BACKGROUND:Latinos are among the fastest growing populations in the United States. While previous work indicates racial/ethnic differences in fibroid prevalence, little is known about the prevalence of this condition among Latina females in the United States. OBJECTIVE:To determine the prevalence of fibroids among reproductive-aged Latina females and identify associated factors in this population. STUDY DESIGN:Environment, Leiomyomas, Latinas, and Adiposity Study is a prospective cohort study of Latina females, based in Southeast Michigan, and conducted using Community Based Participatory Research (CBPR) principles. Data were collected between October 2017 and October 2022, a community health clinic in Detroit, MI and at the University of Michigan's Center for Reproductive Medicine in Ann Arbor, MI. Eligible participants self-identified as Hispanic or Latina; were assigned female sex at birth; were aged 21 to 50 years at enrollment; could speak, read, and write in either English or Spanish; were not currently pregnant; and did not have an implantable electrical device, history of malignancy, or other conditions requiring chemotherapy or radiation. Fibroid symptoms were not a requirement of participation. Fibroid prevalence was rigorously established via self-reported medical history and expert administration of transvaginal ultrasounds. Participant features-including demographics, health, acculturation level, and other factors of interest-were established via surveys, interviews, and in-person measurement. RESULTS:Among Environment, Leiomyomas, Latinas, and Adiposity Study participants who completed a vaginal ultrasound (N=609 of 621 eligible), the mean age was 37.3±7.0 years and 68 (11.2%; confidence interval, 8.6%-13.8%) presented with fibroids. The majority had a single fibroid (75.0%), while 25.0% had 2 or more. The mean size of the largest fibroid-most often intramural (80.9%)-was 2.9±1.2 cm in diameter. Fibroid prevalence was found to be higher in older age groups, rising from 3.5% (confidence interval, 1.4%-10.0%) among participants aged 21 to 30 years, to 8.3% (confidence interval, 4.9%-11.7%) in those aged 31 to 40 years, and 18.7% (confidence interval, 13.3%-24.1%) in those aged between 41 and 50 years (P<.001). Logistic regression models indicated that fibroid presence was associated with younger age at menarche (adjusted odds ratio, 0.84; 95% confidence interval, 0.72-0.99) and increasing gravidity (adjusted odds ratio, 0.80; confidence interval, 0.66-0.97). Findings indicated no significant association with parity (adjusted odds ratio, 0.85; confidence interval, 0.68-1.07). CONCLUSION:Environment, Leiomyomas, Latinas, and Adiposity Study is among the first prospective studies of its size to use an ultrasound confirmation approach to establish fibroid prevalence among Latina females in the United States. Our findings suggest the prevalence of fibroids among Latina females is much lower than previously reported in the literature and markedly lower than that in Black and White women. More research is needed to understand why burden may be lower in this population and how such findings can be used to benefit all women.

Background:Prior studies show that people with larger bodies experience pervasive weight stigma, which is often directly perpetuated by healthcare providers. This pattern has also been observed in women receiving prenatal and postpartum care. Individuals seeking treatment for infertility commonly encounter concrete barriers, such as formalized BMI-based restrictions. These limitations may further compound the isolating and stigmatizing experiences already known to affect women with infertility. Methods:Qualitative study exploring the experiences and perceptions of patients with larger bodies and infertility. Women seeking fertility care within the past 2 years with a BMI ≥ 30 kg/m2 were eligible for participation. Demographic surveys and one-on-one semi-structured interviews were performed. Interviews were deidentified, transcribed, and analyzed inductively using a thematic analysis approach. Major themes and subthemes were identified by two coders with discrepancies being resolved with a third coder. Results:A total of 33 subjects were included in the analysis. Mean age of participants was 36.9 years. Key themes identified included stigmatizing treatment, perceptions of substandard care, complex body relationships, and quality care as an achievable goal. Many participants reported receiving shaming and judgmental care throughout their healthcare encounters including fertility care, which for several directly influenced their decision to pursue treatment. Participants often reported receiving abbreviated, substandard diagnostic evaluations that in many cases missed critical diagnoses. Participants conveyed significant awareness of the impact of weight on fertility and complex weight cycling histories, and this knowledge paired with these experiences often went unaddressed by providers. Conclusion:Consistent with the experiences of patients with larger bodies broadly, patients with infertility similarly report receiving stigmatizing treatment and perceived substandard care from their fertility providers. This potential harm to patients is not inevitable; participants report receiving quality care where providers offer humanizing and individualized care. There is a clear need for personalized and patient-centered treatment for this population of patients, that while marginalized, account for an increasing percentage of fertility patients.

Identify drivers of COVID-19 initial and booster vaccinations. Minority communities were disproportionately impacted by COVID-19, yet many expressed vaccine hesitancy. While a combination of incentivized strategies, namely financial and workplace rewards or mandates, seems to have boosted the rate of vaccination, little is known about the role of vaccine incentives in Black and Latinx communities specifically. Drawing from postcolonial theory and health belief model, our goal was to identify, through qualitative interviews, the perceptions of incentives, such as financial, travel, and employment related, in encouraging vaccination amongst Black and Latinx communities. Interviews were conducted between 2022 and 2023 with 24 Black and 10 Latinx Michigan residents self-reported as up-to-date (2022, completed primary series; 2023, completed bivalent booster) and not up-to-date (2022, incomplete primary series; 2023, no bivalent booster). We used a community-based participatory research approach, collaborating with 15 community-based organizations to develop research questions, interview protocols, and methods for data collection, and analysis. Thematic coding of interviews was conducted. Participants reported that work and travel-related incentives, including bonuses, maintaining employment, and being able to travel, were successful in supporting their decision to vaccinate. Financial incentives were mainly viewed negatively and as causes for suspicion and subsequently disincentivized some participants to take the vaccine. Our results indicate that financial incentives were a less effective way to drive uptake among the Black and Latinx Michiganders we interviewed. Understanding the potentially negative effects of vaccine financial incentives is essential to combat vaccine hesitancy. It is critical to ensure vaccine incentives align with community values and preferences and do not further damage trust in public health.

Across metazoan species, the centromere-specific histone variant CENP-A is essential for accurate chromosome segregation, yet its regulation during the mammalian parental-to-zygote transition is poorly understood. To address this, we generated a CENP-A-mScarlet mouse model that revealed sex-specific dynamics: mature sperm retain 10% of the CENP-A levels present in MII oocytes. However, this difference is resolved in zygotes prior to the first mitosis, using maternally inherited cytoplasmic CENP-A. Notably, the increase in CENP-A at paternal centromeres is independent of sensing CENP-A asymmetry or the presence of maternal chromosomes. Instead, CENP-A equalization relies on the asymmetric recruitment of maternal CENP-C to paternal centromeres. Depletion of maternal CENP-A decreases total CENP-A in both pronuclei without disrupting equalization. In contrast, reducing maternal CENP-C or disruption of its dimerization function impairs CENP-A equalization and chromosome segregation. Therefore, maternal CENP-C acts as a key epigenetic regulator that resets centromeric symmetry at fertilization to preserve genome integrity.

Black and Latinx populations have been disproportionately impacted by COVID-19. While young adults are at lower risk of severe outcomes, they are key to improving the impact of COVID-19 communication in communities of color. To understand young Michiganders’ perspectives on misinformation and communication regarding COVID-19. In 2021, as part of a larger study, four focus groups were conducted with Black and Latinx residents (18 to 29 years old) in Wayne County (including Detroit), Genesee County (including Flint), Washtenaw County, and Kent County, MI. Using a community-based participatory research approach, we conducted 90-min, virtual focus groups. Key themes were identified using inductive coding. Six themes emerged from the young adults: (1) reasons for disproportionate impact; (2) social media algorithms propagating misinformation; (3) education helping young adults identify misinformation; (4) “bribery” and incentivizing viewed critically; (5) wide friend networks and diverse messaging providing broader perspectives, but frequent relocation may hamper community connections; and (6) assisting older generations viewed as a responsibility despite not always feeling trusted by their elders. Participants had a healthy skepticism of COVID-19 information and a sense of responsibility to help their communities. Future work should explore the degree to which young adults may be impacted by misinformation despite their vigilance and how they might contribute to improved health communication.

OBJECTIVES:To evaluate if current night shift work is associated with anti-Müllerian hormone (AMH) concentrations. STUDY DESIGN:We analyzed baseline data from participants in the Study of the Environment, Lifestyle, and Fibroids (SELF), a prospective cohort study of Black women recruited 2010-2012 in metropolitan Detroit, MI. Our cohort comprised 1641 participants with serum AMH determined at baseline. AMH concentrations were used to measure ovarian reserve, i.e. the quantity of oocytes remaining in the ovary. On self-administered baseline questionnaires, participants reported whether they currently worked night shifts and, if so, how frequently. We used multivariable linear regression models to estimate percent differences and 95 % confidence intervals (CI) in mean AMH concentrations across categories of current night shift work (non-current, <1/month, ≥1/month), adjusting for covariates known to be associated with AMH concentrations (e.g., demographic factors such as age, abnormal bleeding, and contraceptive use) and baseline sleep characteristics (sleep duration, satisfaction, and efficiency). MAIN OUTCOME MEASURE:Mean anti-Müllerian hormone concentrations. RESULTS:Mean AMH concentrations were similar in the group of frequent night shift workers (n = 196, 12 %) and the group of infrequent/non-current night shift workers (n = 1445, 88 %): 4.78 ± 4.15 ng/mL vs. 5.14 ± 4.20 ng/mL. Results were similar after adjusting for potential confounders, with only a small percent difference in AMH concentrations of -8.1 % observed between the two groups (95 % CI -19.8 %, 5.4 %). CONCLUSIONS:Frequent night shift work was not appreciably associated with AMH concentrations in this large cohort of reproductive-aged Black women.

Introduction: In Michigan, the COVID-19 pandemic severely impacted Black and Latinx communities. These communities experienced higher rates of exposure, hospitalizations, and deaths compared to Whites. We examine the impact of the pandemic and reasons for the higher burden on communities of color from the perspectives of Black and Latinx community members across four Michigan counties and discuss recommendations to better prepare for future public health emergencies. Methods: Using a community-based participatory research approach, we conducted semi-structured interviews (n = 40) with Black and Latinx individuals across the four counties. Interviews focused on knowledge related to the pandemic, the impact of the pandemic on their lives, sources of information, attitudes toward vaccination and participation in vaccine trials, and perspectives on the pandemic's higher impact on communities of color. Results: Participants reported overwhelming effects of the pandemic in terms of worsened physical and mental health, financial difficulties, and lifestyle changes. They also reported some unexpected positive effects. They expressed awareness of the disproportionate burden among Black and Latinx populations and attributed this to a wide range of disparities in Social Determinants of Health. These included racism and systemic inequities, lack of access to information and language support, cultural practices, medical mistrust, and varied individual responses to the pandemic. Conclusion: Examining perspectives and experiences of those most impacted by the pandemic is essential for preparing for and effectively responding to public health emergencies in the future. Public health messaging and crisis response strategies must acknowledge the concerns and cultural needs of underrepresented populations.

BACKGROUND:In the LIBERTY Long-Term Extension study, once-daily relugolix combination therapy (40 mg relugolix, estradiol 1 mg, norethindrone acetate 0.5 mg) substantially improved uterine fibroid-associated heavy menstrual bleeding throughout the 52-week treatment period in the overall study population. OBJECTIVE:Black or African American women typically experience a greater extent of disease and symptom burden of uterine fibroids vs other racial groups and have traditionally been underrepresented in clinical trials. This secondary analysis aimed to assess the efficacy and safety of relugolix combination therapy in the subgroup population of Black or African American women with uterine fibroids in the LIBERTY Long-Term Extension study. STUDY DESIGN:Black or African American premenopausal women (aged 18-50 years) with uterine fibroids and heavy menstrual bleeding who completed the 24-week randomized, placebo-controlled, double-blind LIBERTY 1 (identifier: NCT03049735) or LIBERTY 2 (identifier: NCT03103087) trials were eligible to enroll in the 28-week LIBERTY Long-Term Extension study (identifier: NCT03412890), in which all women received once-daily, open-label relugolix combination therapy. The primary endpoint of this subanalysis was the proportion of Black or African American treatment responders: women who achieved a menstrual blood loss volume of <80 mL and at least a 50% reduction in menstrual blood loss volume from the pivotal study baseline to the last 35 days of treatment by pivotal study randomized treatment group. The secondary outcomes included rates of amenorrhea and changes in symptom burden and quality of life. RESULTS:Overall, 241 of 477 women (50.5%) enrolled in the LIBERTY Long-Term Extension study self-identified as Black or African American. In Black or African American women receiving continuous relugolix combination therapy for up to 52 weeks, 58 of 70 women (82.9%; 95% confidence interval, 72.0%-90.8%) met the treatment responder criteria for reduction in heavy menstrual bleeding (primary endpoint). A substantial reduction in menstrual blood loss volume from the pivotal study baseline to week 52 was demonstrated (least squares mean percentage change: 85.0%); 64.3% of women achieved amenorrhea; 59.1% of women with anemia at the pivotal study baseline achieved a substantial improvement (>2 g/dL) in hemoglobin levels; and decreased symptom severity and distress because of uterine fibroid-associated symptoms and improvements in health-related quality of life through 52 weeks were demonstrated. The most frequently reported adverse events during the cumulative 52-week treatment period were hot flush (12.9%), headache (5.7%), and hypertension (5.7%). Bone mineral density was preserved through 52 weeks. CONCLUSION:Once-daily relugolix combination therapy improved uterine fibroid-associated heavy menstrual bleeding in most Black or African American women who participated in the LIBERTY Long-Term Extension study. The safety and efficacy profile of relugolix combination therapy in Black or African American women was consistent with previously published results from the overall study population through 52 weeks. Findings from this subanalysis will assist shared decision-making by helping providers and Black or African American women understand the efficacy and safety of relugolix combination therapy as a pharmacologic option for the management of uterine fibroid-associated symptoms.

This JAMA Insights in the Women's Health series discusses the incidence, diagnosis, and treatment of uterine fibroids.

The reproductive and endocrine functions of the ovary involve spatially defined interactions among specialized cell populations. Despite the ovary’s importance in fertility and endocrine health, functional attributes of ovarian cells are largely uncharacterized. Here, we profiled >18,000 genes in 257 regions from the ovaries of two premenopausal donors to examine the functional units in the ovary. We also generated single-cell RNA sequencing data for 21,198 cells from three additional donors and identified four major cell types and four immune cell subtypes. Custom selection of sampling areas revealed distinct gene activities for oocytes, theca, and granulosa cells. These data contributed panels of oocyte-, theca-, and granulosa-specific genes, thus expanding the knowledge of molecular programs driving follicle development. Serial samples around oocytes and across the cortex and medulla uncovered previously unappreciated variation of hormone and extracellular matrix remodeling activities. This combined spatial and single-cell atlas serves as a resource for future studies of rare cells and pathological states in the ovary.