Heart failure strikes younger African-Americans at the same rate as older Caucasians

Treating hypertension and obesity key to heart failure prevention

Heart failure—a disabling and often deadly form of heart disease—is hitting African Americans in their thirties and forties at the same rate as Caucasians in their fifties and sixties, according to a study featured as the lead article of the March 19 issue of the New England Journal of Medicine.

One in 100 African-American men and women developed heart failure at an average age of 39, 20 times the rate in Caucasians, according to Racial Differences in Incident Heart Failure Among Young Adults. Heart failure in African Americans was associated with risk factors such as hypertension and obesity that were already present when these adults were in their twenties.

Treating hypertension and obesity key to heart failure prevention. Heart failure—a disabling and often deadly form of heart disease—is hitting African Americans in their thirties and forties at the same rate as Caucasians in their fifties and sixties, according to a study featured as the lead article of the March 19 issue of the New England Journal of Medicine.

One in 100 African-American men and women developed heart failure at an average age of 39, 20 times the rate in Caucasians, according to Racial Differences in Incident Heart Failure Among Young Adults. Heart failure in African Americans was associated with risk factors such as hypertension and obesity that were already present when these adults were in their twenties.

"These findings should be a wake-up call on the need for African Americans and physicians to address risk factors that can lead to heart failure. Heart failure is disproportionately hitting African Americans in the prime of their lives," said Kirsten Bibbins-Domingo, Ph.D., M.D., lead author of the study and a scholar with the Harold Amos Medical Faculty Development Program of the Robert Wood Johnson Foundation. Bibbins-Domingo is an assistant professor of medicine, epidemiology and biostatistics at the University of California, San Francisco (UCSF) and co-director of the UCSF Center for Vulnerable Populations at San Francisco General Hospital.

Each year, heart failure—also known as congestive heart failure—affects about 5 million people in the United States and results in nearly 300,000 deaths, according to the National Heart, Lung, and Blood Institute, a part of the National Institutes of Health. Heart failure affects the heart's ability to pump blood to the lungs or oxygen-rich blood to the rest of the body and can cause debilitating fatigue, shortness of breath and, eventually, death.

Heart failure is traditionally perceived as a form of heart disease that mostly affects the elderly. The results of the study suggest, however, that heart failure can occur at much younger ages, particularly among African Americans.

Physicians and patients should be aware of the risk factors such as hypertension and obesity and work to prevent and treat these conditions, even among young adults.

"These findings illustrate the importance of identifying solutions to the social, economic, environmental and health care-related factors that contribute to persistent health disparities," said Robert Wood Johnson Foundation President and CEO Risa Lavizzo-Mourey, M.D., M.B.A. "The study results also highlight the urgency of reversing the childhood obesity epidemic. Today's unhealthy children are tomorrow's unhealthy adults. We know that obese children are being diagnosed with conditions previously considered adult illnesses, such as type 2 diabetes and hypertension, and they're at higher lifetime risk for a host of serious health problems, including heart disease, stroke, diabetes, asthma and some forms of cancer. The harsh reality is that, unless we act now to reverse the epidemic of childhood obesity, we may raise the first generation of Americans who will live sicker and die younger than their parents."

This study found that each 10 mmHg increase in diastolic blood pressure (the "bottom" number) among African Americans in their twenties doubles the likelihood of developing heart failure when they are in their forties. "It doesn't matter how young a patient is—hypertension needs to be diagnosed and treated," Bibbins-Domingo said. "The longer you have uncontrolled hypertension, the greater the chance that you will develop heart failure."

Young adults are often unaware that they have hypertension, and even when aware are often untreated or undertreated. Physicians may be reluctant to treat younger adults because cardiovascular complications are perceived to be rare and far in the future. "Our study suggests that the complications of high blood pressure can occur much earlier and should serve as a reminder that current guidelines recommend identification and treatment of blood pressure regardless of the age of the patient," said Bibbins-Domingo. ###

The CARDIA Study—for Coronary Artery Risk Development in Young Adults—was undertaken to describe the development of risk factors for heart disease in young adults. CARDIA—funded by the National Institutes of Health—began in 1985 with 5,115 African-American and Caucasian men and women ages 18 to 30, recruited from Birmingham, Ala., Chicago, Minneapolis and Oakland, Calif.

Resources on heart failure and hypertension are available on the National Heart, Lung, and Blood Institute's Web site:

• Diseases and Conditions Index: Heart Failure: www.nhlbi.nih.gov/health/
• Diseases and Conditions Index: High Blood Pressure: www.nhlbi.nih.gov/health/dci/.

The Harold Amos Medical Faculty Development Program (AMFDP) is celebrating 25 years of increasing diversity in medicine. The program was established to increase the number of faculty from historically disadvantaged backgrounds who can achieve senior rank in academic medicine and who will encourage and foster the development of succeeding classes of such physicians. AMFDP is an extension of the Minority Medical Faculty Development Program. The program name was changed to honor Harold Amos, Ph.D., who was the first African American to chair a department, now the Department of Microbiology and Medical Genetics at the Harvard Medical School. He remained engaged with the program until his death in 2003. For more information, visit www.amfdp.org.

The Robert Wood Johnson Foundation focuses on the pressing health and health care issues facing our country. As the nation's largest philanthropy devoted exclusively to improving the health and health care of all Americans, the Foundation works with a diverse group of organizations and individuals to identify solutions and achieve comprehensive, meaningful and timely change. For more than 35 years the Foundation has brought experience, commitment, and a rigorous, balanced approach to the problems that affect the health and health care of those it serves. When it comes to helping Americans lead healthier lives and get the care they need, the Foundation expects to make a difference in your lifetime. For more information, visit www.rwjf.org.

Contact: Jennifer Combs jcombs@iqsolutions.com 240-221-4256

Helping The Fresh Air Fund Help inner city children

The Fresh Air Fund is an independent, not-for-profit agency that provides free summer vacations to New York City children from low-income communities. Jenny Morgenthau is the Executive Director.

More than 1.7 million children have been helped since 1877 and nearly 10,000 New York City children now enjoy free Fresh Air Fund programs annually. In 2006, 5,000 children visited volunteer host families in suburbs and small town communities across 13 states from Virginia to Maine and Canada; 3,000 children attended five summer camps on a 2,300-acre (9 km2) site in Fishkill, New York; and the fund’s year-round camping program serves an additional 2,000 young people each year.

In 2006, 75% of the total income of the fund came from private individuals.

News Facts:

• Fresh Air Fund Host Families
• Fresh Air Fund Children
• The Fresh Air Fund Host a Child
• The Fresh Air Fund Donate

It has received multiple grants from the Carnegie Corporation, an organization that has supported more than 550 New York City arts and social service institutions since its inception in 2002, and which was made possible through a donation by New York City mayor Michael Bloomberg.

The Fresh Air Fund is an independent, not-for-profit agency that provides free summer vacations to New York City children from low-income communities. Jenny Morgenthau is the Executive Director.

More than 1.7 million children have been helped since 1877 and nearly 10,000 New York City children now enjoy free Fresh Air Fund programs annually. In 2006, 5,000 children visited volunteer host families in suburbs and small town communities across 13 states from Virginia to Maine and Canada; 3,000 children attended five summer camps on a 2,300-acre (9 km2) site in Fishkill, New York; and the fund’s year-round camping program serves an additional 2,000 young people each year.

In 2006, 75% of the total income of the fund came from private individuals.

It has received multiple grants from the Carnegie Corporation, an organization that has supported more than 550 New York City arts and social service institutions since its inception in 2002, and which was made possible through a donation by New York City mayor Michael Bloomberg.

The program

Boys and girls from six to eighteen years old, visit over 300 Fresh Air Friendly Towns each summer. Children on first-time visits are six to twelve years old and stay for two weeks. The program also has a special one-week option for New York City families who would like to host children on their summer vacations outside the city.

Over 65 percent of all children are invited to stay with host families again, year after year. Youngsters may continue with The fund through age eighteen, and many spend the entire summer in the country. Children and volunteer families often form bonds of friendship that last a lifetime.

Each placement with a host family costs the fund $629 (2006).

Selection of children

Children are selected to participate based on financial need. Children are from low-income communities, with the majority receiving some form of public assistance. Youngsters are registered by more than 90 social service and community organizations in all five boroughs of New York City.

Host families

Volunteer host families open their homes to inner-city children for two weeks or more in the summertime. Each Friendly Town community is supervised by a committee of volunteers. Committee members select host families after reviewing their applications, visiting them in their homes and checking their personal references.

There are no financial requirements for hosting a child. Most hosts simply want to share their homes with inner-city youngsters. Host families are not paid. The fund has a program for placing children who have special physical or emotional needs.

In 2004, twelve teens were invited to holiday in Switzerland by Credit Suisse First Boston.

The camping program

Around 3,000 New York City youngsters, aged eight to fifteen, attend five Fresh Air camps on a 2,300-acre (9 km2) site in the Sharpe Reservation near Fishkill, New York.

* Camp Hidden Valley is for boys and girls with and without special needs, eight to twelve years old
* Camp Tommy (named after board member/designer Tommy Hilfiger for his dedication and support of Fresh Air children) is for boys aged twelve to fifteen
* Camp Anita Bliss Coler is for girls aged nine to twelve
* Camp Hayden-Marks Memorial is for boys aged nine to twelve
* Camp Mariah is a coed camp for youngsters aged twelve to fourteen (career campers)

Additionally, 2,000 young people participate in year-round weekend camping experiences.

Special features shared by all camps include a planetarium, model farm, wilderness trail and ropes course. Since 1999, many of the campers have received free guitar lessons on Spirit guitars donated by the Gibson Foundation.

Each placement in a camp costs the fund $1,234 but gives much happiness to many children.

Seven youngsters each year spend the summer at Camp Pioneer on the Sharpe Reservation, training to be counselors.

Career Awareness Program

The innovative Career Awareness Program is designed to help New York City youngsters understand the relationship between school and work and how to make choices that will determine their futures. Youngsters aged twelve to fourteen participate in job shadowing that offers a close-up view of business, and a career fair. The year-round program includes weekend camping trips and an intensive three-and-a-half week summer session at the Career Awareness Camp – Camp Mariah. The career camp is named in honor of Board member/singer Mariah Carey for her dedication, support and commitment to Fresh Air youngsters. Career awareness graduates continue to receive support through the PreOccupations Club and benefit from the guidance of volunteer mentors.

History of The Fund

In 1877, the Reverend Willard Parsons, minister of a small rural parish in Sherman, Pennsylvania, asked members of his congregation to provide country vacations as volunteer host families for children from New York City tenements. This was the beginning of the tradition. By 1884, Reverend Parsons was writing about the fund for the New York Tribune, and the number of children served grew. In 2006, close to 10,000 New York City children experienced the joys of summertime in Friendly Towns and at five Fund camps in upstate New York. When the New York Herald Tribune went out of business in 1966, the New York Times took over sponsorship.

New York City Volunteers

The fund has an active group of New York City volunteers. Metropolitan area volunteers help the fund reach out to New York City parents and children, support Camping, Career Awareness and Friendly Town programs and seek in-kind donations.

Quicklinks: News Facts | Host a Child | Donate | Banners & Buttons | About Fresh Air Fund | Embeddable Videos | Contacts | Multimedia Elements | Tags

This article is licensed under the GNU Free Documentation License. It uses material from the Wikipedia article, Fresh Air Fund

African-Americans lose weight in 12-week, church-based program

Nearly half of overweight and obese African Americans who completed a 12-week, faith-based program lost 5 percent or more of their body weight and most kept it off for at least six months, researchers reported at the American Heart Association's 49th Annual Conference on Cardiovascular Disease Epidemiology and Prevention.

The pilot program was conducted by trained lay leaders at Gospel Water Branch Baptist Church near Augusta, Ga. Researchers were able to collect full data on 35 (nearly 88 percent) of the 40 obese men and women who completed the initial 12 weekly sessions of the Fit Body and Soul (FBS) program. The participants were average age 46 and had an average body mass index (BMI) of 36.

After 12 weeks, almost 46 percent (16/35) of participants had lost 5 percent or more of their starting weight. About 26 percent (nine) lost 7 percent or more.

The program included six monthly "booster" sessions for six months after the 12 weekly behavioral health intervention sessions.

At the study's end, 11 of the 16 subjects (nearly 69 percent) with initial weight-loss success had kept the weight off through the entire nine months.

"This kind of result is remarkable in a faith-based program run by lay leaders when so many other community-based programs have failed," said Sunita Dodani, M.D., Ph.D., M.Sc., FAHA, principal investigator, director, Center for Outcome Research and Education (CORE) and associate professor, Department of Internal Medicine, School of Medicine, Kansas University Medical Center in Kansas City, Kansas.

While similar programs have concentrated on diet and lifestyle changes for weight reduction alone, the FBS program focuses on weight loss and behavioral changes to prevent future diabetes in high-risk church members and relies on lay leaders to administer the program.

The church pastor, the Rev. Robert Ramsey, chose four lay leaders who had two days of training to present the 12 health modules of Fit Body and Soul, a faith-based diabetes prevention program. The lay leaders either had a medical background, such as being a registered nurse, or had been active in the church's health ministry.

The modules were adapted from the National Institutes of Health (NIH)-sponsored Diabetes Prevention Program. The NIH recently approved a $3.7 million grant for five years to scale up the FBS study in a controlled comparison of 20 churches in the Midwest. Ten congregations will run the FBS program and 10 controls will conduct a different community-based health promotion program developed from the Centers for Disease Control Community Guide.

Attrition was fairly high in the small pilot study, so the results need confirmation in the larger, controlled investigation, Dodani said. Of the 35 people who finished the 12 weekly sessions, 21 completed the nine-month program.

Participants in the FBS who lost a modest amount of body weight by changing their diet and exercising may be less likely to develop diabetes.

Diabetes is a major risk factor for heart disease. Being overweight (BMI of 26.9) or obese (BMI of 30.9) increases the risk of diabetes.

"We developed this study because African Americans are known to be at increased risk of both diabetes and obesity and also because studies have shown that, compared to whites, African Americans are less likely to benefit from general community weight-loss programs," Dodani said.

While the feasibility study only tracked weight loss and was limited to men and women who were overweight or obese, the scaled up investigation will be open to people of normal weight who have pre-diabetic elevations in their blood sugar and people with a strong family history of diabetes, Dodani said. ###

Co-authors are: Andrea Kriska, Ph.D. and Venkat K. Narayan, M.D., Ph.D. Individual author disclosures are available on the abstract.

The study was funded by the Association of Professional Teachers and Research of Washington, D.C., and the College of Preventive Medicine at the Medical College of Georgia.

Editor's Note: Search Your Heart is a nationally-driven faith- and community-based educational program designed to reach diverse audiences at higher risk for heart disease with important health messages. The program focuses on three areas: heart disease, nutrition and physical activity. For more information or to bring the Search Your Heart program to your church or community visit: americanheart.org/searchyourheart.

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

Contact: Karen Astle karen.astle@heart.org 214-706-1392 American Heart Association

Black young adults hospitalized for stroke at much higher rate than whites, Hispanics

Florida study suggests urgent need to reduce major stroke risk factors among African-Americans

Tampa FL (March 13, 2009) -- In Florida, black young adults are hospitalized for stroke at a rate three times higher than their white and Hispanic peers, a new study by University of South Florida researchers reports. The study was presented today at the American Heart Association's Council on Epidemiology and Prevention Annual Conference and appears in the online version of the international journal Neuroepidemiology.

Disparities in stroke outcomes between black and white patients have been widely reported for years. While overall death rates for stroke are down, blacks bear a disproportionate burden of disease, disability and death from strokes, said lead author Elizabeth Barnett Pathak, PhD, associate professor of epidemiology at the USF College of Public Health.

Elizabeth Barnett Pathak, Ph.D. Office: 2107, MDC 56 ebarnett@health.usf.edu Phone: (813)-974-2235 Fax: (813)-974-4719

"Our study shows this black-white disparity hasn't improved. In fact, it's clear that the gap emerges even at relatively young ages – among adults hospitalized for strokes in their 20s and 30s – and widens with increasing age," Dr. Pathak said. "It points toward an urgent need for primary prevention of hypertension, obesity, and other stroke risk factors among African Americans to eliminate disparities in stroke." While most strokes occur among the elderly, stroke in young adults can lead to chronic illness and disability that places a terrible burden on the victims and their families, said Michael Sloan, MD, professor of neurology and director of the USF Stroke Program at Tampa General Hospital. "If the stroke is severe it can be very debilitating, impacting the ability of young people to work and raise their families."

And even in young adults strokes can be fatal. The Florida study found 8 to 10 percent of stroke patients died before discharge from the hospital.

The USF researchers examined more than 16,000 stroke cases of young adults hospitalized for stroke in Florida from 2001 through 2006. The study included men and women, ages 25 to 49, from the three largest ethnic groups in Florida: whites, blacks and Hispanics. Among the findings:

* The age-adjusted stroke hospitalization rate for blacks was three times higher than for whites or Hispanics. Stroke hospitalization rates for Hispanics were similar to those for whites.

* The rates at which hospitalized stroke patients died were 15 percent higher for blacks than whites, but this disparity was explained by a greater prevalence of stroke risk factors and complicating illnesses such as diabetes, coronary artery disease and heart failure.

* In contrast, Hispanic stroke patients were 27 percent less likely to die in the hospital than whites after taking risk factors and other illnesses into account. More studies are needed to determine whether Hispanic ethnicity actually confers any sort of protective advantage, the researchers said.

* Black stroke patients were more likely than whites and Hispanics to have been diagnosed with high blood pressure, morbid obesity or drug abuse. White stroke patients were more likely to have been diagnosed with high cholesterol, alcohol abuse or cigarette smoking.

* The majority of black stroke patients (56 percent) where women, while the majority of Hispanic and white patients were men.

* Hispanics were more likely than blacks and whites to suffer a hemorrhagic stroke, triggered by the rupture of a blood vessel in the brain. As with the elderly, the most common type of stroke in younger adults, known as ischemic stroke, was caused by the obstruction of blood flow to the brain.

While the USF study did not find an increase (or decrease) in young adults hospitalized for stroke in Florida, Dr. Sloan is concerned that tough economic times may lead to rise in strokes and other cardiovascular incidents. "When people stop taking their blood pressure pills and other medications because they can no longer afford it, they have strokes and heart attacks," he said. ###

USF Health is dedicated to creating a model of health care based on understanding the full spectrum of health. It includes the University of South Florida's colleges of medicine, nursing, and public health; the schools of biomedical sciences as well as physical therapy & rehabilitation sciences; and the USF Physicians Group. With more than $360 million in research grants and contracts last year, USF is one of the nation's top 63 public research universities and one of 39 community-engaged, four-year public universities designated by the Carnegie Foundation for the Advancement of Teaching. For more information, visit www.health.usf.edu

Contact: Anne DeLotto Baier abaier@health.usf.edu 813-974-3300 University of South Florida Health

Depression treatment, increased physical activity in African-Americans may reduce heart disease

Identifying and treating depression, including increasing physical activity, may improve quality of life and reduce cardiovascular disease and death in African Americans, according to reports presented at the American Heart Association's 2009 Conference on Nutrition, Physical Activity and Metabolism.

In one study, researchers in the Jackson Heart Study (JHS) found high depressive symptoms were prevalent and significantly associated with low physical activity in African Americans. JHS is a population-based, longitudinal study and the largest single-site, prospective, epidemiologic investigation of cardiovascular disease among African Americans ever undertaken.

High depressive symptoms were identified by a standard depression scale and/or characterized by taking antidepressants.

Physical activity scores were in the lowest quartile of the JHS Physical Activity Cohort (JPAC) survey for total physical activity, representing the sum of four index scores: active living, work (for those who were employed or did volunteer work), sport and home life.

Of the 3,092 adults (average age 54; 65 percent women; 12 percent smokers), 17 percent had high depressive symptoms. The prevalence of high depressive symptoms was significantly higher among:

* Women (20 percent compared with 10 percent in men);
* Smokers (28 percent compared with 15 percent in nonsmokers); and
* Those with low total physical activity (25 percent vs. 14 percent in higher physical activity).

Low physical activity was associated with high depressive symptoms in multivariable logistic regression analysis after controlling for age, sex, body mass index, education, income, and smoking.

"It is important to identify individuals with low levels of physical activity as well as those with depression," said Patricia Dubbert, Ph.D., lead author of the study and a psychologist with the Veterans Affairs Medical Center in Jackson, Miss. "Both indicate an individual is at greater risk for adverse health outcomes. We have effective interventions to employ when either or both are identified."

"Behavioral patterns in depressed patients are likely to further negatively impact their cardiovascular disease status," said Ermeg Akylbekova, M.S., a biostatistician for the Jackson Heart Study. "For example, depressed patients are less likely to exercise, tend to eat in a less healthy manner, and are more likely to use tobacco and alcohol. They are also less likely to take medications as prescribed or closely follow their treatment regimen, which may be a serious impediment to treating their cardiovascular condition.

"It is advisable for healthcare providers treating cardiovascular disease patients, whether cardiologists or primary care, to screen all their patients for depression. If concerns arise, a mental health professional should be consulted. Patients have to be monitored for both conditions."

A recent American Heart Association science advisory also recommends screening coronary heart disease patients for depression. ###

Other co-authors are: Thomas Payne, Ph.D.; Sharon Wyatt, Ph.D.; Thomas Mosley, Ph.D.; Mario Sims, Ph.D.; and Herman Taylor, M.D., M.P.H.

(Note: Actual presentation time is 6 p.m. ET, Tuesday, March 10, 2009) NR09-1034 (NPAM 09/ Akylbekova & Dubbert)

Statements and conclusions of study authors that are presented at American Heart Association scientific meetings are solely those of the study authors and do not necessarily reflect association policy or position.

The association makes no representation or warranty as to their accuracy or reliability. The association receives funding primarily from individuals; foundations and corporations (including pharmaceutical, device manufacturers and other companies) also make donations and fund specific association programs and events. The association has strict policies to prevent these relationships from influencing the science content. Revenues from pharmaceutical and device corporations are available at www.americanheart.org/corporatefunding.

Contact: Karen Astle karen.astle@heart.org 214-706-1392 American Heart Association

High blood pressure linked to earlier death among African-American breast cancer patients

A study by researchers at the University of California, San Francisco has shown that hypertension, or high blood pressure, is a predictor of mortality among breast cancer patients, especially those who are African-American, and that hypertension accounts for approximately 30 percent of the survival disparity between African-American and white breast cancer patients.

According to the study's lead author, UCSF epidemiologist Dejana Braithwaite, PhD, of the UCSF Helen Diller Family Comprehensive Cancer Center, who also is an affiliate with the UCSF National Center of Excellence in Women's Health, this is the first study to link cancer mortality with hypertension, and specifically the first to show that hypertension is a predictor of mortality among African-American breast cancer patients.

School of Medicine Fellow Dejana Braithwaite, PhD, became the 2007 recipient of the American Society of Preventive Oncology (ASPO) and the Cancer Research and Prevention Foundation (CRPF) Fellowship, and the New Investigator Award for the 31st Annual ASPO Meeting.

"White women are more likely to get breast cancer, but African-American women are more likely to die from it," said Braithwaite. "We were trying to shed light on the factors that contribute to disparities in survival between the two groups." The study included 416 African-American and 838 white women diagnosed with breast cancer between 1973 and 1986, following them through 1999. All of the women in the study were patients at Kaiser Permanente in Northern California. The patients were all residents of the San Francisco Bay Area and had a known stage of disease and course of cancer treatment. Kaiser Permanente members are representative of the general population for many ethnic, demographic and socioeconomic categories, except for the very high and very low ends of the economic spectrum, according to the study.

The researchers used data from patient records, which they considered more reliable than data self-reported by patients. Kaiser Permanente's division of research has long collaborated with UCSF on breast cancer research.

The study found that African-American breast cancer patients had a higher overall crude mortality, or death from all causes, than whites during the study period: 39.7 percent versus 33.3 percent respectively over a mean follow-up of nine years.

When age, race, tumor characteristics, and breast cancer treatment were controlled, hypertension accounted for 30 percent of the racial disparity in mortality, study findings showed.

"High blood pressure led to poorer outcomes for African-American patients than for their white counterparts," said Braithwaite. "Even if you statistically control for tumor characteristics and breast cancer treatments—chemotherapy, surgery, radiation, and hormone treatment—the adverse effect of hypertension in African-American women means a greater likelihood of death."

Hypertension is not part of the Charlson Comorbidity Index, a widely-used generic tool that provides survival estimates for patients using a range of co-existing conditions or so-called comorbidities. If the results of this study are validated in more contemporary patient populations, the research suggests that hypertension should be included in this Index because of its high predictive value for outcomes, said Braithwaite.

According to study senior author Laura Esserman, MD, director, Carol Franc Buck Breast Care Center; co-leader, Breast Oncology Program, UCSF Helen Diller Family Comprehensive Cancer Center; and part of the UCSF National Center of Excellence in Women's Health, comorbidities have a huge influence on life expectancy and therefore influence treatment decisions for breast cancer. "We started out by trying to determine which comorbidities should be assessed for all patients routinely, and discovered that hypertension in African-Americans is associated with higher mortality from breast cancer," she said.

In addition, this information may provide clues to the cause of higher mortality in African American women with breast cancer, Esserman said.

"The message is that hypertension is a big deal. It affects African-Americans more than other ethnic groups, and it affects their survival overall. Better management of hypertension has potential to improve patient outcomes, particularly among African-American breast cancer patients," Braithwaite concluded. ###

The results are published in the March 2009 print edition of the International Journal of Cancer and appear online at www3.interscience.wiley.com/fulltext/.

Co-authors of the study with Braithwaite and Esserman are Jeff Belkora, PhD; Dan Moore, PhD, and Robert Hiatt, MD, PhD, all of UCSF; C. Martin Tammemagi, PhD, Brock University, Ontario, Canada; Elissa Ozanne, PhD, Massachusetts General Hospital, Boston; Dee West, PhD, Northern California Cancer Center, Fremont, Calif.; William Satariano, PhD, UC-Berkeley; and Michael Liebman, PhD, Windber Research Institute, Windber, Penn.

The study was funded by the Windber Research Institute; Kaiser Permanente's Community Benefit Program and the Surveillance, Epidemiology and End Results (SEER) Program of the National Cancer Institute; and U.S. Department of Defense, Center of Excellence in Breast Cancer Care, principal investigator Laura Esserman.

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.

The Kaiser Permanente division of research conducts, publishes, and disseminates epidemiologic and health services research to improve the health and medical care of Kaiser Permanente members and the society at large. It seeks to understand the determinants of illness and well-being and to improve the quality and cost-effectiveness of health care. Currently, DOR's 400-plus staff is working on more than 250 epidemiological and health services research projects.

Contact: Kirsten Michener kmichener@pubaff.ucsf.edu 415-476-2557 University of California - San Francisco

Xenophobia, for men only

Very few people fear dandelions. Or even dangerous things - like Hummers. We may object to outsized automobiles on principle, but the mere sight of them doesn't make us tremble and sweat and run away. On the other hand, even toddlers show an automatic and powerful fear of snakes, including harmless ones.

That's because of eons of evolution among both dangerous and benign things. There is probably no snake phobia programmed into our genetic code, but we do have an evolved mental readiness to be fearful of certain things in our world. Does this cognitive readiness influence our relationships with other people? Psychologists have been studying this question, and the preliminary answer is yes. In a new study, Michigan State psychologist Carlos David Navarrete used mild shocks to make black and white men and women fearful other black and white men and women. That is, white men were conditioned to be fearful of black men and white men as well as black women and white women, and so forth with the others. Then Navarrete observed to see if these fears lasted or not.

Carlos David Navarrete, received his Ph.D. in 2004 in Biological Anthropology from UCLA. He held postdoctoral positions in psychology at UCLA and at Harvard and is currently an assistant professor in social psychology at Michigan State University. His research on the psychology of prejudice integrates theory and methods from across several disciplines, including social psychology, economics, and evolutionary biology.

The findings, reported in Psychological Science, a journal of the Association for Psychological Science, were intriguing and unexpected. It's known that people are more fearful of "out-groups" - that is, people who are different from them, and this fear of "the other" has been clearly demonstrated with race. But Navarrete found that volunteers' most persistent fears were reserved for men - that is, male members of the out-group. So white men and women feared black men, and black men and women feared white men; all the other lab-induced fears, including any conditioned fear of women diminished. Navarrete ran a number of other tests to clarify the results. He tested for blatant racism (Example: "Generally, blacks are not as smart as whites") and for more subtle, unconscious racism. He also gathered histories of the volunteers' interracial contact- friendships, colleagues, romantic involvements. It was only these histories that mattered: Those with close relationships outside their own race had less persistent fears than did those with little interracial experience.

Why would gender influence these ingrained fears as much as race? It may be that men were more often the aggressors over evolutionary time, so that male faces became a potent cue for danger. So xenophobia is not an equal-opportunity emotion. ###

For more information about this study, please contact: Carlos David Navarrete (cdn@msu.edu) Wray Herbert discusses this study in his blog, We're Only Human... (www.psychologicalscience.org/onlyhuman/)

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

Building trust, increasing awareness among minorities

CAREFREE, A.Z. - As science continues to show an increasing lack of access and poor outcomes among minority patients with cancer, the American Association for Cancer Research is working toward understanding the fundamental issues of trust and awareness among these populations. At the Conference on the Science of Cancer Health Disparities in Carefree, Arizona, the AACR will host a teleconference that highlights important strides in this area.

"As we continue to move forward with our scientific knowledge and medical treatments, we also need to understand if the potential benefits of what we are learning are being communicated effectively to those most at risk," said panel moderator Cheryl Willman, M.D., director and CEO of the University of New Mexico Cancer Research & Treatment Center and co-chair of the conference. "At best, the results are mixed."

Cheryl L. Willman, M.D. Full Member, Hematologic Malignancies Research Program. Director & CEO UNM Cancer Center. Professor of Pathology and Medicine, The Maurice and Marguerite Liberman Chair in Cancer Research Practice Location: Pathology - BMSB Rm 337. Education: Fellowship: UNM School of Medicine (Jul 1985), Specialty in Pathology Internship AND Residency Combined: UNM School of Medicine (Jul 1984). Specialty in Anatomical & Clinical Pathology, Medical School: Mayo Medical School (Jul 1981). Board Certifications: Am Bd Pathology (Sub: Anatomical) : (Jan 1986). Specialties: Pathology

#B76. Examining medical mistrust and breast cancer screening behaviors among African-American, Latina and Arab-American Women At Michigan State University, panel member Karen Patricia Williams, Ph.D., an assistant professor, found that higher levels of medical mistrust among minority women led to late screening for breast cancer. "African-American women had the highest levels of mistrust, but most of the women studied in the other groups were also clustered around strongly agreeing or agreeing with the statement that caution was recommended in dealing with health care organizations," Williams said. Nearly half (49 percent) of women agreed with the statement, "patients have sometimes been deceived or misled by health care organizations." Thirty-nine percent of African-American women did not trust health care organizations to keep their information private, a finding echoed by 15 percent of Latina women and 9 percent of Arab-American women. This lack of trust led to a lower screening rate. Among the women who had never received a clinical breast exam, 44 percent agreed that "health care organizations have sometimes done harmful experiments without our knowledge." Among the women who had not received a clinical breast exam in the past 12 months, 64 percent said they doubted the ability of their health care provider.

Williams said that the findings in Arab and Latina women point out the flaw in blaming all mistrust on the infamous Tuskegee Study of Untreated Syphilis in the Negro Male.

"Intellectuals in medicine like to link all issues of mistrust to that study because it lets us off the hook for anything that might be happening today," said Williams. "This study shows that even groups without that history are showing a level of mistrust, so the problems must be more systemic than that."

#PR-6. Recruiting diverse patients to therapeutic trials: a comparison of three clinical settings

At the University of California San Francisco, Daniel Dohan, Ph.D., associate professor of Health Policy and Social Medicine, is trying to determine the most effective way to recruit minority patients into clinical trials.

The NIH Revitalization Act of 1993 mandates inclusion of minorities in clinical research, but actual recruitment has been problematic.

"Previous research has established that minorities often feel discriminated against, but we wanted to look at this issue from the clinicians' perspective," said Dohan. "What we found is that the incentives that are in place for clinicians are not effective."

Dohan and colleagues studied 10 oncology clinics in three different health care delivery settings: academic medical centers, community-based private practices and public safety-net clinics.

Minority recruitment was not well supported in any setting. In the academic and private practice setting, the culture supported minority recruitment, but there was no real incentive to recruit minorities. In the public setting, providers were motivated by a sense of justice to enroll, but the organizational structure was not available.

"In different clinics, different issues matter, so there is no one size fits all solution," said Dohan. "For example, in a public clinic, they may have translators, but not translators that are equipped to cross cultural barriers in clinical trials."

In private practice and academic settings, clinicians are often rewarded for recruiting patients into clinical trials, but they are not rewarded more for recruiting harder to reach minority patients.

"In a private practice where you have to watch the bottom line, the likelihood is that most of the recruitment is going to pharmaceutical trials, which tend to provide more incentive and do not necessarily require minority recruitment," said Dohan.

#B77. Cancer screening in older South Asian immigrants in United States

New data among South Asian immigrants confirms that cancer screening rates are low largely due a lack of knowledge about available services and the benefits of screening.

Abhijit S. Prabhughate, a doctoral candidate at the Jane Addams College of Social Work at UIC in Chicago, said more research is needed to understand the cultural sensitivities in this population.

"South Asian-Americans are an understudied group. More than 40 percent of the South Asian immigrants in our study did not have health insurance and little is known about their risk," said Prabhughate.

Of 331 total surveyed people, 84 percent were born in India and 14 percent were born in Pakistan. Although 57 percent of them had lived in the United States for a decade or more, only 65 percent had a regular family doctor.

These immigrants were likely to not be screened for breast cancer for the following reasons: not wanting to know if one had cancer, family not wanting the individual to get tested, embarrassment, fear of losing job, language difficulties, and not knowing where to get tested.

They were more likely to be screened if the family or friends encouraged it, or if their insurance paid for it.

#B75. HPV knowledge, attitudes and cultural beliefs among Hispanic men and women living on the Texas-Mexico border

A new study on knowledge, attitudes and cultural responses to the human papillomavirus among Hispanics found that both men and women had low levels of knowledge, significant misunderstandings, and cultural beliefs about HPV that may need to be addressed to decrease the risk of cervical cancer among this population.

Maria E. Fernandez, Ph.D., assistant professor of Health Promotion and Behavioral Sciences at the University of Texas Health Science Center at Houston, School of Public Health, conducted five focus groups in Brownsville, Texas, that included 30 Hispanic women and 11 Hispanic men. Women had a mean age of 41.3 years and men had a mean age of 38.8 years.

Researchers found that participants had little understanding about HPV and its role in cancer. Women believed that a diagnosis of HPV was a diagnosis of cancer and had fatalistic beliefs about the outcome of cancer. Women also thought that they would be reluctant to disclose their HPV positive status to their partners because they believed men would accuse them of infidelity. Men, too, initially attributed their partners' diagnosis of HPV to infidelity. Nevertheless, after a brief explanation about HPV etiology and transmission, men and women began to understand the ambiguity related to an HPV infection and believed that partners would generally support women as they sought health care for the infection."The results of this study suggest that understanding Hispanics' cultural norms and values concerning disease, sexuality and gender is essential to the design and implementation of successful interventions for the prevention and treatment of HPV and cervical cancer," said Fernandez. ###

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

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

Teleconference Dial In: (888) 282-7404

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

All prejudice isn't created equal; whites distribute it unequally to minorities

The Declaration of Independence may proclaim that all men are created equal, but American whites tend to distribute their prejudice unequally toward certain members of minority groups, according to new research.

A series of six studies conducted by University of Washington and Michigan State University psychologists shows that whites react more negatively to racial minority individuals who strongly identify with their racial group than to racial minority individuals who weakly identify with their group.

The research, published in the current issue of the Journal of Personality and Social Psychology, provides an explanation for why some Blacks report personally experiencing more prejudice than others.

Cheryl R. Kaiser, Department of Psychology. Box 351525. University of Washington, Seattle, Washington 98195. U.S.A. Home Page Phone: (206) 616-1435.

"Research has shown that the more minorities identify with their group, the more prejudice they report experiencing," said Kaiser. "Most research has explained this finding by focusing on factors within minorities that make some individuals more susceptible to perceiving prejudice than others. Our studies provide an alternative explanation by showing that whites react more negatively toward strongly identified minorities than weakly identified ones." The researchers believe strongly identified minorities are not paranoid in claiming they experience increased levels of prejudice and weakly identified minorities are not being self-deceptive when they report experiencing low levels of prejudice,

said Cheryl Kaiser, a UW assistant psychology professor and lead author of the paper. Instead, they just may simply be reporting on reality as they experience it.

"Take a situation where a person is ambiguously rejected for a new job," she said. "A person with a strong minority identification might wonder if the rejection was due to prejudice while one with a weak minority identification might not. If you experience more prejudice you expect more prejudice. These things work in tandem and feed each other."

Kaiser and her colleague recruited nearly 400 college students for the six studies that measured whites' attitudes toward Blacks and Latinos. They also were surveyed on their general attitudes about Blacks or Latinos, depending on the study. In the studies, minorities were either described as being strongly identified (where their group was very important and a central aspect of their self) or weakly identified (where their group was less important and not at the core of their self).

She said individuals typically want to be around others who share their values and exclude people who don't share those values or world views. The research indicated that whites perceived strongly identified minorities as less likely to share similar worldviews with them relative to weakly identified minorities.

"We are not arguing that minorities should not identify with their group," said Kaiser. "Such identification can be important and provides meaning, self worth and identity.

"Some research about prejudice has tended to lump members of minorities into homogenous groups. But there is a lot of heterogeneity. People differ in looks, language ability, attitudes and many other ways, but we tend not to pay attention to these factors. That's why it is important to identify those subsets in groups, why people react to them and what are the active ingredients of prejudice. Whites need to understand that they distribute prejudice unevenly and target those who strongly self-identify as being Black." ###

Jennifer Pratt-Hyatt, a doctoral student at Michigan State is the co-author of the paper. The research was funded by the National Science Foundation and the UW's Royalty Research Fund.

For more information, contact Kaiser at 206-616-1435 or ckaiser@u.washington.edu

Contact: Joel Schwarz joels@u.washington.edu 206-543-2580 University of Washington

The 2 worlds of kids' morals

Study investigates race, gender and morality among children in the real and virtual worlds

Children's moral behavior and attitudes in the real world largely carry over to the virtual world of computers, the Internet, video games and cell phones. Interestingly, there are marked gender and race differences in the way children rate morally questionable virtual behaviors, according to Professor Linda Jackson and her team from Michigan State University in the US. Their research (1) is the first systematic investigation of the effects of gender and race on children's beliefs about moral behavior, both in the virtual world and the real world, and the relationship between the two. The study was published online in Springer's journal, Sex Roles.

Linda Jackson, Department of Psychology, Michigan State University, East Lansing, Michigan 48824. U.S.A.

Jackson and her team asked 515 12-year-old children (one-third African American, two-thirds Caucasian American) to fill in a written questionnaire looking at their moral behaviors and attitudes in the real world, and their view of morally questionable behavior in the virtual world. Measures of moral behavior in the real world included whether or not children had lied to parents and/or teachers, whether they had ever cheated, and whether they had ever bullied someone. Examples of morally questionable behavior in the virtual world were sending emails with threats, using sexually explicit or violent language in chat rooms and/or in text messages, hacking computers, and violence in video games.

Overall, African American children were more caring and more flexible about rules when personal goals were at stake than Caucasian American children. More specifically, Caucasian American girls and African American boys and girls viewed morality in the real world from the perspective of the individual's well-being. In contrast, Caucasian American boys' morality in the real world was more rule-based.

When it came to rating virtual behaviors, African American children were more likely than Caucasian American children to find acceptable virtual behaviors that result in real-world harm, for example emailing friends answers in advance of tests or sending text messages during class. The African American children were also more likely to find viewing online pornography acceptable.

For all groups, morality in the real world was related to morality in the virtual world. In other words, the more important good moral character in the real world was, the less acceptable morally questionable virtual behaviors were. There were however some race differences. African American children found some virtual behaviors that might advance individual goals in the real world more acceptable than did Caucasian American children. In contrast, the morality of Caucasian American boys, and to a lesser extent girls, was more rule-based in the virtual world.

The frequency of exposure to information technology also had an effect. The more children used the Internet, the more they found invasion of privacy online, videogame violence and online pornography acceptable.

The authors conclude that: "Educational interventions that are culturally sensitive need to be developed to assure that all children, regardless of race or gender, understand that certain virtual behaviors are unacceptable and in fact may be psychologically harmful, such as video game violence, or physically dangerous, like contacting strangers online." ###

Reference
1. Jackson LA et al (2009). Gender, race and morality in the virtual world and its relationship to morality in the real world. Sex Roles DOI 10.1007/s11199-009-9589-5

Contact: Joan Robinson joan.robinson@springer.com 49-622-148-78130 Springer

Sweetened beverage consumption increases in the US

Over the past two decades, the number of adults consuming sugar-sweetened beverages such as soft drinks, fruit drinks and punches has increased dramatically, according to a study led by researchers at the Johns Hopkins Bloomberg School of Public Health. Researchers examined changes over the past two decades in sugar-sweetened beverage consumption based on nationally representative survey data, and found that sugar-sweetened beverages comprise a significant source of total daily beverage intake and are the largest source of beverage calories consumed daily. Their results are published in the January 2009 issue of the American Journal of Clinical Nutrition.

“More adults are drinking sugar-sweetened beverages and, among those drinkers, consumption has increased,” said Sara N. Bleich, PhD, lead author of the study and assistant professor with the Bloomberg School’s Department of Health Policy and Management.

Sara N. Bleich, My research aims to reduce the escalation of obesity and its related diseases by exploring important research questions related to the intersection between public policy and obesity prevention/control. Most of my research has focused on understanding global trends in adult obesity, obesity-related risk communication, access to health care services for individuals with obesity-related conditions and trends in sugar-sweetened beverage consumption. Going forward, I am particularly interested in examining disparities in practice patterns of obesity care and novel environmental strategies designed to reduce caloric consumption or increase physical activity.

“From 1988 to 2004, the percentage of sugar-sweetened beverage drinkers increased five percent. Per capita consumption of energy from sugar-sweetened beverages increased 46 kilocalories (kcal) per day, and daily sugar-sweetened beverage consumption among drinkers increased 6 ounces per day.” The study also examined trends in sugar-sweetened beverage consumption by age, race/ethnicity and weight loss intention. Sugar-sweetened beverage consumption was highest among young adults (231-289 kcal/day), who consumed roughly 20 percent of their sugar-sweetened beverage calories at work, and lowest among the elderly (68-83 kcal/day). Among race/ethnicity groups, the percentage of sugar-sweetened beverage drinkers and per capita consumption of sugar-sweetened beverages was highest among blacks followed by Mexican Americans. Overweight/obese adults who were trying to lose weight were less likely to drink sugar-sweetened beverages compared to those who were not, but they still consumed a considerable amount from 1999 to 2004 (278 kcal/day). Using dietary data collected in the National Health and Nutrition Examination Surveys (1988 to 1994 and 1999 to 2004), researchers examined national trends in sugar-sweetened beverage consumption (percentage of drinkers, amount consumed, consumption location and type of beverage) among U.S. adults.

Bleich, along with colleagues, identified six mutually exclusive beverage categories: sugar-sweetened beverages (soft drinks, sports drinks, fruit drinks and punches, low-calorie drinks, sweetened tea, and other sweetened beverages), 100 percent juice, diet beverages, milk, coffee or tea, and alcohol.

Earlier studies have linked consumption of sugar-sweetened beverages to the obesity epidemic, which affects two-thirds of adults and increases the risk for adverse health conditions such as type 2 diabetes. Adults are considered to be overweight if their body mass index is 25 or higher, and obese, if 30 or higher.

“Although this analysis does not attempt to estimate the effect of sugar-sweetened beverage intake on obesity incidence, a number of studies have linked sugar-sweetened beverage consumption to obesity and type 2 diabetes,” said Youfa Wang, MD, PhD, author and associate professor with the Bloomberg School’s Center for Human Nutrition. “Based on these nationally representative surveys, our study found higher sugar-sweetened beverage consumption also happened to be among populations at greater risk for obesity. There are few signs of improvement over the past decade and the situation seems to become worse among young adults aged 20 to 44.”

According to Bleich and colleagues, efforts to reduce sugar-sweetened beverage consumption may be an important strategy for reducing empty calorie intake in the adult diet in the United States.

“Increasing Consumption of Sugar-Sweetened Beverages Among US Adults: 1988-1994 to 1999-2004” was written by Sara N. Bleich, Y. Claire Wang, Youfa Wang, and Steven L. Gortmaker.

The researchers were supported in part by the Johns Hopkins Bloomberg School of Public Health and the Robert Wood Johnson Foundation, grant 57891.

Media contact for Johns Hopkins Bloomberg School of Public Health: Natalie Wood-Wright at 410-614-6029 or nwoodwri@jhsph.edu. WEB: 410-614-6029 Johns Hopkins University Bloomberg School of Public Health

PSA levels accurately predict prostate cancer risk in African-American men

PHILADELPHIA – PSA levels appear to be more predictive of three year prostate cancer risk in African-American men compared with Caucasian men with a family history of prostate cancer, according to a paper published in Cancer Prevention Research, a journal of the American Association for Cancer Research.

"It was previously thought that PSA levels were just naturally higher in African-American men, suggesting a need to possibly adjust the threshold upward before recommending a biopsy," said Veda Giri, M.D., director of the Prostate Cancer Risk Assessment Program at Fox Chase Cancer Center.

Giri and colleagues at the University of Chicago observed 646 high-risk men, of whom 63 percent were African-American, in the Prostate Cancer Risk Assessment Program, which has an aggressive early detection approach.

Veda N Giri, MD, I joined the staff of Fox Chase in 2004. Since that time, I have been named the director of the Prostate Cancer Risk Assessment Program. I was appointed to the National Institutes of Health Prostate Cancer Genetics PDQ Editorial Board. At Fox Chase, I am an active member of the IRB (Institutional Review Board) as well as the Executive Steering Committee.

No "race specific" differences in PSA levels were found when race was measured using genetic markers of ancestry or reported by participants. The researchers subsequently analyzed men with a PSA between 1.5 to 4 ng/mL, and who had at least one follow-up visit. They found that among men with a family history of prostate cancer, PSA levels had the same predictive value whether the men were Caucasian or African-American. These findings are unique in that typically men are not recommended for a prostate biopsy until their PSA levels rise above 4 ng/mL. Larger studies with longer follow-up are needed to confirm these findings.

"African-American men and men with a family history of prostate cancer should be encouraged to participate in early detection studies to define personalized screening strategies that may diagnose prostate cancer at a curable point," said Giri. ###

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

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

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

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

Study finds recession associated with increases in minority victims of crime

The victimization of both female and male blacks and Latinos increases during or after periods of economic recession, according to a study by researchers Karen Heimer of the University of Iowa and Janet Lauritsen of the University of Missouri-St. Louis.

The study was presented Sunday, Feb. 15, at the 2009 Annual Meeting of the American Association for the Advancement of Science in Chicago. The study is the first of its kind to estimate trends in serious, non-lethal, violent victimization for non-Latino white, non-Latino black, and Latino males and females using data from the 1973-2005 National Crime Victimization Surveys, according to Lauritsen and Heimer.

"The findings offer new empirical evidence regarding the similarities and differences in risks of serious non-lethal violent victimization across race ethnic-gender groups over time," Heimer said.

Karen Heimer Janet L. Lauritsen

"Minorities experience substantially higher rates of violent victimization than non-Latino whites in the United States," she said. "Our study shows that the higher rates of poverty, urban residence and differential age distributions of non-Latino blacks and Latinos help to explain these groups' higher victimization rates. Moreover, our study examines data from the early 1970s to the present and documents an association between economic downturn and increases in victimization rates among minorities over this period." Heimer said that the findings will be important for police and criminal justice policy-makers, as well as providers of services to victims of crime, who may be concerned about the potential consequences of our current recession for crime and victimization. Lauritsen and Heimer's talk, titled "Long-Term Trends in Exposure to Serious Violent Crime by Race, Ethnicity, and Gender," was part of a AAAS session on "Race, Ethnicity and Violent Crime." ###

Karen Heimer is professor in the University of Iowa College of Liberal Arts and Sciences Department of Sociology and is jointly appointed in the Public Policy Center. She earned her doctorate in sociology from the University of Wisconsin-Madison. Her major areas of interest are victimization, gender, criminology, and criminal punishment. She is currently conducting research on trends in violence against women, women's crime, and race and gender differences in imprisonment in the United States. Her book (co-edited with Candace Kruttschnitt), "Gender and Crime: Patterns of Victimization and Offending," was published by New York University Press in 2006.

STORY SOURCE: University of Iowa News Services, 300 Plaza Centre One, Suite 371, Iowa City, Iowa 52242-2500

MEDIA CONTACT: Gary Galluzzo, writer, 319-384-0009, gary-galluzzo@uiowa.edu

Contact: Gary Galluzzo gary-galluzzo@uiowa.edu 319-384-0009 University of Iowa

US Civil War illustrates costs, benefits of diversity, say UCLA economists

Book finds loyalty, sacrifice highest among soldiers of similar background

Diversity is a double-edged sword, making individuals less likely to be altruistic than they might be in a more homogeneous setting but also inspiring them to scale new intellectual heights and to explore new horizons, argue two UCLA economists in a new book.

"People enjoy being around people they can relate to, and they are uncomfortable with diversity," said Matthew Kahn, a co-author of "Heroes and Cowards: The Social Face of War," which will be published Jan. 21 by Princeton University Press. "But even though people don't like being exposed to people who are different, they benefit from the experience in the long run. They learn the most from those who are different."

The 26th U.S. Colored Volunteer Infantry on parade, Camp William Penn, Pa., 1865. 165-C-692. Pictures of the Civil War. Select Audiovisual Records, National Archives and Records Administration, Washington, DC 20408.

While recent research into lower rates of volunteerism and lack of taxpayer support for local projects in diverse communities has reached similar conclusions, the latest findings are based on a surprising set of subjects: 41,000 soldiers who served in the U.S. Civil War between 1861 and 1865. "Union soldiers, whether in prison camps or in the field, were the most loyal to men who looked like themselves — of the same ethnicity and occupation, from the same state or hometown, or of the same age or related by blood," said co-author Dora L. Costa, a UCLA economics professor.

"We believe that by going back so far in time we're getting at an effect that's universal. This reaction to diversity may be hardwired into us."

Curious about the forces that motivate individuals to acts of heroism, Costa and Kahn set out to mine millions of records on Union soldiers that have been gathered since 1991 into a database funded by the National Institutes of Health.

Tracing enlisted men throughout their tour of duty and into retirement, the Union Army Dataset merges official Union records with now-public census data between 1840 and 1910, essentially providing a cradle-to-the-grave look at the soldiers. Details include a soldier's original economic status, degree of literacy and hometown; his military record, including whether he deserted or ended up in prisoner of war camps and how he fared there; and his eventual residence, livelihood, economic status and degree of literacy.

The researchers then subjected these variables to the same sort of statistical analysis as social scientists who conduct research on living subjects in experimental conditions. The results, insist the UCLA team, are just as valid — and possibly even more trustworthy — than glimpses into human behavior gleaned from laboratory experiments.

"Unlike university laboratory researchers, we examined life-or-death choices," Costa said. "We could never orchestrate an experimental exercise with such high stakes. These are decisions that really mattered to people. As a result, they paid a lot of attention to their decisions, and those decisions reflect profound truths."

Men who served in war companies with men who shared similar characteristics — a common religion, race, ethnic group, socioeconomic status, hometown or even plantation — behaved markedly differently from their counterparts in more diverse companies. For starters, they had much lower desertion rates than the norm of one desertion per 10 Union soldiers. Union soldiers who served alongside men from the same occupations deserted at one-third the rate of counterparts in more diverse companies, as did former slaves who served with former slaves from the same plantation.

"Economic theory says you would look out for your own welfare," Kahn said. "Yet we kept seeing all these very moving examples of people wanting to sacrifice for others."

And the absence of diversity actually outranked other potential sources of loyalty. Costa and Kahn expected to find that company morale or commitment to the cause played as big if not a bigger role in keeping a soldier on the battlefield. Yet they found that companies with the lowest amount of diversity — such as companies in which friends, relatives or neighbors served together — had the lowest desertion rates. The least diverse companies had one-third fewer desertions than more diverse companies with high morale or strong ideological commitments.

"This was one of the most ideological wars in U.S. history," Costa said. "If we find that serving with similar people or buddies matter the most here, then we know the effect is big, and in fact, that's what we found. Even when the ideological stakes are huge, it's serving alongside comrades that keeps you in the war — not commitment to cause."

In addition to inspiring enlistees to persevere, peers also proved important to surviving such grim prisoner of war camps as Andersonville, a Confederate death trap that claimed the lives of close to 40 percent of its captives. Survival rates for Union soldiers born in Ireland, for instance, improved only from 60 percent to 64 percent if they were incarcerated with 15 comrades from their original company, Costa and Kahn found. But the soldiers' survival rates shot up to 90 percent when those 15 comrades were not only from the same company but were also fellow Irish immigrants.

"We believe that your comrades would help you get healthy if you got sick and share their food rations," Kahn said. "So in P.O.W. camps, diversity actually turned out to be a bad thing. It hindered survival rates."

But diversity was not without its benefits. Costa and Kahn focused on three separate kinds of African American troops: troops that consisted primarily of freed slaves, troops that consisted primarily of freemen (African Americans who were not born into slavery) and troops that mixed both kinds of African American enlistees.

While companies with both former slaves and freemen had higher desertion rates than units that consisted primarily of one group or the other, former slaves in the diverse companies learned to write at higher rates than their counterparts in more homogenous units, Costa and Kahn found. In companies comprised almost exclusively former slaves, only 16 percent of soldiers learned to write during their tour of duty. That number nearly doubled in companies in which former slaves mixed with freemen.

"For former slaves who had been prevented from learning to read and write in slavery, diverse companies were almost like a job training program, preparing them for improved economic opportunities down the line," Kahn said.

In addition to being more likely to learn to literacy skills, former slaves in diverse companies also were more likely than their counterparts in more uniform companies to change their slave names, the researchers found.

"Adopting a new name was a measure of taking on the identity of a free person," Costa said. "These former slaves started to see themselves differently as a result of the more expanded horizons of the men with whom they served."

African American soldiers from diverse companies also were much more likely than their counterparts to move away from home after the war. This was especially the case among illiterate soldiers for whom word of mouth was their primary source of information. The economists found that for every 10 percentage-point increase in comrades who hailed from a particular state different than the home state of an illiterate solider, the likelihood of that illiterate soldier ultimately relocating to that state jumped by more than 30 percent.

"We call this 'the Zagat Guide effect,'" Kahn said. "So if we're in the same company, and I'm from New Jersey, you are more likely to move to New Jersey after the war. We believe that I taught you about the benefits of New Jersey. Serving in a diverse unit helped open horizons for men who had previously enjoyed no mobility whatsoever."

"Heroes and Cowards" represents the most extensive use to date of Civil War data amassed by the University of Chicago and Brigham Young University under the direction of Nobel laureate economist Robert Fogel. For the past decade, Costa has been second-in-command on the unparalleled NIH-funded project.

Compiled from records in the National Archives, the Union Army Dataset focuses on Union rather than Confederate records because of the North's famously generous medical benefits for veterans, the authors explained. The most widespread form of assistance to the elderly before the advent of Social Security, these benefits ultimately extended to 90 percent of Union Army veterans. Records for these benefits allow researchers to track the health, whereabouts and other outcomes of Union veterans into old age and to link them to census data for the men, which in turn revealed even more information.

After losing the war, Confederate states offered benefits to veterans on a state-by-state basis, and they did so only when they could afford them, the authors explained. With the South's financial collapse following the war, many Confederate veterans did not receive medical benefits, confounding any attempt to track them through public documents as they aged.

"Confederate records just aren't as comprehensive or useful for this kind of analysis as the Union records," Costa said.

The confluence of increased privacy protections on medical, military and census data and the replacement of a draft armed forces with a voluntary one make military records from later U.S. conflicts less valuable for research purposes than the Civil War documents, the authors contend.

"This material is really a treasure trove," Costa said. "The Union records provide an awesome laboratory for studying human behavior that doesn't exist anywhere else and can't exist again." ###

UCLA is California's largest university, with an enrollment of nearly 38,000 undergraduate and graduate students. The UCLA College of Letters and Science and the university's 11 professional schools feature renowned faculty and offer more than 323 degree programs and majors. UCLA is a national and international leader in the breadth and quality of its academic, research, health care, cultural, continuing education and athletic programs. Four alumni and five faculty have been awarded the Nobel Prize.

Contact: Meg Sullivan msullivan@support.ucla.edu 310-825-1046 University of California - Los Angeles

New study finds blacks still lag in obtaining total knee replacements for arthritis

ATLANTA, Feb. 19, 2009 – A new study released today found blacks remain less likely than whites to undergo total knee replacement, an important intervention for reducing pain and improving physical function among those with disabling knee osteoarthritis. The study also found total knee replacements are increasing substantially in both populations. According to the Arthritis Foundation, the research underscores the need for healthcare providers and people of all races to take proactive measures in preventing and managing the disease.

The Morbidity and Mortality Weekly Report study released by the Centers for Disease Control and Prevention, used Medicare claims data from 2000 to 2006 to estimate the national and state-specific total knee replacements for blacks and whites among U.S. adults aged 65 and older.

Patience Hayock White, MD, MA. Chief Public Health Officer Patience White, M.D., is the chief public health officer of the Arthritis Foundation. In addition to her work at the national office of the Arthritis Foundation, she also is a professor of medicine and pediatrics at the George Washington University School of Medicine and Health Sciences.

The study found that among Medicare enrollees, the prevalence of total knee replacements increased by 58 percent overall. Despite the substantial increase in the rates of total knee replacements for both populations, total knee replacements among blacks was 37 percent lower than for whites in 2000, and remained virtually unchanged in 2006. In addition, the rates for total knee replacements were lowest among black men and highest among white women. The Importance of Taking Action According to the Arthritis Foundation, most Americans are unaware of the seriousness of arthritis and the impact it can have on their lives. Arthritis is the nation's most common cause of disability and costs the U.S. economy more than $128 billion annually. Knee osteoarthritis, the most frequent form of lower extremity arthritis, contributes to 418,000 knee replacement procedures annually and in 2006 accounted for 496,000 hospital discharges and $19 billion in hospital costs.

"Nearly one in two adults may develop knee osteoarthritis over their lifetime, with an equal risk among blacks and whites," said Patience White, MD, MA, chief public health officer for the Arthritis Foundation. "There are steps Americans can take now to prevent increasing disability from knee osteoarthritis, and if surgery becomes necessary, to better prepare themselves."

Tips for Reducing Knee Pain:

To reduce the pain and disability of arthritis, the Arthritis Foundation recommends the following:

* Understand the myth about physical activity and arthritis. Many people think that physical activity can worsen arthritis pain. Nothing could be farther from the truth. Done appropriately, physical activity can help decrease symptoms of knee osteoarthritis. In addition, physical activity is an important component of weight control and helps maintain healthy bones, muscles and joints. For joint-safe exercise programs, try the Arthritis Foundation's Life Improvement Series land or water exercise programs offered at more than 1,700 locations nationwide.

* Control weight. For those already living with symptoms, losing 15 pounds can cut knee pain in half. Maintaining a healthy weight also can lower a person's risk of osteoarthritis. In fact, one study showed that women who lost as little as 11 pounds halved their risk of developing knee osteoarthritis and its accompanying joint pain.

* Discover techniques to manage your arthritis. Participate in the Arthritis Foundation Self-Help Program, a self-management course that teaches people with arthritis how to manage the pain and challenges that arthritis imposes. The course has been shown to lead to a 40 percent reduction in pain.

* Learn more. Contact your local Arthritis Foundation office or visit www.arthritis.org to learn more about programs offered in your area and to order free educational materials, including literature on arthritis in African Americans. For more actions you can take, visit take control of osteoarthritis (arthritis.org/prevent-osteoarthritis) to get started. ###

About the Arthritis Foundation

The Arthritis Foundation is the leading health organization addressing the needs of some 46 million Americans living with arthritis, the nation's most common cause of disability. Founded in 1948, with headquarters in Atlanta, the Arthritis Foundation has multiple service points located throughout the country.

The Arthritis Foundation is the largest private, not-for-profit contributor to arthritis research in the world, funding more than $400 million in research grants since 1948. The foundation helps individuals take control of arthritis by providing public health education; pursuing public policy and legislation; and conducting evidence-based programs to improve the quality of life for those living with arthritis. Information is available 24 hours a day, seven days a week at 1-800-283-7800 or www.arthritis.org.

1 "Weight Loss Reduces the Risk for Symptomatic Knee Osteoarthritis in Women," David T. Felson, MD, MPH; Yuqing Zhang, MB, MPH; John M. Anthony, BA, BS; Allen Naimark, MD; and Jennifer J. Anderson, PhD, Annals of Internal Medicine, 1992; 116:535 539].

Contact: Carol Galbreath cgalbreath@arthritis.org 404-965-7594 Arthritis Foundation