84 percent of African-American and 88 percent of Latino middle class households not financially secure VIDEO

Millions of families experienced economic decline since 2000; households of color hardest hit

New York, NY--As the economic downturn continues, a new report finds that millions of African Americans and Latinos lost economic security between 2000 and 2006, and that more than four out of five are either borderline or at high risk of falling out of the middle class altogether. The new report, "The Downslide Before The Downturn: Declining Economic Security Among Middle Class African Americans and Latinos, 2000-2006" was published today by the policy center Demos and the Institute for Assets and Social Policy (IASP) at Brandeis University.

"The Downslide Before The Downturn" is based on the Middle Class Security Index, co-developed by Demos and IASP/Brandeis, which uses government data and measures the financial security of the middle class by rating household stability across five core economic factors: assets, educational achievement, housing costs, budget and healthcare. Based on how a family ranked in each of these factors, they were defined as financially "secure," "borderline" or "at risk".

"The Downslide Before the Downturn" shows some worrying trends in America's households, including:

* In 2006, before the recession, most US middle class families (76%) were already economically insecure, with only 24 percent experiencing stability across the core Index factors. However, when the numbers are broken down demographically, only 16% of African Americans and 12% of Latinos experienced such security. This is a dramatic decline from 2000, when the national average was 29%, 26% for African Americans and 23% for Latinos.
* In 2006, 88% of Latino and 94% of African-American households lacked sufficient assets to weather a financial emergency, up from 82% and 89% in 2000, respectively.
* The median value of financial assets held by African Americans declined by 33% in the six year period, while those held by Latinos declined by 60% during the same time.
* From 2000 to 2006, median housing costs increased 9% for African American households and 7.5% for Latino households.
* During the same period, the number of families in which at least one member lacked health insurance increased--from 18% to 30% for African Americans and from 26% to 39% for Latinos.

"These results show the precarious position of families who struggle to make it into the middle class amidst policies that do not support broad economic opportunities. Even before things started to slip, African-American and Latino middle-class families were already on weaker footing,

a position that sets them up to lose more ground than they can afford in the current economy," said Jennifer Wheary, one the report's co-authors and a Senior Fellow at Demos.

"The decline in assets experienced by these families is particularly alarming," said Tom Shapiro, Professor and Director of the Institute on Assets and Social Policy at Brandeis University. "Most of these families had few assets to start with. With the value of these assets declining just as families need them most, they will not only find it difficult to weather uncertain times. They'll also experience setbacks that will be felt by future generations. All this points to a need for policies that support asset building even in hard times." ###

"The Downslide before the Downturn" is the fifth report in a series based on the Middle Class Security Index. Recent reports in this series examined the economic security of America's seniors and the overall position of the middle class heading into the recession. In addition to these reports, Demos and IASP/Brandeis have published a Middle Class Security Factsheet that provides information about the broad economic state of the middle class at a glance and a Scorecard that individual families can use to measure their economic stability. To download reports, the Security Scorecard or the Factsheet, visit www.demos.org. To order hard copies or to arrange an interview with one of the authors, please see contact information.

Contact: Laura Gardner gardner@brandeis.edu 781-736-4204 Brandeis University

Study finds African-Americans at greater risk after PCI

Combined rates of heart attack, death and repeat procedures significantly higher

LAS VEGAS, NV (May 8, 2009) — A study from one of the largest public health systems in the country has found that African American patients experienced significantly worse outcomes after angioplasty and stenting than patients of other races, though researchers are not sure why. According to data reported today at the Society for Cardiovascular Angiography and Interventions (SCAI) 32nd Annual Scientific Sessions, no single factor explains why African Americans were at higher risk after percutaneous coronary intervention (PCI), but the hazard was clear.

"We need to be vigilant about evaluating and controlling all risk factors in this vulnerable population of patients," said Sandeep Nathan, MD, an assistant professor of medicine and director of the interventional cardiology fellowship program at the University of Chicago Medical Center. "Despite our best efforts to provide optimal care to all patients, we need to ask, 'What's missing?'"

Sandeep Nathan, MD

For the study, Dr. Nathan and his colleagues recruited 1,410 consecutive patients who had a PCI procedure at Cook County Hospital in Chicago. Patients were included in the study only if complete clinical and procedural information was available and follow-up care would be provided through the Cook County public health system.

Patients were 57 years old, on average. Some 32% were women and 46% were African American. Patients had PCI for a variety of reasons: stable coronary artery disease in 29.1%, a type of heart attack known as ST-elevation myocardial infarction (STEMI) in 17.1%, a non-STEMI heart attack in 27.9%, and unstable angina in 26.0%.

Patients were grouped according to gender and race and followed-up for an average of 1.7 years. During that time, men and women were equally likely to experience a major adverse cardiac event (MACE), which included heart attack, death, or urgent need for another procedure in the treated coronary artery.

The researchers are continuing to comb through the data for factors that signal an increased risk for African Americans after PCI. In the meantime, there are several possible explanations for these findings based on clinical impressions alone, Dr. Nathan said. One of the most likely is that African American patients appeared to wait longer before coming in for treatment. As a result, they were more likely to have advanced coronary disease that was more complicated to treat with PCI, as well as other medical conditions that worsen PCI outcomes, such as high blood pressure and kidney damage. Another key factor may be a lack of adherence to prescribed medications.

These findings may signal a need for better outreach and education. "As physicians, we need to provide excellent medical care, but also be sensitive to sociocultural issues, problems with access to care, and the importance of building trust between the physician and patient," Dr. Nathan said. ###

Dr. Nathan reports no conflicts of interest related to this study.

About SCAI: Headquartered in Washington, D.C., the Society for Cardiovascular Angiography and Interventions is a 4,000-member professional organization representing invasive and interventional cardiologists in more than 60 nations. SCAI's mission is to promote excellence in invasive and interventional cardiovascular medicine through physician education and representation, and advancement of quality standards to enhance patient care.

SCAI's annual meeting has become the leading venue for education, discussion, and debate about the latest developments in this dynamic medical specialty. SCAI's patient and physician education program, Seconds Count, offers comprehensive information about cardiovascular disease. For more information about SCAI and Seconds Count, visit www.scai.org or www.seconds-count.org.

Contact: Kathy Boyd David kbdavid@scai.org 717-422-1181 Society for Cardiovascular Angiography and Interventions

Family-based program helps youth avoid risky behavior -- even those who may be genetically prone to it

Children's behavior is determined, in part, by their genes and by the settings in which they develop. A new longitudinal study describes how a family-based prevention program helped rural African American teens avoid engaging in risky behaviors, even if some of them may have had a genetic risk to do so.

"This study demonstrates that parents play an important role in protecting their children from initiating harmful behaviors, especially when the children's biological makeup may pose a challenge," notes Gene H. Brody, Regents' Professor, director of the Center for Family Research at the University of Georgia, and the lead author of the study. The study, by researchers at the University of Georgia, the University of Iowa, and Vanderbilt University, appears in the May/June 2009 issue of the journal Child Development.

Gene H. Brody, Ph.D. Dr. Brody is a Regents’ Professor of Child and Family Development and Director of CFR. He is an internationally recognized expert on the risk and protective mechanisms that forecast substance use and other problem behaviors among rural African American youth and has translated his findings into efficacious preventive interventions for youth ranging in age from 11 to 19 years. Dr. Brody is the author of more than 200 publications, many of which focus on African American youth development or substance use prevention.

The researchers developed a program called "Strong African American Families" to help rural African American 11-year-olds avoid such risky behaviors as drinking, smoking marijuana, and having sex. Almost 650 children and their mothers participated in the two-and-a-half-year study, which compared mothers and children who took part in the prevention program with mothers and children who only received information about adolescent development. The parents enrolled in the program learned parenting skills that included vigilance, emotional support, communication, and promotion of racial pride. Children who took part learned strategies for setting positive goals, making plans to attain those goals, and avoiding influences that could block their success.

Two years later, the researchers collected DNA from saliva samples from all the children to see if they carried a gene found to increase the risk of substance use. Teens who had the gene but didn't participate in the program were almost twice as likely to have engaged in the risky behaviors as teens who had the gene and took part in the program.

"Much of the protective influence of participation in the prevention program came through the program's enhancement of parenting practices that deter teens' involvement in risky behaviors," adds Brody. "The power of such parenting practices to override genetic predispositions to drug use and other risky behaviors demonstrates the capacity of family-centered prevention programs to benefit developing adolescents." ###

The study was supported by the National Institute on Alcohol Abuse and Alcoholism, and by the National Institute on Drug Abuse.

Summarized from Child Development, Vol. 80, Issue 3, Prevention Effects Moderate the Association of 5-HTTLPR and Youth Risk Behavior Initiation: G×E Hypotheses Tested via a Randomized Prevention Design by Brody, GH, and Beach, SRH (University of Georgia), Philibert, RA (University of Iowa), Chen, Y-f , and Murry, VM (formerly at the University of Georgia, now at Peabody College, Vanderbilt University). Copyright 2009 The Society for Research in Child Development, Inc. All rights reserved.

Contact: Sarah Hutcheon shutcheon@srcd.org 202-289-7905 Society for Research in Child Development

Parental guidelilnes, consequences may be why fewer black teens smoke than whites

It's a curious paradox. Black adults are more likely to smoke than white adults and most smokers start as teenagers. But statistics show that fewer black youths than whites begin smoking as adolescents.

A new University of Washington study indicates that lower rates of smoking among black teens may be the result of black parents setting concrete guidelines about substance use and establishing clearly defined consequences for not following those guidelines.

The research also found that teens who associated with deviant peers – those who were in trouble at school, or who engaged in delinquent behavior or used alcohol or marijuana – were more likely to smoke, according to Martie Skinner, a research scientist with the Social Development Research Group, part of the UW's School of Social Work and the study's lead author.

TITLE: "Ca'ful now, don' you put out ma light". Children--Smoking. RIGHTS INFORMATION: No known restrictions on publication. CREATED/PUBLISHED: c1901.

"This study is important because we looked at how parental guidelines affected peer influences and smoking over a three-year period from the eighth to 10th grades," she said. "Parents can have a strong influence on smoking behavior. "In general, good parenting such as setting clear guidelines about drug use and forming strong relationships with your child reduces the likelihood of teens associating with deviant peers and has a significant impact on whether kids smoke or don't smoke.

Our findings are consistent with other research done here which shows parents are important influences on their teenagers including who they should hang out with.

"Associating with other teens using substances increases a teen's chances of using those substances. This applied to both black and white teens. The majority of eighth graders don't use substances, so it is easy to find other peers who don't use them," she said.

The study found that 15 percent of the black teens reported smoking in the 10th grade compared to 22 percent of the white teens. Black parents were significantly more likely to report guidelines and consequences for substance use. Not surprisingly, black and white teens whose parents smoked reported higher levels of smoking than teens whose parents were non-smokers.

Skinner and her Social Development Research Group colleagues Kevin Haggerty and Richard Catalano collected data from a larger Seattle study designed to prevent substance abuse. The smoking study looked at 331 families - 163 black and 168 white – with slightly more boys than girls.

Skinner thinks rates of smoking among blacks accelerate after leaving high school, a time when many black adolescents are not going to college and move away from their parents' home. She is following the same pool of teenagers in this study to assess their levels of smoking in a follow-up project.

So what can parents do to discourage teen smoking and other substance use? Skinner suggests:

* talking about smoking and substance use directly and not ignoring the topic.
* establishing family guidelines about smoking and moderate consequences for breaking those guidelines.
* keeping communication open so you know what your teen is doing and to maintain a strong relationship.

"These things can be hard to do in the real heat of life," Skinner said. "Getting support from other adults in the child's life, such as teachers, is key. Parenting is the most important thing we do, so we shouldn't hesitate to get help.

"We know family-based interventions can be effective and specific skills to promote healthy development in teens are pretty easily acquired if parents are given good instruction." ###

The National Institute on Drug Abuse funded the study published in the journal Nicotine & Tobacco Research. For more information, contact Skinner at 206-221-2965 or skinnm@u.washington.edu

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

Skin color clue to nicotine dependence

Higher concentrations of melanin -- the color pigment in skin and hair -- may be placing darker pigmented smokers at increased susceptibility to nicotine dependence and tobacco-related carcinogens than lighter skinned smokers, according to scientists.

"We have found that the concentration of melanin is directly related to the number of cigarettes smoked daily, levels of nicotine dependence, and nicotine exposure among African Americans," said Gary King, professor of biobehavioral health, Penn State.

King states that previous research shows that nicotine has a biochemical affinity for melanin. Conceivably, this association could result in an accumulation of the addictive agent in melanin-containing tissues of smokers with greater amounts of skin pigmentation.

Gary King, professor of biobehavioral health, Penn State

"The point of the study is that, if in fact, nicotine does bind to melanin, populations with high levels of melanin could indicate certain types of smoking behavior, dependence, and health outcomes that will be different from those in less pigmented populations," explained King. "And the addiction process may very well be longer and more severe." The team's findings appear in the June issue of the journal Pharmacology, Biochemistry and Behavior.

To investigate the factors linking tobacco use, nicotine exposure, and skin pigmentation, the researchers recruited 150 adult African American smokers from three sites in inner city Harrisburg during summer 2007. Participants provided researchers with the average number of cigarettes smoked each day and answered a questionnaire that measured nicotine dependence -- the Fagerstrom Test of Nicotine Dependence (FTND).

Researchers also measured the smokers' cotinine levels. Cotinine is a metabolic byproduct of nicotine that can be used as a biomarker for tobacco use. King and colleagues surmise that nicotine's half-life may, along with tobacco toxicants, be extended due to the accumulation in melanin-containing tissues.

Statistical analyses of data on the three measures of smoking -- cigarettes per day, FTND score, and cotinine levels -- along with a host of other variables including age, education and social demographics of the smokers, reveal that facultative melanin -- the total amount of melanin acquired genetically plus the amount from the tanning effect of sunlight -- is significantly linked to the number of cigarettes smoked per day as well as the FTND score. This link was not observed with constitutive melanin, which is the amount of melanin solely acquired genetically.

However, the Penn State researcher cautions that additional studies with larger samples of smokers with varying levels of skin pigmentation will be required to provide a clearer picture of the link between skin color and nicotine addiction.

"We also think that studies conducted at different times of the year and in different geographic regions would help avoid seasonal variations such as the effect of tanning during summer," King explained. "Additionally, nicotine levels could also be influenced by factors such as consumption of alcohol, amount of exercise, diet, body fat and stress. Future studies will have to control for these factors as well."

According to King, findings from the study could have potential health implications for African American smokers, who tend to have darker skin, are disproportionately burdened with tobacco-related diseases, and report greater difficulty quitting smoking.

"One of the questions we want to address is why African Americans have lower quit rates than whites," King said. "This avenue of research may help us explore that question more definitively."

Previous studies indicate that even though African Americans smoke fewer cigarettes than some other groups, they have a higher intake of nicotine from each cigarette.

###

Other researchers on the paper include Valerie B. Yerger, Assistant Adjunct Professor, University of California, San Francisco; Guy-Lucien Whembolua, recent doctoral graduate, Penn State; Robert B. Bendel, biostatistician, Washington State University; Rick Kittles, geneticist, University of Chicago; and Eric T. Moolchan, research physician, Alkermes, Inc. (formerly of the National Institute of Drug Abuse).

Penn State's Africana Research Center and the Social Science Research Institute funded this work.

System that regulates blood pressure is amiss in some healthy, young blacks

AUGUSTA, Ga. – When stress increases blood pressure, a natural mechanism designed to bring it down by excreting more salt in the urine doesn't work well in about one-third of healthy, black adolescents, researchers report.

They hope the finding, which is being presented May 8 at the American Society of Hypertension 24th Annual Scientific Program in San Francisco, will lead to early identification of youth at risk of becoming hypertensive adults.

"The way it's supposed to work is the higher your blood pressure goes, the system is supposed to be suppressed so you urinate out more sodium and the blood pressure goes down in response," says Dr. Matthew Diamond, nephrology fellow in the Medical College of Georgia School of Medicine. Dr. Diamond, who is presenting the findings, is a finalist for the society's 2009 Young Investigator-in-Training abstract competition.

Caption: Dr. Matthew Diamond is a nephrology fellow in the Medical College of Georgia School of Medicine. Credit: Medical College of Georgia. Usage Restrictions: None.

The renin-angiotensin-aldosterone system helps regulate blood pressure, prompting the kidneys to hold onto more salt – and fluid – if it's too low and to get rid of salt when it's high. But when MCG researchers looked at the system's activity by measuring levels of the hormones it uses to help regulate sodium excretion, the system – which worked essentially perfectly in healthy white adolescents – appeared dysfunctional in a significant number of the black adolescents.

The study involved 168 15-18-year-olds with normal pressures who had been on sodium- and potassium- controlled diets for two weeks. Researchers took blood pressure, urine and blood samples as participants rested for two hours, played video games intended to stimulate environmental stress, then recovered for two hours at MCG's Georgia Prevention Institute.

"For reasons we don't understand, the black kids have improper suppression of this renin-angiotensin-aldosterone system," Dr. Diamond says.

To make sure the "fight-or-flight" mechanism designed to raise blood pressure to escape a tight spot was not to blame for holding onto sodium, the researchers measured heart rates but could find no relationship. Fat, which produces aldosterone, a hormone that can increase sodium retention, also was ruled out because participants were not obese.

"There is nothing we know about that is explaining what we are seeing yet we have some pathology here that could potentially explain difficult hypertension in kids," he says.

One of his next steps is screen participants for a genetic mutation that has been linked to hypertensive kidney disease to see if that's a factor that can be used to help identify those at risk for hypertension and kidney disease. ###

Study contributors include Dr. John J. White, MCG nephrologist, and Dr. Gregory Harshfield, director of the Georgia Prevention Institute.

Contact: Toni Baker tbaker@mcg.edu 706-721-4421 Medical College of Georgia

Penn geneticist publishes largest-ever study on African genetics revealing origins, migration

PHILADELPHIA – African, American, and European researchers working in collaboration over a 10-year period have released the largest-ever study of African genetic data—more than four million genotypes—providing a library of new information on the continent which is thought to be the source of the oldest settlements of modern humans.

The study demonstrates startling diversity on the continent, shared ancestry among geographically diverse groups and traces the origins of Africans and African Americans. It is published in the April 30 issue of the journal Science Express.

Researchers studied 121 African populations, four African American populations and 60 non-African populations for patterns of variation at 1327 DNA markers. The study traced the genetic structure of Africans to 14 ancestral population clusters that correlated with ethnicity and shared cultural and/or linguistic properties. The research team demonstrated that there is more genetic diversity in Africa than anywhere else on earth.

Dr. Sarah A. Tishkoff. David and Lyn Silfen University Associate Professor, Depts of Genetics and Biology. 428 Clinical Research Building. 415 Curie Boulevard. Philadelphia, PA 19104-6145. Office tel.:215 746-2670. E-mail: tishkoff@mail.med.upenn.edu

They also determined that the ancestral origin of humans was probably located in southern Africa, near the South Africa-Namibian border. Extrapolating the data, scientists were able to map ancient migrations of populations and determined that the exit point of modern humans out of Africa was near the middle of the Red Sea in East Africa. They also provide evidence for ancient common ancestry of geographically diverse hunter-gatherer populations in Africa, including Pygmies from central Africa and click-speaking populations from southern and eastern Africa, suggesting the possibility that the original pygmy language may have contained clicks. Overall, they demonstrate remarkable correspondence between cultural, linguistic, and genetic diversity in Africa.

"This is the largest study to date of African genetic diversity in the nuclear genome," said Sarah Tishkoff, a geneticist with joint appointments in the School of Arts and Sciences and the School of Medicine at the University of Pennsylvania. "This long term collaboration, involving an international team of researchers and years of research expeditions to collect samples from populations living in remote regions of Africa, has resulted in novel insights about levels and patterns of genetic diversity in Africa, a region that has been underrepresented in human genetic studies. Our goal has been to do research that will benefit Africans, both by learning more about their population history and by setting the stage for future genetic studies, including studies of genetic and environmental risk factors for disease and drug response."

Tishkoff says that there is no single African population that is representative of the diversity present on the continent. Therefore, many ethnically diverse African populations should be included in studies of human genetic variation, disease susceptibility, and drug response.

Anthropologists, historians and linguists now have at their disposal a completely new volume of research with which to test theories of human migration, cultural evolution and population history in Africa. Basic scientists, physicians and public health officials now have a foundation for illuminating the complex history of Africans and African-Americans, with implications for studies aimed at finding disease genes in these populations and learning which genetic differences make some individuals more susceptible to diseases like HIV, cancer or malaria.

This study also sheds light on African American ancestry, which they find originates predominantly from western African Niger-Kordofanian (~71 percent), European (~13 percent), and other African (~8 percent) populations, although admixture levels varied considerably among individuals. These results could have important implications for the design and interpretation of studies which aim to identify genetic and environmental risk factors for diseases common in the African American community, including prostate cancer, hypertension and diabetes. ###

The study was funded by the National Cancer Institute, the National Institutes of Health, the Advanced Computing Center for Research and Education at Vanderbilt University, the L.S.B. Leakey and Wenner Gren Foundation, the National Science Foundation, David and Lucile Packard and a Burroughs Wellcome Foundation Career Award given to Tishkoff. Genotyping costs were supported by the National Heart, Lung and Blood Institute Mammalian Genotyping Service.

The study was conducted by Tishkoff, Alessia Ranciaro and Jibril B. Hirbo, formerly with the University of Maryland and now with the Departments of Genetics and Biology at Penn; Floyd A. Reed, also formerly with the University of Maryland and now with Department of Evolutionary Genetics at the Max Planck Institute of Evolutionary Biology; Françoise R. Friedlaender, an independent researcher; Christopher Ehret of the Department of History at the University of California, Los Angeles; Alain Froment of the Musée de l'Homme in Paris; Agnes. A. Awomoyi, formerly of the University of Maryland and currently with the Department of Internal Medicine at Ohio State University; Ogobara Doumbo and Mahamadou A. Thera of the Malaria Research and Training Center, University of Bamako, Mali; Muntaser Ibrahim and Abdalla T. Juma of the Department of Molecular Biology at the University of Khartoum, Sudan; Maritha J. Kotze of the Department of Pathology at the University of Stellenbosch, South Africa; Godfrey Lema and Thomas B. Nyambo of the Department of Biochemistry at Muhimbili University of Health and Allied Sciences, Tanzania; Jason H. Moore of the Departments of Genetics and Community and Family Medicine, Dartmouth Medical School; Holly Mortensen, formerly with the University of Maryland and now with the National Center for Computational Toxicology in the Office of Research and Development, U.S. Environmental Protection Agency; Sabah A. Omar of the Kenya Medical Research Institute; Kweli Powell of the University of Maryland; Gideon S Pretorius of the Division of Human Genetics, University of Stellenbosch, South Africa; Michael W. Smith of the . Laboratory of Genomic Diversity, National Cancer Institute; Charles Wambebe of International Biomedical Research in Africa, Nigeria; James L. Weber of the Marshfield Clinic Research Foundation, Wisc.; and Scott M. Williams of the Department of Molecular Physiology and Biophysics, Center for Human Genetics Research, Vanderbilt University.

The researchers wish to acknowledge the indigenous populations who so graciously donated the DNA samples used in this study.

Contact: Jordan Reese jreese@upenn.edu 215-573-6604 University of Pennsylvania

African-American teens' perceptions of racial discrimination

A three-year study of African American youths' perceptions of racial discrimination has found that many Black teens consider themselves victims of racial discrimination, and these perceptions are linked to how they feel about being Black, particularly their views of how the broader society sees African Americans.

The study, by researchers at the University of North Carolina at Chapel Hill, Fordham University, and the University of Michigan, can be found in the March/April 2009 issue of the journal Child Development.

In an attempt to further our understanding of racial identity among African Americans, the researchers studied more than 200 Black teens ages 14 to 18 who lived and went to school in racially heterogeneous parts of the midwestern United States.

Eleanor K. Seaton, Assistant Professor. Phone: 919-962-2998, 208 Davie Hall, CB# 3270 Psychology Dept. UNC-CH. Chapel Hill, NC 27599-3270 Research Interests: Examining the influence of perceived discrimination on adolescent development among Black youth and in understanding the role of racial identity in well-being among Black youth.

Based on the adolescents' responses to questions about racial group membership, the researchers found that age played a factor in the young people's perceptions: Older teens who had experienced more racial bias felt less positive about being Black. Teens who felt more racial discrimination were more likely to say that society viewed African Americans negatively. "These findings have implications for parents, teachers, and adults who have regular contact with African American youth," says Eleanor K. Seaton, assistant professor in psychology at the University of North Carolina at Chapel Hill, who led the study. "They suggest the need to bolster African American youth's feelings about their racial group membership, especially feelings related to feeling positively about being African American." ### The study was funded by the National Institute of Mental Health and the National Center on Minority Health and Health Disparities (both of the National Institutes of Health), and by the National Science Foundation.

Download this Release in PDF Format, African American Teens’ Perceptions of Racial Discrimination

Contact: Sarah Hutcheon shutcheon@srcd.org 202-289-7905 Society for Research in Child Development

Researchers identify stroke predictors in black patients

WINSTON-SALEM, N.C. – Predictors of atrial fibrillation (AF or afib) might offer physicians a better way to prevent stroke in blacks, according to a new study done by researchers at Wake Forest University School of Medicine.

AF is an irregular and often rapid heart rate that commonly causes poor blood flow to the body, as well as symptoms of heart palpitations, shortness of breath and weakness. Despite low reported prevalence of AF – one of the major risk factors for stroke – in black patients, they suffer strokes five times more often than white patients and die from them two times more often.

That paradox might result from limitations in the methods (electrocardiograms (ECG) or self-report) used to detect AF, said Elsayed Z. Soliman, M.D., M.Sc. M.S., associate director of the Epidemiological Cardiology Research Center (EPICARE) at the School of Medicine and lead author of the study.

Elsayed Z. Soliman, M.D., M.Sc. M.S., associate director of the Epidemiological Cardiology Research Center (EPICARE) at the School of Medicine and lead author of the study.

"The limitations stem from the fact that AF is intermittent in at least 30 percent of patients, and most patients are not aware if they have AF or not," Soliman said. "Trying to detect AF using an ECG, or simply counting on patients to know if they have it, leads to under-diagnosis of the condition most of the time. Our research suggests that being proactive in predicting it may be a better approach." The study appears in the current issue of Stroke, the peer-reviewed journal of the American Heart Association and American Stroke Association. An electrocardiogram is a diagnostic tool that measures and records the electrical activity of the heart. Interpretation of an ECG report allows diagnosis of a wide range of heart conditions from minor to life threatening.

Doctors use ECGs to diagnose AF, and therefore assess the risk of stroke in different patients. However, ECG reports of AF have not been as useful for identifying black patients at high risk. While black patients suffer more ischemic strokes than white patients, their ECG results do not indicate AF as often.

For the study, researchers reviewed ECG data from the Atherosclerosis Risk in Communities (ARIC) study supported by the National Heart, Lung and Blood Institute. More than 15,000 people in North Carolina, Mississippi, Minnesota and Maryland participated in the study during the 1980s and 90s.

Researchers found that, while ECG reports of AF were significantly less in black participants than in whites, black participants ultimately suffered more ischemic strokes. However, the analysis uncovered that ECGs on black participants revealed a higher rate of predictors of future AF than did the ECGs of the white participants. These ECG predictors of AF (P-wave terminal force, P-wave duration, P-wave area and PR duration) represent electrical activity within the upper two chambers of heart, or atria, which are the sources of blood clots that cause stroke if AF occurs. These ECG predictors of AF were strongly predictive of strokes and AF in blacks and whites, so researchers believe their existence could be considered as presence – or future presence – of AF.

"With the blacks having more abnormal ECG predictors of AF, as the results showed, there is a possibility that blacks might actually have a higher prevalence of AF than previous studies have picked up on," Soliman said. "Blacks may have more "intermittent" AF, the difficult type of AF to detect, which could be the reason why previous studies underestimated AF diagnosis more in blacks."

Soliman added that physicians, knowing this, should use the ECG to evaluate black patients' risk of stroke by determining if the patient has certain predictors of AF, instead of the condition itself. If so, the patients may be able to be treated with blood thinners as if they have AF. It is a treatment adjustment that could help prevent stroke, however further investigation into the subject is needed, he said.

"P-wave terminal force in the ECG may provide a strong independent predictor for incidence stroke and AF in clinical practice," Soliman said.

"For the physician evaluating black patients for the risk of stroke, these results show that you cannot think AF is less common in this population," Soliman said.

Soliman said that the next step in research on this subject is to do a long-term ECG study to confirm the hypothesis that AF, especially intermittent AF, has been under-diagnosed in blacks.

"We need further studies using long-term ECG recording – 48 hours to 72 hours – or event monitors to detect AF" he said. "The cost of these tests on population studies has always been an obstacle. However, with the results of this study, it may be worth it." ###

Co-authors on the study are Ronald J. Prineas, M.D., Ph.D., L. Douglas Case, Ph.D., Zhu-ming Zhang, M.D. and David C. Goff Jr., M.D., Ph.D., all of the Division of Public Health Sciences at the Wake Forest University School of Medicine.

Media Relations Contacts: Jessica Guenzel, jguenzel@wfubmc.edu, (336) 716-3487; Bonnie Davis, bdavis@wfubmc.edu, (336) 716-4977; or Shannon Koontz, shkoontz@wfubmc.edu, (336) 716-4587

Wake Forest University Baptist Medical Center (www.wfubmc.edu) is an academic health system comprised of North Carolina Baptist Hospital, Brenner Children's Hospital, Wake Forest University Physicians, and Wake Forest University Health Sciences, which operates the university's School of Medicine and Piedmont Triad Research Park.

The system comprises 1,056 acute care, rehabilitation and long-term care beds and has been ranked as one of "America's Best Hospitals" by U.S. News & World Report since 1993. Wake Forest Baptist is ranked 32nd in the nation by America's Top Doctors for the number of its doctors considered best by their peers. The institution ranks in the top third in funding by the National Institutes of Health and fourth in the Southeast in revenues from its licensed intellectual property.

Contact: Jessica Guenzel jguenzel@wfubmc.edu 336-716-3487 Wake Forest University Baptist Medical Center

Research finds perceived warmth, 'babyfaceness' positive characteristics for black CEOs

Study examined physical characteristics as a predictor of obtaining and maintaining leadership roles

Evanston, Ill. (April 30, 2009) – As President Barack Obama commemorates his 100th day as the country's first black commander-in-chief, a new study by Kellogg School of Management researchers examines the intersection of race and power in corporate America. While many traits of successful leaders transcend racial or ethnic bounds, this study sought to focus on one particular facet of blacks' ascensions to power: the physical characteristics of so-called "babyfaces," and their influence on perception and achievement.

"The Teddy Bear Effect: Does babyfaceness benefit Black CEOs?" will appear in a forthcoming issue of Psychological Science and is co-authored by Robert Livingston and Nicholas Pearce of the Kellogg School.

Robert Livingston. MANAGEMENT & ORGANIZATIONS. Assistant Professor of Management and Organizations

Searching for traits common to black CEOs who have successfully navigated treacherous cultural and corporate terrain, the researchers demonstrate that babyfaces – and perceived warmer physical appearances and personality traits – can benefit black CEOs and act as disarming mechanisms within the social hierarchy. Black CEOs categorized as having a babyface tend to be at the helm of more prestigious corporations than black CEOs who have a more mature appearance.

"Prior research has shown babyface-type traits are a liability for those striving for a leadership role because they undermine perceptions of competence, but these studies focused on white males," said Livingston, lead author and assistant professor of management and organizations at the Kellogg School of Management. "Because a babyface is disarming, we hypothesized that it would provide an advantage to black leaders who have a history of being stigmatized as too threatening to occupy positions of high power."

Methodology

Non-black women and men were shown 40 headshot photos of black men and white women and men. Though the faces were not recognized by participants, all were current or former CEOs of Fortune 500 companies.

Participants were asked to rate how babyfaced, how attractive, and also how old, each person appeared. They also rated each in terms of perceived personality traits. For example, how warm did a person appear? How competent would they be as a leader? Participants were then asked to use those same personality criteria to rate, in general, how they perceive blacks and whites. Finally, participants guessed how much money each person earned.

Rev. Nicholas Pearce

Babyface Definition

The researchers have identified several traits associated with "babyfaceness" including a rounder face, larger forehead, smaller nose, larger ears and fuller, pouty lips. Despite these individual features, babyface is a "gestalt" or whole that is easily recognizable by people. Babyfaceness is an attribute that generalizes across regions, ethnicities, gender and even species, as identified by social psychologists. There is a universal, evolutionary response to babies across all cultures because infants require special care, attention, and nurturing in order to survive.

This adaptive response to infants is over-generalized to adults who have features that resemble babies. The result is that babyfaced adults are treated differently compared with maturefaced adults: babyfaced adults are considered more warm, innocent and trustworthy.

The hypothesis of the current study was that babyfaceness could serve as a "disarming mechanism" that would attenuate the fear, hostility and aggression typically associated with black males. Thus babyfaceness would facilitate the ascension of black males but not white males.

Results

Babyface features had a clear influence on professional achievement, both perceived and real. Black CEOs were rated as being more babyfaced, and having warmer personalities, than whites.

The more babyfaced the black CEO, the more he was also thought to earn. In terms of real, not just perceived, earnings and achievement, the more babyfaced the black CEO, the more prestigious was the company he actually led, reflected by both Fortune 500 ranking and annual corporate revenue. These perceived and real professional benefits were correlated with physical appearance, not to perceptions of age, which was not found to be linked to babyfaceness.

Livingston pointed out that while the 10 black CEO faces were considered warmer than the white faces, blacks as a group were considered less warm than whites overall. Thus, the visual influence of babyfaceness clearly shifted perception, and the playing field. He said, "To function effectively as an African American male in the U.S. it helps to have a disarming mechanism." A disarming mechanism is a physical or behavioral trait, noted Livingston, that eases perceptions of threat—it signals to whites that they do not have a reason to fear this particular black individual. Babyfaceness is but one example: political conservatism, style of speech or dress, smiling behavior, or even a Harvard education might also serve a similar disarming function.

The research notes disarming mechanisms, like warmth, are only necessary for groups that are perceived to be hostile or threatening by default. Prior research has shown warmth to be counterproductive for white male leaders and women leaders. "Female leaders are already 'disarmed' because of traditional caregiver roles and stereotypes," said Livingston. "Women leaders must prove to be strong and assertive, frequently at the expensive of being perceived as lacking warmth." The implication is that black leaders may have to adopt a gentler leadership style compared with white males who can get angry or pound their fists in order to accomplish leadership objectives.

Beyond the Babyface

While facial features may present natural advantages or obstacles to some, other behavioral traits can be developed and used by most anyone. "There are other mechanisms thought to help minorities function and achieve without stoking envy, resentment, fear," said Livingston. "For example, some point to Former U.S. Secretary of State Condoleeza Rice as someone who internalizes shared ideology with the dominant group, and is therefore seen as non-threatening." Livingston adds that although Barack Obama does not possess all of the typical features associated with babyfaceness per se, he does have a disarming appearance. "Big ears or a simple smile can disarm one's appearance from suggested perceptions of threat that might otherwise be associated with black males. This could serve to increase the appeal of the president or even one of Hollywood's most successful actors—Will Smith," he said. ###

• To read the full article or speak with Kellogg School of Management professor Robert Livingston, e-mail Meg Washburn at m-washburn@kellogg.northwestern.edu
• To learn more about the Association of Psychological Science, visit www.psychologicalscience.org.
• To learn more about the Kellogg School of Management, visit www.kellogg.northwestern.edu.

Contact: Meg Washburn m-washburn@kellogg.northwestern.edu 847-491-5446 Association for Psychological Science

New Medicare policy may pose risks to black kidney patients

Policy change could discourage dialysis centers from accepting African-American patients

A change in Medicare reimbursement policy could make it more difficult for African Americans with kidney disease to access dialysis services, suggests a study in an upcoming issue of the Journal of the American Society of Nephrology (JASN). "The change in payment policy may disadvantage a substantial group of dialysis patients," comments Areef Ishani, MD (University of Minnesota).

Under the new policy, the Centers for Medicare & Medicaid Services (CMS) will make a single payment to dialysis units to cover both dialysis and injectable medications, which were previously reimbursed separately.

Areef Ishani, M.D., M.S.

African American dialysis patients have more problems with anemia (low hemoglobin) than white patients and thus may require more treatment with costly erythropoiesis stimulating agents (ESAs) to raise hemoglobin levels. On analysis of 12,000 patients starting dialysis during 2006, the researchers confirmed that African Americans had lower initial hemoglobin levels when starting hemodialysis compared to white patients.

Also, the average required dose of ESAs over the first two months on dialysis was eleven percent higher in African American patients.

Since dialysis centers will no longer be reimbursed for the higher ESA doses, the researchers are concerned that the new policy could create a "financial disincentive" to accept African Americans. "The CMS has suggested that the new reimbursement scheme will adjust for a variety of factors," according to Dr. Ishani. "If race is not included as a payment adjuster, African American patients could be disadvantaged by this policy change."

The study is limited in that it included only patients who were over age 67 at the start of dialysis and had Medicare as their primary insurance source. Also, it only looked at ESA use during the first two months on dialysis.

Dr. Ishani consults for the Chronic Disease Research Group. Haifeng Guo; Thomas Arneson, MD; Lih-Wen Mau, PhD; Suying Li, PhD; and Stephan Dunning are employed by the Chronic Disease Research Group. David Gilbertson, PhD and Allan Collins, MD have received consulting fees from Amgen. ###

The study appears online at jasn.asnjournals.org/ doi 10.1681/ASN.2008080853.

Founded in 1966, the American Society of Nephrology (ASN) is the world's largest professional society devoted to the study of kidney disease. Comprised of 11,000 physicians and scientists, ASN continues to promote expert patient care, to advance medical research, and to educate the renal community. ASN also informs policymakers about issues of importance to kidney doctors and their patients. ASN funds research, and through its world-renowned meetings and first-class publications, disseminates information and educational tools that empower physicians.

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

One hundred days of African-American history

Looking back at President Barack Obama's first 100 days

On November 4, 2008, Barack Obama became the answer to a question that will eventually end up on an African American studies test: Who was the nation's first African American president?

But now that the confetti has blown away and the Inauguration has come and gone, what have the first 100 Days of President Obama's Administration meant to the African American community?

That is the question that will be answered during A Conference Call: A 100 Day Assessment of the Obama Presidency From an African American Perspective, a symposium being held from May 1st through 3rd in Temple University's Anderson Hall, 1114 Berks Street, and Beury Hall, 1901 N. 13th Street.

The symposium, which is co-sponsored by the Center for African American Research and Public Policy at Temple University and the Philadelphia Community Institute of Africana Studies,

will look at the impact that the first 100 days of the Obama Presidency has had on the African American community in terms of the economy, the criminal justice system, and foreign relations through an African American historical perspective.

In addition to looking at the Obama presidency, the symposium will also focus on the discipline of Black History itself as it celebrates its 40th Anniversary. As the first institution to offer a doctorate in Black History, Temple is uniquely qualified to provide this view.

The discussion begins Friday night by investigating how President Obama's election has affected African American politics and political thought. Among the confirmed panelists are poet and activist Amiri Baraka, Ron Walters, director of the African American Leadership Center at the University of Maryland and Kenneth Lawrence, Temple University's senior vice president for Government, Community and Public Affairs. This discussion will be held from 5:30 p.m. to 7:30 p.m. in Anderson Hall, room 13.

Starting the discussion with politics makes sense because there are few political stories in the African American community bigger than the Obama Presidency, said Nathaniel Norment, director of Temple's Center for African American Research and Public Policy and chair of the African American Studies Department.

"We are experiencing a unique and historical political reality with the election of President Barack Obama," Norment said. "African Americans must seize this time to develop strategic economic and political actions that will empower our communities. The conference provides an opportunity to begin this work."

On Saturday, the conference continues with a panel discussion on the evolution of Black Studies from its inception at San Francisco University in the late 1960s to the present day and whether or not it is still relevant in the Age of Obama.

Among those expected to attend this discussion are John Bracey Jr., professor in the W.E.B DuBois Department of African American Studies at the University of Massachusetts-Amherst; Jimmy Garrett, one of the founders of the first Black Studies Department at San Francisco State; Rosemari Mealy, an activist and former member of the Black Panther Party who has studied the place of women within the party and is best known for her book detailing the meeting of Malcolm X and Fidel Castro; and Charles Jones, president of the National Council of Black Studies. This discussion will be held at 10:30 a.m. in room 160 Beury Hall.

In addition to the two plenary sessions, there will be a variety of working groups that will discuss some of the issues that the Obama Administration has tackled during the first 100 Days and whether or not the needs of African Americans have been addressed. Topics such as communications and media, the Labor movement, and Veterans Affairs will be discussed with the help of panelists and facilitators including Henry Nicholas, president of the National Union of Hospital and Healthcare Employees (1199-C), Linn Washington, associate professor in Temple's Department of Journalism and columnist for the Philadelphia Tribune, and Temple poet-in-residence and activist Sonia Sanchez. ###

For more information on A Conference Call: A 100 Day Assessment of the Obama Presidency From an African American Perspective, please contact Denise Clay at 215-204-6522 (office); 215-900-3337(mobile) or denise.clay@temple.edu.

Contact: Denise Clay denise.clay@temple.edu 215-204-6522 Temple University

More African-Americans die from causes that can be prevented or treated

Two-thirds of the difference between death rates among African Americans and Caucasians are now due to causes that could be prevented or cured, according to a new study appearing in the Journal of Epidemiology and Community Health. The study, "Black-White Differences in Avoidable Mortality in the United States, 1980-2005," found that death from preventable or treatable conditions represented half of all deaths for individuals under age 65 and accounted for nearly 70 percent of the black-white mortality difference.

"People should not be dying prematurely from stroke, hypertension, diabetes, colon cancer, appendicitis or the flu. Our study shows that while much progress has been made, our health care system is still failing to meet the very basic needs of some Americans.

Many disparities can be conquered by focusing more on public policies that promote prevention and by ensuring that all Americans have access to good quality health care," said James Macinko, who conducted the research as a Robert Wood Johnson Foundation Health & Society Scholar at the University of Pennsylvania. He is the lead author of the study.

The major reason for the black-white mortality gap—representing about 30 percent of the gap for men and 42 percent for women—is due to conditions that have effective treatments, the study found. Disparities were most pronounced for conditions or diseases for which deaths can be prevented, such as diabetes, stroke, infectious and respiratory diseases, preventable cancers, and circulatory diseases like hypertension.

The conditions analyzed included premature deaths from common infectious diseases, cervical cancers, appendicitis, maternal deaths, hypertension, stroke, diabetes, peptic ulcers and traffic accidents, all of which could be avoided through medical care or health policy changes. The study suggests that the reinforcement of policies that improve access to quality medical care will be important to reducing death disparities.

"As the nation turns its attention to health care reform, we now know that much can be done to reduce racial and ethnic health care disparities and to improve the health care for all Americans," said Macinko. "We also have a lot to learn from other health care systems that measure performance based on preventable deaths."

To analyze the death disparity among African Americans and Caucasians, the scholar used "avoidable mortality," a commonly used measure of health system performance in Europe. It is defined as premature death under age 65 from conditions responsive to medical care, changes in public policy, or behaviors. Over the last decade, avoidable mortality has declined less rapidly in the United States than in other industrialized nations.

"Avoidable mortality gives us one way to assess the shortcomings of our health care system, particularly in the area of prevention," said Irma T. Elo, Ph.D., co-author on the report and an associate professor of sociology at the University of Pennsylvania. "It can help to identify where preventable disparities are greatest and aid in directing resources to where they can improve the health of vulnerable populations." ###

Elo also serves as an affiliated-faculty member for the RWJF Health & Society Scholars Program at the University of Pennsylvania.

The RWJF Health & Society Scholars Program is designed to build the nation's capacity for research, leadership and policy change to address the broad range of factors that affect health. Information about the RWJF Health & Society Scholars Program, including application information, can be found at www.healthandsocietyscholars.org.

Contact: Jennifer Combs jcombs@iqsolutions.com 240-221-4256 RWJF Health & Society Scholars Program

Study of neighborhoods points to modifiable factors, not race, in cancer disparities

While cities have shown considerable racial disparities in cancer survival, those racial disparities virtually disappear among smaller populations, such as neighborhoods within that city. The finding comes from a new analysis published in the May 15, 2009 issue of CANCER, a peer-reviewed journal of the American Cancer Society. The study examined breast and prostate cancer survival rates at different geographic levels, and the results suggest that there are significant societal factors at the root of cancer-related racial disparities.

Previous research has shown that considerable health disparities exist relating to race, ethnicity, geographic location, and other factors. While researchers have been striving to understand the causes of such disparities in survival from some cancers, including cancers of the breast and prostate, the potential roles of innate factors, such as genetic differences, versus modifiable factors, such as socioeconomic differences, remain unclear.

Jaymie R. Meliker, Ph.D.

Researchers led by Jaymie Meliker, Ph.D. of Stony Brook University investigated if these disparities remained among different population sizes—for example whether disparities seen in counties persisted in cities and even neighborhoods. They studied regions in Michigan, drawing from the Michigan Cancer Surveillance Program, which compiled information from 1985-2002 on 124,218 breast cancer and 120,615 prostate cancer patients.

The team's goal was to conduct an analysis of racial disparities in cancer survival at different geographic scales. As the geographic scale decreases, the population becomes more homogenous in terms of socioeconomic status and other characteristics, such as proximity to medical screening facilities. Therefore, the researchers hypothesized that if racial disparities diminished when smaller geographic areas were analyzed, modifiable factors, not biology, may be responsible for the disparity.

The study revealed that whites experienced significantly higher survival rates for prostate and breast cancer compared with blacks throughout much of southern Michigan when large geographic regions were analyzed. However, when the investigators analyzed smaller geographic regions, such as legislative districts and community-defined neighborhoods, disparities diminished or virtually disappeared.

"When racial disparities vanish in small geographic areas, it suggests that modifiable factors are responsible for apparent racial disparities observed at larger geographic scales," the authors write. These modifiable factors could include socioeconomic factors, differences in tumor stage, differences in treatment and the presence of additional health conditions. It is unclear which of these are important, but this study's findings suggest that genetic factors are not likely to play a large role in disparities of survival from prostate and breast cancer. ###

Article: "Breast and prostate cancer survival in Michigan: can geographic analyses assist in understanding racial disparities?" Jaymie R. Meliker, Pierre Goovaerts, Geoffrey M. Jacquez, Gillian A. AvRuskin, and Glenn Copeland. CANCER; Published Online: April 13, 2009 (DOI: 10.1002/cncr.24251); Print Issue Date: May 15, 2009.

Contact: Greg Filiano at gfiliano@notes.cc.sunysb.edu. David Sampson American Cancer Society david.sampson@cancer.org . Claire Greenwell American Cancer Society claire.greenwell@cancer.org 404-417-5883 American Cancer Society

Consuming a little less salt could mean fewer deaths

For every gram of salt that Americans reduce in their diets daily, a quarter of a million fewer new heart disease cases and over 200,000 fewer deaths would occur over a decade, researchers said at the American Heart Association's 49th Annual Conference on Cardiovascular Disease Epidemiology and Prevention.

These results were derived from a validated computer-simulation of heart disease among U.S. adults.

"A very modest decrease in the amount of salt — hardly detectable in the taste of food — can have dramatic health benefits for the U.S.," said Kirsten Bibbins-Domingo, Ph.D., M.D., M.A.S., lead author of the study and an assistant professor of Medicine and of Epidemiology at the University of California, San Francisco. "It was a surprise to see the magnitude of the impact on the population, given the very small reductions in salt that we were modeling."

Kirsten Bibbins-Domingo, Ph.D., M.D. Current position: Assistant Professor in Residence of Medicine, Epidemiology and Biostatistics

A 3-gram–a-day reduction in salt intake (about 1200 mg of sodium) would result in 6 percent fewer cases of new heart disease, 8 percent fewer heart attacks, and 3 percent fewer deaths. Even larger health benefits are projected for African Americans, who are more likely to have high blood pressure and whose blood pressure may be more sensitive to salt. Among African Americans, new heart disease cases would be reduced by 10 percent, heart attacks by 13 percent and deaths by 6 percent. For years, ample evidence has linked salt intake to high blood pressure and heart disease. Yet, salt consumption among Americans has risen by 50 percent and blood pressure has risen by nearly the same amount since the 1970s, according to researchers.

Currently, Americans eat 9-12 grams of salt per day (or 3600-4800 mg of sodium. This amount is far in excess than recommended by most health organizations (5-6 grams/day of salt or 2000-2400 mg sodium). Each gram of salt contains 0.4 grams of sodium.

"It's clear that we need to lower salt intake, but individuals find it hard to make substantial cuts because most salt comes from processed foods, not from the salt shaker," Bibbins-Domingo said. "Our study suggests that the food industry and those who regulate it could contribute substantially to the health of the nation by achieving even small reductions in the amount of salt in these processed foods."

To estimate the benefit of making small reductions in salt intake, the investigators used the Coronary Heart Disease Policy Model, a computer simulation of heart disease in the U.S. adult population. The model can be used to evaluate the impact of policy changes on the health of the nation, and has previously been used to project the future of heart disease in the United States given the current rate of childhood obesity, Bibbins-Domingo said.

The researchers used the model to estimate the impact of an immediate reduction of daily salt intake by 0𔃄 grams on the incidence of cardiovascular disease and deaths between 2010�. In that period, the model suggests that more than 800,000 life-years could be saved for each gram of salt lowered. Larger reductions would have greater benefits, with a 6 gram reduction resulting in 1.4 million fewer heart disease cases, 1.1 million fewer deaths and over 4 million life-years saved.

Because the majority of salt in the diet comes from prepared and packaged foods, the results of the study reveal the need for regulatory changes or voluntary actions by the food industry to make achievable changes in heart health, Bibbins-Domingo said.

The researchers are planning to assess the cost-effectiveness of various interventions already being used to reduce salt consumption in other countries, including industry collaborations, regulations and labeling changes.

Co-authors are: Glenn M. Chertow, M.D., M.P.H.; Andrew E. Moran, M.D., M.A.S.; Pamela G. Coxson, Ph.D.; and Lee Goldman, M.D., M.P.H. Individual author disclosures are available on the abstract.

The study was funded by the University of California, San Francisco Clinical and Translational Sciences Institute Strategic Opportunities for Support intramural grant. ###

Statements and conclusions of study authors that are presented at American Heart Association scientific meetings are solely those of the study authors and do not necessarily reflect association policy or position. The association makes no representation or warranty as to their accuracy or reliability. The association receives funding primarily from individuals; foundations and corporations (including pharmaceutical, device manufacturers and other companies) also make donations and fund specific association programs and events.

The association has strict policies to prevent these relationships from influencing the science content. Revenues from pharmaceutical and device corporations are available at www.americanheart.org/corporatefunding.

Editor's note: The American Heart Association recommends healthy American adults should reduce their sodium intake to less than 2300 mg (about 1 teaspoon) per day. Americans consume up to 75 percent of their sodium from processed foods like tomato sauce, soups, condiments, canned foods and prepared mixes. The FDA and USDA state that an individual food that has the claim "healthy" must not exceed 480 mg sodium per reference amount. "Meal type" products must not exceed 600 mg sodium per labeled serving size. For more information visit: www.americanheart.org/presenter.

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

Elderly blacks and whites are not getting the same care for lung cancer

HOUSTON – (April 13, 2009) – When it comes to the treatment of lung cancer in the elderly, blacks are less likely to get chemotherapy or surgery than whites, according to a new study by epidemiologists at The University of Texas School of Public Health that appears in the May 15 issue of CANCER, a peer-reviewed journal of the American Cancer Society.

The investigators found that lung cancer treatment disparities between blacks and whites were just as large in 2002, as they were in the early 1990s, despite efforts to address inequalities in medical treatment. In fact, the gap between blacks and whites is more pronounced among women, older patients or people in the poorest socioeconomic quartile.

To remedy the situation, the authors wrote, “Efforts should focus on providing appropriate quality treatment and educating blacks on the value of having these treatments to reduce these disparities in receipt of treatment.”

UT School of Public Health researchers Dale Hardy, Ph.D., and Xianglin Du., M.D., Ph.D.

The researchers conducted a retrospective study of 83,101 seniors who were enrolled in Medicare between 1991 and 2002 and diagnosed with non-small cell lung cancer. Medicare is the official federal health insurance for people 65 years of age or more and those with disabilities. Lung cancer is the leading cause of death from all types of cancers in the United States with an estimated 161,840 deaths in 2008.

Non-small cell lung cancer accounts for nearly 90 percent of lung cancer.

“We thought the disparity would have narrowed,” said Dale Hardy, Ph.D., lead author and research associate at the UT School of Public Health. “We were surprised that the gap is still there.”

Hardy now plans to analyze the impact of this treatment disparity on patient outcomes.

In their analysis, the investigators found that blacks with early stage lung cancer were 37 percent less likely than whites to receive surgery and 42 percent less likely to receive chemotherapy. Researchers found no significant difference between blacks and whites when it came to people receiving radiation for advanced stage cancer.

During the advanced stages of cancer, blacks were 57 percent less likely to receive chemotherapy than whites.

Factors contributing to the treatment disparities, according to the researchers, could include blacks being less likely than whites to receive recommendations for surgery and more likely to refuse recommendations for surgical treatments.

Xianglin Du., M.D., Ph.D., an associate professor of epidemiology at the UT School of Public Health, was senior author. Other UT School of Public Health contributors include: Chih-Chin Liu, graduate student; Rui Xia, graduate student; Wenyaw Chan, Ph.D., professor of biostatistics; Arica White, predoctoral fellow; and Keith Burau, Ph.D., associate professor of biostatistics. Janice N. Cormier, M.D., associate professor of surgical oncology and biostatistics at The University of Texas M. D. Anderson Cancer Center, also collaborated on the study.

The study is titled “Racial Disparities and Treatment Trends in a Large Cohort of Elderly Black and White Patients with Nonsmall Cell Lung Cancer.” The study was supported by a grant from the Agency for Healthcare Research and Quality.

Media Contact: Robert Cahill Robert.Cahill@uth.tmc.edu Media Hotline: 713-500-3030

Why do blacks with advanced kidney disease live longer than whites?

Blacks more likely to progress to end stage disease, whites more likely to die before kidney failure

Blacks in the United States are more likely to require dialysis and develop end stage renal disease (ESRD) than whites, but they also live longer than whites once they reach later stages of kidney disease. A study of this phenomenon will appear in an upcoming issue of the Clinical Journal of the American Society Nephrology (CJASN).

Csaba P. Kovesdy, MD (Salem VA Medical Center), John E. Anderson, MD, Stephen F. Derose, MD, and Kamyar Kalantar-Zadeh, MD, PhD (University of California Los Angeles), investigated by comparing 298 black and 945 white male patients with moderate and advanced chronic kidney disease (CKD) who were not on dialysis and who were treated within the Veteran Health Administration (VA) System.

"Studying patients with non-dialysis dependent CKD is important to determine the reasons behind the higher incidence of ESRD in blacks in order to address the root causes of this discrepancy," said Dr. Kovesdy. Conducting the study within the VA System allowed the researchers to analyze a group of patients in which blacks and whites had similar access to health care.

The investigators found that the rates of kidney function decline were similar in blacks and whites, but blacks were less likely to die once they reached moderate to advanced kidney disease.

The lower death rates in black patients with later stages of disease were mainly due to a lower prevalence of cardiovascular disease; the higher incidence of ESRD was explained by clinical characteristics such as lower initial kidney function.

The authors' suspect that lower death rates among blacks with moderate to advanced kidney disease is due to higher death rates among blacks in earlier stages of kidney disease. Blacks who survive earlier stages have fewer health issues (such as cardiovascular disease) than whites. This would explain why blacks had better survival rates than whites among the VA patients. "These survival discrepancies are quite different from what is seen in the general population, where black Americans typically experience higher mortality and lower life expectancy than whites," said Dr. Kovesdy. "More research is needed to explain these differences and to alleviate the racial and ethnic discrepancies in health outcomes in the US," he added. ###

Some of this material was presented at the American Society of Nephrology Renal Week 2008, Philadelphia, PA. This study is supported by grant 1R01DK078106-01 to Dr. Kovesdy and Dr. Kalantar-Zadeh. The study authors reported no financial disclosures.

The article, entitled "Outcomes Associated with Race in Males with Non-Dialysis Dependent CKD," will appear online at cjasn.asnjournals.org/ on April 15, 2009, doi 10.2215/CJN.06031108.

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 CJASN, and the Nephrology Self-Assessment Program (NephSAP). In January 2009, the Society will launch ASN Kidney News, a newsmagazine for nephrologists, scientists, allied health professionals, and staff.

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

Image 2: CDC's Diabetes Program - Data & Trends

Patient preferences play role in racial disparities in rheumatoid arthritis treatment

New study examined whether African-American and white patients with RA differ in how they make trade-offs between risks and benefits related to treatment

Racial disparities in the delivery of healthcare occur even among insured populations with access to care. This suggests that some of the differences in health care utilization among different racial groups may be due to patient preferences. Rheumatoid arthritis (RA) treatment decisions are frequently complex, requiring multiple trade-offs between symptom relief, long-term reduction of disability, adverse events and serious complications. A new study examined whether African American and white patients with RA differ in how they make trade-offs between risks and benefits related to treatment. The study was published in the April issue of Arthritis Care & Research (www3.interscience.wiley.com/journal/77005015/).

Led by Dr. Liana Fraenkel of Yale University, researchers examined how 136 RA patients made trade-offs about specific treatment characteristics related to commonly used RA drugs. These included benefits such as the chance of remission or symptom improvement, and risks such as side effects and theoretical risk of cancer. They analyzed how patients made trade-offs in treatment decisions to determine how respondents value specific characteristics.

The results showed that there were significant differences in the ways that African American and white patients evaluated treatment characteristics. African American patients, who comprised 49 percent of the study sample, attached greater importance to the risk of toxicity, particularly for rare, serious adverse events, and less importance to the likelihood of benefit than white patients. For example, African Americans assigned the greatest importance to the theoretical risk of cancer, whereas white patients were most concerned with the likelihood of remission and halting radiographic progression.

Until now, it has been widely believed that differences in treatment by race can be corrected by changes in either health care providers or the health care system. This is because research on health care disparities has largely focused on access to care, lack of insurance, quality of care due to unconscious practitioner bias and social factors.

Although the Institute of Medicine's model of health disparities includes an acknowledgement that these may be due in part to differences in preferences of care, few studies have tested this notion and racial/cultural differences in risk/benefit perception remain an under-researched field.

"Our study is important because, to the best of our knowledge, this is the first study to formally assess whether risk preference for therapy is one of the potential explanations of the lower use among African Americans of more effective, although more risky, therapy for a chronic disabling disease," the authors state. They point out that disparate models of health and illness may lead to disparate patient preferences, as well as limited communication during clinical visits.

The study showed that African Americans were significantly more risk averse than their white counterparts, which the authors theorize may be due to "cultural risk aversion for gains." This type of risk aversion is based on a learned distrust or low expectations of the healthcare system that arise when a subgroup observes significant gains in lifespan, economic prosperity and power of the larger culture, but does not experience these gains even though they live in the same country or culture.

The authors conclude: "Given these results, physicians should confirm that patients have accurate expectations regarding the natural history and treatment of their disease, and ensure that patient preferences are based on an informed assessment of the pros and cons related to available treatment options." ###

Article: "Understanding Why Rheumatoid Arthritis Patient Treatment Preferences Differ By Race," Florina Constantinescu, Suzanne Goucher, Arthur Weinstein, Wally Smith, Liana Fraenkel, Arthritis & Rheumatism (Arthritis Care & Research), April 2009.

Contact: Sean Wagner medicalnews@bos.blackwellpublishing.com 781-388-8550 Wiley-Blackwell

Image: Rheumatoid Arthritis

Increase in p53 mutation linked to advanced colorectal cancer in blacks

PHILADELPHIA – Researchers have identified a possible genetic cause for increased risk for a more advanced form of colorectal cancer in blacks that leads to shorter survival, according to data published in Clinical Cancer Research, a journal of the American Association for Cancer Research.

Understanding the relationship between molecular defects and differences in colorectal cancer incidence, aggressiveness and clinical outcomes is important in individualizing the treatment and in eliminating racial disparities.

"Several studies have identified a disparity between African-Americans and whites for colorectal cancer. What this study does is pinpoint a possible genetic cause," said Upender Manne, Ph.D., associate professor in the Department of Pathology at the University of Alabama at Birmingham.

For the current study, Manne and colleagues analyzed 137 colorectal adenocarcinomas from African-American patients and 236 colorectal adenocarcinomas from non-Hispanic whites. Researchers assessed these carcinomas for p53 mutations and genotyped for codon 72 polymorphisms.

Overall, whites and African-Americans had a similar rate of p53 mutations. However, the frequency of the Pro72 allele was higher in blacks at 17 percent compared with 7 percent among whites. By contrast, the Arg72 allele frequency was higher in whites at 36 percent than in African-Americans, where the frequency was 19 percent.

representation of a complex between DNA and the protein p53

Presence of the Pro72 allele in blacks was associated with a more than two-fold increase in mortality due to colorectal cancer. "This paper shows that in a subset of patients with the Pro72 allele, and the susceptibility to p53 mutations may be a possible molecular explanation for the racial disparity," said Manne. ### The mission of the American Association for Cancer Research is to prevent and cure cancer. Founded in 1907, AACR is the world's oldest and largest professional organization dedicated to advancing cancer research. The membership includes more than 28,000 basic, translational and clinical researchers; health care professionals; and cancer survivors and advocates in the United States and 80 other countries. The AACR marshals the full spectrum of expertise from the cancer community to accelerate progress in the prevention, diagnosis and treatment of cancer through high-quality scientific and educational programs. It funds innovative, meritorious research grants.

The AACR Annual Meeting attracts more than 17,000 participants who share the latest discoveries and developments in the field. Special conferences throughout the year present novel data across a wide variety of topics in cancer research, treatment and patient care. The AACR publishes five major peer-reviewed journals: Cancer Research; Clinical Cancer Research; Molecular Cancer Therapeutics; Molecular Cancer Research; and Cancer Epidemiology, Biomarkers & Prevention.

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

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

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