Patient-doctor communication is worse for blacks than for whites, study finds VIDEO

CHAPEL HILL – Black patients with high blood pressure experience poorer communication with their doctors than white patients do, a study led by a University of North Carolina at Chapel Hill researcher has found.

"This is an important finding because poorer communication is associated with worse patient satisfaction, adherence to therapy and blood pressure control, which in turn may lead to worse disease outcomes for black patients compared to white patients," said Crystal Wiley Cené, M.D., M.P.H., an assistant professor in the UNC School of Medicine and lead author of the study.

The study is published in the September 2009 issue of the Journal of General Internal Medicine.

Caption: Dr. Crystal Wiley Cené from the UNC School of Medicine discusses her study, which shows that how physicians communicate with their patients has an impact on overall satisfaction, quality of care and health outcomes. Credit: Video produced by Stephanie Crayton of UNC Health Care. Usage Restrictions: None.

Cené, a native of Sneads Ferry, N.C. and a graduate of the Brody School of Medicine at East Carolina University, led the study while completing a fellowship in general internal medicine at Johns Hopkins University School of Medicine in Baltimore, Md. In her study, Cené and colleagues analyzed audio recordings of patient visits with their primary care physician as part of a study of interventions aimed at improving patient adherence to high blood pressure therapy.

The larger study was led by Cené's mentor, Lisa A. Cooper, M.D., M.P.H., a Hopkins professor who earned her M.D. at UNC in 1988. Cooper is also the corresponding author of Cené's article. Previous studies have shown both that patients in poorer health report having worse interpersonal communication with their doctors, and that black patients report poorer patient-doctor communication than white patients. Cené's study was designed to examine whether having uncontrolled blood pressure, in addition to being black, had a greater negative impact on patient-doctor communication than just race alone.

Caption: Crystal Wiley Cené, M.D., M.P.H. is a researcher at University of North Carolina School of Medicine. Credit: UNC School of Medicine. Usage Restrictions: None.

Participants in Cené's study included 226 high blood pressure patients and 39 physicians from 15 primary care practices in Baltimore. Coders listened to recordings of the patient visits and measured several outcomes. These included, but were not limited to, the length of visits and the number of statements devoted to the communication functions of biomedical exchange, psychosocial exchange and rapport building.

The results showed that the black patients had shorter office visits, less biomedical and psychosocial exchange and less rapport building with their doctors than white patients. These differences were statistically significant for psychosocial exchange and rapport building but not for biomedical exchange. Blacks with uncontrolled high blood pressure fared somewhat worse than blacks whose blood pressure was controlled by medication, whereas there were no significant differences among whites based on blood pressure control status.

The researchers found that for each outcome blacks, regardless of whether their blood pressure was controlled or not, had worse communication with their doctors than whites, regardless of the white patients' blood pressure control. The only exception was for an outcome called "patient positive affect," which is a sum of ratings of patients' interest, friendliness, engagement, sympathy and assertiveness behaviors. For this outcome they found that blacks with uncontrolled blood pressure had less positive affect than any of the other groups.

"It seems that in general blacks talk less overall to their physicians than white patients," Cené said. "As a result, communication about specific topics occurs less often. There are several possible reasons why they may talk less to their physicians -- they might not trust the physician or feel that they are 'disconnected' from their doctors, for whatever reasons. This lack of communication by black patients may in turn make their physicians talk less to them." Cené said.

"We believe there also may be an 'unspoken subtext' that occurs in visits between patients and doctors that influences the communication that occurs during the visit," Cené said. "It's possible that black patients are more likely to pick up on that 'unspoken subtext' and it alters their communication with their doctor. This might explain why we found that black patients had less positive affect towards their doctors than white patients. Essentially they are more sensitized to 'cue' into things that the coders could not easily capture just by listening to the audiotapes."

The study concluded that patient race was more important than blood pressure control status in determining the quality of patient-doctor communication and recommended the testing of interventions designed to improve patient-doctor communication as a way to reduce racial disparities in the care of patients with high blood pressure. ###

Contact: Tom Hughes tahughes@unch.unc.edu 919-966-6047 University of North Carolina School of Medicine

Racial disparity studied in patients undergoing liver transplantation for hepatitis B

HBV recurrence higher in Caucasians compared to Asian- and African-Americans -- further study needed

According to the Centers for Disease Control and Prevention (CDC) 1.5 to 2 million Americans are infected with the hepatitis B virus (HBV). Prior studies have shown there to be significant racial differences in access to and outcomes of liver transplantation. Recently, doctors from across the U.S. conducted a multicenter retrospective-prospective study of the waitlist status and outcomes of liver transplant patients with HBV infection. This study led by Natalie Bzowej from California Pacific Medical Center and Anna Lok from the University of Michigan and funded by a grant from the National Institutes of Health (NIH), found there to be similar waitlist and post-transplant outcomes among Asian Americans, African Americans, and Caucasians with HBV. These research findings appear in the September issue of Liver Transplantation, a journal of the American Association for the Study of Liver Diseases, published by Wiley-Blackwell.

Natalie H Bzowej, M.D. 2340 Clay St., 3rd Fl. San Francisco, California 94115. Phone: (415) 600-1020. Fax: (415) 776-0292

The NIH HBV liver transplant study had a total of 274 patients (116 Caucasians, 135 Asians and 23 African Americans) enrolled in 15 centers across the U.S. Participants were placed on the United Network of Organ Sharing (UNOS) liver transplantation recipient waitlist between 1996-2005. The probability of transplantation 1, 3 and 5 years after listing was 53%, 75%, and 88% for African Americans; 48%, 58% and 66% for Asian Americans; and 48%, 57% and 63% for Caucasians. "As expected, the interval between listing and transplantation was shortest for patients with acute liver failure, followed by those with hepatocelluler carcinoma (HCC), and those with endstage cirrhosis.

Our research showed transplant indication and Model for End-stage Liver Disease (MELD) score for endstage cirrhosis patients were the only predictors of transplantation, but race was not," said researchers.

Of the total number of study participants, 170 received transplantations between 2001and 2007. The probability of post-transplant survival at 5 years was 94% for African Americans, 85% for Asian Americans, and 89% for Caucasians. "Analysis indicated that HCC recurrence was the only predictor of post-transplant mortality while race, indication for transplant, and HBV recurrence were not," the authors explained.

According to the research, Caucasians had a higher rate of HBV recurrence with the 4-year recurrence rate at 19% compared to 7% and 6% for Asian Americans and African Americans, respectively. "We found that hepatitis B e antigen (HBeAg) status at listing was the only factor significantly associated with HBV recurrence post-transplant, while race showed a trend," said Dr. Bzowej. "Our findings of a higher rate of HBV recurrence among Caucasians needs to be validated in other studies," she added. Charles D. Howell, MD, Professor of Medicine, The University of Maryland School of Medicine, commented on the NIH HBV liver transplant study in his editorial also published in the September issue of Liver Transplantation. Dr. Howell cited earlier studies where outcomes across the races were varied.

Anna Suk-Fong Lok, M.D., F.R.C.P. Academic office address, A. Alfred Taubman Health Care Center. 1500 East Medical Center Drive. Room 3912. Ann Arbor, MI 48109-5362 Academic office telephone: (734)936-7511, Academic office FAX: (734)936-7392

"The study of the Organ Procurement and Transplantation Network (OPTN) data from 1994-1998 (Reid et al) found that African Americans 18-70 were under-represented on the UNOS liver recipient waiting list. A 2008 study showed African American patients transplanted between 2002 and 2006 experienced lower survival rates than Caucasians," he noted.

Results from NIH HBV liver transplant study indicate similar waitlist and post-transplant outcomes across the three racial groups studied. "More study is necessary to determine whether the disparity between African Americans, Asians, and Caucasians in outcomes of liver transplantation for HBV persists in the most recent era," concluded Dr. Howell. ###

Article: "Liver Transplantation Outcomes among Caucasians, Asian Americans and African Americans with Hepatitis B," Natalie Bzowej, Steven-Huy Han, Bulent Degertekin, Emmet Keeffe, Sukru Emre, Robert Brown, Rajender Reddy, Anna Lok, Liver Transplantation, September 2009.

Editorial: "Racial Disparities in Liver Transplantation for Hepatitis B: To Be or Not to Be," Charles D. Howell, MD, Liver Transplantation, September 2009.

Contact: Dawn Peters medicalnews@wiley.com Web: Wiley-Blackwell

The Civil Rights March on Washington 08/28/1963

Birmingham was a real victory, but a costly one. The long-term solution could not be for African Americans to defeat segregation one city at a time or by absorbing beatings, dog bites, and hosings. Even as the civil rights movement scored real gains, each advance came over dogged opposition. Federal troops were needed to ensure the admission of James Meredith, the first black to study at the University of Mississippi, in 1962. The following year, Alabama’s governor, George Wallace, whose inaugural address promised “segregation now, segregation tomorrow, segregation forever,” staged a “stand in the schoolhouse door.” Only the intervention of federal marshals ensured the enrollment of African Americans Vivian Malone and James Hood at the University of Alabama. The very next day, Medgar Evers, leader of the Mississippi NAACP, was murdered outside his home in Jackson. And in Birmingham itself, on September 15, 1963, three Klansmen planted 19 sticks of dynamite in the basement of the Sixteenth Street Baptist Church, the unofficial headquarters of the Birmingham movement. Four young girls — Addie Mae Collins, Carole Robertson, Cynthia Wesley, and Denise McNair — were killed and 22 injured.

On June 11, 1963, President John F. Kennedy told the nation that he would submit to Congress legislation prohibiting segregation in all privately owned facilities: hotels, restaurants, theaters, retail stores, and the like. “We are confronted primarily,” the president said, “with a moral issue. It is as old as the scriptures and as clear as the American Constitution.” But the obstacles to passage of effective civil rights laws remained imposing.

Civil Rights March on Washington, D.C. [Roy Wilkins, Executive Secretary of the National Association for the Advancement of Colored People; A. Philip Randolph, organizer of the demonstration and veteran labor leader who helped to found the Brotherhood of Sleeping Car Porters, American Federation of Labor (AFL), and a former vice president of the American Federation of Labor and Congress of Industrial Organizations (AFL-CIO); and Walter P. Reuther, President of the United Automobile Workers Union and Vice President of the American Federation of Labor and Congress of Industrial Organizations, leading marchers down the street.] Civil Rights March on Washington, D.C. [Leaders marching from the Washington Monument to the Lincoln Memorial. In the front row, from left are: Whitney M. Young, Jr., Executive Director of the National Urban League; Roy Wilkins, Executive Secretary of the National Association for the Advancement of Colored People; A. Philip Randolph, Brotherhood of Sleeping Car Porters, American Federation of Labor (AFL), and a former vice president of the American Federation of Labor and Congress of Industrial Organizations (AFL-CIO); Walter P. Reuther, President, United Auto Workers Union; and Arnold Aronson, Secretary of the Leadership Conference on Civil Rights.] Civil Rights March on Washington, D.C. [Crowd of marchers at the Lincoln Memorial.], 08/28/1963 Civil Rights March on Washington, D.C. [Young women at the march.], 08/28/1963 Civil Rights March on Washington, D.C. [Close-up view of a crowd at the march.], 08/28/1963 Civil Rights March on Washington, D.C. [A crowd of marchers.], 08/28/1963

A number of black leaders were determined to change the political reality in which members of Congress would consider civil rights legislation. One was A. Philip Randolph. Now well into his 70s, Randolph had earlier organized and for decades led the Brotherhood of Sleeping Car Porters union. African Americans had long supplied large numbers of rail car attendants. These were among the best jobs open to blacks in much of the country, and Randolph, as leader of these porters, had emerged as an important figure in the American labor movement. Back in 1941, President Franklin D. Roosevelt had sought to boost defense production in anticipation of possible U.S. entry into the Second World War. Randolph confronted Roosevelt, demanding an end to segregation in federal government agencies and among defense contractors. Otherwise, Randolph warned, he would launch a massive protest march on Washington, D.C. Roosevelt soon issued an executive order barring discrimination in defense industries and federal bureaus and creating the Fair Employment Practices Committee. After the war, pressure from Randolph contributed to President Harry S Truman’s 1948 order desegregating the American armed forces. Now Randolph and his talented assistant Bayard Rustin contemplated a similar march, hoping “to embody in one gesture civil rights as well as national economic demands.” A “Big Six” group of civil rights leaders was formed to organize the event. Included were Randolph, King, Roy Wilkins (representing the National Association for the Advancement of Colored People), James Farmer (Congress of Racial Equality), John Lewis (Student Nonviolent Coordinating Committee), and Whitney Young Jr. (Urban League). They fixed a date: August 28, 1963, and site for the main rally: the Lincoln Memorial in Washington, D.C. The “March on Washington for Jobs and Freedom” would be the largest political demonstration the nation had ever seen. Chartered buses and trains carried participants from throughout the nation. A quarter-million Americans, and by some estimates even more, gathered that day, among them at least 50,000 whites. On the podium stood a stellar assemblage of civil rights champions, Christian and Jewish religious leaders, labor chiefs, and entertainers. The black contralto Marian Anderson, who had performed at the Lincoln Memorial in 1939 after being refused permission to sing at Washington’s Constitution Hall, offered the national anthem. Each of the Big Six addressed the crowd that day, except for Farmer, who had been arrested during a protest in Louisiana. The best-remembered moment would be King’s. Considered by many the finest oration ever delivered by an American, King’s “I Have a Dream” speech drew on themes from the Bible and from such iconic American texts as the Constitution, the Declaration of Independence, and Abraham Lincoln’s Gettysburg Address. King organized his remarks in the style and structure of a sermon, the kind he had delivered at many a Sunday morning church service. The speech began by linking the civil rights cause to earlier promises unfulfilled. Lincoln’s Emancipation Proclamation, King said, appeared to the freed slaves as “a joyous daybreak to end the long night of their captivity.” But 100 years later, he continued, “the Negro … finds himself an exile in his own land.” When the nation’s founders wrote the Declaration of Independence and the Constitution, “they were signing a promissory note to which every American was to fall heir. This note was a promise that all men, yes, black men as well as white men, would be guaranteed the ‘unalienable rights’ of ‘life, liberty, and the pursuit of happiness.’ ” America, King continued, had defaulted on that promissory note, at least to her citizens of color. We refuse to believe that the bank of justice is bankrupt. We refuse to believe that there are insufficient funds in the great vaults of opportunity of this nation. And so, we’ve come to cash this check, a check that will give us upon demand the riches of freedom and the security of justice. “There will be neither rest nor tranquility in America until the Negro is granted his citizenship rights,” King warned, but he also noted that in the process of gaining our rightful place, we must not be guilty of wrongful deeds. Let us not seek to satisfy our thirst for freedom by drinking from the cup of bitterness and hatred. We must forever conduct our struggle on the high plane of dignity and discipline. We must not allow our creative protest to degenerate into physical violence. Some believe that King spoke extemporaneously as he delivered the “dream” portion of his address. The famed gospel singer Mahalia Jackson was on the stage while King spoke, and she addressed him during the speech: “Tell them about the dream, Martin,” she said. And he did. … and so even though we face the difficulties of today and tomorrow, I still have a dream. It is a dream deeply rooted in the American dream. I have a dream that one day this nation will rise up and live out the true meaning of its creed: “We hold these truths to be self-evident, that all men are created equal.” I have a dream that one day on the red hills of Georgia, the sons of former slaves and the sons of former slave owners will be able to sit down together at the table of brotherhood. I have a dream that one day even the state of Mississippi, a state sweltering with the heat of injustice, sweltering with the heat of oppression, will be transformed into an oasis of freedom and justice. I have a dream that my four little children will one day live in a nation where they will not be judged by the color of their skin but by the content of their character. I have a dream today! As the words and images of the day’s events sped across the nation and around the world, momentum for real change accelerated. But there were battles still to be fought, and victory, while ever closer, still lay in the distance. This article is excerpted from the book Free At Last: The U.S. Civil Rights Movement, published by the Bureau of International Information Programs. View the entire book Free At Last (PDF, 3.6 MB).

Fisk/Vanderbilt program receives $3.7 million to increase minority Ph.D.s in the physical sciences

A unique collaboration between Fisk and Vanderbilt universities that is poised to become the nation's top source of Ph.D.s in physics and astronomy awarded to underrepresented minorities has received a major boost from three federal grants totaling $3.7 million.

The Fisk-Vanderbilt Masters-to-PhD Bridge program was established in 2004. In just five years the program has attracted 31 underrepresented minority students, 60 percent of whom are women, and has become the nation's top producer of blacks earning master's degrees in physics. One of the new grants will be used to strengthen the astronomy/astrophysics infrastructure at Fisk, a historically black university, as well as increase recruitment and retention of underrepresented students. The second grant will fund the expansion of the program to a second historically black institution, Delaware State University, and expand the program from its current focus on astronomy and astrophysics to include materials science. The third grant will provide generous fellowships to support the students participating in the program.

Caption: The following are participants in the Fisk-Vanderbilt Masters-to-PhD Bridge Program: Front row, left to right: John Rigueur, Matthew Richardson, Tomas Yan, Tommy LeBlanc, Trey Mack, Des Campbell, Michael Williams and Shawn Eastmond. Middle row, left to right: Sharina Haynes, Melissa Harrison, Shalanda Satchell, Stacey Lawrence, Lauren Palladino, Fabienne Bastien, Leolene Jean, Brittany Kamai, Bernadette Cogswell, Erica Morgan and Jessica Harris. Back row, left to right: Arnold Burger, Co-Director, Fisk University, Sandra Rosenthal, Vanderbilt University, Keivan Stassun, Co-Director, Vanderbilt University, Provost Chris Brown, Fisk University, Provost Richard McCarty, Vanderbilt University, David Ernst, Vanderbilt University, Kelly Holley-Bockelmann, Vanderbilt University, and Michael Watson, Fisk University. Credit: Don Pickert, Vanderbilt University. Usage Restrictions: None.

"We are pleased to receive this federal support for Fisk, Vanderbilt and Delaware State students which reflects the quality of our existing programs," said Fisk President Hazel R. O'Leary. "With this funding we will expand our existing successful collaboration between Fisk and Vanderbilt in astronomy and astrophysics to increase opportunity and build on our consistent reputation for producing both women scientists and scientists of color for over a century." Each year for the past seven years, U.S. universities have awarded an average of 333 master's degrees in physics, astronomy and astrophysics to women and underrepresented ethnic minorities and 25 Ph.D.'s in astronomy and astrophysics. That averages out to one woman or minority Ph.D. degree every two years for the 53 institutions that grant these degrees. For underrepresented ethnic minorities alone, the average is one Ph.D. every 10 years. Since 2006 Fisk University has awarded about a third of the nation's African American masters in physics. Such small numbers mean that a single program, like the Bridge Program, can have a significant impact.

"Our vision is to enhance the scope and impact of our Masters-to-PhD Bridge Program by expanding it to include all science, technology, engineering and mathematics (STEM) disciplines," said Arnold Burger, professor of physics at Fisk. "This reinforces Fisk as a pipeline to advanced degrees for extremely talented students."

"Through this partnership, more students will have the opportunity to develop valuable, marketable skills at the interface of astronomy, materials science and high-performance computing," added Keivan Stassun, associate professor of astronomy at Vanderbilt and adjunct professor of physics at Fisk who is one of the program's architects. "The result will be enhanced research capability at both Fisk and Vanderbilt, as well as a cadre of highly skilled astrophysics Ph.D. students who will significantly enhance the diversity and quality of the nation's astronomy and astrophysics workforce."

The largest grant, totaling $1.8 million, is directed to Fisk to support the Graduate Opportunities for Fisk Astronomy and Astrophysics Research (GO-FAAR) project. The funds will be used to strengthen Fisk's research infrastructure in astronomy and astrophysics. It will also be used to increase recruitment, retention and degree attainment by underrepresented students. Funding for the project comes from the National Science Foundation's Partnerships in Astronomy & Astrophysics Research and Education (PAARE) program.

The second NSF grant of $1.2 million will fund the expansion of the Bridge Program to include Delaware State University. Students from all three institutions will collaborate in graduate research and instruction and receive full funding support. This grant comes from NSF's Innovation through Institutional Integration project, which supports initiatives that enable faculty, administrators and others in institutions to think and act strategically about the creative integration of NSF-funded awards. The grant enables the Bridge program to expand into the field of materials science, which also suffers from extremely low minority representation.

In addition to these grants, the program has received $784,000 from the Department of Education's Graduate Assistance in Areas of National Need program. This grant will provide attractive fellowships ($30,000 per year plus tuition) for graduate students in science disciplines deemed essential to the nation's economic competitiveness. It will support six to seven new graduate students per year, who will be evenly apportioned among those entering the Bridge program and those entering directly into the Vanderbilt Ph.D. program.

"This significant investment by the federal government is a dramatic recognition of the success of the joint Fisk/Vanderbilt program," said Vanderbilt Provost Richard McCarty. "The complementary strengths of Fisk's master degree and Vanderbilt's Ph.D. programs have combined in a remarkable fashion that provides minority students with the support, encouragement and the skills that they need to succeed in the physical sciences." ###

ABOUT FISK

Fisk University is a coeducational university in Nashville, Tenn., that is grounded in liberal arts and is ranked fourth among 81 schools listed in U.S. News and World Report's "Historically Black Colleges and Universities: Top Schools." A recent National Science Foundation study revealed that Fisk alumni earned more doctorate degrees in the natural sciences than African American graduates from any other college or university in the nation. According to the National Center for Education Statistics, Fisk is ranked No. 1 of all moderately selective colleges when it comes to graduating low-income students.

ABOUT VANDERBILT

Vanderbilt University is a private research university of approximately 6,500 undergraduates and 5,300 graduate and professional students. Founded in 1873, the university comprises 10 schools, a public policy institute, a distinguished medical center and The Freedom Forum First Amendment Center. Vanderbilt, ranked as one of the nation's top universities, offers undergraduate programs in the liberal arts and sciences, engineering, music, education and human development, and a full range of graduate and professional degrees. For more news about Vanderbilt, visit the Vanderbilt News Service homepage on the Internet at www.vanderbilt.edu/News.

Contact: David F. Salisbury david.salisbury@vanderbilt.edu 615-343-6803 Vanderbilt University

Minorities have poorer results, higher rates of inappropriate surgery to prevent stroke

DALLAS – Aug. 25, 2009 – Minorities have poorer results and higher rates of unnecessary surgery from a common procedure used to remove plaque from inside the carotid artery, according to a UT Southwestern Medical Center doctor who is lead author of the study in the journal Stroke.

The multicenter study, available online and appearing in the July issue of the journal, found that higher rates of poor surgical outcomes for carotid endartectomy (CEA) – a procedure performed to prevent stroke – appeared to be due not only to elevated patient clinical risk in African-American and Hispanics, but also to the individual skill and experience of the doctor performing the operation.

"Identifying how various patient, physician and hospital-level factors may contribute to disparities has important implications for the design of clinical and health policy strategies for reducing them," said Dr. Ethan Halm, chief of the William T. and Gay F. Solomon Division of General Internal Medicine at UT Southwestern.

Dr. Ethan Halm, chief of the William T. and Gay F. Solomon Division of General Internal Medicine, helped identify several factors that can affect whether a patient dies or suffers a stroke after carotid-artery surgery. The procedure, one of the most common types of vascular surgeries performed in the U.S., involves opening the carotid artery in the neck and removing harmful plaque to restore blood flow to the brain.

"To my knowledge this is the first study to examine the stepwise impact of patient, surgeon and hospital factors as a way of understanding racial/ethnic disparities in clinically confirmed outcomes of carotid artery surgery," he said. Previous research has demonstrated that minority groups in the U.S. have higher rates of heart attack and stroke. For example, African-Americans have greater numbers and higher severity of strokes, accompanied by higher rates of recurrence or death within 30 days. Yet Hispanics have not been well-studied as a subgroup, Dr. Halm said. The researchers used data from the New York Carotid Artery Surgery (NYCAS) study to examine the medical outcomes of 9,093 Medicare patients who had undergone carotid endartectomy in New York state. Of the patients, 95.3 percent were Caucasian, 2.5 percent were African-American and 2.2 percent were Hispanic. They found that the minorities had much worse clinical outcomes. In the 30 days following surgery, 9.5 percent of the Hispanic patients and 6.9 percent of the African-Americans had died or suffered a stroke due to the procedure, compared with 3.8 percent of Caucasian patients.

One reason minorities had higher complications rates was that they had severe neurological disease and more serious health conditions like heart disease and diabetes.

However, minorities were more likely to be cared for by less-experienced surgeons and hospitals. Adjusting for these patient and provider factors explained the worse results in African-Americans, but did not explain the poorer outcomes in Hispanics.

Rates of unnecessary surgery were also higher in minorities. For Hispanics, CEA was inappropriate in 17.6 percent of the cases; for African-Americans, 13 percent; and for Caucasians, 7.9 percent. The disparity in rates of unnecessary surgery was largely due to the higher burden of serious health conditions among minorities, which put them at much higher short-term risk of complications. If the short-term risk of carotid surgery is too high, the procedure is considered inappropriate.

"These results show we have the worst of all worlds," Dr. Halm said. "CEA is, paradoxically, both overused and underused in minorities and with worse results. More work is needed to help better understand the multiple factors that influence patient selection and surgical referral patterns. Developing evidence-based decision aids to help physicians and patients more accurately weigh the potential risks and benefits of CEA is one strategy we are pursuing to help improve this situation." ###

The NYCAS study was supported by the Agency for Healthcare Research and Quality, Centers for Medicare & Medicaid Services, the Robert Wood Johnson Foundation and the National Institute of Neurological Disorders and Stroke.

Scientists from Mt. Sinai School of Medicine and New York University School of Medicine also contributed to the research in Stroke.

Visit www.utsouthwestern.org/surgery to learn more about clinical services in surgery at UT Southwestern.

Contact: Erin Prather Stafford erin.pratherstafford@utsouthwestern.edu 214-648-3404 UT Southwestern Medical Center

Disparities in cancer care reflect hospital resources, U-M study finds

Hospital quality among factors leading to survival differences

ANN ARBOR, Mich. — Hospitals that treat more black cancer patients have worse survival rates on average for patients with breast and colon cancer, regardless of race, according to a new study from the University of Michigan Comprehensive Cancer Center.

The research helps explain why African-Americans with breast or colon cancer are less likely than white patients to survive the disease.

"This work highlights the importance of how where a patient receives treatment for cancer affects survival after cancer surgery. An important next step will be to determine which system factors are amenable to interventions aimed at improving the quality of cancer care," says study author Tara M. Breslin, M.D., assistant professor of surgery at the U-M Medical School.

Tara M. Breslin, M.D. Assistant Professor of Surgery. University of Michigan Health System. 3303 Cancer & Geriatrics Center, 1500 E. Medical Center Drive. Ann Arbor, MI 48109-5932 e-mail: tarabres@umich.edu

The study used five year survival data from the Surveillance Epidemiology and End Results–Medicare-linked database, a federal collection of cancer incidence, survival, and prevalence. The researchers analyzed data from 25,571 breast cancer patients, 9.7 percent of whom were black, and 22,168 colon cancer patients, 11.8 percent of whom were black. The patients were treated in 436 hospitals. The study appears in the Aug. 20 issue of the Journal of Clinical Oncology. Survival rates were lower for black patients than for white patients with both breast and colon cancer. But hospitals where more than half the patients were black had an increased risk of dying after five years for both black and white patients, compared to hospitals where fewer than 10 percent of patients were black.

All breast cancer patients treated at predominantly black hospitals had a 32 percent increased risk of death after five years, compared with those treated at hospitals that see few black patients. Similarly, colon cancer patients had a 27 percent higher risk of dying at five years.

The researchers also examined patient factors, such as age, cancer stage, other medical conditions and socioeconomic status. They found that after accounting for these factors, black patients still had higher mortality rates.

"Efforts aimed at increasing early detection through screening and decreasing incidence with preventative services are essential for decreasing racial disparities in mortality, but where a patient receives care after a cancer diagnosis may be equally important," says senior study author Arden M. Morris, M.D., M.P.H., assistant professor of surgery at the U-M Medical School and chief of general surgery at the VA Ann Arbor Healthcare System.

The study did not identify what specific hospital factors were at play, but the researchers plan further analyses to determine which hospital systems and aspects of standard therapy are poorly delivered or absent in hospitals serving a high percentage of minority patients. ###

Cancer statistics: 194,280 Americans will be diagnosed with breast cancer this year, and 106,100 will be diagnosed with colon cancer, according to the American Cancer Society.

Additional authors: Niya Gu, Sandra L. Wong, Emily V. Finlayson, Mousumi Banerjee and John D. Birkmeyer, all from U-M

Funding: National Cancer Institute

Reference: Journal of Clinical Oncology, Vol. 27, No. 24, pp. 3945-3950

Resources: U-M Cancer AnswerLine, 800-865-1125. U-M Comprehensive Cancer Center, www.mcancer.org

Contact: Nicole Fawcett nfawcett@umich.edu 734-764-2220 University of Michigan Health System

Obesity increases risk of prostate cancer recurrence for both blacks and whites

DURHAM, N.C. – A new look at a large database of prostate cancer patients shows that obesity plays no favorites when it comes to increasing the risk of recurrence after surgery: Being way overweight is equally bad for blacks and whites, say researchers at Duke University Medical Center.

Studies have shown that obesity is linked to generally worse outcomes in many cancers, including prostate cancer. Because blacks are more likely than whites to develop and die from prostate cancer – and because there is a higher prevalence of obesity among black men with prostate cancer, compared to whites – some studies have suggested that obesity might be a more ominous risk factor for blacks than whites.

Stephen Freedland, M.D.

"Not so," says Stephen Freedland, M.D., an associate professor of urology and pathology in the Duke Prostate Center and the senior author of the study appearing in the journal Cancer. "Obesity leads to worse cancer in both groups." Freedland and Jayakrishnan Jayachandran, M.D. a urologic oncology fellow at Duke and the lead author of the paper, examined the records of 1,415 men enrolled in the Shared Equal Access Regional Cancer Hospital (SEARCH) database who had undergone a radical prostatectomy. Black men comprised almost half (47 percent) of the sample.

After adjusting for various preoperative characteristics, researchers analyzed the relationship between body mass index (BMI) and the aggressiveness of the cancer, as measured by the risk of recurrence. In contrast to other studies, investigators found no association between race and obesity.

Almost a third of the men were obese, regardless of race. "We found that higher BMI was associated with significantly increased risk of cancer recurrence for both blacks and whites," said Jayachandran. "Though prior SEARCH-based studies from our group found that obesity was associated with a higher risk of disease progression as measured by a rising PSA after surgery, it now appears that being obese just means a poorer prognosis, period, regardless of race."

As for why that might be, Jayachandran says he's not sure, but he says it may have something to do with altered hormone levels.

"Obesity is associated with more estrogen and less testosterone, and it may be that lower testosterone promotes more aggressive tumors as recent studies have suggested." In addition, Jayachandran says alteration in the production of other hormones, like insulin, insulin-like growth factor or leptin, which occur in obese men, may also be involved in the development of more aggressive tumors. "This is something we simply do not understand, but we are actively studying all of these factors." ###

Colleagues who contributed to the study include Lionel Bañez, William Aronson, Martha Terris, Joseph Presti Jr., Christopher Amling, and Christopher J. Kane.

The investigative team was supported by the Department of Veterans Affairs, the National Institutes of Health, The Georgia Cancer Coalition, the Department of Defense Prostate Cancer Research Program, and the American Urological Association Foundation/Astellas Rising Star in Urology Award.

Contact: Michelle Gailiun michelle.gailiun@duke.edu 919-660-1306 Duke University Medical Center

Psychologists offer ways to improve prison environment, reduce violent crime

Harsh punishment backfires

TORONTO – U.S. prisons are too punitive and often fail to rehabilitate, but targeting prisoners' behavior, reducing prison populations and offering job skills could reduce prisoner aggression and prevent recidivism, a researcher told the American Psychological Association on Saturday.

"The current design of prison systems don't work," said criminal justice expert Joel Dvoskin, PhD, of the University of Arizona. "Overly punitive approaches used on violent, angry criminals only provide a breeding ground for more anger and more violence."

Joel Dvoskin, Ph.D, A.B.P.P.

Presenting at the American Psychological Association's 117th Annual Convention, Dvoskin discussed his upcoming book, "Applying Social Science to Reduce Violent Offending," which examines why prisons are failing and what needs to change. "Prison environments are replete with aggressive behaviors, and people learn from watching others acting aggressively to get what they want," Dvoskin said in an interview.

Applying behavior modification and social learning principles can work in corrections, he said. "For example, systematic reinforcement of pro-social behaviors is a powerful and effective way to change behavior, but it has never been used as a cornerstone of corrections," he said.

Also, punishment can be effective in changing behavior, but it only works in the short term and immediately after the unwanted behavior happens, he said. While there is a place for punishment, it should be used in psychologically informed and effective ways. However, punishment should not be one-size-fits-all, Dvoskin said.

"We need to know what may be behind the criminal behavior to know what the best treatment is," he said. "A person who commits crimes when drunk but not when sober is likely suffering from an alcohol problem. Treating the alcohol problem may diminish the criminal behavior."

Decreasing prison populations needs to be more of a priority, Dvoskin said. "This can be done by paying more attention to those with the highest risk of violent behavior rather than focusing on lesser crimes, such as minor drug offenses."

Finally, bringing work back into prisons can benefit prisoners by teaching them job skills and filling unmet job needs. With the increase in the criminal population and lack of increase in prison staff, "there is not enough supervision to allow prisoners to work and build skills," Dvoskin said. "This makes it very hard to re-enter into the civilian world and increases the likelihood of going back to prison."

With 7 million American adults in prison and almost 50 percent of them African-American males, many children are growing up without fathers and are at risk for continuing the vicious cycle of criminal behavior, Dvoskin said. "If we don't make the changes now, we will see these numbers go up."

Dvoskin, along with co-editors Jennifer Skeem, Ray Novaco and Kevin Douglas, wanted to find out what social science reveals about preventing and reducing violent crime. "Our intention," said Dvoskin, "is to avoid the extreme partisan bickering about whether to be 'soft' or 'hard' on crime, but to combine social science and common sense so that our correctional systems can more effectively change behavior. After all, isn't that their job?" ###

For more information or an interview, contact Joel Dvoskin at 520-577-3051 or cell 520-906-0366 or by e-mail at joelthed@aol.com

The American Psychological Association, in Washington, D.C., is the largest scientific and professional organization representing psychology in the United States and is the world's largest association of psychologists. APA's membership includes more than 150,000 researchers, educators, clinicians, consultants and students. Through its divisions in 54 subfields of psychology and affiliations with 60 state, territorial and Canadian provincial associations, APA works to advance psychology as a science, as a profession and as a means of promoting health, education and human welfare.

Contact: Pam Willenz pwillenz@apa.org 202-336-5707 American Psychological Association

Low-income kids report first sexual intercourse at 12 years old in new national study

1 in 4 children between 11-16 report having sex

AMES, Iowa -- As a new mother herself, Brenda Lohman admits to being shocked by the results of a new study she co-authored. It found that among nearly 1,000 low-income families in three major cities, one in four children between the ages of 11 and 16 reported having sex, with their first sexual intercourse experience occurring at the average age of 12.77.

"So if 12 years was the average age here, that meant that some kids were starting at 10 or younger," said Lohman, an Iowa State University associate professor of human development and family studies (HDFS). "A handful of kids reported having sex as early as 8 or 9. We know from our follow-up interviews that one boy who reported having sexual intercourse for the first time at age nine had fathered four children by the time he was 18."

Brenda Lohman, Title: Assistant Professor, Department of Human Development and Family Studies. Office: Institute for Social and Behavioral Research. 2625 N Loop #2500 Room 2592 Ames, IA 50010 Phone: 515-294-7413. Email: blohman@iastate.edu

"Those people who say that kids don't have sex at that young of age should think again," she said. "Definitely the age is the most shocking thing about this study." Tina Jordahl, a former Iowa State HDFS and public policy graduate student who is now a market research specialist with Hospice of Central Iowa, collaborated with Lohman on the study. It analyzes data from the "Welfare, Children and Families: A Three-City Study" -- a six-year longitudinal investigation of low-income families living in Boston, Chicago and San Antonio. Their paper, titled "A biological analysis of risk and protective factors associated with early sexual intercourse of young adolescents," was posted online in the Children and Youth Services Review and will be published in an upcoming issue of the journal. Interview data for the study was first collected in 1999 on youth between the ages of 10 and 14, and again in 2001.

Lohman says she also has data collected in 2006 from the same subjects, who were between 16 and 20 by that time.

In the study, boys reported their first sexual intercourse at younger ages (averaging 12.48) than girls (13.16). Boys also had nearly 10 percent higher frequency of intercourse than girls and were also more likely to experience sexual debut (20 percent to 14 percent) between the two years when the first two waves of data were collected.

Recent national research has found that 13 percent of girls and 15 percent of boys have had sex by the time they're 16. Lohman says that means the rate of sex among her low-income sample is only slightly higher among the girls, but almost double among the boys

"The ages [of sexual debut] are a bit younger than the national samples, but not alarmingly so," she said.

African Americans also had 12 percent more early sexual intercourse than whites (29 to 17 percent respectively), although racial differences did not change the age of their first intercourse.

The authors report that periods of instability in family structure and welfare use serve as risk factors for early sexual activity. They found that additional maternal education -- beyond a high school level -- was found to inhibit some of that activity.

"That can be for multiple reasons," Lohman said. "It can be that mothers have better paying jobs and more stable home environment and they're less likely to be in stressful circumstances. It could also be that mothers then have greater cognitive capacities to sort of sit down and discuss the pros and cons of waiting to have sex until you're older."

For that reason, the researchers propose allotting public funding to increase maternal education as a way to reduce early sexual promiscuity among their children.

The study also found the youths' involvement in delinquent acts drastically increases the chances of early sexual activity.

Because of the gender differences in sexual debut, the authors also urge more gender-specific prevention programs that are implemented at earlier ages, especially among high risk populations.

"It may be that boys and girls, starting at younger ages, should have these programs that are designed separately by gender before they're moved back together over time," Lohman said. "And yes, they must start much, much younger than they do now. You have to start before those young kids -- 10 or even younger -- start becoming sexually active."

She says the current political climate in Washington may be right for those types of programs to be developed.

"The Bush administration concentrated on abstinence education programs for all families across the spectrum of income, and Obama is definitely focusing on sexual education and prevention programs," said Lohman. "He's put a lot more money back into those programs that were stripped away during the Bush administration. And given his focus in other areas, he is concentrating on high-risk, low-income disadvantaged families as well." ###

Lohman is currently working on research to determine the relationship between obesity and teen sexuality. She hopes to publish results from that study within the year.

PLEASE NOTE; I can send you a pdf of the study if you'd like to see it.

Professor Lohman also reports that the children told researchers the age of their first sexual partner and if they had ever been abused or if it was voluntary. Thus, they were able to pull out youth who were sexually abused and this paper represents voluntary sexual intercourse.

Contact: Brenda Lohman, Human Development and Family Studies, (515) 294-6230, (773) 505-2872 (c), blohman@iastate.edu
Tina Jordahl, Hospice of Central Iowa, tinajordahl@gmail.com
Cathy Curtis, College of Human Sciences, (515) 294-8175, ccurtis@iastate.edu
Mike Ferlazzo, News Service, (515) 294-8986, ferlazzo@iastate.edu

Contact: Mike Ferlazzo ferlazzo@iastate.edu 515-294-8986 Iowa State University

AFRICAN-AMERICANS WITH COPD USE FEWER HEALTH SERVICES

New research shows that African-Americans (AA) with chronic obstructive pulmonary disease (COPD) use fewer health services than Caucasians with the condition. Researchers from the University of Maryland compared health services utilization and cost outcomes in 4,723 AA patients and 4,021 Caucasians with COPD, asthma, or both. After controlling for age, gender, cohort allocation, and comorbidities, results showed that AA adults with COPD, asthma, or coexisting asthma and COPD used fewer medical services and accounted for lower medical costs than Caucasians.

The authors speculate that the differences in utilization and medical costs may provide an explanation for the racial disparities in outcomes of patients with COPD and asthma. The article is published in the August issue of CHEST, the peer-reviewed journal of the American College of Chest Physicians.

Contact: Jennifer Stawarz jstawarz@chestnet.org 847-498-8306 American College of Chest Physicians

Research examines coping strategies of African-American students in predominantly white schools

A new study examining the interactions of black and white high-achieving students in elite, private high schools reveals how today's millennial generation is negotiating race, identity and academic success. In a paper presented Aug. 8 at the 104th annual meeting of the American Sociological Association (ASA) in San Francisco, Michelle Burstion-Young, a University of Cincinnati doctoral student in sociology, says she is breaking new ground in sociological research – exploring culture and race in the leadership class of the millennial generation – in academically competitive environments where an achievement gap does not exist.

Burstion-Young's study focused on a survey and follow-up interviews with approximately 20 students representing three private prep high schools in the Midwest, including an all-male, all-female and co-ed school.

Michelle Burstion-Young

"Schools are one of the most important sites to study if we are to gain an understanding of how racial interaction is shaped," Burstion-Young writes in the study. "Schools are important not only because they perform the function of education, but also because they are key to how children and young adults become socialized."

"Little is known about how students negotiate the social world of school or how being labeled black (by others and/or self) may influence their social decisions, either by removing options (such as being purposefully excluded or not being included) or creating other options (such as a black social world)," she writes.

Burstion-Young's study examined what she called four coping strategies used by minority students in predominantly white schools

Assimilation – "Acting white" or "acting black" in this environment was not a question of academics, but identity. According to Burstion-Young, both black and white students were dedicated to academic excellence and there were no differences in academic standards. Contrary to previous studies which state that high achieving blacks are viewed as "acting white," Burstion-Young says the black students identified with black culture through association with consumer culture, such as fashion and music, as well as slang and social circles. The students who did not connect to black culture on these levels were viewed as "acting white" – academic achievement (or lack thereof) had little to do with it. In at least one case in this study, an African-American student became so integrated into the white community that she lost her connectedness to her own family and culture, greatly upsetting the family and, Burstion-Young says, eliminating the spirit of integration in creating a generation of bridge-builders across cultures, identifying with each other but accepting and respecting cultural differences.

Integration – Burstion-Young says she found that most of the students actually strived to be bi-cultural or integrated in their dealings with people. Almost all of them placed a great deal of value on being connected with their own black culture and also with the majority (white) culture. She states that they felt that the former was necessary in order for them to have a support system, and that the latter was necessary in order to learn how to be successful in "the real world." Because the students valued being bicultural, associating with white students was not enough to be considered "acting white." Exclusive association with whites was the determining factor.

Separation – During school visits, separation between the races was particularly noted during time spent in the school cafeteria. "Separation is an important strategy for cultivating and maintaining a sense of black culture and while many school officials and white students discourage it on principle," writes Burstion-Young, "most of the black students realize that by not engaging with the black group, they risk being completely ostracized in the long run."

Marginalization – An example would be a shy student representing the only African-American in an AP class. Yet, the same student could be included in extracurricular activities or join African-American friends for lunch in the school cafeteria.

In conclusion, Burstion-Young states that separation seems to be the most popular coping strategy for the social space of students outside of their prep school environments. "The black students in this study were very interested in spending their 'free time' with family, friends and neighbors outside of school," states Bastion-Young. "Because our most intimate connections with people tend to happen intra-racially, the family, friends and neighbors they sought during their free time were overwhelmingly of the same race as themselves."

During school hours, the study revealed that social separation was more likely to occur due to lack of access to the majority/minority, such as not being invited to parties; a lack of interest in the social majority/minority, such as displaying no interest in attending a party or event that crossed racial lines; or preoccupation with one's own culture so that students were not purposefully excluding the other race, but not actively including them.

"For all of these reasons, the terms of most of the school life of blacks seem to be dictated by the dominant culture," writes Burstion-Young. "Therefore many of the students feel they must be instrumental in seeking a black cultural space. When they do, the black students themselves are often accused of being the sole cause of racial separation which I refer to as the 'self segregation paradox,' because it obscures the role the dominant group has in maintaining social separation."

"One of the most important findings of this study," writes Burstion-Young, "is that most students simultaneously use a variety of different coping strategies, but they do so in somewhat different combinations for somewhat different reasons. At the center of their negotiations, however, is an overall concern with identity; more specifically, their coping strategies are geared towards reconciling different, and sometimes contradictory, expectations on identity." ###

Contact: Dawn Fuller dawn.fuller@uc.edu 513-556-1823 University of Cincinnati

$7M grant establishes new UIC center to eliminate health disparities PODCAST

The University of Illinois at Chicago has been awarded a $7.2 million federal grant to establish the UIC Center of Excellence in Eliminating Health Disparities.

PODCAST: An extended interview as MP3 audio file

The new center, funded by a five-year grant from the National Center on Minority Health and Health Disparities of the National Institutes of Health, will focus on health disparities in prostate and colorectal cancer, community-based breast cancer initiatives, and training and educating the next generation of health disparities researchers.

"The new center will be a multi-faceted, university-wide resource to integrate health disparities research and activities," said Elizabeth Calhoun, associate professor of health policy and administration at the UIC School of Public Health, and director and principal investigator of the new center.

Elizabeth Calhoun, UIC associate professor of health policy and administration

"We plan to engage new investigators in health disparities, reaching not only into our undergrad and graduate populations, but even into high school, to build a pipeline of researchers interested in health disparities." Carol Ferrans, professor and associate dean for research at the UIC College of Nursing, is co-director of the center.

Researchers at the center will build upon prior UIC research to implement a community project to eliminate breast cancer disparities in South Side Chicago communities disproportionately affected by high rates of breast cancer deaths. The project will use culturally sensitive messages to promote mammography screening, address beliefs that contribute to screening reluctance, and address personal and health system barriers to screening.

The center's primary research projects will specifically look at disparities in prostate and colorectal cancer.

Colorectal cancer is the second most common cancer among African-American women and the third most common for African-American men. Late stage diagnosis, method of detection, delays from detection to surgical intervention, and disparities in treatment may all contribute to African Americans having the highest mortality from this disease of any racial or ethnic group, according to researchers.

In one study, led by Garth Rauscher, UIC assistant professor of epidemiology, researchers will enroll 500 African-American patients newly diagnosed with colorectal cancer to obtain information about screening, stage at diagnosis and treatment. The researchers will look at personal barriers such as cultural beliefs about cancer, social support, transportation, housing, literacy, perceived stress, fear, medical trust, as well as access barriers such as insurance status.

A second study, led by Vince Freeman, UIC assistant professor of epidemiology, will compile data on prostate and colorectal cancer cases diagnosed between 1995 and 2008 in Chicago to conduct a population-based analysis of clinical, socioeconomic and health care factors that account for mortality differences between African Americans and Caucasians.

Ultimately, these statistical models will allow researchers to predict hot-spot areas heavily burdened with disease, said Calhoun, and provide effective measures for deploying resources such as targeted cancer screenings.

The center has a research core, a training and education core, and a community engagement core, led by Richard Warnecke, Faye Davis, and Carol Ferrans, respectively, who are researchers at the UIC Institute for Health Research and Policy.

Rauscher and Freeman are researchers at the UIC Institute for Health Research and Policy and the UIC Cancer Center.

The new UIC Center of Excellence in Eliminating Health Disparities will involve faculty from all six of UIC's health sciences colleges, the UIC Institute for Health Research and Policy, the UIC Center for Clinical Translational Science, and the UIC Cancer Center to develop a comprehensive strategy to incorporate research, education, policy changes and community partnerships to reduce health disparities in Chicago and beyond. ###

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

For more information about UIC, visit www.uic.edu

Contact: Sherri McGinnis González smcginn@uic.edu 312-996-8277 University of Illinois at Chicago

Rutgers University in Newark will lead 9 college consortium to increase students in STEM fields

$5 million, 5-year program is funded by NSF

(Newark, N.J., Aug. 5, 2009) -- Rutgers University in Newark will lead a $5 million, five-year, multiple-school program that aims to substantially increase the numbers of minority of students pursuing majors – and eventually, careers -- in the fields of science, technology, engineering and math, also known as STEM fields.

Rutgers University-Newark will lead a consortium including Kean University, New Jersey City University, Essex County College, Bloomfield College, Montclair State University, Fairleigh Dickinson University/Teaneck, William Paterson University and Rutgers University, New Brunswick in the five-year Garden State Louis Stokes Alliance for Minority Participation (GS-LSAMP), which is funded by the National Science Foundation (NSF).

Louis Stokes rose from the local housing projects to serve 30 years in the U.S. House, becoming a potent symbol for his Cleveland-based majority-black district. Reluctant to enter the political arena, Stokes was persuaded to run for office by his prominent brother and by community members he had served for decades as a civil rights lawyer. His accomplishments were substantive and of historic proportions. The first black to represent Ohio, Stokes chaired several congressional committees (including the Permanent Select Intelligence Committee) and was the first African American to win a seat on the powerful House Appropriations Committee.

"By working together, Rutgers University and our partner schools are determined to make substantial progress in efforts to 'open the doors' for more students to pursue careers in these critical STEM fields," states Steve J. Diner, chancellor of Rutgers in Newark. "Our goal is to make New Jersey a top state that invests in the rich and deep talent that resides in our nation's minority populations." The consortium aims to double, in five years, the number of minority students completing undergraduate degrees in the STEM disciplines by providing academic support programs, including tutoring and peer-led team learning (PLTL). PLTLs are sessions in which upperclassmen help younger students through difficult STEM classes that have traditionally been a barrier to success and retention. "If we can get students beyond the difficult. introductory 'gateway courses' that scare off many of them, we can improve retention of minorities in the STEM fields," explains Dr. Alexander E. Gates, chair of the Earth and Environmental Sciences department at Rutgers University, Newark. Gates is GS-LSAMP's co-principal investigator and project director. Training for the mentors will be provided by the Educational Opportunity Fund programs at the partner institutions, according to Gates. Another way that GS-LSAMP hopes to increase minority student participation in the STEM fields is by providing opportunities for undergraduates to conduct hands-on laboratory research with faculty members, says Gates.

Other activities include community service, visits to local high schools for recruitment, and internships.

The $5 million GS-LSAMP grant will provide stipends to fund the tutoring and PLTL sessions as well as the research funds for GS-LSAMP scholars enrolled at the consortium schools.

NSF initiated LSAMP – then known as the Alliance for Minority Participation – in 1991, said Gates, and it is ranked as one of the 10 most effective diversity programs in the U.S. by Diverse Issues in Higher Education. The GS-LSAMP is the first such program in New Jersey in 15 years. The award is named for civil rights activist, lawyer and 15-term Congressman Louis Stokes, the first African American member of Congress from the State of Ohio. During his Congressional career he was especially active in health care and public health issues, serving on the Pepper Commission on Comprehensive Health Care. Stokes also was the founder and chairman of the Congressional Black Caucus Health Braintrust. ###

Contact: Carla Capizzi capizzi@andromeda.rutgers.edu 973-353-5262 Rutgers University

Video game minority report: Lots of players, few characters

Comprehensive census of game characters finds Latinos nearly invisible; women, other groups underrepresented.

If the future of entertainment is interactive media, some minorities are still headed back to the past.

The first comprehensive survey of video game characters, encompassing the top 150 games in a year across nine platforms and all rating levels, and weighted by each title's popularity, shows that the video game industry does no better than television in representing American society.

In some cases, video games do worse, said study leader Dmitri Williams, a social psychologist and assistant professor at the USC Annenberg School for Communication.

In his study, Williams cited research showing Latinos are making modest gains on television. By contrast, fewer than 3 percent of video game characters were recognizably Hispanic, and all of them were non-playable, background characters. Imagine if no Latino on television had a speaking part.

"Latino children play more video games than white children. And they're really not able to play themselves," Williams said. "For identity formation, that's a problem. And for generating interest in technology, it may place underrepresented groups behind the curve.

"Ironically, they may even be less likely to become game makers themselves, helping to perpetuate the cycle. Many have suggested that games function as crucial gatekeepers for interest in science, technology, engineering and math."

Women, Native Americans, children and the elderly also were underrepresented. For example, only 10 percent of playable characters surveyed were female, though women now make up 40 percent of video game players.

African-Americans appeared in proportion to their numbers in the real world, but mainly in sports games and in titles that reinforce stereotypes, such as 50 Cent Bulletproof.

Males, whites and adults were overrepresented.

Williams noted that some newer games give players more options for customizing their characters. Those games were included in the survey, with characters chosen randomly.

The fact that random selection did not have a major impact on the results suggests that when players have a choice, their range of options is limited.

The study itself was limited in two important ways. Many games feature non-human characters, and many are first-person games where the player never sees himself or herself. The study only included visible characters that were clearly human.

Still, the breadth of the census and the growing popularity of video games make the findings especially relevant. Total video game revenues now exceed box office and video rental receipts, Williams noted.

"In television, it was always a landmark moment when some minority or disenfranchised group appeared on the screen for the first time," Williams said.

"That kind of visibility is really the first step toward leading to public consciousness and equal treatment. These cultural markers matter."

In their study, the authors discuss possible reasons for their findings. But Williams cautioned against jumping to conclusions. "The characters the developers put in the games do not match the real world," he said. "Our thoughts about why are all informed guesses."

He did have a word of advice for game developers.

"These are highly underserved groups. It's a missed sales opportunity." ###

The study, titled "The virtual census: representations of gender, race and age in video games," is available online in the August issue of the journal New Media & Society, at nms.sagepub.com/content/vol11/

For more discussion about the study, see Williams' blog post at terranova.blogs.com/terra_nova/

The survey covered the majority of titles sold in the 12-month period between March 2005 and February 2006 across console, handheld, PC and online platforms.

Williams' co-authors were Nicole Martins of Indiana University, Mia Consalvo of Ohio State University and James Ivory of Virginia Polytechnic Institute and State University.

Williams received funding for the survey from the University of Illinois at Urbana-Champaign, where he started the research before moving to USC.

Working at the intersection of sociology, psychology, communication and new technology, Williams studies large-scale game worlds for insights about human behavior that might be difficult to obtain in the real world.

Contact: Carl Marziali marziali@usc.edu 213-740-4751 University of Southern California

Box art for "50 Cent: Bulletproof" PS2 version. Fair use in 50 Cent: Bulletproof

Though this image is subject to copyright, I feel its use is covered by the U.S. fair use laws because:

1. Vivendi Universal has released no such images into the public domain, and a replacement image could not be created that would adequately provide the same information.
2. The image is being used for no purpose other than to identify the subject of the article.
3. The image resolution has been significantly decreased from the original, so copies made from it would be of inferior quality.
4. The use of this image neither detracts from the game nor inhibits its salability in any way.

Low prevalence of HPV infection may be tied to poor prognosis for blacks with head and neck cancer

Ground breaking study seeks to explain major disparity in survival between blacks and whites

Researchers at the University of Maryland Marlene and Stewart Greenebaum Cancer have found that head and neck cancer patients who test positive for the human papillomavirus (HPV) have much better survival rates than patients who don't have the virus, according to a new study in the journal Cancer Prevention Research. The researchers also discovered that blacks in the study had a very low rate of HPV infection, and consequently worse survival, which may explain why African-American patients traditionally have had a poor prognosis for head and neck cancer.

"For the first time, we have evidence that the major difference in survival between black and white patients with head and neck cancer appears to be the rate of HPV infection.

Kevin J. Cullen, M.D. Director, University of Maryland Greenebaum Cancer Center Professor of Medicine.

We found an astounding difference in prognosis between patients who are HPV-positive and those who are HPV-negative," says the study's senior author, Kevin J. Cullen, M.D., director of the University of Maryland Marlene and Stewart Greenebaum Cancer Center and professor of medicine at the University of Maryland School of Medicine.

Scott Lippman, M.D., chairman of the Department of Clinical Cancer Prevention at the University of Texas M.D. Anderson Cancer Center, called the study, "practice-changing."

"Squamous cell carcinoma of the head and neck is one of the fastest growing cancers, and this study gives us a new way to assess prognosis for our patients," says Dr. Lippman, who is editor-in-chief of Cancer Prevention Research, which is published by the American Association for Cancer Research.

Dr. Cullen adds, "We need to analyze HPV routinely in specific patients with head and neck cancer, which we're currently not doing. HPV-positive cancer is biologically a very different disease than HPV-negative cancer, and we need to take that into account as we're planning future therapies. Those with HPV-negative disease may not be as well served with our current treatments combining chemotherapy and radiation."

The human papillomavirus is known to cause certain types of cancer and is a major risk factor for head and neck cancer, so researchers were surprised to find that patients with HPV infection had a better prognosis.

Only 4 percent of black patients with squamous cell carcinoma in the study were HPV-positive, compared with 34 percent of white patients. The median overall survival was more than three-fold higher for whites (70.6 months) than for blacks (20.9 months) who were treated with chemotherapy and radiation. Dr. Cullen says the survival rate at five years for HPV-positive patients was about 85 percent, compared to 35 percent for HPV-negative patients. Survival was similar for HPV-negative patients, regardless of race. The study's findings confirm that HPV infection relates specifically to a type of head and neck cancer -- cancer of the oropharynx, which include the tonsils, soft palate and base of the tongue.

Dr. Cullen says, "There is currently no consensus on why blacks fare worse with squamous cell carcinoma of the head and neck than whites, but our findings provide the first clue that a critical reason may be biologic rather than related to issues of access to care, lack of insurance or attitudes of health care providers."

"Many researchers at the University of Maryland School of Medicine are conducting important studies relating to racial disparities in diagnosis and treatment. This groundbreaking study will have a significant impact on how doctors care for patients with head and neck cancer," says E. Albert Reece, M.D., Ph.D., M.B.A., vice president for medical affairs at the University of Maryland and dean of the University of Maryland School of Medicine.

Cancer experts believe that head and neck cancer, particularly oropharyngeal cancer, is on the rise because of an increase in HPV infection in the oral cavity. Overall, about 25 percent of head and neck cancers are tied to HPV infection, Dr. Cullen says. In comparison, HPV causes virtually 100 percent of cervical cancers, and a vaccine has been developed to help prevent this type of cancer by preventing HPV infection.

Researchers don't yet understand why blacks have a lower rate of HPV infection in head and neck cancers than whites, Dr. Cullen says. There is some evidence that HPV transmission associated with oral cancer may be related to sexual practices, but he says there are probably a number of other factors involved, including possible differences in immunity and how the virus can become integrated into the cell's DNA "that now we just don't understand."

In the study, researchers analyzed data from about 200 patients who had been treated at the Greenebaum Cancer Center and then evaluated another group of 230 patients treated as part of a multi-center clinical trial.

The study was funded in part by the Maryland Cigarette Restitution Fund Program, which uses money from a legal settlement with big tobacco companies for cancer research and cancer screening, education and prevention programs in Maryland. "This is really a wonderful example of how CRF-supported research can benefit Marylanders and all people who are battling cancer," Dr. Cullen says. "We are very committed to helping the Cigarette Restitution Fund fulfill its mission of erasing racial disparities in diagnosis and care." ###

The research was also funded by grants from sanofi-aventis U.S. and the Orokawa Foundation.

The University of Maryland Marlene and Stewart Greenebaum Cancer Center is a National Cancer Institute-designated cancer center. It offers a full range of treatments for all types of cancer and has a very active cancer research program. To learn more, go to www.umgcc.org.

Contact: Karen Warmkessel kwarmkessel@umm.edu 410-328-8919 University of Maryland Medical Center

Study shows simple writing assignment improves minority student grades

In a follow-up to a 2006 study, a University of Colorado at Boulder researcher and his colleagues found that an in-class writing assignment designed to reinforce students' sense of identity and personal integrity increased the grade-point averages of African-American middle school students over a two-year period, and reduced the rate at which these students were held back or placed in remediation.

The results suggest that targeted psychological interventions on a wider scale could help narrow the racial achievement gap among U.S. students, one of the most pressing and persistent domestic issues in our country, according to Associate Professor Geoffrey Cohen of CU-Boulder's psychology department and his fellow principal investigators Julio Garcia and Valerie Purdie-Vaughns of Columbia University.

The follow-up study appeared in the April 16 issue of the journal Science. Nancy Apfel and Patricia Brzustoski of Yale University were co-authors on the study.

Geoffrey Cohen is an Associate Professor of Social Psychology at the University of Colorado in Boulder. Much of his research concerns the processes of self-evaluation and identity maintenance. One area of research addresses the effects on achievement motivation of individuals' group memberships, with a focus on the role of social stereotypes in shaping intellectual identity and performance. A second research area links resistance to probative information, and intransigence in negotiation and social conflict, to concerns of identity maintenance. Additional research questions concern manifestations of discrimination in meritocracies, the impact of negative stereotypes about outgroups, attitude formation and change, and the psychology of closed-mindedness.

"In our original study we uncovered evidence that this self-affirming intervention improved the performance of African-Americans in a single academic term," Cohen said. "Now we have evidence that its effects persist over the two years of children's tenure in middle school." The study also suggests that "intervening" early in students' middle school years can have long-lasting benefits by undermining a recurring cycle of increasingly poor performance in school. Over the two years of the 2006-08 study, the grade-point average of African-Americans was, on average, raised by .24 grade points. Low-achieving African Americans benefited most from the intervention, with their GPAs increasing by an average of .41 points on a four-point scale. The assignment had no impact on white students' grades.

"Our intervention is based on the idea that ethnic minority students experience, on average, higher levels of stress in the classroom because they are concerned that if they perform poorly on a test or in a class this will confirm, in the eyes of others, the negative stereotype about their group's intelligence ability," Cohen said.

Past research has found that school settings in general are stressful to many students regardless of race. However, many African-American students may experience chronic stress in school stemming from negative stereotypes portraying them as less intelligent than their peers, according to Cohen. This in turn leads to decreased academic performance.

The study involved three experiments in which seventh graders from middle-class and lower middle-class families were given a series of structured writing assignments throughout the year. They were asked to choose one or two values that were important to them and then write about why they cherished the values. A control group was asked to write about values that others might hold or other neutral topics. A total of 416 students participated, divided in roughly equal numbers by race.

"This exercise, called a self-affirmation, allows a student to reaffirm that he or she is a good and competent person," Cohen said. "This helps reduce stress by allowing the student to think about all the things that matter to them, for example their family or their religion. It makes the possibility of failure less dire."

The study also suggests that how students perform during the school year is strongly correlated to how they perform during the first few weeks of that year. If a student starts off the year feeling more stress due to negative stereotypes, and then performs poorly during the first few weeks of school, this can establish a downward cycle of increasing stress and poor performance that is hard to break, said Cohen.

"Our study shows that early intervention seems to interrupt this downward trend in academic performance," he said.

Cohen and his co-authors also measured the students' sense of success at the beginning of the school year and again at the end. They found that for low-performing African-American students there is a drop in their sense of adequacy in school over the course of the school year, but for students who participated in the exercise, and for white students, their sense of success remained constant over time.

"This suggests that early failure can have a disproportionate effect on the negatively stereotyped group," Cohen said. "The first few weeks of middle school can have a negative effect on a child's self-concept that seems surprisingly persistent. We found that if you can buffer people against this you can potentially have long-term benefits."

Cohen said he plans to continue studying similar psychological interventions on other groups of students to see if similar positive results can be generated and to zero in on the mechanisms underlying these effects.

"In a society where economic success depends heavily on scholastic achievement, even a slight narrowing of the achievement gap would be consequential," Cohen said. "This is especially true for low-achieving students, given the societal, institutional and personal costs of academic failure." ###

Contact: Geoffrey Cohen geoffrey.cohen@colorado.edu 303-492-5105 University of Colorado at Boulder