Racial and cultural in-betweenness meet in the consulting room: the case of 'Anna'

An upper-middle-class black woman, who grew up adapting to a white-dominated environment, entered the consulting room of a multicultural 'white-passing' analyst, and here unique emotional experiences were reflected in dream images of racial disorganization, internal racism, and identity confusion. While sorting through the analysand's internal dynamics, the external world erupted in May 2020 with the murder of George Floyd, catapulting both analysand and analyst (and the nation) into a transformative confrontation with their mutual, deep-seated woundings of American racial and cultural inequities. The analysand's racial complexity directly impacted the analyst's 'white-passing' privilege, bringing into question established classifications of American whiteness. Overlapping dynamics and experiences as 'in-betweeners' and 'outsiders' - a black woman subsumed by a white-dominated society and an immigrant refugee acculturated to American life - provided a common exilic ground for mutual understanding and mirroring. The analyst explores the racial and multicultural straddling that served as a lens into the analysand's fragmented racial identity during the eruption of American racial unrest.

Kidney cancer mortality disparities among Hispanics in the US

INTRODUCTION

Kidney cancer incidence is increasing among Hispanics but rate differences by distinct group, such as Cuban, Puerto Rican, and Mexican have not been studied. To fill this knowledge gap, we use mortality data, reflecting fatal kidney cancers, to examine patterns by race-ethnicity, including detailed Hispanic groups, and correlate the mortality rates with each group's prevalence of known kidney cancer risk factors: smoking, obesity, hypertension, diabetes, and chronic kidney disease.

METHODS

We used individual-level death data for California, Florida, and New York (2008-2018), and population prevalence data from the National Health Interview Surveys (2008-2018). Age-adjusted mortality rates (AAMRs) and regression-derived mortality rate ratios (MRRs) were computed. Pearson correlation analyses assessed the extent to which group-specific risk factor prevalence explained variability in observed AAMRs.

RESULTS

US-born Mexican Americans and American Indians had the highest rates and MRRs compared to Whites: 1.44 (95 %CI: 1.35-1.53) and 1.51 (1.38-1.64) for Mexican American men and women, respectively, and 1.54 (95 %CI: 1.25-1.89) and 1.53 (95 %CI: 1.15-2.04) for American Indians. In contrast, non-Mexican Hispanics had lower rates than Whites. Among males, positive correlations between AAMRs and smoking, obesity, and chronic kidney disease prevalence by race-ethnicity were found.

CONCLUSION

Mexican Americans and American Indians are high-risk for fatal kidney cancer. Disparities are only partially attributable to higher smoking and obesity prevalence, and more so among men than women. A shared risk factor profile, as well as possible genetic similarities, may explain their disproportionately higher kidney cancer mortality, but further research is warranted.

Pain Prevalence, Chronicity and Impact Within Subpopulations Based on Both Hispanic Ancestry and Race: United States, 2010-2017

We provide national surveillance estimates of pain chronicity, severity and impact in adult subpopulations defined by both Hispanic Ancestry and Race. Data are from 144,434 adults who completed validated questionnaires in the 2010-2017 National Health Interview Survey asking about pain status within the last 3 (N = 84,664) or 6 months (N = 59,770). Multivariable logistic regression was used to assess the relationship between pain and ethnicity/race. Compared to White Puerto Rican participants, White participants with Central/South American and Mexican ancestry had reduced odds of reporting Category 3-4 pain and High-Impact Chronic Pain (HICP), while those of Cuban ancestry had reduced odds of only HICP - eg, White participants with Mexican ancestry had 32% lower odds of having Category 3-4 pain and 50% lower odds of having HICP. While no differences were seen between White Puerto Rican and White Non-Hispanic participants for Category 3-4 pain, White Non-Hispanics had 40% lower odds of reporting HICP. Asian Non-Hispanic and Black Non-Hispanic participants had significantly lower odds of reporting Category 3-4 pain and HICP compared to White Puerto Rican participants, eg, Black Non-Hispanic participants had 26% lower odds off having Category 3-4 pain and 42% lower odds of having HICP. Perspective: By examining pain status in discrete demographic groups based on Hispanic Ancestry and Race, this report further documents substantial difference in health status among underserved populations and provides a baseline for continuing surveillance research on pain, with the eventual goal of eliminating disparities in pain assessment and treatment.

The association between etiology of hepatocellular carcinoma and race-ethnicity in Florida

BACKGROUND AND AIM

The incidence of hepatocellular carcinoma (HCC) has risen considerably in the US since 1980. The main causes include metabolic disorders (NAFLD, diabetes, obesity, metabolic syndrome), alcohol-related disease (ALD) and hepatitis C and B virus infections (HCV, HBV). Etiology-specific HCC incidence rates by detailed race-ethnicity are needed to improve HCC control and prevention efforts.

METHODS

All HCC cases diagnosed in Florida during 2014-2015 were linked to statewide hospital discharge data to determine etiology. Age-specific and age-adjusted rates were used to assess the intersection between etiology and detailed racial-ethnicities, including White, African American, Afro-Caribbean, Asian, Cuban, Puerto Rican and Continental Hispanic (Mexican, South and Central American).

RESULTS

Of 3666 HCC cases, 2594 matched with discharge data. HCV was the leading cause of HCC among men and women (50% and 43% respectively), followed by metabolic disorders (25% and 37%) and ALD (16% and 9%). Puerto Rican and African American men had the highest HCV-HCC rates, 7.9 and 6.3 per 100 000 respectively. Age-specific rates for HCV-HCC peaked among baby boomers (those born in 1945-1965). Metabolic-HCC rates were highest among populations above age 70 and among Continental Hispanics. Afro-Caribbean men had high rates of HBV-HCC, whereas Puerto Rican men had high ALD-HCC.

CONCLUSIONS

HCC etiology is associated with specific race/ethnicity. While HCV-related HCC rates are projected to decrease soon, HCC will continue to affect Hispanics disproportionately, based on higher rates of metabolic-HCC (and ALD-HCC) among Continental Hispanics, who demographically represent 80% of all US Hispanics. Multifaceted approaches for HCC control and prevention are needed.

Results from a double-blind randomized control trial Phase I

BACKGROUND

Cuba has a new pneumococcal conjugate vaccine candidate (PCV7-TT). This study evaluates the safety and immunogenicity in healthy infants using 2p+1 vaccination schedule.

METHODS

A phase I, controlled, randomized and double blind clinical trial was designed. 30 unvaccinated healthy infants were included. 20 subjects were assigned to study group (PCV7-TT) and 10 to control group (Synflorix®) to receive the vaccines at 7, 8 months of age (primary series) and 11 months (booster dose). Blood samples were collected 30 days after second dose and post booster for antibodies measure analysis by ELISA and OPA. The statistics analysis included the frequency of occurrence for adverse events and the immune response. Non-parametric tests were used to compare the immune response. The clinical trial was published in the Cuban Public Register of Clinical Trials with code RPCEC00000173 available at http://registroclinico.sld.cu.

RESULTS

Overall, the safety profile of PCV7-TT was similar to Synflorix®. Local reactions were predominant and systemic events were mild in severity. Swelling and redness were frequently associated with PCV7-TT mainly after the first dose (50% and 40% respectively). 15% and 10% of subject reported severe swelling after first dose with PCV7-TT and after second dose with Synflorix®. Mild fever (≥38-≤39), vomiting and sleep disturb were the systemic events reported. 100% of infants achieved pneumococcal IgG antibody concentrations ≥0.35 µg/ml after booster dose for serotypes 1, 14, 18C and 19F in each vaccine group. For serotypes 5, 6B and 23F, more than 80% infants vaccinated with Synflorix® or PCV7-TT achieved protective IgG GMC ≥ 0.35 µg/ml after booster dose. OPA proportion's responders to the seven common serotypes were 89.5% or more after the primary dose and 100% after booster dose in vaccinated with PCV7-TT.

CONCLUSIONS

The Cuban PCV7-TT is safe, well tolerated and immunogenic in healthy infants.

Associations between neighborhood socioeconomic environment and physical activity in Cuban immigrants

Physical inactivity is a major public health concern because it is a determinant of obesity and obesity-related chronic diseases. Few longitudinal studies have examined the association between neighborhood socioeconomic (SES) environment and change in physical activity behaviors. Additionally, few studies have examined this association in immigrant groups or Hispanic subgroups such as Cubans. This research aimed to determine if neighborhood SES is associated with longitudinal change in moderate-to-vigorous physical activity (MVPA) among Cuban immigrants who participate in the Cuban Health Study in Miami, Florida. Data on 280 participants [mean age: 37.4 (±4.6), 48.9% women, mean body mass index: 25.0 (±2.5)] collected at baseline, 12 months and 24 months were analyzed. Minutes of MVPA were objectively measured during each data collection period using accelerometers. A neighborhood SES score was calculated for each participant’s residential census tract from American Community Survey data on median household income, median housing value, educational attainment and occupation. The neighborhood SES score was grouped into tertiles, reflecting low, moderate and high neighborhood SES environment. Multilevel linear models were used to examine the relationship between neighborhood SES and change in MVPA over 24 months. At baseline, 94 (33.6%), 108 (38.6%) and 78 (27.9%) participants resided in low, moderate, and high SES neighborhoods, respectively. After adjusting for age, sex, and body mass index, no difference in average change in MVPA over time was observed between participants residing in low and moderate SES neighborhoods (p=0.48) or low and high SES neighborhoods (p=0.62). In Cuban immigrants, longitudinal change in MVPA may not vary by neighborhood socioeconomic environment.

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Objectively measured time spent in MVPA was calculated among new Cuban immigrant adults.

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Longitudinal associations between neighborhood SES and MVPA were assessed.

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Study participants, on average, increased their physical activity over two years.

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Multilevel modeling indicated that neighborhood SES and change in MVPA were not associated.