Study confirms persistence of diversity problems in academic medicine

A survey study believed to be one of the first efforts to put hard numbers around long-held beliefs about diversity in medical school faculties has affirmed that awareness and sensitivity to racial and ethnic diversity are believed by most faculty to be poor and even poorer among faculty who are members of underrepresented minorities.

The survey, conducted at the Johns Hopkins University School of Medicine, is likely a reflection of diversity issues thought to persist at academic medical institutions across the country, says principal investigator Lisa Cooper, M.D., a professor of medicine in the Johns Hopkins University School of Medicine and the Johns Hopkins Bloomberg School of Public Health.

Lisa A. Cooper, Professor Academic Degrees MD, MPH Departmental Affiliation Epidemiology, Health Policy & Management. Joint Departmental Affiliations, Department of Medicine, Division of General Internal Medicine. Departmental Address. Welch Center for Prevention, Epidemiology, & Clinical Research. 2024 East Monument Street, Suite 2-500. Emai: lisa.cooper@jhmi.edu

"What we are seeing at Johns Hopkins is likely to be the case in medical schools everywhere, namely that enhancing racial and ethnic diversity in medicine in general, and in academic medicine in particular, remains a challenge," Cooper says. The study results appear in the January issue of Academic Medicine. The medical professions have long recognized that diversity among health care providers can improve the health of patients among racial and ethnic minorities and majorities alike, says Cooper. She adds that studies have demonstrated that minority physicians are more likely to practice in underserved areas and to care for patients of their own racial or ethnic group, as well as low-income patients, Medicaid-insured and uninsured patients, and patients with poorer health status. Studies also suggest that minorities welcome practitioners who are part of their communities and sensitive to their cultures. Cooper, who received a 2007 MacArthur Fellowship (also known as a "genius grant") for her landmark studies on racial barriers to health care,

notes that medical schools have strived to increase diversity among the physician workforce by implementing programs that increase the number of minority medical students, such as targeted recruitment efforts and scholarships.

But though minority faculty at medical schools serve as important role models for their students and recruitment magnets for minorities, diversity among faculty continues to lag, Cooper says. Previous studies have shown that minority faculty have lower job satisfaction than majority faculty.

Cooper says the new study, prompted by serious efforts at Johns Hopkins to recruit and retain more minority faculty, was designed to quantify the differences in racial and ethnic perceptions that contribute to this disparity.

The study was led by Cooper and Eboni G. Price, M.D., M.P.H., now assistant professor of medicine at Tulane University, who was a fellow in general internal medicine at Johns Hopkins during the time of this work. Along with their colleagues, Cooper and Price surveyed 703 tenure-track physicians at the Johns Hopkins University School of Medicine from 2004 to 2005. The researchers focused on physicians in clinical departments that had at least one member of an underrepresented minority, defined as black, Hispanic (Mexican American and mainland Puerto Rican), or Native American. They sent surveys by mail to both majority and minority faculty. Of the 352 physicians who returned their surveys, 30 were underrepresented minorities. At Johns Hopkins School of Medicine, whites make up 74.6 percent, blacks/African Americans 3.8 percent, Hispanics 2.9 percent, Asians 18.6 percent, and Native Americans 0.8 percent of the overall faculty.

The survey, which comprised 80 items, asked respondents to rate their level of agreement with a series of statements, such as, "Faculty are recruited to my department in an unbiased manner," and "At Hopkins, networking opportunities for career advancement tend to include ethnic minorities." Overall, the statements were intended to measure perceptions of bias in five areas: department or divisional activities, professional satisfaction, career networking, mentorship, and intentions to stay in academia.

Results showed that fewer than one-third of all the respondents reported experiences of bias in their own department's or division's activities. However, when asked whether they believed overall faculty recruitment was unbiased, only 21 percent of underrepresented minority faculty agreed, compared to 50 percent of majority faculty.

Only 12 percent of underrepresented minority faculty were satisfied with the institution's racial and ethnic diversity, compared to 47 percent of majority faculty. Underrepresented minority faculty were also three times less likely to believe that networking opportunities included minorities.

Notably, more than 80 percent of all groups of respondents believed they would be in a career in academic medicine in five years. However, only 42 percent of underrepresented minority faculty said they would still be at Johns Hopkins in five years, compared to 70 percent of majority faculty.

Cooper says it's unclear whether underrepresented minority faculty planned to leave because of negative experiences or whether they believed that other promising opportunities would be available elsewhere.

Either way, Cooper says, there is work to be done at Johns Hopkins and other academic medical centers to increase job satisfaction for all faculty and for underrepresented minorities in particular. More transparent and diversity-sensitive recruitment practices and increased networking opportunities are needed, along with more studies like hers to quantify the problem and attempt to solve it. ###

Other researchers who participated in this study include Neil R. Powe, M.D., M.P.H., M.B.A., David E. Kern, M.D., M.P.H., Sherita Hill Golden, M.D., M.H.S., and Gary S. Wand, M.D.

For more information, go to:

• www.hopkinsmedicine.org/diversity/
• www.hopkinsmedicine.org/gim/faculty/
• www.hopkinsmedicine.org/Press_releases/

Contact: Christen Brownlee cbrownlee@jhmi.edu 410-955-7823 Johns Hopkins Medical Institutions

Perceptions and experiences of homeless youth vary by race, UCSF study shows

The self-perceptions and life experiences of young homeless people vary significantly by race, according to a new study by researchers at the University of California, San Francisco. The findings underscore the need for a more tailored approach to youth homelessness intervention and prevention programs.

UCSF researchers surveyed 205 white and African American youth in San Francisco who had been homeless in the prior six months, and discovered two groups who told starkly different stories about life on the streets and how they ended up there.

Colette (Coco) Auerswald , M.D., M.S. Assistant Adjunct Professor. PHONE: (415) 476-6692, FAX: (510) 643-8771, LOCATION: 570 University Hall. E-MAIL: auerswaldc@peds.ucsf.edu

"During the course of the study it became clear that while these two groups of homeless youth occupied the same geographic spaces, they seemed to inhabit very different worlds," said senior study author Colette Auerswald, MD, MS, an associate professor of pediatrics and adolescent medicine specialist at UCSF Children's Hospital. The study is currently published online by the journal "Social Science and Medicine" and is available at http://dx.doi.org/10.1016/j.socscimed.2008.12.030. It will appear in an upcoming print edition of the journal. A combination of ethnographic interviews and epidemiological surveys was used to collect data about issues related to family, housing status, self-identification, street survival strategies, service utilization, and drug use.

The researchers found that the majority of white homeless youth in San Francisco had come from other parts of California and the United States. The African Americans were all born and raised in the greater San Francisco Bay Area.

"Our findings showed the African American youth come from Bay Area communities that are in decline with limited opportunities for young people and their families. The resulting dysfunction and lack of resources to support them at home drive them to the streets," said Benjamin Hickler, the study's first author and a PhD candidate in the Medical Anthropology Program at UCSF and UC Berkeley. "White youth, in contrast, are more likely to be runaways from dysfunctional homes where the cost of staying comes at too high a physical and emotional price."

With regard to family relationships, African American youth maintained closer ties to their families than white youth. While 27 percent of the African Americans said they had stayed with their families in the prior month, only 8 percent of the whites had done so.

The researchers also examined the severity of homelessness in the two groups and found that 81 percent of white youth reported being homeless the night before the interview, compared to 62 percent of African Americans. In addition, 81 percent of whites reported being literally homeless – meaning they had lived in a place not meant for human habitation in the last month, such as on the street, in a park, or in a vehicle – compared to 37 percent of African Americans.

The degree to which each group identified with being homeless also varied significantly. In general, white youth seemed to embrace the label of "homelessness" and maintain outward appearances that "looked the part," including having poor hygiene, tattoos and piercings. African Americans had a very different attitude toward being homeless, with many saying it was shameful and something that should be hidden at all costs, while also emphasizing the importance of appearing financially prosperous.

"That difference in self-identity is one of the most salient between the two groups," Auerswald said. "It shows that, in order to be successful, intervention programs must be consistent with the ways in which these kids view themselves. By defining themselves differently, they are also defining their needs differently."

Auerswald also emphasized the importance of having intervention programs that address long-term housing needs and offer vocational services for homeless youth, in addition to basic street outreach efforts.

For both African American and white youth, drug dealing was a common source of income on the streets, with 40 and 36 percent of each group, respectively, reporting that they sold drugs – primarily marijuana. The two groups were also equally as likely to have engaged in survival sex (sex for money, drugs or shelter) with 16 percent of all youth surveyed reporting that they had done so. White youth, however, were significantly more likely to engage in other activities associated with homelessness, such as panhandling or selling items on the sidewalk.

Patterns of drug use also varied between groups. Although both groups reported regularly using marijuana and alcohol, they had very different experiences with injection drugs. Only 1.7 percent of African Americans said they had injected drugs at some point in their lives, compared to 44 percent of white youth. This difference was reflected in a much higher rate of hepatitis C infection among whites.

In the first part of the study, the researchers conducted in-depth, face-to-face interviews with 54 homeless youth in San Francisco between 15 and 24 years old. The information collected during these interviews was used to generate hypotheses about the similarities and differences between groups. These hypotheses were then validated by surveying the larger sample of 205 youth in the same age range. ###

Study participants were recruited on the streets, in three San Francisco neighborhoods where homeless youth typically congregate. Data were collected from May 2003 to March 2005.

The research was funded primarily through the National Institute of Child Health and Development. Additional funding came from the UCSF Research Evaluation and Allocation Committee and the Health Resources and Services Administration Title IV/Ryan White Funds.

One of the nation's top children's hospitals, UCSF Children's Hospital creates an environment where children and their families find compassionate care at the healing edge of scientific discovery, with more than 150 experts in 50 medical specialties serving patients throughout Northern California and beyond. The hospital admits about 5,000 children each year, including 2,000 babies born in the hospital.

UCSF is a leading university dedicated to promoting health worldwide through advanced biomedical research, graduate-level education in the life sciences and health professions, and excellence in patient care. For further information, visit www.ucsf.edu.

Contact: Kate Schoen kschoen@pubaff.ucsf.edu 415-476-2557 University of California - San Francisco

Integrated town that predates Civil War earns landmark status VIDEO

CHAMPAIGN, Ill. – A remote western Illinois field could someday yield tourists instead of crops, adding to the state’s legacy of racial equality that already includes Abraham Lincoln and the nation’s first black president.

Once an integrated town that flourished decades before the Civil War broke the grip of slavery, the lost community’s potential as a heritage attraction got a boost last week when it was designated a National Historic Landmark by U.S. Secretary of the Interior Dirk Kempthorne.

Landmark status puts New Philadelphia among a select group of sites deemed vital in interpreting the nation’s heritage and history.

niversity of Illinois, New Philidelphia excavation Christopher Fennell, a University of Illinois archaeologist, is principal investigator for an ongoing dig on the 42-acre site of New Philadelphia, about 85 miles northwest of St. Louis. Photo by L. Brian Stauffer.

While more than 80,000 sites are listed on the National Register of Historic Places, fewer than 2,500 have been named landmarks. Achieving the nation’s top historic designation should aid fundraising efforts to continue archaeological research of the now-buried town and could ultimately help make New Philadelphia a popular historic destination, said Christopher Fennell, a University of Illinois archaeologist and principal investigator for an ongoing dig on the 42-acre site near Barry, about 85 miles northwest of St. Louis. “The landmark designation doesn’t provide funding in itself, but makes it more likely,” Fennell said. “It provides the highest historic recognition, which can be used to raise funds that will conserve the property and help develop plans to present it to the public.”

Five years of excavations have unearthed more than 85,000 artifacts and remains of 14 buildings from New Philadelphia, the first known U.S. town planned and legally registered by a black man.

Founded in 1836 by freed slave Frank McWorter, the frontier town nestled between the Mississippi and Illinois rivers grew to about 160 people – a third black and two-thirds white – before it began to slowly fade away when it was bypassed by the railroad in 1869.

Researchers say their findings reveal a town that was ahead of its time, with blacks and whites living side-by-side and no signs of racial violence, despite ethnic tensions that engulfed the era and a major slave trading post just 25 miles away in Hannibal, Mo.

Known as “Free Frank,” McWorter was enslaved by a Kentucky man who allowed him to earn wages in his spare time. He used the money to buy his freedom as well as his family’s, and developed a prosperous Illinois farm that enabled him to buy enough land to establish New Philadelphia.

His new town gave free black families a place to build homes and become independent, and his vision of an integrated community soon attracted whites who shared his dream.

Abdul Alkalimat, a U. of I. African-American studies professor and great-great-great grandson of McWorter, says the town’s story offers lessons that still resonate.

“If New Philadelphia is possible, then America is possible,” he said. “It’s a story of average, everyday people – not Harvard bluebloods or people of power. It is rooted in people fighting for their families and economic security. In the end, it really shows that anything is possible.”

Archaeological work at the site built on historical research into McWorter’s life by Juliet Walker, McWorter’s great-great-great granddaughter and a former U. of I. history professor who now is at the University of Texas.

Walker’s book, “Free Frank,” was published by the University of Kentucky Press.

Alkalimat says the timing of New Philadelphia’s landmark status is fitting, with attention focused on Barack Obama’s historic rise to the presidency and this year’s celebration of Lincoln’s 200th birthday.

“It’s a wonderful convergence,” he said. “New Philadelphia is part of the foundation of those bright lights on which Obama and Lincoln now stand.”

Fennell says a letter of support from Obama was likely a key in earning landmark status for New Philadelphia, along with archaeological finds from ongoing research involving the U. of I., the Illinois State Museum, DePaul University and the University of Maryland.

“Obama’s letter was read at a hearing just days before the election,” Fennell said. “Everyone was astounded that his office had that degree of focus when they were in 100 percent campaign mode with the election just around the corner.”

Editor’s note: To contact Christopher Fennell, call 217-333-3616, e-mail: cfennell@illinois.edu, Abdul Alkalimat, 217-333-7781, mcworter@illinois.edu

Contact: Jan Dennis jdennis@illinois.edu 217-333-0568 University of Illinois at Urbana-Champaign

Reactions to racism not as strong as we think

Study finds indifference to racist comments

TORONTO – One reason racism persists is that many people imagine they would respond strongly to a racist act but actually respond with indifference, a new study led by York University shows.

Published in the Jan. 9 issue of Science, "Mispredicting Affective and Behavioral Responses to Racism" examines why acts of blatant racism against blacks still occur with alarming regularity, even though being labeled as a racist in modern society has become a powerful stigma.

Kerry Kawakami Office Location: 324 Behavioural Science Building, York University, 4700 Keele Street, Toronto, ON, Canada, M3J 1P3 Office Phone: (416) 736-2100 ext. 40563. Email Address: kawakami@yorku.ca

"People do not think of themselves as prejudiced, and they predict that they would be very upset by a racist act and would take action," said lead author Kerry Kawakami, a psychology professor in York's Faculty of Health. "However, we found that their responses are much more muted than they expect when they are actually faced with an overtly racist comment." Kawakami led the study at York with graduate student Francine Karmali. University of British Columbia professor Elizabeth Dunn, an expert on people's ability to predict their future emotional responses, and Yale University professor John Dovidio, an expert on prejudice, are co-authors. In the study, students who think they are waiting for an experiment to begin are exposed to racism.

Specifically, a white confederate makes a racist comment about a black confederate when he briefly leaves the room. When he returns, the actual participant is asked to choose a partner to work with on a subsequent exercise.

"What we found was that students were more likely to choose the white confederate as a partner (63 per cent), despite the fact that the white person had made a racist comment about the black person," said Kawakami. "And the racist comments ranged from moderate to one of the most powerful anti-black slurs in the English language."

The findings may seem surprising at a time when America is about to inaugurate its first black president, but the election of one black man does not mean that racism is dead or that people will no longer tolerate acts of racism, Kawakami said.

Notably, there has been little research done on how people respond to prejudice toward others. However, University of British Columbia professor Elizabeth Dunn, one of the authors of the Science article, studies people's ability to predict their own affective and behavioural reactions.

"People often make inaccurate forecasts about how they would respond emotionally to negative events. They vastly overestimate how upset they would feel in bad situations such as hearing a racial slur," said Dunn. "One of the ways that people may stem the tide of negative emotions related to witnessing a racial slur is to re-construe the comment as a joke or as a harmless remark."

Further studies currently being conducted by these researchers are investigating how characteristics related to the racists and the target of prejudice increases or decreases emotional, behavioral, and physiological reactions to racial slurs. Examining people's perceptions of both the white and black confederate may provide important clues as to when people do and do not stand up against racism. ###

York University is the leading interdisciplinary research and teaching university in Canada. York offers a modern, academic experience at the undergraduate and graduate level in Toronto, Canada's most international city. The third largest university in the country, York is host to a dynamic academic community of 50,000 students and 7,000 faculty and staff, as well as more than 200,000 alumni worldwide. York's 11 faculties and 26 research centres conduct ambitious, groundbreaking research that is interdisciplinary, cutting across traditional academic boundaries. This distinctive and collaborative approach is preparing students for the future and bringing fresh insights and solutions to real-world challenges. York University is an autonomous, not-for-profit corporation.

Media Contact:

• Janice Walls, Media Relations, York University, 416 736 2100 x22101/ wallsj@yorku.ca
• Basil Waugh, Public Affairs, University of British Columbia, 604 822 2048 / basil.waugh@ubc.ca

Contact: Janice Walls wallsj@yorku.ca 416-736-2100 x22101 York University

Martin Luther King, Jr.'s Letter from a Birmingham Jail

16 April 1963
My Dear Fellow Clergymen:

While confined here in the Birmingham city jail, I came across your recent statement calling my present activities "unwise and untimely." Seldom do I pause to answer criticism of my work and ideas. If I sought to answer all the criticisms that cross my desk, my secretaries would have little time for anything other than such correspondence in the course of the day, and I would have no time for constructive work.

Martin Luther King Jr. looks through the bars of a Burmingham, Alabama, cell in April 1963.

But since I feel that you are men of genuine good will and that your criticisms are sincerely set forth, I want to try to answer your statement in what I hope will be patient and reasonable terms. I think I should indicate why I am here in Birmingham, since you have been influenced by the view which argues against "outsiders coming in." I have the honor of serving as president of the Southern Christian Leadership Conference, an organization operating in every southern state, with headquarters in Atlanta, Georgia. We have some eighty five affiliated organizations across the South, and one of them is the Alabama Christian Movement for Human Rights. Frequently we share staff, educational and financial resources with our affiliates.

Several months ago the affiliate here in Birmingham asked us to be on call to engage in a nonviolent direct action program if such were deemed necessary. We readily consented, and when the hour came we lived up to our promise. So I, along with several members of my staff, am here because I was invited here. I am here because I have organizational ties here.

But more basically, I am in Birmingham because injustice is here. Just as the prophets of the eighth century B.C. left their villages and carried their "thus saith the Lord" far beyond the boundaries of their home towns, and just as the Apostle Paul left his village of Tarsus and carried the gospel of Jesus Christ to the far corners of the Greco Roman world, so am I compelled to carry the gospel of freedom beyond my own home town. Like Paul, I must constantly respond to the Macedonian call for aid.

Moreover, I am cognizant of the interrelatedness of all communities and states. I cannot sit idly by in Atlanta and not be concerned about what happens in Birmingham. Injustice anywhere is a threat to justice everywhere. We are caught in an inescapable network of mutuality, tied in a single garment of destiny. Whatever affects one directly, affects all indirectly. Never again can we afford to live with the narrow, provincial "outside agitator" idea. Anyone who lives inside the United States can never be considered an outsider anywhere within its bounds. You deplore the demonstrations taking place in Birmingham. But your statement, I am sorry to say, fails to express a similar concern for the conditions that brought about the demonstrations.

King in jail, CREDIT: "[Dr. Martin Luther King Jr., behind bars in jail in St. Augustine, Florida]." United Press International telephoto, 1962. Prints and Photographs Division of the Library of Congress.

I am sure that none of you would want to rest content with the superficial kind of social analysis that deals merely with effects and does not grapple with underlying causes. It is unfortunate that demonstrations are taking place in Birmingham, but it is even more unfortunate that the city's white power structure left the Negro community with no alternative.

In any nonviolent campaign there are four basic steps: collection of the facts to determine whether injustices exist; negotiation; self purification; and direct action. We have gone through all these steps in Birmingham. There can be no gainsaying the fact that racial injustice engulfs this community. Birmingham is probably the most thoroughly segregated city in the United States. Its ugly record of brutality is widely known. Negroes have experienced grossly unjust treatment in the courts. There have been more unsolved bombings of Negro homes and churches in Birmingham than in any other city in the nation. These are the hard, brutal facts of the case. On the basis of these conditions, Negro leaders sought to negotiate with the city fathers. But the latter consistently refused to engage in good faith negotiation.

Then, last September, came the opportunity to talk with leaders of Birmingham's economic community. In the course of the negotiations, certain promises were made by the merchants--for example, to remove the stores' humiliating racial signs. On the basis of these promises, the Reverend Fred Shuttlesworth and the leaders of the Alabama Christian Movement for Human Rights agreed to a moratorium on all demonstrations. As the weeks and months went by, we realized that we were the victims of a broken promise. A few signs, briefly removed, returned; the others remained. As in so many past experiences, our hopes had been blasted, and the shadow of deep disappointment settled upon us. We had no alternative except to prepare for direct action, whereby we would present our very bodies as a means of laying our case before the conscience of the local and the national community. Mindful of the difficulties involved, we decided to undertake a process of self purification. We began a series of workshops on nonviolence, and we repeatedly asked ourselves: "Are you able to accept blows without retaliating?" "Are you able to endure the ordeal of jail?" We decided to schedule our direct action program for the Easter season, realizing that except for Christmas, this is the main shopping period of the year. Knowing that a strong economic-withdrawal program would be the by product of direct action, we felt that this would be the best time to bring pressure to bear on the merchants for the needed change.

Then it occurred to us that Birmingham's mayoral election was coming up in March, and we speedily decided to postpone action until after election day. When we discovered that the Commissioner of Public Safety, Eugene "Bull" Connor, had piled up enough votes to be in the run off, we decided again to postpone action until the day after the run off so that the demonstrations could not be used to cloud the issues. Like many others, we waited to see Mr. Connor defeated, and to this end we endured postponement after postponement. Having aided in this community need, we felt that our direct action program could be delayed no longer.

You may well ask: "Why direct action? Why sit ins, marches and so forth? Isn't negotiation a better path?" You are quite right in calling for negotiation. Indeed, this is the very purpose of direct action. Nonviolent direct action seeks to create such a crisis and foster such a tension that a community which has constantly refused to negotiate is forced to confront the issue. It seeks so to dramatize the issue that it can no longer be ignored. My citing the creation of tension as part of the work of the nonviolent resister may sound rather shocking. But I must confess that I am not afraid of the word "tension." I have earnestly opposed violent tension, but there is a type of constructive, nonviolent tension which is necessary for growth. Just as Socrates felt that it was necessary to create a tension in the mind so that individuals could rise from the bondage of myths and half truths to the unfettered realm of creative analysis and objective appraisal, so must we see the need for nonviolent gadflies to create the kind of tension in society that will help men rise from the dark depths of prejudice and racism to the majestic heights of understanding and brotherhood. The purpose of our direct action program is to create a situation so crisis packed that it will inevitably open the door to negotiation. I therefore concur with you in your call for negotiation. Too long has our beloved Southland been bogged down in a tragic effort to live in monologue rather than dialogue.

One of the basic points in your statement is that the action that I and my associates have taken in Birmingham is untimely. Some have asked: "Why didn't you give the new city administration time to act?" The only answer that I can give to this query is that the new Birmingham administration must be prodded about as much as the outgoing one, before it will act. We are sadly mistaken if we feel that the election of Albert Boutwell as mayor will bring the millennium to Birmingham. While Mr. Boutwell is a much more gentle person than Mr. Connor, they are both segregationists, dedicated to maintenance of the status quo. I have hope that Mr. Boutwell will be reasonable enough to see the futility of massive resistance to desegregation. But he will not see this without pressure from devotees of civil rights. My friends, I must say to you that we have not made a single gain in civil rights without determined legal and nonviolent pressure. Lamentably, it is an historical fact that privileged groups seldom give up their privileges voluntarily. Individuals may see the moral light and voluntarily give up their unjust posture; but, as Reinhold Niebuhr has reminded us, groups tend to be more immoral than individuals.

We know through painful experience that freedom is never voluntarily given by the oppressor; it must be demanded by the oppressed. Frankly, I have yet to engage in a direct action campaign that was "well timed" in the view of those who have not suffered unduly from the disease of segregation. For years now I have heard the word "Wait!" It rings in the ear of every Negro with piercing familiarity. This "Wait" has almost always meant "Never." We must come to see, with one of our distinguished jurists, that "justice too long delayed is justice denied."

We have waited for more than 340 years for our constitutional and God given rights. The nations of Asia and Africa are moving with jetlike speed toward gaining political independence, but we still creep at horse and buggy pace toward gaining a cup of coffee at a lunch counter. Perhaps it is easy for those who have never felt the stinging darts of segregation to say, "Wait." But when you have seen vicious mobs lynch your mothers and fathers at will and drown your sisters and brothers at whim; when you have seen hate filled policemen curse, kick and even kill your black brothers and sisters; when you see the vast majority of your twenty million Negro brothers smothering in an airtight cage of poverty in the midst of an affluent society; when you suddenly find your tongue twisted and your speech stammering as you seek to explain to your six year old daughter why she can't go to the public amusement park that has just been advertised on television, and see tears welling up in her eyes when she is told that Funtown is closed to colored children, and see ominous clouds of inferiority beginning to form in her little mental sky, and see her beginning to distort her personality by developing an unconscious bitterness toward white people; when you have to concoct an answer for a five year old son who is asking: "Daddy, why do white people treat colored people so mean?"; when you take a cross county drive and find it necessary to sleep night after night in the uncomfortable corners of your automobile because no motel will accept you; when you are humiliated day in and day out by nagging signs reading "white" and "colored"; when your first name becomes "nigger," your middle name becomes "boy" (however old you are) and your last name becomes "John," and your wife and mother are never given the respected title "Mrs."; when you are harried by day and haunted by night by the fact that you are a Negro, living constantly at tiptoe stance, never quite knowing what to expect next, and are plagued with inner fears and outer resentments; when you are forever fighting a degenerating sense of "nobodiness"--then you will understand why we find it difficult to wait. There comes a time when the cup of endurance runs over, and men are no longer willing to be plunged into the abyss of despair. I hope, sirs, you can understand our legitimate and unavoidable impatience. You express a great deal of anxiety over our willingness to break laws. This is certainly a legitimate concern. Since we so diligently urge people to obey the Supreme Court's decision of 1954 outlawing segregation in the public schools, at first glance it may seem rather paradoxical for us consciously to break laws. One may well ask: "How can you advocate breaking some laws and obeying others?" The answer lies in the fact that there are two types of laws: just and unjust. I would be the first to advocate obeying just laws. One has not only a legal but a moral responsibility to obey just laws. Conversely, one has a moral responsibility to disobey unjust laws. I would agree with St. Augustine that "an unjust law is no law at all."

Now, what is the difference between the two? How does one determine whether a law is just or unjust? A just law is a man made code that squares with the moral law or the law of God. An unjust law is a code that is out of harmony with the moral law. To put it in the terms of St. Thomas Aquinas: An unjust law is a human law that is not rooted in eternal law and natural law. Any law that uplifts human personality is just. Any law that degrades human personality is unjust. All segregation statutes are unjust because segregation distorts the soul and damages the personality. It gives the segregator a false sense of superiority and the segregated a false sense of inferiority. Segregation, to use the terminology of the Jewish philosopher Martin Buber, substitutes an "I it" relationship for an "I thou" relationship and ends up relegating persons to the status of things. Hence segregation is not only politically, economically and sociologically unsound, it is morally wrong and sinful. Paul Tillich has said that sin is separation. Is not segregation an existential expression of man's tragic separation, his awful estrangement, his terrible sinfulness? Thus it is that I can urge men to obey the 1954 decision of the Supreme Court, for it is morally right; and I can urge them to disobey segregation ordinances, for they are morally wrong.

Let us consider a more concrete example of just and unjust laws. An unjust law is a code that a numerical or power majority group compels a minority group to obey but does not make binding on itself. This is difference made legal. By the same token, a just law is a code that a majority compels a minority to follow and that it is willing to follow itself. This is sameness made legal. Let me give another explanation. A law is unjust if it is inflicted on a minority that, as a result of being denied the right to vote, had no part in enacting or devising the law. Who can say that the legislature of Alabama which set up that state's segregation laws was democratically elected? Throughout Alabama all sorts of devious methods are used to prevent Negroes from becoming registered voters, and there are some counties in which, even though Negroes constitute a majority of the population, not a single Negro is registered. Can any law enacted under such circumstances be considered democratically structured?

Sometimes a law is just on its face and unjust in its application. For instance, I have been arrested on a charge of parading without a permit. Now, there is nothing wrong in having an ordinance which requires a permit for a parade. But such an ordinance becomes unjust when it is used to maintain segregation and to deny citizens the First-Amendment privilege of peaceful assembly and protest.

I hope you are able to see the distinction I am trying to point out. In no sense do I advocate evading or defying the law, as would the rabid segregationist. That would lead to anarchy. One who breaks an unjust law must do so openly, lovingly, and with a willingness to accept the penalty. I submit that an individual who breaks a law that conscience tells him is unjust, and who willingly accepts the penalty of imprisonment in order to arouse the conscience of the community over its injustice, is in reality expressing the highest respect for law.

Of course, there is nothing new about this kind of civil disobedience. It was evidenced sublimely in the refusal of Shadrach, Meshach and Abednego to obey the laws of Nebuchadnezzar, on the ground that a higher moral law was at stake. It was practiced superbly by the early Christians, who were willing to face hungry lions and the excruciating pain of chopping blocks rather than submit to certain unjust laws of the Roman Empire. To a degree, academic freedom is a reality today because Socrates practiced civil disobedience. In our own nation, the Boston Tea Party represented a massive act of civil disobedience.

We should never forget that everything Adolf Hitler did in Germany was "legal" and everything the Hungarian freedom fighters did in Hungary was "illegal." It was "illegal" to aid and comfort a Jew in Hitler's Germany. Even so, I am sure that, had I lived in Germany at the time, I would have aided and comforted my Jewish brothers. If today I lived in a Communist country where certain principles dear to the Christian faith are suppressed, I would openly advocate disobeying that country's antireligious laws.

I must make two honest confessions to you, my Christian and Jewish brothers. First, I must confess that over the past few years I have been gravely disappointed with the white moderate. I have almost reached the regrettable conclusion that the Negro's great stumbling block in his stride toward freedom is not the White Citizen's Counciler or the Ku Klux Klanner, but the white moderate, who is more devoted to "order" than to justice; who prefers a negative peace which is the absence of tension to a positive peace which is the presence of justice; who constantly says: "I agree with you in the goal you seek, but I cannot agree with your methods of direct action"; who paternalistically believes he can set the timetable for another man's freedom; who lives by a mythical concept of time and who constantly advises the Negro to wait for a "more convenient season." Shallow understanding from people of good will is more frustrating than absolute misunderstanding from people of ill will. Lukewarm acceptance is much more bewildering than outright rejection.

I had hoped that the white moderate would understand that law and order exist for the purpose of establishing justice and that when they fail in this purpose they become the dangerously structured dams that block the flow of social progress. I had hoped that the white moderate would understand that the present tension in the South is a necessary phase of the transition from an obnoxious negative peace, in which the Negro passively accepted his unjust plight, to a substantive and positive peace, in which all men will respect the dignity and worth of human personality. Actually, we who engage in nonviolent direct action are not the creators of tension. We merely bring to the surface the hidden tension that is already alive. We bring it out in the open, where it can be seen and dealt with. Like a boil that can never be cured so long as it is covered up but must be opened with all its ugliness to the natural medicines of air and light, injustice must be exposed, with all the tension its exposure creates, to the light of human conscience and the air of national opinion before it can be cured.

In your statement you assert that our actions, even though peaceful, must be condemned because they precipitate violence. But is this a logical assertion? Isn't this like condemning a robbed man because his possession of money precipitated the evil act of robbery? Isn't this like condemning Socrates because his unswerving commitment to truth and his philosophical inquiries precipitated the act by the misguided populace in which they made him drink hemlock? Isn't this like condemning Jesus because his unique God consciousness and never ceasing devotion to God's will precipitated the evil act of crucifixion? We must come to see that, as the federal courts have consistently affirmed, it is wrong to urge an individual to cease his efforts to gain his basic constitutional rights because the quest may precipitate violence. Society must protect the robbed and punish the robber. I had also hoped that the white moderate would reject the myth concerning time in relation to the struggle for freedom. I have just received a letter from a white brother in Texas. He writes: "All Christians know that the colored people will receive equal rights eventually, but it is possible that you are in too great a religious hurry. It has taken Christianity almost two thousand years to accomplish what it has. The teachings of Christ take time to come to earth." Such an attitude stems from a tragic misconception of time, from the strangely irrational notion that there is something in the very flow of time that will inevitably cure all ills. Actually, time itself is neutral; it can be used either destructively or constructively. More and more I feel that the people of ill will have used time much more effectively than have the people of good will. We will have to repent in this generation not merely for the hateful words and actions of the bad people but for the appalling silence of the good people. Human progress never rolls in on wheels of inevitability; it comes through the tireless efforts of men willing to be co workers with God, and without this hard work, time itself becomes an ally of the forces of social stagnation. We must use time creatively, in the knowledge that the time is always ripe to do right. Now is the time to make real the promise of democracy and transform our pending national elegy into a creative psalm of brotherhood. Now is the time to lift our national policy from the quicksand of racial injustice to the solid rock of human dignity.

You speak of our activity in Birmingham as extreme. At first I was rather disappointed that fellow clergymen would see my nonviolent efforts as those of an extremist. I began thinking about the fact that I stand in the middle of two opposing forces in the Negro community. One is a force of complacency, made up in part of Negroes who, as a result of long years of oppression, are so drained of self respect and a sense of "somebodiness" that they have adjusted to segregation; and in part of a few middle-class Negroes who, because of a degree of academic and economic security and because in some ways they profit by segregation, have become insensitive to the problems of the masses. The other force is one of bitterness and hatred, and it comes perilously close to advocating violence. It is expressed in the various black nationalist groups that are springing up across the nation, the largest and best known being Elijah Muhammad's Muslim movement. Nourished by the Negro's frustration over the continued existence of racial discrimination, this movement is made up of people who have lost faith in America, who have absolutely repudiated Christianity, and who have concluded that the white man is an incorrigible "devil."

I have tried to stand between these two forces, saying that we need emulate neither the "do nothingism" of the complacent nor the hatred and despair of the black nationalist. For there is the more excellent way of love and nonviolent protest. I am grateful to God that, through the influence of the Negro church, the way of nonviolence became an integral part of our struggle. If this philosophy had not emerged, by now many streets of the South would, I am convinced, be flowing with blood. And I am further convinced that if our white brothers dismiss as "rabble rousers" and "outside agitators" those of us who employ nonviolent direct action, and if they refuse to support our nonviolent efforts, millions of Negroes will, out of frustration and despair, seek solace and security in black nationalist ideologies--a development that would inevitably lead to a frightening racial nightmare.

Oppressed people cannot remain oppressed forever. The yearning for freedom eventually manifests itself, and that is what has happened to the American Negro. Something within has reminded him of his birthright of freedom, and something without has reminded him that it can be gained. Consciously or unconsciously, he has been caught up by the Zeitgeist, and with his black brothers of Africa and his brown and yellow brothers of Asia, South America and the Caribbean, the United States Negro is moving with a sense of great urgency toward the promised land of racial justice. If one recognizes this vital urge that has engulfed the Negro community, one should readily understand why public demonstrations are taking place. The Negro has many pent up resentments and latent frustrations, and he must release them. So let him march; let him make prayer pilgrimages to the city hall; let him go on freedom rides -and try to understand why he must do so. If his repressed emotions are not released in nonviolent ways, they will seek expression through violence; this is not a threat but a fact of history. So I have not said to my people: "Get rid of your discontent." Rather, I have tried to say that this normal and healthy discontent can be channeled into the creative outlet of nonviolent direct action. And now this approach is being termed extremist. But though I was initially disappointed at being categorized as an extremist, as I continued to think about the matter I gradually gained a measure of satisfaction from the label. Was not Jesus an extremist for love: "Love your enemies, bless them that curse you, do good to them that hate you, and pray for them which despitefully use you, and persecute you." Was not Amos an extremist for justice: "Let justice roll down like waters and righteousness like an ever flowing stream." Was not Paul an extremist for the Christian gospel: "I bear in my body the marks of the Lord Jesus." Was not Martin Luther an extremist: "Here I stand; I cannot do otherwise, so help me God." And John Bunyan: "I will stay in jail to the end of my days before I make a butchery of my conscience." And Abraham Lincoln: "This nation cannot survive half slave and half free." And Thomas Jefferson: "We hold these truths to be self evident, that all men are created equal . . ." So the question is not whether we will be extremists, but what kind of extremists we will be. Will we be extremists for hate or for love? Will we be extremists for the preservation of injustice or for the extension of justice? In that dramatic scene on Calvary's hill three men were crucified. We must never forget that all three were crucified for the same crime--the crime of extremism. Two were extremists for immorality, and thus fell below their environment. The other, Jesus Christ, was an extremist for love, truth and goodness, and thereby rose above his environment. Perhaps the South, the nation and the world are in dire need of creative extremists.

I had hoped that the white moderate would see this need. Perhaps I was too optimistic; perhaps I expected too much. I suppose I should have realized that few members of the oppressor race can understand the deep groans and passionate yearnings of the oppressed race, and still fewer have the vision to see that injustice must be rooted out by strong, persistent and determined action. I am thankful, however, that some of our white brothers in the South have grasped the meaning of this social revolution and committed themselves to it. They are still all too few in quantity, but they are big in quality. Some -such as Ralph McGill, Lillian Smith, Harry Golden, James McBride Dabbs, Ann Braden and Sarah Patton Boyle--have written about our struggle in eloquent and prophetic terms. Others have marched with us down nameless streets of the South. They have languished in filthy, roach infested jails, suffering the abuse and brutality of policemen who view them as "dirty nigger-lovers." Unlike so many of their moderate brothers and sisters, they have recognized the urgency of the moment and sensed the need for powerful "action" antidotes to combat the disease of segregation. Let me take note of my other major disappointment. I have been so greatly disappointed with the white church and its leadership. Of course, there are some notable exceptions. I am not unmindful of the fact that each of you has taken some significant stands on this issue. I commend you, Reverend Stallings, for your Christian stand on this past Sunday, in welcoming Negroes to your worship service on a nonsegregated basis. I commend the Catholic leaders of this state for integrating Spring Hill College several years ago.

But despite these notable exceptions, I must honestly reiterate that I have been disappointed with the church. I do not say this as one of those negative critics who can always find something wrong with the church. I say this as a minister of the gospel, who loves the church; who was nurtured in its bosom; who has been sustained by its spiritual blessings and who will remain true to it as long as the cord of life shall lengthen.

When I was suddenly catapulted into the leadership of the bus protest in Montgomery, Alabama, a few years ago, I felt we would be supported by the white church. I felt that the white ministers, priests and rabbis of the South would be among our strongest allies. Instead, some have been outright opponents, refusing to understand the freedom movement and misrepresenting its leaders; all too many others have been more cautious than courageous and have remained silent behind the anesthetizing security of stained glass windows.

In spite of my shattered dreams, I came to Birmingham with the hope that the white religious leadership of this community would see the justice of our cause and, with deep moral concern, would serve as the channel through which our just grievances could reach the power structure. I had hoped that each of you would understand. But again I have been disappointed.

I have heard numerous southern religious leaders admonish their worshipers to comply with a desegregation decision because it is the law, but I have longed to hear white ministers declare: "Follow this decree because integration is morally right and because the Negro is your brother." In the midst of blatant injustices inflicted upon the Negro, I have watched white churchmen stand on the sideline and mouth pious irrelevancies and sanctimonious trivialities. In the midst of a mighty struggle to rid our nation of racial and economic injustice, I have heard many ministers say: "Those are social issues, with which the gospel has no real concern." And I have watched many churches commit themselves to a completely other worldly religion which makes a strange, un-Biblical distinction between body and soul, between the sacred and the secular.

I have traveled the length and breadth of Alabama, Mississippi and all the other southern states. On sweltering summer days and crisp autumn mornings I have looked at the South's beautiful churches with their lofty spires pointing heavenward. I have beheld the impressive outlines of her massive religious education buildings. Over and over I have found myself asking: "What kind of people worship here? Who is their God? Where were their voices when the lips of Governor Barnett dripped with words of interposition and nullification? Where were they when Governor Wallace gave a clarion call for defiance and hatred? Where were their voices of support when bruised and weary Negro men and women decided to rise from the dark dungeons of complacency to the bright hills of creative protest?"

Yes, these questions are still in my mind. In deep disappointment I have wept over the laxity of the church. But be assured that my tears have been tears of love. There can be no deep disappointment where there is not deep love. Yes, I love the church. How could I do otherwise? I am in the rather unique position of being the son, the grandson and the great grandson of preachers. Yes, I see the church as the body of Christ. But, oh! How we have blemished and scarred that body through social neglect and through fear of being nonconformists.

There was a time when the church was very powerful--in the time when the early Christians rejoiced at being deemed worthy to suffer for what they believed. In those days the church was not merely a thermometer that recorded the ideas and principles of popular opinion; it was a thermostat that transformed the mores of society. Whenever the early Christians entered a town, the people in power became disturbed and immediately sought to convict the Christians for being "disturbers of the peace" and "outside agitators."' But the Christians pressed on, in the conviction that they were "a colony of heaven," called to obey God rather than man. Small in number, they were big in commitment. They were too God-intoxicated to be "astronomically intimidated." By their effort and example they brought an end to such ancient evils as infanticide and gladiatorial contests. Things are different now. So often the contemporary church is a weak, ineffectual voice with an uncertain sound. So often it is an archdefender of the status quo. Far from being disturbed by the presence of the church, the power structure of the average community is consoled by the church's silent--and often even vocal--sanction of things as they are.

But the judgment of God is upon the church as never before. If today's church does not recapture the sacrificial spirit of the early church, it will lose its authenticity, forfeit the loyalty of millions, and be dismissed as an irrelevant social club with no meaning for the twentieth century. Every day I meet young people whose disappointment with the church has turned into outright disgust.

Perhaps I have once again been too optimistic. Is organized religion too inextricably bound to the status quo to save our nation and the world? Perhaps I must turn my faith to the inner spiritual church, the church within the church, as the true ekklesia and the hope of the world. But again I am thankful to God that some noble souls from the ranks of organized religion have broken loose from the paralyzing chains of conformity and joined us as active partners in the struggle for freedom. They have left their secure congregations and walked the streets of Albany, Georgia, with us. They have gone down the highways of the South on tortuous rides for freedom. Yes, they have gone to jail with us. Some have been dismissed from their churches, have lost the support of their bishops and fellow ministers. But they have acted in the faith that right defeated is stronger than evil triumphant. Their witness has been the spiritual salt that has preserved the true meaning of the gospel in these troubled times. They have carved a tunnel of hope through the dark mountain of disappointment. I hope the church as a whole will meet the challenge of this decisive hour. But even if the church does not come to the aid of justice, I have no despair about the future. I have no fear about the outcome of our struggle in Birmingham, even if our motives are at present misunderstood. We will reach the goal of freedom in Birmingham and all over the nation, because the goal of America is freedom. Abused and scorned though we may be, our destiny is tied up with America's destiny. Before the pilgrims landed at Plymouth, we were here. Before the pen of Jefferson etched the majestic words of the Declaration of Independence across the pages of history, we were here. For more than two centuries our forebears labored in this country without wages; they made cotton king; they built the homes of their masters while suffering gross injustice and shameful humiliation -and yet out of a bottomless vitality they continued to thrive and develop. If the inexpressible cruelties of slavery could not stop us, the opposition we now face will surely fail. We will win our freedom because the sacred heritage of our nation and the eternal will of God are embodied in our echoing demands. Before closing I feel impelled to mention one other point in your statement that has troubled me profoundly. You warmly commended the Birmingham police force for keeping "order" and "preventing violence." I doubt that you would have so warmly commended the police force if you had seen its dogs sinking their teeth into unarmed, nonviolent Negroes. I doubt that you would so quickly commend the policemen if you were to observe their ugly and inhumane treatment of Negroes here in the city jail; if you were to watch them push and curse old Negro women and young Negro girls; if you were to see them slap and kick old Negro men and young boys; if you were to observe them, as they did on two occasions, refuse to give us food because we wanted to sing our grace together. I cannot join you in your praise of the Birmingham police department.

It is true that the police have exercised a degree of discipline in handling the demonstrators. In this sense they have conducted themselves rather "nonviolently" in public. But for what purpose? To preserve the evil system of segregation. Over the past few years I have consistently preached that nonviolence demands that the means we use must be as pure as the ends we seek. I have tried to make clear that it is wrong to use immoral means to attain moral ends. But now I must affirm that it is just as wrong, or perhaps even more so, to use moral means to preserve immoral ends. Perhaps Mr. Connor and his policemen have been rather nonviolent in public, as was Chief Pritchett in Albany, Georgia, but they have used the moral means of nonviolence to maintain the immoral end of racial injustice. As T. S. Eliot has said: "The last temptation is the greatest treason: To do the right deed for the wrong reason."

I wish you had commended the Negro sit inners and demonstrators of Birmingham for their sublime courage, their willingness to suffer and their amazing discipline in the midst of great provocation. One day the South will recognize its real heroes. They will be the James Merediths, with the noble sense of purpose that enables them to face jeering and hostile mobs, and with the agonizing loneliness that characterizes the life of the pioneer. They will be old, oppressed, battered Negro women, symbolized in a seventy two year old woman in Montgomery, Alabama, who rose up with a sense of dignity and with her people decided not to ride segregated buses, and who responded with ungrammatical profundity to one who inquired about her weariness: "My feets is tired, but my soul is at rest." They will be the young high school and college students, the young ministers of the gospel and a host of their elders, courageously and nonviolently sitting in at lunch counters and willingly going to jail for conscience' sake. One day the South will know that when these disinherited children of God sat down at lunch counters, they were in reality standing up for what is best in the American dream and for the most sacred values in our Judaeo Christian heritage, thereby bringing our nation back to those great wells of democracy which were dug deep by the founding fathers in their formulation of the Constitution and the Declaration of Independence.

Never before have I written so long a letter. I'm afraid it is much too long to take your precious time. I can assure you that it would have been much shorter if I had been writing from a comfortable desk, but what else can one do when he is alone in a narrow jail cell, other than write long letters, think long thoughts and pray long prayers?

If I have said anything in this letter that overstates the truth and indicates an unreasonable impatience, I beg you to forgive me. If I have said anything that understates the truth and indicates my having a patience that allows me to settle for anything less than brotherhood, I beg God to forgive me.

I hope this letter finds you strong in the faith. I also hope that circumstances will soon make it possible for me to meet each of you, not as an integrationist or a civil-rights leader but as a fellow clergyman and a Christian brother. Let us all hope that the dark clouds of racial prejudice will soon pass away and the deep fog of misunderstanding will be lifted from our fear drenched communities, and in some not too distant tomorrow the radiant stars of love and brotherhood will shine over our great nation with all their scintillating beauty.

Yours for the cause of Peace and Brotherhood, Martin Luther King, Jr.
Published in:
King, Martin Luther Jr.

African-Americans have worse prognosis at colorectal cancer diagnosis

(PHILADELPHIA) African-American patients with colorectal were more likely to present with worse pathological features at diagnosis and to have a worse five-year survival rate compared to Caucasian patients, according to a study conducted by researchers at Thomas Jefferson University.

The results are being presented at the 2009 American Society of Clinical Oncology (ASCO) Gastrointestinal Cancers Symposium. The study was led by Edith Mitchell, M.D., a clinical professor in the Department of Medical Oncology at Jefferson Medical College of Thomas Jefferson University.

Edith Mitchell, MD. Jefferson University Physician Office Address: 925 Chestnut Street Suite 220A. Philadelphia, PA. 19107. PHONE: (215) 955-8874 Board Certifications: Medical Oncology, Internal Medicine. Hospital Affiliation Admitting Privileges: Thomas Jefferson University Hospital. Jefferson Medical College Faculty Appointment: Clinical Professor

Dr. Mitchell is also associate director of Diversity Programs for the Kimmel Cancer Center at Jefferson. "One possible explanation could be the socioeconomic factors that are often associated with African-American patients," Dr. Mitchell said. "For example, research has shown that African-Americans are less likely than Caucasian patients to have health insurance, and thus they may not receive the screening necessary to detect colorectal cancer at an earlier stage." Dr. Mitchell and colleagues obtained data from the tumor registry of Thomas Jefferson University Hospital on 2,500 patients treated for colorectal cancer from 1988 to 2007. They compared those data with data obtained from the National Cancer Institute's Surveillance,

Epidemiology and End Results (SEER) database on 244,701 patients with colorectal cancer treated from 1988 to 2005. The researchers collected data on location, stage and histologic grade of the cancer.

In both patient groups, more African-American patients presented with advanced disease (defined as stage III or stage IV) at diagnosis. African-American patients were also more likely to have proximal – on the right side of the colon – disease. Among patients diagnosed with early-stage disease, the risk for nodal involvement was greater in African-American patients.

African-American patients also had a worse five-year survival, both overall and when stratified by cancer stage.

"Right now, we cannot definitely explain why there are such differences between the African-American and the Caucasian patients," Dr. Mitchell said. "We need to do more studies on prognostic factors related to tumor biology, molecular markers and genetics to account for the racial disparities." ###

Contact: Emily Shafer emily.shafer@jefferson.edu 215-955-5291 Thomas Jefferson University

Outdoor alcohol advertising and problem drinking among African-American women in NYC

January -- New research conducted at Columbia University Mailman School of Public Health indicates that the advertising of alcohol in predominantly African-American neighborhoods of New York City may add to problem drinking behavior among residents. Prior studies have shown that alcohol advertisements are disproportionately located in African- American neighborhoods, but the impact of such advertising on alcohol consumption has been unclear. The study is currently published online by the American Journal of Public Health.

Participants were 139 African-American women between the ages of 21-49 who resided in Central Harlem.

Naa Oyo A. Kwate, Assistant Professor of Sociomedical Sciences, Mailman School of Public Health. 722 W. 168th St., 9th floor. New York, NY 10032. Phone:212-305-5736. Fax: 212-305-0315. Email: nak2106@columbia.edu

The women were eligible to participate if they reported having at least one alcoholic beverage per month for the past six months, but had no history of a formal medical diagnosis of alcohol or substance abuse. Of the sample, 31% were reported to be problem drinkers, defined in the study as endorsing behaviors such as needing a drink first thing in the morning or feeling guilty about drinking. The Mailman School researchers examined the relationship between alcohol advertisements in the women's neighborhood blocks and being a problem drinker. The findings showed that both exposure to alcohol advertising and a family history of alcoholism were related to being a problem drinker.

But even after the researchers statistically controlled for the effect of having a family history of alcoholism, exposure to advertisements was significantly related to problem drinking. While the advertisements did not target women in particular, the language, imagery, and themes clearly targeted African-American people, the researchers noted.

"We found that, on average, exposure to each alcohol ad in a woman's residential block was associated with a 13% increase in the odds of being a problem drinker," says Naa Oyo Kwate, PhD, assistant professor of Sociomedical Sciences at the Mailman School, and the principal investigator of the study. "This finding is significant for public health because residents in the study area were highly exposed to alcohol advertisements, and the associations between exposure and outcome persisted after we controlled for other potential causes of problem drinking."

"Because we did not assess participants' perceptions about the advertising content, or how salient it was for them, the mechanisms by which outdoor advertisements affected problem drinking remain unknown," suggests Ilan Meyer, PhD, associate professor of clinical Sociomedical Sciences and a co-author of the article. "Advertisements may prime people for alcohol consumption, and in turn, high levels of consumption may increase the risk for abuse and dependence."

"Advertisements also may increase the likelihood of problematic drinking patterns among individuals who are already susceptible. That is, individuals who are at risk for, or already contending with, alcohol abuse or dependence may be more likely to continue this behavior in an environment where cues that promote alcohol use are prominent," notes Dr. Meyer. The Mailman School team believes that future study is needed to further investigate possible pathways to problem drinking and the role that exposure to advertisements may play in causing drinking problems.

Dr. Kwate also noted that according to other earlier research, residents often perceive these advertisements to be unfairly marketed toward African American individuals and represent a deliberate targeting scheme for products that damage health. "Thus, to the extent that these advertisements are perceived as manifestations of racism, they may increase the odds of problem drinking," she says. ###

About the Mailman School of Public Health: The only accredited school of public health in New York City, and among the first in the nation, Columbia University's Mailman School of Public Health provides instruction and research opportunities to more than 1000 graduate students in pursuit of masters and doctoral degrees. Its students and more than 300 multi-disciplinary faculty engage in research and service in the city, nation, and around the world, concentrating on biostatistics, environmental health sciences, epidemiology, health policy and management, population and family health, and sociomedical sciences. www.mailman.hs.columbia.edu

Contact: stephanie berger sb2247@columbia.edu 212-305-4372 Columbia University's Mailman School of Public Health

Scholar's new book examines cultural forces behind Obama's victory

CHAMPAIGN, Ill. — Jabari Asim (juh-BAR-ee ah-SEEM) says you could see it coming. He thought a black president was inevitable. Just not quite so soon.

“Early on, I was definitely one of the people who didn’t think he (Obama) had a shot,” says Asim, a scholar-in-residence in African American studies and in journalism at the University of Illinois, and the author of “What Obama Means” (William Morrow), being published on Inauguration Day.

Cultural critic Jabari Asim, a scholar in residence in African American studies and in journalism at Illinois, is the author of "What Obama Means," to be published on Inauguration Day. Asim says he looked back to see how a “harmonic convergence” of trends in media and market forces, as well as in the electorate and in black leadership, made the Obama victory possible. Photo by L. Brian Stauffer

Obama “proved me wrong at almost every step,” said Asim, who also is the editor of the NAACP magazine “The Crisis.” But as a cultural critic, Asim says he looked back to see how a “harmonic convergence” of trends in media and market forces, as well as in the electorate and in black leadership, made the Obama victory possible. For one thing, Obama benefited from many who preceded him in entertainment, sports and other cultural fields – African Americans who not only broke ground, but helped bridge the racial divide.

“There are major cultural categories where the battles he’s fought in politics have already been fought,” Asim said. “We’ve already had Obamas in those fields.”

Asim, who also wrote “The N Word,” takes readers through a reflection on the nation’s cultural history that cites the influence of figures such as Bill Cosby, Michael Jackson, Michael Jordan, Sidney Poitier, Prince, Diana Ross, Will Smith, Denzel Washington and Oprah Winfrey, and the fictional President David Palmer of “24” on television.

The younger voters who broke heavily for Obama in the election “grew up watching Will Smith movies, watching the Cosbys on television, cheering for black baseball, football, basketball players, having black posters on their walls,” Asim said.

Advertising, as well, “has really advanced the image of African Americans,” he said. Television commercials have become “a bastion of diversity.”

Negative portrayals of blacks in the media are still widespread, Asim said, but often overlooked are the numerous positive portrayals that are out there at the same time. “And white people have demonstrated that they are judicious enough to know the difference,” he said, despite long-held black fears to the contrary.

His prime example, perhaps, is that of “gangsta” rappers often decried for their violent and misogynistic lyrics, but who sell most of their albums to white teenage boys, pitch products, and are “very welcome in America’s living rooms.” By comparison, he argues, “how threatening can a black guy with a Harvard Law School accent and a suit and tie be?”

This is not to say that the U.S. is “post-racial” or that relations between the races are healthy, even if moving in the right direction, Asim said. But he concludes that “people are more complicated and sophisticated than we often give them credit for,” and that the electorate overall has matured.

Along with whites overcoming prejudices, blacks have had to overcome “deeply entrenched cynicism about what the possibilities are,” and Obama was “really bold and really challenging” in motivating them to do so, Asim said.

Obama also represented a major and largely generational shift in the nature of African American leadership, away from an outlook and methods based exclusively on protest, Asim said. Many questions were raised early in the primary campaign, for instance, about whether Obama was “black enough,” but Asim said the questions came mainly from white reporters, and not the black community.

The primary questions Asim heard in the black community, he said, were whether Obama could win, and then whether he could survive.

In the end, Asim writes in his epilogue, the fears about a Bradley effect or hidden racism proved to be unfounded. “The remnants of old-school racism that reared up in certain quarters prior to Election Day were not revealed as omens of a November surprise but exposed as the last gasps of a dying pathology,” he writes. “In the end, it was about hope, not hate.”

Editor’s note: To contact Jabari Asim, call 217-333-7781; e-mail: jasim@illinois.edu.

Craig Chamberlain, Social Sciences Editor 217-333-2894; cdchambe@illinois.edu WEB: University of Illinois at Urbana-Champaign

Online racial discrimination linked to depression, anxiety in teens

CHAMPAIGN, Ill. — In the early days of the Internet, some scholars once predicted a lessening of racism and race-based discrimination in online interactions thanks to the anonymity and race-neutral nature of the medium. But according to a new study published by a University of Illinois professor who studies race and the Internet, adolescents are increasingly experiencing both individual and vicarious discrimination online, which in turn triggers stress, depression and anxiety.

Brendesha Tynes, a professor of educational psychology and of African American studies at the U. of I.,

Caption: Educational psychologist Brendesha Tynes says adolescents are increasingly experiencing both individual and vicarious discrimination online, which in turn triggers stress, depression and anxiety. Credit: L. Brian Stauffer. Usage Restrictions: None.

believes that with teenagers increasingly tethered to the Internet (93 percent of whom have Internet access in some form, at last count), more consideration should to be given to race-related online victimization not only as an Internet safety issue, but also as a public health concern for parents. "There's been a lot of publicity about cyber-bullying and teenagers protecting themselves from online predators, and justifiably so," Tynes said. "But people don't know much about online racial discrimination and its effects on adolescent emotional well-being." Tynes along with co-authors Michael T. Giang, David R. Williams and Geneene N. Thompson published their findings in an article titled "Online Racial Discrimination and Psychological Adjustment Among Adolescents" in the December 2008 issue of the Journal of Adolescent Health.

Tynes said that while there have been several studies that have explored online victimization and its effect on psychological functioning, there haven't been any studies on the effects of race-related online victimization.

"The whole goal of this study was to see if there were associations between race-related victimization and negative psychological adjustment," she said. "I wanted to make a distinction between online racial discrimination and offline racial discrimination. Since people of color experience racial discrimination in both face-to-face settings and online, I wanted to find out whether online racial discrimination impacts adjustment over and above what's experienced in offline settings. We've found evidence to suggest that it does."

For the study, Tynes created a measure for race-related online victimization. She discovered that 71 percent of African-American adolescents, along with 71 percent of white and 67 percent of multiracial/other adolescents, experienced vicarious racial discrimination online at least once. Twenty-nine percent of African-American adolescents, and 20 percent of white and 42 percent of multiracial/other adolescents also reported experiencing individual discrimination directed at them while online, according to the published findings.

Tynes's research indicated that, regardless of a victim's racial background, increased exposure to online racial discrimination was significantly related to increased depression; females were found to experience significantly more depression and anxiety than males. Victimization occurred in the usual online mediums – instant messaging, discussion forums, online games and social networking sites – and in text messages received by the victim.

Tynes's findings depart from previous research in the field, which had shown discrimination to disproportionately impact the emotional and physical health primarily of people of color. The variance in her findings could be attributed to the sample or the measures used in her study, she said, since the discrimination gap between whites and blacks is profoundly different, both online and offline.

"More research is needed to determine the impact of those differences," Tynes said.

Tynes said that another disturbing finding in her research was discovering online hate groups who actively try to recruit new members by creating child-friendly Web sites.

"There are white power groups who, for example, lure teens and kids by creating Web sites that are advertised as being for kids," she said, citing the Stormfront "White Pride For Kids' " (sic) Web site.

"That site differs from the main site in that it's only tinged with negative language, not out-and-out racist language," she said. "It's masked racism that uses a bait-and-switch to entice unsuspecting kids."

While the Internet can be seen as an open marketplace of ideas, Tynes said it can also function as an echo chamber of false information, noting that some child-focused Web sites produced by hate groups are created as phony information clearinghouses about historical figures such as Martin Luther King and Barack Obama or historical events such as the Holocaust. The Web sites encourage children to propagate historical canards in their research papers. The published information found on such sites, however, is typically neither factual nor accurate, Tynes said.

As part of their recruiting efforts, hate-mongers will not only congregate in Web sites and discussion forums related to their own ethnic groups, but they will also lurk in forums created for a specific ethnic group of color and "troll" (Internet lingo for deliberately posting a taunting, usually invective-laden message for the sole intention of causing chaos) those message boards, Tynes said.

"I saw many examples of trolls going to sites devoted to a specific ethnic group of color and then posting a negative message filled with racial epithets solely to provoke and inflame members of that community," she said.

Despite all the dangers that lurk online, Tynes still thinks it's important for adolescents to spend time on the Internet.

"When you're not participating in the sites that the kids at your school are participating in," she said, "you can run the risk of feeling isolated from your peers. In a lot of ways, the Internet is sort of an informal classroom for teens."

"For all of its shortcomings, it's a good bridge to help kids become more sophisticated in their understanding of race," she said.

Tynes is not a proponent of strict parental monitoring or restricting teens from exploring the Internet.

"It would be impossible to monitor every Web site that's out there," she said. "I am a proponent of more conversations about race, more study of people's culture, and keeping an open line of communication with our teens about the fact that these things might happen. That's why we need more discussion, so that when teens experience race-related victimization online, it can serve as a buffer to help them to feel a sense of racial pride and a positive racial identity." ###

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

UGA research explores little-known chapter in college desegregation VIDEO

Athens, Ga. - Many of the battles to desegregate Southern colleges and universities were fought in public, but efforts to desegregate the standardized testing that is often a prerequisite to admission have, until now, received little attention. Now, a new University of Georgia study reveals how two men traveled the Deep South, facing hostility and risking violence, to ensure that students received fair and impartial treatment.

"We know a lot of the big stories of the civil rights era, but this is a smaller, virtually unknown one," said study author Jan Bates Wheeler, associate director for accreditation at the UGA Office of Institutional Effectiveness.

WSB-TV newsfilm clip of African American students Charlayne Hunter and Hamilton Holmes on the campus of the University of Georgia in Athens, Georgia, 1961 January 17, Description: In this silent WSB newsfilm clip from Athens, Georgia on January 17, 1961, the University of Georgia's first two African American students, Charlayne Hunter and Hamilton Holmes, walk across campus to attend classes. The clip begins with Hamilton Holmes with a bandage on his right eyebrow, followed by three men who may be plain-clothes police officers. Holmes and the men pass between white students who are standing on either side of the doorway to Meigs Hall, the psychology building. Next, Charlayne Hunter walks up a flight of stairs beside Meigs Hall before she too, enters the building. Charlayne Hunter and Hamilton Holmes applied for admission to the University of Georgia in 1959, but university officials claimed they were unable to admit the two because of a lack of space. After reapplying for admission several times, lawyers for Hunter and Holmes filed a federal lawsuit. On January 6, 1961, federal judge William A. Bootle ordered the university to admit the students immediately. Hunter and Holmes began attending classes at the university on January 11, 1961, ending over 176 years of segregation at the school.

"It's an example of how a few people put forth a lot of effort at great personal risk to make higher education available to people who were being denied access." College entrance exams such as the SAT require that students be tested impartially and under the same conditions. In the segregated South of the early 1960s, however, black students were routinely turned away from testing sites, which were almost always at all-white high schools or colleges. Wheeler notes that some colleges and universities required the SAT as prerequisite to admission purely to create a nearly insurmountable hurdle for prospective black students. When black students were allowed to take the exam, white school administrators often placed them in a separate - and usually inferior - location. One group of black students in Columbia, South Carolina, for example, took the 3-hour SAT in a poorly-lit basement while the proctor talked loudly to an assistant. Wheeler uncovered evidence that Hamilton Holmes and Charlayne Hunter, the first two black students admitted to UGA, were initially turned away from their SAT testing center. In response to such abuses, the College Board, the not-for-profit organization that administers the SAT, began an ambitious campaign in 1960 to desegregate the testing centers. The men who designed the plan intentionally kept the effort from the public.

"They didn't want publicity because they knew that it would further solidify the massive resistance against school desegregation," Wheeler said. "Even after they were successful, they didn't want a history written because they didn't want the school administrators who had cooperated with them to get into trouble."

Wheeler, who recently received her doctorate from the UGA Institute of Higher Education and conducted the research for her dissertation, examined more than 10,000 pages of letters, memos and reports to create the first comprehensive history of what was called a "campaign of quiet persuasion" to desegregate testing centers in the Deep South. The effort was led by the late Ben Cameron Jr. of Sewanee, Tenn., a Southern liberal who -- in a telling display of the changes that were roiling the South -- was the son and namesake of the judge from the U.S. Court of Appeals for the Fifth Circuit who worked to prevent James Meredith from becoming the first black student at the University of Mississippi.

The junior Cameron served with black sailors in World War II but returned to a society where blacks weren't allowed the same freedoms he enjoyed. Wheeler said Cameron's wartime experiences inspired him to work toward a society where skin color is not a barrier to college admission, even if it meant risking his safety and his relationship with his segregationist father.

Between 1960 and 1965, Cameron and staff member Ben Gibson of Atlanta traveled to nearly every school district in Alabama, Georgia, Louisiana, Mississippi and South Carolina to push for desegregation of testing centers. They met with school principals and other officials who oversaw the centers and presented them with two options: maintain a desegregated testing center with equal treatment for all or lose the prestige and convenience associated with being a testing center.

Racial slurs were often hurled at the men, and one school superintendent tried to intimidate Gibson by taking him to a meeting of the segregationist White Citizens Council and on a tour of neighborhoods that were still smoldering from race riots. In Jackson, Miss., the police and the FBI trailed Cameron -- the latter for his protection and the former for unknown reasons. "They were never in any immediate physical danger," Wheeler said, "but they knew that was always a possibility."

Not all of the schools they visited were hostile. Sister Mary Fidelis, head of St. Vincent's Academy for Girls in Savannah, readily agreed to provide up to 500 seats for students of any color. But dozens of testing sites were steadfast in clinging to segregation and were closed by Cameron and Gibson. In some cases, the closing necessitated the opening of testing locations at military bases, including at Redstone Arsenal, the heart of the Army's rocket and missile programs, in Huntsville, Ala.

By 1965, Cameron and Gibson had succeeded in their "campaign of quiet persuasion." They received input from an advisory committee that included well-known figures such as Ralph McGill, publisher of The Atlanta Constitution, and Stephen Wright, president of Fisk University, but traveled the South on their site visits alone. "They were committed to creating a level playing field for all students," Wheeler said. "They stuck to their principles when it would have been easier not to." ###

Contact: Sam Fahmy sfahmy@uga.edu 706-542-5361 University of Georgia