Newly found gene variants account for kidney diseases among African-Americans

Director, Elias A. Zerhouni, M.D. in front of NIH headquarters, Bethesda, MD

For the first time, researchers have identified variations in a single gene that are strongly associated with kidney diseases disproportionately affecting African-Americans. This work was conducted by researchers at the National Institutes of Health (NIH) and by NIH-funded investigators at the Johns Hopkins University. The findings are published online today in two papers in Nature Genetics and will be published in the October print issue.

"These two breakthrough genomic studies on kidney disease illustrate the importance of collaborations between scientists at NIH and NIH-funded investigators at Johns Hopkins," said NIH Director Elias A. Zerhouni, M.D. "This type of government-academic collaboration moves translational research forward and provides the knowledge base for developing new therapies for these chronic health disorders."

The researchers studied nondiabetic kidney diseases that can lead to chronic kidney disease and, in severe cases, to kidney failure requiring long-term dialysis or a kidney transplant. One of these diseases, focal segmental glomerulosclerosis (FSGS), is a kidney disease that leads to kidney failure in more than half of those with the disease over a period of about 10 years. Chronic kidney disease is caused by many different diseases and conditions and affects 26 million Americans. More than 106,000 individuals develop kidney failure and more than 485,000 receive dialysis or transplantation in the United States each year.

Using a type of genome association that relies on differences in the frequency of gene variants between populations, the NIH researchers identified several variations in the MYH9 gene as major contributors to excess risk of kidney disease among African-Americans. The NIH researchers shared their discovery with the Johns Hopkins scientists, who replicated the findings in participants from earlier studies of kidney disease.

Both research teams found statistically significant associations of MYH9 variants with FSGS, HIV-associated FSGS, and all nondiabetic kidney failure. They also found that these variants were much more frequent among people of African ancestry than among whites. The increased risk among African-Americans with these variants is more than 300 percent for FSGS, more than 500 percent for HIV-associated FSGS, and more than 100 percent for all nondiabetic kidney failure. Sixty percent of African-Americans carry the risk variants in contrast to 4 percent of whites.

Though FSGS affects African-Americans more than whites, the rate of progression to kidney failure is believed to the same for both populations. FSGS associated with HIV infection is almost exclusively found in individuals of African descent and, without treatment, progresses more rapidly to kidney failure compared to other forms of kidney disease. FSGS often affects adolescents and young adults as well as older individuals.

In the NIH study, the researchers scanned the genome of 190 African-Americans known to have FSGS, including the form associated with HIV infection, and 222 who did not have FSGS and replicated these findings in additional cases. The Johns Hopkins researchers, members of the Family Investigation of Nephropathy and Diabetes (FIND) consortium, studied more than 2,100 participants of the FIND study and the Choices for Healthy Outcomes in Caring for ESRD (CHOICE) study. FIND, one of the largest multi-center genetic studies of kidney disease ever conducted, has been funded by the NIDDK since 1999.

"MYH9 genetic variations account for some of the excess risk of kidney disease due to hypertension, and much of the excess risk due to FSGS, and HIV-associated FSGS in African-Americans," said Jeffrey B. Kopp, M.D., a kidney specialist and lead author of the NIH study. "We hope this finding will lead to personalized medical therapy that will reduce the burden of chronic kidney disease."

Though diabetes is one of the leading causes of kidney failure, both research teams found no association between the MYH9 variants and diabetes-related kidney failure in African-Americans. "This finding suggests that the mechanisms leading from onset of chronic kidney disease to kidney failure may differ based on the inciting cause," said W.H. Linda Kao, M.H.S., Ph.D., and Rulan S. Parekh, M.D., M.S., the lead and senior authors of the Hopkins study. "Therefore, understanding the role that MYH9 plays in kidney failure may ultimately lead to development of drug therapies that target more specific, rather than common, genetic pathways to prevent kidney disease progression more effectively."

"These two studies are important not only because the MYH9 risk variants account for nearly all the excess burden of FSGS and HIV-associated kidney disease in African-Americans, but also because MYH9 is the first kidney disease gene identified that explains an important health disparity and involves common forms of kidney disease," said Cheryl Winkler, Ph.D., principal scientist with the National Cancer Institute, senior author of the NIH intramural study, and a co-author of the Johns Hopkins study. "In addition, the MYH9 gene's estimated relative risk is higher than that observed for nearly all genetic factors discovered by genome-wide scans, including those for prostate cancer, diabetes, cardiovascular disease, breast cancer, and hypertension."

The different frequencies of genetic variants between African Americans and European Americans have potential implications for future screening strategies for African-Americans with hypertension. It remains unclear whether hypertension is particularly likely to damage the kidney in individuals with these MYH9 variants, and further research will be needed to determine whether individuals identified as having hypertensive kidney disease actually have undiagnosed FSGS.

The variants found in these studies are markers indicating that the MYH9 gene is the location of the disease-causing variations, but the specific variants have not yet been definitively identified. Further studies will be needed to identify the specific causal variants. Most individuals with the gene variants do not develop kidney disease, suggesting that additional genetic or environmental factors contribute to causing kidney disease in particular individuals with the MYH9 variants. ###

This research also was supported by the National Cancer Institute, the National Heart Lung and Blood Institute, the Agency for Healthcare Research and Quality, and by the National Center for Research Resources through its General Clinical Research Centers.

Kopp, J.B. et al. "MYH9 is major-effect risk gene for focal segmental glomerulosclerosis," Nature Genetics, September 14, 2008.

Kao, W.H. Linda et al. "MYH9 is associated with nondiabetic end-stage renal disease in African-Americans," Nature Genetics, September 14, 2008.

For more information on FSGS and kidney failure, visit kidney.niddk.nih.gov/kudiseases/pubs/glomerular/.

For more technical information on glomerular disease, visit intramural.niddk.nih.gov/research/glomerular_diseases/normal_kidney.asp

NIDDK conducts and supports research in diabetes and other endocrine and metabolic diseases; digestive diseases, nutrition, and obesity; and kidney, urologic, and hematologic diseases. Spanning the full spectrum of medicine and afflicting people of all ages and ethnic groups, these diseases encompass some of the most common, severe, and disabling conditions affecting Americans. For more information about NIDDK and its programs, see www.niddk.nih.gov.

The National Institutes of Health (NIH) — The Nation's Medical Research Agency — includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. It is the primary federal agency for conducting and supporting basic, clinical and translational medical research, and it investigates the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit www.nih.gov.

Contact: Arthur Stone niddkmedia@mail.nih.gov 301-496-3583 NIH/National Institute of Diabetes and Digestive and Kidney Diseases

African-American blogs offer key health communications tool

Blogs allow African Americans to discuss HIV and AIDS in an unfiltered way that is both public and private, according to a Penn State researcher, and this exploration may lead to another way to distribute health messages to the African American community.

Lynette Kvasny, Associate Professor of Information Sciences and Technology lkvasnyist.psu.edu 814-865-6458, 329 C Information Sciences and Technology Building. Education: Ph.D., Computer Information Systems Georgia State University 2002, M.S., Computer and Information Systems Georgia State University 1996, B.S., Computer and Information Systems Mercy College 1988. Web Sites: ist.psu.edu/lkvasny

Lynette Kvasny, associate professor of information sciences and technology (IST), an avid blog reader, noticed an interesting conversation on a blog following an August 2006 ABC News story, "Out of Control: AIDS in Black America." "I was really surprised by some of the things I was reading … these were things that I'd never seen discussed in a public forum before," Kvasny said. Kvasny and C. Frank Igwe, a recent IST Ph.D. recipient, analyzed 128 responses to the ABC News story posted from Aug. 24 to Aug. 26, 2006. They separated the comments into themes, including ineffective Black community leadership; the influence of prison and hip-hop cultures; religion; sexual taboos; and African Americans in the media. These categories provided a basis to analyze how ethnic identities are conveyed through technology. The television show pointed to five reasons why AIDS is out of control in Black America, including, those in charge do not see the problem; the government fails to control street drugs and the large African American prison population; the skewed ratio of men to women in the African American community lead to multiple partners for men; a hidden African American homosexual population on the "down low;" and the failure of leadership in the Black community to make AIDS a priority.

"Online conversations provide an opportunity to examine how this community uses language to express their unique position as subjects in HIV/AIDS discourse," the researchers note in "An African-American Weblog Community's Reading of AIDS in Black America," published recently in the Journal of Computer-Mediated Communication. "The relationships among identity, language and computer mediated communication are not straightforward."

Kvasny also noted the varying levels of community that exist within the blog, saying that while individual users are anonymous, they are all united by a common language and a desire to speak out about HIV/AIDS and other issues affecting the Black community. Blogs and message boards also allow people to voice their own opinions, rather than being spoken for by one or several people in the mass media. "Communities like this give people a place to talk about things they couldn't talk about elsewhere," Kvasny said. "The affordances of technology allow people to become members of a virtual community while still remaining anonymous and being able to freely express their thoughts." The researchers looked at two aspects of the online conversation. First are the factors that the blog members thought contributed to the spread of AIDS in the African American population. Included in this were members' presentation of opposing, alternative views to the television report and how they presented those views. Second, the researchers looked for indications of Black communication styles including signifying, emotional intensity and computer-mediated communication techniques like emoticons and turn taking. An analysis of the blog suggested that three things -- ineffective leadership, Black cultural practices and individual behaviors -- were the risk factors for the Black community. Also, analysis of how ideas were expressed showed communication interaction used call-and-response conventions such as acknowledging prior comments by naming the speaker or co-signing the previous comments.

C. Frank Igwe, His expertise includes computer-mediated communications, the digital divide, virtual third places, and electronic online reverse auction exchanges. Frank’s dissertation focused on examining how African Americans utilize weblogs to create virtual “third places” as a means to rebuild aspects of community that are lacking in their “real-world” communities. Frank receive his Ph.D. in IST, and his M.S. in Business Administration, both from Penn State. He also received his M.G.A. from the University of Pennsylvania, and his M.B.A. and B.S. in Environmental Engineering from the University of Oklahoma

The community of bloggers developed shorthand terms for AIDS that were used by the group and emotion, in the form of capitalized comments and other verbal scolding, appeared frequently.

The use of screen names and family terms showed communal support. The acts of advising, consoling and testifying through stories create a community of support through the discussion. The final style element of this African American blogging community involves movement, if only virtual. These include describing actions that would normally be acted out, describing dances, singing lyrics and laughter.

The researchers suggest that African Americans form virtual communities with ethnic identity through the use of language, noting "These self avowed identities suggest that ethnicity is an essential characteristic that finds expression in a public realm."

While realizing that the online community does not reach the entire African-American community, the researchers believe discussions online may impact the larger community as well through interactions with friends and relative who are not online and provide an alternative approach to community health education.

Kvasny said she hopes to continue this research and examine whether blogs are an effective medium for medical practitioners to distribute messages about HIV/AIDS prevention and education. ###

Contact: A'ndrea Elyse Messer aem1@psu.edu 814-865-9481 Penn State

Television viewing and aggression: Some alternative perspectives

Image Credit: SAMHSA is an Agency of the U.S. Department of Health & Human Services

The effect of media violence on behavior is not only an interesting psychological question but is also a relevant public policy and public health issue. Although many studies have been conducted examining the link between violence on TV and aggressive behavior, most of these studies have overlooked several other potentially significant factors, including the dramatic context of the violence and the type of violence depicted as well as the race and ethnicity of the viewers.

In a new study appearing in the September issue of Perspectives on Psychological Science, a journal of the Association for Psychological Science, psychologists Seymour Feshbach from the University of California, Los Angeles and June Tangney from George Mason University investigated the effect that exposure to violent TV programs has on negative behavior in children from different ethnic backgrounds. To investigate this connection, the psychologists conducted a study that evaluated TV viewing habits, intelligence, and behavior in 4th, 5th and 6th grade children. To assess these qualities, the children's parents and teachers completed behavioral questionnaires detailing the children's aggression, delinquency and cruelty. The children took IQ tests and completed surveys indicating the TV programs (which were later categorized as violent or non-violent by the researchers) they had watched during a seven day time period.

The results showed a positive relationship between the amount of violent TV watched and negative personality attributes among white males and females and African-American females. Interestingly though, while there was a correlation between watching violent TV and lower academic performance in African-America males, these boys did not exhibit increased aggression or lower IQ.

The authors speculate that perhaps for African-American males, viewing TV (including violent programs) may play a different role than for white males and African-American and white females. The researchers noted, "The data raise the possibility that processes competing with or overriding the aggression stimulating or aggression modeling effects of viewing violence on television may be more salient for African-American males." For example, viewing TV shows where violent behavior is punished may inhibit feelings of aggression to a greater degree in African-American males. In any case, additional research is required to assess the effects on African-American males of viewing TV aggression.

The authors also suggest that when studying the effect of TV violence on aggression, researchers and policy makers must recognize "the need for a more general conceptualization of the effects of exposure to TV violence, one that takes into account personality differences, ethnic differences, the social context in which TV is viewed, variations in the dramatic context, and other potentially significant moderating factors." ###

Author Contact: Seymour Feshbach at sfeshbac@ucla.edu

Perspectives on Psychological Science is a journal of the Association for Psychological Science. It publishes an eclectic mix of thought-provoking articles on the latest important advances in psychology. For a copy of the article "Television Viewing and Aggression: Some Alternative Perspectives" and access to other Perspectives on Psychological Science research findings, please contact Barbara Isanski at 202-293-9300 or bisanski@psychologicalscience.org.

Contact: Barbara Isanski bisanski@psychologicalscience.org WEB: Association for Psychological Science

Study shows how African-American Ph.D. chemists overcame discrimination to build careers

Willie Pearson, Jr. Photographer: Gary Meek.

A national study of career experiences among African-American Ph.D. chemists shows how these scientists dealt with discriminatory practices and attitudes to build careers in academia, industry and government. While seven out of ten respondents felt they had been hindered by discrimination, less than a handful regretted choosing a career in chemistry.

"Regardless of the experiences they had, these people had remarkably positive feelings about chemistry," said Willie Pearson, Jr., the study's author and chair of the School of History, Technology and Society at the Georgia Institute of Technology. "If they had it to do all over again, they would still see chemistry as an attractive field."

Results of the study, "Beyond Small Numbers: Voices of African-American Ph.D. Chemists," will be presented February 15 at the annual meeting of the American Association for the Advancement of Science (AAAS). The study explores the divergent career experiences of 44 randomly-chosen African-American Ph.D. chemists who received degrees prior to 1994.

"The opportunity structure differed dramatically in many cases over time," said Pearson, who conducted face-to-face interviews with all but one of the scientists. "Most felt that race was an issue, and that it had impacted them in certain ways. But they didn't let that cripple them or stifle their achievement. Racism was just part of the reality that confronted them."

Most respondents began their careers in the academic world, with slightly more than half taking positions at historically black colleges and universities. The Ph.D. chemists choosing academic careers were attracted to institutions similar to the ones where they obtained their undergraduate degrees.

Their experiences changed dramatically over time, affected by federal legislation such as the Civil Rights Act of 1964 and court decisions such as Brown v. Board of Education.

Other key findings include:

• The respondents often found themselves torn between the research they were trained to do and administrative roles that provided salary and advancement opportunities beyond what they could achieve as practicing chemists. For industrial chemists, these administrative positions were often in Equal Employment Opportunity, human resources or community outreach areas with little impact on company decision-making.
• Many of the respondents reported that good work overcame discrimination. "It's difficult not to reward excellence," said Pearson. "While there may be discriminatory practices, by and large the system tended to work for those who did good work."
• In academia as well as industry, experiences varied among departments even within the same institution. "While there might be a company culture, there are also individual unit cultures," he explained. "At one company, chemists reported different career advancement experiences depending on the division in which they worked. For example, in one unit, a chemist had filed racial discrimination complaints, while chemists in two separate units reported supportive and welcoming environments."
• African-American women often had to also confront gender discrimination and were expected to meet a higher standard than their male counterparts. "But I think you would find the same thing with women in general, because chemistry is still largely a male-dominated field," Pearson said.
• If they were the only persons of color in their organizations, African-American chemists sometimes suffered feelings of isolation, which caused stress and depression. In academia, isolated chemists often had difficulty attracting graduate students, which hurt their research and therefore their stature in the field.
• Among industrial chemists, eight of 13 respondents (62 percent) said they were satisfied or very satisfied with their jobs. Among the academic chemists, 16 of the 22 (72 percent) reported that level of satisfaction – while five said they were very dissatisfied.
• Segregation in the South contributed to a 'brain drain' in which African-Americans pursuing chemistry doctorates entered universities outside the region. Most never returned

Daryl Chubin, senior vice president at the National Action Council for Minorities in Education (NACME), said the study is unusual in using interviews to provide an in-depth look at complex issues.

"The value of the analysis is that it looks across a half-century of experience on the part of these minority chemists," he said. "Because of the interviews, the study puts a human face on their experiences. There is a great deal of commonality in what these Ph.D. chemists are saying."

Chubin noted that the experiences reported by the chemists parallel those of today's minority science and engineering students, who often suffer from lack of access, isolation, tokenism, lack of acceptance from others at the institution and limited mentoring opportunities.

"The good news is that they prevailed," he added. "Some of them had very distinguished careers despite this. But it points out the climate in which they had to work, and which still confronts faculty of color."

The qualitative study highlights the importance of mentoring, Chubin and Pearson agree. To be successful in academia, scientists must not only teach and do research, but also write papers, submit grant applications, make professional presentations, compete for graduate students and manage their laboratories. That knowledge isn't taught in the classroom, but comes from working with top faculty.

"Many in the first generation of Ph.D.s didn't have a sense that the degree is only the beginning," Pearson said. "Finishing at a top academic institution is a great achievement, but in the research community, the degree is only the key to get in. Those who did not have a rich publishing experience and knowledge of how to write a grant had a very difficult time."

A shortage of African-American faculty poses a threat to the modest diversity at U.S. colleges and universities as today's full professors look toward retirement. "When we are only producing 30 or so African-American Ph.D.s a year and a number of African-American chemists are at or near retirement age, we risk losing ground, especially in academia," Pearson warned. ###

Technical contact: Willie Pearson (404-385-2265) or e-mail: (willie.pearsonjr@hts.gatech.edu).

Contact: John Toon john.toon@edi.gatech.edu 404-894-6986 Georgia Institute of Technology Research News

Project to Save the Lives of Malnourished Children Voted Top 5 in American Express Members Project

International Medical Corps (IMC) has been voted into the Top 5 as part of the American Express Members Project. After more than 87,000 votes, the project, “Saving the Lives of Malnourished Children,” now enters the final round of voting, which ends October 13. Card members will be able to cast their votes a second and final time to decide how the $2.5 million in funding is divided among the five finalists. The project with the most votes receives $1.5 million; the second-place finisher receives $500,000; third place, $300,000; and fourth and fifth place, $100,000.

“While my children go to bed with full stomachs each night, it is deeply troubling to consider that 5 million children younger than five die each year because they do not have the nutrients their little bodies need to survive,” says Paige Strackman, of Brooklyn, N.Y., who submitted the project to American Express. “We can solve this problem with nutrient-rich, ready-to-eat food. The number of votes during this round determines how many lives will be saved. Every vote makes a difference.”

Hunger and malnutrition kill more people in the world than HIV, tuberculosis, and malaria combined. As food prices rise, millions are being driven deeper into poverty everyday while trying to afford basic staples. Many are at risk of having nothing to eat at all.

“International Medical Corps is deeply grateful for the opportunity to work with Paige on a project that she feels so passionately about,” said Rebecca Milner, Vice President of Institutional Advancement. “We also thank all those who rallied behind this cause to support our life-saving work. Their continued support is going to be critical as we vie for the top Members Project prize.”

Through nutrition programs that provide relief while creating sustainable solutions, International Medical Corps brings nutrition-rich, ready-to-eat food to some of world’s most food-insecure environments, including Ethiopia, Somalia, Chad, and Sudan. With a mission that focuses on training, International Medical Corps works to empower individuals and communities, providing education on how to treat malnutrition, identify warnings signs, and intervene before malnutrition worsens.

Contacts: For Press Inquiries, Stephanie Bowen. Communications Manager. International Medical Corps, 1919 Santa Monica Blvd., Suite 400, Santa Monica, CA 90404. 310-826-7800. sbowen@imcworldwide.org

Most ethnic minority teens don't hang out with ethnic school crowds

Dr. Bradford Brown, is Professor of Human Development and former Chair of the Department of Educational Psychology at the University of Wisconsin-Madison. He received an A.B. in sociology from Princeton University and Ph.D. in human development from the University of Chicago. Before joining the faculty of the University of Wisconsin in 1979. Dr. Brown’s research has focused on adolescent peer relations. He is especially well known for his work on teenage peer groups and peer pressure and their influence on school achievement and social adjustment. WEB: Peer Relations Study Group

Peer relationships are an important part of adolescence for most American adolescents. As teens find their places in the peer system in most high schools, crowds define most students’ status and reputation. Today, schools and communities are growing more ethnically diverse and types of crowds have expanded to include ethnically oriented groups. A new study finds that ethnic minority teens tend not to hang out with crowds made up of their ethnic peers. The study also found that being part of an ethnically oriented crowd at school is, for most Asian students, associated with mostly positive characteristics (such as pride in one’s ethnic background). For most Latino students, being part of an ethnically oriented crowd is associated with a mixed group of characteristics (some pride, but also some feelings of discrimination and stereotyping). The study was conducted by researchers at the University of Wisconsin-Madison, Dartmouth College, and the University of North Carolina-Chapel Hill. It is published in the May/June 2008 issue of the journal Child Development.

The researchers sought to determine what factors explain whether ethnic minority teens are associated with ethnically oriented school crowds (for example, Blacks, Asians, or Mexicans) or with crowds based on individual abilities and interests (such as so-called jocks, druggies, populars, Goths, brains, loners, and nerds). In addition, they sought to understand whether crowds foster discrimination and stereotyping, or affirm young people’s positive ties to their ethnic background.

Researchers polled 2,465 African American, Asian American, and Latino teenagers ages 14 to 19 attending seven public high schools in the midwestern and western United States. The students were given a list of the crowds most commonly mentioned by other teens at their school and asked to indicate the one they identified with most closely. In addition, a group of students placed all their classmates (including those initially polled) into crowds; the researchers then looked for characteristics that distinguished adolescents who were part of ethnically oriented crowds from adolescents who were part of non-ethnic crowds.

The study found that ethnic crowd affiliation was not widespread, particularly among biracial youth. Only about 30% of the teenagers were placed by peers in ethnically oriented crowds, and only half that number associated themselves with such crowds. Teens in the ethnic categories studied were more likely to be placed by peers—and to place themselves—in crowds that were not defined ethnically.

However, since ethnicity is an important factor in the self-image and peer reputation of many youths, the study also sought to determine why some ethnic minorities do associate themselves with ethnic crowds at school. For all three ethnic groups studied, teenagers were more likely to be part of an ethnically oriented crowd if most of their friends came from the same ethnic background and if the students were doing poorly in school. Moreover, Latino and Asian American teens who had positive feelings about their ethnic background were more likely to associate themselves with a crowd made up of other teens from their ethnic group.

Furthermore, Latino students were more likely to be part of an ethnically oriented crowd if they came from lower-income homes and had experienced a lot of ethnic discrimination, perhaps because associating with a Latino crowd served as a defense against negative experiences with other peers at school.

“Adolescent crowds are often disparaged as instruments of peer pressure and stereotyping that interfere with healthy identity development,” notes Bradford Brown, professor of human development and educational psychology at the University of Wisconsin-Madison and the study’s lead author. “Our findings suggest that this might be true for ethnically oriented crowds in multi-ethnic American high schools, at least among Latino youth. In other respects, however our findings suggest that ethnically oriented crowd affiliations can reflect and contribute to healthy identity and social development, particularly among adolescents of Asian backgrounds.” ###

The study was funded, in part, by the U.S. Department of Education.

Summarized from Child Development, Vol. 79, Issue 3, Ethnicity and Image: Correlates of Crowd Affiliation Among Ethnic Minority Youth, by Brown, BB (University of Wisconsin-Madison), Herman, M (Dartmouth College), Hamm, JV (University of North Carolina-Chapel Hill), and Heck, DJ (Horizon Research, Inc.). Copyright 2008 The Society for Research in Child Development, Inc. All rights reserved.

Contact: Andrea Browning abrowning@srcd.org 202-289-7905 Society for Research in Child Development

Racial disparities decline for cancer in Missouri

Sept. 23, 2008 -- Cancer death rates in the United States are highest among African Americans, but a new report shows that in Missouri the disparity in cancer incidence and death between African Americans and whites is declining. As a result, cancer incidence (the rate of newly diagnosed cases) between the races is equal, although the death rate will probably remain higher for African Americans for some time.

The report will be published in an upcoming issue of Missouri Medicine. The lead author is Mario Schootman, Ph.D., co-leader of the Prevention and Control Program at the Siteman Cancer Center at Washington University School of Medicine and Barnes-Jewish Hospital.

"A lot of effort has been made to reduce cancer racial disparity in Missouri," says Schootman, also chief of the Division of Health Behavior Research and associate professor of epidemiology and medicine. "But there is still work to be done, especially in decreasing cancer mortality. Ideally, cancer will become just another bump in the road — an illness that people will be able to live with for many decades and keep under control."

The report shows that in 1996, the rate of new cancer cases was 18 percent higher for African-American Missourians but declined to six percent higher by 2003, the last year for which the data were analyzed. If this downward trend continues, the disparity in new cancer cases between African-American and white Missourians will have disappeared when 2006 data is analyzed, Schootman says.

On average, the overall Missouri cancer incidence rate decreased by 0.8 percent per year, possibly reflecting a drop in smoking rates and other preventive measures. The disparity in incidence between African Americans and whites might have arisen from such factors as differences in physical activity, weight, vitamin D deficiency, diabetes, diet and occupational exposure to pollutants, according to the report.

On the other hand, racial disparity in overall cancer death rates remains. In 2005, the last year for which the data were analyzed, the cancer death rate was 28 percent higher for Missouri's African Americans than for whites. This was down from a 48 percent higher cancer death rate for African Americans in 1990, but the slow pace of the decrease means that racial disparity in cancer deaths will probably continue for several more decades unless more aggressive interventions are used, Schootman says.

Schootman also individually analyzed four major cancers — colorectal, breast, prostate and lung — and found some trends contrary to the overall cancer trends. Instead of decreasing, the gap between African Americans and whites for colorectal cancer death rates remained as large as ever. The death rate for this cancer declined among members of both groups during the study period of 1990 to 2005, but it remained about 42 percent higher for African-American than white Missourians.

"In Missouri, African Americans were more likely to be screened for colorectal cancer than whites during the timeframe of our statistical analysis," Schootman says. "But that doesn't appear to have made enough of a difference in the rate of death yet. The racial disparity in colorectal cancer death rate is one of the most serious concerns raised by this study."

Schootman explains that there are four possible reasons for the higher colorectal cancer death rate: less aggressive treatment, more advanced cancer at time of diagnosis, less patient engagement in lifestyles that reduce risk of dying after diagnosis — such as exercise and weight loss — and more physical characteristics that increase risk of dying — such as a higher body fat percentage.

Racial disparity in breast cancer deaths increased during the study period. African American women in Missouri had a nine percent lower incidence of breast cancer than did white Missourians at the end of the study period but had a 46 percent higher breast cancer death rate. Schootman says that other studies suggest that lack of insurance, fear of testing, delay in seeking care and unfavorable tumor characteristics all contribute to this disparity.

Another major concern raised by the study was the much higher death rate from prostate cancer among African Americans. Despite a decline in racial disparity, African-American Missourians died at a 116 percent higher rate from prostate cancer than white Missourians. Schootman says that a possible explanation is that African Americans adopted prostate cancer screening and new therapies later than did white Missourians.

Racial disparity in lung cancer deaths decreased during the study period, but remained 15 percent higher for African-American Missourians. Other research suggests several reasons for the disparity: differences in referral to specialists, less patient acceptance of therapy due to distrust or misunderstanding and differences in availability of treatment.

To further reduce disparities in cancer incidence and death, state and local health departments, primary care associations, medical and community-based organizations, large employers and health care companies need to focus on providing equal access to preventive and treatment services.

The Siteman Cancer Center's PECaD (Program for the Elimination of Cancer Disparities addresses racial disparities in cancer in the St. Louis region.

"PECaD's efforts to reduce breast cancer disparities in the region include promoting mammography through outreach and our mobile mammography van, together with access to diagnostic and treatment services," says PECaD director, Graham Colditz, M.D., Dr.P.H., the Niess-Gain Professor and associate director of Prevention and Control at the Siteman Cancer Center. "Similar multilevel approaches will be necessary to reduce disparities."

###

Schootman conducted the analysis in collaboration with the Missouri Department of Health and Senior Services, and the Missouri health department has published a more detailed version of this report, Cancer in Missouri: Trends in Disparities Between African Americans and Whites, which is available in PDF format at: dhss.mo.gov/CancerinMissouri/CancerDisparityReport. Information on cancer incidence and deaths for the report came from the Missouri Cancer Registry and the Bureau of Health Informatics.

Eliminating racial disparities in cancer is a key goal of national organizations and agencies such as the American Cancer Society, the National Cancer Institute and the U.S. Department of Health and Human Services. It is also a key goal of the Missouri cancer control plan developed by the Missouri Cancer Consortium.

Schootman M, Yun S. Trends in cancer disparities between African Americans and whites in Missouri. Missouri Medicine, upcoming issue.

Funding from the Centers for Disease Control and Prevention and the National Cancer Institute supported this research.

Washington University School of Medicine's 2,100 employed and volunteer faculty physicians also are the medical staff of Barnes-Jewish and St. Louis Children's hospitals. The School of Medicine is one of the leading medical research, teaching and patient care institutions in the nation, currently ranked third in the nation by U.S. News & World Report. Through its affiliations with Barnes-Jewish and St. Louis Children's hospitals, the School of Medicine is linked to BJC HealthCare.

Siteman Cancer Center is the only federally designated Comprehensive Cancer Center within a 240-mile radius of St. Louis. Siteman Cancer Center is composed of the combined cancer research and treatment programs of Barnes-Jewish Hospital and Washington University School of Medicine. Siteman has satellite locations in West County and St. Peters, in addition to its full-service facility at Washington University Medical Center on South Kingshighway.

Contact: Gwen Ericson ericsong@wustl.edu 314-286-0141 Washington University in St. Louis

Hip hop and linguistics: You ain't heard no research like it!

Unique source material furthers research on African American vernacular English It's rare to use the words 'hip hop' and 'serious academic research' in the same sentence,

but a University of Calgary linguistics professor has relied on rap music as source material for a study of African American vernacular English.

Dr. Darin Howe recently contributed a book chapter that focuses on how black Americans use the negative in informal speech, citing examples from hip hop artists such as Phonte, Jay Z and Method Man. Howe is believed to be the only academic in Canada and one of the few in the world to take a scholarly look at the language of hip hop.

"There is still a lot of prejudice against black vernacular English," Howe says. "People tend to assume it's illogical and ungrammatical, but there is a system there and a grammar that you can describe. Rap music may be ear torture for many people, but for linguists, this is what makes us really excited."

Howe specifically focused on the use of the word 'ain't' and on other negative constructions – or, as it's called in linguistics, negation. "When you have multiple negation it seems really confusing, and what happens in black English is that the negation extends across multiple clauses."

For example, the book chapter quotes Tupac Shakur as saying, "It's like can't nobody never get confused and think I'm like Mike Tyson;" in other words, no one could confuse Tupac with Mike Tyson.

In another example, black English commonly substitutes the word 'ain't' for 'didn't.' So 'I didn't see him' could become, 'I aint see him.' "However, black English speakers know that you should only do this for about half the time," Howe says. "White hip hop artists try to imitate black speech, and for the most part they do a decent job, but when they don't have the rules down it becomes noticeable."

One of the intriguing conclusions that Howe draws is that there is an accelerating divergence in the speech dialects of whites and blacks, a subject that surfaced in the late 1990s with the debate on Ebonics.

Howe's focus was purely on the mechanics of the language and not on the culture of hip hop, which some have criticized as violent and misogynistic. He was assisted by an undergraduate linguistics student, Jeff Long, who is keenly interested in hip hop music and who found many of the examples cited in the research. "It's not often that you can combine your own interests with school work, so it was a real joy for me to work on this," Long says. ###

Howe did his master's thesis on African Nova Scotian English but has since specialized at U of C in native languages and phonology, or speech sounds. His chapter, "Negation in African American Vernacular English," appears in the book, Aspects of English Negation, edited by Yoko Iyeiri and published by John Benjamins Publishing Company / Yushodo Press. To arrange an interview with Dr. Howe, contact his office at (403) 220-6110, or phone Greg Harris, (403) 220-3506 or cell, 540-7306. Phone Harris to request a copy of the chapter.

Contact: Gregory Harris gharris@ucalgary.ca 403-220-3506 University of Calgary

Inage Licensing: This image was originally posted to Flickr by Defame. This file is licensed under Creative Commons Attribution 2.0 License.

No longer an issue of black and white?

Ronald E. Hall, Title: Associate Professor. Office Location: 224 Baker Hall. Phone: 517/432-3729. Fax: 517/353-3038. E-mail: hallr@msu.edu WEB: socialwork.msu.edu Education: Ph.D, Atlanta University, MSW, University of Michigan, MCS, University of Detroit

Skin color, more than race, is important cause of racism, according to new book Racism in the 21st Century The color of a person's skin, more than a person's race, is becoming a key cause of racism, according to a new book Racism in the 21st Century co-written and edited by Ronald Hall, associate professor of social work at Michigan State University. In an era when Barack Obama, the first African-American U.S. presidential candidate nominated by a major political party, is running for president, many people still struggle against prejudice and racism. Lighter-skinned blacks, Hispanics, Asians and other minorities often receive preferential treatment over their darker-skinned counterparts in education, housing, employment, and other areas, Hall and his fellow authors argue.

Immigrant workers with lighter skin color make more money on average than those with darker complexions, according to the research of contributor and Vanderbilt University professor Joni Hersch. In addition, the number of Equal Employment Opportunity Commission (EEOC) complaints on skin-color based discrimination are increasing, the book notes. In 2002, the EEOC successfully sued the owners of a Mexican restaurant in San Antonio, Texas, after the restaurant directed the white manager to hire only light-skinned staff to work in the dining room.

Colorism, discrimination based on skin color, is a centuries-old legacy of Western colonialism, according to Hall.

"Racism is no longer an issue of black and white," said Hall who has researched skin color discrimination for 25 years. "As we move further into the 21st century, with increased levels of interracial marriage, we won't be able to make racial differentiations. You're going to have people, for example, with Asian facial features, African hair texture, and Caucasian skin tones – and that's unprecedented. But the way we'll continue to assess one another, unfortunately, is going to be based on the manifestations of skin color. ###

Ronald Hall (Ed.) Racism in the 21st Century, An Empirical Analysis of Skin Color. XIV, 260 p. 9 illus., 2 in color., Hardcover $49.95, €34.95, £26.50, ISBN 978-0-387-79097-8

Contact: Joan Robinson joan.robinson@springer.com 49-622-148-78130 Springer

International Medical Corps, Saving the Lives of Malnourished Children

International Medical Corps has been matched to one of the Top 25 in American Express’ Members Projects, ‘Saving the Lives of Malnourished Children.’

Chosen out of 1,190 projects, “Saving the Lives of Malnourished Children” is now eligible to receive up to $1.5 million in funding. The project with the most votes receives $1.5 million, 2nd receives $500,000, 3rd $300,000, and 4th and 5th $100,000. The funding – made possible by your votes – would bring a vital lifeline to hungry and malnourished children around the world.

We need your help between now and September 29th. Voting is easy and doesn’t cost a thing!

In just a click, you can save the lives of thousands of malnourished children.

For severely malnourished children, we offer a step-by-step treatment program that gives them what they need to recover, including nutrient-dense food supplements like the peanut-based product, Plumpy'Nut. Our comprehensive monitoring system saves more than 90 percent of children being treated in our feeding centers. Being one of the Top 5 would mean our nutrition could reach more children around the world who need our help.

Hunger and malnutrition kill more people in the world than HIV, tuberculosis, and malaria combined. As food prices rise, this funding is even more critical. More people are being driven deeper into poverty trying to afford basic staples. Many have nothing to eat at all. Your vote makes it possible for fewer young lives to be lost because they do not have enough to eat.

Getting the word out to your friends and family makes a huge difference! Forward this link to a friend and you bring us that much closer to the $1.5 million to help malnourished children around the world!

About International Medical Corps

International Medical Corps (IMC) is a global, humanitarian, nonprofit organization dedicated to saving lives and relieving suffering through health care training and relief and development programs.

Established in 1984 by volunteer doctors and nurses, IMC is a private, voluntary, nonpolitical, nonsectarian organization. Its mission is to improve the quality of life through health interventions and related activities that build local capacity in underserved communities worldwide.

By offering training and health care to local populations and medical assistance to people at highest risk, and with the flexibility to respond rapidly to emergency situations, IMC rehabilitates devastated health care systems and helps bring them back to self-reliance.

Help International Medical Corps

Double your impact. Donate today. Your gift is matched before October 31st.

International Medical Corps has received a pledge of $100,000 in matching funds to provide vital health care to millions of children and families suffering in the global food crisis and other emergencies around the world. Every donation made before October 31st will be matched, dollar for dollar, up to $100,000. That means that we can double every dollar you provide, multiplying your gift and reaching more children and families who so desperately need our help.

Did you know that hunger and malnutrition kill more people than HIV/AIDS, tuberculosis, and malaria combined? As food prices soar, billions of people around the world are more vulnerable to malnutrition and severe food insecurity. Malnutrition often puts children at risk for malaria, diarrhea and respiratory infections – creating a vicious cycle. We see the impact of this emergency at our feeding sites and clinics everyday. By making a donation, you provide a lifeline for children and families who desperately need our help.

Contacts: For Press Inquiries: Stephanie Bowen, Communications Manager, International Medical Corps, 1919 Santa Monica Blvd., Suite 400, Santa Monica, CA 90404, 310-826-7800 sbowen@imcworldwide.org

Racial disparities in radiation therapy rates for breast cancer

Thomas A. Buchholz, M.D., F.A.C.R. Professor of Radiation Oncology, The University of Texas M. D. Anderson Cancer Center. Chair, Department of Radiation Oncology. Medical Director of Radiation Oncology, Ambulatory Clinic Building. Program Director and Section Chief, Breast Radiation Oncology

M. D. Anderson study finds racial disparities in radiation therapy rates for breast cancer. Largest study of its kind reveals blacks less likely than whites to receive standard of care WASHINGTON, DC - Black women are less likely than white women to receive radiation therapy after a lumpectomy, the standard of care for early stage breast cancer, according to a new study by researchers at The University of Texas M. D. Anderson Cancer Center. The study, the largest of its kind, was presented today in advance of the American Society of Clinical Oncology (ASCO) Breast Cancer Symposium, and is the first national study to examine such racial disparities in radiation therapy. Led by Grace Li Smith, M.D., Ph.D., a postdoctoral fellow in M. D. Anderson's Department of Radiation Oncology, the researchers reviewed the Medicare records of more than 37,000 patients diagnosed with early stage breast cancer in 2003.

"Although there have been smaller studies of racial disparities in breast cancer care, no prior research has examined the differences across the nation in the rates of radiation therapy after lumpectomy between whites and blacks," said Smith, the study's first author. "The national Medicare database, because it's so comprehensive, allowed us to determine the extent to which racial disparities in radiation therapy affected patients across the country."

For the retrospective cohort study, Smith and her M. D. Anderson colleagues used Medicare claims to examine the treatment history of women aged 66 and older diagnosed in 2003 with early stage, newly diagnosed breast cancer. Of the 37,305 women who underwent a lumpectomy for their breast cancer, 34,024 were white and 2,305 were black. Overall, 74 percent of the white women received radiation therapy after their lumpectomy; in contrast, 65 percent of the black breast cancer patients received the same treatment.

"The use of radiation after lumpectomy is considered to be the standard of care for women with invasive breast cancer, as clinical trials have demonstrated that it both reduces the chance of recurrence and improves the chance of survival," said Thomas Buchholz, M.D., professor in the Department of Radiation Oncology and the study's senior author. "While there are some breast cancer patients, such as those over age 70, with significant co-morbidities for whom radiation would not be appropriate, this discrepancy remained consistent when specifically looking at patients under the age of 70."

Perhaps the most unexpected aspect of the study, said Smith, was the magnitude of the disparity in specific areas of the country: the Pacific West, 72 (whites) vs. 55 percent (blacks); East South Central, 72 (whites) vs. 57 percent (blacks), and the Northeast, 70 (whites) vs. 58 percent (blacks).

However, in some parts of the country - the Mountain West (76 percent vs. 74 percent) and the North Central Midwest (74 percent vs. 72 percent) - there was virtually no discrepancy in radiation rates between whites and blacks. That level of geographic non-disparity was also surprising and of great benefit for further research, said Smith.

"Until further research is conducted, we may only speculate about the underlying reasons why black and white women are not receiving radiation at the same rate. We don't know if fewer black women are receiving radiation simply because it is not offered to them, because they decline the treatment, or perhaps because they are unable to complete a whole course of treatment due to other health problems. These questions will be important subjects of future study. As a medical community, we need to identify and eliminate any obstacle prohibiting all women from receiving necessary care for their breast cancer."

Smith's plans for follow up research include evaluating the difference in radiation rates results in a difference in mortality. She also plans to investigate whether radiation patterns correlate with other illnesses secondary to breast cancer care, and if there are disparities in other types of cancer treatment.

Smith hopes that results from the study may prompt physicians and patients to work together to overcome some of the barriers to treatment.

"Physicians may be able to help patients identify specific barriers to their care and may be able to be influential in helping patients overcome such obstacles," said Smith. "Or, if there are concerns or misconceptions about radiation treatment, patients themselves may play a role by becoming educated about the value of radiation after lumpectomy and helping to disseminate this information into their communities."

###

In addition to Smith and Buchholz, other authors of the all-M. D. Anderson study include: Tina Shih, Ph.D., associate professor in the Department of Biostatistics; Ying Xu, M.D., senior statistical analyst, Division of Quantitative Sciences; Sharon Giordano, M.D., associate professor in the Department of Breast Medical Oncology; Benjamin Smith, M.D., adjunct assistant professor in the Department of Radiation Oncology; George Perkins, M.D., associate professor in the Department of Radiation Oncology; Welela Tereffe, M.D., assistant professor in the Department of Radiation Oncology; Wendy Woodward, M.D., Ph.D., assistant professor in the Department of Radiation Oncology.

The research was supported by a grant from the Department of Defense Breast Cancer Research Program, BC062438.

About M. D. Anderson

The University of Texas M. D. Anderson Cancer Center in Houston ranks as one of the world's most respected centers focused on cancer patient care, research, education and prevention. M. D. Anderson is one of only 39 Comprehensive Cancer Centers designated by the National Cancer Institute. For five of the past eight years, M. D. Anderson has ranked No. 1 in cancer care in "America's Best Hospitals," a survey published annually in U.S. News and World Report.

Contact: Laura Sussman lsussman@mdanderson.org 713-745-2457 University of Texas M. D. Anderson Cancer Center

New gene variant identified for nondiabetic end stage renal disease in African-Americans

Michael J. Klag. Dean, Bloomberg School of Public Health, The Johns Hopkins University Office of the Dean. The Johns Hopkins Bloomberg School of Public Health. 615 N. Wolfe Street. Baltimore, MD 21205. Phone: (410) 955-3540. Fax: (410) 955-0121. E-mail: mklag@jhsph.edu

Scientists at Johns Hopkins schools of Public Health and Medicine have, for the first time, identified variants in the gene MYH9 that are associated with increased risk for non-diabetic end stage renal disease (ESRD,) which is the near-loss of kidney function leading to either dialysis of transplant. MYH9, located on the 22 chromosome, is the first gene identified for common forms of kidney disease. The study was published online September 14 in the journal Nature Genetics and will be published in the October print edition. In a separate study published in the same issue, researchers at the National Institutes of Health reported similar findings. In the United States, about 26 million Americans have chronic kidney disease with nearly 427,000 Americans requiring dialysis or kidney transplant each year for the treatment of ESRD, according to U.S. government studies. African Americans are affected disproportionately as they have a four-times-higher incidence of end stage renal disease compared to European Americans.

"We are in the midst of an epidemic of chronic kidney disease, in which African Americans are disproportionately affected. This finding does not mean that non-genetic factors, such as socioeconomic indicators and other factors do not contribute to the higher risk of kidney disease in African Americans. It defines a subset of persons most likely vulnerable to the harmful effect of these factors," said study author Michael J. Klag, MD, MPH, dean of the Johns Hopkins Bloomberg School of Public Health.

"Our results show that in addition to environmental and behavioral risk factors, genetic factors play a role as well," said lead author, Linda Kao, PhD, MHS, associate professor in Bloomberg School of Public Health's Department of Epidemiology and the Welch Center for Prevention, Epidemiology and Clinical Research.

"While we know these genetic variations are common among African Americans, not everyone with the variations has disease and not everyone with disease has the variations. Therefore, it is imperative that we understand what other modifiable risk factors are interacting with the genetic risk factors to cause disease."

For the study, researchers used a technique known as admixture mapping to survey genomes of 1,372 African Americans with ESRD and a control group of about 800 African Americans without ESRD. The study identified several alleles, or variations, in the MYH9 gene that were highly associated with non-diabetic ESRD but not diabetic ESRD. These variants were not associated with diabetic ESRD. Even though the variations identified in this study are present in many populations, they are more frequent among individuals with West African ancestry.

"This finding suggests that the mechanisms leading from onset of chronic kidney disease to kidney failure may differ based on the inciting cause," said study author Rulan S. Parekh, MD, associate professor Johns Hopkins School of Medicine and the Welch Center. "Discovery of the gene and its association with kidney disease will lead to future studies to better understand the biology of kidney disease progression and ultimately may direct drug therapy and potential screening of patients." ###

Additional authors include Lucy A. Meoni, ScM; David Reich, PhD; Yvette Berthier-Schaad, PhD; Man Li, MS; Josef Coresh, MD, PhD; Nick Patterson, PhD; Arti Tandon; Neil R. Powe, MD, MPH; Nancy E. Fink, MPH; John H. Sadler, MD; Matthew R. Weir, MD; Hanna E. Abboud, MD; Sharon Adler, MD; Jasmin Divers, PhD; Sudha K. Iyengar, PhD; Barry I. Freedman, MD; Paul L. Kimmel, MD; William C. Knowler, MD, DrPH; Orly F. Kohn, MD; Kristopher Kramp, MS; David J. Leehey, MD; Susanne Nicholas, MD, PhD; Madeleine Pahl, MD; Jeffrey R. Schelling, MD; John R. Sedor, MD; Denyse Thornly-Brown, MD; Cheryl A. Winkler, PhD; and Michael W. Smith, PhD.

The research was supported by grants from the National Institutes of Health and the National Cancer Institute's Center for Cancer Research.

For public health news throughout the day, visit www.jhsph.edu/publichealthnews.

Contact: Tim Parsons tmparson@jhsph.edu 410-955-7619 Johns Hopkins University Bloomberg School of Public Health

Blacks less likely to recognize overweight and obesity, study shows

Gary G. Bennett, PhD, Assistant Professor of Society, Human Development, and Health, Harvard School of Public Health. Area of Research, Cancer Disparities Among Racial and Ethnic Minorities Contact Information, Gary G. Bennett, PhD, Dana-Farber Cancer Institute 44 Binney Street Smith 256 Boston, MA 02115. Office phone: (617) 632-4050, Appointment phone: (617) 632-5674, Fax: (617) 632-1999. E-mail: gbennett@hsph.harvard.edu Our research program comprises both observational and intervention research and focuses on disparities in cancer risk behaviors, with a particular emphasis on the high prevalence of obesity and physical inactivity among blacks. Together, physical inactivity and obesity may account for 25% to 30% of several major cancers: colon, breast (postmenopausal), endometrial, kidney, and esophageal. While a great deal of research has described the physical inactivity and obesity among black adults, comparatively little work has examined the social determinants that might inform behavioral and policy interventions. WEB: Gary G. Bennett, PhD

Researchers say failure to recognize excess body weight poses significant health concerns BOSTON -- Overweight black Americans are two to three times more likely than heavy white Americans to say they are of average weight – even after being diagnosed as overweight or obese by their doctors, according to a study led by Dana-Farber Cancer Institute researchers. Weight "misperception" was most common among black men and women, and also was found among Hispanic men (but not women) compared to their white counterparts. The findings, which appear in the current online issue of the International Journal of Behavioral Nutrition and Physical Activity, are significant as excess body weight is a known risk factor for diabetes, heart disease, many forms of cancer, and premature death. Growing concern over the national obesity epidemic in recent years apparently has not significantly increased overweight blacks’ recognition of their excess pounds, said Gary G. Bennett, PhD, of Dana-Farber’s Center for Community-Based Research and Harvard School of Public Health in Boston, lead author of the study. The report by Bennett and Kathleen Y. Wolin, ScD of Northwestern University is based on an analysis of data collected in the National Health and Nutritional Examination Survey (NHANES), a government-sponsored research study begun in the 1960s. It includes both interviews and physical examinations carried out by mobile units across the country. Analyses of NHANES data collected in 1988-98 and 2001-02 show that the prevalence of misperception actually has increased among blacks. "During this period we’ve seen rapid gains in obesity," said Bennett. "We think it’s a considerable problem that this is still not resonating among blacks and other minorities," he added. Although the prevalence of overweight and obesity is even higher among blacks (estimated at over 75 percent) than the national average, Bennett said less pressure exists in the black community for people to lose weight through diet and exercise because of a cultural acceptance of higher body weights and heavier body shapes. "We think that misperception can be very useful when it comes to protecting people against overly stringent body image ideals and eating disorders," said Bennett, who is black. "But it’s a problem when people fail to realize the health consequences associated with obesity."

The researchers analyzed data on 6,552 overweight and obese men and women who participated in the 1999-2002 NHANES surveys. Included in the analyses were data on height, weight, body mass index, whether they had received a diagnosis of overweight from a doctor, and responses to the question, "Do you consider yourself now to be overweight, underweight, or about the right weight"" Since all the participants were overweight or obese by standard health guidelines, all answers of "about the right weight" were categorized as "inaccurate" or a "misperception" by the researchers. The study was not designed to determine whether the inaccurate statements were intentional or not.

The study found that men were more likely than women to misperceive their weight. Among women, the prevalence of misperception was highest among overweight black women (40.9 percent, compared to 20.6 percent in overweight white women) and men (66.4 percent, compared to 43.2 percent in overweight white men). It was lowest among obese white women (3.1 percent, compared with 11.2 percent in obese black women) and men (8.9 percent, compared to 26.2 of obese black men.)

Altogether, overweight black men and women were twice as likely as whites to make inaccurate body weight perceptions, and obese black adults were even more likely to exhibit weight status misperceptions, according to the report.

Unrealistic assessments of body weight were just as common in people who were relatively financially well off as in poorer people, and in those who had been told by their doctors that they were overweight or obese.

One lesson from the findings, Bennett said, is that "it is probably not sufficient for physicians to simply tell a person that he or she is overweight; doctors should do much more intensive counseling regarding the health consequence of being overweight."

The message is complicated, he added, by research findings showing that blacks generally don’t experience life-shortening health effects until they are more obese compared to whites. "Obesity-associated mortality occurs at a higher BMI (body mass index) among blacks than it does for whites," probably for biological reasons, said Bennett. Yet some of the health effects associated with excess weight, such as diabetes, high cholesterol and hypertension, can be causing harm in blacks long before they result in death.

"The tendency to dramatically underestimate the degree of their overweight should be a clarion call to blacks," Bennett said. "We hope that people will increasingly recognize the health consequences associated with excess weight." ###

The research was supported by the National Institutes of Health and the Dana-Farber/Harvard Cancer Center.

Dana-Farber Cancer Institute (www.dana-farber.org) is a principal teaching affiliate of the Harvard Medical School and is among the leading cancer research and care centers in the United States. It is a founding member of the Dana-Farber/Harvard Cancer Center (DF/HCC), designated a comprehensive cancer center by the National Cancer Institute.

Contact: Janet Haley Dubow janet_haley@dfci.harvard.edu 617-632-5665 Dana-Farber Cancer Institute

Dr. Patricia E. Bath

Dr. Patricia Bath was the first woman ophthalmologist to be appointed to the faculty of the University of California at Los Angeles School of Medicine Jules Stein Eye Institute.

Dr. Bath was the first woman to chair an ophthalmology residency program in the United States.

Dr. Patricia Bath discovered and invented a new device and technique for cataract surgery known as laserphaco. Dr. Bath is the first African American woman doctor to receive a patent for a medical invention.

Born: November 4, 1942, Birthplace: Harlem, New York - Patricia E. Bath, an ophthalmologist and laser scientist, is an innovative research scientist and advocate for blindness prevention, treatment, and cure. Her accomplishments include the invention of a new device and technique for cataract surgery known as laserphaco, the creation of a new discipline known as "community ophthalmology," and appointment as the first woman chair of ophthalmology in the United States, at Drew-UCLA in 1983.

Dr. Patricia E. Bath

Patricia Bath's dedication to a life in medicine began in childhood, when she was first heard about Dr. Albert Schweitzer's service to lepers in the Congo. After excelling in her studies in high school and university and earning awards for scientific research as early as age sixteen, Dr. Bath embarked on a career in medicine. She received her medical degree from Howard University College of Medicine in Washington, D.C., interned at Harlem Hospital from 1968 to 1969, and completed a fellowship in ophthalmology at Columbia University from 1969 to 1970. Following her internship, Dr. Bath completed her training at New York University between 1970 and 1973, where she was the first African American resident in ophthalmology. Bath married and had a daughter Eraka, born 1972.

While motherhood became her priority, she also managed to complete a fellowship in corneal transplantation and keratoprosthesis (replacing the human cornea with an artificial one).

As a young intern shuttling between Harlem Hospital and Columbia University, Bath was quick to observe that at the eye clinic in Harlem half the patients were blind or visually impaired. At the eye clinic at Columbia, by contrast, there were very few obviously blind patients. This observation led her to conduct a retrospective epidemiological study, which documented that blindness among blacks was double that among whites. She reached the conclusion that the high prevalence of blindness among blacks was due to lack of access of ophthalmic care. As a result, she proposed a new discipline, known as community ophthalmology, which is now operative worldwide. Community ophthalmology combines aspects of public health, community medicine, and clinical ophthalmology to offer primary care to underserved populations. Volunteers trained as eye workers visit senior centers and daycare programs to test vision and screen for cataracts, glaucoma, and other threatening eye conditions. This outreach has saved the sight of thousands whose problems would otherwise have gone undiagnosed and untreated. By identifying children who need eyeglasses, the volunteers give these children a better chance for success in school.

Bath was also instrumental in bringing ophthalmic surgical services to Harlem Hospital's Eye Clinic, which did not perform eye surgery in 1968. She persuaded her professors at Columbia to operate on blind patients for free, and she volunteered as an assistant surgeon. The first major eye operation at Harlem Hospital was performed in 1970 as a result of her efforts.

In 1974 Bath joined the faculty of UCLA and Charles R. Drew University as an assistant professor of surgery (Drew) and ophthalmology (UCLA). The following year she became the first woman faculty member in the Department of Ophthalmology at UCLA's Jules Stein Eye Institute. As she notes, when she became the first woman faculty in the department, she was offered an office "in the basement next to the lab animals." She refused the spot. "I didn't say it was racist or sexist. I said it was inappropriate and succeeded in getting acceptable office space. I decided I was just going to do my work." By 1983 she was chair of the ophthalmology residency training program at Drew-UCLA, the first woman in the USA to hold such a position.

Despite university policies extolling equality and condemning discrimination, Professor Bath experienced numerous instances of sexism and racism throughout her tenure at both UCLA and Drew. Determined that her research not be obstructed by the "glass ceilings," she took her research abroad to Europe. Free at last from the toxic constraints of sexism and racism her research was accepted on its merits at the Laser Medical Center of Berlin, West Germany, the Rothschild Eye Institute of Paris, France, and the Loughborough Institute of Technology, England. At those institutions she achieved her "personal best" in research and laser science, the fruits of which are evidenced by her laser patents on eye surgery.

Bath's work and interests, however, have always gone beyond the confines of a university. In 1977, she and three other colleagues founded the American Institute for the Prevention of Blindness, an organization whose mission is to protect, preserve, and restore the gift of sight. The AIPB is based on the principle that eyesight is a basic human right and that primary eye care must be made available to all people, everywhere, regardless of their economic status. Much of the work of the AIPB is done though ophthalmic assistants, who are trained in programs at major universities. The institute supports global initiatives to provide newborn infants with protective anti-infection eye drops, to ensure that children who are malnourished receive vitamin A supplements essential for vision, and to vaccinate children against diseases (such as measles) that can lead to blindness.

As director of AIPB, Bath has traveled widely. On these travels she has performed surgery, taught new medical techniques, donated equipment, lectured, met with colleagues, and witnessed the disparity in health services available in industrial and developing countries.

Dr. Bath is also a laser scientist and inventor. Her interest, experience, and research on cataracts lead to her invention of a new device and method to remove cataracts—the laserphaco probe. When she first conceived of the device in 1981, her idea was more advanced than the technology available at the time. It took her nearly five years to complete the research and testing needed to make it work and apply for a patent. Today the device is use worldwide. With the keratoprosthesis device, Dr. Bath was able to recover the sight of several individuals who had been blind for over 30 years.

In 1993, Bath retired from UCLA Medical Center and was appointed to the honorary medical staff. Since then, she has been an advocate of telemedicine, the use of electronic communication to provide medical services to remote areas where health care is limited. She has held positions in telemedicine at Howard University and St. George's University in Grenada.

Dr. Bath's greatest passion, however, continues to be fighting blindness. Her "personal best moment" occurred on a humanitarian mission to North Africa, when she restored the sight of a woman who had been blind for thirty years by implanting a keratoprosthesis. "The ability to restore sight is the ultimate reward," she says.

What was my biggest obstacle?

Sexism, racism, and relative poverty were the obstacles which I faced as a young girl growing up in Harlem. There were no women physicians I knew of and surgery was a male-dominated profession; no high schools existed in Harlem, a predominantly black community; additionally, blacks were excluded from numerous medical schools and medical societies; and, my family did not possess the funds to send me to medical school. [Dr. Bath says her mother scrubbed floors so she could go to medical school.]

Despite official university policies extolling equality and condemning discrimination, Bath experienced both sexism and racism during her tenure at both UCLA and Drew. Determined that her research not be obstructed by the "glass ceilings," she took her research abroad to Europe, where her research was accepted on its merits at the Laser Medical Center of Berlin, West Germany, the Rothschild Eye Institute of Paris, France, and the Loughborough (England) Institute of Technology. At those institutions she excelled in research and laser science, the fruits of which are evidenced by her patents for laser eye surgery.

How do I make a difference?

I am most proud of my invention of a new technique and concept for cataract surgery, known as laserphaco, which is defined by my publications as well as patents.

Who was my mentor?

Newspaper accounts of the humanitarian work of Dr. Albert Schweitzer (who treated lepers in Africa) and my personal relationship with my family physician, Dr. Cecil Marquez, inspired me with the ambition to become a physician. Both my parents shared my admiration for these two role models and encouraged me to pursue my ambition.

TEXT and IMAGE CREDIT: Government information at NLM Web sites is in the public domain. Public domain information may be freely distributed and copied, but it is requested that in any subsequent use the National Library of Medicine (NLM) be given appropriate acknowledgement. Changing the Face of Medicine

Hair straightening chemicals not linked to breast cancer risk in African-Americans

PHILADELPHIA - Chemical "relaxers" used to straighten hair are not associated with an increased risk of developing breast cancer among African-American women, say researchers who followed 48,167 Black Women's Health Study participants.

In the May issue of Cancer Epidemiology, Biomarkers & Prevention, researchers from Boston University and Howard University Cancer Center found no increase in breast cancer risk due to the type of hair relaxer used or the frequency and duration of use. Women who used relaxers seven or more times a year over a 20 year span or longer had the same risk as women who used the chemicals for less than a year, researchers say.

Lynn Rosenberg is professor of epidemiology at Boston University School of Public Health. She received her M.S. in chemistry from Boston University and M.S. in biostatistics and Sc.D. in epidemiology from Harvard University. Dr. Rosenberg’s research has been in the areas of cancer epidemiology, cardiovascular epidemiology, and drug epidemiology, with a recent emphasis on women’s health. She has carried out multiple studies of risk factors for cancers, including cancer of the breast, cervix, and colon, and for myocardial infarction. Particular interests have been the health effects of oral and injectable contraceptives and of noncontraceptive estrogens. Several important hypotheses have been raised by her studies: that alcohol consumption increases the incidence of breast cancer and that use of nonsteroidal anti-inflammatory drugs decreases the incidence of large bowel cancer. Both hypotheses were subsequently confirmed in numerous studies. Currently, she is PI of the long-running Case-Control Surveillance Study, which has been in progress since 1975; multiple case-control studies are conducted within the same administrative framework to assess the unanticipated effects of medications on the incidence of various cancers. She heads a cross-sectional study of the effect of injectable progestin contraceptives on bone mineral density in African women and women of mixed race in South Africa . She is also PI of the Black Women’s Health Study, the largest follow-up study of the health of African-American women yet conducted. The study, conducted in collaboration with investigators at Howard University, follows 59,000 black women from across the U.S. to assess risk factors for outcomes that include breast cancer, other cancers, hypertension, diabetes, systemic lupus erythematosus, uterine fibroids, and preterm birth. Dr. Rosenberg is the author of over 200 scientific papers.

"This is good news," said the study's lead investigator, Lynn Rosenberg, Sc.D., professor of epidemiology at Boston University School of Public Health. "The present study is definitive that hair relaxers don't cause breast cancer, as much as an epidemiologic study can be." Previous research shows that breast cancer incidence is higher among African-American women age 40 or younger than among Caucasian women of the same age, and this increased risk is not fully explained by known risk factors, such as race and family history. At all ages, African-American women are more likely to die of breast cancer than are Caucasian women. To shed light on these findings and to study potential causes of breast cancer and other serious illnesses that affect black women, the Black Women's Health Study was launched across the United States in 1995. More than 59,000 women completed an initial questionnaire and more than 80 percent have answered follow-up questions every two years since, including questions about use of hair relaxers. Hair relaxers can enter the body through cuts or lesions in the scalp. These products are not fully monitored by the Food and Drug Administration, and thus could contain potentially harmful compounds, Rosenberg said. Manufacturers of hair relaxers and hair dyes are not required to list all ingredients of their products on the packages, as some may be considered trade secrets, she said. "Because hair relaxers are more widely used by younger African-American women than they are used by older African-American women, a connection with increased risk of breast cancer in younger women seemed possible," Rosenberg said. "Also, millions of African-American women use hair relaxers, and substances that are used by millions of women over a span of many years should be monitored for safety." The researchers found that younger women used hair relaxers more than older women did. They also discovered that the majority of women used hair relaxers before age 20 and a third used the chemicals at least seven times a year.

But when they examined the association between use of hair relaxers and breast cancer, based on 574 newly diagnosed cases of breast cancer identified during the follow-up period, they found no connection between use of relaxers and breast cancer incidence overall or among the younger women, even if use had been frequent and of long duration.

The study was funded by the National Cancer Institute. Co-authors include Julie Palmer, Sc.D., and Deborah Boggs, M.S., of Boston University School of Public Health, and Lucile Adams-Campbell, Ph.D., of Howard University Cancer Center. ###

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