Negotiating cancer alone: A qualitative study exploring care experiences of racially and ethnically diverse women diagnosed with breast cancer during COVID-19

COVID-19 has critically impacted cancer care services including reduced screenings, diagnoses, and surgeries; particularly among Black and Latina/x women who already suffer worse outcomes. This qualitative study explored the care experiences of a diverse sample of breast cancer survivors (N = 21; 7 Black, 4 Hispanic, 10 White) undergoing treatment during the pandemic via online semi-structured interviews. Grounded theory analysis yielded the core category "negotiating cancer alone," that included: (1) psychological distress, negotiating the cancer trajectory in isolation; (2) provider/healthcare system diagnostic and treatment delays; (3) heightened anxiety about treatment delays causing cancer progression; (4) supportive care limitations; and (5) disparate experiences of cancer care disruptions. Black and Latina/x women described greater delays in care, financial challenges, treatment complications, and insurance limitations than White women. The study identifies cancer patients' pandemic-related psychological, healthcare system, and health equity challenges and suggests recommendations to support their increased psychological needs during oncologic care disruptions.

Beliefs That White People Are Poor, Above and Beyond Beliefs That Black People Are Poor, Predict White (But Not Black) Americans' Attitudes Toward Welfare Recipients and Policy

In past work, White Americans' beliefs about Black poverty have predicted lower perceived work ethic of the poor, and, thus, less welfare support. In this article, we examine whether beliefs about White poverty predict more positive attributions about the poor among three representative samples of White Americans. Study 1 reveals that White (but not Black) Americans' White-poor beliefs predict increased perceptions that welfare recipients are hardworking, which predict more welfare support. Study 2 demonstrates that the link between White Americans' White-poor beliefs and the humanization of welfare recipients is stronger among White Americans who feel intergroup status threat (i.e., those who hold racial zero-sum beliefs). Study 3 replicates and extends Study 2 by using an experimental approach. Together, these data suggest that White Americans' White-poor beliefs function to humanize welfare recipients as a means to justify policies that could help the ingroup, preserving the racial status quo.

Parental Cognitions, Treatment Engagement, and Child Outcomes of ADHD Behavioral Treatment among Asian American Families

Asian American (AA) families remain critically underrepresented in clinical trials for ADHD interventions. Little is known about AA families' engagement in and outcomes of behavioral treatment (BT). Comparing AA families to other minoritized (OM) families and White families, this study examined parental cognitions, treatment engagement, and child outcomes of BT for ADHD inattentive type (ADHD-I). Path analyses were conducted utilizing data from a randomized controlled trial of BT for ADHD-I (N = 199 children, ages 7-11). Racial/ethnic differences in pretreatment parental self-competence and treatment expectations were examined for AA (n = 29) compared to OM (n = 35) and White (n = 135) parents. Two additional path models were conducted to examine the relations among race/ethnicity, pretreatment parental cognitions, treatment engagement, and posttreatment child outcomes. Direct effects of race/ethnicity and parental cognitions on posttreatment child outcomes as well as their indirect effects via treatment engagement were estimated. At pretreatment, AA parents endorsed lower parental self-competence and treatment expectations compared to OM and White parents. At posttreatment, AA parents reported fewer improvements in ADHD symptoms than White parents and lower global psychosocial improvement than OM parents. For all parents, treatment expectations positively predicted parent- and observer-rated treatment engagement, which in turn predicted child global psychosocial improvement. Path analyses indicated that the relationship between treatment expectations and posttreatment child global improvement was fully mediated by treatment engagement. These findings suggest that treatment expectations impede AA parents' engagement and success in BT. Implications for cultural adaptations of BT to improve AA families' treatment experience are discussed.

Reevaluating the "deaths of despair" narrative: Racial/ethnic heterogeneity in the trend of psychological distress-related death

Despite the significant scientific advancement in deciphering the "deaths of despair" narrative, most relevant studies have focused on drug-, alcohol-, and suicide-related (DAS) deaths. This study directly investigated despair as a determinant of death and the temporal variation and racial heterogeneity among individuals. We used psychological distress (PD) as a proxy for despair and drew data from the US National Health Interview Survey-Linked Mortality Files 1997 to 2014, CDC (Centers for Disease Control and Prevention) Multiple Cause of Death database 1997 to 2014, CDC bridged-race population files 1997 to 2014, Current Population Survey 1997 to 1999, and the American Community Survey 2000 to 2014. We used Cox proportional hazards models to estimate mortality hazard ratios of PD and compared age-standardized PD- and DAS-related mortality rates by race/ethnicity and over time. We found that while Whites had a lower prevalence of PD than Blacks and Hispanics throughout the whole period, they underwent distinctive increases in PD-related death and have had a higher PD-related mortality rate than Blacks and Hispanics since the early 2000s. This was predominantly due to Whites' relatively high and increasing vulnerability to PD less the prevalence of PD. Furthermore, PD induced a more pervasive mortality consequence than DAS combined for Whites and Blacks. In addition, PD- and DAS-related deaths displayed a concordant trend among Whites but divergent patterns for Blacks and Hispanics. These findings suggest that 1) DAS-related deaths underestimated the mortality consequence of despair for Whites and Blacks but overestimated it for Hispanics; and 2) despair partially contributed to the DAS trend among Whites but probably not for Blacks and Hispanics.

Perceptions of Falling Behind "Most White People": Within-Group Status Comparisons Predict Fewer Positive Emotions and Worse Health Over Time Among White (but Not Black) Americans

Despite the persistence of anti-Black racism, White Americans report feeling worse off than Black Americans. We suggest that some White Americans may report low well-being despite high group-level status because of perceptions that they are falling behind their in-group. Using census-based quota sampling, we measured status comparisons and health among Black (N = 452, Wave 1) and White (N = 439, Wave 1) American adults over a period of 6 to 7 weeks. We found that Black and White Americans tended to make status comparisons within their own racial groups and that most Black participants felt better off than their racial group, whereas most White participants felt worse off than their racial group. Moreover, we found that White Americans' perceptions of falling behind "most White people" predicted fewer positive emotions at a subsequent time, which predicted worse sleep quality and depressive symptoms in the future. Subjective within-group status did not have the same consequences among Black participants.

A Phenomenological Divide: Reference Group Consequences for Existential Isolation

An apparent phenomenological divide between majority and minoritized groups exists in contemporary America in terms of feelings of social connection. Drawing on recent findings relating to existential isolation (i.e., the sense that one is alone in one's subjective experience), three studies compare these feelings toward one's in-group and out-group. Study 1 assesses whether Black and White participants vary in their self-reported existential isolation when referencing their own or another racial group. Results reveal Black Americans feel as though other Black Americans share their perceptions more than do White Americans. In contrast, White Americans report similarly shared perceptions by both racial groups. Study 2 (preregistered) assessed these effects with a concealable identity: sexual orientation. Study 3 further replicates these effects and finds effects among Black Americans to significantly differ from a neutral control condition. Implications and future directions for epistemic (in)validation are discussed.

More Than Meets the Eyes: Bringing Attention to the Eyes Increases First Impressions of Warmth and Competence

The present research examined how face masks alter first impressions of warmth and competence for different racial groups. Participants were randomly assigned to view photographs of White, Black, and Asian targets with or without masks. Across four separate studies (total N = 1,012), masked targets were rated significantly higher in warmth and competence compared with unmasked targets, regardless of their race. However, Asian targets benefited the least from being seen masked compared with Black or White targets. Studies 3 and 4 demonstrate how the positive effect of masks is likely due to these clothing garments re-directing attention toward the eyes of the wearer. Participants viewing faces cropped to the eyes (Study 3), or instructed to gaze into the eyes of faces (Study 4), rated these targets similarly to masked targets, and higher than unmasked targets. Neither political affiliation, belief in mask effectiveness, nor explicit racial prejudice moderated any hypothesized effects.

Measurement invariance of the Personality Inventory for the DSM-5 across U.S. East Asian, Southeast Asian, and White participants

The Personality Inventory for the Diagnostic and Statistical Manual of Mental Disorders (DSM), Fifth Edition (PID-5) was developed as a measure of the traits included in the alternative model of personality disorders (AMPD) in Section III of the DSM. The PID-5 is composed of 25 scales measuring each trait in the AMPD across five domains: negative affectivity, detachment, disinhibition, antagonism, and psychoticism. Previous research suggests that there may be important differences in the expression of personality pathology across race and culture, particularly between people with eastern and western cultural heritages. The goal of the current research was to examine the measurement invariance of the PID-5 across these groups. In the current study, 865 young men and women who identified as White, East Asian, or Southeast Asian completed the PID-5 and international personality item pool (IPIP). On the domain level, a multigroup exploratory structural equation model found that the PID-5 had configural and metric invariance, but lacked complete scalar invariance. On an item level, all scales had configural invariance, one lacked metric invariance, and 11 of the 25 scales lacked scalar invariance across race. For the invariant scales, East and Southeast Asians tended to have higher mean scores than White participants. The PID-5 scales had similar relations with IPIP scales across groups. These results suggest that the PID-5 scales are measuring similar constructs across groups on a global, structural level, but that mean scores may represent different levels of latent personality pathology across groups. The PID-5 may be confidently used in these groups, but mean comparisons should be interpreted with caution. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Identifying profiles of school climate in high schools

This cross-sectional study analyzed data from 364,143 students in 492 high schools who completed the Georgia School Climate Survey during the 2017-2018 school year. Through latent profile analysis, we identified that student perceptions of school climate could be classified into three distinct profiles, including positive, moderate, and negative climate. Using multinomial logistic regression, we then identified school and student characteristics that predicted student classification in the student profiles using the total sample and subsamples by race/ethnicity. Among the key results, we found that most of the school characteristics (e.g., percent of students receiving free or reduced lunch, schools with higher percentages of minoritized students) predicting classification in the negative and positive school climate profiles were different for White students compared to minoritized students. For example, Black students in primarily non-White schools were more likely to view school climate positively, whereas the opposite was the case for White students. We also found that Black and Other (e.g., multiracial) students were more likely to be classified in the negative school climate profile and less likely to be classified in the positive school climate profile compared to White students. In contrast, Latino/a/e students were more likely to be classified in the positive school climate profile and less likely to be classified in the negative school climate profile. Implications for research and practice are discussed. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Revisiting the Black-White Mental Health Paradox During the Coronavirus Pandemic

Black Americans have lower rates of depression and anxiety than Whites, despite greater exposure to stressors known to negatively impact mental health, characterized as the Black-White mental health paradox. This study revisited the paradox during the coronavirus pandemic. Drawing on stress process theory, minority stress theory, and the rejection-identification model of discrimination, in-group identity, and well-being, we analyzed original survey data from a quota sample of African American and White adults (N = 594). The survey included a range of stressors and coping resources, including those relevant to the pandemic (e.g., COVID-19 illness) and race (e.g., witnessing anti-Black police violence). Results indicate that despite African Americans' greater exposure and vulnerability to racial discrimination, the Black-White mental health paradox holds, owing in part to protective effects of African American's higher self-esteem. Directions for future exploration of the paradox are presented based on this study's findings.

Vicarious severe school discipline predicts racial disparities among non-disciplined Black and White American adolescents

Racial disparities in school discipline may have collateral consequences on the larger non-suspended student population. The present study leveraged two longitudinal datasets with 1201 non-suspended adolescents (48% Black, 52% White; 55% females, 45% males; Mage : 12-13) enrolled in 84 classrooms in an urban mid-Atlantic city of the United States during the 2016-2017 and 2017-2018 academic years. Classmates' minor infraction suspensions predicted greater next year's defiant infractions among non-suspended Black adolescents, and this longitudinal relation was worse for Black youth enrolled in predominantly Black classrooms. For White youth, classmates' minor infraction suspensions predicted greater defiant infractions specifically when they were enrolled in predominantly non-White classrooms. Racial inequities in school discipline may have repercussions that disadvantage all adolescents regardless of race.

Health-Risk Behaviors and Experiences Among Asian American and Native Hawaiian/Pacific Islander Adolescents in the United States, 2011-2019

OBJECTIVES

Understanding the health-risk behaviors of racial and ethnic groups when disaggregated is an important step in improving the health outcomes of racial and ethnic minority groups. We compared national prevalence estimates for selected health-risk behaviors and experiences of Asian American and Native Hawaiian/Pacific Islander (NHPI) students with those of non-Hispanic White, non-Hispanic Black, and Hispanic students.

METHODS

We analyzed data from the Youth Risk Behavior Survey, a nationally representative survey of US high school students. To generate a sufficient sample of Asian American and NHPI students for analyses, we combined data from 5 survey administrations, conducted in 2011, 2013, 2015, 2017, and 2019 (N = 73 074). We calculated the prevalence and 95% CIs; we analyzed data on Asian American and NHPI adolescents separately to unmask important differences.

RESULTS

Compared with students of other races and ethnicities, Asian American students had the lowest prevalence of alcohol use (16.7%) and marijuana use (10.3%). In contrast, NHPI students were more likely than Asian American students to participate in several health-risk behaviors and experiences, such as substance use (ranging from 4.8% for ever injecting an illegal drug to 31.5% for current alcohol use), having been in a physical fight (15.4%), and having been threatened or injured with a weapon (11.6%). Differential patterns in the prevalence of ever having missed school due to feeling unsafe among NHPI and Asian American students were observed among male and female students.

CONCLUSION

Further disaggregating racial subgroups within broad categories of Asian American and NHPI populations may reveal differences from overall group prevalence, and additional strategies to identify these differences should be investigated.

Vitamin D levels among adult psychiatric inpatients and the association with psychosis

BACKGROUND

The association between low vitamin D levels and mental illness has been described in earlier research. The aim of our study was to examine the association between vitamin D levels with psychotic symptoms among hospitalized patients.

METHODS

A total of 1,456 patient records from an academic psychiatric hospital were examined. Vitamin D levels were classified as normal (>30 ng/mL); insufficient (20 to 30 ng/mL); and deficient (<20 ng/mL). We then analyzed the association among vitamin D groups and symptoms of psychosis.

RESULTS

The average vitamin D level in our sample was 23.59 ng/mL, with 76.2% of patients presenting with vitamin D levels <30 ng/mL. There was a significant association between vitamin D levels <20 ng/mL and symptoms of psychosis (P < .05). African American patients had lower mean vitamin D levels than White patients (15.6 ± 0.2 ng/mL vs 25.8 ± 0.4 ng/mL, P < .001). There was no sex difference in vitamin D levels (females: 23.3 ± 11.5 ng/mL; males: 23.9 ± 11.0 ng/mL).

CONCLUSIONS

Patients with vitamin D levels <30 ng/mL were 1.5 times more likely to have symptoms of psychosis. Patients who were African American, Hispanic, Asian, or biracial had lower vitamin D levels than patients who were White. Multivariate analysis found that after adjusting for age, sex, and race, the association between vitamin D and psychosis was not statistically significant. Possible explanations could include the known tendency to overdiagnose psychosis among individuals who are African American, referral bias, subgroup effect, or an epiphenomenon.

Demographic Differences in Life Dissatisfaction Among Adults: United States, 2021

Objective-Previous work has established life satisfaction as an important indicator of overall health and well-being. This report describes differences in life dissatisfaction by selected characteristics, grouped by family income. Methods-Data from the 2021 National Health Interview Survey were used to examine the percentage of adults that were dissatisfied with life by selected demographic characteristics (age, sex, race and Hispanic origin, and nativity status [born in the United States or U.S. territory]), grouped by family income. Results-In 2021, 4.8% of adults were dissatisfied with life. In general, analyses showed significant differences by all selected demographic characteristics among adults with incomes of less than 200% of the federal poverty level. Among this group, men, adults ages 45-64, White non-Hispanic adults, Black non-Hispanic adults, and adults born in the United States were more likely to be dissatisfied with life compared with their counterparts. No significant differences in life dissatisfaction by selected demographic characteristics among adults with incomes greater than 200% of the federal poverty level were observed. Conclusion-This report presents estimates of life dissatisfaction among adults by demographic subgroups and family income. These results highlight the importance of monitoring life dissatisfaction among detailed subgroups grouped by income, in addition to the overall national estimate.

White children's prosocial behavior toward White versus Black peers: The role of children's effortful control and parents' implicit racial attitudes

White children's effortful control (EC), parents' implicit racial attitudes, and their interaction were examined as predictors of children's prosocial behavior toward White versus Black recipients. Data were collected from 171 White children (55% male, Mage  = 7.13 years, SD = 0.92) and their parent in 2017. Prosocial behavior toward White peers was predicted by children's higher EC. When predicting prosocial behavior toward Black peers and prosocial disparity (the difference between White and Black recipients), parents' implicit racial attitudes moderated the relation between children's EC and children's prosocial behavior. Specifically, children's EC was positively associated with prosocial behavior toward Black peers (and negatively related to inequity in prosocial behavior) only when parents exhibited less implicit racial bias.

Nonverbal face-to-face interactions in macaques and humans: A translational pilot study

Human and nonhuman primate mother-infant dyads engage in face-to-face interactions critical for optimal infant development. In semi-free-ranging rhesus macaques (Macaca mulatta), maternal primiparity and infant sex influence the expression of nonverbal face-to-face mother-infant interactions. However, whether similar patterns of variation exist in laboratory-housed macaques or human mothers is not well understood. Comparing both species would yield information regarding the translational validity of macaques to humans in this important social/developmental domain. In this pilot study, we first compared semi-free-ranging (n = 39) and laboratory-housed (n = 20) macaques, finding that laboratory-housed dyads, first-time mothers, and mothers of sons engaged in higher rates of face-to-face interactions regardless of housing. After translating the nonhuman primate coding scheme for use in a small but diverse group of human mother-infant dyads (N = 27; 44.4% African American, 18.5% American Indian, 7.4% Asian/Asian American, and 29.6% White), we found that, like macaques, human mothers of sons engaged in more face-to-face interactions; however, experienced (vs. first-time) mothers engaged in more interactions. Macaques and humans also engaged in species-specific interactions with their infants. We conclude that components of caregiver-infant nonverbal face-to-face interactions are translatable across human and nonhuman primate species and represent an exciting avenue for future caregiving work.

Race, everyday discrimination, and cognitive function in later life

Discrimination is pernicious in many ways, but there are inconsistent findings regarding whether it is harmful to cognitive function in later life. To address the inconsistency, we use two closely related concepts of everyday discrimination to predict cognitive trajectories in a diverse sample. Using data from the Health and Retirement Study (HRS), we examine whether the frequency of discrimination, measured at baseline with six questions, is related to poorer cognitive function and change in function over time (2008-2016). Age at baseline ranged from 53 to 100. Growth curve models of initial cognitive function and change in function were estimated. Everyday global discrimination was associated with poorer initial cognition and slower declines over time, and these relationships were not moderated by race and ethnicity. By contrast, the relationship between everyday racial discrimination and cognition was moderated by race: more frequent everyday racial discrimination was associated with better initial cognitive function among Black adults but not among Hispanic and White adults. Discrimination is a multifaceted concept, and specific types of discrimination manifest lower or higher cognitive function during later life for White, Black, and Hispanic adults.

Identifying latent themes in suicide among black and white adolescents and young adults using the National Violent Death Reporting System, 2013-2019

Suicide rates for adolescents and young adults (AYA) have risen dramatically in recent years - by almost 60% for Americans aged 10-24 years between 2007 and 2018. This increase has occurred for both whites and Blacks, with the rise in suicide among Black youth of particular note. Blacks historically exhibit lower rates of suicide relative to whites and thus, less is known about the etiology of Black suicide. To gain insight into the underlying causes of suicide among AYA, we examine medical examiner reports from the National Violent Death Reporting System (NVDRS) from 2013 to 2019 for over 26,000 Black and white suicide decedents ages 10-29. We apply structural topic modeling (STM) approaches to describe the broad contours of AYA suicide in the United States today. Our findings reveal distinct patterns by race. Guns, violence and the criminal justice system are prominent features of Black suicide, whether through the mechanism used in the suicide, either by firearm or other violent means such as fire or electrocution, the existence of criminal or legal problems/disputes, the location of death in a jail, or the presence of police. In contrast, the narratives of white AYA are more likely to reference mental health or substance abuse problems. Access to resources, as measured by county median household income, overlay these patterns. Themes more prevalent among Blacks are more common in poorer counties; those more prevalent among whites tend to be more common in wealthier counties. Our findings are consistent with other studies that suggest Black people experience greater exposure to violence and other traumas, systemic racism and interpersonal discrimination that may elevate the risk for suicidal behavior.

Examining Racial/Ethnic Disparities in Coping and Stress Within an Environmental Riskscape

Existing research on racial/ethnic differences in stress and coping is limited by small samples, single-item measures, and lack of inclusion of Mexican Americans. We address these gaps by analyzing data from the Texas City Stress and Health Study, a cross-sectional sample of Black (N = 257), White (N = 304), US-born (N = 689), and foreign-born (N = 749) Mexican Americans residing in proximity to a petrochemical complex. We compared active and avoidant coping by race/ethnicity and explored multivariable associations between coping and perceived stress. Black and foreign-born Mexican American respondents had the highest stressor exposure yet displayed different patterns of coping and perceived stress patterns. Active coping may be particularly effective for African Americans but may not offset extreme stress disparities. For Mexican Americans, the lack of association between coping and stress underscores the need for more work focused on the culturally diverse coping experiences.

Someone who knows and someone I trust: Investigating how and with whom U.S. 8- to 14-year-old youth seek to learn about racial inequality

This study investigated 8- to 14-year-old U.S. children's (N = 202, 47% girls, and 49% White) evaluations of statements reflecting individual and structural attributions for the causes of racial inequality between Black and White people in the United States, the epistemic characteristics they used to seek out more information on this topic, and who they believed reflected these characteristics. With age, participants increasingly endorsed statements reflecting structural attributions for racial inequality (i.e., educational and occupational exclusion), and increasingly reasoned about privilege and racism. In contrast, participants did not endorse statements reflecting individual attributions at any age (i.e., group differences in intelligence and effort), instead reasoning about equality between racial groups. Overall, participants sought expertise (i.e., content knowledge) and interpersonal trust (i.e., closeness and support) in a scenario where they could choose a discussion partner to learn more about racial inequality, and were most likely to seek out their family members, though some also sought out their friends, teachers, and the internet or social media. This study provides insights into who children see as relevant sources for learning about racial inequality and their reasons for trusting them. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

The Positive Aspects of Caregiving Scale can be shortened to six items: application of item response theory

OBJECTIVE

For nearly two decades, with one exception, researchers have used the Positive Aspects of Caregiving Scale (PACS) without a close examination of how the items behave. This study examined PACS' measurement model and item response characteristics, including differential item functioning (DIF) by race.

METHODS

Item response theory was used to analyze the baseline data of the Resources for Enhancing Alzheimer's Caregiver Health (REACH) I trial (N = 1229). Bifactor confirmatory models were estimated to assess dimensionality, and whether the items behaved differently in African Americans and Hispanics, with Whites serving as the comparison, were examined using the multiple-indicators multiple-causes model.

RESULTS

For both 9- and 11-item versions, 1-factor and bifactor solutions supported a unidimensional structure. However, the items performed generally poorly in differentiating levels of the latent construct, especially between moderate and high true scores. Additionally, five items were found to have DIF, which were unrelated to relationship differences among racial groups. While African Americans and Hispanics reported higher positive gains than Whites, their differences were accentuated by the DIF items as a whole. A 6-item version called PACS-II was created by removing the DIF items. Besides reducing estimated racial differences, PACS-II removed race-based heterogeneity of variance that was evidenced in the original, longer versions.

CONCLUSIONS

Being free of racial bias, PACS-II is preferred over the original versions, though the ceiling effect of measurement (prevalence of extreme scores on the high end) remains to be an issue for improvement.

Racial and ethnic differences in the relationship between financial worry and white matter hyperintensities in Latinx, non-Latinx Black, and non-Latinx White older adults

Socioeconomic status (SES) is associated with white matter hyperintensities (WMHs) and contributes to racial and ethnic health disparities. However, traditional measures of SES may not accurately represent individual financial circumstances among non-Latinx Black and Latinx older adults due to longstanding structural inequities. This study examined associations between multiple SES indicators (education, income, subjective financial worry) and WMHs across non-Latinx Black, Latinx, and non-Latinx White older adults in the Washington Heights-Inwood Columbia Aging Project (N = 662). Latinx participants reported the lowest SES and greatest financial worry, while Black participants evidenced the most WMHs. Greater financial worry was associated with higher WMHs volume above and beyond education and income, which were not associated with WMHs. However, this association was only evident among Latinx older adults. These results provide evidence for the minority poverty hypothesis and highlight the need for systemic socioeconomic interventions to alleviate brain health disparities in older adulthood.

Assessing parenting in racially and ethnically diverse families: A lack of measurement equivalence

The present study explored measurement invariance of the Multidimensional Assessment of Parenting Scale (MAPS; Parent & Forehand, 2017) across White, Hispanic, Black, and Asian American parents. Participants included 2,734 parents, 58% of whom were mothers. On average, parents were 36.32 years old (SD = 9.54); the parent sample was 66.9% White non-Hispanic, 10.1% Black, 5.3% Asian, and 17.7% Hispanic regardless of race. Child ages ranged from 3 to 17 years (M = 9.84, SD = 3.71), and 58% were identified as male. Parents completed a demographics questionnaire about themselves and their target child, and the 34-item MAPS. We explored measurement equivalence of the MAPS Broadband Positive and Negative parenting scales using item response theory to identify differential item functioning (DIF). Univariate analyses for Positive and Negative Parenting showed reliability was excellent. Twelve items assessing negative aspects of parenting exhibited bias by race/ethnicity. Specifically, when comparing racial and ethnic groups, three items had nonuniform DIF comparing Black and Asian participants, two items had nonuniform DIF comparing Black and Hispanic participants, and one item showed nonuniform DIF comparing Asian and Hispanic participants. When looking at Positive Parenting, no items showed evidence of DIF. Results from the present study suggest broadband Positive Parenting can be compared across ethnoracial groups, while findings raise concern about assessing Negative Parenting items when examining invariance across race and ethnicity. Findings from the present study imply that racial and ethnic comparisons are potentially invalid. These findings offer guidance for improving parenting assessment for racially/ethnically diverse populations. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Elementary disruptions? Exploring residential move type, timing, and duration of implications during middle childhood

Moving is common during middle childhood, but links between move type and children's development are less well understood. Using nationally-representative, longitudinal data (2010-2016) of ~9900 U.S. kindergarteners (52% boys, 51.48% White, 26.11% Hispanic/Latino, 10.63% Black, 11.78% Asian/Pacific Islander), we conducted multiple-group fixed-effects models estimating associations of within- and between-neighborhood moves, family income, and children's achievement and executive function, testing whether associations persisted or varied by developmental timing. Analyses suggest important spatial and temporal dimensions of moving during middle childhood: between-neighborhood moves had stronger associations than within-neighborhood moves, earlier moves benefited development whereas later moves did not, and associations persisted with significant effect sizes (cumulative Hedges' g = -0.09-1.35). Research and policy implications are discussed.

Years of life lost due to deaths of despair and COVID-19 in the United States in 2020: patterns of excess mortality by gender, race and ethnicity

BACKGROUND

In 2020 COVID-19 was the third leading cause of death in the United States. Increases in suicides, overdoses, and alcohol related deaths were seen-which make up deaths of despair. How deaths of despair compare to COVID-19 across racial, ethnic, and gender subpopulations is relatively unknown. Preliminary studies showed inequalities in COVID-19 mortality for Black and Hispanic Americans in the pandemic's onset. This study analyzes the racial, ethnic and gender disparities in years of life lost due to COVID-19 and deaths of despair (suicide, overdose, and alcohol deaths) in 2020.

METHODS

This cross-sectional study calculated and compared years of life lost (YLL) due to Deaths of Despair and COVID-19 by gender, race, and ethnicity. YLL was calculated using the CDC WONDER database to pull death records based on ICD-10 codes and the Social Security Administration Period Life Table was used to get estimated life expectancy for each subpopulation.

RESULTS

In 2020, COVID-19 caused 350,831 deaths and 4,405,699 YLL. By contrast, deaths of despair contributed to 178,598 deaths and 6,045,819 YLL. Men had more deaths and YLL than women due to COVID-19 and deaths of despair. Among White Americans and more than one race identification both had greater burden of deaths of despair YLL than COVID-19 YLL. However, for all other racial categories (Native American/Alaskan Native, Asian, Black/African American, Native Hawaiian/Pacific Islander) COVID-19 caused more YLL than deaths of despair. Also, Hispanic or Latino persons had disproportionately higher mortality across all causes: COVID-19 and all deaths of despair causes.

CONCLUSIONS

This study found greater deaths of despair mortality burden and differences in burden across gender, race, and ethnicity in 2020. The results indicate the need to bolster behavioral health research, support mental health workforce development and education, increase access to evidence-based substance use treatment, and address systemic inequities and social determinants of deaths of despair and COVID-19.

Measurement invariance of maternal depressive symptoms across the first 2 years since birth and across racial group, education, income, primiparity, and age

Up to 19% of postpartum mothers experience depressive symptoms, which are associated with infant development. Thus, research examining postpartum depression has implications for mothers' and infants' well-being. However, this research relies on the often-untested assumption of measurement invariance-that measures capture the same construct across time and sociodemographic characteristics. In the absence of invariance, measurement bias may confound differences across time and group, contributing to invalid inferences. In a sociodemographically diverse (40.7% African American, 58.9% White; 67.9% below two times the federal poverty line; 19.4% with less than high school education), rural, longitudinal sample (N = 1,275) of mothers, we used moderated nonlinear factor analysis (MNLFA) to examine measurement invariance of the Brief Symptom Inventory-18 (BSI-18) Depressive Symptoms subscale across time since birth, racial group, education, income, primiparity, and maternal age at childbirth. We identified evidence of differential item functioning (DIF; i.e., measurement noninvariance) as a function of racial group and education. Subsequent analyses indicated, however, that the DIF-induced bias had minimal impacts on substantive comparisons examining change over time since birth and group differences. Thus, the presence of measurement noninvariance does not appear to bias substantive comparisons using the BSI-18 Depressive Symptoms subscale across the first 2 years since birth in a sample comprising primarily African American and White mothers living in predominately rural, low-income communities. This study demonstrates the importance of assessing measurement invariance and highlights MNLFA for evaluating the impact of noninvariance as a preliminary step that increases confidence in the validity of substantive inferences. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Race, Concern About COVID-19 Discrimination, and Cigarette Smoking Behavior: Comparison Between US Asian and White Adults Who Use Commercial Tobacco

Anti-Asian discrimination incidents in the USA have resurged during the COVID-19 pandemic. It is unclear how concern about being discriminatorily treated due to the COVID-19 pandemic varies between Asian and Asian American (A&AsA) and White adults. We examined A&AsA vs. White differences in concern about COVID-19 discrimination and associations of this concern with changes in cigarette smoking behaviors before and during the pandemic. Data were from a US representative sample of A&AsA and White adults (≥ 21 years) who currently and formerly used commercial tobacco (n = 1052), collected through an online panel oversampling A&AsA adults in January-February 2021. Participants reported their concern, worry, and stress about COVID-19 discrimination and past-30-day cigarette consumption before and during the pandemic. We examined the association between race and overall concern about COVID-19 discrimination, and this concern's associations with changes in past-30-day cigarette smoking consumption, smoking continuation, and return to smoking using weighted multivariable logistic and linear regression models. Overall concern about COVID-19 discrimination was higher (adjusted mean = 1.7, standard error = 0.16) among A&AsA adults who currently and formerly used commercial tobacco than their White counterparts (adjusted mean = 0.60, standard error = 0.04; p < 0.01). Overall concern about COVID-19 discrimination was associated with increased past-30-day cigarette consumption by 26.5 cigarettes (95% confidence interval [CI] = 1.2-51.9) and 4.4 times (95% CI = 2.3-8.5) greater odds of return to smoking among adults who smoke cigarettes. A&AsA adults who currently and formerly used commercial tobacco disproportionately bore higher concern about COVID-19 discrimination, and in turn could lead to increased smoking behavior and related morbidity and mortality among A&AsA adults.

Associations of Patient Race and Ethnicity With Emergency Department Disposition for Mental Health Visits in the United States

Objective: To describe associations between patient race and ethnicity with emergency department disposition for mental health visits in the United States.

Methods: We identified 674,821 visits for mental health in the 2019 National Emergency Department Sample and classified them by ICD-10 diagnostic group: schizophrenia-spectrum, bipolar, major depressive, anxiety, or other disorders. Racial and ethnic categories were White, Black, Hispanic, or other. Logistic regression models, adjusted for age, sex, insurance status, and medical comorbidities, were used to describe differences in odds of inpatient admission by race/ethnicity and diagnosis.

Results: After covariate adjustment, we did not find overall differences in the likelihood of admission between racial/ethnic groups. However, compared to White patients, admission rates were lower for visits by Black patients for bipolar disorder (OR = 0.71; 95% CI, 0.59-0.84) and major depressive disorder (OR = 0.70; 95% CI, 0.59-0.83) and lower for Hispanic patients (OR = 0.57; 95% CI, 0.47-0.68) for anxiety disorders. There were no significant racial/ethnic differences in admission rates for schizophrenia-spectrum disorders.

Conclusions: Overall admission rates were comparable for Black and White patients. After covariate adjustment, there were no differences across racial/ethnic groups, though some racial/ethnic differences persisted within diagnostic subsets of mood and anxiety disorders.

Everyday perceptions of safety and racial disparities in hair cortisol concentration

OBJECTIVE

Black-White disparities in physiological stress during adolescence are increasingly evident but remain incompletely understood. We examine the role of real-time perceptions of safety in the context of everyday routines to gain insight into the sources of observed adolescent racial differences in chronic stress as measured by hair cortisol concentration (HCC).

METHOD

We combined social survey, ecological momentary assessment (EMA), and hair cortisol data on 690 Black and White youth ages 11-17 from wave 1 of the Adolescent Health and Development in Context (AHDC) study to investigate racial differences in physiological stress. Individual-level, reliability-adjusted measures of perceived unsafety outside the home were drawn from a week-long smartphone-based EMA and tested for association with hair cortisol concentration.

RESULTS

We observed a statistically significant interaction (p < .05) between race and perceptions of unsafety. For Black youth, perceived unsafety was associated with higher HCC (p < .05). We observed no evidence of an association between perceptions of safety and expected HCC for White youth. For youth who perceive their out-of-home activity locations to be consistently safe, the racial difference in expected HCC was not statistically significant. At the high end of perceived unsafety, however, Black-White differences in HCC were pronounced (0.75 standard deviations at the 95th percentile on perceived unsafety; p < .001).

DISCUSSION

These findings call attention to the role of everyday perceptions of safety across non-home routine activity contexts in explaining race differences in chronic stress as assessed by hair cortisol concentrations. Future research may benefit from data on in situ experiences to capture disparities in psychological and physiological stress.

How the "Black criminal" stereotype shapes Black people's psychological experience of policing: Evidence of stereotype threat and remaining questions

Cultural stereotypes that link Black race to crime in the United States originated with and are perpetuated by policies that result in the disproportionate criminalization and punishment of Black people. The scientific record is replete with evidence that these stereotypes impact perceivers' perceptions, information processing, and decision-making in ways that produce more negative criminal legal outcomes for Black people than White people. However, relatively scant attention has been paid to understanding how situations that present a risk of being evaluated through the lens of crime-related stereotypes also directly affect Black people. In this article, I consider one situation in particular: encounters with police. I draw on social psychological research on stereotype threat generally as well as the few existing studies of crime-related stereotype threat specifically to illuminate how the cultural context creates psychologically distinct experiences of police encounters for Black people as compared to White people. I further consider the potential ramifications of stereotype threat effects on police officers' judgments and treatment of Black people as well as for Black people's safety and well-being in other criminal legal contexts and throughout their lives. Finally, I conclude with a call for increased scholarly attention to crime-related stereotype threat and the role it plays in contributing to racial disparities in policing outcomes, particularly with regard to diverse racial, ethnic, and intersectional identities and personal vulnerability factors, and the systemic changes that might mitigate its deleterious effects. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Implications of Cumulative Life Event Stress for Daily Stress Exposure and Cardiovascular Reactivity Among Black and White Americans

OBJECTIVES

Daily stress and cardiovascular reactivity may be important mechanisms linking cumulative life event stress with cardiovascular health and may help to explain racial health disparities. However, studies have yet to examine links between exposure to life event stress, daily stress exposure, and cardiovascular reactivity. This study assessed links between trajectories of life event stress exposure, daily stressors, and cardiovascular reactivity among Black and White individuals.

METHODS

Participants are from the Stress and Well-being in Everyday Life Study in which 238 individuals (109 Black 129 White; ages 33-93), drawn from the longitudinal Social Relations Study, reported life event stress in 1992, 2005, 2015, and 2018. Of those individuals, 169 completed an ecological momentary assessment study in which they reported stress exposure every 3 hr, and 164 wore a heart rate monitor for up to 5 days.

RESULTS

Latent class growth curve models revealed 2 longitudinal trajectories of life event stress: moderate-increasing and low-decreasing. Individuals in the moderate-increasing stress trajectory reported greater daily stress exposure and links did not vary by race. Black individuals in the low-decreasing trajectory and White individuals in the moderate-increasing trajectory showed positive associations between daily stress and heart rate (i.e., were reactive to daily stress exposure). The link between daily stress and heart rate was not significant among Black individuals in the moderate-increasing trajectory and White individuals in the low-decreasing trajectory.

DISCUSSION

Individuals who experience more life events across the adult life course report greater daily stress exposure which has important implications for daily cardiovascular health. Black individuals with moderate-increasing life event stress show evidence of blunted daily stress reactivity (nonsignificant association between daily stress and heart rate) whereas Black individuals with low-decreasing life event stress show evidence of stress reactivity (positive association between daily stress and heart rate). White individuals showed the opposite pattern (albeit marginally). These findings expand the weathering hypothesis and indicate that chronic life event stress may be associated with blunted stress reactivity among Black individuals.

Workplace Harassment, Cyber Incivility, and Climate in Academic Medicine

Importance

The culture of academic medicine may foster mistreatment that disproportionately affects individuals who have been marginalized within a given society (minoritized groups) and compromises workforce vitality. Existing research has been limited by a lack of comprehensive, validated measures, low response rates, and narrow samples as well as comparisons limited to the binary gender categories of male or female assigned at birth (cisgender).

Objective

To evaluate academic medical culture, faculty mental health, and their relationship.

Design, Setting, and Participants

A total of 830 faculty members in the US received National Institutes of Health career development awards from 2006-2009, remained in academia, and responded to a 2021 survey that had a response rate of 64%. Experiences were compared by gender, race and ethnicity (using the categories of Asian, underrepresented in medicine [defined as race and ethnicity other than Asian or non-Hispanic White], and White), and lesbian, gay, bisexual, transgender, queer (LGBTQ+) status. Multivariable models were used to explore associations between experiences of culture (climate, sexual harassment, and cyber incivility) with mental health.

Exposures

Minoritized identity based on gender, race and ethnicity, and LGBTQ+ status.

Main Outcomes and Measures

Three aspects of culture were measured as the primary outcomes: organizational climate, sexual harassment, and cyber incivility using previously developed instruments. The 5-item Mental Health Inventory (scored from 0 to 100 points with higher values indicating better mental health) was used to evaluate the secondary outcome of mental health.

Results

Of the 830 faculty members, there were 422 men, 385 women, 2 in nonbinary gender category, and 21 who did not identify gender; there were 169 Asian respondents, 66 respondents underrepresented in medicine, 572 White respondents, and 23 respondents who did not report their race and ethnicity; and there were 774 respondents who identified as cisgender and heterosexual, 31 as having LGBTQ+ status, and 25 who did not identify status. Women rated general climate (5-point scale) more negatively than men (mean, 3.68 [95% CI, 3.59-3.77] vs 3.96 [95% CI, 3.88-4.04], respectively, P < .001). Diversity climate ratings differed significantly by gender (mean, 3.72 [95% CI, 3.64-3.80] for women vs 4.16 [95% CI, 4.09-4.23] for men, P < .001) and by race and ethnicity (mean, 4.0 [95% CI, 3.88-4.12] for Asian respondents, 3.71 [95% CI, 3.50-3.92] for respondents underrepresented in medicine, and 3.96 [95% CI, 3.90-4.02] for White respondents, P = .04). Women were more likely than men to report experiencing gender harassment (sexist remarks and crude behaviors) (71.9% [95% CI, 67.1%-76.4%] vs 44.9% [95% CI, 40.1%-49.8%], respectively, P < .001). Respondents with LGBTQ+ status were more likely to report experiencing sexual harassment than cisgender and heterosexual respondents when using social media professionally (13.3% [95% CI, 1.7%-40.5%] vs 2.5% [95% CI, 1.2%-4.6%], respectively, P = .01). Each of the 3 aspects of culture and gender were significantly associated with the secondary outcome of mental health in the multivariable analysis.

Conclusions and Relevance

High rates of sexual harassment, cyber incivility, and negative organizational climate exist in academic medicine, disproportionately affecting minoritized groups and affecting mental health. Ongoing efforts to transform culture are necessary.

Complementary and Alternative Medicine Use in Patients With Cancer and Immigration Background

PURPOSE

Studies have shown that patients with cancer are more likely to use complementary and alternative medicine (CAM) than noncancer patients for symptom relief and hope. We aimed to evaluate factors of race, ethnic groups, and immigration status in attitude of patients with cancer in seeking out CAM.

PATIENTS AND METHODS

This is a prospective questionnaire study where information on demographics, cancer information, race/ethnicity, immigration duration, and psychosocial factors was correlated with the CAM use in a community cancer center located in the borough of Brooklyn, at New York City.

RESULTS

Among 658 patients, the prevalence of CAM use was 66.11%. CAM use was 71.98% in females and 54.34% in males (P = .113 × 10-4). Patients of African descent had higher CAM use (72.73%) than the White patients (63.53%; P = .0371). There was no difference of CAM use between the US born (68.77%) and the immigrants (63.98%, P = .199) as a whole; however, comparing with the US born (66.50%), Asian-born immigrants had lower CAM use (53.77%, P = .0161), whereas Latin-American born had a numerical trend toward higher CAM use (74.83%, P = .0608). The number of years of living in the United States was not associated with more CAM use. Prayer and spirituality was the most common CAM subtype used (25.91%). There was no difference in CAM use in the respective non-White ethnic groups whether they were US born or non-US born.

CONCLUSION

In this cohort of patients with cancer enriched with immigration background, CAM use was the highest in African American patients. The use of CAM in the non-White patients was associated with their ethnic background, regardless whether they were US born or not. Cultural roots appeared to be a strong influencing factor for the usage of CAM.

Lessons Learned from Health Disparities in Coronavirus Disease-2019 in the United States

In the United States, the coronavirus disease-2019 (COVID-19) pandemic has disproportionally affected Black, Latinx, and Indigenous populations, immigrants, and economically disadvantaged individuals. Such historically marginalized groups are more often employed in low-wage jobs without health insurance and have higher rates of infection, hospitalization, and death from COVID-19 than non-Latinx White individuals. Mistrust in the health care system, language barriers, and limited health literacy have hindered vaccination rates in minorities, further exacerbating health disparities rooted in structural, institutional, and socioeconomic inequities. In this article, we discuss the lessons learned over the last 2 years and how to mitigate health disparities moving forward.

Experiences of the Flint Water Crisis Among Reproductive-Age Michigan Women in Communities Outside of Flint: Differences by Race and Ethnicity

We sought to understand how women in Michigan communities outside of Flint experienced the Flint water crisis, an avoidable public health disaster widely attributed to structural racism. Using survey data from 950 Michigan women aged 18-45 from communities outside of Flint, we examined racial and ethnic differences in personal connections to Flint, perceived knowledge about the water crisis, and beliefs about the role of anti-Black racism in the water crisis factors that could contribute to poor health via increased psychological stress. We found that White (OR = 0.32; 95% CI: 0.22, 0.46) and Hispanic (OR = 0.21; 95% CI: 0.09, 0.49) women had lower odds than Black women of having family or friends who lived in Flint during the water crisis. Compared to Black women, White women were less likely to be moderately or very knowledgeable about the water crisis (OR = 0.58; 95% CI: 0.41, 0.80). White women (OR = 0.26; 95% CI: 0.18, 0.37), Hispanic women (OR = 0.38; 95% CI: 0.21, 0.68), and women of other races (OR = 0.28; 95% CI: 0.15, 0.54) were less likely than Black women to agree that the water crisis happened because government officials wanted to hurt Flint residents. Among those who agreed, White women (OR = 0.47; 95% CI: 0.30, 0.74) and women of other races (OR = 0.33; 95% CI: 0.12, 0.90) were less likely than Black women to agree that government officials wanted to hurt people in Flint because most residents are Black. We conclude that the Flint water crisis was a racialized stressor, with potential implications for the health of reproductive-age Black women.

Mediators of Ethnic Differences in Dropout Rates From a Randomized Controlled Treatment Trial Among Latinx and Non-Latinx White Primary Care Patients With Anxiety Disorders

ABSTRACT

Disparities in treatment engagement and adherence based on ethnicity have been widely recognized but are inadequately understood. Few studies have examined treatment dropout among Latinx and non-Latinx White (NLW) individuals. Using Andersen's Behavioral Model of Health Service Use (A behavioral model of families' use of health services. 1968; J Health Soc Behav. 1995; 36:1-10) as a framework, we examine whether pretreatment variables (categorized as predisposing, enabling, and need factors) mediate the relationship between ethnicity and premature dropout in a sample of Latinx and NLW primary care patients with anxiety disorders who participated in a randomized controlled trial (RCT) of cognitive behavioral therapy. Data from a total of 353 primary care patients were examined; 96 Latinx and 257 NLW patients participated. Results indicated that Latinx patients dropped out of treatment more often than NLW patients, resulting in roughly 58% of Latinx patients failing to complete treatment compared with 42% of NLW, and approximately 29% of Latinx patients dropping out before engaging in modules related to cognitive restructuring or exposure, relative to 11% of NLW patients. Mediation analyses suggest that social support and somatization partially explained the relationship between ethnicity and treatment dropout, highlighting the importance of these variables in understanding treatment disparities.

All human social groups are human, but some are more human than others: A comprehensive investigation of the implicit association of "Human" to US racial/ethnic groups

All human groups are equally human, but are they automatically represented as such? Harnessing data from 61,377 participants across 13 experiments (six primary and seven supplemental), a sharp dissociation between implicit and explicit measures emerged. Despite explicitly affirming the equal humanity of all racial/ethnic groups, White participants consistently associated Human (relative to Animal) more with White than Black, Hispanic, and Asian groups on Implicit Association Tests (IATs; experiments 1-4). This effect emerged across diverse representations of Animal that varied in valence (pets, farm animals, wild animals, and vermin; experiments 1-2). Non-White participants showed no such Human=Own Group bias (e.g., Black participants on a White-Black/Human-Animal IAT). However, when the test included two outgroups (e.g., Asian participants on a White-Black/Human-Animal IAT), non-White participants displayed Human=White associations. The overall effect was largely invariant across demographic variations in age, religion, and education but did vary by political ideology and gender, with self-identified conservatives and men displaying stronger Human=White associations (experiment 3). Using a variance decomposition method, experiment 4 showed that the Human=White effect cannot be attributed to valence alone; the semantic meaning of Human and Animal accounted for a unique proportion of variance. Similarly, the effect persisted even when Human was contrasted with positive attributes (e.g., God, Gods, and Dessert; experiment 5a). Experiments 5a-b clarified the primacy of Human=White rather than Animal=Black associations. Together, these experiments document a factually erroneous but robust Human=Own Group implicit stereotype among US White participants (and globally), with suggestive evidence of its presence in other socially dominant groups.

Differences in Perceptions of Gun-Related Safety by Race and Gun Ownership in the United States

Motivated by disparities in gun violence, sharp increases in gun ownership, and a changing gun policy landscape, we conducted a nationally representative survey of U.S. adults (n=2,778) in 2021 to compare safety-related views of white, Black, and Hispanic gun owners and non-owners. Black gun owners were most aware of homicide disparities and least expecting of personal safety improvements from gun ownership or more permissive gun carrying. Non-owner views differed. Health equity and policy opportunities are discussed.

Examining Cognitive Decline Across Black and White Participants in the Harvard Aging Brain Study

BACKGROUND

Black Americans are approximately twice as likely to develop dementia as compared to White Americans and the magnitude of this disparity is often attributed to a variety of factors that include psychosocial and vascular risk factors. However, less is known about the potential contribution of Alzheimer's disease pathological differences.

OBJECTIVE

To examine potential differences incross-sectional and longitudinal cognitive performance in black and white participants who were clinically normal at baseline.

METHODS

296 participants (48 African-American/black participants) underwent MRI and amyloid PET at baseline. Linear mixed models were used to examine the main effects of race, years of education, reading ability, Framingham Heart Study cardiovascular risk score (FHS-CVD), white matter hyperintensities (WMH), and amyloid (Aβ) burden on the Preclinical Alzheimer Cognitive Composite-5 (PACC5).

RESULTS

Lower levels of educationalattainment and reading ability were found for blacks compared to whites. By contrast, no differences in FHS-CVD, WMH, or Aβ were found by racial group. Baseline differences in PACC5 score were attenuated after adjusting for educationalfactors, vascular factors, and Aβ, but remained lower for blacks compared to whites (β= -0.24, p = 0.014). Further, blacks demonstrated a faster rate of PACC5 decline longitudinally compared to whites (β  = -0.055, p = 0.025) after adjusting for covariates.

CONCLUSION

Accounting for educationalfactors, vascular factors, and Aβ burden diminished, but did not eliminate, racial differences in PACC5 performance longitudinally. Understanding potential differences in longitudinal cognitive outcomes by race may be important for upcoming secondary prevention trials.