Difference in fat storage may explain lower rate of liver disease in African-Americans

DALLAS – March 27, 2009 – Where different ethnic groups store fat in their bodies may account for differences in the likelihood they'll develop insulin resistance and non-alcoholic fatty liver disease, researchers at UT Southwestern Medical Center have found.

According to research reported in the online edition and the March issue of Hepatology, African-Americans with insulin resistance might harbor factors that protect them from this form of metabolic liver disease.

Despite similarly high rates of associated risk factors such as insulin resistance, obesity and diabetes among African-Americans and Hispanics, African-Americans are less likely than Hispanics to develop non-alcoholic fatty liver disease, or NAFLD. The disease is characterized by high levels of triglycerides in the liver and affects as many as one-third of American adults.

Caption: Researchers, including Drs. Jeffrey Browning (left) and Richard Guerrero, have demonstrated that where different ethnic groups store fat in their bodies may account for variations in the rates those groups develop insulin resistance and non-alcoholic fatty liver disease. Credit: UT Southwestern Medical Center. Usage Restrictions: Please use our credit line.

"If we can identify the factors that protect African-Americans from this liver disease, we may be able to extrapolate those to other populations and perhaps develop targeted therapies to help populations prone to NAFLD," said Dr. Jeffrey Browning, assistant professor of internal medicine in the UT Southwestern Advanced Imaging Research Center and the study's senior author. Previous research has shown that when African-Americans do develop NAFLD, they're less likely to reach the later stages of liver disease.

Prior work by Dr. Browning and other UT Southwestern scientists has revealed that NAFLD is more prevalent among Hispanics than African-Americans or Caucasians.

For the current study, Dr. Browning and his colleagues analyzed data gathered in the multi-ethnic, population-based Dallas Heart Study. Starting in the year 2000, more than 2,100 participants provided blood samples and underwent multiple body scans with magnetic resonance imaging and computed tomography to examine the liver, heart and other organs. Body composition, including fat distribution, also was scrutinized.

The study found that African-Americans and Hispanics both have obesity rates of about 48 percent among their respective populations, as well as diabetes rates of about 21 percent. Only 23 percent of African-Americans, however, have NAFLD, compared with 45 percent of Hispanics.

Similarly, African-Americans are less likely to have high levels of triglycerides and abdominal fat – both characteristics of insulin resistance – when compared with Hispanics or Caucasians, even though overall rates of insulin resistance among all groups are the same, researchers found.

"This presents something of a paradox," Dr. Browning said.

The explanation might lie in where different ethnic groups typically store fat.

Obese Hispanics tend to deposit fat in the liver and visceral adipose tissue – the area around the belly. Obese African-Americans deposit fat predominantly in subcutaneous adipose tissues – the area around the hips and thighs, Dr. Browning said.

"This may be protective," Dr. Browning said. "In animal studies, if subcutaneous fat is increased as opposed to visceral fat, you can actually reverse fatty liver disease."

Scientists aren't sure why the location of fat storage matters.

"This seems to argue that there is a fundamental difference in the lipid metabolism between African-Americans and Hispanics or Caucasians, and this difference is maintained even when insulin resistance is present," Dr. Browning said.

Differences in liver-fat content in Caucasians seem to be based on gender. Caucasian males are at the highest risk for NAFLD, on par with the risk faced by Hispanics in general. Caucasian females are on par with the African-American population, at about 23 percent. Caucasian females, like African-Americans, might benefit from the greater predilection to store fat in lower extremities.

"Research studies traditionally have been based on examining Caucasian males, but this information suggests that there are sometimes ethnic and gender differences that need to be studied individually to determine if there are important clues we're missing because we're lumping everybody together," Dr. Browning said.

Researchers next will study how differences in metabolism affect fatty liver disease. ###

Other researchers from UT Southwestern involved in the study were lead author Dr. Richard Guerrero, a postdoctoral trainee clinician in internal medicine; Dr. Gloria Vega, professor of clinical nutrition; and Dr. Scott M. Grundy, director of the Center for Human Nutrition.

The study was funded by the Donald W. Reynolds Foundation and the National Institutes of Health.

Visit www.utsouthwestern.org/digestive to learn more about UT Southwestern's clinical services in digestive disorders, including liver disease.

Dr. Jeffrey Browning -- www.utsouthwestern.edu/findfac/professional/

Contact: LaKisha Ladson lakisha.ladson@utsouthwestern.edu 214-648-3404 UT Southwestern Medical Center

Do Americans have an identity crisis when it comes to race and ethnicity?

Say goodbye to Italian-Americans and German-Americans and say hello to Vietnamese-Americans, Salvadoran-Americans and a bunch of other hyphenated Americans.

The way people identify themselves in the United States is changing, and the way the federal census classifies them by race or ethnicity isn't painting a clear portrait of America, according to new research.

University of Washington demographers who analyzed 2000 census data contend that because of the way the census was structured many Hispanics or Latinos were eventually lumped into a category called "some other race." So many were placed in that category that it was the third-largest group behind whites and blacks in the census. This led to mistaken reports last year that whites, as opposed to non-Hispanic whites, were projected to be a minority in the U.S. by 2050. Actually, whites -- including Hispanic whites -- are expected to comprise upwards of 70 percent of the population in 2050.

Bizarro (New) © Dan Piraro, King Features Syndicate.

"The truth is many people probably can't accurately report the origins of their ancestors," said Anthony Perez, lead author of a new study and a UW post-doctoral fellow in sociology and the university's Center for Studies in Demography and Ecology. His co-author is Charles Hirschman, a UW professor of sociology and former president of the Population Association of America. The research appears in the March issue of the journal Population and Development Review.

"We have a fair degree of knowledge about where our parents and grandparents came from," said Perez. "But with every generation the number of our ancestors doubles and it is difficult to know the ethnic and racial details of all of them. Many people might have more ethnic or racial groups in their backgrounds than they imagine."

Most Americans, except for recent immigrants, probably descended from multiple geographic, ethnic and racial origins, and the United States was multi-ethnic and multi-racial from the start, the researchers contend.

"With the exception of indigenous people, everyone came from somewhere else. They were immigrants," said Perez. "Frontier societies absorbed many indigenous people and we also have a long history of interracial unions between Americans of European and African descent. It is not just Barack Obama, but most of us are a bunch of 'mutts' from different cultures and backgrounds."

All of this led to what is called Americanization, or the blending away of the specific ancestries that people brought with them. Typically Americanization begins with immigrants coming to the U.S., settling in neighborhoods with their compatriots and retaining their ethnic roots. But within a generation, they or their children learn English, intermarry with other Americans of different backgrounds and their ancestral ties begin to fade. With several more generations, most Americans begin to lose track of their increasingly complex family trees.

This blending has dramatically transformed Native Americans and Hawaiian-Pacific Islanders, most of whom acknowledge multiracial heritage. At the same time, very few whites and blacks acknowledge common ancestry on censuses and surveys.

"The low levels of racial mixture reported by whites and blacks represent an astounding loss of memory or a reluctance to acknowledge such mixing," said Perez. "One-fifth of African-Americans identified multiracial origins in the 1910 census and researchers think that number probably is low. Yet in Census 2000, just 2 percent of blacks and 0.4 percent of white acknowledge shared ancestry. The blurring of memories over many generations, the stigma of race mixing and a long history of segregation and political polarization have probably contributed to the amnesia of shared ancestry among many white and black Americans.

"Whites are notoriously inconsistent about the specifics of ethnic identity. We don't put a lot of stock in their answers because they often change their minds on follow-up questions. There also is inconsistency between parents and their children. The majority of whites have multiple ancestries and some will pick theirs on the basis of cuisine, a favorite relative or trends. And who isn't Irish on St. Patrick's Day?" he said.

What will Americans look like in another 50 years? Perez isn't sure.

"The future face of America is uncertain. It's like predicting the weather 50 years from now. If current rates of intermarriage continue, there is likely to be continued blurring of race and ethnic divisions. Even the race and ethnic categories used in the census may change, as they have in the past. For Asians and Hispanics, there is likely to be continued blending, as with previous generations of immigrants." If intermarriage between blacks and whites continues to increase in the coming year, perhaps there will be greater acknowledgement of their shared ancestry. But this will likely depend also on how well we bridge the social and economic gaps between groups."

The research was supported by the National Institute of Child Health and Human Development. ###

For more information, contact Perez at 206-543-4572 or adperez@u.washington.edu.

Contact: Joel Schwarz joels@u.washington.edu 206-543-2580 University of Washington

Racial biases fade away toward members of your own group

COLUMBUS, Ohio – White people don't show hints of unconscious bias against blacks who belong to the same group as them, a new study suggests.

But this lack of bias only applied to black people in their group, according to the findings. Most white people in the study still showed evidence of some unconscious bias towards blacks who were in an opposing group, or who were unaffiliated with either group.

What impressed the researchers, however, was just how quickly these group bonds could form. The lack of bias toward fellow black group members was uncovered just minutes after whites joined the mixed-race group, and without participants even meeting their fellow members personally.

Jay Van Bavel

"The results suggest that when we share some kind of identity with a group of people, we automatically and immediately feel positively toward them, regardless of race," said Jay Van Bavel, co-author of the study and post-doctoral fellow in psychology at Ohio State University. "You can think in terms of people who go to the playground and play a game of pickup basketball.

All it takes is a flip of a coin to make someone your teammate, and at least for that game, you're going to feel positively toward your teammates, white and black."

Van Bavel conducted the study with William Cunningham, assistant professor of psychology at Ohio State. Their study appears in the March issue of the journal Personality and Social Psychology Bulletin.

The study involved two separate but related experiments with college students, one done in Canada and one in the United States.

The students took a computer test commonly used by psychologists to reveal unconscious, or automatic racial bias. The test examines people's first reactions to seeing a black face, before their conscious mind can edit and override biases.

Even though most people disavow any racial bias, this test consistently shows that about three-quarters of white North Americans have some level of unconscious racial bias, Van Bavel said. These unconscious thoughts can lead people to make biased decisions without realizing they are being biased. For example, a manager may pass over a resume of a person whose name suggests she is an African American, without even recognizing why he is doing it, according to Van Bavel.

William A. Cunningham

The computer test flashes pictures of black and white faces quickly on the screen followed nearly instantaneously by positive words (such as love) or negative words (such as hatred). Participants have to very quickly – within about one-half of a second -- categorize the words as positive or negative.

In general, white people find it more difficult to correctly classify positive words when they were first shown a photo of a black person.

"Seeing a black face automatically activates this association with negative things for many white people and if they don't have time to correct this negative image – which they don't in this study – they associate negative words with black faces," Cunningham said.

In the first experiment, 109 students at the University of Toronto were randomly assigned to one of two groups made up for the study – one named the Lions and the other called the Tigers. A control group learned about the two groups, but was not assigned to either one of them.

Members of the Lions and Tigers were shown photos of the members of both groups, and told it was important to learn who belonged to their team, and who belonged to other team.

Later, they were given the computer bias test. Results showed that students in the control group, who were not a member of either mixed-race group, showed a preference for white faces over black faces, as was expected.

But white members of the two teams showed no bias against black members of their own teams. They did, however, show bias towards black members of the opposing team.

"Team members were evaluating people based on whether they were on the same team – not evaluating them based on their race," Cunningham said.

The second experiment involved 126 students at Ohio State. The setup was essentially the same, except that participants also evaluated white and black faces that were not members of either of the two groups. Results showed that white students showed no bias against blacks who belonged to their team. They showed nearly equivalent levels of bias towards black members of the opposing team, and black members who were not associated with either team.

This suggests that whites were showing increased positive feelings toward black members of their own team, but not increased negative feelings toward blacks who belonged to the opposing team.

"White students felt the same toward blacks on the opposing team and people who didn't belong to any team," Van Bavel said. "That means liking people from your team doesn't mean you have to hate members of the other team."

Van Bavel said the unconscious biases studied in this research have real-life consequences.

"What's dangerous about these attitudes is that they can come into play even when we're not aware of them, and even when we think we are being egalitarian," he said.

But this study suggests there may be ways to battle this unconscious, automatic racism.

"We want to change how people see someone at the very earliest stages. If you see someone as a member of your own team or group, race may not even come to mind. You are thinking about that person in terms of some kind of shared relationship," Van Bavel said.

In the real world, this means creating contexts to show how people are connected whenever possible. This may mean emphasizing our shared identities as residents of a city, fans of a sports team or members of a church.

"It's part of human nature to feel positively about members of our own group," Cunningham said. "The challenge is to find ways to call attention to our shared identities." ###

Contact: Jay Van Bavel, Van-bavel.1@osu.edu or William Cunningham, (614) 247-6139; Cunningham.417@osu.edu

Written by Jeff Grabmeier, (614) 292-8457; Grabmeier.1@osu.edu

Contact: Jay Van Bavel Van-bavel.1@osu.edu 614-247-6139 Ohio State University

Study quantifies racial disparities in cancer mortality rates between blacks and whites

African Americans have a shorter life expectancy than whites, and cancer plays a major role in this disparity. African Americans are more prone to get cancer; they tend to present at a later, deadlier stage; and they have poorer survival rates after diagnosis.

But to what extent are each of these three factors responsible for the disparity in cancer mortality? A new UCLA study, published in Journal of General Internal Medicine Feb. 18, answers that question, finding that for most types of cancer, the disparity in mortality is almost entirely due to the fact that African Americans are more likely to get cancer in the first place. Their stage at presentation and survival after diagnosis play a much smaller role.

Overall, African American men live 1.47 fewer years than white men, and African American women 0.91 fewer years than white women, due to all cancers combined. The results spotlight the need for greater prevention efforts aimed at African Americans.

Comparison of SEER and NHIS data on years of potential life lost (YPLL) due to specific cancers and all cancers combined. YPLL = years of potential life lost before age 75 per 1,000 persons, where n is the number of persons at risk for death in the population. Other GI = other gastrointestinal cancers, including esophageal, pancreatic and liver.

This is the first time that researchers have quantified the role that disparities in cancer incidence, stage at diagnosis and survival after cancer plays in African Americans' shorter life expectancy, according to lead author Dr. Mitchell D. Wong, associate professor of medicine in the division of general internal medicine and health services research at the David Geffen School of Medicine at UCLA. "Putting a number on it is very informative, because when you look at the figures, you see that the reason their mortality is worse is almost entirely due to the fact that blacks are more likely to get cancer," Wong said. "This highlights the importance of prevention — it's where most of the efforts should be." A notable exception to this pattern was breast cancer. While white women are more likely to get breast cancer than African American women, the disparities between whites and blacks in stage at presentation and survival after diagnosis for breast cancer had a large impact on the racial gap in life expectancy.

"This argues for much more research and efforts to close the gap in breast cancer screening and treatment," Wong said.

The researchers analyzed data from the Surveillance and Epidemiology End Result (SEER) cancer registry and the National Health Interview Survey (NHIS). Together, the data sets covered about 2.7 million white and 291,000 African American cancer patients from 12 geographic regions in the United States: San Francisco/Oakland, Connecticut, Detroit, Hawaii, Iowa, New Mexico, Seattle (Puget Sound), Utah, Atlanta, Alaska, San Jose/Monterey and Los Angeles.

Among the other findings:

* Cancer incidence, stage at diagnosis and post-diagnosis survival accounted for 1.12, 0.17 and 0.21 years, respectively, in the life-expectancy disparity among men.
* Among women, those categories accounted for 0.41, 0.26 and 0.31 years, respectively.
* The difference in incidence of cancer had a greater impact on the racial gap in cancer mortality than did the stage at which the cancer was diagnosed.
* The differences in post-diagnosis survival were significant with only two types of cancer: breast (0.14 years) and prostate (0.05 years).

"Continuing to improve cancer treatment and screening is undoubtedly important to improving life expectancy and quality of life for all adults, yet substantial disparities in cancer mortality will persist unless we can find ways to address the enormous impact of racial differences in cancer incidence," the researchers concluded. ###

In addition to Wong, study authors included Susan L. Ettner and Martin F. Shapiro of the David Geffen School of Medicine at UCLA, and John Boscardin of the division of geriatrics at the San Francisco Veterans Administration Medical Center.

The National Institute on Aging, the National Center on Minority Health and Health Disparities, a Pfizer Scholars Grant in Clinical Epidemiology, and a Doris Duke Charitable Foundation Clinical Scientist Development Award funded this study.

The General Internal Medicine and Health Services Research Division in the department of medicine at the David Geffen School of Medicine at UCLA provides a unique interactive environment for collaborative efforts between health services researchers and clinical experts with experience in evidence-based work. The division's 100-plus clinicians and researchers are engaged in a wide variety of projects that examine issues related to access to care, quality of care, health measurement, physician education, clinical ethics and doctor-patient communication. Researchers in the division have close working relationships with economists, statisticians, social scientists and other specialists throughout UCLA and frequently collaborate with their counterparts at the RAND Corp. and the Charles Drew University of Medicine and Science.

Contact: Enrique Rivero erivero@mednet.ucla.edu 310-794-2273 University of California - Los Angeles

Heart failure strikes younger African-Americans at the same rate as older Caucasians

Treating hypertension and obesity key to heart failure prevention

Heart failure—a disabling and often deadly form of heart disease—is hitting African Americans in their thirties and forties at the same rate as Caucasians in their fifties and sixties, according to a study featured as the lead article of the March 19 issue of the New England Journal of Medicine.

One in 100 African-American men and women developed heart failure at an average age of 39, 20 times the rate in Caucasians, according to Racial Differences in Incident Heart Failure Among Young Adults. Heart failure in African Americans was associated with risk factors such as hypertension and obesity that were already present when these adults were in their twenties.

Treating hypertension and obesity key to heart failure prevention. Heart failure—a disabling and often deadly form of heart disease—is hitting African Americans in their thirties and forties at the same rate as Caucasians in their fifties and sixties, according to a study featured as the lead article of the March 19 issue of the New England Journal of Medicine.

One in 100 African-American men and women developed heart failure at an average age of 39, 20 times the rate in Caucasians, according to Racial Differences in Incident Heart Failure Among Young Adults. Heart failure in African Americans was associated with risk factors such as hypertension and obesity that were already present when these adults were in their twenties.

"These findings should be a wake-up call on the need for African Americans and physicians to address risk factors that can lead to heart failure. Heart failure is disproportionately hitting African Americans in the prime of their lives," said Kirsten Bibbins-Domingo, Ph.D., M.D., lead author of the study and a scholar with the Harold Amos Medical Faculty Development Program of the Robert Wood Johnson Foundation. Bibbins-Domingo is an assistant professor of medicine, epidemiology and biostatistics at the University of California, San Francisco (UCSF) and co-director of the UCSF Center for Vulnerable Populations at San Francisco General Hospital.

Each year, heart failure—also known as congestive heart failure—affects about 5 million people in the United States and results in nearly 300,000 deaths, according to the National Heart, Lung, and Blood Institute, a part of the National Institutes of Health. Heart failure affects the heart's ability to pump blood to the lungs or oxygen-rich blood to the rest of the body and can cause debilitating fatigue, shortness of breath and, eventually, death.

Heart failure is traditionally perceived as a form of heart disease that mostly affects the elderly. The results of the study suggest, however, that heart failure can occur at much younger ages, particularly among African Americans.

Physicians and patients should be aware of the risk factors such as hypertension and obesity and work to prevent and treat these conditions, even among young adults.

"These findings illustrate the importance of identifying solutions to the social, economic, environmental and health care-related factors that contribute to persistent health disparities," said Robert Wood Johnson Foundation President and CEO Risa Lavizzo-Mourey, M.D., M.B.A. "The study results also highlight the urgency of reversing the childhood obesity epidemic. Today's unhealthy children are tomorrow's unhealthy adults. We know that obese children are being diagnosed with conditions previously considered adult illnesses, such as type 2 diabetes and hypertension, and they're at higher lifetime risk for a host of serious health problems, including heart disease, stroke, diabetes, asthma and some forms of cancer. The harsh reality is that, unless we act now to reverse the epidemic of childhood obesity, we may raise the first generation of Americans who will live sicker and die younger than their parents."

This study found that each 10 mmHg increase in diastolic blood pressure (the "bottom" number) among African Americans in their twenties doubles the likelihood of developing heart failure when they are in their forties. "It doesn't matter how young a patient is—hypertension needs to be diagnosed and treated," Bibbins-Domingo said. "The longer you have uncontrolled hypertension, the greater the chance that you will develop heart failure."

Young adults are often unaware that they have hypertension, and even when aware are often untreated or undertreated. Physicians may be reluctant to treat younger adults because cardiovascular complications are perceived to be rare and far in the future. "Our study suggests that the complications of high blood pressure can occur much earlier and should serve as a reminder that current guidelines recommend identification and treatment of blood pressure regardless of the age of the patient," said Bibbins-Domingo. ###

The CARDIA Study—for Coronary Artery Risk Development in Young Adults—was undertaken to describe the development of risk factors for heart disease in young adults. CARDIA—funded by the National Institutes of Health—began in 1985 with 5,115 African-American and Caucasian men and women ages 18 to 30, recruited from Birmingham, Ala., Chicago, Minneapolis and Oakland, Calif.

Resources on heart failure and hypertension are available on the National Heart, Lung, and Blood Institute's Web site:

• Diseases and Conditions Index: Heart Failure: www.nhlbi.nih.gov/health/
• Diseases and Conditions Index: High Blood Pressure: www.nhlbi.nih.gov/health/dci/.

The Harold Amos Medical Faculty Development Program (AMFDP) is celebrating 25 years of increasing diversity in medicine. The program was established to increase the number of faculty from historically disadvantaged backgrounds who can achieve senior rank in academic medicine and who will encourage and foster the development of succeeding classes of such physicians. AMFDP is an extension of the Minority Medical Faculty Development Program. The program name was changed to honor Harold Amos, Ph.D., who was the first African American to chair a department, now the Department of Microbiology and Medical Genetics at the Harvard Medical School. He remained engaged with the program until his death in 2003. For more information, visit www.amfdp.org.

The Robert Wood Johnson Foundation focuses on the pressing health and health care issues facing our country. As the nation's largest philanthropy devoted exclusively to improving the health and health care of all Americans, the Foundation works with a diverse group of organizations and individuals to identify solutions and achieve comprehensive, meaningful and timely change. For more than 35 years the Foundation has brought experience, commitment, and a rigorous, balanced approach to the problems that affect the health and health care of those it serves. When it comes to helping Americans lead healthier lives and get the care they need, the Foundation expects to make a difference in your lifetime. For more information, visit www.rwjf.org.

Contact: Jennifer Combs jcombs@iqsolutions.com 240-221-4256

Helping The Fresh Air Fund Help inner city children

The Fresh Air Fund is an independent, not-for-profit agency that provides free summer vacations to New York City children from low-income communities. Jenny Morgenthau is the Executive Director.

More than 1.7 million children have been helped since 1877 and nearly 10,000 New York City children now enjoy free Fresh Air Fund programs annually. In 2006, 5,000 children visited volunteer host families in suburbs and small town communities across 13 states from Virginia to Maine and Canada; 3,000 children attended five summer camps on a 2,300-acre (9 km2) site in Fishkill, New York; and the fund’s year-round camping program serves an additional 2,000 young people each year.

In 2006, 75% of the total income of the fund came from private individuals.

News Facts:

• Fresh Air Fund Host Families
• Fresh Air Fund Children
• The Fresh Air Fund Host a Child
• The Fresh Air Fund Donate

It has received multiple grants from the Carnegie Corporation, an organization that has supported more than 550 New York City arts and social service institutions since its inception in 2002, and which was made possible through a donation by New York City mayor Michael Bloomberg.

The Fresh Air Fund is an independent, not-for-profit agency that provides free summer vacations to New York City children from low-income communities. Jenny Morgenthau is the Executive Director.

More than 1.7 million children have been helped since 1877 and nearly 10,000 New York City children now enjoy free Fresh Air Fund programs annually. In 2006, 5,000 children visited volunteer host families in suburbs and small town communities across 13 states from Virginia to Maine and Canada; 3,000 children attended five summer camps on a 2,300-acre (9 km2) site in Fishkill, New York; and the fund’s year-round camping program serves an additional 2,000 young people each year.

In 2006, 75% of the total income of the fund came from private individuals.

It has received multiple grants from the Carnegie Corporation, an organization that has supported more than 550 New York City arts and social service institutions since its inception in 2002, and which was made possible through a donation by New York City mayor Michael Bloomberg.

The program

Boys and girls from six to eighteen years old, visit over 300 Fresh Air Friendly Towns each summer. Children on first-time visits are six to twelve years old and stay for two weeks. The program also has a special one-week option for New York City families who would like to host children on their summer vacations outside the city.

Over 65 percent of all children are invited to stay with host families again, year after year. Youngsters may continue with The fund through age eighteen, and many spend the entire summer in the country. Children and volunteer families often form bonds of friendship that last a lifetime.

Each placement with a host family costs the fund $629 (2006).

Selection of children

Children are selected to participate based on financial need. Children are from low-income communities, with the majority receiving some form of public assistance. Youngsters are registered by more than 90 social service and community organizations in all five boroughs of New York City.

Host families

Volunteer host families open their homes to inner-city children for two weeks or more in the summertime. Each Friendly Town community is supervised by a committee of volunteers. Committee members select host families after reviewing their applications, visiting them in their homes and checking their personal references.

There are no financial requirements for hosting a child. Most hosts simply want to share their homes with inner-city youngsters. Host families are not paid. The fund has a program for placing children who have special physical or emotional needs.

In 2004, twelve teens were invited to holiday in Switzerland by Credit Suisse First Boston.

The camping program

Around 3,000 New York City youngsters, aged eight to fifteen, attend five Fresh Air camps on a 2,300-acre (9 km2) site in the Sharpe Reservation near Fishkill, New York.

* Camp Hidden Valley is for boys and girls with and without special needs, eight to twelve years old
* Camp Tommy (named after board member/designer Tommy Hilfiger for his dedication and support of Fresh Air children) is for boys aged twelve to fifteen
* Camp Anita Bliss Coler is for girls aged nine to twelve
* Camp Hayden-Marks Memorial is for boys aged nine to twelve
* Camp Mariah is a coed camp for youngsters aged twelve to fourteen (career campers)

Additionally, 2,000 young people participate in year-round weekend camping experiences.

Special features shared by all camps include a planetarium, model farm, wilderness trail and ropes course. Since 1999, many of the campers have received free guitar lessons on Spirit guitars donated by the Gibson Foundation.

Each placement in a camp costs the fund $1,234 but gives much happiness to many children.

Seven youngsters each year spend the summer at Camp Pioneer on the Sharpe Reservation, training to be counselors.

Career Awareness Program

The innovative Career Awareness Program is designed to help New York City youngsters understand the relationship between school and work and how to make choices that will determine their futures. Youngsters aged twelve to fourteen participate in job shadowing that offers a close-up view of business, and a career fair. The year-round program includes weekend camping trips and an intensive three-and-a-half week summer session at the Career Awareness Camp – Camp Mariah. The career camp is named in honor of Board member/singer Mariah Carey for her dedication, support and commitment to Fresh Air youngsters. Career awareness graduates continue to receive support through the PreOccupations Club and benefit from the guidance of volunteer mentors.

History of The Fund

In 1877, the Reverend Willard Parsons, minister of a small rural parish in Sherman, Pennsylvania, asked members of his congregation to provide country vacations as volunteer host families for children from New York City tenements. This was the beginning of the tradition. By 1884, Reverend Parsons was writing about the fund for the New York Tribune, and the number of children served grew. In 2006, close to 10,000 New York City children experienced the joys of summertime in Friendly Towns and at five Fund camps in upstate New York. When the New York Herald Tribune went out of business in 1966, the New York Times took over sponsorship.

New York City Volunteers

The fund has an active group of New York City volunteers. Metropolitan area volunteers help the fund reach out to New York City parents and children, support Camping, Career Awareness and Friendly Town programs and seek in-kind donations.

Quicklinks: News Facts | Host a Child | Donate | Banners & Buttons | About Fresh Air Fund | Embeddable Videos | Contacts | Multimedia Elements | Tags

This article is licensed under the GNU Free Documentation License. It uses material from the Wikipedia article, Fresh Air Fund

African-Americans lose weight in 12-week, church-based program

Nearly half of overweight and obese African Americans who completed a 12-week, faith-based program lost 5 percent or more of their body weight and most kept it off for at least six months, researchers reported at the American Heart Association's 49th Annual Conference on Cardiovascular Disease Epidemiology and Prevention.

The pilot program was conducted by trained lay leaders at Gospel Water Branch Baptist Church near Augusta, Ga. Researchers were able to collect full data on 35 (nearly 88 percent) of the 40 obese men and women who completed the initial 12 weekly sessions of the Fit Body and Soul (FBS) program. The participants were average age 46 and had an average body mass index (BMI) of 36.

After 12 weeks, almost 46 percent (16/35) of participants had lost 5 percent or more of their starting weight. About 26 percent (nine) lost 7 percent or more.

The program included six monthly "booster" sessions for six months after the 12 weekly behavioral health intervention sessions.

At the study's end, 11 of the 16 subjects (nearly 69 percent) with initial weight-loss success had kept the weight off through the entire nine months.

"This kind of result is remarkable in a faith-based program run by lay leaders when so many other community-based programs have failed," said Sunita Dodani, M.D., Ph.D., M.Sc., FAHA, principal investigator, director, Center for Outcome Research and Education (CORE) and associate professor, Department of Internal Medicine, School of Medicine, Kansas University Medical Center in Kansas City, Kansas.

While similar programs have concentrated on diet and lifestyle changes for weight reduction alone, the FBS program focuses on weight loss and behavioral changes to prevent future diabetes in high-risk church members and relies on lay leaders to administer the program.

The church pastor, the Rev. Robert Ramsey, chose four lay leaders who had two days of training to present the 12 health modules of Fit Body and Soul, a faith-based diabetes prevention program. The lay leaders either had a medical background, such as being a registered nurse, or had been active in the church's health ministry.

The modules were adapted from the National Institutes of Health (NIH)-sponsored Diabetes Prevention Program. The NIH recently approved a $3.7 million grant for five years to scale up the FBS study in a controlled comparison of 20 churches in the Midwest. Ten congregations will run the FBS program and 10 controls will conduct a different community-based health promotion program developed from the Centers for Disease Control Community Guide.

Attrition was fairly high in the small pilot study, so the results need confirmation in the larger, controlled investigation, Dodani said. Of the 35 people who finished the 12 weekly sessions, 21 completed the nine-month program.

Participants in the FBS who lost a modest amount of body weight by changing their diet and exercising may be less likely to develop diabetes.

Diabetes is a major risk factor for heart disease. Being overweight (BMI of 26.9) or obese (BMI of 30.9) increases the risk of diabetes.

"We developed this study because African Americans are known to be at increased risk of both diabetes and obesity and also because studies have shown that, compared to whites, African Americans are less likely to benefit from general community weight-loss programs," Dodani said.

While the feasibility study only tracked weight loss and was limited to men and women who were overweight or obese, the scaled up investigation will be open to people of normal weight who have pre-diabetic elevations in their blood sugar and people with a strong family history of diabetes, Dodani said. ###

Co-authors are: Andrea Kriska, Ph.D. and Venkat K. Narayan, M.D., Ph.D. Individual author disclosures are available on the abstract.

The study was funded by the Association of Professional Teachers and Research of Washington, D.C., and the College of Preventive Medicine at the Medical College of Georgia.

Editor's Note: Search Your Heart is a nationally-driven faith- and community-based educational program designed to reach diverse audiences at higher risk for heart disease with important health messages. The program focuses on three areas: heart disease, nutrition and physical activity. For more information or to bring the Search Your Heart program to your church or community visit: americanheart.org/searchyourheart.

Statements and conclusions of study authors that are presented at American Heart Association scientific meetings are solely those of the study authors and do not necessarily reflect association policy or position. The association makes no representation or warranty as to their accuracy or reliability. The association receives funding primarily from individuals; foundations and corporations (including pharmaceutical, device manufacturers and other companies) also make donations and fund specific association programs and events. The association has strict policies to prevent these relationships from influencing the science content. Revenues from pharmaceutical and device corporations are available at www.americanheart.org/corporatefunding.

Contact: Karen Astle karen.astle@heart.org 214-706-1392 American Heart Association

Black young adults hospitalized for stroke at much higher rate than whites, Hispanics

Florida study suggests urgent need to reduce major stroke risk factors among African-Americans

Tampa FL (March 13, 2009) -- In Florida, black young adults are hospitalized for stroke at a rate three times higher than their white and Hispanic peers, a new study by University of South Florida researchers reports. The study was presented today at the American Heart Association's Council on Epidemiology and Prevention Annual Conference and appears in the online version of the international journal Neuroepidemiology.

Disparities in stroke outcomes between black and white patients have been widely reported for years. While overall death rates for stroke are down, blacks bear a disproportionate burden of disease, disability and death from strokes, said lead author Elizabeth Barnett Pathak, PhD, associate professor of epidemiology at the USF College of Public Health.

Elizabeth Barnett Pathak, Ph.D. Office: 2107, MDC 56 ebarnett@health.usf.edu Phone: (813)-974-2235 Fax: (813)-974-4719

"Our study shows this black-white disparity hasn't improved. In fact, it's clear that the gap emerges even at relatively young ages – among adults hospitalized for strokes in their 20s and 30s – and widens with increasing age," Dr. Pathak said. "It points toward an urgent need for primary prevention of hypertension, obesity, and other stroke risk factors among African Americans to eliminate disparities in stroke." While most strokes occur among the elderly, stroke in young adults can lead to chronic illness and disability that places a terrible burden on the victims and their families, said Michael Sloan, MD, professor of neurology and director of the USF Stroke Program at Tampa General Hospital. "If the stroke is severe it can be very debilitating, impacting the ability of young people to work and raise their families."

And even in young adults strokes can be fatal. The Florida study found 8 to 10 percent of stroke patients died before discharge from the hospital.

The USF researchers examined more than 16,000 stroke cases of young adults hospitalized for stroke in Florida from 2001 through 2006. The study included men and women, ages 25 to 49, from the three largest ethnic groups in Florida: whites, blacks and Hispanics. Among the findings:

* The age-adjusted stroke hospitalization rate for blacks was three times higher than for whites or Hispanics. Stroke hospitalization rates for Hispanics were similar to those for whites.

* The rates at which hospitalized stroke patients died were 15 percent higher for blacks than whites, but this disparity was explained by a greater prevalence of stroke risk factors and complicating illnesses such as diabetes, coronary artery disease and heart failure.

* In contrast, Hispanic stroke patients were 27 percent less likely to die in the hospital than whites after taking risk factors and other illnesses into account. More studies are needed to determine whether Hispanic ethnicity actually confers any sort of protective advantage, the researchers said.

* Black stroke patients were more likely than whites and Hispanics to have been diagnosed with high blood pressure, morbid obesity or drug abuse. White stroke patients were more likely to have been diagnosed with high cholesterol, alcohol abuse or cigarette smoking.

* The majority of black stroke patients (56 percent) where women, while the majority of Hispanic and white patients were men.

* Hispanics were more likely than blacks and whites to suffer a hemorrhagic stroke, triggered by the rupture of a blood vessel in the brain. As with the elderly, the most common type of stroke in younger adults, known as ischemic stroke, was caused by the obstruction of blood flow to the brain.

While the USF study did not find an increase (or decrease) in young adults hospitalized for stroke in Florida, Dr. Sloan is concerned that tough economic times may lead to rise in strokes and other cardiovascular incidents. "When people stop taking their blood pressure pills and other medications because they can no longer afford it, they have strokes and heart attacks," he said. ###

USF Health is dedicated to creating a model of health care based on understanding the full spectrum of health. It includes the University of South Florida's colleges of medicine, nursing, and public health; the schools of biomedical sciences as well as physical therapy & rehabilitation sciences; and the USF Physicians Group. With more than $360 million in research grants and contracts last year, USF is one of the nation's top 63 public research universities and one of 39 community-engaged, four-year public universities designated by the Carnegie Foundation for the Advancement of Teaching. For more information, visit www.health.usf.edu

Contact: Anne DeLotto Baier abaier@health.usf.edu 813-974-3300 University of South Florida Health

Depression treatment, increased physical activity in African-Americans may reduce heart disease

Identifying and treating depression, including increasing physical activity, may improve quality of life and reduce cardiovascular disease and death in African Americans, according to reports presented at the American Heart Association's 2009 Conference on Nutrition, Physical Activity and Metabolism.

In one study, researchers in the Jackson Heart Study (JHS) found high depressive symptoms were prevalent and significantly associated with low physical activity in African Americans. JHS is a population-based, longitudinal study and the largest single-site, prospective, epidemiologic investigation of cardiovascular disease among African Americans ever undertaken.

High depressive symptoms were identified by a standard depression scale and/or characterized by taking antidepressants.

Physical activity scores were in the lowest quartile of the JHS Physical Activity Cohort (JPAC) survey for total physical activity, representing the sum of four index scores: active living, work (for those who were employed or did volunteer work), sport and home life.

Of the 3,092 adults (average age 54; 65 percent women; 12 percent smokers), 17 percent had high depressive symptoms. The prevalence of high depressive symptoms was significantly higher among:

* Women (20 percent compared with 10 percent in men);
* Smokers (28 percent compared with 15 percent in nonsmokers); and
* Those with low total physical activity (25 percent vs. 14 percent in higher physical activity).

Low physical activity was associated with high depressive symptoms in multivariable logistic regression analysis after controlling for age, sex, body mass index, education, income, and smoking.

"It is important to identify individuals with low levels of physical activity as well as those with depression," said Patricia Dubbert, Ph.D., lead author of the study and a psychologist with the Veterans Affairs Medical Center in Jackson, Miss. "Both indicate an individual is at greater risk for adverse health outcomes. We have effective interventions to employ when either or both are identified."

"Behavioral patterns in depressed patients are likely to further negatively impact their cardiovascular disease status," said Ermeg Akylbekova, M.S., a biostatistician for the Jackson Heart Study. "For example, depressed patients are less likely to exercise, tend to eat in a less healthy manner, and are more likely to use tobacco and alcohol. They are also less likely to take medications as prescribed or closely follow their treatment regimen, which may be a serious impediment to treating their cardiovascular condition.

"It is advisable for healthcare providers treating cardiovascular disease patients, whether cardiologists or primary care, to screen all their patients for depression. If concerns arise, a mental health professional should be consulted. Patients have to be monitored for both conditions."

A recent American Heart Association science advisory also recommends screening coronary heart disease patients for depression. ###

Other co-authors are: Thomas Payne, Ph.D.; Sharon Wyatt, Ph.D.; Thomas Mosley, Ph.D.; Mario Sims, Ph.D.; and Herman Taylor, M.D., M.P.H.

(Note: Actual presentation time is 6 p.m. ET, Tuesday, March 10, 2009) NR09-1034 (NPAM 09/ Akylbekova & Dubbert)

Statements and conclusions of study authors that are presented at American Heart Association scientific meetings are solely those of the study authors and do not necessarily reflect association policy or position.

The association makes no representation or warranty as to their accuracy or reliability. The association receives funding primarily from individuals; foundations and corporations (including pharmaceutical, device manufacturers and other companies) also make donations and fund specific association programs and events. The association has strict policies to prevent these relationships from influencing the science content. Revenues from pharmaceutical and device corporations are available at www.americanheart.org/corporatefunding.

Contact: Karen Astle karen.astle@heart.org 214-706-1392 American Heart Association

High blood pressure linked to earlier death among African-American breast cancer patients

A study by researchers at the University of California, San Francisco has shown that hypertension, or high blood pressure, is a predictor of mortality among breast cancer patients, especially those who are African-American, and that hypertension accounts for approximately 30 percent of the survival disparity between African-American and white breast cancer patients.

According to the study's lead author, UCSF epidemiologist Dejana Braithwaite, PhD, of the UCSF Helen Diller Family Comprehensive Cancer Center, who also is an affiliate with the UCSF National Center of Excellence in Women's Health, this is the first study to link cancer mortality with hypertension, and specifically the first to show that hypertension is a predictor of mortality among African-American breast cancer patients.

School of Medicine Fellow Dejana Braithwaite, PhD, became the 2007 recipient of the American Society of Preventive Oncology (ASPO) and the Cancer Research and Prevention Foundation (CRPF) Fellowship, and the New Investigator Award for the 31st Annual ASPO Meeting.

"White women are more likely to get breast cancer, but African-American women are more likely to die from it," said Braithwaite. "We were trying to shed light on the factors that contribute to disparities in survival between the two groups." The study included 416 African-American and 838 white women diagnosed with breast cancer between 1973 and 1986, following them through 1999. All of the women in the study were patients at Kaiser Permanente in Northern California. The patients were all residents of the San Francisco Bay Area and had a known stage of disease and course of cancer treatment. Kaiser Permanente members are representative of the general population for many ethnic, demographic and socioeconomic categories, except for the very high and very low ends of the economic spectrum, according to the study.

The researchers used data from patient records, which they considered more reliable than data self-reported by patients. Kaiser Permanente's division of research has long collaborated with UCSF on breast cancer research.

The study found that African-American breast cancer patients had a higher overall crude mortality, or death from all causes, than whites during the study period: 39.7 percent versus 33.3 percent respectively over a mean follow-up of nine years.

When age, race, tumor characteristics, and breast cancer treatment were controlled, hypertension accounted for 30 percent of the racial disparity in mortality, study findings showed.

"High blood pressure led to poorer outcomes for African-American patients than for their white counterparts," said Braithwaite. "Even if you statistically control for tumor characteristics and breast cancer treatments—chemotherapy, surgery, radiation, and hormone treatment—the adverse effect of hypertension in African-American women means a greater likelihood of death."

Hypertension is not part of the Charlson Comorbidity Index, a widely-used generic tool that provides survival estimates for patients using a range of co-existing conditions or so-called comorbidities. If the results of this study are validated in more contemporary patient populations, the research suggests that hypertension should be included in this Index because of its high predictive value for outcomes, said Braithwaite.

According to study senior author Laura Esserman, MD, director, Carol Franc Buck Breast Care Center; co-leader, Breast Oncology Program, UCSF Helen Diller Family Comprehensive Cancer Center; and part of the UCSF National Center of Excellence in Women's Health, comorbidities have a huge influence on life expectancy and therefore influence treatment decisions for breast cancer. "We started out by trying to determine which comorbidities should be assessed for all patients routinely, and discovered that hypertension in African-Americans is associated with higher mortality from breast cancer," she said.

In addition, this information may provide clues to the cause of higher mortality in African American women with breast cancer, Esserman said.

"The message is that hypertension is a big deal. It affects African-Americans more than other ethnic groups, and it affects their survival overall. Better management of hypertension has potential to improve patient outcomes, particularly among African-American breast cancer patients," Braithwaite concluded. ###

The results are published in the March 2009 print edition of the International Journal of Cancer and appear online at www3.interscience.wiley.com/fulltext/.

Co-authors of the study with Braithwaite and Esserman are Jeff Belkora, PhD; Dan Moore, PhD, and Robert Hiatt, MD, PhD, all of UCSF; C. Martin Tammemagi, PhD, Brock University, Ontario, Canada; Elissa Ozanne, PhD, Massachusetts General Hospital, Boston; Dee West, PhD, Northern California Cancer Center, Fremont, Calif.; William Satariano, PhD, UC-Berkeley; and Michael Liebman, PhD, Windber Research Institute, Windber, Penn.

The study was funded by the Windber Research Institute; Kaiser Permanente's Community Benefit Program and the Surveillance, Epidemiology and End Results (SEER) Program of the National Cancer Institute; and U.S. Department of Defense, Center of Excellence in Breast Cancer Care, principal investigator Laura Esserman.

UCSF is a leading university dedicated to promoting health worldwide through advanced biomedical research, graduate-level education in the life sciences and health professions, and excellence in patient care. For further information, visit www.ucsf.edu.

The Kaiser Permanente division of research conducts, publishes, and disseminates epidemiologic and health services research to improve the health and medical care of Kaiser Permanente members and the society at large. It seeks to understand the determinants of illness and well-being and to improve the quality and cost-effectiveness of health care. Currently, DOR's 400-plus staff is working on more than 250 epidemiological and health services research projects.

Contact: Kirsten Michener kmichener@pubaff.ucsf.edu 415-476-2557 University of California - San Francisco

Xenophobia, for men only

Very few people fear dandelions. Or even dangerous things - like Hummers. We may object to outsized automobiles on principle, but the mere sight of them doesn't make us tremble and sweat and run away. On the other hand, even toddlers show an automatic and powerful fear of snakes, including harmless ones.

That's because of eons of evolution among both dangerous and benign things. There is probably no snake phobia programmed into our genetic code, but we do have an evolved mental readiness to be fearful of certain things in our world. Does this cognitive readiness influence our relationships with other people? Psychologists have been studying this question, and the preliminary answer is yes. In a new study, Michigan State psychologist Carlos David Navarrete used mild shocks to make black and white men and women fearful other black and white men and women. That is, white men were conditioned to be fearful of black men and white men as well as black women and white women, and so forth with the others. Then Navarrete observed to see if these fears lasted or not.

Carlos David Navarrete, received his Ph.D. in 2004 in Biological Anthropology from UCLA. He held postdoctoral positions in psychology at UCLA and at Harvard and is currently an assistant professor in social psychology at Michigan State University. His research on the psychology of prejudice integrates theory and methods from across several disciplines, including social psychology, economics, and evolutionary biology.

The findings, reported in Psychological Science, a journal of the Association for Psychological Science, were intriguing and unexpected. It's known that people are more fearful of "out-groups" - that is, people who are different from them, and this fear of "the other" has been clearly demonstrated with race. But Navarrete found that volunteers' most persistent fears were reserved for men - that is, male members of the out-group. So white men and women feared black men, and black men and women feared white men; all the other lab-induced fears, including any conditioned fear of women diminished. Navarrete ran a number of other tests to clarify the results. He tested for blatant racism (Example: "Generally, blacks are not as smart as whites") and for more subtle, unconscious racism. He also gathered histories of the volunteers' interracial contact- friendships, colleagues, romantic involvements. It was only these histories that mattered: Those with close relationships outside their own race had less persistent fears than did those with little interracial experience.

Why would gender influence these ingrained fears as much as race? It may be that men were more often the aggressors over evolutionary time, so that male faces became a potent cue for danger. So xenophobia is not an equal-opportunity emotion. ###

For more information about this study, please contact: Carlos David Navarrete (cdn@msu.edu) Wray Herbert discusses this study in his blog, We're Only Human... (www.psychologicalscience.org/onlyhuman/)

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

Building trust, increasing awareness among minorities

CAREFREE, A.Z. - As science continues to show an increasing lack of access and poor outcomes among minority patients with cancer, the American Association for Cancer Research is working toward understanding the fundamental issues of trust and awareness among these populations. At the Conference on the Science of Cancer Health Disparities in Carefree, Arizona, the AACR will host a teleconference that highlights important strides in this area.

"As we continue to move forward with our scientific knowledge and medical treatments, we also need to understand if the potential benefits of what we are learning are being communicated effectively to those most at risk," said panel moderator Cheryl Willman, M.D., director and CEO of the University of New Mexico Cancer Research & Treatment Center and co-chair of the conference. "At best, the results are mixed."

Cheryl L. Willman, M.D. Full Member, Hematologic Malignancies Research Program. Director & CEO UNM Cancer Center. Professor of Pathology and Medicine, The Maurice and Marguerite Liberman Chair in Cancer Research Practice Location: Pathology - BMSB Rm 337. Education: Fellowship: UNM School of Medicine (Jul 1985), Specialty in Pathology Internship AND Residency Combined: UNM School of Medicine (Jul 1984). Specialty in Anatomical & Clinical Pathology, Medical School: Mayo Medical School (Jul 1981). Board Certifications: Am Bd Pathology (Sub: Anatomical) : (Jan 1986). Specialties: Pathology

#B76. Examining medical mistrust and breast cancer screening behaviors among African-American, Latina and Arab-American Women At Michigan State University, panel member Karen Patricia Williams, Ph.D., an assistant professor, found that higher levels of medical mistrust among minority women led to late screening for breast cancer. "African-American women had the highest levels of mistrust, but most of the women studied in the other groups were also clustered around strongly agreeing or agreeing with the statement that caution was recommended in dealing with health care organizations," Williams said. Nearly half (49 percent) of women agreed with the statement, "patients have sometimes been deceived or misled by health care organizations." Thirty-nine percent of African-American women did not trust health care organizations to keep their information private, a finding echoed by 15 percent of Latina women and 9 percent of Arab-American women. This lack of trust led to a lower screening rate. Among the women who had never received a clinical breast exam, 44 percent agreed that "health care organizations have sometimes done harmful experiments without our knowledge." Among the women who had not received a clinical breast exam in the past 12 months, 64 percent said they doubted the ability of their health care provider.

Williams said that the findings in Arab and Latina women point out the flaw in blaming all mistrust on the infamous Tuskegee Study of Untreated Syphilis in the Negro Male.

"Intellectuals in medicine like to link all issues of mistrust to that study because it lets us off the hook for anything that might be happening today," said Williams. "This study shows that even groups without that history are showing a level of mistrust, so the problems must be more systemic than that."

#PR-6. Recruiting diverse patients to therapeutic trials: a comparison of three clinical settings

At the University of California San Francisco, Daniel Dohan, Ph.D., associate professor of Health Policy and Social Medicine, is trying to determine the most effective way to recruit minority patients into clinical trials.

The NIH Revitalization Act of 1993 mandates inclusion of minorities in clinical research, but actual recruitment has been problematic.

"Previous research has established that minorities often feel discriminated against, but we wanted to look at this issue from the clinicians' perspective," said Dohan. "What we found is that the incentives that are in place for clinicians are not effective."

Dohan and colleagues studied 10 oncology clinics in three different health care delivery settings: academic medical centers, community-based private practices and public safety-net clinics.

Minority recruitment was not well supported in any setting. In the academic and private practice setting, the culture supported minority recruitment, but there was no real incentive to recruit minorities. In the public setting, providers were motivated by a sense of justice to enroll, but the organizational structure was not available.

"In different clinics, different issues matter, so there is no one size fits all solution," said Dohan. "For example, in a public clinic, they may have translators, but not translators that are equipped to cross cultural barriers in clinical trials."

In private practice and academic settings, clinicians are often rewarded for recruiting patients into clinical trials, but they are not rewarded more for recruiting harder to reach minority patients.

"In a private practice where you have to watch the bottom line, the likelihood is that most of the recruitment is going to pharmaceutical trials, which tend to provide more incentive and do not necessarily require minority recruitment," said Dohan.

#B77. Cancer screening in older South Asian immigrants in United States

New data among South Asian immigrants confirms that cancer screening rates are low largely due a lack of knowledge about available services and the benefits of screening.

Abhijit S. Prabhughate, a doctoral candidate at the Jane Addams College of Social Work at UIC in Chicago, said more research is needed to understand the cultural sensitivities in this population.

"South Asian-Americans are an understudied group. More than 40 percent of the South Asian immigrants in our study did not have health insurance and little is known about their risk," said Prabhughate.

Of 331 total surveyed people, 84 percent were born in India and 14 percent were born in Pakistan. Although 57 percent of them had lived in the United States for a decade or more, only 65 percent had a regular family doctor.

These immigrants were likely to not be screened for breast cancer for the following reasons: not wanting to know if one had cancer, family not wanting the individual to get tested, embarrassment, fear of losing job, language difficulties, and not knowing where to get tested.

They were more likely to be screened if the family or friends encouraged it, or if their insurance paid for it.

#B75. HPV knowledge, attitudes and cultural beliefs among Hispanic men and women living on the Texas-Mexico border

A new study on knowledge, attitudes and cultural responses to the human papillomavirus among Hispanics found that both men and women had low levels of knowledge, significant misunderstandings, and cultural beliefs about HPV that may need to be addressed to decrease the risk of cervical cancer among this population.

Maria E. Fernandez, Ph.D., assistant professor of Health Promotion and Behavioral Sciences at the University of Texas Health Science Center at Houston, School of Public Health, conducted five focus groups in Brownsville, Texas, that included 30 Hispanic women and 11 Hispanic men. Women had a mean age of 41.3 years and men had a mean age of 38.8 years.

Researchers found that participants had little understanding about HPV and its role in cancer. Women believed that a diagnosis of HPV was a diagnosis of cancer and had fatalistic beliefs about the outcome of cancer. Women also thought that they would be reluctant to disclose their HPV positive status to their partners because they believed men would accuse them of infidelity. Men, too, initially attributed their partners' diagnosis of HPV to infidelity. Nevertheless, after a brief explanation about HPV etiology and transmission, men and women began to understand the ambiguity related to an HPV infection and believed that partners would generally support women as they sought health care for the infection."The results of this study suggest that understanding Hispanics' cultural norms and values concerning disease, sexuality and gender is essential to the design and implementation of successful interventions for the prevention and treatment of HPV and cervical cancer," said Fernandez. ###

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.

Teleconference Dial In: (888) 282-7404

Contact: Jeremy Moore Jeremy.moore@aacr.org 267-646-0557 American Association for Cancer Research

All prejudice isn't created equal; whites distribute it unequally to minorities

The Declaration of Independence may proclaim that all men are created equal, but American whites tend to distribute their prejudice unequally toward certain members of minority groups, according to new research.

A series of six studies conducted by University of Washington and Michigan State University psychologists shows that whites react more negatively to racial minority individuals who strongly identify with their racial group than to racial minority individuals who weakly identify with their group.

The research, published in the current issue of the Journal of Personality and Social Psychology, provides an explanation for why some Blacks report personally experiencing more prejudice than others.

Cheryl R. Kaiser, Department of Psychology. Box 351525. University of Washington, Seattle, Washington 98195. U.S.A. Home Page Phone: (206) 616-1435.

"Research has shown that the more minorities identify with their group, the more prejudice they report experiencing," said Kaiser. "Most research has explained this finding by focusing on factors within minorities that make some individuals more susceptible to perceiving prejudice than others. Our studies provide an alternative explanation by showing that whites react more negatively toward strongly identified minorities than weakly identified ones." The researchers believe strongly identified minorities are not paranoid in claiming they experience increased levels of prejudice and weakly identified minorities are not being self-deceptive when they report experiencing low levels of prejudice,

said Cheryl Kaiser, a UW assistant psychology professor and lead author of the paper. Instead, they just may simply be reporting on reality as they experience it.

"Take a situation where a person is ambiguously rejected for a new job," she said. "A person with a strong minority identification might wonder if the rejection was due to prejudice while one with a weak minority identification might not. If you experience more prejudice you expect more prejudice. These things work in tandem and feed each other."

Kaiser and her colleague recruited nearly 400 college students for the six studies that measured whites' attitudes toward Blacks and Latinos. They also were surveyed on their general attitudes about Blacks or Latinos, depending on the study. In the studies, minorities were either described as being strongly identified (where their group was very important and a central aspect of their self) or weakly identified (where their group was less important and not at the core of their self).

She said individuals typically want to be around others who share their values and exclude people who don't share those values or world views. The research indicated that whites perceived strongly identified minorities as less likely to share similar worldviews with them relative to weakly identified minorities.

"We are not arguing that minorities should not identify with their group," said Kaiser. "Such identification can be important and provides meaning, self worth and identity.

"Some research about prejudice has tended to lump members of minorities into homogenous groups. But there is a lot of heterogeneity. People differ in looks, language ability, attitudes and many other ways, but we tend not to pay attention to these factors. That's why it is important to identify those subsets in groups, why people react to them and what are the active ingredients of prejudice. Whites need to understand that they distribute prejudice unevenly and target those who strongly self-identify as being Black." ###

Jennifer Pratt-Hyatt, a doctoral student at Michigan State is the co-author of the paper. The research was funded by the National Science Foundation and the UW's Royalty Research Fund.

For more information, contact Kaiser at 206-616-1435 or ckaiser@u.washington.edu

Contact: Joel Schwarz joels@u.washington.edu 206-543-2580 University of Washington

The 2 worlds of kids' morals

Study investigates race, gender and morality among children in the real and virtual worlds

Children's moral behavior and attitudes in the real world largely carry over to the virtual world of computers, the Internet, video games and cell phones. Interestingly, there are marked gender and race differences in the way children rate morally questionable virtual behaviors, according to Professor Linda Jackson and her team from Michigan State University in the US. Their research (1) is the first systematic investigation of the effects of gender and race on children's beliefs about moral behavior, both in the virtual world and the real world, and the relationship between the two. The study was published online in Springer's journal, Sex Roles.

Linda Jackson, Department of Psychology, Michigan State University, East Lansing, Michigan 48824. U.S.A.

Jackson and her team asked 515 12-year-old children (one-third African American, two-thirds Caucasian American) to fill in a written questionnaire looking at their moral behaviors and attitudes in the real world, and their view of morally questionable behavior in the virtual world. Measures of moral behavior in the real world included whether or not children had lied to parents and/or teachers, whether they had ever cheated, and whether they had ever bullied someone. Examples of morally questionable behavior in the virtual world were sending emails with threats, using sexually explicit or violent language in chat rooms and/or in text messages, hacking computers, and violence in video games.

Overall, African American children were more caring and more flexible about rules when personal goals were at stake than Caucasian American children. More specifically, Caucasian American girls and African American boys and girls viewed morality in the real world from the perspective of the individual's well-being. In contrast, Caucasian American boys' morality in the real world was more rule-based.

When it came to rating virtual behaviors, African American children were more likely than Caucasian American children to find acceptable virtual behaviors that result in real-world harm, for example emailing friends answers in advance of tests or sending text messages during class. The African American children were also more likely to find viewing online pornography acceptable.

For all groups, morality in the real world was related to morality in the virtual world. In other words, the more important good moral character in the real world was, the less acceptable morally questionable virtual behaviors were. There were however some race differences. African American children found some virtual behaviors that might advance individual goals in the real world more acceptable than did Caucasian American children. In contrast, the morality of Caucasian American boys, and to a lesser extent girls, was more rule-based in the virtual world.

The frequency of exposure to information technology also had an effect. The more children used the Internet, the more they found invasion of privacy online, videogame violence and online pornography acceptable.

The authors conclude that: "Educational interventions that are culturally sensitive need to be developed to assure that all children, regardless of race or gender, understand that certain virtual behaviors are unacceptable and in fact may be psychologically harmful, such as video game violence, or physically dangerous, like contacting strangers online." ###

Reference
1. Jackson LA et al (2009). Gender, race and morality in the virtual world and its relationship to morality in the real world. Sex Roles DOI 10.1007/s11199-009-9589-5

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

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, 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 nwoodwri@jhsph.edu. WEB: 410-614-6029 Johns Hopkins University Bloomberg School of Public Health