Racial disparities decline for cancer in Missouri

Sept. 23, 2008 -- Cancer death rates in the United States are highest among African Americans, but a new report shows that in Missouri the disparity in cancer incidence and death between African Americans and whites is declining. As a result, cancer incidence (the rate of newly diagnosed cases) between the races is equal, although the death rate will probably remain higher for African Americans for some time.

The report will be published in an upcoming issue of Missouri Medicine. The lead author is Mario Schootman, Ph.D., co-leader of the Prevention and Control Program at the Siteman Cancer Center at Washington University School of Medicine and Barnes-Jewish Hospital.

"A lot of effort has been made to reduce cancer racial disparity in Missouri," says Schootman, also chief of the Division of Health Behavior Research and associate professor of epidemiology and medicine. "But there is still work to be done, especially in decreasing cancer mortality. Ideally, cancer will become just another bump in the road — an illness that people will be able to live with for many decades and keep under control."

The report shows that in 1996, the rate of new cancer cases was 18 percent higher for African-American Missourians but declined to six percent higher by 2003, the last year for which the data were analyzed. If this downward trend continues, the disparity in new cancer cases between African-American and white Missourians will have disappeared when 2006 data is analyzed, Schootman says.

On average, the overall Missouri cancer incidence rate decreased by 0.8 percent per year, possibly reflecting a drop in smoking rates and other preventive measures. The disparity in incidence between African Americans and whites might have arisen from such factors as differences in physical activity, weight, vitamin D deficiency, diabetes, diet and occupational exposure to pollutants, according to the report.

On the other hand, racial disparity in overall cancer death rates remains. In 2005, the last year for which the data were analyzed, the cancer death rate was 28 percent higher for Missouri's African Americans than for whites. This was down from a 48 percent higher cancer death rate for African Americans in 1990, but the slow pace of the decrease means that racial disparity in cancer deaths will probably continue for several more decades unless more aggressive interventions are used, Schootman says.

Schootman also individually analyzed four major cancers — colorectal, breast, prostate and lung — and found some trends contrary to the overall cancer trends. Instead of decreasing, the gap between African Americans and whites for colorectal cancer death rates remained as large as ever. The death rate for this cancer declined among members of both groups during the study period of 1990 to 2005, but it remained about 42 percent higher for African-American than white Missourians.

"In Missouri, African Americans were more likely to be screened for colorectal cancer than whites during the timeframe of our statistical analysis," Schootman says. "But that doesn't appear to have made enough of a difference in the rate of death yet. The racial disparity in colorectal cancer death rate is one of the most serious concerns raised by this study."

Schootman explains that there are four possible reasons for the higher colorectal cancer death rate: less aggressive treatment, more advanced cancer at time of diagnosis, less patient engagement in lifestyles that reduce risk of dying after diagnosis — such as exercise and weight loss — and more physical characteristics that increase risk of dying — such as a higher body fat percentage.

Racial disparity in breast cancer deaths increased during the study period. African American women in Missouri had a nine percent lower incidence of breast cancer than did white Missourians at the end of the study period but had a 46 percent higher breast cancer death rate. Schootman says that other studies suggest that lack of insurance, fear of testing, delay in seeking care and unfavorable tumor characteristics all contribute to this disparity.

Another major concern raised by the study was the much higher death rate from prostate cancer among African Americans. Despite a decline in racial disparity, African-American Missourians died at a 116 percent higher rate from prostate cancer than white Missourians. Schootman says that a possible explanation is that African Americans adopted prostate cancer screening and new therapies later than did white Missourians.

Racial disparity in lung cancer deaths decreased during the study period, but remained 15 percent higher for African-American Missourians. Other research suggests several reasons for the disparity: differences in referral to specialists, less patient acceptance of therapy due to distrust or misunderstanding and differences in availability of treatment.

To further reduce disparities in cancer incidence and death, state and local health departments, primary care associations, medical and community-based organizations, large employers and health care companies need to focus on providing equal access to preventive and treatment services.

The Siteman Cancer Center's PECaD (Program for the Elimination of Cancer Disparities addresses racial disparities in cancer in the St. Louis region.

"PECaD's efforts to reduce breast cancer disparities in the region include promoting mammography through outreach and our mobile mammography van, together with access to diagnostic and treatment services," says PECaD director, Graham Colditz, M.D., Dr.P.H., the Niess-Gain Professor and associate director of Prevention and Control at the Siteman Cancer Center. "Similar multilevel approaches will be necessary to reduce disparities."

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Schootman conducted the analysis in collaboration with the Missouri Department of Health and Senior Services, and the Missouri health department has published a more detailed version of this report, Cancer in Missouri: Trends in Disparities Between African Americans and Whites, which is available in PDF format at: dhss.mo.gov/CancerinMissouri/CancerDisparityReport. Information on cancer incidence and deaths for the report came from the Missouri Cancer Registry and the Bureau of Health Informatics.

Eliminating racial disparities in cancer is a key goal of national organizations and agencies such as the American Cancer Society, the National Cancer Institute and the U.S. Department of Health and Human Services. It is also a key goal of the Missouri cancer control plan developed by the Missouri Cancer Consortium.

Schootman M, Yun S. Trends in cancer disparities between African Americans and whites in Missouri. Missouri Medicine, upcoming issue.

Funding from the Centers for Disease Control and Prevention and the National Cancer Institute supported this research.

Washington University School of Medicine's 2,100 employed and volunteer faculty physicians also are the medical staff of Barnes-Jewish and St. Louis Children's hospitals. The School of Medicine is one of the leading medical research, teaching and patient care institutions in the nation, currently ranked third in the nation by U.S. News & World Report. Through its affiliations with Barnes-Jewish and St. Louis Children's hospitals, the School of Medicine is linked to BJC HealthCare.

Siteman Cancer Center is the only federally designated Comprehensive Cancer Center within a 240-mile radius of St. Louis. Siteman Cancer Center is composed of the combined cancer research and treatment programs of Barnes-Jewish Hospital and Washington University School of Medicine. Siteman has satellite locations in West County and St. Peters, in addition to its full-service facility at Washington University Medical Center on South Kingshighway.

Contact: Gwen Ericson ericsong@wustl.edu 314-286-0141 Washington University in St. Louis

Hip hop and linguistics: You ain't heard no research like it!

Unique source material furthers research on African American vernacular English It's rare to use the words 'hip hop' and 'serious academic research' in the same sentence,

but a University of Calgary linguistics professor has relied on rap music as source material for a study of African American vernacular English.

Dr. Darin Howe recently contributed a book chapter that focuses on how black Americans use the negative in informal speech, citing examples from hip hop artists such as Phonte, Jay Z and Method Man. Howe is believed to be the only academic in Canada and one of the few in the world to take a scholarly look at the language of hip hop.

"There is still a lot of prejudice against black vernacular English," Howe says. "People tend to assume it's illogical and ungrammatical, but there is a system there and a grammar that you can describe. Rap music may be ear torture for many people, but for linguists, this is what makes us really excited."

Howe specifically focused on the use of the word 'ain't' and on other negative constructions – or, as it's called in linguistics, negation. "When you have multiple negation it seems really confusing, and what happens in black English is that the negation extends across multiple clauses."

For example, the book chapter quotes Tupac Shakur as saying, "It's like can't nobody never get confused and think I'm like Mike Tyson;" in other words, no one could confuse Tupac with Mike Tyson.

In another example, black English commonly substitutes the word 'ain't' for 'didn't.' So 'I didn't see him' could become, 'I aint see him.' "However, black English speakers know that you should only do this for about half the time," Howe says. "White hip hop artists try to imitate black speech, and for the most part they do a decent job, but when they don't have the rules down it becomes noticeable."

One of the intriguing conclusions that Howe draws is that there is an accelerating divergence in the speech dialects of whites and blacks, a subject that surfaced in the late 1990s with the debate on Ebonics.

Howe's focus was purely on the mechanics of the language and not on the culture of hip hop, which some have criticized as violent and misogynistic. He was assisted by an undergraduate linguistics student, Jeff Long, who is keenly interested in hip hop music and who found many of the examples cited in the research. "It's not often that you can combine your own interests with school work, so it was a real joy for me to work on this," Long says. ###

Howe did his master's thesis on African Nova Scotian English but has since specialized at U of C in native languages and phonology, or speech sounds. His chapter, "Negation in African American Vernacular English," appears in the book, Aspects of English Negation, edited by Yoko Iyeiri and published by John Benjamins Publishing Company / Yushodo Press. To arrange an interview with Dr. Howe, contact his office at (403) 220-6110, or phone Greg Harris, (403) 220-3506 or cell, 540-7306. Phone Harris to request a copy of the chapter.

Contact: Gregory Harris gharris@ucalgary.ca 403-220-3506 University of Calgary

Inage Licensing: This image was originally posted to Flickr by Defame. This file is licensed under Creative Commons Attribution 2.0 License.

No longer an issue of black and white?

Ronald E. Hall, Title: Associate Professor. Office Location: 224 Baker Hall. Phone: 517/432-3729. Fax: 517/353-3038. E-mail: hallr@msu.edu WEB: socialwork.msu.edu Education: Ph.D, Atlanta University, MSW, University of Michigan, MCS, University of Detroit

Skin color, more than race, is important cause of racism, according to new book Racism in the 21st Century The color of a person's skin, more than a person's race, is becoming a key cause of racism, according to a new book Racism in the 21st Century co-written and edited by Ronald Hall, associate professor of social work at Michigan State University. In an era when Barack Obama, the first African-American U.S. presidential candidate nominated by a major political party, is running for president, many people still struggle against prejudice and racism. Lighter-skinned blacks, Hispanics, Asians and other minorities often receive preferential treatment over their darker-skinned counterparts in education, housing, employment, and other areas, Hall and his fellow authors argue.

Immigrant workers with lighter skin color make more money on average than those with darker complexions, according to the research of contributor and Vanderbilt University professor Joni Hersch. In addition, the number of Equal Employment Opportunity Commission (EEOC) complaints on skin-color based discrimination are increasing, the book notes. In 2002, the EEOC successfully sued the owners of a Mexican restaurant in San Antonio, Texas, after the restaurant directed the white manager to hire only light-skinned staff to work in the dining room.

Colorism, discrimination based on skin color, is a centuries-old legacy of Western colonialism, according to Hall.

"Racism is no longer an issue of black and white," said Hall who has researched skin color discrimination for 25 years. "As we move further into the 21st century, with increased levels of interracial marriage, we won't be able to make racial differentiations. You're going to have people, for example, with Asian facial features, African hair texture, and Caucasian skin tones – and that's unprecedented. But the way we'll continue to assess one another, unfortunately, is going to be based on the manifestations of skin color. ###

Ronald Hall (Ed.) Racism in the 21st Century, An Empirical Analysis of Skin Color. XIV, 260 p. 9 illus., 2 in color., Hardcover $49.95, €34.95, £26.50, ISBN 978-0-387-79097-8

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

International Medical Corps, Saving the Lives of Malnourished Children

International Medical Corps has been matched to one of the Top 25 in American Express’ Members Projects, ‘Saving the Lives of Malnourished Children.’

Chosen out of 1,190 projects, “Saving the Lives of Malnourished Children” is now eligible to receive up to $1.5 million in funding. The project with the most votes receives $1.5 million, 2nd receives $500,000, 3rd $300,000, and 4th and 5th $100,000. The funding – made possible by your votes – would bring a vital lifeline to hungry and malnourished children around the world.

We need your help between now and September 29th. Voting is easy and doesn’t cost a thing!

In just a click, you can save the lives of thousands of malnourished children.

For severely malnourished children, we offer a step-by-step treatment program that gives them what they need to recover, including nutrient-dense food supplements like the peanut-based product, Plumpy'Nut. Our comprehensive monitoring system saves more than 90 percent of children being treated in our feeding centers. Being one of the Top 5 would mean our nutrition could reach more children around the world who need our help.

Hunger and malnutrition kill more people in the world than HIV, tuberculosis, and malaria combined. As food prices rise, this funding is even more critical. More people are being driven deeper into poverty trying to afford basic staples. Many have nothing to eat at all. Your vote makes it possible for fewer young lives to be lost because they do not have enough to eat.

Getting the word out to your friends and family makes a huge difference! Forward this link to a friend and you bring us that much closer to the $1.5 million to help malnourished children around the world!

About International Medical Corps

International Medical Corps (IMC) is a global, humanitarian, nonprofit organization dedicated to saving lives and relieving suffering through health care training and relief and development programs.

Established in 1984 by volunteer doctors and nurses, IMC is a private, voluntary, nonpolitical, nonsectarian organization. Its mission is to improve the quality of life through health interventions and related activities that build local capacity in underserved communities worldwide.

By offering training and health care to local populations and medical assistance to people at highest risk, and with the flexibility to respond rapidly to emergency situations, IMC rehabilitates devastated health care systems and helps bring them back to self-reliance.

Help International Medical Corps

Double your impact. Donate today. Your gift is matched before October 31st.

International Medical Corps has received a pledge of $100,000 in matching funds to provide vital health care to millions of children and families suffering in the global food crisis and other emergencies around the world. Every donation made before October 31st will be matched, dollar for dollar, up to $100,000. That means that we can double every dollar you provide, multiplying your gift and reaching more children and families who so desperately need our help.

Did you know that hunger and malnutrition kill more people than HIV/AIDS, tuberculosis, and malaria combined? As food prices soar, billions of people around the world are more vulnerable to malnutrition and severe food insecurity. Malnutrition often puts children at risk for malaria, diarrhea and respiratory infections – creating a vicious cycle. We see the impact of this emergency at our feeding sites and clinics everyday. By making a donation, you provide a lifeline for children and families who desperately need our help.

Contacts: For Press Inquiries: Stephanie Bowen, Communications Manager, International Medical Corps, 1919 Santa Monica Blvd., Suite 400, Santa Monica, CA 90404, 310-826-7800 sbowen@imcworldwide.org

Racial disparities in radiation therapy rates for breast cancer

Thomas A. Buchholz, M.D., F.A.C.R. Professor of Radiation Oncology, The University of Texas M. D. Anderson Cancer Center. Chair, Department of Radiation Oncology. Medical Director of Radiation Oncology, Ambulatory Clinic Building. Program Director and Section Chief, Breast Radiation Oncology

M. D. Anderson study finds racial disparities in radiation therapy rates for breast cancer. Largest study of its kind reveals blacks less likely than whites to receive standard of care WASHINGTON, DC - Black women are less likely than white women to receive radiation therapy after a lumpectomy, the standard of care for early stage breast cancer, according to a new study by researchers at The University of Texas M. D. Anderson Cancer Center. The study, the largest of its kind, was presented today in advance of the American Society of Clinical Oncology (ASCO) Breast Cancer Symposium, and is the first national study to examine such racial disparities in radiation therapy. Led by Grace Li Smith, M.D., Ph.D., a postdoctoral fellow in M. D. Anderson's Department of Radiation Oncology, the researchers reviewed the Medicare records of more than 37,000 patients diagnosed with early stage breast cancer in 2003.

"Although there have been smaller studies of racial disparities in breast cancer care, no prior research has examined the differences across the nation in the rates of radiation therapy after lumpectomy between whites and blacks," said Smith, the study's first author. "The national Medicare database, because it's so comprehensive, allowed us to determine the extent to which racial disparities in radiation therapy affected patients across the country."

For the retrospective cohort study, Smith and her M. D. Anderson colleagues used Medicare claims to examine the treatment history of women aged 66 and older diagnosed in 2003 with early stage, newly diagnosed breast cancer. Of the 37,305 women who underwent a lumpectomy for their breast cancer, 34,024 were white and 2,305 were black. Overall, 74 percent of the white women received radiation therapy after their lumpectomy; in contrast, 65 percent of the black breast cancer patients received the same treatment.

"The use of radiation after lumpectomy is considered to be the standard of care for women with invasive breast cancer, as clinical trials have demonstrated that it both reduces the chance of recurrence and improves the chance of survival," said Thomas Buchholz, M.D., professor in the Department of Radiation Oncology and the study's senior author. "While there are some breast cancer patients, such as those over age 70, with significant co-morbidities for whom radiation would not be appropriate, this discrepancy remained consistent when specifically looking at patients under the age of 70."

Perhaps the most unexpected aspect of the study, said Smith, was the magnitude of the disparity in specific areas of the country: the Pacific West, 72 (whites) vs. 55 percent (blacks); East South Central, 72 (whites) vs. 57 percent (blacks), and the Northeast, 70 (whites) vs. 58 percent (blacks).

However, in some parts of the country - the Mountain West (76 percent vs. 74 percent) and the North Central Midwest (74 percent vs. 72 percent) - there was virtually no discrepancy in radiation rates between whites and blacks. That level of geographic non-disparity was also surprising and of great benefit for further research, said Smith.

"Until further research is conducted, we may only speculate about the underlying reasons why black and white women are not receiving radiation at the same rate. We don't know if fewer black women are receiving radiation simply because it is not offered to them, because they decline the treatment, or perhaps because they are unable to complete a whole course of treatment due to other health problems. These questions will be important subjects of future study. As a medical community, we need to identify and eliminate any obstacle prohibiting all women from receiving necessary care for their breast cancer."

Smith's plans for follow up research include evaluating the difference in radiation rates results in a difference in mortality. She also plans to investigate whether radiation patterns correlate with other illnesses secondary to breast cancer care, and if there are disparities in other types of cancer treatment.

Smith hopes that results from the study may prompt physicians and patients to work together to overcome some of the barriers to treatment.

"Physicians may be able to help patients identify specific barriers to their care and may be able to be influential in helping patients overcome such obstacles," said Smith. "Or, if there are concerns or misconceptions about radiation treatment, patients themselves may play a role by becoming educated about the value of radiation after lumpectomy and helping to disseminate this information into their communities."

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In addition to Smith and Buchholz, other authors of the all-M. D. Anderson study include: Tina Shih, Ph.D., associate professor in the Department of Biostatistics; Ying Xu, M.D., senior statistical analyst, Division of Quantitative Sciences; Sharon Giordano, M.D., associate professor in the Department of Breast Medical Oncology; Benjamin Smith, M.D., adjunct assistant professor in the Department of Radiation Oncology; George Perkins, M.D., associate professor in the Department of Radiation Oncology; Welela Tereffe, M.D., assistant professor in the Department of Radiation Oncology; Wendy Woodward, M.D., Ph.D., assistant professor in the Department of Radiation Oncology.

The research was supported by a grant from the Department of Defense Breast Cancer Research Program, BC062438.

About M. D. Anderson

The University of Texas M. D. Anderson Cancer Center in Houston ranks as one of the world's most respected centers focused on cancer patient care, research, education and prevention. M. D. Anderson is one of only 39 Comprehensive Cancer Centers designated by the National Cancer Institute. For five of the past eight years, M. D. Anderson has ranked No. 1 in cancer care in "America's Best Hospitals," a survey published annually in U.S. News and World Report.

Contact: Laura Sussman lsussman@mdanderson.org 713-745-2457 University of Texas M. D. Anderson Cancer Center

New gene variant identified for nondiabetic end stage renal disease in African-Americans

Michael J. Klag. Dean, Bloomberg School of Public Health, The Johns Hopkins University Office of the Dean. The Johns Hopkins Bloomberg School of Public Health. 615 N. Wolfe Street. Baltimore, MD 21205. Phone: (410) 955-3540. Fax: (410) 955-0121. E-mail: mklag@jhsph.edu

Scientists at Johns Hopkins schools of Public Health and Medicine have, for the first time, identified variants in the gene MYH9 that are associated with increased risk for non-diabetic end stage renal disease (ESRD,) which is the near-loss of kidney function leading to either dialysis of transplant. MYH9, located on the 22 chromosome, is the first gene identified for common forms of kidney disease. The study was published online September 14 in the journal Nature Genetics and will be published in the October print edition. In a separate study published in the same issue, researchers at the National Institutes of Health reported similar findings. In the United States, about 26 million Americans have chronic kidney disease with nearly 427,000 Americans requiring dialysis or kidney transplant each year for the treatment of ESRD, according to U.S. government studies. African Americans are affected disproportionately as they have a four-times-higher incidence of end stage renal disease compared to European Americans.

"We are in the midst of an epidemic of chronic kidney disease, in which African Americans are disproportionately affected. This finding does not mean that non-genetic factors, such as socioeconomic indicators and other factors do not contribute to the higher risk of kidney disease in African Americans. It defines a subset of persons most likely vulnerable to the harmful effect of these factors," said study author Michael J. Klag, MD, MPH, dean of the Johns Hopkins Bloomberg School of Public Health.

"Our results show that in addition to environmental and behavioral risk factors, genetic factors play a role as well," said lead author, Linda Kao, PhD, MHS, associate professor in Bloomberg School of Public Health's Department of Epidemiology and the Welch Center for Prevention, Epidemiology and Clinical Research.

"While we know these genetic variations are common among African Americans, not everyone with the variations has disease and not everyone with disease has the variations. Therefore, it is imperative that we understand what other modifiable risk factors are interacting with the genetic risk factors to cause disease."

For the study, researchers used a technique known as admixture mapping to survey genomes of 1,372 African Americans with ESRD and a control group of about 800 African Americans without ESRD. The study identified several alleles, or variations, in the MYH9 gene that were highly associated with non-diabetic ESRD but not diabetic ESRD. These variants were not associated with diabetic ESRD. Even though the variations identified in this study are present in many populations, they are more frequent among individuals with West African ancestry.

"This finding suggests that the mechanisms leading from onset of chronic kidney disease to kidney failure may differ based on the inciting cause," said study author Rulan S. Parekh, MD, associate professor Johns Hopkins School of Medicine and the Welch Center. "Discovery of the gene and its association with kidney disease will lead to future studies to better understand the biology of kidney disease progression and ultimately may direct drug therapy and potential screening of patients." ###

Additional authors include Lucy A. Meoni, ScM; David Reich, PhD; Yvette Berthier-Schaad, PhD; Man Li, MS; Josef Coresh, MD, PhD; Nick Patterson, PhD; Arti Tandon; Neil R. Powe, MD, MPH; Nancy E. Fink, MPH; John H. Sadler, MD; Matthew R. Weir, MD; Hanna E. Abboud, MD; Sharon Adler, MD; Jasmin Divers, PhD; Sudha K. Iyengar, PhD; Barry I. Freedman, MD; Paul L. Kimmel, MD; William C. Knowler, MD, DrPH; Orly F. Kohn, MD; Kristopher Kramp, MS; David J. Leehey, MD; Susanne Nicholas, MD, PhD; Madeleine Pahl, MD; Jeffrey R. Schelling, MD; John R. Sedor, MD; Denyse Thornly-Brown, MD; Cheryl A. Winkler, PhD; and Michael W. Smith, PhD.

The research was supported by grants from the National Institutes of Health and the National Cancer Institute's Center for Cancer Research.

For public health news throughout the day, visit www.jhsph.edu/publichealthnews.

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

Blacks less likely to recognize overweight and obesity, study shows

Gary G. Bennett, PhD, Assistant Professor of Society, Human Development, and Health, Harvard School of Public Health. Area of Research, Cancer Disparities Among Racial and Ethnic Minorities Contact Information, Gary G. Bennett, PhD, Dana-Farber Cancer Institute 44 Binney Street Smith 256 Boston, MA 02115. Office phone: (617) 632-4050, Appointment phone: (617) 632-5674, Fax: (617) 632-1999. E-mail: gbennett@hsph.harvard.edu Our research program comprises both observational and intervention research and focuses on disparities in cancer risk behaviors, with a particular emphasis on the high prevalence of obesity and physical inactivity among blacks. Together, physical inactivity and obesity may account for 25% to 30% of several major cancers: colon, breast (postmenopausal), endometrial, kidney, and esophageal. While a great deal of research has described the physical inactivity and obesity among black adults, comparatively little work has examined the social determinants that might inform behavioral and policy interventions. WEB: Gary G. Bennett, PhD

Researchers say failure to recognize excess body weight poses significant health concerns BOSTON -- Overweight black Americans are two to three times more likely than heavy white Americans to say they are of average weight – even after being diagnosed as overweight or obese by their doctors, according to a study led by Dana-Farber Cancer Institute researchers. Weight "misperception" was most common among black men and women, and also was found among Hispanic men (but not women) compared to their white counterparts. The findings, which appear in the current online issue of the International Journal of Behavioral Nutrition and Physical Activity, are significant as excess body weight is a known risk factor for diabetes, heart disease, many forms of cancer, and premature death. Growing concern over the national obesity epidemic in recent years apparently has not significantly increased overweight blacks’ recognition of their excess pounds, said Gary G. Bennett, PhD, of Dana-Farber’s Center for Community-Based Research and Harvard School of Public Health in Boston, lead author of the study. The report by Bennett and Kathleen Y. Wolin, ScD of Northwestern University is based on an analysis of data collected in the National Health and Nutritional Examination Survey (NHANES), a government-sponsored research study begun in the 1960s. It includes both interviews and physical examinations carried out by mobile units across the country. Analyses of NHANES data collected in 1988-98 and 2001-02 show that the prevalence of misperception actually has increased among blacks. "During this period we’ve seen rapid gains in obesity," said Bennett. "We think it’s a considerable problem that this is still not resonating among blacks and other minorities," he added. Although the prevalence of overweight and obesity is even higher among blacks (estimated at over 75 percent) than the national average, Bennett said less pressure exists in the black community for people to lose weight through diet and exercise because of a cultural acceptance of higher body weights and heavier body shapes. "We think that misperception can be very useful when it comes to protecting people against overly stringent body image ideals and eating disorders," said Bennett, who is black. "But it’s a problem when people fail to realize the health consequences associated with obesity."

The researchers analyzed data on 6,552 overweight and obese men and women who participated in the 1999-2002 NHANES surveys. Included in the analyses were data on height, weight, body mass index, whether they had received a diagnosis of overweight from a doctor, and responses to the question, "Do you consider yourself now to be overweight, underweight, or about the right weight"" Since all the participants were overweight or obese by standard health guidelines, all answers of "about the right weight" were categorized as "inaccurate" or a "misperception" by the researchers. The study was not designed to determine whether the inaccurate statements were intentional or not.

The study found that men were more likely than women to misperceive their weight. Among women, the prevalence of misperception was highest among overweight black women (40.9 percent, compared to 20.6 percent in overweight white women) and men (66.4 percent, compared to 43.2 percent in overweight white men). It was lowest among obese white women (3.1 percent, compared with 11.2 percent in obese black women) and men (8.9 percent, compared to 26.2 of obese black men.)

Altogether, overweight black men and women were twice as likely as whites to make inaccurate body weight perceptions, and obese black adults were even more likely to exhibit weight status misperceptions, according to the report.

Unrealistic assessments of body weight were just as common in people who were relatively financially well off as in poorer people, and in those who had been told by their doctors that they were overweight or obese.

One lesson from the findings, Bennett said, is that "it is probably not sufficient for physicians to simply tell a person that he or she is overweight; doctors should do much more intensive counseling regarding the health consequence of being overweight."

The message is complicated, he added, by research findings showing that blacks generally don’t experience life-shortening health effects until they are more obese compared to whites. "Obesity-associated mortality occurs at a higher BMI (body mass index) among blacks than it does for whites," probably for biological reasons, said Bennett. Yet some of the health effects associated with excess weight, such as diabetes, high cholesterol and hypertension, can be causing harm in blacks long before they result in death.

"The tendency to dramatically underestimate the degree of their overweight should be a clarion call to blacks," Bennett said. "We hope that people will increasingly recognize the health consequences associated with excess weight." ###

The research was supported by the National Institutes of Health and the Dana-Farber/Harvard Cancer Center.

Dana-Farber Cancer Institute (www.dana-farber.org) is a principal teaching affiliate of the Harvard Medical School and is among the leading cancer research and care centers in the United States. It is a founding member of the Dana-Farber/Harvard Cancer Center (DF/HCC), designated a comprehensive cancer center by the National Cancer Institute.

Contact: Janet Haley Dubow janet_haley@dfci.harvard.edu 617-632-5665 Dana-Farber Cancer Institute

Dr. Patricia E. Bath

Dr. Patricia Bath was the first woman ophthalmologist to be appointed to the faculty of the University of California at Los Angeles School of Medicine Jules Stein Eye Institute.

Dr. Bath was the first woman to chair an ophthalmology residency program in the United States.

Dr. Patricia Bath discovered and invented a new device and technique for cataract surgery known as laserphaco. Dr. Bath is the first African American woman doctor to receive a patent for a medical invention.

Born: November 4, 1942, Birthplace: Harlem, New York - Patricia E. Bath, an ophthalmologist and laser scientist, is an innovative research scientist and advocate for blindness prevention, treatment, and cure. Her accomplishments include the invention of a new device and technique for cataract surgery known as laserphaco, the creation of a new discipline known as "community ophthalmology," and appointment as the first woman chair of ophthalmology in the United States, at Drew-UCLA in 1983.

Dr. Patricia E. Bath

Patricia Bath's dedication to a life in medicine began in childhood, when she was first heard about Dr. Albert Schweitzer's service to lepers in the Congo. After excelling in her studies in high school and university and earning awards for scientific research as early as age sixteen, Dr. Bath embarked on a career in medicine. She received her medical degree from Howard University College of Medicine in Washington, D.C., interned at Harlem Hospital from 1968 to 1969, and completed a fellowship in ophthalmology at Columbia University from 1969 to 1970. Following her internship, Dr. Bath completed her training at New York University between 1970 and 1973, where she was the first African American resident in ophthalmology. Bath married and had a daughter Eraka, born 1972.

While motherhood became her priority, she also managed to complete a fellowship in corneal transplantation and keratoprosthesis (replacing the human cornea with an artificial one).

As a young intern shuttling between Harlem Hospital and Columbia University, Bath was quick to observe that at the eye clinic in Harlem half the patients were blind or visually impaired. At the eye clinic at Columbia, by contrast, there were very few obviously blind patients. This observation led her to conduct a retrospective epidemiological study, which documented that blindness among blacks was double that among whites. She reached the conclusion that the high prevalence of blindness among blacks was due to lack of access of ophthalmic care. As a result, she proposed a new discipline, known as community ophthalmology, which is now operative worldwide. Community ophthalmology combines aspects of public health, community medicine, and clinical ophthalmology to offer primary care to underserved populations. Volunteers trained as eye workers visit senior centers and daycare programs to test vision and screen for cataracts, glaucoma, and other threatening eye conditions. This outreach has saved the sight of thousands whose problems would otherwise have gone undiagnosed and untreated. By identifying children who need eyeglasses, the volunteers give these children a better chance for success in school.

Bath was also instrumental in bringing ophthalmic surgical services to Harlem Hospital's Eye Clinic, which did not perform eye surgery in 1968. She persuaded her professors at Columbia to operate on blind patients for free, and she volunteered as an assistant surgeon. The first major eye operation at Harlem Hospital was performed in 1970 as a result of her efforts.

In 1974 Bath joined the faculty of UCLA and Charles R. Drew University as an assistant professor of surgery (Drew) and ophthalmology (UCLA). The following year she became the first woman faculty member in the Department of Ophthalmology at UCLA's Jules Stein Eye Institute. As she notes, when she became the first woman faculty in the department, she was offered an office "in the basement next to the lab animals." She refused the spot. "I didn't say it was racist or sexist. I said it was inappropriate and succeeded in getting acceptable office space. I decided I was just going to do my work." By 1983 she was chair of the ophthalmology residency training program at Drew-UCLA, the first woman in the USA to hold such a position.

Despite university policies extolling equality and condemning discrimination, Professor Bath experienced numerous instances of sexism and racism throughout her tenure at both UCLA and Drew. Determined that her research not be obstructed by the "glass ceilings," she took her research abroad to Europe. Free at last from the toxic constraints of sexism and racism her research was accepted on its merits at the Laser Medical Center of Berlin, West Germany, the Rothschild Eye Institute of Paris, France, and the Loughborough Institute of Technology, England. At those institutions she achieved her "personal best" in research and laser science, the fruits of which are evidenced by her laser patents on eye surgery.

Bath's work and interests, however, have always gone beyond the confines of a university. In 1977, she and three other colleagues founded the American Institute for the Prevention of Blindness, an organization whose mission is to protect, preserve, and restore the gift of sight. The AIPB is based on the principle that eyesight is a basic human right and that primary eye care must be made available to all people, everywhere, regardless of their economic status. Much of the work of the AIPB is done though ophthalmic assistants, who are trained in programs at major universities. The institute supports global initiatives to provide newborn infants with protective anti-infection eye drops, to ensure that children who are malnourished receive vitamin A supplements essential for vision, and to vaccinate children against diseases (such as measles) that can lead to blindness.

As director of AIPB, Bath has traveled widely. On these travels she has performed surgery, taught new medical techniques, donated equipment, lectured, met with colleagues, and witnessed the disparity in health services available in industrial and developing countries.

Dr. Bath is also a laser scientist and inventor. Her interest, experience, and research on cataracts lead to her invention of a new device and method to remove cataracts—the laserphaco probe. When she first conceived of the device in 1981, her idea was more advanced than the technology available at the time. It took her nearly five years to complete the research and testing needed to make it work and apply for a patent. Today the device is use worldwide. With the keratoprosthesis device, Dr. Bath was able to recover the sight of several individuals who had been blind for over 30 years.

In 1993, Bath retired from UCLA Medical Center and was appointed to the honorary medical staff. Since then, she has been an advocate of telemedicine, the use of electronic communication to provide medical services to remote areas where health care is limited. She has held positions in telemedicine at Howard University and St. George's University in Grenada.

Dr. Bath's greatest passion, however, continues to be fighting blindness. Her "personal best moment" occurred on a humanitarian mission to North Africa, when she restored the sight of a woman who had been blind for thirty years by implanting a keratoprosthesis. "The ability to restore sight is the ultimate reward," she says.

What was my biggest obstacle?

Sexism, racism, and relative poverty were the obstacles which I faced as a young girl growing up in Harlem. There were no women physicians I knew of and surgery was a male-dominated profession; no high schools existed in Harlem, a predominantly black community; additionally, blacks were excluded from numerous medical schools and medical societies; and, my family did not possess the funds to send me to medical school. [Dr. Bath says her mother scrubbed floors so she could go to medical school.]

Despite official university policies extolling equality and condemning discrimination, Bath experienced both sexism and racism during her tenure at both UCLA and Drew. Determined that her research not be obstructed by the "glass ceilings," she took her research abroad to Europe, where her research was accepted on its merits at the Laser Medical Center of Berlin, West Germany, the Rothschild Eye Institute of Paris, France, and the Loughborough (England) Institute of Technology. At those institutions she excelled in research and laser science, the fruits of which are evidenced by her patents for laser eye surgery.

How do I make a difference?

I am most proud of my invention of a new technique and concept for cataract surgery, known as laserphaco, which is defined by my publications as well as patents.

Who was my mentor?

Newspaper accounts of the humanitarian work of Dr. Albert Schweitzer (who treated lepers in Africa) and my personal relationship with my family physician, Dr. Cecil Marquez, inspired me with the ambition to become a physician. Both my parents shared my admiration for these two role models and encouraged me to pursue my ambition.

TEXT and IMAGE CREDIT: Government information at NLM Web sites is in the public domain. Public domain information may be freely distributed and copied, but it is requested that in any subsequent use the National Library of Medicine (NLM) be given appropriate acknowledgement. Changing the Face of Medicine

Hair straightening chemicals not linked to breast cancer risk in African-Americans

PHILADELPHIA - Chemical "relaxers" used to straighten hair are not associated with an increased risk of developing breast cancer among African-American women, say researchers who followed 48,167 Black Women's Health Study participants.

In the May issue of Cancer Epidemiology, Biomarkers & Prevention, researchers from Boston University and Howard University Cancer Center found no increase in breast cancer risk due to the type of hair relaxer used or the frequency and duration of use. Women who used relaxers seven or more times a year over a 20 year span or longer had the same risk as women who used the chemicals for less than a year, researchers say.

Lynn Rosenberg is professor of epidemiology at Boston University School of Public Health. She received her M.S. in chemistry from Boston University and M.S. in biostatistics and Sc.D. in epidemiology from Harvard University. Dr. Rosenberg’s research has been in the areas of cancer epidemiology, cardiovascular epidemiology, and drug epidemiology, with a recent emphasis on women’s health. She has carried out multiple studies of risk factors for cancers, including cancer of the breast, cervix, and colon, and for myocardial infarction. Particular interests have been the health effects of oral and injectable contraceptives and of noncontraceptive estrogens. Several important hypotheses have been raised by her studies: that alcohol consumption increases the incidence of breast cancer and that use of nonsteroidal anti-inflammatory drugs decreases the incidence of large bowel cancer. Both hypotheses were subsequently confirmed in numerous studies. Currently, she is PI of the long-running Case-Control Surveillance Study, which has been in progress since 1975; multiple case-control studies are conducted within the same administrative framework to assess the unanticipated effects of medications on the incidence of various cancers. She heads a cross-sectional study of the effect of injectable progestin contraceptives on bone mineral density in African women and women of mixed race in South Africa . She is also PI of the Black Women’s Health Study, the largest follow-up study of the health of African-American women yet conducted. The study, conducted in collaboration with investigators at Howard University, follows 59,000 black women from across the U.S. to assess risk factors for outcomes that include breast cancer, other cancers, hypertension, diabetes, systemic lupus erythematosus, uterine fibroids, and preterm birth. Dr. Rosenberg is the author of over 200 scientific papers.

"This is good news," said the study's lead investigator, Lynn Rosenberg, Sc.D., professor of epidemiology at Boston University School of Public Health. "The present study is definitive that hair relaxers don't cause breast cancer, as much as an epidemiologic study can be." Previous research shows that breast cancer incidence is higher among African-American women age 40 or younger than among Caucasian women of the same age, and this increased risk is not fully explained by known risk factors, such as race and family history. At all ages, African-American women are more likely to die of breast cancer than are Caucasian women. To shed light on these findings and to study potential causes of breast cancer and other serious illnesses that affect black women, the Black Women's Health Study was launched across the United States in 1995. More than 59,000 women completed an initial questionnaire and more than 80 percent have answered follow-up questions every two years since, including questions about use of hair relaxers. Hair relaxers can enter the body through cuts or lesions in the scalp. These products are not fully monitored by the Food and Drug Administration, and thus could contain potentially harmful compounds, Rosenberg said. Manufacturers of hair relaxers and hair dyes are not required to list all ingredients of their products on the packages, as some may be considered trade secrets, she said. "Because hair relaxers are more widely used by younger African-American women than they are used by older African-American women, a connection with increased risk of breast cancer in younger women seemed possible," Rosenberg said. "Also, millions of African-American women use hair relaxers, and substances that are used by millions of women over a span of many years should be monitored for safety." The researchers found that younger women used hair relaxers more than older women did. They also discovered that the majority of women used hair relaxers before age 20 and a third used the chemicals at least seven times a year.

But when they examined the association between use of hair relaxers and breast cancer, based on 574 newly diagnosed cases of breast cancer identified during the follow-up period, they found no connection between use of relaxers and breast cancer incidence overall or among the younger women, even if use had been frequent and of long duration.

The study was funded by the National Cancer Institute. Co-authors include Julie Palmer, Sc.D., and Deborah Boggs, M.S., of Boston University School of Public Health, and Lucile Adams-Campbell, Ph.D., of Howard University Cancer Center. ###

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 nearly 26,000 basic, translational, and clinical researchers; health care professionals; and cancer survivors and advocates in the United States and more than 70 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, CR, is a magazine for cancer survivors, patient advocates, their families, physicians, and scientists. It provides a forum for sharing essential, evidence-based information and perspectives on progress in cancer research, survivorship, and advocacy.

Contact: Greg Lester lester@aacr.org 267-646-0554 American Association for Cancer Research

A Survey of African American College Students: Reactions to the Terrorist Acts of September 11, 2001

ED456377 - A Survey of African American College Students: Reactions to the Terrorist Acts of September 11, 2001. Full text in PDF format. ERIC #: ED456377 Title: A Survey of African American College Students: Reactions to the Terrorist Acts of September 11, 2001. Authors: Duncan, Cecil.

Descriptors: Black Colleges; Black Students; College Students; Coping; Higher Education; Interpersonal Communication; Posttraumatic Stress Disorder; Resilience (Personality); Student Reaction; Student Surveys

A survey instrument was developed to identify the impact the World Trade Center and the Pentagon bombings of September 11, 2001, had on African American college students attending an Historically Black College-University (HBCU) in the South. The survey was administered to 136 students 8 days after the bombings in an effort to gain insight into their immediate impact on a select group of Americans.

Students who participated in the study appeared to have experienced a number of reactions typical of persons who were in close proximity to a disaster but were not direct victims themselves. They did not have symptoms consistent with posttraumatic stress syndrome disorder.

Most had serious concerns about flying, while a sizable minority felt unsafe in general. Few blamed Middle Easterners in general for the terrorist acts, and even fewer wanted profiling to be used as a means of identifying terrorists. The respondents appeared to be doing what they needed to do to return to normalcy, and talking about the incident may be the most therapeutic thing they did. Several limitations of the study are discussed, including that it occurred just eight days after the bombings, which may have been too early to assess the impact on the participants. (JDM)

African-Americans twice as likely as Caucasians to die following a liver operation

Timothy M. Pawlik received his undergraduate degree from Georgetown University and his medical degree from Tufts University School of Medicine. He completed his surgical training at the University of Michigan Hospital and spent two years at the Massachusetts General Hospital as a surgical oncology research fellow. Dr. Pawlik went on for advanced training in surgical oncology at The University of Texas M. D. Anderson Cancer Center in Houston. His main clinical interests include alimentary tract surgery, with a special interest in hepatic and pancreatobiliary diseases. Dr. Pawlik also has an interest in medical ethics and completed a fellowship in medical ethics at the Harvard School of Public Health as well as a Masters in Theology from Harvard Divinity School in Boston.

CHICAGO (September 3, 2008) – New research published in the Journal of the American College of Surgeons shows African Americans are more than twice as likely as Caucasians to die in the hospital after surgical removal of part of the liver -- an increasingly used procedure for the treatment of liver cancer. In recent years, a large body of evidence has emerged revealing significant racial disparities in health care and outcomes in the United States. Previous studies have documented racial disparities in surgical mortality after cardiovascular and cancer procedures. Because of such studies, the identification and elimination of these disparities has become a national public health priority. "Our study shows a racial divide in regards to in-hospital mortality after major hepatectomy," according to Timothy Pawlik, MD, MPH, FACS, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Md. "This finding is of special note because of the magnitude of the observed gap in outcomes." Using hospital discharge data from the Nationwide Inpatient Sample, researchers retrospectively reviewed 3,552 patients who underwent major hepatectomy between 1998 and 2005. The overall racial makeup was 59 percent Caucasian, 6 percent African-American, 5 percent Hispanic, 7 percent Asian/Pacific Islander and 24 percent other or unknown, which included records with missing race and those from states that do not report race. "There has previously not been any research on racial disparities in the outcomes of liver resection, but it is an important issue to examine as the use of hepatic resection has increased dramatically in the U.S.,"

added Hari Nathan, MD, department of surgery, Johns Hopkins University School of Medicine and the study's lead investigator. "Given this increase, studies are needed to clarify the nature of this disparity and identify targets for intervention."

The odds of dying following this type of liver operation were twice as high for African Americans compared with Caucasians. After adjustment for clinical, hospital, and socioeconomic risk factors, data revealed that African-American patients were twice as likely to die compared to Caucasian patients (odds ratio 2.15, 95 percent confidence, interval 1.28 to 3.61).

Researchers believe that differences in preoperative health status may underlie some of the observed disparity in outcomes, a theory supported by the finding that African-American patients who died in the hospital as a complication of a hepatectomy did so much sooner than their Caucasian counterparts. Hospital factors may also explain racial disparities in outcomes, insofar as minority patients might receive care at hospitals with generally poorer outcomes. ###

About the American College of Surgeons

The American College of Surgeons is a scientific and educational organization of surgeons that was founded in 1913 to raise the standards of surgical practice and to improve the care of the surgical patient. The College is dedicated to the ethical and competent practice of surgery. Its achievements have significantly influenced the course of scientific surgery in America and have established it as an important advocate for all surgical patients. The College has more than 72,000 members and is the largest organization of surgeons in the world. For more information, visit www.facs.org.

Contact: Sally Garneski pressinquiry@facs.org 312-202-5409 Weber Shandwick Worldwide

Periodic limb movement during sleep is less common in African-Americans; associated with insomnia

Christopher L. Drake, Ph.D. Make An Appointment 1-800-HENRYFORD (1-800-436-7936) Specialties: Sleep Medicine Office Locations: Henry Ford Hospital 2799 West Grand Boulevard Detroit, MI, 48202 Board Certifications: American Board of Sleep Medicine. Post Graduate Training: Ph.D. - Bowling Green State University (OH) - Psychology

Study is the first to determine the prevalence of periodic limb movements during sleep in a population-based sample using standardized criteria Westchester, Ill. – A study in the Sept. 1 issue of the journal Sleep is the first to objectively determine the prevalence of periodic limb movements during sleep (PLMS) in a population-based sample, finding a lower prevalence of PLMS in African-Americans and a higher rate of insomnia complaints in people with PLMS. Results show that the overall prevalence of PLMS is 7.6 percent, with a lower prevalence of 4.3 percent in African-Americans and a higher prevalence of 9.3 percent in Caucasians. Complaints of insomnia are reported by 45 percent of people with PLMS, compared with only 25 percent of people without PLMS. "The study is consistent with the idea that genetic factors may play a role in the development of PLMS," said principal investigator Christopher L. Drake, PhD, senior bioscientific staff at the Sleep Disorders and Research Center at Henry Ford Hospital in Detroit, Mich.

According to the American Academy of Sleep Medicine, PLMS involves uncontrollable, repetitive muscle movements such as extending the big toe or bending the ankle. These frequent movements occur in one or both legs during sleep and often result in brief arousals, and in some cases, full awakenings from sleep.

The AASM also reports that low brain iron may play a role in worsening PLMS. According to the authors, studies demonstrate higher iron stores in African-Americans, providing a possible explanation for the racial differences found in the study. The results also are consistent with previous findings of racial differences for PLMS in children as young as five to seven years of age, suggesting that the racial differences found in adults may be present from an early age and pointing to potential genetic factors.

Data were collected as a part of a larger epidemiological study on daytime sleepiness in the general population of tri-county Detroit. The final sample included 592 individuals between the ages of 18 and 65 years, with an average age of 42 years. African-Americans made up 31.5 percent of the study group.

Participants were evaluated during a 24-hour laboratory assessment, which included an overnight polysomnogram and a five-nap, daytime, multiple sleep latency test. Participants also recorded sleep diaries two weeks prior to the laboratory assessment.

PLMS was defined as an average of 15 or more leg movements per hour of sleep. Individuals with PLMS were slightly but significantly older. Self-reported symptoms of either sleepiness or sleep disturbance were higher in participants with PLMS (56 percent) than in those without PLMS (29 percent). ###

Information for patients and the public about PLMS is available from the American Academy of Sleep Medicine at www.sleepeducation.com/Disorder.aspx?id=10.

Sleep is the official journal of the Associated Professional Sleep Societies, LLC, a joint venture of the American Academy of Sleep Medicine and the Sleep Research Society. For a copy of the study, "Periodic Limb Movements during Sleep: Population Prevalence, Clinical Correlates and Racial Differences," or to arrange an interview with an AASM spokesperson, please contact Kelly Wagner, AASM public relations coordinator, at (708) 492-0930, ext. 9331, or kwagner@aasmnet.org.

How media covered Katrina aftermath affects response by blacks and whites

Cheryl Kaiser is an Assistant Professor in the UW Department of Psychology. She is affiliated with the Social/Personality and Diversity Science Research Areas. Broadly speaking, her research examines the self and social perception, particularly as these topics relate to prejudice and intergroup relations. Much of her research examines factors that affect whether individuals perceive prejudice-related threats, their cognitive, emotional, and behavioral responses to these threats, and the implications of how they cope with these threats for well being and interpersonal relationships. She is also interested in the application of this research for law and legal processes. Cheryl R. Kaiser Department of Psychology University of Washington Seattle, Washington 98195 U.S.A. Phone: (206) 616-1435 ckaiser@u.washington.edu

New research shows that black and white Americans responded differently when exposed to a video presentation that described Hurricane Katrina and then blamed the botched relief efforts on one of two causes: either government incompetence or racism, because the majority of Katrina's victims were black. "In laboratory experiments over the last decade, whites have tended to have negative reactions including negative emotions and attitudes towards minorities when racism was blamed for or cited as the reason for something. When Katrina happened it offered an opportunity to look at a real world problem that came into our living rooms and the belief system, or world view, that everyone has," said Cheryl Kaiser, a University of Washington assistant professor of psychology and lead author of a new study. The study is noteworthy because, unlike previous research that looked at claims of discrimination, whites did not express outright negativity toward blacks. Instead it indicated that whites who were exposed to racial discrimination claims displayed strong positive attitudes toward whites rather than negative attitudes at blacks. Blacks tended to have less favorable attitudes toward whites after seeing the race-blame video than the government-incompetence video, but the difference was not significant. Blacks also showed strong positive attitudes toward blacks in both scenarios.

For the study Kaiser and her colleagues from Syracuse and Michigan State universities recruited 93 white and 60 black undergraduate college students. The majority in each group were women.

Each participant viewed the video presentation individually on a computer monitor equipped with headphones. All of the students watched a five-minute clip taken from a National Geographic program about the hurricane. Then the video content was divided into two experimental conditions.

In a race-blame condition, half the participants viewed a six-minute series of segments in which Katrina victims, public figures and journalists claimed that the government had responded slowly to the disaster because the majority of victims were black. The other participants saw a six-minute government-incompetence series of clips in which victims, public figures and journalists said government incompetence caused the ineffective disaster response. Then all of the participants viewed a three-minute slide show, consisting of 96 photographs, showing the physical damage and physical suffering caused by the hurricane.

After the video presentation, each participant filled out questionnaires that assessed their attachment to their own racial group and their attitudes toward blacks, whites and a number of filler groups such as teachers and politicians. In addition, they were asked to provide an explanation for the disaster response they recalled being made most often in the video they saw.

Kaiser said that media coverage that focused on racial explanations for the aftermath of Katrina did affect white Americans' attitudes and could have potentially important consequences for intergroup relations.

"Our sense is some white Americans couldn't understand the claims of racism and it was hard for them to think skin color was responsible for people surviving the hurricane and getting relief. This study helps us understand why discrimination claims make a large number of people in the U.S. uncomfortable. These claims act as a threat to the perceived fairness of our system and people who are at the top, generally white, want to maintain the status quo," she said. ###

The paper, published in the current issue of the journal Social Justice Research, was funded by grants from the National Science Foundation. Co-authors are Collette Eccleston, an assistant psychology professor at Syracuse, and Nao Hagiwara, a psychology doctoral student at Michigan State.

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

Study points to 1 cause of higher rates of transplanted kidney rejection in blacks

HLA region of Chromosome 6

A Johns Hopkins research team reports it may have an explanation for at least some of the higher organ rejection rates seen among black - as compared to white - kidney transplant recipients. In a study of 50 healthy adult men, 25 black and 25 white, significantly different amounts of certain immune system cells were found between the races. These cells, known as human leukocyte antigen-specific, or HLA-specific B cells, when "sensitized" produce antibodies linked to transplanted kidney rejection, says Andrea Zachary, professor of medicine at Johns Hopkins and lead researcher of the study.

It's been long known that HLA-reactive antibodies produced by B cells are one of the ways that transplanted organs are rejected. Zachary developed a novel method for counting HLA-specific B cells more accurately, leading to the hypothesis that B cell numbers make a difference in transplant retention and rejection.

"Now that we have an accurate way to count these cells, we are able to confirm what we long suspected, that blacks might have a bigger army of HLA-specific B cells," says Zachary who presented her findings at the Congress of the International Transplant Society in Sydney, Australia on Aug. 12.

Zachary says that patients become sensitized when exposed to HLA in blood or tissue that is not their own. Sensitized HLA-specific B cells then produce antibodies that attack transplanted organs containing foreign HLA. Patients can become sensitized from a blood transfusion, transplantation or pregnancy.

"If the recipient is not sensitized, B cells represent only a patient's potential for making antibodies," says Zachary. "However about a third of patients in need of a kidney are sensitized since they're often on their second or third transplantation and may have undergone transfusions. In the study, Zachary and her team gathered blood samples from 25 adult black males and 25 adult white males. They were all healthy and all non-sensitized. They also gathered blood samples from 10 sensitized adult black males and 25 sensitized white males.

Results showed that the black non-sensitized males tested had an average of 17.2 percent more HLA-sensitive B cells than the white non-sensitized males tested. Among the sensitized group, black males had an average of 22.9 percent more HLA-sensitive B cells than white males.

HLA antigens are proteins that sit on the surface of blood and tissue cells. Each person has a specific set, similar to a fingerprint. Rejection of a transplant occurs when the recipient's immune system sees the donor's HLA antigens as foreign and attacks those antigens with cells or antibodies. The amount of antibody made depends on the number of B cells a recipient has.

"Knowing that blacks have an increased number of HLA-specific B cells - which increases their opportunity for antibody-mediated rejection - we may be able to customize treatments for black recipients to account for these differences and lessen the likelihood that the organ will be rejected," says Zachary. ###

Additional Johns Hopkins researchers who worked on this study are Mary S. Leffell, Ph.D.; and Dessislava Kopchaliifka, Ph.D., of the Department of Medicine and J. Keith Melancon, M.D., of the Department of Surgery.

Contact: Eric Vohr evohr1@jhmi.edu 410-955-8665 Johns Hopkins Medical Institutions

Muscle mass may not fully explain higher creatinine in blacks with kidney disease

Credit: Joy Hsu, MD Usage Restrictions: None

New theories needed to account for racial differences Why do black patients with advanced kidney disease have higher levels of creatinine, a standard indicator of kidney function, than whites" Contrary to what doctors have thought,

the difference may not necessarily reflect differences in muscle mass related to younger age or differences in body composition, reports a study in the July 2008 issue of the Clinical Journal of the American Society of Nephrology (CJASN).

Led by Dr Joy Hsu of University of California, San Francisco, School of Medicine, the researchers measured serum creatinine concentrations and estimated body composition in more than 3,000 dialysis patients. Doctors measure creatinine to estimate how well a patient's kidneys are functioning—a higher creatinine level is generally a sign of lower kidney function. Creatinine levels were compared for black patients versus those of other racial/ethnic groups.

As in previous studies, blacks had higher creatinine levels than non-black patients. "A widely assumed explanation for this racial difference is that black patients tend to develop end-stage kidney disease earlier than whites," Dr Hsu explains. "So blacks on dialysis tend to be younger than whites and persons of other races and ethnicities and so may have more muscle mass, and creatinine is a natural breakdown product of muscle."

To test this assumption, the researchers used a technique called bioelectrical impedance analysis to estimate the patients' muscle mass. "We hypothesized that adjusting for muscle mass and related factors would eliminate or reduce the racial differences in serum creatinine level," says Dr Hsu.

However, even after adjustment, creatinine levels continued to be significantly higher for black patients. "The higher creatinine levels in black patients compared to non-black patients could not be entirely explained by differences in age, sex, body size, or muscle mass," according to Dr Hsu.

In the United States, rates of kidney disease—including end-stage renal disease (ESRD), requiring dialysis or transplantation to replace lost kidney function—are substantially higher among blacks than whites. The higher serum creatinine levels in black patients are another significant difference. "It is also unclear how this racial difference in creatinine levels is related to racial differences in kidney disease," says Dr. Hsu.

If muscle mass isn't necessarily the answer, more research will be needed to find the real reason why black patients have higher blood creatinine levels than white patients, Dr. Hsu adds. "Perhaps the answer or answers to this question will help explain why blacks are affected by progressive chronic kidney disease more so than whites." ###

The study, entitled "Higher Serum Creatinine Concentrations in Blacks with Chronic Kidney Disease: Beyond Nutritional Status and Body Composition," is available online at cjasn.asnjournals.org/ and in print in the July 2008 issue of CJASN.

The American Society of Nephrology (ASN) is a not-for-profit organization of 11,000 physicians and scientists dedicated to the study of nephrology and committed to providing a forum for the promulgation of information regarding the latest research and clinical findings on kidney diseases. ASN publishes the Journal of the American Society of Nephrology (JASN), the Clinical Journal of the American Society of Nephrology (CJASN), and the Nephrology Self-Assessment Program (NephSAP).

Contact: Shari Leventhal sleventhal@asn-online.org 202-416-0658 American Society of Nephrology

Racial Differences in Treating Vision Disorders

Study Alerts Eye Doctors of Racial Differences in Treating Vision Disorders

Blacks are more likely to lose vision due to increased pressure in the brain than other races, reports an Emory Eye Center researcher in the March 11, 2008 issue of Neurology, the journal of the American Academy of Neurology

The pressure, called idiopathic intracranial hypertension, was identified as causing the disorder, says Beau Bruce, MD, a neuro-ophthalmology fellow at the Emory University School of Medicine and lead researcher for the study.

"The racial factor is purely just that," says Dr. Bruce. "Other factors such as differences in diagnosis, treatment or care don't seem to matter. We found that intracranial hypertension clearly affects black people more aggressively. This would tell us that ophthalmologists and others treating blacks need to monitor their vision very closely."

Timothy W. Olsen, MD, director of Emory Eye Center, says, "Dr. Bruce and colleagues have discovered an interesting association that warrants further investigation. Identification of the key risk factors certainly help clinicians in patient management."

Idiopathic intracranial hypertension has no known cause. Those affected may experience headache, ringing in the ears and vision problems. Blurriness and double vision are typical. This disease is most common in young, obese black women.

Seventeen years of records at Emory Eye Center were reviewed for the study. All patients in the study had intracranial hypertension. Of the 450 patients, 197 were black, 246 were white, five were Hispanic and two were Asian. The black patients were 3.5 times more likely to end of up severe vision loss in at least one eye. Further, they were five times more likely to become legally blind than the non-black patients.

Dr. Bruce notes that the black patients in his study did have other risk factors including weight (higher body mass index), higher frequency of low blood iron and higher pressures around the brain than other study participants. Vision loss in blacks could be explained somewhat by those factors, he says.

Research to Prevent Blindness, Inc. and the National Institutes of Health helped fund the study.

About Emory Eye Center - The Department of Ophthalmology and Emory Eye Center have a mission to conduct pioneering research into blinding eye diseases, to educate and train eye professionals, and to provide excellent patient care. The Department includes 23 ophthalmologists, seven optometrists, nine basic scientists, 11 post-doctoral fellows, and nine researchers in other Emory departments who hold joint appointments in the Department of Ophthalmology. Ophthalmology research is supported by $6 million in NIH funding. The Department has remained in the top rankings by U.S. News & World Report for the 11 years the magazine has held a ranking for Ophthalmology. For more information visit Emory Eye Center

Media Contact: Joy Bell jbell@emory.edu (404) 778-3711 WEB: The Woodruff Health Sciences Center of Emory University

Promoting seat belt use among black motorists

Nathaniel C. Briggs, M.D., M.Sc. Assistant Professor. Family & Community Medicine (615) 327-5502 Fax (Fax) 1005 Dr. D.B. Todd Boulevard. 2nd Floor, Old Hospital, Room D206, Nashville, TN 37208 nbriggs@mmc.edu. WED: Meharry Medical College - Faculty

New study investigates link between seat belt laws and racial disparities in seat belt use Seat belts reduce injuries and deaths in motor vehicle crashes, but previous studies have found that blacks buckle up significantly less often than whites. An article in the August issue of the American Journal of Preventive Medicine by researchers from Meharry Medical College may shed some new light on the racial disparity in seatbelt use, and how it could be eliminated.

Nathaniel C. Briggs, M.D. and his Meharry - State Farm Alliance research team found that racial differences in seatbelt use vary according to the type of seatbelt law enforced by individual states. In states with secondary seatbelt laws, where motorists can be cited for a seatbelt law violation only if stopped for another offense, blacks are significantly less likely to wear seatbelts than whites. In states with primary laws, where motorists can be stopped solely for not wearing a seat belt, the disparity disappears.

Although 49 states (all except New Hampshire) and the District of Columbia have seat belt laws, only 25 have primary laws. Therefore, Briggs et al. believe that, if the 24 states with secondary seatbelt laws upgraded to a primary law, the disparity in seat belt use between blacks and whites would be eliminated virtually throughout the country. In turn, this could lead to a reduction in the disproportionate number of motor vehicle crash-related injuries and deaths reported among blacks.

While two previous studies found that disparities in seatbelt use between black and white motorists were reduced under primary laws, the studies were limited in scope and the research was inconclusive.

Using data from the Fatality Analysis Reporting System (FARS), a U.S. population-based archive of information on motor vehicle crash fatalities maintained by the National Highway Traffic Safety Administration (NHTSA), investigators looked at seatbelt use among 11,574 black and 73,639 white occupants of passenger cars or light trucks who were aged 16 years and older and fatally injured in crashes between January 1, 1999 and December 31, 2003. In the 33 U.S. states with accurate reporting of decedent race, 7 states had primary seat belt laws, 22 states had secondary laws and an additional 4 states transitioned from secondary to primary laws during the study period.

Compared with secondary-law states, seat belt use in primary-law states was 18 percent higher among blacks and 15 percent higher among whites. In secondary-law states blacks are only 89 percent as likely as whites to use seatbelts, whereas in primary-law states blacks are 105 percent as likely as whites to buckle up. The low prevalence of seatbelt use in secondary law states is largely limited to urban areas, where blacks are only 75 percent as likely as whites to wear seatbelts. The black-white seatbelt use disparity in secondary law states also seems to be limited to motorists ages 16-29 and 50+. Regardless of state seat belt law, black-white seat belt use disparities were most marked at the extremes of driving age.

While it is unclear what accounts for the increased seatbelt use among black motorists in primary law states, Briggs et al. suggest that the findings may reflect concerns of blacks about the possibility of racial profiling, or differential enforcement, whereby law enforcement officers could selectively stop and cite minority motorists for seatbelt law violations.

The authors note that "The issue of differential enforcement has received little attention in the peer-reviewed literature, and should be addressed using methodologically robust epidemiologic studies. In the interim, however, the passage of primary seat belt laws, in conjunction with provisions or companion legislation to monitor and prevent racial profiling, appears to be justified given the possibility that we can achieve racial parity in motor vehicle crash mortality rates." ###

The article is "Seat belt Law Enforcement and Racial Disparities in Seat belt Use" by Nathaniel C. Briggs, M.D., M.Sc., David G. Schlundt, Ph.D., Robert S. Levine, M.D., Irwin A. Goldzweig, M.S., Nathan Stinson, Jr., M.D., Dr.P.H., and Rueben C. Warren, D.D.S., Dr.P.H.

The article appears in the American Journal of Preventive Medicine, Volume 31, Issue 2 (August 2006) published by Elsevier).

Contact: Charlotte Seidman eajpm@ucsd.edu 858-457-7292 American Journal of Preventive Medicine