Genetic ancestry of African-Americans reveals new insights about gene expression

Alkes Price, Assistant Professor of Epidemiology Department of Epidemiology Department of Biostatistics 665 Huntington Avenue Building 2, Room 211 Boston, Massachusetts 02115. 617.432.2262. aprice@hsph.harvard.edu

The amount of proteins produced in cells—a fundamental determinant of biological outcomes collectively known as gene expression—varies in African American individuals depending on their proportion of African or European genetic ancestry. These findings, by researchers based in Boston, Philadelphia and Oxford, are published December 5 in the open-access journal PLoS Genetics. Gene expression is known to vary among individuals and to be influenced by both genetic and environmental factors. Previous studies have reported gene expression differences among human populations, but it has been suggested that this could be due to non-genetic effects.

Populations of recently mixed ancestry such as African Americans, who on average inherit about 80% African and 20% European ancestry, offer a solution to this question, since individuals vary in their proportion of European ancestry while the analysis of a single population minimizes non-genetic factors.

In this study, the researchers show that gene expression levels in African Americans vary as a function of each individual's proportion of European ancestry. The differences due to ancestry (i.e. population differences between all Africans and all Europeans) were generally small—much smaller than differences between individuals within the same population; nevertheless, the authors were able to draw a distinction between effects of genetic ancestry at the location of the expressed gene (cis) and genetic ancestry elsewhere in the genome (trans). They conclude that only about 12% of heritable variation in human gene expression is due to cis regulation.

First author Alkes Price says, "It was a surprise that these conclusions could be drawn given that the differences due to genetic ancestry are so small." However, he cautioned that the results were confined to gene expression levels in a particular type of tissue known as lymphoblastoid cell lines, and have yet to be verified in other tissue types. ###

PLEASE ADD THIS LINK TO THE PUBLISHED ARTICLE IN ONLINE VERSIONS OF YOUR REPORT: dx.plos.org/10.1371/journal (link will go live on Friday, December 5)

CITATION: Price AL, Patterson N, Hancks DC, Myers S, Reich D, et al. (2008) Effects of cis and trans Genetic Ancestry on Gene Expression in African Americans. PLoS Genet 4(12): e1000294. doi:10.1371/journal.pgen.1000294

CONTACT: Alkes Price Assistant Professor, Departments of Epidemiology and Biostatistics Harvard School of Public Health aprice@hsph.harvard.edu

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Genetic variation increases HIV risk in Africans

Professor Weiss and the study of HIV/AIDS, Professor Weiss is a leading international authority on HIV and AIDS, having been responsible for some of the most important research breakthroughs in the field. His team identified CD4 as the cell surface receptor for the HIV virus, and contributed to the development of the first screening test to detect HIV in blood banks and prevent transmission of the disease through transfusions. Professor Weiss was awarded the Ernst Chain Award, in recognition of his contribution to HIV/AIDS research, in 2007. He currently leads a $25 million research consortium funded by the Bill and Melinda Gates Foundation which is searching for a vaccine against HIV.

A genetic variation which evolved to protect people of African descent against malaria has now been shown to increase their susceptibility to HIV infection by up to 40 per cent, according to new research. Conversely, the same variation also appears to prolong survival of those infected with HIV by approximately two years. The discovery marks the first genetic risk factor for HIV found only in people of African descent, and sheds light on the differences in genetic makeup that play a crucial role in susceptibility to HIV and AIDS. The research, published today in Cell Host & Microbe, was co-authored by Professor Robin Weiss, UCL Infection and Immunity, who worked with colleagues in the US to analyse data from a 25-year study of thousands of Americans of different ethnic backgrounds. The gene that the research focused on encodes a binding protein found on the surface of cells, called Duffy Antigen Receptor for Chemokines (DARC).

The variation of this gene, which is common in people of African descent, means that they do not express DARC on red blood cells. DARC influences the levels of inflammatory and anti-HIV blood factors called chemokines.

Discussing the findings, Professor Weiss said: "The big message here is that something that protected against malaria in the past is now leaving the host more susceptible to HIV.

"In sub-Saharan Africa, the vast majority of people do not express DARC on their red blood cells and previous research has shown that this variation seems to have evolved to protect against a particular form of malaria. However, this protective effect actually leaves those with the variation more susceptible to HIV."

Lead author of the study, Professor Sunil K. Ahuja, from The University of Texas Health Science Center at San Antonio, added: "It turns out that having this variation is a double-edged sword. The finding is another valuable piece in the puzzle of HIV-AIDS genetics."

HIV affects 25 million people in sub-Saharan Africa today, an HIV burden greater than any other region of the world. Around 90 per cent of people in Africa carry the genetic variation, meaning that it may be responsible for an estimated 11 per cent of the HIV burden there. The authors observe that sexual behaviour and other social factors do not fully explain the large discrepancy in HIV prevalence in populations around the world, which is why genetic factors are a vital field of study. ###

Notes for Editors

1. Journalists seeking more information, or to interview Professor Robin Weiss, can contact Ruth Metcalfe in the UCL Media Relations Office on tel: +44 (0)20 7679 9739, mobile: +44 (0)7990 675 947, out of hours: +44 (0)7917 271 364, e-mail: r.metcalfe@ucl.ac.uk

2. The paper 'Duffy Antigen Receptor for Chemokines (DARC) Mediates Trans-infection of HIV-1 from Red Blood Cells to Target cells and Affects HIV-AIDS Susceptibility' is published in the journal Cell Host & Microbe, published by Cell Press. This is not an open-access journal but copies of the paper can be obtained from Ruth Metcalfe, UCL Media Relations, using the above contact details.

3. The authors of this paper are from: South Texas Veterans Health Care System, Texas, US; The University of Texas Health Science Center in San Antonio, US; UCL; Uniformed Services University, Maryland, US; Wilford Hall United States Air Force Medical Center, US and the San Antonio Military Medical Center.

4. In the UK, this work was supported by a grant to Professor Weiss from the Medical Research Council.

About UCL, Founded in 1826, UCL was the first English university established after Oxford and Cambridge, the first to admit students regardless of race, class, religion or gender, and the first to provide systematic teaching of law, architecture and medicine. In the government's most recent Research Assessment Exercise, 59 UCL departments achieved top ratings of 5* and 5, indicating research quality of international excellence.

UCL is in the top ten world universities in the 2007 THES-QS World University Rankings, and the fourth-ranked UK university in the 2007 league table of the top 500 world universities produced by the Shanghai Jiao Tong University. UCL alumni include Marie Stopes, Jonathan Dimbleby, Lord Woolf, Alexander Graham Bell, and members of the band Coldplay. www.ucl.ac.uk

Contact: Ruth Metcalfe r.metcalfe@ucl.ac.uk 020-767-99739 University College London

More young black men have done prison time than served in the military or earned a college degree

Being jailed in federal or state prisons has become so common for African Americans today that more young black men in the United States have done time than have served in the military or earned a college degree, according to a new study.

The paper, appearing in the most recent American Sociological Review (published by the American Sociological Association), estimates that 20 percent of all black men born from 1965 to 1969 had served time in prison by the time they reached their early 30s. By comparison, less than 3 percent of white males born in the same time period had been in prison.

Equally startling, the risks of prison incarceration rose steeply with lower levels of education. Among blacks, 30.2 percent of those who didn't attend college had gone to prison by 1999 and 58.9 percent of black high school dropouts born from 1965 through 1969 had served time in state or federal prison by their early 30s.

Becky Pettit: Assistant Professor of Sociology, brings the perspectives of demography and economic sociology to the study of social, gender and racial inequalities. Her current projects include a study of the consequences of the rise in the American prison population for the labor market experiences of low-skill men and a study of the role of state policies in institutionalizing gender inequalities in the labor market.

"More strikingly than patterns of military enlistment, marriage or college graduation, prison time differentiates the young adulthood of black men from the life course of white males. Imprisonment is now a common life event for an entire demographic group," said Becky Pettit, one of the study's authors and a University of Washington assistant professor of sociology. Bruce Western, a Princeton University professor of sociology, is the co-author. The study also looked at men born from 1945 through 1949. The study draws on publicly available data on inmates in federal and state prisons from the federal Bureau of Justice Statistics, but does not include information on time spent in local jails, which hold an estimated one-third of the incarcerated prison population. Hispanics were not included because data were not available, particularly about men born in the 1940s. The incarceration rate for black men born in 1945 to 1949 was 10.6 percent by the time they were in their early 30s, but increased to 20.5 percent for those born in the 1965-1969 period. Among white men the overall risk of imprisonment grew from 1.4 percent to 2.9 percent over the same period.

The increase in incarceration rate marked a dramatic shift in the life course for young black males. In addition to estimating the risk of incarceration for birth cohorts by race and education, the researchers compared the prevalence of spending time in prison to other important life events for men born from 1965-1969 who survived until 1999. Pettit and Western found that 22.4 percent of surviving black men born in that period had spent time in jail, while just 17.4 percent had served in the military and only 12.5 percent had earned a bachelor's degree.

By the end of 1999, 1.3 million men were in federal or state prisons. The researchers said that changes in penal policy through the 1970s and 1980s, including custodial sentences for drug offenses and mandatory minimum sentences, helped fuel the expansion of the penal system and has led to growing disparities in the risk of incarceration among men of different education levels.

"Prison is no longer just for the most violent or incorrigible offenders. Inmates are increasingly likely to be serving time for drug offenses or property crimes," Pettit said. "While there is enduring racial disproportionality in imprisonment, we find that the lifetime risk of incarceration is increasingly stratified by education. Over the past 30 years the risk of incarceration has grown for both blacks and whites, but has grown the fastest among men who have a high school diploma or less."

"This has become increasingly important because we know ex-prisoners face a variety of challenges after incarceration," said Western. "These range from employer discrimination in the job market to increased risks of divorce and separation in family life. The experience of imprisonment in America has emerged as a key social division, marking a new pattern in the lives of recent birth cohorts of black men." ###

The research was supported in part by the National Science Foundation and the Russell Sage Foundation.

Contact: Johanna Ebner / Lee Herring pubinfo@asanet.org 202-383-9005 x332 American Sociological Association

Archaeologists find evidence of earliest African slaves brought to new world

A study by James Burton and T. Douglas Price of the University of Wisconsin-Madison and Vera Tiesler of the Autonomous University of the Yucatan provides the earliest definitive link between the African Diaspora and the New World. Digging in a colonial-era graveyard in Campeche, one of the oldest European cities in Mexico, archaeologists found and researchers chemically analyzed what they believe are the oldest remains of slaves brought from African to the New World. Pictured here is a grave where skeletons of Africans were found in the cemetery in Campeche, Mexico. Photo by: courtesy T. Douglas Price

In the early European histories of the New World, there are numerous accounts of African slaves accompanying explorers and colonists. Now, digging in a colonial era graveyard in one of the oldest European cities in Mexico, archaeologists have found what they believe are the oldest remains of slaves brought from Africa to the New World. The remains date between the late-16th century and the mid-17th century, not long after Columbus first set foot in the Americas. The discovery is to be reported in an upcoming edition of the American Journal of Physical Anthropology by a team of researchers from the University of Wisconsin-Madison and the Autonomous University of the Yucatan. The African origin of the slaves was determined through the reading of telltale signatures locked at birth into the tooth enamel of individuals by strontium isotopes, a chemical which enters the body through the food chain as nutrients pass from bedrock through soil and water to plants and animals. The isotopes found in the teeth are an indelible signature of birthplace, as they can be directly linked to the bedrock of specific locales, giving archaeologists a powerful tool to trace the migration of individuals on the landscape. The new study, which was supported by the National Science Foundation, draws on isotope ratios found in the teeth of four individuals from among 180 burials found in a multiethnic burial ground associated with the ruins of a colonial church in Campeche, Mexico, a port city on the Yucatan Peninsula.

The new isotopic studies are important, according to the new report's authors, James Burton and T. Douglas Price of UW-Madison and Vera Tiesler of the Autonomous University of the Yucatan, because they provide the earliest definitive physical link between the African Diaspora and the New World. Over a span of nearly 400 years, as many as 12 million people were placed in bondage and brought across the Atlantic under horrific conditions to work, primarily, in the mines and plantations of the New World.

"This is the earliest documentation of the African Diaspora in the New World," says Price, a UW-Madison professor of anthropology. "It does mean that slaves were brought here almost as soon as Europeans arrived."

In early colonial Mexico, Campeche was an important Spanish gateway to the New World. It served as a base for exploration and conquest and was a key defensive outpost in a region infested with pirates. Presumably, slaves from the infamous West African port of Elmina were shipped to Campeche where they may have been used as domestic servants.

The discovery of the remains of slaves born in Africa from such an early date shows that slavery became an integral aspect of the New World economy not long after the Conquistadors completed the subjugation of Mexico, says Price.

Archaeological and historical evidence, including a map of colonial Campeche, suggest the graveyard was in use from about 1550 to the late 1600s. It was uncovered, along with the foundations of a colonial era church, in 2000 by construction workers digging around Campeche's central park. The site was excavated under the direction of Tiesler.

The archaeologists were drawn to some of the individuals buried in the colonial cemetery because of distinctive dental mutilations, a decorative practice characteristic of Africa.

Burton and Price, in collaboration with Tiesler, are conducting a much broader study of human mobility in ancient Mesoamerica using isotopic analysis. They conducted a blind study of the isotopic content of teeth from 10 individuals from the Campeche churchyard. Four of the samples, says Burton, "were like something we'd never seen."

The ratios, he explains, were well off the charts for anyone born in Mesoamerica. Instead, they reflected the geology of West Africa, which is underlain by a massive shield of ancient rock, much older than the geology of Mexico and Central America.

The chemical analysis, combined with the distinctive dental mutilation, provides strong evidence that "these folks were born in Africa and brought to the New World," says Price. " The thing that impresses me is that it was happening so early. "

African slaves were brought to the New World as the Spanish needed labor to harvest timber and work in the mines that enriched Spain. Early in their rule, the Spanish enslaved Indians to perform heavy labor, but they turned to the African slave trade as diseases introduced by Europeans decimated native peoples. ###

Terry Devitt, 608-262-8282, trdevitt@wisc.edu WEB: More news Photos

Contact: T. Douglas Price tdprice@wisc.edu 608-262-2575 University of Wisconsin-Madison

Racism's cognitive toll: Subtle discrimination is more taxing on the brain

While certain expressions of racism are absent from our world today, you do not have to look very hard to know that more subtle forms of racism persist, in schools and workplaces and elsewhere. How do victims experience these more ambiguous racist messages" Are they less damaging than overt hostility" And what are the mental and emotional pathways by which these newer forms of discrimination actually cause personal harm"

Psychologists have some theories about how the experience of racism plays out in the brain—and what that means today compared to before. All human beings are driven by a few core needs, including the need to understand the world around us. When people do things to us, we must know why, and if we are uncertain we will spend whatever cognitive power we have available to diagnose the situation.

The problem is that we have limited cognitive resources, so when we are solving one problem, we have difficulty focusing on another at the same time. Some psychologists reason from this that subtle racism might actually be more, not less, damaging than the plain antipathy of yesterday, sapping more mental energy.

Old-fashioned racism—a “No Negroes Allowed” sign, for example—is hateful and hurtful, but it’s not vague or confusing. It doesn’t require much cognitive work to get it. But if you’re the most qualified candidate for a job, and know it, and still don’t get the job for some undisclosed reason—that demands some processing. Princeton psychologists Jessica Salvatore and J. Nicole Shelton decided to explore this idea in the laboratory. They ran an experiment in which volunteers witnessed a company’s hiring decisions from the inside. They saw the competing resumes of the candidates and the interviewer’s comments and recommendations. This wasn’t a real company, and there were no real people involved, but the volunteers believed it was all real.

The experiment left no doubt about which candidate was best qualified, and sometimes that candidate was chosen, sometimes not. Sometimes the company passed over the best candidate for blatantly racist reasons; the reviewer might comment that the candidate belonged to “too many minority organizations,” for example. Other times the best candidate was simply passed over for no good reason. The psychologists ran the experiment many times, in every combination, so that both black and white volunteers saw black candidates reviewed by whites and by blacks and the same for white candidates.

After witnessing these fair and unfair hiring decisions, the study volunteers took the so-called Stroop test. During this test, the names of colors flash on the screen for an instant, but in the “wrong” colors (the word “red” in green letters, for example), and the idea is to quickly identify the color of the letters. It tests capacity for mental effort, and the idea in this study was to see if experiencing subtle racism interfered with that mental capacity.

It did, at least for blacks, and more than the overt racism did. As reported in the September issue of Psychological Science, black volunteers who had witnessed unfair but ambiguous hiring decisions did much less well on the Stroop test, suggesting that they were using all their mental resources to make sense of the unfairness. Interestingly, white volunteers were more impaired by overt racism than by the more ambiguous discrimination. Salvatore and Shelton figure this is because whites rarely experience any racism; they do not even notice the subtle forms of racism, and are thrown off balance when they are hit over the head by overt acts. Many blacks, by contrast, have developed coping strategies for the most hateful kinds of racism; it’s the constant, vague, just-below-the-surface acts of racism that impair performance, day in and day out. ###

Author Contact: Nicole Shelton nshelton@princeton.edu

Psychological Science is ranked among the top 10 general psychology journals for impact by the Institute for Scientific Information. For a copy of the article “Cognitive Costs of Exposure to Racial PRejudice” and access to other Psychological Science research findings, please contact Catherine West at (202) 783-2077 or cwest@psychologicalscience.org.

For more insights into human behavior, visit "We're Only Human . . ." at www.psychologicalscience.org/onlyhuman.

Contact: Catherine West cwest@psychologicalscience.org 202-783-2077 Association for Psychological Science

Race guides neighborhood evaluation, study says

Detroit, Michigan. Back view of a Negro dressed in a zoot suit, walking in the business district, Library of Congress Prints and Photographs Division Washington, D.C. 20540

Race is a powerful determinant of how whites regard a neighborhood, according to a recent study at the University of Illinois at Chicago and the University of Michigan. The investigation, appearing in the latest issue of the journal Du Bois Review: Social Science Research on Race, indicates that neighborhood evaluations are socially constructed and contribute to ongoing racial segregation. "We sought to determine whether whites are colorblind in their evaluations of neighborhoods, or whether racial composition still matters

-- even when holding constant the quality of the neighborhood," said Maria Krysan, professor of sociology at UIC and the report's lead author. Co-authors are Reynolds Farley and Mick Couper of the University of Michigan Institute for Social Research.

The survey-based experiment involved more than 600 randomly selected white adults aged 21 and older living in the Chicago and Detroit metropolitan areas.

Participants were shown videos of various neighborhoods -- lower working class to upper class -- with actors posing as residents. Residents were portrayed doing exactly the same activities in each neighborhood, such as picking up mail or talking to neighbors.

While the survey participants viewed the same neighborhoods in the videos, they were randomly assigned to see white residents, black residents or a mix of both.

Participants were then asked to evaluate the neighborhoods in terms of housing cost, property upkeep, school quality, safety and future property values.

Whites who saw white residents in the video rated neighborhoods significantly more positively in four of the five dimensions when compared to whites who saw black residents in the identical neighborhood. Racially mixed neighborhoods fell in between.

"These findings demonstrate that 'objective' characteristics such as housing are not sufficient for whites to overcome the stereotypes they have about communities with African-American residents," said Krysan, who is also affiliated with the University of Illinois Institute of Government and Public Affairs.

Participants were also questioned regarding their endorsement or rejection of racial stereotypes. Whites who held negative stereotypes about blacks as a group were more likely to produce disapproving neighborhood evaluations.

According to the researchers, property value stagnation is one consequence of whites excluding neighborhoods solely due to the presence of black residents.

"This segregation limits occupational opportunities for blacks, ensures that blacks and whites will seldom have the chance to attend school together, and seriously limits the acquisition of wealth by African-Americans," said Michigan's Farley, who noted that racial segregation remains common in the older metropolises of the Midwest and Northeast.

Harvard University sociologist Lawrence Bobo, editor of the Du Bois Review, lauded the new study.

"It is rare to find research that combines high-quality new data with such grounded, real-world issues," he said. "Thanks to this highly innovative piece of research, we now understand far better than ever before the factors that create and sustain racial segregation of neighborhoods in America." ###

The study was funded by the National Science Foundation, the University of Michigan, the Ford Foundation, and UIC.

Established in 1948, the University of Michigan Institute for Social Research is among the world's oldest academic survey research organizations and a world leader in the development and application of social science methodology.

UIC ranks among the nation's top 50 universities in federal research funding and is Chicago's largest university with 25,000 students, 12,000 faculty and staff, 15 colleges and the state's major public medical center. A hallmark of the campus is the Great Cities Commitment, through which UIC faculty, students and staff engage with community, corporate, foundation and government partners in hundreds of programs to improve the quality of life in metropolitan areas around the world.

Contact: Brian Flood bflood@uic.edu 312-996-7681 University of Illinois at Chicago

Research demonstrates differing genetic makeup of lung cancer in African-American patients

Cartoon diagram of the epidermal growth factor receptor (EGFR) (rainbow colored, N-terminus = blue, C-terminus = red) complexed with its ligand epidermal growth factor (magenta) based on the PDB 1NQL crystallographic coordinates.

Informs clinical development of EGFR inhibitor drugs The tumors of African-American non-small cell lung cancer patients are more likely to carry a higher number of copies of the epidermal growth factor receptor (EGFR) gene and fewer mutations of EGFR itself than Caucasians according to a study presented at the 2008 Chicago Multidisciplinary Symposium in Thoracic Oncology, cosponsored by ASTRO, ASCO, IASLC and the University of Chicago.

These genetic factors have been shown to predict long-term outcome and tumor responses when taking erlotinib and gefitinib – common EGFR inhibitor drugs.

Previous studies have determined that ethnicity can have an influence on the risk and outcome of non-small cell lung cancer patients, with African-American patients experiencing a higher risk and poorer outcomes. Ethnic background can also impact the genetic make-up and responsiveness of non-small cell lung cancer to EGFR gene blocking drugs. For example, a large number of Asian patients carry mutations of the EGFR gene than Caucasians, which can determine the likelihood of major clinical responses to EGFR inhibitor drugs while a higher copy number of EGFR is a predictor of better long-term outcome with the use of these drugs.

Researchers at the Departments of Medicine, Pathology and Biostatistics at Case Western Reserve University in Cleveland; the Departments of Medicine and Pathology at the University of Colorado Cancer Center in Aurora, Colo.; and the Instituto Clinico Humanitas IRCCS in Rozzano, Italy, sought to determine the frequency of EGFR abnormalities in African American patients since there is a paucity of data on this population.

The study authors observed 53 African-American patients with resected non-small cell lung cancer and found few EGFR mutations and an increase in the frequency of tumors with a high copy number of the EGFR gene. Previous studies have shown that an increase in the number of copies, regardless of mutation, predicts a better outcome with EGFR inhibitor drugs.

"The findings of this study were surprising since it was not expected that drug-sensitizing EGFR mutations would be so rare in this patient population," Rom Leidner, M.D., one of the study's authors and a clinical fellow in hematology/oncology at Case Western Reserve University said. "African-American patients remain underrepresented in clinical studies in oncology and therefore our knowledge base about how to modify our treatment strategies for this patient population remains poorly defined."

Researchers hope that the findings of their study could impact how clinical studies are designed in the future and how EGFR-targeted agents are used in the future. ###

The abstract, "A Study of Genetic Abnormalities of the EGFR Pathway in African American Patients with Non-Small Cell Lung Cancer," will be presented in a poster discussion session Friday, November 14, 2008 from 9:30 a.m. to 10:00 a.m. To speak to Dr. Leidner, please call Beth Bukata or Nicole Napoli on November 13-14, 2008, in the Press Room at the Chicago Marriott at 312-595-3177. You may also e-mail them at bethb@astro.org or nicolen@astro.org.

Contact: Beth Bukata bethb@astro.org 703-839-7332 American Society for Therapeutic Radiology and Oncology

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Hypertension develops early, silently, in African-American men

Kevin Heffernan, Ph.D. ostdoctoral Fellow Molecular Cardiology Research Center Tufts Medical Center 800 Washington Street, Box 080 Boston, MA 02111, 617-636-1441 Kevin Heffernan Kevin Heffernan was born and raised in the Bronx NY. He completed his BS in Exercise Science at the University of Scranton, his MS in Applied Physiology and Nutrition at Columbia University, and his PhD in Kinesiology/Exercise Physiology at the University of Illinois at Urbana-Champaign. Kevin has recently joined the Vascular Function Study Group in the Division of Cardiology. His research will focus on novel mechanisms influencing endothelial function and exercise capacity in patients with cardiovascular disease. When Kevin is not in the lab he enjoys resistance training, long walks on the beach and candlelit dinners.

Study points to central blood pressure as key to screening BETHESDA, Md. (Nov. 17, 2008) − Young and healthy African-American men have higher central blood pressure and their blood vessels are stiffer compared to their white counterparts, signs that the African American men are developing hypertension early and with little outward sign, according to a new study. While the study found that central blood pressure -- the pressure in the aorta, near the heart -- was higher in the African-American men, the study found no difference in brachial blood pressure -- measured on the arm -- between the two groups. Taken together, the findings suggest that hypertension (high blood pressure) may be developing undetected in young African-American men and that measuring central blood pressure may be a better means of detecting the problem as it develops. "Central blood pressure holds greater prognostic value than conventional brachial blood pressure as central pressure more aptly reflects the load encountered by the heart," the authors explained. "Thus, brachial blood pressure may neglect important information on cardiovascular burden and response to therapy in African-American men."

The study, "Racial differences in central blood pressure and vascular function in young men" was carried out by Kevin S. Heffernan, Sae Young Jae, Kenneth R. Wilund, Jeffrey A. Woods and Bo Fernhall, at the University of Illinois, Urbana-Champaign. The study appears online in the American Journal of Physiology-Heart and Circulatory Physiology, published by The American Physiological Society. Dr. Heffernan has since moved to Tufts Medical Center in Boston. Dr. Jae is also affiliated with the University of Seoul.

'Silent killer'

African-American men have higher levels of hypertension than white men. Hypertension is known as the silent killer because it can develop without the individual knowing it. According to the U.S. Centers for Disease Control and Prevention, hypertension is a major risk factor for heart disease, stroke, congestive heart failure, and kidney disease. In 2002, hypertension was listed as a primary or contributing cause of death for 277,000 Americans.

The University of Illinois researchers hypothesized that the blood vessels of the black men would show greater dysfunction than the white men, even though both groups were young and equally healthy and fit. The vascular damage they looked for included stiffening and thickening of the blood vessels. These conditions result in pulsatile (not smooth) blood flow (and at higher pressure) to organs. The pressure can damage the organs over time.

Both groups healthy

The study included 55 young men, 30 white and 25 African-American. Most were university seniors. The average age was 23. There were no differences between the groups on a variety of measures, including heart rate, cardiorespiratory fitness, body mass index, body fat, blood lipids and glucose levels.

The researchers measured vascular function in a variety of ways, including:

* aortic blood pressure and stiffness
* brachial blood pressure
* carotid artery blood pressure
* carotid artery thickness and stiffness

They found the African-American men had similar brachial blood pressure, compared to the white men, but they had significantly higher:

* Central blood pressure, a measure of the pressure found in the artery, near the heart. The researchers used an instrument that takes blood pressure at the wrist and then calculates the central blood pressure.
* Carotid artery pressure. The carotid artery runs through the neck.

The African-American men, unlike the white men, also showed signs of early vascular damage that could lead to hypertension. For example, they had:

* Thicker carotid arteries, a sign of vascular damage that is usually found in older individuals and associated with atherosclerosis.
* Stiffer arteries, which are associated with high blood pressure. When the heart beats, blood flows through stiff arteries at greater speed and pressure. Elastic arteries provide a smoother blood flow and help prevent damage to organs receiving the blood and place less stress on the heart.
* Less change in diameter of the arteries when the heart beats, another measure of vascular stiffness. A healthy artery is more elastic will change in size as the blood flows through with each beat of the heart.

"Although having a similar cardiovascular risk factor profile as young white men, diffuse macrovascular and microvascular dysfunction is present at a young age in apparently healthy African American men," the authors wrote. "Values seen are comparable to values often reported in older individuals or individuals with more advanced hypertensive disease," they said.

These results do not shed light on why this happens to young and fit African-American men, Heffernan said. There may be environmental differences, such as differences in diet, which were not examined as part of this study, he said. ###

Editor's Notes: To arrange an interview with Dr. Heffernan, please contact Christine Guilfoy at cguilfoy@the-aps.org or (301) 634-7253.

A fuller audio interview with Dr. Heffernan is available in Episode 15 of the APS podcast, Life Lines, at www.lifelines.tv.

Funding: American Heart Association and the American College of Sports Medicine

Physiology is the study of how molecules, cells, tissues and organs function to create health or disease. The American Physiological Society (APS) has been an integral part of this scientific discovery process since it was established in 1887.

Find the full interview with Dr. Kevin Heffernan in Episode 15 of Life Lines. Interview begins at 13:26. The link is at lifelines.libsyn.com/

Contact: Christine Guilfoy cguilfoy@the-aps.org 301-634-7253 American Physiological Society

African-Americans with depression and heart attack have greater risk of death

Susmita Parashar, Dr. Mallik graduated from the All India Institute of Medical Sciences, New Delhi, India in 1996. She attended State University of New York, Syracuse, NY for her Internal Medicine internship from 1997 to 1998. After completing her residency at Medical College of Georgia, Augusta, GA in 2000, she joined the Division of General Internal Medicine at Emory University as an academic faculty member. In 2003, she became an Assistant Professor of Medicine at Emory. She completed her Master of Public Health and Master of Science from Emory in 2005.

African-American patients with acute myocardial infarction (MI) and previously treated depression that persists at their MI hospitalization have an increased risk of post-MI death, according to Emory researcher Susmita Parashar, MD, MPH. Parashar, a member of the cardiology division, Emory University School of Medicine, presented findings Nov. 12 at the American Heart Association Scientific Sessions conference in New Orleans. "Our study shows that prior depression that persists at the time of MI may indicate a more severe, enduring or recurrent depression," says Parashar. "Thus, it is important to screen and identify persistent depressive symptoms at the time of hospitalization for MI because targeting of interventions regarding persistent depression may improve outcomes." Often referred to as a heart attack, MI occurs when the blood supply to part of the heart is interrupted. This decreased blood supply is commonly due to blockage of a coronary artery and if left untreated can cause damage and/or death (infarction) of heart muscle tissue. Classical symptoms of acute MI include sudden chest pain, shortness of breath, nausea, vomiting, palpatations, sweating and anxiety.

Heart attacks are the leading cause of death for both men and women in the U.S. Risk factors include cardiovascular disease, older age, tobacco use, diabetes, high blood pressure, obesity, chronic kidney disease, heart failure, excessive alcohol consumption and chronic high level of stress.

Using the Patient Health Questionnaire as part of a prospective myocardial infraction registry, Parashar and her team measured depressive symptoms in 397 African-American MI patients at Grady Memorial Hospital in metro Atlanta.

Patients were assessed and categorized as past, new, persistent or never depressed. Patients were followed up for a maximum of 58 months after MI. Researchers examined the relative prognostic importance of current, past versus persistent depression on mortality among African Americans with acute MI adjusting for demographic, clinical and quality of care variables.

Preliminary results show patients with persistent depression were almost three times as likely to die after MI compared with never depressed patients. ###

Contact: Juliette Merchant jmmerch@emory.edu 404-778-1503 Emory University

Black entrepreneurs 4 times more likely to be refused credit than white businesses

Stuart Fraser, Associate Professor of Enterprise Centre for Small and Medium Sized Enterprises, Enterprise Group. Room D1.18 (Social Studies Building) Warwick Business School The University of Warwick Coventry, CV4 7AL, UK.

A research paper, by Dr Stuart Fraser of Warwick Business School at the University of Warwick, has found that many Ethnic Minority owned Businesses (EMBs) in the UK struggle to obtain credit in comparison to White owned businesses. Black and Bangladeshi owned businesses are the most likely to be refused credit, facing up to four times as many refusals as white owned businesses. Warwick Business School researcher Dr Stuart Fraser examined the small business credit market using data from the UK Survey of Small and Medium Finances (UKSMEF). He found that in particular Bangladeshi and Black owned firms are several times more likely to be denied loans than Indian and White owned businesses. The survey found that 36% of Black African firms had been denied loans compared to 29% of Black Caribbean, 20.6% of Bangladeshi, 12.2% Pakistani, 7.3% Indian, and 8.2% white owned businesses.

At face value, these results would seem to be an indication of ethnic discrimination, however Dr Fraser found that a further analysis of the loan denials and interest rates pointed to differences in creditworthiness rather than ethnic discrimination as an explanation for poorer EMB credit outcomes. In particular, more than half of Black African firms (55.7%), and 40.6% of Black Caribbean firms, exceeded their overdraft limit or missed loan repayments versus about one in four (23.3%) of White owned firms. – and it is this factor that appears to account for their higher loan denial rates.

The research found that one clear reason for this much higher incidence of missed loan repayments and exceeding overdraft limits (financial delinquency) was the much younger age of the Pakistani, Bangladeshi and Black owned firms compared to Indian and White firms. Black African owned businesses averaged 6 years, Black Caribbean 6.9, Bangladeshi, 6.5, Pakistani 8.3, Indian 14.2, and White owned 18.7 years. Other key reasons for financial delinquency include the business owner lacking a financial qualification or suitable financial advice and the business already having too much debt. In the case of Black African firms the research also points to cultural differences as a possible explanation for higher delinquency rates.

The research also found that Black Caribbean firms in the UK are less likely to apply for loans than White owned businesses due to fears of rejection based upon discrimination.

Dr Fraser points to the increasing use of 'arms length' credit and behavioural scoring systems, which do not allow transactions to be tainted by dubious judgements based upon ethnic perceptions by loan officers. He notes that scoring systems may explain the absence of racial bias, but ironically, they may also be responsible for misperceptions of racial bias since the reasons for rejection are not usually made clear to the applicant in these cases.

Dr Fraser says "Improvement in information flows between finance providers and businesses about the criteria used to make credit assessments including providing the reasons for rejection would help tackle the misperceptions of discrimination. In particular, finance providers should make it more clear to EMBs that defaulting on a loan or exceeding an overdraft limit could have adverse consequences for future credit."

This research highlights a number of factors which need to be addressed in order to reduce ethnic variations in loan denial rates: lack of financial skills and advice; poor financial performance; and ethnic and cultural differences. Targeting EMBs for assistance with skills advice may help reduce delinquency rates and improve access to finance. This, together with finance providers investing more in their relationships with Black firms could cause significant reductions in dissatisfaction. ###

Download the research paper: Is there Ethnic Discrimination in the UK Market for Small Business Credit?

For further information please contact: Peter Dunn, Press and Media Relations , University of Warwick Tel: +44 (0)24 76 523708 cell/mobile +44 (0)7767 655860 p.j.dunn@warwick.ac.uk Or Vincent Hammersley, Director of Communications
Warwick Business School Tel +44 (0) 2476 524124 Cell/Mobile +44 (0)7985 956624 Vin.Hammersley@wbs.ac.uk

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Additional study authors include Judith Sayad and Ronald Markwardt.

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

Efforts for whites to appear colorblind may backfire

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

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

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

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

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

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

Claiming color blindness

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

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

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

Political correctness has surprising results

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

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

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

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

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

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

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

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

Gifts, affirmations boost medication adherence in African-Americans

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

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

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

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

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

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

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

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

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

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

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

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

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

Individual author disclosures can be found on the abstract.

The National Heart Lung and Blood Institute funded the study.

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

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

Blood Pressure Control Inequality Linked to Deaths Among Blacks

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

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

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

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

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

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

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

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

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

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

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

ERSD, heart disease and African-Americans with hypertensive nephrosclerosis

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

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

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

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

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

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

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

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

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

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

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

ASN is a not-for-profit organization of 11,000 physicians and scientists dedicated to the study of nephrology and committed to providing a forum for the promulgation of information regarding the latest research and clinical findings on kidney disease. ASN Renal Week 2008, the largest nephrology meeting of its kind, will provide a forum for 11,000 nephrologists to discuss the latest findings in renal research and engage in educational sessions related to advances in the care of patients with kidney and related disorders. Renal Week 2008 will take place November 4 – November 9 at the Pennsylvania Convention Center in Philadelphia, PA.

Contact: Shari Leventhal sleventhal@asn-online.org WEB: American Society of Nephrology

Family problems affect African-American children more than other races

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

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

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

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

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

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

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

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

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

Minority patients discouraged from cancer screening by negative messages

Robert A. Nicholson, PhD, Secondary Faculty, Department of Community Health, Division of Behavioral Science and Health Education. Donco Building Room # 208, Saint Louis University Medical Center. Tel:(314) 977-8490 nicholra@slu.edu WEB: Nicholson | Behavioral Science

PHILADELPHIA – New behavioral science research published in Cancer Epidemiology, Biomarkers & Prevention, a journal of the American Association for Cancer Research, found that constantly emphasizing the negative consequences of a lack of cancer screening among minorities can actually make them less likely to go for screening. "We have typically assumed that one of the best ways to motivate individuals is to point out disparities in health, but we may be having negative unintended consequences," said Robert Nicholson, Ph.D., an assistant professor in the Department of Neurology and Psychiatry at the St. Louis University School of Public Health. "Instead of motivating people who would be less likely to get these services in the first place, we may be driving them away."

Minority communities have been historically underserved by cutting edge medical efforts, and leaders in cancer and other health groups have tried to increase awareness and compliance with known prevention and treatment strategies. However, whether this communication was effective was not known.

Nicholson and colleagues conducted a double-blind, randomized trial among 300 African-American adults. The adults were asked to read one of four articles about colon cancer and then answer questions about their likelihood of getting screened.

The first article emphasized that colon cancer was an important problem for African-Americans. The second emphasized that outcomes for blacks with colon cancer were worse than for whites, while a third said that although outcomes for African-Americans were improving the improvement was less than seen among whites. Finally, a fourth article discussed how outcomes for blacks with colon cancer were improving over time.

If African-Americans read the article that said outcomes for blacks were improving over time, they were more likely to have a positive emotional response than if they read any of the other three articles. The article most likely to cause a negative response was the one that simply stated the problem.

Similarly, those that read the article about African-Americans making progress in outcomes for colon cancer were far more likely to want to be screened than those who read any of the other three articles.

The mean age of the participants was 54.4 years, 76 percent were women and 89 percent had completed high school. Comprehension analysis found that all participants understood what they had read.

Nicholson said they did not ask questions about motivation, but he suggests that a general mistrust of the medical community may be playing a role. If information reinforces that mistrust, then African-Americans are less likely to be screened.

"We believe that a positive message would go a long way toward overcoming mistrust," Nicholson said. "We need the right kind of message for the right kind of person, and not to assume that what we have always done is working." ###

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

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

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

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

African-Americans have unique lung cancer risks from chronic obstructive pulmonary disease

Carol J. Etzel, Ph.D. The University of Texas M. D. Anderson Cancer Center Department of Epidemiology.

PHILADELPHIA – Scientists at the M.D. Anderson Cancer Center have developed a risk prediction assessment for lung cancer specifically for African Americans that suggests a greater risk from chronic obstructive pulmonary disease (COPD), according to a report published in the September issue of Cancer Prevention Research, a journal of the American Association for Cancer Research.

Etzel and colleagues analyzed data from 491 African Americans with lung cancer and 497 African Americans without lung cancer to identify risk factors for the disease. They then compared these risk factors with a previously established risk prediction model for whites.

What was unique to African Americans was the risk associated with chronic obstructive pulmonary disease. African American men with a prior history of chronic obstructive pulmonary disease had a more than sixfold increased risk of lung cancer, similar to that seen with smoking. This is approximately two-fold higher than the risk typically seen from chronic obstructive pulmonary disease among whites.

"The one size fits all risk prediction clearly does not work," said Carol Etzel, Ph.D., assistant professor of epidemiology at the University of Texas M.D. Anderson Cancer Center.

As with whites, smoking was a significant risk factor for lung cancer. Current smokers had a more than sixfold increased risk of lung cancer, and former smokers had a more than threefold increased risk. This decreased risk was confined to those who had quit smoking more than ten years prior to diagnosis; these patients had a 58 percent decreased risk compared with patients who had quit within the previous ten years.

Researchers also found that hay fever, previously shown to be protective among whites, was also protective among African Americans. Specifically, African Americans with hay fever were 44 percent less likely to develop lung cancer, a rate that had been previously seen among whites.

African American males have a higher risk of lung cancer incidence at 110.6 per 100,000 compared with 81 per 100,000 among white males. Mortality is also higher among African American men at 95.8 per 100,000 compared with 72.6 among whites. Lung cancer incidence and mortality rates among women are comparable.

Etzel said the risk prediction model detailed in Cancer Prevention Research is part of an ongoing project to establish risk models among different ethnic groups; a model for Hispanics is currently under development.

"What we hope is that a doctor can use these models to encourage their patients to take steps to prevent lung cancer. Even if they are never smokers, they can be at risk," said Etzel. ###

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