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Introduction: Discrimination in medical settings (DMS) contributes to healthcare disparities in the United States, but few studies have determined the extent of DMS in a large national sample and across different populations. This study estimated the national prevalence of DMS and described demographic and health-related characteristics associated with experiencing DMS in seven different situations., Methods: Survey data from 41,875 adults participating in the All of Us Research Program collected in 2021-2022 and logistic regression were used to examine the association between sociodemographic and health-related characteristics and self-reported DMS among adults engaged with a healthcare provider within the past 12 months. Statistical analysis was performed in 2023-2024., Results: About 36.89% of adults reported having experienced at least one DMS situation. Adults with relative social and medical disadvantages had higher prevalence of experiencing DMS. Compared to their counterparts, respondents with higher odds of experiencing DMS in at least one situation identified as female, non-Hispanic Black, having at least some college, living in the South, renter, having other living arrangement, being publicly insured, not having a usual source of care, having multiple chronic conditions, having any disability, and reporting fair or poor health, p<0.05., Conclusions: The findings indicate a high prevalence of DMS, particularly among some population groups. Characterizing DMS may be a valuable tool for identifying populations at risk within the healthcare system and optimizing the overall patient care experience. Implementing relevant policies remains an essential strategy for mitigating the prevalence of DMS and reducing healthcare disparities., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Objective: To examine the pattern of health services access and utilization that may contribute to racial/ethnic disparities in receiving continuous positive airway pressure (CPAP) treatment for obstructive sleep apnea (OSA)., Methods: This cross-sectional study used a national sample from the All of Us Research Program, which included over 80 % of participants from underrepresented populations in biomedical research. Study participants included adults aged 18 years and older diagnosed with OSA (N = 8518). Diagnosis of OSA and CPAP treatment were ascertained by diagnostic and procedural codes from the electronic health records. Sociodemographic characteristics and health service utilization factors were identified using self-reported survey data., Results: With this national survey, the overall diagnosed prevalence of OSA was 8.8 %, with rates of 8.12 % in non-Hispanic (NH) Black adults, 5.99 % in Hispanic adults, and 10.35 % in NH White adults. When comparing to NH White adults, Hispanic adults were less likely to receive CPAP treatment for OSA after adjusting for socioeconomic and demographic characteristics, access to and utilization of health services, and comorbidities such as obesity and having multiple chronic conditions (OR = 0.73, 95 % CI = 0.59,0.90), p < 0.01., Conclusions: The rates of CPAP treatment among OSA patients are not consistent across racial and ethnic groups. Unequal access to health services based on residence may contribute to these differences. Interventions that target disparities in OSA diagnosis, access to treatment, and barriers in insurance coverage could potentially help reduce racial and ethnic differences in OSA diagnosis and management., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests:Vivian Hsing-Chun Wang reports financial support was provided by National Institute on Minority Health and Health Disparities (USA). Donglan Zhang reports financial support was provided by National Institute on Minority Health and Health Disparities (USA). Yike Li reports financial support was provided by National Institute on Minority Health and Health Disparities (USA). David T. Kent reports a relationship with Nyxoah S.A. (Belgium) that includes: board membership, equity or stocks, and non-financial support. David T. Kent reports a relationship with Invicta Medical Inc (USA) that includes: consulting or advisory and non-financial support. David T. Kent reports a relationship with Inspire Medical Systems Inc (USA) that includes: non-financial support. David T. Kent reports a relationship with Laborie Medical Technologies Inc (USA) that includes: non-financial support. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Objectives: To highlight the use of calibration weighting to improve the precision of estimates obtained from All of Us data and increase the return of value to communities from the All of Us Research Program., Materials and Methods: We used All of Us (2017-2022) data and raking to obtain prevalence estimates in two examples: discrimination in medical settings (N = 41 875) and food insecurity (N = 82 266). Weights were constructed using known population proportions (age, sex, race/ethnicity, region of residence, annual household income, and home ownership) from the 2020 National Health Interview Survey., Results: About 37% of adults experienced discrimination in a medical setting. About 20% of adults who had not seen a doctor reported being food insecure compared with 14% of adults who regularly saw a doctor., Conclusions: Calibration using raking is cost-effective and may lead to more precise estimates when analyzing All of Us data., (© The Author(s) 2024. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Background: The All of Us Research Program aims to collect longitudinal health-related data from a million individuals in the United States. An inherent challenge of a non-probability sampling strategy through voluntary participation in All of Us is that findings may not be nationally representative for addressing health and health care at the population level. We generated survey weights for the All of Us data that can be used to address the challenge., Research Design: We developed raked weights using demographic, health, and socioeconomic variables available in both the 2020 National Health Interview Survey (NHIS) and All of Us . We then compared the unweighted and weighted prevalence of a set of health-related variables (health behaviors, health conditions, and health insurance coverage) estimated from All of Us data with the weighted prevalence estimates obtained from NHIS data., Subjects: The sample included 100,391 All of Us participants 18 years of age and older with complete data collected between May 2017 and January 2022 across the United States., Results: Final variables in the raking procedure included age, sex, race/ethnicity, region of residence, annual household income, and home ownership. The mean percentage difference between known proportions obtained from the NHIS and All of Us was reduced by 18.89% for health-related variables after applying the raked weights., Conclusions: Raking improved the comparability of prevalence estimates obtained from All of Us to known national prevalence estimates. Refining the process of variable selection for raking may further improve the comparability between All of Us and nationally representative data., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Author(s).)

Purpose: Treatment of small cell lung cancer (SCLC) with brain metastatic disease has traditionally involved whole brain radiation therapy (WBRT). The role of stereotactic radiosurgery (SRS) is unclear., Methods and Materials: Our study was a retrospective review of an SRS database evaluating patients with SCLC who received SRS. A total of 70 patients and 337 treated brain metastases (BM) were analyzed. Forty-five patients had previous WBRT. The median number of treated BM was 4 (range, 1-29)., Results: Median survival was 4.9 months (range, 0.70-23.9). The number of treated BM was correlated with survival; patients with fewer BM had improved overall survival ( P < .021). The number of treated BM was associated with different brain failure rates; 1-year central nervous system control rates were 39.2% for 1 to 2 BM, 27.6% for 3 to 5 BM, and 0% for >5 treated BM. Patients with previous WBRT had worse brain failure rates ( P < .040). For patients without previous WBRT, the 1-year distant brain failure rate was 48%, and median time to distant failure was 15.3 months., Conclusions: SRS for SCLC in patients with <5 BM appears to offer acceptable control rates. Patients with >5 BM have high rates of subsequent brain failure and are not ideal candidates for SRS., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2023 Published by Elsevier Inc. on behalf of American Society for Radiation Oncology.)

Based on the findings from the National Lung Screening Trial, the U.S. Preventive Services Task Force recommends annual low dose computed tomography (LDCT) lung cancer screening (LCS) among high-risk adults. Approximately 54% of individuals seeking LCS report current cigarette smoking. Effective smoking cessation interventions, offered at the time of LCS, enhances the health benefits of screening that are attributable to reductions in lung cancer overall and tobacco-related mortality. Considering these data, the Centers for Medicare & Medicaid Services' (CMS) 2015 decision to cover LCS with LDCT required that radiology imaging facilities make tobacco cessation interventions available for people who smoke. In February 2022, CMS reversed their 2015 coverage requirement for delivering tobacco use treatment at the time of LDCT; CMS retained the requirement for counseling during the shared decision-making visit prior to the exam. The policy change does not diminish the importance of offering high-quality tobacco cessation services in conjunction with routine LDCT for LCS. However, LCS programs face a range of barriers to implementing tobacco use treatment in their settings. As a result, implementation has lagged. Closing the "evidence to practice" gap is the focus of implementation science, a field that offers a set of rigorous methods and a systematic approach to identifying and overcoming contextual barriers to implementing evidence-based guidelines in a range of clinical settings. In this paper, we describe how implementation science frameworks and methods can be used to help guide LCS programs in their efforts to integrate tobacco use treatment and discuss policy changes needed to further facilitate the delivery of TUT as an essential component of the LCS process., (© The Author(s) 2022. Published by Oxford University Press on behalf of the Society of Behavioral Medicine.)

Vaccine uptake variation across demographic groups remains a public health barrier to overcome the coronavirus pandemic despite substantial evidence demonstrating the effectiveness of COVID-19 vaccines against severe illness and death. Generational cohorts differ in their experience with historical and public health events, which may contribute to variation in beliefs about COVID-19 vaccines. Nationally representative longitudinal data (December 20, 2020 to July 23, 2021) from the Understanding America Study (UAS) COVID-19 tracking survey (N = 7279) and multilevel logistic regression were used to investigate whether generational cohorts differ in COVID-19 vaccine beliefs. Regression models adjusted for wave, socioeconomic and demographic characteristics, political affiliation, and trusted source of information about COVID-19. Birth-year cutoffs define the generational cohorts: Silent (1945 and earlier), Boomer (1946-1964), Gen X (1965-1980), Millennial (1981-1996), and Gen Z (1997-2012). Compared to Boomers, Silents had a lower likelihood of believing that COVID-19 vaccines have many known harmful side effects (OR = 0.52, 95%CI = 0.35-0.74) and that they may lead to illness and death (OR = 0.53, 95%CI = 0.37-0.77). Compared to Boomers, Silents had a higher likelihood of believing that the vaccines provide important benefits to society (OR = 2.27, 95%CI = 1.34-3.86) and that they are useful and effective (OR = 1.97, 95%CI = 1.17-3.30). Results for Gen Z are similar to those reported for Silents. Beliefs about COVID-19 vaccines markedly differ across generations. This is consistent with the idea of generational imprinting-the idea that some beliefs may be resistant to change through adulthood. Policy strategies other than vaccine education may be needed to overcome this pandemic and future public health challenges., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Objective: Dietary recommendations (DR) in the USA may be inadequate at improving diets in racial/ethnic minority communities and may require redesign of the systems driving their development over the long term. Meanwhile, cultural adaptation of evidence-based DR may be an important strategy for mitigating nutrition disparities, but less is known about the adaptability of these recommendations to meet the needs of diverse groups. We examined the content and origin of major DRs - aspects that provide context on their potential universality across populations and evaluated their potential for cultural adaptation., Design: Case studies of Dietary Approaches to Stop Hypertension (DASH), the Mediterranean diet (MD), the EAT-Lancet diet (EAT) and the NOVA classification system., Setting: United States., Participants: Racial/ethnic minority populations., Results: Current DR differ in their origin/evolution but are similar in their reductionist emphasis on physical health. DASH has been successfully adapted for some cultures but may be challenged by the need for intensive resources; MD may be more beneficial if applied as part of a broader set of food procurement/preparation practices than as just diet alone; EAT-Lancet adaptation may not honor existing country-specific practices that are already beneficial to human and environmental health (e.g. traditional/plant-based diets); evidence for cultural adaptation is limited with NOVA, but classification of levels of food processing has potential for widespread application., Conclusions: For DR to equitably support diverse populations, they must move beyond a Eurocentric or 'general population' framing, be more inclusive of cultural differences and honour social practices to improve diet and reduce disparities.

Several restriction policies implemented in many states in the United States have demonstrated their effectiveness in mitigating the spread of the coronavirus disease (COVID-19), but less is known about the differences in views on the restriction policies among different population segments. This study aimed to understand which different population groups of adults in the United States consider several key restriction policies as necessary to combat COVID-19. Survey data from Wave 64 (March 19-24, 2020) of the Pew Research Center's American Trends Panel (n=10,609) and logistic regression were used to evaluate the association between socioeconomic and demographic characteristics, employment status, political party affiliation, news exposure, census region, and opinions about COVID-19 restriction policies. The policies included restricting international travel, imposing business closures, banning large group gatherings, cancelling entertainment events, closing schools, limiting restaurants to carry-out only, and postponing state primary elections. Most survey respondents viewed COVID-19 restriction policies as necessary. Views on each restriction policy varied substantially across some population segments such as age, race, and ethnicity. Regardless of population segments, those who followed news closely or considered themselves Democrat/lean Democrat were more likely to consider all the policies as necessary than those not following the news closely or those who considered themselves Republican/lean Republican. The effectiveness of key COVID-19 restriction policies is likely to vary substantially across population groups given that views on the need to implement these policies vary widely. Tailored health messages may be needed for some population segments given divergent views on COVID-19 restriction policies., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Introduction: Added sugars and high glycemic index (GI) foods might play a role in cardiometabolic pathogenesis. Our study aimed to describe the top sources of added sugars and types of high GI foods in diets of children by race/ethnicity., Methods: We examined data for 3,112 children, aged 6 to 11 years from the National Health and Nutrition Examination Survey (NHANES), 2011 to 2016. Mean intake was estimated and linear regression models tested for differences by race/ethnicity. Population proportions for food sources were created and ranked, accounting for survey weighting when appropriate., Results: Asian American and Mexican American children had the lowest reported added sugar intake. Cereals were observed to contribute highly to added sugar intake. Soft drinks did not contribute as much added sugar intake for Asian American children as it did for children of other races/ethnicities. Asian American children consumed significantly more high GI foods than other groups. Types of high GI foods differed meaningfully across racial/ethnic groups (ie, Mexican American: burritos/tacos; other Hispanic, White, and Black: pizza; Asian American: rice). Rice accounted for 37% of total high GI foods consumed by Asian American children., Conclusions: Sources of added sugars and types of high GI foods in children's diets vary across racial/ethnic groups. Targeting foods identified as top sources of added sugars for all race/ethnicities and focusing on substitution of whole grains may reduce obesity, diabetes, and related cardiometabolic risk more equitably.

Objective: Previous studies in China showed large sex differences in childhood overweight and obesity (OW/OB) rates. However, limited research has examined the cause of these sex differences. The present study aimed to examine individual and parental/familial factors associated with sex differences in childhood OW/OB rates in China., Design: Variables associated with child weight status, beliefs and behaviours, and obesity-related parenting practices were selected to examine their sex differences and association with a sex difference in child OW/OB outcomes using logistic regression analysis., Setting: Cross-sectional data analysis using the 2011 China Health and Nutrition Survey., Subjects: Children aged 6-17 years (n 1544) and their parents., Results: Overall child OW/OB prevalence was 16·8 %. Adolescent boys (AB; 12-17 years) were about twice as likely to be overweight/obese as adolescent girls (AG; 15·5 v. 8·4 %, P<0·05). AB more likely had energy intake exceeding recommendations, self-perceived underweight, underestimated their body weight and were satisfied with their physical activity level than AG. AG more likely practised weight-loss management through diet and self-perceived overweight than AB. Mothers more likely identified AG's weight accurately but underestimated AB's weight. Stronger associations with risk of childhood OW/OB were found in boys than girls in dieting to lose weight (OR=6·7 in boys v. 2·6 in girls) and combined maternal and child perception of the child's overweight (OR=35·4 in boys v. 14·2 in girls)., Conclusions: Large sex differences in childhood obesity may be related to the sex disparities in weight-related beliefs and behaviours among children and their parents in China.

Objective: Childhood obesity has increased rapidly in China, but understanding is limited on how parents perceive their child's weight status and how this perception affects weight-related parenting practices. We examined maternal perception of her child's weight status and its association with demographics, subsequent weight-related parenting practices, the child's health behaviours and weight change. Design/Setting/Subjects Maternal perception of child's weight status and health behaviours from the China Health and Nutrition Surveys were assessed at baseline and in follow-up surveys for 816 children aged 6-18 years during 2004-2011. Associations were tested using mixed models., Results: Overall, maternal and child perceptions of the child's weight status were fairly consistent (κ w=0·56), 63·8 % of mothers had correct perception. While 9·6 % of mothers perceived their child as overweight, 10·9 % of children did so, and 13·6 % of children were indeed overweight. Compared with mothers who viewed their children as normal weight, mothers who thought their children were overweight were more likely to encourage their children to increase their physical activity (OR; 95 % CI: 1·8; 1·0, 3·3) and to diet (4·3; 2·3, 7·8). Children perceived as overweight by their mothers were more likely to have insufficient physical activity (2·8; 1·6, 4·7) and gain more weight during follow-up (BMI Z-score, β (se): 1·0 (0·1); P<0·01) than children perceived by their mothers as normal weight., Conclusions: In China, mothers who perceive their child as overweight are more likely to encourage their child to exercise and modify their diet for weight management, but this encouragement does not seem to improve the child's health behaviours and weight status.

Perfusion deficits on lung scanning in narcotic addicts are frequently demonstrable. To determine the angiographic and hemodynamic correlates of these deficits, right heart catheterization with selective pulmonary angiography was carried out in 7 addicts with abnormal lung scans, and one with normal scan. Four had angiographic abnormalities corresponding to the regions of perfusion defects on lung scan. These consisted of large vessel cut-offs, intraluminal filling defects and/or considerably reduced vascularity. Three subjects had normal angiograms in the presence of abnormal perfusion scans. One subject had normal angiogram and scan. All eight patients had normal pulmonary artery pressures and calculated pulmonary vascular resistances. This study demonstrates that (1) angiographic abnormalities in larger pulmonary arteries may be found in narcotic addicts with perfusion defects on lung scanning, and (2) these findings may be present without significant hemodynamic alterations.

Hemodynamic and angiographic data obtained during pain from four patients with Prinzmetal's variant angina are reported. The left ventricular pressure-time index did not increase before or during attacks of angina in three of the four patients; left ventricular systolic performance was impaired during pain in all three. In one of these three patients left ventricular pressure-volume data obtained during angina suggested a reduction in diastolic compliance; in another, pain and S-T segment elevation were present during coronary arterial spasm. The fourth patient had an increase in both arterial blood pressure and heart rate before an attack; in this patient coronary arterial spasm could not be demonstrated during the period of pain and S-T elevation. The data presented suggest that hemodynamic factors that increase the myocardial oxygen requirements are absent and that coronary arterial spasm is present in some, but not all, patients with variant angina.