Saturday, February 28, 2009

Sweetened beverage consumption increases in the US

Over the past two decades, the number of adults consuming sugar-sweetened beverages such as soft drinks, fruit drinks and punches has increased dramatically, according to a study led by researchers at the Johns Hopkins Bloomberg School of Public Health. Researchers examined changes over the past two decades in sugar-sweetened beverage consumption based on nationally representative survey data, and found that sugar-sweetened beverages comprise a significant source of total daily beverage intake and are the largest source of beverage calories consumed daily. Their results are published in the January 2009 issue of the American Journal of Clinical Nutrition.

“More adults are drinking sugar-sweetened beverages and, among those drinkers, consumption has increased,” said Sara N. Bleich, PhD, lead author of the study and assistant professor with the Bloomberg School’s Department of Health Policy and Management.

Sara N. Bleich

Sara N. Bleich, My research aims to reduce the escalation of obesity and its related diseases by exploring important research questions related to the intersection between public policy and obesity prevention/control. Most of my research has focused on understanding global trends in adult obesity, obesity-related risk communication, access to health care services for individuals with obesity-related conditions and trends in sugar-sweetened beverage consumption.

Going forward, I am particularly interested in examining disparities in practice patterns of obesity care and novel environmental strategies designed to reduce caloric consumption or increase physical activity.
“From 1988 to 2004, the percentage of sugar-sweetened beverage drinkers increased five percent. Per capita consumption of energy from sugar-sweetened beverages increased 46 kilocalories (kcal) per day, and daily sugar-sweetened beverage consumption among drinkers increased 6 ounces per day.”

The study also examined trends in sugar-sweetened beverage consumption by age, race/ethnicity and weight loss intention. Sugar-sweetened beverage consumption was highest among young adults (231-289 kcal/day), who consumed roughly 20 percent of their sugar-sweetened beverage calories at work, and lowest among the elderly (68-83 kcal/day).

Among race/ethnicity groups, the percentage of sugar-sweetened beverage drinkers and per capita consumption of sugar-sweetened beverages was highest among blacks followed by Mexican Americans. Overweight/obese adults who were trying to lose weight were less likely to drink sugar-sweetened beverages compared to those who were not, but they still consumed a considerable amount from 1999 to 2004 (278 kcal/day).

Using dietary data collected in the National Health and Nutrition Examination Surveys (1988 to 1994 and 1999 to 2004), researchers examined national trends in sugar-sweetened beverage consumption (percentage of drinkers, amount consumed, consumption location and type of beverage) among U.S. adults.
Bleich, along with colleagues, identified six mutually exclusive beverage categories: sugar-sweetened beverages (soft drinks, sports drinks, fruit drinks and punches, low-calorie drinks, sweetened tea, and other sweetened beverages), 100 percent juice, diet beverages, milk, coffee or tea, and alcohol.

Earlier studies have linked consumption of sugar-sweetened beverages to the obesity epidemic, which affects two-thirds of adults and increases the risk for adverse health conditions such as type 2 diabetes. Adults are considered to be overweight if their body mass index is 25 or higher, and obese, if 30 or higher.

“Although this analysis does not attempt to estimate the effect of sugar-sweetened beverage intake on obesity incidence, a number of studies have linked sugar-sweetened beverage consumption to obesity and type 2 diabetes,” said Youfa Wang, MD, PhD, author and associate professor with the Bloomberg School’s Center for Human Nutrition. “Based on these nationally representative surveys, our study found higher sugar-sweetened beverage consumption also happened to be among populations at greater risk for obesity. There are few signs of improvement over the past decade and the situation seems to become worse among young adults aged 20 to 44.”

According to Bleich and colleagues, efforts to reduce sugar-sweetened beverage consumption may be an important strategy for reducing empty calorie intake in the adult diet in the United States.

“Increasing Consumption of Sugar-Sweetened Beverages Among US Adults: 1988-1994 to 1999-2004” was written by Sara N. Bleich, Y. Claire Wang, Youfa Wang, and Steven L. Gortmaker.

The researchers were supported in part by the Johns Hopkins Bloomberg School of Public Health and the Robert Wood Johnson Foundation, grant 57891.

Media contact for Johns Hopkins Bloomberg School of Public Health: Natalie Wood-Wright at 410-614-6029 or WEB: 410-614-6029 Johns Hopkins University Bloomberg School of Public Health

Thursday, February 26, 2009

PSA levels accurately predict prostate cancer risk in African-American men

PHILADELPHIA – PSA levels appear to be more predictive of three year prostate cancer risk in African-American men compared with Caucasian men with a family history of prostate cancer, according to a paper published in Cancer Prevention Research, a journal of the American Association for Cancer Research.

"It was previously thought that PSA levels were just naturally higher in African-American men, suggesting a need to possibly adjust the threshold upward before recommending a biopsy," said Veda Giri, M.D., director of the Prostate Cancer Risk Assessment Program at Fox Chase Cancer Center.

Giri and colleagues at the University of Chicago observed 646 high-risk men, of whom 63 percent were African-American, in the Prostate Cancer Risk Assessment Program, which has an aggressive early detection approach.

Veda N Giri, MD

Veda N Giri, MD, I joined the staff of Fox Chase in 2004. Since that time, I have been named the director of the Prostate Cancer Risk Assessment Program. I was appointed to the National Institutes of Health Prostate Cancer Genetics PDQ Editorial Board. At Fox Chase, I am an active member of the IRB (Institutional Review Board) as well as the Executive Steering Committee.
No "race specific" differences in PSA levels were found when race was measured using genetic markers of ancestry or reported by participants.

The researchers subsequently analyzed men with a PSA between 1.5 to 4 ng/mL, and who had at least one follow-up visit. They found that among men with a family history of prostate cancer, PSA levels had the same predictive value whether the men were Caucasian or African-American.

These findings are unique in that typically men are not recommended for a prostate biopsy until their PSA levels rise above 4 ng/mL. Larger studies with longer follow-up are needed to confirm these findings.
"African-American men and men with a family history of prostate cancer should be encouraged to participate in early detection studies to define personalized screening strategies that may diagnose prostate cancer at a curable point," said Giri. ###

The mission of the American Association for Cancer Research is to prevent and cure cancer. Founded in 1907, AACR is the world's oldest and largest professional organization dedicated to advancing cancer research. The membership includes more than 28,000 basic, translational and clinical researchers; health care professionals; and cancer survivors and advocates in the United States and 80 other countries.

AACR marshals the full spectrum of expertise from the cancer community to accelerate progress in the prevention, diagnosis and treatment of cancer through high-quality scientific and educational programs. It funds innovative, meritorious research grants. The AACR Annual Meeting attracts more than 17,000 participants who share the latest discoveries and developments in the field. Special conferences throughout the year present novel data across a wide variety of topics in cancer research, treatment and patient care.

AACR publishes five major peer-reviewed journals: Cancer Research; Clinical Cancer Research; Molecular Cancer Therapeutics; Molecular Cancer Research; and Cancer Epidemiology, Biomarkers & Prevention. Its most recent publication and its sixth major journal, Cancer Prevention Research, is dedicated exclusively to cancer prevention, from preclinical research to clinical trials. The AACR also publishes CR, a magazine for cancer survivors and their families, patient advocates, physicians and scientists. CR provides a forum for sharing essential, evidence-based information and perspectives on progress in cancer research, survivorship and advocacy.

Contact: Jeremy Moore 267-646-0557 American Association for Cancer Research

Tuesday, February 24, 2009

Study finds recession associated with increases in minority victims of crime

The victimization of both female and male blacks and Latinos increases during or after periods of economic recession, according to a study by researchers Karen Heimer of the University of Iowa and Janet Lauritsen of the University of Missouri-St. Louis.

The study was presented Sunday, Feb. 15, at the 2009 Annual Meeting of the American Association for the Advancement of Science in Chicago. The study is the first of its kind to estimate trends in serious, non-lethal, violent victimization for non-Latino white, non-Latino black, and Latino males and females using data from the 1973-2005 National Crime Victimization Surveys, according to Lauritsen and Heimer.

"The findings offer new empirical evidence regarding the similarities and differences in risks of serious non-lethal violent victimization across race ethnic-gender groups over time," Heimer said.

Karen Heimer

Karen Heimer

Janet L. Lauritsen

Janet L. Lauritsen
"Minorities experience substantially higher rates of violent victimization than non-Latino whites in the United States," she said. "Our study shows that the higher rates of poverty, urban residence and differential age distributions of non-Latino blacks and Latinos help to explain these groups' higher victimization rates. Moreover, our study examines data from the early 1970s to the present and documents an association between economic downturn and increases in victimization rates among minorities over this period."

Heimer said that the findings will be important for police and criminal justice policy-makers, as well as providers of services to victims of crime, who may be concerned about the potential consequences of our current recession for crime and victimization.

Lauritsen and Heimer's talk, titled "Long-Term Trends in Exposure to Serious Violent Crime by Race, Ethnicity, and Gender," was part of a AAAS session on "Race, Ethnicity and Violent Crime." ###
Karen Heimer is professor in the University of Iowa College of Liberal Arts and Sciences Department of Sociology and is jointly appointed in the Public Policy Center. She earned her doctorate in sociology from the University of Wisconsin-Madison. Her major areas of interest are victimization, gender, criminology, and criminal punishment. She is currently conducting research on trends in violence against women, women's crime, and race and gender differences in imprisonment in the United States. Her book (co-edited with Candace Kruttschnitt), "Gender and Crime: Patterns of Victimization and Offending," was published by New York University Press in 2006.

STORY SOURCE: University of Iowa News Services, 300 Plaza Centre One, Suite 371, Iowa City, Iowa 52242-2500

MEDIA CONTACT: Gary Galluzzo, writer, 319-384-0009,

Contact: Gary Galluzzo 319-384-0009 University of Iowa

Sunday, February 22, 2009

US Civil War illustrates costs, benefits of diversity, say UCLA economists

Book finds loyalty, sacrifice highest among soldiers of similar background

Diversity is a double-edged sword, making individuals less likely to be altruistic than they might be in a more homogeneous setting but also inspiring them to scale new intellectual heights and to explore new horizons, argue two UCLA economists in a new book.

"People enjoy being around people they can relate to, and they are uncomfortable with diversity," said Matthew Kahn, a co-author of "Heroes and Cowards: The Social Face of War," which will be published Jan. 21 by Princeton University Press. "But even though people don't like being exposed to people who are different, they benefit from the experience in the long run. They learn the most from those who are different."

26th U.S. Colored Volunteer Infantry

The 26th U.S. Colored Volunteer Infantry on parade, Camp William Penn, Pa., 1865. 165-C-692.

Pictures of the Civil War. Select Audiovisual Records, National Archives and Records Administration, Washington, DC 20408.
While recent research into lower rates of volunteerism and lack of taxpayer support for local projects in diverse communities has reached similar conclusions, the latest findings are based on a surprising set of subjects: 41,000 soldiers who served in the U.S. Civil War between 1861 and 1865.

"Union soldiers, whether in prison camps or in the field, were the most loyal to men who looked like themselves — of the same ethnicity and occupation, from the same state or hometown, or of the same age or related by blood," said co-author Dora L. Costa, a UCLA economics professor.
"We believe that by going back so far in time we're getting at an effect that's universal. This reaction to diversity may be hardwired into us."

Curious about the forces that motivate individuals to acts of heroism, Costa and Kahn set out to mine millions of records on Union soldiers that have been gathered since 1991 into a database funded by the National Institutes of Health.

Tracing enlisted men throughout their tour of duty and into retirement, the Union Army Dataset merges official Union records with now-public census data between 1840 and 1910, essentially providing a cradle-to-the-grave look at the soldiers. Details include a soldier's original economic status, degree of literacy and hometown; his military record, including whether he deserted or ended up in prisoner of war camps and how he fared there; and his eventual residence, livelihood, economic status and degree of literacy.

The researchers then subjected these variables to the same sort of statistical analysis as social scientists who conduct research on living subjects in experimental conditions. The results, insist the UCLA team, are just as valid — and possibly even more trustworthy — than glimpses into human behavior gleaned from laboratory experiments.

"Unlike university laboratory researchers, we examined life-or-death choices," Costa said. "We could never orchestrate an experimental exercise with such high stakes. These are decisions that really mattered to people. As a result, they paid a lot of attention to their decisions, and those decisions reflect profound truths."

Men who served in war companies with men who shared similar characteristics — a common religion, race, ethnic group, socioeconomic status, hometown or even plantation — behaved markedly differently from their counterparts in more diverse companies. For starters, they had much lower desertion rates than the norm of one desertion per 10 Union soldiers. Union soldiers who served alongside men from the same occupations deserted at one-third the rate of counterparts in more diverse companies, as did former slaves who served with former slaves from the same plantation.

"Economic theory says you would look out for your own welfare," Kahn said. "Yet we kept seeing all these very moving examples of people wanting to sacrifice for others."

And the absence of diversity actually outranked other potential sources of loyalty. Costa and Kahn expected to find that company morale or commitment to the cause played as big if not a bigger role in keeping a soldier on the battlefield. Yet they found that companies with the lowest amount of diversity — such as companies in which friends, relatives or neighbors served together — had the lowest desertion rates. The least diverse companies had one-third fewer desertions than more diverse companies with high morale or strong ideological commitments.

"This was one of the most ideological wars in U.S. history," Costa said. "If we find that serving with similar people or buddies matter the most here, then we know the effect is big, and in fact, that's what we found. Even when the ideological stakes are huge, it's serving alongside comrades that keeps you in the war — not commitment to cause."

In addition to inspiring enlistees to persevere, peers also proved important to surviving such grim prisoner of war camps as Andersonville, a Confederate death trap that claimed the lives of close to 40 percent of its captives. Survival rates for Union soldiers born in Ireland, for instance, improved only from 60 percent to 64 percent if they were incarcerated with 15 comrades from their original company, Costa and Kahn found. But the soldiers' survival rates shot up to 90 percent when those 15 comrades were not only from the same company but were also fellow Irish immigrants.

"We believe that your comrades would help you get healthy if you got sick and share their food rations," Kahn said. "So in P.O.W. camps, diversity actually turned out to be a bad thing. It hindered survival rates."

But diversity was not without its benefits. Costa and Kahn focused on three separate kinds of African American troops: troops that consisted primarily of freed slaves, troops that consisted primarily of freemen (African Americans who were not born into slavery) and troops that mixed both kinds of African American enlistees.

While companies with both former slaves and freemen had higher desertion rates than units that consisted primarily of one group or the other, former slaves in the diverse companies learned to write at higher rates than their counterparts in more homogenous units, Costa and Kahn found. In companies comprised almost exclusively former slaves, only 16 percent of soldiers learned to write during their tour of duty. That number nearly doubled in companies in which former slaves mixed with freemen.

"For former slaves who had been prevented from learning to read and write in slavery, diverse companies were almost like a job training program, preparing them for improved economic opportunities down the line," Kahn said.

In addition to being more likely to learn to literacy skills, former slaves in diverse companies also were more likely than their counterparts in more uniform companies to change their slave names, the researchers found.

"Adopting a new name was a measure of taking on the identity of a free person," Costa said. "These former slaves started to see themselves differently as a result of the more expanded horizons of the men with whom they served."

African American soldiers from diverse companies also were much more likely than their counterparts to move away from home after the war. This was especially the case among illiterate soldiers for whom word of mouth was their primary source of information. The economists found that for every 10 percentage-point increase in comrades who hailed from a particular state different than the home state of an illiterate solider, the likelihood of that illiterate soldier ultimately relocating to that state jumped by more than 30 percent.

"We call this 'the Zagat Guide effect,'" Kahn said. "So if we're in the same company, and I'm from New Jersey, you are more likely to move to New Jersey after the war. We believe that I taught you about the benefits of New Jersey. Serving in a diverse unit helped open horizons for men who had previously enjoyed no mobility whatsoever."

"Heroes and Cowards" represents the most extensive use to date of Civil War data amassed by the University of Chicago and Brigham Young University under the direction of Nobel laureate economist Robert Fogel. For the past decade, Costa has been second-in-command on the unparalleled NIH-funded project.

Compiled from records in the National Archives, the Union Army Dataset focuses on Union rather than Confederate records because of the North's famously generous medical benefits for veterans, the authors explained. The most widespread form of assistance to the elderly before the advent of Social Security, these benefits ultimately extended to 90 percent of Union Army veterans. Records for these benefits allow researchers to track the health, whereabouts and other outcomes of Union veterans into old age and to link them to census data for the men, which in turn revealed even more information.

After losing the war, Confederate states offered benefits to veterans on a state-by-state basis, and they did so only when they could afford them, the authors explained. With the South's financial collapse following the war, many Confederate veterans did not receive medical benefits, confounding any attempt to track them through public documents as they aged.

"Confederate records just aren't as comprehensive or useful for this kind of analysis as the Union records," Costa said.

The confluence of increased privacy protections on medical, military and census data and the replacement of a draft armed forces with a voluntary one make military records from later U.S. conflicts less valuable for research purposes than the Civil War documents, the authors contend.

"This material is really a treasure trove," Costa said. "The Union records provide an awesome laboratory for studying human behavior that doesn't exist anywhere else and can't exist again." ###

UCLA is California's largest university, with an enrollment of nearly 38,000 undergraduate and graduate students. The UCLA College of Letters and Science and the university's 11 professional schools feature renowned faculty and offer more than 323 degree programs and majors. UCLA is a national and international leader in the breadth and quality of its academic, research, health care, cultural, continuing education and athletic programs. Four alumni and five faculty have been awarded the Nobel Prize.

Contact: Meg Sullivan 310-825-1046 University of California - Los Angeles

Friday, February 20, 2009

New study finds blacks still lag in obtaining total knee replacements for arthritis

ATLANTA, Feb. 19, 2009 – A new study released today found blacks remain less likely than whites to undergo total knee replacement, an important intervention for reducing pain and improving physical function among those with disabling knee osteoarthritis. The study also found total knee replacements are increasing substantially in both populations. According to the Arthritis Foundation, the research underscores the need for healthcare providers and people of all races to take proactive measures in preventing and managing the disease.

The Morbidity and Mortality Weekly Report study released by the Centers for Disease Control and Prevention, used Medicare claims data from 2000 to 2006 to estimate the national and state-specific total knee replacements for blacks and whites among U.S. adults aged 65 and older.

Patience White, M.D.

Patience Hayock White, MD, MA. Chief Public Health Officer

Patience White, M.D., is the chief public health officer of the Arthritis Foundation. In addition to her work at the national office of the Arthritis Foundation, she also is a professor of medicine and pediatrics at the George Washington University School of Medicine and Health Sciences.
The study found that among Medicare enrollees, the prevalence of total knee replacements increased by 58 percent overall. Despite the substantial increase in the rates of total knee replacements for both populations, total knee replacements among blacks was 37 percent lower than for whites in 2000, and remained virtually unchanged in 2006. In addition, the rates for total knee replacements were lowest among black men and highest among white women.

The Importance of Taking Action

According to the Arthritis Foundation, most Americans are unaware of the seriousness of arthritis and the impact it can have on their lives. Arthritis is the nation's most common cause of disability and costs the U.S. economy more than $128 billion annually. Knee osteoarthritis, the most frequent form of lower extremity arthritis, contributes to 418,000 knee replacement procedures annually and in 2006 accounted for 496,000 hospital discharges and $19 billion in hospital costs.
"Nearly one in two adults may develop knee osteoarthritis over their lifetime, with an equal risk among blacks and whites," said Patience White, MD, MA, chief public health officer for the Arthritis Foundation. "There are steps Americans can take now to prevent increasing disability from knee osteoarthritis, and if surgery becomes necessary, to better prepare themselves."

Tips for Reducing Knee Pain:

To reduce the pain and disability of arthritis, the Arthritis Foundation recommends the following:

* Understand the myth about physical activity and arthritis. Many people think that physical activity can worsen arthritis pain. Nothing could be farther from the truth. Done appropriately, physical activity can help decrease symptoms of knee osteoarthritis. In addition, physical activity is an important component of weight control and helps maintain healthy bones, muscles and joints. For joint-safe exercise programs, try the Arthritis Foundation's Life Improvement Series land or water exercise programs offered at more than 1,700 locations nationwide.

* Control weight. For those already living with symptoms, losing 15 pounds can cut knee pain in half. Maintaining a healthy weight also can lower a person's risk of osteoarthritis. In fact, one study showed that women who lost as little as 11 pounds halved their risk of developing knee osteoarthritis and its accompanying joint pain.

* Discover techniques to manage your arthritis. Participate in the Arthritis Foundation Self-Help Program, a self-management course that teaches people with arthritis how to manage the pain and challenges that arthritis imposes. The course has been shown to lead to a 40 percent reduction in pain.

* Learn more. Contact your local Arthritis Foundation office or visit to learn more about programs offered in your area and to order free educational materials, including literature on arthritis in African Americans. For more actions you can take, visit take control of osteoarthritis ( to get started. ###

About the Arthritis Foundation

The Arthritis Foundation is the leading health organization addressing the needs of some 46 million Americans living with arthritis, the nation's most common cause of disability. Founded in 1948, with headquarters in Atlanta, the Arthritis Foundation has multiple service points located throughout the country.

The Arthritis Foundation is the largest private, not-for-profit contributor to arthritis research in the world, funding more than $400 million in research grants since 1948. The foundation helps individuals take control of arthritis by providing public health education; pursuing public policy and legislation; and conducting evidence-based programs to improve the quality of life for those living with arthritis. Information is available 24 hours a day, seven days a week at 1-800-283-7800 or

1 "Weight Loss Reduces the Risk for Symptomatic Knee Osteoarthritis in Women," David T. Felson, MD, MPH; Yuqing Zhang, MB, MPH; John M. Anthony, BA, BS; Allen Naimark, MD; and Jennifer J. Anderson, PhD, Annals of Internal Medicine, 1992; 116:535 539].

Contact: Carol Galbreath 404-965-7594 Arthritis Foundation

Wednesday, February 18, 2009

The liberating effects of losing control

Self-control is one of our most cherished values. We applaud those with the discipline to regulate their appetites and actions, and we try hard to instill this virtue in our children. We celebrate the power of the mind to make hard choices and keep us on course. But is it possible that willpower can sometimes be an obstacle rather than a means to happiness and harmony?

Tufts University psychologists Evan Apfelbaum and Samuel Sommers were intrigued by the notion that too much self-control may indeed have a downside - and that relinquishing some power might be paradoxically tonic, both for individuals and for society.

Evan Paul Apfelbaum

Evan Paul Apfelbaum
They explored the virtue of powerlessness in the arena of race relations. They figured that well-intentioned people are careful - sometimes hyper-careful - not to say the wrong thing about race in a mixed-race group. Furthermore, they thought that such effortful self-control might actually cause both unease and guarded behavior,
which could in turn be misconstrued as racial prejudice.
To test this, they ran a group of white volunteers through a series of computer-based mental exercises that are so challenging that they temporarily deplete the cognitive reserves needed for discipline. Once they had the volunteers in this compromised state of mind, they put them (and others not so depleted) into a social situation with the potential for racial tension - Samuel Sommers

Samuel Sommers
they met with either a white or black interviewer and discussed racial diversity.

Afterward, the volunteers rated the interaction for comfort, awkwardness, and enjoyment. In addition, independent judges - both black and white - analyzed the five-minute interactions, commenting on how cautious the volunteers were, how direct in their answers - and how racially prejudiced.

As reported in Psychological Science, a journal of the Association for Psychological Science, those who were mentally depleted - that is, those lacking discipline and self-control - found talking about race with a black interviewer much more enjoyable than did those with their self-control intact. That's presumably because they weren't working so hard at monitoring and curbing what they said. What's more, independent black observers found that the powerless volunteers were much more direct and authentic in conversation. And perhaps most striking, blacks saw the less inhibited whites as less prejudiced against blacks. In other words, relinquishing power over oneself appears to thwart over-thinking and "liberate" people for more authentic relationships. ###

For more information about this study, please contact: Evan Apfelbaum ( or Samuel Sommers (

Psychological Science is ranked among the top 10 general psychology journals for impact by the Institute for Scientific Information. For a copy of the article "Liberating Effects of Losing Executive Control: When Regulatory Strategies Turn Maladaptive" and access to other Psychological Science research findings, please contact Barbara Isanski at 202-293-9300 or

Contact: Barbara Isanski WEB: Association for Psychological Science

Monday, February 16, 2009

White patients benefit more than blacks in surviving surgical complications at teaching hospitals

Elderly patients who undergo surgery at teaching-intensive hospitals have better survival rates than at nonteaching hospitals, but these better survival rates apparently occur in white patients, not black patients.

"We found an advantage in surgical outcomes for patients in teaching-intensive hospitals compared to nonteaching hospitals, as we had expected from other studies," said study leader Jeffrey H. Silber, M.D., Ph.D., director of the Center for Outcomes Research at The Children's Hospital of Philadelphia, and a professor at the University of Pennsylvania. "What we didn't expect was that better outcomes in teaching hospitals occurred for white patients but not for black patients." Furthermore, he added, the survival advantage from teaching hospitals came from lower death rates after complications (lower rates of a measurement called "failure-to-rescue"), not from lower complication rates.

Jeffrey H. Silber

Jeffrey H. Silber, Professor of Pediatrics, Anesthesia, and Health Care Management
Director, Center for Outcomes Research, The Children’s Hospital of Philadelphia

PhD, The Wharton School, University of Pennsylvania, 1990; MD, Johns Hopkins Medical School, 1980; AB, Washington University, St. Louis, 1976
The study appears in the February issue of the Archives of Surgery.

The study group analyzed Medicare claims from 4.6 million patients aged 65 to 90 admitted for general, orthopedic and vascular surgery at 3,270 acute care hospitals in the United States from 2000 to 2005. Hospitals were classified as nonteaching hospitals if they had no residents, and teaching hospitals were scaled by their ratio of residents to hospital beds.

The researchers measured mortality 30 days after surgery, in-hospital complications and failure-to-rescue, defined as the probability of death following complications. They found that compared to nonteaching hospitals, hospitals with the highest ratio of residents to beds had 15 percent lower mortality after surgery, no difference in complications, and 15 percent lower odds of death after complications (failure-to-rescue).
However, these benefits were observed in white patients, not black patients. These associations were adjusted for patient illness on admission, and adjusting for income level did not change these results. Unlike whites, for black patients, the odds of death, complication and failure to rescue were similar at both teaching and nonteaching hospitals.

Silber's group did not find lower rates of complications in teaching-intensive hospitals. "Overall, the improved survival rates were not because patients were less likely to have complications, but because they were less likely to die from those complications in teaching hospitals," said Silber, who first developed failure-to-rescue as a quality of care measure more than a decade ago. The National Quality Forum subsequently adopted it as a hospital quality indicator.

Black patients displayed higher complication rates than white patients at both teaching and nonteaching hospitals, though there was no difference in complication rates between teaching and nonteaching hospitals for both black or white patients. While white patients at teaching hospitals experienced better survival rates after complications than black patients when compared to nonteaching hospitals, black patients experienced the same survival after complications at both types of hospitals. The researchers found this racial disparity existed not only across different hospitals, but also for white and black patients within the same hospitals.

"We don't yet know why these racial disparities exist in surgical outcomes, but we have some working hypotheses," said Silber. His group offers possible explanations, such as unintentional differences in communication between patients and providers. Also, in previous work, Silber and colleagues found that surgical procedures take longer for black patients than white patients in some hospitals. "That finding raised the question of whether less experienced physicians might be more often operating on black patients," he added.

However, Silber noted, the current study relied on Medicare claims data, not on detailed medical records, so it did not provide specific information on patient care that might shed light on the reasons for the observed racial disparities. "Our findings provide a starting point for further studies of detailed patient care that might shed light on why these disparities exist and how they could be reduced." ###

Funding for the study came from the National Heart, Lung, and Blood Institute of the National Institutes of Health, the U.S. Department of Veterans Affairs and the National Science Foundation. Silber's co-authors were from The Children's Hospital of Philadelphia; the University of Pennsylvania; Veteran's Administration Hospital, Philadelphia; the University of California Davis School of Medicine; Boston University School of Public Health; and the Veteran's Administration Hospital, Boston.

About The Children's Hospital of Philadelphia: The Children's Hospital of Philadelphia was founded in 1855 as the nation's first pediatric hospital. Through its long-standing commitment to providing exceptional patient care, training new generations of pediatric healthcare professionals and pioneering major research initiatives, Children's Hospital has fostered many discoveries that have benefited children worldwide. Its pediatric research program is among the largest in the country, ranking second in National Institutes of Health funding. In addition, its unique family-centered care and public service programs have brought the 430-bed hospital recognition as a leading advocate for children and adolescents. For more information, visit

Contact: John Ascenzi 267-426-6055 Children's Hospital of Philadelphia

Saturday, February 14, 2009

Avoiding secondhand smoke during pregnancy

New study of African-American women shows social factors impact success

San Diego, January 27, 2009 – Environmental Tobacco Smoke (ETS) commonly called secondhand smoke, can harm a developing fetus and may account for complications during pregnancy and birth. It is now known that non-whites experience more adverse pregnancy effects than do whites from smoking and ETS exposure. In an article published in the March 2009 issue of the American Journal of Preventive Medicine, researchers examined whether black, non-smoking women were able to avoid ETS exposure early in pregnancy and the social contextual factors that affected their success in avoiding secondhand smoke.

This study was conducted by investigators from The George Washington University Medical Center School of Public Health & Health Services, Children's National Medical Center, RTI International, and the Eunice Kennedy Shriver National Institute of Child Health and Human Development.

secondhand smokeData were collected from 1044 women as part of a randomized, multiple–risk behavior intervention trial that addressed four risks for adverse pregnancy outcomes: cigarette smoking, ETS exposure, depression and intimate partner violence (IPV). In this study, the investigators analyzed data from 450 non-smokers who reported having partners, friends, household or family members who smoked.

Demographic factors such as age, education, marital status and household income were collected, as was reproductive history information. Attitudes about being pregnant were assessed, as were mental health-related items such as depression symptoms and alcohol or illicit drug use.

Interpersonal factors included having a current partner, the father's desire to have the baby and the incidence of IPV either before or during pregnancy.

Direct ETS exposure factors such as smoking by others in the household, household smoking bans, perceived support from significant others to avoid secondhand smoke and perceived harmfulness of ETS exposure to the baby's health were also measured. To accurately determine ETS exposure, cotinine levels in the mother's saliva were measured. Cotinine is a widely accepted biomarker for tobacco exposure.

Twenty-seven percent of pregnant nonsmokers were confirmed as ETS avoiders. The odds of ETS avoidance were increased among women who reported household smoking bans, reported the father wanted the baby and where no/few family members/friends smoked. The odds were decreased among women who had a current partner, reported any intimate partner violence during pregnancy and reported little social support to prevent ETS exposure.

Writing in the article, Susan Michele Blake, PhD, The George Washington University Medical Center, School of Public Health and Health Services, states, "Results highlight the importance of comprehensive prenatal screening to identify a woman's psychosocial and behavioral risks. Before addressing ETS exposure, it is important to gain a complete understanding of the social context of a woman's pregnancy. While providing behavioral counseling and skills-based interventions, it is important to consider other factors that could exacerbate risks for IPV and poor pregnancy outcomes." ###

The article is "Environmental Tobacco Smoke Avoidance Among Pregnant African-American Nonsmokers" by Susan M. Blake, PhD; Kennan D. Murray, MPH; M. Nabil El-Khorazaty, PhD; Marie G. Gantz, PhD; Michele Kiely, DrPH; Dana Best, MD, MPH; Jill G. Joseph, MD, PhD; and Ayman A.E. El- Mohandes, MD. It appears in the American Journal of Preventive Medicine, Volume 36, Issue 3 (March 2009) published by Elsevier.

Contact: AJPM Editorial Office 858-457-7292 Elsevier Health Sciences

Thursday, February 12, 2009

The Obama effect: Researchers cite President's role in reducing racism

TALLAHASSEE, Fla. -- President Obama spurred a dramatic change in the way whites think about African-Americans before he had even set foot in the Oval Office, according to a new study.

Florida State University Psychology Professor E. Ashby Plant and University of Wisconsin-Madison Professor Patricia Devine have documented a decrease in racial prejudice during the Fall 2008 period between the Democratic Party's nomination of Barack Obama and the Nov. 4 election. They call it the Obama Effect.

"The unprecedented drop in implicit bias observed in our studies indicates that the impact of Obama's historic campaign went beyond his winning the election," the researchers wrote in a paper outlining the study's results that has not yet been published.

Ashby Plant

"The fact that close to a quarter of our participants listed Obama indicates that he had permeated many people's consciousness to the point that he was highly accessible."

Ashby Plant, Florida State University Department of Psychology.
"It appears to have produced a fundamental change in at least the minds of the American public. Although the full impact of this historic election will play out over time, we are encouraged by the early returns."

About 300 non-black (white, Asian or Hispanic) college students in Wisconsin and Florida participated in a variety of experiments and surveys designed to measure stereotyping and implicit prejudice -- that is, the kind of prejudice that is typically described as "automatic" or "knee-jerk" and, although not directly stated, can influence people's behavior. The researchers found that 51 percent of the participants demonstrated automatic preferences for white people. The others had no preference or preferred blacks.
This is significant because previous research, even Plant's own studies conducted on the same college campuses, typically has found that about 80 percent of white people demonstrate an automatic preference for other whites.

The researchers suspected that the dramatic change could be attributed to exposure to Obama during his presidential campaign and sought to find out if there was indeed, a connection. To do so, they asked participants what comes to mind when they think of African-Americans and what they anticipated would come to mind for others when they think of African-Americans. Participants listed a range of responses, including traits, physical characteristics, food items and people. Almost 22 percent listed Obama on at least one list, and 50 percent named at least one other positive exemplar such as Martin Luther King Jr.

"The fact that close to a quarter of our participants listed Obama indicates that he had permeated many people's consciousness to the point that he was highly accessible," Plant said. "We were able to demonstrate that the accessibility of positive exemplars in people's minds was related to their degree of implicit bias."

What's more: Those who had low levels of implicit prejudice were quick to make an association between race and government -- a connection the researchers believe is directly attributable to Obama. In this experiment, participants were exposed to the word "black" on a computer screen for 55 milliseconds. Although the exposure was too brief for conscious processing, these participants quickly selected government-related words such as president, election or senator rather than neutral words in a lexical decision task.

Although researchers found a decrease in stereotyping of blacks, it is still notable that 51 percent demonstrated a bias against blacks, Plant said.

"Our findings suggest that these people are less likely to have positive exemplars and words related to Obama's campaign come to mind when they think of black people," Plant said. "However, it is not clear why they responded this way. It is possible they were less exposed to the campaign media blitz. Alternatively, the strength and stability of their racial attitudes may have resulted in a resistance to change."

The researchers noted that the longevity of the effects is unclear, and it's also not known whether the positive impact of the exposure to Obama will continue. The success of his presidency may have implications for his future role as an exemplar.

"If his presidency is highly successful, he would activate positive traits, thoughts and feelings for most people," the researchers said. "However, the result may be less positive should his presidency prove to be less successful." ###

Plant and Devine's research team included FSU doctoral students Corey Columb, Saul L. Miller, Joanna Goplen and B. Michelle Peruche and UW-Madison doctoral student William T.L. Cox. The study was funded in part by a National Science Foundation grant.

Contact: E. Ashby Plant 850-644-5533 Florida State University

Monday, February 9, 2009

Black women with uterine cancers more likely to die than white patients

Black women with cancers of the uterus are less likely to survive the disease than white women, and relatively little progress has been made over the past two decades to narrow this racial difference. That is the conclusion of a new study published in the March 15, 2009 issue of CANCER, a peer-reviewed journal of the American Cancer Society.

While previous research has shown that black women are more likely to die from uterine cancers than their white counterparts, little is known about the factors involved in this discrepancy. In addition, studies have not looked at whether efforts to provide equal treatment to all patients have lessened this disparity in recent years.

To investigate the issue, Dr. Jason Wright, assistant professor of obstetrics and gynecology at Columbia University College of Physicians and Surgeons, and colleagues studied the clinical data of 80,915 patients, 7 percent of whom were black, who were documented to have uterine cancer between 1988 and 2004 in the Surveillance, Epidemiology and End Results (SEER) Database. The investigators divided the data into three groups based on when women were diagnosed: 1988-1993, 1994-1998, and 1999-2004.

The researchers found that black patients were significantly younger and had more advanced and more aggressive tumors than white women. Advanced cancers (stage III/IV) occurred in 27 percent of blacks between 1988 and 1993 and in 28 percent from 1999 to 2004. The corresponding figures for white women were 14 percent from 1988 to 1993 and 17 percent from 1999 to 2004.

Overall, black women were 60 percent more likely to die from their tumors than white women, and for each of the three time periods, survival was worse for blacks than for whites.

Dr. Wright and his team also found that over time, the incidence of serous tumors and clear cell tumors (two aggressive types of cancer) increased and the use of radiation decreased for both races. Lymph node dissection was performed to determine tumor stage more commonly in both races in recent years, and its use was well matched between the two groups (45 percent of blacks and 48 percent of whites).

The investigators note that differences in tumor characteristics and inequalities in care cannot completely explain the survival disparity between races found in this study. Biological differences might also play a role. Racial differences in risk factors such as obesity, medical comorbidities, and estrogen use have also been proposed as contributing to observed racial disparities in uterine cancer survival. ###

The authors of the study conclude that further work to delineate the factors that impair survival in black women with uterine cancers is clearly needed.

Article: "Racial disparities for uterine corpus tumors: changes in clinical characteristics and treatment over time." Jason D. Wright, Jessica Fiorelli, Peter B. Schiff, William M. Burke, Amanda L. Kansler, Carmel J. Cohen, and Thomas J. Herzog. CANCER; Published Online: February 09, 2009 (DOI: 10.1002/cncr.24160); Print Issue Date: March 15, 2009.

Contact: David Sampson Web: American Cancer Society

Columbia University College of Physicians Logo

Saturday, February 7, 2009

Faces and race, A new tool to blunt racial bias

A new tool to blunt racial bias.

PROVIDENCE, R.I. [Brown University] — There may be a simple way to address racial bias: Help people improve their ability to distinguish between faces of individuals of a different race.

Brown University and University of Victoria researchers learned this through a new measurement system and protocol they developed to train Caucasian subjects to recognize different African American faces. Their efforts are summed up in "Perceptual Other-Race Training Reduces Implicit Racial Bias," a study to be published Jan. 21, 2009, in PLoS ONE, the online, peer-reviewed journal from the Public Library of Science.

Race and Face

Caption: New research suggests that training people to recognize facial differences among individuals of other races may blunt the effect of racial bias.

Credit: VizCogLab, University of Victoria. Usage Restrictions: None.

"The idea is this that this sort of perceptual training gives you a new tool to address the kinds of biases people show unconsciously and may not even be aware they have," said Michael J. Tarr, a Brown cognitive neuroscientist and a senior author of the paper. "There is a strong connection between the way we perceive and categorize the world and the way we end up making stereotypes and generalizations about social entities."

The hope is that the researchers' training program could someday be used to train anyone who comes into contact with other races — police officers, social workers or immigration officials, said Tarr, the Sidney A. and Dorothea Doctors Fox Professor of Ophthalmology and Visual Sciences and a professor of cognitive and linguistic sciences at Brown.

The research is the product of a wide collaboration. Sophie Lebrecht, a third-year Ph.D student in the Department of Cognitive and Linguistic Sciences and a member of Tarr's lab, is the study's lead author. Jim Tanaka, a professor at the University of Victoria and Lara Pierce, a graduate student at McGill University, collaborated on the research.
Lebrecht was interested in the interaction of visual processing with other cognitive functions such as emotion or social processing. She came up with the idea for the project with Tarr's encouragement.

Researchers used 20 Caucasian subjects for the overall study, which incorporated a measurement developed at Brown and dubbed the Affective Lexical Priming Score (ALPS). The ALPS measure is similar to, and builds on, a test developed at Harvard University known as the Implicit Association Test (IAT), which helps to identify unconscious social biases.

The ALPS measurement involved first showing each subject a series of pictures of different races, such as African American and Caucasian faces. All the faces were shown in black and white, so subjects would focus on facial features rather than skin color.

On each ALPS trial, each test subject was shown a picture of a face, which then disappeared. The test subject then saw a word that could be real or nonsense — "tree" or "malk," for example — and had to decide whether the word was a real word or nonsense word. Real words could imply something positive or negative.

Lebrecht found that prior to training, subjects more quickly responded if the word was negative and followed an African-American face. Subjects responded more slowly if the word was positive and followed an African-American face.

After using the ALPS to measure each subjects' implicit racial bias, the subjects took part in about 10 hours of facial recognition training. Half learned to tell apart individual African-American faces and half learned simply to tell whether the faces were African-American or not.

The training worked on a number of levels. Individual subjects improved their ability to tell the difference between seperate Africa-American faces. Those same subjects who improved that ability also showed the greatest reduction in their implicit racial bias as measured by the ALPS system. Their positive associations with African-American faces increased and they had fewer negative associations with African-American faces.

While the researchers are not claiming they can eliminate racial bias, they suggest that teaching people to tell the difference better between individual faces of a different race is at least one way to help reduce that bias.

Lebrecht said that developing a system that teaches people to make those distinctions should be helpful in reducing generalizations based on social stereotypes.

"If you give people the tools to start individuating, maybe they will make more individual (rather than stereotypical) attributions," she said. ###

Funding for the study came from the Perceptual Expertise Network, a collaborative award from the James S. McDonnell Foundation; the Temporal Dynamics of Learning Center at the University of California–San Diego; the National Science Foundation, a National Sciences and Engineering Research Council of Canada award; and a Brown University National Eye Institute training grant (the National Institutes of Health).

Contact: Mark Hollmer 401-863-1862 Brown University

Thursday, February 5, 2009

African-Americans Aware and Accepting, but Often Do Not Receive, the HPV Vaccine

CAREFREE, A.Z. - Although only 25 percent of eligible African-American adolescents have received the HPV vaccine, a new survey presented at the American Association for Cancer Research conference on the Science of Cancer Health Disparities, suggests they have a positive view of the treatment and might respond to more education.

The Pennsylvania Department of Public Health is funding research to develop ways to increase the rate of HPV vaccination among those at highest risk. HPV vaccination prevents cervical cancer by inoculating against the human papillomavirus.

"The consensus among those surveyed in our study was that it would be a good, beneficial option," said Ian Frank, M.D., professor of medicine in the Infectious Diseases Division of the University of Pennsylvania.

Ian Frank, M.D.

Ian Frank, M.D. Dr. Frank’s main area of research is the use of antiretroviral therapy to treat HIV infection. He has been studying novel approaches to control HIV replication, including the use of antiretroviral treatment interruption and vaccines to augment the HIV specific immune responses as adjuctive HIV therapy.

He is also studying the etiologies of the complications of long-term antiretroviral treatment, including hyperlipidemia and insulin resistance.
The HPV vaccine, approved for use in the United States as Gardasil and manufactured by Merck and Co., has been shrouded in controversy since it was released in June 2006.

Frank said the controversies break down into four basic areas. Following approval, Merck pushed for mandatory vaccination, which is generally opposed by citizens in the United States who believe health care decisions should not be forced. Others were concerned about the long-term efficacy of the vaccine or its possible side effects.

Most famously, some groups insisted that if adolescents were aware that they could inoculate themselves against the human papillomavirus, which is spread through sexual contact, they would be more likely to have early sexual relations.

"I doubt that whether or not she is at risk for cervical cancer is on an adolescent's mind in the heat of the moment," said Frank.
Frank said the African-Americans who participated in the survey conducted by his research group were aware of these controversies, but they did not outweigh their positive views of the vaccine as an option.

Researchers surveyed 71 females for the study; 94 percent were African-American and the mean age was 15.3 years. Approximately 60 percent of them had had their first sexual encounter when they were 14 years old.

Of those who had not received the vaccine, 43.9 percent said they were very likely or likely to do so soon. A majority believed it was a "good" or "very good" idea and they generally viewed the vaccine as "safe," "effective" and a "wise choice."

Forty-five caregivers of adolescents also participated in the study, all of whom were African-American, 94 percent were female and 47.9 percent had a high school diploma.

The caregivers agreed that the vaccine was "safe," "effective" and a "wise choice," but two-thirds of them could not recall their health care provider ever mentioning the HPV vaccine.

"Many of these caregivers, most of whom were women, reported feeling overwhelmed by the challenges of raising an adolescent girl, but they wanted to protect their daughters from health and emotional risks," said Frank. "This suggests they would respond positively to an increased effort to inoculate." ###

The mission of the American Association for Cancer Research is to prevent and cure cancer. Founded in 1907, AACR is the world's oldest and largest professional organization dedicated to advancing cancer research. The membership includes more than 28,000 basic, translational and clinical researchers; health care professionals; and cancer survivors and advocates in the United States and 80 other countries. The AACR marshals the full spectrum of expertise from the cancer community to accelerate progress in the prevention, diagnosis and treatment of cancer through high-quality scientific and educational programs. It funds innovative, meritorious research grants.

The AACR Annual Meeting attracts more than 17,000 participants who share the latest discoveries and developments in the field. Special conferences throughout the year present novel data across a wide variety of topics in cancer research, treatment and patient care. The AACR publishes five major peer-reviewed journals: Cancer Research; Clinical Cancer Research; Molecular Cancer Therapeutics; Molecular Cancer Research; and Cancer Epidemiology, Biomarkers & Prevention.

The AACR's most recent publication and its sixth major journal, Cancer Prevention Research, is dedicated exclusively to cancer prevention, from preclinical research to clinical trials. The AACR also publishes CR, a magazine for cancer survivors and their families, patient advocates, physicians and scientists. CR provides a forum for sharing essential, evidence-based information and perspectives on progress in cancer research, survivorship and advocacy.

Contact: Jeremy Moore 267-646-0557 American Association for Cancer Research

Tuesday, February 3, 2009

African-American parents more likely to report distrust of medical research

Distrust of medical research appears more common among African American parents than white parents and may present a barrier to enrollment of minority children in research studies, according to a report in the February issue of Archives of Pediatrics & Adolescent Medicine, one of the JAMA/Archives journals.

The inclusion of ethnic minorities and children in research helps ensure that results can be applied to the general population, according to background information in the article. The National Institutes of Health have mandated that researchers include representatives of these groups. However, African Americans frequently remain underrepresented.

Participants in the Tuskegee Syphilis Study

Participants in the Tuskegee Syphilis Study, Item from Record Group 442: Records of the Centers for Disease Control and Prevention, 1921 - 2002
"African Americans' distrust of medical research has been suggested to be an important reason for their lack of participation," the authors write. "This distrust may be attributed both to a cultural memory of victimization and exploitation during clinical experiments, such as in the Tuskegee Syphilis Study, and to personal experiences with discrimination."
Kumaravel Rajakumar, M.D., of the University of Pittsburgh School of Medicine and Children's Hospital of Pittsburgh, and colleagues surveyed 190 parents (140 African American and 50 white) who accompanied their children to a primary care clinic between August 2004 and April 2005. In addition to demographic characteristics, participants were asked about their attitudes toward their child's medical care, beliefs about medical research and whether incentives (such as money or free medical care) would affect their decision about allowing their child to participate in research.

As compared with white parents, African American parents:

* More often reported distrust of medical research, when questions assessing trust were combined and analyzed (67 percent vs. 50 percent)
* More often believed that physicians prescribe medications as a way of experimenting on unknowing patients (40 percent vs. 28 percent)
* Were more likely to believe that medical research involves too much risk to the participant (46.8 percent vs. 26 percent), that physicians will not make full disclosures regarding their child's participation (24.6 percent vs. 10 percent) and that research participants would be favored and receive better medical care (48.6 percent vs. 28 percent)

Education level was also associated with distrust, with high distrust scores among 74 percent of those with less than a high school education vs. 44 percent of college graduates. However, race remained associated with higher levels of distrust even after the researchers controlled for education, with African American parents having two times the odds of being distrusting compared with white parents.

"Although the overall attitude toward medicine and research was positive in both African American and white parents, the degree of distrust was significantly greater among African American parents," the authors write. "Our data suggest that African American parents with higher levels of distrust are less likely to enroll their children in clinical research. Additionally, traditional incentives (financial compensation and free medicine, transportation and medical care) did not overcome the barrier of high distrust."

"Strategies for overcoming the distrust in medicine and research among African American parents are warranted to ensure adequate representation of African American children in clinical research," they conclude. These strategies might include culturally appropriate recruitment materials, use of research assistants with similar racial and cultural backgrounds and the establishment of community research advisory boards.

(Arch Pediatr Adolesc Med. 2009;163[2]:108-114. Available pre-embargo to the media at

Editor's Note: This study was supported in part by a grant from the National Center on Minority Health Disparities and a grant from the National Institute of Child Health and Human Development, National Institutes of Health. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

Editorial: Minority Representation Needed in Research Institutions

Community involvement in research governance and decision-making are critical but are only part of the solution, writes Somnath Saha, M.D., M.P.H., of the Portland VA Medical Center, Ore., in an accompanying editorial.

"From the perspective of minority communities, research institutions will continue to have a biased slant until more people from their communities are part of those institutions," Dr. Saha writes. "Many minority groups are grossly underrepresented in the health care professions and in the research enterprise.

"If we want our study samples to be broadly representative, then we should make every effort to make our institutions equally representative by increasing the presence of minority clinicians, scientists and members of research teams and institutional review boards. If we want minority communities to participate in our work, we must first fix the racial and ethnic imbalance that continues to tilt our ivory towers."

(Arch Pediatr Adolesc Med. 2009;163[2]:181-182. Available pre-embargo to the media at

Editor's Note: Please see the article for additional information, including author contributions and affiliations, financial disclosures, funding and support, etc. ###

Contact: Marc Lukasiak 412-692-5016 JAMA and Archives Journals

Sunday, February 1, 2009

Study confirms persistence of diversity problems in academic medicine

A survey study believed to be one of the first efforts to put hard numbers around long-held beliefs about diversity in medical school faculties has affirmed that awareness and sensitivity to racial and ethnic diversity are believed by most faculty to be poor and even poorer among faculty who are members of underrepresented minorities.

The survey, conducted at the Johns Hopkins University School of Medicine, is likely a reflection of diversity issues thought to persist at academic medical institutions across the country, says principal investigator Lisa Cooper, M.D., a professor of medicine in the Johns Hopkins University School of Medicine and the Johns Hopkins Bloomberg School of Public Health.

Lisa A. Cooper

Lisa A. Cooper, Professor Academic Degrees MD, MPH Departmental Affiliation Epidemiology, Health Policy & Management. Joint Departmental Affiliations, Department of Medicine, Division of General Internal Medicine.

Departmental Address. Welch Center for Prevention, Epidemiology, & Clinical Research. 2024 East Monument Street, Suite 2-500. Emai:
"What we are seeing at Johns Hopkins is likely to be the case in medical schools everywhere, namely that enhancing racial and ethnic diversity in medicine in general, and in academic medicine in particular, remains a challenge," Cooper says. The study results appear in the January issue of Academic Medicine.

The medical professions have long recognized that diversity among health care providers can improve the health of patients among racial and ethnic minorities and majorities alike, says Cooper.

She adds that studies have demonstrated that minority physicians are more likely to practice in underserved areas and to care for patients of their own racial or ethnic group, as well as low-income patients, Medicaid-insured and uninsured patients, and patients with poorer health status. Studies also suggest that minorities welcome practitioners who are part of their communities and sensitive to their cultures.

Cooper, who received a 2007 MacArthur Fellowship (also known as a "genius grant") for her landmark studies on racial barriers to health care,
notes that medical schools have strived to increase diversity among the physician workforce by implementing programs that increase the number of minority medical students, such as targeted recruitment efforts and scholarships.

But though minority faculty at medical schools serve as important role models for their students and recruitment magnets for minorities, diversity among faculty continues to lag, Cooper says. Previous studies have shown that minority faculty have lower job satisfaction than majority faculty.

Cooper says the new study, prompted by serious efforts at Johns Hopkins to recruit and retain more minority faculty, was designed to quantify the differences in racial and ethnic perceptions that contribute to this disparity.

The study was led by Cooper and Eboni G. Price, M.D., M.P.H., now assistant professor of medicine at Tulane University, who was a fellow in general internal medicine at Johns Hopkins during the time of this work. Along with their colleagues, Cooper and Price surveyed 703 tenure-track physicians at the Johns Hopkins University School of Medicine from 2004 to 2005. The researchers focused on physicians in clinical departments that had at least one member of an underrepresented minority, defined as black, Hispanic (Mexican American and mainland Puerto Rican), or Native American. They sent surveys by mail to both majority and minority faculty. Of the 352 physicians who returned their surveys, 30 were underrepresented minorities. At Johns Hopkins School of Medicine, whites make up 74.6 percent, blacks/African Americans 3.8 percent, Hispanics 2.9 percent, Asians 18.6 percent, and Native Americans 0.8 percent of the overall faculty.

The survey, which comprised 80 items, asked respondents to rate their level of agreement with a series of statements, such as, "Faculty are recruited to my department in an unbiased manner," and "At Hopkins, networking opportunities for career advancement tend to include ethnic minorities." Overall, the statements were intended to measure perceptions of bias in five areas: department or divisional activities, professional satisfaction, career networking, mentorship, and intentions to stay in academia.

Results showed that fewer than one-third of all the respondents reported experiences of bias in their own department's or division's activities. However, when asked whether they believed overall faculty recruitment was unbiased, only 21 percent of underrepresented minority faculty agreed, compared to 50 percent of majority faculty.

Only 12 percent of underrepresented minority faculty were satisfied with the institution's racial and ethnic diversity, compared to 47 percent of majority faculty. Underrepresented minority faculty were also three times less likely to believe that networking opportunities included minorities.

Notably, more than 80 percent of all groups of respondents believed they would be in a career in academic medicine in five years. However, only 42 percent of underrepresented minority faculty said they would still be at Johns Hopkins in five years, compared to 70 percent of majority faculty.

Cooper says it's unclear whether underrepresented minority faculty planned to leave because of negative experiences or whether they believed that other promising opportunities would be available elsewhere.

Either way, Cooper says, there is work to be done at Johns Hopkins and other academic medical centers to increase job satisfaction for all faculty and for underrepresented minorities in particular. More transparent and diversity-sensitive recruitment practices and increased networking opportunities are needed, along with more studies like hers to quantify the problem and attempt to solve it. ###

Other researchers who participated in this study include Neil R. Powe, M.D., M.P.H., M.B.A., David E. Kern, M.D., M.P.H., Sherita Hill Golden, M.D., M.H.S., and Gary S. Wand, M.D.

For more information, go to:Contact: Christen Brownlee 410-955-7823 Johns Hopkins Medical Institutions