Background Previous research suggests that some women are using integrative and complementary holistic approaches to optimize their own health and treat infertility. We aimed to determine patterns of integrative medicine use among those seeking fertility optimization by 1) Characterizing patterns of integrative medicine use to increase fertility; 2) Identifying demographic predictors associated with such integrative medicine use; and 3) Exploring cultural and religious influences on use of integrative medicine. Methods Cross-sectional self-reported survey data were collected from 1460 patients presenting to an academic fertility center in Chicago, Illinois. Variables were described with univariate frequencies and proportions, unadjusted bivariate comparisons were made between patient-level factors and reported integrative modality use, and multivariable logistic regression evaluated the strength of covariate-adjusted predictors of reported integrative medicine utilization. Results 80.4% of respondents reported using at least one integrative medicine modality to treat infertility (Acupuncture: 38.5%, Yoga: 27.6%, Massage: 25.8%, Meditation: 16.7%, and Herbal supplements: 18.5%). Diet therapy was the most frequently utilized modality (74.0%) followed by body therapy (45.2%), traditional alternative medicine (42.0%), mind therapy (32.1%), and senses therapy (23.0%). Any integrative medicine modality use was 4.03 times more likely among Hindu respondents compared to participants that identified as not religious (95% CI 1.2–13.7, p < 0.026). Significant differences in specific modality use were observed by race, religious affiliation, age, income, and insurance coverage. Conclusion Most infertility patients in our study reported using at least one integrative medicine modality to help them conceive. Utilization was associated with age of participant, religious affiliation, annual income, and insurance coverage. Further research is needed to assess the impact of integrative medicine utilization on patient quality of life and outcomes.

BACKGROUND:The overrepresentation of White participants in food allergy research contributes to the development of research questions and interventions not driven by those disproportionately affected by the condition. This ultimately limits the generalizability of research findings and affects the development of knowledge about food allergy and food allergy management.OBJECTIVE:To develop recommendations to combat inequitable research paradigms and increase participation of racially underrepresented populations in food allergy research.METHODS:This study used a modified consensus development method, known as a Delphi method, to assemble the expertise of food allergy clinicians, advocacy leaders, community-engaged researchers, and patients.RESULTS:Findings resulted in 18 recommendations within four domains: community partnership, intentional engagement and messaging, recruitment activities, and dissemination.CONCLUSIONS:Findings from this study provide food allergy researchers with specific recommendations for examining their efforts more critically toward recruiting and engaging with racially underrepresented populations, effectively transitioning from a research-on to a research-with relationship with individuals and families living with food allergy.

Food allergy (FA) affects an estimated 8% of children and 11% of adults.1,2 Population-level survey data suggest that 45.3% of adults and 39.9% of children having FAs are allergic to multiple foods and that racial and ethnic minorities have the highest prevalence of FA in childhood.1,2 Although the cross-reactivity of specific food proteins has been established, much less is known about its clinical relevance and association with sociodemographic characteristics.3 Here, we present the degree to which common cross-reactive food proteins are reported as co-occurring FAs and the associated sociodemographic characteristics in a large food-allergic patient registry.

NIAID-sponsored Guidelines for Prevention of Peanut Allergy (PPA) recommend introduction of peanut-containing foods during the first year of life for most infants. However little is known regarding PPA guidelines awareness and current infant feeding practices regarding common food allergens—particularly among parents with food allergy.

Evidence suggests that food allergy (FA) may be disproportionately prevalent and burdensome among racial/ethnic minority populations in the US. However, to effectively ameliorate racial/ethnic disparities in FA management and outcomes, more data are needed to understand current management practices among lower SES patients/caregivers—particularly those at-risk of food insecurity who may be at elevated risk of adverse outcomes.

PURPOSE:To better understand the beliefs about a causal role of emotional stress maintained by women seeking fertility care.METHODS:A cross-sectional, self-administered survey was distributed to fertility care patients at an academic fertility center in Illinois. Of 5000 consecutive patients, 1460 completed the survey and were included in the study sample.RESULTS:Members of our sample (N = 1460) were between 20 and 58 years (mean = 36.2, SD = 4.4). Most respondents were White (72.2%), were in a heterosexual relationship (86.8%), and felt that their physician understood their cultural background (79.4%). Of the sample, 28.9% believed emotional stress could cause infertility, 69.0% believed emotional stress could reduce success with fertility treatment, and 31.3% believed that emotional stress could cause a miscarriage, with evidence of significant racial differences. Less than a quarter (23.8%) of the sample believed emotional stress had no impact on fertility. Lower household income and educational attainment were associated with a greater belief in emotional stress as a causative factor in reproduction with regard to infertility, fertility treatment, and miscarriage.CONCLUSION:The majority of women seeking fertility care believe emotional stress could reduce the success of fertility treatment. Furthermore, beliefs about emotional stress and reproduction significantly differ based on race/ethnicity, income, and education. Particular attention should be paid to specific groups of women who may more likely not be aware of the lack of a proven biological relationship between emotional stress and reproduction.

Objective: To study the racial and socioeconomic characteristics of women seeking fertility care in a state with mandated insurance coverage for fertility testing and treatment. Design: Cross-sectional, self-administered survey. Setting: Academic fertility center in Illinois. Patient(s): Of 5,000 consecutive fertility care patients, 1,460 completed the survey and were included in the study sample. Intervention(s): None. Main Outcome Measure(s): Details about demographic characteristics and health care access on the basis of patient race/ethnicity and socioeconomic status. Result(s): The mean age of participants was 36.1 years; 75.5% were White, 10.2% Asian, 7.3% Black, 5.7% Latinx, and 1.3% Other. Most women had a bachelor’s (35.5%) or master’s degree (40.5%) and an annual household income of >$100,000 (81.5%). Black and Hispanic women traveled twice as far (median 10 miles) as White and Asian women (median 5 miles for both) for treatment. Black women (14.7%) were more likely to report that their race was a barrier to getting fertility treatment compared with White (0.0%), Hispanic (5.1%), and Asian (5.4%) women. Black and Hispanic women were approximately twice as likely to report income level (26.5% and 20.3%, respectively) and weight (7.8% and 8.9%, respectively) as barriers compared with White and Asian respondents. Conclusion(s): Significant racial and socioeconomic disparities exist among fertility patients accessing care. Beyond providing all Americans with health insurance that covers fertility treatment, further research in the general population is needed to understand the complex social, cultural, racial, and economic factors that prohibit many individuals from accessing needed fertility care.

Disparities in food allergy (FA) are emerging. Yet, racial differences in dietary quality among children with FA are unclear. Black and White children (0-12 years old) with a diagnosed FA were enrolled into a prospective, multi-site, cohort study. Demographic data collected merged with dietary assessment data gleaned from the Automated Self-Administered 24-hour Dietary Assessment Survey. Healthy Eating Index (HEI) scores were calculated using one 24-hour diet recall. Univariable statistics described demographics and mean HEI scores ranging from 0 to 100 (100=superior diet quality). Two-sided independent t-tests were used to compare mean HEI scores across groups. Multivariable linear regression evaluated significant predictors of mean HEI scores. Cross-product terms of income by race were evaluated. Among 157 children with a baseline diet data, the majority were white (77.1%) male (62.8%), and 5-12 years of age (60.5%). HEI scores ranged from 21.8 to 82.2; the mean was 53.4 (SD: 12.6). There were significant racial differences with respect to mean HEI scores (Mwhite: 55.1, SD: 12.6; Mblack: 47.7, SD: 12.9, p=0.002). Adjusting for current child age, gender, multiple FAs, and annual household income, this effect was not significant (Beta: 3.5; p=0.4). We did not find a significant interaction between race and income. Mean HEI scores in this food-allergic, multiracial sample were comparable to that reported in the general US pediatric population. Although a trend in lower diet quality among Black compared to White children was identified, ongoing diet assessment may elucidate nutritional differences in this cohort.

Background: Racial differences in food allergy outcomes exist. Objectives: Our aim is to characterize phenotypic differences between black and white children with food allergy (FA). Methods: We are conducting a prospective multi-center cohort study enrolling African-American (AA) or Caucasian (W) children aged 0-12 years diagnosed with …

Background Polycystic ovary syndrome (PCOS) is a complex and multi-faceted endocrine disorder that affects 5–20% of women. Literature is limited regarding potentially differing PCOS phenotypes among women around the world. Objective To use Flo app technology to understand the multifaceted characteristics of PCOS across several countries and identify contributing risk factors to the development of this condition. Study design Flo is a widely used female health and wellbeing app with period tracking functionality that provides a globally representative and medically unbiased perspective on PCOS symptomatology. A chatbot dialog on PCOS was subsequently administered on the Flo application (app) to users from 142 countries (with at least 100 respondents) who have the app running in English during September–October 2019. Results For analyses, we selected the five countries with the greatest number of respondents: US ( n = 243,238), UK ( n = 68,325), India ( n = 40,092), Philippines ( n = 35,131), and Australia ( n = 29,926). Bloating was the most frequently reported symptom among PCOS-positive women and appeared to be the main predictor of PCOS in our model (odds ratio 3·76 [95% CI 3·60–3·94]; p < 0·0001). Additional top predictors of PCOS are high blood cholesterol and glucose levels. As BMI increased, the percentage of women who reported a physician-confirmed PCOS diagnosis also increased. However, women in India did not follow this trend. Conclusion Our findings are based on the largest known PCOS dataset and indicate that symptoms are more complex than previously understood. The most frequently reported symptoms (bloating, facial hirsutism, irregular cycles, hyperpigmentation, and baldness) are broader than those included in the Rotterdam criteria. Future work should reevaluate and refine the criteria utilized in PCOS diagnosis.

Eczema is a risk factor for peanut allergy (PA) development. Racial differences in eczema and food allergy outcomes exist. This study aims to explore potential racial differences in eczema history among peanut allergic children. Black and White children (0-12 years old) with a diagnosed food allergy were enrolled into FORWARD, a prospective, multi-site, cohort study. Parent-proxy responses were obtained for the intake and 12 month follow-up survey. Surveys included questions on timing of dietary introduction of peanut, current food allergies, and eczema related outcomes. Pearson X2 tests were used to compare differences by race. Responses for the 12 month follow-up survey were received for 183 peanut allergic children (n= 46 Black, 137 White). Of the 183, 153 had eczema. Among Black children with PA, 89.1% reported ever having eczema vs 81.8% of White children. For medications during the first year of life, 59.5% used topical prescription medication to control eczema while 16.3% received antibiotics for skin infection related to eczema. No statistically significant differences in race were observed. However, among children with PA who ever had eczema, only 38 (24.8%) introduced peanut early (before 1 year of age). Among those that were ever introduced peanut (n=94), early introduction was more common among White children (49.3%) than Black children (16.0%), p=0.01. Regardless of race, the majority of children with PA had a history of eczema. Additionally, Black children were less likely than White children to be introduced to peanut products early. These are important considerations for current PA prevention guideline implementation.

Early dietary introduction of certain allergenic foods before 6 months of age may decrease food allergy (FA) incidence. Considering racial differences in US FA prevalence, this study characterizes timing of peanut, egg, and milk introduction among food-allergic Black and White children. Black and White children (0-12 years old) with a diagnosed FA were enrolled into a prospective, multi-site, cohort study. In the intake survey, parents of children with peanut (n=182; 68 Black/114 White), egg (n=136; 99 White/37 Black), and milk (n=82; 27 Black/55 White) allergies reported timing of dietary introduction of each allergenic food. Age of introduction was categorized into ≤6 months, 7-10 months, and ≥11 months. Pearson X2 tests were used to compare timing of food introduction by race. Only 2.9% of Black children with peanut allergy were introduced to peanut at ≤6 months, 8.8% between 7-10 months, and 88.2% at ≥11 months, compared to White children (21.9%, 25.4%, and 52.6% respectively) (X2=4.66; p<0.001). For milk, 25.9% of Black children were introduced at ≤6 months, 18.5% between 7-10 months, and 55.6% at ≥11 months, compared to White children (49.1%, 23.6%, and 27.3%) (X2=6.52;p=.04). Finally, 10.8% of Black children were introduced egg at ≤6 months, 27.0% between 7-10 months, and 62.2% at ≥11 months, compared to White children (25.3%, 32.3%, and 42.4%) (X2=5.07;p=.08). Peanut, milk, and egg are introduced earlier to White children compared to Black children, possibly contributing to racial differences in FA prevalence. Education on early introduction, especially the 2017 Prevention of Peanut Allergy Guidelines, may be needed.

BACKGROUND:The experiences of Black children with food allergy (FA) are not well characterized, particularly with respect to bullying victimization and other psychosocial outcomes.OBJECTIVE:To evaluate bullying experiences of Black and White children with FA, including associations with peer relationships, anxiety, and school policies.METHODS:Surveys were administered to parents of 252 children with physician-diagnosed FA enrolled in the multisite FORWARD cohort. The surveys assessed demographics, atopic disease, bullying victimization, and school FA management practices and policies. Descriptive statistics of bullying by race were compared by χ2 tests. Multiple logistic regression analyses adjusting for race, age, parental education, household income, child sex, and multi-FA compared adjusted probabilities of bullying victimization by school policies.RESULTS:Nearly 20% of school-aged children were bullied for FA with no substantial racial differences overall, though for children ages 11 years and up, White children reported higher rates of bullying. However, Black children experienced non-FA-related bullying twice as frequently as White children (38.6% vs 17.7%; P = .002). Most of the caregivers (85.7%) who intervened in their child's bullying reported that it was helpful. Among parents, 17.3% reported that they were teased or bullied owing to their child's FA. More than half of the respondents (54.8%) reported that some allergens are banned from their child's school, most typically peanut. In schools banning peanuts, FA-related bullying was less frequently reported by all students who have food allergy.CONCLUSION:Bullying owing to FA is common, and caregivers, medical professionals, and school administrators can help reduce bullying by screening for bullying and supporting and educating school policies.

Abstract Polycystic ovary syndrome (PCOS) is known to affect 6%-12% of women of reproductive age in the United States. PCOS is a heterogeneous condition associated with menstrual cycle irregularity and androgen excess. Though many women with PCOS have a BMI classified as overweight or obese, information is limited on how specific symptoms and BMI mediate PCOS diagnoses in the general population. A questionnaire on PCOS-related symptoms and previous PCOS diagnosis was available to Flo users during one month (2019). Women aged 18-44 years seeking to track their cycle or to conceive, who were not pregnant, on active contraception or in stabilization mode after pregnancy, and had Flo app running in English met the study inclusion criteria. Participant characteristics including age and BMI were also collected from Flo app users during the sign-up process. All users in the study had agreed to the use of their de-identified and aggregated data for research purposes. The differences in clinical manifestation of PCOS symptoms between BMI groups were analyzed. Of US users with BMI data in the whole cohort, 8,808 women reported having physician-diagnosed PCOS, 5,551 women reported not having a PCOS diagnosis, and 58,478 reported that they had not been checked for PCOS. Of women with PCOS, 19.5% were normal weight (BMI 18.5-24.9), 19.7% were overweight (BMI 25.0-29.9), 20.4% were obese (30.0-34.9), 17.8% were severly obese (BMI 35.0-39.9), and 21.0% were morbidly obese (BMI 40+). The most common symptoms among PCOS positive women were bloating (38.7%), hirsutism (38.2%), and irregular cycle (26.0%). A direct relationship exists between BMI and having PCOS, as the percentage of PCOS in obese, severely obese, and morbidly obese BMI groups was higher (1.37, 1.87, and 2.12 times, respectively) than in the whole cohort. Similarly, among women who report acne, skin hyperpigmentation, bloating, hirsutism, heavy menses, baldness, family history of PCOS, high cholesterol, irregular cycle, and inability to conceive for > 1 year, there is a direct relationship between BMI and the percentage of women with PCOS. Moreover, when identifying symptoms and findings serving as strong predictors of a positive PCOS diagnosis, hirsutism, high glucose, and high levels of both cholesterol and glucose were the top symptoms and findings for women with BMI 18.5-34.9. Hirsutism, high glucose, and inability to conceive for > 1 year were the strongest predictors of PCOS for women with BMI 35+. Among all users with hirsutism, the percentage of women with PCOS increased 3.65 times compared to the whole cohort, making it the strongest predictor of PCOS. Understanding BMI patterns as they relate to PCOS symptoms allows for better understanding the pathophysiology of PCOS. Among women with PCOS in the United States, changes in BMI are associated with variations in the many symptoms of PCOS.

An estimated 8% of children in the United States have an IgE-mediated food allergy (FA).1 Children with FA and their families experience substantial impairments in quality of life due to the constant vigilance required for food allergen avoidance.2 Physician diagnosis of suspected FAs is important to avoid unnecessarily restrictive diets, provide patient counseling, and ensure epinephrine prescriptions for emergency treatment. However, data from a nationally representative survey in 2009 suggest that approximately 1 in 3 food-allergic US children had not received confirmatory allergy testing by a physician.

Abstract Polycystic ovary syndrome (PCOS) is a common gynecological endocrine disorder associated with menstrual irregularity and androgen excess. The worldwide prevalence of PCOS among women of reproductive age ranges from 5-20%. Mobile menstrual cycle apps, such as Flo, provide an opportunity to gather data on the characteristics of PCOS in a globally representative and medically unbiased population. The objective of this study was to report PCOS symptomatology relative to country in order to better characterize PCOS and its differing phenotypes among users around the world. A questionnaire on PCOS related symptoms and previous PCOS diagnosis was available to Flo users during one month (2019). The geographical location of the user was estimated based on the IP address. Study inclusion criteria included women aged 18-44 years seeking to track their cycle or to conceive, who were not pregnant, on active contraception, or in stabilization mode after pregnancy and had Flo app running in English. All users in the study had agreed to the use of their de-identified and aggregated data for research purposes.The highest number of Flo app users who completed the PCOS questionnaire were coming from the following top 5 countries: United States (US) (n=240,732), United Kingdom (UK) (n=67,696), India (n=40,171), the Philippines (n=35,097), and Australia (n=28,946). The percentage of self-reported PCOS in these countries was 14.4% with higher percentages in India, the Philippines, and Australia (22.6%, 20.0%, 15.9, respectively) and lower in the US and UK (12.2% and 13.71%, respectively). In the US, UK, and Australia, the most common self-reported symptoms of PCOS positive women were bloating, hirsutism, and irregular cycles. In India and the Philippines, the most common symptoms of women with PCOS were bloating, baldness, and irregular cycles. Hirsutism, high glucose and high levels of both cholesterol and glucose are the three top symptoms increasing the probability of PCOS in all studied countries. The percentage of self-reported PCOS increases 3.04 times among users that reported hirsutism compared to all users that positively responded to the PCOS self-assessment question. Probability of PCOS among users that report hirsutism increases 3.85 times for Australia and 4.24 times for India. Australia and India had higher percentages of self-reported PCOS among those who reported experiencing nearly all PCOS related symptoms. Using Flo’s software, we are able to determine that geographic location has an effect on the phenotypic presentation of PCOS. Understanding the distribution of PCOS symptomology around the world will help to better characterize PCOS and improve diagnosis and treatment on both an individual and global scale.