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Educational attainment is among the most substantial protective factors against cigarette smoking, including during pregnancy. Although Minorities’ Diminished Returns (MDRs) of educational attainment, defined as weaker protective effect of education for racial and ethnic minority groups compared to Non-Hispanic Whites, has been demonstrated in previous studies; such MDRs are not tested for cigarette smoking during pregnancy. To better understand the relevance of MDRs to tobacco use during pregnancy, this study had three aims: firstly, to investigate the association between educational attainment and cigarette smoking in pregnant women; secondly, to compare racial and ethnic groups for the association between educational attainment and cigarette smoking; and thirdly, to explore the mediating effect of poverty status on such MDRs, among American adults during pregnancy. This cross-sectional study explored a nationally representative sample of pregnant American women (n = 338), which was taken from the Population Assessment of Tobacco and Health (PATH; 2013). Current smoking was the outcome. Educational attainment was the independent variable. Region and age were the covariates. Poverty status was the mediator. Race and ethnicity were the effect modifiers. Overall, a higher level of educational attainment (OR = 0.54, p< 0.05) was associated with lower odds of current smoking among pregnant women. Race (OR = 2.04, p< 0.05) and ethnicity (OR = 2.12, p< 0.05) both showed significant interactions with educational attainment on smoking, suggesting that the protective effect of educational attainment against smoking during pregnancy is smaller for Blacks and Hispanics than Non-Hispanic Whites. Poverty status fully mediated the above interactions. In the United States, highly educated pregnant Black and Hispanic women remain at higher risk of smoking cigarettes, possibly because they are more likely to live in poverty, compared to their White counterparts. The results suggest the role that labor market discrimination has in explaining lower returns of educational attainment in terms of less cigarette smoking by racial and ethnic minority pregnant women.
Shervin Assari; Shanika Boyce. Social Determinants of Cigarette Smoking among American Women during Pregnancy. Women 2021, 1, 128 -136.
AMA StyleShervin Assari, Shanika Boyce. Social Determinants of Cigarette Smoking among American Women during Pregnancy. Women. 2021; 1 (3):128-136.
Chicago/Turabian StyleShervin Assari; Shanika Boyce. 2021. "Social Determinants of Cigarette Smoking among American Women during Pregnancy." Women 1, no. 3: 128-136.
Background The COVID-19 pandemic brings unforeseen challenges in medical education. The current study aims to: 1) describe third-year medical students' experiences with the novel Shelf-Exam-Type Question Didactics (SET QD) before (in-person) and during (virtual) COVID-19. Methods In this qualitative study using grounded theory, we conducted purposive sampling and used 23 in-depth semi-structured interviews. Audio recordings were transcribed verbatim and the Atlas.Ti software was used to manage the thematic analysis. Results There are three themes and eight subthemes that emerged: 1) The SET QD Framework (sub-themes: questions as learning opportunities; interleaving; notable clinical scenarios; team learning; accountability). 2) Experienced Educator (subtheme: transformational teaching). 3) Virtual Accessibility (sub-themes: alleviating time constraints, and mitigating life-stressors). Conclusions Medical students regarded SET QD as impactful for shelf exam preparation, clinical preparation, and long-term retention of the material. This novel virtual didactic method may be used in non-surgical clerkships as well.
Jose A. Negrete Manriquez; Shahrzad Bazargan-Hejazi; Sue J. Nahm; Christian de Virgilio. Exploring a novel approach to surgery clerkship didactics during the COVID-19 pandemic: A qualitative study. The American Journal of Surgery 2021, 1 .
AMA StyleJose A. Negrete Manriquez, Shahrzad Bazargan-Hejazi, Sue J. Nahm, Christian de Virgilio. Exploring a novel approach to surgery clerkship didactics during the COVID-19 pandemic: A qualitative study. The American Journal of Surgery. 2021; ():1.
Chicago/Turabian StyleJose A. Negrete Manriquez; Shahrzad Bazargan-Hejazi; Sue J. Nahm; Christian de Virgilio. 2021. "Exploring a novel approach to surgery clerkship didactics during the COVID-19 pandemic: A qualitative study." The American Journal of Surgery , no. : 1.
Chronic low back pain is one of the most common, poorly understood, and potentially disabling chronic pain conditions from which older adults suffer. The existing low back pain research has relied almost exclusively on White/Caucasian participant samples. This study examines the correlates of chronic low back pain among a sample of underserved urban African American and Latino older adults. Controlling for age, gender, race/ethnicity, education, living arrangement, and number of major chronic conditions, associations between low back pain and the following outcome variables are examined: (1) healthcare utilization, (2) health-related quality of life (HR-QoL) and self-rated quality of health; and (3) physical and mental health outcomes. Methods: We recruited nine hundred and five (905) African American and Latino older adults from the South Los Angeles community using convenience and snowball sampling. In addition to standard items that measure demographic variables, our survey included validated instruments to document HR-QoL health status, the Short-Form McGill Pain Questionnaire-2, Geriatric Depression Scale, sleep disorder, and healthcare access. Data analysis includes bivariate and 17 independent multivariate models. Results: Almost 55% and 48% of the Latino and African American older adults who participated in our study reported chronic low back pain. Our data revealed that having low back pain was associated with three categories of outcomes including: (1) a higher level of healthcare utilization measured by (i) physician visits, (ii) emergency department visits, (iii) number of Rx used, (iv) a higher level of medication complexity, (v) a lower level of adherence to medication regimens, and (vi) a lower level of satisfaction with medical care; (2) a lower level of HR-QoL and self-assessment of health measured by (i) physical health QoL, (ii) mental health QoL, and (iii) a lower level of self-rated health; and (3) worse physical and mental health outcomes measured by (i) a higher number of depressive symptoms, (ii) a higher level of pain, (iii) falls, (iv) sleep disorders, (v) and being overweight/obese. Discussion: Low back pain remains a public health concern and significantly impacts the quality of life, health care utilization, and health outcomes of underserved minority older adults. Multi-faceted and culturally sensitive interventional studies are needed to ensure the timely diagnosis and treatment of low back pain among underserved minority older adults. Many barriers and challenges that affect underserved African American and Latino older adults with low back pain simply cannot be addressed in over-crowded EDs. Our study contributes to and raises the awareness of healthcare providers and health policymakers on the necessity for prevention, early diagnosis, proper medical management, and rehabilitation policies to minimize the burdens associated with chronic low back pain among underserved older African American and Latino patients in an under-resourced community such as South Los Angeles.
Mohsen Bazargan; Margarita Loeza; Tavonia Ekwegh; Edward Adinkrah; Lucy Kibe; Sharon Cobb; Shervin Assari; Shahrzad Bazargan-Hejazi. Multi-Dimensional Impact of Chronic Low Back Pain among Underserved African American and Latino Older Adults. International Journal of Environmental Research and Public Health 2021, 18, 7246 .
AMA StyleMohsen Bazargan, Margarita Loeza, Tavonia Ekwegh, Edward Adinkrah, Lucy Kibe, Sharon Cobb, Shervin Assari, Shahrzad Bazargan-Hejazi. Multi-Dimensional Impact of Chronic Low Back Pain among Underserved African American and Latino Older Adults. International Journal of Environmental Research and Public Health. 2021; 18 (14):7246.
Chicago/Turabian StyleMohsen Bazargan; Margarita Loeza; Tavonia Ekwegh; Edward Adinkrah; Lucy Kibe; Sharon Cobb; Shervin Assari; Shahrzad Bazargan-Hejazi. 2021. "Multi-Dimensional Impact of Chronic Low Back Pain among Underserved African American and Latino Older Adults." International Journal of Environmental Research and Public Health 18, no. 14: 7246.
Background:Aim: To examine racial/ethnic variations in the effect of parents’ subjective neighborhood safety on children’s cognitive performance. Methods: This cross-sectional study included 10,027 children from the Adolescent Brain Cognitive Development (ABCD) study. The exposure variable was parents’ subjective neighborhood safety. The outcomes were three domains of children’s cognitive performance: general cognitive performance, executive functioning, and learning/memory. We used mixed-effects regression models for data analysis. Results: Overall, parents’ subjective neighborhood safety was positively associated with children’s executive functioning, but not general cognitive performance or learning/memory. Higher parents’ subjective neighborhood safety had a more positive influence on the executive functioning of non-Hispanic White than Asian American children. Higher parents’ subjective neighborhood safety was associated with higher general cognitive performance and learning/memory for non-White children relative to non-Hispanic White children. Conclusion: The race/ethnicity of children moderates the association between neighborhood safety and cognitive performance. This becomes more complicated, as the patterns seem to differ across ethnicity and cognitive domains. It is unknown whether the observed racial/ethnic variations in the effect of neighborhood safety on cognitive performance are neighborhood characteristics such as residential segregation. Addressing neighborhood inequalities is needed if we wish to reduce racial/ethnic inequities in the cognitive development of children.
Shervin Assari; Shanika Boyce; Ritesh Mistry; Alvin Thomas; Harvey Nicholson; Ryon Cobb; Adolfo Cuevas; Daniel Lee; Mohsen Bazargan; Cleopatra Caldwell; Tommy Curry; Marc Zimmerman. Parents’ Perceived Neighborhood Safety and Children’s Cognitive Performance: Complexities by Race, Ethnicity, and Cognitive Domain. Urban Science 2021, 5, 46 .
AMA StyleShervin Assari, Shanika Boyce, Ritesh Mistry, Alvin Thomas, Harvey Nicholson, Ryon Cobb, Adolfo Cuevas, Daniel Lee, Mohsen Bazargan, Cleopatra Caldwell, Tommy Curry, Marc Zimmerman. Parents’ Perceived Neighborhood Safety and Children’s Cognitive Performance: Complexities by Race, Ethnicity, and Cognitive Domain. Urban Science. 2021; 5 (2):46.
Chicago/Turabian StyleShervin Assari; Shanika Boyce; Ritesh Mistry; Alvin Thomas; Harvey Nicholson; Ryon Cobb; Adolfo Cuevas; Daniel Lee; Mohsen Bazargan; Cleopatra Caldwell; Tommy Curry; Marc Zimmerman. 2021. "Parents’ Perceived Neighborhood Safety and Children’s Cognitive Performance: Complexities by Race, Ethnicity, and Cognitive Domain." Urban Science 5, no. 2: 46.
Intersectional research on childhood suicidality requires studies with a reliable and valid measure of suicidality, as well as a large sample size that shows some variability of suicidality across sex by race intersectional groups. Objectives: We aimed to investigate the feasibility of intersectionality research on childhood suicidality in the Adolescent Brain Cognitive Development (ABCD) study. We specifically explored the reliability and validity of the measure, sample size, and variability of suicidality across sex by race intersectional groups. Methods: We used cross-sectional data (wave 1) from the ABCD study, which sampled 9013 non-Hispanic white (NHW) or non-Hispanic black (NHB) children between the ages of 9 and 10 between years 2016 and 2018. Four intersectional groups were built based on race and sex: NHW males (n = 3554), NHW females (n = 3158), NHB males (n = 1164), and NHB females (n = 1137). Outcome measure was the count of suicidality symptoms, reflecting all positive history and symptoms of suicidal ideas, plans, and attempts. To validate our measure, we tested the correlation between our suicidality measure and depression and Child Behavior Checklist (CBCL) sub-scores. Cronbach alpha was calculated for reliability across each intersectional group. We also compared groups for suicidality. Results: We observed some suicidality history in observed 3.2% (n = 101) of NHW females, 4.9% (n = 175) of NHW males, 5.4% (n = 61) of NHB females, and 5.8% (n = 68) of NHB males. Our measure’s reliability was acceptable in all race by sex groups (Cronbach alpha higher than 0.70+ in all intersectional groups). Our measure was valid in all intersectional groups, documented by a positive correlation with depression and CBCL sub-scores. We could successfully model suicidality across sex by race groups, using multivariable models. Conclusion: Given the high sample size, reliability, and validity of the suicidality measure, variability of suicidality, it is feasible to investigate correlates of suicidality across race by sex intersections in the ABCD study. We also found evidence of higher suicidality in NHB than NHW children in the ABCD study. The ABCD rich data in domains of social context, self-report, schools, parenting, psychopathology, personality, and brain imaging provides a unique opportunity to study intersectional differences in neural circuits associated with youth suicidality.
Shervin Assari; Shanika Boyce; Mohsen Bazargan. Feasibility of Race by Sex Intersectionality Research on Suicidality in the Adolescent Brain Cognitive Development (ABCD) Study. Children 2021, 8, 437 .
AMA StyleShervin Assari, Shanika Boyce, Mohsen Bazargan. Feasibility of Race by Sex Intersectionality Research on Suicidality in the Adolescent Brain Cognitive Development (ABCD) Study. Children. 2021; 8 (6):437.
Chicago/Turabian StyleShervin Assari; Shanika Boyce; Mohsen Bazargan. 2021. "Feasibility of Race by Sex Intersectionality Research on Suicidality in the Adolescent Brain Cognitive Development (ABCD) Study." Children 8, no. 6: 437.
Family conflict is known to operate as a major risk factor for children’s suicidal thoughts and behaviors (STBs). However, it is unknown whether this effect is similar or different in Black and White children. Objectives: We compared Black and White children for the association between family conflict and STBs in a national sample of 9–10-year-old American children. Methods: This cross-sectional study used data from the Adolescent Brain Cognitive Development (ABCD) study. This study included 9918 White or Black children between the ages of 9 and 10 living in married households. The predictor variable was family conflict. Race was the moderator. The outcome variable was STBs, treated as a count variable, reflecting positive STB items that were endorsed. Covariates included ethnicity, sex, age, immigration status, family structure, parental education, and parental employment, and household income. Poisson regression was used for data analysis. Results: Of all participants, 7751 were Whites, and 2167 were Blacks. In the pooled sample and in the absence of interaction terms, high family conflict was associated with higher STBs. A statistically significant association was found between Black race and family conflict, suggesting that the association between family conflict and STBs is stronger in Black than White children. Conclusion: The association between family conflict and STBs is stronger in Black than White children. Black children with family conflict may be at a higher risk of STBs than White children with the same family conflict level. These findings align with the literature on the more significant salience of social relations as determinants of mental health of Black than White people. Reducing family conflict should be regarded a significant element of suicide prevention for Black children in the US.
Shervin Assari; Shanika Boyce; Mohsen Bazargan; Cleopatra Caldwell. Race, Family Conflict and Suicidal Thoughts and Behaviors among 9–10-Year-Old American Children. International Journal of Environmental Research and Public Health 2021, 18, 5399 .
AMA StyleShervin Assari, Shanika Boyce, Mohsen Bazargan, Cleopatra Caldwell. Race, Family Conflict and Suicidal Thoughts and Behaviors among 9–10-Year-Old American Children. International Journal of Environmental Research and Public Health. 2021; 18 (10):5399.
Chicago/Turabian StyleShervin Assari; Shanika Boyce; Mohsen Bazargan; Cleopatra Caldwell. 2021. "Race, Family Conflict and Suicidal Thoughts and Behaviors among 9–10-Year-Old American Children." International Journal of Environmental Research and Public Health 18, no. 10: 5399.
Aim: This study tested sex differences in the association between hippocampal volume and working memory of a national sample of 9–10-year-old children in the US. As the hippocampus is functionally lateralized (especially in task-related activities), we explored the results for the right and the left hippocampus. Methods: This is a cross-sectional study using the Adolescent Brain Cognitive Development (ABCD) Study data. This analysis included baseline ABCD data (n = 10,093) of children between ages 9 and 10 years. The predictor variable was right and left hippocampal volume measured by structural magnetic resonance imaging (sMRI). The primary outcome, list sorting working memory, was measured using the NIH toolbox measure. Sex was the moderator. Age, race, ethnicity, household income, parental education, and family structure were the covariates. Results: In the overall sample, larger right (b = 0.0013; p< 0.001) and left (b = 0.0013; p< 0.001) hippocampal volumes were associated with higher children’s working memory. Sex had statistically significant interactions with the right (b = −0.0018; p = 0.001) and left (b = −0.0012; p = 0.022) hippocampal volumes on children’s working memory. These interactions indicated stronger positive associations between right and left hippocampal volume and working memory for females compared to males. Conclusion: While right and left hippocampal volumes are determinants of children’s list sorting working memory, these effects seem to be more salient for female than male children. Research is needed on the role of socialization, sex hormones, and brain functional connectivity as potential mechanisms that may explain the observed sex differences in the role of hippocampal volume as a correlate of working memory.
Shervin Assari; Shanika Boyce; Tanja Jovanovic. Association between Hippocampal Volume and Working Memory in 10,000+ 9–10-Year-Old Children: Sex Differences. Children 2021, 8, 411 .
AMA StyleShervin Assari, Shanika Boyce, Tanja Jovanovic. Association between Hippocampal Volume and Working Memory in 10,000+ 9–10-Year-Old Children: Sex Differences. Children. 2021; 8 (5):411.
Chicago/Turabian StyleShervin Assari; Shanika Boyce; Tanja Jovanovic. 2021. "Association between Hippocampal Volume and Working Memory in 10,000+ 9–10-Year-Old Children: Sex Differences." Children 8, no. 5: 411.
Background: Recent studies have shown that parental educational attainment is associated with a larger superior temporal cortical surface area associated with higher reading ability in children. Simultaneously, the marginalization-related diminished returns (MDRs) framework suggests that, due to structural racism and social stratification, returns of parental education are smaller for black and other racial/ethnic minority children compared to their white counterparts. Purpose: This study used a large national sample of 9–10-year-old American children to investigate associations between parental educational attainment, the right and left superior temporal cortical surface area, and reading ability across diverse racial/ethnic groups. Methods: This was a cross-sectional analysis that included 10,817 9–10-year-old children from the Adolescent Brain Cognitive Development (ABCD) study. Parental educational attainment was treated as a five-level categorical variable. Children’s right and left superior temporal cortical surface area and reading ability were continuous variables. Race/ethnicity was the moderator. To adjust for the nested nature of the ABCD data, mixed-effects regression models were used to test the associations between parental education, superior temporal cortical surface area, and reading ability overall and by race/ethnicity. Results: Overall, high parental educational attainment was associated with greater superior temporal cortical surface area and reading ability in children. In the pooled sample, we found statistically significant interactions between race/ethnicity and parental educational attainment on children’s right and left superior temporal cortical surface area, suggesting that high parental educational attainment has a smaller boosting effect on children’s superior temporal cortical surface area for black than white children. We also found a significant interaction between race and the left superior temporal surface area on reading ability, indicating weaker associations for Alaskan Natives, Native Hawaiians, and Pacific Islanders (AIAN/NHPI) than white children. We also found interactions between race and parental educational attainment on reading ability, indicating more potent effects for black children than white children. Conclusion: While parental educational attainment may improve children’s superior temporal cortical surface area, promoting reading ability, this effect may be unequal across racial/ethnic groups. To minimize the racial/ethnic gap in children’s brain development and school achievement, we need to address societal barriers that diminish parental educational attainment’s marginal returns for middle-class minority families. Social and public policies need to go beyond equal access and address structural and societal barriers that hinder middle-class families of color and their children. Future research should test how racism, social stratification, segregation, and discrimination, which shape the daily lives of non-white individuals, take a toll on children’s brains and academic development.
Shervin Assari; Shanika Boyce; Mohsen Bazargan; Alvin Thomas; Ryon Cobb; Darrell Hudson; Tommy Curry; Harvey Nicholson; Adolfo Cuevas; Ritesh Mistry; Tabbye Chavous; Cleopatra Caldwell; Marc Zimmerman. Parental Educational Attainment, the Superior Temporal Cortical Surface Area, and Reading Ability among American Children: A Test of Marginalization-Related Diminished Returns. Children 2021, 8, 412 .
AMA StyleShervin Assari, Shanika Boyce, Mohsen Bazargan, Alvin Thomas, Ryon Cobb, Darrell Hudson, Tommy Curry, Harvey Nicholson, Adolfo Cuevas, Ritesh Mistry, Tabbye Chavous, Cleopatra Caldwell, Marc Zimmerman. Parental Educational Attainment, the Superior Temporal Cortical Surface Area, and Reading Ability among American Children: A Test of Marginalization-Related Diminished Returns. Children. 2021; 8 (5):412.
Chicago/Turabian StyleShervin Assari; Shanika Boyce; Mohsen Bazargan; Alvin Thomas; Ryon Cobb; Darrell Hudson; Tommy Curry; Harvey Nicholson; Adolfo Cuevas; Ritesh Mistry; Tabbye Chavous; Cleopatra Caldwell; Marc Zimmerman. 2021. "Parental Educational Attainment, the Superior Temporal Cortical Surface Area, and Reading Ability among American Children: A Test of Marginalization-Related Diminished Returns." Children 8, no. 5: 412.
Introduction: Cerebellum cortex fractional anisotropy is a proxy of the integrity of the cerebellum cortex. However, less is known about how it is shaped by race and socioeconomic status (SES) indicators such as parental education and household income. Purpose: In a national sample of American pre-adolescents, this study had two aims: to test the effects of two SES indicators, namely parental education and household income, on cerebellum cortex fractional anisotropy, and to explore racial differences in these effects. Methods: Using data from the Adolescent Brain Cognitive Development (ABCD) study, we analyzed the diffusion Magnetic Resonance Imaging (dMRI) data of 9565, 9–10-year-old pre-adolescents. The main outcomes were cerebellum cortex fractional anisotropy separately calculated for right and left hemispheres using dMRI. The independent variables were parental education and household income; both treated as categorical variables. Age, sex, ethnicity, and family marital status were the covariates. Race was the moderator. To analyze the data, we used mixed-effects regression models without and with interaction terms. We controlled for propensity score and MRI device. Results: High parental education and household income were associated with lower right and left cerebellum cortex fractional anisotropy. In the pooled sample, we found significant interactions between race and parental education and household income, suggesting that the effects of parental education and household income on the right and left cerebellum cortex fractional anisotropy are all significantly larger for White than for Black pre-adolescents. Conclusions: The effects of SES indicators, namely parental education and household income, on pre-adolescents’ cerebellum cortex microstructure and integrity are weaker in Black than in White families. This finding is in line with the Marginalization-related Diminished Returns (MDRs), defined as weaker effects of SES indicators for Blacks and other racial and minority groups than for Whites.
Shervin Assari; Shanika Boyce. Race, Socioeconomic Status, and Cerebellum Cortex Fractional Anisotropy in Pre-Adolescents. Adolescents 2021, 1, 70 -94.
AMA StyleShervin Assari, Shanika Boyce. Race, Socioeconomic Status, and Cerebellum Cortex Fractional Anisotropy in Pre-Adolescents. Adolescents. 2021; 1 (2):70-94.
Chicago/Turabian StyleShervin Assari; Shanika Boyce. 2021. "Race, Socioeconomic Status, and Cerebellum Cortex Fractional Anisotropy in Pre-Adolescents." Adolescents 1, no. 2: 70-94.
The primary purpose of this study was to analyze the completion of advance directives among African American and White adults and examine related factors, including demographics, socio-economic status, health conditions, and experiences with health care providers. This study used data from the Survey of California Adults on Serious Illness and End-of-Life 2019. We compared correlates of completion of advance directives among a sample of 1,635 African American and White adults. Multivariate analysis was conducted. Whites were 50% more likely to complete an advance directive than African Americans. The major differences between African Americans and Whites were mainly explained by the level of mistrust and discrimination experienced by African Americans and partially explained by demographic characteristics. Our study showed that at both bivariate and multivariate levels, participation in religious activities was associated with higher odds of completion of an advance directive for both African Americans and Whites. Interventional studies needed to address the impact of mistrust and perceived discrimination on advance directive completion. Culturally appropriate multifaceted, theoretical- and religious-based interventions are needed that include minority health care providers, church leaders, and legal counselors to educate, modify attitudes, provide skills and resources for communicating with health care providers and family members.
Mohsen Bazargan; Sharon Cobb; Shervin Assari. Completion of advance directives among African Americans and Whites adults. Patient Education and Counseling 2021, 1 .
AMA StyleMohsen Bazargan, Sharon Cobb, Shervin Assari. Completion of advance directives among African Americans and Whites adults. Patient Education and Counseling. 2021; ():1.
Chicago/Turabian StyleMohsen Bazargan; Sharon Cobb; Shervin Assari. 2021. "Completion of advance directives among African Americans and Whites adults." Patient Education and Counseling , no. : 1.
Introduction. The Orbitofrontal Cortex (OFC) is a cortical structure that has implications in cognition, memory, reward anticipation, outcome evaluation, decision making, and learning. As such, OFC activity correlates with these cognitive brain abilities. Despite research suggesting race and socioeconomic status (SES) indicators such as parental education may be associated with OFC activity, limited knowledge exists on multiplicative effects of race and parental education on OFC activity and associated cognitive ability. Purpose. Using functional brain imaging data from the Adolescent Brain Cognitive Development (ABCD) study, we tested the multiplicative effects of race and parental education on left lateral OFC activity during an N-Back task. In our study, we used a sociological rather than biological theory that conceptualizes race and SES as proxies of access to the opportunity structure and exposure to social adversities rather than innate and non-modifiable brain differences. We explored racial variation in the effect of parental educational attainment, a primary indicator of SES, on left lateral OFC activity during an N-Back task between Black and White 9–10 years old adolescents. Methods. The ABCD study is a national, landmark, multi-center brain imaging investigation of American adolescents. The total sample was 4290 9–10 years old Black or White adolescents. The independent variables were SES indicators, namely family income, parental education, and neighborhood income. The primary outcome was the average beta weight for N-Back (2 back versus 0 back contrast) in ASEG ROI left OFC activity, measured by functional Magnetic Resonance Imaging (fMRI) during an N-Back task. Ethnicity, age, sex, subjective SES, and family structure were the study covariates. For data analysis, we used linear regression models. Results. In White but not Black adolescents, parental education was associated with higher left lateral OFC activity during the N-Back task. In the pooled sample, we found a significant interaction between race and parental education on the outcome, suggesting that high parental education is associated with a larger increase in left OFC activity of White than Black adolescents. Conclusions. For American adolescents, race and SES jointly influence left lateral OFC activity correlated with cognition, memory, decision making, and learning. Given the central role of left lateral OFC activity in learning and memory, our finding calls for additional research on contextual factors that reduce the gain of SES for Black adolescents. Cognitive inequalities are not merely due to the additive effects of race and SES but also its multiplicative effects.
Shervin Assari; Shanika Boyce; Mohammed Saqib; Mohsen Bazargan; Cleopatra Caldwell. Parental Education and Left Lateral Orbitofrontal Cortical Activity during N-Back Task: An fMRI Study of American Adolescents. Brain Sciences 2021, 11, 401 .
AMA StyleShervin Assari, Shanika Boyce, Mohammed Saqib, Mohsen Bazargan, Cleopatra Caldwell. Parental Education and Left Lateral Orbitofrontal Cortical Activity during N-Back Task: An fMRI Study of American Adolescents. Brain Sciences. 2021; 11 (3):401.
Chicago/Turabian StyleShervin Assari; Shanika Boyce; Mohammed Saqib; Mohsen Bazargan; Cleopatra Caldwell. 2021. "Parental Education and Left Lateral Orbitofrontal Cortical Activity during N-Back Task: An fMRI Study of American Adolescents." Brain Sciences 11, no. 3: 401.
Introduction: Although the putamen has a significant role in reward-seeking and motivated behaviors, including eating and food-seeking, minorities’ diminished returns (MDRs) suggest that individual-level risk and protective factors have weaker effects for Non-Hispanic Black than Non-Hispanic White individuals. However, limited research is available on the relevance of MDRs in terms of the role of putamen functional connectivity on body mass index (BMI). Purpose: Building on the MDRs framework and conceptualizing race and socioeconomic status (SES) indicators as social constructs, we explored racial and SES differences in the associations between putamen functional connectivity to the salience network and children’s BMI. Methods: For this cross-sectional study, we used functional magnetic resonance imaging (fMRI) data of 6473 9–10-year-old Non-Hispanic Black and Non-Hispanic White children from the Adolescent Brain Cognitive Development (ABCD) study. The primary independent variable was putamen functional connectivity to the salience network, measured by fMRI. The primary outcome was the children’s BMI. Age, sex, neighborhood income, and family structure were the covariates. Race, family structure, parental education, and household income were potential moderators. For data analysis, we used mixed-effect models in the overall sample and by race. Results: Higher right putamen functional connectivity to the salience network was associated with higher BMI in Non-Hispanic White children. The same association was missing for Non-Hispanic Black children. While there was no overall association in the pooled sample, a significant interaction was found, suggesting that the association between right putamen functional connectivity to the salience network and children’s BMI was modified by race. Compared to Non-Hispanic White children, Non-Hispanic Black children showed a weaker association between right putamen functional connectivity to the salience network and BMI. While parental education and household income did not moderate our association of interest, marital status altered the associations between putamen functional connectivity to the salience network and children’s BMI. These patterns were observed for right but not left putamen. Other/Mixed Race children also showed a pattern similar to Non-Hispanic Black children. Conclusions: The association between right putamen functional connectivity to the salience network and children’s BMI may depend on race and marital status but not parental education and household income. While right putamen functional connectivity to the salience network is associated with Non-Hispanic White children’s BMI, Non-Hispanic Black children’ BMI remains high regardless of their putamen functional connectivity to the salience network. This finding is in line with MDRs, which attributes diminished effects of individual-risk and protective factors for Non-Hispanic Black children to racism, stratification, and segregation.
Shervin Assari; Shanika Boyce. Resting-State Functional Connectivity between Putamen and Salience Network and Childhood Body Mass Index. Neurology International 2021, 13, 85 -101.
AMA StyleShervin Assari, Shanika Boyce. Resting-State Functional Connectivity between Putamen and Salience Network and Childhood Body Mass Index. Neurology International. 2021; 13 (1):85-101.
Chicago/Turabian StyleShervin Assari; Shanika Boyce. 2021. "Resting-State Functional Connectivity between Putamen and Salience Network and Childhood Body Mass Index." Neurology International 13, no. 1: 85-101.
Background: Numerous studies have documented multilevel racial inequalities in health care utilization, medical treatment, and quality of care in minority populations in the United States. Palliative care for people with serious illness and hospice services for people approaching the end of life are no exception. It is also well established that Hispanics and non-Hispanic Blacks are more likely than non-Hispanic Whites to have less knowledge about advance care planning and directives, hospice, and palliative care. Both qualitative and quantitative research has identified lack of awareness of palliative and hospice services as one of the major factors contributing to the underuse of these services by minority populations. However, an insufficient number of racial/ethnic comparative studies have been conducted to examine associations among various independent factors in relation to awareness of end-of-life, palliative care and advance care planning and directives. Aims: The main objective of this analysis was to examine correlates of awareness of palliative, hospice care and advance directives in a racially and ethnically diverse large sample of California adults. Methods: This cross-sectional study includes 2,328 adults: Hispanics (31%); non-Hispanic Blacks (30%); and non-Hispanic Whites (39%) from the Survey of California Adults on Serious Illness and End-of-Life 2019. Using multivariate analysis, we adjusted for demographic and socio-economic variables while estimating the potential independent impact of health status, lack of primary care providers, and recent experiences of participants with a family member with serious illnesses. Results: Hispanic and non-Hispanic Black participants are far less likely to report that they have heard about palliative and hospice care and advance directives than their non-Hispanic White counterparts. In this study, 75%, 74%, and 49% of Hispanics, non-Hispanic Blacks, and non-Hispanic White participants, respectively, claimed that they have never heard about palliative care. Multivariate analysis of data show gender, age, education, and income all significantly were associated with awareness. Furthermore, being engaged with decision making for a loved one with serious illnesses and having a primary care provider were associated with awareness of palliative care and advance directives. Discussion: Our findings reveal that lack of awareness of hospice and palliative care and advance directives among California adults is largely influenced by race and ethnicity. In addition, demographic and socio-economic variables, health status, access to primary care providers, and having informal care giving experience were all independently associated with awareness of advance directives and palliative and hospice care. These effects are complex, which may be attributed to various historical, social, and cultural mechanisms at the individual, community, and organizational levels. A large number of factors should be addressed in order to increase knowledge and awareness of end-of-life and palliative care as well as completion of advance directives and planning. The results of this study may guide the design of multi-level community and theoretically-based awareness and training models that enhance awareness of palliative care, hospice care, and advance directives among minority populations.
Mohsen Bazargan; Sharon Cobb; Shervin Assari; Lucy W. Kibe. Awareness of Palliative Care, Hospice Care, and Advance Directives in a Racially and Ethnically Diverse Sample of California Adults. American Journal of Hospice and Palliative Medicine® 2021, 38, 601 -609.
AMA StyleMohsen Bazargan, Sharon Cobb, Shervin Assari, Lucy W. Kibe. Awareness of Palliative Care, Hospice Care, and Advance Directives in a Racially and Ethnically Diverse Sample of California Adults. American Journal of Hospice and Palliative Medicine®. 2021; 38 (6):601-609.
Chicago/Turabian StyleMohsen Bazargan; Sharon Cobb; Shervin Assari; Lucy W. Kibe. 2021. "Awareness of Palliative Care, Hospice Care, and Advance Directives in a Racially and Ethnically Diverse Sample of California Adults." American Journal of Hospice and Palliative Medicine® 38, no. 6: 601-609.
Objectives: Existing epidemiologic information shows disparities in low-dose aspirin use by race. This study investigates the frequency, pattern, and correlates of both self- and clinician-prescribed low-dose aspirin use among underserved African Americans aged 55 years and older. Methods: This cross-sectional study conducted a comprehensive evaluation of all over-the-counter and prescribed medications used among 683 African American older adults in South Central Los Angeles, California. Correlation between use of low-dose aspirin and sociodemographic variables, health care continuity, health behaviors, and several major chronic medical conditions were examined. In addition, the use of low-dose aspirin as self prescribed versus clinician prescribed was examined. Multivariate logistic regression was performed to examine correlates of low-dose aspirin use. Results: Overall, 37% of participants were taking low-dose aspirin. Sixty percent of low-dose aspirin users were taking low-dose aspirin as self prescribed and 40% were taking it as prescribed by a clinician. Major aspirin-drug interactions were detected in 75% of participants who used low-dose aspirin, but no significant differences in aspirin-drug interactions were found between those who used aspirin as self prescribed and those who used it as clinician prescribed. No negative association between being diagnosed with gastrointestinal conditions and aspirin used was detected. Being diagnosed with diabetes mellitus or a heart condition was associated with higher use of aspirin. However, only 50% with high risk of cardiovascular took prescribed (38%) or self-prescribed (62%) low-dose aspirin. One third of participants aged 70 years and older with low risk of cardiovascular were using aspirin. Conclusions: Among underserved African-American middle-aged and older adults, many who could potentially benefit from aspirin are not taking it; and many taking aspirin have no indication to do so and risk unnecessary side effects. Compared with non-Hispanic Whites, African Americans are more likely to be diagnosed with diabetes, hypertension, and heart conditions at earlier stages of life; as a result, the role of preventive intervention, including safe and appropriate use of low-dose aspirin among this segment of our population, is more salient. Interventional studies are needed to promote safe and effective use of low-dose aspirin among underserved African-American adults.
Mohsen Bazargan; Cheryl Wisseh; Edward Adinkrah; Shanika Boyce; Ebony O. King; Shervin Assari. Low-Dose Aspirin Use Among African American Older Adults. The Journal of the American Board of Family Medicine 2021, 34, 132 -143.
AMA StyleMohsen Bazargan, Cheryl Wisseh, Edward Adinkrah, Shanika Boyce, Ebony O. King, Shervin Assari. Low-Dose Aspirin Use Among African American Older Adults. The Journal of the American Board of Family Medicine. 2021; 34 (1):132-143.
Chicago/Turabian StyleMohsen Bazargan; Cheryl Wisseh; Edward Adinkrah; Shanika Boyce; Ebony O. King; Shervin Assari. 2021. "Low-Dose Aspirin Use Among African American Older Adults." The Journal of the American Board of Family Medicine 34, no. 1: 132-143.
PURPOSE Although we know that racial and ethnic minorities are more likely to have mistrust in the health care system, very limited knowledge exists on correlates of such medical mistrust among this population. In this study, we explored correlates of medical mistrust in a representative sample of adults. METHODS We analyzed cross-sectional study data from the Survey of California Adults on Serious Illness and End-of-Life 2019. We ascertained race/ethnicity, health status, perceived discrimination, demographics, socioeconomic factors, and medical mistrust. For data analysis, we used multinomial logistic regression models. RESULTS Analyses were based on 704 non-Hispanic Black adults, 711 Hispanic adults, and 913 non-Hispanic White adults. Racial/ethnic background was significantly associated with the level of medical mistrust. Adjusting for all covariates, odds of reporting medical mistrust were 73% higher (adjusted odds ratio [aOR] = 1.73; 95% CI, 1.15-2.61, P <.01) and 49% higher (aOR = 1.49; 95% CI, 1.02-2.17, P <.05) for non-Hispanic Black and Hispanic adults when compared with non-Hispanic White adults, respectively. Perceived discrimination was also associated with higher odds of medical mistrust. Indicating perceived discrimination due to income and insurance was associated with 98% higher odds of medical mistrust (aOR = 1.98; 95% CI, 1.71-2.29, P <.001). Similarly, the experience of discrimination due to racial/ethnic background and language was associated with a 25% increase in the odds of medical mistrust (aOR = 1.25; 95% CI, 1.10-1.43; P <.001). CONCLUSIONS Perceived discrimination is correlated with medical mistrust. If this association is causal, that is, if perceived discrimination causes medical mistrust, then decreasing such discrimination may improve trust in medical clinicians and reduce disparities in health outcomes. Addressing discrimination in health care settings is appropriate for many reasons related to social justice. More longitudinal research is needed to understand how complex societal, economic, psychological, and historical factors contribute to medical mistrust. This type of research may in turn inform the design of multilevel community- and theory-based training models to increase the structural competency of health care clinicians so as to reduce medical mistrust.
Mohsen Bazargan; Sharon Cobb; Shervin Assari. Discrimination and Medical Mistrust in a Racially and Ethnically Diverse Sample of California Adults. The Annals of Family Medicine 2021, 19, 4 -15.
AMA StyleMohsen Bazargan, Sharon Cobb, Shervin Assari. Discrimination and Medical Mistrust in a Racially and Ethnically Diverse Sample of California Adults. The Annals of Family Medicine. 2021; 19 (1):4-15.
Chicago/Turabian StyleMohsen Bazargan; Sharon Cobb; Shervin Assari. 2021. "Discrimination and Medical Mistrust in a Racially and Ethnically Diverse Sample of California Adults." The Annals of Family Medicine 19, no. 1: 4-15.
The authors have requested that the following changes be made to their paper
Shervin Assari; Shanika Boyce; Mohsen Bazargan. Erratum: Subjective Family Socioeconomic Status and Adolescents’ Attention: Blacks’ Diminished Returns. Children 2020, 7, 80. Children 2020, 8, 15 .
AMA StyleShervin Assari, Shanika Boyce, Mohsen Bazargan. Erratum: Subjective Family Socioeconomic Status and Adolescents’ Attention: Blacks’ Diminished Returns. Children 2020, 7, 80. Children. 2020; 8 (1):15.
Chicago/Turabian StyleShervin Assari; Shanika Boyce; Mohsen Bazargan. 2020. "Erratum: Subjective Family Socioeconomic Status and Adolescents’ Attention: Blacks’ Diminished Returns. Children 2020, 7, 80." Children 8, no. 1: 15.
Objectives: Published research in disparities in advance care planning, palliative, and end-of-life care is limited. However, available data points to significant barriers to palliative and end-of-life care among minority adults. The main objective of this scoping review was to summarize the current published research and literature on disparities in palliative and hospice care and completion of advance care planning and directives among non-Hispanc Blacks. Methods: The scoping review method was used because currently published research in disparities in palliative and hospice cares as well as advance care planning are limited. Nine electronic databases and websites were searched to identify English-language peer-reviewed publications published within last 20 years. A total of 147 studies that addressed palliative care, hospice care, and advance care planning and included non-Hispanic Blacks were incorporated in this study. The literature review include manuscripts that discuss the intersection of social determinants of health and end-of-life care for non-Hispanic Blacks. We examined the potential role and impact of several factors, including knowledge regarding palliative and hospice care; healthcare literacy; communication with providers and family; perceived or experienced discrimination with healthcare systems; mistrust in healthcare providers; health care coverage, religious-related activities and beliefs on palliative and hospice care utilization and completion of advance directives among non-Hispanic Blacks. Discussion: Cross-sectional and longitudinal national surveys, as well as local community- and clinic-based data, unequivocally point to major disparities in palliative and hospice care in the United States. Results suggest that national and community-based, multi-faceted, multi-disciplinary, theoretical-based, resourceful, culturally-sensitive interventions are urgently needed. A number of practical investigational interventions are offered. Additionally, we identify several research questions which need to be addressed in future research.
Mohsen Bazargan; Shahrzad Bazargan-Hejazi. Disparities in Palliative and Hospice Care and Completion of Advance Care Planning and Directives Among Non-Hispanic Blacks: A Scoping Review of Recent Literature. American Journal of Hospice and Palliative Medicine® 2020, 38, 688 -718.
AMA StyleMohsen Bazargan, Shahrzad Bazargan-Hejazi. Disparities in Palliative and Hospice Care and Completion of Advance Care Planning and Directives Among Non-Hispanic Blacks: A Scoping Review of Recent Literature. American Journal of Hospice and Palliative Medicine®. 2020; 38 (6):688-718.
Chicago/Turabian StyleMohsen Bazargan; Shahrzad Bazargan-Hejazi. 2020. "Disparities in Palliative and Hospice Care and Completion of Advance Care Planning and Directives Among Non-Hispanic Blacks: A Scoping Review of Recent Literature." American Journal of Hospice and Palliative Medicine® 38, no. 6: 688-718.
Background. Racial disparities in influenza vaccination among underserved minority older adults are a public health problem. Understanding the factors that impact influenza vaccination behaviors among underserved older African-Americans could lead to more effective communication and delivery strategies. Aims. We aimed to investigate rate and factors associated with seasonal influenza vaccination among underserved African-American older adults. We were particularly interested in the roles of demographic factors, socioeconomic status, and continuity and patient satisfaction with medical care, as well as physical and mental health status. Methods. This community-based cross-sectional study recruited 620 African-American older adults residing in South Los Angeles, one of the most under-resources areas within Los Angeles County, with a population of over one million. Bivariate and multiple regression analyses were performed to document independent correlates of influenza vaccination. Results. One out of three underserved African-American older adults aged 65 years and older residing in South Los Angeles had never been vaccinated against the influenza. Only 49% of participants reported being vaccinated within the 12 months prior to the interview. One out of five participants admitted that their health care provider recommended influenza vaccination. However, only 45% followed their provider’s recommendations. Multivariate logistic regression shows that old-old (≥75 years), participants who lived alone, those with a lower level of continuity of care and satisfaction with the accessibility, availability, and quality of care, and participants with a higher number of depression symptoms were less likely to be vaccinated. As expected, participants who indicated that their physician had advised them to obtain a flu vaccination were more likely to be vaccinated. Our data shows that only gender was associated with self-report of being advised to have a flu shot. Discussion. One of the most striking aspects of this study is that no association between influenza vaccination and being diagnosed with chronic obstructive pulmonary disease or other major chronic condition was detected. Our study confirmed that both continuity of care and satisfaction with access, availability, and quality of medical care are strongly associated with current influenza vaccinations. We documented that participants with a higher number of depression symptoms were less likely to be vaccinated. Conclusion. These findings highlight the role that culturally acceptable and accessible usual source of care van play as a gatekeeper to facilitate and implement flu vaccination among underserved minority older adults. Consistent disparities in influenza vaccine uptake among underserved African-American older adults, coupled with a disproportionate burden of chronic diseases, places them at high risk for undesired outcomes associated with influenza. As depression is more chronic/disabling and is less likely to be treated in African-Americans, there is a need to screen and treat depression as a strategy to enhance preventive care management such as vaccination of underserved African-American older adults. Quantification of associations between lower vaccine uptake and both depression symptoms as well as living alone should enable health professionals target underserved African-American older adults who are isolated and suffer from depression to reduce vaccine-related inequalities.
Mohsen Bazargan; Cheryl Wisseh; Edward Adinkrah; Hoorolnesa Ameli; Delia Santana; Sharon Cobb; Shervin Assari. Influenza Vaccination among Underserved African-American Older Adults. BioMed Research International 2020, 2020, 1 -9.
AMA StyleMohsen Bazargan, Cheryl Wisseh, Edward Adinkrah, Hoorolnesa Ameli, Delia Santana, Sharon Cobb, Shervin Assari. Influenza Vaccination among Underserved African-American Older Adults. BioMed Research International. 2020; 2020 ():1-9.
Chicago/Turabian StyleMohsen Bazargan; Cheryl Wisseh; Edward Adinkrah; Hoorolnesa Ameli; Delia Santana; Sharon Cobb; Shervin Assari. 2020. "Influenza Vaccination among Underserved African-American Older Adults." BioMed Research International 2020, no. : 1-9.
Although some research has been done on end-of-life (EOL) preferences and wishes, our knowledge of racial differences in the EOL wishes of non-Hispanic White and non-Hispanic Black middle-aged and older adults is limited. Previous studies exploring such racial differences have focused mainly on EOL decision-making as reflected in advance healthcare directives concerning life-sustaining medical treatment. In need of examination are aspects of EOL care that are not decision-based and therefore not normally covered by written advance healthcare directives. This study focuses on racial differences in non-decision-based aspects of EOL care, that is, EOL care that incorporates patients’ beliefs, culture, or religion. To test the combined effects of race, socioeconomic status, health status, spirituality, perceived discrimination and medical mistrust on the EOL non-decision-based desires and wishes of a representative sample of non-Hispanic White and non-Hispanic Black older California adults. This cross-sectional study used data from the Survey of California Adults on Serious Illness and End-of-Life 2019. To perform data analysis, we used multiple logistic regression models. Non-Hispanic Blacks reported more EOL non-decision-based desires and wishes than non-Hispanic Whites. In addition to gender, age, and education other determinants of EOL non-decision-based medical desires and wishes included perceived and objective health status, spirituality, and medical trust. Poverty level, perceived discrimination did not correlate with EOL medical wishes. Non-Hispanic Blacks desired a closer relationship with their providers as well as a higher level of respect for their cultural beliefs and values from their providers compared with their White counterparts. Awareness, understanding, and respecting the cultural beliefs and values of older non-Hispanic Black patients, that usually are seen by non-Hispanic Black providers, is the first step for meaningful relationship between non-Hispanic Black patients and their providers that directly improve the end-of-life quality of life for this segment of our population.
Mohsen Bazargan; Sharon Cobb; Shervin Assari. End-of-Life Wishes Among Non-Hispanic Black and White Middle-Aged and Older Adults. Journal of Racial and Ethnic Health Disparities 2020, 1 -10.
AMA StyleMohsen Bazargan, Sharon Cobb, Shervin Assari. End-of-Life Wishes Among Non-Hispanic Black and White Middle-Aged and Older Adults. Journal of Racial and Ethnic Health Disparities. 2020; ():1-10.
Chicago/Turabian StyleMohsen Bazargan; Sharon Cobb; Shervin Assari. 2020. "End-of-Life Wishes Among Non-Hispanic Black and White Middle-Aged and Older Adults." Journal of Racial and Ethnic Health Disparities , no. : 1-10.
The study aimed to investigate sex differences in the boosting effects of household income on children’s executive function in the US. This is a cross-sectional study using data from Wave 1 of the Adolescent Brain Cognitive Development (ABCD) study. Wave 1 ABCD included 8608 American children between ages 9 and 10 years old. The independent variable was household income. The primary outcome was executive function measured by the stop-signal task. Overall, high household income was associated with higher levels of executive function in the children. Sex showed a statistically significant interaction with household income on children’s executive function, indicating a stronger effect of high household income for female compared to male children. Household income is a more salient determinant of executive function for female compared to male American children. Low-income female children remain at the highest risk regarding poor executive function.
Shervin Assari; Shanika Boyce; Mohsen Bazargan; Cleopatra Howard Caldwell. Sex Differences in the Association between Household Income and Children’s Executive Function. Sexes 2020, 1, 19 -31.
AMA StyleShervin Assari, Shanika Boyce, Mohsen Bazargan, Cleopatra Howard Caldwell. Sex Differences in the Association between Household Income and Children’s Executive Function. Sexes. 2020; 1 (1):19-31.
Chicago/Turabian StyleShervin Assari; Shanika Boyce; Mohsen Bazargan; Cleopatra Howard Caldwell. 2020. "Sex Differences in the Association between Household Income and Children’s Executive Function." Sexes 1, no. 1: 19-31.