Gretchen E. White

Introduction: To successfully recruit and retain faculty members from underrepresented backgrounds (URBs), we need to understand the factors that attract them to research careers in the first place. However, scholarship in this area has focused largely on students who are contemplating research careers rather than faculty members who are currently in such careers. Methods: This study explores the career motivations of early-career health researchers (faculty members and postdoctoral fellows) from URBs. It was conducted as part of a cluster randomized trial across 25 academic institutions investigating a support intervention. We conducted 1-hour semi-structured qualitative interviews with scholars from URBs in both the intervention and control arms of the trial. To our knowledge, this is the largest qualitative study of early-career faculty members from URBs to date. Results: Seventy-eight individuals were interviewed. Our analysis revealed six key themes pertinent to participants’ motivations to pursue research careers: (1) love of science; (2) making a larger impact; (3) happenstance and economic considerations; (4) family, community, and a path out of poverty; (5) the role of mentors and role models; and (6) support programs for scholars from URBs. Conclusions: Our results align with prior studies while offering new insights into the motivations of URB faculty members in research careers. These insights can and should inform the design of programs to both recruit and retain URM faculty members in research careers.

Introduction: Scientific teams that are comprised of different types of researchers have higher research productivity, and there is a need for evidence-based methods to improve the biomedical research workforce. Building Up a Biomedical Research Workforce (Building Up) was a multi-center, cluster-randomized, unblinded controlled trial with one intervention arm and one control arm, conducted at 25 United States academic medical centers. The authors tested the hypothesis that participants from backgrounds underrepresented in science who are randomized to the intervention will have greater numbers of peer-reviewed publications and increased Psychological Capital, compared to the control group. Methods: The study included a 10-month intervention period and follow-up assessments occurring one, two, and three years after the intervention began. The intervention arm received a 10-month intervention with monthly meetings, near-peer mentoring, networking opportunities, and grant- and scientific-writing coursework. Participants in the control arm experienced the usual forms of mentoring, networking, and coursework that their institutions provided. Results: Of the 220 participants who completed the pre-intervention assessment (98% of all enrolled participants), 71% completed the post-intervention assessment at year 1, 60% at year 2, and 66% at year 3. Individuals in the intervention arm had significantly higher levels of self-efficacy, resilience, and optimism in the three years following the start of the intervention, compared to the control arm. Discussion: This finding suggests that the Building Up intervention can increase participants’ Psychological Capital.

Introduction: The purpose of this research was to understand perceptions and experiences of inclusion among underrepresented early-career biomedical researchers (postdoctoral fellows and early-career faculty) enrolled in the Building Up study. Because inclusion is vital to job satisfaction and engagement, our goal was to shed light on aspects of and barriers to inclusion within the academic workforce. Methods: We used qualitative interviews to assess workplace experiences of 25 underrepresented postdoctoral fellows and early-career faculty including: their daily work experiences; sense of the workplace culture within the institutions; experiences with microaggressions, racism, and discrimination; and whether the diversity, equity, and inclusion (DEI) policies and practices at their institution enhanced their experiences. Using qualitative methods, we identified themes that highlighted high-level characteristics of inclusion. Results: Four distinct themes were identified: (1) participants appreciated the flexibility, versatility, and sense of fulfillment of their positions which enhanced feelings of inclusion; (2) greater psychological safety led to a greater sense of belonging to a research community; (3) participants had varied experiences of inclusion in the presence of microaggressions, racism, and discrimination; and (4) access to opportunities and resources increased feelings of value within the workplace. Discussion: Our findings provide new insight into how inclusion is experienced within the institution among underrepresented early-career biomedical researchers. This research points to specific approaches that could be used to enhance experiences of inclusion and to address barriers. More research is needed to understand how to accomplish a balance between the two, so that perceptions of inclusion outweigh negative experiences.

Objective: To identify factors associated with incident alcohol consumption, hazardous drinking, alcohol-related problems, and substance use up to 8 years following metabolic and bariatric surgery (MBS) during adolescence. Background: In this cohort, nearly half of those who underwent MBS as adolescents screened positive for alcohol use disorder, symptoms of alcohol-related harm, or alcohol-related problems within 8 years post-surgery. Moreover, persistent or heavy marijuana use following MBS during adolescence is higher than national data. Methods: This study includes 217 adolescents (aged 13–19 years) enrolled in a 5-center prospective cohort study who underwent Roux-en-Y gastric bypass or vertical sleeve gastrectomy between 2007 and 2011 and were followed for up to 8 years. Participants self-reported alcohol use via the Alcohol Use Disorders Identification Test and substance use for up to 8 years. Results: Female sex, pre-surgery lower body mass index, and pre-surgery substance use were independently associated with increased risk of incident post-surgery hazardous drinking. Pre-surgery psychiatric counseling was significantly associated with increased risk for new-onset substance use post-surgery. Starting substance use post-surgery or continuing pre- to post-surgery was independently associated with a higher risk of post-surgery hazardous drinking. Greater percent weight loss, starting post-surgery or continuing pre- to post-surgery psychiatric counseling, using alcohol, and hazardous drinking were independently associated with a higher risk of post-surgery substance use. Conclusions: Future research with a nonsurgical control group should be examined to further elucidate the relationships between MBS and alcohol and substance use following surgery during adolescence.

Objective: Researchers from underrepresented groups leave research positions at a disproportionate rate. We aim to identify factors associated with self-efficacy in career advancement and career commitment among underrepresented post-doctoral fellows and early-career faculty.Methods: Building Up is a cluster-randomized trial with 25 academic health institutions. In September-October 2020, 219 Building Up participants completed the pre-intervention assessment, which included questions on demographics, science identity, mentoring, self-efficacy in career advancement (i.e., advancement is open to me, confidence in career progression, confidence in overcoming professional barriers), and career commitment (i.e., intent to continue research training or studying in a field related to biomedical sciences). Using logistic and multinomial logistic regression, we identified characteristics independently associated with self-efficacy in career advancement and career commitment.Results: The cohort is 80% female, 33% non-Hispanic/Latinx Black, and 34% Hispanic/Latinx. Having mentors that address diversity was significantly associated with the belief that advancement is open to them (OR = 1.7). Higher science identity (OR = 4.0) and having mentors that foster independence (OR = 1.8) were significantly associated with confidence in career progression. Higher science identity was also significantly associated with confidence in overcoming professional barriers (OR = 2.3) and intent to continue studying in a field related to biomedical sciences (OR = 3.3). Higher age (OR = 2.3) and higher science identity (OR = 4.2) were significantly associated with intent to continue research training.Discussion: Science identity and mentoring play key roles in self-efficacy in career advancement and career commitment. These factors may contribute to retention of underrepresented early-career biomedical researchers.

Background: Opioids are a key component of pain management among patients with metastatic cancer pain. However, the evidence base available to guide opioid-related decision-making in individuals with advanced cancer is limited. Patients with advanced cancer or cancer that is unlikely to be cured frequently experience pain. Opioids are a key component of pain management among patients with metastatic cancer pain. Many individuals with advanced cancer are now living long enough to experience opioid-related harm. Emerging evidence from chronic noncancer pain literature suggests that longer-term opioid therapy may have limited benefits for pain and function, and opioid-related harms are also a major concern. However, whether these benefits and harms of opioids apply to patients with cancer-related pain is unknown. Objective: This manuscript outlines the protocol for the “Opioid Therapy for Pain in Individuals With Metastatic Cancer: The Benefits, Harms, and Stakeholder Perspectives (BEST) Study.” The study aims to better understand opioid decision-making in patients with advanced cancer, along with opioid benefits and harms, through prospective examination of patients’ pain experiences and opioid side effects and understanding the decision-making by patients, care partners, and clinicians. Methods: This is a multicenter, prospective cohort study that aims to enroll 630 patients with advanced cancer, 20 care partners, and 20 clinicians (670 total participants). Patient participants must have an advanced solid cancer diagnosis, defined by the American Cancer Society as cancer that is unlikely to be cured. We will recruit patient participants within 12 weeks after diagnosis so that we can understand opioid benefits, harms, and perspectives on opioid decision-making throughout the course of their advanced cancer (up to 2 years). We will also specifically elicit information regarding long-term opioid use (ie, opioids for ≥90 consecutive days) and exclude patients on long-term opioid therapy before an advanced cancer diagnosis. Lived-experience perspectives related to opioid use in those with advanced cancer will be captured by qualitative interviews with a subset of patients, clinicians, and care partners. Our data collection will be grounded in a behavioral decision research approach that will allow us to develop future interventions to inform opioid-related decision-making for patients with metastatic cancer. Results: Data collection began in October 2022 and is anticipated to end by November 2024. Conclusions: Upon successful execution of our study protocol, we anticipate the development of a comprehensive evidence base on opioid therapy in individuals with advanced cancer guided by the behavioral decision research framework. The information gained from this study will be used to guide interventions to facilitate opioid decisions among patients, clinicians, and care partners. Given the limited evidence base about opioid therapy in people with cancer, we envision this study will have significant real-world implications for cancer-related pain management and opioid-related clinical decision-making. International Registered Report Identifier (IRRID): DERR1-10.2196/54953

There have been numerous investigations of aberrant eating and substance abuse among patients who have undergone bariatric surgery, which affects the metabolism and the pharmacokinetics of alcohol. However, there is a dearth of literature considering the complex interplay between changes in post‐surgery food and alcohol consumption. Furthermore, despite the increasing recognition of issues surrounding replacing food consumption with alcohol consumption (Food and Alcohol Disturbance [FAD]), most emerging research has focused on young adult populations. This perspective reviews and synthesizes the small but growing body of research on the interplay between food and alcohol consumption, particularly FAD, and considers its application to bariatric surgery in general. There are unique considerations for patients who have undergone bariatric surgery. Patients experience altered gastric anatomy, which affects food and alcohol metabolism, and are advised to abstain from drinking alcohol after surgery. After reviewing the available literature, this perspective highlights future directions for research and practice in bariatric surgery.

BACKGROUND Opioids are a key component of pain management among patients with metastatic cancer pain. However, the evidence base available to guide opioid-related decision-making in individuals with advanced cancer is limited. Patients with advanced cancer or cancer that is unlikely to be cured frequently experience pain. Opioids are a key component of pain management among patients with metastatic cancer pain. Many individuals with advanced cancer are now living long enough to experience opioid-related harm. Emerging evidence from chronic noncancer pain literature suggests that longer-term opioid therapy may have limited benefits for pain and function, and opioid-related harms are also a major concern. However, whether these benefits and harms of opioids apply to patients with cancer-related pain is unknown. OBJECTIVE This manuscript outlines the protocol for the “Opioid Therapy for Pain in Individuals With Metastatic Cancer: The Benefits, Harms, and Stakeholder Perspectives (BEST) Study.” The study aims to better understand opioid decision-making in patients with advanced cancer, along with opioid benefits and harms, through prospective examination of patients’ pain experiences and opioid side effects and understanding the decision-making by patients, care partners, and clinicians. METHODS This is a multicenter, prospective cohort study that aims to enroll 630 patients with advanced cancer, 20 care partners, and 20 clinicians (670 total participants). Patient participants must have an advanced solid cancer diagnosis, defined by the American Cancer Society as cancer that is unlikely to be cured. We will recruit patient participants within 12 weeks after diagnosis so that we can understand opioid benefits, harms, and perspectives on opioid decision-making throughout the course of their advanced cancer (up to 2 years). We will also specifically elicit information regarding long-term opioid use (ie, opioids for ≥90 consecutive days) and exclude patients on long-term opioid therapy before an advanced cancer diagnosis. Lived-experience perspectives related to opioid use in those with advanced cancer will be captured by qualitative interviews with a subset of patients, clinicians, and care partners. Our data collection will be grounded in a behavioral decision research approach that will allow us to develop future interventions to inform opioid-related decision-making for patients with metastatic cancer. RESULTS Data collection began in October 2022 and is anticipated to end by November 2024. CONCLUSIONS Upon successful execution of our study protocol, we anticipate the development of a comprehensive evidence base on opioid therapy in individuals with advanced cancer guided by the behavioral decision research framework. The information gained from this study will be used to guide interventions to facilitate opioid decisions among patients, clinicians, and care partners. Given the limited evidence base about opioid therapy in people with cancer, we envision this study will have significant real-world implications for cancer-related pain management and opioid-related clinical decision-making. INTERNATIONAL REGISTERED REPORT DERR1-10.2196/54953