People with disabilities from culturally and linguistically diverse (CLD) backgrounds experience discrimination related to their multiple cultural identities. Complex organizational responses and workforce training are needed to effectively address the resulting inequalities they experience. Yet, there is little guidance about effective practices for organizations serving people with disabilities from CLD backgrounds. Similarly, little research exists about effective cultural and linguistic competence (CLC) training provided by such organizations. Chapter 1 details a scoping review study that identified 29 documents related to CLC for organizations supporting people with disabilities from CLD backgrounds. Frequency counts and a qualitative thematic analysis were used to describe those documents and their recommendations. Although 24 themes were identified that provide relevant organizational CLC recommendations, few of the reviewed documents attended to the intersection of disability and race/ethnicity, exhibited methodological rigor, or included perspectives of diverse people with disabilities. Often, recommendations in the identified documents lacked clarity and detail, and were therefore not easily translatable into interventions. In most documents, little attention was paid to standards or methods that could be used to evaluate the recommended CLC initiatives. A series of tables present the documents, their qualities, and 24 recommendation themes. Chapter 2 is an exploratory, holistic, and retrospective single-case study of CLC training provided by an interdisciplinary leadership training program. Multi-source interviews and review of archival data were used to research evidence of the presence of activities, content, and structure of infused CLC training in a year-long training program designed to develop leadership abilities in an interdisciplinary group of disability-serving professionals and advocates. Interviews were conducted with three course faculty and three trainees of the 2015-2016 training year. Archival data from the 2015-2016 training year contributed triangulation across type of data. Qualitative analysis and interpretation were performed by a diverse research team. The results and discussion are presented via thick description and illustrate a model of CLC training that seeks to acculturate trainees to a collaborative culture of humility, inclusion, and social justice via a learning community mechanism.

Racial, ethnic and gender disparities have been found among a variety of health variables, but to date no study has comprehensively examined whether similar differences exist between sleep variables such as duration, efficiency and quality, in early adolescence. There is a general consensus among previous literature that adolescence is a time when a decrease in total sleep time and an increase in sleep problems are observed. Previous literature, however, mainly focused on the influence of puberty to explain these changes. the current study examined if differences exist between 1462 Caucasian, Hispanic/Latino, and African American early adolescents (ages 10-14 years) on sleep duration, efficiency and quality. Results showed that adolescent boys reported significantly longer sleep durations, better sleep quality, shorter sleep onset latencies, and later rise times than girls. Results also showed that sixth graders slept longer than seventh and eighth graders, and that seventh graders woke up much earlier than the other two grades. Lastly, results showed that Caucasian students reported longer sleep onset latencies and lower sleep efficiencies than African American students. Trends were observed for boys having greater sleep efficiencies than girls and for Caucasian students sleeping longer than Hispanic students. Based on the differences observed in our sample, introducing sleep education in middle school is discussed.

Background: Context and purpose of the study. To examine (1) associations between county-level zoning to support farmers' market placement and county-level farmers' market availability, rural/urban designation, percent African American residents, and percent of residents living below poverty and (2) individual-level associations between zoning to support farmers' markets; fruit and vegetable consumption and body mass index (BMI) among a random sample of residents of six North Carolina (NC) counties. Methods: Zoning ordinances were scored to indicate supportiveness for healthy food outlets. Number of farmers' markets (per capita) was obtained from the NC-Community Transformation Grant Project Fruit and Vegetable Outlet Inventory (2013). County-level census data on rural/urban status, percent African American, and percent poverty were obtained. For data on farmers' market shopping, fruit and vegetable consumption, and BMI, trained interviewers conducted a random digit dial telephone survey of residents of six NC counties (3 urban and 3 rural). Pearson correlation coefficients and multilevel linear regression models were used to examine county-level and individual-level associations between zoning supportiveness, farmers' market availability, and fruit and vegetable consumption and BMI. Results: At the county-level, healthier food zoning was greater in more urban areas and areas with less poverty. At the individual-level, self-reported fruit and vegetable consumption was associated with healthier food zoning. Conclusions: Disparities in zoning to promote healthy eating should be further examined, and future studies should assess whether amending zoning ordinances will lead to greater availability of healthy foods and changes in dietary behavior and health outcomes.

TITLE: Racial disparities associated with colon cancer screening in a nationally representative sample; A cross-sectional study AUTHOR INFO Yorandos Tafesse MD1 Manik Ahuja PhD, MA1 Author Affiliations: 1College of Public Health, East Tennessee State University, Johnson City, TN 37614, United States Colon cancer impacts nearly 2 million individuals in the U.S. each year. Early detection of colon cancer using colonoscopy can reduce the risk of mortality. The United States Preventive Services Task Force (USPSTF) recommends routine screening for colon cancer for all adults 50 to 75 years of age. Colon cancer screening behavior is different across a variety of predictor variables. Previous studies have identified older age, male gender, higher education, higher income, marriage, and the presence of chronic diseases to be associated with increased odds of colon cancer screening. However, less is known about the role of racial differences in screening. This study aims to determine if colon cancer screening rates are different between Whites and racial minorities in the United States controlling for potential confounders. This research can help bridge the existing gap on this topic and aid in identifying high-risk racial groups that could be targeted by future intervention strategies. We used cross-sectional data from the 2019 Behavioral Risk Factor Surveillance System, a nationally representative U.S. telephone-based survey of adults aged 18 years or older. We extracted data for adults age 50 or older (n=10,972). Logistic regression analyses were conducted to test the association between race and colon cancer screening. We also included chronic disease status, alcohol use, smoking, gender, and age in our model. Chronic disease status was coded as self-report 2 or more, 1 and 0 chronic diseases (referent), which included the summation of heart disease, hypertension, COPD, and diabetes. Overall, colon cancer screening is as follows among Whites (77.2%), Blacks (72.4%), Asian (60.1%), American Indian/Alaska Native (69.7%), and Hispanic (68.6%). Logistic regression results revealed that having 2 or more chronic diseases (OR=1.73; 95% CI 1.53,1.96), 1 chronic disease (OR=1.45; 95% CI 1.31,1.65), and female gender (OR=1.14; 95% CI 1.04,1.23) were associated with higher odds of screening. Race/ethnic minority status (OR=0.72; 95% CI 0.65, 0.81), low income (OR=0.64; 95% CI 0.57,0.70), and less than high school education (OR=0.71; 95% CI 0.59,0.84) were associated with lower odds of screening. Our research showed that racial minorities have lower odds of colon cancer screening after adjusting for gender, age, chronic diseases, income, and education status. Preventive practices should focus on increasing awareness on and availability of colon cancer screening means to racial minorities in the United States. Further research on the association between race and other screening modalities will help maximize the impacts of targeted interventions.

Introduction and Background Individuals in rural areas do not have the same access to health care as individuals who live in urban areas. Individuals who live in rural areas tend to not get the care that they need due to income and location. Purpose Statement Healthcare differs for those who live in rural versus urban populations. How can the intervention of telehealth help to decrease the health disparities for individuals who live in rural communities? Literature Review We searched the phrases “rural and urban” and “health disparities” in google scholar and restricted the search to articles that were published from 2018 to now and we narrowed it down to 3 articles. For the two articles that included our intervention of telehealth we did a Google Scholar advanced search and used the keywords “telehealth” and “health disparities” and filtered the search to where the most recent would be shown and we narrowed it down to 2 articles. Findings The research that we collected strongly suggests that there are health disparities among rural areas compared to urban areas, meaning that rural areas do not have as good of access to adequate health care. The intervention of telehealth however could help improve the health disparities for those in rural areas. Conclusions Rural areas do not have as good of access to healthcare as those who live in urban areas. Our research gave a variety of different examples of how rural areas have a disadvantage when it comes to the quality of healthcare individuals receive. Telehealth can help to decrease these health disparities and improve the quality of care that individuals in rural areas receive.

Background: Although racial and ethnic differences in healthcare have been extensively documented in the United States, little attention has been paid to the quality of health care for the foreign-born population in the United States. Objectives: This study examines the association between patient perceptions of the patient-physician interaction and nativity status. Research Design: Cross-sectional telephone survey. Subjects: A total of 6674 individuals (US-born ≤ 5156; foreign-born ≤ 1518) 18 years of age and older. Measures: Seven questions measuring the quality of patient-physician interactions. Results: Of the 7 outcome variables examined in the unadjusted logistic regression model, only 2 remained statistically significant in the fully adjusted model. For both the total sample and for Asians only, compared with US-born, foreign-born individuals were at greater odds [total sample, odds ratio (OR) ≤ 1.43; 95% confidence interval (CI) ≤ 1. 01ĝ€"2.04; Asians, OR ≤ 3.25; 95% CI ≤ 1.18ĝ€"8.95] of reporting that their physician did not involve them in their care as much as they would have liked. Compared with US-born Asians, foreign-born Asians were at greater odds of reporting that their physician did not spend as much time with them as they would have liked (OR ≤ 4.19; 95% CI ≤ 1.68ĝ€"10.46). Discussion: Findings from our study suggest that we should not only track disparities by race and ethnicity but also by nativity status.

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Seasonal influenza produces substantial disease within the United States every year. Despite the availability of safe and effective vaccines for influenza, millions of individuals go unvaccinated each flu season, with notable differences across racial/ethnic groups. Using the Behavioral Risk Factor Surveillance System (BRFSS), I examine vaccination rates among non-Hispanic whites and Hispanics during the 2000-2009 influenza seasons. After developing a new method that addresses shortcomings of BRFSS vaccination measures, I find that non-Hispanic whites exhibit higher vaccination rates than Hispanics. Through a series of logistic regression models I show that the disparities between non-Hispanic whites and Hispanics narrow after controlling for healthcare coverage and socioeconomic characteristics. This suggests that seasonal influenza vaccination may be improved among U.S. Hispanics by addressing structural barriers in receiving the vaccine, especially access to health care.

Indiana University-Purdue University Indianapolis (IUPUI) / My first aim identified enrollment patterns and variables that predict enrollment in a diverse underserved population and evaluated barriers to enrollment. We analyzed data from the INGENIOUS, (Indiana GENomics Implementation and Opportunity for the UnderServed), pharmacogenomics implementation clinical trial conducted at a community hospital for underserved subjects and a statewide healthcare system. Our main finding revealed, African-Americans were less likely to refuse the study than non-Hispanic Whites (Safety net, OR =0.68, p<0.002; Academic hospital, OR=0.64, p<0.001), using a logistic regression model. The most frequent barriers to enrollment included not being interested, being too busy, transportation, and illness in African-American and non-Hispanic White subjects. In conclusion, improving research awareness, widening the inclusion criteria, and hiring recruiters who represent potential enrollees, should improve enrollment in African-Americans and other diverse populations. My 2nd research aim evaluated racial/ethnic differences in pharmacokinetics, safety, efficacy, and pharmacogenetics in 213 new molecular entities (NMEs). The current approved drug label for NMEs between 2014 to 2018 was updated in the FDA database. A qualitative analysis revealed ~ 9% (n=20/213) of NMEs reported racial/ethnic differences in the approved product label for PK, safety, efficacy, and/or pharmacogenetics. In conclusion, evaluating racial/ethnic differences in drug exposure and response early in the drug development program is essential to providing recommendations for different racial/ethnic subpopulations. My final aim 3, identified genetic biomarkers of Taxane Induced Peripheral Neuropathy (TIPN) in African-American breast cancer patients. We used an innovative computational tool, ALDY, to identify genetic variants in CYP2C8, CYP3A4, and CYP3A5 in 207 breast cancer subjects. TaqMan SNP genotyping for SNP, rs776746 (T>C) was performed in 160 subjects. Subjects were collapsed into three metabolizer groups; normal, intermediate, and poor metabolizer to test the association of peripheral neuropathy, dose reductions and CYP2C8/CYP3A5 metabolizer status. A logistic regression revealed CYP2C8 metabolizer status is associated with grades 3-4 peripheral neuropathy (p=0.04, OR= 2.21). CYP2C8*2 was modestly associated with dose reductions. In conclusion, evaluating pharmacogenetic and pharmacokinetic studies of paclitaxel and CYP2C8 is important. These studies may lead to clinical actionable prescribing of paclitaxel and improve the tolerance and efficacy in African-American breast cancer patients. / 2022-02-16

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