Minorities have poorer results, higher rates of inappropriate surgery to prevent stroke

DALLAS – Aug. 25, 2009 – Minorities have poorer results and higher rates of unnecessary surgery from a common procedure used to remove plaque from inside the carotid artery, according to a UT Southwestern Medical Center doctor who is lead author of the study in the journal Stroke.

The multicenter study, available online and appearing in the July issue of the journal, found that higher rates of poor surgical outcomes for carotid endartectomy (CEA) – a procedure performed to prevent stroke – appeared to be due not only to elevated patient clinical risk in African-American and Hispanics, but also to the individual skill and experience of the doctor performing the operation.

"Identifying how various patient, physician and hospital-level factors may contribute to disparities has important implications for the design of clinical and health policy strategies for reducing them," said Dr. Ethan Halm, chief of the William T. and Gay F. Solomon Division of General Internal Medicine at UT Southwestern.

Dr. Ethan Halm, chief of the William T. and Gay F. Solomon Division of General Internal Medicine, helped identify several factors that can affect whether a patient dies or suffers a stroke after carotid-artery surgery. The procedure, one of the most common types of vascular surgeries performed in the U.S., involves opening the carotid artery in the neck and removing harmful plaque to restore blood flow to the brain.

"To my knowledge this is the first study to examine the stepwise impact of patient, surgeon and hospital factors as a way of understanding racial/ethnic disparities in clinically confirmed outcomes of carotid artery surgery," he said. Previous research has demonstrated that minority groups in the U.S. have higher rates of heart attack and stroke. For example, African-Americans have greater numbers and higher severity of strokes, accompanied by higher rates of recurrence or death within 30 days. Yet Hispanics have not been well-studied as a subgroup, Dr. Halm said. The researchers used data from the New York Carotid Artery Surgery (NYCAS) study to examine the medical outcomes of 9,093 Medicare patients who had undergone carotid endartectomy in New York state. Of the patients, 95.3 percent were Caucasian, 2.5 percent were African-American and 2.2 percent were Hispanic. They found that the minorities had much worse clinical outcomes. In the 30 days following surgery, 9.5 percent of the Hispanic patients and 6.9 percent of the African-Americans had died or suffered a stroke due to the procedure, compared with 3.8 percent of Caucasian patients.

One reason minorities had higher complications rates was that they had severe neurological disease and more serious health conditions like heart disease and diabetes.

However, minorities were more likely to be cared for by less-experienced surgeons and hospitals. Adjusting for these patient and provider factors explained the worse results in African-Americans, but did not explain the poorer outcomes in Hispanics.

Rates of unnecessary surgery were also higher in minorities. For Hispanics, CEA was inappropriate in 17.6 percent of the cases; for African-Americans, 13 percent; and for Caucasians, 7.9 percent. The disparity in rates of unnecessary surgery was largely due to the higher burden of serious health conditions among minorities, which put them at much higher short-term risk of complications. If the short-term risk of carotid surgery is too high, the procedure is considered inappropriate.

"These results show we have the worst of all worlds," Dr. Halm said. "CEA is, paradoxically, both overused and underused in minorities and with worse results. More work is needed to help better understand the multiple factors that influence patient selection and surgical referral patterns. Developing evidence-based decision aids to help physicians and patients more accurately weigh the potential risks and benefits of CEA is one strategy we are pursuing to help improve this situation." ###

The NYCAS study was supported by the Agency for Healthcare Research and Quality, Centers for Medicare & Medicaid Services, the Robert Wood Johnson Foundation and the National Institute of Neurological Disorders and Stroke.

Scientists from Mt. Sinai School of Medicine and New York University School of Medicine also contributed to the research in Stroke.

Visit www.utsouthwestern.org/surgery to learn more about clinical services in surgery at UT Southwestern.

Contact: Erin Prather Stafford erin.pratherstafford@utsouthwestern.edu 214-648-3404 UT Southwestern Medical Center

Disparities in cancer care reflect hospital resources, U-M study finds

Hospital quality among factors leading to survival differences

ANN ARBOR, Mich. — Hospitals that treat more black cancer patients have worse survival rates on average for patients with breast and colon cancer, regardless of race, according to a new study from the University of Michigan Comprehensive Cancer Center.

The research helps explain why African-Americans with breast or colon cancer are less likely than white patients to survive the disease.

"This work highlights the importance of how where a patient receives treatment for cancer affects survival after cancer surgery. An important next step will be to determine which system factors are amenable to interventions aimed at improving the quality of cancer care," says study author Tara M. Breslin, M.D., assistant professor of surgery at the U-M Medical School.

Tara M. Breslin, M.D. Assistant Professor of Surgery. University of Michigan Health System. 3303 Cancer & Geriatrics Center, 1500 E. Medical Center Drive. Ann Arbor, MI 48109-5932 e-mail: tarabres@umich.edu

The study used five year survival data from the Surveillance Epidemiology and End Results–Medicare-linked database, a federal collection of cancer incidence, survival, and prevalence. The researchers analyzed data from 25,571 breast cancer patients, 9.7 percent of whom were black, and 22,168 colon cancer patients, 11.8 percent of whom were black. The patients were treated in 436 hospitals. The study appears in the Aug. 20 issue of the Journal of Clinical Oncology. Survival rates were lower for black patients than for white patients with both breast and colon cancer. But hospitals where more than half the patients were black had an increased risk of dying after five years for both black and white patients, compared to hospitals where fewer than 10 percent of patients were black.

All breast cancer patients treated at predominantly black hospitals had a 32 percent increased risk of death after five years, compared with those treated at hospitals that see few black patients. Similarly, colon cancer patients had a 27 percent higher risk of dying at five years.

The researchers also examined patient factors, such as age, cancer stage, other medical conditions and socioeconomic status. They found that after accounting for these factors, black patients still had higher mortality rates.

"Efforts aimed at increasing early detection through screening and decreasing incidence with preventative services are essential for decreasing racial disparities in mortality, but where a patient receives care after a cancer diagnosis may be equally important," says senior study author Arden M. Morris, M.D., M.P.H., assistant professor of surgery at the U-M Medical School and chief of general surgery at the VA Ann Arbor Healthcare System.

The study did not identify what specific hospital factors were at play, but the researchers plan further analyses to determine which hospital systems and aspects of standard therapy are poorly delivered or absent in hospitals serving a high percentage of minority patients. ###

Cancer statistics: 194,280 Americans will be diagnosed with breast cancer this year, and 106,100 will be diagnosed with colon cancer, according to the American Cancer Society.

Additional authors: Niya Gu, Sandra L. Wong, Emily V. Finlayson, Mousumi Banerjee and John D. Birkmeyer, all from U-M

Funding: National Cancer Institute

Reference: Journal of Clinical Oncology, Vol. 27, No. 24, pp. 3945-3950

Resources: U-M Cancer AnswerLine, 800-865-1125. U-M Comprehensive Cancer Center, www.mcancer.org

Contact: Nicole Fawcett nfawcett@umich.edu 734-764-2220 University of Michigan Health System

Obesity increases risk of prostate cancer recurrence for both blacks and whites

DURHAM, N.C. – A new look at a large database of prostate cancer patients shows that obesity plays no favorites when it comes to increasing the risk of recurrence after surgery: Being way overweight is equally bad for blacks and whites, say researchers at Duke University Medical Center.

Studies have shown that obesity is linked to generally worse outcomes in many cancers, including prostate cancer. Because blacks are more likely than whites to develop and die from prostate cancer – and because there is a higher prevalence of obesity among black men with prostate cancer, compared to whites – some studies have suggested that obesity might be a more ominous risk factor for blacks than whites.

Stephen Freedland, M.D.

"Not so," says Stephen Freedland, M.D., an associate professor of urology and pathology in the Duke Prostate Center and the senior author of the study appearing in the journal Cancer. "Obesity leads to worse cancer in both groups." Freedland and Jayakrishnan Jayachandran, M.D. a urologic oncology fellow at Duke and the lead author of the paper, examined the records of 1,415 men enrolled in the Shared Equal Access Regional Cancer Hospital (SEARCH) database who had undergone a radical prostatectomy. Black men comprised almost half (47 percent) of the sample.

After adjusting for various preoperative characteristics, researchers analyzed the relationship between body mass index (BMI) and the aggressiveness of the cancer, as measured by the risk of recurrence. In contrast to other studies, investigators found no association between race and obesity.

Almost a third of the men were obese, regardless of race. "We found that higher BMI was associated with significantly increased risk of cancer recurrence for both blacks and whites," said Jayachandran. "Though prior SEARCH-based studies from our group found that obesity was associated with a higher risk of disease progression as measured by a rising PSA after surgery, it now appears that being obese just means a poorer prognosis, period, regardless of race."

As for why that might be, Jayachandran says he's not sure, but he says it may have something to do with altered hormone levels.

"Obesity is associated with more estrogen and less testosterone, and it may be that lower testosterone promotes more aggressive tumors as recent studies have suggested." In addition, Jayachandran says alteration in the production of other hormones, like insulin, insulin-like growth factor or leptin, which occur in obese men, may also be involved in the development of more aggressive tumors. "This is something we simply do not understand, but we are actively studying all of these factors." ###

Colleagues who contributed to the study include Lionel Bañez, William Aronson, Martha Terris, Joseph Presti Jr., Christopher Amling, and Christopher J. Kane.

The investigative team was supported by the Department of Veterans Affairs, the National Institutes of Health, The Georgia Cancer Coalition, the Department of Defense Prostate Cancer Research Program, and the American Urological Association Foundation/Astellas Rising Star in Urology Award.

Contact: Michelle Gailiun michelle.gailiun@duke.edu 919-660-1306 Duke University Medical Center

Psychologists offer ways to improve prison environment, reduce violent crime

Harsh punishment backfires

TORONTO – U.S. prisons are too punitive and often fail to rehabilitate, but targeting prisoners' behavior, reducing prison populations and offering job skills could reduce prisoner aggression and prevent recidivism, a researcher told the American Psychological Association on Saturday.

"The current design of prison systems don't work," said criminal justice expert Joel Dvoskin, PhD, of the University of Arizona. "Overly punitive approaches used on violent, angry criminals only provide a breeding ground for more anger and more violence."

Joel Dvoskin, Ph.D, A.B.P.P.

Presenting at the American Psychological Association's 117th Annual Convention, Dvoskin discussed his upcoming book, "Applying Social Science to Reduce Violent Offending," which examines why prisons are failing and what needs to change. "Prison environments are replete with aggressive behaviors, and people learn from watching others acting aggressively to get what they want," Dvoskin said in an interview.

Applying behavior modification and social learning principles can work in corrections, he said. "For example, systematic reinforcement of pro-social behaviors is a powerful and effective way to change behavior, but it has never been used as a cornerstone of corrections," he said.

Also, punishment can be effective in changing behavior, but it only works in the short term and immediately after the unwanted behavior happens, he said. While there is a place for punishment, it should be used in psychologically informed and effective ways. However, punishment should not be one-size-fits-all, Dvoskin said.

"We need to know what may be behind the criminal behavior to know what the best treatment is," he said. "A person who commits crimes when drunk but not when sober is likely suffering from an alcohol problem. Treating the alcohol problem may diminish the criminal behavior."

Decreasing prison populations needs to be more of a priority, Dvoskin said. "This can be done by paying more attention to those with the highest risk of violent behavior rather than focusing on lesser crimes, such as minor drug offenses."

Finally, bringing work back into prisons can benefit prisoners by teaching them job skills and filling unmet job needs. With the increase in the criminal population and lack of increase in prison staff, "there is not enough supervision to allow prisoners to work and build skills," Dvoskin said. "This makes it very hard to re-enter into the civilian world and increases the likelihood of going back to prison."

With 7 million American adults in prison and almost 50 percent of them African-American males, many children are growing up without fathers and are at risk for continuing the vicious cycle of criminal behavior, Dvoskin said. "If we don't make the changes now, we will see these numbers go up."

Dvoskin, along with co-editors Jennifer Skeem, Ray Novaco and Kevin Douglas, wanted to find out what social science reveals about preventing and reducing violent crime. "Our intention," said Dvoskin, "is to avoid the extreme partisan bickering about whether to be 'soft' or 'hard' on crime, but to combine social science and common sense so that our correctional systems can more effectively change behavior. After all, isn't that their job?" ###

For more information or an interview, contact Joel Dvoskin at 520-577-3051 or cell 520-906-0366 or by e-mail at joelthed@aol.com

The American Psychological Association, in Washington, D.C., is the largest scientific and professional organization representing psychology in the United States and is the world's largest association of psychologists. APA's membership includes more than 150,000 researchers, educators, clinicians, consultants and students. Through its divisions in 54 subfields of psychology and affiliations with 60 state, territorial and Canadian provincial associations, APA works to advance psychology as a science, as a profession and as a means of promoting health, education and human welfare.

Contact: Pam Willenz pwillenz@apa.org 202-336-5707 American Psychological Association

Low-income kids report first sexual intercourse at 12 years old in new national study

1 in 4 children between 11-16 report having sex

AMES, Iowa -- As a new mother herself, Brenda Lohman admits to being shocked by the results of a new study she co-authored. It found that among nearly 1,000 low-income families in three major cities, one in four children between the ages of 11 and 16 reported having sex, with their first sexual intercourse experience occurring at the average age of 12.77.

"So if 12 years was the average age here, that meant that some kids were starting at 10 or younger," said Lohman, an Iowa State University associate professor of human development and family studies (HDFS). "A handful of kids reported having sex as early as 8 or 9. We know from our follow-up interviews that one boy who reported having sexual intercourse for the first time at age nine had fathered four children by the time he was 18."

Brenda Lohman, Title: Assistant Professor, Department of Human Development and Family Studies. Office: Institute for Social and Behavioral Research. 2625 N Loop #2500 Room 2592 Ames, IA 50010 Phone: 515-294-7413. Email: blohman@iastate.edu

"Those people who say that kids don't have sex at that young of age should think again," she said. "Definitely the age is the most shocking thing about this study." Tina Jordahl, a former Iowa State HDFS and public policy graduate student who is now a market research specialist with Hospice of Central Iowa, collaborated with Lohman on the study. It analyzes data from the "Welfare, Children and Families: A Three-City Study" -- a six-year longitudinal investigation of low-income families living in Boston, Chicago and San Antonio. Their paper, titled "A biological analysis of risk and protective factors associated with early sexual intercourse of young adolescents," was posted online in the Children and Youth Services Review and will be published in an upcoming issue of the journal. Interview data for the study was first collected in 1999 on youth between the ages of 10 and 14, and again in 2001.

Lohman says she also has data collected in 2006 from the same subjects, who were between 16 and 20 by that time.

In the study, boys reported their first sexual intercourse at younger ages (averaging 12.48) than girls (13.16). Boys also had nearly 10 percent higher frequency of intercourse than girls and were also more likely to experience sexual debut (20 percent to 14 percent) between the two years when the first two waves of data were collected.

Recent national research has found that 13 percent of girls and 15 percent of boys have had sex by the time they're 16. Lohman says that means the rate of sex among her low-income sample is only slightly higher among the girls, but almost double among the boys

"The ages [of sexual debut] are a bit younger than the national samples, but not alarmingly so," she said.

African Americans also had 12 percent more early sexual intercourse than whites (29 to 17 percent respectively), although racial differences did not change the age of their first intercourse.

The authors report that periods of instability in family structure and welfare use serve as risk factors for early sexual activity. They found that additional maternal education -- beyond a high school level -- was found to inhibit some of that activity.

"That can be for multiple reasons," Lohman said. "It can be that mothers have better paying jobs and more stable home environment and they're less likely to be in stressful circumstances. It could also be that mothers then have greater cognitive capacities to sort of sit down and discuss the pros and cons of waiting to have sex until you're older."

For that reason, the researchers propose allotting public funding to increase maternal education as a way to reduce early sexual promiscuity among their children.

The study also found the youths' involvement in delinquent acts drastically increases the chances of early sexual activity.

Because of the gender differences in sexual debut, the authors also urge more gender-specific prevention programs that are implemented at earlier ages, especially among high risk populations.

"It may be that boys and girls, starting at younger ages, should have these programs that are designed separately by gender before they're moved back together over time," Lohman said. "And yes, they must start much, much younger than they do now. You have to start before those young kids -- 10 or even younger -- start becoming sexually active."

She says the current political climate in Washington may be right for those types of programs to be developed.

"The Bush administration concentrated on abstinence education programs for all families across the spectrum of income, and Obama is definitely focusing on sexual education and prevention programs," said Lohman. "He's put a lot more money back into those programs that were stripped away during the Bush administration. And given his focus in other areas, he is concentrating on high-risk, low-income disadvantaged families as well." ###

Lohman is currently working on research to determine the relationship between obesity and teen sexuality. She hopes to publish results from that study within the year.

PLEASE NOTE; I can send you a pdf of the study if you'd like to see it.

Professor Lohman also reports that the children told researchers the age of their first sexual partner and if they had ever been abused or if it was voluntary. Thus, they were able to pull out youth who were sexually abused and this paper represents voluntary sexual intercourse.

Contact: Brenda Lohman, Human Development and Family Studies, (515) 294-6230, (773) 505-2872 (c), blohman@iastate.edu
Tina Jordahl, Hospice of Central Iowa, tinajordahl@gmail.com
Cathy Curtis, College of Human Sciences, (515) 294-8175, ccurtis@iastate.edu
Mike Ferlazzo, News Service, (515) 294-8986, ferlazzo@iastate.edu

Contact: Mike Ferlazzo ferlazzo@iastate.edu 515-294-8986 Iowa State University

AFRICAN-AMERICANS WITH COPD USE FEWER HEALTH SERVICES

New research shows that African-Americans (AA) with chronic obstructive pulmonary disease (COPD) use fewer health services than Caucasians with the condition. Researchers from the University of Maryland compared health services utilization and cost outcomes in 4,723 AA patients and 4,021 Caucasians with COPD, asthma, or both. After controlling for age, gender, cohort allocation, and comorbidities, results showed that AA adults with COPD, asthma, or coexisting asthma and COPD used fewer medical services and accounted for lower medical costs than Caucasians.

The authors speculate that the differences in utilization and medical costs may provide an explanation for the racial disparities in outcomes of patients with COPD and asthma. The article is published in the August issue of CHEST, the peer-reviewed journal of the American College of Chest Physicians.

Contact: Jennifer Stawarz jstawarz@chestnet.org 847-498-8306 American College of Chest Physicians

Research examines coping strategies of African-American students in predominantly white schools

A new study examining the interactions of black and white high-achieving students in elite, private high schools reveals how today's millennial generation is negotiating race, identity and academic success. In a paper presented Aug. 8 at the 104th annual meeting of the American Sociological Association (ASA) in San Francisco, Michelle Burstion-Young, a University of Cincinnati doctoral student in sociology, says she is breaking new ground in sociological research – exploring culture and race in the leadership class of the millennial generation – in academically competitive environments where an achievement gap does not exist.

Burstion-Young's study focused on a survey and follow-up interviews with approximately 20 students representing three private prep high schools in the Midwest, including an all-male, all-female and co-ed school.

Michelle Burstion-Young

"Schools are one of the most important sites to study if we are to gain an understanding of how racial interaction is shaped," Burstion-Young writes in the study. "Schools are important not only because they perform the function of education, but also because they are key to how children and young adults become socialized."

"Little is known about how students negotiate the social world of school or how being labeled black (by others and/or self) may influence their social decisions, either by removing options (such as being purposefully excluded or not being included) or creating other options (such as a black social world)," she writes.

Burstion-Young's study examined what she called four coping strategies used by minority students in predominantly white schools

Assimilation – "Acting white" or "acting black" in this environment was not a question of academics, but identity. According to Burstion-Young, both black and white students were dedicated to academic excellence and there were no differences in academic standards. Contrary to previous studies which state that high achieving blacks are viewed as "acting white," Burstion-Young says the black students identified with black culture through association with consumer culture, such as fashion and music, as well as slang and social circles. The students who did not connect to black culture on these levels were viewed as "acting white" – academic achievement (or lack thereof) had little to do with it. In at least one case in this study, an African-American student became so integrated into the white community that she lost her connectedness to her own family and culture, greatly upsetting the family and, Burstion-Young says, eliminating the spirit of integration in creating a generation of bridge-builders across cultures, identifying with each other but accepting and respecting cultural differences.

Integration – Burstion-Young says she found that most of the students actually strived to be bi-cultural or integrated in their dealings with people. Almost all of them placed a great deal of value on being connected with their own black culture and also with the majority (white) culture. She states that they felt that the former was necessary in order for them to have a support system, and that the latter was necessary in order to learn how to be successful in "the real world." Because the students valued being bicultural, associating with white students was not enough to be considered "acting white." Exclusive association with whites was the determining factor.

Separation – During school visits, separation between the races was particularly noted during time spent in the school cafeteria. "Separation is an important strategy for cultivating and maintaining a sense of black culture and while many school officials and white students discourage it on principle," writes Burstion-Young, "most of the black students realize that by not engaging with the black group, they risk being completely ostracized in the long run."

Marginalization – An example would be a shy student representing the only African-American in an AP class. Yet, the same student could be included in extracurricular activities or join African-American friends for lunch in the school cafeteria.

In conclusion, Burstion-Young states that separation seems to be the most popular coping strategy for the social space of students outside of their prep school environments. "The black students in this study were very interested in spending their 'free time' with family, friends and neighbors outside of school," states Bastion-Young. "Because our most intimate connections with people tend to happen intra-racially, the family, friends and neighbors they sought during their free time were overwhelmingly of the same race as themselves."

During school hours, the study revealed that social separation was more likely to occur due to lack of access to the majority/minority, such as not being invited to parties; a lack of interest in the social majority/minority, such as displaying no interest in attending a party or event that crossed racial lines; or preoccupation with one's own culture so that students were not purposefully excluding the other race, but not actively including them.

"For all of these reasons, the terms of most of the school life of blacks seem to be dictated by the dominant culture," writes Burstion-Young. "Therefore many of the students feel they must be instrumental in seeking a black cultural space. When they do, the black students themselves are often accused of being the sole cause of racial separation which I refer to as the 'self segregation paradox,' because it obscures the role the dominant group has in maintaining social separation."

"One of the most important findings of this study," writes Burstion-Young, "is that most students simultaneously use a variety of different coping strategies, but they do so in somewhat different combinations for somewhat different reasons. At the center of their negotiations, however, is an overall concern with identity; more specifically, their coping strategies are geared towards reconciling different, and sometimes contradictory, expectations on identity." ###

Contact: Dawn Fuller dawn.fuller@uc.edu 513-556-1823 University of Cincinnati

$7M grant establishes new UIC center to eliminate health disparities PODCAST

The University of Illinois at Chicago has been awarded a $7.2 million federal grant to establish the UIC Center of Excellence in Eliminating Health Disparities.

PODCAST: An extended interview as MP3 audio file

The new center, funded by a five-year grant from the National Center on Minority Health and Health Disparities of the National Institutes of Health, will focus on health disparities in prostate and colorectal cancer, community-based breast cancer initiatives, and training and educating the next generation of health disparities researchers.

"The new center will be a multi-faceted, university-wide resource to integrate health disparities research and activities," said Elizabeth Calhoun, associate professor of health policy and administration at the UIC School of Public Health, and director and principal investigator of the new center.

Elizabeth Calhoun, UIC associate professor of health policy and administration

"We plan to engage new investigators in health disparities, reaching not only into our undergrad and graduate populations, but even into high school, to build a pipeline of researchers interested in health disparities." Carol Ferrans, professor and associate dean for research at the UIC College of Nursing, is co-director of the center.

Researchers at the center will build upon prior UIC research to implement a community project to eliminate breast cancer disparities in South Side Chicago communities disproportionately affected by high rates of breast cancer deaths. The project will use culturally sensitive messages to promote mammography screening, address beliefs that contribute to screening reluctance, and address personal and health system barriers to screening.

The center's primary research projects will specifically look at disparities in prostate and colorectal cancer.

Colorectal cancer is the second most common cancer among African-American women and the third most common for African-American men. Late stage diagnosis, method of detection, delays from detection to surgical intervention, and disparities in treatment may all contribute to African Americans having the highest mortality from this disease of any racial or ethnic group, according to researchers.

In one study, led by Garth Rauscher, UIC assistant professor of epidemiology, researchers will enroll 500 African-American patients newly diagnosed with colorectal cancer to obtain information about screening, stage at diagnosis and treatment. The researchers will look at personal barriers such as cultural beliefs about cancer, social support, transportation, housing, literacy, perceived stress, fear, medical trust, as well as access barriers such as insurance status.

A second study, led by Vince Freeman, UIC assistant professor of epidemiology, will compile data on prostate and colorectal cancer cases diagnosed between 1995 and 2008 in Chicago to conduct a population-based analysis of clinical, socioeconomic and health care factors that account for mortality differences between African Americans and Caucasians.

Ultimately, these statistical models will allow researchers to predict hot-spot areas heavily burdened with disease, said Calhoun, and provide effective measures for deploying resources such as targeted cancer screenings.

The center has a research core, a training and education core, and a community engagement core, led by Richard Warnecke, Faye Davis, and Carol Ferrans, respectively, who are researchers at the UIC Institute for Health Research and Policy.

Rauscher and Freeman are researchers at the UIC Institute for Health Research and Policy and the UIC Cancer Center.

The new UIC Center of Excellence in Eliminating Health Disparities will involve faculty from all six of UIC's health sciences colleges, the UIC Institute for Health Research and Policy, the UIC Center for Clinical Translational Science, and the UIC Cancer Center to develop a comprehensive strategy to incorporate research, education, policy changes and community partnerships to reduce health disparities in Chicago and beyond. ###

UIC ranks among the nation's top 50 universities in federal research funding and is Chicago's largest university with 25,000 students, 12,000 faculty and staff, 15 colleges and the state's major public medical center. A hallmark of the campus is the Great Cities Commitment, through which UIC faculty, students and staff engage with community, corporate, foundation and government partners in hundreds of programs to improve the quality of life in metropolitan areas around the world.

For more information about UIC, visit www.uic.edu

Contact: Sherri McGinnis González smcginn@uic.edu 312-996-8277 University of Illinois at Chicago

Rutgers University in Newark will lead 9 college consortium to increase students in STEM fields

$5 million, 5-year program is funded by NSF

(Newark, N.J., Aug. 5, 2009) -- Rutgers University in Newark will lead a $5 million, five-year, multiple-school program that aims to substantially increase the numbers of minority of students pursuing majors – and eventually, careers -- in the fields of science, technology, engineering and math, also known as STEM fields.

Rutgers University-Newark will lead a consortium including Kean University, New Jersey City University, Essex County College, Bloomfield College, Montclair State University, Fairleigh Dickinson University/Teaneck, William Paterson University and Rutgers University, New Brunswick in the five-year Garden State Louis Stokes Alliance for Minority Participation (GS-LSAMP), which is funded by the National Science Foundation (NSF).

Louis Stokes rose from the local housing projects to serve 30 years in the U.S. House, becoming a potent symbol for his Cleveland-based majority-black district. Reluctant to enter the political arena, Stokes was persuaded to run for office by his prominent brother and by community members he had served for decades as a civil rights lawyer. His accomplishments were substantive and of historic proportions. The first black to represent Ohio, Stokes chaired several congressional committees (including the Permanent Select Intelligence Committee) and was the first African American to win a seat on the powerful House Appropriations Committee.

"By working together, Rutgers University and our partner schools are determined to make substantial progress in efforts to 'open the doors' for more students to pursue careers in these critical STEM fields," states Steve J. Diner, chancellor of Rutgers in Newark. "Our goal is to make New Jersey a top state that invests in the rich and deep talent that resides in our nation's minority populations." The consortium aims to double, in five years, the number of minority students completing undergraduate degrees in the STEM disciplines by providing academic support programs, including tutoring and peer-led team learning (PLTL). PLTLs are sessions in which upperclassmen help younger students through difficult STEM classes that have traditionally been a barrier to success and retention. "If we can get students beyond the difficult. introductory 'gateway courses' that scare off many of them, we can improve retention of minorities in the STEM fields," explains Dr. Alexander E. Gates, chair of the Earth and Environmental Sciences department at Rutgers University, Newark. Gates is GS-LSAMP's co-principal investigator and project director. Training for the mentors will be provided by the Educational Opportunity Fund programs at the partner institutions, according to Gates. Another way that GS-LSAMP hopes to increase minority student participation in the STEM fields is by providing opportunities for undergraduates to conduct hands-on laboratory research with faculty members, says Gates.

Other activities include community service, visits to local high schools for recruitment, and internships.

The $5 million GS-LSAMP grant will provide stipends to fund the tutoring and PLTL sessions as well as the research funds for GS-LSAMP scholars enrolled at the consortium schools.

NSF initiated LSAMP – then known as the Alliance for Minority Participation – in 1991, said Gates, and it is ranked as one of the 10 most effective diversity programs in the U.S. by Diverse Issues in Higher Education. The GS-LSAMP is the first such program in New Jersey in 15 years. The award is named for civil rights activist, lawyer and 15-term Congressman Louis Stokes, the first African American member of Congress from the State of Ohio. During his Congressional career he was especially active in health care and public health issues, serving on the Pepper Commission on Comprehensive Health Care. Stokes also was the founder and chairman of the Congressional Black Caucus Health Braintrust. ###

Contact: Carla Capizzi capizzi@andromeda.rutgers.edu 973-353-5262 Rutgers University

Video game minority report: Lots of players, few characters

Comprehensive census of game characters finds Latinos nearly invisible; women, other groups underrepresented.

If the future of entertainment is interactive media, some minorities are still headed back to the past.

The first comprehensive survey of video game characters, encompassing the top 150 games in a year across nine platforms and all rating levels, and weighted by each title's popularity, shows that the video game industry does no better than television in representing American society.

In some cases, video games do worse, said study leader Dmitri Williams, a social psychologist and assistant professor at the USC Annenberg School for Communication.

In his study, Williams cited research showing Latinos are making modest gains on television. By contrast, fewer than 3 percent of video game characters were recognizably Hispanic, and all of them were non-playable, background characters. Imagine if no Latino on television had a speaking part.

"Latino children play more video games than white children. And they're really not able to play themselves," Williams said. "For identity formation, that's a problem. And for generating interest in technology, it may place underrepresented groups behind the curve.

"Ironically, they may even be less likely to become game makers themselves, helping to perpetuate the cycle. Many have suggested that games function as crucial gatekeepers for interest in science, technology, engineering and math."

Women, Native Americans, children and the elderly also were underrepresented. For example, only 10 percent of playable characters surveyed were female, though women now make up 40 percent of video game players.

African-Americans appeared in proportion to their numbers in the real world, but mainly in sports games and in titles that reinforce stereotypes, such as 50 Cent Bulletproof.

Males, whites and adults were overrepresented.

Williams noted that some newer games give players more options for customizing their characters. Those games were included in the survey, with characters chosen randomly.

The fact that random selection did not have a major impact on the results suggests that when players have a choice, their range of options is limited.

The study itself was limited in two important ways. Many games feature non-human characters, and many are first-person games where the player never sees himself or herself. The study only included visible characters that were clearly human.

Still, the breadth of the census and the growing popularity of video games make the findings especially relevant. Total video game revenues now exceed box office and video rental receipts, Williams noted.

"In television, it was always a landmark moment when some minority or disenfranchised group appeared on the screen for the first time," Williams said.

"That kind of visibility is really the first step toward leading to public consciousness and equal treatment. These cultural markers matter."

In their study, the authors discuss possible reasons for their findings. But Williams cautioned against jumping to conclusions. "The characters the developers put in the games do not match the real world," he said. "Our thoughts about why are all informed guesses."

He did have a word of advice for game developers.

"These are highly underserved groups. It's a missed sales opportunity." ###

The study, titled "The virtual census: representations of gender, race and age in video games," is available online in the August issue of the journal New Media & Society, at nms.sagepub.com/content/vol11/

For more discussion about the study, see Williams' blog post at terranova.blogs.com/terra_nova/

The survey covered the majority of titles sold in the 12-month period between March 2005 and February 2006 across console, handheld, PC and online platforms.

Williams' co-authors were Nicole Martins of Indiana University, Mia Consalvo of Ohio State University and James Ivory of Virginia Polytechnic Institute and State University.

Williams received funding for the survey from the University of Illinois at Urbana-Champaign, where he started the research before moving to USC.

Working at the intersection of sociology, psychology, communication and new technology, Williams studies large-scale game worlds for insights about human behavior that might be difficult to obtain in the real world.

Contact: Carl Marziali marziali@usc.edu 213-740-4751 University of Southern California

Box art for "50 Cent: Bulletproof" PS2 version. Fair use in 50 Cent: Bulletproof

Though this image is subject to copyright, I feel its use is covered by the U.S. fair use laws because:

1. Vivendi Universal has released no such images into the public domain, and a replacement image could not be created that would adequately provide the same information.
2. The image is being used for no purpose other than to identify the subject of the article.
3. The image resolution has been significantly decreased from the original, so copies made from it would be of inferior quality.
4. The use of this image neither detracts from the game nor inhibits its salability in any way.

Low prevalence of HPV infection may be tied to poor prognosis for blacks with head and neck cancer

Ground breaking study seeks to explain major disparity in survival between blacks and whites

Researchers at the University of Maryland Marlene and Stewart Greenebaum Cancer have found that head and neck cancer patients who test positive for the human papillomavirus (HPV) have much better survival rates than patients who don't have the virus, according to a new study in the journal Cancer Prevention Research. The researchers also discovered that blacks in the study had a very low rate of HPV infection, and consequently worse survival, which may explain why African-American patients traditionally have had a poor prognosis for head and neck cancer.

"For the first time, we have evidence that the major difference in survival between black and white patients with head and neck cancer appears to be the rate of HPV infection.

Kevin J. Cullen, M.D. Director, University of Maryland Greenebaum Cancer Center Professor of Medicine.

We found an astounding difference in prognosis between patients who are HPV-positive and those who are HPV-negative," says the study's senior author, Kevin J. Cullen, M.D., director of the University of Maryland Marlene and Stewart Greenebaum Cancer Center and professor of medicine at the University of Maryland School of Medicine.

Scott Lippman, M.D., chairman of the Department of Clinical Cancer Prevention at the University of Texas M.D. Anderson Cancer Center, called the study, "practice-changing."

"Squamous cell carcinoma of the head and neck is one of the fastest growing cancers, and this study gives us a new way to assess prognosis for our patients," says Dr. Lippman, who is editor-in-chief of Cancer Prevention Research, which is published by the American Association for Cancer Research.

Dr. Cullen adds, "We need to analyze HPV routinely in specific patients with head and neck cancer, which we're currently not doing. HPV-positive cancer is biologically a very different disease than HPV-negative cancer, and we need to take that into account as we're planning future therapies. Those with HPV-negative disease may not be as well served with our current treatments combining chemotherapy and radiation."

The human papillomavirus is known to cause certain types of cancer and is a major risk factor for head and neck cancer, so researchers were surprised to find that patients with HPV infection had a better prognosis.

Only 4 percent of black patients with squamous cell carcinoma in the study were HPV-positive, compared with 34 percent of white patients. The median overall survival was more than three-fold higher for whites (70.6 months) than for blacks (20.9 months) who were treated with chemotherapy and radiation. Dr. Cullen says the survival rate at five years for HPV-positive patients was about 85 percent, compared to 35 percent for HPV-negative patients. Survival was similar for HPV-negative patients, regardless of race. The study's findings confirm that HPV infection relates specifically to a type of head and neck cancer -- cancer of the oropharynx, which include the tonsils, soft palate and base of the tongue.

Dr. Cullen says, "There is currently no consensus on why blacks fare worse with squamous cell carcinoma of the head and neck than whites, but our findings provide the first clue that a critical reason may be biologic rather than related to issues of access to care, lack of insurance or attitudes of health care providers."

"Many researchers at the University of Maryland School of Medicine are conducting important studies relating to racial disparities in diagnosis and treatment. This groundbreaking study will have a significant impact on how doctors care for patients with head and neck cancer," says E. Albert Reece, M.D., Ph.D., M.B.A., vice president for medical affairs at the University of Maryland and dean of the University of Maryland School of Medicine.

Cancer experts believe that head and neck cancer, particularly oropharyngeal cancer, is on the rise because of an increase in HPV infection in the oral cavity. Overall, about 25 percent of head and neck cancers are tied to HPV infection, Dr. Cullen says. In comparison, HPV causes virtually 100 percent of cervical cancers, and a vaccine has been developed to help prevent this type of cancer by preventing HPV infection.

Researchers don't yet understand why blacks have a lower rate of HPV infection in head and neck cancers than whites, Dr. Cullen says. There is some evidence that HPV transmission associated with oral cancer may be related to sexual practices, but he says there are probably a number of other factors involved, including possible differences in immunity and how the virus can become integrated into the cell's DNA "that now we just don't understand."

In the study, researchers analyzed data from about 200 patients who had been treated at the Greenebaum Cancer Center and then evaluated another group of 230 patients treated as part of a multi-center clinical trial.

The study was funded in part by the Maryland Cigarette Restitution Fund Program, which uses money from a legal settlement with big tobacco companies for cancer research and cancer screening, education and prevention programs in Maryland. "This is really a wonderful example of how CRF-supported research can benefit Marylanders and all people who are battling cancer," Dr. Cullen says. "We are very committed to helping the Cigarette Restitution Fund fulfill its mission of erasing racial disparities in diagnosis and care." ###

The research was also funded by grants from sanofi-aventis U.S. and the Orokawa Foundation.

The University of Maryland Marlene and Stewart Greenebaum Cancer Center is a National Cancer Institute-designated cancer center. It offers a full range of treatments for all types of cancer and has a very active cancer research program. To learn more, go to www.umgcc.org.

Contact: Karen Warmkessel kwarmkessel@umm.edu 410-328-8919 University of Maryland Medical Center

Study shows simple writing assignment improves minority student grades

In a follow-up to a 2006 study, a University of Colorado at Boulder researcher and his colleagues found that an in-class writing assignment designed to reinforce students' sense of identity and personal integrity increased the grade-point averages of African-American middle school students over a two-year period, and reduced the rate at which these students were held back or placed in remediation.

The results suggest that targeted psychological interventions on a wider scale could help narrow the racial achievement gap among U.S. students, one of the most pressing and persistent domestic issues in our country, according to Associate Professor Geoffrey Cohen of CU-Boulder's psychology department and his fellow principal investigators Julio Garcia and Valerie Purdie-Vaughns of Columbia University.

The follow-up study appeared in the April 16 issue of the journal Science. Nancy Apfel and Patricia Brzustoski of Yale University were co-authors on the study.

Geoffrey Cohen is an Associate Professor of Social Psychology at the University of Colorado in Boulder. Much of his research concerns the processes of self-evaluation and identity maintenance. One area of research addresses the effects on achievement motivation of individuals' group memberships, with a focus on the role of social stereotypes in shaping intellectual identity and performance. A second research area links resistance to probative information, and intransigence in negotiation and social conflict, to concerns of identity maintenance. Additional research questions concern manifestations of discrimination in meritocracies, the impact of negative stereotypes about outgroups, attitude formation and change, and the psychology of closed-mindedness.

"In our original study we uncovered evidence that this self-affirming intervention improved the performance of African-Americans in a single academic term," Cohen said. "Now we have evidence that its effects persist over the two years of children's tenure in middle school." The study also suggests that "intervening" early in students' middle school years can have long-lasting benefits by undermining a recurring cycle of increasingly poor performance in school. Over the two years of the 2006-08 study, the grade-point average of African-Americans was, on average, raised by .24 grade points. Low-achieving African Americans benefited most from the intervention, with their GPAs increasing by an average of .41 points on a four-point scale. The assignment had no impact on white students' grades.

"Our intervention is based on the idea that ethnic minority students experience, on average, higher levels of stress in the classroom because they are concerned that if they perform poorly on a test or in a class this will confirm, in the eyes of others, the negative stereotype about their group's intelligence ability," Cohen said.

Past research has found that school settings in general are stressful to many students regardless of race. However, many African-American students may experience chronic stress in school stemming from negative stereotypes portraying them as less intelligent than their peers, according to Cohen. This in turn leads to decreased academic performance.

The study involved three experiments in which seventh graders from middle-class and lower middle-class families were given a series of structured writing assignments throughout the year. They were asked to choose one or two values that were important to them and then write about why they cherished the values. A control group was asked to write about values that others might hold or other neutral topics. A total of 416 students participated, divided in roughly equal numbers by race.

"This exercise, called a self-affirmation, allows a student to reaffirm that he or she is a good and competent person," Cohen said. "This helps reduce stress by allowing the student to think about all the things that matter to them, for example their family or their religion. It makes the possibility of failure less dire."

The study also suggests that how students perform during the school year is strongly correlated to how they perform during the first few weeks of that year. If a student starts off the year feeling more stress due to negative stereotypes, and then performs poorly during the first few weeks of school, this can establish a downward cycle of increasing stress and poor performance that is hard to break, said Cohen.

"Our study shows that early intervention seems to interrupt this downward trend in academic performance," he said.

Cohen and his co-authors also measured the students' sense of success at the beginning of the school year and again at the end. They found that for low-performing African-American students there is a drop in their sense of adequacy in school over the course of the school year, but for students who participated in the exercise, and for white students, their sense of success remained constant over time.

"This suggests that early failure can have a disproportionate effect on the negatively stereotyped group," Cohen said. "The first few weeks of middle school can have a negative effect on a child's self-concept that seems surprisingly persistent. We found that if you can buffer people against this you can potentially have long-term benefits."

Cohen said he plans to continue studying similar psychological interventions on other groups of students to see if similar positive results can be generated and to zero in on the mechanisms underlying these effects.

"In a society where economic success depends heavily on scholastic achievement, even a slight narrowing of the achievement gap would be consequential," Cohen said. "This is especially true for low-achieving students, given the societal, institutional and personal costs of academic failure." ###

Contact: Geoffrey Cohen geoffrey.cohen@colorado.edu 303-492-5105 University of Colorado at Boulder

Why are African-Americans less likely to survive certain cancers?

It's not due soley to poverty or inferior health care, study finds

MAYWOOD, Il. - African Americans are more likely than other races to die from breast, prostate and ovarian cancers, but this disparity is not due to poverty or inferior healthcare, a first-of-its-kind study has found.

Researchers followed more than 19,000 patients who were enrolled in cancer clinical trials conducted by the Southwest Oncology Group, a National Cancer Institute-funded clinical trials national cooperative. Patients of all races received the same advanced treatments by the same doctors.

"It was a level playing field for everyone, with the same quality care," said lead author Dr. Kathy Albain. "So our findings cast doubt on a prevailing theory that African Americans have lower cancer survival rates because of poverty, poor access to quality care or other socioeconomic factors." Albain is a breast and lung cancer specialist at Loyola University Health System's Cardinal Bernardin Cancer Center.

If poverty or other socioeconomic factors were to blame, then the survival gap should exist for all cancers.

But the study, published in the Journal of the National Cancer Institute, found there was no statistically significant association between race and survival for lung and colon cancers, leukemia, lymphoma or myeloma.

"The good news for African Americans is that for most common cancers, they have the same survival rates as all other races," Albain said.

The cancers that did show survival gaps -- breast, prostate and ovarian -- are gender-related. The findings therefore suggest that the survival gap is due to a complex interaction of biologic factors in the tumor and inherited variations in common genes that control metabolism of drugs and hormones, Albain said. People with different patterns of these genes metabolize cancer drugs and their own hormones differently, and experience different side effects.

"We are actively conducting new research based on these findings to explore interactions among tumor biology, treatment, sex, race, inherited genes and survival," Albain said.

Dr. Patrick Stiff, director of the Cardinal Bernardin Cancer Center, said: "This groundbreaking study will provide investigators with a road map for future research that will improve outcomes of patients of all races and socioeconomic status."

Researchers identified 19,457 adult cancer patients enrolled in 35 Southwest Oncology Group clinical trials who were followed for at least 10 years after treatment. Twelve percent of the patients were African American. During the course of the study, African Americans were 49 percent more likely than other races to die from early-stage, postmenopausal breast cancer; 41 percent more likely to die from early stage, premenopausal breast cancer; 61 percent more likely to die from advanced-stage ovarian cancer and 21 percent more likely to die from advanced-stage prostate cancer. ###

Albain is a professor in the Department of Medicine, Division of Hematology/Oncology, Loyola University Chicago Stritch School of Medicine. Her co-authors are Joseph Unger and John Crowley of the Southwest Oncology Group Statistical Center, Dr.Charles Coltman of the University of Texas Health Science Center and Dr. Dawn Hershman of Columbia University College of Physicians and Surgeons.

The study was funded by the National Cancer Institute.

Based in the western suburbs of Chicago, Loyola University Health System is a quaternary care system with a 61-acre main medical center campus, the 36-acre Gottlieb Memorial Hospital campus and 28 primary and specialty care facilities in Cook, Will and DuPage counties. The medical center campus is conveniently located in Maywood, 13 miles west of the Chicago Loop and 8 miles east of Oak Brook, Ill. The heart of the medical center campus, Loyola University Hospital, is a 561-licensed bed facility. It houses a Level 1 Trauma Center, a Burn Center and the Ronald McDonald® Children's Hospital of Loyola University Medical Center. Also on campus are the Cardinal Bernardin Cancer Center, Loyola Outpatient Center, Center for Heart & Vascular Medicine and Loyola Oral Health Center as well as the LUC Stritch School of Medicine, the LUC Marcella Niehoff School of Nursing and the Loyola Center for Fitness. Loyola's Gottlieb campus in Melrose Park includes the 264-bed community hospital, the Gottlieb Center for Fitness and the Marjorie G. Weinberg Cancer Care Center.

Contact: Jim Ritter jritter@lumc.edu 708-216-2445 Loyola University Health System

Physician trust, early screening reduces disparities for prostate cancer

Men who have a regular, ongoing relationship with a health care provider are more likely to receive prostate cancer screening and less likely to be diagnosed with advanced prostate cancer, regardless of their race, according to a University of North Carolina study published in the current issue of the journal Cancer.

The study compared the experiences of black and white men over age 50 and newly diagnosed with prostate cancer in North Carolina and Louisiana. The goal was to find underlying reasons why African-American men have a higher incidence of prostate cancer and a higher rate of death from the disease than their white counterparts.

"We found that Caucasian (white) men tended to be seen regularly by the same physician, which appears to be associated with greater trust in their doctors and in physicians in general," said study author William R. Carpenter, Ph.D., research assistant professor of health policy and management in the UNC Gillings School of Global Public Health and a member of UNC Lineberger Comprehensive Cancer Center. "They were also more likely than their African-American counterparts to get regular prostate cancer screenings, and to get all their medical care at a physician's office."

William R. Carpenter, PhD. Research Assistant Professor Health Policy and Management

The study enrolled 1,031 black and white men, age 50 and older, within weeks of their prostate cancer diagnosis. A study nurse conducted a structured survey and acquired biological specimens in a home visit and obtained other medical information from each patient's medical records. In this study, the stage of prostate cancer at diagnosis was similar between races, but the mean Gleason scores, an indication of the aggressiveness of the disease, were higher for blacks than for whites.

Blacks were less likely than whites to report participation in prostate cancer screening prior to diagnosis. Men without a prior history of screening were more likely to be diagnosed with advanced disease and/or more aggressive forms of prostate cancer. However, when men of either race had established relationships with a health care provider, the differences in prostate cancer stage at diagnosis went away.

"This evidence leads us to think that encouraging African-Americans to establish an ongoing relationship with a regular care provider may encourage more appropriate use of prostate cancer screening, and thus reduce racial disparities in prostate cancer diagnosis and treatment, which, by extension, may reduce disparities in prostate cancer deaths," Carpenter said.

James Mohler, M.D., chair of the department of urology at Roswell Park Cancer Institute in Buffalo, N.Y., and principal investigator of the study, said, "The goal of the study was to gain a deeper understanding of the role of racial disparities in prostate cancer outcomes. These findings suggest that differences in screening result from inconsistent or poorer quality interaction between an African-American man and the American health care system. If the interaction is poor, the care giver may not 'get around' to discussing or offering preventive health care, such as prostate cancer screening. Improving the interaction between all men, and especially African-American men, and their primary care givers should reduce prostate cancer deaths in all men and decrease the racial disparity in prostate deaths in African-American men." Mohler is a member of UNC Lineberger Comprehensive Cancer Center.

Carpenter added, "Factors in health care systems, including setting and continuity of care, may hinder the development of physician-patient relationships, and possibly preclude discussions beyond the immediate medical issue at hand, including discussions of preventive health and preferences in use of early detection. These factors and relationships can influence whether there are discussions beyond the immediate medical issue at hand, including discussions of preventive health and preferences in use of health care services such as prostate cancer screening." ###

Other UNC authors include Paul Godley, M.D., Jeannette Bensen, Ph.D., Merle Mishel, Ph.D., and Timothy Finnegan, M.D. Other authors include the study's co-principal investigator, Elizabeth Fontham, Ph.D., from the Louisiana State University Health Science Center in New Orleans.

The research was supported by the U.S. Department of Defense and the National Cancer Institute.

Contact: Dianne Shaw dgs@med.unc.edu 919-966-5905 University of North Carolina School of Medicine

Researchers uncover genetic variants linked to blood pressure in African-Americans

Findings may point to new avenues for treatment, prevention

A team led by researchers from the National Institutes of Health today reported the discovery of five genetic variants related to blood pressure in African-Americans, findings that may provide new clues to treating and preventing hypertension. The effort marks the first time that a relatively new research approach, called a genome-wide association study, has focused on blood pressure and hypertension in an African-American population.

Hypertension, or chronic high blood pressure, underlies an array of life-threatening conditions, including heart disease, stroke and kidney disease. Diet, physical activity and obesity all contribute to risk of hypertension, but researchers also think genetics plays an important role.

Eric D. Green, M.D., Ph.D. Caption: Dr. Eric D. Green, Scientific Director, Division of Intramural Research, NHGRI. Credit: Maggie Bartlett, NHGRI Date Created: November 12, 2002

About one-third of U.S. adults suffer from hypertension. The burden is considerably greater in the African-American community, in which the condition affects 39 percent of men and 43 percent of women. "This work underscores the value of using genomic tools to untangle the complex genetic factors that influence the risk for hypertension and other common diseases," said Eric Green, M.D., Ph.D., scientific director for the National Human Genome Research Institute (NHGRI), part of NIH. "We hope these findings eventually will translate into better ways of helping the millions of African-Americans at risk for hypertension, as well as improved treatment options for other populations."

In addition to NHGRI researchers, scientists from the Coriell Institute for Medical Research in Camden, N.J.; Boston University; and Howard University, in Washington, D.C., collaborated on the study, which was published in the July 17 online issue of PLoS Genetics.

To produce their findings, researchers analyzed DNA samples from 1,017 participants in the Howard University Family Study, a multigenerational study of families from the Washington, D.C., metropolitan area who identified themselves as African-American. Half of the volunteers had hypertension and half did not. To see if there were any genetic differences between the two groups, researchers scanned the volunteers' DNA, or genomes, analyzing more than 800,000 genetic markers called single-nucleotide polymorphisms (SNPs).

The researchers found five genetic variants significantly more often in people with hypertension than in those without the condition. The variants were associated with high systolic blood pressure, but not with diastolic blood pressure or combined systolic/diastolic blood pressure.

Blood pressure is measured in millimeters of mercury (mm Hg), and expressed with two numbers; for example, 120/80 mm Hg. The first number (systolic pressure) is the pressure when the heart beats while pumping blood. The second number (diastolic pressure) is the pressure in large arteries when the heart is at rest between beats.

"This is the first genome-wide association study for hypertension and blood pressure solely focused on a population with majority African ancestry," said the study's senior author, Charles Rotimi, Ph.D., NHGRI senior investigator and director of the trans-NIH Center for Research on Genomics and Global Health (CRGGH). "Although the effect of each individual genetic variant was modest, our findings extend the scope of what is known generally about the genetics of human hypertension."

In a genome-wide association study, researchers identify strategically selected markers of genetic variation. If disease status differs for individuals with certain genetic variants, this indicates that something in that chromosomal neighborhood likely influences the disease. Variants detected using this approach can accurately point to the region of the genome involved, but may not themselves directly influence the trait.

In May, two major international studies used the genome-wide association approach to identify 13 genetic variants associated with blood pressure and hypertension in people with primarily European and South Asian ancestry. While each variant was associated with only a slight increase in blood pressure, that work found that the more variants an individual had, the greater his or her risk of hypertension. Two genes identified by one of those studies were also associated with blood pressure in the new study.

In their pioneering study of African-Americans, Dr. Rotimi and his colleagues found that all of the five genetic variants associated with blood pressure were located in or near genes that code for proteins thought to be biologically important in hypertension and blood pressure. Previous research had implicated two of those genes in blood pressure regulation, and additional analyses by Dr. Rotimi's group revealed that all of the variants are likely involved in biological pathways and networks related to blood pressure and hypertension.

An existing class of anti-hypertension drugs, called calcium channel blockers, already targets one of the genes, CACNA1H. However, the additional genes may point to new avenues for treatment and prevention.

To follow up and expand upon their findings in African-Americans, the researchers scanned DNA from 980 West Africans with and without hypertension. The work confirmed that some of the genetic variants detected in African-Americans were also associated with blood pressure in West Africans. "The Western African population is of particular significance since it is the ancestral population of many African-Americans," said lead author Adebowale Adeyemo, M.D., CRGGH staff scientist. ###

This study was supported by the NHGRI, CRGGH, and the National Institute of General Medical Sciences, all part of NIH; and by a W.W. Smith Foundation grant to the Coriell Institute. The Howard University General Clinical Research Center carried out the enrollment of study participants.

For more information about hypertension, visit www.nhlbi.nih.gov/health/.

To learn more about the genome-wide association approach, visit www.genome.gov/.

NHGRI is one of the 27 institutes and centers at the NIH, an agency of the Department of Health and Human Services. The NHGRI Division of Intramural Research develops and implements technology to understand, diagnose and treat genomic and genetic diseases. Additional information about NHGRI can be found at its Web site, www.genome.gov.

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

Contact: Raymond MacDougall macdougallr@mail.nih.gov 301-402-0911 NIH/National Human Genome Research Institute

'Go to the doctor? Only if I'm really sick...'

Black men's notion of masculinity leads to avoidance of health-related behaviors

African American men could be putting their health at risk by avoiding disease screening, in the belief that the results might threaten their masculinity. Because they prove their masculinity through their sexuality and sexual performance, seeking medical advice including HIV/AIDS testing goes against their notion of masculinity. Waverly Duck, a Post Doctoral Associate from the Department of Sociology at Yale University in the US, argues that current leading theories of gender and masculinity and health behavior models are not relevant enough to African American men and their distinctive notion of masculinity. His results (1) are published online in Springer's Journal of African American Studies.

Waverly Duck

Duck studied how African American men conceptualize masculinity and how it relates to their health behaviors. Through a combination of focus groups and in-depth interviews, he asked African American men about their own understanding of their gender identity and examined how that identity, as well as how it is achieved and maintained, relates to their health. The study found that being sexually active is an important component of African American men's notion of masculinity.

Two-thirds of the participants described masculinity based on patriarchy, heterosexuality, subordination of others, economic security and physical dominance – also known as hegemonic masculinity – as the standard. However, when they are economically marginalized, sexuality and sexual performance become the means by which they prove their masculinity. Health seeking behaviors, including going to the doctor and HIV/AIDS testing, go against their notion of masculinity by potentially interfering with the freedom of their sexual activities. However, they considered it acceptable to get screened for health conditions they perceived as curable, if the cure allowed them to resume normal sexual relations.

Dr. Waverly Duck's work challenges conventional approaches to black masculinity and attempts to lay the foundation for a more nuanced way of looking at it. He argues that a new health behavior model for Black men should be developed - one that explores the link between their history and how it affects health promoting and health avoidance behaviors.

He concludes: "If men use avoiding going to the doctor to exhibit masculinity, then new strategies of health intervention should be promoted to this population. Voluntary health screening procedures for conditions such as prostate cancer, heart disease and HIV/AIDS tests should be available and conducted in hospital emergency rooms, settings where African American men frequently have contact with the medical profession." ###

Reference
1. Duck W (2009). Black male sexual politics: avoidance of HIV/AIDS testing as a masculine health practice. Journal of African American Studies DOI 10.1007/s12111-009-9097-2

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

New book explores post-emancipation education of blacks in Mississippi

CHAMPAIGN, Ill. – In the years immediately following the Civil War, the question of education for newly emancipated slaves in Mississippi centered on whether schools should seek to educate blacks as citizens or train them as subsistence laborers. While many whites favored the laborer option, those who had been freed wanted schools established by and for themselves as a means of achieving independence, equality and political empowerment – in essence, full citizenship, says Christopher M. Span, a professor of educational policy studies at the University of Illinois.

The story of the politics and policies of public education for newly freed slaves in post-bellum Mississippi is the subject of Span's new book, "From Cotton Field to Schoolhouse: African American Education in Mississippi, 1862-1875" (The University of North Carolina Press).

Caption: Christopher M. Span, a professor of educational policy studies at Illinois, has written a new book, "From Cotton Field to Schoolhouse: African-American Education in Missisippi, 1862-1875," that explores the question of education for newly emancipated slaves in post-bellum Mississippi. Credit: L. Brian Stauffer. Usage Restrictions: None.

Other books have traced the challenges of education in the South during the Reconstruction Era, but Span's book appears to be the first significant piece of contemporary scholarship to tell the story of the public education of formerly enslaved black Mississippians. "I wanted to know what value knowledge and literacy had in the slave community, and how people who were once enslaved became literate," Span said. "I always knew that African-Americans valued education, even though that runs counter to popular consensus."

"There's an idea today that African-Americans devalue school," he said. "But if you look at the historical record, you would see it's anything but that."

Even though they lived in a country that had sanctioned their slavery and bondage for generations, Span said newly free black Mississippians still had "a fundamental belief in all of the things that makes America so great."

"Freedpeople were willing to risk their own lives to ensure that, if they couldn't have it – whether it's democracy, schooling, equality or land ownership – their children could."

In fact, the children of former slaves in Mississippi were going to school in record numbers. But despite the explosion of educational opportunities for blacks in the state, the type of schools they were attending didn't match with what they thought formal schooling would do for them – namely, become full-fledged citizens of society.

"The schools barely went beyond the elementary grades, and there were very few secondary schooling opportunities for them," Span said. "They may have had an opportunity to get, at best, what we would think of today as an eighth grade education. An overwhelming number of schools educated them to have a rudimentary understanding of literacy and mathematics and numeracy, but not very much beyond that. And there were very few opportunities for them to advance their education once they left school."

Although the newly freed made heroic efforts to get the most out of their educational opportunities, schooling was most often used to redirect their ambitions.

"Should freedpeople be educated as a full-fledged citizen or as a cheap source of labor? – that was the big question during that time," Span said. "You had northerners who would go south convinced that freedpeople needed help in their transition from slave to free. And then you had southern whites, particularly those in Mississippi, who thought that if anything they should be taught how to be laborers, and should continue to labor the land for those who enslaved them prior to the Civil War. And then you had the freedpeople themselves, who really desired to be equals."

"That's really how you began to see how those ideological strands play out in the schools and the type of curriculum and opportunity African-American school children would receive," Span said.

The pedagogy played out the way Mississippi's political economy existed before the Civil War – around the cotton cycle, and around the demand for having a steady, cheap and near-permanent labor force to work the fields.

But that ran contrary to what former slaves wanted in Mississippi, Span said.

"If they envisioned working the lands, it would be lands they owned and possessed themselves, and not for someone else's profit," he said.

Span said Mississippi was an interesting case study for black education in the South because it could be thought of as ground zero for the recalcitrance of ruling-class southern whites during Reconstruction.

"What happened was a significant minority of whites in Mississippi who would go to great lengths to ensure that the state was for whites only," Span said. "And you would see an equal number of African-Americans who wanted to be equals at the table. It wasn't just a call for equality for people who had been enslaved, it really was a call for equality for everybody, regardless of race, class or previous condition of servitude. It was really a call for universal access to education for everyone, including poor, dispossessed whites."

The history from that period of time reflects on the present in that "we should never doubt one's thirst for knowledge and education," Span said.

"Those values haven't been lost in the African-American community. I just think the most sensational acts and aspects of culture seem to have taken precedence over the things that are still at the foundation of ordinary, everyday people who live out their lives and attempt to do the best they can, and want to see something better for their children the next day. The quest for knowledge and for schools and for one to have something better is still there." ###

Contact: Phil Ciciora pciciora@illinois.edu 217-333-2177 University of Illinois at Urbana-Champaign

No race disparities in risk of AIDS and death in HIV patients in Kaiser Permanente system

Surprising trend toward better outcomes for Hispanics

OAKLAND, Calif., July 20, 2009 – Kaiser Permanente researchers found no disparities by race or ethnicity in risk of AIDS and death among HIV-infected patients in a setting of similar access to care. This is despite lower Anti-Retroviral Therapy adherence among Hispanics and African-Americans compared to whites. Researchers also saw a trend toward better outcomes for Hispanics.

The study, which appears online in The Journal of General Internal Medicine, is one of the largest to date to evaluate racial and ethnic differences in clinical outcomes among HIV-infected patients.

Michael J. Silverberg, PhD, MPH, has been a research scientist at the Division of Research (DOR), Kaiser Permanente Northern California since 2004. He received his doctorate in epidemiology from the Johns Hopkins University, Bloomberg School of Public Health in 2001; and his masters in public health in epidemiology from the School of Public Health, University of California, Los Angeles in 1999.

"When it comes to HIV among Kaiser Permanente members, it appears that access to care is the key to eliminating racial and ethnic disparities," said the study's lead author Michael Silverberg, a researcher at the Kaiser Permanente Division of Research. He explained that equal access may likely improve prevention and also encourage early treatment. Kaiser Permanente is the largest private provider of HIV care in the United States. Dr. Silverberg said that certain aspects of Kaiser Permanente care may reduce differences in outcomes among racial/ethnic groups in that most patients have medical insurance coverage and their HIV care is guided by the principles of integrated, chronic condition management and multi-disciplinary HIV specialty care. Another advantage of this setting is Kaiser Permanente's large HIV registry, which has historical data on more than 17,000 patients, including a substantial number of racial/ethnic minorities. This study is among the first to include a large number of Hispanic patients and comprehensively account for other factors -- such as socioeconomic status, HIV disease stage and ART adherence -- that may contribute to racial/ethnic disparities, according to the investigators.

Hispanics had a statistically significant 34 percent survival benefit compared with whites and a 42 percent survival benefit compared with blacks. However, no statistically significant differences for racial/ethnic groups were observed after adjustment for demographics, socioeconomic status and clinical factors.

The study was a retrospective observational cohort study from 1996 to 2005 in Kaiser Permanente, an integrated delivery system with more than 3 million members in Northern California. Researchers studied 3,106 whites, 919 Blacks and 661 Hispanics infected with HIV and looked at differences in ART adherence, new AIDS events and all-cause mortality.

"This observation of reduced mortality in HIV-infected Hispanics is somewhat surprising giving the observed lower adherence rates, reduced immunological responses and lower census-based socioeconomic status compared to whites," said Silverberg. Hispanics had particularly low numbers of cardiovascular and cancer-related deaths. He explained that this phenomenon, also called the Hispanic Paradox, may occur because of differences in diet, genetics and extended family support.

This study is part of Kaiser Permanente's larger ongoing work to end health disparities by providing equitable access and care to its 8.6 million members, by targeting resources to areas in need in communities across the United States, by investing in disparities research, and by implementing strategies that support equity in health nationwide, including universal health coverage. ###

Additional investigators on the study include Wendy Leyden, MPH, Charles P. Quesenberry, Jr., Ph.D., and Michael A. Horberg, MD, MAS, all affiliated with the Kaiser Permanente Division of Research in Oakland, Calif. The research was funded by a Community Benefit grant from Kaiser Permanente Northern California, and a career development award from the National Institute for Allergy and Infectious Diseases, part of the National Institutes of Health.

About the Kaiser Permanente Division of Research (http://www.dor.kaiser.org/)

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.

About Kaiser Permanente

Kaiser Permanente is committed to helping shape the future of health care. We are recognized as one of America's leading health care providers and not-for-profit health plans. Founded in 1945, our mission is to provide high-quality, affordable health care services to improve the health of our members and the communities we serve. We currently serve 8.6 million members in nine states and the District of Columbia. Care for members and patients is focused on their total health and guided by their personal physicians, specialists and team of caregivers.

Our expert and caring medical teams are empowered and supported by industry-leading technology advances and tools for health promotion, disease prevention, state-of-the art care delivery and world-class chronic disease management. Kaiser Permanente is dedicated to care innovations, clinical research, health education and the support of community health. For more information, go: www.kp.org/newscenter.

Contact: Emily Schwartz eschwartz@golinharris.com 415-274-7926 Golin/Harris International