Journal of Racial and Ethnic Health Disparities

AimWe examined associations between smoking and HbA1c among U.S. adults, and whether these associations vary by diabetes status. MethodsWe analyzed NHANES data from 2015-2018 for adults aged [&ge;]20 years. Smoking was assessed by self-report and serum cotinine. Survey-weighted multivariable linear regression was used to evaluate the association between smoking and HbA1c in the full population (N=9,214) and in adults without diabetes (N=7,328), adjusting for demographics, blood pressure, waist circumference, lipids, and C-reactive protein. ResultsAfter adjustment for cardiometabolic covariates, there was no significant association between smoking and HbA1c in the full population (former: {beta}=0.029%, p=0.30; current: {beta}=0.053%, p=0.13). Among adults without diabetes, former smoking was not associated with HbA1c, whereas current smoking remained significantly associated (former: {beta}=-0.001%, p=0.923; current: {beta}=0.067%, p<0.001). These findings were similar when cotinine was used as the exposure measure, with active smoking ([&ge;]3.0 ng/mL) associated with higher HbA1c among non-diabetic adults (p<0.001), but not in the full population. ConclusionsAmong adults without diabetes, current but not former smoking was associated with higher HbA1c. The absence of an association in former smokers suggests that this effect may attenuate following cessation. These findings support early cessation interventions and may inform cessation counseling and diabetes screening.

Many Asian American (AA) subgroups experience disproportionate rates of cardiometabolic (CMB) conditions, yet the contextual drivers of these disparities remain unclear. Little is known about the role of Asian residential segregation, often conceptualized as Asian enclaves, with limited prior work largely ignoring region of origin and nativity. Using six years of population-based survey data from New York City (N>6,000 AAs) linked with multiple sources of community data, we examine how residence in ethnicity-specific enclaves relates to CMB risks (obesity, hypertension, and diabetes), whether these associations differ by nativity, and the extent to which neighborhood socioeconomic conditions, the built environment, social cohesion, and institutional support account for observed associations. Our combined concentration-based and spatial clustering analysis identified five East Asian enclaves and six South Asian enclaves, with no geographic overlap between the two. Logistic regression analyses show that residence in an East Asian enclave was associated with lower odds of obesity (OR=0.63), while residence in a South Asian enclave was linked to higher odds of diabetes (OR=1.42) and hypertension (OR=1.46). These associations were present only among foreign-born individuals. After adjusting for neighborhood characteristics, the lower obesity risk in East Asian enclaves persisted, while elevated risks in South Asian enclaves were partly reduced. Both suggest a role for unmeasured enclave factors, including cultural and food environments. Our findings challenge the view that Asian enclaves are monolithically health-promoting and redirects scholarly attention toward disaggregated approaches to investigating AA health disparities.

ObjectiveTo examine racial and ethnic inequities in wealth and health among New York City adults. MethodsWe conducted the 2024 NYC Racial Wealth and Health Gap Survey using a stratified quota sample of 2,866 adults across 11 racial and ethnic groups. Wealth was measured through self-reported assets and debts, and health through self-reported status and psychological distress. We calculated descriptive statistics across groups and used quantile regression to test for significant differences in assets and debts compared with White respondents. ResultsWhite and Chinese respondents reported the highest median net worth ($142,000 and $320,000), while Other Black and Puerto Rican respondents reported the lowest ($25 and $160). Lower wealth was associated with poorer health and higher psychological distress. Prevalence of excellent or very good health increased from 36% in the lowest wealth quartile to 59% in the highest, with the steepest wealth-health gradients among Chinese and Multiracial respondents. ConclusionWealth inequities are linked to health disparities across racial and ethnic groups in New York City. Surveillance of local wealth data can guide equity-focused policies addressing economic and racial drivers of health disparities.

Adverse cardiometabolic factors and poor mental health in early adulthood are linked to long-term disease risk. We conducted a cross-sectional study of 2,783 adults aged 21 to 35 years in Puerto Rico to characterize self-reported demographic, health, and behavioral profiles and to examine sex- and age-related differences. Findings showed that 40.5% reported over 5 days of poor mental health and 20.4% over 5 days of poor physical health in the past month. Most participants had health insurance (90.3%), yet 36.9% reported financial barriers to care, and 32.3% lacked a primary care provider. Preventive care engagement was mixed, with low influenza vaccination (30.4%) but higher HIV/STD testing (70.7%), PAP smear screening (77.9%), and HPV vaccination (54.7%). Over half were overweight or obese (57.2%), 14.7% reported elevated levels of blood sugar or prediabetes, and 10.9% hypertension. Females reported poorer mental health but higher engagement in preventive services, whereas males were more likely to lack insurance or a primary care provider and to report hypertension and tobacco use. Younger adults reported worse mental health and higher loneliness, while older groups showed greater cardiometabolic factors. These findings highlight the need for interventions to improve preventive care, increase awareness of cardiometabolic risk, and enhance mental health among young adults.

Background: Few studies have examined racioethnic disparities in cardiovascular disease (CVD) in women after breast cancer treatment, who are at higher risk due to cardiotoxic cancer treatment. Methods: Based on the Pathways Heart Study of women with a history of breast cancer, this analysis examines the association between cardiometabolic risk factors (hypertension, diabetes, and dyslipidemia) and CVD events with self-reported race and ethnicity, as well as genetic similarity. Multivariable logistic and Cox proportional hazards regression models were used to test race and ethnicity and genetic similarity with prevalent and incident cardiometabolic risk factors and CVD events. Results: Of the 4,071 patients in this analysis, non-Hispanic Black (NHB), Asian, and Hispanic women were more likely to have prevalent and incident diabetes than non-Hispanic White (NHW) women. Analysis of genetic similarity revealed results consistent with self-reported race and ethnicity. For CVD risk, NHB women were more likely to develop heart failure and cardiomyopathy than NHW women. In contrast, Hispanic women were at lower risk of any incident CVD, serious CVD, arrhythmia, heart failure or cardiomyopathy, and ischemic heart disease, which was consistent with the associations found with Native American ancestry. Conclusions: This is the largest multi-ethnic study of disparities in CVD health in breast cancer survivors, demonstrating corroborating findings between self-reported race and ethnicity and genetic similarity. The results highlight disparities in cardiometabolic risk factors and CVD among breast cancer survivors that warrant more research and clinical attention in these distinct, high-risk populations.

Background: Cardiovascular outcomes for young adults, particularly Latino individuals, have worsened, in contrast with trends for older persons. Stress and psychosocial resilience resources have been associated with cardiovascular health (CVH) among middle-aged and older adults, but these associations have not been characterized in young adults and Latino populations. We examined the association between chronic stress, resilience resources, and CVH in PR-OUTLOOK, a large community cohort study of 18-29 year olds residing in Puerto Rico. Methods: Participants (n=2,676; 61.9% female) were assessed between September 2020 and March 2024. The American Heart Association Life?s Essential 8 (LE8), derived from surveys, laboratory assays, and physical examinations (range: 0-100, suboptimal CVH = <80) measured CVH. Surveys assessed chronic stress and resilience resources (optimism, religiosity, spirituality, and social support). Multivariable logistic regression, adjusting for age, sex, marital status, subjective social standing, and maternal education, examined associations between chronic stress and CVH, and the potential protective effect of resilience resources (moderation effect). With mediation analysis, using nonparametric bootstrap standard errors with 1,000 replications, we tested whether resilience factors were in the pathway of the stress-CVH association (mediation effect). Results: High chronic stress was associated with suboptimal CVH (OR=1.46; 95% CI: 1.19, 1.80) and resilience factors did not moderate this association (all p > 0.05); however, optimism and social support mediated it, accounting for 26% and 10% of the association, respectively. Conclusions: Chronic stress was associated with suboptimal CVH directly and indirectly through lower resilience resources. Longitudinal studies should better characterize these associations.

BackgroundLiterature on sexual assault prevalence among homeless women is limited, with few studies disaggregating risk by geography, resource access, mental health, LGBTQ status, or disability. ObjectiveThis study provides two distinct meta-analyses to ascertain the aggregated overall prevalence (k=20 studies) and the aggregated 12-month prevalence (k=14 studies) of sexual assault among homeless women. By examining each recall period independently, we elucidate cumulative burden throughout the life cycle and annual risk, offering unique insights for public health interventions. By synthesizing global data, we aimed to clarify risks for women with disabilities, mental illness, or Lesbian, Gay, Bisexual, Transgender, Queer or Questioning, Plus (LGBTQ+) identities to inform crisis care interventions. MethodsFollowing PRISMA 2020 guidelines, six databases were searched for studies published after 2010 reporting sexual assault prevalence in homeless women. Twenty studies met the inclusion criteria. Random-effects meta-analyses were performed using a logit transformation. Heterogeneity was assessed with I{superscript 2} and Cochrans Q; publication bias with funnel plots and Eggers test. ResultsThe pooled lifetime prevalence of sexual assault was 39.2 % (95 % CI 25-56 %), and 12-month prevalence was 22 % (95 % CI 16-30 %). Heterogeneity was extreme (I{superscript 2} = 97 %). Subgroup analyses showed the highest prevalence among women with disabilities (92 %, single study), followed by LGBTQ+ (33 %) and women with mental illness (34 %). HIV-positive women had the lowest prevalence (2.6 %). Eggers test indicated no publication bias (p = 0.64). ConclusionHomeless women face disproportionately high rates of sexual assault, far exceeding the general female population, with particularly elevated estimates among women with disabilities, LGBTQ+ women, and those with mental illness. These preliminary findings highlight the need for improved screening practices and tailored public health interventions to address sexual assault in doubly vulnerable populations. Standardizing definitions of sexual assault and investigating risk factors could lead to more tailored public health interventions. HighlightsO_LIMarked Epidemiologic Burden: Nearly 40% of homeless women report lifetime sexual assault. C_LIO_LIPersistent risk: One in five homeless women assaulted within the past 12 months. C_LIO_LIMarginalized Impact: Rates highest among disabled, LGBTQ+, and HIV+ women. C_LIO_LIHigh Variability: Extreme heterogeneity (I{superscript 2} {approx} 97%) shows research inconsistency. C_LIO_LIResearch Priority: Standardize methods and definitions to improve accuracy. C_LI

ObjectivesDyslipidemia is prevalent among Nigerians living with diabetes, but the rate and extent of treatment have not been well-studied. The objective of this study was to determine the prevalence, treatment rates and control of dyslipidemia among diabetes patients in northern Nigeria. MethodsWe conducted a multicenter, cross-sectional study of diabetes clinic patients. We noted cardiovascular risk factors, lipid-lowering treatments and examination findings, including body mass index, blood pressure, glycated hemoglobin, lipid profile, glomerular filtration rate and urinalysis. Outcome measures were the rate of dyslipidemia, the proportion of patients treated for dyslipidemia, and the proportion of patients with low density lipoprotein cholesterol goal and target for primary prevention of cardiovascular disease. ResultsThe study enrolled 403 participants (58.8% females), of whom 59.6% had dyslipidemia. Female gender and proteinuria were independently associated with dyslipidemia, with odds ratios of 1.74 and 2.26, respectively. Other cardiovascular risk factors of participants were hypertension (56.8%), obesity (52.6%), chronic kidney disease (36.5%), atrial fibrillation (7.9%), heart failure (5.0%), cigarette smoking (4.7%), excess alcohol use (2.0%), and previous cardiovascular disease (14.4%). In those with dyslipidemia, 51.3% took lipid-lowering treatments comprising statins (49.6%), clofibrate (1.7%) and statins combined with clofibrate (1.2%). None took other lipid-lowering treatments beside dietary control, probably due to high costs compared to statins. Only 17.1% of all participants attained the target for primary prevention of cardiovascular disease in people with diabetes. ConclusionMost patients had dyslipidemia, which was more prevalent in females. Only a sixth of all patients had attained the treatment target. Treatment for dyslipidemia was limited to statins and fibrates, contrary to guideline recommendations for the use of ezetimibe, bempedoic acid, icosapent ethyl, or PCSK9 inhibitors for those who failed intensive statin therapy. There is a need for physician adherence to practice guidelines for the treatment of dyslipidemia, and improved access to treatment in northern Nigeria.

Objective: In this study, we utilized a large-scale clinical database to evaluate the relationship between polypharmacy and adverse outcomes among type 2 diabetes patients in rural Montana to inform strategies that improve adherence, reduce preventable complications, and promote equitable diabetes care in underserved regions. Research Design and Methods: 591 patients from the Big Sky Care Connect Database (BSCC) with type 2 diabetes and medication history were stratified into 3 cohorts based on prescribed number of medications: (1-4 medications, non-polypharmic), (5-9 medications, polypharmic), and ([&ge;]10 medications, hyperpolypharmic). Each cohort was examined for Major Adverse Cardiovascular Events (MACE) and Diabetes Complication Severity Index (DCSI). Descriptive statistics, multivariate logistic regressions, linear regression, and Poisson regression analyses were performed. Results: Medication count was associated with male gender ({beta} = -2.1341, p < 0.001). Both medication count (IRR 1.06 per additional medication, p < 0.001) and age (IRR 1.03 per year, p < 0.001) were significant predictors of MACE. Neuropathy and nephropathy prevalence was statistically significant (p < 0.001) across patient cohorts and increased with medication count.

Objective: This preliminary public health report assessed acute and chronic health burdens, focusing on cardiovascular health, among unsheltered individuals experiencing homelessness. It aims to guide medical referrals, deliver targeted health education, and prioritize services within a community based nonprofit. Methods: A field based needs assessment used a structured questionnaire to evaluate acute and chronic health burdens. Clinical measures included blood pressure (BP), heart rate (HR), pain scores (normalized to 0 to 10), nicotine use, and diabetes prevalence. Of 72 initial responses, 59 BP, 65 HR, and 66 pain scores were usable. BP was classified per ACC/AHA (2017) guidelines [1], including Hypertensive Crisis. Nicotine and diabetes data from a secondary survey yielded 39 and 38 usable responses of 116. Ethical oversight ensured informed consent, participant capacity assessment, and emergency protocols. Data were analyzed descriptively. Results: Participants were predominantly male (N = 53 of 72) with ages ranging from 24 to 70 years (Mean = 42.96; Median = 41; N = 70). The cohort was primarily White/Caucasian (N = 30) and Black/African American (N = 27). Cardiovascular assessments revealed substantial acute risk: 72.88% (N = 43 of 59) of BP readings were classified as Total High Blood Pressure, and 10.17% (N = 6 of 59) met criteria for Hypertensive Crisis or higher, including readings of 210/137 mmHg and 286/127 mmHg. Mean and median HR were both 96 bpm (N = 65). Chronic symptom burden was notable, with a mean pain score of 3.74 and 19.70% (N = 13) reported severe pain (7 to 10). Self-reported comorbidities included current smoking in 15.38% (N = 6 of 39) and a history of diabetes in 13.16% (N = 5 of 38). Conclusion: Findings show a high prevalence of acute cardiovascular risk, particularly severe hypertension, among the unsheltered population. These results highlight the urgent need for improved outreach, targeted cardiovascular and primary care referrals, and follow up screenings. Expanding health education on the effects of uncontrolled diabetes and smoking is recommended to reduce future cardiovascular events.

Childhood socioeconomic position (SEP) can have lifelong effects on health. Many studies have used adult height as a surrogate marker for early-life conditions. In this study, we derived the non-genetic component of height, calculated as the residual from sex-specific standardized height regressed on genetically predicted height, as a surrogate for childhood SEP, using data from the Hispanic Community Healthy Study/Study of Latinos (2008-2011). A positive residual would indicate favorable early-life conditions promoting growth, while a negative residual indicates early-life adversity that may stunt the development. The height residual was associated with early-life variables such as parental education, year of birth, US nativity and age at first migration to the US (50 states/DC), supporting the validity of height residual as a surrogate for early-life conditions. Furthermore, a height residual was positively associated with better cardiovascular health (CVH) and cognitive function among middle-aged and older adults. Interestingly, among <35 years old, the height residual was negatively associated with the "Lifes Essential 8" clinical CVH scores. These results suggest the non-genetic component of height as a surrogate for childhood environment, with predictive value for CVH and cognitive function.

ABSTRACT: Importance: Rural urban disparities in chronic disease prevalence are well established; however, the extent to which individual level socioeconomic status (SES) contributes to these disparities remains unclear. Objective: To examine the associations of rurality and SES with the prevalence of five most burdensome chronic diseases among adults. Design: We conducted a retrospective cross sectional study of adults across 27 Upper Midwest counties using the Expanded Rochester Epidemiology Project (E REP) medical record data linkage system to evaluate associations between rurality, SES and chronic disease prevalence. Prevalence of clinically diagnosed asthma, diabetes, hypertension, coronary heart disease, and mood disorders was identified from International Classification of Diseases ICD9/10 codes over a five-year period (2014 to 2019). Setting: Population based Participants: Adults over 18 years residing in the 27 E REP counties, excluding those missing rural urban residence status. Exposure: HOUSES index, an individual level measure of SES, served as the primary measure, while rurality based on Rural Urban Commuting Area (RUCA) codes 4-10 was the secondary measure. Main Outcome: Prevalence of the five clinically diagnosed chronic diseases was identified using ICD9/10 codes from 2014 to 2019. Mixed effect logistic regression models were used and adjusted for demographics and general medical examination receipt, to assess rural urban and SES differences for prevalence of each chronic disease. Results: Among 455,802 adults with available HOUSES index, 42.8% lived in rural areas, 53.8% were female and 87.4% were non-Hispanic White. In the unadjusted analysis, rural and urban populations showed comparable asthma and CHD prevalence, while mood disorders, hypertension, and diabetes were more common in urban areas. After adjusting for demographic factors and healthcare utilization, rural urban differences were no longer statistically significant, whereas SES remained strongly associated with all diseases in a dose response manner (e.g., adjusted Odds Ratio for hypertension (ref: HOUSES index Q4): 1.14, 1.27, and 1.42 for HOUSES index Q3, Q2, and Q1, respectively). Conclusions and Relevance: Individual level SES measured by the HOUSES index, was more strongly associated with chronic disease prevalence than rurality, supporting its integration into population health assessment and risk stratification.

Background Diverse epigenetic clocks are known to capture health risks associated with increased adiposity, but their estimates have never been combined to represent a holistic estimate of biological age acceleration (BAA). There is also a gap in research using epigenetic clocks to study adiposity in lower-middle income Asian countries. Methods and Findings Data from 1,745 participants (21.7{+/-}0.3 years old, 45% female) of the Cebu (Philippines) Longitudinal Health and Nutrition Survey were analyzed. BAA was calculated using PCHorvath 2, PCHannum, PCPhenoAge, PCGrimAge, PCDNAmTL, and DunedinPACE. After ascertaining suitability for factor analysis (Kaiser-Meyer-Olkin 0.81), factor analysis was used to create PCFactorAge. Analogously, FactorAge was created using Horvath, Hannum, PhenoAge, GrimAge, DNAmTL, and DunedinPACE. BMI, waist circumference (WC), and waist-to-height ratio (WHtR) were used to represent adiposity. Linear regression was used to test the association of each adiposity measure with each BAA measure. BMI, WC, and WHtR were positively associated with both BAA combinations: 5 kg/m2 higher BMI corresponded to 0.097 (p=0.015) standard deviation (SD) increase in FactorAge and 0.099 (p=0.004) SD increase in PCFactorAge; 10 cm increase in WC--with 0.091 (p=0.005) SD increase in FactorAge and 0.094 (p<0.001) SD increase in PCFactorAge; 0.1 increase in WHtR--with 0.164 (p=0.001) SD increase in FactorAge and 0.163 (p<0.001) SD increase in PCFactorAge. Additionally, WHtR was associated with meaningful increases in PhenoAge, PCPhenoAge, PCHorvath 2, PCHannum, PCGrimAge, and DunedinPACE. WC was positively associated with PCHorvath 2, PCHannum, PCPhenoAge, and DunedinPACE. BMI was positively associated with PCHannum, PCPhenoAge, and DunedinPACE. Conclusions Our study presents a novel approach to creating a BAA estimate using multiple epigenetic clocks and shows that adiposity measures predict this factor in a young Filipino cohort.

BackgroundThe COVID-19 pandemic disrupted access to sexual and reproductive health (SRH) services, including contraception. Understanding contraceptive use during this period is critical for strengthening health system resilience in small developing states. ObjectiveTo identify factors associated with contraceptive use among reproductive-age women during the COVID-19 pandemic in Barbados. MethodsA cross-sectional online survey was conducted in Barbados between April 28 and May 3, 2020 among adults aged [&ge;]18 years. This analysis is restricted to women aged 18-49 years. Current contraceptive use (yes/no) was assessed among non-pregnant respondents. Associations with sociodemographic factors, relationship status, and psychosocial distress (Hospital Anxiety and Depression Scale [HADS] were examined using bivariate tests and logistic regression. Variables, alcohol and marijuana use had >15% missing data which limited. ResultsA total of 1,094 women aged 18-49 years completed the survey and were included in descriptive analyses. At the time of the survey, 2.7% (n=29) reported being pregnant and 7.3% (n=80) reported not being pregnant but planning pregnancy; the majority 89.7%, (n=981) were neither pregnant nor planning pregnancy. Among non-pregnant women with contraceptive data, 34.2% (n=333) reported current contraceptive use. Moderate-to-severe anxiety symptoms were reported by 36.5%, and moderate or clinically significant global distress by 39.0%. Contraceptive use was significantly associated with HADS anxiety (p=0.021) and HADS global distress (p=0.016), but not depression (p=0.211). Women who were partnered (p=0.014) or married/cohabitating (p<0.001) were more likely to report contraceptive use compared with single women. University education was strongly associated with contraceptive use (p<0.001). Women aged 26 - 39 years were more likely to use contraception relative to those aged 40 - 49 years, while women aged 18 - 25 years were less likely. ConclusionsDuring the early phase of the COVID-19 pandemic in Barbados, contraceptive use among non-pregnant reproductive-age women was associated with psychosocial distress (especially anxiety), relationship status, education, and age. Emergency preparedness in small developing states should prioritize continuity of SRH services, mental health integration, and access to self-managed contraceptive options.

BackgroundUndiagnosed diabetes represents a major challenge for health systems worldwide. While low socioeconomic status is typically associated with reduced healthcare access, the relationship between socioeconomic position and diabetes detection remains poorly characterized in Latin American settings with fragmented health systems. MethodsWe analyzed data from 4,409 Argentine adults who underwent capillary glucose measurement in the Third Step of the 2018 National Survey of Risk Factors. Among 471 individuals with elevated glucose ([&ge;]110 mg/dL), we examined the association between household income quintile and undiagnosed status using multivariable logistic regression, adjusting for age, sex, health coverage type, education, body mass index, physical activity, and smoking. ResultsContrary to expectations, undiagnosed dysglycemia increased with socioeconomic status: from 45.8% in the lowest quintile to 67.8% in the fourth quintile, with a slight decrease to 61.1% in the highest quintile. After full adjustment, each higher income quintile was associated with 22% greater odds of remaining undiagnosed (OR=1.22; 95% CI: 1.04-1.44; p=0.014). Notably, enrollment in public assistance programs (Plan Estatal) was associated with substantially lower odds of undiagnosed dysglycemia compared to social security coverage (OR=0.27; 95% CI: 0.09-0.79). Results were robust across multiple weighting specifications. ConclusionsHigher socioeconomic status paradoxically increases the likelihood of undiagnosed dysglycemia in Argentina, challenging conventional assumptions about healthcare access. Targeted public programs appear effective at identifying cases among vulnerable populations, while gaps persist in higher-income groups. These findings suggest that diabetes screening strategies should not overlook populations traditionally considered to have adequate healthcare access.

Cardiovascular disease (CVD) remains the leading cause of mortality in the United States, despite being largely preventable through effective management of risk factors. This study evaluates the impact of Phase II cardiac rehabilitation (CR) on functional capacity and quality of life, using data from the Montana Outcomes Project Cardiac Rehabilitation Registry. Functional capacity improvements were assessed via the six-minute walk test (6MWT) and Dartmouth COOP questionnaire, with statistical analyses exploring the influence of CR session attendance, demographic factors, and referring diagnoses. Results demonstrated significant gains in 6MWT, with a mean improvement of 330.73 feet (p < .0001), and quality of life scores across all subgroups. A dose-response relationship was observed, indicating greater improvements with increased CR sessions (p < .0001), though diminishing returns were observed beyond 24-35 visits. Demographic factors and complex conditions influenced outcomes, underscoring the need for tailored strategies to enhance CR access and effectiveness. These findings highlight the critical role of CR in improving patient outcomes and emphasize the importance of addressing barriers to participation in underserved populations.

ObjectiveExplore self-reported racial discrimination in healthcare. MethodsRepresentative population sample, Switzerland, repeated cross-sectional data 2016 to 2024 (N=15,525). ResultsContrary to expectation, respondents from the migration-related population (foreign citizens, foreign born, migration background, first/second generation) report less racial discrimination than members of the majority population. Over time, we see an increase in the non migration-related population reporting (racial) discrimination in healthcare, while the share for the migration-related population is constant. The validity of the instrument is demonstrated with reported discrimination at work and in housing and the results are reliable across specifications and statistical controls. ConclusionWe speculate that in some cases, reported racial discrimination may express unmet expectations in healthcare more generally.

Objectives. To test whether the association between household income and tooth retention differs by race/ethnicity and whether this interaction varies by reason for the most recent dental visit among US adults. Methods. We analyzed 13,190 adults in the National Health and Nutrition Examination Survey (2009 to 2018). Survey weighted linear regression estimated interactions between household income and race/ethnicity in models of tooth retention, stratified by reason for last dental visit. Results. Higher income was associated with greater tooth retention across groups, but income related gains were larger for Non-Hispanic White adults than for Non Hispanic Black and Mexican American adults, particularly in problem-focused care settings. In problem focused visits, each higher income category was associated with 0.5 additional teeth among White adults (95% CI 0.4, 0.6) versus 0.2 (95% CI 0.0, 0.4) among Black adults and 0.1 (95% CI 0.1, 0.3) among Mexican American adults. Racial differences were attenuated in routine check-up contexts. Conclusions. Income related gains in tooth retention differed by race/ethnicity and dental care context. Public Health Implications. Expanding access alone may be insufficient to reduce racial inequities in oral health.

BackgroundOut-of-hospital cardiac arrest (OHCA) survival depends on timely bystander cardiopulmonary resuscitation (CPR) and quick defibrillation via automated external defibrillator (AED). However, access to CPR education and willingness to intervene are not equitably distributed. Within the Muslim community, intersecting religious identity, language, immigration-related concerns, and other social determinants of health may affect CPR/AED education, bystander response, and ultimately OHCA outcomes, underscoring the need for culturally responsive, faith-based training models. MethodsA survey based cross sectional study was conducted to evaluate the perceived barriers to emergency response and lay rescuer cardiopulmonary resuscitation (CPR). Individuals aged 13 years and older were recruited between January and June 2025 through convenience sampling at free, non-certification public CPR/AED classes, where participants self-reported demographic characteristics and barriers to calling 9-1-1 or initiating CPR. Analyses compared Muslim and non-Muslim participants using Fisher exact tests and multivariable logistic regression models adjusted for demographic and socioeconomic factors, with results reported as odds ratios (OR) and 95% confidence intervals (CI). ResultsOf the 651 surveys collected, 33% of participants identified as Muslim, and 46% reported no prior CPR/AED training, with a higher proportion among Muslim respondents (57% vs 41%). Religion was significantly associated with some perceived barriers, with Muslim participants more likely to report law enforcement as a barrier to calling 9-1-1 (OR: 0.53 for non-Muslims vs Muslims, p=0.04) and less likely to report "no problem" starting CPR (OR: 0.91, p=0.04). Race and gender also influenced barriers, with non-white and female participants more likely to report immigration status, language, cost, and concern for violence as barriers to initiating CPR or calling 9-1-1. ConclusionMuslim participants were more confident in performing CPR, but reported less confidence in calling 9-1-1, revealing gaps in emergency response readiness. This emphasizes the importance of culturally adapted CPR/AED training that addresses specific barriers within faith-based communities and to strengthen all links of the chain of survival.

ObjectiveTo characterize associations between tattooing and health status. MethodsWe used data from [~]27,000 respondents to the 2020-2022 Utah Behavioral Risk Factor Surveillance System (BRFSS). Multivariable Poisson regression was used to calculate prevalence ratios (PR) and 95% confidence intervals (CI) associating ever receiving a tattoo with physical/mental health status. ResultsIn this cross-sectional study, ever receiving a tattoo was associated with self-reported "poorer" vs. "excellent" overall health, particularly among women (PR=3.08 [95% CI: 2.26- 4.21]). Tattooing was also associated with obesity (women, PR=1.40 [95% CI: 1.22-1.61]; men, PR=1.21 [95% CI: 1.04-1.40]) and chronic pain (women, PR=1.59 [95% CI: 1.43-1.77]; men, PR=1.55 [95% CI: 1.37-1.76]). Tattooed individuals were more likely to have been diagnosed with a depressive disorder (women, PR=1.64 [95% CI: 1.53-1.75]; men, PR=1.55 [95% CI: 1.39-1.73]) and to have had six or more teeth removed, vs. none (women, PR=2.18 [95% CI: 1.61-2.96]; men, PR=2.88 [95% CI: 2.10-3.95]). ConclusionsPublic health entities may consider partnering with tattoo studios and conventions to provide information about nutrition, exercise, dental care, mental health resources, and health screenings.