Black transgender women are disproportionately exposed to discrimination and healthcare barriers associated with poor health and delayed treatment-seeking. Consequently, traditional treatment pathways may not be accessible. Thus, health self-management (HSM) may be critical in promoting health among Black transgender women. The purpose of this study is to examine the relationships among intersectional discrimination, self-efficacy for health management, and mental health outcomes (PTSD symptoms, depressive symptoms, and unhealthy days) among Black transgender women, and to determine whether self-efficacy modifies or explains the association between intersectional discrimination and these health outcomes. We analyzed quantitative survey data from a community-based United States sample of 154 Black transgender women to advance our understanding of the associations between intersectional discrimination, self-efficacy to manage one's health, and distal health outcomes. Analyses included Pearson's correlations, T-tests, and multiple linear regression. Higher self-efficacy was associated with better mental health overall but did not consistently buffer the effects of intersectional discrimination, suggesting partial mediation rather than full mediation or moderation. Among Black transgender women, racism and cisgenderism may be influencing other components in the pathway between context and health outcomes, contributing to higher self-reported self-efficacy or reducing the potential effect of self-efficacy on health outcomes. Future research should further examine the historical and present-day prejudicial systems that affect one's self-efficacy to manage their health and take an anti-cisgenderist and anti-racist approach to discussing HSM with Black transgender women.
This study examines whether residential contexts account for Black-White disparities in epigenetic age acceleration (EAA), a key biomarker of premature aging. Relevant hypotheses are tested by merging survey, biomarker, and contextual data from non-Hispanic Black and White older-adult participants of the Health and Retirement Study who provided venous blood samples in 2016 (n = 3187; mean age = 69). Using multigroup structural equation modeling techniques, we decompose direct and indirect paths between a latent variable of EAA-comprised of GrimAge, PhenoAge, and DunedinPoAm38 clocks-and five features of residential contexts: racial clustering of residents, air pollution, greenspace, household incomes, and perceived disorder. We find that White respondents who lived in areas with a high clustering of other White residents in 2010 exhibit lower EAA in 2016, relative to White peers who lived in areas with fewer White residents. Higher household incomes in predominantly White areas account for around 25% of this association. With one minor exception, we find no significant paths between residential contexts and EAA among Black participants. These findings are also robust to numerous control measures and sensitivity analyses. Our study highlights concentrated privilege in predominantly White areas as potential drivers of Black-White health and aging disparities. We discuss the broader implications of our study and outline several avenues for future research that could advance our findings.
Black adolescents face disproportionate behavioral health and substance use risks amplified by structural racism and discrimination, yet access to culturally grounded, family-centered preventive interventions remains exceedingly rare. Telehealth may advance prevention equity by eliminating geographic and logistical access barriers. A randomized controlled trial enrolled 170 families with Black adolescents (ages 11-12) assigned to T-SAAF-a telehealth adaptation of the evidence-based Strong African American Families program-or a no-treatment control. At 2 year follow-up, 145 families (85%) completed assessments. Youth-reported conduct problems and substance use onset were analyzed using ANCOVA and binary logistic regression, adjusting for baseline scores, age, sex, time between assessments, and caregiver educational attainment. T-SAAF participants reported significantly fewer conduct problems at 2 year follow-up (M = 1.51, 95% CI [1.35, 1.67]) than controls (M = 1.77, 95% CI [1.59, 1.94]; F[1,137] = 4.49, p = 0.036, η2 = 0.032). T-SAAF did not significantly reduce odds of substance use onset (OR = 1.22, 95% CI [0.48, 3.09], p = 0.68). A brief, culturally grounded telehealth family intervention reduced conduct problems among Black adolescents at a 2 year follow-up, relative to a no-treatment control. Substance use onset did not differ between conditions. These findings position digitally delivered, family-centered prevention as a promising, equity-focused strategy for extending evidence-based programming to underserved Black families. Trial Registration ClinicalTrials.gov NCT05253235; registered February 22, 2022.
Black men experience a disproportionate burden of lung cancer yet remain underrepresented in screening and smoking cessation programs. Community-based approaches combining culturally relevant information with patient navigation may help address these gaps. This Phase II developmental feasibility study examined a culturally targeted, navigator-led lung health intervention to support knowledge, decision-making, and early engagement with lung cancer screening and cessation resources among Black men who smoke (March 2023-June 2024). Forty participants recruited through barbershop outreach completed three staged sessions-an in-person educational visit with targeted materials and a screening decision aid, followed by brief navigation contacts. Outcomes were assessed at baseline, post-intervention, and 6-week follow-up. Participants demonstrated improvements in lung cancer-related knowledge, decisional clarity, and readiness to consider screening and cessation. Satisfaction with targeted materials and navigator support was high. Nearly half reported contacting healthcare providers regarding screening, and some scheduled low-dose CT examinations, while Quitline engagement remained modest. Findings support the feasibility and acceptability of culturally targeted navigation delivered in barbershops and may strengthen early behavioral engagement along the lung health continuum for Black men. Larger controlled trials with longer follow-up are needed to evaluate sustained behavioral outcomes.
Keloid is a fibroproliferative scar with marked ethnic disparities, disproportionately affecting Asian and Black populations. Single-cell RNA sequencing (scRNA-seq) studies have mapped keloid pathology, but cross-study differences complicate generalization. We performed a meta-analysis to identify composition and transcriptional programs associated with keloid across ethnicities. We aggregated human skin scRNA-seq datasets containing keloid and healthy samples with documented ethnicity (Asian, Black, White). After quality control and batch integration (scVI/scANVI), we annotated cell types and subtypes. Differential abundance was estimated with scCODA, Milo, and propeller. Pseudobulk differential expression was meta-analyzed using random-effects models. Ligand-receptor signaling was inferred with CellChat/NicheNet. The harmonized atlas comprised 112 donors, 147 samples, and 487,293 cells from 8 studies. Keloid demonstrated higher proportions of vascular endothelial cells and fibroblasts across all methods. Ethnicity-stratified analysis revealed endothelial expansion in Asian and Black relative to White populations, while fibroblast expansion was greater in White keloids. Endothelial subtyping showed increased post-capillary venules and arteriolar states. Fibroblast analysis revealed expansion of mesenchymal/ADAM12+ and pro-inflammatory populations. Meta-analysis implicated TGF-β/SMAD, integrin/FAK, and YAP/TAZ mechanotransduction pathways as candidate pathogenic programs warranting functional validation. Cross-study synthesis identifies shared and ethnicity-stratified endothelial and fibroblast programs in keloid. Expansion of post-capillary venules and ADAM12+ fibroblasts provides candidate therapeutic targets pending functional validation and a framework for understanding ethnic disparities in keloid formation.
Due to the rise of global e-commerce platforms like Alibaba, online interactions between rural Chinese wig sellers and Black clients are increasing. However, the racial implications of such platform-mediated business relations remain underexplored. Based on ethnographic fieldwork in Xuchang, a leading distribution and export center for wigs products in the global supply chain, this research examines the active role of Alibaba in orchestrating, structuring, and shaping the racial knowledge formation of rural Chinese wig sellers in their daily online interactions with Black clients. We argue that the exploitative nature of platform capitalism creates stress and exhaustion among rural wig sellers and pushes them to draw narrow and hasty conclusions about Blackness that dovetail with racialized hierarchy in the global wig industry and logistics networks. This research bridges the gap between platform studies and critical race studies and contributes to the reconceptualization of relations between platform and race.
When it comes to enhancing the way bioelectrochemical systems perform, improving how microorganisms and electrodes interact remains challenging. Here, we have modified anodes to improve the performance of microbial fuel cells (MFCs). Specifically, we modified a graphite plate anode (GP) by using three strategieselectroactivation (EGP), electroactivation followed by black phosphorus incorporation (EGP/BP), and subsequent EGP/BP electropolymerization with polypyrrole (EGP/BP/PPy)and evaluated EGP, EGP/BP, and EGP/BP/PPy in dual-chamber MFCs. The MFC anodic biofilm was formed from mangrove sediment in sodium acetate. Scanning electron microscopy confirmed that the modification strategies modified the GP surface and that a robust biofilm emerged after each treatment. The highly modified EGP/BP/PPy performed the best and reached a maximum voltage of 530.0 ± 35 mV, compared to 100.0 ± 18 mV and 10.8 ± 2 mV achieved with EGP/BP and EGP, respectively. EGP/BP/PPy also provided the highest maximum power density and Coulombic charge. Modifying the GP surface influenced the bacterial community composition. The genus Alcaligenes predominated under all the tested conditions, but other electroactive genera such as Pseudomonas and Geobacter emerged in EGP/BP/PPy. Therefore, combining BP and PPy to functionalize GP provided a stable and conductive electroactive biofilm, which enhanced bacterial adhesion, electron transfer, and energy generation. This work highlights that synergistic electrode functionalization improves electrode conductivity and microbial activity, which paves the way for advanced biohybrid electrochemical systems to be designed.
I first learned about the baby blues in medical school as a short definition: mood swings, tearfulness, and irritability resolving within two weeks. When I experienced them after giving birth during my second year of training, they felt far more complex than what I had read. I remember lying in the hospital that first night, overcome with tears and questioning if I was already falling short as a mother. Intellectually, I knew shifting hormones were at play, yet the sadness and guilt felt undeniably real. As a Black woman, I also carried the weight of cultural expectations. There is a persistent narrative that we must be strong, resilient, and unshaken no matter the circumstance. This expectation, often described as the Superwoman Schema, can make vulnerability feel unacceptable and discourage seeking support. For me, it added another layer to an already difficult transition. This experience deepened my understanding of how cultural identity shapes postpartum emotions and underscored the importance of making intentional space for emotional health, particularly for those whose cultural narratives may silence their struggles.
Black soldier fly (BSF) larvae efficiently convert organic residues into protein- and lipid-rich biomass, with oil extracted from BSF larvae exhibiting notable antioxidant potential. This study investigated larval growth, oil yield, and antioxidant properties for four feeding substrates made from cereal byproducts: wheat bran, rice bran, sorghum grain, and red quinoa hulls. BSF larvae reared for 7 days on different substrates displayed significant differences in body size, moisture content, and oil extraction efficiency. Wheat-bran-fed larvae had the lowest moisture content and largest size, whereas red-quinoa-fed larvae exhibited the highest moisture content but smallest size. Sorghum-fed larvae had the highest oil yield, followed by larvae fed with wheat bran, red quinoa, or rice bran. Oils extracted from larvae reared on the four substrates were analyzed for total phenolic content (TPC) and antioxidant activity using the 2,2-diphenyl-1-picrylhydrazyl (DPPH), 2,2'-azinobis-3-ethylbenzothiazoline-6-sulfonic acid (ABTS), and ferric reducing antioxidant power (FRAP) assays. Oil extracted from red-quinoa-fed larvae had the highest TPC (79.25 ± 1.04 μg of gallic acid equivalents per gram of oil) and strongest radical scavenging abilities (IC50 for DPPH = 22.0 ± 1.1 μg/mL, IC50 for ABTS = 11.6 ± 1.0 μg/mL, and FRAP = 29.24 ± 1.00 μg of vitamin C equivalents per gram of oil), closely followed by oil extracted from rice-bran-fed larvae. Pearson correlations indicated that TPC strongly predicted antioxidant performance (r = -0.995 to 0.962, p < 0.01). Red quinoa optimizes the functional quality of BSF oil. Rice bran offers a balance between oil yield and bioactivity. These findings highlight the effects of feed substrate on BSF oil properties.
Black soldier fly larvae (BSFL) are rich in crude protein (CP) and crude fat (EE), offering substantial potential for animal feed and biodiesel production. However, their nutritional composition is dynamically influenced by multiple factors. Traditional chemical detection methods are inefficient to meet the practical demands of modern farming. Therefore, this study developed a machine learning-based prediction method for the major nutritional components of BSFL. By collecting larval growth data under different feeding substrates and environmental conditions, six regression models were evaluated. Results demonstrated that Light Gradient Boosting Machine (LightGBM), achieved optimal performance in predicting CP content (determination coefficient (R2) = 0.711, mean absolute error (MAE) = 3.515, root mean square error (RMSE) = 4.913), while K-Nearest Neighbors outperformed the other five models in predicting EE content (R2 = 0.702, MAE = 4.508, RMSE = 5.975). Validation on five practical substrates produced mean absolute errors of 3.14 percentage points for CP and 3.42 percentage points for EE, indicating promising predictive potential under tested conditions. SHapley Additive exPlanations analysis identified larval instar stage and initial weight as the most important predictive factors for CP, and feeding substrate as the most influential factor for EE prediction. This study provided a data-driven tool to rapidly evaluate BSFL nutritional components, supporting optimization of farming strategies, although validation under broader conditions is still required.
Black soldier fly larva (BSFL) protein has gained attention as a sustainable alternative protein source in poultry nutrition. However, its effects on gut-related processes remain insufficiently characterized. This study evaluated the in vitro digestibility and fermentability of BSFL protein compared to plant-based proteins, including wheat gluten, corn distillers' dried grains with solubles (DDGS corn), and peas, using an in vitro digestion, absorption, and fermentation model. Crude protein, degree of protein hydrolysis, and in vitro protein digestibility (IVPD) were assessed, alongside gas production kinetics, ammonia, short-chain fatty acids (SCFA), branched-chain fatty acids, and microbiota modulation of a single, pooled broiler cecal inoculum during fermentation. An IVPD of 63.5% was observed for BSFL, being lower than for wheat gluten (84.4%) and peas (74.6%), and higher than for DDGS corn (36.9%) (P < 0.05). Its gas production (92.5 mL g-1) and SCFA levels (23.8 mmol L-1) are similar to those of other protein ingredients (P < 0.05). Peas showed the highest total SCFA (45.7 mmol L-1) and total gas production (147.3 mL g-1). Microbiota analysis revealed distinct communities shaped by protein ingredient. Fermentation of BSFL was associated with a relatively higher abundance of Escherichia-Shigella, warranting further investigation. In addition, relatively higher abundances of Lactobacillus and Bifidobacterium were associated with BSFL. As no differentially abundant genera were identified by ANCOM-BC2, these microbiota-related findings should be considered exploratory. Overall, BSFL protein appears to be a promising partial replacement for plant-based proteins in broiler diets, demonstrating similar digestibility, but promoting distinct microbiota-associated responses. © 2026 Society of Chemical Industry.
School exclusions represent harmful disciplinary responses to emotional, behavioural or relational needs that increase risks of escalation, educational disengagement, and justice system involvement. Racial-ethnic and gender inequalities in school responses to mental health needs perpetuate inequalities in health, education and justice outcomes. Developed in partnership with peer researchers and community stakeholders, we examined systematic differences between exclusions, Special Educational Needs and Disability (SEND) for Social, Emotional and Mental Health (SEMH) needs and juvenile justice contacts, based on gender and racial-ethnic group. We examined rates, timing and risk ratios of exclusions in relation to SEND-for-SEMH and juvenile justice contacts using national linked education and justice system data for 3.7m children (born 1997-2003) attending state schools in England aged 5-16. Boys from Mixed white-Black, Mixed Other, Black, Pakistani, Bangladeshi, Romani, and Irish Traveller backgrounds, plus Mixed white-Black Caribbean, Black Caribbean, and Romani girls, were significantly more likely to be excluded before/without receiving SEND-for-SEMH. Most girls and pupils from Asian, Black African, Black Other, white Other, Mixed white-Asian, Mixed Other and Other racial-ethnic group backgrounds were significantly less likely to receive SEND-for-SEMH following exclusions. Among those excluded first, boys from white Irish, Mixed race/ethnicity, Black Caribbean, Black Other, Romani and Irish Traveller backgrounds faced significantly elevated risk of juvenile justice contacts. Linked data reveals how systematic discrimination in school responses fuels the cycle of unmet mental health need and justice involvement. Reducing inequalities in health, education and youth justice requires co-ordinated integration across systems and equitable access to mental health care.
Firearm mortality surveillance relies on aggregate demographic categories or low-dimensional stratifications, obscuring how race, ethnicity, sex, age, and intent intersect to shape risk among youth and young adults. The Centers for Disease Control and Prevention (CDC)'s transition to single-race population estimates created a structural break between historical and contemporary data series. Consequently, the 25-year trajectory of intersectional firearm mortality across changing federal classification frameworks remains uncharacterized. We aimed to characterize 25-year national trajectories in firearm homicide and suicide across intersecting domains of race or ethnicity, sex, age, and intent among US youth and young adults (aged 0-24 y), identifying specific sociodemographic groups experiencing the highest and most rapidly changing burdens. This study used the CDC WONDER Underlying Cause of Death database (25-year window from 1999-2024). To address the 2018 transition, a 2-period design was deployed: period 1 (1999 to 2020) used bridged 4-category race data, and period 2 (2018 to 2024) used 6-category single-race data. Crude death rates and disparity ratios (referenced to non-Hispanic White youth) were calculated using the Byar approximation. Average annual percentage changes (AAPCs) were modeled via log-linear regression. Analyses incorporated finalized 2024 CDC WONDER data in January 2026. Among 200,704 firearm deaths among youth aged 0-24 years from 1999 to 2024, overall mortality declined through 2013, reversed in 2014, and rose 28.9% from 2019 to 2020. In 2024, the overall rate declined 12% from 2023 but remained above the 2019 prepandemic baseline. During 2018-2024, Black non-Hispanic male youth experienced the highest pooled firearm homicide rate (44.03 per 100,000; 95% CI 43.46-44.61), 23.8 times the rate among White non-Hispanic males. The annual rates within this cohort increased from 33.28 in 2018 to 53.75 in 2021 before declining to 37.06 in 2024 (AAPC, +2.4%; P=.56), while the Black-to-White disparity ratio widened from 19.3 to 24.4. Black non-Hispanic female youth had the highest female firearm homicide rate (6.03 per 100,000), exceeding male rates in 7 of 12 other demographic groups. American Indian or Alaska Native non-Hispanic male youth experienced the highest pooled firearm suicide rate (11.74 per 100,000). Firearm suicide increased significantly among Black non-Hispanic male youth (AAPC, +9.2%; 95% CI +3.2% to +15.4%; P=.01), with a substantial but nonsignificant upward trend among Black non-Hispanic female youth (AAPC, +11.7%; P=.08), while White non-Hispanic male rates remained stable (AAPC, -0.1%; P=.91). Consequently, the Black-to-White non-Hispanic male suicide rate ratio shifted from 0.67 in 2018 to 1.07 in 2024, marking the first time Black youth rates surpassed White youth rates in modern public health surveillance history. Firearm homicide and suicide among US youth exhibit distinct demographic concentration patterns that are systematically obscured by aggregated public health surveillance. Disaggregated surveillance remains imperative to design targeted prevention strategies.
Racial-ethnic and gender inequalities are well documented in Special Educational Needs and Disability (SEND) provision for Social, Emotional and Mental Health (SEMH) and mental health-related referrals, hospital admissions and service use. Understanding whether coordination between these systems differs systematically across groups is essential for identifying opportunities for equitable provision and access. Developed in partnership with peer researchers and community stakeholders, we examined cross-system pathways, between SEND-for-SEMH and mental health-related hospital contacts, based on gender and racial-ethnic group. Population-level analysis of ECHILD linked National Pupil Database and Hospital Episode Statistics for 1.7m children (ages 5-16) attending state schools in England (2005-2018). We examined rates, timing and risk ratios of pathways between systems. Substantial variation exists by gender, racial-ethnic group, and at their intersection. Nearly all girls were significantly less likely to receive SEND-for-SEMH following mental health-related hospital contact. Among girls with hospital contacts who never received SEND-for-SEMH, 49.8% had an inpatient admission. All pupils from Asian, Black African, Mixed Other, white Other and Other racial-ethnic backgrounds were significantly less likely to receive SEND-for-SEMH following hospital contacts. Conversely, Black Caribbean, Mixed white-Black Caribbean, Romani and Irish Traveller boys were recorded with SEND-for-SEMH at substantially higher rates and faster on enrolment. Linked administrative data reveals intersectional discrimination and systematic coordination failures not captured in single-system analyses. Findings demonstrate need for standardised mental health guidance and equity-oriented frameworks to address the persistent biases in system pathways as well as statutory integrated care pathway to address unmet need following in-patient hospital admissions.
Cannabis use is increasing in the United States, including among pregnant women. Legalization of cannabis and decreased public perceptions of risk have contributed to increased cannabis use. Relatively few studies have examined the association of cannabis use with maternal mental health in pregnancy, particularly among Black women who have higher rates of adverse pregnancy outcomes. Biosocial Impacts on Black Births (BIBB) is a prospective study conducted from 2017-2022 in three prenatal care sites in Michigan, Ohio and Florida with pregnant Black women (n = 1,066). We examined the associations between self-reported cannabis use in pregnancy and psychological health. Psychological health was assessed using the Center for Epidemiologic Studies Depression Scale (CES-D), the Cohen's Perceived Stress Scale, and the Psychological General Well-Being (PGWB) Index. Over 20% of women (n = 227) reported cannabis use during pregnancy. The mean age was 27 years, >60% of the participants completed a high school education, and 85% were living with the father of the baby. The most common reasons for use were to reduce stress and nausea. After controlling for confounding by state of residence, maternal age, education level, marital status, current financial status, gestational age at enrollment, and tobacco use, cannabis use in pregnancy was associated with higher levels of depressive symptoms (β = 3.44; 95% CI: 1.8, 5.1), higher perceived stress (β = 2.78; CI: 1.8, 3.7), and lower levels of maternal psychological well-being (β = -4.5; CI: -7.1, -1.9). These findings highlight the importance of health care provider awareness about prenatal cannabis use and psychological health in pregnant women. Prospective studies are needed to examine factors related to cannabis use in pregnancy to potentially reduce adverse outcomes associated with use.
Robust national evidence on mental health-related service use is necessary to guide equitable policy interventions. We described referrals to mental health services, mental health-related emergency department attendances and hospital admissions amongst secondary school pupils in England, by social strata. We used linked records from state-funded schools and national health services (ECHILD) in England to create a secondary school cohort of 5,629,719 pupils entering Year 7 from 2012/13 to 2021/22. We measured rates of service use by gender, racial-ethnic group, free school meal (FSM) eligibility, the index of multiple deprivation (IMD) and region of residence. Service contacts were captured in the Mental Health Services Data Set and Hospital Episode Statistics. Pupils were followed up until the first chronological event of: service contact, age 21 years, death or end of study (31st August 2022). We found higher rates of mental health-related service use among females, adolescents who were FSM eligible, in the most deprived IMD groups, living in the North of England and from White Irish Traveller and Mixed Black Caribbean-White racial-ethnic groups. Consistently lower rates were estimated for males, adolescents living in London and Bangladeshi, Indian, Pakistani and Black African racial-ethnic groups. There was consistency in relative rates across services, particularly by FSM eligibility, IMD groups and racial-ethnic group. We present the first national estimates of referrals to mental health services, alongside hospital contacts, within a school cohort. We found stark variation in rates of contacts by social strata, which were broadly consistent across service types.
This study focused on Whitmania pigra to establish a multi-dimensional "activity-component" evaluation system. The quality differences between medicinal materials harvested after cocoon production and those harvested under normal conditions were systematically compared in terms of in vitro/in vivo pharmacodynamic effects and chemical compositions. The results showed that although W. pigra harvested after cocoon production complied with the standards specified in the Chinese Pharmacopoeia(2025 edition), its antithrombin activity(P<0.05) and soluble protein content(P<0.001) were significantly lower than those of normally harvested W. pigra. In vivo pharmacodynamic experiments demonstrated that the group treated with post-cocoon harvested W. pigra exhibited significantly inferior effects in inhibiting the black tail length and black tail rate of rats, as well as in improving plasma antithrombotic indices including prothrombin time(PT, P<0.05), activated partial thromboplastin time(APTT, P<0.05), D-dimer(P<0.05), and P-selectin(P<0.01), compared with the normal harvest group. Furthermore, HPLC fingerprinting combined with principal component analysis(PCA), cluster analysis(CA), and orthogonal partial least squares-discriminant analysis(OPLS-DA) confirmed the differences between normally harvested and post-cocoon harvested W. pigra, and seven key differential characteristic components such as uracil and hypoxanthine were identified. In conclusion, the in vitro/in vivo pharmacological activities and content of bioactive components in W. pigra harvested after cocoon production are reduced, resulting in a significant decline in medicinal quality. Accordingly, such medicinal materials are not recommended to be used as decoction pieces in clinical practice.
In England, people from marginalised groups, such as people with severe mental illness (SMI), are more likely to be diagnosed with breast cancer at a late stage. Differences in routes to diagnosis may be a contributing factor. Differences in route to diagnosis, for individuals diagnosed with breast cancer, were compared between the broader population and ethnic minority groups, men, people living in deprived areas, people with a learning disability and people with SMI. Demographic characteristics and differences in route to diagnosis were assessed using primary care records, derived from the Clinical Practice Research Datalink, and the Cancer Registry. People were eligible for inclusion if they received a primary diagnosis of breast cancer, were aged 18+, and were diagnosed between January 2009 and December 2018. Binary logistic regression was used to compare the proportion diagnosed via each route. 29,311 (33.9%) people were diagnosed via screening, 42,810 (49.5%) via urgent suspected referral, 2,525 (2.92%) via emergency presentation, and 7,185 (8.3) via other routes. The proportion diagnosed via screening was lower for people in deprived areas (0.87 [0.83-0.91], p<0.001), people with SMI (0.87 [0.78-0.96], p<0.01), and people of Black or Asian ethnicity (p<0.01). These groups were all more likely to be diagnosed via urgent suspected referral (p<0.05). Black ethnicity, SMI, and higher deprivation, specifically, were more likely to be diagnosed via emergency presentation (p<0.05). Routes to diagnosis differ between population groups. These findings identify areas where targeted efforts could help reduce inequalities, offering opportunities to improve cancer outcomes.
Medicaid, a public insurance program for low-income individuals, covers over 40% of United States births. It disproportionately serves racial minority groups who already face elevated obstetrical risks. Coverage gaps compared to private insurance may further exacerbate these adverse outcomes. Our objective was to assess severe maternal morbidity (SMM) and in-hospital mortality at the intersection of race and insurance status. We analyzed obstetric deliveries from 2015-2022 using the National Inpatient Sample. Ten interaction terms compared Medicaid versus private insurance across White, Black, Hispanic, Asian, and Native American groups. SMM complications were defined using ICD-10 codes. Demographics were compared using bivariate tests [p<0.05 and standardized differences>0.2]. Multivariable logistic regression models estimated odds ratios and 95% confidence intervals of SMM and mortality, adjusted for preexisting/gestational comorbidities, year, caesarean section, and hospital region. Among 23.5 million weighted deliveries, 43.8% were insured by Medicaid. Medicaid coverage was higher among Black (66.7%), Hispanic (66.6%) and Native American (67.6%) individuals compared to White (32.3%) and Asian (27.9%) patients. Adjusted odds of SMM were higher among all intersectional groups compared to White patients with private insurance (all p<0.001). Within each racial category, SMM odds were significantly greater for the Medicaid versus private groups. However, increased odds of mortality were primarily observed for those with Medicaid rather than by race. Racial disparities in SMM are amplified for those with public insurance. However, mortality risk is primarily driven by insurance rather than race. Policy reform ensuring equitable coverage is critical to mitigate obstetrical inequities.
Youth suicide and depression rates increased during the COVID-19 pandemic. In Philadelphia, firearm violence surged and has since declined to pre-pandemic levels. We examined whether youth depression and suicide risk also declined and whether community firearm violence moderated these trajectories, given its documented associations with trauma and stress in youth. This cross-sectional study examined 71 663 well visits among youth aged 12 to 18 years in a pediatric primary care network in Philadelphia, 2017 to 2024. Youth were screened for depression and suicidality using the Patient Health Questionnaire, modified for teens. Three pandemic eras were defined by stay-at-home orders and the World Health Organization's declaration ending the global emergency. Neighborhoods were classified as firearm violence hot, neutral, and cold spots based on cumulative police-reported shootings. Period differences in mental health outcomes were evaluated using models accounting for patient clustering and interaction terms testing moderation by community violence. Among 35 137 patients (50% female, 67% non-Hispanic Black), community firearm violence moderated changes in youth suicide risk from the pre- to post-pandemic period: risk declined in cold spots (-2.2 percentage points [pp] [95 % CI -3.9 to -0.4]) but increased in neutral (+0.9 pp [0.1-1.6]) and hot spots (+2.0 pp [0.3-3.7]). Overall, suicide risk remained elevated post-pandemic (10.8% vs 9.6%, +1.1 pp [1.1-1.2]), particularly among non-Hispanic Black and Medicaid-insured youth, whereas depression returned to pre-pandemic levels (7.6% vs 7.3%). After the pandemic, suicide risk remained elevated among youth in areas with high community firearm violence. Beyond universal screening, addressing persistent pandemic-related stressors within the context of community firearm violence is critical for improving youth mental health.