Black gay men may be at increased HIV risk

Preferences in the race of sexual partners influenced by subtle racism may perpetuate HIV-related health disparities

Black gay men have less choice when it comes to sexual partners than other groups and, as a result, their sexual networks are closely knit. These tightly interconnected networks make the rapid spread of HIV more likely. In a study1) looking at social and sexual mixing between ethnic groups in men who have sex with men, H. Fisher Raymond and Willi McFarland, from the San Francisco Department of Public Health in the US, show that social barriers faced by Black gay men may have a serious impact on their health and well-being. Their findings are published in Springer's journal AIDS and Behavior.

In the US, there is a disproportionate burden of HIV infection in Black Americans, who accounted for nearly half of all HIV/AIDS cases diagnosed in 2006 – four times the national average.

Raymond and McFarland's research looks at the current levels of sexual mixing between racial and ethnic groups of men who have sex with men in San Francisco, and identifies reasons that underlie these sexual mixing patterns.

A total of 1,142 gay men took part in computer-assisted interviews. They were asked about their own ethnicity, the race of their sexual partners in the last six months, their perception of how easy it is to meet sexual partners of different ethnicities, where they meet sexual partners, their view of HIV infection risk and the predominant race of their network of friends.

Black gay men are the least preferred of sexual partners by other races. Black men are perceived to be riskier to have sex with, which can lead to men of other races avoiding Black men as sexual partners. They are also perceived as less welcome in the common social venues of gay men in San Francisco. As a result, Black men are three times more likely to have sexual partners that are also Black, than would be expected by chance alone.

In the authors' view, the combination of attitudes on the part of non-Black gay men, friendships and social networks that are less likely to include Blacks, and the environments found in gay venues serve to separate Black gay men from other groups. Consequently, the sexual networks of Blacks are pushed to be more highly interconnected than other groups, with the potential for a more rapid spread of HIV and a higher sustained prevalence of infection among Black gay men.

The authors conclude: "The racial disparity in HIV observed for more than a decade will not disappear until the challenges posed by a legacy of racism towards Blacks in the US are addressed." ###

The study is available online free of charge on Springer's information platform SpringerLink at dx.doi.org/10.1007/

Reference

1. Raymond HF & McFarland W (2009). Racial mixing and HIV risk among men who have sex with men. AIDS and Behavior; DOI 10.1007/s10461-009-9574-6. The full-text article is available to journalists as a pdf.

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

Study finds people residing in poor communities not benefiting from recent drop in colorectal cancer

Lack of access to health care may be to blame

ATLANTA — A new study suggests that a drop in colorectal cancer incidence seen nationwide has not occurred among people living in poorer communities, and suggests that barriers to health care may be to blame. The study appears online in the journal Cancer Causes and Control.

Colorectal cancer (CRC) incidence rates have decreased rapidly in the United States since 1998, in large part from the use of endoscopic screening, which can detect and remove polyps before they turn into cancer. However, studies have not fully explored whether all populations, including people of different ages, race/ethnicity, and with differing levels of access to medical care have seen such a drop.

Colorectal cancer is a disease in which malignant (cancer) cells form in the tissues of the colon or the rectum. The colon is part of the body's digestive system.

To explore the issue, American Cancer Society epidemiologists examined CRC incidence trends from 1995 to 2004 from 19 cancer registries covering about 53 percent of the U.S. population, comparing incidence rates among different ages, races/ethnicities (whites, African Americans, and Hispanics), and county-level indicators of access to health care: poverty level, supply of primary care physicians (PCPs), insurance rates, and metro vs. non-metro area. They also analyzed changes in rates of screening using endoscopy screening and fecal occult blood stool test (FOBT) for the same set of county-level indicators.

The researchers found that CRC incidence rates decreased significantly across all categories of counties among whites ages 65 and over, who are almost all covered by Medicare, but not among those ages 50 to 64 in counties with high uninsured or poverty rates, fewer PCPs, or in non-metro areas. Among African Americans and Hispanics, incidence rates did not decrease among 50 to 64 year olds in general or among those ages 65 and over residing in counties with high poverty rates, low PCP supply, and non-metro counties (African Americans only). Colorectal endoscopic screening rates increased significantly among whites in both age groups, but not among Hispanics (ages 50 to 64 in general and ages 65 and over residing in high poverty counties) or African Americans residing in counties with higher uninsured rates (ages 50 to 64), low PCP supply, high poverty rates, and non-metro counties (ages 65 and over). FOBT rates remained unchanged during the study time period.

The authors say the study suggests that the decrease in incidence rates among whites 65 and older across all categories of counties may in part reflect an increase in endoscopic screening rates after Medicare expanded reimbursement of selected screening tools in 1998 and 2001. In contrast, the lack of decrease in CRC incidence rates among some population subgroups, including those 50 to 64 year old Hispanics and African Americans in general and whites residing in the most disadvantaged areas, may reflect lack of access to primary care as well as endoscopic screening services.

The authors conclude that that individuals residing in poorer communities with lower access to medical care have not experienced the reduction in CRC incidence rates that have benefited more affluent communities, and that this is likely explained in part by lower utilization of colorectal endoscopic screening even in older populations with coverage through Medicare. They say further research is needed on factors that explain the disparities and potential interventions to address them. ###

Article: "Trends in colorectal cancer incidence rates by age, race/ethnicity, and indices of access to medical care, 1995–2004 (United States)" Yongping Hao, Ahmedin Jemal, Xingyou Zhang, Elizabeth M. Ward. Cancer Causes Control DOI 10.1007/s10552-009-9379-y, Published online June 19, 2009.

Contact: David Sampson david.sampson@cancer.org WEB: American Cancer Society

What is different in reflux esophagitis between African-Americans and non-Hispanic whites?

There is minimal data evaluating the prevalence of GERD complications in any United States general population, other than non-Hispanic whites. Presently, it is thought that such complications occur less frequently in African-Americans than in non-Hispanic whites. A research group in Jacksonville, FL investigated the prevalence of reflux esophagitis between non-Hispanic whites and African-Americans. The distribution of esophagitis severity and its complications were equivalent between groups, except for Barrett's esophagus.

A research article to be published June 21, 2009 in the World Journal of Gastroenterology addresses this question. The research team, lead by Dr. Vega at the University of Florida Health Science Center/Jacksonville, performed a retrospective search of the endoscopy database at the University of Florida Health Science Center/Jacksonville for all cases of reflux esophagitis and its complications from 1 January to 31 March 2001.

Endoscopic image of Barrett's esophagus

The database search identified 259 patients with reflux esophagitis or its complications. One hundred seventy one were non-Hispanic whites and 88 were African Americans. Mean ages and male/female ratios were similar in the two groups. RE grade, esophageal ulcer, stricture, and hiatal hernia frequency were likewise similar in the groups.

Endoscopic and histological Barrett's esophagus was present more often in non-Hispanic whites than in African Americans. Heartburn was a more frequent indication for endoscopy in non-Hispanic whites with erosive esophagitis than in African Americans.

This is the first study to report that reflux esophagitis and its complications, other than Barrett's esophagus, occur at a similar frequency in nHw and AA. In addition, indication for the index endoscopy appears to be different in the above ethnic groups. By understanding GERD and its complications among ethnic groups in the United States, this study might indicate future avenues for investigation to prevent the development of Barrett's esophagus and esophageal adenocarcinoma. ###

Reference: Vega KJ, Chisholm S, Jamal MM. Comparison of reflux esophagitis and its complications between African Americans and non-Hispanic whites. World J Gastroenterol 2009; 15(23): 2878-2881 World J Gastroenterol

Contact: Lin Tian wjg@wjgnet.com 86-105-908-0039 World Journal of Gastroenterology

Aerobically unfit young adults on road to diabetes in middle age

Young African-Americans, women at higher risk

CHICAGO --- Most healthy 25 year olds don't stay up at night worrying whether they are going to develop diabetes in middle age. The disease is not on their radar, and middle age is a lifetime away.

As it turns out, many should be concerned. Researchers at Northwestern University Feinberg School of Medicine have found that young adults (18 to 30 years old) with low aerobic fitness levels --as measured by a treadmill test -- are two to three times more likely to develop diabetes in 20 years than those who are fit.

The study also shows that young women and young African Americans are less aerobically fit than men and white adults in the same age group, placing a larger number of these population subgroups at risk for diabetes.

Mercedes R. Carnethon, PhD

"These young adults are setting the stage for chronic disease in middle age by not being physically active and fit," said Mercedes Carnethon, lead author and assistant professor of preventive medicine at Northwestern's Feinberg School. "People who have low fitness in their late teens and 20's tend to stay the same later in life or even get worse. Not many climb out of that category." The study will be published in the July issue of Diabetes Care.

In the study, the most important predictor of who will develop diabetes is the participants' Body Mass Index (BMI), a measure of the body's fat content.

"The overwhelming importance of a high BMI to the development of diabetes was somewhat unexpected and leads us to think that activity levels need to be adequate not only to raise aerobic fitness, but also to maintain a healthy body weight," Carnethon said. "If two people have a similar level of fitness, the person with the higher BMI is more likely to develop diabetes."

Carnethon stressed that unfit young adults can avoid a future with diabetes by exercising and losing weight. "Improving your fitness through physical activity is one way you can modify your body fat," she said. "Research shows that combining regular physical activity with a carefully balanced diet can help most people maintain a healthy body weight and lower the likelihood of developing diabetes."

This is the longest observational study to focus on the relationship between aerobic fitness and the development of diabetes. Most previous research has focused on the self-reported health behavior of physical activity, but people don't always accurately report their activity level. Fitness, easily measured by a standard treadmill test, provides a more accurate measure than a self-report.

In addition, this study is the first to look at the development of diabetes over a 20- year period. Because diabetes develops over a long period of time, the number of people affected in the population rises with age. Previous studies that followed adults for a shorter period of time may have stopped short before diabetes was diagnosed.

Data from the study came from the Coronary Artery Risk Development in Young Adults (CARDIA) study, which began in January 1984 and ended in December 2001. The fitness study included 3,989 participants at baseline and 2,231 at the 20-year testing. The black and white men and women were 18 to 30 at the time of enrollment. Fasting blood sugar levels (the blood marker used to define diabetes) were measured at the beginning of the study and multiple times over 20 years. ###

The study was funded by the National Heart, Lung and Blood Institute.

NORTHWESTERN NEWS: www.northwestern.edu/newscenter/

Contact: Marla Paul Marla-Paul@northwestern.edu 312-503-8928 Northwestern University

American Society for Microbiology honors Terry A. Krulwich

The 2009 American Society for Microbiology (ASM) William A. Hinton Research Training Award will be presented to Terry A. Krulwich, Ph.D., Professor, Pharmacology and Biological Chemistry, and Program Director, Post-Baccalaureate Research Education Program (PREP), Mount Sinai School of Medicine, New York. This award recognizes outstanding contributions toward fostering the research training of underrepresented minorities in microbiology. It honors William A. Hinton, a physician-research scientist and one of the first African-Americans to join the ASM.

Dr. Krulwich is credited with revolutionizing the training of underrepresented minorities at Mount Sinai. She takes a personal interest in each student and works to ensure they excel beyond their expectations.

Terry A. Krulwich

She identifies gaps in their learning and designs individualized plans to guarantee their success. Dr. Krulwich served as Dean of the Graduate School of Biological Sciences from 1981 to 2002 and established and directed the Medical Scientist Training Program (MSTP). Over 100 underrepresented students were mentored by Krulwich during this time.

In 2001, she received funding from the National Institute of General Medical Sciences to establish PREP which provides recent college graduates from underrepresented minority groups one- to two-years of intensive mentored research to facilitate their pursuing a Ph.D. or M.D./Ph.D. degree. Almost 40 students have participated and 70% of them have entered Ph.D. or M.D./Ph.D. training.

Dr. Krulwich, a Fellow of the American Academy of Microbiology, received her Ph.D. from the University of Wisconsin, Madison. ###

The William A. Hinton Research Training Award will be presented during the 109th General Meeting of the ASM, May 17-21, 2009 in Philadelphia, Pennsylvania. ASM is the world’s oldest and largest life science organization and has more than 43,000 members worldwide. ASM’s mission is to advance the microbiological sciences and promote the use of scientific knowledge for improved health and economic and environmental well-being.

Contact: Garth Hogan ghogan@asmusa.org WEB: American Society for Microbiology

Study finds segregation decreases access to surgical care for minorities

CHICAGO (June 11, 2009) – New research published in the June issue of the Journal of the American College of Surgeons reveals that in counties with the highest levels of segregation, an increase in the African-American or Hispanic population was associated with a decrease in the availability and use of surgical services and an increase in the number of emergency room visits. This research supports prior studies that have shown that minority groups in the United States have comparatively poorer access to a range of health care services, often resulting in late diagnosis of illness and delayed treatment.

African Americans are the most segregated racial group in the U.S. Studies have shown that segregated African-American communities have higher infant mortality rates, decreased access to appropriate cancer care and worse outcomes from organ transplantation than other racial groups experience.

J. W. Awori Hayanga, M.D., M.P.H.

Both African Americans and Hispanics living in counties with a higher proportion of African-American population report that they experience difficulty obtaining health care as compared with African Americans living in counties with a smaller African-American population. Through the National Institutes of Health and Healthy People 2010, the federal government has set forth goals to explore, account for and minimize these disparities.

However, despite these goals, improving access to health care continues to pose a considerable challenge to health policy makers in their attempts to establish equity in the provision of care.

"In the most segregated counties, we found that an increase as small as one percent in the African-American or Hispanic population was associated with a significant decrease in the availability and utilization of surgical services, a difference that was not present in counties with the least segregation," said Awori J. Hayanga, MD, MPH, Administrative Chief Resident, Department of General Surgery, University of Michigan Health System. "We hope this report will guide budgetary decisions and incentives by health policy makers in their bid to close the racial health disparity gap and increase access to surgical health care across racial lines, particularly in the most segregated areas."

A cross-sectional analysis was performed on data from the 2004 U.S. Department of Health and Human Services Area Resource File, a nationwide record of health care, economic and demographic data. Each of the 3,219 U.S. counties was categorized into one of three levels – most, moderately or least segregated – using the Isolation Index, a measure of the probability that a member of one minority group will come into contact with members of the same racial group. Multivariable linear regression analysis was performed to examine the association between access to surgical services and proportion of minority population with varying levels of segregation, adjusting for socioeconomic and health characteristics.

Results showed that in the most segregated counties, each percentage point increase in Hispanic or African-American population was associated with a statistically significant decrease in outpatient surgery volume (p< href="http://www.facs.org/" target="ext">www.facs.org.

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

Study supports validity of test that indicates widespread unconscious bias

In the decade since the Implicit Association Test was introduced, its most surprising and controversial finding is its indication that about 70 percent of those who took a version of the test that measures racial attitudes have an unconscious, or implicit, preference for white people compared to blacks. This contrasts with figures generally under 20 percent for self report, or survey, measures of race bias.

A new study published this week validates those findings, showing that the Implicit Association Test, a psychological tool, has validity in predicting behavior and, in particular, that it has significantly greater validity than self-reports in the socially sensitive topics of race, gender, ethnicity, sexual orientation and age.

Anthony G. Greenwald

The research, published in the Journal of Personality and Social Psychology, is an overview and analysis of 122 published and unpublished reports of 184 different research studies. In this analysis, 85 percent of the studies also included self-reporting measures of the type generally used in surveys. This allowed the researchers, headed by University of Washington psychology Professor Anthony Greenwald, to compare the test's success in predicting social behavior and judgment with the success of self-reports.

"In socially sensitive areas, especially black-white interracial behavior, the test had significantly greater predictive value than self-reports. This finding establishes the Implicit Association Test's value in research to understand the roots of race and other discrimination," said Greenwald. "What was especially surprising was how ineffective standard self-report measurers were in the areas in which the test measures have been of greatest interest – predicting interracial behavior."

Greenwald created the Implicit Association Test in 1998 and he and Mahzarin Banaji, a Harvard psychology professor, and Brian Nosek, a University of Virginia associate professor of psychology, further developed it. Since then the test has been used in more than 1,000 research studies around the world. More than 10 million versions of the test have been completed at an Internet site where they are available as a self-administer demonstration.

The research looked at studies covering nine different areas – consumer preference, black-white interracial behavior, personality differences, clinical phenomena, alcohol and drug use, non-racial intergroup behavior, gender and sexual orientation, close relationships and political preferences.

Findings also showed that:

* Across all nine of these areas, measures of the test were useful in predicting social behavior.
* Both the test, which is implicit, and self-reports, which are explicit, had predictive validity independent of each other. This suggests the desirability of using both types of measure in surveys and applied research studies.
* In consumer and political preferences both measures effectively predicted behavior, but self-reports had significantly greater predictive validity.

Studies in the research came from a number of countries including Germany, the Netherlands, Italy, the United Kingdom, Australia, Canada, Poland and the United States. They looked at such topics as attitudes of undecided voters one-month prior to an Italian election; treatment recommendations by physicians for black and white heart attack victims; and reactions to spiders before and after treatment for arachnophobia, or spider phobia.

"The Implicit Association Test is controversial because many people believe that racial bias is largely a thing of the past. The test's finding of a widespread, automatic form of race preference violates people's image of tolerance and is hard for them to accept. When you are unaware of attitudes or stereotypes, they can unintentionally affect your behavior. Awareness can help to overcome this unwanted influence," said Greenwald. ###

Co-authors of the new study are Banaji, T. Andrew Poehlman of Southern Methodist University and Eric Uhlmann of Northwestern University. The National Science Foundation, National Institute of Mental Health, the Third Millennium Foundation and the Rockefeller Foundation funded the research.

For more information, contact Greenwald at 206-543-7227 or agg@u.washington.edu; Banaji at banaji@fas.harvard.edu Nosek at 434-924-0666 or nosek@virginia.edu.

More information about the Implicit Association Test and examples of the test can be found at Project Implicit's Web site: implicit.harvard.edu/implicit/

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

Pre-pregnancy depressed mood may heighten risk for premature birth

Researchers trying to uncover why premature birth is a growing problem in the United States and one that disproportionately affects black women have found that pre-pregnancy depressive mood appears to be a risk factor in preterm birth among both blacks and whites.

Black women, however, have nearly two times the odds of having a preterm birth compared to white women, according to Amelia Gavin, a University of Washington assistant professor of social work and lead author of a new study that appears online in the June issue of the Journal of Women's Health.

"Preterm births are one of the most significant health disparities in the United States and the overall number of these births increased from 10.6 percent in 2000 to 12.8 percent in 2005," she said.

melia Gavin, Assistant Professor, Social Welfare Doctoral Faculty. gavina@u.washington.edu. Office: 127C Phone: 206-616-8847. UW School of Social Work. 4101 15th Avenue NE. 354900, Seattle WA 98105-6299

While there appears to be some sort of link between giving birth prematurely and depressed mood, the study found no cause and effect, said Gavin, who studies health disparities. She believes the higher preterm birth rate among blacks may be the result of declining health over time among black women. For this study, premature birth referred to any child born after less than 37 weeks of gestation. Normal gestation ranges from 38 to 42 weeks. Data for the study was drawn from a larger longitudinal investigation looking at the risks for cardiovascular disease among more than 5,000 young adults in four metropolitan areas. The Coronary Artery Risk Development in Young Adults Study also collected information about mental health and pregnancy outcomes. Between 1990 and 1996, 555 women in the larger study gave birth. These women were the subjects in the depression-premature birth study.

"At this point we can't say that pre-pregnancy depressive mood is a cause of preterm birth or how race effects this association," said Gavin. "But it seems to be a risk factor in giving birth prematurely and higher pre-pregnancy depressive mood among black women compared to white women may indirectly contribute to the greater odds of preterm birth found among black women."

In the study 18.1 percent of the black women had a preterm birth compared to 8.5 percent of the white women.

This difference may be the result of what she calls "weathering," or accelerated declines in health due to repeated socioeconomic and political factors.

"What some people experience by being black takes a toll on the physiological system, and over time wear and tear that occurs across neural, neuroendocrine and immune systems as a result of chronic exposure to stressors lead to health disparities for blacks. Some of this may manifest itself in premature birth and low-birth weight," Gavin said.

The study did not look at depressive mood or depression during pregnancy because the larger research project did not collect that data. She hopes to replicate and expand her findings by analyzing data from another study to look at depressive mood prior to pregnancy and childhood poverty to see if those two factors in part explain the black and white difference in preterm delivery. That study also will look at the role antidepressive medication plays in preterm birth.

"My ultimate goal is to incorporate a life course health development framework to examine disparities in birth outcomes," she said. "You have to look at the context of health across the life course of a woman, not just during pregnancy."

The consequences of higher preterm delivery are a growing burden on the health care system and parents. Studies have shown that preterm babies have higher morbidity rates and U.S. preterm birth rates are creeping up with no good explanation. In the U.S. the population at greatest risk for major depression is women of childbearing age and the onset and course of depression are often intertwined with reproductive events. A recent national study reported that 8.4 percent of pregnant women in the past year experienced major depression and only slightly more than 14 percent of those women sought treatment for any mood disorder. ###

Co-authors of the study are David Chae of Emory University, Sarah Mustillo of Purdue University, and Dr. Catarina Kiefe of the University of Alabama at Birmingham and the Birmingham Veterans Affairs Medical Center. The National Center for Research Resources and the Roadmap for Medical Research, both components of the National Institutes of Health, funded the research.

For more information, contact Gavin 206-616-8847 or gavina@u.washington.edu.

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

Cognitive impairment is associated with reduced survival among both African-Americans and whites

CHICAGO – Alzheimer's disease and its precursor, mild cognitive impairment, appear to be associated with an increased risk of death among both white and African American older adults according to a new, long-term research study by neurological experts at the Alzheimer's Disease Center at Rush University Medical Center. The study findings are published in the June issue of Archives of Neurology, one of the JAMA/Archives journals.

Data from two earlier national surveys have suggested that life expectancy among patients with Alzheimer's disease may be greater for African Americans than for whites, according to Robert Wilson, PhD, a neuropsychologist at the Alzheimer's Disease Center at Rush and the study's lead author.

"In these surveys, the diagnosis of Alzheimer's disease is not based on a uniform clinical evaluation but derived from medical records, which increases the likelihood of substantial variation in the quality of diagnostic classifications," said Wilson.

Comparison of a normal aged brain (left) and an Alzheimer's patient's brain (right). Differential characteristics are pointed out.

However, the results from this study show that the presence and severity of mild cognitive impairment and Alzheimer's disease are associated with reduced survival among African Americans and these effects are comparable to those seen among whites, according to Wilson.

Alzheimer's disease reduces life expectancy and has emerged as a leading cause of death in the United States. "There is limited knowledge about the consequences of mild cognitive impairment and Alzheimer's disease in African Americans," said Wilson. "In this study we evaluated the risk of death among both African Americans and whites in an urban community during a 10 year follow-up."

Rush researchers evaluated the risk of death associated with incident Alzheimer's disease and diagnoses were based on a uniform, detailed clinical evaluation. They also examined survival rates among participants with mild cognitive impairment.

A total of 1,715 older adults (average age 80.1, 52.5 percent African American) who came from four adjacent neighborhoods in Chicago participated in the study. Each participant had a clinical evaluation that included medical history, a neurological examination and cognitive function testing, which analyzes thinking, learning and memory.

Based on these evaluations, an experienced physician diagnosed 296 (17.3 percent) of participants with Alzheimer's disease, 597 (34.8 percent) with mild cognitive impairment and 20 (1.2.) percent with other forms of dementia, while 802 (46.80 percent had no cognitive impairment.

During the 10-year follow-up (average observation period 4.7 years) 634 individuals died (37 percent), including 25.8 percent of those without cognitive impairment, 40.4 percent of those with mild cognitive impairment, 59.1 percent of those with Alzheimer's disease and 60 percent of those with other forms of dementia.

"Compared with people without cognitive impairment, risk of death was increased by about 50 percent among those with mild cognitive impairment and was nearly three-fold greater among those with Alzheimer's disease," said Wilson. "These effects were seen among African Americans and whites and did not differ by race."

Among individuals with mild cognitive impairment, risk of death increased as cognitive impairment became more severe, another association that did not differ by race. A similar association between disease severity and survival was seen among patients with Alzheimer's disease, although that effect was slightly stronger for African Americans than whites.

"Overall, these results do no suggest strong racial differences in survival for persons with mild cognitive impairment and Alzheimer's disease," said Wilson. "If there are racial differences, it will be important to determine whether they are due to diagnostic bias or whether they reflect actual differences in the underlying neurobiology of the disease or in how affected individuals are cared for." ###

Rush University Medical Center is an academic medical center that encompasses the more than 600 staffed-bed hospital (including Rush Children's Hospital), the Johnston R. Bowman Health Center and Rush University. Rush University, with more than 1,730 students, is home to one of the first medical schools in the Midwest, and one of the nation's top-ranked nursing colleges. Rush University also offers graduate programs in allied health and the basic sciences. Rush is noted for bringing together clinical care and research to address major health problems, including arthritis and orthopedic disorders, cancer, heart disease, mental illness, neurological disorders and diseases associated with aging.

Contact: Deborah Song deb_song@rush.edu 312-942-0588 Rush University Medical Center

Widely used body fat measurements overestimate fatness in blacks

The body mass index (BMI) and waistline measurement overestimate obesity in blacks, according to a new study. The results, which were presented at The Endocrine Society's 91st Annual Meeting in Washington, D.C., suggest that conventional methods for estimating body fat may need to become race-specific.

"Compared to Caucasians, African-Americans of the same age, gender, waist circumference, weight and height may have lower total and abdominal fat mass," said principal investigator and study leader Samuel Dagogo-Jack, MD, professor of medicine and chief, Division of Endocrinology, Diabetes and Metabolism, University of Tennessee Health Science Center, Memphis. "These findings argue for a review of the existing cutoffs for healthy BMI and waist circumference among African-Americans."

Samuel Dagogo-Jack, MD is the A. C. Mullins Professor in Translational Research; Professor of Medicine & Chief of the Division of Endocrinology, Diabetes & Metabolism; and Director of the Fellowship Training Program in Endocrinology, Diabetes and Metabolism at the University of Tennessee College of Medicine, Memphis, TN.

BMI is a simple and common method of estimating someone's body fat levels, based on that person's weight and height measurement. Obesity experts classify an adult who has a BMI less than 18.5 as underweight; normal weight is 18.5 to 24.9, overweight is 25 to 29.9 and obese is more than 30. An indirect measurement, BMI is not a reliable indicator of body fat for people who have a large body frame or lots of lean muscle. More specialized methods, such as DEXA bone density scanning or computed tomography (CT), can directly measure total and regional body fat, but these methods are expensive and more time-consuming. The waist circumference is used to identify abdominal obesity. This fat around the middle carries a higher risk for obesity-related complications such as diabetes and heart disease. Experts define abdominal obesity as a waist circumference greater than 40 inches in men and more than 35 inches in nonpregnant women.

National data show that blacks have higher rates of obesity and type 2 diabetes than whites. Dagogo-Jack and his co-workers therefore examined whether the relationship between body fat and BMI would differ by race. In a study funded by the National Institutes of Health and the American Diabetes Association, they compared how close BMI was to body fat directly measured by DEXA in whites and blacks. The researchers performed the same comparison for waist circumference and abdominal fat. They studied 93 nondiabetic adults (53 blacks and 40 whites) who have one or both parents with type 2 diabetes. Subjects had a broad range of body weights.

The correlation between DEXA-measured total fat and the BMI was higher in whites than blacks, the authors reported. The same was true for the correlation between directly measured abdominal fat and waist size.

Therefore, body fat is likely to be lower in blacks than in whites of the same weight and height, Dagogo-Jack said. He said their data suggest that muscle mass may be higher in blacks, which would explain the dissociation between weight expressed as BMI and measured body fat.

"If our results are confirmed in a larger study population by other researchers, the obesity field will need to develop ethnic-specific cutoffs for what values represent overweight and obesity," he concluded. ###

Contact: Aaron Lohr alohr@endo-society.org 240-427-7157 The Endocrine Society

Long and short sleep durations are associated with increased risk for diabetes

Long and short sleep durations are associated with increased risk for diabetes

WESTCHESTER, Ill. –According to a research abstract that was presented on Monday, June 8, at SLEEP 2009, the 23rd Annual Meeting of the Associated Professional Sleep Societies, both long and short sleepers are at greater risk for diabetes. Individuals sleeping for more than eight hours per night may be particularly vulnerable.

Results indicate that the adjusted odds ratio was 1.24 for diabetes associated with short sleep (five hours per night or less) and 1.48 for diabetes associated with long sleep (nine or more hours per night). The prevalence of diabetes was 12 percent for blacks and 8 percent for whites, and the prevalence of obesity (body mass index of 30 kg/m2 or greater) was 52 percent for blacks and 38 percent for whites.

Dr. Girardin Jean-Louis is Associate Professor in the Department of Medicine and Director of the Research Core at the Center for Health Disparities Research, SUNY Downstate Disorders Center. He is well known in the field of Sleep Medicine and has made a significant contribution in the literature on aging and sleep, circadian rhythm, and ethno-gerontology. He has been involved in several important NIH-funded studies, which have led to 150 publications, 45 in peer-reviewed journals and 105 in scientific conference proceedings and book chapters. Dr. Jean-Louis maintains an active research program at the center, working with several minority fellows, residents, medical students, and college students. His research interests include: associations of metabolic syndrome with sleep apnea and cardiovascular disease, effects of sleep apnea on ocular blood flow, eye diseases and circadian-rhythm dysfunctions, and insomnia in medical and psychiatric disorders.

According to lead author Girardin Jean-Louis, PhD, associate professor at the SUNY Downstate Medical Center at the Brooklyn Health Disparities Research Center in New York, findings suggest that both patients who have excessive or insufficient sleep time have increased risk for developing diabetes, a serious health condition. "Both blacks and whites who were obese tended to have short sleep time. These findings suggest that race significantly influenced the risk of obesity conferred by short sleep duration," said Jean-Louis. "As obesity is associated with diabetes and sleep apnea, it may be that more blacks are at risk for sleep apnea and diabetes, which are both linked to cardiovascular disease." The study involved data from 29,818 individuals who completed the 2005 National Health Interview Survey, a cross-sectional household interview survey using multistage area probability and design. Data were collected from all 50 states and Washington, D.C. Participants were between the ages of 18 and 85 years; 85 percent of the sample was white and 15 percent was black; 56 percent of participants were women. The authors conclude that more research is needed to identify the factors that could explain the relationship between long sleep duration and diabetes. ### The annual SLEEP meeting brings together an international body of 6,000 leading researchers and clinicians in the field of sleep medicine to present and discuss new findings and medical developments related to sleep and sleep disorders. More than 1,300 research abstracts will be presented at the SLEEP meeting, a joint venture of the AASM and the Sleep Research Society.

The three-and-a-half-day scientific meeting will bring to light new findings that enhance the understanding of the processes of sleep and aid the diagnosis and treatment of sleep disorders such as insomnia, narcolepsy and sleep apnea.

Abstract Title: Sleep duration and risk of diabetes: analysis of the National Health Interview Survey
Presentation Date: Monday, June 8
Category: Sleep Deprivation
Abstract ID: 0459

Contact: Kelly Wagner kwagner@aasmnet.org 708-492-0930 American Academy of Sleep Medicine

No insurance? No colonoscopy

John M Inadomi highlights the disparity in colorectal cancer screening (CRCS) among different socioeconomic and ethnic groups in US society in a recent review published by F1000 Medicine Reports (www.f1000medicine.com/reports).

Colorectal cancer is the second leading cause of cancer-related death in the developed world. In this report, John Inadomi, chief of Clinical Gastroenterology at the San Francisco General Hospital and a frequent contributor to F1000 Medicine, writes that the uptake of certain types of screening has been linked to inadequate medical insurance amongst the poorer socio-economic and ethnic groups.

Of the several screening modalities currently available, colonoscopy, sigmoidoscopy and fecal occult blood testing (FOBT) have been shown to reduce colorectal cancer incidence or mortality. Inadomi draws attention to the high prevalence of 'flat' colonic lesions since some screening methods are less likely to detect flat lesions, patients who opt for these modalities (e.g. for financial reasons) could be at risk of lesions being missed.

Colorectal cancer is a disease in which malignant (cancer) cells form in the tissues of the colon or the rectum. The colon is part of the body's digestive system.

One study cited in Inadomi's report found that "African-American women were half as likely as white women to report having undergone screening by colonoscopy." Added to this, awareness of the different tests for CRCS was significantly lower among African-Americans than whites. Correspondingly, there was a similar significant difference in lack of medical insurance coverage between these groups. New technologies used in rural primary care practice to educate people to different types of CRCS have proven to raise the number of patient intention to get screened, helping to overcome socio-economic barriers.

While recognising that language, culture and economic inequality remain significant barriers, Inadomi is optimistic about "the use of new technology and techniques for disseminating information among patients and their providers", and concludes that the efficacy of CRCS may be better improved by "specific educational interventions" than by any given advance in current screening technologies. ###

Notes to Editors

1. Dr John M Inadomi, Faculty Member for F1000 Medicine, is Associate Professor of Clinical Medicine and chief of Clinical Gastroenterology at the San Francisco General Hospital www.f1000medicine.com/member/1749530870211937

2. The full text of this F1000 Medicine Reports article is available at www.f1000medicine.com/reports/10.3410/m1-17/

3. Please name F1000 Medicine Reports and Faculty of 1000 Medicine in any story you write. If you are writing for the web, please link to the website (details below).

4. Non-polypoid or 'flat' colonic neoplasia is present in 9% of the screening population and up to 15% of patients with a prior history of colonic cancer in the US.

5. The F1000 Medicine Reports journal (ISSN 1757-5931), publishes short commentaries by expert clinicians focussing on the most important studies identified by Faculty of 1000 Medicine that are likely to change clinical practice. The commentaries summarise the implications of important new research findings for clinicians www.f1000medicine.com/reports

6. Faculty of 1000 Medicine, www.f1000medicine.com, is a unique online service that helps you stay informed of high impact articles and access the opinions of global leaders in medicine. Our distinguished international faculty select and evaluate key articles across medicine, providing a rapidly updated, authoritative guide to the medical literature that matters.

7. Please contact Kathleen Wets, Director of Sales & Marketing, for a complimentary journalist subscription to Faculty of 1000 www.f1000.com (which includes F1000 Medicine Reports).

Contact: Kathleen Wets kathleen@f1000.com 44-207-323-0323 Faculty of 1000: Biology and Medicine

Stepping up minority recruiting

NIH grant funds School of Medicine's effort to educate minority researchers

Medical schools nationwide struggle to recruit minority physicians, but Temple has met that challenge head on and has the record to prove its success.

Since 1971, nearly 700 underrepresented African American and Latino physicians have completed their medical training at the School of Medicine. And this summer, the school will strengthen its efforts to educate minorities thanks to a catchy acronym and the perseverance of Raul DeLa Cadena.

Backed by a five-year, $500,000 National Institutes of Health (NIH) training grant, the associate professor of physiology and thrombosis research is launching the Short Term Education Program for Undergraduate and Predoctoral students (STEP UP) to increase the number of minorities involved in health-related research.

Raul DeLa Cadena

"We believe producing a physician scientist who is engaged in doing research in areas related to minority health will help eliminate health disparities," said DeLa Cadena. STEP UP begins this summer as a three-month research-based training program for 12 students from ethnic groups that the NIH has shown to be underrepresented in the health professions.

The cohort will include eight undergraduates who have finished at least one year of college and are interested in medicine, dentistry, pharmacy or other health careers; and four medical students who have successfully completed their first year of medical education. Participants will pair with a mentor and get training and hands-on experience in biomedical research topics such as safety in the research laboratory, research misconduct, the use of experimental animal models and health disparities.

Promoting diversity is familiar ground for DeLa Cadena. As assistant dean of the school's recruitment, admissions and retention program, he and his staff provide support and opportunities for prospective applicants, students and alumni from groups that are underrepresented in medicine.

"Despite the fact that African Americans make up at least 12 percent of this country's population, they and other emerging majorities are clearly underrepresented in medicine and the health professions," said DeLa Cadena. "Their representation as scientists is even more scant."

Between 2001 and 2005, the School of Medicine ran a similar program — the Short-Term Summer Research Program — which trained 70 underrepresented students in the health professions. But in 2005 the NIH changed the initiative to promote diversity in research activities, and it's taken DeLa Cadenda three years of fine-tuning to satisfy the NIH's new funding requirements.

"It was so frustrating not to have been able to offer something over the past three years," said DeLa Cadena, "especially when we've witnessed the success we've had with students who took the previous short-term summer program."

Ann Igbre was one of the 70 Temple students who participated in the summer program in 2004. She calls the experience "wonderful."

"The program introduced me to research and really helped me understand the importance of research in medicine," said Igbre. "That summer, I was able to put together a simple research question, test it and see the results. Plus, having that experience on my resume was great when applying for residency."

Now in the ophthalmology residency program at Temple, Igbre is studying racial differences in diabetic retinopathy. She credits the summer program for making her a competitive applicant and is glad to hear that more minority students like her will get opportunities through STEP UP.

The STEP UP grant comes with few strings. The research must be within the scope of areas of interest to the National Heart, Lung and Blood Institute (NHLBI). This requirement places the Cardiovascular Center, the Lung Center and the Thrombosis Research Center in an ideal position to train a future cohort of health professional scientists.

"I strongly believe physician scientists as well as other health professional scientists from minority backgrounds will go on to study research diseases that afflict their ethnic group in a disproportionate fashion, such as hypertension, cardiovascular disease, stroke and Type 2 diabetes," said DeLa Cadena. "And it's exciting to be a part of that effort." ###

Contact: Megan Chiplock chiplock@temple.edu 215-707-1731 Temple University

African Americans are more vulnerable to welfare penalties

In two new studies, sociologists reveal racial disparities in welfare sanctions and explore welfare use among Mexican Americans

WASHINGTON, DC — African Americans are significantly more likely to be sanctioned by the United States welfare system than whites, according to research published in the June issue of the American Sociological Review, the flagship journal of the American Sociological Association.

In a study led by sociologist Sanford F. Schram, a team of researchers conducted a multi-pronged analysis to determine how and why race influences sanctioning under welfare reform in the United States. The study combined real-life data from the Florida Welfare Transition program and experimental data from a survey in which case workers were asked to make sanctioning decisions based on hypothetical scenarios.

Sanford Schram teaches social theory and social policy in the Graduate School of Social Work and Social Research at Bryn Mawr College. Office: Room 212, Graduate School of Social Work and Social Research, Bryn Mawr College 300 Airdale Rd. Bryn Mawr PA 19010-1697. Hours: Th 10-11:30 am or by appointment. Phone: 610-520-2622, Fax: 610-520-2655. Email: sschram@brynmawr.edu

"Welfare sanctions should be imposed in response to client behavior in both law and principle, yet this research indicates that in practice, sanctions are often used in response to client characteristics," said Sanford F. Schram, a professor of social theory and policy at Bryn Mawr College's Graduate School of Social Work and Social Research. "This study provides powerful evidence that race and stereotype-consistent traits interact to shape the allocation of punishment at the frontlines of welfare reform." Findings from experimental and administrative data both supported the vulnerability of African Americans to welfare sanctions, especially when a recipient had a history of one or more sanctions.

According to experimental data, black welfare clients with a prior sanction were 29 percent more likely to be sanctioned than previously-sanctioned whites, and 45 percent more likely to be sanctioned than whites without a prior sanction. In the administrative data, the risk of a first-time sanction was 14 percent higher for African Americans than for white clients. When there were prior sanctions, the risk doubled to 28 percent for blacks compared to whites who had no sanction history.

"White clients in these experiments suffered no statistically discernible negative effects when linked to characteristics that hold negative meanings in the welfare-to-work context," Schram said. "Minority clients, however, enjoyed no such immunity: their odds of being sanctioned increased in the presence of discrediting markers even when the details of their case did not change a bit."

Despite identical situations posed to welfare case workers in experimental surveys, a pregnant Hispanic with four children was significantly more likely to be sanctioned than a white client with only one child. Although results differed in a similar analysis of administrative data, the lack of consistency between the two data sets confirms previous research that demonstrated a narrower gap between Hispanic and white stereotypes than between black and white stereotypes.

Experimental data for this study came from a Web-based survey completed during a two-week period at the end of 2006 by 144 case managers with the Florida Welfare Transition program. Case managers were presented with realistic rule-violation scenarios in which key client characteristics were randomly assigned. Case managers then were asked if they would impose a sanction in response to the scenario. The hypothetical scenarios randomized the client's race (white, African American or Hispanic) and the client's personal situation. In one scenario, the client was a young mother of multiple children and in another she was a repeat welfare recipient with a history of sanctions.

Experimental data were analyzed in conjunction with real-world administrative data from the Florida Department of Children and Families. The data set included monthly, individual-level records for those who received Temporary Assistance for Needy Families (TANF) between January 2000 and April 2004. In an effort to match the scenarios provided in the experimental survey as closely as possible, records were analyzed based on the joint effects of (1) ethnicity and family size and (2) the joint effects of racial status and sanction history. The total administrative sample included more than 6,000 women and nearly 20,000 monthly observation records of participants.

Schram's co-authors for this study included Joe Soss, Cowles Professor for the Study of Public Service at the University of Minnesota, Richard C. Fording, Professor of Political Science at the University of Kentucky, and Linda Houser, a doctoral candidate at Bryn Mawr College.

Immigrants and Welfare

In another study to examine welfare in the context of demographic groups in the June issue of the American Sociological Review, sociologists Jennifer Van Hook and Frank D. Bean found that, prior to welfare reform, Mexican immigrants were more likely than other groups to transition from welfare to work, particularly in states that provided more generous welfare benefits.

"This research refutes welfare reform assumptions that immigrants and disadvantaged native citizens seek out and maintain welfare assistance for the same reasons," said Jennifer Van Hook, associate professor of sociology and demography at the Pennsylvania State University. "In the case of Mexican immigrants, welfare seems to be used primarily to minimize the effects of gaps in employment, not to avoid work or perpetuate dependency."

Among women who reported receiving Aid to Families with Dependent Children (AFDC, the pre-welfare reform version of TANF), Mexican immigrants were significantly more likely to exit welfare within one year (57.7 percent) than were white (37.9 percent) or black (36.4 percent) natives.

Using samples of 4,071 racially diverse immigrant women and 9,265 white or black native women from the Survey of Income and Program Participation (SIPP), Van Hook and Bean analyzed longitudinal data from the 1990 through 1993 annual SIPP panels. The researchers chose to analyze pre-welfare reform data due to the lack of special restrictions related to migration status on the welfare eligibility of legal immigrants. The Personal Responsibility and Work Opportunity Reconciliation Act (Welfare Reform Act) of 1996 barred legal immigrants entering the United States after August 22, 1996, from receiving assistance for the first five years after entry.

The research underscores the importance of taking cultural considerations into account in explaining immigrant welfare behaviors. Van Hook and Bean attribute the lower rates of welfare receipt and higher rates of post-welfare employment of Mexican immigrant women to the strong pro-employment cultural orientation among these immigrants.

"Our research suggests that the strong involvement of work and family in the Mexican decision to migrate leads to the prioritization of employment well after migration, minimizing welfare receipt and increasing post-welfare employment," Van Hook said. "Further, immigrant public assistance may in fact have a positive effect on integration, helping immigrants to work their way out of poverty and off welfare."

Welfare reform is not likely to deter future Mexican immigration, according to Van Hook and Bean, if policymakers are indeed misguided in assuming that immigrants are drawn to the United States by welfare, or that immigrants assimilate into welfare. Instead, welfare reform actually may delay economic incorporation, particularly if no other form of economic settlement assistance is available to immigrants experiencing conditions of great economic need. ###

The research articles "Deciding to Discipline: Race, Choice and Punishment at the Frontlines of Welfare Reform" and "Explaining Mexican Immigrant Welfare Behaviors: The Importance of Employment-Related Cultural Repertoires" as well as author interviews are available by request for members of the media. Contact Jackie Cooper, ASA's Media Relations Officer, at pubinfo@asanet.org or (202) 247-9871.

About the American Sociological Association

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

Contact: Jackie Cooper pubinfo@asanet.org 202-247-9871 American Sociological Association

Job loss can make you sick, new study finds

BOSTON—In the face of rising unemployment and businesses declaring bankruptcy, a new study has found that losing your job can make you sick. Even when people find a new job quickly, there is an increased risk of developing a new health problem, such as hypertension, heart disease, heart attack, stroke or diabetes as a result of the job loss. The study will be published in the May 8 issue of Demography.

"In today's economy, job loss can happen to anybody," said Kate Strully, who conducted the research as a Robert Wood Johnson Foundation Health and Society scholar at the Harvard School of Public Health. "We need to be aware of the health consequences of losing our jobs and do what we can to alleviate the negative effects."

Workers who are in poor health have a 40 percent increase in the odds of being laid off or fired, but Strully's findings go beyond sicker people being more likely to lose their jobs.

David R. Williams, Florence Sprague Norman and Laura Smart Norman. Professor of Public Health (Harvard School of Public Health) Professor of African and African American Studies (Harvard University) Contact dwilliam@hsph.harvard.edu. 617-432-6807 (Phone) 617-496-5794 (FAX) 615 Kresge Building. 677 Huntington Ave Boston, MA 02115

She finds that "job churning," defined as high rates of job loss but low unemployment, has negative health consequences for workers who were not already sick. For those who lost their job—white or blue collar—through no fault of their own, such as an establishment closure, the odds of reporting fair or poor health increased by 54 percent, and among respondents with no pre-existing health conditions, it increased the odds of a new health condition by 83 percent. Even when workers became re-employed, those workers had an increased risk of new stress-related health conditions. Unlike the results of job loss due to an establishment closure, when health effects were analyzed based on workers who were fired or laid off, significant differences were found based on the workers' occupations. While being fired or laid off or leaving a job voluntarily more than doubles the odds of a fair or poor health report among blue-collar workers, such job displacements have no significant association with the health reports of white-collar workers. The reasons for this disparity are unclear based on the study results.

"As we consider ways to improve health in America during a time of economic recession and rising unemployment, it is critical that we look beyond health care reform to understand the tremendous impact that factors like job loss have on our health," says David R. Williams, Norman Professor of Public Health at the Harvard School of Public Health, Professor of African and African American Studies and of Sociology at Harvard University and staff director of the Robert Wood Johnson Foundation Commission to Build a Healthier America. "Where and how we live, work, learn and play have a greater impact on how healthy we are than the health care we receive."

The study was conducted based on data from the U.S. Panel Study of Income Dynamics, a nationally representative survey from 1999, 2001 and 2003. The study looked at establishment closures that included a range of occupations, including managerial or professional positions (30 percent displacement), sales, clerical, and craft jobs, (33 percent displacement), a machine operator jobs (20 percent displacement), and service positions (13 percent displacement). ###

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/

The research findings presented here are those of the researcher and are not necessarily the views of the Robert Wood Johnson Foundation.

Contact: Natalia Barolin nbarolin@iqsolutions.com 240-221-4088 Robert Wood Johnson Foundation Health & Society Scholars

Low levels of vitamin D linked to common vaginal infection in pregnant women

Findings may explain higher rates of infection among African-Americans

PITTSBURGH, – Pregnant women with low levels of vitamin D may be more likely to suffer from bacterial vaginosis (BV) – a common vaginal infection that increases a woman's risk for preterm delivery, according to a University of Pittsburgh study. Available online and published in the June issue of the Journal of Nutrition, the study may explain why African-American women, who often lack adequate vitamin D, are three times more likely than white women to develop BV.

"Bacterial vaginosis affects nearly one in three reproductive-aged women, so there is great need to understand how it can be prevented," said Lisa M. Bodnar, Ph.D., M.P.H., R.D., assistant professor of epidemiology, obstetrics and gynecology, University of Pittsburgh. "It is not only associated with a number of gynecologic conditions, but also may contribute to premature delivery – the leading cause of neonatal mortality – making it of particular concern to pregnant women."

Lisa M. Bodnar, PhD, MPH, RD. Assistant Professor Department of Epidemiology A742 Crabtree Hall 130 DeSoto Street Pittsburgh, PA 15261 Phone: 412.624.9032 Fax: 412.624.7397 E-mail: bodnar@edc.pitt.edu

The study, which included 469 pregnant women, sought to determine whether poor vitamin D status played a role in predisposing women, especially African-Americans, to BV. Dr. Bodnar and colleagues at Magee-Womens Research Institute found that 41 percent of the study participants had BV and of these, 93 percent had insufficient levels of vitamin D. They also found that the prevalence of BV decreased as vitamin D levels rose.

Vitamin D may play a role in BV by regulating the production and function of antimicrobial molecules, which in turn may help the immune system prevent and control bacterial infection. However, only about one in four Americans gets enough vitamin D. Vitamin D deficiency may be more common in African-Americans because dark pigmentation limits the amount of vitamin D that can be made in the skin through casual exposure to sunlight. African-American women also are less likely to meet dietary recommendations of vitamin D.

"Although this is a preliminary study, it points out an interesting connection between vitamin D and BV," said Dr. Bodnar. "We don't recommend pregnant women take mega-doses of vitamin D based on these findings, but they should talk with their doctor if they have concerns about their vitamin D status. All women should be encouraged to eat a healthy diet and take a prenatal vitamin before they become pregnant or as soon as they find out they are pregnant." ###

Co-authors of the study include Marijane A. Krohn, Ph.D., and Hyagriv N. Simhan, M.D., with the University of Pittsburgh and Magee-Womens Research Institute. The study was funded by the National Institutes of Health.

Contact: Clare Collins CollCX@upmc.edu 412-647-3555 University of Pittsburgh Schools of the Health Sciences

Blacks more likely to opt for life-sustaining measures at end of life

PITTSBURGH, When faced with a terminal illness, African-American seniors were two times more likely than whites to say they would want life-prolonging treatments, according to a University of Pittsburgh study available online and published in the June issue of the Journal of General Internal Medicine.

The study, led by Amber E. Barnato, M.D., M.P.H., associate professor of medical, clinical and translational science and health policy, University of Pittsburgh, was based on interviews and surveys with more than 2,800 Medicare beneficiaries 65 years and older, making it the largest nationally representative sample of U.S. seniors' end-of-life treatment preferences. Overall, the majority of Medicare beneficiaries surveyed preferred not to die in a hospital or to receive life-sustaining measures at the end of life.

Amber E. Barnato, M.D., M.P.H. Assistant Professor of Medicine and Health Policy and Management. Associate Director, Clinical Scientist Training Program Office: 200 Meyran Ave. Suite 200. Pittsburgh, PA 15213. Phone: 412-692-4875 Fax: 412-246-6954 Email: barnatoae@upmc.edu

During interviews, study respondents were asked about their treatment preferences in the event they were diagnosed with a terminal illness and had less than a year to live. More African-Americans (18 percent) than whites (8 percent) reported that they would prefer to die in a hospital. African-Americans (28 percent) also were more likely than whites (15 percent) to report that they would opt for life-prolonging drugs, even if the treatment made them feel worse all of the time. Only 49 percent of African-Americans compared to 74 percent of whites responded that they would want potentially life-shortening palliative drugs (for pain and comfort only). Lastly, when asked whether they would opt for mechanical ventilation to extend their lives for a week, 24 percent of African-Americans said they would, compared to 13 percent of whites. When mechanical ventilation would extend life by one month, this percentage rose to 36 percent in African-Americans, compared to 21 percent in whites.

"We collected detailed information about personal and social factors that might explain the relationship between African-Americans and preference for more intensive end-of-life treatment. An overly optimistic view of the ability of mechanical ventilation, a breathing machine, to save lives and return people to their normal activities explained some, but not all, of this difference," said Dr. Barnato.

Although the study looked at differences in treatment preferences by race, Dr. Barnato cautions it should not be viewed as an invitation to generalize. "As doctors, we should ask each patient and family about their goals of treatment, then offer the treatments that meet those goals, rather than making assumptions about treatment preferences based on race," she said. ###

The study was funded by the National Institute on Aging. Co-authors include Denise Anthony, Ph.D., Dartmouth College; Jonathan Skinner, Ph.D., and Elliott Fisher, M.D., M.P.H., Dartmouth Medical School; and Patricia Gallagher, Ph.D., University of Massachusetts.

Contact: Clare Collins CollCX@upmc.edu 412-647-3555 University of Pittsburgh Schools of the Health Sciences

Clear racial discrepancies exist among patients with CKD

Due to sociological factors, black patients face higher rates of death in early stages of the disease

Washington, DC (May 19, 2008) — Black patients have a higher risk of dying in the early stages of chronic kidney disease (CKD) than whites, according to a study appearing in the July 2008 issue of the Journal of the American Society Nephrology (JASN). The findings may explain why blacks have better survival rates once they reach advanced stages of the disease—in essence, because only the healthiest blacks are surviving long enough to develop later stages of the disease. If white patients are given better care in managing their condition early on, even less healthy patients may live to develop advanced disease. But, their compromised health may put them at increased risk of death in the long term compared with blacks.

In addition, the study’s results indicate that racial differences in the death rates of chronic kidney disease patients depend more on sociological factors than on biological ones. Poverty and lack of education and medical insurance in particular may contribute to the high death rates among black individuals.

Previous research has documented that, in general, mortality rates for black individuals are persistently higher than those for whites. However, among patients with late-stage chronic kidney disease, the trend is reversed and black individuals have a survival advantage over whites. Hispanic patients also seem to have a survival advantage over whites in these situations.

Puzzled by this paradox, Dr. Rajnish Mehrotra of the Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center and colleagues set out to find an explanation. They assessed data from a total of 14,611 patients in the Third National Health and Nutrition Examination Survey (NHANESIII), a population-based survey of community-dwelling individuals.

The investigators found that 2,892 of the individuals in the survey had chronic kidney disease, 1,127 of whom died during follow-up. Among those with early-stage disease who were younger than 65 years, blacks had a 78% higher risk of death compared with whites. This elevated risk was significantly related to socioeconomic status and access-to-care. There was also a nonsignificant trend for higher mortality among Hispanics compared with whites.

Dr. Mehrotra and his team conclude that their findings may explain the lower mortality rates observed among black individuals with advanced kidney disease. Blacks may not be receiving as high a quality of care as whites during the early stages of their disease, so that only healthier blacks are surviving and developing later stages of chronic kidney disease.

“These data suggest that factors such as education, poverty, and lower probability of medical insurance may be more important in mediating the high risk for death among younger black individuals than are biologic differences,” the authors write. “This, in turn, may help in prioritizing interventions aimed at reducing the disparities among younger black individuals with chronic kidney disease.” ###

The study entitled, “Racial Differences in Mortality among Those with CKD,” is available online at jasn.asnjournals.org/ and will appear in print in the July issue of JASN.

Dr. Mehrotra is supported by a K23 grant from the National Institutes of Health (NIH). Support for this work was also provided by other grants from NIH.

The American Society of Nephrology (ASN) is a not-for-profit organization of 11,000 physicians and scientists dedicated to the study of nephrology and committed to providing a forum for the promulgation of information regarding the latest research and clinical findings on kidney diseases. ASN publishes the Journal of the American Society of Nephrology (JASN), the Clinical Journal of the American Society of Nephrology (CJASN), and the Nephrology Self-Assessment Program (NephSAP). In January 2009, ASN will launch a newsmagazine.

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

Bringing underrepresented groups into mathematics

Mathematics departments honored for outstanding efforts

Providence, RI---The Committee on the Profession (CoProf) of the American Mathematical Society (AMS) has announced the selection of two outstanding mathematics department programs to be designated as Mathematics Programs that Make a Difference. For 2009 the honored programs are the Department of Statistics at North Carolina State University, and the Department of Mathematics at the University of Mississippi.

"These two departments have outstanding records in recruiting members of underrepresented groups and mentoring them to successfully complete their graduate degrees," said Alejandro Adem of the University of British Columbia, chair of CoProf and of the selection committee for the award. "The AMS Committee on the Profession was extremely impressed with their accomplishments, which can serve as a model for other departments in the United States."

Diversity a Priority: NCSU's Department of Statistics

Caption: These are members of the department of statistics at North Carolina State University. Credit: Photo by Marc Hall, courtesy of the NCSU Department of Statistics. Usage Restrictions: Contact for permission to publish this photograph: Sastry G. Pantula Pantula@stat.ncsu.edu.

The Department of Statistics at North Carolina State University (NCSU) has made diversity of students and faculty a top priority. Out of 40 faculty in the department, 11 are female, 3 are African-American, and 2 are Hispanic. In the past 10 years, 15 minority students have received master's degrees and 2 have received Ph.D.s. The department has about 160 graduate students, including 9 African-Americans and 4 Hispanics; over 50 percent are female.

The department's approach includes communication with faculty at other institutions, active and sustained recruiting of minority students, and careful mentoring. NCSU has cultivated ties to other institutions, in particular historically black colleges and universities, as well as to organizations such as the Society for the Advancement of Chicanos and Native Americans in Science (SACNAS). Through such connections, NCSU has reached undergraduate students interested in advanced work in statistics and provided them with information to decide whether NCSU is a good fit for them for graduate school. A co-Director of Graduate Programs, Pam Arroway travels extensively to various small colleges and summer programs to recruit students and to network and maintain strong relationships with their mentors.

Once students are recruited into the graduate program, they benefit from extensive mentoring from faculty advisors. Each new student is also assigned to a more-advanced student who acts as a mentor, or "stat buddy". A key figure in the department's mentoring efforts has been faculty member Kimberly Weems, who organizes many social activities for minority students and meets individually with them to ensure their successful progress through the program.

Caption: These are members of the University of Mississippi department of mathematics. Credit: University of Mississippi Department of Mathematics. Usage Restrictions: Contact for permission to use this photograph: Gerard Buskes mmbuskes@olemiss.edu.

Setting the student-centered tone is department head Sastry Pantula, who has twice been selected for a university diversity award. Other department faculty have received similar recognition, including Weems and Jackie Hughes-Oliver. Recently a graduate student in the department, Anthony Franklin, received a university diversity award for his support of students and for recruiting new students of all backgrounds.

This dynamic department has pursued and received many grants, including two National Science Foundation VIGRE grants that proved crucial in supporting minority students. Recently the department received an S-STEM (Scholarships in Science, Technology, Engineering, and Mathematics) grant from the NSF, which will provide scholarships for United States undergraduate and graduate students with financial need. The department participates in many existing diversity programs, workshops, and conferences, and also designs and hosts some of its own. Some of the more recent such events are StatFest, Infinite Possibilities Conference, a Pipeline Workshop for Faculty of Women's Colleges and Minority Institutions, and Building Future Faculty. NCSU's long-term commitment, with strong support from its administration, is making a difference in diversity in the mathematical sciences.

Nurturing African-American Mathematicians: University of Mississippi's Department of Mathematics

The southern United States is home to many of the nation's African-Americans, and yet the universities in that part of the country have not historically been large producers of African-American Ph.D.s in mathematics. But the University of Mississippi (UM) has started to reverse this trend, becoming a national leader in nurturing and mentoring African-Americans in doctoral study. Over the past decade, 11 African-Americans have received mathematics doctorates from Ole Miss. That the university was once a symbol of educational segregation in the United States gives this success story special importance.

Since 2001, the UM mathematics department has received two GAANN (Graduate Assistance in Areas of National Need) grants from the U.S. Department of Education; the grants provide fellowships for graduate study. The fellowships proved to be transformational for the department, allowing it to quadruple the number of graduate students and to ensure that they are financially well supported. At the same time the department worked diligently to provide more careful nurturing of its graduate student population, both in research and in professional development.

Contributions to these achievements were made by the entire UM mathematics department, including 10 faculty who have served as GAANN dissertation advisors. Among the key leaders have been the co-principal investigators of the GAANN grants, Gerard Buskes and Donald Cole. As an African-American faculty member and assistant to the chancellor for multicultural affairs, Cole has been a role model and mentor for the African-American graduate students, while Buskes serves as advisor and mentor to the GAANN students. Buskes eloquently described the department's efforts in an article, "Mississippi Mathematics Renaissance," which appeared in the January 2007 issue of the Notices of the AMS. This article celebrated a high point in the department's efforts, the awarding of Ph.D.s to six African-Americans in 2006, which is the largest cohort of African-American mathematics Ph.D.'s ever produced at any university in the United States.

In her nomination letter, Sylvia Bozeman of Spelman College, winner of the 2008 AAAS Mentor Award, wrote this regarding the department's work recruiting and retaining students from underrepresented groups: "It is this visionary effort, by all involved, and the resulting unprecedented success that deserves to be set forth as a model for other departments who are more hesitant to attempt change. The testimony of the leadership at Ole Miss as to how the influx of minority and female students with high academic goals transformed the department and the atmosphere therein should be amplified as other graduate departments contemplate the call for more student diversity." ###

See the citation for more information on these two programs at www.ams.org/employment/citation2009. Photographs are available upon request.

CoProf created the Mathematics Programs that Make a Difference designation in 2005 as a way to bring recognition to outstanding programs that successfully address the issue of underrepresented groups in mathematics. Read more, including information about programs that have been recognized, at www.ams.org/employment/makeadiff.

Find out more about AMS and AMS-affiliated prizes at www.ams.org/prizes-awards.

Contacts: Mike Breen or Annette Emerson, AMS Public Awareness Officers Telephone: 401-455-4000 Email: paoffice@ams.org

Sastry G. Pantula, Professor Head, Department of Statistics and Director, Institute of Statistics North Carolina State University Raleigh, NC 27695-8203 Tel: (919) 515-1949 Email: Pantula@stat.ncsu.edu

Gerard Buskes, Professor Department of Mathematics University of Mississippi University, MS 38677 Tel: 662-915-7425 Email: mmbuskes@olemiss.edu

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