Minority patients discouraged from cancer screening by negative messages

Robert A. Nicholson, PhD, Secondary Faculty, Department of Community Health, Division of Behavioral Science and Health Education. Donco Building Room # 208, Saint Louis University Medical Center. Tel:(314) 977-8490 nicholra@slu.edu WEB: Nicholson | Behavioral Science

PHILADELPHIA – New behavioral science research published in Cancer Epidemiology, Biomarkers & Prevention, a journal of the American Association for Cancer Research, found that constantly emphasizing the negative consequences of a lack of cancer screening among minorities can actually make them less likely to go for screening. "We have typically assumed that one of the best ways to motivate individuals is to point out disparities in health, but we may be having negative unintended consequences," said Robert Nicholson, Ph.D., an assistant professor in the Department of Neurology and Psychiatry at the St. Louis University School of Public Health. "Instead of motivating people who would be less likely to get these services in the first place, we may be driving them away."

Minority communities have been historically underserved by cutting edge medical efforts, and leaders in cancer and other health groups have tried to increase awareness and compliance with known prevention and treatment strategies. However, whether this communication was effective was not known.

Nicholson and colleagues conducted a double-blind, randomized trial among 300 African-American adults. The adults were asked to read one of four articles about colon cancer and then answer questions about their likelihood of getting screened.

The first article emphasized that colon cancer was an important problem for African-Americans. The second emphasized that outcomes for blacks with colon cancer were worse than for whites, while a third said that although outcomes for African-Americans were improving the improvement was less than seen among whites. Finally, a fourth article discussed how outcomes for blacks with colon cancer were improving over time.

If African-Americans read the article that said outcomes for blacks were improving over time, they were more likely to have a positive emotional response than if they read any of the other three articles. The article most likely to cause a negative response was the one that simply stated the problem.

Similarly, those that read the article about African-Americans making progress in outcomes for colon cancer were far more likely to want to be screened than those who read any of the other three articles.

The mean age of the participants was 54.4 years, 76 percent were women and 89 percent had completed high school. Comprehension analysis found that all participants understood what they had read.

Nicholson said they did not ask questions about motivation, but he suggests that a general mistrust of the medical community may be playing a role. If information reinforces that mistrust, then African-Americans are less likely to be screened.

"We believe that a positive message would go a long way toward overcoming mistrust," Nicholson said. "We need the right kind of message for the right kind of person, and not to assume that what we have always done is working." ###

The mission of the American Association for Cancer Research is to prevent and cure cancer. Founded in 1907, AACR is the world's oldest and largest professional organization dedicated to advancing cancer research. The membership includes more than 28,000 basic, translational and clinical researchers; health care professionals; and cancer survivors and advocates in the United States and 80 other countries.

AACR marshals the full spectrum of expertise from the cancer community to accelerate progress in the prevention, diagnosis and treatment of cancer through high-quality scientific and educational programs. It funds innovative, meritorious research grants. The AACR Annual Meeting attracts more than 17,000 participants who share the latest discoveries and developments in the field. Special conferences throughout the year present novel data across a wide variety of topics in cancer research, treatment and patient care.

AACR publishes five major peer-reviewed journals: Cancer Research; Clinical Cancer Research; Molecular Cancer Therapeutics; Molecular Cancer Research; and Cancer Epidemiology, Biomarkers & Prevention. The AACR's most recent publication and its sixth major journal, Cancer Prevention Research, is dedicated exclusively to cancer prevention, from preclinical research to clinical trials. The AACR also publishes CR, a magazine for cancer survivors and their families, patient advocates, physicians and scientists. CR provides a forum for sharing essential, evidence-based information and perspectives on progress in cancer research, survivorship and advocacy.

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

African-Americans have unique lung cancer risks from chronic obstructive pulmonary disease

Carol J. Etzel, Ph.D. The University of Texas M. D. Anderson Cancer Center Department of Epidemiology.

PHILADELPHIA – Scientists at the M.D. Anderson Cancer Center have developed a risk prediction assessment for lung cancer specifically for African Americans that suggests a greater risk from chronic obstructive pulmonary disease (COPD), according to a report published in the September issue of Cancer Prevention Research, a journal of the American Association for Cancer Research.

Etzel and colleagues analyzed data from 491 African Americans with lung cancer and 497 African Americans without lung cancer to identify risk factors for the disease. They then compared these risk factors with a previously established risk prediction model for whites.

What was unique to African Americans was the risk associated with chronic obstructive pulmonary disease. African American men with a prior history of chronic obstructive pulmonary disease had a more than sixfold increased risk of lung cancer, similar to that seen with smoking. This is approximately two-fold higher than the risk typically seen from chronic obstructive pulmonary disease among whites.

"The one size fits all risk prediction clearly does not work," said Carol Etzel, Ph.D., assistant professor of epidemiology at the University of Texas M.D. Anderson Cancer Center.

As with whites, smoking was a significant risk factor for lung cancer. Current smokers had a more than sixfold increased risk of lung cancer, and former smokers had a more than threefold increased risk. This decreased risk was confined to those who had quit smoking more than ten years prior to diagnosis; these patients had a 58 percent decreased risk compared with patients who had quit within the previous ten years.

Researchers also found that hay fever, previously shown to be protective among whites, was also protective among African Americans. Specifically, African Americans with hay fever were 44 percent less likely to develop lung cancer, a rate that had been previously seen among whites.

African American males have a higher risk of lung cancer incidence at 110.6 per 100,000 compared with 81 per 100,000 among white males. Mortality is also higher among African American men at 95.8 per 100,000 compared with 72.6 among whites. Lung cancer incidence and mortality rates among women are comparable.

Etzel said the risk prediction model detailed in Cancer Prevention Research is part of an ongoing project to establish risk models among different ethnic groups; a model for Hispanics is currently under development.

"What we hope is that a doctor can use these models to encourage their patients to take steps to prevent lung cancer. Even if they are never smokers, they can be at risk," said Etzel. ###

The mission of the American Association for Cancer Research is to prevent and cure cancer. Founded in 1907, AACR is the world's oldest and largest professional organization dedicated to advancing cancer research. The membership includes more than 28,000 basic, translational and clinical researchers; health care professionals; and cancer survivors and advocates in the United States and 80 other countries.

AACR marshals the full spectrum of expertise from the cancer community to accelerate progress in the prevention, diagnosis and treatment of cancer through high-quality scientific and educational programs. It funds innovative, meritorious research grants. The AACR Annual Meeting attracts more than 17,000 participants who share the latest discoveries and developments in the field. Special conferences throughout the year present novel data across a wide variety of topics in cancer research, treatment and patient care.

AACR publishes five major peer-reviewed journals: Cancer Research; Clinical Cancer Research; Molecular Cancer Therapeutics; Molecular Cancer Research; and Cancer Epidemiology, Biomarkers & Prevention. Its most recent publication and its sixth major journal, Cancer Prevention Research, is dedicated exclusively to cancer prevention, from preclinical research to clinical trials. The AACR also publishes CR, a magazine for cancer survivors and their families, patient advocates, physicians and scientists. CR provides a forum for sharing essential, evidence-based information and perspectives on progress in cancer research, survivorship and advocacy.

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

MYH9 gene variations help explain high rate of kidney disease in African-Americans

Gene expression pattern of the MYH9 gene.

Possible new approaches to screening and prevention in African-American families

Several recent studies have suggested that common gene variations may be responsible for much of the elevated risk of kidney disease in African Americans. New research on the MYH9 gene—and its implications for the screening and possible prevention of kidney disease in the African American population—will be summarized in a press briefing to be held at the American Society of Nephrology's 41st Annual Meeting and Scientific Exposition in Philadelphia, PA.

"The susceptible variants in the gene MYH9 are very frequent among African Americans and account for a substantial proportion of the higher risk of end-stage renal disease (ESRD) in African Americans compared to European Americans," comments Rulan S. Parekh, MD, of Johns Hopkins University School of Medicine in Baltimore, MD, who will introduce the press briefing. "Discovery of this gene has opened up a new area of research to focus on both the mechanism of disease and also potential use for screening in the population."

In September, researchers from the National Institutes of Health (NIH) in Bethesda, MD, and Johns Hopkins University published independent studies showing that variations of the "non-muscle myosin heavy chain 9" gene (MYH9) are linked to certain types of kidney disease that are more common in African Americans, including focal segmental glomerulosclerosis (FSGS), HIV-associated nephropathy, and non-diabetic ESRD.

Variations of MYH9 may also explain the increased rate of hypertension-related kidney disease in African Americans, which tends to persist even with effective treatment to lower blood pressure. Overall, the gene variants appear to increase the risk of developing any form of ESRD, which is irreversible kidney failure requiring dialysis or transplantation not related to diabetes.

The discoveries have major public health implications because of the high frequency of MYH9 variants among African Americans with kidney disease: up to 60 percent, compared with four percent of European Americans.

At the press briefing, Dr. Parekh will introduce a panel of researchers at the forefront of ongoing research on MYH9. The speakers will share their perspectives on the discoveries so far, key areas for further study, and the implications for risk screening and efforts to reduce kidney disease in the African-American population.

Cheryl Winkler, PhD, of NIH will summarize key findings on the link between MYH9 and FSGS, including the methods and concepts that led to the discoveries. New studies by Dr. Winkler, along with Jeffrey Kopp, MD, and other NIH researchers, suggest that MYH9 explains most of the racial difference in FSGS risk (F-FC254). Research by Dr. Kopp and Dr. Winkler will also be presented as part of a free communications session entitled, "Gene Mapping in Common Kidney Diseases" on Friday, November 7, from 4:00 p.m.-6:00 p.m. in Room 104 of the Pennsylvania Convention Center.

Dr. Winkler will also discuss new research on the geographic distribution of the MYH9 risk alleles (TH-PO107). Rates of highest-risk gene variant appear highest in populations from southern Africa; in contrast, the high-risk allele is infrequent in Europeans, and "rare to absent" in Asians. The findings suggest that selection of the high-risk MYH9 risk variants was an ancient event in human evolution (TH-PO109). Dr. Winkler will also present her research findings for poster numbers TH-PO107 and TH-PO109 on Thursday, November 6, from 10:00 a.m.-Noon in Hall A/B of the Pennsylvania Convention Center.

Linda Kao, PhD, of Johns Hopkins University will focus on the risk of non-diabetes-related ESRD related to MYH9 variants. Dr. Kao and Dr. Parekh were involved in the genome-wide study showing that the risk of nondiabetic ESRD is strongly related to higher African American ancestry on chromosome 22 (F-FC255). People with the MYH9 at-risk variants were at up to double the risk of having nondiabetic ESRD. In contrast, MYH9 does not affect the risk of ESRD resulting from diabetes, which remains the most common cause of kidney disease. Dr. Kao's research will also be presented as part of a free communications session entitled, "Gene Mapping in Common Kidney Diseases" on Friday, November 7, from 4:00 p.m.-6:00 p.m. in Room 104 of the Pennsylvania Convention Center.

Barry I. Freedman, MD, of Wake Forest University in Winston-Salem, NC, will discuss evidence on the relationship between MYH9 and early kidney disease. A new study suggests that these common MYH9 variants are related to albuminuria—leakage of the protein albumin in the urine, an early sign of kidney disease—in African Americans with high blood pressure, but not necessarily in European Americans (TH-PO108). Many cases of kidney disease attributed to hypertension or unknown causes in African Americans may actually be related to MYH9 variants, through a process similar to FSGS (TH-PO94). It's too early to tell whether MYH9 is related to lupus nephritis—another cause of kidney disease that's more common in African Americans (TH-PO106). On Thursday November 6, Dr. Freedman will also present his research on poster numbers TH-PO108, TH-PO94, and TH-PO106 from 10:00 a.m.-Noon in Hall A/B of the Pennsylvania Convention Center.

Dr Kopp will summarize the findings of the genetic risk associated with MYH9 variants and kidney disease. He will also address the implications of the new discoveries for patients and physicians, including the possible role of MYH9 screening.

The presentations will be followed by a brief question-and-answer session, moderated by Dr. Parekh. It's important to note that most African Americans with MYH9 gene variants will not develop kidney disease. However, MYH9 gene testing may become an important new tool to identify African American patients and families at increased risk. "In the future, therapeutics and screening may target those who have MYH9 genetic variants to prevent progression to ESRD," according to Dr. Parekh. ###

The Press Briefing, "Discovery of a Gene Associated with Kidney Diseases among African Americans," will be presented on Friday, November 7, 2008, from 12:15 p.m.-1:15 p.m. in Room 303A of the Pennsylvania Convention Center in Philadelphia, PA.

ASN is a not-for-profit organization of 11,000 physicians and scientists dedicated to the study of nephrology and committed to providing a forum for the promulgation of information regarding the latest research and clinical findings on kidney disease. ASN Renal Week 2008, the largest nephrology meeting of its kind, will provide a forum for 11,000 nephrologists to discuss the latest findings in renal research and engage in educational sessions related to advances in the care of patients with kidney and related disorders. Renal Week 2008 will take place November 4 – November 9 at the Pennsylvania Convention Center in Philadelphia, PA.

Contact: Shari Leventhal sleventhal@asn-online.org WEB: American Society of Nephrology

Image Licensing: Permission is granted to copy, distribute and/or modify this document under the terms of the GNU Free Documentation License, Version 1.2 or any later version published by the Free Software Foundation; with no Invariant Sections, no Front-Cover Texts, and no Back-Cover Texts.

* Image Description: Gene expression pattern of the MYH9 gene.
* Image Source: Diagram created by User:AndrewGNF based on data from Su AI, Wiltshire T, Batalov S, et al (2004). "A gene atlas of the mouse and human protein-encoding transcriptomes". Proc. Natl. Acad. Sci. U.S.A. 101 (16): 6062–7. doi:10.1073/pnas.0400782101. PMID 15075390. Creation supported by the Genomics Institute of the Novartis Research Foundation.

Researchers Advance Health Communication for At-Risk Populations

Glen Cameron Professor Strategic Communication Maxine Wilson Gregory Chair in Journalism Research. 140-E Walter Williams Hall, Missouri School of Journalism, Columbia, MO 65211-1200 Phone: 573-884-2607, Fax: 573-882-4823, E-mail: camerong@missouri.edu

The $8.6 Million Grant Will Fund Efforts to Improve Health Literacy, Health Outcomes. Columbia, Mo. -- The National Cancer Institute (NCI) has awarded an $8.6 million grant to the University of Missouri Health Communication Research Center (HCRC), in partnership with Washington University in St. Louis, to advance health communication that will improve health literacy and health outcomes for at-risk populations. The project promotes the importance of ensuring access to understandable health information. According to the National Assessment of Adult Literacy, only 12 percent of adults have proficient health literacy, which means that they have the skills needed to manage their health. The announcement supports Health Literacy Month, which is recognized in October. The renewal grant will fund the continuation of Ozioma (which means "good news" in Nigerian), a biweekly news service created by MU researchers that produces localized cancer-related news releases for black communities.

The researchers analyzed the effectiveness of the news service and found that providing localized cancer news to black newspapers increased cancer news coverage and, therefore, prompted changes in readers' behaviors.

Our goal is to build on the findings from the Ozioma study by advancing tailored communication and health public relations to improve health outcomes for at-risk and general populations," said Jon Stemmle, HCRC assistant director. "We will develop a news information bureau that will provide locally relevant and race-specific cancer news stories to minority newspapers in predominately minority markets throughout the United States."

The news service will provide health stories to 36 newspapers. According to the researchers, the objective is to develop a permanent news service for NCI that targets every minority newspaper service in the United States.

"Providing people with understandable health information is essential to improving their health literacy," said Glen T. Cameron, HCRC director and the Maxine Wilson Gregory Chair in Journalism Research. "We hope to engage media in this process through our new news service, Informing Smart Health Decisions (I-SHD). Most press releases are general in form, created for the mass media audience. I-SHD is a cutting-edge approach to media relations that localizes a general release by region, state or community. We use local quotes, graphics and data to make the story more meaningful both for the local media and their audience."

The HCRC team consists of Cameron, Stemmle and María Len-Ríos, an assistant professor of strategic communication at the School, and a team of HCRC graduate students. The project also will include members of the Health Communication Research Laboratory at Washington University in St. Louis.

Contact: Emily Smith SmithEA@missouri.edu 573-882-3346 University of Missouri-Columbia

Teacher recruitment program will put more African-American men in Florida elementary schools

Call Me MISTER is a program to increase the pool of teachers from a broader, more diverse background, particularly among the lowest-performing elementary schools. The program is based at Clemson University, where it was founded with an original goal of doubling the number of African-American men in South Carolina’s elementary schools.

Call Me MISTER soon will be in seven states.

In Florida, where less than 1 percent of elementary teachers are black men, the program will be housed with the North East Florida Educational Consortium (NEFEC), and initially delivered at five community colleges, mostly in the northeastern part of the state. As the participants — the Misters — finish their first two years of school, they will transfer to three senior-level colleges taking part in Call Me MISTER: the University of Florida, the University of North Florida and Bethune-Cookman University.

The Misters are largely selected from under-served, socioeconomically disadvantaged and educationally at-risk communities. After graduation, they are expected to return to critical-need schools.

“I am elated about this program that addresses the shortage of minority males in the classroom. In my 11 years of recruiting teachers, particularly minorities, there has not been any initiative that empowers, encourages and excels like Call Me MISTER,” said Ulysees L. Gilbert II, coordinator of educator recruitment at NEFEC. “We are blessed to have this program in our state and many thanks to Rep. Joe Pickens — now the next president of St. Johns River Community College — for making it happen financially.”

Pickens arranged for a presentation to Gov. Charlie Crist’s chief of staff, which, with the cooperation of Education Commissioner Eric Smith, led to a one-year $300,000 appropriation for the program.

“I am thrilled at the opportunity to bring this program to Florida,” said Pickens. “I know firsthand that we don’t have enough black male teachers to be role models for a significant segment of our student population.”

As a former school board attorney, Pickens said he observed the shortage for many years.

Call Me MISTER’s director says the program has a proven track record for recruiting and training, and that original goal of doubling the numbers in South Carolina will be exceeded with the graduation of 100 Misters currently enrolled in the program.

“This is an excellent opportunity for the state of Florida and Call Me MISTER,” said Roy Jones, who oversees the program from his office at Clemson University. “Call Me MISTER in Florida will take things to a new level. It will become a national model for teacher recruitment.”

The first cohort of Misters in Florida will begin in January with 25, five each at St. Johns Community College in Palatka, the host college for the program; Florida Community College in Jacksonville; Lake City Community College; Central Florida Community College in Ocala; and North Florida Community College in Madison.

Call Me MISTER (Mentors Instructing Students Toward Effective Role Models) is licensed through Clemson University. License fees are reinvested into the management and further development of the program.

Call Me MISTER can be found in Georgia, Missouri, Pennsylvania and Virginia, in addition to South Carolina, where it is available to young men in 13 institutions of higher education across the state. An agreement for a program in Kentucky is pending.

END

CONTACT: Roy Jones, 864-656-7915 royj@clemson.edu CONTACT: Ulysses L. Gilbert, 386-329-3800 GilbertU@nefec.org WRITER: Ross Norton, 864-656-4810 rnorton@clemson.edu WEB: Clemson Home

Hypertension Disparity Linked to Environment

Social environment may play a greater role in the disparity between the numbers of African Americans living with hypertension compared to non-Hispanic whites with the disease. A study by researchers at the Johns Hopkins Bloomberg School of Public Health found that the disparity was substantially reduced when comparing groups of African Americans and non-Hispanic whites living in similar social environments. The results are published in the November 2008 print edition of Social Science and Medicine.

“Our study found that nearly 31 percent of the hypertension disparity among African Americans and non-Hispanic whites is attributable to environmental factors,” says Roland James Thorpe Jr., PhD, lead author of the study and an assistant scientist with the Bloomberg School’s Hopkins Center for Health Disparities Solutions. “These findings show that ethnic disparities could be linked to a number of factors other than race. Careful review of psychosocial factors, stress, coping strategies, discrimination and other personality characteristics could play a large role in reducing or eliminating the disparity.”

Commonly referred to as the “silent killer,” hypertension is the most common cardiovascular disease, affecting 65 million adults in the U.S. Hypertension is a serious condition that can damage the heart and blood vessels and eventually lead to stroke, heart failure, heart attack, kidney failure and vision problems. Previous studies have found that African Americans tend to have an earlier onset and higher prevalence of the disease than non-Hispanic whites.

Thorpe, along with colleagues from the Bloomberg School’s Center for Health Disparities Solutions and North Carolina Central University, compared data from the Exploring Health Disparities in the Integrated Communities (EHDIC) study and the National Health and Nutrition Examinations Survey (NHANES) to determine if racial disparities in hypertension persisted in communities where there is a minimal difference in social environments. The EHDIC study examines racial disparities among African Americans and non-Hispanic whites with the same median socioeconomic status who reside in the same community. NHANES, a cross-sectional survey, reviews the health, function and nutritional status of people in U.S.

“After adjusting for demographic variables, our research found that while African Americans still displayed greater odds of being hypertensive compared to non-Hispanic whites, there was a dramatic decrease in the ratio. Our study concluded that race differences in social and environmental exposures partially accounted for race differences in hypertension,” said Thomas LaVeist, PhD, senior author of the study and director of the Hopkins Center for Health Disparities Solutions. “These findings support our theory that the disparity is likely caused by environmental factors along with several external factors and not biological differences among race groups, as previously suspected.”

“Social context as an explanation for race disparities in hypertension: Findings from the Exploring Health Disparities in Integrated Communities (EHDIC) Study” was written by Roland James Thorpe, Dwayne T. Brandon and Thomas A. LaVeist.

The researchers were funded by grants from the National Center on Minority Health; Health Disparities of the National Institutes of Health (NIH); and Pfizer, Inc.

Public Affairs media contact: Natalie Wood-Wright at 410-614-6029 or nwoodwri@jhsph.edu.

Contact: Natalie Wood-Wright nwoodwri@jhsph.edu 410-614-6029 Johns Hopkins University Bloomberg School of Public Health

Making a difference in minority health

The underground railroad / Chas. T. Webber

Making a difference in minority health SAN DIEGO, Oct. 27 – Experts from the Center for Minority Health (CMH) at the University of Pittsburgh Graduate School of Public Health will address the successes and challenges of reducing health disparities at the American Public Health Association 136th Annual Meeting and Exposition in San Diego,

Oct. 25 to 29. Faculty will present innovative programs that improve the health and well-being of racial and ethnic minorities.

Nurses and Barbers Work Together to Promote Prostate Cancer Prevention

Prostate cancer is the second-leading cause of death in African-American men, higher than any other racial or ethnic group. To create an opportunity for African-American men to learn about prostate cancer prevention in their own communities, CMH developed Health Advocates In Reach (HAIR). HAIR trains barbers to deliver accurate health information to peers and customers with the assistance of oncology nurses, public health professionals and prostate cancer survivors. Since 2005, CMH project director Mario Browne, M.P.H., has coordinated the efforts of HAIR, which has reached 275 men with prostate cancer information and screened 139 African-American men.

Abstract number 186259, scheduled for 8:30 a.m. PDT, Monday, Oct. 27

The Underground Railroad Bicycle Route: Exploring African-American History by Bicycle

To increase physical activity among African-Americans and diversify the cycling community, CMH partnered with Adventure Cycling Association in 2004 to create the Underground Railroad Bicycle Route, a 2,100 mile cycling route from Mobile, Ala. to Owen Sound, Ontario. In May 2007, 20 riders from across the U.S. launched the inaugural tour, spanning 53 days. Since that time, organizers have developed two maps for the route – a long distance and short distance tour to accommodate all types of cyclists. Led by the director of CMH, Stephen Thomas, Ph.D., Philip Hallen Professor of Community Health and Social Justice, and Mario Browne, M.P.H., CMH project director, the project combines history, culture and education to celebrate the courage and determination of freedom seekers and to engage people of all walks of life in physical activity. Hundreds of cyclists of all races, ethnicities and ages have cycled all or portions of the bike route since 2007.

Abstract number 181775, scheduled for 3:12 p.m. PDT, Monday, Oct. 27 ###

CMH was established in 1994 with a grant from the Richard King Mellon Foundation. CMH is committed to taking a lead role in the nation's prevention agenda to eliminate racial and ethnic health disparities as described in Healthy People 2010, a Department of Health and Human Services Initiative. For more information on CMH, visit http://www.cmh.pitt.edu.

Contact: Clare Collins collcx@upmc.edu 412-352-2886 University of Pittsburgh Schools of the Health Sciences

Race and insurance status associated with death from trauma

African American and Hispanic patients are more likely to die following trauma than white patients, and uninsured patients have a higher death risk when compared with those who have health insurance, according to a report in the October issue of Archives of Surgery, one of the JAMA/Archives journals.

Health disparities based on race, income and insurance status have previously been documented in patients with cancer and those undergoing surgery, among other treatments and conditions, according to background information in the article.

Adil H. Haider, M.D., M.P.H., of the Johns Hopkins University School of Medicine, Baltimore, and colleagues reviewed data from the National Trauma Data Bank for 429,751 patients age 18 to 64 years treated at approximately 700 trauma centers nationwide between 2001 and 2005. Of these, 72,249 were African American, 41,770 were Hispanic and 262,878 were white; 47 percent had health insurance.

Overall, death rates were higher among African American (8.2 percent) and Hispanic (9.1 percent) patients than among white patients (5.7 percent). Uninsured patients were also more likely to die than insured patients (8.6 percent vs. 4.4 percent). "Mortality rates were substantially higher for all uninsured patients, almost doubling for African American (4.9 percent to 11.4 percent) and Hispanic patients (6.3 percent to 11.3 percent) compared with white patients (4.2 percent to 7.9 percent)," the authors write. "The absence of health insurance increased a trauma patient's adjusted odds of death by almost 50 percent."

Patients in minority groups were much more likely to be uninsured than white patients—about one-third of white patients, two-thirds of African American patients and two-thirds of Hispanic patients lacked insurance. Lack of insurance is associated with poorer baseline health status; because pre-existing conditions are known to affect trauma outcomes, this could partially account for the higher death rates in the uninsured, the authors note.

However, insurance status alone could not explain all racial disparities in trauma death rates. "Of the insured patients, both Hispanic and African American patients had significantly higher odds of mortality compared with white patients," the authors note. Other issues that may contribute to racial differences include mistrust, subconscious bias and stereotyping, but further study is needed to explore these possibilities, they continue.

"Understanding insurance and race-dependent differences is a crucial first step toward ameliorating health care disparities," the authors conclude. "The next step will be to comprehend the underlying reasons for these differences, which will enable the development of interventions to close the gap between patients of different races and payer statuses." ###

(Arch Surg. 2008;143[10]:945-949. Available pre-embargo to the media at www.jamamedia.org.)

Editor's Note: This study was supported by the Johns Hopkins University School of Medicine Department of Surgery New Faculty Academic Support Group. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

Contact: Eric A. Vohr evohr1@jhmi.edu 410-955-8665 JAMA and Archives Journals

Racial disparities in cardiovascular health linked to birth weight, slavery

Evanston, Ill. - October 16, 2008 – Two new articles examine the theory of "fetal programming" and their effect on racial health disparities. The studies, published in American Journal of Human Biology, suggest that the higher rates of hypertension and cardiovascular disease present in African Americans may be a consequence of low birth weights, and that these low birth weights may be a result of social rather than genetic factors.

It is well-established that the nutritional and psychological state of a pregnant mother can influence whether her child will later develop cardiovascular disease as an adult.

Nutrients and hormones present in the womb shape a fetus's development, in part by silencing certain genes in the body. These influences can persist into later life to impact adult health. Researchers from Northwestern University argue that such intergenerational impacts of environmental factors could help explain black-white differences in cardiovascular health in the U.S.

Five generations on Smith's Plantation, Beaufort, South Carolina, Civil War Photograph Collection (Library of Congress).

"A pregnant African American mother's experience of well documented stressors, including social forces such as discrimination and racism, could have lingering effects on diseases like hypertension, diabetes and heart attacks in her children," says Christopher Kuzawa and Elizabeth Sweet, who co-authored this piece. By synthesizing this new evidence, they argue that social forces, rather than genes, may underlie the problem of racial inequity in heart attacks and strokes in the U.S. In a related editorial in the journal, Peter Ellison, Editor-in-Chief, explains that some of the most persistent health disparities in the United States occur between African Americans and European Americans.

The causes of those disparities are many and their roots are deep. They are entwined with the history of slavery and discrimination, with rural and inner city neglect, with differential wealth and differential access to health care, with cultural traditions and cultural biases, according to Ellison.

A second study in the Journal states that the average birth weight among African-American babies is approximately 250 grams lower than the average birth weight of whites, a difference that represents nearly 10 percent of an average infant's body weight. According to Grazyna Jasienska, co-author of the study, this may also be the result of conditions experienced by their ancestors during the period of slavery passed through epigenetic, rather than genetic, mechanisms.

Current socio-economic conditions which are, on average, worse for African-Americans, can explain only part of the observed birth weight variation, according to Jasienska. Nor is there reason to think that lower birth weight of African-Americans is due to original African genetic heritage. Prior studies have shown that contemporary black women who were born in African countries ancestral to slave populations, but who live in the U.S., give birth to children with significantly higher weight than black women in the U.S. who have slave ancestry.

"Slaves experienced poor nutrition during all stages of life, suffered from a heavy burden of infectious diseases and, in addition, experienced high energetic costs of hard physical labor," says Jasienska. "Even a short-term nutritional deprivation of pregnant women, when very severe, has been shown to have an intergenerational effect," says Jasienska. Dutch women exposed to famine as fetuses in mid- and late gestation have also been shown to have reduced birth weights, and the effect was detectable years later because birth weight of their children was also reduced.

The fetal programming concept suggests that physiology and metabolism, including growth and fat accumulation of the developing fetus, and, thus its birth weight, depend on intergenerational signal of environmental quality passed through generations of matrilinear ancestors.

A child's birth weight depends on the condition of his or her mother during pregnancy but also, recent research indicates, on the conditions the mother faced as a child and even as a fetus. As a result, a child's birth weight may be influenced by nutritional conditions of its grandmother and even great-grandmother. The resulting effects can be seen in both childhood and adulthood, and include a higher risk of hypertension, diabetes and cardiovascular disease.

Jasienska states that, in the U.S. , the condition of many slaves did not immediately improve after the abolition of slavery, so the causes are not as far removed in time from contemporary African Americans as it may seem. Census data from the year 1900 showed that African Americans continued to suffer higher mortality than whites from all major diseases except cancer. Even though several generations have passed since then, it may not have been enough time to eliminate the negative impact of slavery on the health of the contemporary African-American population. ###

Contact: Sean Wagner, swagner@wiley.com 781-388-8550 Wiley-Blackwell

Landmark study links sleep, memory problems in elderly African-Americans

Alyssa Gamaldo, North Carolina State University. Department of Psychology. Campus Box 7650. Raleigh, NC 27695, Phone: 919-515-6141, FAX: 919-515-1716. Email: aagamald@ncsu.edu

A landmark study led by North Carolina State University researchers shows that African-American seniors who have trouble falling asleep are at higher risk of having memory problems – raising the possibility that identifying and treating sleep difficulties in the elderly may help preserve their cognitive functioning. The study is the first to examine the link between sleep and cognitive functioning in older African-Americans.

The study, led by NC State psychology Ph.D. student Alyssa A. Gamaldo, shows that older African-Americans who reported having trouble falling asleep tended to do much worse on memory tests than those study participants who did not have trouble falling asleep. Gamaldo says that the difference was particularly apparent in tests related to "working memory," which is the ability to multitask or do two things at once. The study examined 174 subjects between the ages of 65 and 90.

Gamaldo says the findings raise additional questions, which will have to be addressed in future research. For example, Gamaldo says, "it is not clear if lack of sleep is the issue. Is it the quantity of sleep, the quality of sleep, or something else altogether?"

The study raises questions for future research on both sleep and cognitive functioning in the elderly. The findings indicate that sleep may need to be accounted for as a confounding variable in cognition studies targeting seniors. In addition, the findings show that sleep research may need to increase its focus on older adults in order to fully explore the impacts of sleep problems on cognition in seniors.

"If we can better understand how sleep quantity, as well as quality, influences general cognitive functioning, perhaps we could better maintain memory throughout life – including later in life," Gamaldo says. ###

The study, "The Relationship Between Reported Problems Falling Asleep and Cognition Among African American Elderly," will be published in the November issue of Research on Aging. The study's co-authors are Dr. Jason C. Allaire, assistant professor of psychology at NC State, and Dr. Keith E. Whitfield, professor of psychology and neuroscience at Duke University.

Note to editors: The study abstract follows.

"The Relationship Between Reported Problems Falling Asleep and Cognition Among African American Elderly" - Authors: Alyssa A. Gamaldo, Dr. Jason C. Allaire, North Carolina State University; Dr. Keith E. Whitfield, Duke University, Published: November 2008 in Research on Aging

Abstract: This study examined the relationship between elders' cognitive performance and self-reported trouble falling asleep. Analyses were conducted on 174 older independently living, community dwelling African Americans (M age = 72.74; range = 65 to 90). Cognitive performance was measured using the Mini-Mental State Examination, Forward Digit Span task, Backward Digit Span task, Alpha Span task, and California Verbal Learning Test.

Results suggested that individuals who reported trouble falling asleep tended to perform significantly worse than individuals who did not report trouble falling asleep on measures tapping short-term memory and working memory after controlling for age, education, gender, depression, and current health. These results demonstrate that a self-report of sleep difficulty may be a unique predictor of cognitive performance.

Contact: Matt Shipman matt_shipman@ncsu.edu 919-515-6386 North Carolina State University

Black patients with chronic pain less likely to be tested for obesity

Carmen R. Green, MD, Director, Pain Research Division. Associate Professor of Anesthesiology. Phone: 734-936-4240, Fax: 734-936-9091, Email: carmeng@umich.edu

ANN ARBOR, Mich. — At the intersection of two U.S. health epidemics – obesity and chronic pain – researchers from the University of Michigan Health System found black patients with chronic pain were less likely to have their weight or body mass index (BMI) recorded, even though they are at higher risk for having obesity when compared with their white counterparts. This new study also revealed that obesity is related to greater disability and poorer functioning, over and above the impact of a person’s pain level.

Obesity contributes to chronic pain and several other chronic conditions, leading to decreased health and quality of life. Chronic pain also leads to decreased health and quality of life, says senior author Carmen R. Green, M.D. Disparities in the chronic pain experience and obesity exist, with blacks more likely to be negatively impacted, she notes.

Black people also are more likely to experience disability and lower physical functioning than white people, when faced with chronic pain, says Green, associate professor of anesthesiology and health management and policy, and director of Pain Medicine Research at the U-M Medical School and School of Public Health. The study appears in the Journal of Pain.

“Assessing a patient’s weight and height is necessary to calculate BMI. Once assessed, a dialogue can begin between the patient and health care team to address obesity,” Green says. “These findings provide further evidence of the negative effect obesity, measured via BMI, can have on a person’s overall health and well-being in general and on chronic pain in particular.

“This is a reminder about the importance of assessing height and weight and measuring BMI in patients with chronic pain, especially minorities.”

However, the goal is made more difficult because black patients are less likely to have their BMI assessed, the study found. “Both chronic pain and obesity are reaching epidemic proportions. Considering their public health implications in terms of disability, BMI should be regularly assessed especially in populations who are at increased risk,” Green says.

It is not clear why it was less likely black patients would have their BMI measured, even though they may be at increased risk for higher BMI and obesity, researchers say. But they point out that the gap could indicate a lower quality of care than what is provided to white patients.

BMI is a measure of body fat based on height and weight. According to the National Institutes of Health, people with a BMI lower than 18.5 are considered underweight; people between 18.5 and 24.9 are normal weight; people between 25 and 29.9 are overweight; and those with a BMI of 30 or higher are obese. This table shows the BMI of people at various weights and heights.

By the numbers:

Researchers studied 183 people – 92 white and 91 black, 68 men and 115 women, ages 31 to 46. New black patients attending a pain clinic at U-M were asked to participate, and were matched with a white chronic pain patient of the same gender and similar age.

When the height and weight was available it was taken from the electronic medical record. Patients were asked to indicate on a diagram of the human body where they were in pain, how long they’ve been in pain and what caused it. They also were given the McGill Pain Questionnaire and the West Haven Yale Multidimensional Pain Inventory to evaluate the intensity of their pain and its impact on their life.

The BMI was notably higher for blacks than whites (31.6 vs. 27.6). Blacks were less likely to have complete height and weight data in their records than whites (73 percent vs. 84 percent). Those without BMI data had higher pain severity scores.

In addition to Green, Julia Caldwell, M.D. and Tamera Hart-Johnson, M.S. were co-authors of the paper.

AETNA Quality Care Foundation provided funding for the study.

Reference: Journal of Pain and doi:10.1016, Body Mass Index and Quality of Life: Examining Blacks and Whites With Chronic Pain. # # #

Contact: Katie Vloet kgazella@umich.edu 734-764-2220 University of Michigan Health System

Seeing race and seeming racist? Whites go out of their way to avoid talking about race

Evan P. Apfelbaum was born in Boston, Massachusetts and attended Newton North High School. He received a B.S. in Psychology and Music from Union College (2002) and a M.S. in Experimental Psychology from Tufts University (2007), where he expects to receive his Ph.D. in 2009. Department of Psychology • Tufts University 490 Boston Avenue • Medford MA 02155. 617.627.2524, E-Mail: Evan.Apfelbaum@Tufts.edu Personal website: Evan Apfelbaum

Efforts to appear unbiased lead to misunderstandings between the races, studies find. WASHINGTON – White people – including children as young as 10 -- may avoid talking about race so as not to appear prejudiced, according to new research. But that approach often backfires as blacks tend to view this "colorblind" approach as evidence of prejudice, especially when race is clearly relevant. These results are from two separate sets of experiments led by researchers from Tufts University and Harvard Business School. Their findings are reported in the October issue of the Journal of Personality and Social Psychology and the September issue of Developmental Psychology. Both journals are published by the American Psychological Association.

"Efforts to talk about race are fraught with the potential for misunderstandings," said the studies' lead author, Evan Apfelbaum, a PhD candidate at Tufts University. "One way that whites try to appear unbiased is to avoid talking about race altogether, a tendency we refer to as strategic colorblindness."

In one study, 101 white undergraduate students were paired with either a white or black female partner who pretended to be another participant. The pairs were presented with 30 photographs of faces that varied in race, gender and background color. Each white participant's objective was to guess which of the photographs the partner was holding by asking as few yes-or-no questions as possible.

Even though asking about the race of the person in the photograph was a sound strategy for completing the task, white participants were far less likely to do so with a black versus a white partner. Moreover, when the black partner was the first one to have a turn asking questions, whether she mentioned race had a dramatic effect. White participants whose black partner asked about race mentioned race on their own turn 95 percent of the time. When the black partner never asked about race, white participants only did so 10 percent of the time.

"There was clear evidence the white participants' behavior was influenced by the precedent set by their partner, but especially when that partner was black," said Samuel Sommers, assistant professor at Tufts and co-author of both papers. "Whites are strategically avoiding the topic of race because they're worried that they'll look bad if they admit they notice it in other people."

The researchers also wanted to see how outsiders interpreted such interactions. In another experiment, 74 black and white college students evaluated videos of whites engaging in the photo task. The results showed that whites' effort to appear colorblind backfired. Black observers rated whites' avoidance of asking about race as being evidence of prejudice. What's more, when the researchers showed silent video clips of whites from the study to another group of individuals, those whites who avoided asking about race were judged as less friendly, just on the basis of their nonverbal behavior.

"The findings suggest that when race is clearly relevant, whites who think that it is a wise social strategy to avoid talking about race should think again," said Apfelbaum.

Even children appear to adopt this strategically colorblind approach. In another set of experiments, 101 white children between the ages of 8 and 11 were asked to perform a similar photo task. The children were told that asking as few yes-or-no questions as possible would mean they would get a higher score on the task.

The results showed that the older children, ages 10 and 11, avoided asking about race more than the younger children, even though this led them to perform less efficiently than their younger counterparts on the task. In a control version where all the faces in the photos were white, the older children outperformed the younger children, as expected. "This result is fascinating because it shows that children as young as 10 feel the need to try to avoid appearing prejudiced, even if doing so leads them to perform poorly on a basic cognitive test," said Kristin Pauker, a PhD candidate at Tufts and co-author of this study.

The authors associated with both studies said their findings offer several important implications. "Our findings don't suggest that individuals who avoid talking about race are racists," Apfelbaum explained. "On the contrary, most are well-intentioned people who earnestly believe that colorblindness is the culturally sensitive way to interact. But, as we've shown, bending over backward to avoid even mentioning race sometimes creates more interpersonal problems than it solves." ###

Article: "Seeing Race and Seeming Racist? Evaluating Strategic Colorblindness in Social Interaction," Evan P. Apfelbaum, PhD candidate, and Samuel R. Sommers, PhD, Tufts University; Michael Norton, PhD, Harvard Business School; Journal of Personality and Social Psychology, Vol. 95, No. 4. (Full text of this article is available from the APA Public Affairs Office and at www.apa.org/journals/releases/) In PDF Format.

Article: "Learning (Not) to Talk About Race: When Older Children Underperform in Social Categorization," Evan P. Apfelbaum, PhD candidate, Kristin Pauker, PhD candidate, Nalini Ambady, PhD, and Samuel R. Sommers, PhD, Tufts University; Michael I. Norton, PhD, Harvard Business School; Developmental Psychology, Vol. 44, No. 5. (Full text of this article is available from the APA Public Affairs Office and at www.apa.org/journals/releases/) in PDF Format.

Contact Samuel Sommers by e-mail at sam.sommers@tufts.edu; his phone number is 617-627-5293.

The American Psychological Association (APA), in Washington, DC, 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 148,000 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 human welfare.

Contact: Public Affairs Office public.affairs@apa.org 202-336-5700 American Psychological Association

African-Americans may be at higher risk of stroke-causing brain lesions

Specialties: Neurology, Title: Associate Professor, Department of Neurology; Medical Director of Georgetown Stroke Center. Medical Degree: University of Arizona, Tuscon, 1992. Internship: UCLA, Internal Medicine, 1993. Residency: UCLA, Neurology, 1996. Fellowship: Cerebrovascular Disease Fellowship, UCLA, 1998. Certification: Neurology; Vascular Neurology. Special Interests: Acute stroke therapies, Neuroimaging in stroke. Address: Georgetown University Hospital, 4000 Reservoir Rd., NW, Building D, Suite 207, Washington, DC 20007, Phone: (202) 877-3154

ST. PAUL, Minn. – Cerebral microbleeds, which are small bleeds within the brain, appear to be more common in African-Americans than in Caucasians, increasing the likelihood of having a stroke, according to a study published in the October 7, 2008, issue of Neurology®, the medical journal of the American Academy of Neurology. These types of brain lesions can be an important indicator for stroke. For the study, 87 people from the Washington, DC, area who had suffered a certain type of stroke, called an intracerebral hemorrhage, underwent brain scans. This kind of stroke involves bleeding in the brain and makes up 10 to 15 percent of all strokes. Researchers also determined the group's risk factors for stroke such as age, hypertension and alcohol use. Forty-two of the people were African-American while 45 were Caucasian. The study found that African-Americans had 32 percent more microbleeds than Caucasians. African-Americans were also more likely to have these types of lesions in several different areas of the brain. While African-Americans had more lesions in the lower and middle parts of the brain, Caucasians had them most frequently near the surface of the brain. "Finding racial differences that could be linked with a higher prevalence for these brain lesions may lead to new methods for testing and treating people to prevent stroke," said study author Chelsea Kidwell, MD, with Georgetown University Medical Center in Washington, DC, and member of the American Academy of Neurology.

"Knowing if a person has a higher likelihood of having these brain lesions or bleeding in the brain is important for doctors and patients when caring for medically underserved groups of people and optimally treating their stroke risk factors," said Kidwell. Hemorrhagic stroke is two to three times more common in minority populations, including African-Americans. Microbleeds are found in 50 to 80 percent of this type of stroke. ###

The study was supported by the National Institute of Neurological Disorders and Stroke.

The American Academy of Neurology, an association of more than 21,000 neurologists and neuroscience professionals, is dedicated to improving patient care through education and research. A neurologist is a doctor with specialized training in diagnosing, treating and managing disorders of the brain and nervous system such as epilepsy, dystonia, migraine, Huntington's disease, and dementia. For more information about the American Academy of Neurology, visit www.aan.com.

Contact: Rachel Seroka rseroka@aan.com 651-695-2738 American Academy of Neurology

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

African-American blogs offer key health communications tool

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

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

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

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

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

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

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

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

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

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

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

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

Television viewing and aggression: Some alternative perspectives

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

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

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

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

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

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

Author Contact: Seymour Feshbach at sfeshbac@ucla.edu

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

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

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

Willie Pearson, Jr. Photographer: Gary Meek.

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

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

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

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

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

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

Other key findings include:

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

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

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

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

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

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

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

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

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

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