Socio-cultural, genetic data work together to reveal health disparities

GAINESVILLE, Fla. — When it comes to health disparities between different groups, how society sees people in terms of race might play a greater role than genetics, according to a new University of Florida study.

The study also showed that taking stock of socio-cultural factors might improve our understanding of how genes influence individual health — regardless of race.

Consider high blood pressure, a complex disease governed both by genetic and environmental factors. Not only was social classification better than genetic-based ancestry at predicting disease status, it also brought to light a link between a particular gene and blood pressure that was not apparent when only genetic ancestry was considered.

Connie Mulligan, Ph.D. Title : Associate Professor of Anthropology and Associate Director of the UF Genetics Institute Interests : Human genetic variation, genetics of complex disease, New World/Asia colonization, ancient DNA. Clarence Gravlee , Ph.D. Title: Assistant Professor Interests: Medical anthropology; social inequalities in health; ethnicity, race, and racism; human biological variation; cultural dimensions of psychosocial stress; social network analysis; cognitive anthropology; qualitative and quantitative research methods

The study, to be published Wednesday (Sept. 9) in the journal PLoS ONE, is the first to rigorously combine both socio-cultural and genetic data to simultaneously test the relative contributions of each to racial inequalities in health. "What's really groundbreaking is that we've got both types of data and they're of equivalent sophistication," said co-author Connie Mulligan, Ph.D., an associate professor of anthropology and an associate director of the UF Genetics Institute. The results suggest that previously reported associations between genetic ancestry and health might be accounted for by socio-cultural factors related to race and racism, and not necessarily to genetic differences between races. It also suggests that including socio-cultural factors can strengthen genetics studies and help reveal how social inequalities can lead to biological differences. "We have to take seriously the way race shapes people's experiences, the environments they live in and their life chances," said lead author Clarence C. Gravlee, Ph.D., an assistant professor of anthropology at UF. "In day to day life, people often assume that race exists as biology. Most anthropologists and geneticists reject that idea and see race instead as a cultural construct. The point of our paper is that race is so embedded in our society that it affects biology by shaping the types of environments that people live in." How social and or genetic factors drive racial inequalities in health and the role of race in genetic and biomedical research are the source of much controversy and study. Some scientists see race as useful for pinpointing gene-based susceptibility to complex diseases, but others caution that looking at race from a purely genetic standpoint can mask social causes of racial inequalities. "We have to look at these in a way that will allow us to tell the whole story, not from one side or the other," said Jay Kaufman, Ph.D., an associate professor of epidemiology, biostatistics and occupational health at McGill University and author of the upcoming book "Racing in Circles: Myths about Genes and Race in Biomedical Research." Kaufman was not involved in the UF study. In general, members of racial minorities in the United States suffer poorer health, and more die prematurely compared with their white counterparts. African-Americans are three times more likely than whites to die from high blood pressure, according to the American Heart Association.

"The sheer scale of inequalities in sickness and death deserves our attention," Gravlee said. "Researchers have an obligation to explain the origins of these inequalities and to identify social factors that could be targeted for policy change."

To examine the link between African ancestry and blood pressure, the UF team studied 87 adults in Puerto Rico, using two variables for which "race" is often used as a surrogate: genetic ancestry and social classification.

Genetic ancestry was assessed using gene variants that show large frequency differences among groups from different continents. Social classification was assessed by observers to estimate how people are perceived in everyday life in terms of skin pigmentation, or "color" (pronounced coh-lohr). The researchers found that the three major "color" categories had overlapping genetic ancestry, and that there was a strong link between "color" and blood pressure, but not between genetic ancestry and blood pressure.

Next, they looked at whether taking account of social factors changed our understanding of genes thought to affect hypertension. When only genetic ancestry was considered, no association was evident between candidate genes for hypertension and blood pressure. But when "color" and socio-economic status were included in the analysis, a significant association between the gene variant and blood pressure was uncovered.

"One of the important points here is that you can have an association between two biological variables like genetic ancestry and blood pressure, but it could be that the social and cultural implications of having African ancestry is what is driving this association," Gravlee said.

Health differences could arise from differing stresses people face based on how society sees and treats them.

"There's no doubt about the fact that perceptions matter," Kaufman said. "This article reinforces the idea that if you don't pay attention to how people are perceived you miss a big chunk of the story."

The researchers found that the group of people who carried the associated genetic variant also contained multiple categories of "color" and socio-economic status. When these different socio-cultural categories were separated, the protective effect of the genetic variant became evident.

"What's exciting about our study, is that we can show the value of including socio-cultural data by revealing a genetic association that would otherwise have been missed," Mulligan said. "This is important in convincing other researchers that it is worthwhile to include nongenetic data in a genetic study rather than simply controlling for nongenetic factors." ###

Contact: Czerne M. Reid czerne@ufl.edu 352-273-5814 University of Florida

James Cleveland "Jesse" Owens (September 12, 1913 – March 31, 1980)

James Cleveland "Jesse" Owens (September 12, 1913 – March 31, 1980).

Owens attended The Ohio State University only after employment was found for his father, ensuring the family could be supported. He was affectionately known as the "Buckeye Bullet" and won a record eight individual NCAA championships, four each in 1935 and 1936.

At the 1936 Olympics in Berlin, Germany, Jesse Owens, the son of Lawrence County Alabama sharecroppers, Henry and Emma Owens, achieved international fame by winning four gold medals: one each in the 100 metres, the 200 metres, the long jump, and as part of the 4x100 meter relay team. and shattered Adolph Hitler's claim of Aryan superiority. His victory transcended athletics; the 110,000 Germans in Olympic Stadium cheered him on, and often stopped Owens on the streets of Berlin for an autograph or picture. Four years after his death, a street outside the Olypmic Stadium was named in his honor.

James Cleveland "Jesse" Owens (September 12, 1913 – March 31, 1980) PHOTO: Public Domain Clipart

In 1976, Jesse Owens was awarded the Presidential Medal of Freedom. In 1990, President George H.W. Bush posthumously awarded him the Congressional Medal of Honor for "an unrivaled athletic triumph, but more than that, a triumph for all humanity." Battling Discrimination at the 1936 Olympics--An Unsent Letter. This letter (Page 1) (Page 2) from NAACP leader Walter White to Jesse Owens urges him not to participate in the 1936 Olympic games in Berlin, which was under Nazi rule, but it was never sent.

In the letter, White writes: "The very preeminence of American Negro athletes gives them an unparalleled opportunity to strike a blow at racial bigotry and to make other minority groups conscious of the sameness of their problems with ours . . . But the moral issue involved is, in my opinion, far greater than immediate or future benefit to the Negro as a race. If the Hitlers and Mussolinis of the world are successful it is inevitable that dictatorships based upon prejudice will spread . . ."

The U. S. did send an Olympic team to Berlin, and Owens was its star, winning four gold medals.

High school put-downs make it hard for students to learn, study says

URBANA – High-school put-downs are such a staple of teen culture that many educators don't take them seriously. However, a University of Illinois study suggests that classroom disruptions and psychologically hostile school environments can contribute to a climate in which good students have difficulty learning and students who are behind have trouble catching up.

"We need to get away from the idea that bullying is always physical. Bullying can also include verbal harassment, which can be just as damaging and detrimental to student learning," said Christy Lleras, a U of I assistant professor of human and community development.

The study used data from the National Educational Longitudinal Study and included 10,060 African American, Latino, and white tenth graders in 659 U.S. high schools. It is one of the first to look at the national incidence of verbal harassment in public and private high schools, she said.

Christy Lleras, a professor of human and community development, says that ability grouping, a pedagogical tool for sorting students into different academic tracks based on their perceived academic ability, is a “net-loss” practice that not only impedes the literacy of lower-grouped minority students, but also doesn’t substantially strengthen the reading ability of higher-grouped minority students. | Photo by L. Brian Stauffer

"In looking at whether students felt safe at school, students' fear for their physical safety was actually pretty low. But 70 percent of the students said they were bothered by disruptions in their classroom, and one in five students said that they were often put down by their peers in school," she said. Lleras came to three interesting conclusions as she reviewed the data. One was that smaller, private, and more affluent schools do very little to protect students from verbal abuse. "I assumed that the sorts of school environments that protect students from physical harm would also protect students from emotional harm, and that was not the case. These 'safe' schools are not significantly reducing the likelihood that students will experience harassment by their peers," she said. This was especially true for adolescent boys. The results showed that boys experience verbal harassment from peers more often than girls, particularly if they are in private schools, Lleras said. Lleras also found that African American high-school students who thought of themselves as very good students were more likely to experience verbal put-downs from their peers, but only when they were in high-minority schools.

Why would high-achieving African-American students in high-minority schools face more verbal harassment? Lleras doesn't believe it can be entirely attributed to the oppositional culture hypothesis—namely, that high-achieving minority students are more likely to be negatively sanctioned by their peers for their efforts than white students.

She speculates that verbal put-downs in these schools may be a coping strategy that students use when they don't have the skills to do the work and have little hope of acquiring them in their academic environment.

"When high-achieving minority kids are put down by their peers, it can contribute to a climate in which lower-achieving kids fall farther and farther behind and must struggle to catch up. This hostile school climate isn't a cause of the racial achievement gap--we see evidence of the achievement gap well before middle school--but it contributes to it," she said.

"Sadly, verbal harassment is just one more thing these students have to deal with, and as long as we accept it because it's not physical bullying, we're doing a grave disservice to the kids who need non-disruptive and focused learning environments the most," she said.

The study was published in the Journal of School Violence. ###

Contact: Phyllis Picklesimer p-pickle@illinois.edu 217-244-2827 University of Illinois at Urbana-Champaign

Office of Naval Research's Rear Admiral addresses diversity with HBCU presidents

ARLINGTON, Va. - Saying America's future depended on its ability to compete in the global marketplace, the U.S. Navy's Chief of Naval Research addressed a gathering of presidents of historically black colleges and universities on Sept. 1 in Washington, D.C. He told them "in order to maintain the health of the defense science and engineering workforce, we must continue to engage every bright young mind that has the capability to help us invent the future."

Rear Admiral Nevin P. Carr Jr., whose office provides the science and technology needed to maintain the U.S. Navy and Marine Corps' technological war-fighting dominance, was among more than 1,200 participants attending the 2009 National Historically Black Colleges and Universities Week Conference. Held from Aug. 30 to Sept. 2, the White House-sponsored event attracted federal, state and local agencies interested in invigorating the relationship between the surviving 105 HBCUs and the government.

Caption: Admiral Nevin P. Carr, Chief of Navy Research addresses HBCU pesidents at a gathering in Washington D.C. Credit: U.S. Navy. Usage Restrictions: None.

For the Office of Naval Research, that relationship dates back to 1985 with initial funding for research at HBCU institutions, Carr said in his speech. In 1989, a dedicated program was established, supporting undergraduate and graduate students at five HBCUs. In 1992, investment increased to $6 million annually, then rose to $10 million in 1994. Through the mid-90s to 2002, ONR supported programs at 22 schools, among them HBCUs, and provided educational support for hundreds of deserving students.

Ninety percent of those students graduated on time with undergraduate degrees in science and engineering, and 80 percent went on to get master's degrees.

"Today, our HBCU programs include the summer faculty research program, the research and education partnership program, and the research partnership program--all directed towards increasing the participation of HBCU institutions in naval science and technology," Carr said. "We do this because we need to attract every bright young mind we can to a career in science and technology."

According to the National Science Foundation, only 31 percent of U.S. graduate students pursue degrees in science and engineering. As of 2004, only 35 percent of those graduates were from under-represented populations, such as African-American, Hispanic and Asian.

Carr's presence at the event underscored ONR's commitment to building the Navy's future force through investment in the science, technology, engineering and mathematics pipeline. The rear admiral was among distinguished speakers that included CIA Director Leon Panetta, U.S. Secretary of Education Arne Duncan and Environmental Protection Agency Administrator Lisa Jackson.

"Shifting demographics in the U.S. means we must focus our attention on reaching out more to diverse communities," Carr said. "The demographic trends are well established and clear.No single segment of any population can provide the needed capacity. We need to tap the entire crew." ###

About The Office of Naval Research

The Department of the Navy's Office of Naval Research (ONR) provides the science and technology necessary to maintain the Navy and Marine Corps' technological war-fighting dominance. Through its affiliates, ONR is a leader in S&T with engagement in 50 states, 70 countries, 1,035 institutions of higher learning, and nearly 1,000 industry partners. ONR employs approximately 1,400 people, comprising uniformed, civilian and contract personnel.

Contact: Peter Vietti onrcsc@navy.mil 703-588-2167 Office of Naval Research

Pancreatic cancer affects blacks at higher rates

PHILADELPHIA – Regardless of risk factors linked to pancreatic cancer, such as smoking and body mass index (BMI), blacks experienced higher rates of pancreatic cancer death than whites.

"Reducing overweight/obesity and smoking will help reduce pancreatic cancer overall, as well as prevent other diseases," said Lauren D. Arnold, Ph.D., M.P.H., postdoctoral research associate in the department of surgery at Washington University in St. Louis.

"We still have a long way to go towards understanding pancreatic cancer disparities."

Results of this cohort study are published online in Cancer Epidemiology, Biomarkers & Prevention, a journal of the American Association for Cancer Research.

Caption: Lauren D. Arnold, Ph.D., M.P.H., is a postdoctoral research associate in the department of surgery at Washington University in St. Louis. Credit: Lauren D. Arnold, Ph.D., M.P.H. Usage Restrictions: None.

Pancreatic cancer is a rapidly fatal disease that is challenging for researchers to study and treat. Because there are no good screening tests and symptoms do not often appear until the disease has spread, Arnold said that most people die within two years of diagnosis. Statistically, pancreatic cancer claims the lives of black Americans more so than whites — between 2001 and 2005, blacks had a 32 percent higher death rate, according to background information in the study obtained from the National Cancer Institute statistics. Arnold and colleagues examined risk factors for pancreatic cancer and separately evaluated them among black and white participants.

Using data from the Cancer Prevention Study II (CPS-II), they assessed whether these risk factor patterns explained differences in incidence and mortality. CPS-II is a longitudinal study that originally enrolled more than one million participants in 1982. Participants provided information such as race/ethnicity, medical history and health habits. The researchers tracked cancer deaths in the CPS-II and evaluated the outcomes.

Regardless of gender and race, findings showed that smoking was the biggest risk factor for pancreatic cancer. Increasing risk of pancreatic cancer was associated with increasing BMI. When considered by race, blacks had a 42 percent increased risk of pancreatic cancer death compared to whites.

Excess risk of disease remained, even when the researchers eliminated all other risk factors from the calculation.

"We hoped to find that by accounting for known and suspected pancreatic cancer risk factors, such as smoking, diabetes and BMI, and by looking at this in the context of race and gender, we'd be able to explain the higher rates of pancreatic cancer in blacks," Arnold said. "Unfortunately, we were unable to explain these differences."

Maria Elena Martinez, Ph.D., M.P.H., said although differences in risk factor patterns were shown, overall, they did not account for the pancreatic cancer mortality rates evident by race. Martinez is the Richard H. Hollen Professor of Cancer Prevention at the University of Arizona, director of the Cancer Health Disparities Institute at the Arizona Cancer Center, and an editorial board member for Cancer Epidemiology, Biomarkers & Prevention.

"The results most certainly point to the need for additional work to explain these racial disparities in risk of pancreatic cancer," she said. "Factors other than those assessed by the researchers may be responsible for the disparities. These can include unidentified lifestyle and/or environmental factors, genetic factors or unique gene-environment interactions."

What makes this study different from previous studies that explored differences in relationship to risk for pancreatic cancer is that this study comes from a large group of cancer-free individuals and examines their risk of developing pancreatic cancer over a long period of time.

Arnold noted one limitation with this study is that higher death rates from an illness in certain populations may be the result of limited or no access to health care. However, past studies have shown that problems with access to health care might not be causing the higher pancreatic cancer death rates in blacks; blacks and whites are both usually diagnosed in relatively late stages of disease, which makes treatment difficult and survival low.

"Our data do not explain what is causing these disparities, but we hope it encourages researchers to continue looking for reasons why blacks develop and die from pancreatic cancer at higher rates than whites," Arnold said. "Clinicians who have patients with a family history of pancreatic cancer or other risk factors for the disease should communicate the benefits of losing weight and quitting smoking, if anything, to help reduce their risk of pancreatic cancer." ###

The mission of the American Association for Cancer Research is to prevent and cure cancer. Founded in 1907, AACR is the world's oldest and largest professional organization dedicated to advancing cancer research. The membership includes more than 28,000 basic, translational and clinical researchers; health care professionals; and cancer survivors and advocates in the United States and nearly 90 other countries. The AACR marshals the full spectrum of expertise from the cancer community to accelerate progress in the prevention, diagnosis and treatment of cancer through high-quality scientific and educational programs. It funds innovative, meritorious research grants. The AACR Annual Meeting attracts more than 17,000 participants who share the latest discoveries and developments in the field.

Special conferences throughout the year present novel data across a wide variety of topics in cancer research, treatment and patient care. The AACR publishes six major peer-reviewed journals: Cancer Research; Clinical Cancer Research; Molecular Cancer Therapeutics; Molecular Cancer Research; Cancer Epidemiology, Biomarkers & Prevention; and Cancer Prevention Research. The AACR also publishes CR, a magazine for cancer survivors and their families, patient advocates, physicians and scientists. CR provides a forum for sharing essential, evidence-based information and perspectives on progress in cancer research, survivorship and advocacy.

Contact: Tara Yates tara.yates@aacr.org 267-646-0558 American Association for Cancer Research

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