Why do blacks fare worse with cancer? Access, economics not the whole story

An analysis of clinical trial data from a U-M based group implicates biological factors behind worse outcomes for African-Americans with breast, ovarian, or prostate cancer.

ANN ARBOR, Mich. - An analysis of almost 20,000 patient records from the Southwest Oncology Group’s database of clinical trials finds, for the first time, that African-American breast, ovarian, and prostate cancer patients tend to die earlier than patients of other races even when they get identical medical treatment and other confounding socioeconomic factors are controlled for. The finding points to biological or host genetic factors as the potential source of the survival gap.

Based at U-M, the Southwest Oncology Group conducts cancer clinical trials through a network of more than 500 affiliated institutions.

“When you look at the dialogue about the issue of race and cancer survival that’s gone on over the years,” says the paper’s lead author, Kathy Albain, M.D., a breast and lung cancer specialist at Loyola University’s Cardinal Bernardin Cancer Center,

“it always seems to come down to general conclusions that African-Americans may in part have poorer access to quality treatment, may be diagnosed in later stages, and may not have the same standard of care delivered as Caucasian patients, leading to a disparity in survival.”

The study, published in the Journal of the National Cancer Institute (JNCI), found that when treatment was uniform and differences in tumor prognostic factors, demographics, and socioeconomic status were controlled, there was in fact no statistically significant difference in survival based on race for a number of other cancers — lung, colon, lymphoma, leukemia, and multiple myeloma.

“The good news is that for most common cancers,” Albain says, “if you get good treatment, your survival is the same regardless of race. But this is not the case for breast, ovarian, and prostate cancers.”

Even with good treatment by the same doctors, African-American patients with one of these three cancers faced a significantly higher risk of death than did other patients, ranging from a 21% higher risk for those with prostate cancer to a 61% higher risk for ovarian cancer patients.

The elimination of treatment and socioeconomic factors as the cause of this higher mortality “implicates biology,” says study co-author Dawn L. Hershman, M.D., of the Columbia University College of Physicians and Surgeons.

“There may be differences in genetic factors by race that alter the metabolism of chemotherapy drugs or that make cancers more resistant or more aggressive,” she adds.

Hershman published a smaller study last month that found that, at least with breast cancer, disparities in survival based on race persist even after adjusting for differences in treatment. That study, published in the Journal of Clinical Oncology, analyzed data on 634 breast cancer patients.

“Our study of multiple cancers is distinguished from others that have looked at race-based disparities by its size and by the source of its data,” says Joseph Unger of the Southwest Oncology Group’s Statistical Center, who was statistician and co-author on the new JNCI study.

The study analyzed records from 35 clinical trials — going back as far as 1974 — that had been conducted by the Southwest Oncology Group, an NCI-sponsored cooperative group headquartered at the University of Michigan. Using data from clinical trials, which are already controlled for a range of potentially confounding factors such as differences in diagnosis, treatment, and follow-up, helps throw the remaining factors into sharper relief, according to Frank L. Meyskens, Jr., M.D.

“It’s because of the similar way that people are treated on clinical trials that these differences are even detectable,” he says. Meyskens is associate chair for Cancer Control and Prevention for the Southwest Oncology Group and director of the University of California-Irvine’s Chao Family Comprehensive Cancer Center.

The urgency of addressing the reasons for racial disparities in outcomes — both sociological and biological — is amplified by another recent study in the Journal of Clinical Oncology. It predicts the cancer incidence among minorities will nearly double in the coming decades, increasing 99% by 2030 compared to an expected 31% increase among whites.

And the American Society of Clinical Oncology, the field’s premier professional organization, recently issued a “Disparities in Cancer Care” policy statement that recommends a set of strategies for improving outcomes for minority cancer patients.

“The elimination of socioeconomic and healthcare access disparities must be a priority in the United States,” says Lisa Newman, M.D., director of the Breast Care Center at the University of Michigan Comprehensive Cancer Center. “However, Dr. Albain’s landmark study demonstrates that further investigation of race- or ethnicity-associated differences in primary tumor biology is also important.”

Additional Authors
John Crowley, Ph.D., of the Southwest Oncology Group Statistical Center and Charles A. Coltman, M.D., of the University of Texas Health Science Center

Funding
National Cancer Institute

About the Southwest Oncology Group
Headquartered at the University of Michigan, the Southwest Oncology Group is one of the largest cancer clinical trials cooperative groups in the United States. Funded primarily by the National Cancer Institute, the group designs and conducts clinical trials to advance the science of cancer prevention and treatment and to improve the quality of life for cancer survivors. The almost 5,000 physician-researchers in the Group’s network practice at more than 500 institutions, including 19 of the National Cancer Institute-designated cancer centers. The Group is headquartered at the University of Michigan in Ann Arbor, Mich. (734-998-7140). The Group has an operations office in San Antonio, Texas and a statistical center in Seattle, Wash.

Contact: Frank DeSanto fdesanto@umich.edu 734-998-0114 University of Michigan Health System

Genetic factors implicated in survival gap for breast, ovarian or prostate cancer

NEW YORK – A new finding reveals that African-American patients with breast, ovarian, and prostate cancer tend to die earlier than patients of other races with these cancers, even when they receive identical medical treatment and when socioeconomic factors are controlled for. The finding, an analysis of almost 20,000 patient records from 35 clinical trials, points to biological or genetic factors as the potential source of the survival gap. Dawn Hershman, M.D, M.S., a Columbia University Medical Center oncologist whose research is dedicated to examining racial and ethnic disparities in cancer outcome and in cancer survivorship, was the senior author of the research published online by the Journal of the National Cancer Institute (JNCI).

Dawn Hershman, M.D, M.S

The study analyzed patient records from clinical trials – going back as far as 1974 – conducted by the Southwest Oncology Group (SWOG). The investigators conducted an analysis that controlled for comparable treatment, disparities in tumor prognosis, demographics, and socioeconomic status, and found no statistically significant difference in survival based on race for a number of cancers – including lung, colon, lymphoma, leukemia and multiple myeloma.

However, African-American patients with breast, ovarian, or prostate cancers – the gender specific tumors – were found to face a significantly higher risk of death than did other patients, ranging from 21 percent higher for those with prostate cancer to 61 percent higher for ovarian cancer patients.

The poorer outcome for African-American cancer patients was supported by separate data published last month in the Journal of Clinical Oncology (JCO), which found that disparities in breast cancer survival based on race persisted even after adjusting for differences in treatment. That analysis of data from 634 breast cancer patients who participated in two SWOG-conducted trials was led by first author Dr. Hershman. Findings revealed that African-American women received similar dose intensity and cumulative dose as the Caucasian breast cancer patients, but were more likely to discontinue treatment early or experience treatment delay. In addition, African-American women had lower white blood counts, but no increase in infections complications. While Dr. Hershman and her team adjusted for these specific treatment related factors and other known predictors of outcome, such as age, hormone receptor status, stage, and treatment, African-American women still faced a lower rate of survival.

"The findings from these two studies are important as they suggest a possible role for biologic factors such as genetics, hormonal factors, comorbid conditions and tumor biology in cancer disparities. A better understanding of all the factors that contribute are critical, so that continued progress can be made toward reducing cancer mortality for patients of all races and ethnicities," says Dr. Hershman, assistant professor of medicine and epidemiology at Columbia University Medical Center and co-director of the breast cancer program at the Herbert Irving Comprehensive Cancer Center at NewYork-Presbyterian Hospital/Columbia University Medical Center. "There may be differences in genetic factors by race that alter the metabolism of chemotherapy drugs or that make cancers more resistant or more aggressive. We are now starting research to determine the role of these factors in this disparity."

"When you look at the dialogue about the issue of race and cancer survival that has gone on over the years, it always seems to come down to general conclusions that African-Americans in part have poorer access to quality treatment, may be diagnosed in later stages and may not have the same standard of care delivered as Caucasian patients, leading to a disparity in survival," says Kathy Albain, M.D., of Loyola University's Cardinal Bernardin Cancer Center, lead, and senior author of the JNCI and JCO papers, respectively. "The good news is that for most common cancers, your survival is the same regardless of race. But this is not the case for breast, ovarian, and prostate cancers."

"The need to address the racial disparities in cancer survival outcomes – both sociological and biological – has never been more urgent," says Dr. Hershman. "With the incidence of cancer among minorities predicted to double in the next two decades – while comparable incidence among whites is only expected to rise 31 percent – this is a crucially important public health issue to understand all the factors that alter survival outcomes." ###

The Southwest Oncology Group is one of the largest cancer clinical trials cooperative groups in the United States. Funded primarily by the National Cancer Institute, the group designs and conducts clinical trials to advance the science of cancer prevention and treatment and to improve the quality of life for cancer survivors. The almost 5,000 physician-researchers in the Group's network practice at more than 500 institutions, including 19 of the National Cancer Institute-designated cancer centers. For more information, please visit www.swog.org.

Columbia University Medical Center provides international leadership in basic, pre-clinical and clinical research, in medical and health sciences education, and in patient care. The medical center trains future leaders and includes the dedicated work of many physicians, scientists, public health professionals, dentists, and nurses at the College of Physicians and Surgeons, the Mailman School of Public Health, the College of Dental Medicine, the School of Nursing, the biomedical departments of the Graduate School of Arts and Sciences, and allied research centers and institutions.

Established in 1767, Columbia's College of Physicians and Surgeons was the first institution in the country to grant the M.D. degree and is now among the most selective medical schools in the country. Columbia University Medical Center is home to the most comprehensive medical research enterprise in New York City and state and one of the largest in the United States. Columbia University Medical Center is affiliated with NewYork-Presbyterian Hospital, the nation's largest not-for-profit hospital provider. For more information, please visit www.cumc.columbia.edu.

Contact: Elizabeth Streich eas2125@columbia.edu 212-305-6535 Columbia University Medical Center

Online computer games could encourage children to eat healthy foods

Children who play an online game promoting healthy foods and beverages appear more likely to choose nutritious snacks than those who play a game promoting unhealthy products, according to a report in the July issue of Archives of Pediatrics & Adolescent Medicine, one of the JAMA/Archives journals.

Obesity rates among U.S. children and youth have tripled during the past 40 years, according to background information in the article. "One potential contributor to the rise in obesity is media exposure, primarily because television advertising markets high-calorie foods and beverages that have little nutritional value," the authors write. "We know far less about how newer media influence children's food preferences, but Internet use is a very popular activity among youth aged 8 to 18 years. Marketers have taken notice of this online revenue-generating opportunity in which exposure to products costs less than traditional television advertisements and legal restrictions and regulations are virtually non-existent."

Food Guide Pyramid

Advergames—online computer games developed specifically to promote a brand, often featuring logos and characters—are present on many food and beverage Web sites. Tiffany A. Pempek, Ph.D., and Sandra L. Calvert, Ph.D., of Georgetown University, Washington, D.C., conducted a study involving 30 low-income, African American children age 9 to 10 years.

One group played a game, based on Pac-Man, that rewarded them for having their computer character choose bananas, orange juice and other healthy foods and beverages. A second group played a different version of the same game that instead rewarded consumption of soda, candy bars, cookies and bags of potato chips.

These two groups were instructed to select a snack from among options featured in the game after playing, whereas a third, control group selected a snack and beverage before playing the healthy version of the game. The children reported liking both versions of the game and played for an average of 9 minutes and 32 seconds.

Children who played the healthy version before selecting a snack were significantly more likely than those playing the unhealthy version to choose a banana and orange juice instead of soda and potato chips. "With only 10 minutes of exposure, our results revealed that children selected and ate whatever snacks were being marketed by the advergame, healthy or not," the authors write.

The findings suggest that public concerns about online games that market unhealthy foods are justified, the authors note, but also that the technology could be used to promote nutritious foods. "Eating patterns established during childhood affect health throughout the lifespan. Thus, it is important that we find ways to promote a healthy lifestyle for our children from an early age, particularly those who come from low-income neighborhoods where the risk of obesity is greatest," the authors write.

Despite concerns that low-income children do not have Internet access, children in the study reported being online daily or at least several times per week. "Overall, our results suggest that reaching low-income African American children via the Internet is feasible and that the use of advergames is a potential way to alter their eating habits in favor of more nutritious foods," the authors conclude. ###

Editor's Note: This study was supported by a Reflective Engagement in the Public Interest grant from Georgetown University. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

Contact: Rachel Pugh rmp47@georgetown.edu 202-687-4328 JAMA and Archives Journals

Why African-Americans are at greater risk of hypertension and kidney disease

Study finds growth factor higher in blacks compared to whites

NEW YORK (July 13, 2009) -- Physician-scientists from NewYork-Presbyterian Hospital/Weill Cornell Medical Center believe that a heightened level a certain growth factor in the blood may explain why blacks have a greater prevalence of hypertension and kidney disease compared to whites. Results from a new study are the first to show that an elevated level of a protein, called transforming growth factor B1 (TGF-B1), raises the risk of hypertension and renal disease in humans.

African Americans constitute about 32 percent of all patients treated for kidney failure in the U.S. and are four times more likely to develop renal disease than whites, according to the National Institutes of Health's U.S. Renal Data System. The researchers' findings, published in this month's issue of the journal Kidney International, may someday lead to the development of a new class of anti-hypertensive and kidney disease drugs that target the TGF-B1 protein.

Manikkam Suthanthiran, M.B.,B.S

"I believe we may now understand a great puzzle: why the black population has a greater prevalence of hypertension and kidney disease," says Dr. Manikkam Suthanthiran, first author of the study and attending physician at NewYork-Presbyterian/Weill Cornell, Stanton Griffis Distinguished Professor of Medicine, Professor of Biochemistry and Professor of Medicine in Surgery at Weill Cornell Medical College.

Results from the study revealed that the TGF-B1 protein was significantly higher in 186 black study participants compared with 147 white participants.

After controlling for race, sex and age, TGF-B1 protein levels were highest in hypertensive blacks (46 ng/ml). Non-hypertensive blacks also had higher levels (42 ng/ml) compared to hypertensive whites (40 ng/ml) and non-hypertensive whites (39 ng/ml), demonstrating that even healthy black patients may be at higher risk for future hypertension and renal disease compared to healthy and hypertensive whites.

"Many black patients may have a disadvantage from the start -- having a higher baseline level of TGF-B1," says Dr. Phyllis August, senior author and attending physician in the division of hypertension at NewYork-Presbyterian Hospital/Weill Cornell Medical Center, Ralph A. Baer Professor of Medical Research and professor of medicine atWeill Cornell Medical College.

While the exact mechanisms of TGF-B1 require further study, the authors believe that in black patients, higher levels of the growth factor are correlated with lower renin activity -- an enzyme that constricts blood vessels and raises blood pressure. High blood pressure is the leading risk factor for end-stage kidney disease.

The authors believe it may be possible that higher levels of TGF-B1 boost retention of sodium salt within the kidneys, leading to higher blood pressure in the kidney and also lower levels of renin.

Greater levels of TGF-B1 in blacks were also positively associated with body mass index (BMI) -- indicator of body fatness compared to height -- and metabolic syndrome -- a group of abnormalities that is associated with atherosclerotic vascular disease and diabetes.

"Future clinical studies must be done so we may fully understand the specific role of TGF-1 in how the kidney handles sodium, blood pressure and kidney disease." Says Dr. August. ###

NewYork-Presbyterian Hospital/Weill Cornell Medical Center

NewYork-Presbyterian Hospital/Weill Cornell Medical Center, located in New York City, is one of the leading academic medical centers in the world, comprising the teaching hospital NewYork-Presbyterian and Weill Cornell Medical College, the medical school of Cornell University. NewYork-Presbyterian/Weill Cornell provides state-of-the-art inpatient, ambulatory and preventive care in all areas of medicine, and is committed to excellence in patient care, education, research and community service.

Weill Cornell physician-scientists have been responsible for many medical advances -- including the development of the Pap test for cervical cancer; the synthesis of penicillin; the first successful embryo-biopsy pregnancy and birth in the U.S.; the first clinical trial for gene therapy for Parkinson's disease; the first indication of bone marrow's critical role in tumor growth; and, most recently, the world's first successful use of deep brain stimulation to treat a minimally conscious brain-injured patient.

NewYork-Presbyterian Hospital also comprises NewYork-Presbyterian Hospital/Columbia University Medical Center, NewYork-Presbyterian Morgan Stanley Children's Hospital, NewYork-Presbyterian Hospital/Westchester Division and NewYork-Presbyterian Hospital/The Allen Pavilion. NewYork-Presbyterian is the #1 hospital in the New York metropolitan area and is consistently ranked among the best academic medical institutions in the nation, according to U.S.News & World Report.

Weill Cornell Medical College is the first U.S. medical college to offer a medical degree overseas and maintains a strong global presence in Austria, Brazil, Haiti, Tanzania, Turkey and Qatar. For more information, visit www.nyp.org and www.med.cornell.edu.

Office of Public Affairs, Weill Cornell Medical College, 525 East 68th Street, Box 144. New York, NY 10065. tel: 212.821.0560, fax: 212.821.0576. email: pr@nyp.org

Contact: Limda Kamateh lib9027@med.cornell.edu 212-821-0560 New York- Presbyterian Hospital/Columbia University Medical Center

Teens who believe they'll die young are more likely to engage in risky behavior, University of Minnesota research finds

MINNEAPOLIS / ST. PAUL — University of Minnesota Medical School researcher Iris Borowsky, M.D., Ph.D., and colleagues found that one in seven adolescents believe that it is highly likely that they will die before age 35, and this belief predicted that the adolescents' would engage in risky behaviors.

Borowsky and colleagues analyzed data collected by the National Longitudinal Study of Adolescent Health, a nationally representative sample of more than 20,000 youth in grades 7 through 12 during three separate study years. In the first set of interviews, nearly 15 percent of adolescents predicted they had a 50/50 chance or less of living to age 35. Those who engaged in risky behaviors such as illicit drug use, suicide attempts, fighting, or unsafe sexual activity in the first year were more likely in subsequent years to believe they would die at a young age. Vice versa, those who predicted that they'd die young during the first interview were more likely in later years to begin engaging in these same risky behaviors and have poor health outcomes. Notably, these teens were significantly more likely to be diagnosed with HIV/AIDS just six years later, regardless of their sexual preference.

Four black children in yard Library of Congress Prints and Photographs Division Washington, D.C. 20540 USA

"While conventional wisdom says that teens engage in risky behaviors because they feel invulnerable to harm, this study suggests that in some cases, teens take risks because they overestimate their vulnerability, specifically their risk of dying," Borowsky said. "These youth may take risks because they feel hopeless and figure that not much is at stake."

Nearly 25 percent of youth living in households that receive public assistance and more than 29 percent of American-Indian, 26 percent of African-American, 21 percent of Hispanic, and 15 percent of Asian youth reported believing they would die young—compared to just 10 percent of their Caucasian peers.

"Our findings reinforce the importance of instilling a sense of hope and optimism in youth," Borowsky said. "Strong connections with parents, families, and schools, as well as positive media messages, are likely important factors in developing an optimistic outlook for young people."

She also notes that study findings support physician screening of adolescents for this perceived risk of early death. "This unusually common pessimistic view of the future is a powerful marker for high-risk status and thus deserves attention."

There was no significant relationship between perceived risk of dying before age 35 and actual death from all causes during the six year study period. ###

The study "Health Status and Behavioral Outcomes for Youth Who Anticipate a High Likelihood of Early Death," will be published in the July issue of Pediatrics.

The study was funded by a grant from the National Institute of Child Health and Human Development, with cooperative funding from 17 other agencies.

Dedicated to excellence, diversity and service, the University of Minnesota Medical School educates the next generation of physicians, advances patient care, and discovers breakthroughs in biomedical research that enhance health in Minnesota and beyond. Its commitment to transform medical education, Rural Physician Associate Program, and success in training Native American physicians are well-known. More than 1,500 Medical School physicians and scientists provide world-class care and carry out nearly $200 million in research, which informs the treatments and care that patients receive. For more information, go to www.med.umn.edu.

Contact: Laura Stroup stro0481@umn.edu 612-624-5680 University of Minnesota

Race origins and health disparites

Today's racial categories evolved from negative assumptions made hundreds of years ago to justify slavery.

Much is often said about the glaring statistics showing that some racial and ethnic minorities face greater risks than whites when it comes to health.

Nina T. Harawa, an Assistant Professor and researcher at Charles Drew University, says today's disparities are linked to many factors, including economics, access to health care and the impact of living in a race conscious society.

But in the recent issue of Ethnicity and Disease, she writes that the concept of race is often misunderstood or inconsistently used when examining differences (or "disparities") in health outcomes.

Caption: Nina T. Harawa, MPH, PhD is a researcher at Charles Drew University. Credit: Charles Drew University. Usage Restrictions: None.

"There is no gold standard for the use of race in health research," said Harawa, who co-wrote the article with Assistant Professor Chandra L. Ford, PhD, of the UCLA School of Public Health. Harawa said there are no readily agreed-upon standards for measuring someone's race, as in the case of gauging someone's age. Nevertheless, race has been used to categorize people since before the country's founding.

Efforts to simplify the complexities of race— including genetic, cultural and socioeconomic variations—have made race-related research "a minefield of often premature and ultimately wrong conclusions," she said.

To understand health disparities in the various population groups, she said, researchers need to understand how today's racial categories evolved from the negative assumptions made hundreds of years ago to justify slavery.

"Advancing our ability to address racial/ethnic disparities in health requires a historically informed understanding of these issues, including how the notion of fixed and distinct races became fixed in the American mind," she wrote.

A report, titled "Health Disparities: A Case for Closing the Gap", recently released by the U.S. Health and Human Services, shows significant disparities:

* 48 percent of all African American adults suffer from a chronic disease compared to 39 percent of the general population.
* Eight percent of White Americans develop diabetes while 15 percent of African Americans, and 14 percent of Hispanics and 18 percent of American Indians develop diabetes.
* African Americans are 15 percent more likely to be obese than Whites.

"Minorities and low income Americans are more likely to be sick and less likely to get the care they need," said Health and Human Services Secretary Kathleen Sebelius after the release of her report earlier this month. However, Dr. Harawa points out there are also exceptions, such as first generation Latino immigrants who have health advantages in many areas despite high levels of poverty and generally low levels of education. Further, Black immigrants frequently experience much better health outcomes than do other Black populations in the US.

Unfortunately, today's race and ethnic categories often fail to make these distinctions. ###

Nina T. Harawa, MPH, PhD, is an epidemiologist. Her research involves both documenting and understanding trends in the distribution of HIV infections and developing effective HIV prevention interventions. She has conducted and led numerous studies examining the prevalence of HIV infection and risky behaviors in a variety of high-risk populations.

"Race Origins and Health Disparities" by Nina Harawa, MPH, PhD, and Chandra Ford, PhD, can be found here in PDF format: Race Origins and Health Disparities

Contact: John L. Mitchell johnmitchell@cdrewu.edu 323-563-4981 Charles Drew University of Medicine and Science

2 studies shed light on racial disparities in cancer survival

Black women diagnosed with breast cancer have a greater chance of dying from the disease than white women, according to a new study published online July 7 in the Journal of the National Cancer Institute.

Age-standardized breast cancer mortality rates in the U.S. have remained higher and declined more slowly among black women. This study was undertaken because the underlying causes of this disparity were unclear.

To explore this, Idan Menashe, Ph.D., of the Division of Cancer Epidemiology and Genetics at the National Cancer Institute, in Rockville, Md., and colleagues used the Surveillance, Epidemiology, and End Results program to investigate almost 250,000 women diagnosed with breast cancer from January 1990 through December 2003. Researchers calculated black-to-white ratios of mortality, incidence, hazard of breast cancer death (probability of dying from the disease), and incidence-based mortality, with some analyses stratified by estrogen receptor (ER) status and age.

Idan Menashe

The researchers found a statistically significantly higher hazard of death in black women diagnosed with breast cancer compared to whites, especially in the first few years after diagnosis. Hazard rates of breast cancer death declined substantially for ER-positive tumors and modestly for ER-negative tumors but were persistently higher for blacks than whites.

"These differences in hazard may reflect racial differences in response and access to innovations in breast cancer treatment, as well as other biological and non-biological factors," the authors write. "Hence, greater emphasis should be placed on identifying the reasons for these increased hazards among black women and on developing new therapeutic approaches to address the disparity."

In another study, also published in this issue, Kathy S. Albain, M.D., of Loyola University Medical Center in Maywood, Ill., found that even when African American patients received the same care as all other patients, their survival rates were lower for breast, prostate and ovarian cancers, but were equivalent for all other major cancers.

Albain and colleagues analyzed records of more than 19,000 patients who participated in phase III cancer clinical trials conducted by the Southwest Oncology Group.

"Patients of all races had the same doctors and received the same state-of-the-art treatments," Albain said. "It was a level playing field for everyone. So our findings cast doubt on a widely accepted theory that African Americans' lower survival rates for certain cancers are solely due to such factors as poverty and poor access to quality health care."

Albain's study found no statistically significant association between race and survival for lung cancer, colon cancer, lymphoma, leukemia, or myeloma.

The cancers that did show survival gaps -- breast, prostate and ovarian -- are gender-related and the survival disparity persisted after adjustment for treatment factors, tumor variables, and socioeconomic status. The findings therefore suggest that the survival gap for these cancers is most likely due to an interaction of tumor biologic factors, hormonal environment, and inherited variations genes that control metabolism of drugs, toxins and hormones, Albain said.

In an accompanying editorial, Otis W. Brawley, M.D., of the American Cancer Society, said results of the Albain et al. study provide evidence that racial differences in the U.S. for certain cancers can be attributed to unequal care. He points out that blacks are less likely to have disease detected early and less likely to receive adequate treatment when it is detected.

The Menashe et al. study, according to Brawley, showed clear differences in mortality by race.

"Taken together, the two studies and others do not suggest that blacks have a different kind of breast cancer, but rather that there are multiple kinds of breast cancer and a higher proportion of black breast cancer patients have the worse kinds," the editorialist writes. "No race has a monopoly on the good kind, nor the bad kind of breast cancer, but the prevalences differ." ###

Contacts:

• Menashe et al. study: NCI Press Officers, ncipressofficers@mail.nih.gov, (301)496-6641
• Albain et al. study: Frank DeSanto, fdesanto@med.umich.edu, (734) 998-0114
• Jim Ritter, Loyola University Health System, jritter@lumc.edu, 708-216-2445
• Editorial: David Sampson, David.Sampson@cancer.org, 213.368.8523

Citations:

• Article: Menashe et al. Underlying Causes of the Black – White Racial Disparity in Breast Cancer Mortality: A Population-Based Analysis. J Natl Cancer Inst 2009, 101: 993-1000.
• Article: Albain et al. Racial Disparities in Cancer Survival Among Randomized Clinical Trials of the Southwest Oncology Group. J Natl Cancer Inst 2009, 101: 984-992.
• Editorial: Brawley O. Is Race Really a Negative Prognostic Factor for Cancer? J Natl Cancer Inst 2009, 101: 970-971.

Contact: Steve Graff jncimedia@oxfordjournals.org 301-841-1285. Journal of the National Cancer Institute

Did Bush's court appointments emphasized ideology over diversity?

CORVALLIS, Ore. – The judicial appointments of former president George W. Bush suggests that his motivation for appointing nontraditional judges was driven more by ideology and strategy than concerns for diversity, a new analysis shows.

The examination of all the federal judicial appointments over the two terms of the Bush presidency show that while he did make a number of diverse appointments, especially with Hispanics, overall the federal courts did not gain in the number of minority judges during Bush's tenure.

The analysis appears in an article in the current issue of Judicature and was written by Jennifer Segal Diascro, an assistant professor in the Department of Government at American University, and Rorie Spill Solberg, an associate professor in the Department of Political Science at Oregon State University.

Rorie Spill Solberg, Associate Professor. Contact Information Office: 310 Gilkey Hall Address: Department of Political Science Oregon State University Corvallis, OR 97331-5303. Phone: (541) 737-2811. Fax: (541) 737-2289. Email: Rorie Spill Solberg

"The key is to look at the replacement patterns," said Spill Solberg. "Bush did appoint many minorities, but in order to have a gain in diversity, you have to replace more seats with diverse judges than you started with or else it doesn't equate with a diverse bench." Diascro and Solberg relied on statements from President Bush and members of his administration to determine that ideology played a role in his appointments, and relied on statistical analyses by Carp et al. (published in the same issue of Judicature) that reveal that his appointees to the lower courts were indeed conservative. To assess the relative ideology of Judge Sonia Sotomayor and other women on Obama's short list, Diascro and Solberg utilized the Judicial Common Space scores developed by Lee Epstein and colleagues.

The empirical measurements used to assess ideology are all reliable and valid measures employed by political scientists.

According to the article, when compared with all presidents since Jimmy Carter, Bush maintained the status quo in appointing nontraditional judges to the bench. He appointed more men (78 percent overall) then women (22 percent) and more whites (82 percent) than minorities (18 percent), but as Spill Solberg points out, that pattern was true for Bush's predecessors.

When comparing total appointments, Bush appointed more white females (50) than Carter (32), Ronald Reagan (27) or George H.W. Bush (31), but less than Bill Clinton (83). He appointed more Hispanic females (12) than Clinton (5), but fewer African American females (8 compared to 15) than Clinton, so the overall diversity representation is about the same, or in some cases less than during Clinton's presidency.

In particular, Spill Solberg said, African-American judges did not see a significant increase under the Bush administration. "At the end of eight years in office, African Americans held 8.5 percent of the seats on the court of appeals, an increase of only half a percent from the end of the Clinton administration," the study points out.

Spill Solberg said that like Carter, Reagan and George H.W. Bush, George W. Bush often appointed minorities to seats for political gain or for ideological purposes.

"There is a tendency, and we see this across the political spectrum, to use bench appointments to gain clout with certain voters," she said. "The Bush administration was actively courting the Hispanic vote, so it isn't surprising that he made more appointments of Hispanic judges than African Americans, but it was often also based on judicial philosophy."

In contrast, the study shows that Clinton often stressed diversity and representation over ideology. He often picked moderate and conservative minority and female judges even though they did not necessarily reflect his own political philosophies. Diascro said Democrats have had an easier time appointing a diverse bench that also serves their political and ideological goals as nontraditional candidates tend to come from groups that vote Democratic.

"We suspect that Bush had many Hispanic conservatives from which to choose when filling vacancies on the bench, and he chose to appoint traditional candidates instead," Diascro said. "He cared about diversity, but it was not his first priority."

The study's authors stress that diversity in the federal court system remains important as a way of representing the broad range of experiences of the public that the system is supposed to serve. This is true from a symbolic perspective, lending legitimacy to an otherwise non-democratic branch of government; but it may also be true substantively, said Diascro.

"Personal experiences matter and impact how you view the law," Spill Solberg said. "The experiences of woman may differ from those of a man in the same way that the experiences of a prosecutor may differ from the experiences of other lawyers. It is more complicated as we see with Justice Thomas who brings the experiences of an African American filtered through the lens of a conservative ideology."

Looking ahead, Diascro and Spill Solberg thoughtfully analyze what the judicial legacy of Barack Obama's presidency will be compared to his predecessors. Their conclusion so far is that Obama will emphasize diversity over ideology like Clinton and that his nomination of Judge Sotomayor to the Supreme Court is a demonstration of this.

"His nominations thus far demonstrate his reluctance to appoint ideologues," the authors write. "This is especially true for Judge Sotomayor, who is not the most liberal choice among the female candidates reportedly on the President's short list." ###

Note: For copies of the upcoming issue of Judicature, contact David Richert, editor, Judicature, American Judicature Society (www.ajs.org) 848 Dodge, #468, Evanston, IL 60202 (773) 973-0145 tel; (773) 338-9687 fax; drichert@ajs.org or Laury Lieurance, llieurance@ajs.org, 800-626-4089.

Media contact: Angela Yeager, 541-737-0784; angela.yeager@oregonstate.edu
Sources: Rorie Spill Solberg, 541-737-2811, rorie.spillsolberg@oregonstate.edu; Jennifer Segal Diascro, 202-885-2246, diascro@american.edu

Contact: Rorie Spill Solberg rorie.spillsolberg@oregonstate.edu 541-737-2811 Oregon State University

James Webster Smith and Henry O. Flipper

In 1870, James Webster Smith became the first African-American admitted to the United States Military Academy. Ironically, the academy's first African American cadet came from South Carolina, the first state to secede from the Union and the state with the highest percentage of slaves before the Civil War.

Smith was spared the hazing that was so common among his classmates. He was, rather, completely ostracized by the Corps and, after being turned back (forced to repeat a year) once for academic deficiencies, was dismissed for academic failure after four years at West Point. Smith had broken a critical barrier, however, and in 1873, a Georgian by the name of Henry O. Flipper would benefit.

Flipper was no more popular than Smith, but, in the words of a classmate, “never pushed” the bounds of social equality and so was more easily tolerated. Flipper survived his years at the academy by being as determined as his classmates were prejudiced. In 1877 he became the academy’s first African-American graduate, ranking 50th in a class of 76.

Henry O. Flipper

Cadet Smith. James Webster Smith's cadetship was marred by discrimination from his very first day at West Point, When Smith presented his appointment papers to the commandant, he was waved away and several white cadets threatened to resign. During his four years at West Point he was the center of oontroversy, being tried by court-martial on two occasions, Smith was a pioneer in a hostile environment and suffered dearly as a result. Cadet O;Flipper, on the other hand, was of a more accommodating nature. Flipper, whose interest in West Point extended back several years before his admission, was aware of' Smith's difficulties through newspaper articles of the day. He went to West Point expecting to be mistreated.

He was mentally prepared for the worst, and when the worst did not occur, felt relieved. He took particular care not to repeat conduct which had caused Smith trouble. The greater majority of this avoided conduct dealt with social equality. Flipper was ostracized socially and, in contrast to Smith, did not complain

For this, he was spared the brutality that Smith had suffered. In modern terminology, Cadet Flipper may have been called an Uncle Tom. Yet, if he had not acquiecsed, he probably would have been forced out as was Smith.

SOURCES:

• Postwar Change and Contraction
• Recruiting the Black Cadet

Racial variations in excessive daytime sleepiness depend on measurement

WESTCHESTER, Ill. – According to a research abstract that was presented on Monday, June 8, at SLEEP 2009, the 23rd Annual Meeting of the Associated Professional Sleep Societies, white Americans are more likely to report experiencing excessive daytime sleepiness (EDS) more days per month than Asians, African Americans and Hispanics, but African Americans experience more severe EDS.

Results indicate that of all racial groups in the study, white participants were most likely to report feeling excessively sleepy for more than five days a month. Of the total sample, 18.4 percent of white Americans reported EDS, as compared to 12.1 percent of Chinese, 14.3 percent of African Americans and 16.8 percent of Hispanics. The study also found that according to the Epworth Sleepiness Scale (ESS), a questionnaire used to measure the frequency of dozing off during the daytime, African Americans experienced higher rates of EDS than other racial groups. Of the total study, 13 percent of African Americans, 7.9 percent of whites, 7.7 percent of Chinese and 9.3 percent of Hispanics experience daytime sleepiness.

According to lead author of the study Kelly Glaze Baron, PhD, postdoctoral fellow, at the Feinberg School of Medicine at Northwestern University in Chicago, Ill., the largest factor that explained higher EDS in African Americans was differences in physical health, including being more likely to be overweight and having higher rates of chronic diseases such as diabetes and high blood pressure. African Americans also reported to sleeping for less hours than other racial groups, which also contributes to higher rates of sleepiness.

These results have public health implications. "If African Americans are less likely to report feeling overly sleepy but more likely to have pathological sleepiness, they may be less likely to get treatment for sleep disorders," said Baron.

The study included data from 5,173 men and women with an average age of 66.4 years. Of the total sample, 40.7 percent of participants were white, 11.3 percent were Chinese, 26.2 percent were African American and 21.3 percent were Hispanic. Demographic information, health behavior (exercise and smoking), physical health and medications, sleep (self reported sleep time, diagnosis with sleep disturbance symptoms), depression, social support and chronic burden were collected. EDS was measured through self report of frequency (more than five days per month) and the ESS.

Authors of the study claim that feeling overly sleepy takes into account attitudes, values and comparisons to family and friends. Findings of this study indicate that dozing off during the daytime has a stronger relationship to current health status. ###

How likely are you to doze off or fall asleep in the following situations, in contrast to feeling just tired? This refers to your usual way of life in recent times. Even if you have not done some of these things recently try to work out how they would have affected you.

Use the following scale to choose the most appropriate number for each situation:

• 0 = no chance of dozing
• 1 = slight chance of dozing
• 2 = moderate chance of dozing
• 3 = high chance of dozing

Situation	Chance Of Dozing
Sitting and reading
Watching TV
Sitting inactive in a public place (e.g. a theater or a meeting)
As a passenger in a car for an hour without a break
Lying down to rest in the afternoon when circumstances permit
Sitting and talking to someone
Sitting quietly after a lunch without alcohol
In a car, while stopped for a few minutes in traffic

The annual SLEEP meeting brings together an international body of 6,000 leading researchers and clinicians in the field of sleep medicine to present and discuss new findings and medical developments related to sleep and sleep disorders.

More than 1,300 research abstracts will be presented at the SLEEP meeting, a joint venture of the AASM and the Sleep Research Society. The three-and-a-half-day scientific meeting will bring to light new findings that enhance the understanding of the processes of sleep and aid the diagnosis and treatment of sleep disorders such as insomnia, narcolepsy and sleep apnea.

Abstract Title: Race/Ethnic Variation in Excessive Daytime Sleepiness: The Multi-Ethnic Study of Atherosclerosis. Presentation Date: Monday, June 8. Category: Healthcare Services, Research & Educatio, Abstract ID: 1197

Contact: Kelly Wagner kwagner@aasmnet.org 708-492-0930 American Academy of Sleep Medicine

Black gay men may be at increased HIV risk

Preferences in the race of sexual partners influenced by subtle racism may perpetuate HIV-related health disparities

Black gay men have less choice when it comes to sexual partners than other groups and, as a result, their sexual networks are closely knit. These tightly interconnected networks make the rapid spread of HIV more likely. In a study1) looking at social and sexual mixing between ethnic groups in men who have sex with men, H. Fisher Raymond and Willi McFarland, from the San Francisco Department of Public Health in the US, show that social barriers faced by Black gay men may have a serious impact on their health and well-being. Their findings are published in Springer's journal AIDS and Behavior.

In the US, there is a disproportionate burden of HIV infection in Black Americans, who accounted for nearly half of all HIV/AIDS cases diagnosed in 2006 – four times the national average.

Raymond and McFarland's research looks at the current levels of sexual mixing between racial and ethnic groups of men who have sex with men in San Francisco, and identifies reasons that underlie these sexual mixing patterns.

A total of 1,142 gay men took part in computer-assisted interviews. They were asked about their own ethnicity, the race of their sexual partners in the last six months, their perception of how easy it is to meet sexual partners of different ethnicities, where they meet sexual partners, their view of HIV infection risk and the predominant race of their network of friends.

Black gay men are the least preferred of sexual partners by other races. Black men are perceived to be riskier to have sex with, which can lead to men of other races avoiding Black men as sexual partners. They are also perceived as less welcome in the common social venues of gay men in San Francisco. As a result, Black men are three times more likely to have sexual partners that are also Black, than would be expected by chance alone.

In the authors' view, the combination of attitudes on the part of non-Black gay men, friendships and social networks that are less likely to include Blacks, and the environments found in gay venues serve to separate Black gay men from other groups. Consequently, the sexual networks of Blacks are pushed to be more highly interconnected than other groups, with the potential for a more rapid spread of HIV and a higher sustained prevalence of infection among Black gay men.

The authors conclude: "The racial disparity in HIV observed for more than a decade will not disappear until the challenges posed by a legacy of racism towards Blacks in the US are addressed." ###

The study is available online free of charge on Springer's information platform SpringerLink at dx.doi.org/10.1007/

Reference

1. Raymond HF & McFarland W (2009). Racial mixing and HIV risk among men who have sex with men. AIDS and Behavior; DOI 10.1007/s10461-009-9574-6. The full-text article is available to journalists as a pdf.

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

Study finds people residing in poor communities not benefiting from recent drop in colorectal cancer

Lack of access to health care may be to blame

ATLANTA — A new study suggests that a drop in colorectal cancer incidence seen nationwide has not occurred among people living in poorer communities, and suggests that barriers to health care may be to blame. The study appears online in the journal Cancer Causes and Control.

Colorectal cancer (CRC) incidence rates have decreased rapidly in the United States since 1998, in large part from the use of endoscopic screening, which can detect and remove polyps before they turn into cancer. However, studies have not fully explored whether all populations, including people of different ages, race/ethnicity, and with differing levels of access to medical care have seen such a drop.

Colorectal cancer is a disease in which malignant (cancer) cells form in the tissues of the colon or the rectum. The colon is part of the body's digestive system.

To explore the issue, American Cancer Society epidemiologists examined CRC incidence trends from 1995 to 2004 from 19 cancer registries covering about 53 percent of the U.S. population, comparing incidence rates among different ages, races/ethnicities (whites, African Americans, and Hispanics), and county-level indicators of access to health care: poverty level, supply of primary care physicians (PCPs), insurance rates, and metro vs. non-metro area. They also analyzed changes in rates of screening using endoscopy screening and fecal occult blood stool test (FOBT) for the same set of county-level indicators.

The researchers found that CRC incidence rates decreased significantly across all categories of counties among whites ages 65 and over, who are almost all covered by Medicare, but not among those ages 50 to 64 in counties with high uninsured or poverty rates, fewer PCPs, or in non-metro areas. Among African Americans and Hispanics, incidence rates did not decrease among 50 to 64 year olds in general or among those ages 65 and over residing in counties with high poverty rates, low PCP supply, and non-metro counties (African Americans only). Colorectal endoscopic screening rates increased significantly among whites in both age groups, but not among Hispanics (ages 50 to 64 in general and ages 65 and over residing in high poverty counties) or African Americans residing in counties with higher uninsured rates (ages 50 to 64), low PCP supply, high poverty rates, and non-metro counties (ages 65 and over). FOBT rates remained unchanged during the study time period.

The authors say the study suggests that the decrease in incidence rates among whites 65 and older across all categories of counties may in part reflect an increase in endoscopic screening rates after Medicare expanded reimbursement of selected screening tools in 1998 and 2001. In contrast, the lack of decrease in CRC incidence rates among some population subgroups, including those 50 to 64 year old Hispanics and African Americans in general and whites residing in the most disadvantaged areas, may reflect lack of access to primary care as well as endoscopic screening services.

The authors conclude that that individuals residing in poorer communities with lower access to medical care have not experienced the reduction in CRC incidence rates that have benefited more affluent communities, and that this is likely explained in part by lower utilization of colorectal endoscopic screening even in older populations with coverage through Medicare. They say further research is needed on factors that explain the disparities and potential interventions to address them. ###

Article: "Trends in colorectal cancer incidence rates by age, race/ethnicity, and indices of access to medical care, 1995–2004 (United States)" Yongping Hao, Ahmedin Jemal, Xingyou Zhang, Elizabeth M. Ward. Cancer Causes Control DOI 10.1007/s10552-009-9379-y, Published online June 19, 2009.

Contact: David Sampson david.sampson@cancer.org WEB: American Cancer Society

What is different in reflux esophagitis between African-Americans and non-Hispanic whites?

There is minimal data evaluating the prevalence of GERD complications in any United States general population, other than non-Hispanic whites. Presently, it is thought that such complications occur less frequently in African-Americans than in non-Hispanic whites. A research group in Jacksonville, FL investigated the prevalence of reflux esophagitis between non-Hispanic whites and African-Americans. The distribution of esophagitis severity and its complications were equivalent between groups, except for Barrett's esophagus.

A research article to be published June 21, 2009 in the World Journal of Gastroenterology addresses this question. The research team, lead by Dr. Vega at the University of Florida Health Science Center/Jacksonville, performed a retrospective search of the endoscopy database at the University of Florida Health Science Center/Jacksonville for all cases of reflux esophagitis and its complications from 1 January to 31 March 2001.

Endoscopic image of Barrett's esophagus

The database search identified 259 patients with reflux esophagitis or its complications. One hundred seventy one were non-Hispanic whites and 88 were African Americans. Mean ages and male/female ratios were similar in the two groups. RE grade, esophageal ulcer, stricture, and hiatal hernia frequency were likewise similar in the groups.

Endoscopic and histological Barrett's esophagus was present more often in non-Hispanic whites than in African Americans. Heartburn was a more frequent indication for endoscopy in non-Hispanic whites with erosive esophagitis than in African Americans.

This is the first study to report that reflux esophagitis and its complications, other than Barrett's esophagus, occur at a similar frequency in nHw and AA. In addition, indication for the index endoscopy appears to be different in the above ethnic groups. By understanding GERD and its complications among ethnic groups in the United States, this study might indicate future avenues for investigation to prevent the development of Barrett's esophagus and esophageal adenocarcinoma. ###

Reference: Vega KJ, Chisholm S, Jamal MM. Comparison of reflux esophagitis and its complications between African Americans and non-Hispanic whites. World J Gastroenterol 2009; 15(23): 2878-2881 World J Gastroenterol

Contact: Lin Tian wjg@wjgnet.com 86-105-908-0039 World Journal of Gastroenterology

Aerobically unfit young adults on road to diabetes in middle age

Young African-Americans, women at higher risk

CHICAGO --- Most healthy 25 year olds don't stay up at night worrying whether they are going to develop diabetes in middle age. The disease is not on their radar, and middle age is a lifetime away.

As it turns out, many should be concerned. Researchers at Northwestern University Feinberg School of Medicine have found that young adults (18 to 30 years old) with low aerobic fitness levels --as measured by a treadmill test -- are two to three times more likely to develop diabetes in 20 years than those who are fit.

The study also shows that young women and young African Americans are less aerobically fit than men and white adults in the same age group, placing a larger number of these population subgroups at risk for diabetes.

Mercedes R. Carnethon, PhD

"These young adults are setting the stage for chronic disease in middle age by not being physically active and fit," said Mercedes Carnethon, lead author and assistant professor of preventive medicine at Northwestern's Feinberg School. "People who have low fitness in their late teens and 20's tend to stay the same later in life or even get worse. Not many climb out of that category." The study will be published in the July issue of Diabetes Care.

In the study, the most important predictor of who will develop diabetes is the participants' Body Mass Index (BMI), a measure of the body's fat content.

"The overwhelming importance of a high BMI to the development of diabetes was somewhat unexpected and leads us to think that activity levels need to be adequate not only to raise aerobic fitness, but also to maintain a healthy body weight," Carnethon said. "If two people have a similar level of fitness, the person with the higher BMI is more likely to develop diabetes."

Carnethon stressed that unfit young adults can avoid a future with diabetes by exercising and losing weight. "Improving your fitness through physical activity is one way you can modify your body fat," she said. "Research shows that combining regular physical activity with a carefully balanced diet can help most people maintain a healthy body weight and lower the likelihood of developing diabetes."

This is the longest observational study to focus on the relationship between aerobic fitness and the development of diabetes. Most previous research has focused on the self-reported health behavior of physical activity, but people don't always accurately report their activity level. Fitness, easily measured by a standard treadmill test, provides a more accurate measure than a self-report.

In addition, this study is the first to look at the development of diabetes over a 20- year period. Because diabetes develops over a long period of time, the number of people affected in the population rises with age. Previous studies that followed adults for a shorter period of time may have stopped short before diabetes was diagnosed.

Data from the study came from the Coronary Artery Risk Development in Young Adults (CARDIA) study, which began in January 1984 and ended in December 2001. The fitness study included 3,989 participants at baseline and 2,231 at the 20-year testing. The black and white men and women were 18 to 30 at the time of enrollment. Fasting blood sugar levels (the blood marker used to define diabetes) were measured at the beginning of the study and multiple times over 20 years. ###

The study was funded by the National Heart, Lung and Blood Institute.

NORTHWESTERN NEWS: www.northwestern.edu/newscenter/

Contact: Marla Paul Marla-Paul@northwestern.edu 312-503-8928 Northwestern University

American Society for Microbiology honors Terry A. Krulwich

The 2009 American Society for Microbiology (ASM) William A. Hinton Research Training Award will be presented to Terry A. Krulwich, Ph.D., Professor, Pharmacology and Biological Chemistry, and Program Director, Post-Baccalaureate Research Education Program (PREP), Mount Sinai School of Medicine, New York. This award recognizes outstanding contributions toward fostering the research training of underrepresented minorities in microbiology. It honors William A. Hinton, a physician-research scientist and one of the first African-Americans to join the ASM.

Dr. Krulwich is credited with revolutionizing the training of underrepresented minorities at Mount Sinai. She takes a personal interest in each student and works to ensure they excel beyond their expectations.

Terry A. Krulwich

She identifies gaps in their learning and designs individualized plans to guarantee their success. Dr. Krulwich served as Dean of the Graduate School of Biological Sciences from 1981 to 2002 and established and directed the Medical Scientist Training Program (MSTP). Over 100 underrepresented students were mentored by Krulwich during this time.

In 2001, she received funding from the National Institute of General Medical Sciences to establish PREP which provides recent college graduates from underrepresented minority groups one- to two-years of intensive mentored research to facilitate their pursuing a Ph.D. or M.D./Ph.D. degree. Almost 40 students have participated and 70% of them have entered Ph.D. or M.D./Ph.D. training.

Dr. Krulwich, a Fellow of the American Academy of Microbiology, received her Ph.D. from the University of Wisconsin, Madison. ###

The William A. Hinton Research Training Award will be presented during the 109th General Meeting of the ASM, May 17-21, 2009 in Philadelphia, Pennsylvania. ASM is the world’s oldest and largest life science organization and has more than 43,000 members worldwide. ASM’s mission is to advance the microbiological sciences and promote the use of scientific knowledge for improved health and economic and environmental well-being.

Contact: Garth Hogan ghogan@asmusa.org WEB: American Society for Microbiology

Study finds segregation decreases access to surgical care for minorities

CHICAGO (June 11, 2009) – New research published in the June issue of the Journal of the American College of Surgeons reveals that in counties with the highest levels of segregation, an increase in the African-American or Hispanic population was associated with a decrease in the availability and use of surgical services and an increase in the number of emergency room visits. This research supports prior studies that have shown that minority groups in the United States have comparatively poorer access to a range of health care services, often resulting in late diagnosis of illness and delayed treatment.

African Americans are the most segregated racial group in the U.S. Studies have shown that segregated African-American communities have higher infant mortality rates, decreased access to appropriate cancer care and worse outcomes from organ transplantation than other racial groups experience.

J. W. Awori Hayanga, M.D., M.P.H.

Both African Americans and Hispanics living in counties with a higher proportion of African-American population report that they experience difficulty obtaining health care as compared with African Americans living in counties with a smaller African-American population. Through the National Institutes of Health and Healthy People 2010, the federal government has set forth goals to explore, account for and minimize these disparities.

However, despite these goals, improving access to health care continues to pose a considerable challenge to health policy makers in their attempts to establish equity in the provision of care.

"In the most segregated counties, we found that an increase as small as one percent in the African-American or Hispanic population was associated with a significant decrease in the availability and utilization of surgical services, a difference that was not present in counties with the least segregation," said Awori J. Hayanga, MD, MPH, Administrative Chief Resident, Department of General Surgery, University of Michigan Health System. "We hope this report will guide budgetary decisions and incentives by health policy makers in their bid to close the racial health disparity gap and increase access to surgical health care across racial lines, particularly in the most segregated areas."

A cross-sectional analysis was performed on data from the 2004 U.S. Department of Health and Human Services Area Resource File, a nationwide record of health care, economic and demographic data. Each of the 3,219 U.S. counties was categorized into one of three levels – most, moderately or least segregated – using the Isolation Index, a measure of the probability that a member of one minority group will come into contact with members of the same racial group. Multivariable linear regression analysis was performed to examine the association between access to surgical services and proportion of minority population with varying levels of segregation, adjusting for socioeconomic and health characteristics.

Results showed that in the most segregated counties, each percentage point increase in Hispanic or African-American population was associated with a statistically significant decrease in outpatient surgery volume (p< href="http://www.facs.org/" target="ext">www.facs.org.

Contact: Sally Garneski pressinquiry@facs.org 312-202-5409 Weber Shandwick Worldwide

Study supports validity of test that indicates widespread unconscious bias

In the decade since the Implicit Association Test was introduced, its most surprising and controversial finding is its indication that about 70 percent of those who took a version of the test that measures racial attitudes have an unconscious, or implicit, preference for white people compared to blacks. This contrasts with figures generally under 20 percent for self report, or survey, measures of race bias.

A new study published this week validates those findings, showing that the Implicit Association Test, a psychological tool, has validity in predicting behavior and, in particular, that it has significantly greater validity than self-reports in the socially sensitive topics of race, gender, ethnicity, sexual orientation and age.

Anthony G. Greenwald

The research, published in the Journal of Personality and Social Psychology, is an overview and analysis of 122 published and unpublished reports of 184 different research studies. In this analysis, 85 percent of the studies also included self-reporting measures of the type generally used in surveys. This allowed the researchers, headed by University of Washington psychology Professor Anthony Greenwald, to compare the test's success in predicting social behavior and judgment with the success of self-reports.

"In socially sensitive areas, especially black-white interracial behavior, the test had significantly greater predictive value than self-reports. This finding establishes the Implicit Association Test's value in research to understand the roots of race and other discrimination," said Greenwald. "What was especially surprising was how ineffective standard self-report measurers were in the areas in which the test measures have been of greatest interest – predicting interracial behavior."

Greenwald created the Implicit Association Test in 1998 and he and Mahzarin Banaji, a Harvard psychology professor, and Brian Nosek, a University of Virginia associate professor of psychology, further developed it. Since then the test has been used in more than 1,000 research studies around the world. More than 10 million versions of the test have been completed at an Internet site where they are available as a self-administer demonstration.

The research looked at studies covering nine different areas – consumer preference, black-white interracial behavior, personality differences, clinical phenomena, alcohol and drug use, non-racial intergroup behavior, gender and sexual orientation, close relationships and political preferences.

Findings also showed that:

* Across all nine of these areas, measures of the test were useful in predicting social behavior.
* Both the test, which is implicit, and self-reports, which are explicit, had predictive validity independent of each other. This suggests the desirability of using both types of measure in surveys and applied research studies.
* In consumer and political preferences both measures effectively predicted behavior, but self-reports had significantly greater predictive validity.

Studies in the research came from a number of countries including Germany, the Netherlands, Italy, the United Kingdom, Australia, Canada, Poland and the United States. They looked at such topics as attitudes of undecided voters one-month prior to an Italian election; treatment recommendations by physicians for black and white heart attack victims; and reactions to spiders before and after treatment for arachnophobia, or spider phobia.

"The Implicit Association Test is controversial because many people believe that racial bias is largely a thing of the past. The test's finding of a widespread, automatic form of race preference violates people's image of tolerance and is hard for them to accept. When you are unaware of attitudes or stereotypes, they can unintentionally affect your behavior. Awareness can help to overcome this unwanted influence," said Greenwald. ###

Co-authors of the new study are Banaji, T. Andrew Poehlman of Southern Methodist University and Eric Uhlmann of Northwestern University. The National Science Foundation, National Institute of Mental Health, the Third Millennium Foundation and the Rockefeller Foundation funded the research.

For more information, contact Greenwald at 206-543-7227 or agg@u.washington.edu; Banaji at banaji@fas.harvard.edu Nosek at 434-924-0666 or nosek@virginia.edu.

More information about the Implicit Association Test and examples of the test can be found at Project Implicit's Web site: implicit.harvard.edu/implicit/

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

Pre-pregnancy depressed mood may heighten risk for premature birth

Researchers trying to uncover why premature birth is a growing problem in the United States and one that disproportionately affects black women have found that pre-pregnancy depressive mood appears to be a risk factor in preterm birth among both blacks and whites.

Black women, however, have nearly two times the odds of having a preterm birth compared to white women, according to Amelia Gavin, a University of Washington assistant professor of social work and lead author of a new study that appears online in the June issue of the Journal of Women's Health.

"Preterm births are one of the most significant health disparities in the United States and the overall number of these births increased from 10.6 percent in 2000 to 12.8 percent in 2005," she said.

melia Gavin, Assistant Professor, Social Welfare Doctoral Faculty. gavina@u.washington.edu. Office: 127C Phone: 206-616-8847. UW School of Social Work. 4101 15th Avenue NE. 354900, Seattle WA 98105-6299

While there appears to be some sort of link between giving birth prematurely and depressed mood, the study found no cause and effect, said Gavin, who studies health disparities. She believes the higher preterm birth rate among blacks may be the result of declining health over time among black women. For this study, premature birth referred to any child born after less than 37 weeks of gestation. Normal gestation ranges from 38 to 42 weeks. Data for the study was drawn from a larger longitudinal investigation looking at the risks for cardiovascular disease among more than 5,000 young adults in four metropolitan areas. The Coronary Artery Risk Development in Young Adults Study also collected information about mental health and pregnancy outcomes. Between 1990 and 1996, 555 women in the larger study gave birth. These women were the subjects in the depression-premature birth study.

"At this point we can't say that pre-pregnancy depressive mood is a cause of preterm birth or how race effects this association," said Gavin. "But it seems to be a risk factor in giving birth prematurely and higher pre-pregnancy depressive mood among black women compared to white women may indirectly contribute to the greater odds of preterm birth found among black women."

In the study 18.1 percent of the black women had a preterm birth compared to 8.5 percent of the white women.

This difference may be the result of what she calls "weathering," or accelerated declines in health due to repeated socioeconomic and political factors.

"What some people experience by being black takes a toll on the physiological system, and over time wear and tear that occurs across neural, neuroendocrine and immune systems as a result of chronic exposure to stressors lead to health disparities for blacks. Some of this may manifest itself in premature birth and low-birth weight," Gavin said.

The study did not look at depressive mood or depression during pregnancy because the larger research project did not collect that data. She hopes to replicate and expand her findings by analyzing data from another study to look at depressive mood prior to pregnancy and childhood poverty to see if those two factors in part explain the black and white difference in preterm delivery. That study also will look at the role antidepressive medication plays in preterm birth.

"My ultimate goal is to incorporate a life course health development framework to examine disparities in birth outcomes," she said. "You have to look at the context of health across the life course of a woman, not just during pregnancy."

The consequences of higher preterm delivery are a growing burden on the health care system and parents. Studies have shown that preterm babies have higher morbidity rates and U.S. preterm birth rates are creeping up with no good explanation. In the U.S. the population at greatest risk for major depression is women of childbearing age and the onset and course of depression are often intertwined with reproductive events. A recent national study reported that 8.4 percent of pregnant women in the past year experienced major depression and only slightly more than 14 percent of those women sought treatment for any mood disorder. ###

Co-authors of the study are David Chae of Emory University, Sarah Mustillo of Purdue University, and Dr. Catarina Kiefe of the University of Alabama at Birmingham and the Birmingham Veterans Affairs Medical Center. The National Center for Research Resources and the Roadmap for Medical Research, both components of the National Institutes of Health, funded the research.

For more information, contact Gavin 206-616-8847 or gavina@u.washington.edu.

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

Cognitive impairment is associated with reduced survival among both African-Americans and whites

CHICAGO – Alzheimer's disease and its precursor, mild cognitive impairment, appear to be associated with an increased risk of death among both white and African American older adults according to a new, long-term research study by neurological experts at the Alzheimer's Disease Center at Rush University Medical Center. The study findings are published in the June issue of Archives of Neurology, one of the JAMA/Archives journals.

Data from two earlier national surveys have suggested that life expectancy among patients with Alzheimer's disease may be greater for African Americans than for whites, according to Robert Wilson, PhD, a neuropsychologist at the Alzheimer's Disease Center at Rush and the study's lead author.

"In these surveys, the diagnosis of Alzheimer's disease is not based on a uniform clinical evaluation but derived from medical records, which increases the likelihood of substantial variation in the quality of diagnostic classifications," said Wilson.

Comparison of a normal aged brain (left) and an Alzheimer's patient's brain (right). Differential characteristics are pointed out.

However, the results from this study show that the presence and severity of mild cognitive impairment and Alzheimer's disease are associated with reduced survival among African Americans and these effects are comparable to those seen among whites, according to Wilson.

Alzheimer's disease reduces life expectancy and has emerged as a leading cause of death in the United States. "There is limited knowledge about the consequences of mild cognitive impairment and Alzheimer's disease in African Americans," said Wilson. "In this study we evaluated the risk of death among both African Americans and whites in an urban community during a 10 year follow-up."

Rush researchers evaluated the risk of death associated with incident Alzheimer's disease and diagnoses were based on a uniform, detailed clinical evaluation. They also examined survival rates among participants with mild cognitive impairment.

A total of 1,715 older adults (average age 80.1, 52.5 percent African American) who came from four adjacent neighborhoods in Chicago participated in the study. Each participant had a clinical evaluation that included medical history, a neurological examination and cognitive function testing, which analyzes thinking, learning and memory.

Based on these evaluations, an experienced physician diagnosed 296 (17.3 percent) of participants with Alzheimer's disease, 597 (34.8 percent) with mild cognitive impairment and 20 (1.2.) percent with other forms of dementia, while 802 (46.80 percent had no cognitive impairment.

During the 10-year follow-up (average observation period 4.7 years) 634 individuals died (37 percent), including 25.8 percent of those without cognitive impairment, 40.4 percent of those with mild cognitive impairment, 59.1 percent of those with Alzheimer's disease and 60 percent of those with other forms of dementia.

"Compared with people without cognitive impairment, risk of death was increased by about 50 percent among those with mild cognitive impairment and was nearly three-fold greater among those with Alzheimer's disease," said Wilson. "These effects were seen among African Americans and whites and did not differ by race."

Among individuals with mild cognitive impairment, risk of death increased as cognitive impairment became more severe, another association that did not differ by race. A similar association between disease severity and survival was seen among patients with Alzheimer's disease, although that effect was slightly stronger for African Americans than whites.

"Overall, these results do no suggest strong racial differences in survival for persons with mild cognitive impairment and Alzheimer's disease," said Wilson. "If there are racial differences, it will be important to determine whether they are due to diagnostic bias or whether they reflect actual differences in the underlying neurobiology of the disease or in how affected individuals are cared for." ###

Rush University Medical Center is an academic medical center that encompasses the more than 600 staffed-bed hospital (including Rush Children's Hospital), the Johnston R. Bowman Health Center and Rush University. Rush University, with more than 1,730 students, is home to one of the first medical schools in the Midwest, and one of the nation's top-ranked nursing colleges. Rush University also offers graduate programs in allied health and the basic sciences. Rush is noted for bringing together clinical care and research to address major health problems, including arthritis and orthopedic disorders, cancer, heart disease, mental illness, neurological disorders and diseases associated with aging.

Contact: Deborah Song deb_song@rush.edu 312-942-0588 Rush University Medical Center

Widely used body fat measurements overestimate fatness in blacks

The body mass index (BMI) and waistline measurement overestimate obesity in blacks, according to a new study. The results, which were presented at The Endocrine Society's 91st Annual Meeting in Washington, D.C., suggest that conventional methods for estimating body fat may need to become race-specific.

"Compared to Caucasians, African-Americans of the same age, gender, waist circumference, weight and height may have lower total and abdominal fat mass," said principal investigator and study leader Samuel Dagogo-Jack, MD, professor of medicine and chief, Division of Endocrinology, Diabetes and Metabolism, University of Tennessee Health Science Center, Memphis. "These findings argue for a review of the existing cutoffs for healthy BMI and waist circumference among African-Americans."

Samuel Dagogo-Jack, MD is the A. C. Mullins Professor in Translational Research; Professor of Medicine & Chief of the Division of Endocrinology, Diabetes & Metabolism; and Director of the Fellowship Training Program in Endocrinology, Diabetes and Metabolism at the University of Tennessee College of Medicine, Memphis, TN.

BMI is a simple and common method of estimating someone's body fat levels, based on that person's weight and height measurement. Obesity experts classify an adult who has a BMI less than 18.5 as underweight; normal weight is 18.5 to 24.9, overweight is 25 to 29.9 and obese is more than 30. An indirect measurement, BMI is not a reliable indicator of body fat for people who have a large body frame or lots of lean muscle. More specialized methods, such as DEXA bone density scanning or computed tomography (CT), can directly measure total and regional body fat, but these methods are expensive and more time-consuming. The waist circumference is used to identify abdominal obesity. This fat around the middle carries a higher risk for obesity-related complications such as diabetes and heart disease. Experts define abdominal obesity as a waist circumference greater than 40 inches in men and more than 35 inches in nonpregnant women.

National data show that blacks have higher rates of obesity and type 2 diabetes than whites. Dagogo-Jack and his co-workers therefore examined whether the relationship between body fat and BMI would differ by race. In a study funded by the National Institutes of Health and the American Diabetes Association, they compared how close BMI was to body fat directly measured by DEXA in whites and blacks. The researchers performed the same comparison for waist circumference and abdominal fat. They studied 93 nondiabetic adults (53 blacks and 40 whites) who have one or both parents with type 2 diabetes. Subjects had a broad range of body weights.

The correlation between DEXA-measured total fat and the BMI was higher in whites than blacks, the authors reported. The same was true for the correlation between directly measured abdominal fat and waist size.

Therefore, body fat is likely to be lower in blacks than in whites of the same weight and height, Dagogo-Jack said. He said their data suggest that muscle mass may be higher in blacks, which would explain the dissociation between weight expressed as BMI and measured body fat.

"If our results are confirmed in a larger study population by other researchers, the obesity field will need to develop ethnic-specific cutoffs for what values represent overweight and obesity," he concluded. ###

Contact: Aaron Lohr alohr@endo-society.org 240-427-7157 The Endocrine Society