Permanent Contraception

Objective

The Medicaid Consent to Sterilization policy is a known barrier to permanent contraception (PC) fulfillment and is associated with disparities in fulfillment. While physician perspectives regarding the policy are well described, knowledge of how patients with Medicaid seeking PC perceive this waiting period is limited.

Study Design

We interviewed 81 participants with a documented desire for PC at discharge from their hospital-based delivery at four medical centers across the United States. Interviews were audio-recorded, transcribed, and analyzed using rapid qualitative methodologies and thematic content analysis.

Results

Of the 81 participants interviewed, the 56 participants subject to the mandatory waiting period through insurance status or state residency were included in this analysis. Key positive themes included the role of the waiting period in facilitating minimization of regret, independent decision making, and protection against coercion and bias. Key negative themes included interference with reproductive autonomy, harm to the patient-clinician relationship, and introduction of unwanted doubt into contraceptive decisions. In addition, participants expressed both indifference and nuance when discussing the waiting period, and misinformation about the waiting period was prevalent during interviews. Participants with favorable opinions commonly changed their mind regarding PC, while participants with negative opinions were steadfast in their desires for PC and often experienced PC non-fulfillment.

Conclusion

Postpartum patients hold diverse views on the current Medicaid Consent to Sterilization policy's mandated waiting period. Patient engagement is fundamental when reevaluating and revising this policy to balance supporting autonomous decision-making about PC while protecting against reproductive coercion and regret.

Implications

In policy revision discussions, it is important to consider whether a mandated waiting period is the best way to minimize regret and promote autonomy. Revision that accounts for the complexity of patient desires and needs is imperative to achieving the dual goals of minimizing coercion and ensuring autonomously-desired provision.

"It's a reasonable gamble"-rural residents' experience participating in cancer clinical trials at a single rural trial unit

BACKGROUND

We conducted a qualitative study to examine what factors influence rural-residing people with cancer to participate in cancer clinical trials (CCT) and what factors influence their retention in CCT.

METHODS

Purposive sampling was used to recruit participants from a regional cancer centre in Victoria, Australia, to participate in a semi-structured interview. Eligible participants were ≥ 18 years of age at the time of cancer diagnosis, newly consented to a clinical trial (< 1 year) or have been a trial participant for ≥ 1 year, lived in a non-metropolitan area classified within the Monash Modified (MM) Model 2-7 and able to provide informed consent. Thematic analysis was used to analyse the interview data.

RESULTS

Seventeen participants were interviewed; 10 identified as female and seven as male. Participant's ages ranged from 52 to 77 years, with a median age of 62 years. Eight participants had been on a CCT for ≤ 1 and 10 for ≥ 1 year. Factors that influenced their decision to participate in a CCT included trust and confidence in clinical trial staff, exposure to and trust in the experiences of cancer peers, altruism, low-risk trials and local access to trials. The factors influencing their decision to remain in a CCT included balancing the benefits and burdens of the trial, having no doubts about participating despite knowing the risks and seeing the personal benefits of participating in a CCT.

CONCLUSION

Our study shows that trust-based relationships, peer support, and altruism encourage rural residents to participate in CCT. To improve access to CCT for rural residents, a multi-faceted approach involving clinicians, health services, trial sponsors and policymakers is needed. These approaches must promote and facilitate the inclusion of diverse populations, prioritise CCT participation, and inform patients of CCT opportunities. We must recognise the knowledge and expertise of rural patients and caregivers and ensure they are involved as co-designers of future CCTs.

Association of race and ethnicity with mortality in adults with SLE: a systematic literature review and meta-analysis

OBJECTIVES

Ethnicity and health outcomes are intrinsically interrelated, although mechanisms are complex. SLE is a disease with higher incidence in Asian, Black, Hispanic and Indigenous populations than in White populations. SLE is associated with premature mortality, but it is unclear if ethnicity impacts on health outcomes as studies are frequently underpowered. We aimed to describe the association between SLE and mortality across different racial and ethnic groups using meta-analysis.

METHODS

We identified studies of adults with SLE that reported mortality, stratified by racial and ethnic group, through a systematic literature review. We used a pairwise meta-analysis to determine the pooled odds ratio (OR) of death for those from underserved groups compared with those of White race and ethnicity.

RESULTS

Thirty-seven studies, comprising 85 578 patients with SLE, were included. Mortality was higher in Black patients (OR 1.30 (95% CI 1.16 to 1.46)) and Indigenous patients (OR 1.47 (95% CI 1.11 to 1.94)), while Asian and Hispanic patients showed no significant differences compared with White patients with SLE. Seventy per cent of included studies were conducted in the USA and when excluded, the significant difference in mortality between Black and White individuals with SLE was no longer seen (OR 0.84 (95% CI 0.54 to 1.31)).

CONCLUSION

Overall, patients with SLE from Black or Indigenous racial and ethnic groups had higher mortality than those of White race and ethnicity. We observed no significant association in the mortality of Black patients compared with White patients from non-USA cohorts, but a scarcity of data outside of the USA was highlighted. We promote caution in the use of race and ethnicity as a factor in determining mortality risk until more generalisable data are available.

PROSPERO REGISTRATION NUMBER

CRD42023379034.

A pilot mixed methods randomized control trial investigating the feasibility and acceptability of a culturally tailored intervention focused on beliefs, mistrust and race-congruent peer support for Black adults with diabetes

Introduction

Black adults disproportionately experience poor glycemic control and medication nonadherence, yet few diabetes self-management programs address their unique health beliefs, provider mistrust and sociocultural barriers to taking diabetes medications. This 6-month pilot randomized feasibility trial compared a culturally tailored diabetes self-management program, incorporating beliefs about diabetes, mistrust, and race-congruent peer support to a standard diabetes program.

Methods

An embedded mixed methods design examined the feasibility of the pilot trial, including recruitment, retention, intervention adherence and participant acceptability. Data were collected through participant self-reported questionnaires, field notes, semi-structured interviews, and focus groups. Qualitative content analysis inductively explored participants' feedback on the program, participation barriers and potential strategies to overcome the challenges. Mixed methods integration was implemented using a side-by-side joint display to compare, synthesize and interconnect the quantitative and qualitative results across all feasibility domains.

Results

Thirteen participants (93%) completed the trial, demonstrating high adherence and retention. Community outreach and a prerequisite orientation using motivational interviewing were feasible and appropriate to recruit potential participants. Participants expressed high satisfaction and acceptability, highlighting the importance of peer support, cultural relevant content and a safe space for sharing experiences. Barriers to participation were identified including schedule conflicts and difficulties in engagement.

Discussion

Future large-scale effectiveness trials should consider combining multimedia into recruitment methods, tailoring the program to address medication-taking goals, and addressing social and environmental barriers to support sustained lifestyle changes.

Cross-sectional design and protocol for Artificial Intelligence Ready and Equitable Atlas for Diabetes Insights (AI-READI)

INTRODUCTION

Artificial Intelligence Ready and Equitable for Diabetes Insights (AI-READI) is a data collection project on type 2 diabetes mellitus (T2DM) to facilitate the widespread use of artificial intelligence and machine learning (AI/ML) approaches to study salutogenesis (transitioning from T2DM to health resilience). The fundamental rationale for promoting health resilience in T2DM stems from its high prevalence of 10.5% of the world's adult population and its contribution to many adverse health events.

METHODS

AI-READI is a cross-sectional study whose target enrollment is 4000 people aged 40 and older, triple-balanced by self-reported race/ethnicity (Asian, black, Hispanic, white), T2DM (no diabetes, pre-diabetes and lifestyle-controlled diabetes, diabetes treated with oral medications or non-insulin injections and insulin-controlled diabetes) and biological sex (male, female) (Clinicaltrials.org approval number STUDY00016228). Data are collected in a multivariable protocol containing over 10 domains, including vitals, retinal imaging, electrocardiogram, cognitive function, continuous glucose monitoring, physical activity, home air quality, blood and urine collection for laboratory testing and psychosocial variables including social determinants of health. There are three study sites: Birmingham, Alabama; San Diego, California; and Seattle, Washington.

ETHICS AND DISSEMINATION

AI-READI aims to establish standards, best practices and guidelines for collection, preparation and sharing of the data for the purposes of AI/ML, including guidance from bioethicists. Following Findable, Accessible, Interoperable, Reusable principles, AI-READI can be viewed as a model for future efforts to develop other medical/health data sets targeted for AI/ML. AI-READI opens the door for novel insights in understanding T2DM salutogenesis. The AI-READI Consortium are disseminating the principles and processes of designing and implementing the AI-READI data set through publications. Those who download and use AI-READI data are encouraged to publish their results in the scientific literature.

Methodology for promoting equity-informed research in sport and exercise medicine: recommendations from the AMSSM Collaborative Research Network

BACKGROUND

Limited guidance exists for conducting research on health disparities within the field of sport and exercise medicine (SEM). This review aimed to identify and summarise existing best practices for conducting equitable, diverse and inclusive research within SEM.

METHODS

A narrative review with evidence synthesis was conducted using electronic databases, reference lists, manual searches and relevant publications from other organisations. Search terms associated with steps of the research process were used in tandem with 'equity', 'inclusion' and 'health disparities'.

RESULTS

We developed a research roadmap for SEM researchers with methodological recommendations to develop and conduct equity-informed and equity-focused research. This roadmap serves as a tool for SEM researchers and clinicians to design, execute and disseminate research with a health disparities lens. We recommend SEM researchers should build an equitable, diverse and inclusive research team and include community members; apply a multilevel, intersectional framework; minimise and acknowledge potential biases in the study design and incorporate qualitative or mixed-methods approaches if appropriate; apply multiple inclusive strategies for recruiting and retaining diverse populations; collect accurate and representative data using inclusive data collection methods and tools with validity and reliability in the populations of interest; apply measures with evidence of validity and reliability in the populations of interest; implement a data analysis plan that reflects the conceptual and theoretical frameworks; and promote broad dissemination and interventions that ultimately address and reduce health inequities.

CONCLUSION

SEM researchers should consider these methodological recommendations to conduct equity-informed and equity-focused research to address health disparities in SEM.

A Systematic Review and Meta-Analysis Assessing Diversity and Representation in Diabetic Retinopathy Clinical Trials in the U.S

PURPOSE

To perform a systematic review and meta-analysis assessing the diversity and representation of diabetic retinopathy (DR) patients in clinical trials conducted in the United States from January 1, 2018, to December 31, 2023.

METHODS

A comprehensive search strategy was conducted on May 28th, 2024 using MEDLINE (PubMed) and Embase (Elsevier) to identify relevant clinical trials. Inclusion criteria included trials published between January 1, 2018 and December 31, 2023, focusing on interventions for DR that were conducted in the United States. Screening and data extraction were independently performed by three reviewers.

RESULTS

Eleven clinical trials met the inclusion criteria and were analyzed for participant representation based on sex, age, and race/ethnicity. Sex representation was rated as good in 9 of the 11 studies. However, age representation was rarely reported (only 1/11 studies) and race/ethnicity representation was poor in 6 of the 11 studies. The findings highlight significant underrepresentation of Asian and Black populations.

CONCLUSION

This study reveals substantial disparities in the demographic representation within DR clinical trials in the United States, emphasizing the critical need for improved inclusion strategies. Enhancing diversity in these trials is essential for producing research findings that are more applicable to the broader population affected by DR, ultimately contributing to more equitable healthcare outcomes and advancing the effectiveness of treatments across diverse demographic groups.

Exploring Trust in Research Among Black American Men at a Health Promotion Symposium in Rural North Carolina

Despite efforts to diversify research and health programs, Black American men remain a "hard-to-reach" population while collectively suffering from some of the worst health outcomes in the United States. Faith- and community-based approaches have shown potential to engage Black Americans in health promotion and health research activities. The purpose of this article is to examine health research participation and trust in research among a sample of Black American men in rural North Carolina who attended a community-based health symposium, culturally tailored for Black American men (n = 112). A cross-sectional survey was administered among men to learn about health status, health concerns, and perception of health research. Among 106 men who completed the survey, most reported no prior participation in health research (68.87%), but almost a third of men reported interest in participating in health research. No significant differences in trust in research was found based on interest in research participation (interested in research participation, not interested in research participation, no response), presenting an opportunity to increase the trustworthiness of medical institutions and build relationships with this population. These findings will inform future research and health programming for Black American men in rural locations.

Socioeconomic Factors Associated With Participation in Postmortem Tissue Donation in Pediatric Central Nervous System Tumors

BACKGROUND

The gift of postmortem tissue donation is critical to pediatric central nervous system (CNS) research. As a "Center of Excellence" for the Gift from a Child Program, our institution has a well-established postmortem tissue donation program. Our objective was to determine if differences exist between patients who participated in and those that declined research-based autopsy.

PROCEDURE

We performed a single-institution retrospective chart review of pediatric patients with CNS malignancies who died from their disease between January 1, 2021 and December 31, 2022. Individual clinical, demographic, and socioeconomic data were assessed. Population-level data were estimated using Zip Code Tabulation Areas. Descriptive statistics were used to compare categorical data.

RESULTS

Among the 23 patient families approached during the study time frame, 8/23 (35%) consented to participation. In the consented (C) versus declined (D) group, there was a higher percentage of White, non-Hispanic/Latino patients by self-reported race (C: 88% vs. D: 55%), and no patients who identified as Asian or Hispanic/Latino (C: 0% and 0% vs. D: 13% and 27%). Of all patients approached, two required interpreters (9%), and both families declined participation. The rate of private insurance was higher in the consented group (C: 75% vs. D: 47%) compared to Medicaid as primary insurance in the declined group (C: 13% vs. D: 53%).  CONCLUSIONS: Future research should aim to understand and improve identified disparities to ensure research advancements benefit all children with CNS malignancies. One area we plan to address is improved communication with non-English-speaking families by partnering with our interpreter services.

A qualitative study of Black breast cancer previvors' and survivors' experiences after positive genetic testing

Black women have a disproportionately high mortality rate from breast cancer, which is likely influenced by an intersection of environmental, cultural, economic, and social factors. Few published studies capture the experiences of Black women after a genetic diagnosis associated with increased risk for breast cancer. This study aims to explore the perspectives and experiences of Black women who carry a pathogenic variant associated with increased breast cancer risk and identify barriers to care for this population. We conducted semi-structured interviews with 16 participants with and without histories of breast cancer. The sample included representation across a range of demographic groups (e.g., income level, employment status, insurance status, and education level). Reflexive thematic analysis was the methodology used to analyze data. Five major themes emerged from participants' descriptions of their experiences during and after genetic testing: (1) searching for representation; (2) information enabling agency; (3) healthcare providers as facilitators or barriers to care; (4) self-identity impacting disclosure; and (5) evolving mental health and coping strategies. Participants identified barriers to care including challenging or misinformed healthcare providers, medical racism, and a lack of Black representation in the cancer community. This work deepens our understanding of the nuanced experiences of Black women across the continuum of cancer care, illustrates unmet needs, and provides a foundation for future research that includes the perspectives of Black women.

"Being alone for a whole year [is hard]" Families reflect on the emotional toll of stem cell transplantation for sickle cell disease

OBJECTIVE

Sickle cell disease (SCD) is associated with significant morbidity and mortality. Hematopoietic stem cell transplantation (HCT) can improve health-related quality of life (HRQOL) but may be physically and emotionally challenging. Thus, the aim of this study was to understand the experience of HCT from the perspective of youth and young adults (YYAs) post-HCT for SCD and their parents.

METHODS

YYAs were recruited from an urban hospital. Sociodemographic and HCT-specific information was analyzed for all enrolled. YYAs and/or their primary caregivers during HCT, participated in semi-structured interviews (e.g., pre-HCT knowledge, challenges, advice for families/health care providers). Interviews were audio-recorded, transcribed, and analyzed using content analysis.

RESULTS

There were 19 YYAs enrolled (63.2% male; 68.4% Black or African American; 47.4% Hispanic or Latino; M days post-HCT = 1946.53 ± 1329.13; M age at HCT = 10.95 ± 6.10 years old; M current age 15.74 ± 5.78 years old). Interviews were done with six YYAs alone, five YYA-caregiver dyads, and eight caregivers alone. The caregivers were all mothers. Participants reported underestimating the emotional impact HCT would have on themselves and their family members. They experienced challenges related to isolation, academics, finances, and post-HCT medical needs. In contrast, they felt well prepared for physiological aspects of HCT. They sought HCT to improve YYAs' HRQOL and encouraged others to consider it, but to be cognizant of the potential psychosocial impact.

CONCLUSIONS

This study highlights the importance of preparing families for the psychosocial effects of HCT. Incorporating psychosocial assessment, education, and intervention throughout HCT has the potential to promote HRQOL for YYAs and their families.

Motivation to Clinical Trial Participation: Health Information Distrust and Healthcare Access as Explanatory Variables and Gender as Moderator

Background: There is significant underrepresentation in clinical trials across diverse populations. Less is known about how health system-related factors, such as relationships and trust, mediate the motivation for clinical trial participation. We aimed to investigate whether health system-related factors explain the association between sociodemographic factors and motivation for participation. Additionally, we explored whether the mediating effects differ by gender. Methods: We used the Health Information National Trends Survey 2020 cycle-4 data. Motivation for clinical trial participation, assessed through eight items, was the outcome variable (range 1-4). Predictors included age, race, ethnicity, education, general health, and depression. The health system-related explanatory variables were health information distrust, having a regular provider, and the frequency of healthcare visits. Gender was the moderator. A structural equation model (SEM) was used for the overall and gender-stratified analyses. Results: Among the 3865 participants (mean [SE] age of 48.4 [0.53] years, 51.4% women, and 24.3% non-White), older age (β = -0.170; p < 0.001) and non-White race (β = -0.078; p < 0.01) were negatively associated, and higher education (β = 0.117; p < 0.001) was positively associated with motivation. Higher distrust (β = -0.094; p < 0.01) decreased motivation, whereas having a regular provider increased motivation (β = 0.087; p < 0.01). The gender-stratified SEM revealed that women, but not men, with higher distrust showed lower motivation (β = -0.121; p < 0.01), and men, but not women, with a regular healthcare provider showed higher motivation (β = 0.116; p < 0.01). Conclusions: Our study found that women with higher distrust showed lower motivation, while men with a regular healthcare provider demonstrated higher motivation. These gender differences highlight the need for tailored recruitment approaches that account for their distinct relationships with the health system.

Reporting of participant race and ethnicity from COVID-19 randomized controlled drug and biologicals trials: a scoping review

Racial and ethnic minorities have been disproportionally burdened by hospitalization and death due to COVID-19. Participation of individuals of diverse races and ethnicities in clinical trials, according to study-level characteristics of randomized controlled trials (RCTs) that test effectiveness of COVID-19 drugs, could be insightful for future researchers. Our objective for this scoping review was to describe the frequency of race and ethnicity reported as demographic variables and specific reporting of race and ethnicity according to COVID-19 RCT characteristics. We conducted comprehensive searches in PubMed, ProQuest, World Health Organization Database, and Cochrane Central Register of Controlled Trials, and gray literature via preprint servers from January 1, 2020, to May 4, 2022. We included RCTs on emergency- or conditionally approved COVID-19 drug interventions (remdesivir, baricitinib, and molnupiravir) with or without comparators. Self-reported race as American Indian/Pacific Islander, Asian, Black/African American, or White, ethnicity as Hispanic/Latinx, study design characteristics, and participant-relevant data were collected. In total, 17 RCTs with 17 935 participants were included. Most (n = 13; 76%) reported at least 1 race and ethnicity and were US-based, industry-funded RCTs. Asian, Black, Latinx, and White participants were mostly enrolled in RCTs that studied remdesivir. Native American and Hawaiian participants were mostly assessed for progression to high-flow oxygen/noninvasive ventilation. Time to recovery was assessed predominantly in Black and White participants, whereas hospitalization or death was mostly assessed in Asian, Latinx, and multirace participants. Trialists should be aware of RCT-level factors and characteristics that may be associated with low participation of racial and ethnic minorities, which could inform evidence-based interventions to increase minority participation.

Barriers and facilitators to conducting human subjects research at a safety net institution from the perspective of researchers

INTRODUCTION

The COVID-19 pandemic revealed glaring problems with clinical research enterprise. Faced with crisis, several trials opened rapidly but enrolled homogenous populations with few Black, Indigenous, and People of Color (BIPOC) individuals. Inclusive trial enrollment is important to inspire trust and confidence in BIPOC populations that have been historically excluded or harmed from research and to improve the generalizability of research findings. Safety-net hospitals and institutions often care for BIPOC populations, and thus it is essential to improve equitable participation in research at these institutions. In this study, we sought to understand barriers and facilitators to research participation at safety net institutions.

METHODS

We conducted semi-structured interviews among principal investigators, research assistants, research coordinators, and research nurses who conducted human subjects research at an urban, safety-net hospital from October, 2022 to December, 2022. We used inductive qualitative methods to identify themes associated with barriers and facilitators to clinical research participation.

RESULTS

We completed 28 interviews and identified five themes: (1) compared to non-safety net systems, safety-net systems were perceived to require additional resources and funding to achieve comparable research recruitment and retention; (2) language barriers and translational processes are burdensome for researchers; (3) interactions between research staff and patients impact trust; (4) social determinants of health specific to safety-net populations are a barrier to participation; (5) competing priorities between clinical staff and researchers exist.

CONCLUSION

Safety net institutions face several barriers to conducting human subjects research. However, identified facilitators may help inform future efforts to reduce inequities in research participation.