OBJECTIVE To compare the rate of diagnosing clinically significant prostate cancer (csPCa) in men with elevated prostate-specific antigen (PSA) stratified by baseline IsoPSA Index, thus assessing IsoPSA's intermediate-term predictive ability for csPCa. MATERIAL AND METHODS Single-center retrospective review of consecutive patients (n = 1578) who underwent IsoPSA testing from November 2016-August 2022. Data dichotomized into patients with low (<= 6) and high IsoPSA Indices (> 6). Most recent subsequent IsoPSA and PSA tests, prostate biopsy, and magnetic resonance imaging (MRI) collected. Time-to-event Kaplan-Meier estimates generated for the risk of csPCa stratified by baseline IsoPSA Index. RESULTS Among 541 patients with initial low IsoPSA Indices (<= 6), 23 (4.3%) were diagnosed with csPCa on a subsequent biopsy. Also, among these 541 patients, 204 had an MRI, of which 48/204 (23.5%) showed suspicious lesions (PIRADS >= 4). Among 1037 patients with initial high IsoPSA Indices, 366 (35.3%) were diagnosed with csPCa on a subsequent biopsy. Also, among these 1037 patients, 712 had an MRI, of which 342/712 (48.0%) showed suspicious lesions (PIRADS >= 4). After 12, 24, and 30 months, respectively, the risk of developing csPCa was 0.4% (95% CI 0.1%-1.6%), 2.5% (1.4%-4.4%), and 6.3% (4%-9.6%) in patients with low IsoPSA Indices, compared to 5.9% (4.6%-7.6%), 31.7% (28.3%-35.4%), and 49.5% (45.3%-53.9%) in patients with high IsoPSA Indices. Limitations include the retrospective review of prospectively collected data and unknown true csPCa rates as not all patients were biopsied. CONCLUSION The risk of developing csPCa was smaller in patients with initial low vs high IsoPSA Indices over the ensuing 30 months, which supports using IsoPSA to safely avoid follow-up testing. UROLOGY 201: 69-75, 2025. (c) 2025 Elsevier Inc. All rights are reserved, including those for text and data mining, AI training, and similar technologies.

BACKGROUND:Unintentional traumatic injuries pose a significant public health challenge, impacting not only injured individuals but also their families. Existing research has largely focused on the effects of a child's injury on their family, with limited attention to the consequences of parental injury on children's health. This study aims to explore the consequences of unintentional parental injury on children's health outcomes, health care utilization, and socioeconomic barriers to care. METHODS:We utilized data from the National Health Interview Survey (NHIS) for 2020, 2021, and 2023, creating parent-child dyads where the parent was injured. Injury was defined by a positive response to experiencing an injury and seeking medical consultation after. Children aged 5 years to 17 years and their parents were included. Three outcome domains were examined: health outcomes, health care utilization, and socioeconomic health impacts. Bivariate and logistic regression analyses were conducted to assess the impact of parental injury on these outcomes. RESULTS:We identified 414 (weighted = 1,338,068) injured parent-child dyads and 10,352 noninjured dyads. Children of injured parents had higher odds of being diagnosed with attention-deficit hyperactivity disorder/attention-deficit disorder (odds ratio [OR], 1.69; 95% confidence interval [CI], 1.31-2.40; p = 0.005), higher Washington Group Composite Disability Scores (OR, 1.77; 95% CI, 1.25-2.47; p = 0.001), and increased injury odds (OR, 2.29; 95% CI, 1.58-3.28; p < 0.001). They also showed higher rates of urgent care visits, with significantly higher emergency department visits (OR, 1.49; 95% CI, 1.02-2.13; p = 0.03). Financial toxicity was significant, with increased odds of delaying (OR, 2.37; 95% CI, 1.14-5.40; p = 0.03) or avoiding care (OR, 3.06; 95% CI, 1.06-7.76; p = 0.02) due to cost. CONCLUSION:This study highlights the broad-reaching impact of parental injury on children, including worse health outcomes, increased health care utilization, and significant financial barriers. These findings underscore the need for comprehensive trauma care that addresses the holistic needs of families, incorporating strategies to mitigate both health and socioeconomic challenges. LEVEL OF EVIDENCE:Prognostic and Epidemiological; Level III.

Objective To automate the generation of three validated nephrometry scoring systems on preoperative computerised tomography (CT) scans by developing artificial intelligence (AI)‐based image processing methods. Subsequently, we aimed to evaluate the ability of these scores to predict meaningful pathological and perioperative outcomes. Patients and Methods A total of 300 patients with preoperative CT with early arterial contrast phase were identified from a cohort of 544 consecutive patients undergoing surgical extirpation for suspected renal cancer. A deep neural network approach was used to automatically segment kidneys and tumours, and then geometric algorithms were used to measure the components of the concordance index (C‐Index), Preoperative Aspects and Dimensions Used for an Anatomical classification of renal tumours (PADUA), and tumour contact surface area (CSA) nephrometry scores. Human scores were independently calculated by medical personnel blinded to the AI scores. AI and human score agreement was assessed using linear regression and predictive abilities for meaningful outcomes were assessed using logistic regression and receiver operating characteristic curve analyses. Results The median (interquartile range) age was 60 (51–68) years, and 40% were female. The median tumour size was 4.2 cm and 91.3% had malignant tumours. In all, 27% of the tumours were high stage, 37% high grade, and 63% of the patients underwent partial nephrectomy. There was significant agreement between human and AI scores on linear regression analyses ( R ranged from 0.574 to 0.828, all P < 0.001). The AI‐generated scores were equivalent or superior to human‐generated scores for all examined outcomes including high‐grade histology, high‐stage tumour, indolent tumour, pathological tumour necrosis, and radical nephrectomy (vs partial nephrectomy) surgical approach. Conclusions Fully automated AI‐generated C‐Index, PADUA, and tumour CSA nephrometry scores are similar to human‐generated scores and predict a wide variety of meaningful outcomes. Once validated, our results suggest that AI‐generated nephrometry scores could be delivered automatically from a preoperative CT scan to a clinician and patient at the point of care to aid in decision making.

292 Background: IsoPSA is a structure-based serum assay. Initial studies demonstrated that it outperformed total and percent-free PSA in detecting clinically significant prostate cancer (csPCa) (i.e., grade group (GG) ≥2) on biopsy. This led to an overall reduction in invasive testing and magnetic resonance imaging (MRI). We sought to compare the risk of csPCa in patients with an initially normal or high IsoPSA, thus assessing IsoPSA’s prospective predictive ability of csPCa. Methods: We performed a single-center retrospective review of patients (n=1578) who underwent IsoPSA testing from November 2016 to August 2022. Data was dichotomized into patients with normal (≤6) and high IsoPSA (>6). We collected the outcomes of any follow-up IsoPSA, prostate biopsy, MRI, and diagnosis of prostate cancer. In the case of multiple follow-up tests, the most recent one was recorded. Results: The median follow-up time of 1578 patients who underwent IsoPSA testing was 24 months (IQR 16-29). Among 541 patients with an initial normal IsoPSA, 60 (11.1%) had a subsequent high IsoPSA, 23 (4.3%) had csPCa on a subsequent biopsy, and 48 (8.9%) had suspicious lesions on MRI (PI-RADS 4-5). Among 1037 patients with an initial high IsoPSA, 366 (35.3%) had csPCa on a subsequent biopsy and 342 (33%) had suspicious lesions on MRI. The sensitivity of IsoPSA to predict csPCa was 94.1%, and its negative predictive value was 89.3%. Conclusions: With 24-month follow-up, 4.3% of patients with normal IsoPSA developed csPCa, suggesting that a low baseline IsoPSA provides durable information about the 2-year risk of csPCa.[Table: see text]

IntroductionFor adult trauma patients, the likelihood of receiving treatment at a hospital properly equipped for trauma care can vary by race and sex. This study examines whether a pediatric patient's race/ethnicity and sex are associated with treatment at a high acuity trauma hospital (HATH).Materials and methodsUsing the 2017 National Inpatient Sample, we identified pediatric trauma patients ( ≤16 y) using International Classification of Diseases-10 codes. Because trauma centers are not defined in National Inpatient Sample, we defined HATHs as hospitals which transferred 0% of pediatric neurotrauma. We used logistic regression to examine associations between race/ethnicity, sex, age, and treatment at a HATH, adjusted for factors including Injury Severity Score, mechanism of injury, and region.ResultsOf 18,085 injured children (median Injury Severity Score 3 [IQR 1-8]), 67% were admitted to a HATH. Compared to White patients, Hispanic (odds ratio [OR] 0.85 [95% confidence interval [CI] 0.79-0.93]) and other race/ethnicity patients (OR 0.85 [95% CI 0.78-0.93]) had a significantly lower odds of treatment at a HATH. Children aged 2-11 (OR 1.36 [95% CI 1.27-1.46]) were more likely to be treated at a HATH compared to adolescents (age 12-16). After adjustment for other factors, sex was not associated with treatment at a HATH.ConclusionsOur study demonstrated racial and ethnic disparities in access to HATHs for pediatric trauma patients. Hispanic and other race/ethnicity pediatric trauma patients have lower odds of treatment at HATHs. Further research is needed to study the root causes of these disparities to ensure that all children with injuries receive equitable and high-quality care.

Medical mistrust (MM) is seen as a barrier to assessing healthcare needs and addressing health disparities; however, limited literature has focused on assessing MM for vulnerable populations, especially racial/ethnic minority and sexual/gender minority youth and young adults (YYA). Between February 2021 and March 2022, we conducted the Youth and Young Adults COVID-19 Study, a prospective cohort of minoritized YYA aged 14 to 24 years (n = 1027), within the United States and its territories. Participants were recruited through a combination of paid social media ads, outreach with organizations serving marginalized youth, and an existing registry, targeting racial and ethnic minority and LGBTQ + youth for a study on COVID-19 health behaviors. Multiple multinomial logistic regression models were developed to examine associations between demographics and three dimensions of MM including healthcare experience, government information, and scientific information. Most participants were between the ages of 18 and 21 years (48.3

Transgender individuals are disproportionately affected by HIV in the United States. Given increased risk of HIV among youth, there is a need to understand HIV risk and protective factors among transgender individuals who are 18 years and younger. Patterns of HIV testing, HIV education, and condom use have known associations with HIV outcomes among youth in general, but are understudied among transgender youth. This study assessed these outcomes by developing a series of sex-stratified multivariable logistic regression models using pooled Youth Risk Behavior Survey data. Results indicate female and male transgender youth as well as males who were not sure they were transgender were more likely have tested for HIV compared with their not transgender peers. Male transgender youth were significantly less likely to have received HIV education compared with not transgender males. Females not sure if they were transgender and male transgender youth were significantly less likely to have used condoms compared with, respectively, not transgender female and not transgender male counterparts. In sum, condom use and HIV education both remain lower among transgender individuals relative to their not-transgender peers. This highlights the need for the promotion of culturally appropriate HIV education and HIV prevention supports among transgender youth.

623 Background: The Centrality index (C-index) score is a validated nephrometry scoring system that requires precise measurements and mathematical calculations of cross sectional imaging. Like other nephrometry scores, its implementation has been slowed by required time investment and interobserver variability. We sought to automate this score on preoperative computerized tomography scans by developing an artificial intelligence-generated C-index score. We then aimed to evaluate its ability to predict meaningful oncologic and perioperative outcomes as compared to human-generated C-index nephrometry scores. Methods: 300 patients with preoperative computerized tomography with early arterial contrast phase were identified from a cohort of 544 consecutive patients undergoing surgical extirpation for suspected renal cancer. A deep neural network approach was used to automatically segment kidneys and tumors, and then programed to generate the measurements and calculate C-index score. Human C-index scores were independently calculated by medical personnel blinded to AI-scores. AI- and Human score agreement was assessed using bivariate linear regression correlation and their predictive abilities for both oncologic and perioperative outcomes were assessed using logistic regression and compared with receiver operating characteristic (ROC) curve analyses with measurements of areas under the curve (AUC). Results: Median age was 60 years (IQE 51–68), and 40% were female. Median tumor size was 4.2 cm and 91.3% had malignant tumors. 27% were high stage, 37% high grade, and 63% underwent partial nephrectomy. There was significant agreement between Human scores and AI-scores on linear regression analysis (R2 = 0.738, p <0.0001). Both AI- and Human generated C-index scores similarly predicted meaningful oncologic outcomes, with lower levels of either C-index score associated with increased risk of malignant histology (H-score p = 0.018, AI score p =0.014) high-grade disease (both p <0.0001), and high stage disease (both p <0.0001). Lower levels of either AI or human generated C-index scores also predicted a radical nephrectomy rather than partial nephrectomy surgical approach (both p <0.0001). AUC measurements (Table) were similar but consistently superior for AI generated C-index scores. Conclusions: Fully automated AI-generated C-index scores are comparable to human-generated C-index scores and predict a wide variety of meaningful patient-centered outcomes. Once validated in additional populations, our results suggest that our AI generated C-index could be delivered automatically from a preoperative CT scan to a clinician and patient at the point of care to aid in decision making. [Table: see text]

You have accessJournal of UrologyCME1 Apr 2023PD08-06 FULLY AUTOMATED TUMOR CONTACT SURFACE AREA PREDICTS POSTOPERATIVE IPSILATERAL GFR PRESERVATION FOLLOWING PARTIAL NEPHRECTOMY Andrew Wood, Nicholas Heller, Tarik Benidir, Nour Abdallah, Fabian Isensee, Resha Tejpaul, Chalairat Suk-Ouichai, Caleb Curry, Alex You, Erick Remer, Samuel Haywood, Robert Abouassaly, Steven Campbell, Nikolaos Papanikolopoulos, and Christopher Weight Andrew WoodAndrew Wood More articles by this author , Nicholas HellerNicholas Heller More articles by this author , Tarik BenidirTarik Benidir More articles by this author , Nour AbdallahNour Abdallah More articles by this author , Fabian IsenseeFabian Isensee More articles by this author , Resha TejpaulResha Tejpaul More articles by this author , Chalairat Suk-OuichaiChalairat Suk-Ouichai More articles by this author , Caleb CurryCaleb Curry More articles by this author , Alex YouAlex You More articles by this author , Erick RemerErick Remer More articles by this author , Samuel HaywoodSamuel Haywood More articles by this author , Robert AbouassalyRobert Abouassaly More articles by this author , Steven CampbellSteven Campbell More articles by this author , Nikolaos PapanikolopoulosNikolaos Papanikolopoulos More articles by this author , and Christopher WeightChristopher Weight More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003239.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Tumor Contact Surface Area (CSA) is an externally validated nephrometry scoring system that requires measurement of multiple dimensions of cross sectional imaging. Despite studies demonstrating its ability to predict glomerular filtration rate (GFR) following partial nephrectomy (PN), its implementation has been slowed by required time investment and interobserver variability. We sought to evaluate the utility of artificial intelligence (AI) generated CSA as compared to human-generated CSA in predicting post-PN GFR. METHODS: A total of 300 patients with preoperative computerized tomography with early arterial contrast phase were identified from a cohort of 544 consecutive patients undergoing surgical extirpation for suspected renal cancer. A deep neural network approach was used to automatically segment kidneys and tumors, and then programed to generate the measurements and calculate tumor CSA. Human CSA scores were independently calculated by medical personnel blinded to AI-scores. Ipsilateral GFR before and after surgery was calculated from volumetric analyses of kidney parenchyma and pre and post-operative GFR values. AI-CSA and Human-CSA were then compared with regards to their ability to predict Ipsilateral GFR preservation. RESULTS: After removal of patients undergoing RN and those without requisite data for GFR calculation, a total of 150 patients were included in the analysis. There was significant agreement between Human CSA and AI-CSA on linear regression analysis (R2=0.74, p<0.0001). On univariate linear regression analysis, both AI- (r=0.217, p=0.0076) and Human generated (r=0.187, p=0.021) CSA similarly predicted ipsilateral GFR preservation. However, when incorporated into a MV model incorporating age, gender, body mass index, diabetes status, and ischemia time, only AI generated tumor CSA remained a significant predictor of ipsilateral GFR preservation (p=0.021). CONCLUSIONS: Fully automated tumor CSA calculations are not inferior, and may be superior, to human generated CSA calculations in predicting post-operative GFR after PN. Once validated, our results suggest that AI generated CSA could be delivered automatically from a preoperative CT scan to a clinician and patient at the point of care to aid in decision making. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e234 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Andrew Wood More articles by this author Nicholas Heller More articles by this author Tarik Benidir More articles by this author Nour Abdallah More articles by this author Fabian Isensee More articles by this author Resha Tejpaul More articles by this author Chalairat Suk-Ouichai More articles by this author Caleb Curry More articles by this author Alex You More articles by this author Erick Remer More articles by this author Samuel Haywood More articles by this author Robert Abouassaly More articles by this author Steven Campbell More articles by this author Nikolaos Papanikolopoulos More articles by this author Christopher Weight More articles by this author Expand All Advertisement PDF downloadLoading ...

325 Background: IsoPSA is a structure-based serum assay exploring the spectrum of possible prostate-specific antigen (PSA) isoforms. It was shown to outperform total and percent-free PSA in detecting clinically significant prostate cancer (csPCa) (grade group (GG) ≥2 on biopsy). IsoPSA reduced unnecessary biopsies and magnetic resonance imaging (MRI). We sought to compare the outcomes of eventual biopsy and imaging of surveilled patients with an initially normal or high IsoPSA, thus assessing IsoPSA’s prospective predictive ability of csPCa. Methods: We performed a single-center retrospective review of patients who underwent IsoPSA testing from 2017-present. Data was dichotomized into patients with normal (≤6) and high IsoPSA (>6). We collected the outcomes of any consequent IsoPSA and PSA test, prostate biopsy and MRI. We calculated the statistical IsoPSA’s characteristics for the prediction of csPCa on biopsy. Results: The median follow-up time of 811 patients who underwent IsoPSA testing was 18 months (IQR, 16.5-20). Among 443 patients with initial low IsoPSA, 5 (1.1%) had a csPCa on a subsequent biopsy, 19 (4.3%) subsequent high IsoPSA, 122 (27.5%) rising PSA, and 22 (5%) csPCa on MRI. Among 368 patients with initial high IsoPSA, 105 (28.5%) had a csPCa on a subsequent biopsy and 106 (28.8%) on an MRI. The sensitivity of IsoPSA to predict csPCa was 95.5%, and the NPV was 94.8%. Among 124 patients with high IsoPSA and initial negative biopsy, 110 had a subsequent negative and 14 a positive biopsy (10GG1 (8.1%), 4 ≥GG2 (3.2%)), with a respective median IsoPSA of 7.2 and 9.6 (p=0.007). An IsoPSA>10 generated an OR of csPCa of 7.2 (95%CI 2.1-25.2, p=0.0005). Conclusions: In 18-month follow-up, 1.1% of patients with normal IsoPSA developed csPCa compared to 28.5% of patients with high IsoPSA. In the cohort of patients with high IsoPSA and initially negative biopsy, 3.2% eventually developed csPCa, however, having a significantly higher IsoPSA than those who remained negative. The odds of having csPCa were 7 times higher with IsoPSA>10. [Table: see text]

Purpose To assess whether the COVID-19 pandemic has inequitably impacted key social determinants of health (SDoH), specifically employment, housing, and health care, for U.S. transgender populations. Methods Between April 13, 2020 and August 3, 2020, we conducted a national, cross-sectional online survey of sexual and gender minority individuals (N=870). We used logistic regression to calculate both unadjusted and adjusted odds of unemployment, homelessness/housing instability, and interruptions in medical care owing to the pandemic by gender and gender modality. Adjusted models controlled for age, race/ethnicity, and region. Results In adjusted models, transgender and gender diverse people had 2.12 times the odds of reporting homelessness/housing instability and 2.88 times the odds of reporting medical care interruptions compared with cisgender peers. Transgender men, women, and nonbinary people had 4.12, 3.29, and 3.48 times the adjusted odds of interruptions in medical care compared with cisgender men, respectively. We did not observe significant differences in employment. Conclusions Findings add empirical support to the hypothesis that socioeconomic consequences of COVID-19 are inequitably impacting transgender people. To contextualize our results and support future research in this area, we present a conceptual model of the short- and long-term impacts of COVID-19 on transgender populations using a framework of stigma as a fundamental cause of health inequities. Our findings emphasize that public health professionals must urgently consider-and intervene to address-the pandemic's SDoH-related impacts on transgender populations.

You have accessJournal of UrologyCME1 May 2022MP42-04 FINANCIAL BURDEN OF BLADDER CANCER CARE: CDC NATIONAL HEALTH SURVEY ANALYSIS Laura Bukavina, Alberto Castro Bigalli, Thomas Cwalina, Caleb Curry, Michael Callegari, Megan Prunty, Ilaha Isali, Mohit Sindhani, Adam Calaway, Lee Ponsky, Andres Correa, Alexander Kutikov, and Sarah Psutka Laura BukavinaLaura Bukavina More articles by this author , Alberto Castro BigalliAlberto Castro Bigalli More articles by this author , Thomas CwalinaThomas Cwalina More articles by this author , Caleb CurryCaleb Curry More articles by this author , Michael CallegariMichael Callegari More articles by this author , Megan PruntyMegan Prunty More articles by this author , Ilaha IsaliIlaha Isali More articles by this author , Mohit SindhaniMohit Sindhani More articles by this author , Adam CalawayAdam Calaway More articles by this author , Lee PonskyLee Ponsky More articles by this author , Andres CorreaAndres Correa More articles by this author , Alexander KutikovAlexander Kutikov More articles by this author , and Sarah PsutkaSarah Psutka More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002608.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Financial toxicity (FT) has been associated with inferior clinical outcomes and is particularly relevant in bladder cancer (BCa). We aimed to analyze the impact of FT in BCa patients through measurement of the prevalence of delayed or missed clinical care secondary to FT. METHODS: We used 2008-2016 Centers for Disease Control National Health Interview Survey (CDC NHIS) to identify adults with history of BCa, stratified by age (18-64yo, >65yo) and compared them to adults without a history of cancer. We measured the following financial stressors 1) delaying or foregoing medical care 2) delay in dental care 3) worry about medical bills 4) delay in seeking mental health 5) difficulties paying for prescription medication. We used sampling and design variables to account for the complex survey design and participant nonresponse, and to make the estimates nationally representative. To estimate the association between covariates and BCa related problems, we used multivariable logistic regression (predictive margins). RESULTS: BCa survivors (18-64yo) did not report higher incidence of delay in care or foregoing care, worrying about medical bills, or inability to afford prescription medication. BCa survivors (>65yo) reported higher incidence of inability to afford mental care (17.14% vs 0.52%), delaying or foregoing care (10.26% vs 4.8%). However, BCa patients did not report an increase in worry about paying for medical bills (6.15 % vs 23.05%), and inability to afford prescriptions (0.68 vs 15.98%). On multivariable analysis, the odds ratio of individual measures reported highlighted that BCa survivors were less likely to report worrying about medical costs [OR 0.66, p=0.037] as compared to individuals without cancer (after adjusting for clinical characteristics and comorbidities), although they were more likely to report delay in medical care [OR 1.16, p=0.045] (Table 2). CONCLUSIONS: Identification of patients at risk for excess medical financial hardships is needed to move the discussion from problem acknowledgement to identifying solutions and implementing strategies. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e731 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Laura Bukavina More articles by this author Alberto Castro Bigalli More articles by this author Thomas Cwalina More articles by this author Caleb Curry More articles by this author Michael Callegari More articles by this author Megan Prunty More articles by this author Ilaha Isali More articles by this author Mohit Sindhani More articles by this author Adam Calaway More articles by this author Lee Ponsky More articles by this author Andres Correa More articles by this author Alexander Kutikov More articles by this author Sarah Psutka More articles by this author Expand All Advertisement PDF downloadLoading ...

Introduction: Sexual minority and/or racial/ethnic minority youth may use alcohol at school as a form of minority stress-based coping. Polyvictimization is particularly prevalent among sexual minority and/or racial/ethnic minority youth and may be a useful proxy measure for minority stressors. Methods: Data from local administrations of the Youth Risk Behavior Survey were pooled across 42 jurisdiction years (biennially, 2009-2017) and analyzed in 2022, resulting in a sample of 118,052 U.S. youth. The prevalence of alcohol use at school was examined by sexual identity, race/ethnicity, and their intersections, stratified by sex. Multivariable logistic regression models were built to examine the disparities in alcohol use at school and the impact of school-based polyvictimization. Results: At the intersections of race/ethnicity and sexual identity, 25 of 30 sexual minority and/or racial/ethnic minority subpopulations had greater odds of alcohol use at school than their White heterosexual same-sex peers. Hispanic/Latinx not-sure males (AOR=9.15; 95% CI=5.97, 14.03) and Hispanic/Latinx lesbian females (AOR=11.24; 95% CI=6.40, 19.77) were most likely to report alcohol use at school. After adjusting for polyvictimization, the magnitude of association was attenuated for most sexual minority and/or racial/ethnic minority subpopulations; however, all but 2 significant associations remained. Conclusions: Sexual minority and/or racial/ethnic minority youth were more likely than White heterosexual peers to use alcohol at school, with the greatest odds among multiply marginalized and polyvictimized youth. Interventions should consider addressing more than school-based victimization alone because disparities persisted, although at a lower magnitude, after accounting for polyvictimization. Future longitudinal studies are warranted to further explore the associations between multiply marginalized identities, school-based polyvictimization, and alcohol use at school. (C) 2022 American Journal of Preventive Medicine. Published by Elsevier Inc. All reserved.

BACKGROUND: Sexual minority and racial/ethnic minority youth experience a higher burden of asthma. The frameworks of minority stress theory and intersectionality suggest that sexual minority and racial/ethnic minority youth may experience disparities in nonremitting asthma. OBJECTIVE: To examine adjusted odds of nonremitting asthma by sexual identity, race/ethnicity, and their intersections, along with their relationship with traditional nonremitting asthma risk factors (weight status and smoking) and victimization (bullying, cyberbullying, and forced sex). METHODS: We used data from the Youth Risk Behavior Survey pooled across 41 jurisdiction-years (biennially, 2009-2017), resulting in a sample of 21,789 US youth. The prevalence of nonremitting asthma was examined by sexual identity, race/ethnicity, and their intersections, stratified by sex. Bivariate associations and backward logistic regression models, stratified by sex, were built to examine nonremitting asthma disparities and the effects of selected traditional correlates and victimization variables. RESULTS: At the intersections, 8 sexual minority and racial/ ethnic minority subpopulations were significantly more likely to have nonremitting asthma compared with White heterosexual sex-matched peers. White gay males and Black lesbian females had the highest odds of nonremitting asthma. Traditional risks of nonremitting asthma and victimization were associated with attenuated odds of nonremitting asthma. CONCLUSIONS: Many sexual minority and racial/ethnic youth subpopulations are more likely to have nonremitting asthma. Evidence suggests that traditional nonremitting asthma risk factors and victimization may partly explain disparities in nonremitting asthma. Asthma management guidelines should be updated to include population health disparities of sexual and racial/ethnic minorities. (C) 2021 American Academy of Allergy, Asthma & Immunology

Attaining equity in vaccination distribution is a moral and ethical goal that ensures all members of our community are properly cared for. We suggest a comprehensive approach that involves allocating community resources based on local economic, demographic, and COVID-19 infection data, removing technology barriers by staffing vaccine appointment call-in centers, distributing vaccines based on objective factors (eg, household density) rather than on a “first come, first served” basis, and creating pop-up vaccination sites at trusted community organizations such as federally qualified healthcare centers, churches, libraries, and barber/beauty shops. Until every community is safe, no community will be safe.

Objectives. To comprehensively assess asthma disparities and identify correlates in youths at the intersections of sex, sexual identity, and race/ethnicity in the United States. Methods. We obtained a diverse sample of youths (n = 307 073) from the Centers for Disease Control and Prevention's Youth Risk Behavior Survey. We pooled data across 107 jurisdiction-years (2009-2017). We calculated lifetime asthma prevalence by sexual identity, race/ethnicity, and their intersections-stratified by sex. We developed multivariable weighted logistic regression models to examine the impact of selected correlates on lifetime asthma prevalence. Results. Lesbian, gay, and bisexual youths have significant disparities in asthma prevalence compared with heterosexual peers. Moreover, across sex, higher prevalence of lifetime asthma was seen for most sexual identity and race/ethnicity subpopulations (27 of 30) when compared with White heterosexual sex-matched participants. Selected traditional risk factors (overweight, obese, and smoking) and bullying tended to attenuate odds among groups, especially those with a minority sexual identity. Conclusions. Asthma inequities at the intersection of sexual identity and race/ethnicity are substantive. Future studies should investigate the mechanisms contributing to these disparities to promote health equity among vulnerable youth populations.

Sexual and gender minority (SGM) populations may be affected disproportionately by health emergencies such as the coronavirus disease 2019 (COVID-19) pandemic. Health professionals must take immediate steps to ensure equitable treatment of SGM populations. These steps are to (1) maintain and increase cultural responsiveness training and preparedness for SGM populations, (2) increase use of sexual orientation and gender identity measures in surveillance, (3) conduct research on the impacts of COVID-19 on SGM populations, and (4) include equity-focused initiatives in disaster preparedness plans. These actions toward equity would begin to allow for our current health system to care more appropriately for SGM populations.

The ongoing COVID-19 pandemic has had widespread social, psychological, and economic impacts. However, these impacts are not distributed equally: already marginalized populations, specifically racial/ethnic minority groups and sexual and gender minority populations, may be more likely to suffer the effects of COVID-19. The COVID-19 Resiliency Survey was conducted by the city of Chicago to assess the impact of COVID-19 on city residents in the wake of Chicago's initial lockdown, with particular focus on the experiences of minority populations. Chi-square tests of independence were performed to compare COVID-19-related outcomes and impacts on heterosexual vs. sexual minority populations, cisgender vs. gender minority populations, and White vs. racial/ethnic minority subgroups. Marginalized populations experienced significant disparities in COVID-19 exposure, susceptibility, and treatment access, as well as in psychosocial effects of the pandemic. Notably, Black and Latinx populations reported significant difficulties accessing food and supplies (p = 0.002). Healthcare access disparities were also visible, with Black and Latinx respondents reporting significantly lower levels of access to a provider to see if COVID-19 testing would be appropriate (p = 0.013), medical services (p = 0.001), and use of telehealth for mental health services (p = 0.001). Sexual minority respondents reported significantly lower rates of using telehealth for mental health services (p = 0.011), and gender minority respondents reported significantly lower levels of primary care provider access (p = 0.016). There are evident COVID-19 disparities experienced in Chicago especially for Black, Latinx, sexual minority, and gender minority groups. A greater focus must be paid to health equity, including providing increased resources and supplies for affected groups, adapting to inequities in the built environment, and ensuring adequate access to healthcare services to ameliorate the burden of COVID-19 on these marginalized populations.

HIV remains a serious concern among youth, particularly among sexual minority youth (SMY). Risk behaviors including low rates of HIV testing and inconsistent condom use as well as use of substances before sex contribute to these disparities. Therefore, HIV education in schools may be a valuable tool for reducing HIV-related risk behaviors. Using a large, pooled sample of youth ( N = 169,468) from the 2009–2017 Youth Risk Behavior Survey (YRBS), we conducted the first population-level assessment of associations between HIV education and risk behavior prevalence among high school–aged youth by sexual behavior (i.e., sex of sexual partner [s]) in the USA. Results demonstrated that racial/ethnic minority youth and SMY were less likely to have received HIV education than White or heterosexual peers. HIV education was associated with less substance use at last sex. Among males, HIV education was associated with increased condom use and HIV testing, emphasizing its promise as a potential intervention for risk behavior reduction. Results are discussed in light of current literature with future recommendations.