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Background: Breast cancer (BC) affects racial and ethnic groups differently, leading to disparities in clinical presentation and outcomes. It is unclear how Hispanic ethnicity affects BC outcomes based on geographic location and proximity to the United States (U.S.)/Mexico border. We hypothesized that the impact of race/ethnicity on BC outcomes depends on geographic location and country of origin within each BC subtype. Methods: We analyzed BC data from the Texas Cancer Registry by race/ethnicity/birthplace according to BC subtype (luminal A/luminal B/human epidermal growth factor receptor 2 [HER2]/triple-negative breast cancer[TNBC]). Other covariates included age, geographic location (U.S., Mexico), residency (border, non-border), treatments, and comorbidities. Crude and adjusted effects of race/ethnicity and birthplace on overall survival (OS) were analyzed using Cox regression methods. Results: Our analysis of 76,310 patient records with specific BC subtypes revealed that Hispanic and non-Hispanic Black (NHB) patients were diagnosed at a younger age compared with non-Hispanic White (NHW) patients for all BC subtypes. For the 19,748 BC patients with complete data on race/ethnicity/birthplace/residency, Hispanic patients had a higher mortality risk in the Luminal A subtype, regardless of birthplace, whereas U.S.-born Hispanics had a higher risk of death in the TNBC subtype. In contrast, NHB patients had a higher mortality risk in the Luminal A and HER2 subtypes. Residence along the U.S./Mexico border had little impact on OS, with better outcomes in Luminal A patients and worse outcomes in Luminal B patients aged 60-74 years. Conclusion: Race/ethnicity, geographic birth location, and residency were significant predictors of survival in BC. Migration, acculturation, and reduced healthcare access may contribute to outcome differences.

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Integrative Behavioral Couple Therapy (IBCT) posits that couple distress can, in part, be attributed to four factors labeled with the acronym DEEP: natural Uifferences between partners in their perspectives, beliefs, interests, and personalities, partner's Emotional sensitivities related to these differences, the External, contextual stressors that often exacerbate their differences and sensitivities, and the resultant Patterns of distressed interaction. Although an extensive assessment process captures these four components and thus tailors targets for intervention based on the unique characteristics of each couple, it does not explicitly consider the uniqueness of African American couples. Given the historical and contemporary realities that African American couples face (e.g., anti-Black racism), the purpose of this article is to help clinicians use IBCT with African American couples in a culturally responsive way. We begin this article by highlighting the unique needs of African American couples. We then provide a broad overview of the benefits of adopting a multicultural lens of awareness, knowledge, and skills in clinical work, present an atheoretical overview of IBCT, and offer specific recommendations to attend to the unique cultural experiences of African American couples. Finally, we present a case study to exemplify our suggestions and highlight implications of using IBCT with African American couples in a culturally responsible way.

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OBJECTIVE: Reducing the nicotine content in cigarettes decreases their addictiveness and abuse liability, including among adolescents. Whether these effects differ by race/ethnicity is unknown. This study is a secondary analysis of previously published data collected between 2014-2017. We examined racial/ethnic differences in the effects of smoking cigarettes with varying nicotine content levels on subjective effects and tobacco withdrawal among adolescents who smoke daily. METHODS: Across two counterbalanced sessions, 50 adolescents recruited from Rhode Island (ages 15-19; 30 % Underrepresented Minorities [URM], 20 % Asians and Pacific Islanders [API]; 50 % Non-Hispanic Whites) self-administered a very low nicotine content (VLNC; 0.4 mg nicotine/g of tobacco) or normal nicotine content control (NNC; 15.8 mg/g) research cigarette following overnight abstinence. Subjective effects were reported post-administration and tobacco withdrawal outcomes were calculated from pre- to post-administration scores. Multilevel linear models tested main and interactive effects between cigarette nicotine content and race/ethnicity on all study outcomes. RESULTS: Participants reported lower positive subjective effects and reductions in smoking urges after smoking a VLNC cigarette relative to smoking an NNC cigarette (ps < 0.01). A main effect of race/ethnicity emerged, such that API (vs. URM and White) adolescents reported lower positive subjective effects, greater craving reduction, and higher cigarette aversion after smoking, regardless of nicotine content (ps < 0.05). Significant interactions were found between race/ethnicity and nicotine content for cigarette aversion, such that API adolescents rated VLNC (vs. NNC) cigarettes as less aversive than White and URM adolescents did (p = 0.03). CONCLUSIONS: Findings provide evidence that VLNC cigarettes may reduce abuse liability and tobacco withdrawal symptoms for adolescents across racial/ethnic groups and particularly for API youth.

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Despite decades of extensive research and clinical insights on the increased risk of all-cause and disease-specific morbidity and mortality due to obesity, the obesity paradox still presents a unique perspective, i.e., having a higher body mass index (BMI) offers a protective effect on adverse health outcomes, particularly in people with known cardiovascular disease (CVD). This protective effect may be due to modifiable factors that influence body weight status and health, including physical activity (PA) and cardiorespiratory fitness (CRF), as well as non-modifiable factors, such as race and/or ethnicity. This article briefly reviews the current knowledge surrounding the obesity paradox, its relationship with PA and CRF, and compelling considerations for race and/or ethnicity concerning the obesity paradox. As such, this review provides recommendations and a call to action for future precision medicine to consider modifiable and non-modifiable factors when preventing and/or treating obesity.

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Feelings of entrapment-posited to arise when attempts to escape from defeating or humiliating circumstances are blocked-may confer increased risk for psychopathology and suicidal thoughts and behaviors (STB), particularly among minoritized individuals who often have more frequent exposure to such experiences. Including entrapment in empirical models may aid research efforts in further exploring its role in minority mental health. The Entrapment Scale Short-Form (E-SF), a brief version of the 16-item Entrapment Scale, is one tool that may be utilized toward this end; however, to do so meaningfully, its psychometric properties and measurement invariance must be evaluated in diverse samples. This study aimed to examine the factor structure, measurement invariance, and convergent validity of the E-SF across race/ethnicity and sexual orientation in a combined transnational sample of minoritized adults (total N = 1,194). Results supported a one-factor model of the E-SF that was invariant across samples, race/ethnicity, sexual orientation, and history of suicide attempt. Furthermore, significant positive correlations observed between theoretically relevant constructs of anxiety, depression, and posttraumatic stress disorder symptoms supported its convergent validity. Implications include disproportionate levels of entrapment experienced by minoritized individuals-particularly by sexual minorities-which likely reflect the discrimination frequently endured by these individuals.

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OBJECTIVES: To investigate the trends and racial/ethnic disparities in adequate prenatal care (PNC) use in the USA. METHODS: A repeated cross-sectional study was conducted using May 2016-May 2021 data from the Pregnancy Risk Assessment Monitoring System (PRAMS). A primary outcome was the Kotelchuck index, a measure of the adequacy of PNC use, and the year was a key independent variable. Multinomial and binary logistic regression analyses were performed to examine PNC utilization using multiple imputations with chained equations. RESULTS: Among the 190,262 pregnant individuals, adequate PNC use was largely consistent from 2016 to 2019. However, there was an immediate drop from 77.4-78.3% between 2016 and 2019 to 75.2% in 2020 and 75.8% in 2021. Conversely, both intermediate and inadequate PNC use tended to increase in 2020 and 2021. Adequate PNC use, when compared to inadequate use, showed significantly lower odds in 2020 (adjusted Odds Ratio [aOR] 0.87, 95% CI 0.78-0.96; p = 0.009) and 2021 (aOR 0.87, 95% CI 0.77-0.99; p = 0.033) than in 2016. Notably, Hispanic participants experienced substantial impacts (aOR 0.75, 95% CI 0.64-0.88; p = 0.001 in 2020 and aOR 0.72, 95% CI 0.59-0.89; p = 0.002 in 2021). CONCLUSIONS: While adequate PNC use was a steady, slightly upward trend before 2020, it had a steep decline afterward. It is worth noting that Hispanic individuals were severely affected. Targeted interventions or policies to address barriers to PNC and foster equitable and sustainable care models are required.

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INTRODUCTION: It is unknown whether race/ethnicity affects access and/or survival after neoadjuvant (NAC) or adjuvant chemotherapy (ADJ) at radical cystectomy (RC). We addressed these knowledge gaps. MATERIAL AND METHODS: Within the Surveillance, Epidemiology, and End Results database (2007-2020), we identified NAC candidates (T2-T4N0M0) and ADJ candidates (T3-T4 and/or N1-3). We focused on the four most prevalent race/ethnicities: Caucasians, Hispanics, African American (AA), and Asian/Pacific Islanders (API). Multivariable logistic regression models (MLR) tested access to NAC and ADJ. Subsequently, within NAC-exposed patients, survival analyses consisting of Kaplan-Meier plots and multivariable Cox regression models addressed CSM according to race/ethnicity were fitted. We repeated the same methodology in ADJ-exposed patients. RESULTS: In 6418 NAC candidates, NAC was administered in 1011 (19.0%) Caucasians, 88 (21.0%) Hispanics, 65 (17.0%) AA, and 53 (18.0%) API. In MLR, AA exhibited lower access rates to NAC (OR 0.83, p = 0.04). In NAC-exposed patients, AA independently predicted higher CSM (HR 1.3, p < 0.001) and API independently predicted lower CSM (HR 0.83, p = 0.03). Similarly, in 5195 ADJ candidates, ADJ was administered to 1387 (33.0%) Caucasians, 100 (28.0%) Hispanics, 105 (29.0%) AA, and 90 (37.0%) API. In MLR, AA (OR 68, p = 0.003) and Hispanics (OR 0.69, p = 0.004) exhibited lower access rates to ADJ. In ADJ-exposed patients, AA independently predicted lower CSM (HR 1.32, p < 0.001), while API showed better CSM (HR 0.82, p = 0.01). CONCLUSION: Relative to Caucasians, AA are less likely to receive either NAC or ADJ. Moreover, relative to Caucasians, AA exhibit higher CSM even when treated with either NAC or ADJ.

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Studies in the United Kingdom have shown distinctions in intergenerational co-residency between UK-born and foreign-born individuals, however, little research has examined how factors such as immigrant incorporation, economic adaptation, and kin availability shape household formation patterns among immigrants. This paper uses data from the UK Household Longitudinal Study (2009-2010) to explore differences in the likelihood of UK-born and foreign-born working-aged adults to co-reside with at least one parent, highlighting distinctions by life stage (age) at migration and gender. Results show that, regardless of life stage at migration, foreign-born women and men are less likely to co-reside with parents than UK-born, however, intergenerational co-residency is high among some second-generation immigrant groups, particularly UK-born Indian, Pakistani, and Bangladeshi individuals. These findings challenge cultural assumptions about household formation patterns and point to the need for additional research on how economic inequality, kin availability, and gender norms shape immigrant household composition.

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BACKGROUND: County-level barriers (sociodemographic barriers, limited healthcare system resources, healthcare accessibility barriers, irregular healthcare seeking behaviors, low vaccination history) may impact individuals' reasons for receiving the COVID-19 vaccine. METHODS: This study linked data from REACH-US (Race-Related Experiences Associated with COVID-19 and Health in the United States), a nationally representative, online survey of 5475 adults living in the U.S (January-March 2021) to county-level barriers in the COVID-19 Vaccine Coverage Index. County-level vaccination barriers were measured using the COVID-19 Vaccine Coverage Index. Participants reported why they would or would not receive the COVID-19 vaccine in an open-ended item and their responses were coded using thematic analysis. Descriptive statistics and chi-square tests assessed whether reasons for COVID-19 vaccination intentions varied by county-level barriers and whether these distributions varied across racial/ethnic groups. RESULTS: Thematic analysis revealed twelve themes in participants' reasons why they would or would not receive the COVID-19 vaccine. Themes of societal responsibility (9.8% versus 7.7%), desire to return to normal (8.1% versus 4.7%), and trust in science/healthcare/government (7.7% versus 5.1%) were more frequently reported in counties with low/medium barriers (versus high/very high) (p-values < 0.05). Concerns of COVID-19 vaccine side effects/safety/development (25.3% versus 27.9%) and concerns of access/costs/availability/convenience (1.9% versus 3.6%) were less frequently reported in counties with low/medium barriers (versus high/very high) (p-values < 0.05). Trends in the prevalence of these themes varied across racial/ethnic groups (p-values < 0.05). CONCLUSIONS: Future pandemic responses should consider potential ways county-level barriers shape reasons for COVID-19 vaccination.

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PURPOSE: To assess whether neighborhood-level measures of policing are spatio-temporally associated with psychiatric hospialization among adolescents and young adults in New York City, and whether this association varies by neighborhood racial composition. METHODS: We derived population-based measures of policing from the New York City Police Department (NYPD), psychiatric hospitalization from Statewide Planning and Research Cooperative System (SPARCS) data, and socio-demographic data from the American Community Survey (ACS), aggregated by month and ZIP Code Tabulation Area (ZCTA) from 2006 to 2014. Multi-level negative binomial regression models assessed hospitalization-time of youth aged 10-24 as the dependent variable and the rate of policing events as the primary independent variable, adjusting for neighborhood poverty, unemployment, and educational attainment. Multiplicative interaction was assessed between policing and tertiles of the percentage of Black residents. RESULTS: A total of 11,900,192 policing incidents and 2,118,481 person-days of hospitalization were aggregated to 19,440 ZCTA-months. After adjusting for neighborhood-level sociodemographic characteristics, an increase in one policing incident per 1,000 residents was associated with a 0.3% increase in the rate of youth psychiatric hospitalization time (IRR 1.003 [1.001-1.005]). Neighborhood racial composition modified this effect; not only was the rate of psychiatric hospitalization and policing higher in neighborhoods with a higher proportion of Black residents, but the association between these was also significantly higher in neighorhoods with a larger share of Black residents compared with predominantly non-Black neighborhoods. CONCLUSION: Neighborhoods experiencing higher rates of policing during the study period experienced higher burdens of psychiatric hospitalization among adolescent and young adult residents. This association was larger in neighborhoods of color which have been disproportionately targeted by "hot spot" and order-maintenance policing practices and policies.

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Studies indicate parental incarceration (PI) is associated with children's externalizing behaviors. Fewer studies have examined whether the relationship persists into adulthood, manifesting specifically in violent behavior, and differs by race/ethnicity or sex of the individual exposed to PI during childhood. Wave I and Wave IV National Longitudinal Study of Adolescent to Adult Health data where average respondent age was 15.7 and 28.8 years, respectively, was used to expand understanding of PI impact on U.S. male and female violent behavior. PI was associated with fighting, fighting that seriously injured someone, and any violent delinquent behavior in adulthood. When examining the moderating effect of race/ethnicity, the association between PI and fighting was stronger for Hispanic persons than Non-Hispanic White persons. In analysis stratified by race/ethnicity, Hispanic persons who reported PI compared to those who did not were 4.78 [95% CI: 2.43, 9.38] times as likely to report fighting and Non-Hispanic Black persons who reported PI compared to those who did not were 1.88 times as likely (CI 1.01, 3.51) to report fighting. Sex was not found to be a moderator of the association between PI and violent delinquent behaviors. Results indicate the influence of PI on violent behavior persists into adulthood and differs by race/ethnicity. Differing patterns of elevated violence risk in adults with PI history suggest tailored preventive strategies may be of value.

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Purpose: The present study investigated associations of sexual orientation and/or gender identity-based medical mistrust and racial/ethnic-based medical mistrust, respectively, with unmet medical care need among lesbian, gay, bisexual, transgender, queer, and/or sexually or gender diverse (LGBTQ+) people of color (POC) assigned female at birth (AFAB). We also tested the interaction of the two types of medical mistrust on unmet medical care need. Methods: Participants were 266 LGBTQ+ POC AFAB. Participants completed measures of medical mistrust based on race/ethnicity and LGBTQ+ identity. Unmet medical care need was assessed using the item: "During the past 12 months, was there ever a time where you felt that you needed health care but you didn't receive it?" Multivariate logistic regression models were run with either type of medical mistrust, as well as their interaction, as the predictor and unmet medical care need as the outcome variable. Results: There were no significant main effects of either type of medical mistrust on unmet medical care need. However, there was an interaction between the two types of medical mistrust, such that associations between each type of medical mistrust and unmet medical care needs were stronger at higher levels of the other type of medical mistrust. Racial/ethnic medical mistrust was associated with a greater likelihood of unmet medical needs at high, but not low, levels of LGBTQ+ medical mistrust. Conclusions: Racial/ethnic medical mistrust and LGBTQ+ medical mistrust exacerbate each other's influence on unmet medical care need. These results underscore the need for inclusive clinical practices for LGBTQ+ POC.

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PURPOSE: To identify whether race/ethnicity plays a role in knowledge of clinical trials among patients with a gynecologic malignancy. PATIENTS AND METHODS: A cross-sectional survey was conducted at a tertiary medical center. Participants were adults (≥18 years old), with gynecologic malignancy, and literate in English, Spanish or Chinese. Participants completed a 9-item clinical trial knowledge assessment. Demographic characteristics were summarized using descriptive statistics. A multivariable model was employed to evaluate the relationship between race/ethnicity and clinical trial knowledge. RESULTS: 245 patients were approached, 25 (10.2%) declined. Among participants, 108 (50.2%) were white, and 107 (49.8%) were people of color. Significant differences were noted for age, education, birthplace, and income; no difference was observed for cancer type or stage. The median number of correct answers for the knowledge assessment was seven. 67 (62%) white vs 26 (24.3%) people of color had an above average clinical trial knowledge score (p < 0.001). Multivariable analysis showed white participants were 2.7 times more likely to have an above average clinical trial knowledge score. White participants overall utilized more resources. Elder adults (≥65 years old) had higher knowledge of clinical trials compared to non-elder adults (<65 years old); however, these findings were not significant. CONCLUSION: This study observed significant differences in clinical trial knowledge between white and people of color diagnosed with a gynecologic malignancy. White patients utilize more informational resources compared to people of color. Further studies need to develop resources and outreach mechanisms that will increase access and diversity in clinical trial participation.

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Understanding socioeconomic factors contributing to uterine cancer survival disparities is crucial, especially given the increasing incidence of uterine cancer, which disproportionately impacts racial/ethnic groups. We investigated the impact of county-level socioeconomic factors on five-year survival rates of uterine cancer overall and by histology across race/ethnicity. We included 333,013 women aged ≥ 30 years with microscopically confirmed uterine cancers (2000-2018) from the Surveillance, Epidemiology, and End Results 22 database followed through 2019. Age-standardized five-year relative survival rates were compared within race/ethnicity and histology, examining the differences across tertiles of county-level percent (%)

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INTRODUCTION: Research investigating racialized inequities in cervical cancer screening has rarely considered the influence of socioeconomic position (SEP), a key social determinant of health that intersects with race/ethnicity and racism. Thus, data on socioeconomic inequities in Pap test use within racialized groups-including Black women, who are at elevated risk of cervical cancer morbidity and mortality-are limited. METHODS: Using 2011-2019 data from the National Survey of Family Growth and guided by an intersectional framework, we used multivariable logistic regression to examine the association between educational attainment, employment status, and income and the adjusted odds of Pap test use in the last 3 years among Black U.S. women. RESULTS: Compared to Black women with a bachelor's degree or greater, those with less than a high school diploma ([odds ratio] = 0.45; [95% confidence interval] 0.31-0.67) and a high school diploma/GED (0.57; 0.40-0.81) had significantly lower odds of Pap test use, adjusting for sociodemographic factors. Unemployed women had significantly lower adjusted odds of Pap test use compared to employed women (0.67; 0.50-0.89), and women living below 100% of the federal poverty level (FPL) had significantly lower adjusted odds of Pap test use relative to those living at or above 300% FPL (0.63; 0.45-0.88). CONCLUSION: Low-SEP Black women had significantly lower adjusted odds of Pap test use relative to their higher SEP counterparts. Interventions that address both racism and economic barriers to care are needed to facilitate access to regular cervical cancer screening among low-SEP Black women.

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BACKGROUND: High-risk medication use is associated with an increased risk of adverse events, but little is known about its chronic utilization by key demographic groups. We aimed to study the associations between age, sex, and race/ethnicity with new chronic use of high-risk medications in older adults. METHODS: In this retrospective cohort study, we analyzed data from older adults aged ≥65 years enrolled in a national health insurer who started a high-risk medication between 2017 and 2022 across 16 high-risk medication classes. We used generalized estimating equations to estimate the associations between sociodemographic classifications and the onset of chronic high-risk medication use after initiation (≥90 days' supply across ≥2 fills within 180 days). We adjusted the analyses for sociodemographic and clinical patient characteristics and added three-way interaction terms for race/ethnicity, sex, and age to explore whether the outcome varied across different subgroups of race/ethnicity, age, and sex. RESULTS: Across 2,751,069 patients (mean age: 74 years [SD = 7], 72% White, 60% Female), 406,075 (15%) became new chronic users of ≥1 high-risk medication. Compared to White older adults, Asian (RR = 0.81, 95% CI: 0.79-0.84), Black (RR = 0.92, 95% CI: 0.90-0.94), and Hispanic (RR = 0.85, 95% CI: 0.83-0.86) older adults had a lower risk of becoming new chronic users. Men had a higher risk compared to women (RR = 1.09, 95% CI: 1.08-1.10). Age was not significantly associated with new chronic high-risk medication use (≥75 years: RR = 1.00, 95% CI: 1.00-1.01). We observed differences across some medication classes, like benzodiazepines, first-generation antihistamines, and antimuscarinics for which non-White older adults were at a higher risk. The joint presence of specific age, sex, and race/ethnicity characteristics decreased the risk of becoming a new chronic user (e.g., Hispanic/Female/65-74 years: RR = 0.96, 95% CI: 0.94-0.99). CONCLUSIONS: New chronic high-risk medication use varied across older adults by sociodemographic characteristics, suggesting the need to individualize medication optimization approaches and better understand how systematic barriers in access to health care may influence differences in high-risk medication use in older adults.

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Objectives: We investigated the associations of lifetime and everyday discrimination with cognitive function. Methods: Data were from the Chicago Community Adult Health Study (n=2952, mean age=43 years [SD=17]). We fitted multivariable linear regression models to quantify the discrimination-cognition associations. Results: Major lifetime (ß1 vs 0 episodes of discrimination = 0.56; 95% CI, 0.15-0.96; ß2+ vs 0 episodes of discrimination = 0.64, 95% CI, 0.31-0.97) and everyday (ß=0.10, 95% CI, 0.06-0.14) discrimination were positively associated with cognition, and these associations did not differ by race/ethnicity. Among older adults, major lifetime discrimination, but not everyday discrimination, was positively associated with cognition (ß2+ vs 0 episodes of discrimination =1.79; 95% CI, 0.79-2.79). Discussion: Measurement and selection bias may partially explain the counterintuitive study findings. We call for longitudinal research to further investigate the discrimination-cognition relationship.

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Using 1998-2022 Women's Health Initiative (WHI) data, our study provides contemporary fracture data by race and ethnicity, specifically focusing on Hispanic and Asian women. Fractures of interest included any clinical, hip, and major osteoporotic fractures (MOFs). We utilized the updated race and ethnicity information collected in 2003, which included seven Asian and five Hispanic origin groups. We computed crude and age-standardized fracture incidence rates per 10 000 woman-years across race and ethnic categories and by Asian and Hispanic origin. We used Cox proportional hazards model, adjusting for age and WHI clinical trial arm, to evaluate the risk of fracture (1) by race compared to White women, (2) Asian origin compared to White women, (3) Hispanic compared to non-Hispanic women, and (4) Asian and Hispanic origins compared the most prevalent origin group. Over a median (interquartile range) follow-up of 19.4 (9.2-24.2) years, 44.2% of the 160 824 women experienced any clinical fracture, including 36 278 MOFs and 8962 hip fractures. Compared to White women, Black, Pacific Islander, Asian, and multiracial women had significantly lower risk of any clinical and MOFs, while only Black and Asian women had significantly lower hip fracture risk. Within Asian women, Filipina women had 24% lower risk of any clinical fracture compared to Japanese women. Hispanic women had significantly lower risk of any clinical, hip, and MOF fractures compared to non-Hispanic women, with no differences in fracture risk observed within Hispanic origin groups. In this diverse sample of postmenopausal women, we confirmed racial and ethnic differences in fracture rates and risk, with novel findings among within Asian and Hispanic subgroups. These data can aid in future longitudinal studies evaluate contributors to racial and ethnic differences in fractures.

We provided contemporary fracture rates by race and ethnicity, specifically focusing on multiple Hispanic and Asian subgroups, using 1998-2022 data from the Women's Health Initiative. Over a median follow-up of 19.4 years, 43.4% of the 154 948 women experienced any clinical fracture, including 8679 hip and 34 546 major osteoporotic fractures. Compared to White women, Black, Pacific Islander, Asian, and multiracial women had significantly lower risk of any clinical and major osteoporotic fractures (MOFs); while only Black and Asian women had significantly lower hip fracture risk when compared to White women. Within Asian women, Filipina women had 24% lower risk of any clinical fracture compared to Japanese women. Hispanic women had significantly lower risk of any clinical, hip, and MOF fractures compared to non-Hispanic women, with no differences in fracture risk observed within Hispanic women. In this diverse sample of postmenopausal women, we confirmed racial and ethnic differences in fracture rates and risk, with novel findings among Pacific Islander women and within Asian and Hispanic subgroups.

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BACKGROUND: Depression among older adults is a pressing public health concern, necessitating accurate assessment tools. The Geriatric Depression Scale (GDS) offers a brief and efficient means of screening depressive symptoms, yet its performance across ethno-racial groups remains understudied. This study aimed to compare the ability of various brief forms of the GDS to detect depressive symptoms and to assess potential ethno-racial differences in symptom endorsement among White, Black/African-American, and American Indian/Alaska Native older adults. METHODS: Data were obtained from the Wisconsin Alzheimer's Disease Research Center (ADRC) clinical cohort, comprising 555 cognitively healthy individuals at risk for dementia. We used participants' baseline data for this cross-sectional analysis. Depressive symptoms were assessed using multiple brief forms of the GDS, derived from a systematic review and meta-analysis. We examined internal consistency and correlations with global Clinical Dementia Rating (CDR) scores. We conducted Kruskal-Wallis tests and post hoc pairwise comparisons to assess ethno-racial group differences in symptom endorsement. RESULTS: Descriptive statistics revealed a predominance of female and White participants, with notable representation from Black and American Indian/Alaska Native groups. All GDS versions demonstrated moderate to high internal consistency. Significant positive correlations were observed between GDS scores and global CDR scores. Ethno-racial group differences in depressive symptom endorsement were evident, with Black participants consistently reporting higher levels of symptoms across most GDS versions. However, American Indian/Alaska Native participants endorsed significantly fewer symptoms than Black participants in one GDS version. CONCLUSION: The study highlights the importance of considering ethno-racial differences in depressive symptomatology when assessing older adults. While the GDS demonstrates overall reliability, variations in symptom endorsement across different ethno-racial groups underscore the need for culturally sensitive assessment tools and interventions. Future research should further explore these group differences and develop tailored approaches to depression screening and treatment in diverse older adult populations.

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OBJECTIVES: African American children are documented as having poor sleep health due to shorter sleep duration, sleep timing, and sleep behaviors compared to White peers, contributing to child health disparities. Identifying cultural-environmental, and societal factors impacting a child's sleep among African American families is essential for developing interventions for this population. This study evaluated holistically why African American children may have poorer sleep health by examining sleep duration, timing, and behaviors. This was assessed by examining sleep-related beliefs, barriers, and facilitators to sleep schedules and routines. We also explored parental ideas for a sleep intervention. METHODS: African American mothers of preschool-aged children (2-5years) were recruited using local partnerships and social media. Individual semistructured interviews were conducted by phone. Interviews were transcribed, coded, and analyzed thematically using grounded-theory. RESULTS: Eighteen African American mothers completed the study. Five themes related to sleep emerged: The importance of adequate nighttime sleep, the influence of family and friends on parental sleep practices, the relationship between environmental and home dynamics on child sleep duration, the impact of acute and chronic societal-level stressors on family sleep health, and considerations for culturally tailored interventions to improve child sleep health. CONCLUSIONS: Good sleep health was important among African American mothers. Cultural-environmental and societal factors significantly impact children's sleep health. Clinicians and researchers should be aware of financial resources and home dynamics leading to challenges with adequate sleep health when developing or adapting sleep interventions. Identifying cultural-environmental, and societal factors must be considered for targeted efforts to improve sleep health in African American children.