Little is known about the spatial clustering of neighborhood deprivation across the United States (US). Using data from the 2010 US Census Bureau, we created a neighborhood deprivation index (NDI: higher NDI indicates higher deprivation/ lower neighborhood socioeconomic status) for each county within the US County level scores were loaded into ArcGIS 10.5.1 where they were mapped and analyzed using Moran’s I and Anselin Local Moran’s I. Ultimately, NDI varies spatially across the US. The highest NDI scores were found in the Southeastern and Southwestern US states, and inland regions of Southern California. This information is critical for public health initiative development as planners may need to tailor the scale of their efforts based on the higher NDI neighborhoods of the county or geographic region with potentially greater chronic disease burden.

Background: Community-based participatory research is an effective tool for improving health outcomes in minority communities. Few community-based participatory research studies have evaluated methods of optimizing smartphone apps for health technology-enabled interventions in African Americans. Objective: This study aimed to utilize focus groups (FGs) for gathering qualitative data to inform the development of an app that promotes physical activity (PA) among African American women in Washington, DC. Methods: We recruited a convenience sample of African American women (N=16, age range 51-74 years) from regions of Washington, DC metropolitan area with the highest burden of cardiovascular disease. Participants used an app created by the research team, which provided motivational messages through app push notifications and educational content to promote PA. Subsequently, participants engaged in semistructured FG interviews led by moderators who asked open-ended questions about participants’ experiences of using the app. FGs were audiorecorded and transcribed verbatim, with subsequent behavioral theory-driven thematic analysis. Key themes based on the Health Belief Model and emerging themes were identified from the transcripts. Three independent reviewers iteratively coded the transcripts until consensus was reached. Then, the final codebook was approved by a qualitative research expert. Results: In this study, 10 main themes emerged. Participants emphasized the need to improve the app by optimizing automation, increasing relatability (eg, photos that reflect target demographic), increasing educational material (eg, health information), and connecting with community resources (eg, cooking classes and exercise groups). Conclusions: Involving target users in the development of a culturally sensitive PA app is an essential step for creating an app that has a higher likelihood of acceptance and use in a technology-enabled intervention. This may decrease health disparities in cardiovascular diseases by more effectively increasing PA in a minority population.

Little is understood about associations between neighborhood characteristics and depression, a cardiovascular disease (CVD) risk factor, in diverse populations. We examined relationships between pe...

Despite the widespread prevalence of cases associated with the coronavirus disease 2019 (COVID-19) pandemic, little is known about the spatial clustering of COVID-19 in the United States. Data on COVID-19 cases were used to identify U.S. counties that have both high and low COVID-19 incident proportions and clusters. Our results suggest that there are a variety of sociodemographic variables that are associated with the severity of COVID-19 county-level incident proportions. As the pandemic evolved, communities of color were disproportionately impacted. Subsequently, it shifted from communities of color and metropolitan areas to rural areas in the U.S. Our final period showed limited differences in county characteristics, suggesting that COVID-19 infections were more widespread. The findings might address the systemic barriers and health disparities that may result in high incident proportions of COVID-19 clusters.

Introduction Although physical activity (PA) reduces cardiovascular disease (CVD) risk, physical inactivity remains a pressing public health concern, especially among African American (AA) women in the USA. PA interventions focused on AA women living in resource-limited communities with scarce PA infrastructure are needed. Mobile health (mHealth) technology can increase access to PA interventions. We describe the development of a clinical protocol for a multilevel, community-based, mHealth PA intervention for AA women. Methods and analysis An mHealth intervention targeting AA women living in resource-limited Washington, DC communities was developed based on the socioecological framework for PA. Over 6 months, we will use a Sequential Multi-Assignment, Randomized Trial approach to compare the effects on PA of location-based remote messaging (named ‘tailored-to-place’) to standard remote messaging in an mHealth intervention. Participants will be randomised to a remote messaging intervention for 3 months, at which point the intervention strategy will adapt based on individuals’ PA levels. Those who do not meet the PA goal will be rerandomised to more intensive treatment. Participants will be followed for another 3 months to determine the contribution of each mHealth intervention to PA level. This protocol will use novel statistical approaches to account for the adaptive strategy. Finally, effects of PA changes on CVD risk biomarkers will be characterised. Ethics and dissemination This protocol has been developed in partnership with a Washington, DC-area community advisory board to ensure feasibility and acceptability to community members. The National Institutes of Health Intramural IRB approved this research and the National Heart, Lung, and Blood Institute provided funding. Once published, results of this work will be disseminated to community members through presentations at community advisory board meetings and our quarterly newsletter. Trial registration number NCT03288207.

Despite the recent momentum of skin of color conversations in dermatology, adequate research on skin of color diseases is still lacking and African Americans/Blacks are often underrepresented in clinical trials. This underrepresentation is especially glaring in hidradenitis suppurativa (HS) clinical trials [1]. HS is a chronic inflammatory skin condition that commonly affects intertriginous areas and is characterized by painful nodules, draining sinus tracts, and hypertrophic scarring [2]. A recent systematic review focusing on racial populations reports the average prevalence rate of HS as highest in African Americans compared to both Whites and Hispanics/Latinos [3]. Additionally, a study evaluating 47,690 HS patients across the USA found that the disease affects 54.1% (25,780/47,690) Whites compared to 32.6% (15,540/47,690) African Americans; however, when standardized to the US population, the adjusted prevalence of HS was shown to disproportionately affect African American patients with a three-fold increase compared to Whites [4]. Taking into account the wide distribution of populations affected, African Americans are minimally included in HS clinical trials [1]. Of 15 phase II and III HS trials published over the last 12 years (2007–2019), 68% of the participants were Caucasian while only 14.0% were of African descent [1]. This disparity hinders our complete understanding of the therapeutic effects and responses in African Americans, which may lead to the development and use of HS treatments that are neither reflective nor fully applicable to diverse patient populations. The lack of racial and ethnic diversity in HS clinical trials has been highlighted in the literature [1], but barriers and possible explanations are still unclear. Herein we explore the lack of African American representation in these studies by examining the clinical trial locations within the USA and by discussing potential barriers to African American inclusion.