Henrietta Lacks and America's dark history of research involving African Americans

Black International Faculty in U.S. Academia: Reflections of a pharmacy educator

BACKGROUND

Black international faculty enhance diversity in pharmacy schools, are well suited to mentor international students, support cultural competence training for students, and may contribute substantially to research activities in schools of pharmacy. Understanding the experiences of black international faculty is critical to their recruitment and retention in pharmacy schools. Yet, there is very limited research about the experience of black international faculty in US pharmacy schools.

PURPOSE

This reflection paper seeks to highlight the unique challenges experienced by black international faculty in US pharmacy schools, drawing from both personal experiences and existing literature. This reflection and perspective study also provides recommendations to improve black international faculty representation and experience.

DISCUSSION

Black international faculty experience structural, interpersonal, and internalized racism, as depicted by the Mechanism of Oppression Framework provided by Weinreb and Sun. US pharmacy schools need to take decisive actions to combat racism and improve the experience and representation of black international faculty. Regular faculty and student trainings on topics such as racism, implicit bias, stereotype threats, and impostor's syndrome should be mandated. A safe space should be provided for faculty to express their concerns about racism. Teaching ability should be assessed objectively by using reliable and validated measures of teaching effectiveness after reviewing recorded lectures or peer observations of teaching.

Parental Barriers and Sociodemographic Disparities in Childhood Vaccination Post-COVID-19 in Tennessee

INTRODUCTION

The COVID-19 pandemic disrupted routine childhood vaccinations schedules, posing significant challenges among underserved communities. Understanding how different sociodemographic groups in Tennessee perceive and navigate childhood vaccination barriers is critical for developing strategies to improve vaccination rates and reduce vulnerability to vaccine-preventable diseases.

METHODS

A cross-sectional survey was conducted to explore barriers to vaccination across diverse sociodemographic groups in Tennessee. Data were collected from caregivers/parents of children aged 18 years and younger across all 95 counties in Tennessee at community events and through partnerships with schools and other local organizations. Parental responses were analyzed to identify barriers in access, concern, and importance domains. The distribution of barriers across different sociodemographic groups such as race, income, education level, and insurance status was identified. Descriptive statistics, non-parametric tests, and log-binomial regressions were used to address the research objectives.

RESULTS

This study found that the most prominent barriers to childhood vaccination were concerns regarding vaccine safety and side effects. Significant differences in vaccine barriers were observed across racial and ethnic groups for access barriers (p < 0.001), concern barriers (p = 0.006), and importance barriers (p < 0.001). Parents with lower education levels, children without health insurance, and lower-income families faced disproportionate challenges across two of the three barrier domains studied (access and perceived importance of vaccines). Additionally, concern barriers (aPR = 0.998, p < 0.001) and importance barriers (aPR = 0.997, p < 0.001) were strongly associated with the parent-reported prevalence of up-to-date vaccination status.

CONCLUSIONS

Addressing parental vaccination barriers related to concern, access, and perceived importance is crucial, particularly for underserved populations including low-income families, uninsured parents, racial/ethnic minorities, and those with limited education. A sustained, equity-focused approach integrating scientific communication, community engagement, and policy interventions is essential for increasing vaccine uptake and ensuring equitable vaccination access.

Modality-level obstacles and initiatives to improve representation in fetal, infant, and toddler neuroimaging research samples

Fetal, infant, and toddler (FIT) neuroimaging researchers study early brain development to gain insights into neurodevelopmental processes and identify early markers of neurobiological vulnerabilities to target for intervention. However, the field has historically excluded people from global majority countries and from marginalized communities in FIT neuroimaging research. Inclusive and representative samples are essential for generalizing findings across neuroimaging modalities, such as magnetic resonance imaging, magnetoencephalography, electroencephalography, functional near-infrared spectroscopy, and cranial ultrasonography. These FIT neuroimaging techniques pose unique and overlapping challenges to equitable representation in research through sampling bias, technical constraints, limited accessibility, and insufficient resources. The present article adds to the conversation around the need to improve inclusivity by highlighting modality-specific historical and current obstacles and ongoing initiatives. We conclude by discussing tangible solutions that transcend individual modalities, ultimately providing recommendations to promote equitable FIT neuroscience.

Black community member perceptions and ethics recommendations on epigenomic research

BACKGROUND

Social epigenomics research investigates links between social experiences and epigenetic modifications, which may ultimately impact health. Such research holds promise for precision medicine and addressing health disparities based on social conditions, but also brings unique ethical challenges. The linking of social experiences to biological changes risks pathologizing experiences, potentially leading individuals and communities to be seen as 'damaged.' This stigmatization or stereotyping based on experiences also risks placing disproportionate personal responsibility for health. These risks are likely to be amplified in historically marginalized communities already facing discrimination. It is therefore essential to engage members of historically marginalized communities to explore attitudes about social epigenomics research. This study focuses on the Black and African American (B/AA) population in the USA, studying perceptions of social epigenomic research participants, research decliners, and broadly representative community members to identify perceived benefits and risks of social epigenomic research as well as strategies to maximize benefits and lower risks for both participants and communities.

RESULTS

Both research participants and community members perceived potential benefit of social epigenomic research for the B/AA population. While most research participants did not perceive research related risks, community members identified risks both specific to social epigenomic research and more generalized to medical research. Several of the risks identified, and a belief that the likelihood of harms was greater than the likelihood of benefits, were based on past research injustices to B/AA research participants and mistrust in the medical and research enterprise. However, community members provided concrete strategies for maximizing the chance of benefits and lowering risk of harms including acknowledging and addressing biases and past injustices, ensuring transparency and understanding, positive framing of research, thorough research and dissemination, and engaging with communities before, throughout, and beyond the research process.

CONCLUSIONS

While B/AA community members identified risk of both individual and community harm from social epigenomic research, they also perceived potential health benefits for the B/AA community. Through concerted efforts to apply community recommendations to lower risks and enhance benefits, researchers can conduct ethical and valid epigenomic research that aims to address health disparities with historically marginalized communities.

Taking Health into Your Own Hands: Evaluating Patient and Provider Perspectives of Human Papillomavirus Self-Sampling for Cervical Cancer Screenings and Opportunities for Education

Human papillomavirus (HPV) self-sampling was approved for use in clinical settings by the U.S. Food and Drug Administration (FDA) in May 2024 to identify high-risk HPV, responsible for most cervical cancer. This study explored patient and healthcare provider perspectives of HPV self-collection to assess perceived benefits, barriers, and facilitators to implementing this new screening service. Twenty patients at a cervical cancer screening event in the Bronx, NY, watched an instructional video and completed a survey regarding their willingness to use HPV self-sampling. Nine healthcare providers from the Montefiore Health System and affiliated Albert Einstein College of Medicine participated in semi-structured interviews to discuss their knowledge and beliefs toward adopting HPV self-sampling. Qualitative transcripts were coded in Dedoose and thematic analysis was used to identify emergent themes which were narratively described and supported by direct quotes. Patient participants were largely interested in HPV self-sampling and expressed willingness to use the modality at future screenings. Provider participants discussed anticipated benefits and concerns of HPV self-sampling, including expanding screening reach, prioritizing patients' needs, inadequate sampling, and losing opportunities for comprehensive care provided during pelvic exams. Patient and provider participants expressed enthusiasm about self-sampling improving access to cervical cancer screening, particularly for communities lacking access to current healthcare infrastructure. Provider participants critically questioned how HPV self-sampling could be introduced into their clinical practice. Both groups emphasized the need for further education to improve patient health literacy on self-sampling and for provider education through peer sharing, lectures, and information dissemination through heavily used mobile applications.

Beyond Tuskegee: A contemporary qualitative assessment of barriers to research participation among Black women

BACKGROUND

Health care inequities have partially contributed to the existing racial gaps in health. Despite having lower incidence rates of breast cancer, Black women have a 41% higher mortality rate than White women. Black individuals remain underrepresented in research. Diversity in research is paramount to the improvement of clinical care practices and subgroup-specific guidelines.

METHODS

Black women from various community venues across geographic regions of the United States were invited via email, online fliers, social media platforms, and word of mouth to participate in focus groups. Six online focus groups of six to 10 Black women aged 25-65 years (N = 38) with and without a history of cancer were conducted with an in-depth semistructured discussion guide.

RESULTS

Most participants were college educated (32 of 38; 84.2%), aged 50 years or older (31 of 38; 81.6%), and had an annual income of $50,000 or more (26 of 38; 68.4%). Several barriers to research participation were identified. They included a lack of empathy and respect in health care settings, apprehension regarding the sharing of personal information, mistrust of medical research, and logistical/technical barriers. Alternatively, building individual and community trust and communicating the value of conducting research beneficial to the Black community were viewed as facilitators to research participation.

CONCLUSIONS

Successful engagement of Black women in research requires the acknowledgment and consideration of the numerous barriers that affect their ability to participate. Black women are more inclined to participate in research when the research team is knowledgeable, has experience within their communities, and engages trusted community partners. Additionally, the research must be meaningful and impactful to future generations of Black women.

Opening the Cabinets: A Critical Evaluation of Skeletal Teaching Collections in the United States

The collections of human remains within our university laboratories and classrooms are considered by many to be integral to teaching osteology. However, as an outgrowth of the Western scientific tradition of mind/body dualism, human remains within skeletal teaching collections are often regarded differently than those in museums or applied contexts. From processing to storage, the personhood of each individual becomes abstracted as we purchase, "inherit," handle, organize, and digitally scan their bones for teaching purposes. In this way, skeletons within teaching collections are ontologically transformed from people to objects. The objectification of human bodies is rooted in Enlightenment era scientific practices that are directly connected to colonialism and white supremacy. Here, we argue that the anonymization of the skeletons of people in academic institutions, and the maintenance of non-consent-based skeletal collections, perpetuates structural violence on the deceased and their descendant communities. We critically examine the origins and ethics of non-consent-based anatomical teaching collections and discuss the violence within these assemblages. Finally, we develop practical steps toward a more humanistic and ethical osteological classroom and pedagogy. Suggested strategies include ceasing the use of skeletal individuals for whom consent is unknown or non-existent and instead using only skeletal or replica skeletal materials from those who have donated or willed their bodies and engaging with critical pedagogical perspectives to challenge norms in our field.

Race and socioeconomic disparities in mortality and end-of-life care following aneurysmal subarachnoid hemorrhage

BACKGROUND

This study explores racial and socioeconomic disparities in aneurysmal subarachnoid hemorrhage (aSAH) care, highlighting the impact on treatment and outcomes. The study aims to shed light on inequities and inform strategies for reducing disparities in healthcare delivery.

METHODS

In this cohort study the National Inpatient Sample database was queried for patient admissions with ruptured aSAH from 2016 to 2020. Multivariable analyses were performed estimating the impact of socioeconomic status and race on rates of acute treatment, functional outcomes, mortality, receipt of life-sustaining interventions (mechanical ventilation, tracheostomy, gastrostomy, and blood transfusions), and end-of-life care (palliative care and do not resuscitate).

RESULTS

A total of 181 530 patients were included. Minority patients were more likely to undergo treatment (OR 1.15, 95% CI 1.09 to 1.22, P<0.001) and were less likely to die (OR 0.89, 95% CI 0.84 to 0.95, P<0.001) than White patients. However, they were also more likely to have a tracheostomy (OR 1.47, 95% CI 1.33 to 1.62, P<0.001) and gastrostomy tube placement (OR 1.43, 95%CI 1.32 to 1.54, P<0.001), while receiving less palliative care (OR 0.75, 95% CI 0.70 to 0.80, P<0.001). This trend persisted when comparing minority patients from wealthier backgrounds with White patients from poorer backgrounds for treatment (OR 1.10, 95% CI 1.00 to 1.21, P=0.046), mortality (OR 0.82, 95% CI 0.74 to 0.89, P<0.001), tracheostomy tube (OR 1.27, 95% CI 1.07 to 1.48, P<0.001), gastrostomy tube (OR 1.34, 95% CI 1.18 to 1.52, P<0.001), and palliative care (OR 0.76, 95% CI 0.69 to 0.84, P<0.001).

CONCLUSIONS

Compared with White patients, minority patients with aSAH are more likely to undergo acute treatment and have lower mortality, yet receive more life-sustaining interventions and less palliation, even in higher socioeconomic classes. Addressing these disparities is imperative to ensure equitable access to optimal care and improve outcomes for all patients regardless of race or class.

Ethical data acquisition for LLMs and AI algorithms in healthcare

Artificial intelligence (AI) algorithms will become increasingly integrated into our healthcare systems in the coming decades. These algorithms require large volumes of data for development and fine-tuning. Patient data is typically acquired for AI algorithms through an opt-out system in the United States, while others support an opt-in model. We argue that ethical principles around autonomy, patient ownership of data, and privacy should be prioritized in the data acquisition paradigm.

Racial Disparities in Surgical Oncologic Research Funding and Impact on Diverse Populations

Racial disparities in surgical oncology research funding significantly impact minority researchers and diverse populations. This review explores historical factors contributing to the underrepresentation of minorities in academic medicine. Strategies for addressing these disparities include enhancing diversity in the physician workforce and improving funding opportunities for minority researchers, with the goal of improving patient outcomes and reducing cancer care disparities.

The impact of Black founding fathers on the specialty of gynecologic oncology

INTRODUCTION

The formative period of the specialty of gynecologic oncology was from 1968 to 1972 and became a board-certified specialty in 1973. During this formation there were no Black physicians participating in this process. We chronicle and document the incorporation of the first three board-certified Black physicians in the specialty of gynecologic oncology here for historical purposes.

METHODS

We highlight the hostile climate experienced by Black physicians before and during the formation of gynecologic oncology, review the acceptance and training of the first three Black physicians in the specialty and recognize their significant contributions to the field.

RESULTS

The biographies and the narrative of these men describe their impact and contribution to medicine. We chronicle the historic presence of the first board-certified Black gynecologic oncologists and pelvic surgeons in the United States.

CONCLUSION

These three men represent the Black Founding Fathers of gynecologic oncology. Their perseverance in the face of adversity and commitment to excellence have left an indelible impact on the institutions that they developed, the individuals that they trained, and the patients that they served.

A Scoping Review of Medical Mistrust Among Racial, Ethnic, and Gender Minorities With Breast and Ovarian Cancer

An overarching theme in clinical literature suggests an inherent mistrust among populations of color within the healthcare system and the importance of healthcare professionals to bridge this gap in care. This is especially true when addressing cancer care in underserved populations due to mistrust in providers, diagnostic tools, and treatments. Ovarian cancer is difficult to diagnose early in all populations; however, women of color who have an intrinsic mistrust of the medical community will delay or refuse screenings or treatments that could be greatly beneficial. Similarly, although breast cancer rates are high in women of color, many are reluctant to utilize genetic screenings or counseling services due to bad experiences with healthcare, both personally and within their community. Moreover, transgender patients are at a unique disadvantage, as they face barriers to accessing culturally competent care while also being at a higher risk for developing cancer. The objective of this study was to conduct a scoping review of the literature in order to synthesize knowledge about the climate of mistrust between medical providers and racial, ethnic, and gender minorities with breast cancer and ovarian cancer. It is imperative for healthcare workers to acknowledge medical mistrust and strive to reduce internalized bias, increase their availability to patients, and ensure patients feel heard, respected, and well cared for during visits. Improving care by physicians can enhance trust between underserved communities and healthcare workers, encouraging all people to actively seek proper medical care and cancer screening, potentially resulting in a reduction of mortality and morbidity rates.

More than Just a Number: Perspectives from Black Male Participants on Community-Based Interventions and Clinical Trials to Address Cardiovascular Health Disparities

BACKGROUND

Black Americans remain significantly underrepresented and understudied in research. Community-based interventions have been increasingly recognized as an effective model for reckoning with clinical trial participation challenges amongst underrepresented groups, yet a paucity of studies implement this approach. The present study sought to gain insight into Black male participants' perception of clinical trials before and after participating in a community-based team lifestyle intervention in the United States.

METHODS

Black Impact, a 24-week community-based lifestyle intervention, applied the American Heart Association's Life's Simple 7 (LS7) framework to assess changes in the cardiovascular health of seventy-four Black male participants partaking in weekly team-based physical activities and LS7-themed education and having their social needs addressed. A subset of twenty participants completed an exit survey via one of three semi-structured focus groups aimed at understanding the feasibility of interventions, including their perceptions of participating in clinical trials. Data were transcribed verbatim and analyzed using a content analysis, which involved systematically identifying, coding, categorizing, and interpreting the primary patterns of the data.

RESULTS

The participants reported a positive change in their perceptions of clinical trials based on their experience with a community-based lifestyle intervention. Three prominent themes regarding their perceptions of clinical trials prior to the intervention were as follows: (1) History of medical abuse; (2) Lack of diversity amongst research teams and participants; and (3) A positive experience with racially concordant research teams. Three themes noted to influence changes in their perception of clinical trials based on their participation in Black Impact were as follows: (1) Building trust with the research team; (2) Increasing awareness about clinical trials; and (3) Motivating participation through community engagement efforts.

CONCLUSIONS

Improved perceptions of participating in clinical trials were achieved after participation in a community-based intervention. This intervention may provide a framework by which to facilitate clinical trial participation among Black men, which must be made a priority so that Black men are "more than just a number" and no longer "receiving the short end of the stick".

Racial and Ethnic Disparities in Sports Medicine and the Importance of Diversity

Within orthopedics surgery as a specialty, sports medicine is one of the least diverse surgical subspecialties. Differences in minority representation between patient and provider populations are thought to contribute to disparities in care, access, and outcomes.

Deconstructing Social Work Exam Bias: Advocacy Practice Guidelines to Close the Gap

INTRODUCTION

The social work profession is in a precarious situation regarding licensure. Test takers of color are struggling to pass social work licensure exams at rates comparable to their White counterparts, per data released by the Association of Social Work Boards (ASWB). As a nation, we are required to meet the needs of our increasingly diverse population. Yet the recruitment and retention of a diverse body of social workers is unlikely to be actualized if disparities persist in these exams. Given ASWB's monopoly on social work exams and the likelihood that many states will continue to require the exams for licensure, we sought to explore public responses to the data released, using the National Association of Social Work (NASW) as our starting point. As the nation's largest association of social workers, having local chapters within each state, NASW serves as an area of connection between social workers nationwide.

METHODS

We utilized content analysis to explore emerging themes and conduct a review of the state chapter's public responses to exam pass rate data.

RESULTS

A variety of state chapter's responses, with few states engaging in advocacy efforts or taking action to facilitate change.

DISCUSSION

Advocacy efforts play a pivotal role in the restructuring of fragmented systems. This study revisits seemingly ignored disparities diverse test takers may face, while also serving as a call-to-action in advocacy engagement. We conclude with a set of advocacy practice guidelines for use in the promotion of equitable licensing opportunities for all test takers.

The power of representation: Statistical analysis of diversity in US Alzheimer's disease genetics data

INTRODUCTION

Alzheimer's disease (AD) is a complex disease influenced by genetics and environment. More than 75 susceptibility loci have been linked to late-onset AD, but most of these loci were discovered in genome-wide association studies (GWAS) exclusive to non-Hispanic White individuals. There are wide disparities in AD risk across racially stratified groups, and while these disparities are not due to genetic differences, underrepresentation in genetic research can further exacerbate and contribute to their persistence. We investigated the racial/ethnic representation of participants in United States (US)-based AD genetics and the statistical implications of current representation.

METHODS

We compared racial/ethnic data of participants from array and sequencing studies in US AD genetics databases, including National Institute on Aging Genetics of Alzheimer's Disease Data Storage Site (NIAGADS) and NIAGADS Data Sharing Service (dssNIAGADS), to AD and related dementia (ADRD) prevalence and mortality. We then simulated the statistical power of these datasets to identify risk variants from non-White populations.

RESULTS

There is insufficient statistical power (probability <80%) to detect single nucleotide polymorphisms (SNPs) with low to moderate effect sizes (odds ratio [OR]<1.5) using array data from Black and Hispanic participants; studies of Asian participants are not powered to detect variants OR <= 2. Using available and projected sequencing data from Black and Hispanic participants, risk variants with OR = 1.2 are detectable at high allele frequencies. Sample sizes remain insufficiently powered to detect these variants in Asian populations.

DISCUSSION

AD genetics datasets are largely representative of US ADRD burden. However, there is a wide discrepancy between proportional representation and statistically meaningful representation. Most variation identified in GWAS of non-Hispanic White individuals have low to moderate effects. Comparable risk variants in non-White populations are not detectable given current sample sizes, which could lead to disparities in future studies and drug development. We urge AD genetics researchers and institutions to continue investing in recruiting diverse participants and use community-based participatory research practices.

Advancing Equity in Cancer Research: Opportunities for Sponsors, Institutions, and Investigators

Numerous studies have documented patient-level barriers to research participation that are often connected to social determinants of health. As described in this paper, to significantly move the needle toward greater diversity and inclusion in cancer research, it will take a full commitment to integrating an equity lens across the cancer research ecosystem, specifically among sponsors, institutions, and investigators.

Association of Demographic and Socioeconomic Indicators With the Use of Wearable Devices Among Children

Importance

The use of consumer-grade wearable devices for collecting data for biomedical research may be associated with social determinants of health (SDoHs) linked to people's understanding of and willingness to join and remain engaged in remote health studies.

Objective

To examine whether demographic and socioeconomic indicators are associated with willingness to join a wearable device study and adherence to wearable data collection in children.

Design, Setting, and Participants

This cohort study used wearable device usage data collected from 10 414 participants (aged 11-13 years) at the year-2 follow-up (2018-2020) of the ongoing Adolescent Brain and Cognitive Development (ABCD) Study, performed at 21 sites across the United States. Data were analyzed from November 2021 to July 2022.

Main Outcomes and Measures

The 2 primary outcomes were (1) participant retention in the wearable device substudy and (2) total device wear time during the 21-day observation period. Associations between the primary end points and sociodemographic and economic indicators were examined.

Results

The mean (SD) age of the 10 414 participants was 12.00 (0.72) years, with 5444 (52.3%) male participants. Overall, 1424 participants (13.7%) were Black; 2048 (19.7%), Hispanic; and 5615 (53.9%) White. Substantial differences were observed between the cohort that participated and shared wearable device data (wearable device cohort [WDC]; 7424 participants [71.3%]) compared with those who did not participate or share data (no wearable device cohort [NWDC]; 2900 participants [28.7%]). Black children were significantly underrepresented (-59%) in the WDC (847 [11.4%]) compared with the NWDC (577 [19.3%]; P < .001). In contrast, White children were overrepresented (+132%) in the WDC (4301 [57.9%]) vs the NWDC (1314 [43.9%]; P < .001). Children from low-income households (<$24 999) were significantly underrepresented in WDC (638 [8.6%]) compared with NWDC (492 [16.5%]; P < .001). Overall, Black children were retained for a substantially shorter duration (16 days; 95% CI, 14-17 days) compared with White children (21 days; 95% CI, 21-21 days; P < .001) in the wearable device substudy. In addition, total device wear time during the observation was notably different between Black vs White children (β = -43.00 hours; 95% CI, -55.11 to -30.88 hours; P < .001).

Conclusions and Relevance

In this cohort study, large-scale wearable device data collected from children showed considerable differences between White and Black children in terms of enrollment and daily wear time. While wearable devices provide an opportunity for real-time, high-frequency contextual monitoring of individuals' health, future studies should account for and address considerable representational bias in wearable data collection associated with demographic and SDoH factors.