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

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

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

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

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

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

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

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

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

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

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

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

Delaying Needed Medicine

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

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

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

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

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

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

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

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

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

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

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

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

News briefs from the American Sociological Review: Inequalities in education

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

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

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

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

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

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

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

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

Socioeconomic Desegregation Alone Is Not Effective in Improving Classroom Performance

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

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

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

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

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

Competition for College Admissions Perpetuates Class Divide in Higher Education

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

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

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

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

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

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

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

About the American Sociological Association

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

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

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

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

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

Lynn Rosenberg, Sc.D.

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

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

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

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

Lung cancer risk increases with expression of specific genes

Possible correlation to increased risk for African-Americans

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Demonstrators Protest at Republic of Guinea UN mission VIDEO

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

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

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

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

TEXT: Central Intelligence Agency

Researchers Identify Gene Variant Linked to Glaucoma

An international team, led by researchers from the University of California, San Diego School of Medicine and the National Eye Institute, has discovered gene variants for glaucoma in a black population. The finding could lead to future treatments or a cure for this disease, which leads to blindness in two million Americans each year.

The study by Kang Zhang, MD, PhD, Director of the Institute for Genomic Medicine and professor of ophthalmology and human genetics at the Shiley Eye Center at UC San Diego and J. Fielding Hejtmancik, MD, PhD, medical officer and chief of the Ophthalmic Molecular Genetics Section at the National Eye Institute, National Institutes of Health, along with the Barbados Family Study Group and colleagues in the United States, China and Barbados, will be published in the early online edition of the Proceedings of the National Academy of Science (PNAS) the week of September 21.

Kang Zhang, MD, PhD

Glaucoma is the leading cause of blindness among blacks, affecting close to five percent of the population. The researchers chose to conduct the study in the Afro-Caribbean population of Barbados, where the incidence of glaucoma is double that figure – nearly 10 percent of all residents of the island – and where there is a strong genetic predisposition. Known as “the silent thief of sight,” glaucoma is a neurodegenerative disease that causes the death of ganglion cells of the retina, resulting in gradual and irreversible loss of peripheral vision. Reducing intra-ocular pressure can slow the progression to blindness, but there is no cure or reversal for glaucoma.

“The cause and progression of glaucoma are poorly understood, although we know there is a strong genetic predisposition to the disease,” said co-author Robert N. Weinreb, MD, Director of the Hamilton Glaucoma Center and Distinguished Professor of Ophthalmology at UC San Diego.

“We have now identified very common gene variants that have a dramatic impact on an individual’s risk for developing glaucoma,” Zhang added. “These gene variants are present in 40 percent of individuals with glaucoma in the Barbados population and explains nearly one-third of their genetic risk for the disease. This study should give us a better handle on earlier diagnoses and new therapies.”

Looking at 249 patients with glaucoma and 128 control subjects, the research built on early studies which scanned the entire human genome. The scientists then homed in on a particular segment of the human genome, and finally localized the gene on chromosome 2.

“Once we understand the specific gene or protein structure that is altered in the disease, we are one step closer to developing gene or stem cell-based therapies to treat glaucoma,” said Zhang. Identifying the gene variants can also provide a more accurate and earlier diagnosis, allowing early intervention to slow glaucoma’s progression.

Additional contributors to the study include researchers at the University of Utah; Yale

University; Stony Brook University; University of the West Indies; Qingdao University, Qingdao, China; Sichuan Provincial People’s Hospital, China; and West China Hospital, Sichuan University.

This work was supported by grants from the National Eye Institute of National Institutes of Health, Research to Prevent Blindness and the Burroughs Wellcome Fund. # # #

Media Contact: Debra Kain, 619-543-6163, ddkain@ucsd.edu

Vice Admiral Samuel Lee Gravely, Jr.

Vice Admiral Samuel Lee Gravely, Jr. had a distinguished naval career as a surface warfare officer and manager. All leaders, civilian and military, officer or enlisted, government service grade or Senior Executive Service could learn the characteristics of effective leadership from Gravely's thirty-eight years in the Navy. There are several notable achievements to his credit including being the first African-American to command a combatant ship, to be promoted to flag rank, and to command a naval fleet. Gravely's life and naval career, spanning from 1944 to 1982, also reflect the improved status of African-Americans in the Navy and in American Society. As a distinguished veteran of World War II, and the Korean and Vietnam Wars, his military service suggests several qualities that a successful leader should possess.

Samuel Lee Gravely, Jr.

The first attribute is simply "to be ready." Gravely could not always determine when an opportunity would arise but he made sure that he had prepared himself to be able to respond to it. Obstacles must be turned into opportunities. For example, when the officers club prevented Gravely from entering, he used the time to complete Navy correspondence courses. The additional education and training helped him become a better officer.

Like any other sailor, Gravely did not like every job the Navy gave him but he did his best in each of them. In that sense, Gravely believed that all jobs were good jobs because they were chances to excel. Regardless of the size of one's command, lead with integrity, professionalism, and care. Gravely was a strategist as he faced more than a few challenges. Instead of being overwhelmed by them or focusing on them, he found creative ways to circumvent them or to accept them and he always strove to learn from his experiences. Gravely never sat on his laurels. He continued to learn and to expand his horizons. His career also suggests that leaders must be realistic and optimistic. While Gravely understood the naval policies designed to limit African-Americans in the Navy, he did not let them limit or discourage him. Another important characteristic is having the right attitude, as well as the appropriate credentials. He believed that success and respect were not given to anyone; they had to be earned. Another attribute of leadership is perseverance. An effective leader has to be committed enough to the cause to focus on the goal.

Despite the difficulties, Gravely enjoyed his naval service. This reminds leaders that it is important to know your job and to do it well but you should not forget to enjoy the work. An effective leader strives to make a positive difference for others and has a genuine concern for others. Good leaders are not born; they are developed and one measure of their success is that they have trained others to be effective leaders.

Finally, where one starts does not necessarily have to guarantee where he ends up. Instead of accepting the odds for failure, one can beat the odds by working and studying hard. Gravely began his career as a seaman apprentice at Great Lakes in 1942 and rose through the ranks to become a three star admiral.

090516-N-5549O-086 PASCAGOULA, Miss. (May 16, 2009) Acting Secretary of the Navy the Honorable BJ Penn addresses hundreds of guests during the christening ceremony for the Arleigh Burke class destroyer USS Gravely (DDG-107) at Northrop Grumman Shipbuilding, Pascagoula, Miss.

The newest destroyer honors Samuel L. Gravely who was the first African American to command a warship (USS Theodore E. Chandler); to command a major warship (USS Jouett); to achieve flag rank and eventually vice admiral; and to command a numbered fleet (Third). (U.S. Navy photo by Mass Communication Specialist 2nd Class Kevin S. O’Brien/Released)

Heart Healthy Home Cooking African American Style

Heart Healthy Home Cooking African American Style With Every Heartbeat Is Life

Good food is one of life’s great joys. And good meals are a shared pleasure at the heart of African American family life and special celebrations. This recipe book brings together many African American favorite recipes, prepared in a heart healthy way, lower in saturated fat, cholesterol, and sodium! It shows how to prepare dishes in ways that help protect you and your family from heart disease and stroke. This is important because heart disease and stroke are the first and the third leading cause of death for African Americans. By making small changes in the way you and your family eat, you can help reduce your risk for heart disease and stroke.

This updated recipe book includes new recipes, along with some of your old favorites. New information on heart healthy food substitutions and food safety is also included. So, make a start today. Give those old favorites a new, tasty, heart healthy makeover. And help keep the heart of your family strong.

DOWNLOAD: Heart Healthy Home Cooking African American Style in PDF Format.

Racial disparities in diabetes prevalence linked to living conditions

The higher incidence of diabetes among African Americans when compared to whites may have more to do with living conditions than genetics, according to a study led by researchers at the Johns Hopkins Bloomberg School of Public Health. The study, available online in advance of publication in the October 2009 edition of the Journal of General Internal Medicine, found that when African Americans and whites live in similar environments and have similar incomes, their diabetes rates are similar, which contrasts with the fact that nationally diabetes is more prevalent among African Americans than whites.

Researchers from the Hopkins Center for Health Disparities Solutions and Case Western Reserve University School of Medicine compared data from the 2003 National Health Interview Survey (NHIS) with the Exploring Health Disparities in Integrated Communities Southwest Baltimore (EHDIC-SWB) Study. The Baltimore study was conducted in a racially integrated urban community without race differences in socioeconomic status.

Thomas A. LaVeist, Ph.D. is Professor of Health Policy and Management, and Director of the Center for Health Disparities Solutions at the Johns Hopkins Bloomberg School of Public Health.

In recent decades the United States has seen a sharp increase in diabetes prevalence, with African Americans having a considerably higher occurrence of type 2 diabetes and other related complications compared to whites. "While we often hear media reports of genes that account for race differences in health outcomes, genes are but one of many factors that lead to the major health conditions that account for most deaths in the United States," said Thomas LaVeist, PhD, director of the Hopkins Center for Health Disparities Solutions and lead author of the study. Some researchers have speculated that disparities in diabetes prevalence are the result of genetic differences between race groups.

However, LaVeist noted that those previous studies were based on national data where African Americans and whites tend to live in separate communities with different levels of exposure to health risks. The EHDIC-SWB study accounts for racial differences in socioeconomic and environmental risk exposures to determine if the diabetes race disparity reported in national data is similar when black and white Americans live under comparable conditions.

"I don't mean to suggest that genetics play no role in race differences in health, but before we can conclude that health disparities are mainly a matter of genetics we need to first identify a gene, polymorphism or gene mutation that exists in one race group and not others. And when that gene is found we need to then demonstrate that that gene is also associated with diabetes," LaVeist said. "On the other hand, there is overwhelming evidence that behavior, medical care and the environment are huge drivers of race differences in health. It seems more likely that the answer to health disparities will be found among these factors."

Researchers in this study found that within their sample of racially integrated communities without race differences in socioeconomic and environmental factors, prevalence estimates of diabetes are similar between African Americans and whites. According to the study, "Previous research has demonstrated that when African Americans and whites access similar health care facilities their health care outcomes are more similar."

The study's authors said their findings support the need for future health disparities research and creative approaches to examining health disparities within samples that account for socioeconomic and social environmental factors. ###

Additional authors of "Environmental and Socio-Economic Factors as Contributors to Racial Disparities in Diabetes Prevalence" are Roland J. Thorpe, Jr., PhD; Jessica E. Galarraga, MPH; Kelly M. Bower, MSN, MPH, RN; and Tiffany L. Gary-Webb, PhD.

The study was supported by funding from the National Center on Minority Health and Health Disparities (NCMHD), a center of the National Institutes of Health (NIH).

Contact: Tim Parsons tmparson@jhsph.edu 410-955-7619 Johns Hopkins University Bloomberg School of Public Health

Young Black Women Prone to Gain More Unhealthy Abdominal Fat than Hispanics, Study Shows

WINSTON-SALEM, N.C. – Black women ages 20 to 29 have increased amounts of unhealthy abdominal and visceral fat than Hispanic women the same age, and young women of both age groups have more as compared to their elders, according to researchers from Wake Forest University Baptist Medical Center and colleagues.

The new research shows that accumulation of abdominal fat that increases risk of type 2 diabetes is greatest in young adulthood for blacks and Hispanics, said endocrinologist Kristen G. Hairston, M.D., M.P.H., lead author of an article published online June 1 by the American Diabetes Association. The study is the first to look at a large minority cohort using computed tomography (CT) scanning to measure longitudinal changes over time in visceral and subcutaneous adipose tissue, which are different types of abdominal fat.

Kristen G. Hairston, M.D., M.P.H. Assistant Professor, Department Name: Endocrinology and Metabolism. Appointments: (336) 713-7251, Office Phone: (336) 713-7251, Night Phone: (336) 713-7251, Fax: (336) 713-7255. Clinic Location: University Internal Medicine at Stratford Executive Park, 500 Shepherd Street, Suite 300, Winston-Salem, NC. Office Address: Medical Center Blvd. Winston Salem, NC 27157-1047. Email Address: kghairs@wfubmc.edu

The study followed 389 blacks and 844 Hispanics ages 20 to 69, men and women, grouped by age in 10-year increments. The researchers took baseline measurements of visceral adipose tissue (VAT) and subcutaneous abdominal tissue (SAT) from 1999 to 2002 with follow-up measurements in 2005-2007. VAT is fat that resides within the abdominal cavity around internal organs and has been linked to metabolic disturbances. SAT is the kind of fat that one can pinch, like “love handles.” The study found that the young adult age group (ages 20 to 29) had the largest five-year increase in measured adiposity, or fat, regardless of race or gender. The increase in VAT averaged 18 and 12 square centimeters (cm2) among young black and Hispanic women, respectively, and 13 and 7 cm2 among young men. The five-year increase in (SAT) was 89 and 53 cm2 among young black and Hispanic women, respectively, and 76 and 30 cm2 among young men. In general, fat accumulation declined in the older age groups. Abdominal fat accumulation, particularly the visceral type, is significant because previous studies show that VAT changes of this magnitude differentiate those who develop diabetes from those who don’t. Until this study, this pattern of excessive abdominal fat accumulation in young adults has not been reported using CT-measured “fat depots.”

The findings, however, are consistent with several other studies that used measurements such as body mass index and waist circumference. In this study, abdominal tissue area was measured at the L4/L5 vertebral region by CT.

“Our data may help to further identify unique populations at risk for type 2 diabetes and those for whom behavioral intervention might be most effective,” said Hairston, assistant professor of endocrinology and metabolism.

Grants from the National Institutes of Health funded the research. The article, titled “Five-year change in visceral adipose tissue quantity in a minority cohort: The IRAS Family Study,” appears online at care.diabetesjournals.org/content/early/2009/05/28/dc09-0336.abstract. It was published in the August issue of Diabetes Care, a publication of the American Diabetes Association.

Media Relations Contacts: Annette Porter, aporter@wfubmc.edu; (336) 716-2416; or Bonnie Davis, bdavis@wfubmc.edu; or Shannon Koontz, shkoontz@wfubmc.edu, (336) 716-4587.

New Obesity Data Shows Blacks Have the Highest Rates of Obesity

Blacks had 51 percent higher prevalence of obesity, and Hispanics had 21 percent higher obesity prevalence compared with whites, according to researchers with the Centers for Disease Control and Prevention.

Greater prevalences of obesity for blacks and whites were found in the South and Midwest than in the West and Northeast. Hispanics in the Northeast had lower obesity prevalence than Hispanics in the Midwest, South or West. The study, in CDC′s Morbidity and Mortality Weekly Report, examined data from 2006-2008. “This study highlights that in the United States, blacks and Hispanics are disproportionately affected by obesity,” said Dr. William H. Dietz, Director of CDC′s Division of Nutrition, Physical Activity, and Obesity, “If we have any hope of stemming the rise in obesity, we must intensify our efforts to create an environment for healthy living in these communities.”

William H. Dietz, MD, PhD, is the Director of the Division of Nutrition, Physical Activity, and Obesity at the CDC.

The study uses data from the Behavioral Risk Factor Surveillance System (BRFSS), of the Centers for Disease Control and Prevention. BRFSS is an ongoing, state-based, random-digit–dialed telephone survey of the U.S. civilian, noninstitutionalized population aged 18 years and older. The study found that in 40 states, obesity prevalence among blacks was 30 percent or more. In five of those states, Alabama, Maine, Mississippi, Ohio, and Oregon, obesity prevalence among blacks was 40 percent or greater.

For blacks, the prevalence of obesity ranged from 23 percent to 45.1 percent among all states and the District of Columbia; among Hispanics in 50 states and DC, the prevalence of obesity ranged from 21 percent to 36.7 percent, with 11 states having an obesity prevalence of 30 percent or higher. Among whites in 50 states and the District of Columbia, the prevalence of obesity ranged from 9 percent to 30.2 percent, with only West Virginia having a prevalence of 30 percent or more. “We know that racial and ethnic differences in obesity prevalence are likely due to both individual behaviors, as well as differences in the physical and social environment,” said Liping Pan, M.D., M.P.H., lead author and epidemiologist. “We need a combination of policy and environmental changes that can create opportunities for healthier living.”

For this study analysis, CDC analyzed the 2006−2008 BRFSS data. For more information on obesity trends, tables, including an animated map, visit www.cdc.gov/obesity/data/trends. To learn more about CDC′s efforts in the fight against obesity or for more information about nutrition, physical activity, and maintaining a healthy weight, visit www.cdc.gov/nccdphp/dnpao. ####

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Contact: CDC Division of Media Relations (404) 639-3286

JEC Chair Maloney Statement on African American Unemployment

Washington, D.C. - Today the Bureau of Labor Statistics (BLS) released its monthly jobs report for August. Congresswoman Carolyn B. Maloney, Chair of the Joint Economic Committee, released the following statement in reaction to the labor market conditions facing the African American community:

“Today's employment numbers show that although the economy shows signs of recovery, employers are still reluctant to hire,” said Rep. Maloney. “I am optimistic that as more stimulus projects get underway in the coming months, more African Americans will be heading back to work."

Some quick facts from the August Jobs Report from the Bureau of Labor Statistics:
· The unemployment rate for African American workers is now at 15.1 percent, up 6.2 percentage points from the start of the recession in December 2007.

Carolyn B. Maloney

· The share of African Americans with a job has dropped 5.0 percentage points over the recession to 52.8 percent. The last time the employment-to-population ratio for African Americans was this low was August 1984. · The unemployment rate for African American males 20 and over is 17.0 percent, 8.8 percentage points higher than at the start of the recession. This means that more than 1 in 6 African American men, age 20 or over, is unemployed and actively searching for work. And African American men are more likely to be unemployed for a longer period of time.

The median duration of unemployment for African American men is 21.8 weeks, much higher than the median duration of 15.6 weeks for white men.
· The unemployment rate for African American women age 20 and over has risen 4.8 percentage points since the start of the recession to 11.9 percent.
· Unemployment among minority teens is especially high –1 in 3 African American and Hispanic teens are unemployed. That compares with 1 in 4 for white teens

Black patients have lower rate of survival after in-hospital cardiac arrest

Compared with white patients, black patients who have an in-hospital cardiac arrest are significantly less likely to survive to hospital discharge, having lower rates of successful resuscitation and postresuscitation survival, although much of this survival difference was associated with the hospital in which black patients received care, according to a study in the September 16 issue of JAMA.

"Survival following in-hospital cardiac arrest represents a unique opportunity to examine racial disparities in medical care and outcomes. In-hospital cardiac arrest is an emergency condition tightly linked to processes of care and for which there is little debate regarding clinical appropriateness of treatment in eligible patients," according to background information in the article. "Racial differences in survival have not been previously studied after in-hospital cardiac arrest, an event for which access to care is not likely to influence treatment."

Paul S. Chan, M.D., M.Sc. Specialty: Cardiology, Office Information: Cardiovascular Consultants, P.C. 12330 Metcalf Avenue, Suite 280 Overland Park, KS 66213 816.931.1883. 20 N.E. Saint Lukes Boulevard. Lee's Summit, MO 64086. 816.931.1883

Paul S. Chan, M.D., M.Sc., of Saint Luke's Mid America Heart Institute, Kansas City, Mo., and colleagues used data from the National Registry of Cardiopulmonary Resuscitation (NRCPR) to examine whether racial differences exist in survival for patients with in-hospital cardiac arrest. The study included 10,011 patients from 274 hospitals who underwent defibrillation for a cardiac arrest. The average age in the study population was 67 years, 6,021 were men (60.1 percent), and 1,883 were black (18.8 percent). Several patient and hospital factors differed by race, including white cardiac arrest patients being older and more likely to be male; black patients were more likely to have ventricular fibrillation as their initial presenting arrest rhythm, were sicker at the time of cardiac arrest (higher rates of renal insufficiency, diabetes mellitus, central nervous system depression, acute stroke, pneumonia, sepsis, major trauma, and requirement for hemodialysis),

and were more likely to be admitted to a hospital unit not monitored, to a hospital with greater than 500 beds, and in the southeastern United States.

The researchers found that black patients had a 27 percent lower overall rate, and a 12 percent lower absolute rate, of survival to hospital discharge, compared with white patients. "These unadjusted survival differences by race were, in large part, attributable to black patients being more likely to receive treatment at hospitals with worse outcomes."

These differences narrowed after adjusting for patient characteristics and for the hospital to which the patient was admitted. "However, further adjustment for hospital process variables did not meaningfully [diminish] residual differences, and black patients remained 10 percent less likely to survive to hospital discharge," the authors note.

"Lower rates of survival to discharge for blacks reflected lower rates of both successful resuscitation (55.8 percent vs. 67.4 percent for whites) and postresuscitation survival (45.2 percent vs. 55.5 percent for whites)," they write. "The racial difference in postresuscitation survival was eliminated after multivariable adjustment, and was largely explained by the hospital site at which patients received postresuscitation care."

"Collectively, these findings suggest that strategies to eliminate racial disparities in survival after in-hospital cardiac arrest are not likely to succeed unless they are accompanied by successful identification and implementation of interventions that improve resuscitation survival in those poorly performing hospitals in which black patients are more likely to receive care." ###

Contact: Kaitlin Staniforth kstaniforth@saint-lukes.org 816-932-2826 JAMA and Archives Journals

Socio-cultural, genetic data work together to reveal health disparities

GAINESVILLE, Fla. — When it comes to health disparities between different groups, how society sees people in terms of race might play a greater role than genetics, according to a new University of Florida study.

The study also showed that taking stock of socio-cultural factors might improve our understanding of how genes influence individual health — regardless of race.

Consider high blood pressure, a complex disease governed both by genetic and environmental factors. Not only was social classification better than genetic-based ancestry at predicting disease status, it also brought to light a link between a particular gene and blood pressure that was not apparent when only genetic ancestry was considered.

Connie Mulligan, Ph.D. Title : Associate Professor of Anthropology and Associate Director of the UF Genetics Institute Interests : Human genetic variation, genetics of complex disease, New World/Asia colonization, ancient DNA. Clarence Gravlee , Ph.D. Title: Assistant Professor Interests: Medical anthropology; social inequalities in health; ethnicity, race, and racism; human biological variation; cultural dimensions of psychosocial stress; social network analysis; cognitive anthropology; qualitative and quantitative research methods

The study, to be published Wednesday (Sept. 9) in the journal PLoS ONE, is the first to rigorously combine both socio-cultural and genetic data to simultaneously test the relative contributions of each to racial inequalities in health. "What's really groundbreaking is that we've got both types of data and they're of equivalent sophistication," said co-author Connie Mulligan, Ph.D., an associate professor of anthropology and an associate director of the UF Genetics Institute. The results suggest that previously reported associations between genetic ancestry and health might be accounted for by socio-cultural factors related to race and racism, and not necessarily to genetic differences between races. It also suggests that including socio-cultural factors can strengthen genetics studies and help reveal how social inequalities can lead to biological differences. "We have to take seriously the way race shapes people's experiences, the environments they live in and their life chances," said lead author Clarence C. Gravlee, Ph.D., an assistant professor of anthropology at UF. "In day to day life, people often assume that race exists as biology. Most anthropologists and geneticists reject that idea and see race instead as a cultural construct. The point of our paper is that race is so embedded in our society that it affects biology by shaping the types of environments that people live in." How social and or genetic factors drive racial inequalities in health and the role of race in genetic and biomedical research are the source of much controversy and study. Some scientists see race as useful for pinpointing gene-based susceptibility to complex diseases, but others caution that looking at race from a purely genetic standpoint can mask social causes of racial inequalities. "We have to look at these in a way that will allow us to tell the whole story, not from one side or the other," said Jay Kaufman, Ph.D., an associate professor of epidemiology, biostatistics and occupational health at McGill University and author of the upcoming book "Racing in Circles: Myths about Genes and Race in Biomedical Research." Kaufman was not involved in the UF study. In general, members of racial minorities in the United States suffer poorer health, and more die prematurely compared with their white counterparts. African-Americans are three times more likely than whites to die from high blood pressure, according to the American Heart Association.

"The sheer scale of inequalities in sickness and death deserves our attention," Gravlee said. "Researchers have an obligation to explain the origins of these inequalities and to identify social factors that could be targeted for policy change."

To examine the link between African ancestry and blood pressure, the UF team studied 87 adults in Puerto Rico, using two variables for which "race" is often used as a surrogate: genetic ancestry and social classification.

Genetic ancestry was assessed using gene variants that show large frequency differences among groups from different continents. Social classification was assessed by observers to estimate how people are perceived in everyday life in terms of skin pigmentation, or "color" (pronounced coh-lohr). The researchers found that the three major "color" categories had overlapping genetic ancestry, and that there was a strong link between "color" and blood pressure, but not between genetic ancestry and blood pressure.

Next, they looked at whether taking account of social factors changed our understanding of genes thought to affect hypertension. When only genetic ancestry was considered, no association was evident between candidate genes for hypertension and blood pressure. But when "color" and socio-economic status were included in the analysis, a significant association between the gene variant and blood pressure was uncovered.

"One of the important points here is that you can have an association between two biological variables like genetic ancestry and blood pressure, but it could be that the social and cultural implications of having African ancestry is what is driving this association," Gravlee said.

Health differences could arise from differing stresses people face based on how society sees and treats them.

"There's no doubt about the fact that perceptions matter," Kaufman said. "This article reinforces the idea that if you don't pay attention to how people are perceived you miss a big chunk of the story."

The researchers found that the group of people who carried the associated genetic variant also contained multiple categories of "color" and socio-economic status. When these different socio-cultural categories were separated, the protective effect of the genetic variant became evident.

"What's exciting about our study, is that we can show the value of including socio-cultural data by revealing a genetic association that would otherwise have been missed," Mulligan said. "This is important in convincing other researchers that it is worthwhile to include nongenetic data in a genetic study rather than simply controlling for nongenetic factors." ###

Contact: Czerne M. Reid czerne@ufl.edu 352-273-5814 University of Florida

James Cleveland "Jesse" Owens (September 12, 1913 – March 31, 1980)

James Cleveland "Jesse" Owens (September 12, 1913 – March 31, 1980).

Owens attended The Ohio State University only after employment was found for his father, ensuring the family could be supported. He was affectionately known as the "Buckeye Bullet" and won a record eight individual NCAA championships, four each in 1935 and 1936.

At the 1936 Olympics in Berlin, Germany, Jesse Owens, the son of Lawrence County Alabama sharecroppers, Henry and Emma Owens, achieved international fame by winning four gold medals: one each in the 100 metres, the 200 metres, the long jump, and as part of the 4x100 meter relay team. and shattered Adolph Hitler's claim of Aryan superiority. His victory transcended athletics; the 110,000 Germans in Olympic Stadium cheered him on, and often stopped Owens on the streets of Berlin for an autograph or picture. Four years after his death, a street outside the Olypmic Stadium was named in his honor.

James Cleveland "Jesse" Owens (September 12, 1913 – March 31, 1980) PHOTO: Public Domain Clipart

In 1976, Jesse Owens was awarded the Presidential Medal of Freedom. In 1990, President George H.W. Bush posthumously awarded him the Congressional Medal of Honor for "an unrivaled athletic triumph, but more than that, a triumph for all humanity." Battling Discrimination at the 1936 Olympics--An Unsent Letter. This letter (Page 1) (Page 2) from NAACP leader Walter White to Jesse Owens urges him not to participate in the 1936 Olympic games in Berlin, which was under Nazi rule, but it was never sent.

In the letter, White writes: "The very preeminence of American Negro athletes gives them an unparalleled opportunity to strike a blow at racial bigotry and to make other minority groups conscious of the sameness of their problems with ours . . . But the moral issue involved is, in my opinion, far greater than immediate or future benefit to the Negro as a race. If the Hitlers and Mussolinis of the world are successful it is inevitable that dictatorships based upon prejudice will spread . . ."

The U. S. did send an Olympic team to Berlin, and Owens was its star, winning four gold medals.

High school put-downs make it hard for students to learn, study says

URBANA – High-school put-downs are such a staple of teen culture that many educators don't take them seriously. However, a University of Illinois study suggests that classroom disruptions and psychologically hostile school environments can contribute to a climate in which good students have difficulty learning and students who are behind have trouble catching up.

"We need to get away from the idea that bullying is always physical. Bullying can also include verbal harassment, which can be just as damaging and detrimental to student learning," said Christy Lleras, a U of I assistant professor of human and community development.

The study used data from the National Educational Longitudinal Study and included 10,060 African American, Latino, and white tenth graders in 659 U.S. high schools. It is one of the first to look at the national incidence of verbal harassment in public and private high schools, she said.

Christy Lleras, a professor of human and community development, says that ability grouping, a pedagogical tool for sorting students into different academic tracks based on their perceived academic ability, is a “net-loss” practice that not only impedes the literacy of lower-grouped minority students, but also doesn’t substantially strengthen the reading ability of higher-grouped minority students. | Photo by L. Brian Stauffer

"In looking at whether students felt safe at school, students' fear for their physical safety was actually pretty low. But 70 percent of the students said they were bothered by disruptions in their classroom, and one in five students said that they were often put down by their peers in school," she said. Lleras came to three interesting conclusions as she reviewed the data. One was that smaller, private, and more affluent schools do very little to protect students from verbal abuse. "I assumed that the sorts of school environments that protect students from physical harm would also protect students from emotional harm, and that was not the case. These 'safe' schools are not significantly reducing the likelihood that students will experience harassment by their peers," she said. This was especially true for adolescent boys. The results showed that boys experience verbal harassment from peers more often than girls, particularly if they are in private schools, Lleras said. Lleras also found that African American high-school students who thought of themselves as very good students were more likely to experience verbal put-downs from their peers, but only when they were in high-minority schools.

Why would high-achieving African-American students in high-minority schools face more verbal harassment? Lleras doesn't believe it can be entirely attributed to the oppositional culture hypothesis—namely, that high-achieving minority students are more likely to be negatively sanctioned by their peers for their efforts than white students.

She speculates that verbal put-downs in these schools may be a coping strategy that students use when they don't have the skills to do the work and have little hope of acquiring them in their academic environment.

"When high-achieving minority kids are put down by their peers, it can contribute to a climate in which lower-achieving kids fall farther and farther behind and must struggle to catch up. This hostile school climate isn't a cause of the racial achievement gap--we see evidence of the achievement gap well before middle school--but it contributes to it," she said.

"Sadly, verbal harassment is just one more thing these students have to deal with, and as long as we accept it because it's not physical bullying, we're doing a grave disservice to the kids who need non-disruptive and focused learning environments the most," she said.

The study was published in the Journal of School Violence. ###

Contact: Phyllis Picklesimer p-pickle@illinois.edu 217-244-2827 University of Illinois at Urbana-Champaign

Office of Naval Research's Rear Admiral addresses diversity with HBCU presidents

ARLINGTON, Va. - Saying America's future depended on its ability to compete in the global marketplace, the U.S. Navy's Chief of Naval Research addressed a gathering of presidents of historically black colleges and universities on Sept. 1 in Washington, D.C. He told them "in order to maintain the health of the defense science and engineering workforce, we must continue to engage every bright young mind that has the capability to help us invent the future."

Rear Admiral Nevin P. Carr Jr., whose office provides the science and technology needed to maintain the U.S. Navy and Marine Corps' technological war-fighting dominance, was among more than 1,200 participants attending the 2009 National Historically Black Colleges and Universities Week Conference. Held from Aug. 30 to Sept. 2, the White House-sponsored event attracted federal, state and local agencies interested in invigorating the relationship between the surviving 105 HBCUs and the government.

Caption: Admiral Nevin P. Carr, Chief of Navy Research addresses HBCU pesidents at a gathering in Washington D.C. Credit: U.S. Navy. Usage Restrictions: None.

For the Office of Naval Research, that relationship dates back to 1985 with initial funding for research at HBCU institutions, Carr said in his speech. In 1989, a dedicated program was established, supporting undergraduate and graduate students at five HBCUs. In 1992, investment increased to $6 million annually, then rose to $10 million in 1994. Through the mid-90s to 2002, ONR supported programs at 22 schools, among them HBCUs, and provided educational support for hundreds of deserving students.

Ninety percent of those students graduated on time with undergraduate degrees in science and engineering, and 80 percent went on to get master's degrees.

"Today, our HBCU programs include the summer faculty research program, the research and education partnership program, and the research partnership program--all directed towards increasing the participation of HBCU institutions in naval science and technology," Carr said. "We do this because we need to attract every bright young mind we can to a career in science and technology."

According to the National Science Foundation, only 31 percent of U.S. graduate students pursue degrees in science and engineering. As of 2004, only 35 percent of those graduates were from under-represented populations, such as African-American, Hispanic and Asian.

Carr's presence at the event underscored ONR's commitment to building the Navy's future force through investment in the science, technology, engineering and mathematics pipeline. The rear admiral was among distinguished speakers that included CIA Director Leon Panetta, U.S. Secretary of Education Arne Duncan and Environmental Protection Agency Administrator Lisa Jackson.

"Shifting demographics in the U.S. means we must focus our attention on reaching out more to diverse communities," Carr said. "The demographic trends are well established and clear.No single segment of any population can provide the needed capacity. We need to tap the entire crew." ###

About The Office of Naval Research

The Department of the Navy's Office of Naval Research (ONR) provides the science and technology necessary to maintain the Navy and Marine Corps' technological war-fighting dominance. Through its affiliates, ONR is a leader in S&T with engagement in 50 states, 70 countries, 1,035 institutions of higher learning, and nearly 1,000 industry partners. ONR employs approximately 1,400 people, comprising uniformed, civilian and contract personnel.

Contact: Peter Vietti onrcsc@navy.mil 703-588-2167 Office of Naval Research

Pancreatic cancer affects blacks at higher rates

PHILADELPHIA – Regardless of risk factors linked to pancreatic cancer, such as smoking and body mass index (BMI), blacks experienced higher rates of pancreatic cancer death than whites.

"Reducing overweight/obesity and smoking will help reduce pancreatic cancer overall, as well as prevent other diseases," said Lauren D. Arnold, Ph.D., M.P.H., postdoctoral research associate in the department of surgery at Washington University in St. Louis.

"We still have a long way to go towards understanding pancreatic cancer disparities."

Results of this cohort study are published online in Cancer Epidemiology, Biomarkers & Prevention, a journal of the American Association for Cancer Research.

Caption: Lauren D. Arnold, Ph.D., M.P.H., is a postdoctoral research associate in the department of surgery at Washington University in St. Louis. Credit: Lauren D. Arnold, Ph.D., M.P.H. Usage Restrictions: None.

Pancreatic cancer is a rapidly fatal disease that is challenging for researchers to study and treat. Because there are no good screening tests and symptoms do not often appear until the disease has spread, Arnold said that most people die within two years of diagnosis. Statistically, pancreatic cancer claims the lives of black Americans more so than whites — between 2001 and 2005, blacks had a 32 percent higher death rate, according to background information in the study obtained from the National Cancer Institute statistics. Arnold and colleagues examined risk factors for pancreatic cancer and separately evaluated them among black and white participants.

Using data from the Cancer Prevention Study II (CPS-II), they assessed whether these risk factor patterns explained differences in incidence and mortality. CPS-II is a longitudinal study that originally enrolled more than one million participants in 1982. Participants provided information such as race/ethnicity, medical history and health habits. The researchers tracked cancer deaths in the CPS-II and evaluated the outcomes.

Regardless of gender and race, findings showed that smoking was the biggest risk factor for pancreatic cancer. Increasing risk of pancreatic cancer was associated with increasing BMI. When considered by race, blacks had a 42 percent increased risk of pancreatic cancer death compared to whites.

Excess risk of disease remained, even when the researchers eliminated all other risk factors from the calculation.

"We hoped to find that by accounting for known and suspected pancreatic cancer risk factors, such as smoking, diabetes and BMI, and by looking at this in the context of race and gender, we'd be able to explain the higher rates of pancreatic cancer in blacks," Arnold said. "Unfortunately, we were unable to explain these differences."

Maria Elena Martinez, Ph.D., M.P.H., said although differences in risk factor patterns were shown, overall, they did not account for the pancreatic cancer mortality rates evident by race. Martinez is the Richard H. Hollen Professor of Cancer Prevention at the University of Arizona, director of the Cancer Health Disparities Institute at the Arizona Cancer Center, and an editorial board member for Cancer Epidemiology, Biomarkers & Prevention.

"The results most certainly point to the need for additional work to explain these racial disparities in risk of pancreatic cancer," she said. "Factors other than those assessed by the researchers may be responsible for the disparities. These can include unidentified lifestyle and/or environmental factors, genetic factors or unique gene-environment interactions."

What makes this study different from previous studies that explored differences in relationship to risk for pancreatic cancer is that this study comes from a large group of cancer-free individuals and examines their risk of developing pancreatic cancer over a long period of time.

Arnold noted one limitation with this study is that higher death rates from an illness in certain populations may be the result of limited or no access to health care. However, past studies have shown that problems with access to health care might not be causing the higher pancreatic cancer death rates in blacks; blacks and whites are both usually diagnosed in relatively late stages of disease, which makes treatment difficult and survival low.

"Our data do not explain what is causing these disparities, but we hope it encourages researchers to continue looking for reasons why blacks develop and die from pancreatic cancer at higher rates than whites," Arnold said. "Clinicians who have patients with a family history of pancreatic cancer or other risk factors for the disease should communicate the benefits of losing weight and quitting smoking, if anything, to help reduce their risk of pancreatic cancer." ###

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 nearly 90 other countries. The 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. The AACR publishes six major peer-reviewed journals: Cancer Research; Clinical Cancer Research; Molecular Cancer Therapeutics; Molecular Cancer Research; Cancer Epidemiology, Biomarkers & Prevention; and Cancer Prevention Research. 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: Tara Yates tara.yates@aacr.org 267-646-0558 American Association for Cancer Research

Patient-doctor communication is worse for blacks than for whites, study finds VIDEO

CHAPEL HILL – Black patients with high blood pressure experience poorer communication with their doctors than white patients do, a study led by a University of North Carolina at Chapel Hill researcher has found.

"This is an important finding because poorer communication is associated with worse patient satisfaction, adherence to therapy and blood pressure control, which in turn may lead to worse disease outcomes for black patients compared to white patients," said Crystal Wiley Cené, M.D., M.P.H., an assistant professor in the UNC School of Medicine and lead author of the study.

The study is published in the September 2009 issue of the Journal of General Internal Medicine.

Caption: Dr. Crystal Wiley Cené from the UNC School of Medicine discusses her study, which shows that how physicians communicate with their patients has an impact on overall satisfaction, quality of care and health outcomes. Credit: Video produced by Stephanie Crayton of UNC Health Care. Usage Restrictions: None.

Cené, a native of Sneads Ferry, N.C. and a graduate of the Brody School of Medicine at East Carolina University, led the study while completing a fellowship in general internal medicine at Johns Hopkins University School of Medicine in Baltimore, Md. In her study, Cené and colleagues analyzed audio recordings of patient visits with their primary care physician as part of a study of interventions aimed at improving patient adherence to high blood pressure therapy.

The larger study was led by Cené's mentor, Lisa A. Cooper, M.D., M.P.H., a Hopkins professor who earned her M.D. at UNC in 1988. Cooper is also the corresponding author of Cené's article. Previous studies have shown both that patients in poorer health report having worse interpersonal communication with their doctors, and that black patients report poorer patient-doctor communication than white patients. Cené's study was designed to examine whether having uncontrolled blood pressure, in addition to being black, had a greater negative impact on patient-doctor communication than just race alone.

Caption: Crystal Wiley Cené, M.D., M.P.H. is a researcher at University of North Carolina School of Medicine. Credit: UNC School of Medicine. Usage Restrictions: None.

Participants in Cené's study included 226 high blood pressure patients and 39 physicians from 15 primary care practices in Baltimore. Coders listened to recordings of the patient visits and measured several outcomes. These included, but were not limited to, the length of visits and the number of statements devoted to the communication functions of biomedical exchange, psychosocial exchange and rapport building.

The results showed that the black patients had shorter office visits, less biomedical and psychosocial exchange and less rapport building with their doctors than white patients. These differences were statistically significant for psychosocial exchange and rapport building but not for biomedical exchange. Blacks with uncontrolled high blood pressure fared somewhat worse than blacks whose blood pressure was controlled by medication, whereas there were no significant differences among whites based on blood pressure control status.

The researchers found that for each outcome blacks, regardless of whether their blood pressure was controlled or not, had worse communication with their doctors than whites, regardless of the white patients' blood pressure control. The only exception was for an outcome called "patient positive affect," which is a sum of ratings of patients' interest, friendliness, engagement, sympathy and assertiveness behaviors. For this outcome they found that blacks with uncontrolled blood pressure had less positive affect than any of the other groups.

"It seems that in general blacks talk less overall to their physicians than white patients," Cené said. "As a result, communication about specific topics occurs less often. There are several possible reasons why they may talk less to their physicians -- they might not trust the physician or feel that they are 'disconnected' from their doctors, for whatever reasons. This lack of communication by black patients may in turn make their physicians talk less to them." Cené said.

"We believe there also may be an 'unspoken subtext' that occurs in visits between patients and doctors that influences the communication that occurs during the visit," Cené said. "It's possible that black patients are more likely to pick up on that 'unspoken subtext' and it alters their communication with their doctor. This might explain why we found that black patients had less positive affect towards their doctors than white patients. Essentially they are more sensitized to 'cue' into things that the coders could not easily capture just by listening to the audiotapes."

The study concluded that patient race was more important than blood pressure control status in determining the quality of patient-doctor communication and recommended the testing of interventions designed to improve patient-doctor communication as a way to reduce racial disparities in the care of patients with high blood pressure. ###

Contact: Tom Hughes tahughes@unch.unc.edu 919-966-6047 University of North Carolina School of Medicine