The development and deployment of COVID-19 vaccines were crucial to combating the global pandemic, but vaccine hesitancy posed a challenge and remains a crucial problem today. Understanding who delays or refuses vaccination and why can help with current and future vaccine campaigns by suggesting both target audiences and messaging. Because hesitant individuals report different reasons for their hesitancy, distinguishing between different types of hesitancy can help identify who will benefit from which strategies. Using 311,494 responses from the U.S. COVID-19 Trends & Impact Survey (CTIS), we used Latent Class Analysis to examine distributions of concurrently reported reasons for hesitancy, comparing distributions of responses across racial and ethnic groups. Using responses from both the early phase of vaccine availability and after all U.S. adults became eligible in the spring of 2021, we investigated differences between prospective vs. lived hesitancy. LCA revealed three different types of COVID-19 vaccine hesitancy. Some respondents primarily reported health-related concerns as reasons for hesitancy, while others indicates distrust of the government and vaccines, but the majority report fewer distinct reasons. In February 2021, White, Black, and Hispanic respondents had similar distributions of these types, but by May the results diverged. In May, White respondents were more likely to report trust concerns than Black or Hispanic respondents, who were more likely to report health concerns as their reasons for continued hesitancy. Our results contribute to the development of a more nuanced picture of COVID-19 vaccine hesitancy and the motivations behind it. The distinction between health-concerned and distrustful types of vaccine hesitancy highlights the importance of confidence in vaccine uptake, and in targeted strategies to address address hesitancy.

Socioeconomically disadvantaged and racially minoritized populations bear an elevated risk of adverse childhood experiences (ACEs), but few studies evaluate whether racial disparities in ACEs persist within socioeconomic strata. We examine the effect of both childhood socioeconomic characteristics and race on ACE burden. Data are from a population-based sample (N = 1381) of US-born non-Hispanic Black (NHB) and White (NHW) women aged 20–49 years in Metropolitan Detroit and Los Angeles County, 2011–2014. Recalled data on ACEs aged < 13 years, childhood household socioeconomic position (chSEP) aged < 13 years, childhood neighborhood poverty rate (cNPR) aged 6 years (based on US Census tract), and covariates were collected during in-person interviews. ACEs are parameterized as an index (i.e., number of adversities, range 0–12) and as individual adversities. We estimate associations between cNPR (≥ 20

Abstract Background: Asian Americans experience a disproportionately higher prevalence of Helicobacter pylori (H. pylori) infection. However, there persists limited awareness about H. pylori infection and the associated factors among this population. Methods: To assess the level of H. pylori-related knowledge and its association with immigration and provider-related factors, we conducted a cross-sectional pilot study involving 131 Asian American individuals aged 30-75 in the greater Philadelphia and NYC areas. Participants administered a questionnaire covering topics including migration experiences, provider characteristics, medical encounters, and other relevant covariates. Poisson regression was used to evaluate the relationship between these factors and H. pylori knowledge scores. Results: Among all participants, 78% (102/131) were not racially concordant with their PCP, and 39% (51/131) had limited English proficiency. Vietnamese participants had the highest mean H. pylori knowledge score (10.8, SD: 1.4), followed by Chinese (7.2, SD: 4.7) and Korean (5.7, SD: 4.4). In the crude model, racial concordance with PCPs showed a positive relationship (IRR: 1.33, 95% CI: 1.14–1.56) with knowledge scores, while length of immigration demonstrated a weak negative relationship (IRR: 0.98, 95% CI: 0.97–0.99). In the adjusted model, personal health experiences (aIRR: 1.3, 95% CI: 1.10–1.54) and patient-provider communication (aIRR: 1.71, 95% CI: 1.43–2.06) as key determinants of H. pylori knowledge. Conclusion: H. pylori knowledge in Asian Americans is influenced by immigration experiences and the trust between patients and providers, which affects information exchange, medical comprehension, and treatment adherence. Therefore, interventions aimed at improving H. pylori knowledge within the Asian American community should prioritize fostering trust between patients and their healthcare providers. This trust serves as a crucial foundation for facilitating informed decision-making and implementing preventive measures against gastric cancer. Citation Format: Zhiqing E. Liu, Jerry Kai-Chun Fu, Wenyue Lu, Phuong Do, Kathy Zhou, Ellen Kim, Yin Tan, Lin Zhu, Grace X. Ma. Patient-provider trust and immigration experiences and h. pylori knowledge among Asian Americans [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr A064.

Abstract Introduction: Early detection through routine screening is also necessary to improve the mortality rate of colorectal cancer (CRC). However, testing is up to date in only 63% of eligible adults, and rates are lower among minority race/ethnicity groups and the underinsured. Fecal immunochemical test (FIT) is non-invasive, home-based screening kit that has been an important and cost-effective option in resource-limited settings. Vietnamese Americans were disproportionally affected by CRC, yet screening rates in this population were suboptimal. Reducing this disparity requires efforts to address upstream factors such as systemic discrimination, sociocultural norms, interpersonal factors, in addition to individual-level barriers to CRC care. Methods: From 2017 to 2020, we conducted a large-scale community-based randomized controlled trial of a culturally appropriate multilevel intervention to increase colorectal cancer (CRC) screening among 801 underserved Vietnamese Americans aged 50 or older from 20 community-based organizations (CBOs) in the greater Philadelphia metropolitan area. Specifically, the intervention is conducted at three levels: (1) individual-level: education through group workshops and other medium, automated text messaging reminders, as well as patient navigation; (2) interpersonal-level: engagement of participants’ families and friends; (3) CBO-level: CBO leaders engagement and promotion of CRC screening, displaying CRC screening promotion poster at CBO facility, and organizational role improvement. Results: The study sample consist of 801 eligible Vietnamese American participants, among whom, 746 completed the 12-month follow-up survey. Most (95%) of the participants had limited English proficiency. Analyses of baseline data revealed links between CRC screening uptake and several contextual and environmental factors, including neighborhood Asian ethnic density, social deprivation, and built environment, indicating systemic and community-level barriers to CRC care. Our multilevel intervention was effective in promoting the uptake of CRC screening in the target population. At 12-month follow-up, participants from the intervention group had significantly higher rates of having had a FIT test than those in the control group (89.56% v 7.59%, p < .001) or any CRC test (91.48% vs 42.41%, p < .001). Furthermore, the intervention was effective in increasing CRC-screening related self-efficacy, de-stigmatizing CRC and CRC screening and improving social norm among participants in the intervention arm. Conclusion: In conclusion, by improving social norms and elevation CBO/community engagement in relation to CRC care, our project significantly improved CRC screening uptake among Vietnamese Americans. Implementing community-based strategies like partnering with relevant community- based organizations are important for meeting CRC screening targets. Citation Format: Grace X Ma, Lin Zhu, Yin Tan, Phuong Do, Guercie Guerrier, Min Qi Wang, Minhhuyen T Nguyen, Tam Tran, Philip Pham. Promoting colorectal cancer screening among underserved Vietnamese Americans through a multilevel community-based randomized controlled trial [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr B085.

Purpose The fecal immunochemical test (FIT) is a non-invasive method for colorectal cancer (CRC) screening, particularly effective in underserved Vietnamese American communities with low screening rates. This study reports on a culturally tailored multilevel intervention, incorporating FIT, aimed at increasing CRC screening among these populations aged 50 or above in the Greater Philadelphia metropolitan area. Methods From 2017 to 2020, we conducted a two-arm cluster randomized controlled trial to test the efficacy of a culturally tailored, multicomponent multilevel intervention aimed at increasing CRC screening uptake via enhanced self-awareness and self-efficacy, improved access to care, and changes in social norms and removal of stigma. The intervention group received multicomponent, multilevel CRC intervention including provision of a FIT self-sampling kit, with intervention approaches informed by the Centers for Disease Control's Clinical Preventive Services (CPS) Guidelines for adults 50+. The control group received only the CPS education. Results The study sample consisted of 746 eligible Vietnamese American participants recruited from 20 community-based organizations, with 95% having limited English proficiency. At 12-month follow-up, the intervention group showed substantially higher rates of FIT completion (89.56% vs. 7.59%, p < .001) and any CRC testing (91.48% vs. 42.41%, p < .001) compared to the control group. Conclusion The results suggest that the community-based, culturally-tailored multilevel intervention, which incorporates with FIT self-testing, effectively enhances CRC screening among low-income Vietnamese Americans. Additionally, these results underscore the significance of community-oriented strategies, like collaborating with relevant community-based organizations, in achieving CRC screening targets.

PURPOSE:To report the demographics of assault-related orbital fractures over a 7-year period treated at a level I urban trauma center, as well as describe and analyze the variation in assault rates across different racial/ethnic neighborhoods for patients residing in Milwaukee County.METHODS:A retrospective chart review was conducted for patients who sustained assault-related orbital fractures from January 1, 2013, through December 31, 2019, at the Froedtert & Medical College of Wisconsin, in Milwaukee, Wisconsin. A series of negative binomial regression models evaluating the association of neighborhood (i.e., US census tract) racial/ethnic composition, poverty, unemployment, percentage female head-of-household, and education level with neighborhood rate of orbital trauma was conducted.RESULTS:A total of 410 adult patients with orbital fractures attributed to assault were identified during the seven-year period, of whom 326 (80%) resided in Milwaukee County. Among these patients, 242 (74%) were male, 260 (81%) were single, and 206 (63%) were non-Hispanic Black. Majority non-Hispanic Black, Hispanic, and Other-type minority neighborhoods have 5.30, 3.35, and 3.94 times higher incidence rates of orbital assault, respectively, compared with the majority of non-Hispanic White neighborhoods. The elevated incidence rates were significantly attenuated across all minority neighborhoods after accounting for neighborhood factors of poverty, unemployment, and low education level. Low education had the strongest association with the incidence of assault-related orbital fractures, followed by unemployment.CONCLUSIONS:Results indicate that minority neighborhoods suffer from compounded burdens of both social and economic disadvantage as well as violent assaults. Additional resources allocated to poor minority communities are needed.

Abstract Introduction: Asian Americans is a Hepatitis B (HBV) disparity population who only account for 7% of the US population but experience nearly 60% burden of chronic HBV, which is associated with 75% of hepatocellular carcinoma (HCC). Adherence to HBV medication guideline is a practical approach to preventing liver cancer. However, limited studies have been conducted on promoting HBV medication adherence among underserved Asian American HBV patients. Methods: This study utilized 18-month follow-up data from a randomized controlled clinical trial aimed at improving long-term adherence to HBV medication adherence. Eligible Asian American HBV patients were recruited in the Greater Philadelphia and New York City areas from community-based organizations and clinics that serving the targeted population. Guided by Community-based Participatory Research (CBPR) approach, we developed and implemented Virtual Patient Navigation Toolkit and Text Messaging (VPN Toolkit+TM) to promote HBV pill-taking among the targeted population. HBV medication adherence was assessed using the Morisky 8-Item Medication Adherence Scale with a score ranges from 0 to 8, depression was measured with Patient Health Questionnaire-9, and knowledge of HBV was evaluated with a 10-item scale. A p-value that is smaller than 0.5 is considered statistically significant. Results: Among 149 participants (108 Chinese and 41 Vietnamese) who were prescribed HBV medication, 44.97% were female. Bivariate analysis showed that medication adherence was significantly higher in the intervention group than in the control (7.25 vs. 5.57, p<0.001 ) group at the 18-month follow-up. Results from the multivariable analysis revealed that compared with their control group counterparts, intervention group participants had significantly higher Morisky medication score (Coef.= 0.66, p=0.044), controlling for demographics, depression level, and HBV knowledge score. The results indicated that there was a significant intervention effect in medication adherence at 18-month follow-up. In addition, we found that a lower depression score (Coef.=-0.11, p<0.001) and a higher level of HBV related knowledge (Coef.=0.40, p<0.001) were significant predictors of better HBV medication adherence at 18-month follow-up assessment, with other variables held constant. Conclusion: The findings imply the necessity of promoting VPN Toolkit+ TM intervention among medically underserved HBV pill-taking patients. Moreover, targeted interventions addressing psychosocial barriers and promoting HBV-related knowledge would effectively promote HBV medication adherence among Asian Americans with chronic HBV infection. Citation Format: Wenyue Lu, Lin Zhu, Thoin Begum, Yin Tan, Minhhuyen T. Nguyen, Xiaoli Ma, Sarah Lai, Tam Tran, Phuong Do, Elizabeth Handorf, Ming-Chin Yeh, Grace X. Ma. An effective intervention toolkit to promote medication adherence among Asian Americans living with chronic hepatitis B [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr C100.

AffiliationsD. Phuong Do is with the Zilber School of Public Health, University of Wisconsin-Milwaukee. Reanne Frank is with the Department of Sociology and the Institute for Population Research, Ohio State University, Columbus.

Colorectal cancer (CRC) is one of the most common cancers in the USA and ranks third among all cancers as the leading cause of death. CRC screening is key for early detection and better patient outcomes and is recommended for individuals between ages 50 and 75. Vietnamese Americans are an Asian ethnic group that engages in low levels of colorectal cancer screening. This study aimed to determine how the environment plays a role in being able to obtain CRC screenings. A total of 517 Vietnamese Americans aged 50 years and older residing in Philadelphia County were included in the study. This study found that individuals who live in a neighborhood with greater composition of Asians were less likely to have been screened. Other neighborhood characteristics such as neighborhood walkability, social deprivation, and the presence of Federally Qualified Health Centers and Hospitals in one's neighborhood were not linked to screening. Future interventions should aim to target specific Asian neighborhoods that experience disparities in screening Colorectal cancer (CRC) is one of the most predominant cancers in the USA and ranks third among all cancers in incidence and mortality. Vietnamese Americans exhibit persistently lower screening rates compared to the general U.S. population, due to cultural, economic, and environmental barriers. The impact of environmental factors in particular is not well known, and lack of geographical access may be a significant barrier to accessing screening. This study aims to elucidate build and neighborhood environmental factors affecting CRC screening rates among Vietnamese Americans. A total of 517 Vietnamese Americans 50 years and older residing in Philadelphia County were included in the study. Surveys were collected to determine CRC screening behavior and sociodemographic characteristics. Individual neighborhood characteristics, which included the Walk Score, was obtained based on the participant's address. Neighborhood characteristics were calculated using census-tract level data for the social deprivation index, ethnic composition, and presence of hospitals or federally qualified health centers (FQHC). The generalized linear mixed model revealed that residing in an ethnically dense neighborhood was negatively associated with CRC screening (beta = -0.67, SE = 0.29, p = .01), while social deprivation (beta = 0.30, SE = 0.27, p = .27) and presence of FQHCs or hospitals (beta = 0.16, SE = 0.30, p = .58) were not. Individual neighborhood characteristics including the Walk Score (beta = 0.21, SE = 0.26, p = .43) was not associated with CRC screening behavior. Neighborhood characteristics, specifically ethnic density is associated with lower uptake of screening in this population. Future interventions should aim to target specific Vietnamese American and other Asian ethnic neighborhoods that may experience disparities in screening. Lay Summary Colorectal cancer (CRC) is one of the most common cancers in the USA and ranks third among all cancers as the leading cause of death. CRC screening is key for early detection and better patient outcomes and is recommended for individuals between ages 50 and 75. Vietnamese Americans are an Asian ethnic group that engages in low levels of colorectal cancer screening. This study aimed to determine how the environment plays a role in being able to obtain CRC screenings. A total of 517 Vietnamese Americans aged 50 years and older residing in Philadelphia County were included in the study. This study found that individuals who live in a neighborhood with greater composition of Asians were less likely to have been screened. Other neighborhood characteristics such as neighborhood walkability, social deprivation, and the presence of Federally Qualified Health Centers and Hospitals in one's neighborhood were not linked to screening. Future interventions should aim to target specific Asian neighborhoods that experience disparities in screening.

Despite tremendous efforts to quickly identify the 'vaccine hesitant' in the USA, what has emerged instead is a complex picture of a highly heterogeneous unvaccinated population. Although numerous factors have been implicated in influencing US COVID-19 vaccine decision-making, the role that prior coronavirus disease 2019 (COVID-19) infection may play in vaccine receipt has been largely uninvestigated. Using data from two separate US national surveys, the US COVID-19 Trends and Impact Survey and the Household Pulse Survey, we find that roughly one-quarter of unvaccinated survey respondents has had a prior COVID-19 infection. Prior COVID-19 infection halves the odds of receiving the vaccine. This information is consequential for ongoing vaccine outreach efforts.

Abstract Objective: To investigate whether food insecurity helps explain the association between income and psychological distress and if its role differs by disability status. Design: Using 2011–2017 National Health Interview Survey cross-sectional data (n 102 543), we conducted linear regression models, fully interacted with disability status, to estimate the association between income-to-poverty ratio (IPR) (<1, 1–<2, 2–<4, ≥4) and psychological distress (Kessler 6 (K6) Scale, range: 0–24). Base models adjusted for socio-demographic factors. We then added food security (secure, low and very low), interacted with disability, and conducted post-estimation adjusted Wald tests. Setting: USA. Participants: Nationally representative sample of non-institutionalised adults 18 years and older. Results: The association between income and psychological distress was stronger for people with disabilities. Compared to those in the highest income category (IPR ≥4), poor individuals (IPR < 1) with and without disabilities scored 2·10 (95 % CI (1·74, 2·46)) and 0·81 (95 % CI (0·69, 0·93)) points higher on the K6 Scale, respectively. Accounting for food insecurity reduced the estimated income disparity in psychological distress significantly more among individuals with disabilities (0·96 points or 46 %) than without disabilities (0·34 points or 42 %), decreasing the difference in the income disparity between those with and without disabilities by 48 % (0·62 points). Further, food insecurity more strongly predicted psychological distress for individuals with disabilities independent of socio-economic disadvantage. Conclusions: Food insecurity plays a more important role in shaping patterns of psychological distress for people with disabilities, explaining more of the association between income and psychological distress among those with than without disabilities. Improving food security may reduce mental health disparities.

PURPOSE:Rural preventable cancer disparities are often attributed in part to lower screening rates secondary to compromised health care access. When considering higher cervical cancer incidence and mortality, existing analyses primarily consider differences in Pap testing rather than the preferred method of HPV testing, which is more sensitive in identifying severe cases of cervical dysplasia.METHODS:Logistic regression using data from the 2016 and 2018 Behavioral Risk Factor Surveillance System was used to examine urban and rural rates of cervical cancer screening according to national guidelines. Propensity score weighting was used to account for baseline sociodemographic differences between rural and urban populations in the 2016 landline sample.FINDINGS:In 2016 and 2018, rural women were less likely than urban women to have current cervical cancer screening. This disparity was explained by sociodemographic variables in 2016. Among women with current cervical cancer screening, rural women were significantly less likely than urban women to undergo HPV testing in both 2016 and 2018.CONCLUSION:Rural women with current cervical cancer screening were significantly less likely than their urban counterparts to have HPV testing. It is possible that updates to preventive care guidelines may be slower to reach rural providers, rural patients may be unaware that HPV testing was completed, or rural practice configuration may complicate the integration of HPV testing into clinical practice. Failure to undergo HPV testing may lead to delayed cervical dysplasia diagnosis, missed opportunities for early intervention, and contribute to rural/urban disparities in cervical cancer incidence and mortality.

Background Residential segregation, a geospatial manifestation of structural racism, is a fundamental driver of racial and ethnic health inequities, and longitudinal studies examining segregation’s influence on cardiovascular health are limited. This study investigates the impact of segregation on hypertension in a multiracial and multiethnic cohort and explores whether neighborhood environment modifies this association. Methods and Results Leveraging data from a diverse cohort of adults recruited from 6 sites in the United States with 2 decades of follow‐up, we used race‐ and ethnicity‐stratified Cox models to examine the association between time‐varying segregation with incident hypertension in 1937 adults free of hypertension at baseline. Participants were categorized as residing in segregated and nonsegregated neighborhoods using a spatial‐weighted measure. We used a robust covariance matrix estimator to account for clustering within neighborhoods and assessed effect measure modification by neighborhood social or physical environment. Over an average follow‐up of 7.35 years, 65.5% non‐Hispanic Black, 48.1% Chinese, and 53.7% Hispanic participants developed hypertension. Net of confounders, Black and Hispanic residents in segregated neighborhoods were more likely to develop hypertension relative to residents in nonsegregated neighborhoods (Black residents: hazard ratio [HR], 1.33; 95% CI, 1.09–1.62; Hispanic residents: HR, 1.33; 95% CI, 1.04–1.70). Results were similar but not significant among Chinese residents (HR, 1.20; 95% CI, 0.83–1.73). Among Black residents, neighborhood social environment significantly modified this association such that better social environment was associated with less pronounced impact of segregation on hypertension. Conclusions This study underscores the importance of continued investigations of groups affected by the health consequences of racial residential segregation while taking contextual neighborhood factors, such as social environment, into account.

Background: Colorectal cancer (CRC) disproportionately affects Vietnamese Americans, especially those with low income and were born outside of the United States. CRC screening tests are crucial for prevention and early detection. Despite the availability of noninvasive, simple-to-conduct tests, CRC screening rates in Asian Americans, particularly Vietnamese Americans, remain suboptimal. The purpose of this study was to evaluate the interplay of multilevel factors – individual, interpersonal, and community – on CRC screening behaviors among low-income Vietnamese Americans with limited English proficiency. Methods: This study is based on the Sociocultural Health Behavior Model, a research-based model that incorporates 6 factors associated with decision-making and health-seeking behaviors that result in health care utilization. Using a community-based participatory research approach, we recruited 801 Vietnamese Americans from community-based organizations. We administered a survey to collect information on sociodemographic characteristics, health-related factors, and CRC screening-related factors. We used structural equation modeling (SEM) to identify direct and indirect predictors of lifetime CRC screening. Results: Bivariate analysis revealed that a greater number of respondents who never screened for CRC reported limited English proficiency, fewer years of US residency, and lower self-efficacy related to CRC screening. The SEM model identified self-efficacy (coefficient = 0.092, P < .01) as the only direct predictor of lifetime CRC screening. Educational attainment (coefficient = 0.13, P < .01) and health beliefs (coefficient = 0.040, P < .001) had a modest significant positive relationship with self-efficacy. Health beliefs (coefficient = 0.13, P < .001) and educational attainment (coefficient = 0.16, P < .01) had significant positive relationships with CRC knowledge. Conclusions: To increase CRC screening uptake in medically underserved Vietnamese American populations, public health interventions should aim to increase community members’ confidence in their abilities to screen for CRC and to navigate associated processes, including screening preparation, discussions with doctors, and emotional complications.

PURPOSE:Given that the relationships between higher BMI and adverse health outcomes are nonconstant and most pronounced at either ends of the BMI distribution, we assess the association between neighborhood poverty and BMI at multiple points along the BMI distribution. METHODS:Using data from the 1999 to 2015 Panel Study of Income Dynamics of Black and White adults in the United States, we estimate quantile regression models while jointly applying a marginal structural modeling approach to account for time-varying individual-level factors that may be simultaneously mediators as well as confounders. RESULTS:Neighborhood poverty was not found to be associated with bodyweight at any point along the BMI distribution for Black or White males. However, high neighborhood poverty, compared to low neighborhood poverty, predicted increases in bodyweight for Black females at the lower end of the BMI distribution and for White females at the higher end of the BMI distribution. No association was found between neighborhood poverty and BMI at the mean. CONCLUSIONS:Results identify the most vulnerable subgroups, suggesting that White females at the higher end of the BMI distribution as well as Black females at the lower end of the BMI distribution are particularly sensitive to obesogenic environments.

BACKGROUND Age-adjusted COVID-19 mortality estimates have exposed a previously hidden excess mortality burden for the US Hispanic population. Multiple explanations have been put forth, including unequal quality/access to health care, higher proportion of pre-existing health conditions, multigenerational household composition, and disproportionate representation in telecommute-unfriendly occupations. However, these hypotheses have been rarely tested. OBJECTIVE We examine age-stratified patterns of Hispanic COVID-19 mortality vis-a-vis patterns of exposure to evaluate the multiple posited hypotheses. METHODS We use a combination of public and restricted data from the Centers of Disease Control and Prevention and leverage national and subnational race- and age-stratified COVID-19 mortality and case burdens/advantages to evaluate the workplace vulnerability hypothesis. We also use individual-level information on prior health conditions and mortality from the case data to assess whether observed patterns are consistent with the other hypotheses. RESULTS Our results indicate that the disproportionate burdens for both COVID-19 case and mortality for the Hispanic population are largest among the working-age groups, supporting the hypothesis that workplace exposure plays a critical role in heightening vulnerability to COVID-19 mortality. We find little evidence to support the hypotheses regarding multigenerational household composition, pre-existing health conditions, or unequal quality/access to health care. CONCLUSION Our findings point to the key roles played by age structure and differential exposure in contributing to the disproportionately severe impact of COVID-19 on the Hispanic population. CONTRIBUTION We contribute evidence to explain the driving factors in the observed excess COVID-19 mortality burden among Hispanics. Our findings underscore the importance of focusing on more robust workplace protections, particularly for working-age minority populations.

Using 2008-2017 National Health Interview Survey data (N = 127,973), we investigated the relationship between income and psychological distress, measured by the Kessler 6 (K6) Scale (range 0-24), net of education, employment, and other sociodemographic characteristics. Regression models allowed the association to differ by disability status and number of disabilities. Lower income predicted higher psychological distress for those with and without disabilities. However, the adverse association was stronger among people with disabilities. Compared to those with incomes at least four times the poverty threshold, poor individuals with disabilities scored 2.81 (95% CI = 2.55,3.67) points higher on the K6 Scale versus 0.58 (95% CI = 0.48,0.69) points higher for those without disabilities. Differences in associations by number of disabilities were not statistically significant. Nonetheless, those with multiple disabilities were still at increased risk of distress because they were disproportionately poor. People with disabilities who are poor are particularly disadvantaged and should be prioritized in outreach efforts.

Introduction We examined how neighborhood ethnic composition influences colorectal cancer (CRC) screening behavior in Asian American adults and explored whether associations between psychosocial predictors, including knowledge, self-efficacy, and barriers affecting CRC screening behavior, varied by level of neighborhood ethnic composition. Methods Filipino, Korean, and Vietnamese Americans (N = 1,158) aged 50 years or older were included in the study. Psychosocial factors associated with CRC screening, CRC screening behavior, and sociodemographic characteristics were extracted from participants' data. Neighborhood ethnic composition was characterized as the census-tract-level percentage of Asian residents. Participants' addresses were geocoded to the census tract level to determine whether they resided in an ethnically dense neighborhood. Multilevel logistic regression models were run with and without interaction terms. Results In mixed-effects logistic regression model 1, residing in an ethnically dense neighborhood was associated with lower odds of CRC screening (odds ratio [OR] = 0.65; 95% CI, 0.45-0.93; P = .02) after controlling for age, sex, education, ethnic group, and neighborhood socioeconomic status. Greater perceived barriers to CRC screening (OR = 0.62; 95% CI, 0.50-0.77; P < .001) resulted in significantly lower odds of obtaining a CRC screening, while higher self-efficacy (OR = 1.17, 95% CI, 1.11-1.23, P < .001) was associated with higher odds. In model 2, among those residing in a high ethnic density neighborhood, greater barriers to screening were associated with lower odds of having obtained a CRC screening (OR = 0.53; 95% CI, 0.30-0.96; P= .04). Conclusion We found that residing in an ethnically dense neighborhood indicated higher disparities in obtaining CRC screenings. Future studies should examine socioeconomic and cultural disparities, as well as disparities in the built environment, that are characteristic of ethnically dense neighborhoods and assess the impact of these disparities on CRC screening behaviors.

We overcome a lack of frontline worker status information in most COVID-19 data repositories to document the extent to which occupation has contributed to COVID-19 disparities in the United States. Using national data from over a million U.S. respondents to a Facebook-Carnegie Mellon University survey administered from September 2020 to March 2021, we estimated the likelihoods of frontline workers, compared to non-frontline workers, 1) to ever test positive for SARs-Cov-2 and 2) to test positive for SARs-Cov-2 within the past two weeks. Net of other covariates including education level, county-level political environment, and rural residence, both healthcare and non-healthcare frontline workers had higher odds of having ever tested positive for SARsCov-2 across the study time period. Similarly, non-healthcare frontline workers were more likely to test positive in the previous 14 days. Conversely, healthcare frontline workers were less likely to have recently tested positive. Our findings suggest that occupational exposure has played an independent role in the uneven spread of the virus. In particular, non-healthcare frontline workers have experienced sustained higher risk of testing positive for SARs-Cov-2 compared to non-frontline workers. Alongside more worker protections, future COVID19 and other highly infectious disease response strategies must be augmented by a more robust recognition of the role that structural factors, such as the highly stratified U.S. occupational landscape, have played in the uneven toll of the COVID-19 pandemic.

Abstract Introduction: This study examined how neighborhood ethnic composition influences colorectal cancer (CRC) screening behavior in Asian Americans and explored whether the associations between psychosocial predictors including knowledge, self-efficacy, and barriers with CRC screening behavior varied by the level of neighborhood ethnic composition. Methods: A total of 1,057 Filipino, Korean, and Vietnamese Americans aged 50 and older were included in the study. Psychosocial factors associated with CRC screening, CRC screening behavior, and socio-demographics were extracted from participants’ survey data. Neighborhood ethnic composition was characterized as the census-tract level percentage of Asian residents. Participant’s addresses were geocoded to the census tract level to determine whether they resided in an ethnically dense neighborhood. Results: The mixed-effects logistic regression model 1 illustrated that residing in an ethnically dense neighborhood was associated with lower odds of CRC screening (OR=0.65, 95% CI=0.49, 0.77; p=0.019) after controlling for age, gender, education, and ethnic group. Furthermore, greater perceived barriers to CRC screening (OR= 0.62; 95% CI=0.55, 0.90; p<0.001) resulted in a lower odds of obtaining a CRC screening, while higher self-efficacy (OR=1.17, 95% CI=1.11, 1.23, p<0.001) was associated with greater odds of CRC screening. In model 2, among those residing in a high ethnically dense neighborhood, greater barriers to screening was associated with lower odds of having obtained a CRC screening (OR=0.51; 95% CI=0.28, 0.93; p=0.028). Conclusion: The study findings revealed that residing in an ethnically dense neighborhood led to a lower likelihood of having obtained a CRC screening. Future studies should examine disparities in built environment, socioeconomic, and cultural factors that are characteristic of ethnically dense neighborhoods and their impact on CRC screening participation. Citation Format: Aisha Bhimla, Ming-Chin Yeh, Tyrell Mann-Barnes, Phuong Do, Chul Kim, Hemi Park, Grace X. Ma. The effects of neighborhood ethnic density and psychosocial factors on colorectal cancer screening behavior among Asian American adults [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-166.