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 DATA SOURCES: Published articles, references from bibliographies, census data, personal contact, unpublished data.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.     

Weight, self-esteem, ethnicity, and depressive symptomatology during pregnancy among inner-city women.

The relationship of weight and self-esteem to depressive symptomatology was examined among 36 African American and 96 European American pregnant inner-city women. Lower self-esteem and higher deviations from medically ideal weight predicted increased dysphoria during the 3rd trimester for European American women, but only lower self-esteem predicted increased dysphoria for African American women. These results support the hypothesis that African Americans are less likely than European Americans to experience negative psychological repercussions of greater weight. Consistent with findings among nonpregnant middle-class samples, these results extend the association between heavier weight and increased risk for psychological distress to pregnant women of European American descent. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

American = White?

Six studies investigated the extent to which American ethnic groups (African, Asian, and White) are associated with the category "American." Although strong explicit commitments to egalitarian principles were expressed in Study 1, Studies 2-6 consistently revealed that both African and Asian Americans as groups are less associated with the national category "American" than are White Americans. Under some circumstances, a dissociation between mean levels of explicit beliefs and implicit responses emerged such that an ethnic minority was explicitly regarded to be more American than were White Americans, but implicit measures showed the reverse pattern (Studies 3 and 4). In addition, Asian American participants themselves showed the American = White effect, although African Americans did not (Study 5). The American = White association was positively correlated with the strength of national identity in White Americans. Together, these studies provide evidence that to be American is implicitly synonymous with being White. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Caring for the caregiver: expanding ways of knowing through experiments in self-care

When compared to Caucasians, diabetes mellitus and its complications are more prevalent among African Americans. Locus of control and social support were suggested as correlates of diabetes outcomes and health care practices that might have clinical implications. A sample of 24 African Americans and 80 Caucasians with Type II diabetes completed questionnaires and gave venous blood specimens. African Americans had significantly higher glycohemoglobin values (p = .049) and BMI values (p = .048). African Americans also took fewer doses of medication (p = .046) and tested their blood glucose less frequently (p = .062). Correlation patterns for the two groups differed as well. Social support variables were more often related to health care practices and outcomes for African Americans than for Caucasians. The findings indicate that nursing interventions resulting in increased social support could be especially effective for African Americans with Type II diabetes.     

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 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)     

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)     

Hepatic lipase activity is lower in African American men than in white American men: effects of 5' flanking polymorphism in the hepatic lipase gene (LIPC)

Plasma high density lipoprotein cholesterol (HDL-C) concentrations are higher in African American men than in white men, but the mechanism(s) responsible for this ethnic difference has not been elucidated. This study examined the relationship between hepatic lipase activity, plasma HDL-C concentrations, and a hepatic lipase polymorphism (-514T) in African American and white American men. Consistent with previous reports, plasma HDL-C concentrations were significantly higher in African American men than in white American men. Mean post-heparin plasma hepatic lipase activity was significantly lower in African American than in white American men (27 +/- 12 vs. 44 +/- 17 mmol x h(-1) x l(-1), P < 0.001). The -514T hepatic lipase allele was associated with low hepatic lipase activity in both populations, and was 3-fold more common among African Americans than white Americans. Taken together, these data suggest that genetic differences in hepatic lipase activity contribute to the differences in plasma HDL-C concentrations between African American men and white American men.     

Subjective, behavioral, and physiological reactivity to ethnically matched and ethnically mismatched film clips.

This study examined whether individuals from 4 major ethnic groups within the United States (African American, Chinese American, European American, and Mexican American) showed greater subjective, behavioral, and physiological responses to emotional film clips (amusement, sadness, and disgust) with actors from their own ethnic group (ethnically matched) compared with actors from the other 3 ethnic groups (ethnically mismatched). Evidence showed greater responsivity to ethnically matched films for African Americans and European Americans, with the largest effect for African Americans. These findings were consistent across both sex and level of cultural identification. Findings of ethnic difference notwithstanding, there were many areas in which ethnic differences were not found (e.g., little or no evidence was found of greater response to ethnically matched films in Chinese-American or Mexican- American participants). These findings indicate that the emotional response system clearly reacts to stimuli of diverse ethnic content; however, the system is also amenable to subtle "tuning" that allows for incrementally enhanced responding to members of one's own ethnic or cultural group. (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.     

Stress, psychosocial resources, and depressive symptomatology during pregnancy in low-income, inner-city women.

The authors examined the prospective influence of stress, self-esteem, and social support on the postpartum depressive symptoms of 191 inner-city women (139 European Americans and 52 African Americans) over 3 waves of data collection. Depressive symptomatology was measured by multiple indicators, including self-report and clinical scales. Women became less depressed as they move from prenatal to postpartum stages and adjusted to their pregnancy and its consequences. LISREL and regression analyses indicated that stress was related to increased depression, whereas greater income and social support were related to decreased depression. Self-esteem was related to lower depression at the prenatal and postpartum periods but not to change in depression from the prenatal to the postpartum period. The results also indicated that self-esteem and social support did not have additional stress-buffering effects over and above their direct effects on depression. Finally, African American women did not differ from European American women terms of depression or in terms of how they were impacted by stress or psychosocial resources. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Childhood socioeconomic status is associated with psychosocial resources in African Americans: The Pittsburgh Healthy Heart Project.

Objective: To determine whether lower childhood socioeconomic status (SES) was associated with fewer psychosocial resources independent of adult SES, and whether these associations differed by race/ethnicity. Method: Cross-sectional study of 342 middle-aged (M = 60.5 ± 4.7) African American (n = 49) and Caucasian (n = 293) adults. Childhood SES and adult SES were assessed via highest parental education and participant education, respectively. Participants completed: (a) 6 days of ecological momentary assessment via electronic diaries to assess social support and the number of social interactions and (b) self-report measures of social support, social network diversity, and coping—specifically, active, planning, and emotion focused coping. Results: The interaction term for childhood SES and race/ethnicity significantly predicted several psychosocial resources. Lower childhood SES was associated with less perceived social support in daily life, a less diverse social network, and more limited use of proactive coping strategies in adulthood among African Americans, regardless of adult SES. Comparable associations were not observed among Caucasians. Conclusions: Childhood SES is associated with psychosocial resources in adulthood among African Americans, independent of SES in adulthood. Given emerging associations between childhood SES and health in adulthood, future studies to disentangle the role of psychosocial resources as a mediating pathway and to further examine racial/ethnic variations across these associations are warranted. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Can racial differences in cognitive test performance be reduced by presenting problems in a social context?

It is well documented that African Americans tend to score lower on cognitive ability tests than White Americans. The cause of this performance difference is still being hotly debated and actively researched. Recently, J. E. Helms (1992) argued that cognitive ability tests fail to adequately assess African American intelligence because they do not account for the emphasis placed on social relations and the effect of social context on reasoning in the African American culture. To evaluate this argument, racial subgroup performance differences on Wason conditional reasoning items presented in the standard abstract form and in a social relationship form were examined. Contrary to Helms's argument, results indicate that presenting Wason conditional reasoning items in a social context did not reduce the difference between African American and White American Performance. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Factor structure of the Anxiety Sensitivity Index among African American college students.

This study examined the factor structure of the Anxiety Sensitivity Index (ASI) among African American college students. Confirmatory factor analysis indicated the 3-factor solution commonly found among other populations did not fit the data for African Americans. Although an exploratory factor analysis indicated the presence of a Mental Incapacitation factor, the Physical Concerns factor was divided into unsteady and cardiovascular concerns. Items typically comprising the Social factor were reflective of emotional controllability among African Americans. The ASI was also moderately correlated with measures of anxiety and depression providing only weak evidence of convergent and discriminate validity of the ASI for African Americans. Although support for the multidimensional nature of AS was found, the factor composition differs for African Americans. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The role of person-environment fit in the job satisfaction and tenure intentions of African American employees.

In light of speculation that the determinants of job satisfaction and tenure for African American employees may not be adequately captured by the theory of work adjustment (TWA; Dawis & Lofquist, 1984), in the present study the authors tested assumptions of the TWA with an African American sample by (a) examining the strength of fit-satisfaction and fit-turnover intentions relationships, (b) testing the ability of racial climate to moderate the fit-satisfaction and fit-turnover intentions relationships, (c) analyzing qualitative data related to the determinants of job satisfaction, and (d) investigating potential differences in the fit-satisfaction and fit-turnover intentions relationships for African Americans and European Americans. Self-report data were collected from African American employees (n = 204) that assessed fit perceptions, departmental racial climate, job satisfaction, and turnover intentions. African American employees' reports of fit perceptions explained variance in job satisfaction (43.20%) and turnover intentions (20.20%); however, racial climate did not emerge as a moderator. Qualitative results supported these findings. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A localized double-quantum filter for the in vivo detection of brain glucose

OBJECTIVES: Despite decreasing infant mortality in North Carolina, the gap between African Americans and Whites persists. This study examined how racial differences in infant mortality vary by maternal education. METHODS: Data came from Linked Birth and Infant Death files for 1988 through 1993. Multiple logistic regression models adjusted for confounders. RESULTS: Infant mortality risk ratios comparing African Americans and Whites increased with higher levels of maternal education. Education beyond high school reduced risk of infant mortality by 20% among Whites but had little effect among African Americans. CONCLUSIONS: Higher education magnifies racial differences in infant mortality on a multiplicative scale. Possible reasons include greater stress, fewer economic resources, and poorer quality of prenatal care among African Americans.     

Differences by race in the decline of health over time

Previous research on race differences in health, we believe, has failed to take into account the initial state of health of the respondents. Other research has demonstrated that elders in poor health are more likely to experience a change in their health over time. It is unclear if the greater probability of decline in health observed among African Americans is a result of being more likely to begin such observations in health states that are worse than those for Whites. This investigation examines declines in health over a 30-month period in a sample of African American and White elders who began the study in similar "good health." Findings support the supposition that African Americans are more likely to report a decline in their health, regardless of the health measure used. Differences by race in the decline of health appear to be a consequence of economic and educational discrepancies between the two groups.     

Political orientation and modern versus aversive racism: Tests of Dovidio and Gaertner's (1998) integrated model.

According to J. F. Dovidio and S. L. Gaertner's (1998) integrated model of racism, politically liberal European Americans tend to express racism differently than conservative European Americans, with liberals demonstrating aversive racism and conservatives, symbolic or modern racism. In support of the model, in Experiment 1 liberals showed bias in favor of a twice-prosecuted African American relative to a European American in their judgment of double jeopardy, whereas conservatives did the reverse. Experiment 2 replicated these effects while eliminating a confound in the design of Experiment 1. Experiment 3 found evidence for the intrapsychic conflict hypothesized to underlie aversive racism. Specifically, only liberals displayed greater physiological arousal to the touch of an African American versus a European American experimenter. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Inflammatory breast carcinoma incidence and survival: the surveillance, epidemiology, and end results program of the National Cancer Institute, 1975-1992

BACKGROUND: Little is known about the cause of inflammatory breast carcinoma (IBC), the most aggressive form of breast cancer. To the authors' knowledge, no studies have investigated whether IBC risk factors are different from those for breast carcinoma overall, and there has been only one report of IBC incidence and survival patterns. METHODS: The authors used data from the Surveillance, Epidemiology, and End Results program of the National Cancer Institute for the period 1975-1992 to calculate age-adjusted incidence and survival rates for 913 white and 121 African American women with IBC involving dermal invasion of lymphatic ducts and 166,375 white and 13,674 African American women with other types of breast carcinoma (non-IBC). RESULTS: Between 1975-1977 and 1990-1992, IBC incidence doubled, increasing among whites from 0.3 to 0.7 cases per 100,000 person-years and among African Americans from 0.6 to 1.1 cases. However, rates for African Americans varied due to the small numbers of IBC cases. The twofold increase in IBC incidence was higher than that observed for non-IBC during the same period (27% for African Americans and 25% for whites). IBC patients were significantly younger at diagnosis than non-IBC patients; and among both IBC and non-IBC patients, African Americans were younger than whites. Overall survival was significantly worse for IBC patients than for non-IBC patients and for African Americans than for whites. Among whites, 3-year survival improved more for IBC patients than for non-IBC patients between 1975-1979 and 1988-1992, increasing from 32% to 42% for IBC patients (P=0.0001) and from 80% to 85% for non-IBC patients (P=0.0001). CONCLUSIONS: The disparities observed in incidence trends and age at diagnosis, particularly according to race, highlight the need for further investigation of the differences between IBC and non-IBC incidence.     

Challenging conventional wisdom about who quits: Revelations from corporate America.

Findings from 20 corporations from the Attrition and Retention Consortium, which collects quit statistics about 475,458 professionals and managers, extended and disputed established findings about who quits. Multilevel analyses revealed that company tenure is curvilinearly related to turnover and that a job's past attrition rate strengthens the (negative) performance- exit relationship. Further, women quit more than men, while African Americans, Hispanic Americans, and Asian Americans quit more than White Americans, though racial differences disappeared after confounds were controlled for. African American, Hispanic American, and Asian American women quit more than men of the same ethnicities and White Americans, but statistical controls nullified evidence for dual discrimination toward minority women. Greater corporate flight among women and minorities during early employment nonetheless hampers progress toward a more diversified workforce in corporate America. (PsycINFO Database Record (c) 2010 APA, all rights reserved)