搜索结果：Race and social problems

Robust longitudinal studies of within-child changes in mental health associated with the COVID-19 pandemic are lacking, as are studies examining sources of heterogeneity in such changes. To investigate within-child changes, overall and between subgroups, in youth mental health from prepandemic to midpandemic. This cohort study used longitudinal prepandemic and midpandemic data from the Environmental influences on Child Health Outcomes (ECHO) Program, collected between January 1, 2015, and March 12, 2020 (prepandemic), and between March 13, 2020, and August 31, 2022 (midpandemic). Data were analyzed between December 1, 2022, and June 1, 2024. The sample included 9 US-based observational longitudinal pediatric ECHO cohorts. Cohorts were included if they collected the Child Behavior Checklist (CBCL) School Age version before and during the pandemic on more than 20 participants of normal birth weight aged 6 to 17 years. The COVID-19 pandemic. Prepandemic to midpandemic changes in CBCL internalizing, externalizing, depression, anxiety, and attention-deficit/hyperactivity disorder (ADHD) scores were estimated, and differences in outcome trajectories by child sociodemographic characteristics (age, sex, race, ethnicity, and poverty level) and prepandemic mental health problems were examined using established CBCL clinical score thresholds. A total of 1229 participants (mean [SD] age during the pandemic, 10.68 [2.29] years; 625 girls [50.9%]) were included. The sample was socioeconomically diverse (197 of 1056 children [18.7%] lived at ≤130% of the Federal Poverty Level; 635 (51.7%) identified as White, 388 (31.6%) as Black, 147 (12.0%) as multiracial, 40 (3.3%) as another race, and 118 (9.6%) as Hispanic). Generalized linear mixed-effects models revealed minor decreases in externalizing problems (β = -0.88; 95% CI, -1.16 to -0.60), anxiety (β = -0.18; 95% CI, -0.31 to -0.05), and ADHD (β = -0.36; 95% CI, -0.50 to -0.22), but a minor increase in depression (β = 0.22; 95% CI, 0.10 to 0.35). Youth with borderline or clinically meaningful prepandemic scores experienced decreases across all outcomes, particularly externalizing problems (borderline, β = -2.85; 95% CI, -3.92 to -1.78; clinical, β = -4.88; 95% CI, -5.84 to -3.92). Low-income (β = -0.76; 95% CI, -1.14 to -0.37) and Black (β = -0.52; 95% CI, -0.83 to -0.20) youth experienced small decreases in ADHD compared with higher income and White youth, respectively. In this longitudinal cohort study of economically and racially diverse US youth, there was evidence of differential susceptibility and resilience for mental health problems during the pandemic that was associated with prepandemic mental health and sociodemographic characteristics.

The COVID-19 pandemic was a world-wide health emergency that resulted in individuals experiencing challenges in numerous life domains. Life domains affected included physical and mental health, finances, and social isolation. Many health and research professionals evidenced concern that veterans were more likely than civilians to experience COVID-19 related problems due to their "at-risk" health status. Veterans are at-risk for health problems due to encountering unique military experiences such as traumatic exposures, development of trauma-related mental health symptoms or disorders, combat-related injuries, and disability, exposure to toxins such as burn pits and biological agents, and living with chronic stress during their transition to civilian life. It was suggested that the disruptions and challenges the COVID-19 pandemic created could trigger mental health problems among veterans. Indeed, based on cumulative stress theory, female veterans and veterans from racial and ethnic minority groups were thought to be particularly vulnerable for experiencing mental health challenges. The current study examined changes in the symptoms of depression and anxiety before, during, and after the COVID-19 pandemic among a large and diverse sample of post-9/11 veterans. As predicted, when compared to White male veterans, male and female veterans from racial and ethnic minority groups reported having higher symptom levels of anxiety and depression before, during, and after the COVID-19 pandemic. All veterans, except for females from racial and ethnic minority groups, reported experiencing increases in symptoms over time. Exposure to adverse childhood experiences (ACEs), combat exposure, and length of longest deployment were inconsistently associated with symptoms over time. The results suggest that the COVID-19 pandemic was associated with individuals experiencing increased anxious and depressive symptoms over time, although not in a wholly consistent manner. Future global health emergencies may have differential gender- and race/ethnicity-based effects on veterans; thus, veteran-serving organizations should carefully plan their responses to such crises.

To determine associations between multiple domains of psychosocial stressors and coping strategies in relation to sleep health among Black/African American (BAA) women. Among 1678 BAA participants with complete data enrolled in the Study of Environment, Lifestyle and Fibroids, we conducted principal components analysis on 43 self-reported stressors, yielding six components of psychosocial stressors and three components of coping strategies. Self-reported sleep measures included sleep duration (very short, short, vs. recommended sleep), frequent insomnia symptoms (trouble falling or staying asleep at least 15 days/month vs. <15&#xa0;days/month), and waking up feeling unrested (&#x2265;4 days/week vs. <4&#xa0;days/week). Using Poisson regression with robust variance while adjusting for sociodemographic characteristics, we estimated prevalence ratios (PRs) and 95% confidence intervals (CIs) for each sleep measure comparing the presence vs. absence of stressors. Median age (interquartile range) was 29.3 (26.3-32.0) years and 45% had an annual household income of less than $20&#x2009;000. The following psychosocial stressors were highly prevalent: perceived racism (84.5%), financial strain (84.1%), and emotional distress (73.7%). Emotional distress (PR&#x2009;=&#x2009;2.26 [95% CI = 1.63 to 3.12]) and financial strain (PR&#x2009;=&#x2009;1.41 [1.05-1.91]) were associated with more frequent insomnia symptoms. Social/emotional support (PR&#x2009;=&#x2009;0.80 [0.68-0.95]) and resilience/personal strength (PR&#x2009;=&#x2009;0.82 [0.70-0.97]) were associated with lower prevalence of very short sleep duration. BAA women reporting experiences with racism vs. not had a higher prevalence of short sleep (PR&#x2009;=&#x2009;1.14 [1.05-1.23]). Among women who did shift work, financial strain was associated with a 22% (PR&#x2009;=&#x2009;1.22 [1.03-1.45]) higher prevalence of short sleep. These findings may inform interventions aimed at addressing stressors associated with poor sleep. Statement of Significance Based on a novel array of 43 potential psychosocial stressors, we found that stressors such as financial strain, emotional distress, and medical/crime/family problems were associated with poor sleep health (e.g. insomnia symptoms) while coping strategies (e.g. social/emotional support and resilience/personal strength) were associated with more favorable sleep health (e.g. recommended hours of sleep) among an understudied sample of 1678 young Black/African American women. Our study measuring specific, understudied stressors is novel and important to identify which stressors/coping strategies to prioritize for intervention. For instance, our observed associations between racism and medical/crime/family problems in relation to poorer sleep health indicates a need to address medical problems, such as improving healthcare quality, addressing race-based perceived unfair treatment, and increasing access to healthcare.

The increase in alcohol use problems and opioid use disorder (OUD) highlights the need for research on effective medication treatments for patients with dual diagnoses. This study analyzed trends and social disparities in prescribing OUD medications for patients who initially had alcohol use problems and later received their first OUD diagnosis. This study used merged data from the New York State Office of Addiction Services and Supports and the Medicaid to analyze individuals aged 18 years and older who initially had primary alcohol use problems and later had OUD for the first time between 2005 and 2018. It examined the rates of new buprenorphine and naltrexone prescriptions across various demographic and socioeconomic groups. Among 27,029 clients, the average rate of new buprenorphine was 64.23 per 1000 clients (95% CI 61.30-67.15), with upward trends. The 18-35 age group had the highest buprenorphine utilization (111.48 per 1000 clients) and highest increase rates compared with other age groups. The white non-Hispanic group had the highest rates of buprenorphine (119.23 per 1000 clients) and showed larger increase over time compared with other race or ethnicity groups. Disabled patients showed slower increasing rates of buprenorphine than other groups. Upward trends were observed in naltrexone. All observed differences were statistically significant (P < 0.05). Trends showed increased use of OUD medications, with varying rates of buprenorphine utilization across different ages, races, and employment statuses. Despite this, the rates of receiving new buprenorphine remained low, suggesting a need for innovative methods to expand access to treatments.

Phthalates are ubiquitous endocrine disrupting chemicals previously linked with behavioral problems in children. We investigated associations of gestational phthalate exposure with problem behaviors and social skills in adolescents using the Health Outcomes and Measures of the Environment (HOME) Study. Parent offspring pairs (n&#xa0;=&#xa0;216) were recruited between 2003 and 2006 in Cincinnati, Ohio. Maternal urine samples collected at 16- and 26-weeks' gestation were analyzed for nine phthalate metabolites. At the 12-year follow-up, adolescents and caregivers completed the Social Skills Improvement System (SSiS), which measures social skills (SSiS-SS) and problem behaviors (SSiS-PB). Multivariable linear regressions were performed for each phthalate metabolite controlling for potential confounders including maternal age, child race and ethnicity, maternal depression, marital status, income, child sex, cotinine, polybrominated diphenyl ether 47, and lead. Regressions were performed for the overall sample and stratified by sex. We evaluated mixture effects using quantile g-computation models. No individual phthalates were significantly associated with either the caregiver or adolescent reported SSiS-SS score. Mono-isobutyl phthalate (MiBP) was significantly associated with increased adolescent reported SSiS-PB score (&#x3b2;: 5.94, 95% CI: 0.75, 11.12, p&#xa0;=&#xa0;0.03). In our sex-stratified analysis we found evidence for a detrimental association with phthalates and both SSiS-SS and SSiS-PB in male adolescents only. This was consistent in the linear and quantile g-computation models. We found evidence for sex specific associations between gestational phthalate exposures and social skills and problem behaviors in adolescents. This extends previous research on phthalates and child behavior into adolescence and suggests sex specific effects of phthalates.

ADHD can impair children's functioning. Socioeconomic and sociodemographic factors present barriers to treatment access and lead to disparate outcomes in children with ADHD. The purpose of this study was to describe trajectories of functional outcomes and ADHD symptom counts across 3&#x2009;years and explore the moderating effects of income and race/ethnicity on these trajectories among U.S. children with ADHD. This longitudinal study of children currently and/or previously meeting diagnostic criteria for ADHD (N&#x2009;=&#x2009;1,587, age&#x2009;=&#x2009;9-10&#x2009;years at baseline) used data from the Adolescent Brain Cognitive Development (ABCD) Study&#xae;. Outcomes were child-reported functional outcome measures (family conflict, prosocial behavior, and school experiences) and parent-reported inattentive and hyperactive symptom counts across 3&#x2009;years. Multi-level, mixed-effects models for longitudinal data were used to characterize each outcome trajectory and examine the moderating effects of baseline household income and race/ethnicity. The sample was 68% male and 54% White, with 53% meeting diagnostic criteria for past-only ADHD, 12% current-only ADHD, and 35% both past and current ADHD. Significant changes in family conflict, school experiences, inattentive symptom counts, and hyperactive symptom counts were demonstrated across 3&#x2009;years (trajectories, p&#x2009;<&#x2009;.05). Income significantly moderated prosocial behavior trajectories, while race/ethnicity significantly moderated family conflict and prosocial behavior trajectories (time interaction, p&#x2009;<&#x2009;.05). The findings suggest that factors related to income and race/ethnicity influence trajectories of change in family conflict and prosocial behavior outcomes in children with a history of ADHD. Future studies should explore these disparities and identify targets for intervention, such as increased access to diagnosis and treatment for individuals at risk of poorer functional outcomes.

Substance use-including the use and co-use of alcohol, cigarettes, and illicit drugs-often emerges in adolescence. However, the longitudinal structure of polysubstance use and its social-ecological predictors are less understood. We examined (a) higher-order trajectories of polysubstance use (encompassing alcohol, cigarette, and illicit drug use) and (b) their associations with individual- and family-level factors. Participants were 568 eighth- and tenth graders (M age = 14.46; 50.5% girls) from Miami-Dade County, FL, and Prince George's County, MD, in a six-wave longitudinal study on alcohol use. Adolescents reported age, sex, race/ethnicity, attention problems, positive parenting, and family structure. Latent growth curve modeling was used. Racial/ethnic composition was 40.8% Hispanic, 35.0% non-Hispanic Black, 6.9% non-Hispanic White, 10.6% others, and 6.7% multiracial. Results indicated the presence of higher-order polysubstance trajectories comprising individual alcohol, cigarette, and illicit drug use, which increased linearly over time. Polysubstance use trajectories were predicted by both individual- and family-level factors. For instance, Black, Hispanic, other, and multiracial adolescents evidenced less steep increases in polysubstance use than White adolescents (average &#x3b2; s&#x2009;=&#x2009;-0.25) and positive parenting predicted lower baseline polysubstance use (&#x3b2;&#x2009;=&#x2009;-0.11, p&#x2009;<&#x2009;0.05). We also found unique associations with individual substance use trajectories; for example, single-parent households predicted steeper cigarette-use slope (&#x3b2;&#x2009;=&#x2009;0.08, p&#x2009;<&#x2009;0.05), and attention problems predicted higher baseline alcohol-use (&#x3b2;&#x2009;=&#x2009;0.10, p&#x2009;<&#x2009;0.05). Age was associated with most trajectories, whereas sex was not associated with any. Findings highlight the need to integrate both overarching and substance-specific risk factors into treatment, prevention, and policy efforts to address adolescent substance use.

Despite long-standing racial and ethnic disparities in autism spectrum (AS) diagnosis, recent research suggests that overall, greater numbers of Black and Latine children are now diagnosed with AS as compared with non-Latine White (NLW) children in some US regions. However, gaps remain in the equitable detection of Black and Latine children with AS without significant developmental impairment. The objective of this study was to determine whether the clinical profiles of young children evaluated for AS across a statewide system of early autism diagnosis in Indiana vary by race and ethnicity. We examined racial and ethnic differences in: (1) AS symptom severity, (2) developmental functioning, (3) adaptive functioning, and (4) behavior problems in a sample of 147 children, aged 14 to 48 months (M = 2.6 years), referred for AS evaluation. Clinical profiles of young children evaluated differed significantly by race and ethnicity, with Black and Latine children exhibiting lower developmental ( p = 0.008) and adaptive abilities ( p = 0.01) and higher AS symptoms ( p = 0.03) as compared with NLW children. Potential explanations for findings include racial and ethnic differences in family and community awareness and knowledge about AS and follow-through on evaluation referral, both driven by social determinants of health (SDOH) affecting minoritized children. Bias in screening and assessment instruments and clinician surveillance, screening, and referral practices may also underlie differences in clinical profiles of children evaluated. Future research is needed to understand the SDOH that influence AS detection and diagnosis to improve equitable access to early diagnosis and intervention.

Black women uniquely experience a myriad of intersecting oppressions along with racial discrimination that increases their vulnerability to trauma. Experiences of racial discrimination manifest as race-related stress, or worse an emotional wound, race-related trauma. Protective factors that facilitate coping for black women are resilience and social support. Under investigation were black women's experiences of racial stress, specifically, perseverative cognition (PC) and anticipatory race-related stress (ARRS), and trauma symptoms. PC and ARRS derive from the Prolonged Activation and Anticipatory Race-Related Stress Scale. The moderating effects of resilience and social support were also examined. Data were collected from 216 black female students at a Historically Black College or University. The findings indicate (1) PC was associated with higher trauma symptoms (&#xdf; = 4.46; p < .001); (2) ARSS was positively associated with trauma symptoms (&#xdf; = 4.82; p < .001); (3) Social support (&#xdf; = - 2.04; p < .001) and resilience (&#xdf; = - 2.80; p < .05) moderated the association between ARRS and trauma symptoms such that the association between racial stress and trauma symptoms was stronger under the condition of low social support and resilience. Treatment must include culturally relevant interventions and capitalize on protective factors to facilitate healing for black women.

Consultation is a key service delivered by school psychologists that can reduce the burden of mental health problems and promote healthier school climates given its emphasis on problem solving, prevention and intervention, and supporting educator skill and competence. The purpose of this systematic review was to document how demographic and study design information was reported in the school consultation research and to identify common practice elements that cut across consultation outcome studies with promising student social and behavioral outcomes. We examined 48 studies (39 group design and 9 single-case design) published between 1980 and 2024 and applied a distillation method (Chorpita & Daleiden, 2009) to summarize demographic and study designs employed and to identify specific practice elements that emerged. Seventy-two percent of studies included students receiving tier two supports as the target for consultation. Forty-three percent of studies included graduate students as consultants, while only 10.4&#xa0;% of studies included school psychologists as consultants. Demographic characteristics of consultants (i.e., gender reported 33.3&#xa0;% and race/ethnicity reported 27.1&#xa0;%) was less frequently reported when compared to the demographic characteristics of consultees and students. At the teacher level, consultant modeling (present in 58.3&#xa0;% of studies) was the most common practice element, followed by performance feedback (56.3&#xa0;%), and family engagement (41.7&#xa0;%). At the student level, praise (present in 56.3&#xa0;% of studies) was the most common practice element, followed by goal setting (52.1&#xa0;%), functional behavioral assessment, and tangible rewards (47.9&#xa0;% of studies). The relative infrequency with which some practice elements were coded (e.g., praise for teacher, cultural adaptation for teacher and student) point to avenues for enhancing school consultation research and practice.

Sudden unexpected infant death (SUID) is the leading cause of postneonatal mortality, with disparities attributed to social determinants of health (SDOH). SUID in the Hispanic population has received limited attention, despite the fact that one-fourth of US children are Hispanic. To compare SUID rates and risk factors among Hispanic and non-Hispanic infants, and associated interactions among SUID, SDOH, and acculturation. This US nationwide retrospective cohort study used US National Center for Health Statistics (NCHS) linked birth and infant death data, and Pregnancy Risk Assessment Monitoring System (PRAMS) data from 1996 to 2017. All live births (NCHS) or participants (PRAMS) with documented maternal ethnicity were included. Data were analyzed from February to October 2024. Maternal Hispanic ethnicity. The primary outcome was postneonatal SUID occurring at age 28 to 364 days, as designated by International Classification of Diseases, Ninth Revision codes 798, 799, and 913 (1996-1999), and International Statistical Classification of Diseases and Related Health Problems, Tenth Revision codes R95, R99, and W75 (2000-2017). Odds ratios (ORs) were calculated by exposure, and adjusted ORs controlled for risk factors in a multivariable model. Maternal nativity variables associated with race, poverty, local SUID rates, and region of origin were investigated. Subgroup analysis explored the relative association of Hispanic ethnicity with SUID risk factors. Maternally reported risk factors were compared according to Hispanic ethnicity. Among 88&#x202f;067&#x202f;608 live births (median [IQR] maternal age, 27 [22-32] years; median [IQR] gestational age, 39 [38-40] weeks) and 54&#x202f;828 SUID deaths, there were 7173 SUID deaths among 19&#x202f;887&#x202f;156 Hispanic infants. The SUID rate was lower for Hispanic infants (0.36 deaths per 1000 live births) than for non-Hispanic infants (0.70 deaths per 1000 live births), across essentially all factors analyzed. Overall, Hispanic infants had 33% lower odds of SUID than non-Hispanic infants (adjusted OR, 0.67; 95% CI, 0.65-0.69). Infants of non-US-born Hispanic mothers had lower SUID rates, regardless of race, county-level poverty, local SUID rates, or Hispanic region of origin, except Puerto Rican infants. Altered associations with detrimental and protective factors were found, despite a mixed picture of risk. In this cohort study of SUID in infants born from 1996 to 2017, Hispanic infants had lower SUID rates than non-Hispanic infants, despite adverse SDOH. Risk factors operated differently in Hispanic infants, challenging current conceptualizations of risk. Understanding how risk operates in Hispanic populations can help to better address the mortality burden of SUID.

Black Americans have been disproportionally affected by the HIV epidemic, and experience significant disparities in sleep health, mental health, and physical health domains. Using longitudinal data from a sample of Black adults with HIV, the current study examined the associations between stigma and mental and physical health outcomes and how sleep disturbance may play a mediating role. Data were drawn from a recent randomized controlled trial. Questionnaires were used to examine internalized and anticipated HIV stigma, perceived discrimination (enacted stigma) based on multiple social identities (i.e., HIV-serostatus, race, sexual orientation), sleep disturbance, mental health problems (depressive and posttraumatic stress disorder [PTSD] symptoms), and mental and physical health-related quality of life (HRQOL) at baseline, 7-month follow-up, and 13-month follow-up assessments. Linear mixed modeling was used to examine main effects of stigma on health outcomes; causal mediation analysis was used to estimate indirect paths through sleep disturbance. Internalized and anticipated HIV stigma and multiple discrimination were associated with more sleep disturbance, more depressive and PTSD symptoms, and poorer mental and physical HRQOL. Results also indicated significant indirect paths (i.e., mediation) through greater sleep disturbance between HIV-related stigma and discrimination and mental health and health-related quality of life. Results support that sleep disturbance is a mediating pathway through which different forms of stigmas impact health outcomes. Sleep may be an intervention target to help improve mental and physical well-being and reduce health disparities among racial and ethnic minority people with HIV.

Improved knowledge of factors that influence treatment engagement could help treatment providers and systems better engage patients. The present study used machine learning to explore associations between individual- and neighborhood-level factors, and SUD treatment engagement. This was a secondary analysis of the Global Appraisal of Individual Needs (GAIN) dataset and United States Census Bureau data utilizing random forest machine learning and generalized linear mixed modelling. Our sample (N&#xa0;=&#xa0;15,873) included all people entering SUD treatment at GAIN sites from 2006 to 2012. Predictors included an array of demographic, psychosocial, treatment-specific, and clinical measures, as well as environment-level measures for the neighborhood in which patients received treatment. Greater odds of treatment engagement were predicted by adolescent age and psychiatric comorbidity, and at the neighborhood-level, by low unemployment and high population density. Lower odds of treatment engagement were predicted by Black/African American race, and at the neighborhood-level by high rate of public assistance and high income inequality. Regardless of the degree of treatment engagement, individuals receiving treatment in areas with high unemployment, alcohol sale outlet concentration, and poverty had greater substance use and related problems at baseline. Although these differences reduced with treatment and over time, disparities remained. Neighborhood-level factors appear to play an important role in SUD treatment engagement. Regardless of whether individuals engage with treatment, greater loading on social determinants of health such as unemployment, alcohol sale outlet density, and poverty in the therapeutic landscape are associated with worse SUD treatment outcomes.

Mental health literacy (MHL) is an important part of the help-seeking process, yet there is a lack of knowledge about the MHL of adolescents in the Caribbean. This region is important to study as it is underrepresented in mental health research globally. The aim of this study is to explore the ability of adolescents in Bermuda to recognize depression and social phobia (social anxiety) and their beliefs about the sources of help for a peer with these mental health problems. This cross-sectional study surveyed middle and high school students aged 10-19 years in Bermuda. Online surveys conducted between November 2022 and June 2023 gathered demographic data including age, gender and race, and assessed the ability to recognize depression and social anxiety from descriptions provided in randomly assigned vignettes, and beliefs about sources of help. Across 15 middle and high schools, 2423 adolescents (out of 3593 eligible participants) completed all demographic and MHL survey questions (1139 males, 1272 females). Recognition rates for depression and social anxiety were 60% and 53%, respectively. Compared to females, males endorsed a greater variety of help sources. Reporting symptoms of depression or anxiety reduced the likelihood of endorsing multiple sources of help. MHL of adolescents in Bermuda is sub-optimal, particularly for social anxiety. Mental health promotion programs may be useful in improving recognition rates.

Research suggests there are differences in children's internalizing and externalizing symptoms as a function of age, race, sex, and socioeconomic status (SES). Males, Black children, and children experiencing lower SES have been rated as having more externalizing problems. Female and older children have been rated as having higher internalizing symptoms. The validity of these findings rests on the assumption that the measures mean the same thing across groups and developmental time (i.e., measurement invariance [MI]). Without assuring MI, results may represent differences in measurement and not true differences in the underlying construct. The Strengths and Difficulties Questionnaire (SDQ) is a widely used tool to measure internalizing and externalizing symptoms. Papers have evaluated MI of the SDQ in school-aged children. However, to our knowledge, no studies of young children have examined MI across Black and White families from diverse SES backgrounds. Data from the Family Life Project were used to evaluate MI of the SDQ across child age (35 to 90 months), race, sex, and SES. Using moderated nonlinear factor analysis (MNLFA), multiple SDQ items demonstrated measurement noninvariance as a function of child demographic variables. Results suggest that it is important to test and adjust for noninvariance with the SDQ when applied to early childhood populations comprising Black and White children from diverse SES backgrounds. An MNLFA approach improves our ability to validly measure and compare symptoms of psychopathology in diverse early childhood populations. This could have implications for our understanding of rates of mental health challenges and treatment in early childhood. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

To better understand and characterize how young adults with minoritized racial and ethnic identities perceive and experience the discrimination against them. We applied an intersectional lens and examined variation in perceived discrimination by sex (across all racial/ethnic groups) and United States immigrant generation status (among Latine participants). Data were collected from young adults (MAge = 23.3, SD = 0.51) who self-identified as Black (N = 164), American Indian/Alaska Native (AIAN; N = 261), and/or Latine (N = 884) who were part of a longitudinal community sample originally recruited from 24 small/rural communities. Participants reported the frequency and type of discrimination they experienced in their day-to-day life. Those reporting frequent discrimination were asked to indicate the primary reason/s (e.g., race, gender). Descriptive analyses were completed separately within each racial/ethnic group and by immigrant generation status among the Latine sample. Chi-square tests assessed differences in the prevalence of discrimination experiences by sex and immigrant generation status. Two thirds or more of Black, AIAN, and Latine YA reported experiencing discrimination. Across all ethnic/racial groups, the most commonly cited reasons for discrimination were race/ethnicity, gender, and age, and more females than males reported gender and age as reasons for discrimination. More first- and second-generation than third-generation Latine young adults (YA) reported race and ancestry as reasons for discrimination. Attributing discrimination to identity factors beyond race and ethnicity was common among ethnic and racial minoritized YA, underscoring the importance of considering intersectional identities when studying experiences of interpersonal discrimination.

Distress is common among patients with cancer, and evidence of disparities associated with distress has been mixed. Head and neck cancer (HNC) is one of the most emotionally distressing cancers and is also a highly disparate disease. However, it is unknown whether there are disparities associated with patient-reported distress in HNC. To examine racial and sociodemographic factors associated with clinically meaningful distress in a cohort of patients with HNC. This retrospective cohort study analyzed data from a single tertiary institution at a National Cancer Institute-designated comprehensive cancer center in the Southeastern US. Participants included adult patients from January 2017 to December 2022 with confirmed diagnoses of head and neck squamous cell carcinoma who received radiation therapy up to 5 weeks from initial diagnosis. The outcome of interest was clinically meaningful distress (score of at least 4 on the distress thermometer). The distress thermometer is a single-item, self-reported tool used to measure a person's level of psychological distress over the past week, represented on a scale from 0 (no distress) to 10 (extreme distress). Patients were included in the study if they had visits with clinicians in the radiation oncology department within 5 weeks of diagnosis. Sociodemographic factors were race and ethnicity, age, sex, marital status, and health insurance status. Clinical variables (stage of presentation, anatomical subsites, smoking, and alcohol history) and problem list domain items were included in the adjusted model. Using multivariable logistic regression analysis, odds of meaningful distress by sociodemographic factors were estimated, adjusting for clinical factors and problem list domains. A total of 507 patients met the inclusion criteria. The study population included 389 male patients (76.7%). The median (IQR) age of participants was 63 (56-71) years, with a racial distribution of 89 Black patients (17.6%), 385 White patients (75.9%), and 33 patients of other categories (6.9%), including Asian, Native American, multiracial, declined to respond, and unknown. Overall, 232 patients (45.8%) had meaningful distress. The median (IQR) DT score for the entire cohort was 3 (0-6). Black patients had the highest rate of physical concerns (n&#x2009;=&#x2009;31 [34.8%]) compared to the other racial groups (78 White patients [20.3%] and 7 persons of other race [21.2%]). However, in the final multivariable model, race was not significantly associated with clinically meaningful distress (Black compared with White: adjusted odds ratio [aOR], 0.76 [95% CI, 0.45-1.28]; other compared with White: aOR, 0.85 [95% CI, 0.37-1.94]). Compared to those married, unmarried patients were significantly more likely to report distress (aOR, 1.61 [95% CI, 1.05-2.50]). Also, patients with emotional problems had double the odds of reporting clinically meaningful distress (aOR, 2.03 [95% CI, 1.02-4.08]). Other factors associated with significant clinical distress included tobacco use (aOR, 2.14 [95% CI, 1.02-4.50]) and reported practical problems (aOR, 2.08 [95% CI, 1.17-3.69]). Independent of race or sociodemographic factors, the results of this retrospective cohort study underscore the need for social and emotional support in mitigating distress and optimizing mental health care in this patient population. Further studies should explore distress trajectories across the HNC continuum and their impact on HNC outcomes.

Examine how milestone development, demographics, and emotional/behavioral functioning predict autistic females meeting the cutoff on a commonly used Autism screening tool (Social Communication Questionnaire: SCQ). We hypothesized that autistic girls with fewer developmental delays, whose parents have lower education, or are Black or Multiracial would be less likely to meet the SCQ cutoff. Further, those with more symptoms of Withdrawal/Depression, Social Problems, Thought Problems, and Attention Problems on the (Child Behavioral Checklist: CBCL) would be more likely to screen positive. A subset of participants enrolled in a large national cohort (SPARK) were included (5,946 autistic females). A cutoff score on the SCQ of 11&#xa0;was used to form groups: Meet (M: N&#x2009;=&#x2009;5,186) and Not Meeting (NM: N&#x2009;=&#x2009;760). Autistic girls who had delayed toileting and motor milestones and whose parents attained higher education were more likely to screen positive. Girls who scored within the clinical range on the CBCL Thought Problems and Attention Problems syndrome scales were more likely to screen positive. Race and reported symptoms on the Withdrawn/Depressed and Social Problems syndrome scales did not relate to screening status. Results further support the existing literature suggesting that autistic girls must present with more significant delays/symptoms to be screened and diagnosed with autism, which can could impact their access to early intervention services and future skill development. Future research should examine additional factors that specifically put females at a disadvantage for being accurately identified, particularly for those who are speaking and/or of average cognitive ability.

Racism is a driver of community health disparities, and there is a dearth of evidence-based multilevel antiracism interventions developed in partnership with community constituents. Community-engaged systems science defines intervention points within complex systems and was utilized for early-phase multilevel intervention development within the ORBIT translational model to improve type 2 diabetes (T2DM) management among Black patients in the South. Group model-building sessions were conducted with five primary care physicians, thirteen nurses, six support staff, and nine Black patients with T2DM in North Florida and analyzed with qualitative systems science methods. Facilitation scripts were developed with a core modeling team consisting of investigators and community partners. Resulting systems maps suggested leverage points for interventions, including strategies to increase trust and support, such as increasing appointment length and quality and deepening the health care system's understanding of race and culture as strengths instead of barriers. Formal care coordination pathways to reduce structural racism and address social determinants of health without stigma are needed, with multilevel interventions to address provider support and improve trust. This study demonstrates how to use community-engaged systems science within a translational behavioral medicine framework to define multilevel interventions to reduce health disparities in other systems. Racism contributes to health problems in many communities, especially among Black patients with type 2 diabetes in the southern U.S. This study worked directly with patients and healthcare providers in North Florida to better understand how racism affects diabetes care. Using a method called &#x201c;community-engaged systems science,&#x201d; researchers and community members mapped out how different parts of the healthcare system interact. They found key areas to improve, such as building trust between patients and providers, making appointments longer and more meaningful, and recognizing race and culture as strengths. The study also highlighted the need for better coordination in care and ways to address social challenges without stigma. These insights will help design multi-level solutions to reduce health disparities and improve diabetes outcomes.