The increasing importance of genomic information in clinical care heightens our need to examine how individuals understand, value, and communicate about this information. Based on a conceptual framework of genomics-related health literacy, we examined whether health literacy was related to knowledge, self-efficacy, and perceived importance of genetics and FHH and communication about FHH in a medically underserved population. The analytic sample was comprised of 624 patients at a primary care clinic at a large urban hospital. About half of participants (47%) had limited health literacy; 55% had no education beyond high school and 58% were Black. In multivariable models, limited health literacy was associated with lower genetic knowledge (β=−0.55; SE=0.10, p<.0001), lower awareness of FHH (OR=0.50; 95% CI=0.28,0.90, p=.020), greater perceived importance of genetic information (OR=1.95; 95% CI=1.27,3.00, p=.0022) but lower perceived importance of FHH information (OR=0.47; 95% CI=0.26,0.86, p=.013), and more frequent communication with a doctor about FHH (OR=2.02; 95% CI=1.27,3.23, p=.0032). The findings highlight the importance of considering domains of genomics-related health literacy (e.g., knowledge, oral literacy) in developing educational strategies for genomic information. Health literacy research is essential to avoid increasing disparities in information and health outcomes as genomic information reaches more patients.

Interpersonal and Communication Skills.

Objective: Residency is a challenging time in the lives of physicians. In this study, we examined the relationship between general self-efficacy, defined as the belief in one's own capabilities in a variety of situations, and burnout and psychological well-being in a sample of surgical residents. Design:In the context of a larger study, a cross-sectional survey was administered to residents. The survey included measures of general self-efficacy, the emotional exhaustion and personal accomplishment domains of burnout, and general psychological well-being. We examined correlations between self-efficacy and these well-being outcomes and used multivariable linear regression models that controlled for age, gender, post-graduate year, ethnicity, and the interaction between gender and self-efficacy. Setting:We surveyed residents at Stanford Health Care, a tertiary care center, between the fall of 2010 and the spring of 2013.Participants: 179 residents from 9 surgical sub-specialties responded to the survey for a response rate of 76%. Results:Residents reported high levels of self-efficacy, and over a third reported high emotional exhaustion. Eighty-nine percent of residents had average or high personal accomplishment. In adjusted regression analyses, general self-efficacy was negatively predictive of emotional exhaustion (B = −0.43, p = 0.0127) and positively predictive of personal accomplishment (B = 0.33, p = 0.0185) and general psychological well-being (B = 0.34, p = 0.0010). There was no interaction between gender and general self-efficacy in regression analyses (ps ≥ 0.6776).

IntroductionWe examined racial/ethnic heterogeneity in self-reported diabetes prevalence over 15 years.MethodsWe used National Health Interview Survey data for 1997 through 2012 on 452,845 adults aged 18 years or older. Annual self-reported diabetes prevalence was estimated by race/ethnicity and education. We tested for trends over time by education and race/ethnicity. We also analyzed racial/ethnic and education trends in average annual prevalence.ResultsDuring the 15 years studied, diabetes prevalence differed significantly by race/ethnicity (P < .001) and by Hispanic subgroup (P < .001). Among participants with less than a high school education, the 5-year trend in diabetes prevalence was highest among Cubans and Cuban Americans (β5YR = 4.8, P = .002), Puerto Ricans (β5YR = 2.2, P = .06), non-Hispanic blacks (β5YR = 2.2, P < .001), and non-Hispanic whites (β5YR = 2.1, P < .001). Among participants with more than a high school education, non-Hispanic blacks had the highest average annual prevalence (5.5%) and Puerto Ricans had the highest 5-year trend in annual diabetes prevalence (β5YR = 2.6, P = .001).ConclusionsIn this representative sample of US adults, results show ethnic variations in diabetes prevalence. The prevalence of diabetes is higher among Hispanics than among non-Hispanic whites, unevenly distributed across Hispanic subgroups, and more pronounced over time and by education. Findings support disaggregation of data for racial/ethnic populations in the United States to monitor trends in diabetes disparities and the use of targeted, culturally appropriate interventions to prevent diabetes.

No abstract

Synopsis The SLC30A8 gene encodes the zinc transporter ZnT-8, which provides zinc for insulin-hexamer formation. Genome-wide association studies have shown that a polymorphic variant in SLC30A8 is associated with altered susceptibility to type 2 diabetes and we recently reported that glucose-stimulated insulin secretion is decreased in islets isolated from Slc30a8 knockout mice. The present study examines the molecular basis for the islet-specific expression of Slc30a8. VISTA analyses identified two conserved regions in Slc30a8 introns 2 and 3, designated enhancers A and B, respectively. Transfection experiments demonstrated that enhancer B confers elevated fusion gene expression in both βTC-3 cells and αTC-6 cells. In contrast, enhancer A confers elevated fusion gene expression selectively in βTC-3 and not αTC-6 cells. These data suggest that enhancer A is an islet beta cell-specific enhancer and that the mechanisms controlling Slc30a8 expression in alpha and beta cells are overlapping but distinct. Gel retardation and chromatin immunoprecipitation (ChIP) assays revealed that the islet-enriched transcription factor Pdx-1 binds enhancer A in vitro and in situ, respectively. Mutation of two Pdx-1 binding sites in enhancer A markedly reduces fusion gene expression suggesting that this factor contributes to Slc30a8 expression in beta cells, a conclusion consistent with developmental studies showing that restriction of Pdx-1 to pancreatic islet beta cells correlates with the induction of Slc30a8 gene and ZnT-8 protein expression in vivo.

CONDENSATIONBlack-white health disparities in the rate of unintended pregnancies can be reduced by providing education, reducing access barriers, and providing contraception at no cost. 2009, 2010, and 2011. We estimated an absolute measure (rate difference (RD)) and a relative measure (rate ratio (RR)) to examine Black-White disparities in the rates of unintended pregnancy.Results: While national rates of unintended pregnancy are decreasing, racial disparities in these rates persist. The Black-White rate difference dropped from 158.5 per 1,000 in 2008 to 120.1 per 1,000 in 2011; however, the relative ratio disparity decreased only from 2.6 to 2.5, suggesting that Black sexually active teens in the U.S.have 2.5 times the rate of unintended pregnancy as White teenagers. In the CHOICE Project, there was a decreasing trend in racial disparities in unintended pregnancy rates Draft 12/6/17 Unintended Pregnancies: Reducing Health Disparities Page | 4 among sexually active teens (age 15-19); RR=3.7), 2010 RR=1.2) and 2013-2014 (RD=-1.5; RR=1.0). Conclusions:When barriers to cost, access, and knowledge were removed, such as in the Contraceptive CHOICE Project, Black-White disparities in unintended pregnancy rates among sexually active teens are reduced on both absolute and relative scales.The rate of unintended pregnancy was almost equal between Black and White women compared to large Black-White disparities on the national level. Word Count: 343Draft 12/6/17

Physical activity among youth is shaped by the natural and built environment within which they live; however, few studies have focused on assessing playground safety and proximity in detail as part of the built environment for youth physical activity. We analyzed data on 100 publicly accessible playgrounds from Play Across St. Louis, a community-partnered study of the built environment for youth physical activity. Outcomes included overall playground safety, maintenance, and construction scores; distance to nearest playground; and distance to nearest top playground. Independent variables included neighborhood % youth, % black residents, % owner-occupied units, and % vacant units. Playgrounds in the city have varying degrees of safety and proximity. Mean overall playground safety score was 67.0 % (CI = 63.5, 70.4). Neighborhood % youth and % black residents were inversely associated with overall playground safety (p = 0.03 and p < 0.01) and maintenance (p < 0.01 and p < 0.0001). Mean distance to nearest playground was 638.1 and 1488.3 m to nearest top playground. Clusters of low safety scores were found in the northern and central areas while all high safety score clusters were found in the southern part of St. Louis. Public playground safety and proximity vary across St. Louis neighborhoods, especially by neighborhood demographics. Disparities in playground safety and proximity reveal an opportunity to develop community-wide interventions focused on playgrounds for youth activity. Further work is needed to examine the association between playground safety, proximity, and use and youth physical activity and weight.