Fear, misconceptions about screenings keep many African-Americans from getting mammograms

Monica Peek, MD, MPH. Assistant Professor of Medicine Department of Medicine, General Internal Medicine. Practice Location: University of Chicago Medical Center 5841 S. Maryland Avenue Chicago, IL 60637 Center for Advanced Medicine, 5758 S. Maryland Avenue, Chicago, IL 60637 Year Started Practice: 1999, Board Certification: Internal Medicine, Specialties: General Internal Medicine, Medical School: Johns Hopkins University, Internship: Stanford University Hospital, Residency: Stanford University Hospital, Membership: Nat'l Medical Association, Society of Gen. Internal Med. Languages Spoken: English

Training physicians and caregivers to improve cultural sensitivity and communication with economically disadvantaged African-American patients could influence these women to get mammograms that could save their lives, according to a new study in the Journal of General Internal Medicine. The study found that many African-American women perceive they are being treated with disrespect and receive inadequate explanations about screenings when they go to health care facilities. These experiences influenced their decisions to skip mammograms. They also fear they won't receive correct treatment so they avoid mammograms altogether, the study adds. "The issue here is not whether these feelings are founded or unfounded," said study author Monica Peek, MD, MPH, assistant professor of medicine at the Medical Center. "The study gives more direction to health professionals on how they can adapt their treatment styles to encourage this high-risk group of women to get screened." The findings may help account for the huge disparity between death rates from breast cancer in white versus African-American women.

Nationally, African-American women have a 35 percent higher mortality rate from breast cancer than white women, according to the National Cancer Institute. In Chicago, the mortality rate for African-American women is dramatically higher than for white women -- 73 percent -- according to the Sinai Urban Health Institute.

The findings are based on feedback gathered during focus groups that included 29 low-income African-American women who were at least 40 years old. The women were asked about their perception of mammograms, whether they would undergo one to screen for breast cancer, and other related questions.

Despite recommendations for women 40 and older to have annual mammograms, only 55 percent of the women reported having a mammogram within the last two years. One woman in the study had a history of breast cancer.

Participants in the study were low-income, medically underserved African-American women who lived in urban, economically challenged neighborhoods throughout Chicago. Participants received a $15 gift certificate to a grocery store in exchange for their participation.

Asked why they did not go for regular mammograms, women in the study gave several reasons. Some felt they had not been treated with respect or not received adequate information from clinical teams during prior visits to health care facilities.

One woman recounted feeling uncomfortable when she was left alone while her images were being developed and read by a radiologist.

"You see, when they left me, there wasn't nobody with me to talk to me," she said.

Other study participants said they thought anyone with breast cancer would inevitably die from the disease, so there was no use getting a mammogram.

"I didn't know that it was a possibility to live after you had breast cancer or had been found having breast cancer," one woman said.

"Everybody I know who had breast cancer [has] died. I [wasn't aware] of anything different," another woman said.

Women also said that stories circulate of patients who had bad experiences undergoing mammograms and received incorrect cancer treatments, such as an unnecessary mastectomy. Those tales are all spun into the urban folklore about mammograms and impact women's decisions not to get screened. The study adds that because of their fears, some women delay getting screened, which leads to worse health outcomes such as late-stage cancer diagnosis and higher mortality rates.

The study points to the need for physicians to be trained in cultural sensitivity. If health care providers tailored their care appropriately for this population, these patients may be more likely to return for repeat mammograms. The study also suggests the need for more community-based health educators to work within underserved communities, explaining the breast cancer screening process, addressing misperceptions, and reinforcing the health messages women receive from their physicians.

"African-American women have a high need for comprehensive information and better communication from their health care providers on breast cancer prevention and treatment. Sadly, we heard none of the women in our study were aware of early diagnosis or positive breast cancer outcomes," Peek said. ###

The study was funded by the Open Society Institute's Medicine as a Profession (MAP) fellowship program and Susan G. Komen for the Cure. Peek is currently supported by the Robert Wood Johnson Foundation Harold Amos Medical Faculty Development program.

Additional study authors include Judith Sayad and Ronald Markwardt.

Contact: Martha O'Connell Martha.OConnell@uchospitals.edu 773-834-8089
University of Chicago Medical Center

Efforts for whites to appear colorblind may backfire

Tufts University researchers find that efforts to avoid the topic of race may have unintended results

MEDFORD/SOMERVILLE, Mass. -- New research shows that whites often avoid using race to describe other people, particularly in interactions with blacks. However further research reveals that such efforts to appear colorblind and unprejudiced are associated with less-friendly nonverbal behaviors.

"Many whites seem to think that appearing colorblind – avoiding race during social interaction – is a good way to appear unbiased," said Samuel R. Sommers, Ph.D., assistant professor of psychology in the School of Arts and Sciences at Tufts University. "Despite that perception that colorblindness may make a positive impression on others, our data suggests that it often backfires."

Samuel R. Sommers, Ph.D., assistant professor of psychology in the School of Arts and Sciences at Tufts University

In one study, researchers examined whites' reluctance to admit to their ability to categorize others on the basis of race. This study tested how fast whites categorized people in photos using different characteristics, including race, and compared that data with whites' estimates of how quickly they would be able to make those categorizations. A second study examined the consequences of whites' reluctance to identify other people according to their race.

The studies appear in the current issue of "Psychological Science" (Volume 17, Number 11). Sommers co-authored the paper with Evan P. Apfelbaum, a Ph.D. candidate at Tufts, as well as Michael I. Norton from Harvard Business School and additional researchers at Tufts and Massachusetts Institute of Technology.

Claiming color blindness

In the first study, 57 white participants completed either a "sorting task" or a "hypothetical task." With the sorting task, participants sorted 24 photos of black and white volunteers according to seven characteristics: race, gender, age, color of the background in the photo, hair color, facial expression, and facial hair. In the hypothetical task, participants were asked to estimate how quickly they would categorize using each of the seven characteristics if they were to perform the sorting task.

The results for the sorting task showed that participants were quickest to categorize the photos by background color, then gender, then race. However, in the hypothetical task, participants estimated that the two slowest characteristics to determine would be race followed by age. Further research showed that blacks' speed at categorizing photos by race was comparable to whites' but their estimates of their ability to do this were more accurate than the estimates of white participants.

"Whites sometimes deny the ease with which they can categorize others by race," Sommers said. "And they'll even avoid using race as a simple descriptor of someone else."

Political correctness has surprising results

The second study examined some of the possible consequences of whites' reluctance to use race to differentiate people. Thirty white participants were randomly paired with a white or black partner who was in fact a "confederate" in the research project. The pair played a game in which one person asked questions to identify a target face in a set of photos. Questioners were told that their objective was to identify the photo the answerer was looking at by asking as few yes/no questions as possible.

The white participants, who all played the role of questioner, were given 32 photos of faces that varied by the same categories as those in the first study, including gender, background color and race. The "confederates" acted as answerers and were given a copy of the target photo. They answered yes or no questions until the questioner determined which of the 32 photos the answerer held.

The results showed that the questioner was less likely to mention race when the answerer was black (64 percent of the time) than when the answerer was white (93 percent of the time). This led to less-efficient performance times when white questioners were paired with black answerers because they asked more questions to identify the target photo.

In addition to slower performance, reluctance to differentiate by race was associated with less friendly nonverbal behaviors.

"When we showed independent coders video clips of questioners in the study without audio, they noted that the white participants who avoided talking about race with a black partner made less eye contact with their partners and appeared to be less friendly," Sommers said. "By their nonverbal behavior alone, the whites who are trying to appear colorblind to impress their black partners ironically come across as distant and unfriendly." ###

CONTACT: Kimberly M. Thurler kim.thurler@tufts.edu (617) 627-3175

Tufts University, located on three Massachusetts campuses in Boston, Medford, Somerville, and Grafton, and in Talloires, France, is recognized among the premier research universities in the United States. Tufts enjoys a global reputation for academic excellence and for the preparation of students as leaders in a wide range of professions. A growing number of innovative teaching and research initiatives span all Tufts campuses, and collaboration among the faculty and students in the undergraduate, graduate and professional programs across the university's eight schools is widely encouraged.

Contact: Suzanne Miller suzanne_c.miller@tufts.edu 617-627-4703 Tufts University

Gifts, affirmations boost medication adherence in African-Americans

PDF of Image

A patient education program that included self-affirmation and positive affect in the form of occasional gifts significantly increased medication adherence among African Americans with high blood pressure, according to research presented at the American Heart Association's Scientific Sessions 2008. The randomized, controlled trial found that calling patients occasionally with positive messages, coupled with standard information about hypertension encouraged them to take their medication more often than patients who received usual care.

"This is good news." said Olugbenga Ogedegbe, M.D., lead author of the study and an associate professor of medicine at the New York University School of Medicine. "We have a very cheap intervention that helps patients improve adherence. The key question here is 'How do we integrate this into daily practice?' "

Adherence — taking medication consistently and correctly — is a major issue in all patient populations and especially African Americans.

"African Americans have been shown in some studies to be nearly twice as likely to not take their medicines when compared to Caucasians," Ogedegbe said.

For this study, researchers measured adherence, with electronic monitors installed on the caps of the blood pressure pill bottles. The monitors recorded each time the pill bottles were opened. Researchers consider this method far more reliable than patient self-report.

The study of 252 African Americans with hypertension found that those who received unexpected quarterly gifts by mail plus bi-monthly calls reminding them of positive life experiences took their medication 43 percent of the time over 12 months. Patients who just received a workbook on their disease with no additional intervention (control group) took their medicines 36 percent of the time during the year-long study.

"The adherence level is still woefully low," Ogedegbe said.

Of the study patients, 80 percent were women, average age 58. All were prescribed at least one anti-hypertension medication.

Although, most of the study participants were women, Ogedegbe expects the results to also apply to African-American men.

Each patient in the study in the intervention group and in the control group received a 10-chapter hypertension education workbook that detailed ways to combat hypertension. Those in the intervention group also were called every two months with homework from the workbook along with reminders to think about proud moments in their lives, their goals and the values they hold dear. The calls were not costly, Ogedegbe said, because they came from research assistants with college degrees rather than medical professionals.

The intervention group also received up to six small gifts unexpectedly throughout the 12-month study duration, which included an umbrella and a duffle bag. The items were adorned with positive messages such as, "It's a beautiful day."

"The whole idea is to reduce the amount of negativity patients have in terms of their health," Ogedegbe said. "If you are depressed, you are much less likely to take your medicine. This study attacked it from two ways by reducing the rate of depressed feelings and helping patients affirm their own positive feelings. When people receive unexpected good news or gifts it tends to induce positive feelings and it is shown to carry over into other areas of life." ###

Co-authors are: Carla Boutin-Foster, M.D; Martin T. Wells, Ph.D.; John P. Allegrante, Ph.D.; Jared B. Jobe, Ph.D.; and Mary E. Charlson, M.D.

Individual author disclosures can be found on the abstract.

The National Heart Lung and Blood Institute funded the study.

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

Contact: AHA News Media Staff Office bridgette.mcneill@heart.org 504-670-6524 American Heart Association

Blood Pressure Control Inequality Linked to Deaths Among Blacks

Kevin Fiscella, M.D., M.P.H. Associate Professor of Family Medicine and Community & Preventive Medicine with tenure, University of Rochester School of Medicine & Dentistry Associate Director, Rochester Center to Improve Communication in Health Care HIV Clinical Coordinator, Westside Community Health Center

Racial disparity in the control of hypertension contributes to the deaths of almost 8,000 black men and women in the United States annually, according to a first-of-its-kind study published today in the Annals of Family Medicine by University of Rochester Medical Center researchers. The researchers concluded that the deaths could be avoided or postponed if blacks had their hypertension, or high blood pressure, controlled to the same level as whites. “Disparity in the control of blood pressure is one of the most important, if not the most important, contributor to racial disparity in cardiovascular mortality, and probably overall mortality,” said Kevin Fiscella, M.D., M.P.H., lead author of the article and associate professor of family medicine and of community and preventive medicine at the Medical Center. “If we as clinicians are going to reduce cardiovascular and stroke-related deaths, we need to pay attention to all the barriers to improving blood pressure control, particularly for minority patients” Fiscella said. Although not clearly known, the likely causes of the racial disparity include differences in access to care, clinician management and communication, hypertension severity, and patient adherence.

“There is evidence from previous studies that access barriers and financial and interpersonal communication barriers affect the ability of black patients to get medical care or to take their medication as prescribed,” Fiscella said.

Fiscella and Kathleen Holt, Ph.D., adjunct professor of community and preventive medicine at the Medical Center, are authors of the articles, which is the first effort to quantify the toll of racial disparity in blood pressure control. The article is part of a package of articles on racial disparity in the Annals of Family Medicine that is accompanied by editorials from former U.S. Surgeon General David Satcher, M.D., Ph.D., and Crystal Wile Cené, M.D., M.P.H., and Lisa A. Cooper, M.D., M.P.H. They call on clinicians, researchers, health care administrators, health care planners and policy makers to work together to gain a better understanding of the barriers faced by ethnic minorities.

Hypertension is a precursor to cardiovascular disease, which is the leading cause of death in the United States and which occurs at the highest rate among black Americans.

The researchers analyzed data of 1,545 black adults and 1,335 white adults. The mean blood pressure among blacks with hypertension was approximately six mm/Hg (millimeters of mercury) higher than that for the total adult black population and seven mm/Hg higher than that for whites with hypertension.

A reduction in mean blood pressure among blacks to that of whites would reduce the annual number of deaths among blacks from heart disease by 5,480 and from stroke by 2,190, the researchers concluded.

“There is evidence for racial disparity in patient adherence to antihypertensive medication, including studies conducted within the Veterans Administration Health System, where fewer differences in access appear to exist,” the researchers state in the article. “Differences in adherence by race may be due to affordability of medicines, personal beliefs, anticipated adverse effects, and health literacy that disproportionately affect blacks. Although multiple causes may contribute to racial disparity in blood pressure control, this disparity is not inevitable. Disparity in hypertension control is significantly smaller in the Veterans Administration Health System, where access barriers are fewer.”

Elimination of racial disparity in blood pressure control is an attainable goal, provided sufficient resources are available to discover and address adherence barriers, the researchers conclude.

Funding for the research was provided by the Robert Wood Johnson Foundation and through a grant from the National Heart, Lung, and Blood Institute.

Contact: Michael Wentzel Michael_Wentzel@urmc.rochester.edu 585-275-1309 University of Rochester Medical Center

ERSD, heart disease and African-Americans with hypertensive nephrosclerosis

For most patients with chronic kidney disease (CKD), the risk of experiencing a cardiovascular related death is greater than the risk of progressing to end-stage renal disease (ESRD).

According to research being presented at the American Society of Nephrology's 41st Annual Meeting and Scientific Exposition in Philadelphia, Pennsylvania, African Americans with CKD caused by high blood pressure (hypertensive nephrosclerosis) demonstrated a higher risk of progressing to ESRD than dying from heart disease related events.

Tahira Alves, MD, of Vanderbilt University in Nashville, Tennessee, will present the cardiovascular and renal results from the AASK (African American Study of Kidney Disease) Cohort Study (2002-2007), which followed the original AASK Trial (1996-2001).

Of 1,094 eligible patients from the original AASK Trial, 691 were enrolled in the subsequent AASK Cohort study. The patients received intensive follow-up to keep their blood pressure at a target level of less than 130/80 mm Hg (millimeters of mercury). The average age at the start of the study was 55 years.

During 11 years' follow-up, the patients were at higher risk of progressing to ESRD than of experiencing cardiovascular disease events such as myocardial infarction (heart attack). For each 100 "patient-years" of follow-up, there were four cases of ESRD (permanent loss of kidney function requiring dialysis or transplantation). By comparison, the rate of cardiovascular disease events was 3.2 per 100 patient-years.

The risk of death from cardiovascular disease was 0.8 per 100 patient-years. Of 74 deaths that occurred during the Cohort period of the AASK Study, more than 60 percent were from causes other than cardiovascular disease.

The finding that ESRD risk is higher than cardiovascular risk for African Americans with hypertensive nephrosclerosis is in direct contrast to what has been previously reported in other CKD populations. "The AASK trial and the subsequent cohort study allow the medical community to gain a broader understanding of incident cardiovascular disease and mortality during long-term follow-up in an entirely African-American population with nondiabetic hypertensive nephrosclerosis," comments Dr. Alves.

The findings are limited by the fact that the primary goal of the AASK trial was to detect changes in kidney function, ESRD, and/or risk of death. Cardiovascular events were measured as a secondary outcome.

The results may provide additional insight into the relationship between high blood pressure and kidney disease in African Americans, as well as some of the reported racial differences in the rates and outcomes of ESRD. "The study is timely given the increased recognition of medical health disparities observed among African American patients," Dr. Alves adds. "This type of information is needed if solutions are to be sought at the clinical and policy levels." ###

The AASK studies were sponsored by the National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health.

The study abstract, "African-Americans (AA) with Hypertensive Nephrosclerosis Are Paradoxically More Likely To Reach End Stage Renal Disease (ESRD) Than Have a Cardiovascular Event," (TH-FC051) will be presented as part of a Free Communications session on the topic of "Effects of Traditional and Nontraditional Risk Factors on Cardiovascular Risk in Chronic Kidney Disease and End Stage Renal Disease" on Thursday, November 6, at 5:36 p.m. in Room 108 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

Family problems affect African-American children more than other races

Mother and Father with their eight children in Chicago's south side, ARC Identifier: 556173 Local Identifier: 412-DA-13721, Creator: Environmental Protection Agency. National Archives at College Park, 8601 Adelphi Road, College Park, MD 20740-6001 PHONE: 301-837-3530, FAX: 301-837-3621

Columbus, OH – November 5, 2008 – It is a common belief that girls tend to internalize their problems, becoming depressed or anxious, while boys externalize their problems, turning to violence against people or property. A new study in the Journal of Marital and Family Therapy found that this idea did not hold for African-American youth who were in the juvenile justice system. For them, whether they internalized or externalized depended not on gender but on what was happening within their families. Results showed that family dynamics mediated the relationship between gender and mental health issues for African-American court-involved youth. Both girls and boys showed similar levels of externalizing and internalizing behavior, once family dysfunction was taken into account. Such a relationship was not found in White families. In addition, African-American girls report more externalizing, "acting out" behaviors, than other groups including African-American males, White males and females.

"Families may matter in a different way for African-American youth than what we're finding for White youth," the authors conclude. "We are now trying to identify exactly what is different in African-American families that affects whether youth internalize or externalize problems, and how best to help them. This means identifying those family strengths that buffer against these problem behaviors as well as focusing on family risk factors that increase the likelihood of these difficulties."

Stephen M. Gavazzi of The Ohio State University, Jennifer M. Bostic and Courtney M. Yarcheck of the OSU Center for Family Research, and Ji-Young Lim of Miami University of Ohio examined factors related to gender, race/ethnicity, family factors, and mental health issues is a sample of 2,549 Caucasian and African American youth coming to the attention of juvenile courts. ###

This study is published in the Journal of Marital and Family Therapy. Media wishing to receive a PDF of this article may contact journalnews@bos.blackwellpublishing.net.

Stephen Gavazzi is affiliated with The Ohio State University and can be reached for questions at gavazzi.1@osu.edu.

The Journal of Marital & Family Therapy (JMFT) is published quarterly by the American Association for Marriage and Family Therapy (AAMFT) and, with over 20,000 subscribers, is the best known and most influential family therapy journal in the world.

Wiley-Blackwell was formed in February 2007 as a result of the acquisition of Blackwell Publishing Ltd. by John Wiley & Sons, Inc., and its merger with Wiley's Scientific, Technical, and Medical business. Together, the companies have created a global publishing business with deep strength in every major academic and professional field. Wiley-Blackwell publishes approximately 1,400 scholarly peer-reviewed journals and an extensive collection of books with global appeal. For more information on Wiley-Blackwell, please visit www.wiley-blackwell.com or interscience.wiley.com.

Contact: Amy Molnar journalnews@bos.blackwellpublishing.net 201-748-8844 Wiley-Blackwell

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