Provider Implicit Bias in Prescribing HIV Pre-exposure Prophylaxis (PrEP) to People Who Inject Drugs

BACKGROUND

Multiple HIV outbreaks among people who inject drugs (PWIDs) have occurred in the USA since 2015, highlighting the need for additional HIV prevention tools. Despite high levels of need, pre-exposure prophylaxis (PrEP) is drastically underutilized among PWIDs. Implicit bias toward PWID held by clinicians may impede PrEP scale-up among these underserved patients. This study examined how primary care providers' (PCPs) clinical decisions related to PrEP can be impacted by biases when the patient has a history of substance use.

METHODS

We conducted an online survey of PCPs (n = 208). The survey included the implicit association test (IAT) to assess unconscious attitudes toward PWIDs, direct questions regarding clinicians' explicit PWID attitudes, and an embedded experiment in which we systematically varied the risk behavior of a hypothetical patient and asked PCPs to make clinical judgments.

RESULTS

A minority (32%) of PCPs reported explicit PWID bias. The IAT indicated strong implicit PWID bias (meant IAT score = 0.59, p < .0001) among 88% of the sample. Only 9% of PCPs had no implicit or explicit PWID bias. PWID patients were judged as less likely to adhere to a PrEP regimen, less responsible, and less HIV safety conscious than heterosexual or gay male patients. Anticipated lack of adherence mediated PCPs' intent to prescribe PrEP to PWID.

CONCLUSIONS

PCPs' bias may contribute to PrEP being under-prescribed to PWID. Implicit and explicit PWID biases were common in our sample. This study illustrates the need to develop and test tailored interventions to decrease biases against PWID in primary care settings.

A Health Profile of African Immigrant Men in the United States

African immigrants (AI) are the fastest growing group of immigrants to the U.S. however, their health and health practices remains poorly characterized. Thus, this study aimed to describe the health profile of this under-described U.S. population. In order to contextualize their health profiles, we compared AI (n=95) to other U.S. Black populations, namely African Americans (AA, n=271) and Caribbean American (CA, n=203) immigrants. We used cross-sectional survey data from a prostate cancer health study with 569 Black adult male participants, ages 21 years or older. Demographic characteristics were compared using Chi-square tests and prevalence ratios, and prevalence odds ratios (POR) were estimated for AIs compared to AA and CA immigrants using a log-binomial regression model. Results revealed that AI exhibited significantly lower prevalence of asthma and diabetes, when compared to AA and CA immigrants. Furthermore, AI reported lower consumption of alcohol than AA (POR, 0.43, 95%CI 0.24, 0.75) and lower smoking prevalence than AA (POR, 0.19, 95%CI 0.05, 0.70) and CA immigrants (POR, 0.21, 95%CI 0.05, 0.76). Additionally, AI reported significantly lower medical mistrust than CA (POR, 0.51, 95%CI 0.26, 0.95), significantly low financial strain than CAs immigrants (POR, 1.66, 95%CI 1.00, 2.75) and significantly higher levels of religious coping than both AA (POR, 2.43, 95%CI 1.43, 4.12) and CA immigrant men (POR, 1.78, 95%CI 1.03, 3.08). This study further supports emerging evidence that Blacks in the U.S. are not a monolithic group and that it is necessary to assess the Black subgroups separately. In addition, as one of the fastest growing immigrant populations, it is critical for future research to understand African immigrant's health needs and its correlates.

Exergaming: A Good Exercise Option During the Coronavirus Pandemic

The purpose of this study was to evaluate Wii sports programs as a potential physical activity solution to increasing inactivity among young adults and potentially improving the immune system. An evaluation was done on five Wii Sports games, including tennis, baseball, bowling, golf, and boxing. Measures included caloric expenditure and metabolic equivalents (MET) expended. A total of 16 subjects participated in two interactive video game sessions that took place over a 14-day period, in which their caloric expenditure (based on metabolic equivalents and rate of perceived exertion [RPE]) was compared with accepted reference values associated with playing the actual sports. Results showed that Wii sports were associated with higher MET values than published norms for other actual sports, and all Wii sports showed caloric expenditure that was four to ten times higher than traditional sedentary gaming. In conclusion, the results justify the integration of interactive video-gaming technologies into future fitness programs targeted toward young adults and, consequently, decrease the risk of metabolic syndrome and obesity.

Previous pre-eclampsia, gestational diabetes mellitus and the risk of cardiovascular disease: A nested case-control study in Sweden

OBJECTIVE

Pre-eclampsia and gestational diabetes mellitus (GDM) are two common pregnancy complications that affect birth outcomes and are associated with a long-term risk of cardiovascular disease (CVD). The aims of this study were to investigate if the pre-eclampsia association with CVD is independent of GDM and modified by body mass index (BMI) or GDM.

DESIGN

Case-control study.

SETTING

Sweden.

POPULATION

Cases were women with a first CVD event between 1991 and 2008 and a previous pregnancy who were matched with controls without CVD (1:5) by year of birth, age and region of birth.

METHODS

Conditional logistic regression was used to evaluate the associations of GDM, pre-eclampsia and maternal BMI with CVD adjusted for potential confounders and effect modifications with interaction tests.

MAIN OUTCOME MEASURES

CVD.

RESULTS

There were 2639 cases and 13 310 controls with complete data. Pre-eclampsia and GDM were independent risk factors for CVD (adjusted odds ratio [aOR] 2.59, 95% CI 2.12-3.17 and aOR 1.47, 95% CI 1.04-2.09, respectively). After stratifying by maternal BMI, the adjusted association of pre-eclampsia with CVD did not differ notably between BMI groups: normal weight (aOR 2.65, 95% CI 1.90-3.69), overweight (aOR 2.67, 95% CI 1.52-4.68) and obesity (aOR 3.03, 95% CI 0.74-12.4). Similar findings were seen when stratifying on GDM/non-GDM.

CONCLUSIONS

Pre-eclampsia and GDM are independent risk factors for later CVD and having both during pregnancy is a major risk factor for later CVD. The association between pre-eclampsia and CVD is not modified by BMI. Effective CVD preventive programs for high-risk women are urgently needed in order to improve women's long-term health.

Genetic Testing in the Latinx community: Impact of acculturation and provider relationships

OBJECTIVES

The current study aimed to explore attitudes toward genetic germline testing and intentions to test in Latinas from Southern California. We hypothesized that patients' acculturation and education levels, as well as comfort with health care providers, are positively associated with attitudes and intentions toward genetic testing.

METHODS

A survey was offered concurrently to Latinx female patients at a gynecologic oncology practice and to unaffiliated Latinx community members. The survey assessed demographics, structural, psychosocial, and acculturation factors and genetic testing attitudes and intentions via validated scales.

RESULTS

Of 148 surveys collected, 66% of responders had low levels of acculturation. 50% of women had government-subsidized insurance; 22% had no schooling in the US. 67% of participants did not carry a diagnosis of cancer. Women with higher acculturation levels were more likely to consider genetic testing (r_s = 0.54, p = .001). Higher acculturated women and less acculturated women under 50 were more likely to consider testing if it had been recommended by a female, trusted, or Hispanic/Latinx provider (r_s = 0.22, p = .01, r_s = 0.27, p = .003 and r_s = 0.19, p = .003, respectively) or if there was a recent cancer diagnosis (self or family, r_s = 0.19, p = .03). Overall, education correlated with intention to test. The more education outside of the US, the less negative was the attitude toward being tested (r_s = -0.41, p = .002).

CONCLUSIONS

Direct experiences with cancer, more schooling and higher acculturation coupled with provider characteristics determined if Latinas were more open to testing. Provider characteristics mattered: having a female, Latinx, Spanish speaking provider was important for genetic testing decision-making. These findings are particularly pertinent in areas with high Latinx populations.

Original Research: COVID-19 Vaccine Hesitancy Among Southern California Nurses

PURPOSE

The purpose of this study was to elucidate characteristics of vaccine-hesitant nurses at two large Southern California medical centers where rates of COVID-19 vaccination were lower than expected.

METHODS

This study is a secondary analysis of nurse participants in a cross-sectional study conducted at the two medical centers. Participants completed an online survey regarding their demographics; work setting and role characteristics; influenza vaccination history; COVID-19 knowledge and beliefs; and personal history of COVID-19 exposure, diagnosis, and disease impact (infection or death) on those closest to them.

RESULTS

Of 869 nurse participants, most (78.6%) were vaccinated and 21.4% were unvaccinated; more than half of the unvaccinated participants reported being unwilling to be vaccinated ("vaccine hesitant"). The χ 2 comparisons revealed no significant differences between vaccinated and vaccine-hesitant nurses in terms of education, contact with COVID-19 patients, work environment, or having friends and family impacted by COVID-19. Binary logistic regression showed that nurses who had no history of recent influenza vaccination were 10 times more likely to be vaccine hesitant, those who had inaccurate knowledge about COVID-19 vaccines were seven times more likely to be vaccine hesitant, and younger nurses and those with a prior COVID-19 diagnosis were approximately three times more likely to be vaccine hesitant. Furthermore, 17.3% of all participants were unwilling to recommend COVID-19 vaccination to others.

CONCLUSION

The findings offer a nuanced understanding of vaccine hesitancy among nurses and will be useful to the planning and development of policies, campaigns, and interventions aimed at increasing vaccination rates among nurses. Changing attitudes is essential, and particular attention must be paid to nurses who are unwilling to recommend vaccination to others. Effective interventions are needed.

Acculturative stress, stigma, and mental health challenges: emic perspectives from Somali young adults in San Diego county's 'Little Mogadishu'

OBJECTIVES

The purpose of this study was to explore the social factors that contribute to the mental health challenges that Somali young adults endure.

DESIGN

In a two-phase qualitative approach carried-out in the San Diego area, in phase-I, we conducted exploratory interviews with key-informants including clinicians and local Somali leaders (n = 7) who are familiar with the challenges of young Somalis. This information was then augmented through a focus group discussion with Somali young adults (n = 4) to gain further contextual knowledge and for access to the larger community of young people for phase-II. In this second phase, we carried-out individual interviews with 21 Somali young adults. Interviews covered topics including the social factors influencing their mental health, typical strategies for coping with psychological distress, barriers to seeking professional mental health services, and suggestions for combating mental health problems affecting young Somalis.

RESULTS

Participant narratives indicate that psychological distress (depression and posttraumatic stress disorder) are highly pervasive, and that shame, acculturative stress and ethnic discrimination as well as parents' dismissive reactions to their children's emotional problems perpetuate mental health problems. Coping strategies included support from friends, religious activities, and playing soccer. Suggestions for addressing their challenges centered on engagement from their own community to advocate for mental health.

CONCLUSIONS

Implications of this study are discussed in the context of bridging intergenerational and acculturation divides to deliver culturally competent interventions that improve the mental health and well-being of Somali young adults and aid them in their adjustment to the U.S.

Psychotherapy employed additionally to Psychopharmacotherapy is not related to Better Treatment Outcome in Major Depressive Disorder

Introduction

Although numerous effective antidepressant (AD) strategies are available for the treatment of major depressive disorder (MDD), many patients do not achieve satisfactory treatment response.

Objectives

The aims of the present European, cross-sectional, multicenter, naturalistic study were (1) to determine the proportion of patients suffering from primary MDD who received additional psychotherapy to their ongoing psychopharmacotherapy and (2) to identify the associated socio-demographic and clinical patterns.

Methods

Patients receiving both treatments were compared to those lacking concomitant additional psychotherapy that was manual-driven psychotherapy (MDP) in all cases.

Results

While 68.8% of a total of 1279 MDD patients received exclusively psychopharmacotherapy, 31.2% underwent a psychopharmacotherapy-MDP combination. The latter patient population was rather younger, higher educated, employed, exhibited an earlier mean age of MDD onset, lower severity of current depressive symptoms with lower odds of suicidality and higher rates of melancholic features, and comorbid asthma and migraine, and was generally treated with lower daily doses of their first-line ADs. Whereas agomelatine was more commonly dispensed in these patients, selective serotonin reuptake inhibitors were more often prescribed in MDD patients lacking additional MDP. No significant between-group differences were detected in terms of treatment outcome.

Conclusions

The fact that the employment of additional MDP was not related to better treatment outcome in MDD represents our major and clinically most relevant finding. Generally, MDP was employed in a minority of our patients who experienced rather beneficial socio-demographic and clinical characteristics. This might reflect an inferior accessibility of these psychotherapeutic techniques for patients who are more severely ill and less socio-economically privileged.

Disclosure

References Bartova L, Fugger G, Dold M, Swoboda MMM, Zohar J, Mendlewicz J, Souery D, Montgomery S, Fabbri C, Serretti A, Kasper S. Combining psychopharmacotherapy and psychotherapy is not associated with better treatment outcome in major depressive disor

Exploring the Usability of a Community Resiliency Model Approach in a High Need/Low Resourced Traumatized Community

This study tested the usability of a non-stigmatizing community-based trauma intervention delivered by trained community members. The Community Resiliency Model (CRM) was taught to a high-crime, low-income community designated as a Mental Health Provider Shortage Area (19 MPSA score). Five groups of Latino, African-American, LGBTQ, Asian Pacific Islander, and Veteran participants (N-57) with a history of complex/cumulative traumas and untreated posttraumatic stress undertook a five-day 40-h CRM training with master trainers. Measures included Treatment Relevance, Use and Satisfaction (TRUSS), Brief CRM Questionnaire (Brief CRM), and Symptom Questionnaire (SQ). Participant preparedness to teach CRM to others was high (98%) and sustained at the 3-6 months follow-up with 93% reporting a daily use. Pre-to post comparison analyses showed a significant decrease in distress indicators and increase in wellbeing indicators. CRM's high usability holds promise for a broader, low cost and sustainable implementation in traumatized and under-resourced communities.

Stick or twist? Cost-effectiveness of siponimod compared with continuing existing disease-modifying therapies in the treatment of active secondary progressive multiple sclerosis in the UK

OBJECTIVE

Identification of the phenotypic transition from relapsing-remitting multiple sclerosis (RRMS) to secondary progressive multiple sclerosis (SPMS) is often delayed due to disease complexity and an unwillingness to withdraw RRMS disease-modifying therapies (DMTs), driven by limited SPMS treatment options. Despite the paucity of clinical evidence for efficacy in patients with SPMS, DMTs licensed for RRMS are frequently continued into the early stages of SPMS. The cost-effectiveness of oral siponimod, an active SPMS DMT, versus continued oral or infused RRMS DMTs for patients with active SPMS, was evaluated.

METHODS

A cohort Markov model based on disease progression through Expanded Disability Status Scale health states, with annual cycles and lifetime horizon, was employed to determine the cost-effectiveness of siponimod from a UK National Health Service (NHS) perspective for patients with active SPMS. Baseline characteristics, health state utility values, hazard ratios for time to 6-month confirmed disability progression, annualized relapse rate ratios and adverse events for siponimod were obtained from the phase 3 EXPAND clinical trial, supplemented by published literature. Published costs, resource use data and comparator efficacy data were obtained from the literature and, in the absence of data, reasonable assumptions were made.

RESULTS

Quality-adjusted life years (QALYs) were greater for siponimod versus all comparators (3.45 versus 2.69-2.83). Incremental cost-effectiveness ratios (ICERs), calculated as cost per QALY, for siponimod versus natalizumab (dominant), ocrelizumab (£4,760), fingolimod (£10,033) and dimethyl fumarate (£15,837) indicated that siponimod was cost-effective at the commonly accepted willingness-to-pay threshold of £30,000/QALY.

CONCLUSIONS

Recognition of active SPMS and treatment of this phenotype with siponimod offers a cost-effective and clinically beneficial treatment approach compared with the continuation of oral or infused RRMS DMTs.

Prevalence and Social-Ecological Correlates of Intimate Partner Violence in a Conflict Zone-Evidence From the 2015 Afghanistan Demographic and Health Survey

This study examined the prevalence and social-ecological correlates of male-to-female intimate partner violence (IPV) in Afghanistan. Using data from the 2015 Afghanistan Demographic and Health Survey, which included 20,793 currently married women, we found that the past-year prevalence of physical IPV was highest (46%), followed by emotional (34%) and sexual forms (6%). Results also showed that the risk of IPV in general was associated with an array of community and societal-, family and relationship-, and person-level factors. Our findings point to potential intervention targets for women in this conflict zone where IPV is a highly pervasive and complex societal challenge.

Chronic Absenteeism: Risks and Protective Factors Among Low-Income, Minority Children and Adolescents

BACKGROUND

Low-income and racial/ethnic minority students often face distinct challenges in attending school eading to lower academic performance, low graduation rates, and overall, an indicator of diminished long-term social and financial stability. Chronic absenteeism is a national problem and to address this, a better understanding of risks and points of intervention for the students most at risk is needed. This cross-sectional study sought to assess risks and protective factors associated with chronic absenteeism in a predominantly low-income minority school district in Southern.

METHODS

Conducted in southern California, students (N = 24,439) ages 9 to 21 years were recruited. A logistic regression was used to assess the role poor physical and mental health, safety, bullying, and family risk factors attributed to chronic absenteeism.

RESULTS

Results revealed that asthma (odds ratio [OR] = 1.35, p < .001), being overweight/obese (OR = 1.38, p < .01), presence of family risk factors (OR = 1.49, p < .001), bullying (OR = 0.84, p < .05) and perceptions of safety at school (OR = 1.24, p < .05) increased the odds of chronic absenteeism, while protective factors such as support (OR = 1.30, p < .001), increased sleep (OR = 0.96, p < .001) and positive growth mindset (OR = 0.96, p < .001), mitigated it.

CONCLUSION

This study not only identifies risk but protective factors worth adhering to, to promote school attendance. Future research should further examine the role of mental health in chronic absenteeism.

Exploring Mental Health during the Initial COVID-19 Lockdown in Mumbai: Serendipity for Some Women

Background: This study explored how low-income women already distressed by reproductive challenges were affected during the initial lockdown conditions of the COVID-19 pandemic in Mumbai, India. Methods: Women with reproductive challenges and living in established slums participated in a longitudinal mixed-methods study comparing their mental health over time, at pre-COVID-19 and at one and four-months into India's COVID-19 lockdown. Results: Participants (n = 98) who presented with elevated mental health symptoms at baseline had significantly reduced symptoms during the initial lockdown. Improvements were associated with income, socioeconomic status, perceived stress, social support, coping strategies, and life satisfaction. Life satisfaction explained 37% of the variance in mental health change, which was qualitatively linked with greater family time (social support) and less worry about necessities, which were subsidized by the government. Conclusions: As the pandemic continues and government support wanes, original mental health issues are likely to resurface and possibly worsen, if unaddressed. Our research points to the health benefits experienced by the poor in India when basic needs are at least partially met with government assistance. Moreover, our findings point to the critical role of social support for women suffering reproductive challenges, who often grieve alone. Future interventions to serve these women should take this into account.

Use of Complementary and Alternative Medicine for Prostate Cancer among African Americans, African Immigrants and Caribbean Immigrants

Black men have the highest rate of prostate cancer (PCa) morbidity and mortality in the US, and often receive delayed and/or poorer-quality treatment. This inequity has led many to turn to complementary and alternative medicine/therapies (CAM). However, little is known about the use of these therapies within the Black community. The purpose of this study was to describe types of CAM therapies used, and the reasons behind their use for overall health and PCa treatment and prevention among three groups of Black males, namely African Americans, Caribbean Immigrants and African Immigrants. This study used a mixed-methods design with a quantitative phase (n = 575) followed by a qualitative phase (n = 61) with participants recruited from various parts of the country. Results revealed differences among subgroups in CAM use for overall health and PCa, as well as differences in the types of CAM therapies used and differences in the reasons behind their use. The findings of this study reveal a prevalence of CAM use for overall health and PCa within three different groups of Black men and identifies the specific CAM used. There were significant differences in the types of CAM used by each subgroup for both overall health and PCa. This study also shows that there is value in looking at Black subgroups distinctively, for their rates of CAM use and reasons for use, are distinctly different.

P–222 Can we optimise the time that we perform the fertilisation check in the lab? Lessons learnt from time-lapse incubation

Study question

Can time-lapse data be used to identify the optimum time to perform the fertilisation check for oocytes cultured in standard incubation?

Summary answer

The optimum time to perform fertilisation checks for oocytes cultured in standard incubation is 16.5hpi+/–0.5h.

What is known already

Time-lapse incubation allows the embryologist to retrospectively review collated images of oocytes and embryos to capture important embryological observations that may have otherwise been missed. This is a luxury not available to embryologists when oocytes or embryos are cultured in standard incubation. Traditionally, the optimum time to perform the fertilisation check is 17 hours post insemination (hpi) +/- 1 hour. It was hypothesised that this could be fine-tuned ensuring the maximum number of fertilised oocytes were observed, thereby increasing the number of usable embryos for the patient.

Study design, size, duration

This was a retrospective, multicentre analysis including data from 27,022 ICSI derived embryos cultured in time-lapse incubation between January 2011 to November 2019.

Participants/materials, setting, methods

The time of pronuclei appearance and disappearance was recorded using the time-lapse incubation software. The number of oocytes exhibiting normal fertilisation (defined as the presence of two pronuclei) during 30 minute intervals from 15hpi to 20hpi was determined.

Main results and the role of chance

Between 15–17.5hpi the average number of oocytes exhibiting normal fertilisation was 98.19% with most oocytes having visible pronuclei at 16–16.5hpi (98.32%). At 18–18.5hpi the number of visible pronuclei falls to 95.53% and continues to fall to 87.02% at 19.5–20hpi meaning that over 3000 (11%) normally fertilised oocytes, within this cohort, would not be identified.

Limitations, reasons for caution

The conclusions of this investigation cannot be effectively extrapolated to IVF embryos as only ICSI embryos were used for the determination of the results.

Wider implications of the findings: The optimum time to perform fertilisation checks for oocytes cultured in standard incubation is 16.5hpi+/–0.5h. However, without the use of time-lapse incubation, the fertilisation of at least 2% of embryos that create a fetal heart will be missed, even if the fertilisation check is performed in the optimum window (16.5hpi+/–0.5h).

Trial registration number

Not applicable

P–282 A time lapse analysis of 36,671 embryos to compare the incidence of early stage abnormal cleavage events in ICSI and IVF derived embryos

Study question

Is this incidence of early stage abnormal cleavage events different between embryos created following ICSI compared with IVF?

Summary answer

Embryos derived from ICSI are more likely to exhibit abnormal cleavage compared with those from IVF. This difference is most marked in women ≥35 years.

What is known already

Time lapse imaging (TLI) has been instrumental in allowing detailed annotation of early embryo development to provide an objective aid for embryo selection in ART cycles. Amongst several abnormal cleavage events reported, rapid cleavage and multichotomous mitosis/direct cleavage, during the first days after fertilisation have been demonstrated to be associated with lower blastulation rates, reduced implantation potential, increased aneuploidy and poor pregnancy outcomes. With ICSI being utilised commonly, and being the insemination method of choice in some clinics, the incidence of abnormal cleavage was investigated in association with insemination method, ICSI or IVF.

Study design, size, duration

The incidence of abnormal cleavage events was evaluated in a large multicentre retrospective analysis of 36,671 embryos from 6689 patients treated in 8 IVF clinics enabled with time lapse imaging, between 2011 - 2019. This constituted 10931 IVF embryos and 25740 ICSI embryos.

Participants/materials, setting, methods

Following ICSI or after IVF fertilisation check, embryos were time-lapse imaged every 10 minutes and annotated using the EmbryoScope. Second cell cycle durations were calculated as follows: time to reach 3-cell (t3) from 2-cell (t2) (t3-t2 = cc2). These were analysed using a welch t-test as three groups of abnormal cleavage: direct cleavage/trichotomous mitosis (DC) - where cc2=0 hours(h), rapid cleavage within 2h (R2) - where 0&lt;cc2&lt;2h and rapid cleavage between 2–5h (R5) where 2h&lt;cc2&lt;5h.

Main results and the role of chance

The incidence of DC, R2 and R5 in the whole cohort of embryos was 5%, 8% and 9% respectively. In the subpopulation of IVF embryos the incidence of DC, R2 and R5 was 4%, 8% and 9% respectively. In the subpopulation of ICSI embryos the incidence of DC, R2 and R5 was 6%, 8% and 9% respectively. The incidence of DC was significantly higher in ICSI embryos compared with IVF (p &lt; 0.001) whilst R2 and R5 were the same. ICSI derived embryos had a mean (± SE) cc2 value of 9.39 ± 0.03h, compared with 9.56 ± 0.05h for IVF embryos (p &lt; 0.0038). Examination of data split by maternal age demonstrated that ICSI oocytes from women of advanced maternal age (≥35) also had significantly more embryos exhibiting rapid cleavages R2 and R5 than IVF oocytes (p &lt; 0.007). There were no significant differences however, in rates of abnormal cleavages between ICSI and IVF in embryos from women aged &lt;30 (p = 0.06).

Male-factor diagnoses showed no significant differences in abnormal cleavage values between ICSI or IVF in all three abnormal cleavage categories.

Limitations, reasons for caution

This analysis could not control for all potential confounders therefore it is possible that the increased abnormal cleavages observed in this investigation are a result of another, or combination of factors. Despite quality assurance programs being in place across all clinics, there is a risk of annotation bias.

Wider implications of the findings: There is a higher incidence of early abnormal cleavage in embryos derived from ICSI, particularly in those from women of increased age and this research may help elucidate the reasons for this and add to the debate regarding the appropriateness of the increasing use of ICSI.

Trial registration number

Not applicable

P–792 The introduction of an embryo morphokinetics annotation quality assurance scheme across ten fertility clinics including 59 participants

Study question

Can a group-wide quality assurance scheme be developed to effectively determine inter-operator agreement for morphokinetic parameters of interest.

Summary answer

Very strong agreement was found between all operators except for one, therefore this scheme effectively identified areas of improvement in inter-operator annotations.

What is known already

Where fertility clinics use embryo morphokinetics to determine viability potential, quality assurance of annotations is essential. Embryo selection algorithms rely on the manual determination of certain morphokinetic parameters. Variations in these parameters can lead to differences in the algorithm score attributed to an embryo thus potentially affecting its fate. It is vital that all embryologists involved in embryo annotation and selection are consistent with their annotation approach through regular quality assurance mechanisms.

Study design, size, duration

Each participant was required to annotate the same three embryos for morphokinetic parameters of interest, including tPB2, tPNf, t2 to t5, t8, tM, tSB, tB. Participants were also required to grade embryos at 68 hours post insemination (hpi), 112hpi and to assess additional parameters used for embryo selection or future investigations, such as the extent of morula compaction. The aim of this scheme is to release new distribution each quarter to ensure regular participation.

Participants/materials, setting, methods

All embryologists responsible for embryo annotation in a single, UK fertility group were enrolled onto the scheme. A total of 59 participants from 10 fertility clinics in the UK were included. Inter-operator agreement was assessed using two-way, mixed intraclass correlation coefficient (ICC) for consistency. Five categories of agreement were determined based on ICC score; very weak (0–0.2), weak (0.21–0.4), moderate (0.41–0.6), strong (0.61–0.8) and very strong (0.81–1.0).

Main results and the role of chance

Very strong agreement (0.81–1.0) was observed between all operators for all parameters assessed except for one operator who showed a weak agreement (0.21–0.4) with all other operators. Descriptive statistics revealed standard deviations (SD) ranging from 0.34 (t3) to 3.43 (t5). For each parameter the SD across the three assessed embryos ranged from 0.34–3.43; tPB2 (0.11–0.98), tPNf (2.06–4.40), t2 (0.22–0.80), t3 (0.16–0.70), t4 (0.39–0.65). t5 (2.40–5.44), t8 (0.33–2.72), tM (1.00–2.72), tSB (1.08–2.67), tB (1.12–1.81). These results indicate a high concordance with less subjective annotations such as the cell stage divisions and more variability with the subjective annotations such as the blastulation parameters. The concordance with less well practiced or understood annotations, such as extent of morula compaction, planar or tetrahedral orientation at the four cell stage as well as angle of extrusion of second polar body in relation to the first polar body, was poorer as indicated using descriptive statistics. This highlighted the need for experience in performing these annotations before drawing conclusions regarding their predictive nature in relation to an embryo’s viability.

Limitations, reasons for caution

The variability between more subjective parameters would be expected to be higher than others. The participation in these schemes can create false environments which do not reflect how an embryologist would usually score; they may spend longer on some decisions given the nature of the scheme.

Wider implications of the findings: Quality assurance of morphokinetic annotations across clinics utilising standardised selection models is crucial. Robust annotation policies and education programmes are essential in achieving consistent results between operators. Quality assurance schemes can identify individuals who lack consistency overall and can identify reliably annotated parameters to inform inclusion in embryo selection algorithms.

Trial registration number

Not applicable

P–164 Mulitcentre derived time lapse algorithms developed using 6228 transferred embryos with known birth outcome incorporating novel morphological and morphokinetic markers

Study question

Can incorporation of novel markers of morphology with known temporal events successfully rank embryos to enable prediction of propensity for live birth?

Summary answer

Incorporation of variables for trophectoderm and morula grading demonstrably enhanced the model to rank embryos in order of potential for live birth.

What is known already

Models built using morphokinetic markers of development are widely used to rank embryos within a cohort. Such models include defined temporal parameters which are closely related to morphological grade. However, morphological grading by an embryologist is subjective and is not strongly correlated to outcome. Combining with defined kinetic events has been suggested to improve prediction of outcome.

Study design, size, duration

Data from 6228 known live birth outcome embryos from 8 UK clinics between 2011 – 2018 were investigated using an exploratory approach to identify novel markers of development.

Participants/materials, setting, methods

Five significant variables were defined, a derivative of time to start of blastulation; a derivative of trophectoderm grade; a kinetic variable utilising t3, t4, t5 and t8; an interval variable of tB-tSB and a variable based on novel morula classification. To maximise the output, a proxy value was derived for missing datapoints. The model was built using logistical regression and validated using fivefold cross validation with the data split as 80% training and 20% test.

Main results and the role of chance

An algorithm was developed including the five significant variables identified with an AUC of 0.685 demonstrating reliable prediction of live birth. Without morphological variables, the AUC was 0.674 demonstrating the improvement in the prediction value by including the derivative of the trophectoderm and morula grade. This resulted in ten classes of algorithm scores, 1–10, giving a live birth rate from 2% to 46%, irrespective of patient variables, for chance of live birth.

Limitations, reasons for caution

Successful application of the algorithm is reliant on stringent quality assurance for maintenance of accurate annotation and grading, and may not be transferable between laboratories with different SOPs.

Wider implications of the findings: The addition of a trophectoderm and morula grade in combination with morphokinetic parameters, increases the predictive value of the algorithm in relation to live birth outcome. Using proxy values allows maximization of data for model generation, and allows the model to be applied when missing values are present.

Trial registration number

Not applicable

P–206 Does oocyte vitrifcation affect morphokinetics of subsequent embryo development?

Study question

Are the morphokinetic profiles, as assessed using time-lapse technology, of human embryos developed from vitrified oocytes different to those from fresh oocytes.

Summary answer

Vitrification of oocytes does have an effect on early developmental morphokinetic profiles, but this is normalized by the time the embryo has reached blastocyst.

What is known already

Vitrification of oocytes is now commonplace, but little is known about the effect this may have on subsequent embryo development.

Study design, size, duration

This was a retrospective data analysis, from 8 fertility clinics in the UK between 2012 and 2019. Embryos from patients in the vitrified group (n = 557) were matched to fresh patient controls (n = 539). The matching was performed based on the following criteria: type of treatment, patient age, cause of infertility and number of embryos.

Participants/materials, setting, methods

The embryos in each group were compared for mean morphokinetics of key developmental stages in hours post insemination (hpi). Parameters compared included early cleavage divisions (t2-t8), time to start of compaction (tSC), time to morula (tM), time to start blastulation (tSB), time to full blastocyst (tB) and duration of compaction (tB-tSC). Treatment outcomes were compared between the two groups, including percentage of blastocyst formation, clinical pregnancy rate, implantation rate and live birth rate.

Main results and the role of chance

The results showed a significant delay across all early cleavage divisions as follows for vitrified and fresh oocytes respectively: 2-cell (28.14 vs 26.10 (p &lt; 0.001)), 3 cell (37.56 vs 35.37 (p &lt; 0.001)), 4 cell (40.58 vs 37.54 (p &lt; 0.001)), 5 cell (50.31 vs 47.14 (p &lt; 0.001)), 6 cell (53.99 vs 50.87 (p &lt; 0.001)), 7 cell (57.08 vs 54.48 (p &lt; 0.001)) and 8 cell (61.26 vs 58.91 (p &lt; 0.01)). In addition, tSC was also significantly delayed in the vitrified group (80.65 vs 76.36 (p &lt; 0.001)). However, the compaction stage was significantly shorter in the vitrified oocytes (19.02 vs 22.45 (p &lt; 0.001)). Therefore, there was no difference in the time that embryos derived from fresh and vitrified oocytes reached the blastocyst stage (108.03 vs 107.78 (p &gt; 0.05)). No difference was found in clinical pregnancy, implantation or live birth rates but significantly fewer blastocyst developed from vitrified oocytes compared to fresh (36.09% vs 42.4% (p &lt; 0.05)).

Limitations, reasons for caution

Although this was a matched analysis, it was a retrospective in nature therefore is subject to confounders. However, it would be problematic to perform a prospective randomized controlled trial to address this study question given the need to randomize patients to elective freezing of oocytes prior to embryo creation.

Wider implications of the findings: Vitrification of oocytes may affect early developmental morphokinetic profiles, but any effect is normalized by the time the embryo has reached blastocyst. However, fewer blastocysts may develop following oocyte vitrification. This may have implications for oocyte donation banks and those patients choosing to cryopreserve oocytes.

Trial registration number

NA

Stillbirth and infant death: mental health among low-income mothers in Mumbai

Background

India has the highest number of stillbirths and the highest neonatal death rate in the world. In the context of its pronatalist society, women who experience perinatal loss often encounter significant social repercussions on top of grief. Furthermore, even when pregnancy outcomes were favorable, adverse life circumstances put some women at risk for postnatal depression. Therefore, perinatal loss and postnatal depression take a heavy toll on women’s mental health. The purpose of this study is to assess mental health among a sample of Mumbai slum-dwelling women with a history of recent childbirth, stillbirth, or infant death, who are at risk for perinatal grief, postnatal depression, or mental health sequelae.

Methods

We conducted a mixed method, cross-sectional study. A focus group discussion informed the development of a comprehensive survey using mainly internationally validated scales. After rigorous forward and back-translation, surveys were administered as face-to-face structured interviews due to low literacy and research naiveté among our respondents. Interviews were conducted by culturally, linguistically, gender-matched, trained research assistants.

Results

Of our reproductive age (N = 260) participants, 105 had experienced stillbirth, 69 had a history of infant death, and 25 had experienced both types of loss. Nearly half of the sample met criteria for postnatal depression, and 20% of these women also met criteria for perinatal grief. Anxiety and depression varied by subgroup, and was highest among women desiring an intervention.

Conclusions

Understanding factors contributing to women’s suffering related to reproductive challenges in this pronatalist context is critically important for women’s wellbeing.

Physical training for patients with depression and anxiety - a randomized controlled study

Introduction

Pharmaceutical treatment and psychotherapy constitute the most common treatment methods for depression and anxiety. Physical training has been shown to have comparable effect to cognitive behavioral therapy in treatment of mild to moderate depression and anxiety. Physically active individuals also show lower risks to develop depression and relapse in depression.

Objectives

The objectives are to evaluate how physical activity can affect depressive and anxiety symptoms, by examining biomarkers in the blood and from the gut and also by measuring cognitive functions. Hopefully, this can lead to new treatment strategies for patients with depression and anxiety.

Methods

102 patients are randomized to two groups and undergo 12 weeks intervention as add-on to standard outpatient psychiatric treatment. The first group will participate in physical training three times per week and the other group will receive relaxation therapy on a weekly basis. Daily activity intensity will be measured before and at the last week of intervention with an accelerometer. Blood and faeces sample collection, symptom grading by clinician together with self-rating scales and cognitive screening will be performed at baseline, week 12 and one year of follow-up. The cognitive screenings are performed digitally in cooperation with Mindmore.

Results

The RCT is currently recruiting patients at the Department of Psychiatry of Örebro University Hospital.

Conclusions

The project aims to be holistic in its approach, combining the defining clinical psychiatric symptoms in patients who have both depression and anxiety with the finding and evaluation of new biomarkers from blood and gut to improve cognitive functions.

Disclosure

No significant relationships.

Perinatal Grief Among Poor Rural and Urban Women in Central India

PURPOSE

Given the pressures surrounding women's reproductive role in India, and persistent high rates of perinatal death, the purpose of this study is to describe and compare poor rural and urban Indian women's experiences of perinatal grief.

PARTICIPANTS AND METHODS

Two cross-sectional studies were compared on shared quantitative variables. Poor rural (N = 217) and urban, slum-dwelling (N = 149) Central Indian women with a history of stillbirth, and/or infant death were recruited with the aid of local community health workers. Trained, local, gender, and linguistically matched research assistants conducted the structured interviews. Shared quantitative variables include demographics, Social Provision Scale, Shortened Ways of Coping-Revised, Perinatal Grief Scale, social norms and autonomy.

RESULTS

While similar with respect to SES, age, number of living sons and perinatal loss experiences, these samples of poor women differed significantly across many variables, most notably women's household position, joint family living, number of live daughters, religious coping, autonomy, and degrees of perinatal grief. While perinatal grief was significantly associated with many variables bi-variably, most lost their relative influence in our stepwise multivariable modeling within site (rural/urban), with only social norms and social support remaining significant for rural (31% of variance) and wishful thinking and social norms for urban participants (38.4% of variance). In the combined sample household position, social support and social norms remained significant and explained 53.6% of the adjusted variance.

CONCLUSION

In both samples, perinatal grief was high following perinatal loss. Both groups of women with perinatal loss have increased risk of mental health sequelae. Notably, the context affected how they experienced perinatal grief, with rural women's grief being higher and more affected by their societal pressures and isolation. Such nuances are important considerations for much-needed tailored approaches to future interventions.

Prevalence and social determinants of tobacco use in Afghanistan

Background

Limited evidence exists on the prevalence and social determinants of tobacco use in Afghanistan—a fragile post-war context where the tobacco epidemic is on the rise. This study aimed to estimate the prevalence and social determinants of tobacco use in Afghan men and women.

Methods

Data from the 2015 Afghanistan Demographic and Health Survey of 10 760 men and 29 461 women were used to generate weighted prevalence estimates for smoking, smokeless tobacco (SLT) products including chew and snuff tobacco, ‘any tobacco use’ and ‘dual tobacco use’. We also modelled associations with tobacco outcomes using binary logistic regressions.

Results

We found that for men, smoking cigarettes was the most prevalent form of tobacco use (21.9% [95% confidence interval {CI} 21.2–22.7]). Prevalence rates were far lower for women, with cigarette/pipe smoking at 3.4% (95% CI 3.2–3.7). For both sexes, tobacco use was inversely associated with education and positively associated with agricultural and skilled and unskilled manual labour occupations. Wealth increased the odds of smoking for men but decreased the odds for women. Media exposure had little influence on tobacco use among women; however, the effects were more varied for men.

Conclusions

Our results demonstrate social inequalities in tobacco use among Afghan men and women, which calls for stronger tobacco control measures and continued monitoring of this growing epidemic.

Abstract PO-181: Associations of characteristics of hair dye and relaxer use with tumor clinicopathologic features among Black and White women with breast cancer

Introduction: In our previous findings from the Women’s Circle of Health Study (WCHS), we observed statistically significant associations between use of hair dye and relaxer, which contain potentially mutagenic and endocrine-disrupting chemicals, and increased breast cancer risk. In the current analysis, we sought to expand upon our earlier findings by assessing associations between hair product use and breast tumor clinicopathology. Methods: Risk factor data (including characteristics of hair product use) were collected through in-person interviews, and tumor clinicopathology data were abstracted from available pathology records of 2,998 breast cancer cases (2,227 Black, 771 White). Associations between hair product use and tumor clinicopathology were analyzed using multivariable-adjusted, binomial and multinomial logistic regression models. Further analysis was performed in subsets by race and estrogen receptor (ER) status. Results: Numerous characteristics of hair product use were associated with more aggressive tumor features. Longer (&gt;10 years) use of relaxers and earlier exposure to relaxers (≤12 years old at first use) were associated with increased odds of poorly differentiated tumors (OR 2.15, 95% CI: 1.08-4.28 and OR 2.00, 95% CI: 1.05-3.82, respectively).

History of regular relaxer use (OR 1.51, 95% CI: 1.23-1.87) and dual use of both hair dyes and relaxers (OR 1.40, 95% CI: 1.02-1.92) were associated with increased odds of ER- status. Compared to sole salon application, utilization of both salon and home- kit application types for hair dyes was associated with increased odds of higher tumor grade (moderately differentiated: OR 1.74, 95% CI: 1.05-2.87; poorly differentiated: OR 2.52, 95% CI: 1.51-4.20). These associations were consistent among Black, but not White, women. Combination use of salon and home-kit relaxer application types was associated with increased odds of tumors &gt;2.0 cm (OR 1.88, 95% CI: 1.27-2.77). Conclusions: While recent research has supported a connection between hair product use and breast cancer risk, this is the first study to examine the associations of hair product use with breast tumor features. Our findings showed that certain characteristics, particularly the magnitude of exposure to these products and application types of hair dye and relaxer, are associated with tumor features that are indicative of more aggressive phenotypes, including higher grade and ER- status. These findings generate new hypotheses about the potential impact of hair product use on breast cancer outcomes, warranting further study.

Citation Format: Rohan Rao, Jasmine A. McDonald, Emily S. Barrett, Dede Teteh, Susanne Montgomery, Bo Qin, Yong Lin, Chi-Chen Hong, Christine B. Ambrosone, Kitaw Demisse, Elisa V. Bandera, Adana A.M. Llanos. Associations of characteristics of hair dye and relaxer use with tumor clinicopathologic features among Black and White women with breast cancer [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PO-181.

Women and Infertility in a Pronatalist Culture: Mental Health in the Slums of Mumbai

Background

Infertility is a global problem, with high prevalence in India. As a pronatalist society, infertility is particularly problematic in India, causing stigma, shame, and blame especially for women. Infertility consequences for women include discrimination, social exclusion, and abandonment, putting them at high risk for mental health distress. Furthermore, mental health is highly stigmatized and specialized care is largely unavailable. Despite the cultural importance of childbearing, research on infertility distress and resulting mental health sequelae is lacking, particularly among low-income women. The purpose of this study is to assess mental health, using validated scales, among Mumbai slum-dwelling women with a history of infertility.

Methods

We conducted a mixed-method, cross-sectional study. A focus group discussion with community health workers (n = 7) informed the development of a comprehensive survey. The survey consisted of validated scales whenever possible, in addition to questions pertaining to women’s sociodemographic and reproductive history. After rigorous forward and back translation, the surveys were conducted as face-to-face structured interviews due to low literacy levels and the research naiveté of our respondents. Interviews were conducted by culturally, linguistically, gender-matched, trained research assistants.

Results

Mumbai slum-dwelling women of reproductive age suffering from infertility (N = 74) participated. Most (85%) women and their husbands (66%) reported previous infertility testing. Participants had elevated mental health distress (anxiety and depression symptomology) largely explained by general health, length of marriage, and coping strategy employed.

Conclusion

Women facing the double stigma of mental health and infertility need innovative programs to address their challenges.

Heavy is the Head That Wears the Crown: Black Men's Perspective on Harmful Effects of Black Women's Hair Product Use and Breast Cancer Risk

Racial disparities in breast cancer are well-documented, and Black women assume a disproportionate burden of breast cancer mortality. Black women also commonly use hair products containing endocrine disrupting chemicals (EDCs) more often at an increased rate, as compared to other racial/ethnic groups. Emerging findings have reported the use of hair and other personal care products containing EDCs may contribute to breast cancer risk. While some sociocultural perspectives about hair and identity have been explored, the role of beauty expectations upheld by males has not been studied. Through a community-based participatory methodology, we explored perceptions and beliefs held by Black men regarding Black women's hair, chemical exposures in hair products, and breast cancer risk. Focus groups and key informant interviews-among men with and without partners with a history of breast cancer-were used to examine the male perspective regarding the attractiveness of Black hairstyles, opinions of beauty norms, and knowledge of breast cancer risk factors. Interviews were audio-recorded, transcribed, and analyzed guided by grounded theory methods. From the 66 participants interviewed, there was general support for natural hairstyles, which were associated with confidence and self-esteem in women. Men agreed that beauty standards and societal pressures play notable roles in the women's personal behaviors though they mostly lacked knowledge of women's breast cancer risk related to EDCs found in personal care products. Participants suggested a multipronged strategy centered on community education involving social and traditional media campaigns, and the engagement of policy makers in intervention efforts.

Non-psychotic mental disorders in adolescent men and risk of myocardial infarction: a national cohort study

Background/Purpose

Recent studies show that early life stress is associated with later risk of cardiovascular disease (CVD) and stress may also increase the risk of psychiatric disease. We investigated the association between non-psychotic mental disorders in adolescence and subsequent myocardial infarction, and the role of stress resilience and physical fitness in this association.

Method

This is a register-based cohort study with 238 013 males born between 1952 and 1956 followed from 1987 to 2010 using information from Swedish registers. Stress resilience was measured at a compulsory military conscription examination using a semi-structured interview with a psychologist. Physical fitness was measured at conscription examination with a cycle ergometer test. A total of 34 503 men were diagnosed with a non-psychotic mental disorder at conscription. Using Cox regression, we estimated the association of mental disorders with myocardial infarction after adjustment for other established CVD risk factors in adolescence. Stress resilience and physical fitness were included in the adjusted model in a second set of analyses.

Results

A total of 5891 diagnoses of first myocardial infarction were identified. Non-psychotic mental disorders were associated with an increased risk of myocardial infarction, with a hazard ratio (HR) and confidence interval (CI) of 1.51 (1.41–1.62). The association remained statistically significant after adjustment for other important potential confounders in adolescence such as systolic and diastolic blood pressure, body mass index, inflammation, cognitive function, parental socioeconomic index and a summary disease score (HR 1.24 (CI 1.13–1.35)). The association was further explained by stress resilience and lifestyle factors assessed with a cardiovascular fitness test in adolescence, as the association attenuated but remained statistically significant when further adjusting for stress resilience and physical fitness (HR 1.18 (CI 1.08–1.29)).

Conclusion

A non-psychotic mental disorder in adolescences may increase the risk of developing myocardial infarction later in life. This association was partly but not completely explained by poorer stress resilience and physical fitness. Effective prevention might focus on behaviour/lifestyle and psychosocial stress in early life.

Funding Acknowledgement

Type of funding source: None

Understanding the Use of Electronic Means to Seek Personal Health Information Among Adults in the United States

In this study, we explored who is most likely to use electronic means to seek health information and why; our research was guided by the Health Belief Model (HBM). We used the National Cancer Institute’s Health Information Trends Survey (HINTS) dataset for 2017 and 2018 (n=6,697). We found that 67.5% of US adults used electronic means to seek health information and that females (52.4%), non-Hispanic whites (63.8%), those with at least some college education (76.5%), and those with a household income of at least $50,000 per year (58.3%) were most likely to do so. Respondents reporting depression were 42% more likely to use electronic means to seek health information, suggesting that stigma about mental health may direct people with depression to seek online information to avoid face-to-face communication. Using a tablet to track progress on a health-related goal [odds ratio (OR)=2.38, p<0.0001], and using a tablet to make a decision about treating an illness (OR=6.00, p<0.0001) were highly associated with seeking electronic health information. As the internet remains largely unregulated, this suggests that health systems link their patients to trustworthy resources for preventive and treatment-related information, since many already engage in internet-guided health information-seeking.

African Immigrant Health: Prostate Cancer Attitudes, Perceptions, and Barriers

Prostate cancer (PCa) is the second leading cause of cancer-related death among Black men who present with higher incidence, mortality, and survival compared to other racial groups. African immigrant men, however, are underrepresented in PCa research and thus this research sought to address that gap. This study applied a social determinants of health framework to understand the knowledge, perceptions, and behavioral tendencies regarding PCa in African immigrants. African immigrant men and women residing in different parts of the country (California, Texas, Colorado, Oklahoma, and Florida) from various faith-based organizations, African community groups, and social groups were recruited to participate in key informant interviews (n = 10) and two focus groups (n = 23). Four themes were identified in this study: (a) PCa knowledge and attitudes-while knowledge is very limited, perceptions about prostate health are very strong; (b) culture and gender identity strongly influence African health beliefs; (c) preservation of manhood; and (d) psychosocial stressors (e.g., financial, racial, immigration, lack of community, and negative perceptions of invasiveness of screening) are factors that play a major role in the overall health of African immigrant men. The results of this qualitative study unveiled perceptions, attitudes, beliefs, and knowledge of PCa among African immigrants that should inform the planning, development, and implementation of preventive programs to promote men's health and PCa awareness.

Health-Predictive Social-Environmental Stressors and Social Buffers Are Place Based: A Multilevel Example From San Bernardino Communities

Significant evidence demonstrates the powerful effects social determinants have on health-related perceptions, behaviors, and health outcomes. However, these factors are often studied out of context, despite the acknowledgement that social determinants of health are place based. This research aimed to demonstrate that health-related perceptions are dependent on where one lives. Via a community-based participatory study, participants were randomly selected from 3 residential regions varying distances from a freight railyard (nearest n = 300, middle n = 338, farthest n = 327), all mostly low-income, predominately Latino areas. Interview-administered surveys with adults were collected by bilingual trained community members (87% response) in English/Spanish. Adjusted-logistic regression models assessed residential region as a predictor of stressors (perceptions of community safety, community noise disturbance, health care access, food insecurity) and buffers (3 neighborhood cohesion variables), after adjusting for household income, race/ethnicity, gender, and age. Each region experienced a unique amalgam of stressors and buffers. In general, the region closest to the railyard experienced more stressors (odds ratio [OR] = 1.58; 95% CI 1.12-2.20) and less buffers (OR = 0.69; 95% CI 0.49-0.96) than the region furthest from the railyard. More than half of participants in each region reported 2 or more stressors and 2 or more buffers. In this seemingly homogenous study population, place remained important in spite of traditionally used socioeconomic factors, such as household income and race/ethnicity. Social determinants of health should be studied with regard to their environmental context, which will require interdisciplinary collaboration to improve multilevel research methods. Including the study of social buffers will also promote sustainable, positive change to reduce health disparities.

Abstract B039: I am good but depressed: The mental health impact of breast cancer on the black community

In the US Black women have higher incidence and mortality rates of breast cancer than White women. Patients diagnosed with breast cancer (BC) are known to experience a decline in mental health (MH). Patient’s reactions after diagnosis can involve denial, depression, anxiety, and anger. Close relatives and friends of patients are often also psychologically affected although their involvement and support of the BC patient has been associated with better survival outcomes. There is a gap in our understanding of the mental health impact on Black BC patient’s close friends and family members. The purpose of this study is to explore the MH impact of a BC diagnosis on Black BC patient’s close friends and family. Methodology: Analysis were conducted on a data set of African American (AA) and African/ Caribbean (AC) Women in Southern California. The data were collected from 2014-2016, using a 40-item questionnaire. Analysis included descriptive and inferential statistics. Survey data was analyzed using SPSS Version 25. Results: In our sample (N= 172), 57.8% of respondents were relatives and friends of patients with BC, compared to 35.1% of respondents who were not impacted by the disease. AA (81.3%) were significantly more impacted by BC than our AC participants (57.4%) (p=0.001). While the self-reported MH status of the respondents was excellent (46.4%) or good (35.7%) overall and no one reported their MH status as poor , among participants impacted by the disease (n=105), a higher proportion (18.1%) reported feeling depressed several days (p=0.61) versus those who were unaffected (n=60) by BC (13.3 %). It is important to note, when we analyzed the entire sample of the study (i.e. those with family and friends with breast cancer and those without), there was a significant difference in our respondents’ self-report of their MH status and feelings of depression (p=0.008). Discussion: AA and AC women often have poorer recovery outcomes from BC than White women, including MH issues, though little is known about the MH on the Black BC patients’ close family/friends. In this study, most participants reported their MH as excellent or good and although not statistically significant, we found some differences if respondents reported having a close relative/friend with a history of BC. Our findings point to the need for future studies to better link the diagnosis temporally with BC and should consider if the instrument is appropriate for this community considering the discrepancy in the interpretation of MH versus depression. Future research should consider creating culturally tailored tools to assess the MH impact of BC diagnosis on patients’ relatives and friends.

Citation Format: Dorothy Galloway, Dede Teteh, Phyllis Clark, Eudora Mitchell, Rick Kittles, Susanne Montgomery. I am good but depressed: The mental health impact of breast cancer on the black community [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr B039.

Abstract A044: Black identity, hair product use, and breast cancer: Exploring breast health issues in Black women

Introduction: The parent study investigated the potential role of hair products for breast cancer etiology in a community sample of Black women. Black women are diagnosed and die from breast cancer more than White women. Hair across the African diaspora is synonymous with identity. Black women use more hair products containing endocrine-disrupting chemicals than other races. Currently there is no hair, identity, and health scale. To better understand the cultural influence of hair product usage for Black women, given the possible link between product use and breast cancer, we assessed identity, perceived risk, knowledge, and attitude about Black hair and breast cancer. The purpose of this study was to validate a hair, identity, and breast health scale in a diverse sample of Black women.

Methods: In phase 1 of our study we explored the cultural and personal meaning of hair for Black women (N=125). Transcribed qualitative interviews were analyzed using grounded theory methods. Survey items were created based on emerging themes. In the survey phase of the study, Black women completed a 27-item scale to rate the degree of agreement with statements related to identity, hair products, and breast cancer diagnosis. Principal component analyses were conducted to investigate the underlying factor structure of influence of hair and identity on cancer diagnosis. A confirmatory factor analysis (CFA) confirmed whether one, two, or three factors best explain our identity, hair product use, and breast cancer diagnosis scale.

Results: Our participants (N = 211) comprised 70% African American, 18% African, and 7% Caribbean Black women aged 29 to 64. Factor analysis yielded two factors that accounted for 61% of the total variance. Five items tapping into sociocultural perspectives about hair and identity loaded on Factor 1 and accounted for 32% of the total variance. Cronbach's alpha for this 5-item subscale was 0.82 (95% CI = 0.77-0.86). Six items assessing hair product usage, perceived risk, and breast cancer diagnosis accounted for 29% of the total variance. Cronbach's alpha for the 6-item subscale was 0.82 (95% CI =0.74-0.86). Confirmatory factor analysis confirmed the two-factor structure (root mean square error of approximation= 0.03; Comparative fit index= 0.91; Tucker Lewis index = 0.88) for this newly created identity, hair product use, and breast cancer diagnosis scale.

Conclusions: As we seek to better understand cultural influences that perpetuate disparities in mammography screening rates, the impact of hair on identity for Black women should also be recognized. Our hair, identity, and breast health scale may provide insights to comprehend the social and behavioral patterns of Black women in relation to breast cancer prevention and hair product risk. Considering these sociocultural perspectives of women across the African diaspora may yield culturally appropriate strategies that inform interventions about identity, hair product risk, and breast cancer prevention.

Citation Format: Dede K. Teteh, Marissa Ericson, Eudora Mitchell, Phyllis Clark, Rick Kittles, Susanne Montgomery. Black identity, hair product use, and breast cancer: Exploring breast health issues in Black women [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr A044.

Abstract B028: The stages of change model approach to reducing endocrine-disrupting chemical exposures linked to breast cancer risk for Black women

In the US Black women (BW) are more likely to die from breast cancer (BC) than White women. Research increasingly supports the association between ingredients found in hair and personal care products and BC risk, linked to endocrine disrupting chemicals (EDCs). BW spend more money on hair products (HPs) containing EDCs than other racial groups. Some scholars posit that for many BW, hair is synonymous with identity. To further explore the complex interplay between hair, identity, and breast health we developed and validated the Black Identity, Hair Product Use, and Breast Cancer Scale (BHBS). The purpose of this study is to provide direction on the utility of the scale in capturing sociocultural factors related to BC risk and HPs use for intervention planning. Methods: The 11-item BHBS scale includes two subscales, one measuring sociocultural perspectives about hair and identity (5-items) and the other perceived breast cancer risk related to HPs (6-items). Response options strongly disagree/disagree are categorized as “low importance” and strongly agree/agree as “high importance”. Analysis includes descriptive and inferential statistics. Survey data was analyzed using SPSS Version 25. Results: Participants (N=185) were African/Caribbean and African American women ages 29 to 79. Eight percent (n=15) had been diagnosed with BC. Forty percent had a mammogram previously and 59.5% intended to have a mammogram in the future. BW (89.5%) who are concerned about BC and intend to watch the ingredients of products were more likely to intend to have a mammogram in the future (p=0.02). 46.6% of BW who are concerned about BC and intend to watch the ingredients of the products they use, felt pressure from their female friends to straighten their hair (p=0.04). On the contrary, 84.6% women who plan to adjust how they use HPs because of their concern about BC: 1) did not think it necessary for BW to have their hair straight in order to be successful in business (p=0.03) and 2) did not think BW needed to straighten their hair in order to attract Black men (p=0.003). Furthermore, 92.4% of women who wanted to learn more about the health risks of HPs (88% of all), agreed that BW needed to straighten their hair to attract Black men (p=0.03). Overall, participants were interested in learning more about BC risk and HPs use through social media (88.1%) and from their stylist (82.2%). Discussion: In the US straight hair for BW continues to represent Eurocentric ideals of beauty and acceptance resulting in BW using HPs containing EDCs. While many of our participants intend (contemplation) to watch ingredients or learn (contemplation) more about HP related health risks, they felt pressure (friends, partners) to straighten their hair. However, those who worry (contemplation) about ingredients or plan (preparation) to adjust their HPs use, felt less need to submit to peers, or societal ideals of success and mate selection linked to straight hair. Thus, the stages of change model maybe used to develop health-related behavior interventions for our participants.

Citation Format: Dede K Teteh, Phyllis Clark Clark, Eudora Mitchell, Rick Kittles, Susanne Montgomery. The stages of change model approach to reducing endocrine-disrupting chemical exposures linked to breast cancer risk for Black women [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr B028.

Mind and body exercises (MBE), prescribed antidepressant medication, physical exercise and depressive symptoms - a longitudinal study

AIMS

Earlier studies show that participation in mind and body exercises (MBE) is cross-sectionally associated with high levels of depressive symptoms and antidepressants. This study investigates the longitudinal interrelationship between depressive symptoms, MBE and antidepressants.

METHODS

3269 men and 4318 women aged 24-74 years participated in the Swedish Longitudinal Occupational Survey of Health (SLOSH). Measures of MBE practice and depressive symptoms were drawn from the SLOSH questionnaire, data on prescription drugs were obtained from the Swedish Prescribed Drug Register. Structural Equation Modeling (SEM) was used to analyze temporal relationships.

RESULTS

Both MBE practice and antidepressants in 2012 was associated with higher levels of depressive symptoms two years later. Depressive symptoms in turn were associated with higher levels of later MBE practice and antidepressants. These relationships seemed to be explained by confounding by indication and were of higher magnitude for antidepressants than for MBE.

CONCLUSION

Overall, SEM analysis shows that MBE and antidepressant treatment were both bi-directionally associated with depressive symptoms over time. Part of the explanation is likely to be confounding by indication: those with symptoms of depression more likely to undertake treatment, and MBE alone may be more common among those with less severe depression. The results clarify some of our findings from earlier studies and give some important, new information on what people are doing to manage depressive symptoms on a societal level, regarding self-care, medication, and the combination of both.

Preparing for Community Health Worker Integration Into Clinical Care Teams Through an Understanding of Patient and Community Health Worker Readiness and Intent

There is a rising demand to expand the successful roles community health workers (CHWs) offer into clinical settings (clinic-based community health worker [cCHW]) to support patient services. Using survey data, we evaluated patient and CHW readiness and intent to adopt cCHW clinical care integration. We found CHW and patient readiness to become or utilize a cCHW significantly predicted CHW and patient intent to become or utilize a cCHW; however, in our study, CHWs experienced greater readiness to serve as cCHWs than did patients to utilize cCHWs.

Psychosocial Stress, Glucocorticoid Signaling, and Prostate Cancer Health Disparities in African American Men

Recent advances in our understanding of racial disparities in prostate cancer (PCa) incidence and mortality that disproportionately affect African American (AA) men have provided important insights into the psychosocial, socioeconomic, environmental, and molecular contributors. There is, however, limited mechanistic knowledge of how the interplay between these determinants influences prostate tumor aggressiveness in AA men and other men of African ancestry. Growing evidence indicates that chronic psychosocial stress in AA populations leads to sustained glucocorticoid signaling through the glucocorticoid receptor (GR), with negative physiological and pathological consequences. Compelling evidence indicates that treatment of castration-resistant prostate cancer (CRPC) with anti-androgen therapy activates GR signaling. This enhanced GR signaling bypasses androgen receptor (AR) signaling and transcriptionally activates both AR-target genes and GR-target genes, resulting in increased prostate tumor resistance to anti-androgen therapy, chemotherapy, and radiotherapy. Given its enhanced signaling in AA men, GR-together with specific genetic drivers-may promote CRPC progression and exacerbate tumor aggressiveness in this population, potentially contributing to PCa mortality disparities. Ongoing and future CRPC clinical trials that combine standard of care therapies with GR modulators should assess racial differences in therapy response and clinical outcomes in order to improve PCa health disparities that continue to exist for AA men.

Pediatric Chronic Illness Management: A Qualitative Dyadic Analysis of Adolescent Patient and Parent Illness Narratives

In pediatric chronic illness, little is known about the relational interactions between adolescent patients, parents, and illnesses and how they influence self-management of illness. We conducted interviews with 32 individuals (16 dyads) representing adolescents diagnosed with a chronic illness and their primary parent who had been referred to a psychosocial treatment program for challenges with illness management. Interviews were conducted individually and analyzed dyadically using grounded theory to better understand the relational processes that may be contributing to illness management difficulties. Results include a theory of patient-parent illness responses and how parental illness meanings play a role in adolescent self-management. Results can be used to better understand and treat family relational patterns that may be influencing pediatric illness management challenges.

The Black identity, hair product use, and breast cancer scale

INTRODUCTION

Across the African Diaspora, hair is synonymous with identity. As such, Black women use a variety of hair products, which often contain more endocrine-disrupting chemicals than products used by women of other races. An emerging body of research is linking chemicals in hair products to breast cancer, but there is no validated instrument that measures constructs related to hair, identity, and breast health. The objective of this study was to develop and validate the Black Identity, Hair Product Use, and Breast Cancer Scale (BHBS) in a diverse sample of Black women to measure the social and cultural constructs associated with Black women's hair product use and perceived breast cancer risk.

METHODS

Participants completed a 27-item scale that queried perceptions of identity, hair products, and breast cancer risk. Principal Component Analyses (PCA) were conducted to establish the underlying component structures, and confirmatory factor analysis (CFA) was used to determine model fit.

RESULTS

Participants (n = 185) were African American (73%), African, and Caribbean Black women (27%) aged 29 to 64. PCA yielded two components that accounted for 61% of total variance. Five items measuring sociocultural perspectives about hair and identity loaded on subscale 1 and accounted for 32% of total variance (α = 0.82; 95% CI = 0.77-0.86). Six items assessing perceived breast cancer risk related to hair product use loaded on subscale 2 and accounted for 29% of total variance (α = 0.82 (95% CI = 0.74-0.86). CFA confirmed the two-component structure (Root Mean Square Error of Approximation = 0.03; Comparative Fit Index = 0.91; Tucker Lewis Index = 0.88).

CONCLUSIONS

The BHBS is a valid measure of social and cultural constructs associated with Black women's hair product use and perceived breast cancer risk. This scale is useful for studies that assess cultural norms in the context of breast cancer risk for Black women.

Perceptions of organizational readiness for training and implementation of clinic-based community health workers

PURPOSE

The purpose of this paper is to assess perceptions of organizational readiness to integrate clinic-based community health workers (cCHWs) between traditional CHWs and potential cCHW employers and their staff in order to inform training and implementation models.

DESIGN/METHODOLOGY/APPROACH

A cross-sectional mixed-methods approach evaluated readiness to change perceptions of traditional CHWs and potential employers and their staff. Quantitative methods included a printed survey for CHWs and online surveys in Qualtrics for employers/staff. Data were analyzed using SPSS software. Qualitative data were collected via focus groups and key informant interviews. Data were analyzed with NVIVO 11 Plus software.

FINDINGS

CHWs and employers and staff were statistically different in their perceptions on appropriateness, management support and change efficacy (p<0.0001, 0.0134 and 0.0020, respectively). Yet, their differences lay within the general range of agreement for cCHW integration (4=somewhat agree to 6=strongly agree). Three themes emerged from the interviews which provided greater insight into their differences and commonalities: perspectives on patient-centered care, organizational systems and scope of practice, and training, experiences and expectations.

ORIGINALITY/VALUE

Community health workers serve to fill the gaps in the social and health care systems. They are an innovation as an emerging workforce in health care settings. Health care organizations need to learn how to integrate paraprofessionals such as cCHWs. Understanding readiness to adopt the integration of cCHWs into clinical settings will help prepare systems through trainings and adapting organizational processes that help build capacity for successful and sustainable integration.

Association of major California freight railyards with asthma-related pediatric emergency department hospital visits

Asthma is a major health threat and leading cause of chronic morbidity among children. Air pollutants have been linked to exacerbations and promotion of initial development of asthma. Extensive research already conducted assessing adverse health impacts associated with exposure to pollutants from vehicular traffic. However, little research conducted assessing exposure to pollutants stemming from goods movement industry, such as freight railyards. This study's purpose to assess potential association between residential proximity to major freight railyards and asthma-related emergency room (ER) visits in children. This study included children ≤14 yrs. old, living within 30-mile radius of one of 18 freight railyards in California, and having utilized emergency room services between 2007 and 2009, identified through California Office of Statewide Health Planning and Development (OSHPD) database. Logistic regression modeling with all 18 railyards, and models with top 5 polluting railyards, conducted to assess for potential association between asthma related ER visit (asthma vs. non-asthma visit) and railyard residential proximity. A total 109,645 asthma related ER visits identified, majority among low income, minority populations. Within 18 railyard model, children closest to railyard (0-5 miles) were at significant increased odds (OR = 1.15, 95%CI: 1.10-1.20) for asthma related ER visit and stronger odds observed for 5 top emitting railyards (OR = 1.40, 95%CI: 1.29-1.52). Our findings indicate a strong link between asthma ER visits for children and residential proximity to railyards, especially among low-income and minority communities. There's a critical need to better understand complex health risks for individuals residing in these communities and mitigation efforts for this vulnerable population.

Patient and Community Health Worker Perceptions of Community Health Worker Clinical Integration

Traditional community health workers (CHWs) are expanding their role into clinical settings (cCHW) to support patients with care coordination and advocacy services. We investigated the potential to integrate cCHWs, via evaluation of patients' and CHWs' key demographics, needs, and abilities. This mixed-methods study, including adult patients and CHWs, was conducted in the Inland Valley of Southern California, between 2016 and 2017. Survey data, key informant interviews, and focus group discussions were evaluated to compare patient/CHW core demographics, and contrast patient-identified healthcare needs against CHW-identified cCHW service capabilities. Quantitative data were evaluated descriptively and bi-variably using two-sample independent t tests and Pearson's Chi square tests. Qualitative data were coded for emerging themes using a priori and standard grounded theory methods. Patients and CHWs were significantly similar in age, education, and income, but significantly differed in gender, race, United States generation, and marital status. For all healthcare-related services in which patients and CHWs exhibited significant differences, the odds CHWs perceived themselves capable of performing services were greater than patients' stated need of services. Patients and CHWs overlapped regarding their expectations of cCHWs. Although patients and CHWs differed somewhat, they shared many of the same expectations for cCHW integration. This information is critical to further contextualize cCHW training programs and emphasizes the need to education patients about this exciting new form of healthcare delivery. The active role of cCHWs in the clinical care team and the community may expand patient access to preventive healthcare, improve care quality, and minimize health inequities.