African-Americans with colorectal cancer have poorer outcomes, lower survival rates

New study in Journal of the American College of Surgeons finds racial disparities in screening and treatment for several cancers

CHICAGO (November 12, 2009) – New research published in the November issue of the Journal of the American College of Surgeons shows that African-American patients with colorectal cancer are more likely to be diagnosed with advanced disease and are less likely to undergo surgical procedures compared with Caucasians, suggesting that improvements in screening and rates of operation may reduce differences in colorectal cancer outcomes for African-Americans.

Racial disparities previously have been demonstrated in numerous studies for a number of cancers, typically due to unequal access to care. As a result, the identification and elimination of these disparities has become a national public health priority.

Timothy Louis Fitzgerald, MD, FACS, Associate Professor.

"Colorectal cancer is the only gastrointestinal cancer that is routinely screened for and can be effectively treated, yet African-Americans still have a profoundly lower survival rate than Caucasians," said Timothy L. Fitzgerald, MD, FACS, associate professor, department of surgery, division of surgical oncology, East Carolina University in Greenville, NC. "Our analysis suggests that these disparities may be attributable to a lack of access to or use of care. It is imperative that screening and treatment are delivered equally to all patients."

East Carolina researchers used four years of population-based Medicare and Medicaid administrative claims merged with the Michigan Tumor Registry and identified data for 18,260 patients (≥66 years) with colorectal (n=13,001; 11.31 percent African-American), pancreatic (n=2,427; 14.38 percent African-American), gastric (n=1,739; 17.49 percent African-American) and esophageal (n=1,093; 13.50 percent African-American) cancer. Key data used in the analysis included likelihood of late-stage diagnosis, likelihood of surgical treatment after diagnosis, and survival.

In evaluating an unadjusted analyses, researchers discovered that African-American patients with colorectal cancer were more likely to present with metastatic disease (23.17 percent versus 14.75 percent Caucasians; p(0.05) and less likely to undergo operations (71.25 percent versus 79.05 percent; p(0.05), regardless of socioeconomic factors. This finding was the case even when the analysis was confined to patients with localized, surgically treatable diseases.

The median survival of African-Americans with colorectal cancer (39 months versus 56 months) and esophageal cancer (5 months versus 9 months) in the study was significantly less than that for Caucasians (p ( 0.05). Survival was similarly poor for pancreatic and gastric cancer patients regardless of race.

In conducting a multivariate analysis, the research team found that African-American patients had a higher likelihood of dying from colorectal cancer than Caucasian patients did. However, this difference did not persist when adjustments were made for disease stage and presence or absence of a surgical procedure (hazard ratio = 1.15, 95% CI = 1.06 – 1.24). There was no association between survival and race for patients with esophagus, gastric or pancreatic cancer. Other variables of interest and statistical significance were median household income below $35,000, a dual eligibility insurance status and older age, all of which were negatively associated with colorectal cancer survival. ###

About the American College of Surgeons

The American College of Surgeons is a scientific and educational organization of surgeons that was founded in 1913 to raise the standards of surgical practice and to improve the care of the surgical patient. The College is dedicated to the ethical and competent practice of surgery. Its achievements have significantly influenced the course of scientific surgery in America and have established it as an important advocate for all surgical patients. The College has more than 77,000 members and is the largest organization of surgeons in the world. For more information, visit www.facs.org.

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

Physician bias might keep life-saving transplants from black and Hispanic patients

(Washington, DC) Physician bias might be the reason why African Americans are not receiving kidney/pancreas transplants at the same rate as similar patients in other racial groups. Dr. Keith Melancon, director of kidney and pancreas transplantation at Georgetown University Hospital and associate professor of surgery at Georgetown University Medical Center, and colleagues explore this phenomenon in the November issue of the American Journal of Transplantation.

Medicare coverage for people needing a simultaneous kidney/pancreas transplant has increased in the past decade. In July 1999 Medicare made the changes as a conscious effort by the government intended to address racial and economic disparities that existed. But increased Medicare dollars have not translated into more access for African Americans or Hispanics.

J. Keith Melancon, M.D.

"Our research raised the possibility of racial bias on the part of physicians who might incorrectly assume that African Americans are type 2 diabetics when in fact, they would metabolically meet the criteria for type 1 diabetes," said Dr. Melancon. "Since this is a transplant that is most often performed in type 1 diabetics, their doctors might not even raise the possibility with their black patients. Also, health care providers might incorrectly predict worse outcomes for black patients, despite research that shows they do about as well as other racial groups."

Dr. Melancon's group took a look at the national transplant list before and after the Medicare changes in July 1999. Of the patients already listed for transplant, African Americans were 27% less likely to be recommended for a kidney pancreas transplant than Caucasians. Hispanics were 25% less likely to be recommended. After the Medicare changes African Americans were 28% less likely to be recommended for kidney/pancreas transplant and Hispanics were 31% less likely to be recommended.

"So, the situation for African Americans and Hispanics actually got worse instead of better," said Dr. Melancon.

The benefits of a kidney pancreas transplant are the list is much shorter; 2200 compared with over 80,000 for a kidney alone, according to the United Network of Organ Sharing (www.unos.org). Patient survival and kidney graft survival are better in kidney pancreas transplants.

"I don't think the medical community has been aggressive enough about kidney/pancreas transplant, especially in African Americans who are assumed to have type 2 diabetes. When a person has type 2 diabetes and they are obese, the benefit of a kidney/pancreas transplant is often outweighed by the risks of surgery which are higher in an obese person. So they are not offered the transplant. There is also a population of people with diabetes who are sort of between type 1 and type 2. This procedure would work for them too. But I think the medical community is, in some cases, making assumptions about the African American and Hispanic population that they are not making with other racial groups."

A kidney/pancreas transplant is the only current, reliable way to give diabetics normal glucose and insulin levels 24 hours a day. It's not technically a cure, but it does eliminate the medical problems associated with diabetes. ###

About Georgetown University Medical Center

Georgetown University Medical Center is an internationally recognized academic medical center with a three-part mission of research, teaching and patient care (through Georgetown's affiliation with MedStar Health). GUMC's mission is carried out with a strong emphasis on public service and a dedication to the Catholic, Jesuit principle of cura personalis -- or "care of the whole person." The Medical Center includes the School of Medicine and the School of Nursing and Health Studies, both nationally ranked, the world-renowned Lombardi Comprehensive Cancer Center and the Biomedical Graduate Research Organization (BGRO), home to 60 percent of the university's sponsored research funding.

About Georgetown University Hospital

Georgetown University Hospital is a not-for-profit, acute care teaching and research hospital with 609 beds located in Northwest Washington, D.C. Founded in the Jesuit principle of cura personalis - caring for the whole person - Georgetown is committed to offering a variety of innovative diagnostic and treatment options within a trusting and compassionate environment.

Georgetown's centers of excellence include cancer, neurosciences, gastroenterology, transplant and vascular diseases. Along with Magnet nurses, internationally recognized physicians, advanced research and cutting-edge technologies, Georgetown's healthcare professionals have a reputation of medical excellence and leadership. Georgetown University Hospital is a proud member of MedStar Health.

Contact: Marianne Worley worleym@gunet.georgetown.edu 202-444-4659 Georgetown University Medical Center

Regional variations in rhinosinusitis shows southerners, women most frequent outpatients

New research released at world's largest ENT meeting

San Diego, CA – A four year study of the regional impact of chronic rhinosinusitis (CRS) indicates that African-Americans living in southern states account for the highest proportion of CRS outpatient treatment, according to new research presented at the 2009 American Academy of Otolaryngology-Head and Neck Surgery Foundation (AAO-HNSF) Annual Meeting & OTO EXPO, in San Diego, CA.

The NIH-supported study, which included 4,617 patient visits for CRS, found that the prevalence of female outpatients was significantly higher than that of men in all regions. Primary care specialties (which include internal medicine, general, family practice, and pediatrics) were most frequently visited, although approximately 20 percent of visits for CRS took place in the emergency room.

The study's authors also found that Northeast-based care providers ordered significantly fewer diagnostic services, and prescribed or continued fewer medications at the patient visit for all demographics. The authors believe this indicates that further research is warranted into regional differences of diagnosis and treatment of CRS, and how this impacts management of the disease.

Rhinosinusitis is estimated to affect approximately 14 percent of the U.S. adult population annually; the patient visits chronicled in this study represent approximately 91.2 million national outpatient visits for CRS. However, CRS accounts for only 2 percent of all outpatient visits in the U.S. ###

About the AAO-HNS

The American Academy of Otolaryngology – Head and Neck Surgery (http://www.entnet.org), one of the oldest medical associations in the nation, represents more than 12,000 physicians and allied health professionals who specialize in the diagnosis and treatment of disorders of the ears, nose, throat, and related structures of the head and neck. The Academy serves its members by facilitating the advancement of the science and art of medicine related to otolaryngology and by representing the specialty in governmental and socioeconomic issues. The organization's vision: "Empowering otolaryngologist-head and neck surgeons to deliver the best patient care."

Contact: Matt Daigle newsroom@entnet.org 703-535-3754 American Academy of Otolaryngology -- Head and Neck Surgery

Higher risk of GI diseases may mean more vigilance, earlier screenings for minorities

San Diego, CA (October 26, 2009) – Three studies presented this week at the American College of Gastroenterology's 74th Annual Scientific meeting in San Diego underscore the growing disparities in gastrointestinal disease, particularly colon cancer and Barrett's Esophagus, among certain ethnic and gender populations, including African Americans, Latinos and women. These race- and gender-specific disparities underscore the need for education and vigilance among these populations and perhaps more aggressive screening tactics than the population in general.

Using data from more than 500,000 cases of colorectal cancer contained the National Cancer Institute's Surveillance, Epidemiology and End Results Registry, Dr. Robert Wong of California Pacific Medical Center, preformed a retrospective cohort study to analyze the race and gender- specific disparities in colorectal cancer epidemiology.

Dr Robert Wong

Dr. Wong's analysis indicates that from 1973 through 2004, there has been a shift of newly diagnosed cancers to the proximal, or right side colon among the population in general. Females, however, have the greatest proportion of proximal cancers and female Hispanics in particular, show the greatest gender disparity versus Hispanic males (47.7 percent vs 28.2 percent). In addition, while advanced stage colorectal cancers showed a steady decline during the study period, African Americans have the greatest proportion of advanced cancers among all racial and ethnic group.

In fact, between 2001 and 2004, a full quarter (25.2 percent) of all colorectal cancers found in black males were advanced-stage cancers, the highest proportion of any ethnic group.

"The significantly higher rates of proximal cancers among women and advanced cancers in the African American population is concerning," reports Dr. Wong. "While we still must consider whether environmental and genetic factors play a role in these disparities, potential gaps in access to health care resources and education may also contribute to these differences. We should use this information to make improvements to cancer screening and prevention programs."

Proximal Cancers in African Americans

In another study of racial disparities in the prevalence and location of colon adenomas conducted at the University of Illinois at Chicago Medical Center, Dr. Amit Gajera and a team of researchers performed a retrospective analysis of 3220 patient records collected between 2005 and 2007 to determine whether the distribution and number of adenomas could be correlated to ethnic or racial group.

The study found that African American patients not only were more likely than other racial groups to have multiple polyps, but that those polyps were more often located on the proximal side of the colon as compared to other racial groups. The team also assessed whether these disparities could be the result of environmental factors such as alcohol or tobacco use, but found no correlation.

"Understanding that African American patients have a propensity for developing multiple polyps located on the all important right side of the colon is a critical factor for choosing an appropriate screening method," explains Dr. Gajera. "In these cases, we must consider whether flexible sigmoidoscopy is as effective as colonoscopy for examining the proximal colon where these polyps and adenomas are often lurking."

About Colorectal Cancer Screening in African Americans

Because of the high incidence of colorectal cancer and a greater prevalence of proximal or right-sided polyps and cancerous lesions in African Americans, in 2009, the American College of Gastroenterology updated its colorectal cancer screening guideline to include a recommendation for African Americans to begin colorectal cancer screening earlier, at age 45, rather than at age 50 as recommended to average risk patients. According to the ACG guideline, colonoscopy is the preferred strategy for colorectal cancer screening.

Largest Cohort Study to-Date Examines Barrett's Esophagus Prevalence Among Latinos

Historically, middle-aged white males with chronic gastroesophogeal reflux (GERD) have displayed the highest incidence of Barrett's Esophagus (BE). Given that Latinos are the largest and fastest-growing minority ethnic group in the United States, researchers at The University of Southern California conducted a study to determine the prevalence of BE in the Latino population compared to Non-Latino Whites, as well as identify risk factors associated with BE in Latinos.

The research team, led by Dr. Kian Keyashian and Dr. John Kim, reviewed the records of 627 patients, taken from the Los Angeles County and University of Southern California Medical Center who underwent endoscopy for primary symptoms of GERD between March 2005 and January 2009. There were no significant differences between the Latinos and non-Latino Whites in the prevalence of BE or long-segment BE and no difference in the average length of BE. In addition to established risk factors for BE, insulin resistance was also associated with BE among the Latino population.

"Previous studies to compare the prevalence of Barrett's Esophagus in Latinos and non-Latino whites have been inconclusive," explains Dr. Keyashian. "With this large cohort, we have demonstrated that Latino race may confer a higher risk for Barrett's Esophagus than previously described in the literature and, therefore, should be considered in screening Latinos for this potentially dangerous condition." ###

About the American College of Gastroenterology

Founded in 1932, the American College of Gastroenterology (ACG) is an organization with an international membership of more than 11,000 individuals from 80 countries. The College is committed to serving the clinically oriented digestive disease specialist through its emphasis on scholarly practice, teaching and research. The mission of the College is to serve the evolving needs of physicians in the delivery of high quality, scientifically sound, humanistic, ethical, and cost-effective health care to gastroenterology patients. www.acg.gi.org/

View releases on other research breaking at the ACG meeting at www.acg.gi.org/media/press

Contact: Jennifer Burke Labriola burkepr@gmail.com 203-405-1479 American College of Gastroenterology

Low vitamin D levels explains most ESRD risk in African-Americans

Future studies will tell whether raising vitamin D Levels can slow kidney disease

Low levels of vitamin D may account for nearly 60 percent of the elevated risk of end-stage renal disease (ESRD) in African Americans, according to a report in the December Journal of the American Society of Nephrology (JASN). "Our study adds to previous evidence linking vitamin D deficiency to the progression of kidney disease and the need for dialysis," comments Michal L. Melamed, MD, of Albert Einstein College of Medicine (Bronx, NY). "It also explains a fair amount of the increased risk of ESRD in African Americans." Vitamin D is obtained from sun exposure, food and food supplements.

Michal L. Melamed, MD

Melamed and colleagues analyzed a nationwide sample of 13,000 Americans, including measurements of the vitamin D metabolite 25(OH)D. Medicare data were used to identify participants who eventually required dialysis therapy for ESRD. "We found that the participants with the lowest 25(OH)D levels were 2.6 times as likely to end up on dialysis compared to those with higher levels," says Melamed.

The researchers then tested whether 25(OH)D levels could contribute to the higher risk of ESRD in African Americans, compared to whites. "African Americans have lower 25(OH)D levels and a higher risk of ESRD," Melamed explains. "We found that 25(OH)D deficiency was responsible for about 58 percent of the excess risk for ESRD experienced by African Americans."

Vitamin D deficiency is a very common problem in the United States. In recent years, studies have linked low vitamin D to many different health problems, including diabetes, high blood pressure, cancers, and heart disease. The new results add to previous evidence that low 25(OH)D levels are an important risk factor for ESRD. "This is another good reason to make sure that people get enough vitamin D," Melamed adds.

Although it can't prove any cause-and-effect relationship, the study also suggests that vitamin D deficiency is a key contributor to the high risk of ESRD in African Americans. More research is needed to confirm these findings, and to determine whether treatment to raise low vitamin D levels can help to preserve kidney function. "We are currently in the process of enrolling for a clinical trial of vitamin D repletion in patients with chronic kidney disease to further test these hypotheses," says Melamed. ###

Dr. Melamed's research will also be presented as part of a Poster Session during ASN Renal Week on October 30, 2009. This poster presentation is entitled, "25-Hydroxyvitamin D Levels and Progressive Kidney Disease: Contribution to the Excess Risk of ESRD in Non-Hispanic Blacks" (F-PO1101).

Other authors included Paul Muntner, PhD (University of Alabama at Birmingham); Thomas Hostetter, MD (also of Albert Einstein College of Medicine); Erin Michos, MD; Brad Astor, PhD (Johns Hopkins School of Medicine); and Neil R. Powe, MD, MBA, FASN (University of California- San Francisco). Dr Hostetter has consulted for Bristol Myers Squibb, Eli Lilly, and Wyeth. None of the other co-authors reported financial disclosures.

The study entitled, "25-Hydroxyvitamin D Levels, Race, and the Progression of Kidney Disease," will appear in an upcoming issue of JASN, and online at //jasn.asnjournals.org/ on October 29, 2009, doi 10.1681/ASN.2009030283.

The American Society of Nephrology (ASN) does not offer medical advice. All content in ASN publications is for informational purposes only, and is not intended to cover all possible uses, directions, precautions, drug interactions, or adverse effects. This content should not be used during a medical emergency or for the diagnosis or treatment of any medical condition. Please consult your doctor or other qualified health care provider if you have any questions about a medical condition, or before taking any drug, changing your diet or commencing or discontinuing any course of treatment. Do not ignore or delay obtaining professional medical advice because of information accessed through ASN. Call 911 or your doctor for all medical emergencies.

Founded in 1966, ASN is the world's largest professional society devoted to the study of kidney disease. Comprised of 11,000 physicians and scientists, ASN continues to promote expert patient care, to advance medical research, and to educate the renal community. ASN also informs policymakers about issues of importance to kidney doctors and their patients. ASN funds research, and through its world-renowned meetings and first-class publications, disseminates information and educational tools that empower physicians.

Contact: Shari Leventhal sleventhal@asn-online.org 202-416-0658 American Society of Nephrology

Study finds delay in follow-up among African-American women receiving abnormal breast finding

A new analysis has identified a significant delay in follow-up times among African-American women after the finding of a suspicious breast abnormality. Published in the December 15, 2009 issue of Cancer, a peer-reviewed journal of the American Cancer Society, the study indicates that African-American women may face obstacles to receiving appropriate breast cancer–related care.

In the United States, and particularly South Carolina, African-American women suffer disproportionately higher mortality rates from breast cancer compared to white women. Studies have indicated that African-American women experience significantly longer time intervals from an abnormal mammogram to diagnostic testing or are less likely to comply with recommended diagnostic follow-up exams within six months of an abnormal mammogram.

Swann Arp Adams, MS, PhD, of the University of South Carolina in Columbia,

To investigate further, Swann Arp Adams, MS, PhD, of the University of South Carolina in Columbia, and her colleagues studied medical data from participants of the Best Chance Network, a state-wide service program that provides free mammography screenings to economically disadvantaged and medically underserved women. The program is part of the National Breast and Cervical Cancer Early Detection Program (NBCCEDP). Dr. Adams and her team analyzed tumor characteristics and patients' adherence to recommended tests following abnormal mammograms.

While African-American women were just as likely as white women to complete diagnostic procedures after abnormal mammography findings, there was a significantly longer time between the first clinical exam and to complete a diagnostic follow-up (median time = 44 days for African Americans and 40 days for European Americans). When time was measured in the number of days between the mammogram and the date of final status, a significant effect of race was no longer evident. Because the clinical breast examination typically precedes the diagnostic mammogram, these findings suggest that the racial differences may occur early in the process. While the reasons for the delay are unknown, they may result from poor communication between patient and doctor, lack of patient trust in her doctor, lack of transportation, proximity of clinics to the patient, and other factors.

The researchers say evidence indicates delayed follow-up of breast abnormalities can result in detecting the breast cancer at a later stage, pointing to one study that found a delayed diagnosis of breast cancer of as little as three months is associated with lower survival than those with prompt follow-up.

The researchers add that the finding of no disparities existing in the overall completion of the follow-up is an encouraging evaluation of the NBCCEDP, as it suggests that the program is making progress toward eliminating racial disparities in breast cancer and offer areas for strengthening.

"Programs specially aimed at providing breast cancer screening to economically disadvantaged women like the National Breast and Cervical Cancer Early Detection Program are successful in eliminating some of the racial disparities seen in breast cancer," said Dr. Adams. "There are still improvements that could be made in the program to help identify and eliminate barriers to timely completion of testing procedures," she added. ###

Article: "Racial differences in follow-up of abnormal mammography findings among economically disadvantaged women." Swann Arp Adams, Emily Rose Smith, James Hardin, Irene Prabhu Das, Jeanette Fulton, and James R. Hebert. Cancer; Published Online: October 26, 2009 (DOI: 10.1002/cncr.24633); Print Issue Date: December 15, 2009.

Contact: David Sampson david.sampson@cancer.org WEB: american cancer society

Partners in weight loss success may help African-Americans shed more pounds

Enrolling in a weight loss program with a family member or friend appears to enhance weight loss among African Americans, but only if the involved partner attends sessions frequently or also loses weight, according to a report in the October 26 issue of Archives of Internal Medicine, one of the JAMA/Archives journals.

Obesity and its cardiovascular complications affect many African Americans, according to background information in the article. Standard behavioral treatments for obesity appear to be less successful in African Americans than in whites. Cultural modifications to these standard programs—such as the inclusion of family members and support networks—may enhance their effectiveness.

Shiriki Kumanyika, PhD, MPH, a Professor in the Department of Biostatistics and Epidemiology at the University of Pennsylvania School of Medicine.

Shiriki K. Kumanyika, Ph.D., M.P.H., and colleagues at the University of Pennsylvania School of Medicine, Philadelphia, conducted a two-year trial of a culturally specific weight loss program among 344 African American men and women. The goal was to achieve and maintain a 5 percent to 10 percent weight loss. Components of the program included counseling that encouraged self-monitoring of food intake and physical activity, distribution of pedometers, group sessions involving weight and activity checks and skill building, and community-based field workshops such as cooking demonstrations and gym visits.

A total of 63 individuals enrolled in the program alone and 281 enrolled with a friend or family member (130 of whom were designated as the main, or index, participants and 151 as partners). Of the participants with partners, 65 (and 78 partners) were randomly assigned to a high-support group in which both individuals were expected to attend and participate fully in all treatment sessions. The remaining 65 (and 73 partners) were assigned to a low-support group, in which some portions of the program were restricted to the main participants. All participants' progress was measured at six, 12, 18 and 24 months.

After 24 months, main participants had lost an average of 2.4 kilograms (about 5.3 pounds). Participants in the two family groups initially had better attendance and greater weight loss than those in the individual group, but these changes were not statistically significant and decreased over time.

However, participants whose partners attended more personally tailored counseling sessions had lost more weight at six months in the high-support group and at six, 12 and 24 months in the low-support group. In addition, those in both family groups whose partner lost at least 5 percent of their body weight had greater weight loss at six months than those whose partner lost less than 5 percent (6.1 percent vs. 2.9 percent of body weight lost in the high-support group and 6.1 percent vs. 3.1 percent in the low-support group).

"We evaluated family and friend social support as a specific cultural adaptation strategy, which was added to an ethnic-specific program that was also adapted in other respects," the authors conclude. "Beneficial effects on weight loss were linked to actual rather than assigned partner participation and to partner success in losing weight. Further studies may elucidate ways to facilitate effective family or friend participation and to improve absolute weight losses." ###

(Arch Intern Med. 2009;169[19]:1795-1804. Available pre-embargo to the media at www.jamamedia.org.)

Editor's Note: This study was funded by a grant from the National Heart, Lung, and Blood Institute. Laboratory analyses were provided through a General Clinical Research Center Grant from the National Institutes of Health/National Center for Research Resources. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

Contact: Karen Kreeger karen.kreeger@uphs.upenn.edu 215-349-5658 JAMA and Archives Journals

Higher risk of GI diseases may mean more vigilance, earlier screenings for minorities

San Diego, CA (October 26, 2009) – Three studies presented this week at the American College of Gastroenterology's 74th Annual Scientific meeting in San Diego underscore the growing disparities in gastrointestinal disease, particularly colon cancer and Barrett's Esophagus, among certain ethnic and gender populations, including African Americans, Latinos and women. These race- and gender-specific disparities underscore the need for education and vigilance among these populations and perhaps more aggressive screening tactics than the population in general.

Using data from more than 500,000 cases of colorectal cancer contained the National Cancer Institute's Surveillance, Epidemiology and End Results Registry, Dr. Robert Wong of California Pacific Medical Center, preformed a retrospective cohort study to analyze the race and gender- specific disparities in colorectal cancer epidemiology.

Dr. Wong's analysis indicates that from 1973 through 2004, there has been a shift of newly diagnosed cancers to the proximal, or right side colon among the population in general. Females, however, have the greatest proportion of proximal cancers and female Hispanics in particular, show the greatest gender disparity versus Hispanic males (47.7 percent vs 28.2 percent).

In addition, while advanced stage colorectal cancers showed a steady decline during the study period, African Americans have the greatest proportion of advanced cancers among all racial and ethnic group. In fact, between 2001 and 2004, a full quarter (25.2 percent) of all colorectal cancers found in black males were advanced-stage cancers, the highest proportion of any ethnic group.

"The significantly higher rates of proximal cancers among women and advanced cancers in the African American population is concerning," reports Dr. Wong. "While we still must consider whether environmental and genetic factors play a role in these disparities, potential gaps in access to health care resources and education may also contribute to these differences. We should use this information to make improvements to cancer screening and prevention programs."

Proximal Cancers in African Americans

In another study of racial disparities in the prevalence and location of colon adenomas conducted at the University of Illinois at Chicago Medical Center, Dr. Amit Gajera and a team of researchers performed a retrospective analysis of 3220 patient records collected between 2005 and 2007 to determine whether the distribution and number of adenomas could be correlated to ethnic or racial group.

The study found that African American patients not only were more likely than other racial groups to have multiple polyps, but that those polyps were more often located on the proximal side of the colon as compared to other racial groups. The team also assessed whether these disparities could be the result of environmental factors such as alcohol or tobacco use, but found no correlation.

"Understanding that African American patients have a propensity for developing multiple polyps located on the all important right side of the colon is a critical factor for choosing an appropriate screening method," explains Dr. Gajera. "In these cases, we must consider whether flexible sigmoidoscopy is as effective as colonoscopy for examining the proximal colon where these polyps and adenomas are often lurking."

About Colorectal Cancer Screening in African Americans

Because of the high incidence of colorectal cancer and a greater prevalence of proximal or right-sided polyps and cancerous lesions in African Americans, in 2009, the American College of Gastroenterology updated its colorectal cancer screening guideline to include a recommendation for African Americans to begin colorectal cancer screening earlier, at age 45, rather than at age 50 as recommended to average risk patients. According to the ACG guideline, colonoscopy is the preferred strategy for colorectal cancer screening.

Largest Cohort Study to-Date Examines Barrett's Esophagus Prevalence Among Latinos

Historically, middle-aged white males with chronic gastroesophogeal reflux (GERD) have displayed the highest incidence of Barrett's Esophagus (BE). Given that Latinos are the largest and fastest-growing minority ethnic group in the United States, researchers at The University of Southern California conducted a study to determine the prevalence of BE in the Latino population compared to Non-Latino Whites, as well as identify risk factors associated with BE in Latinos.

The research team, led by Dr. Kian Keyashian and Dr. John Kim, reviewed the records of 627 patients, taken from the Los Angeles County and University of Southern California Medical Center who underwent endoscopy for primary symptoms of GERD between March 2005 and January 2009. There were no significant differences between the Latinos and non-Latino Whites in the prevalence of BE or long-segment BE and no difference in the average length of BE. In addition to established risk factors for BE, insulin resistance was also associated with BE among the Latino population.

"Previous studies to compare the prevalence of Barrett's Esophagus in Latinos and non-Latino whites have been inconclusive," explains Dr. Keyashian. "With this large cohort, we have demonstrated that Latino race may confer a higher risk for Barrett's Esophagus than previously described in the literature and, therefore, should be considered in screening Latinos for this potentially dangerous condition." ###

About the American College of Gastroenterology

Founded in 1932, the American College of Gastroenterology (ACG) is an organization with an international membership of more than 11,000 individuals from 80 countries. The College is committed to serving the clinically oriented digestive disease specialist through its emphasis on scholarly practice, teaching and research. The mission of the College is to serve the evolving needs of physicians in the delivery of high quality, scientifically sound, humanistic, ethical, and cost-effective health care to gastroenterology patients. www.acg.gi.org/

View releases on other research breaking at the ACG meeting at www.acg.gi.org/media/press

Contact: Jennifer Burke Labriola burkepr@gmail.com 203-405-1479 American College of Gastroenterology

Study finds racial segregation a strong factor in learning disparities

Racial segregation in the schools is fueling the learning disparity between young black and white children, while out-of-school factors are more important to the growth of social class gaps, according to a study by Emory University sociologist Dennis Condron.

His findings were published in the October issue of the American Sociological Review.

Condron was perplexed by prior research showing that schools narrow the achievement gap among students of varying social classes while widening the gap between black and white students. To tease out possible reasons for this difference, he analyzed data from the Kindergarten Cohort of the Early Childhood Longitudinal Study.

Dennis Condron

He found that between the fall and spring of first grade, black students' reading and math skills fall almost two months behind those of white students. After controlling for other factors, the data suggested that segregation of schools was a primary driver of this early black-white learning disparity. In contrast, out-of-school factors explained the growth of social class gaps.

"This research adds an important piece to the puzzle of when and why social class and black-white inequalities in academic achievement emerge," says Condron, assistant professor of sociology. "And I hope it raises awareness that social class and black-white achievement gaps come from different sources to some extent. We tend to speak of 'the' achievement gap, but in reality different gaps probably have different sources and require different solutions."

His research also indicated that regardless of social class, black students are less often taught by certified teachers than are white students, and black students are far more likely than white students to attend predominantly minority schools, high-poverty schools and schools located in disadvantaged neighborhoods.

The findings are "a reminder of a persistent problem," Condron says, decades after the 1954 U.S. Supreme Court decision in Brown v. the Board of Education of Topeka struck down state laws establishing separate schools for black and white students.

"De facto segregation remains high these days, with important implications for education," he says. "When it comes to both housing and schools, race trumps class as the central axis upon which blacks and whites are segregated. Real solutions to the black-white achievement gap lie far beyond schools and require changes to society more broadly." ###

Condron's study is the lead article in the October issue of the American Sociological Review, which also features two other studies of educational inequality.

A specialist in educational disparities, Condron is currently analyzing data on more than 80 countries to research the impact of economic inequality on countries' average achievement levels.

Contact: Beverly Clark beverly.clark@emory.edu 404-712-8780 Emory University

African-American lung cancer patients may have different response to new cancer-fighting drugs

UH Case Medical Center study in JCO reinforces focus on personalized treatment for patients based on ethnicity

Clinical research out of University Hospitals Case Medical Center has found that African Americans with a common form of lung cancer have a lower frequency of drug-sensitizing genetic mutations, which may impact response to new cancer-fighting drugs. Published online in the Journal of Clinical Oncology, the study by Rom Leidner, MD, and colleagues report that ethnicity plays a significant role in non-small cell lung cancer (NSCLC) genetics and more personalized treatments may be beneficial to cancer patients.

African American patients with NSCLC are significantly less likely than Caucasian counterparts to harbor activating mutations of the epidermal growth factor receptor (EGFR) gene in their cancers, which suggests that common oral EGFR inhibitor drugs, such as Tarceva® (erlotinib), are unlikely to yield dramatic remissions.

Lung cancer US distribution

Additionally, cancer biopsy testing revealed that African American patients with NSCLC are significantly more likely to have increased copies of the EGFR gene than Caucasians. Detection of increased copies of the Her2 gene in breast cancer, a gene closely related to EGFR, has been the basis for major advances in therapy using drugs which target Her2.

"We are finding that ethnicity may play a significant role in a variety of cancers," says Dr. Leidner, an oncologist with Ireland Cancer Center of University Hospitals Case Medical Center and Visiting Instructor at Case Western Reserve University School of Medicine. "It was already known that a higher proportion of East Asian NSCLC patients harbor mutations of the EGFR gene than Caucasians, and that these mutations are associated with a higher likelihood of major responses to EGFR inhibitors. Before our study, however, surprisingly little data existed for African American patients with this common type of lung cancer."

These findings add to a growing body of evidence demonstrating genetic variation in genetic pathways between ethnic groups, and underscores the need for incorporation of these differences into the design of future clinical trials with agents targeting the EGFR pathway.

Epidemiologic studies have suggested that African Americans have a higher risk of NSCLC and have poorer outcomes with treatment. Ethnic background and genetic make-up are linked, and consequently, may impact the likelihood of major responses to oral EGFR inhibiting drugs. For example, in large international lung cancer trials a higher percentage of East Asian NSCLC patients were found to carry drug-sensitizing mutations of the EGFR gene than Caucasians, and as predicted the highest rates of response to EGFR inhibitor drugs were found in the East Asian patients.

The recently published findings have led the researchers to initiate a follow-up study. This multi-center effort will review the overall rates of response, or lack thereof, among African American patients with NSCLC treated at the Case Comprehensive Cancer Center with EGFR inhibitor drugs during the course of their illness.

"In the future, this may lead clinical cancer researchers to be able to take advantage of these findings for a 'smart-design approach' to clinical trials in lung cancer, with novel treatments and biomarkers employed among different patient populations or even individuals," says Stanton Gerson, MD, Director of the University Hospitals Ireland Cancer Center as well as the Case Comprehensive Cancer Center. "Targeted treatments for patients based on a myriad of genetic and ethnic factors are the wave of the future and may lead the way to improved cure rates for our cancer patients." ###

About University Hospitals

University Hospitals serves the needs of patients through an integrated network of hospitals, outpatient centers and primary care physicians. At the core of our health system is University Hospitals Case Medical Center. The primary affiliate of Case Western Reserve University School of Medicine, University Hospitals Case Medical Center is home to some of the most prestigious clinical and research centers of excellence in the nation and the world, including cancer, pediatrics, women's health, orthopedics and spine, radiology and radiation oncology, neurosurgery and neuroscience, cardiology and cardiovascular surgery, organ transplantation and human genetics.

Its main campus includes the internationally celebrated UH Rainbow Babies & Children's Hospital, ranked second in the nation for the care of critically ill newborns; UH MacDonald Women's Hospital, Ohio's only hospital for women; and UH Ireland Cancer Center, part of the NCI-designated Case Comprehensive Cancer Center. For more information, go to www.uhhospitals.org

Contact: Alicia Reale alicia.reale@UHhospitals.org 216-844-5158 University Hospitals Case Medical Center

Inequalities in Education

News briefs from the American Sociological Review: Inequalities in education
October issue of flagship journal reports on the black-white achievement gap, socioeconomic desegregation in schools and class inequality in higher education

WASHINGTON, DC — Research published in the October issue of the American Sociological Review puts a spotlight on inequalities in education. The following briefs highlight selected sociological findings.

Racial Segregation Fuels Early Black-White Achievement Gap, Data Suggest

Racial segregation of schools, and thereby segregated neighborhoods, appears to be a leading source of academic achievement disparities between young black and white children, according to research by sociologist Dennis J. Condron of Emory University.

Analyzing data from the Early Childhood Longitudinal Study-Kindergarten Cohort (ECLS-K), Condron examines the perplexing role of schools in narrowing the achievement gap among students of varying social classes while widening the gap between black and white students. He finds that between the fall and spring of first grade, black students' reading and math skills fall almost two months behind those of white students.

The data suggest that school factors—especially racial segregation—primarily fuel this early black-white learning disparity, which stands in contrast to the primary role of non-school circumstances (e.g., family, health, social resources) in fueling achievement gaps by social class.

The research also indicates that regardless of social class, black students are less often taught by certified teachers than are white students, and black students are far more likely than white students to attend predominantly minority schools, high-poverty schools and schools located in disadvantaged neighborhoods.

Condron suggests that "real solutions to the black-white achievement gap lie far beyond schools and require changes to society more broadly," such as reducing residential segregation and income and wealth inequality between blacks and whites. He also highlights the need for more studies with both fall and spring data, which would help researchers better understand when and how achievement gaps emerge.

("Social Class, School and Non-School Environments, and Black/White Inequalities in Children's Learning," by Dennis J. Condron, Emory University, in the American Sociological Review, October 2009)

Socioeconomic Desegregation Alone Is Not Effective in Improving Classroom Performance

Although past research has linked academic achievement gains to socioeconomic desegregation in schools, a new analysis reveals some hidden academic and psychological risks of integrating low-income students in schools with predominantly middle- and upper-class student populations that might undercut such achievement gains.

Sociologist Robert Crosnoe of the University of Texas at Austin finds that low-income students were more likely to be enrolled in lower-level math and science courses when they attended schools with mostly middle- and upper-class students, versus schools with low-income student bodies. Likewise, low-income students who attended schools with wealthier student populations were more likely to feel isolated and have negative feelings about themselves. These results were even more pronounced for black and Hispanic students.

Using a sample of low-income public high school students from the National Longitudinal Study of Adolescent Health, Crosnoe finds support for the theory that students' academic success is a function of how they view themselves and how others evaluate them relative to the academic skills and performance of their peers.

Crosnoe argues that achieving statistical representation in schools in not sufficient. He asserts that "desegregation efforts must attend to the social integration of students with lower socioeconomic status, as well as their distribution across courses."

("Low-Income Students and the Socioeconomic Composition of Public High Schools," by Robert Crosnoe, University of Texas at Austin, in the American Sociological Review, October 2009)

Competition for College Admissions Perpetuates Class Divide in Higher Education

Increased competition for college admissions combined with the heightened emphasis on test scores in recent decades has fueled the growth of class inequality in American higher education, according to sociologist Sigal Alon of Tel-Aviv University.

Using data from three nationally representative surveys (National Longitudinal Study of the High School Class of 1972, High School and Beyond, National Education Longitudinal Survey), Alon examines how social class affects college admissions of the high school graduating classes of 1972, 1982 and 1992.

Students from low socioeconomic strata in all three graduating classes were at a marked disadvantage in access to postsecondary education, and this disadvantage increased with college selectivity. Alon finds that the class divide grows during times of high competition in college admissions because privileged high school students are able to adapt to the tightening admissions requirements (i.e., the greater emphasis on test scores), while their underprivileged counterparts are unable to follow suit. This leads to a class-based polarization of test scores, restricting the opportunities of talented underprivileged seniors the most. During periods of declining competition in admissions, Alon finds a convergence in test scores among students of various socioeconomic statuses, leading to a smaller class divide in college enrollment.

"Strides toward equal opportunity in higher education will only be made when the screening tool used in college admissions becomes impervious to training or preparation," said Alon. She predicts that the momentum for going SAT-optional among liberal arts colleges will fall short of equalizing opportunity as long as privileged youth can adapt to the new screening tool used by institutions to sort the influx of applicants. She suggests that class-based affirmative action is one solution to reduce inequality in admissions to four-year colleges.

("The Evolution of Class Inequality in Higher Education: Competition, Exclusion, and Adaptation," by Sigal Alon, Tel-Aviv University, in the American Sociological Review, October 2009) ###

The research articles described above are available by request for members of the media. Contact ASA's Public Information Office at pubinfo@asanet.org or (202) 247-9871.

The American Sociological Review is the flagship journal of the American Sociological Association.

About the American Sociological Association

The American Sociological Association (www.asanet.org), founded in 1905, is a non-profit membership association dedicated to serving sociologists in their work, advancing sociology as a science and profession, and promoting the contributions to and use of sociology by society.

Contact: Johanna Olexy pubinfo@asanet.org 202-383-9005 American Sociological Association

Study: Managers' hiring practices vary by race, ethnicity

White, Asian and Hispanic managers tend to hire more whites and fewer blacks than black managers do, according to a new study out of the University of Miami School of Business Administration.

Using more than two years of personnel data from a large U.S. retail chain, the study found that when a black manager in a typical store is replaced by a white, Asian or Hispanic manager, the share of newly hired blacks falls from 21 to 17 percent, and the share of whites hired rises from 60 to 64 percent. The effect is even stronger for stores located in the South, where the replacement of a black manager causes the share of newly hired blacks to fall from 29 to 21 percent. In locations with large Hispanic populations, Hispanics hire more Hispanics and fewer whites than white managers. The study is out this month in the Journal of Labor Economics.

The finding is clear evidence that the race or ethnicity of those who make hiring decisions can have a strong impact in the racial makeup of a company's workforce, says Laura Giuliano, an assistant professor of economics at the University of Miami School of Business, who authored the study with David Levine and Jonathan Leonard from the University of California, Berkeley.

How strong is the impact? Consider a typical store with 40 employees located in the Southern U.S. According to the data, replacing a black manager with a non-black manager would result in the replacement of three to four black workers with white workers over the course of one year.

The effect in a non-Southern store would also be significant, if a bit more subtle. Replacing a black manager in a non-Southern store would result in one black worker being replaced by a white worker over a year.

"From the viewpoint of a district manager who is observing just a small sample of stores, this change might go unnoticed or appear insignificant," Giuliano said. "However, the change may appear more significant from the point of view of job seekers -- and especially black job seekers. In fact, the change in non-Southern stores amounts to a proportional decline of 15 percent in the number of blacks employed."

The data used by Giuliano and her colleagues were especially well suited to sorting out the role race plays in hiring. While previous studies have also suggested that manager race plays a role, those studies have been unable to distinguish that role from other factors such as the demographic makeup of the local labor pool. Giuliano and her colleagues were able to isolate the race factor by tracking individual stores that experienced a change of manager.

"This means we can compare the hiring patterns of consecutive managers of different races in the same store," she said. "Hence we can isolate the effect of a manager's race by comparing the hiring patterns of managers when they hire from similar labor pools under similar conditions."

The researchers were also able to use their data to offer some partial explanations for why these differences in hiring patterns exist.

They found that both black and non-black managers tend to hire people who live close to them. So if black managers live in predominantly black neighborhoods, their hiring network is also likely to be predominantly black.

The research also suggests that black managers hire fewer whites because whites may be less willing to work for black managers. The study found that when a white manager is replaced with a black manager, the rate at which white workers quit their jobs increases by 15 percent.

"We interpret this increase in the white quit rate as evidence of discriminatory sorting by white job seekers," the authors write. "It implies that whites who dislike working for black managers often avoid working for black managers in the first place." ###

Laura Giuliano, David I. Levin and Jonathan Leonard, "Manager Race and the Race of News Hires." Journal of Labor Economics 27:4 (October 2009).

Since 1983, the Journal of Labor Economics has presented international research that examines issues affecting the economy as well as social and private behavior. The Journal publishes both theoretical and applied research results relating to the U.S. and international data.

The University of Miami School of Business Administration is a comprehensive business school, offering undergraduate business, full-time MBA, Executive MBA, MS, PhD and non-degree executive education programs. One of 12 colleges and schools at the University of Miami, the School is located in a major hub of international trade and commerce and acclaimed for the global orientation and diversity of its faculty, students and curriculum. The School delivers its programs at its main campus in Coral Gables as well as at locations across Florida and abroad. More information about the University of Miami School of Business can be found at www.bus.miami.edu.

Contact: Kevin Stacey kstacey@press.uchicago.edu 773-834-0386 University of Chicago Press Journals

Continuing racial differences in HIV prevalence in US

HIV prevalence among African Americans is ten times greater than the prevalence among whites. This racial disparity in HIV prevalence has persisted in the face of both governmental and private actions, involving many billions of dollars, to combat HIV. In the November 2009 issue of the American Journal of Preventive Medicine, researchers from the University of North Carolina at Chapel Hill examine factors responsible for the stark racial disparities in HIV infection in the U.S. and the now concentrated epidemic among African Americans.

The Centers for Disease Control and Prevention (CDC) estimates that 45% of new HIV infections in the U.S. in 2006 occurred among non-Hispanic blacks. Among the 13,184 adolescents and young adults in The National Longitudinal Study of Adolescent Health, a nationally representative study, HIV seroprevalence was almost 0.5% among blacks – 20 times that of whites.

Adaora A. Adimora, M.D., M.P.H

While individual-level sexual behaviors can contribute to the disparity in HIV prevalence, these observed differences in individual behaviors do not fully explain the marked racial differences in HIV infection prevalence. Even when comparisons are stratified by education, poverty index, marital status, age at first sexual intercourse, lifetime number of sex partners, history of male homosexual activity, illicit drug use, injection drug use, and HSV-2 antibody positivity, HIV prevalence among African Americans exceeds that of whites, typically substantially.

The authors suggest a number of social factors that may contribute to the difference in infection rates. Because of racially segregated mixing patterns and the much higher HIV seroprevalence in African Americans, exposure to the virus is more likely among blacks than among whites for any given number of partners or frequency of sexual contacts. The prevalence of concurrent sexual partnerships (relationships that overlap in time) is higher among U.S. blacks than whites and this can spread infection through a sexual network faster than the same number of new, sequential relationships. Poverty, a reality of life for a disproportionately large number of African Americans, is strongly associated with HIV infection. The population gender ratio (number of men:women) is a major determinant of the structure of sexual networks and both high male mortality and disproportionate incarceration of black men reduce the gender ratio among African Americans. This likely influences not only marriage rates, but also participation in sexual risk behaviors and sexual mixing and other network patterns.

According to the authors, the overall impact of these factors constitutes structural violence; a social system characterized by inequalities in power and life chances of sufficient magnitude to restrict a group of people from realizing their full potential and put them "in harm's way." Although the link between social context and disease is increasingly recognized, with a few notable exceptions, the specific role of structural violence in the HIV epidemic among African Americans has received considerably less research attention.

Writing in the article, Adaora A. Adimora, MD, MPH, University of North Carolina at Chapel Hill, School of Medicine, states, "Continuing racial disparities in HIV infection more than 2 decades after the identification of the virus and availability of an accurate test are an indictment of the U.S. response to the epidemic. Existing interventions have failed to control the epidemic in African Americans in part because critical features of the socioeconomic context promote behaviors that transmit HIV and increase the risk of HIV infection even among those who do not have high-risk behaviors. Failure to address these structural determinants has allowed the epidemic to continue in the black community. There is a need for research and interventions that are informed by expertise in public health, medicine, basic science, and social sciences – along with expertise in economics, business and finance, education, criminal justice, political science, and other disciplines…Governments should be held accountable for progress or lack thereof in eliminating inequities." ###

The article is "Ending the Epidemic of Heterosexual HIV Transmission Among African Americans" by Adaora A. Adimora, MD, MPH, Victor J. Schoenbach, PhD, and Michelle A. Floris-Moore, MD. It appears in the American Journal of Preventive Medicine, Volume 37, Issue 5 (November 2009) published by Elsevier.

Contact: AJPM Editorial Office eAJPM@ucsd.edu 858-457-7292 Elsevier Health Sciences

Insured African-Americans more likely to use emergency room than other insured groups

Health insurance, and the access it provides to a primary care physician, should reduce the use of a major driver of health care costs: the emergency room.

Yet in a policy brief released today by the UCLA Center for Health Policy Research, researchers found that in California, privately insured African Americans enrolled in HMOs are far more likely to use the ER and to delay getting needed prescription drugs than HMO-insured members of other racial and ethnic groups. The research was funded by the California Office of the Patient Advocate.

It's not that African Americans fail to see their doctors, researchers say. In fact, of all HMO enrollees, African Americans were the most likely to report seeing a doctor in the past year, according to the authors of the brief, "African-Americans in Commercial HMOs Are More Likely to Delay Prescription Drugs and Use the Emergency Room."

Dylan Roby, Ph.D. Assistant Professor, Health Services, Research Scientist, UCLA Center for Health Policy Research, BOX 957143. Los Angeles, CA 90095-7143 (310) 794-3953 Fax: (310) 794-2686 E-mail: droby@.ucla.edu

Patient income and illness did not predict ER or prescription drug use either. Researchers found greater ER use and delays in getting prescription drugs even among African American HMO enrollees who were generally healthy and had higher incomes. While the reasons behind the ER use and drug delays among African Americans are the subject of future research, lead author Dylan Roby, a research scientist with the UCLA Center for Health Policy Research, said the data suggests that the way health maintenance organizations or their contracted physicians provide care — and the way patients respond to that care — may create obstacles to timely primary care, as well as foster excessive use of the emergency room and delays in getting needed medications. African Americans Depend on HMOs

More than two-thirds of insured African Americans in California are enrolled in HMOs (67.3 percent, or 1.35 million), compared with 64.7 percent (4.5 million) of insured Latinos and 51.6 percent (8 million) of whites.

Using data from the 2007 California Health Interview Survey (CHIS), researchers found that African American patients enrolled in commercial HMO plans were more likely to delay getting needed prescription drugs. Those enrolled in commercial Kaiser Permanente plans were more likely to use the ER, they said.

"It's troubling, because it suggests that even if you are insured and well-off, you still may not be getting the care you need," Roby said. "It also suggests that HMOs that are designed to provide preventive care and to make sure people have their medications are not able to do so."

Kaiser Permanente is the most popular HMO among African Americans, with one-fourth of all insured African Americans enrolled in the Oakland-based insurance carrier. Despite HMO emphasis on preventive care, however, more than a quarter (25.4 percent) of all privately insured African Americans enrolled in a Kaiser Permanente plan used the emergency room in the past year — in contrast to 14 percent of Asian American enrollees and 17.5 percent of Latinos.

The reasons could range from the relative affordability of emergency-room services to the ease of accessing those services, Roby said.

"If it takes days or weeks to get an appointment with your doctor and just hours to be seen in the ER, people might make the easier choice, especially if it is convenient and affordable," he said. "On the other hand, if someone knows their local ER is overcrowded and expensive, they may be more likely to wait and see their own doctor."

Delaying Needed Medicine

Privately insured African American HMO enrollees also were notably more likely to delay getting needed prescription drugs. Prescription drug delays were about 10 percent higher for privately insured African Americans enrolled in non-Kaiser commercial HMO plans than for whites in comparable commercial plans.

Costs, geography and the pharmacy benefits offered by a given HMO may all inhibit the timely purchase of prescription drugs.

"We need to think about how the cost of prescriptions and delays in getting needed medications are compromising health status and quality of life," Roby said.

The research helps health advocates in California identify key health and health care issues for African American HMO members, said Sandra Perez, director of the California Office of the Patient Advocate. "This is the first step in understanding how HMOs can close the gaps in the quality of care and access they provide to their members."

Roby recommended an education campaign for both patient and provider that would address appropriate use of the ER and primary care services, as well as the importance of medication adherence and getting prescribed medications and refills.

"African American HMO members need to be empowered to find a doctor they are comfortable with, while health plans need to make a greater effort to connect patients with that doctor," Roby said. ###

The policy brief was supported by a grant from the California Office of the Patient Advocate as part of a targeted educational outreach program.

The California Health Interview Survey is the nation's largest state health survey and one of the largest health surveys in the United States.

The California Office of the Patient Advocate is a state office established to inform and educate consumers about their rights and responsibilities as health plan enrollees and to teach them how to make best use of the services offered by their health plans.

The UCLA Center for Health Policy Research is one of the nation's leading health policy research centers and the premier source of health-related information on Californians.

For more news, visit the UCLA Newsroom or follow us on Twitter.

Contact: Gwendolyn Driscoll gdriscoll@ucla.edu 310-794-0930 University of California - Los Angeles

News briefs from the American Sociological Review: Inequalities in education

October issue of flagship journal reports on the black-white achievement gap, socioeconomic desegregation in schools and class inequality in higher education

WASHINGTON, DC — Research published in the October issue of the American Sociological Review puts a spotlight on inequalities in education. The following briefs highlight selected sociological findings.

Racial Segregation Fuels Early Black-White Achievement Gap, Data Suggest

Racial segregation of schools, and thereby segregated neighborhoods, appears to be a leading source of academic achievement disparities between young black and white children, according to research by sociologist Dennis J. Condron of Emory University.

Assistant Professor Department of Sociology Emory University Atlanta, GA 30322 Telephone: 404-727-6272 FAX: 404-727-7532 E-MAIL: dennis.condron@emory.edu OFFICE: 232 Tarbutton Hall

Analyzing data from the Early Childhood Longitudinal Study-Kindergarten Cohort (ECLS-K), Condron examines the perplexing role of schools in narrowing the achievement gap among students of varying social classes while widening the gap between black and white students. He finds that between the fall and spring of first grade, black students' reading and math skills fall almost two months behind those of white students. The data suggest that school factors—especially racial segregation—primarily fuel this early black-white learning disparity, which stands in contrast to the primary role of non-school circumstances (e.g., family, health, social resources) in fueling achievement gaps by social class. The research also indicates that regardless of social class, black students are less often taught by certified teachers than are white students, and black students are far more likely than white students to attend predominantly minority schools, high-poverty schools and schools located in disadvantaged neighborhoods.

Condron suggests that "real solutions to the black-white achievement gap lie far beyond schools and require changes to society more broadly," such as reducing residential segregation and income and wealth inequality between blacks and whites. He also highlights the need for more studies with both fall and spring data, which would help researchers better understand when and how achievement gaps emerge.

("Social Class, School and Non-School Environments, and Black/White Inequalities in Children's Learning," by Dennis J. Condron, Emory University, in the American Sociological Review, October 2009)

Socioeconomic Desegregation Alone Is Not Effective in Improving Classroom Performance

Although past research has linked academic achievement gains to socioeconomic desegregation in schools, a new analysis reveals some hidden academic and psychological risks of integrating low-income students in schools with predominantly middle- and upper-class student populations that might undercut such achievement gains.

Sociologist Robert Crosnoe of the University of Texas at Austin finds that low-income students were more likely to be enrolled in lower-level math and science courses when they attended schools with mostly middle- and upper-class students, versus schools with low-income student bodies. Likewise, low-income students who attended schools with wealthier student populations were more likely to feel isolated and have negative feelings about themselves. These results were even more pronounced for black and Hispanic students.

Using a sample of low-income public high school students from the National Longitudinal Study of Adolescent Health, Crosnoe finds support for the theory that students' academic success is a function of how they view themselves and how others evaluate them relative to the academic skills and performance of their peers.

Crosnoe argues that achieving statistical representation in schools in not sufficient. He asserts that "desegregation efforts must attend to the social integration of students with lower socioeconomic status, as well as their distribution across courses."

("Low-Income Students and the Socioeconomic Composition of Public High Schools," by Robert Crosnoe, University of Texas at Austin, in the American Sociological Review, October 2009)

Competition for College Admissions Perpetuates Class Divide in Higher Education

Increased competition for college admissions combined with the heightened emphasis on test scores in recent decades has fueled the growth of class inequality in American higher education, according to sociologist Sigal Alon of Tel-Aviv University.

Using data from three nationally representative surveys (National Longitudinal Study of the High School Class of 1972, High School and Beyond, National Education Longitudinal Survey), Alon examines how social class affects college admissions of the high school graduating classes of 1972, 1982 and 1992.

Students from low socioeconomic strata in all three graduating classes were at a marked disadvantage in access to postsecondary education, and this disadvantage increased with college selectivity. Alon finds that the class divide grows during times of high competition in college admissions because privileged high school students are able to adapt to the tightening admissions requirements (i.e., the greater emphasis on test scores), while their underprivileged counterparts are unable to follow suit. This leads to a class-based polarization of test scores, restricting the opportunities of talented underprivileged seniors the most. During periods of declining competition in admissions, Alon finds a convergence in test scores among students of various socioeconomic statuses, leading to a smaller class divide in college enrollment.

"Strides toward equal opportunity in higher education will only be made when the screening tool used in college admissions becomes impervious to training or preparation," said Alon. She predicts that the momentum for going SAT-optional among liberal arts colleges will fall short of equalizing opportunity as long as privileged youth can adapt to the new screening tool used by institutions to sort the influx of applicants. She suggests that class-based affirmative action is one solution to reduce inequality in admissions to four-year colleges.

("The Evolution of Class Inequality in Higher Education: Competition, Exclusion, and Adaptation," by Sigal Alon, Tel-Aviv University, in the American Sociological Review, October 2009) ###

The research articles described above are available by request for members of the media. Contact ASA's Public Information Office at pubinfo@asanet.org or (202) 247-9871.

The American Sociological Review is the flagship journal of the American Sociological Association.

About the American Sociological Association

The American Sociological Association (www.asanet.org), founded in 1905, is a non-profit membership association dedicated to serving sociologists in their work, advancing sociology as a science and profession, and promoting the contributions to and use of sociology by society.

Contact: Johanna Olexy pubinfo@asanet.org 202-383-9005 American Sociological Association

Boston University School of Medicine's black women's health study receives $9.1 million award

(Boston) – The Black Women's Health Study (BWHS) of the Sloan Epidemiology Center at Boston University School of Medicine's (BUSM) has received a five-year continuation of grant funding award from the National Cancer Institute. The $9.1M award will cover years 16-20 of the largest follow-up study of the health of African-American women.

Lynn Rosenberg, Sc.D., an associate director of the Slone Epidemiology Center and professor of epidemiology at BUSM, is the principal investigator of the BWHS, which has followed 59,000 black women from across the United States since 1995.

Lynn Rosenberg, Sc.D.

"African American women are more likely to be affected by aggressive breast cancers and at younger ages than other U.S. women," said Rosenberg. "We are grateful that the National Cancer Institute recognizes the importance of studying causes of breast cancer in African American women." ###

The BWHS has published multiple papers on breast cancer, including on topics of special interest to African American women that have not been studied previously, such as the influence of breast cancer risk on experiences of racism. The BWHS also assesses risk factors for outcomes other than cancer that disproportionately affect black women. These include diabetes, systemic lupus erythematosus, sarcoidosis, and preterm birth. Funding for these assessments has been provided by the National Institutes of Health and several foundations.

More information on the BWHS can be found at www.bu.edu/bwhs/. For more information on Boston University School of Medicine, please visit www.bumc.bu.edu/.

Contact: Michelle Roberts michelle.roberts@bmc.org 617-638-8491 Boston University Medical Center>

Lung cancer risk increases with expression of specific genes

Possible correlation to increased risk for African-Americans

AURORA, COLO – A recent study published in the October 2009 issue of the Journal of Thoracic Oncology determined that variations of specific genetic markers identified in previous research, or SNPs, may indicate a greater lung cancer risk in African Americans than in whites. The genes CHRNA3 and CHRNA5 may contribute to lung cancer risk due directly or through their association with nicotine dependence. Although their presence is less frequent in African Americans, the risk for lung cancer may be greater when present.

Researchers from the Karmanos Cancer Institute in Detroit, MI and the MD Anderson Cancer Center in Houston, TX evaluated data on 1,508 non-small cell lung cancer(NSCLC) patients (38 percent of which were African American) selected from the Detroit SEER Cancer registry and 1,314 corresponding control patients matched based on age, gender and race. The three case-controlled studies examined family history of lung cancer, smoking history, and age. Using unconditional logistical regression, a type of statistical analysis, researchers identified associations between SNPs and lung cancer risk while controlling for age, sex and smoking behavior.

Ann G. Schwartz, Ph.D., M.P.H

Despite reporting lower levels of smoking, lung cancer incidence remains higher for African Americans, than for whites, so this is an important population in which to study the role of CHRNA3 and CHRNA5 genes and risk of lung cancer. Previous conclusions from the genome-wide associates studies (GWAS) identified associations between NSCLC risk, smoking behaviors and SNPs on the chromosome 15q25.1. The present study concentrated on the genes CHRNA3 and CHRNA5, confirming a stronger association with the risk of lung cancer than with nicotine dependence in African Americans.

"This research confirms that differences on a genetic level can alter our risks for lung cancer," said lead investigator Ann Schwartz. "This research extends the need for such discoveries across diverse populations." ###

Journal of Thoracic Oncology (JTO) – (journals.lww.com/jto)

The JTO is rapidly becoming a prized resource for medical specialists and scientists who focus on the detection, prevention, diagnosis and treatment of lung cancer. The JTO is the official monthly journal of the International Association for the Study of Lung Cancer (IASLC.org) and emphasizes a multidisciplinary approach, including original research (clinical trials and translational or basic research), reviews and opinion pieces.

Contact: Megan Richter mrichter@spectrumscience.com 202-587-2556 International Association for the Study of Lung Cancer.

Ensign Jesse LeRoy Brown, USN, (1926-1950)

Jesse LeRoy Brown was born in Hattiesburg, Mississippi, on 13 October 1926. He enlisted in the Naval Reserve in 1946 and was appointed a Midshipman, USN, the following year. After attending Navy pre-flight school and flight training, he was designated a Naval Aviator in October 1948, the first African-American to achieve this status. Midshipman Brown was then assigned to Fighter Squadron 32. He received his commission as Ensign in April 1949.

During the Korean War, his squadron operated from USS Leyte (CV-32), flying F4U-4 Corsair fighters in support of United Nations forces. On 4 December 1950, while on a close air support mission near the Chosin Reservoir, Ensign Brown's plane was hit by enemy fire and crashed. Despite heroic efforts by other aviators, he could not be rescued and died in his aircraft. Ensign Jesse L. Brown was awarded the Distinguished Flying Cross for his Korean War combat service.

USS Jesse L. Brown (DE-1089) was named in honor of Ensign Jesse LeRoy Brown.

Photo #: USN 1146845. Ensign Jesse L. Brown, USN. In the cockpit of an F4U-4 Corsair fighter, circa 1950. He was the first African-American Naval Aviator, and flew with Fighter Squadron 32 (VF-32) from USS Leyte (CV-32). Official U.S. Navy Photograph.

Reproductions of this image may also be available through the National Archives photographic reproduction system as Photo # 428-N-1146845.

Photo #: NH 94599-KN (Color), "Black History" Poster, Featuring Ensign Jesse L. Brown, the first African-American Naval Aviator, and the ship named in his honor, USS Jesse L. Brown (FF-1089). The original artwork was created circa 1976 by William M. Moser, of the Navy Recruiting Command. U.S. Naval Historical Center Photograph.

Demonstrators Protest at Republic of Guinea UN mission VIDEO

Guinea has had a history of authoritarian rule since gaining its independence from France in 1958. Lansana CONTE came to power in 1984 when the military seized the government after the death of the first president, Sekou TOURE. Guinea did not hold democratic elections until 1993 when Gen. CONTE (head of the military government) was elected president of the civilian government. He was reelected in 1998 and again in 2003, though all the polls were marred by irregularities. History repeated itself in December 2008 when following President CONTE's death, Capt. Moussa Dadis CAMARA led a military coup, seizing power and suspending the constitution as well as political and union activity.

Guinea has maintained some semblance of internal stability despite spillover effects from conflict in Sierra Leone and Liberia.

Demonstrators outside the Permanent United Nations Mission of the Republic of Guinea, 140 east 39th street, New York, NY 10016. September 29, 2009. Video courtesy Public Domain Audio Video

As those countries have rebuilt, however, Guinea's own vulnerability to political and economic crisis has increased. Declining economic conditions and popular dissatisfaction with corruption and bad governance prompted two massive strikes in 2006, and a third nationwide strike in early 2007.

TEXT: Central Intelligence Agency