Expanding the Reach of an Evidence-Based, System-Level, Racial Equity Intervention: Translating ACCURE to the Maternal Healthcare and Education Systems.

The abundance of literature documenting the impact of racism on health disparities requires additional theoretical, statistical, and conceptual contributions to illustrate how anti-racist interventions can be an important strategy to reduce racial inequities and improve population health. Accountability for Cancer Care through Undoing Racism and Equity (ACCURE) was an NIH-funded intervention that utilized an antiracism lens and community-based participatory research (CBPR) approaches to address Black-White disparities in cancer treatment completion. ACCURE emphasized change at the institutional level of healthcare systems through two primary principles of antiracism organizing: transparency and accountability. ACCURE was successful in eliminating the treatment completion disparity and improved completion rates for breast and lung cancer for all participants in the study. The structural nature of the ACCURE intervention creates an opportunity for applications in other health outcomes, as well as within educational institutions that represent social determinants of health. We are focusing on the maternal healthcare and K-12 education systems in particular because of the dire racial inequities faced by pregnant people and school-aged children. In this article, we hypothesize cross-systems translation of a system-level intervention exploring how key characteristics of ACCURE can be implemented in different institutions. Using core elements of ACCURE (i.e., community partners, milestone tracker, navigator, champion, and racial equity training), we present a framework that extends ACCURE's approach to the maternal healthcare and K-12 school systems. This framework provides practical, evidence-based antiracism strategies that can be applied and evaluated in other systems to address widespread structural inequities.

'It's like you don't have a roadmap really': using an antiracism framework to analyze patients' encounters in the cancer system.

Background: Cancer patients can experience healthcare system-related challenges during the course of their treatment. Yet, little is known about how these challenges might affect the quality and completion of cancer treatment for all patients, and particularly for patients of color. Accountability for Cancer Care through Undoing Racism and Equity is a multi-component, community-based participatory research intervention to reduce Black-White cancer care disparities. This formative work aimed to understand patients' cancer center experiences, explore racial differences in experiences, and inform systems-level interventions.Methods: Twenty-seven breast and lung cancer patients at two cancer centers participated in focus groups, grouped by race and cancer type. Participants were asked about what they found empowering and disempowering regarding their cancer care experiences. The community-guided analysis used a racial equity approach to identify racial differences in care experiences.Results: For Black and White patients, fear, uncertainty, and incomplete knowledge were disempowering; trust in providers and a sense of control were empowering. Although participants denied differential treatment due to race, analysis revealed implicit Black-White differences in care.Conclusions: Most of the challenges participants faced were related to lack of transparency, such that improvements in communication, particularly two-way communication could greatly improve patients' interaction with the system. Pathways for accountability can also be built into a system that allows patients to find solutions for their problems with the system itself. Participants' insights suggest the need for patient-centered, systems-level interventions to improve care experiences and reduce disparities.

Effects of combined pre- and post-natal enrichment on anxiety-like, social, and cognitive behaviours in juvenile and adult rat offspring.

The pre- and post-natal periods are characterized by unrivalled growth and are sensitive to environmental changes. A correctly stimulating early environment is essential for developing natural behaviors and maintaining affective wellness. Five litters of rat progeny were co-housed through gestation until juvenile age in housing providing physical and social enrichment. Five control litters were housed separately in standard conditions. Half of the offspring were tested in the elevated plus-maze and the social interaction test as juveniles (five weeks old) with the other half tested in the Morris water maze. As adults (11 weeks old), the testing groups were reversed. Weight was monitored weekly. Enriched offspring had leaner body weights. In the elevated plus-maze, control juvenile progeny spent a higher percentage of time in the open arms, showed greater locomotor activity, less grooming, and more rearing (males only). In the social interaction test, enriched juvenile offspring were found to sniff their conspecific more, display more self-grooming behaviour as well as show less locomotor activity and body contact. In the Morris water maze probe test, enriched rats demonstrated improved memory for the platform position and more effective search strategies with increased platform crossings, middle crossing as well as more time spent in the platform quadrant and less thigmotaxis behaviour. Adult female rat offspring also demonstrated superior memory for the platform position and crossed the maze middle more often. These results suggest that combined pre- and post-natal environmental enrichment influences physiology and behaviour in offspring rats with some of those influences being long-lasting.

In utero programming alters adult response to chronic mild stress: part 3 of a longitudinal study.

Exposure to stress before birth may lay the foundation for the development of sensitivities or protection from psychiatric disorders while later stress exposure may trigger either their expression or suppression. This report, part three of a longitudinal study conducted in our laboratory, aimed to examine the interaction between early and adult stress and their effects on measures of anxiety and depression. In parts one and two, we reported the effects of gestational stress (GS) in Long Evans rat dams and their juvenile and young adult offspring. In this third and final installment, we evaluated the effects of GS and chronic mild stress (CMS) in the adult female offspring at 6 month and 12 month time-points. The two by two design included a combination of GS and CMS and the appropriate control groups. Using Hierarchical Linear Modeling, main effects of GS on corticosterone level at the 12 month time-point was found while main effects of CMS were seen in body weight, sucrose preference, and corticosterone, and significant interactions between group at the 6 and 12 month time-points. The GS group had the lowest sucrose preference during CMS at 6 months supporting a cumulative effect of early and later life stress. The GS/CMS group showed lower corticosterone at 12 months than the GS/noCMS group indicating a possible mismatch between prenatal programming and later life stress. These results highlight the importance of early life factors in exerting potentially protective effects in models involving later life stress.

Bisphenol-A: epigenetic reprogramming and effects on reproduction and behavior.

Bisphenol A (BPA) is a synthetic compound used in the production of many polycarbonate plastics and epoxy resins. It is one of the most widely produced chemicals in the world today and is found in most canned goods, plastics, and even household dust. Exposure to BPA is almost universal: most people have measurable amounts of BPA in both urine and serum. BPA is similar in structure to estradiol and can bind to multiple targets both inside and outside the nucleus, in effect acting as an endocrine disruptor. Research on BPA exposure has accelerated in the past decade with findings suggesting that perinatal exposure to BPA can negatively impact both male and female reproduction, create alterations in behavior, and act as a carcinogen. BPA can have both short term and long term effects with the latter typically occurring through epigenetic mechanisms such as DNA methylation. This review will draw on both human and animal studies in an attempt to synthesize the literature and examine the effects of BPA exposure on reproduction, behavior, and carcinogenesis with a focus on the potential epigenetic mechanisms by which it acts.

Environmental-enrichment-related variations in behavioral, biochemical, and physiologic responses of Sprague-Dawley and Long Evans rats.

The behavioral, biochemical, and physiologic consequences of 6 wk of environmental enrichment were evaluated in male Long Evans and Sprague-Dawley rats and compared with those of rats in standard single-housing conditions. Standard housing provided little or no social or physical stimulation whereas environmental enrichment comprised group housing for 8 h daily in a 3-story cage equipped with novel stimuli. Dependent measures included performance in the forced swim test, thresholds for brain-stimulation reward, sucrose intake and preference, determination of corticosterone levels before and after brief restraint stress, and rate of weight gain. In forced swimming tests, active behaviors (diving, swimming with struggling, and climbing) tended to dominate over passive behaviors (sinking, floating) in both groups and outbred rat stocks (especially in enriched groups) on the first day. These behaviors were replaced with maintenance behaviors such as grooming and swimming without struggling on the second exposure, with enriched Long Evans rats showing the largest decline in activity. Baseline plasma corticosterone levels were elevated in both rat stocks after 6 wk of enrichment. After restraint stress, hormone levels in enriched animals tended to peak earlier and approach or exceed baseline values more quickly than was observed in the comparable control groups. Rate of body weight gain was greater in enriched Long Evans rats than Sprague-Dawley or control rats. Our observations indicate that stock- and group-associated differences in several indices occur in association with enrichment. The data support the claim that environmental enrichment may render animals more resilient to challenges.

Behavioral and physiological effects of chronic mild stress in female rats.

Anhedonia, a core symptom of clinical depression, refers to the loss of interest in normally rewarding stimuli; the chronic mild stress paradigm, an animal model of depression, was designed with this as an underlying feature. The procedure consists of the administration of a variety of ecologically relevant stressors over long durations. Its effects have been thoroughly investigated in male but not female rats. This study examines the appropriateness of stressors designed to evaluate the development and progression of depression in two strains of female rats, the effectiveness of two measures of anhedonia, and the relationship between stress reactivity and the estrous cycle. Changes in hedonic status were indexed for three weeks following a three week baseline period using two standard behavioral measures of anhedonia: sucrose intake and preference and thresholds for brain stimulation reward. Decreases in 24 h sucrose intake were observed in both strains during the first week of stress manipulations, and continued to decline thereafter for the remainder of the stress phase; in contrast, sucrose preference was unaffected by the stressors, indicating an overall reduction in fluid intake. No changes in the thresholds for brain stimulation reward were observed. The cyclical pattern of estrous was altered in both strains with a significant reduction in the number of regular cycles as a consequence of both the stressors and brain stimulation reward. Furthermore, cyclicity was not reinstated in many animals even six weeks after stress manipulations and behavioral tests had ceased. While the physiological measures suggest that the mild stressors are disruptive to female rats, the results of the behavioral tests are not consistent with the notion that the stressors induce an anhedonic state.

Evaluation of the effects of chronic mild stressors on hedonic and physiological responses: sex and strain compared.

The chronic mild stress (CMS) paradigm was developed in order to simulate in animals the symptom of anhedonia, a major feature of depression. Typically, changes in hedonic status are interpreted from a decrease in either intake or preference for a mild sucrose solution. Although the incidence of clinical depression is significantly higher in women than in men, the study of this disorder in most animal models of depression has been based on the responses of male rodents. The purpose of this study was to compare the effects of 6 weeks of CMS administration among male and female rats of two rat strains, Sprague-Dawley (SD) and Long Evans (LE), with respect to physiological (body, adrenal gland, and spleen weight) and biochemical (plasma corticosterone levels) indices of stress as well as evaluations of 1 and 24 h sucrose intake and preference. Estrous cycle was tracked throughout the study. Overall, our results indicate a slower rate of weight gain in animals, greater in males, exposed to the chronic stressor regime. Furthermore, CMS is shown to disrupt estrous cycling, predominantly in the Long Evans strain of rats. The main behavioral finding was a significant reduction in 24 h sucrose intake in female treated groups, which was not accompanied by alterations in preference. Corticosterone levels were elevated in CMS-treated animals relative to the singly housed control groups, but exposure to a subsequent stressor was not influenced by the stress history. Taken together, the effects of chronic stressor exposure are evident, based on physiological and biochemical indices, although none of the measures distinguished any striking gender specific reactions. The usefulness of sucrose intake or preference as behavioral indices of CMS-induced anhedonia in males and females is modest at best.