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Madden EB, Hindorff LA, Bonham VL, Akintobi TH, Burchard EG, Baker KE, Begay RL, Carpten JD, Cox NJ, Di Francesco V, Dillard DA, Fletcher FE, Fullerton SM, Garrison NA, Hammack-Aviran CM, Hiratsuka VY, Hildreth JEK, Horowitz CR, Hughes Halbert CA, Inouye M, Jackson A, Landry LG, Kittles RA, Leek JT, Limdi NA, Lockhart NC, Ofili EO, Pérez-Stable EJ, Sabatello M, Saulsberry L, Schools LE, Troyer JL, Wilfond BS, Wojcik GL, Cho JH, Lee SSJ, Green ED. Advancing genomics to improve health equity. Nat Genet 2024:10.1038/s41588-024-01711-z. [PMID: 38684898 DOI: 10.1038/s41588-024-01711-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 03/08/2024] [Indexed: 05/02/2024]
Abstract
Health equity is the state in which everyone has fair and just opportunities to attain their highest level of health. The field of human genomics has fallen short in increasing health equity, largely because the diversity of the human population has been inadequately reflected among participants of genomics research. This lack of diversity leads to disparities that can have scientific and clinical consequences. Achieving health equity related to genomics will require greater effort in addressing inequities within the field. As part of the commitment of the National Human Genome Research Institute (NHGRI) to advancing health equity, it convened experts in genomics and health equity research to make recommendations and performed a review of current literature to identify the landscape of gaps and opportunities at the interface between human genomics and health equity research. This Perspective describes these findings and examines health equity within the context of human genomics and genomic medicine.
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Affiliation(s)
- Ebony B Madden
- Office of the Director, National Human Genome Research Institute, Bethesda, MD, USA.
| | - Lucia A Hindorff
- Office of the Director, National Human Genome Research Institute, Bethesda, MD, USA
| | - Vence L Bonham
- Office of the Director, National Human Genome Research Institute, Bethesda, MD, USA
| | - Tabia Henry Akintobi
- Department of Community Health and Preventative Medicine, Morehouse School of Medicine, Atlanta, GA, USA
| | - Esteban G Burchard
- Department of Bioengineering and Therapeutic Sciences, University of California, San Francisco, CA, USA
| | | | - Rene L Begay
- Centers for American Indian and Alaska Native Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - John D Carpten
- Comprehensive Cancer Center, City of Hope, Duarte, CA, USA
| | - Nancy J Cox
- Vanderbilt Genetics Institute, Vanderbilt University, Nashville, TN, USA
| | | | - Denise A Dillard
- Department of Medical Education and Clinical Sciences, Washington State University College of Medicine, Seattle, WA, USA
| | - Faith E Fletcher
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX, USA
| | | | - Nanibaa' A Garrison
- Institute for Society and Genetics, University of California, Los Angeles, Los Angeles, CA, USA
- Institute for Precision Health, UCLA David Geffen School of Medicine, Los Angeles, CA, USA
- Division of General Internal Medicine and Health Services Research, UCLA David Geffen School of Medicine, Los Angeles, CA, USA
| | | | - Vanessa Y Hiratsuka
- Center for Human Development, University of Alaska Anchorage, Anchorage, AK, USA
| | | | | | - Chanita A Hughes Halbert
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, CA, USA
| | - Michael Inouye
- Department of Public Health and Primary Care, University of Cambridge Victor Phillip Dahdaleh Heart and Lung Research Institute, Cambridge, UK
| | - Amber Jackson
- Office of the Director, National Human Genome Research Institute, Bethesda, MD, USA
| | - Latrice G Landry
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Jeff T Leek
- Fred Hutchinson Cancer Research Center, University of Washington, Seattle, WA, USA
| | - Nita A Limdi
- Department of Neurology, University of Alabama, Birmingham School of Medicine, Birmingham, AL, USA
| | - Nicole C Lockhart
- Office of the Director, National Human Genome Research Institute, Bethesda, MD, USA
| | - Elizabeth O Ofili
- Department of Medicine, Morehouse School of Medicine, Atlanta, GA, USA
| | | | - Maya Sabatello
- Center for Precision Medicine and Genomics, Columbia University, New York, NY, USA
- Department of Medical Humanities and Ethics, Columbia University, New York, NY, USA
| | - Loren Saulsberry
- Department of Public Health Sciences, The University of Chicago, Chicago, IL, USA
| | | | - Jennifer L Troyer
- Office of the Director, National Human Genome Research Institute, Bethesda, MD, USA
| | | | - Genevieve L Wojcik
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Judy H Cho
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Sandra S-J Lee
- Department of Medical Humanities and Ethics, Columbia University, New York, NY, USA
| | - Eric D Green
- Office of the Director, National Human Genome Research Institute, Bethesda, MD, USA
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Wossenseged F, Franklin K, Gordon T, Buscetta A, Wallen GR, Bonham VL, Farmer N. Bidirectional Relationship Between Sickle Cell Disease and Food Insecurity: Scoping Review. Health Equity 2024; 8:238-248. [PMID: 38595934 PMCID: PMC11002324 DOI: 10.1089/heq.2023.0147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/08/2024] [Indexed: 04/11/2024] Open
Abstract
Introduction In the United States, sickle cell disease (SCD)-the homozygous inheritance of a point mutation within the beta-globin chain of hemoglobin-affects between 80,000 and 100,000 people. Adequate nutrition can influence the pathophysiology of SCD, and individuals with SCD who are undernourished are more likely to have impaired immune function and disease exacerbation. Undernourishment is often caused by food insecurity (FI), which is defined as "a household-level economic and social condition of limited or uncertain access to adequate food" by the USDA. FI disproportionately affects African Americans, a population disproportionately affected by SCD in the United States. Objectives We performed a scoping review to better understand the relationship between FI and SCD severity. Methods A comprehensive search for peer-reviewed research articles and meeting abstracts was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Selected studies were reviewed for descriptive analysis by three independent reviewers. Results In total, 72 studies were identified, 62 were excluded for meeting inclusion criteria. The remaining 10 studies, 5 of which were meeting abstracts, were reviewed. Although limited evidence is available, the results of this scoping review suggest a bidirectional relationship between SCD and FI. Seven key themes were identified to help elucidate this relationship: 1) prevalence of FI among individuals with SCD, 2) child versus caregiver experiences of FI, 3) psychosocial factors, 4) food assistance benefits, 5) dietary intake, 6) external spending, 7) healthcare utilization. Conclusion Findings from this scoping review suggest how SCD and FI work in tandem to exacerbate each other. Furthermore, the findings illustrate current gaps in the literature and opportunities for actions to address FI among individuals living with SCD.
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Affiliation(s)
- Faeben Wossenseged
- Social and Behavioral Research Branch, National Institutes of Health, National Human Genome Research Institute, Bethesda, Maryland, USA
| | - Kristina Franklin
- Translational Biobehavioral and Health Disparities Branch, National Institutes of Health, Clinical Center, Bethesda, Maryland, USA
| | - Talya Gordon
- Translational Biobehavioral and Health Disparities Branch, National Institutes of Health, Clinical Center, Bethesda, Maryland, USA
| | - Ashley Buscetta
- Social and Behavioral Research Branch, National Institutes of Health, National Human Genome Research Institute, Bethesda, Maryland, USA
| | - Gwenyth R. Wallen
- Translational Biobehavioral and Health Disparities Branch, National Institutes of Health, Clinical Center, Bethesda, Maryland, USA
| | - Vence L. Bonham
- Social and Behavioral Research Branch, National Institutes of Health, National Human Genome Research Institute, Bethesda, Maryland, USA
| | - Nicole Farmer
- Translational Biobehavioral and Health Disparities Branch, National Institutes of Health, Clinical Center, Bethesda, Maryland, USA
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Jackson TA, Buscetta AJ, Ramirez HC, Bonham VL, Minniti CP. Leg ulcers are indicators of systemic dysfunction in individuals with sickle cell disease. Am J Hematol 2024; 99:767-769. [PMID: 38433376 DOI: 10.1002/ajh.27250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 01/04/2024] [Accepted: 01/08/2024] [Indexed: 03/05/2024]
Abstract
Leg ulcers in individuals living with Sickle Cell Disease are evidence of systemic dysfunction. Data from a U.S. study link leg ulcers to wider pulse pressure and markers of chronic hemolysis, inflammation, renal, and liver dysfunction.
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Affiliation(s)
- Tiffany A Jackson
- Health Disparities Unit, Social and Behavioral Research Branch, National Human Genome Research Institute, Bethesda, Maryland, USA
| | - Ashley J Buscetta
- Health Disparities Unit, Social and Behavioral Research Branch, National Human Genome Research Institute, Bethesda, Maryland, USA
| | - Hasmin C Ramirez
- Health Disparities Unit, Social and Behavioral Research Branch, National Human Genome Research Institute, Bethesda, Maryland, USA
| | - Vence L Bonham
- Health Disparities Unit, Social and Behavioral Research Branch, National Human Genome Research Institute, Bethesda, Maryland, USA
| | - Caterina P Minniti
- Department of Medicine, Einstein College of Medicine, Bronx, New York, USA
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Floyd KJ, Wossenseged F, Buscetta AJ, Fasaye GA, Bonham VL. Views of adults living with sickle cell disease on the theoretical return of secondary genomic findings. Genet Med 2024; 26:100993. [PMID: 37811899 PMCID: PMC10859184 DOI: 10.1016/j.gim.2023.100993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 09/30/2023] [Accepted: 10/02/2023] [Indexed: 10/10/2023] Open
Abstract
PURPOSE Although the body of research investigating research participants' opinions on the return of actionable secondary genomic findings grows, there has been limited study of individuals with genetic conditions, such as sickle cell disease (SCD). It is imperative that the views of diverse research participants on return of results (RoR) be investigated and rooted in the context of advancing health equity in genomics research. METHODS We conducted qualitative, semi-structured interviews with 30 adults living with SCD with differing insurance coverages and utilized a directed content analysis to derive themes. RESULTS Study findings show that living with SCD is a key influence on views of RoR. Participants were in favor of RoR while expressing concern regarding the burden RoR would place on their SCD management. Respondents also expressed an expectation for researchers to devote resources toward seeking ancillary care downstream and discussed how barriers faced when navigating SCD would inform their access to ancillary care. CONCLUSION Research participants living with chronic genetic conditions such as SCD are generally in favor of RoR but anticipate experiencing barriers to care similar to those faced navigating their SCD. Understanding the views of diverse cohorts on RoR will help researchers better understand downstream barriers participants may face.
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Affiliation(s)
- K Jameson Floyd
- Health Disparities Unit, Social and Behavioral Research Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD
| | - Faeben Wossenseged
- Health Disparities Unit, Social and Behavioral Research Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD
| | - Ashley J Buscetta
- Health Disparities Unit, Social and Behavioral Research Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD
| | - Grace-Ann Fasaye
- Center for Cancer Research, Genetics Branch, National Cancer Institute. National Institutes of Health, Bethesda, MD
| | - Vence L Bonham
- Health Disparities Unit, Social and Behavioral Research Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD.
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Okah E, Cronholm PF, Crow B, Persaud A, Westby A, Bonham VL. Race-Based Care and Beliefs Regarding the Etiology of Racial Differences in Health Outcomes. Am J Prev Med 2023; 64:477-482. [PMID: 36935165 PMCID: PMC10031413 DOI: 10.1016/j.amepre.2022.10.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 10/12/2022] [Accepted: 10/28/2022] [Indexed: 02/11/2023]
Abstract
INTRODUCTION Physicians' perspectives regarding the etiology of racial health differences may be associated with their use of race in clinical practice (race-based practice). This study evaluates whether attributing racial differences in health to genetics, culture, or social conditions is associated with race-based practice. METHODS This is a cross-sectional analysis, conducted in 2022, of the Council of Academic Family Medicine Education Research Alliance 2021 general membership survey. Only actively practicing U.S. physicians were included. The survey included demographic questions; the Racial Attributes in Clinical Evaluation (RACE) scale (higher scores imply greater race-based practice); and 3 questions regarding beliefs that racial differences in genetics, culture (e.g., health beliefs), or social conditions (e.g., education) explained racial differences in health. Three multivariable linear regressions were used to evaluate the relationship between RACE scores and beliefs regarding the etiology of racial differences in health. RESULTS Of the 4,314 survey recipients, 949 (22%) responded, of whom 689 were actively practicing U.S. physicians. In multivariable regressions controlling for age, gender, race, ethnicity, and practice characteristics, a higher RACE score was associated with a greater belief that differences in genetics (β=3.57; 95% CI=3.19, 3.95) and culture (β=1.57; 95% CI=0.99, 2.16)-in but not social conditions-explained differences in health. CONCLUSIONS Physicians who believed that genetic or cultural differences between racial groups explained racial differences in health outcomes were more likely to use race in clinical care. Further research is needed to determine how race is differentially applied in clinical care on the basis of the belief in its genetic or cultural significance.
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Affiliation(s)
- Ebiere Okah
- Department of Family Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Department of Family Medicine and Community Health, School of Medicine, University of Minnesota, Minneapolis, Minnesota.
| | - Peter F Cronholm
- Department of Family Medicine and Community Health, University of Pennsylvania, Philadelphia, Pennsylvania; The Center for Public Health Initiatives, University of Pennsylvania, Philadelphia, Pennsylvania; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Brendan Crow
- Family Medicine Residency Program, Mountain Area Health Education Center (MAHEC), Asheville, North Carolina
| | - Anitra Persaud
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; National Human Genome Research Institute, NIH, Bethesda, Maryland
| | - Andrea Westby
- Department of Family Medicine and Community Health, School of Medicine, University of Minnesota, Minneapolis, Minnesota
| | - Vence L Bonham
- National Human Genome Research Institute, NIH, Bethesda, Maryland
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Adams AD, Jumah N, Okun N, Bonham VL. Equitable delivery of expanded genetic technologies: Considerations for prenatal and reproductive care. Prenat Diagn 2023; 43:435-442. [PMID: 36825328 DOI: 10.1002/pd.6338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 02/06/2023] [Accepted: 02/21/2023] [Indexed: 02/25/2023]
Affiliation(s)
- April D Adams
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Baylor College of Medicine, Houston, Texas, USA.,Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas, USA
| | - Naana Jumah
- Northern Ontario School of Medicine, Thunder Bay, Ontario, Canada.,Centre for Rural and Northern Health Research, Lakehead University, Thunder Bay, Ontario, Canada
| | - Nanette Okun
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Vence L Bonham
- Social and Behavioral Research Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland, USA
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Buscetta AJ, Abdallah KE, Floyd KJ, Wossenseged FS, Conn CA, Ramirez HC, Bonham VL. Examining resilience of individuals living with sickle cell disease in the COVID-19 pandemic. BMC Psychol 2022; 10:156. [PMID: 35725582 PMCID: PMC9207426 DOI: 10.1186/s40359-022-00862-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 06/06/2022] [Indexed: 12/03/2022] Open
Abstract
Background The COVID-19 pandemic has impacted the physical and mental health of people worldwide including those living with genetic conditions. Sickle cell disease (SCD) is a hematologic chronic disease that causes multisystem damage and morbidity. Individuals living with SCD have had to continue managing their care for their chronic disease while following public health measures to protect against infection with COVID-19. Promoting resilience has been posited as being psychologically protective for those living with SCD. This study examines changes in resilience over time in a SCD population in the context of the COVID-19 pandemic. Methods Ninety-seven adults living with SCD completed two parent studies: (1) The INSIGHTS Study, a cross-sectional natural history study conducted from 2014–2019 and (2) The Living with SCD in COVID-19 Pandemic Study, an online survey conducted in 2020. Changes over time in resilience, perceived stress, emotional distress, and physical and mental health were analyzed in multivariable repeated measures model. Results Results showed that the psychological resilience of our study cohort had significantly decreased (0.19, p=0.01) over time. Resilience during the pandemic was associated with better mental health and physical health and lower perceived stress and emotional distress. In addition, results showed that marital status, education level, and employment were significantly associated with the psychological resilience of study participants. Conclusion Resilience declined during the COVID-19 pandemic but was still associated with better physical and mental health outcomes. Future studies should investigate the relationship between resilience and sociodemographic factors.
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Affiliation(s)
- Ashley J Buscetta
- Social and Behavioral Research Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland, USA.
| | - Khadijah E Abdallah
- Social and Behavioral Research Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland, USA.,Emory University, Atlanta, Georgia, USA
| | - K Jameson Floyd
- Social and Behavioral Research Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Faeben S Wossenseged
- Social and Behavioral Research Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Corinne A Conn
- Social and Behavioral Research Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland, USA.,University of California San Francisco School of Medicine, CA, San Francisco, USA
| | - Hasmin C Ramirez
- Social and Behavioral Research Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Vence L Bonham
- Social and Behavioral Research Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland, USA
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Appelbaum PS, Burke W, Parens E, Zeevi DA, Arbour L, Garrison NA, Bonham VL, Chung WK. Is there a way to reduce the inequity in variant interpretation on the basis of ancestry? Am J Hum Genet 2022; 109:981-988. [PMID: 35659933 PMCID: PMC9247826 DOI: 10.1016/j.ajhg.2022.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The underrepresentation of non-European ancestry groups in current genomic databases complicates interpretation of their genetic test results, yielding a much higher prevalence of variants of uncertain significance (VUSs). Such VUS findings can frustrate the goals of genetic testing, create anxiety in patients, and lead to unnecessary medical interventions. Approaches to addressing underrepresentation of people with genetic ancestries other than European are being undertaken by broad-based recruitment efforts. However, some underrepresented groups have concerns that might preclude participation in such efforts. We describe here two initiatives aimed at meeting the needs of underrepresented ancestry groups in genomic datasets. The two communities, the Sephardi Jewish community in New York and First Peoples of Canada, have very different concerns about contributing to genomic research and datasets. Sephardi concerns focus on the possible negative effects of genetic findings on the marriage prospects of family members. Canadian Indigenous populations seek control over the research uses to which their genetic data would be put. Both cases involve targeted efforts to respond to the groups' concerns; these efforts include governance models aimed at ensuring that the data are used primarily to inform clinical test analyses and at achieving successful engagement and participation of community members. We suggest that these initiatives could provide models for other ancestral groups seeking to improve the accuracy and utility of clinical genetic testing while respecting the underlying preferences and values of community members with regard to the use of their genetic data.
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Affiliation(s)
- Paul S Appelbaum
- Department of Psychiatry, Columbia University Irving Medical Center, and New York State Psychiatric Institute, New York, NY 10032, USA.
| | - Wylie Burke
- Department of Bioethics and Humanities, University of Washington, Seattle, WA 98195, USA
| | - Erik Parens
- The Hastings Center, Garrison, NY 10524, USA
| | - David A Zeevi
- Dor Yeshorim, The Committee for the Prevention of Jewish Genetic Diseases, Jerusalem, Israel
| | - Laura Arbour
- Department of Medical Genetics, University of British Columbia, Vancouver, BC, Canada; Division of Medical Sciences, University of Victoria, Victoria, BC V8P 5C2, Canada; BC Children's Hospital Research Institute, Victoria, BC V8P 5C2, Canada
| | - Nanibaa' A Garrison
- Institute for Society and Genetics, University of California, Los Angeles, Los Angeles, CA 90095, USA; Institute for Precision Health, University of California Los Angeles, Los Angeles, CA 90095; Division of General Internal Medicine and Health Services Research, University of California, Los Angeles, Los Angeles, CA 9009, USA5
| | - Vence L Bonham
- Social and Behavioral Research Branch, National Human Genome Research Institute, Bethesda, MD 20892, USA
| | - Wendy K Chung
- Department of Pediatrics, Columbia University Irving Medical Center, New York, NY 10032, USA; Department of Medicine, Columbia University Irving Medical Center, New York, NY 10032, USA
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Sodeke S, Fletcher FE, Brown VA, Stone JR, Wilson CB, Franklin TH, Royal CDM, Bonham VL. Herstory as an Important Force in Bioethics. Hastings Cent Rep 2022; 52 Suppl 1:S83-S88. [PMID: 35470893 DOI: 10.1002/hast.1379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
This tribute celebrates the life and work of Marian Gray Secundy (1938-2002), who was the first director of the National Center for Bioethics in Research and Health Care, a passionate advocate for health equity, a visionary scholar, and a skilled editor and collaborator. Within the tribute are several short remembrances in which individuals describe their association with Secundy to honor her as a leader, friend, scholar, advocate, and teacher in bioethics.
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Abstract
OBJECTIVE Precision medicine is revolutionizing cancer treatment. However, there has been limited investigation of barriers patients endure to access precision cancer medicine. This study aims to report the experiences of underserved patient populations with limited access to genomic testing, clinical trials, and precision cancer treatment. METHODS A mixed-method study was employed to quantitatively evaluate patients (N=300) seeking precision cancer medicine between January 2014- August 2017. Qualitatively, we conducted semi-structured interviews with eight case managers who navigate the health care and health insurance systems to provide patients with access to precision cancer medicine care. All interviews were analyzed to identify themes. RESULTS Within our patient cohort, 69% were diagnosed in stage I of cancer disease. Overall, 27 patients (9%) were denied treatment as a final outcome of their case due to insurance denials, 35 patients (12%) died before gaining access to precision cancer medicine, and 6 patients (2%) received precision cancer medicine through clinical trials. Four broad thematic areas emerged from the qualitative analysis: 1) lack of patient, provider and insurer knowledge of precision cancer medicine; 2) barriers to clinical trial participation; 3) lack of patient health literacy; and 4) barriers to timely access to care. CONCLUSION Our combined analyses suggest that both system-level and patient-level barriers limit patient access to precision cancer medicine options. Additionally, we found that these barriers may exist not only for traditionally underserved patients, but also for resourced and insured patients trying to access precision cancer medicine.
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Affiliation(s)
- Kayla E. Cooper
- Social and Behavioral Research Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD
| | - Khadijah E. Abdallah
- Social and Behavioral Research Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD
| | - Rebekah S.M. Angove
- Department of Research and Evaluation, Patient Advocate Foundation, Hampton, VA
| | | | - Vence L. Bonham
- Social and Behavioral Research Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD
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Byeon YJJ, Islamaj R, Yeganova L, Wilbur WJ, Lu Z, Brody LC, Bonham VL. Evolving use of ancestry, ethnicity, and race in genetics research-A survey spanning seven decades. Am J Hum Genet 2021; 108:2215-2223. [PMID: 34861173 PMCID: PMC8715140 DOI: 10.1016/j.ajhg.2021.10.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 10/20/2021] [Indexed: 12/11/2022] Open
Abstract
To inform continuous and rigorous reflection about the description of human populations in genomics research, this study investigates the historical and contemporary use of the terms "ancestry," "ethnicity," "race," and other population labels in The American Journal of Human Genetics from 1949 to 2018. We characterize these terms' frequency of use and assess their odds of co-occurrence with a set of social and genetic topical terms. Throughout The Journal's 70-year history, "ancestry" and "ethnicity" have increased in use, appearing in 33% and 26% of articles in 2009-2018, while the use of "race" has decreased, occurring in 4% of articles in 2009-2018. Although its overall use has declined, the odds of "race" appearing in the presence of "ethnicity" has increased relative to the odds of occurring in its absence. Forms of population descriptors "Caucasian" and "Negro" have largely disappeared from The Journal (<1% of articles in 2009-2018). Conversely, the continental labels "African," "Asian," and "European" have increased in use and appear in 18%, 14%, and 42% of articles from 2009-2018, respectively. Decreasing uses of the terms "race," "Caucasian," and "Negro" are indicative of a transition away from the field's history of explicitly biological race science; at the same time, the increasing use of "ancestry," "ethnicity," and continental labels should serve to motivate ongoing reflection as the terminology used to describe genetic variation continues to evolve.
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Affiliation(s)
- Yen Ji Julia Byeon
- Department of Sociology, Princeton University, Princeton, NJ 08544, USA; Social and Behavioral Research Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Rezarta Islamaj
- National Center for Biotechnology Information, National Library of Medicine, National Institutes of Health, Bethesda, MD 20894, USA
| | - Lana Yeganova
- National Center for Biotechnology Information, National Library of Medicine, National Institutes of Health, Bethesda, MD 20894, USA
| | - W John Wilbur
- National Center for Biotechnology Information, National Library of Medicine, National Institutes of Health, Bethesda, MD 20894, USA
| | - Zhiyong Lu
- National Center for Biotechnology Information, National Library of Medicine, National Institutes of Health, Bethesda, MD 20894, USA
| | - Lawrence C Brody
- Division of Genomics and Society, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD 20892, USA.
| | - Vence L Bonham
- Social and Behavioral Research Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD 20892, USA.
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Thomas SP, Amini K, Floyd KJ, Willard R, Wossenseged F, Keller M, Scott JB, Abdallah KE, Buscetta A, Bonham VL. Cultivating diversity as an ethos with an anti-racism approach in the scientific enterprise. HGG Adv 2021; 2:100052. [PMID: 35047843 PMCID: PMC8756537 DOI: 10.1016/j.xhgg.2021.100052] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
The diversity of the U.S. population is currently not reflected in the genomic workforce and across the greater scientific enterprise. Although diversity and inclusion efforts have focused on increasing the number of individuals from underrepresented groups across scientific fields, structural racism remains. Thus, the cultivation and adoption of diversity as an ethos requires shifting our focus to being intentional about an institution’s character, culture, and climate. One way for this ethos to be sustained is by facilitating an intentional anti-racism approach within the field. Adopting a new perspective on diversity utilizing an anti-racism approach will support genomics researchers as we build supportive, collaborative research environments. We seek to expand critical thought in the framing of diversity in the research enterprise and propose an anti-racism approach that informs deliberate actions required to address structural racism.
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Affiliation(s)
- Shameka P Thomas
- Social and Behavioral Research Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Kiana Amini
- Social and Behavioral Research Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - K Jameson Floyd
- Social and Behavioral Research Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Rachele Willard
- Social and Behavioral Research Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Faeben Wossenseged
- Social and Behavioral Research Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Madison Keller
- Social and Behavioral Research Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Jamil B Scott
- Office of the Director, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Khadijah E Abdallah
- Social and Behavioral Research Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Ashley Buscetta
- Social and Behavioral Research Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Vence L Bonham
- Social and Behavioral Research Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD 20892, USA
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Walker A, Bonham VL, Boyce A, Clayton EW, Garcia D, Johnson S, Laeyendecker O, Lewis M, Margolick JB, Mathews D, Parker MJ, Spicer P, Thio CL, Geller G, Kahn J. Ethical Issues in Genetics and Infectious Diseases Research: An Interdisciplinary Expert Review. Ethics Med Public Health 2021; 18:100684. [PMID: 34263019 PMCID: PMC8274576 DOI: 10.1016/j.jemep.2021.100684] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
PURPOSE Research in genetics and infectious diseases (ID) presents novel configurations of ethical, legal, and social issues (ELSIs) related to the intersection of genetics with public health regulations and the control of transmissible diseases. Such research includes work both in pathogen genetics and on the ways that human genetics affect responses to ID. This paper identifies and systematizes the unique issues at this intersection, based on an interdisciplinary expert review. BASIC PROCEDURES This paper presents results of a formal issue-spotting exercise among twenty experts in public health, law and genomics, biobanking, genetic epidemiology, ID medicine and public health, philosophy, ethics and ID, ethics and genomics, and law and ID. The focus of the exercise was on the collection, storage, and sharing of genetic information relating to ID. MAIN FINDINGS The issue-spotting exercise highlighted the following ELSIs: risks in reporting to government authorities, return of individual research results, and resource allocation - each taking on specific configurations based on the balance between public health and individual privacy/protection. PRINCIPAL CONCLUSIONS The public health implications of interactions between genomics and ID frame considerations for equity and justice. In the context of the COVID-19 pandemic, these issues are especially pressing.
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Affiliation(s)
- Alexis Walker
- Berman Institute of Bioethics, Johns Hopkins University, 1809 Ashland Avenue, Baltimore MD 21205 USA
| | - Vence L. Bonham
- Social and Behavioral Research Branch, National Human Genome Research Institute, 31 Center Drive, Bethesda MD 20894 USA
| | - Angie Boyce
- Berman Institute of Bioethics, Johns Hopkins University, 1809 Ashland Avenue, Baltimore MD 21205 USA
| | - Ellen Wright Clayton
- Center for Biomedical Ethics and Society, Vanderbilt University Medical Center, 1211 Medical Center Drive, Nashville TN 37232 USA
| | - Debra Garcia
- International Society for Biological and Environmental Repositories, 750 W Pender St #301, Vancouver BC V6C 1G8 Canada
| | - Stephanie Johnson
- Wellcome Centre for Ethics and the Humanities and Ethox Centre, University of Oxford, Oxford OX1 2JD UK
| | - Oliver Laeyendecker
- Johns Hopkins University School of Medicine, 733 N Broadway, Baltimore MD 21205 USA,National Institute of Allergy and Infectious Diseases, National Institutes of Health, 5601 Fishers Ln, Bethesda, MD 20892 USA
| | - Michelle Lewis
- Berman Institute of Bioethics, Johns Hopkins University, 1809 Ashland Avenue, Baltimore MD 21205 USA
| | - Joseph B. Margolick
- Johns Hopkins University Bloomberg School of Public Health, 615 N Wolfe St, Baltimore MD 21205 USA
| | - Debra Mathews
- Berman Institute of Bioethics, Johns Hopkins University, 1809 Ashland Avenue, Baltimore MD 21205 USA,Johns Hopkins University School of Medicine, 733 N Broadway, Baltimore MD 21205 USA
| | - Michael J. Parker
- Wellcome Centre for Ethics and the Humanities and Ethox Centre, University of Oxford, Oxford OX1 2JD UK
| | - Paul Spicer
- Department of Anthropology and the Center for Applied Social Research, University of Oklahoma, 455 W Lindsey St, Norman OK 73069 USA
| | - Chloe L. Thio
- Johns Hopkins University School of Medicine, 733 N Broadway, Baltimore MD 21205 USA
| | - Gail Geller
- Berman Institute of Bioethics, Johns Hopkins University, 1809 Ashland Avenue, Baltimore MD 21205 USA,Johns Hopkins University School of Medicine, 733 N Broadway, Baltimore MD 21205 USA
| | - Jeffrey Kahn
- Berman Institute of Bioethics, Johns Hopkins University, 1809 Ashland Avenue, Baltimore MD 21205 USA,Johns Hopkins University Bloomberg School of Public Health, 615 N Wolfe St, Baltimore MD 21205 USA
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14
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Byeon J, Blizinsky KD, Persaud A, Findley K, Lee J, Buscetta AJ, You S, Bittinger K, Minniti CP, Bonham VL, Grice EA. Insights into the skin microbiome of sickle cell disease leg ulcers. Wound Repair Regen 2021; 29:801-809. [PMID: 33964094 PMCID: PMC8410641 DOI: 10.1111/wrr.12924] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 03/10/2021] [Accepted: 04/14/2021] [Indexed: 01/04/2023]
Abstract
Leg ulcers are estimated to occur in 1%-10% of North American patients with sickle cell disease (SCD). Their pathophysiology remains poorly defined, but as with other chronic wounds, it is hypothesised that the microbial milieu, or microbiome, contributes to their healing and clinical outcomes. This study utilises 16S ribosomal RNA (rRNA) gene sequencing to describe, for the first time, the microbiome of the SCD leg ulcer and its association with clinical factors. In a cross-sectional analysis of 42 ulcers, we recovered microbial profiles similar to other chronic wounds in the predominance of anaerobic bacteria and opportunistic pathogens including Staphylococcus, Corynebacterium, and Finegoldia. Ulcers separated into two clusters: one defined by predominance of Staphylococcus and smaller surface area, and the other displaying a greater diversity of taxa and larger surface area. We also find that the relative abundance of Porphyromonas is negatively associated with haemoglobin levels, a key clinical severity indicator for SCD, and that Finegoldia relative abundance is negatively associated with CD19+ B cell count. Finally, ratios of Corynebacterium:Lactobacillus and Staphylococcus:Lactobacillus are elevated in the intact skin of individuals with a history of SCD leg ulcers, while the ratio of Lactobacillus:Bacillus is elevated in that of individuals without a history of ulcers. Investigations of the skin microbiome in relation to SCD ulcer pathophysiology can inform clinical guidelines for this poorly understood chronic wound, as well as enhance broader understanding about the role of the skin microbiome in delayed wound healing.
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Affiliation(s)
- Julia Byeon
- Social and Behavioral Research BranchNational Human Genome Research Institute, National Institutes of HealthBethesdaMarylandUSA
| | - Katherine D. Blizinsky
- All of Us Research ProgramNational Institutes of HealthBethesdaMarylandUSA
- NeurologyRush Alzheimer's Disease Center, Rush Medical CollegeChicagoIllinoisUSA
| | - Anitra Persaud
- Social and Behavioral Research BranchNational Human Genome Research Institute, National Institutes of HealthBethesdaMarylandUSA
| | - Keisha Findley
- Social and Behavioral Research BranchNational Human Genome Research Institute, National Institutes of HealthBethesdaMarylandUSA
| | - Jung‐Jin Lee
- The Children's Hospital of PhiladelphiaMicrobiome Center Roberts Center for Pediatric ResearchPhiladelphiaPennsylvaniaUSA
| | - Ashley J. Buscetta
- Social and Behavioral Research BranchNational Human Genome Research Institute, National Institutes of HealthBethesdaMarylandUSA
| | - Shuo You
- Department of Medicine, Division of HematologyMontefiore Medical Center, Albert Einstein College of MedicineBronxNew YorkUSA
| | - Kyle Bittinger
- The Children's Hospital of PhiladelphiaMicrobiome Center Roberts Center for Pediatric ResearchPhiladelphiaPennsylvaniaUSA
| | - Caterina P. Minniti
- Albert Einstein College of Medicine, Center for Sickle Cell Disease ResearchMontefiore Medical CenterBronxNew YorkUSA
| | - Vence L. Bonham
- Social and Behavioral Research BranchNational Human Genome Research Institute, National Institutes of HealthBethesdaMarylandUSA
| | - Elizabeth A. Grice
- Department of Dermatology and MicrobiologyUniversity of Pennsylvania Perelman School of MedicinePhiladelphiaPennsylvaniaUSA
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Jefferson JM, Sims WM, Umeh N, Byeon YJJ, Abdallah KE, Bonham VL, Naik RP, Smith‐Whitley K. Splenic infarction in sickle cell trait: A comprehensive systematic review of case studies. eJHaem 2021; 2:585-600. [PMID: 34870278 PMCID: PMC8635393 DOI: 10.1002/jha2.248] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Sickle cell trait (SCT), a commonly asymptomatic condition, has many associated clinical complications that upon presentation, can be very difficult to attribute to SCT. The effects of SCT on the spleen, for example, are not completely understood, though there have been a number of case reports detailing related complications in diverse populations. Our objective was to perform the first comprehensive case report review of splenic infarction in SCT patients to highlight the relevance of this seemingly rare condition. We conducted an extensive literature search reviewing case reports and case series of acute splenic infarctions from 1970 to 2020. This comprehensive search resulted in 54 articles with a total of 85 individuals. The ages ranged from 7 to 65, 12% were female. Individuals were of African‐American (26%), European (16%), South Asian (13%), Middle Eastern (7%), Latin American (7%), North or East African (4%), Mediterranean (4%), West African (1%), and unknown (22%) origins. Although splenic infarct in SCT patients has been associated with high altitudes, 39% of cases reporting altitude occurred below 3000 m. Among cases where HbS values were recorded, 88% occurred in individuals with HbS levels higher than 35%, suggesting that high HbS values may be a risk factor for splenic infarction. Our findings indicate that splenic infarct occurs across a wide range of demographic populations and environmental settings. While our understanding of SCT evolves, the findings here suggest that future advances in research and healthcare could benefit more from real‐time surveillance and registry initiation for various SCT outcomes such as splenic infarct.
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Affiliation(s)
- Jamal M. Jefferson
- National Human Genome Research Institute, Division of Intramural Research, Social and Behavioral Research Branch National Institutes of Health Bethesda Maryland
| | - Wynton M. Sims
- National Human Genome Research Institute, Division of Intramural Research, Social and Behavioral Research Branch National Institutes of Health Bethesda Maryland
| | - Nkeiruka Umeh
- National Human Genome Research Institute, Division of Intramural Research, Social and Behavioral Research Branch National Institutes of Health Bethesda Maryland
| | - Yen Ji Julia Byeon
- National Human Genome Research Institute, Division of Intramural Research, Social and Behavioral Research Branch National Institutes of Health Bethesda Maryland
| | - Khadijah E. Abdallah
- National Human Genome Research Institute, Division of Intramural Research, Social and Behavioral Research Branch National Institutes of Health Bethesda Maryland
| | - Vence L. Bonham
- National Human Genome Research Institute, Division of Intramural Research, Social and Behavioral Research Branch National Institutes of Health Bethesda Maryland
| | - Rakhi P. Naik
- Division of Hematology, Department of Medicine Johns Hopkins University Baltimore Maryland
| | - Kim Smith‐Whitley
- Division of Hematology and Director of the Comprehensive Sickle Cell Center Children's Hospital of Philadelphia Philadelphia Pennsylvania
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16
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Raymond MB, Cooper KE, Parker LS, Bonham VL. Practices and Attitudes toward Returning Genomic Research Results to Low-Resource Research Participants. Public Health Genomics 2021; 24:241-252. [PMID: 34229325 DOI: 10.1159/000516782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Accepted: 04/21/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Many research programs are challenged to accommodate low-resource research participants' (LRRP) ancillary care needs when returning genomic research results. We define LRRP as those who are low income, uninsured, underinsured, or facing barriers to act upon the results returned. This study evaluates current policies and practices surrounding return of results (RoR) to LRRP, as well as the attitudes of investigators toward providing ancillary care to LRRP. METHODS A semi-structured interview study was conducted with representatives of 35 genomic research programs nationwide. Eligible programs were returning, or planning to return, medically actionable genomic results to participants. RESULTS Three content categories emerged from this study, including: (1) RoR structures, (2) barriers to RoR to LRRP, and (3) solutions to meet community and LRRP needs. Three major structures of RoR emerged: (1) RoR Embedded in Clinical Care, (2) RoR Independent of Clinical Care, and (3) Reliance on Clinical Partnerships to Facilitate RoR. Inadequacy of program resources to address the needs of LRRP was commonly considered a significant obstacle. The attitudes and views of informants regarding responsibility to provide ancillary care for LRRP receiving genomic results were highly varied. Some informants believed that genomic sequencing and testing was not a priority for LRRP because of other pressing issues in their lives, such as housing and food insecurity. Research programs differ regarding whether clinical and social support for LRRP is considered within the purview of the research team. Some programs instituted accommodations for LRRP, including social work referral and insurance enrollment assistance. CONCLUSION Support to access downstream treatment is not readily available for LRRP in many genomic research programs. Development of best practices and policies for managing RoR to LRRP is needed.
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Affiliation(s)
- Megan B Raymond
- Social and Behavioral Research Branch, National Human Genome Research, National Institutes of Health, Bethesda, Maryland, USA.,University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Kayla E Cooper
- Social and Behavioral Research Branch, National Human Genome Research, National Institutes of Health, Bethesda, Maryland, USA
| | - Lisa S Parker
- University of Pittsburgh, Center for Bioethics & Health Law, Human Genetics, Graduate School of Public Health, Pittsburgh, Pennsylvania, USA
| | - Vence L Bonham
- Social and Behavioral Research Branch, National Human Genome Research, National Institutes of Health, Bethesda, Maryland, USA
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17
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Hollister BM, Zilbermint M, Minniti CP, Buscetta AJ, Abdallah KE, You S, Soldin SJ, Meyer JS, Stratakis CA, Bonham VL. Lower hair cortisol among patients with sickle cell disease may indicate decreased adrenal reserves. Am J Blood Res 2021; 11:140-148. [PMID: 34079627 PMCID: PMC8165714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 03/01/2021] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Sickle cell disease (SCD) is a chronic illness that presents with a wide range of phenotypic variation. Stress may be a contributing factor to differences that are found in this population. OBJECTIVES Our objective is to determine the relationship between hair cortisol content (HCC), a biomarker of stress, and other clinical measures in individuals with SCD. METHODS We collected hair samples and other clinical measures from 73 subjects with SCD (mean age: 39 ± 12 years, 63% female). RESULTS HCC was lower among individuals who had greater than 30% hemoglobin S, compared with those who had less than 30% hemoglobin S (W=272.5, P=0.01). Lower HCC was also associated with report of not being on a chronic transfusion program (β=48.34, SE=14.09, P=0.001) and higher ferritin levels (β=-0.006, SE=0.002, P=0.02). Furthermore, HCC was significantly correlated with serum cortisol (rs=0.26, P=0.03) and corticosterone (rs=0.29, P=0.01). We also observed a consistent pattern of low steroid values among our population. CONCLUSION Our findings suggest that individuals with higher hemoglobin S and ferritin, both markers of severe SCD, may have decreased cortisol levels. This is consistent with the relationship we observed between higher HCC among individuals who are on a chronic blood transfusion program, which typically increases quality of life. Our results suggest that hair cortisol may be an indicator in patients with SCD who could be at risk for developing adrenal insufficiency. We recommend that clinicians treating patients with SCD follow the Endocrine Society guidelines for testing for adrenal insufficiency and treat accordingly.
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Affiliation(s)
- Brittany M Hollister
- Social and Behavioral Research Branch, National Human Genome Research Institute, National Institutes of HealthBethesda, Maryland, USA
- The University of Florida Genetics InstituteGainesville, Florida, USA
| | - Mihail Zilbermint
- Section on Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of HealthBethesda, Maryland, USA
- Division of Endocrinology, Diabetes, and Metabolism, Johns Hopkins University School of MedicineBaltimore, Maryland, USA
- Johns Hopkins Community Physicians at Suburban HospitalBethesda, Maryland, USA
| | - Caterina P Minniti
- Division of Hematology, Department of Oncology, Montefiore Medical Center, Albert Einstein College of MedicineNew York, New York, USA
| | - Ashley J Buscetta
- Social and Behavioral Research Branch, National Human Genome Research Institute, National Institutes of HealthBethesda, Maryland, USA
| | - Khadijah E Abdallah
- Social and Behavioral Research Branch, National Human Genome Research Institute, National Institutes of HealthBethesda, Maryland, USA
| | - Shuo You
- Division of Hematology, Department of Oncology, Montefiore Medical Center, Albert Einstein College of MedicineNew York, New York, USA
| | - Steven J Soldin
- Department of Laboratory Medicine, Clinical Center, National Institutes of HealthBethesda, Maryland, USA
| | - Jerrold S Meyer
- Department of Psychological and Brain Sciences, University of MassachusettsAmherst, Massachusetts, USA
| | - Constantine A Stratakis
- Section on Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of HealthBethesda, Maryland, USA
| | - Vence L Bonham
- Social and Behavioral Research Branch, National Human Genome Research Institute, National Institutes of HealthBethesda, Maryland, USA
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18
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Desine S, Eskin L, Bonham VL, Koehly LM. Social support networks of adults with sickle cell disease. J Genet Couns 2021; 30:1418-1427. [PMID: 33847032 DOI: 10.1002/jgc4.1410] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 02/13/2021] [Accepted: 02/15/2021] [Indexed: 11/10/2022]
Abstract
Sickle cell disease (SCD) can cause both physical and psychological complications, such as severe pain and depression. These effects often necessitate social and caregiving support. Few studies have assessed support networks within the adult SCD population. Here, we describe the support networks of adults with SCD and identify who in these networks (1) provides emotional support, (2) is dependable during crisis situations, including social and financial adversities, and (3) provides assistance in health crises. Forty-nine adults with SCD completed surveys and social network assessments through interview. Generalized mixed-effects linear regression models were fitted to investigate the composition of support provision within these personal networks. Our findings indicate that parents and 'other important people' (e.g., friends, spouses) play key roles in the support provided to those with SCD. Siblings with SCD appeared to be more emotionally supportive than unaffected siblings. With much research centered around the pediatric and adolescent SCD populations, focus needs to extend to adults and the individuals involved in their care and disease management. Understanding the flow of support within these networks can help genetic counselors and healthcare providers to better identify both social ties that serve as support resources and less supportive relationships for individuals living with SCD and other chronic genetic conditions that might be targeted for intervention.
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Affiliation(s)
- Stacy Desine
- Health Disparities Unit, Social and Behavioral Research Branch, National Human Genome Research Institute, Bethesda, MD, USA
| | - Lena Eskin
- Social Network Methods Section, Social and Behavioral Research Branch, National Human Genome Research Institute, Bethesda, MD, USA
| | - Vence L Bonham
- Health Disparities Unit, Social and Behavioral Research Branch, National Human Genome Research Institute, Bethesda, MD, USA
| | - Laura M Koehly
- Social Network Methods Section, Social and Behavioral Research Branch, National Human Genome Research Institute, Bethesda, MD, USA
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19
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Koehly LM, Persky S, Shaw P, Bonham VL, Marcum CS, Sudre GP, Lea DE, Davis SK. Social and behavioral science at the forefront of genomics: Discovery, translation, and health equity. Soc Sci Med 2021; 271:112450. [PMID: 31558303 PMCID: PMC9745643 DOI: 10.1016/j.socscimed.2019.112450] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Accepted: 07/25/2019] [Indexed: 12/15/2022]
Abstract
This special issue highlights the unique role that social and behavioral science has to play at the forefront of genomics. Through the introduction of papers comprising this special issue, we outline priority research areas at the nexus of genomics and the social and behavioral sciences. These include: Discovery science; clinical and community translation, and equity, including engagement and inclusion of diverse populations in genomic science. We advocate for genomic discovery that considers social context, neural, cognitive, and behavioral endophenotypes, and that is grounded in social and behavioral science research and theory. Further, the social and behavioral sciences should play a leadership role in identifying best practices for effective clinical and community translation of genomic discoveries. Finally, inclusive research that engages diverse populations is necessary for genomic discovery and translation to benefit all. We also highlight ways that genomics can be a fruitful testbed for the development and refinement of social and behavioral science theory. Indeed, an expanded ecological lens that runs from genomes to society will be required to fully understand human behavior.
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Affiliation(s)
- Laura M. Koehly
- Corresponding author. 31 Center Drive, Rm B1B54, Bethesda, MD, 20892-2073, USA. (L.M. Koehly)
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20
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Bonham VL, Green ED. The genomics workforce must become more diverse: a strategic imperative. Am J Hum Genet 2021; 108:3-7. [PMID: 33417888 DOI: 10.1016/j.ajhg.2020.12.013] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 12/12/2020] [Indexed: 01/08/2023] Open
Abstract
The National Human Genome Research Institute (NHGRI) recently published a new strategic vision for the future of human genomics, the product of an extensive, multi-year engagement with numerous research, medical, educational, and public communities. The theme of this 2020 vision-The Forefront of Genomics-reflects NHGRI's critical role in providing responsible stewardship of the field of human genomics, especially as genomic methods and approaches become increasingly disseminated throughout biomedicine. Embracing that role, the new NHGRI strategic vision features a set of guiding principles and values that provide an ethical and moral framework for the field. One principle emphasizes the need to champion a diverse genomics workforce because "the promise of genomics cannot be fully achieved without attracting, developing, and retaining a diverse workforce, which includes individuals from groups that are currently underrepresented in the genomics enterprise." To build on the remarkable metamorphosis of the field over the last three decades, enhancing the diversity of the genomics workforce must be embraced as an urgent priority. Toward that end, NHGRI recently developed an "action agenda" for training, employing, and retaining a genomics workforce that reflects the diversity of the US population.
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21
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Hiratsuka VY, Hahn MJ, Woodbury RB, Hull SC, Wilson DR, Bonham VL, Dillard DA, Avey JP, Beckel-Mitchener AC, Blome J, Claw K, Ferucci ED, Gachupin FC, Ghazarian A, Hindorff L, Jooma S, Trinidad SB, Troyer J, Walajahi H. Alaska Native genomic research: perspectives from Alaska Native leaders, federal staff, and biomedical researchers. Genet Med 2020; 22:1935-1943. [PMID: 32839571 PMCID: PMC7708301 DOI: 10.1038/s41436-020-0926-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 07/22/2020] [Accepted: 07/27/2020] [Indexed: 11/09/2022] Open
Abstract
Meaningful engagement of Alaska Native (AN) tribes and tribal health organizations is essential in the conduct of socially responsible and ethical research. As genomics becomes increasingly important to advancements in medicine, there is a risk that populations not meaningfully included in genomic research will not benefit from the outcomes of that research. AN people have historically been underrepresented in biomedical research; AN underrepresentation in genomics research is compounded by mistrust based on past abuses, concerns about privacy and data ownership, and cultural considerations specific to this type of research. Working together, the National Human Genome Research Institute and two Alaska Native health organizations, Southcentral Foundation and the Alaska Native Health Board, cosponsored a workshop in July 2018 to engage key stakeholders in discussion, strengthen relationships, and facilitate partnership and consideration of participation of AN people in community-driven biomedical and genomic research. AN priorities related to translation of genomics research to health and health care, return of genomic results, design of research studies, and data sharing were discussed. This report summarizes the perspectives that emerged from the dialogue and offers considerations for effective and socially responsible genomic research partnerships with AN communities.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Katrina Claw
- Department of Medicine-Bioinformatics, University of Colorado Denver, Aurora, CO, USA
| | | | - Francine C Gachupin
- Department of Family and Community Medicine, University of Arizona, Tucson, AZ, USA
| | | | | | - Sonya Jooma
- National Institutes of Health, Bethesda, MD, USA
| | - Susan B Trinidad
- Department of Bioethics, University of Washington, Seattle, WA, USA
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22
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Abdallah K, Buscetta A, Cooper K, Byeon J, Crouch A, Pink S, Minniti C, Bonham VL. Emergency Department Utilization for Patients Living With Sickle Cell Disease: Psychosocial Predictors of Health Care Behaviors. Ann Emerg Med 2020; 76:S56-S63. [PMID: 32928463 PMCID: PMC7486179 DOI: 10.1016/j.annemergmed.2020.08.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Study objective Individuals living with sickle cell disease (SCD) often require urgent care; however, some patients hesitate to present to the emergency department (ED), which may increase the risk of serious clinical complications. Our study aims to examine psychosocial, clinical, and demographic factors associated with delaying ED care. Methods This was a cross-sectional study of 267 adults with SCD from the national INSIGHTS Study. The binary outcome variable asked whether, in the past 12 months, participants had delayed going to an ED when they thought they needed care. Logistic regression was performed with clinical, demographic, and psychosocial measures. Results Approximately 67% of the participants reported delaying ED care. Individuals who delayed care were more likely to have reported higher stigma experiences (odds ratio [OR]=1.09; 95% confidence interval [CI] 1.03 to 1.16), more frequent pain episodes (OR=1.15; 95% CI 1.01 to 1.32), lower health care satisfaction (OR= 0.74; 95% CI 0.59 to 0.94), and more frequent ED visits (OR=6.07; 95% CI 1.18 to 31.19). Disease severity and demographics, including sex, age, and health insurance status, were not significantly associated with delay in care. Conclusion Psychosocial factors, including disease stigma and previous negative health care experiences, are associated with delay of ED care in this SCD cohort. There is a need to further investigate the influence of psychosocial factors on the health care–seeking behaviors of SCD patients, as well as the downstream consequences of these behaviors on morbidity and mortality. The resulting knowledge can contribute to efforts to improve health care experiences and patient-provider relationships in the SCD community.
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Affiliation(s)
- Khadijah Abdallah
- Social and Behavioral Branch, National Human Genome Research Institute, National Institute of Health, Bethesda, MD.
| | - Ashley Buscetta
- Social and Behavioral Branch, National Human Genome Research Institute, National Institute of Health, Bethesda, MD
| | - Kayla Cooper
- Social and Behavioral Branch, National Human Genome Research Institute, National Institute of Health, Bethesda, MD
| | - Julia Byeon
- Social and Behavioral Branch, National Human Genome Research Institute, National Institute of Health, Bethesda, MD
| | - Andrew Crouch
- Division of Hematology/Sickle Cell Center, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY
| | - Sabrina Pink
- Division of Hematology/Sickle Cell Center, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY
| | - Caterina Minniti
- Division of Hematology/Sickle Cell Center, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY
| | - Vence L Bonham
- Social and Behavioral Branch, National Human Genome Research Institute, National Institute of Health, Bethesda, MD
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23
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Abstract
BACKGROUND A first therapeutic target of somatic genome editing (SGE) is sickle cell disease (SCD), the most commonly inherited blood disorders, affecting more than 100,000 individuals in the United States. Advancement of SGE is contingent on patient participation in first in human clinical trials. However, seriously ill patients may be vulnerable to overestimating the benefits of early phase studies while underestimating the risks. Therefore, ensuring potential clinical trial participants are fully informed prior to participating in a SGE clinical trial is critical. Methods: We conducted a mixed-methods study of adults with SCD as well as parents and physicians of individuals with SCD. Participants were asked to complete a genetic literacy survey, watch an educational video about genome editing, complete a two-part survey, and take part in focus group discussions. Focus groups addressed topics on clinical trials, ethics of gene editing, and what is not understood regarding gene editing. All focus groups were audio-recorded, transcribed, and analyzed using conventional content analysis techniques to identify major themes. Results: Our study examined the views of SCD stakeholders regarding what they want and need to know about genome editing to make an informed decision to participate in a SGE clinical trial. Prominent themes included stakeholders' desire to understand treatment side effects, mechanism of action of SGE, trial qualification criteria, and the impact of SGE on quality of life. In addition, some physicians expressed concerns about the extent to which their patients would understand concepts related to SGE; however, individuals with SCD demonstrated higher levels of genetic literacy than estimated by physicians. Conclusions: Designing ethically robust genome editing clinical trials for the SCD population will require, at a minimum, addressing the expressed information needs of the community through culturally sensitive engagement, so that they can make informed decisions to consider participation in clinical trials.
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Affiliation(s)
- Stacy Desine
- Social and Behavioral Research Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD
| | - Brittany M. Hollister
- Social and Behavioral Research Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD
| | - Khadijah E. Abdallah
- Social and Behavioral Research Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD
| | - Anitra Persaud
- Social and Behavioral Research Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD
| | - Sara Chandros Hull
- Department of Bioethics, Clinical Center, National Institutes of Health, Bethesda, MD
- Bioethics Core, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD
| | - Vence L. Bonham
- Social and Behavioral Research Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD
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24
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Stewart CA, Cooper KE, Raymond MB, Fletcher FE, Bonham VL. Pragmatic Clinical Trial-Collateral Findings: Recognizing the Needs of Low-Resource Research Participants. Am J Bioeth 2020; 20:19-21. [PMID: 31896326 DOI: 10.1080/15265161.2019.1687786] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
| | | | | | - Faith E Fletcher
- Department of Health Behavior, University of Alabama at Birmingham School of Public Health
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25
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Abstract
There is growing recognition that the genomic and precision medicine revolution in health care can deepen health disparities. This has produced urgent calls to prioritize inclusion of historically underrepresented populations in research and to make genomic databases more inclusive. Answering the call to address health care disparities in the delivery of genomic and precision medicine requires a consideration of important, yet understudied, legal issues that have blocked progress. This article introduces a special issue of Ethnicity & Disease which contains a series of articles that grew out of a public conference to investigate these legal issues and propose solutions. This 2018 conference at Meharry Medical College was part of an NIH-funded project on "LawSeqSM" to evaluate and improve the law of genomics in order to support appropriate integration of genomics into clinical care. This conference was composed of presentations and interactive sessions designed to specify the top legal barriers to health equity in precision medicine and stimulate potential solutions. This article synthesizes the results of those discussions. Multiple legal barriers limit broad inclusion in genomic research and the development of precision medicine to advance health equity. Problems include inadequate privacy and anti-discrimination protections for research participants, lack of health coverage and funding for follow-up care, failure to use law to ensure access to genomic medicine, and practices by research sponsors that tolerate and entrench disparities. Analysis of the legal barriers to health equity in precision medicine is essential for progress. Progressive use of law is vital to avoid worsening of health care disparities.
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Affiliation(s)
- Susan M. Wolf
- Consortium on Law and Values in Health, Environment & the Life Sciences; Law School; Medical School, University of Minnesota, Minneapolis, MN
| | - Vence L. Bonham
- Social and Behavioral Research Branch, Division of Intramural Research, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD
| | - Marino A. Bruce
- Program for Research on Faith and Health, Vanderbilt Center for Research on Men’s Health, Center for Medicine, Health, and Society, Vanderbilt University, Nashville, TN
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26
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Hollister BM, Gatter MC, Abdallah KE, Armsby AJ, Buscetta AJ, Byeon YJJ, Cooper KE, Desine S, Persaud A, Ormond KE, Bonham VL. Perspectives of Sickle Cell Disease Stakeholders on Heritable Genome Editing. CRISPR J 2019; 2:441-449. [PMID: 31742431 PMCID: PMC6919256 DOI: 10.1089/crispr.2019.0034] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Advances in CRISPR technology and the announcement of the first gene-edited babies have sparked a global dialogue about the future of heritable genome editing (HGE). There has been an international call for public input to inform a substantive debate about benefits and risks of HGE. This study investigates the views of the sickle cell disease (SCD) community. We utilized a mixed-methods approach to examine SCD stakeholders' views in the United States. We found SCD stakeholders hold a nuanced view of HGE. Assuming the technology is shown to be safe and effective, they are just as supportive of HGE as genetics professionals, but more supportive than the general public. However, they are also concerned about the potential implications of HGE, despite this support. As discourse surrounding HGE advances, it is crucial to engage disease communities and other key stakeholders whose lives could be altered by these interventions.
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Affiliation(s)
- Brittany M. Hollister
- Social and Behavioral Research Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland
| | - Mariclare C. Gatter
- Social and Behavioral Research Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland
| | - Khadijah E. Abdallah
- Social and Behavioral Research Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland
| | - Alyssa J. Armsby
- Department of Genetics, Stanford School of Medicine, Stanford University, Stanford, California
- Department of Cardiology, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Ashley J. Buscetta
- Social and Behavioral Research Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland
| | - Yen Ji Julia Byeon
- Social and Behavioral Research Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland
| | - Kayla E. Cooper
- Social and Behavioral Research Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland
| | - Stacy Desine
- Social and Behavioral Research Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland
| | - Anitra Persaud
- Social and Behavioral Research Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Kelly E. Ormond
- Department of Genetics, Stanford School of Medicine, Stanford University, Stanford, California
- Stanford Center for Biomedical Ethics, Stanford School of Medicine, Stanford University, Stanford, California
| | - Vence L. Bonham
- Social and Behavioral Research Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland
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27
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Popejoy AB, Ritter DI, Crooks K, Currey E, Fullerton SM, Hindorff LA, Koenig B, Ramos EM, Sorokin EP, Wand H, Wright MW, Zou J, Gignoux CR, Bonham VL, Plon SE, Bustamante CD. The clinical imperative for inclusivity: Race, ethnicity, and ancestry (REA) in genomics. Hum Mutat 2019; 39:1713-1720. [PMID: 30311373 DOI: 10.1002/humu.23644] [Citation(s) in RCA: 86] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 08/17/2018] [Accepted: 08/30/2018] [Indexed: 12/12/2022]
Abstract
The Clinical Genome Resource (ClinGen) Ancestry and Diversity Working Group highlights the need to develop guidance on race, ethnicity, and ancestry (REA) data collection and use in clinical genomics. We present quantitative and qualitative evidence to characterize: (1) acquisition of REA data via clinical laboratory requisition forms, and (2) information disparity across populations in the Genome Aggregation Database (gnomAD) at clinically relevant sites ascertained from annotations in ClinVar. Our requisition form analysis showed substantial heterogeneity in clinical laboratory ascertainment of REA, as well as marked incongruity among terms used to define REA categories. There was also striking disparity across REA populations in the amount of information available about clinically relevant variants in gnomAD. European ancestral populations constituted the majority of observations (55.8%), allele counts (59.7%), and private alleles (56.1%) in gnomAD at 550 loci with "pathogenic" and "likely pathogenic" expert-reviewed variants in ClinVar. Our findings highlight the importance of implementing and supporting programs to increase diversity in genome sequencing and clinical genomics, as well as measuring uncertainty around population-level datasets that are used in variant interpretation. Finally, we suggest the need for a standardized REA data collection framework to be developed through partnerships and collaborations and adopted across clinical genomics.
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Affiliation(s)
- Alice B Popejoy
- Department of Biomedical Data Science, Stanford University, Standford, California
| | - Deborah I Ritter
- Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - Kristy Crooks
- Department of Pathology, University of Colorado, Anschutz Medical Campus, Aurora, Colorado.,Department of Medicine, Division of Bioinformatics and Personalized Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Erin Currey
- Division of Genomics and Society, National Human Genome Research Institute (NHGRI), Bethesda, Maryland
| | | | - Lucia A Hindorff
- Division of Genomics and Society, National Human Genome Research Institute (NHGRI), Bethesda, Maryland
| | - Barbara Koenig
- Department of Anthropology, History, and Social Medicine, University of California, San Francisco
| | - Erin M Ramos
- Division of Genomics and Society, National Human Genome Research Institute (NHGRI), Bethesda, Maryland
| | - Elena P Sorokin
- Department of Biomedical Data Science, Stanford University, Standford, California
| | - Hannah Wand
- Department of Biomedical Data Science, Stanford University, Standford, California
| | - Mathew W Wright
- Department of Biomedical Data Science, Stanford University, Standford, California
| | - James Zou
- Department of Biomedical Data Science, Stanford University, Standford, California
| | - Christopher R Gignoux
- Department of Medicine, Division of Bioinformatics and Personalized Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Vence L Bonham
- Social and Behavioral Research Branch, National Human Genome Research Institute (NHGRI), Bethesda, Maryland
| | - Sharon E Plon
- Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - Carlos D Bustamante
- Department of Biomedical Data Science, Stanford University, Standford, California
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28
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Williams JK, Bonham VL, Wicklund C, Coleman B, Taylor JY, Cashion AK. Advocacy and actions to address disparities in access to genomic health care: A report on a National Academies workshop. Nurs Outlook 2019; 67:605-612. [PMID: 31395393 DOI: 10.1016/j.outlook.2019.06.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 05/17/2019] [Accepted: 06/15/2019] [Indexed: 01/01/2023]
Abstract
BACKGROUND In the United States, access to genomic risk assessment, testing, and follow up care is most easily obtained by those who have sufficient financial, educational, and social resources. Multiple barriers limit the ability of populations without those resources to benefit from health care that integrates genomics in assessment of disease risk, diagnosis, and targeted treatment. PURPOSE To summarize barriers and potential actions to reduce genomic health care disparities. METHOD Summarize authors' views on discussions at a workshop hosted by the National Academy of Medicine. DISCUSSION Barriers include access to health care providers that utilize genomics, genetic literacy of providers and patients, and absence of evidence of gene variants importance in ancestrally diverse underserved populations. CONCLUSION Engagement between underserved communities, health care providers, and policy makers is an essential component to raise awareness and seek solutions to barriers in access to genomic health care for all populations.
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Affiliation(s)
- Janet K Williams
- College of Nursing, The University of Iowa, Iowa City, IA; American Academy of Nursing, Washington, DC.
| | - Vence L Bonham
- National Human Genome Research Institute, National Institutes of Health, Bethesda, MD
| | | | - Bernice Coleman
- American Academy of Nursing, Washington, DC; Cedars-Sinai, Los Angeles, CA
| | - Jacquelyn Y Taylor
- American Academy of Nursing, Washington, DC; New York University Rory Meyers College of Nursing, New York, NY
| | - Ann K Cashion
- American Academy of Nursing, Washington, DC; National Institute of Nursing Research, National Institutes of Health, Bethesda, MD
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29
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Ormond KE, Bombard Y, Bonham VL, Hoffman-Andrews L, Howard H, Isasi R, Musunuru K, Riggan KA, Michie M, Allyse M. The clinical application of gene editing: ethical and social issues. Per Med 2019; 16:337-350. [DOI: 10.2217/pme-2018-0155] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Gene-editing techniques have progressed rapidly in the past 5 years. There are already ongoing human somatic gene-editing clinical trials for multiple diseases. And there has been one purported scenario of human germline gene editing in late 2018. In this paper, we will review the current state of the technology, discuss the ethical and social issues that surround the various forms of gene editing, as well as review emerging stakeholder data from professionals, the ‘general public’ and individuals and families dealing with genetic diseases potentially treatable by gene editing.
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Affiliation(s)
- Kelly E Ormond
- Department of Genetics & Stanford Center for Biomedical Ethics, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Yvonne Bombard
- Institute of Health Policy, Management & Evaluation, University of Toronto; Li Ka Shing Knowledge Institute of St Michael’s Hospital, Toronto, ON, Canada
- Li Ka Shing Knowledge Institute of St Michael’s Hospital, Toronto, ON, Canada
| | - Vence L Bonham
- Social & Behavioral Research Branch, National Human Genome Research Institute, NIH, Bethesda, MD 20892, USA
| | - Lily Hoffman-Andrews
- Penn Center for Inherited Cardiac Disease, Penn Medicine, Philadelphia, PA 19104, USA
| | - Heidi Howard
- Centre for Research Ethics & Bioethics, Uppsala University, Uppsala, Sweden
- Society & Ethics Research, Connecting Science, Wellcome Genome Campus, Cambridge, UK
| | - Rosario Isasi
- Dr J T Macdonald Foundation Department of Human Genetics, Institute of Bioethics & Health Policy, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - Kiran Musunuru
- Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, PA 19104, USA
| | - Kirsten A Riggan
- Biomedical Ethics Research Program, Mayo Clinic, Rochester, MN 55905, USA
| | - Marsha Michie
- Department of Bioethics, Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA
| | - Megan Allyse
- Biomedical Ethics Research Program & Center for Individualized Medicine, Mayo Clinic, Rochester, MN 55905, USA
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30
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Horowitz CR, Orlando LA, Slavotinek AM, Peterson J, Angelo F, Biesecker B, Bonham VL, Cameron LD, Fullerton SM, Gelb BD, Goddard KAB, Hailu B, Hart R, Hindorff LA, Jarvik GP, Kaufman D, Kenny EE, Knight SJ, Koenig BA, Korf BR, Madden E, McGuire AL, Ou J, Wasserstein MP, Robinson M, Leventhal H, Sanderson SC. The Genomic Medicine Integrative Research Framework: A Conceptual Framework for Conducting Genomic Medicine Research. Am J Hum Genet 2019; 104:1088-1096. [PMID: 31104772 PMCID: PMC6556906 DOI: 10.1016/j.ajhg.2019.04.006] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 04/10/2019] [Indexed: 01/13/2023] Open
Abstract
Conceptual frameworks are useful in research because they can highlight priority research domains, inform decisions about interventions, identify outcomes and factors to measure, and display how factors might relate to each other to generate and test hypotheses. Discovery, translational, and implementation research are all critical to the overall mission of genomic medicine and prevention, but they have yet to be organized into a unified conceptual framework. To fill this gap, our diverse team collaborated to develop the Genomic Medicine Integrative Research (GMIR) Framework, a simple but comprehensive tool to aid the genomics community in developing research questions, strategies, and measures and in integrating genomic medicine and prevention into clinical practice. Here we present the GMIR Framework and its development, along with examples of its use for research development, demonstrating how we applied it to select and harmonize measures for use across diverse genomic medicine implementation projects. Researchers can utilize the GMIR Framework for their own research, collaborative investigations, and clinical implementation efforts; clinicians can use it to establish and evaluate programs; and all stakeholders can use it to help allocate resources and make sure that the full complexity of etiology is included in research and program design, development, and evaluation.
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Affiliation(s)
- Carol R Horowitz
- Center for Health Equity and Community Engaged Research, Icahn School of Medicine, New York, NY 10029, USA; Department of Population Health Science and Policy, Icahn School of Medicine, New York, NY 10029, USA.
| | - Lori A Orlando
- Duke Center for Applied Genomics and Precision Medicine, Durham, NC 27708, USA
| | - Anne M Slavotinek
- Department of Pediatrics, Division of Genetics, University of California, San Francisco, CA 94143, USA
| | - Josh Peterson
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - Frank Angelo
- Clinical Sequencing Evidence-Generating Research Coordinating Center, University of Washington, Seattle, WA 98195, USA; Department of Medicine, Division of Medical Genetics, University of Washington, Seattle, WA 98195, USA
| | | | - Vence L Bonham
- Social and Behavioral Research Branch, National Human Genome Research Institute, NIH, Bethesda, MD 20892, USA
| | | | - Stephanie M Fullerton
- Clinical Sequencing Evidence-Generating Research Coordinating Center, University of Washington, Seattle, WA 98195, USA; Department of Bioethics and Humanities, University of Washington, Seattle, WA 98195, USA
| | - Bruce D Gelb
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | | | - Benyam Hailu
- Division of Scientific Programs, National Institute of Minority Health and Health Disparities, NIH, Bethesda, MD 20892, USA
| | - Ragan Hart
- Clinical Sequencing Evidence-Generating Research Coordinating Center, University of Washington, Seattle, WA 98195, USA; Department of Medicine, Division of Medical Genetics, University of Washington, Seattle, WA 98195, USA
| | - Lucia A Hindorff
- Division of Genomic Medicine, National Human Genome Research Institute, NIH, Bethesda, MD 20892, USA
| | - Gail P Jarvik
- Clinical Sequencing Evidence-Generating Research Coordinating Center, University of Washington, Seattle, WA 98195, USA; Department of Medicine, Division of Medical Genetics, University of Washington, Seattle, WA 98195, USA
| | - Dave Kaufman
- Division of Genomics and Society, National Human Genome Research Institute, NIH, Bethesda, MD 20892, USA
| | - Eimear E Kenny
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; The Center for Population Genomic Health, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Sara J Knight
- Division of Preventive Medicine, University of Alabama at Birmingham and Birmingham VA Medical Center, Birmingham, AL 35205, USA
| | - Barbara A Koenig
- Program in Bioethics, University of California, San Francisco, CA 94143, USA
| | - Bruce R Korf
- Department of Genetics, University of Alabama at Birmingham, Birmingham, AL 35205, USA
| | - Ebony Madden
- Division of Genomic Medicine, National Human Genome Research Institute, NIH, Bethesda, MD 20892, USA
| | - Amy L McGuire
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX 77030, USA
| | - Jeffrey Ou
- Clinical Sequencing Evidence-Generating Research Coordinating Center, University of Washington, Seattle, WA 98195, USA; Department of Medicine, Division of Medical Genetics, University of Washington, Seattle, WA 98195, USA
| | - Melissa P Wasserstein
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | | | - Howard Leventhal
- Department of Psychology, Institute for Health, Rutgers University, New Brunswick, NJ 08901, USA
| | - Saskia C Sanderson
- Behavioural Science and Health Department, University College London, London, UK
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31
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Affiliation(s)
- Vence L Bonham
- National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland
| | - Eric D Green
- National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland
| | - Eliseo J Pérez-Stable
- National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, Maryland
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32
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Sellers SL, Cunningham BA, Bonham VL. Correction to: Physician Knowledge of Human Genetic Variation, Beliefs About Race and Genetics, and Use of Race in Clinical Decision-making. J Racial Ethn Health Disparities 2019; 6:647-648. [PMID: 30903568 DOI: 10.1007/s40615-019-00579-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We discovered that two of the items in the knowledge index were incorrectly identified. We reran all the analyses and none of the major findings changed. However, we would like to correct the error since our hope is that others will use the measure.
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Affiliation(s)
- Sherrill L Sellers
- College of Education, Health & Society, Miami University, 210 E. Spring Street, Oxford, OH, 45056, USA.
| | - Brooke A Cunningham
- Department of Family Medicine and Community Health, University of Minnesota Medical School, 717 Delaware Street Se, Rm 420, MMC 381, Minneapolis, MN, 55414, USA
| | - Vence L Bonham
- Social and Behavioral Research Branch, National Human Genome Research Institute, National Institutes of Health, 31 Center Drive Room B1B37-G, Bethesda, MD, 20892, USA
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33
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Abstract
The potential of genomics to improve health comes with the peril that the benefits will not be equitably available to all populations. Existing health disparities can be exacerbated if the implementation of genomic medicine does not intentionally focus on health equity. Defining what health equity means in the context of genomics and outlining how it can be achieved is important for the future of the field. Strategies to improve health equity include addressing underrepresentation of diverse populations in genomic research, investigating how genomic services can be deployed in diverse health care settings and underserved communities, increasing workforce diversity, supporting infrastructure development outside traditional research centers, and engaging communities and health care providers. By employing these strategies, the genomic research community can advance health equity in genomic medicine.
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Affiliation(s)
- Sonya Jooma
- National Human Genome Research Institute, National Institutes of Health, Bethesda, MD
| | - Michael J Hahn
- National Human Genome Research Institute, National Institutes of Health, Bethesda, MD
| | - Lucia A Hindorff
- National Human Genome Research Institute, National Institutes of Health, Bethesda, MD
| | - Vence L Bonham
- National Human Genome Research Institute, National Institutes of Health, Bethesda, MD
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34
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Affiliation(s)
- Yen Ji Julia Byeon
- Social and Behavioral Research Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland
| | - Sherrill L Sellers
- Department of Family Science and Social Work, Miami University, Oxford, OH
| | - Vence L Bonham
- Social and Behavioral Research Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland
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35
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Abdallah KE, Calzone KA, Jenkins JF, Moss ME, Sellers SL, Bonham VL. A Comparison of Physicians' and Nurse Practitioners' Use of Race in Clinical Decision-Making. Ethn Dis 2019; 29:1-8. [PMID: 30713409 DOI: 10.18865/ed.29.1.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Objective The debate over use of race as a proxy for genetic risk of disease continues, but little is known about how primary care providers (nurse practitioners and general internal medicine physicians) currently use race in their clinical practice. Our study investigates primary care providers' use of race in clinical practice. Methods Survey data from three cross-sectional parent studies were used. A total of 178 nurse practitioners (NPs) and 759 general internal medicine physicians were included. The outcome of interest was the Racial Attributes in Clinical Evaluation (RACE) scale, which measures explicit use of race in clinical decision-making. Predictor variables included the Genetic Variation Knowledge Assessment Index (GKAI), which measures the providers' knowledge of human genetic variation. Results In the final multivariable model, NPs had an average RACE score that was 1.60 points higher than the physicians' score (P=.03). The GKAI score was not significantly associated with the RACE outcome in the final model (P=.67). Conclusions Physicians had more knowledge of genetic variation and used patients' race less in the clinical decision-making process than NPs. We speculate that these differences may be related to differences in discipline-specific clinical training and approaches to clinical care. Further exploration of these differences is needed, including examination of physicians' and NPs' beliefs about race, how they use race in disease screening and treatment, and if the use of race is contributing to health care disparities.
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Affiliation(s)
- Khadijah E Abdallah
- Health Disparities Unit, Social and Behavioral Research Branch, Division of Intramural Research, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD
| | - Kathleen A Calzone
- Genetics Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Jean F Jenkins
- Office of the Director, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD (retired)
| | - Melissa E Moss
- Health Disparities Unit, Social and Behavioral Research Branch, Division of Intramural Research, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD.,Department of Psychology, University of Oregon, Eugene, OR
| | - Sherrill L Sellers
- Department of Family Science and Social Work, Miami University, Oxford, OH
| | - Vence L Bonham
- Health Disparities Unit, Social and Behavioral Research Branch, Division of Intramural Research, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD
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Naik RP, Smith-Whitley K, Hassell KL, Umeh NI, de Montalembert M, Sahota P, Haywood C, Jenkins J, Lloyd-Puryear MA, Joiner CH, Bonham VL, Kato GJ. Clinical Outcomes Associated With Sickle Cell Trait: A Systematic Review. Ann Intern Med 2018; 169:619-627. [PMID: 30383109 PMCID: PMC6487193 DOI: 10.7326/m18-1161] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Background Although sickle cell trait (SCT) is largely a benign carrier state, it may increase risk for certain clinical outcomes. Purpose To evaluate associations between SCT and clinical outcomes in children and adults. Data Sources English-language searches of PubMed, CINAHL, the Cochrane Library, Current Contents Connect, Scopus, and Embase (1 January 1970 to 30 June 2018) and bibliographies of review articles. Study Selection Observational controlled studies (published in English) in children or adults that examined an association between SCT and any of 24 clinical outcomes specified a priori in the following 6 categories: exertion-related injury; renal, vascular, pediatric, and surgery- or trauma-related outcomes; and overall mortality. Data Extraction A single reviewer extracted study data, which was checked by another; 2 reviewers independently assessed study quality; and strength of evidence was assessed by consensus. Data Synthesis Of 7083 screened studies, 41 met inclusion criteria. High-strength evidence supported a positive association between SCT and risk for pulmonary embolism, proteinuria, and chronic kidney disease. Moderate-strength evidence supported a positive association between SCT and exertional rhabdomyolysis and a null association between SCT and deep venous thrombosis, heart failure or cardiomyopathy, stroke, and pediatric height or weight. Absolute risks for thromboembolism and rhabdomyolysis were small. For the remaining 15 clinical outcomes, data were insufficient or strength of evidence was low. Limitation Publication bias was possible, and high-quality evidence was scant. Conclusion Sickle cell trait is a risk factor for a few adverse health outcomes, such as pulmonary embolism, kidney disease, and exertional rhabdomyolysis, but does not seem to be associated with such complications as heart failure and stroke. Insufficient data or low-strength evidence exists for most speculated complications of SCT. Primary Funding Source National Human Genome Research Institute.
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Affiliation(s)
| | - Kim Smith-Whitley
- Children’s Hospital of Philadelphia and University of
Pennsylvania, Philadelphia, Pennsylvania
| | | | - Nkeiruka I. Umeh
- National Human Genome Research Institute of the National Institutes
of Health, Bethesda, Maryland
| | | | - Puneet Sahota
- Children’s Hospital of Philadelphia and University of
Pennsylvania, Philadelphia, Pennsylvania
| | - Carlton Haywood
- University of Pennsylvania, Philadelphia, Pennsylvania; Johns
Hopkins Berman Institute of Bioethics, Baltimore, Maryland
| | - Jean Jenkins
- National Human Genome Research Institute of the National Institutes
of Health, Bethesda, Maryland
| | | | | | - Vence L. Bonham
- National Human Genome Research Institute of the National
Institutes of Health, Bethesda, Maryland
| | - Gregory J. Kato
- Vascular Medicine Institute at the University of Pittsburgh School
of Medicine, Pittsburgh, Pennsylvania
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Affiliation(s)
- Vence L. Bonham
- *Senior Advisor to the Director on Genomics and Health Disparities and Associate Investigator, National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland
- Corresponding author: National Human Genome Research Institute, National Institutes of Health, 31 Center Drive Room B1-B37-G, Bethesda, Maryland, , Tel: 301-594-3973
| | - Eric D. Green
- Director, National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland
| | - Eliseo J. Pérez-Stable
- Director, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, Maryland
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Abstract
Advances in genomic medicine are arising from efforts to build a national learning healthcare system (LHS) and large-scale precision medicine studies. However, the underlying evidence base lacks sufficient data from populations historically underrepresented in biomedical research. Although the literature on health and healthcare disparities is extensive, disparities in the availability and quality of health information about diverse and underrepresented populations are less well characterized. This Perspective describes scientific and ethical benefits to incorporating health information from diverse and underrepresented populations in the LHS, resulting in a more robust and generalizable LHS. Near-term recommendations for incorporating diversity into the evidence base for genomic medicine are proposed, even as the groundwork for national and international efforts is underway.
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Affiliation(s)
- Lucia A Hindorff
- Division of Genomic Medicine, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Vence L Bonham
- Division of Intramural Research, Social & Behavioral Research Branch & Office of the Director, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Lucila Ohno-Machado
- UCSD Health Department of Biomedical Informatics, University of California San Diego, La Jolla, CA, 92093, USA
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Abstract
Precision medicine research initiatives aim to use participants' electronic health records (EHRs) to obtain rich longitudinal data for large-scale precision medicine studies. Although EHRs vary widely in their inclusion and formatting of social and behavioral data, these data are essential to investigating genetic and social factors in health disparities. We explore possible biases in collecting, using, and interpreting EHR-based social and behavioral data in precision medicine research and their consequences for health equity.
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Affiliation(s)
- Brittany Hollister
- A health disparities postdoctoral fellow at the National Human Genome Research Institute within the National Institutes of Health in Bethesda, Maryland
| | - Vence L Bonham
- An associate investigator in the Social and Behavioral Research Branch (SBRB) of the National Human Genome Research Institute within the National Institutes of Health in Bethesda, Maryland
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Crouch EM, Bonham VL, Abdallah K, Buscetta A, Vinces G, Heo M, Minniti CP. Nutritional supplement profile of adults with sickle cell disease. Am J Hematol 2018; 93:10.1002/ajh.25129. [PMID: 29726579 PMCID: PMC6215738 DOI: 10.1002/ajh.25129] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 04/30/2018] [Accepted: 05/01/2018] [Indexed: 11/07/2022]
Affiliation(s)
- Elena M Crouch
- Division of Hematology, Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Vence L. Bonham
- Social and Behavioral Research Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Khadijah Abdallah
- Social and Behavioral Research Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Ashley Buscetta
- Social and Behavioral Research Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Giacomo Vinces
- Department of Family Medicine, Montefiore Medical Center, Bronx, NY, US
| | - Moonseong Heo
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Caterina P. Minniti
- Division of Hematology, Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
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Landry LG, Ali N, Williams DR, Rehm HL, Bonham VL. Lack Of Diversity In Genomic Databases Is A Barrier To Translating Precision Medicine Research Into Practice. Health Aff (Millwood) 2018; 37:780-785. [DOI: 10.1377/hlthaff.2017.1595] [Citation(s) in RCA: 138] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Latrice G. Landry
- Latrice G. Landry is a fellow in the Laboratory for Molecular Medicine, Partners Personalized Medicine, in Cambridge, Massachusetts, and in the Office of Minority Health, Food and Drug Administration, in Silver Spring, Maryland
| | - Nadya Ali
- Nadya Ali is an MD candidate in the Michigan State University College of Human Medicine, in East Lansing
| | - David R. Williams
- David R. Williams is a professor in the Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, in Boston, Massachusetts, and in the Department of African and African American Studies, Harvard University, in Cambridge
| | - Heidi L. Rehm
- Heidi L. Rehm is the chief genomic officer in the Center for Genomic Medicine and Department of Medicine at Massachusetts General Hospital, in Boston, and medical director of the Broad Institute Clinical Research Sequencing Platform, in Cambridge
| | - Vence L. Bonham
- Vence L. Bonham is an associate investigator in the Social and Behavioral Research Branch, Division of Intramural Research, and senior adviser to the director on genomics and health disparities at the National Human Genome Research Institute, National Institutes of Health, in Bethesda, Maryland
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Abstract
Recent studies have highlighted the imperatives of including diverse and under-represented individuals in human genomics research and the striking gaps in attaining that inclusion. With its multidecade experience in supporting research and policy efforts in human genomics, the National Human Genome Research Institute is committed to establishing foundational approaches to study the role of genomic variation in health and disease that include diverse populations. Large-scale efforts to understand biology and health have yielded key scientific findings, lessons and recommendations on how to increase diversity in genomic research studies and the genomic research workforce. Increased attention to diversity will increase the accuracy, utility and acceptability of using genomic information for clinical care.
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Affiliation(s)
- Lucia A Hindorff
- National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland 20892-2152, USA
| | - Vence L Bonham
- National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland 20892-2152, USA
| | - Lawrence C Brody
- National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland 20892-2152, USA
| | - Margaret E C Ginoza
- National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland 20892-2152, USA
| | - Carolyn M Hutter
- National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland 20892-2152, USA
| | - Teri A Manolio
- National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland 20892-2152, USA
| | - Eric D Green
- National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland 20892-2152, USA
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Abstract
To fully achieve the goals of a genomics‐enabled learning health care system, purposeful efforts to understand and reduce health disparities and improve equity of care are essential. This paper highlights 3 major challenges facing genomics‐enabled learning health care systems, as they pertain to ancestrally diverse populations: inequality in the utility of genomic medicine; lack of access to pharmacogenomics in clinical care; and inadequate incorporation of social and environmental data into the electronic health care record. We advance a framework that cannot only be used to directly improve care for all within the learning health system but can also be used to focus on the needs to address racial and ethnic health disparities and improve health equity.
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Affiliation(s)
- Katherine D Blizinsky
- Research Fellow, Social and Behavioral Research Branch, National Human Genome Research Institute, National Institutes of Health, 31 Center Drive Building 31 Room B1B37-G, Bethesda, Maryland 20892-2070
| | - Vence L Bonham
- Associate Investigator, Social and Behavioral Research Branch, National Human Genome Research Institute, National Institutes of Health, 31 Center Drive Building 31 Room B1B37-G, Bethesda, Maryland 20892-2070
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Umeh NI, Ajegba B, Buscetta AJ, Abdallah KE, Minniti CP, Bonham VL. The psychosocial impact of leg ulcers in patients with sickle cell disease: I don't want them to know my little secret. PLoS One 2017; 12:e0186270. [PMID: 29045487 PMCID: PMC5646800 DOI: 10.1371/journal.pone.0186270] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2017] [Accepted: 09/28/2017] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Sickle cell disease (SCD) impacts millions of individuals worldwide and more than 100,000 people in the United States. Leg ulcers are the most common cutaneous manifestation of SCD. The health status of individuals living with chronic leg ulcers is not only influenced by clinical manifestations such as pain duration and intensity, but also by psychosocial factors. Garnering insights into the psychosocial impact can provide a more holistic view of their influence on quality of life. METHODS Semi-structured interviews were conducted with participants living with active SCD-associated leg ulcers or with a history of ulcers. Subjects were recruited from an ongoing study (INSIGHTS, Clin Trial.Gov NCT02156102) and consented to this qualitative phase of the study. Five areas were explored: leg ulcer pain, physical function, social-isolation, social relationships and religious support. Data was collected from 20 individuals during these interviews and a thematic analysis was performed and reported. RESULTS Twenty participants with a mean age of 42.4 (SD ± 11.1years) were included in the study. Major themes identified included:1) pain (acute and chronic); 2) compromised physical function as demonstrated by decreased ability to walk, run, and play sports; 3) social isolation from activities either by others or self-induced as a means of avoiding certain emotions, such as embarrassment; 4) social relationships (family support and social network); 5) support and comfort through their religion or spirituality. CONCLUSIONS SCD patients with leg ulcers expressed that they experience social isolation, intense and frequent ulcer pain, and difficulty in physical function. SCD-associated leg ulcers have been studied from a clinical approach, but the psychosocial factors investigated in this study informs how quality of life is impacted by the leg ulcers.
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Affiliation(s)
- Nkeiruka I. Umeh
- Social and Behavioral Research Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland, United States of America
- Albany Medical College, Albany, New York, United States of America
| | - Brittany Ajegba
- Social and Behavioral Research Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland, United States of America
- Michigan State University, College of Human Medicine, East Lansing, Michigan, United States of America
| | - Ashley J. Buscetta
- Social and Behavioral Research Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Khadijah E. Abdallah
- Social and Behavioral Research Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Caterina P. Minniti
- Montefiore Medical Center, Division of Hematology, Sickle Cell Center, Bronx, New York City, New York, United States of America
| | - Vence L. Bonham
- Social and Behavioral Research Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland, United States of America
- * E-mail:
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Abstract
As the field of genomics enters the second decade after the completion of the International Human Genome Project, human genomics research is still far from reflective of the ancestral diversity found in global populations. This special issue of the Journal of Community Genetics brings together a global perspective on the need for researchers and health care professionals to support achievable milestones that will enhance global ancestral diversity in genomic research for the 21st century, and integrate the resulting knowledge into health care that benefits everyone. As the publications in this special issue illustrate, this will require focused community engagement, including often overlooked isolated populations, as well as meaningful integration of genomics and health services across the global landscape. With the advancement of sequencing technology and reduction in the cost, the time has come to address critical barriers.
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Affiliation(s)
- Martina C Cornel
- Department of Clinical Genetics and Amsterdam Public Health Research Institute, Section Community Genetics, VU University Medical Center, BS7, A527, Mail A509 APH, PO Box 7057, 1007 MB, Amsterdam, The Netherlands.
| | - Vence L Bonham
- Division of Intramural Research, Social and Behavioral Research Branch, National Institutes of Health, National Human Genome Research Institute, Bethesda, MD, USA
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Bonham VL, Umeh NI, Cunningham BA, Abdallah KE, Sellers SL, Cooper LA. Primary Care Physicians' Collection, Comfort, and Use of Race and Ethnicity in Clinical Practice in the United States. Health Equity 2017; 1:118-126. [PMID: 28966994 PMCID: PMC5621603 DOI: 10.1089/heq.2017.0015] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Purpose: The clinical utility of race and ethnicity has been debated. It is important to understand if and how race and ethnicity are communicated and collected in clinical settings. We investigated physicians' self-reported methods of collecting a patient's race and ethnicity in the clinical encounter, their comfort with collecting race and ethnicity, and associations with use of race in clinical decision-making. Methods: A national cross-sectional study of 787 clinically active general internists in the United States. Physicians' self-reported comfort with collecting patient race and ethnicity, their collection practices, and use of race in clinical care were assessed. Bivariate and multivariable regression analyses were conducted to examine associations between comfort, collection practices, and use of race. Results: Most physicians asked patients to self-report their race or ethnicity (26.5%) on an intake form or collected this information directly from patients (26.2%). Most physicians were comfortable collecting patient race and ethnicity (84.3%). Physicians who were more comfortable collecting patient race and ethnicity (β=1.65; [95% confidence interval; CI 0.03–3.28]) or who directly collected patients' race and ethnicity (β=1.24 [95% CI 0.07–2.41]) were more likely to use race in clinical decision-making than physicians who were uncomfortable. Conclusions: This study documents variation in physician comfort level and practice patterns regarding patient race and ethnicity data collection. As the U.S. population becomes more diverse, future work should examine how physicians speak about race and ethnicity with patients and their use of race and ethnicity data impact patient–physician relationships, clinical decision-making, and patient outcomes.
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Affiliation(s)
- Vence L Bonham
- Social and Behavioral Research Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland
| | - Nkeiruka I Umeh
- Social and Behavioral Research Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland.,Albany Medical College, Albany, New York
| | - Brooke A Cunningham
- Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Khadijah E Abdallah
- Social and Behavioral Research Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland
| | - Sherrill L Sellers
- College of Education, Health and Society, Miami University, Oxford, Ohio
| | - Lisa A Cooper
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Findley K, Williams DR, Grice EA, Bonham VL. Health Disparities and the Microbiome. Trends Microbiol 2016; 24:847-850. [PMID: 27712950 DOI: 10.1016/j.tim.2016.08.001] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Revised: 07/30/2016] [Accepted: 08/10/2016] [Indexed: 01/05/2023]
Abstract
An individual's microbiome is likely to be an important contributor to certain health disparity diseases and conditions. We present a framework to study the role of the microbiome and the multiple factors that are likely to influence differences in disease predisposition, onset, and progression at the individual and population level.
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Affiliation(s)
- Keisha Findley
- Social and Behavioral Research Branch, National Human Genome Research Institute, National Institutes of Health, 31 Center Drive Room B1B37-G, Bethesda, MD 20892, USA
| | - David R Williams
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Kresge Building Room 615, Boston, MA 02115, USA
| | - Elizabeth A Grice
- Departments of Dermatology and Microbiology, Perelman School of Medicine, University of Pennsylvania, 421 Curie Boulevard, 1007 BRB II/III, Philadelphia, PA 19104, USA
| | - Vence L Bonham
- Social and Behavioral Research Branch, National Human Genome Research Institute, National Institutes of Health, 31 Center Drive Room B1B37-G, Bethesda, MD 20892, USA.
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Sellers SL, Moss ME, Calzone K, Abdallah KE, Jenkins JF, Bonham VL. Nurses' Use of Race in Clinical Decision Making. J Nurs Scholarsh 2016; 48:577-586. [PMID: 27676232 DOI: 10.1111/jnu.12251] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/02/2016] [Indexed: 11/30/2022]
Abstract
PURPOSE To examine nurses' self-reported use of race in clinical evaluation. DESIGN This cross-sectional study analyzed data collected from three separate studies using the Genetics and Genomics in Nursing Practice Survey, which includes items about use of race and genomic information in nursing practice. The Racial Attributes in Clinical Evaluation (RACE) scale was used to measure explicit clinical use of race among nurses from across the United States. METHODS Multivariate regression analysis was used to examine associations between RACE score and individual-level characteristics and beliefs in 5,733 registered nurses. FINDINGS Analysis revealed significant relationships between RACE score and nurses' race and ethnicity, educational level, and views on the clinical importance of patient demographic characteristics. Asian nurses reported RACE scores 1.41 points higher than White nurses (p < .001), and Black nurses reported RACE scores 0.55 points higher than White nurses (p < .05). Compared to diploma-level nurses, the baccalaureate-level nurses reported 0.69 points higher RACE scores (p < .05), master's-level nurses reported 1.63 points higher RACE scores (p < .001), and doctorate-level nurses reported 1.77 points higher RACE scores (p < .01). In terms of clinical importance of patient characteristics, patient race and ethnicity corresponded to a 0.54-point increase in RACE score (p < .001), patient genes to a 0.21-point increase in RACE score (p < .001), patient family history to a 0.15-point increase in RACE score (p < .01), and patient age to a 0.19-point increase in RACE score (p < .001). CONCLUSIONS Higher reported use of race among minority nurses may be due, in part, to differential levels of racial self-awareness. A relatively linear positive relationship between level of nursing degree nursing education and use of race suggests that a stronger foundation of knowledge about genetic ancestry, population genetics and the concept "race" and genetic ancestry may increase in clinical decision making could allow nurses to more appropriately use of race in clinical care. Integrating patient demographic characteristics into clinical decisions is an important component of nursing practice. CLINICAL RELEVANCE Registered nurses provide care for diverse racial and ethnic patient populations and stand on the front line of clinical care, making them essential for reducing racial and ethnic disparities in healthcare delivery. Exploring registered nurses' individual-level characteristics and clinical use of race may provide a more comprehensive understanding of specific training needs and inform nursing education and practice.
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Affiliation(s)
- Sherrill L Sellers
- *Associate Dean for Undergraduate Education and Professor, Department of Family Studies and Social Work, Miami University, Oxford, OH, USA.
| | - Melissa E Moss
- *Postbaccalaureate Intramural Research Training Award (IRTA) Fellow, Health Disparities Unit, Social and Behavioral Research Branch, Division of Intramural Research, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
| | - Kathleen Calzone
- Senior Nurse Specialist, Research, National Cancer Institute, Center for Cancer Research, Genetics Branch, National Institutes of Health, Bethesda, MD, USA
| | - Khadijah E Abdallah
- Research Analyst, Health Disparities Unit, Social and Behavioral Research Branch, Division of Intramural Research, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
| | - Jean F Jenkins
- Clinical Advisor, Office of the Director, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
| | - Vence L Bonham
- Associate Investigator, Health Disparities Unit, Social and Behavioral Research Branch, Division of Intramural Research, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
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Affiliation(s)
- Vence L Bonham
- From the Social and Behavioral Research Branch, National Human Genome Research Institute, Bethesda, MD (V.L.B.); the Department of Clinical Research and Leadership, George Washington University, Washington, DC (S.L.C.); and the Department of African and African American Studies and Center on Genomics, Race, Identity, Difference, Duke University, Durham, NC (C.D.R.)
| | - Shawneequa L Callier
- From the Social and Behavioral Research Branch, National Human Genome Research Institute, Bethesda, MD (V.L.B.); the Department of Clinical Research and Leadership, George Washington University, Washington, DC (S.L.C.); and the Department of African and African American Studies and Center on Genomics, Race, Identity, Difference, Duke University, Durham, NC (C.D.R.)
| | - Charmaine D Royal
- From the Social and Behavioral Research Branch, National Human Genome Research Institute, Bethesda, MD (V.L.B.); the Department of Clinical Research and Leadership, George Washington University, Washington, DC (S.L.C.); and the Department of African and African American Studies and Center on Genomics, Race, Identity, Difference, Duke University, Durham, NC (C.D.R.)
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