Relationship of education to the racial gap in neonatal and postneonatal mortality

OBJECTIVE: To examine the impact of education on race differences in neonatal and postneonatal mortality. METHODS: Data were from North Carolina's Linked Birth and Infant Death File for 1988 through 1993. The study population included 169,601 African American births and 400,359 European American births, with 2606 and 3060 deaths, respectively. Multiple logistic regression was used to assess the effects of race and education on neonatal and postneonatal mortality, adjusting for sociodemographic, lifestyle, and medical risk factors. RESULTS: Risks of death were higher for African Americans than for European Americans, more so in the neonatal than in the postneonatal period. Odds ratios (with 95% confidence intervals in parentheses) comparing African Americans to European Americans were as follows: neonatal deaths, 2.2 (1.9-2.5), 2.3 (2.1-2.6), and 2.8 (2.5-3.2) for less than 12, 12, and more than 12 years of education; and postneonatal deaths, 1.3 (1.1-1.6), 1.5 (1.3-1.7), and 2.1 (1.7-2.6), respectively. The biggest gap was for deaths in the first day of life, with odds ratios ranging from 2.8 to 3.6. Education had no impact on neonatal mortality in either race. Medical factors were more influential in the neonatal than in the postneonatal period, whereas environmental and social factors appeared to play a greater role in the postneonatal period. CONCLUSIONS: Racial differences in neonatal death are increasing and may be related to inequities in the provision of health care. The racial gap in the postneonatal period, although declining, has not disappeared and may be more related to environmental, social, and economic factors.     

Racial and ethnic differences in determinants of intrauterine growth retardation and other compromised birth outcomes

OBJECTIVES: This study examined the extent of variation by race/ethnicity in the prevalence of adverse birth outcomes, whether differentials persisted after other risk factors were controlled for, and whether the direction and magnitude of relationships differed by type of outcome. METHODS: A revised system of measurement was used to estimate multinomial logistic models in a large, nationally representative US data set. RESULTS: Considerable racial/ethnic variation was found across birth outcome categories; differences persisted in the adjusted parameter estimates; and the effects of other risk factors on birth outcomes were similar as to direction, but varied somewhat in magnitude. The odds of compromised birth outcomes were much higher among African Americans than among Mexican Americans and non-Hispanic Whites. CONCLUSIONS: In addition to persistent racial inequality, we found strong adverse effects of both inadequate and "adequate-plus" prenatal care and smoking. Risk of intrauterine growth retardation was higher in the absence of medical insurance, and risk of all adverse birth outcomes was lower among mothers participating in the Special Supplemental Food Program for Women, Infants, and Children.     

Differences between African Americans and Whites in reactions to affirmative action programs in hiring, promotion, training, and layoffs.

This study examines the reactions of African Americans and Whites to affirmative action programs (AAPs) applied to 4 human resource activities: hiring, promotion, training, and layoffs. The results of a scenario-based experimental study conducted on a large sample (N > 800) of advanced undergraduate and MBA business school participants generally supported the hypothesis that human resource activity elicited systematic differences in reaction to AAPs between African Americans and Whites. The authors also replicated previous research on the effect of AAP strength and prior discrimination by the organization on reactions to AAPs. Results indicated that AAP strength levels moderated racial differences in reaction to AAPs, while the moderating role of prior discrimination by the organization was not supported. Implications for future research are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Impact of expenditures for veterinary services and medical supplies on dairy farm productivity and profitability

OBJECTIVES: This study was undertaken to explore smoking patterns and attitudes that influence smoking cessation and relapse among African Americans. METHODS: Baseline data from eight Community Intervention Trial for Smoking Cessation (COMMIT) sites were analyzed. RESULTS: Compared with Whites, African Americans who smoke less than 25 cigarettes per day were 1.6 times more likely to smoke within 10 minutes of awakening (a behavioral indicator of nicotine dependence), adjusting for education, age, and gender (OR = 1.2 for heavier smokers). African Americans reported a stronger desire to quit smoking and reported serious quit attempts in the past year. African Americans favored tobacco restrictions (they were 1.8 times more likely than Whites to view smoking as a serious community problem, 1.7 times more likely to favor restrictions on cigarette vending machines, and 2.1 times more likely to prohibit smoking in their car). African Americans were lighter/moderate, menthol smokers. CONCLUSIONS: African Americans find smoking socially unacceptable and are strongly motivated to quit, but their "wake-up" smoking may indicate high nicotine dependence, making abstinence difficult even for lighter smokers.     

Race differences in psychopathology and disparities in treatment seeking: Community and jail-based treatment-seeking patterns.

Whites in community samples use mental health services at a much higher rate than African Americans (Kessler et al., 2005). Is this also the case among those in jails? In this study of jail inmates (229 African American, 185 White), there were no race differences in the overall need for mental health treatment (63% of participants had significant symptoms on the Personality Assessment Inventory), but race differences in the level and types of symptoms were evident. In addition, although Whites were more likely to report preincarceration treatment, there were no differences in treatment seeking or access to mental health programs while in jail, implying that if barriers to treatment in the community were removed (cost/insurance, location/transportation, time), racial disparities in treatment utilization may be reduced. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Racial differences in eligibility and enrollment in a smoking cessation clinical trial.

Objective: The purpose of this study was to compare the recruitment, eligibility screening, and enrollment of African American and White smokers into an intensive smoking cessation intervention trial [The Chicago STOP Smoking Trial (C-STOP)]. Methods: We compared demographic, smoking, substance use, and medical/psychiatric screening data from the recruitment records of 1,189 non-Hispanic, African American and White smokers screened for eligibility in the last year of a randomized pharmacological and behavioral smoking cessation trial. The study took place at a large urban medical center and two satellite locations within the Chicago metropolitan area. Results: Interest levels in the study were high among African American smokers, with twice as many African Americans as Whites contacting study staff for information and an initial screening. However, African Americans were nearly three times as likely not to be enrolled in the trial as Whites, because of higher ineligibility rates, failure to attend a screening session, and lower participation rates even among those meeting eligibility requirements. Conclusions: Racial differences were observed nearly at all levels of enrollment determination. These critical barriers to inclusion of African Americans in smoking cessation research limit our understanding of treatment efficacy and ultimately the ability to reduce the health disparities in tobacco-related disease experienced by African Americans. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Evidence for racial prejudice at the implicit level and its relationship with questionnaire measures

The content of spontaneously activated racial stereotypes among White Americans and the relation of this to more explicit measures of stereotyping and prejudice were investigated. Using a semantic priming paradigm, a prime was presented outside of conscious awareness (BLACK or WHITE), followed by a target stimulus requiring a word-nonword decision. The target stimuli included attributes that varied in valence and stereotypicality for Whites and African Americans. Results showed reliable stereotyping and prejudice effects: Black primes resulted in substantially stronger facilitation to negative than positive stereotypic attributes, whereas White primes facilitated positive more than negative stereotypic traits. The magnitude of this implicit prejudice effect correlated reliably with participants' scores on explicit racial attitude measures, indicating that people's spontaneous stereotypic associations are consistent with their more controlled responses.     

Individualistic and collectivistic worldviews: Implications for understanding perceptions of racial discrimination in African Americans and British Caribbean Americans.

Cultural worldviews and perceived racial discrimination were examined among Americans (n = 106) and British Caribbean Americans (n = 95), both of African descent, who were recruited through university student organizations, community organizations, and snowball sampling. Consistent with public perceptions of differences in the experience of race among these 2 groups, multiple regression analyses revealed African Americans were more likely than British Caribbean Americans to perceive racial discrimination in the United States. In addition, a cultural worldview focus on individuality and equality (i.e., horizontal individualism) moderated the relationship between ethnic group and perceived racial discrimination. British Caribbean Americans who endorsed greater agreement with horizontal individualism were less likely to perceive racial discrimination. The same worldview was unrelated to African Americans' perceptions of racial discrimination. The results are discussed with respect to within-group heterogeneity among persons of African descent. Implications for counseling persons of African descent and future research directions are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Racial differences in birth outcomes: The role of general, pregnancy, and racism stress.

Objective: This study examined the role of psychosocial stress in racial differences in birth outcomes. Design: Maternal health, sociodemographic factors, and 3 forms of stress (general stress, pregnancy stress, and perceived racism) were assessed prospectively in a sample of 51 African American and 73 non-Hispanic White pregnant women. Main Outcome Measures: The outcomes of interest were birth weight and gestational age at delivery. Only predictive models of birth weight were tested as the groups did not differ significantly in gestational age. Results: Perceived racism and indicators of general stress were correlated with birth weight and tested in regression analyses. In the sample as a whole, lifetime and childhood indicators of perceived racism predicted birth weight and attenuated racial differences, independent of medical and sociodemographic control variables. Models within each race group showed that perceived racism was a significant predictor of birth weight in African Americans, but not in non-Hispanic Whites. Conclusions: These findings provide further evidence that racism may play an important role in birth outcome disparities, and they are among the first to indicate the significance of psychosocial factors that occur early in the life course for these specific health outcomes. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Reaching out to the African American community through innovative strategies

PURPOSE/OBJECTIVES: To describe the University of Pittsburgh Cancer Institute's African American Cancer Program, including innovative strategies that were used, barriers that were encountered, an evaluation of each component, and future directions and implications. DATA SOURCES: Published articles, references from bibliographies, census data, personal contact, unpublished data. DATA SYNTHESIS: Cancer morbidity and mortality is higher among African Americans than Caucasians. The University of Pittsburgh Cancer Institute pilot-tested four interventions to increase awareness, provide education and early detection opportunities, and overcome barriers to cancer care among African Americans. CONCLUSION: Constant presence, cultural sensitivity, and repetition are necessary to overcome the barriers to increased awareness and behavioral changes in the African American community. A more formalized evaluation component is necessary to draw definitive conclusions. IMPLICATIONS FOR NURSING PRACTICE: To develop cancer prevention and education programs that meet the unique needs of African Americans, nurses must be aware of barriers and cultural differences.     

Photodynamic therapy (PDT) and photodiagnosis (PD) using endogenous photosensitization induced by 5-aminolevulinic acid (ALA): current clinical and development status

Although low levels of social support have been related to mortality from coronary heart disease, little is known about the role of social support among Mexican Americans. The authors therefore examined the relationship between social support and long-term survival in the Corpus Christi Heart Project. They developed a social support scale that used data collected during in-hospital interviews of 292 Mexican Americans and 304 non-Hispanic Whites who survived a myocardial infarction for more than 28 days. The scale incorporated three measures: marital status; if not married, whether living alone; and whether advised to seek help. During an average follow-up period of 43 months, 115 participants died. Survival following myocardial infarction was greater for those with high or medium social support than for those with low social support. With age, gender, ethnicity, education, employment, smoking, diabetes, hypertension, and hypercholesterolemia included in a proportional hazards regression model, the relative risk of mortality was 1.89 (95% CI, 1.20-2.97) for those with low social support. But when the two ethnic groups were analyzed separately, low social support was no longer a significant predictor of mortality for non-Hispanic Whites, whereas for Mexican Americans, the relative risk of mortality was 3.38 (95% CI, 1.73-6.62) for those with low social support.     

Standardization Committee for Haematology. External Quality Assurance Program for General Hematology. Evaluation of the 1994 results

Concerns about the cultural competence of child mental health services has led to the examination of racial/ethnic and gender differences in the prevalence of psychiatric symptoms. This study examines racial and gender differences in depressive and substance abuse symptomatology in a high-risk population of adolescents living in five residential group homes in South Carolina. We surveyed 299 youth ages 12 to 17, including 101 African American and 198 Whites. They completed the Centers for Epidemiological Studies-Depression scale (CES-D) and questions on substance abuse, demographics, and psychosocial functioning. No significant differences were found in the percentages of Whites and African Americans scoring above 16+ and 23+ cutoff scores on the CES-D, but significant gender differences were identified. Neither race nor race by age group interactions were found to be significantly correlated in regression analyses with CES-D score nor multiple substance use, whereas gender (p < .001) and school performance were significantly correlated with CES-D score, and poverty was correlated with multiple substance use. Our results indicate that levels of depressive symptomatology as measured by the CES-D are much more sensitive to gender than to race in high-risk populations. Different gender cutoffs are indicated when using systematic instruments in the measurement of depressive symptoms.     

Modeling relationships among socioeconomic status, hostility, cardiovascular reactivity, and left ventricular mass in African American and White children.

In African American and White children and adolescents (N?=?147), socioeconomic status (SES) was measured in 2 ways: (a) using neighborhood-level measures of population density, median income, educational attainment, and the number of children born to single mothers and (b) using family-level measures of parents' occupation and education. Structural equation modeling revealed that both lower family SES and lower neighborhood SES were independently associated with greater hostility and consequently greater cardiovascular reactivity to laboratory stressors in African Americans. Independent of neighborhood SES, only lower family SES was associated with greater cardiovascular reactivity in Whites. Heightened cardiovascular reactivity was associated with greater left ventricular mass (LVM) in Whites and marginally greater LVM in African Americans. Results suggest the importance of using multiple indicators of SES and confirm the relationship between SES and LVM in African Americans and Whites, albeit through different pathways. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Chronic stress burden, discrimination, and subclinical carotid artery disease in African American and Caucasian women.

This study examined the association between a composite index of stress that included measures of life events, ongoing stress, discrimination, and economic hardship and subclinical carotid disease among 109 African American and 225 Caucasian premenopausal women. African Americans reported more chronic stress and had higher carotid intima-media thickness (IMT) as compared with Caucasians. Among African Americans only, the composite stress index and unfair treatment were associated with higher IMT. These effects were partially mediated by biological risk factors. African Americans who reported experiencing racial discrimination had marginally more carotid plaque than did those who did not report experiencing racial discrimination. The results suggest that African Americans may be particularly vulnerable to the burden of chronic stress. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Lower thrombolytic use for African Americans with myocardial infarction: an influence of clinical presentation?

BACKGROUND: After myocardial infarction, African Americans have been reported to undergo fewer catheterization and revascularization procedures than whites, but few studies have addressed racial variations in the delivery of thrombolytic therapy. METHODS: We conducted a retrospective analysis of data prospectively collected on consecutive patients admitted with acute myocardial infarction to the 16-bed coronary care unit of a large, urban teaching hospital. RESULTS: Over a 5-year period, 1948 consecutive patients were admitted with acute myocardial infarction to a single coronary care unit. Thrombolysis was administered to 19% of 1024 African Americans and 29% of 924 whites (P <.01). The initial diagnostic impression on admission was "definite" infarction less often in African Americans (30%) than in whites (43%, P <.001), a difference that appeared to largely account for the difference in thrombolytic administration in a multivariable model. Mortality adjusted for age and concomitant illnesses was similar in African Americans compared with whites (relative risk 1.0, 95% confidence interval 0.78 to 1.51). CONCLUSIONS: Much of the racial variation in thrombolytic administration could be accounted for by differences in clinical presentation, an issue that requires further study.     

Prevalence and impact of risk factors for lower body difficulty among Mexican Americans, African Americans, and whites

BACKGROUND: The purpose of the study was to estimate the prevalence of sociodemographic, health behavior, chronic disease, and impairment factors and their impact on difficulty in lower body function among two age-cohorts (51-61 and 71-81 years) of Mexican Americans, African Americans, and Whites. METHODS: Reports from 8,727 and 4,510 self-respondents of the 1992 baseline Health and Retirement Survey and the 1993 baseline Assets and Health Dynamics Study, respectively, were used to estimate prevalence. Multiple linear regression of the 4-item lower body difficulty scale (alpha = .80) was used to estimate the direct effects of the risk factors within the age-cohort and ethnicity groups. RESULTS: Overall, the risk factors are more prevalent among both minority groups and the older age-cohort. Lower body deficits are particularly high among Mexican Americans and the younger age-cohort of African Americans. The impact of risk factors does not vary much by ethnicity or age-cohort. Female gender, pain, arthritis, and heart and lung disease are the major risk factors, and they account for about one-third of the variance in lower body difficulty for each group. CONCLUSIONS: Efforts to prevent or reduce lower body difficulty should pay particular attention to pain, arthritis, and heart and lung disease. The central role of sociodemographic and behavioral factors in chronic disease argues for their continued inclusion in disability modeling and prevention.     

Ethnic differences in the psychosocial antecedents of needle/syringe disinfection

This study examined psychosocial antecedents of needle/syringe disinfection by 209 injection drug users in three ethnic groups. Among Whites, high perceived self-efficacy for risk reduction had a positive effect on subsequent disinfection attempts. Among African Americans and Mexican Americans, peer norms favorable to risk reduction had a positive effect on subsequent disinfection attempts, while self-efficacy had no effect. These results suggest that risk-reduction capabilities may be rooted in individualistic perceptions of the self among White drug users, while 'collective self' perceptions are more relevant to these capabilities among African American and Mexican American drug users. HIV risk intervention may have more impact in specific ethnic groups if these distinctions are taken into account. Results also demonstrate the importance of comparing models of behavior change across ethnic groups.     

Determinants of poor pregnancy outcomes among teenagers in Sweden

OBJECTIVE: To study pregnancy outcomes among teenagers and to determine whether age-related increases in risk are due to differences in socioeconomic conditions, maternal smoking, or anthropometric status. METHODS: All single births during 1990-1991 to mothers aged less than 25 years recorded in the Swedish Medical Birth Registry were studied (n = 62,433). The pregnancy outcomes analyzed were late fetal death, infant mortality, preterm birth, low birth weight, small for gestational age, and low Apgar scores. Information on maternal age, parity, family situation, maternal smoking, maternal height, and weight gain during pregnancy was recorded in the Medical Birth Registry. Information on socioeconomic characteristics was obtained from the Population Census. Logistic regression analysis was used to define the determinants of the adverse outcomes among teenagers. RESULTS: Compared with women aged 20-24 years, girls of 17 years or less were at higher risk for preterm birth (odds ratio [OR] 1.6), and this increased risk remained essentially unchanged after controlling for major confounding factors (OR 1.5). Teenagers also had a crude 50% higher risk of late fetal death and infant mortality, but this risk was reduced after controlling for the effect of socioeconomic characteristics (adjusted OR 1.2). CONCLUSIONS: The increase in risk of late fetal death and infant mortality associated with low maternal age is substantially an effect of teenagers' poorer socioeconomic situation. However, the increase in preterm birth among younger teenagers suggests that young maternal age may be a biologic risk factor for preterm birth.     

Relation of parental birth weights to infant birth weight among African Americans and whites in Illinois: a transgenerational study

The authors used a transgenerational data set of Illinois vital records to ascertain the relation between parental birth weights and infant birth weight. The infant generation consisted of all African Americans and whites born in Illinois during 1989-1991. The parent generation included the mothers and fathers who were also born in Illinois between 1956 and 1975. In the infant cohort, the rate of low birth weight (LBW) (<2,500 g) was 11.7% for African Americans (n = 15,287) versus 5.0% for whites (n = 117,708) (relative risk (RR) = 2.3, 95% confidence interval (CI) 2.2-2.5). For African Americans, the LBW rate was 17.9% among those born to LBW mothers (n = 1,943) compared with 10.8% among those born to non-LBW mothers (n = 13,344) (RR = 1.8, 95% CI 1.6-1.9). For whites, the LBW rate was 8.5% among those born to LBW mothers (n = 2,174) compared with 4.8% among those born to non-LBW mothers (n = 115,534) (RR = 1.7, 95% CI 1.6-2.0). A weaker association was observed between paternal birth weight and infant birth weight. The authors conclude that parental birth weights are important risk factors for LBW in both African Americans and whites.     

Age and education effects on relationships of cognitive test scores with brain structure in demographically diverse older persons.

This study examined how age and education influence the relationship between neuropsychological test scores and brain structure in demographically diverse older adults spanning the range from normal cognition to dementia. A sample of 351 African Americans, 410 Hispanics, and 458 Whites underwent neuropsychological testing. Volumetric magnetic resonance imaging (MRI) measures of total brain, white matter hyperintensity, and hippocampus were available for 79 African Americans, 102 Hispanics, and 134 Whites. The authors used latent variable modeling to examine effects of age, education, and brain volumes on test scores and determine how much variance brain volumes explained in unadjusted and age- and education-adjusted scores. Age adjustment resulted in weaker relationships of test scores with MRI variables; adjustment for ethnicity yielded stronger relationships. Education adjustment increased relationships with MRI variables in the combined sample and Hispanics, made no difference in Whites, but decreased some associations in African Americans. Results suggest that demographic adjustment is beneficial when demographic variables are strongly related to test scores independent of measures of brain structure, but adjustment has negative consequences when effects of demographic characteristics are mediated by brain structure. (PsycINFO Database Record (c) 2010 APA, all rights reserved)